I have been in Shiprock for four weeks now, and so far have found it to be one of my most rewarding experiences in residency.

Many of the patients are living without running water or electricity, which is amazing in a country as rich as the United States. Just last week I saw a gentleman with obstructive sleep apnea who has had a CPAP machine for years, but has been unable to use it because he does not have any electricity. You also see a lot of the same diseases that you see at Duke, but in different proportions - there is tons of diabetes, rheumatoid arthritis, gall bladder disease, ear disease, but very little lung cancer.

On the other hand, the hospital itself has lots of resources, although somewhat limited in comparison to teaching institutions such as Duke. There are MRIs, but only on Tuesdays. There are TTEs, but only about 12 a month. There is an ICU, but it only has 4 beds. As a result, you have to work closely with the neighboring hospitals, and it has been very illuminating to be the "Outside Hospital." I have already transferred a patient with likely renal cell carcinoma and paraneoplastic syndrome to a neighboring hospital because we have no oncologists here. Another patient needed a biliary drain changed, and so I sent him to a neighboring hospital with an interventional radiologist; he went there for the procedure and then came back the same day.

The physicians here come from a wide range of backgrounds, and are very collegial and interested in teaching. Almost all of them live on the "hospital compound," and so are next door neighbors. They regularly get together for various events; just last week we all met up in the evening to watch a slide show presented by a physician who had recently been in India. You also work closely with the surgical service and the family medicine service, and it has been fun to be a consultant on a variety of cases.

Emily Schroeder 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.