Thomas Sequist discusses barriers to care in American Indian communities.

To underscore the public health challenges facing American Indians, Thomas Sequist, MD, MPH, shows a colorful photo of the desert landscape in the Four Corners region of the Southwest. What makes the view so beautiful – the vast remoteness it depicts – also reflects much of what drives the immense barriers to care faced by the Native Americans who live on nearby reservations.

Hundreds of miles of open space in every direction mean that it can take several hours for patients to drive to their primary care physician for a simple checkup. Rural roads that flood easily or snake through the Rocky Mountains make such trips even more challenging.

Social determinants like these have important implications for health care delivery in American Indian communities, Sequist said during a Medical Grand Rounds lecture held in conjunction with the Minority Faculty Career Development Awards (MFCDA) ceremony on May 26. The 2017 MFCDA winners were also announced during the event (see related story).

“Geographic isolation is one of the most important determinants in providing high-quality care,” said Sequist, a primary care physician in the Phyllis Jen Center for Primary Care, chief quality and safety officer at Partners HealthCare and previous MFCDA recipient.

Narrowing the Gap

During his presentation, “Our Urgent Need to Address American Indian Health Equity,” Sequist highlighted ways in which American Indians experience disproportionately poor health outcomes and how BWH is working to reduce some of the gaps around access to advanced care.

Overall, American Indians are at higher risk for chronic diseases such as diabetes and heart disease. And while life expectancy has gradually increased among white American men, it has remained flat among Native American men, Sequist noted.

Meanwhile, care options are limited. The U.S. Indian Health Services (IHS) provides health care for American Indians living on or near their native homeland, but there are profound deficiencies, Sequist said. Many facilities lack tertiary and quaternary care, and they are chronically understaffed. Access to specialists is extremely limited in rural areas.

The Brigham is helping American Indian communities overcome these challenges on several fronts, Sequist said. The Four Directions Summer Research Program provides an opportunity for Native American undergraduates to explore career opportunities in medicine and receive mentorship from BWH and Harvard Medical School staff.

Additionally, the Brigham and Women’s Outreach Program sends BWH faculty volunteers to IHS hospitals serving the Navajo Nation in New Mexico and Arizona. There, volunteers support patient care and provide training for local medical staff. A telemedicine-based initiative enables BWH providers to offer remote consultations and training opportunities for IHS clinicians by phone or video conferencing.

In a recent interview with The New England Journal of Medicine, Heather Kovich, MD, chief of staff at Northern Navajo Medical Center in Shiprock, N.M., explained how valuable the partnership with BWH has been for IHS providers.

“We train in academic centers where we have constant interactions with other professionals, and it can be a real shock and feel very isolating to move to a rural environment,” she told NEJM. “Programs where you build real relationships with experts at academic centers can go a long way to making us feel more supported and respected in the medical community. More importantly, they help our patients.”