Greetings from Shiprock. We are having a wonderful time out here. One of the main reasons I wanted to work in the Indian Health Service was to experience this unique publicly-funded healthcare system. The Indian Health Service provides free medical care, including free prescription coverage, and free hospital care, to all of the Navajo Indians on the reservation. No copays, no deductibles, etc. I do not get the sense that the patients realize how different this is than health care for other Americans. From what I have seen thus far, the care provided to these patients is excellent, despite the fact that per capita health care expenditures are less than half of that for the total US population. The health care system here is based in organized and systematic primary care. Specialists are few and far between, and generally play a true "consultant" role – often over the phone rather than in person. It has been a very valuable experience for me, as someone interested in going into academic primary care, to work in a system in which primary care physicians play the central role in the care of patients, both inpatient and outpatient.

It has also been fascinating to learn about the culture and history of the Navajo - something I knew little about before coming here. Yesterday I traveled two hours west into the Arizona town of Kayenta, also on the Navajo reservation. We were there to screen former uranium miners for lung disease, and to help those with lung disease attempt to obtain compensation from the federal government. The US government recruited the Navajo to work in uranium mines in this area in the 1950s and 60s. Although the miners were exposed to radon exposures well in excess of that known to be hazardous, they were not informed of this risk, and the mines were not ventilated to improve safety. Beginning in 1990, by act of congress, former uranium miners with lung disease could apply for compensation from the government. A branch of the Indian Health Service runs clinics to screen patients that would like to be evaluated to see whether they qualify for compensation. In addition to working in a uranium mine for more than two years, one of the patients we met yesterday had also worked as a code talker during World War II, another interesting piece of US history. He told us about how he was recruited and worked in the South Pacific, only to be "captured" by an American soldier who mistook him for Japanese, and freed only when he was recognized by his own unit. Incidentally, there is a museum about the code talkers in Kayenta, located inside of the Burger King. Fast food is unfortunately at the center of life here.

Hope all is well in Durham, Erin

Erin Van Scoyoc is a Senior Resident in the Department of Medicine. She is currently completing a three month global health rotation at the Northern Navajo Medical Center in Shiprock, New Mexico.