Manish Pandya Four Corners Nephrology

Manish Pandya
Four Corners Nephrology
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INTRODUCTION
GEOGRAPHY
NATIVE AMERICAN
BURDEN OF DISEASES
HEALTH CARE ORGANIZATION
BARRIERS TO HEALTH CARE
SOLUTIONS
ARIZONA
NEW MEXICO
COLORADO
UTAH
NATIVE AMERICAN TRIBES
NAVAJO ( Diné), HOPI, MOUTAIN UTE, SOUTHERN UTE, JICARILLA APACHE
LARGEST NATIVE AMERICAN RESERVATION
>290,000 PEOPLE ( 2002)
25,000 SQUARE MILES
NAVAJO COUNTRY
Lies within 4 mountains
North ( Hesperus Peak)
East ( Blanca Peak)
South ( Mount Taylor)
West ( San Francisco Peaks)
Switzerland
Size:~ 16,000 sq. miles
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Prevalence of DM: 22%
Unemployment rate: 42%
Population living below national poverty line: 43%
Average life expectancy: 74 years
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DIABETES
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Virtually unknown prior to WWII
>40% over the age 45 Navajos are diabetic
HYPERTENSION
IgA NEPHROPATHY
OTHER CAUSES
adjusted* ESRD incidence rate, per million/year, by race, in the
U.S. population, 1980-2012
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~ 800-1000 years ago arrival in the southwest area
Diné: The People
1846: US defeated Mexico
“ The long walk”: 1864-68. Fort Sumner, NM. 300 miles
1868 treaty: return to four corners area.
1933: livestock reduction
1950s: food assistance, boarding school
1968: first grocery store
Traditional Navajo Medicine Man
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Road network establishment
Access to Neighboring cities
Food with preservatives with no electricity ( no refrigeration) and no
running water
Change of diet infiltrating into traditions
Effects of alcohol including acute and chronic pancreatitis
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Generally do not live in villages
Small groups scattered across the whole reservation
Largely due to availability of water and grazing land
Hogan, six sided home
Diet: wild onion, spinach, bread from homemade grind corn, acorn,
pinon nuts, deer meat, praire dogs, rabbit, sheep, goat etc
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Navajo Area Indian Health Service
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6 Hospitals
7 Health Centers
15 Health Stations
One of 12 IHS regional administrative units
IHS, an agency of US Public Health Service, Department of Health and
Human Services
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IHS
Tribal insurance
Medicare: Novitas and Noridian
3 State Medicaids
Self Pay
Commercial insurance
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Social factors
Economical factors
Transportation
Physician staffing at IHS
Language
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Traditions meet Modern Medicine
Dietary changes
Physical activities
“ Move it”
Bicycles!
Cost effective solution
Shiprock
Monument Valley
Canyon De Chelly
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Was prepared with the help of Ms. Welma James, Ms. Emerson, Mr.
Arrington, Dr. Jim and many other fascinating individuals.