My husband and I moved to the Navajo Reservation nearly six years ago to become “rez docs.” I’m a pediatrician; he’s an internist. We completed two monthlong rotations in Shiprock, N.M., during our training, and friends and family offered constant praise for our decision to work with a marginalized population in the middle of what they perceived as a barren desert.
At first, I accepted this praise, feeling that my work here was righteous. But this pandemic has put into clearer focus the complexity of my place here. It has made me a better doctor, broken my heart and left me in awe of the strength and resilience of the Diné (Navajo people).
Our presence here—the doctors swooping in from elsewhere, the outside support, especially during the pandemic—hasn’t absolved white people of the structural racism and trauma inflicted on the Diné. It certainly didn’t protect this community from Covid-19. The helicopter transports to bigger hospitals off the reservation three, four and five times a day over the past year all carried Navajo patients.
We “outsiders” may share a zip code with our patients, but our lives and opportunities are entirely different. If you drew a color map depicting Covid-19 cases per capita, the government housing neighborhood where many non-native doctors and nurses live would be an island of light yellow—indicating negligible numbers—amid a Covid-saturated sea of eggplant.
This disparity has nothing to do with doctors’ stellar public health adherence. It’s about our privilege and power. Early in the pandemic, my husband felt ill at work. He had access to immediate testing and then walked to an on-call apartment, where he quarantined while awaiting his result. When it came back negative three days later, he returned home. Soon after, when our nanny was exposed, my husband and I traded childcare duties for two weeks, taking advantage of our paid sick leave.
Among the Navajo, there is no denial of Covid-19, and everyone wears masks. But there are overcrowded homes full of multi-generational families, grandparents watching grandchildren while parents go to “essential” jobs with limited worker protections. There are underlying health conditions, like obesity and diabetes brought on by a lack of food sovereignty. There are limited places for the sick to isolate.
The stark reality of our patients’ lives crystallized for me at the height of the pandemic. Because children were largely spared the disease, and in-person visits ceased for a time, I was tasked with making phone calls to check on my colleagues’ patients who required home oxygen after being discharged from the hospital. The calls often felt jarringly intimate. On the other end of the line, patients were in bed or out feeding their animals or sitting by their televisions. I imagined their frail figures, a cannula line in their nostrils, struggling to breathe. “Ya’at’eeh,” I would greet them in Navajo. “How are you feeling? Do you have that pulse oximeter to put on your finger? Can you read me the numbers? Can I have you walk for a couple minutes so I can make sure your oxygen saturation is OK?”
The voices on the other end of the phone were tired, afraid, frustrated, grieving. But they were also funny, strong, kind, resilient and grateful. I made notes about who had recently lost someone or whose spouse or child or mother was hospitalized. I realized my role—perhaps more important than getting their oxygen levels—was to help them carry their fear and grief.
These days, I’m again able to see children and families in-clinic, which has brought for me new priorities. I’ve realized how little can be conveyed in a 15-minute visit if core concerns are left heavy in the air, and so now I take the time to ask every family how they’re doing, who they lost and what is hard. I try to leave space for difficult answers. How can I expect a mother who has just lost her mother to want to discuss infant sleep routines? What adolescent wants to hear about reducing sugar-sweetened beverages when he is coaching three siblings through their remote learning and trying to do his own?
As I write this, I worry about focusing on the hard before mentioning the strong, a mistake I often observe among family, friends and the media when discussing under-resourced populations. There is historical trauma here, but there is also a long history of rising up and overcoming. The Diné have a deep commitment to protecting each other and their culture. They have endured through the forced removal and attempted genocide of the Long Walk of 1864, the boarding school era and the ongoing structural and abject racism of today to preserve their language, stories, land and traditions.
Many lives on the Navajo Nation have been lost in the pandemic, but many were saved because people protected their elders, stayed home when they could and weren’t selfish. Vaccination rates and vaccine acceptance are better here than almost anywhere in the country, an effort led by Navajo people.
When I reflect on what I will carry with me from this time, I realize it’s the thing my white privilege caused me to miss when I first got here. Despite this tragic year and the ongoing disparities and oppression the Diné face, their strength and resilience remain. That’s the most important story.