DPT Student Immersed in Native American Culture during clinical rotation on Navajo Reservation

Navajo Nation Reservation. Source: http://bible.ovu.edu/missions/indians/navajres.htm

I sat down with Elizabeth Palladino PT, DPT, a recent graduate of The University of Scranton (#FreshPT), who completed a clinical rotation on the Navajo Indian Reservation. She worked at facilitates which are part of the Fort Defiance Indian Hospital Board including Tséhootsooí Medical Center in Fort Defiance, Arizona and Nahata Dziil Health Clinic in Sanders, AZ. In our interview, Elizabeth discusses the opportunity she was given to treat and learn about the Physical Therapy profession in a unique clinical environment.

What was the practice setting and clinical environment like?

What was the dynamic of your clinical? (Was there one main facility, many facilities, how many disciplines were present on site?)

TMC was the main facility with a satellite clinic, Nahata Dziil Health Clinic, located about an hour away.  TMC provides acute care and pharmacy services as well as an outpatient clinic for physical, occupational, and speech therapy.  TMC also has a Mobile Health Clinic, which includes clinics such as rheumatology, women’s health, elder wellness, flu clinics, and sports and school physicals.

What about health insurance on the reservation was different from what may be seen in many other PT locations if anything? (# of visit, coverage?)

Unlike other facilities, patients were able to receive an unlimited number of PT visits through a contract and compact with Indian Health Service (IHS), which is “The Federal Health Program for American Indians and Alaska Natives.”  Those with chronic diseases and disorders truly benefited, allowing their care to be unrestricted by an allotted number of visits, which is a problem commonly seen in facilities elsewhere today.

How many patients did you treat each day?

On average, I saw between 8 to 12 patients a day.  It was common for patients to miss their appointments secondary to reasons including, but not limited to, transportation difficulties, adverse weather conditions, family responsibilities, and accidental no-shows.  During my time at the two facilities, I primarily saw middle-aged adults, with slightly more females than males. There were also pediatric, adolescent, and geriatric patients.

What were the most common diagnoses you treated?

Many of the patients had orthopedic injuries or disorders, such as rotator cuff impingement, ligament sprains, or piriformis syndrome.  Low back pain was by far the most common general diagnosis seen at both of the clinics. My clinical instructor specialized in pelvic floor PT, so there were many patients who were treated for urinary incontinence.  Other, less common, diagnoses included Guillain-Barre Syndrome, spastic diplegia, and Noonan Syndrome.

How large of a factor did education for health wellness & prevention play a role into your treatments?

Education for wellness and prevention occurred on a daily basis with just about every patient.  American Indians and Alaska Natives have a high rate of type 2 diabetes, which as we know, can be associated with many other comorbidities and risk factors.  I often discussed possible impairments resulting from a sedentary lifestyle as well as ways to maintain an active, healthy routine. As with choosing different interventions, education had to be individualized and meaningful to each patient in order to make a positive impact.  I also spent a great deal of time educating patients on the anatomy and risk factors related to their injuries, disorders, or diseases. In return, patients became increasingly mindful of their bodies.

What was the most interesting thing you learned about our profession in this setting?

I learned that sometimes we are not just physical therapists—we are also educators, resources, and listeners.  Many patients I saw had faced or were currently facing unimaginable hardships. Sometimes I served as a shoulder to cry on and an ear for listening.  Often, I helped to facilitate a referral to a mental health professional for patients struggling with apparent depression and anxiety. In this setting, PTs have the opportunity to inspire patients to make healthy lifestyle choices to reach positive outcomes in and outside of therapy.

Was communication between different healthcare disciplines threaded through a patient’s treatment?

Communication between healthcare disciplines occurred as necessary through a patient’s course of treatment, depending on the patient’s diagnosis, just as it would occur at any other facility outside of the reservation.  Updates were provided to and concerns were addressed with the patients’ medical doctors.

For students looking to complete a clinical rotation on a reservation, what would your #1 piece of advice be?

Be respectful of the Navajo culture and don’t be afraid to ask questions.  Demonstrate a willingness to understand more about their history and traditions.  I found that with many patients, showing an appreciation of their background helped to develop a positive rapport and establish trust during our treatment sessions.

What did you learn about the importance of physical therapy’s impact on healthcare during this rotation?

Physical therapists can make a huge impact on healthcare in this setting.  Not only can we serve as worthy educators to our patients, but also as educators to other healthcare providers.  During this rotation, I provided a presentation with my clinical instructor, to the women’s health clinicians regarding our role in pelvic floor physical therapy.  This was a fantastic opportunity to openly discuss how we can help these types of patients as PTs, as well as collaborate with others, as part of an interdisciplinary team.

I love to travel and meet new people as much as possible.  This rotation allowed me to grow as a physical therapist and expand my horizons by learning about another culture.  I had the best time meeting and collaborating with other healthcare professionals and students from all over the country.  I highly recommend branching out and taking the chance to work on a reservation at some point if at all possible!

Elizabeth Palladino PT, DPT

Erika Doyle PT, DPT