Bending the Arc in the Navajo Nation

Did you know that the Navajo Nation has a severe shortage of health care providers? One in every four positions for doctors is empty, creating desperate need for decent medical care for people who have long been marginalized. And frequently when those positions are filled, outsiders are brought in at a very high cost and usually don’t stay.

This summer we had the privilege of screening Bending the Arc for the HEAL Initiative, an organization aiming to address the need for health care workers on the front lines of global health. They work in communities like this across the world—training and equipping local health professionals who are more likely to commit and stay for the long run. Through their two-year fellowship program, HEAL trains health professionals dedicated to serving the underserved. As part of their annual meeting, HEAL screened Bending the Arc in the Navajo Nation for 45 health professionals from eight countries, and hosted a discussion about the trajectory of global health.

We spoke with Sriram Shamasunder, co-founder of HEAL and Assistant Clinical Professor of Medicine at UCSF, about the event. Sriram trained at Harbor UCLA Medical Center, and his co-founder of HEAL trained at Brigham and Women’s Hospital in Boston and participated in global health equity program with Paul Farmer and Jim Yong Kim. HEAL works extensively with PIH.

Can you give me some background on HEAL?

Dr. Phuoc V. Le and I co-founded HEAL after we met in Haiti. We were both working with Partners In Health in the aftermath of the earthquake. We realized that the ethos of PIH—and the commitment of the founders—was beyond what we were seeing with other volunteers in Haiti at the time. Phuoc eventually came to UCSF, where I was on faculty, and together we started HEAL out of the values of PIH—preferential options for the poor, solidarity, community health.

What were your goals in starting HEAL?

We wanted to build a community of frontline health professionals who chose to serve underserved communities as their long-term career choice. We wanted to make the front lines a first choice career for medical professionals.

How does HEAL work?

Right now we have 90 health professionals across eight countries that go through our program for two years. Over half of them are either Native American or international, including from countries where PIH operates, like Malawi, Mexico, etc.   

There are countless underserved communities, both in the United States and abroad, in desperate need of adequate medical services. For example, 25 percent of physician jobs in the Navajo Nation are empty, and the others are oftentimes filled with temporary physicians at high cost and marginal quality. We also know that local health professionals who are from those communities are more likely to commit to them for the long run, and we want to equip those people with all the tools and mentorship necessary to serve their communities well. So we started HEAL to be the intermediary, providing training to local people and placing them in underserved communities in need of physicians. We currently work internationally and domestically (Navajo Nation).

Tell us about screening Bending the Arc on the Navajo Reservation.

Over the last three weeks we’ve had all of our groups together—Navajo Nation, Bay Area, front-line health professionals from all over the world. During this time we screened the film for 45 health professionals from eight countries, using the film as a starting point for a robust discussion about the trajectory of global health.

We were able to talk about the process of making the film and getting it out in the world. It was a really cool moment because one of our fellows from Haiti (Marcel) is in the film, and there was massive cheering from all the fellows when they saw him on screen.

The film is incredibly inspiring, but what was most remarkable was the conversation it launched following.

What were the key takeaways from this conversation?

We talked a lot about what is normalized in global health and in the world, and it challenged us to re-evaluate these things. In the film you see Jim ask the question—are these drugs on patent or not? And no one at the WHO had even asked this question because it was a blind spot. So the conversation became “What are our blind spots?”

That conversation is exciting because it tells so much of our collective history—we are all in some way part of that. These are the next generation of practitioners that were inspired by the work of Partners In Health and want to take it forward. The film shows our shared history and prods us to ask the question of how to take it forward.

What were some of the blind spots that were discussed?

They talked a lot about some of the noncommunicable disease processes—-diabetes, cancer treatment, etc.—and feeling like the systems we have are not set up to support people. The advocacy and urgency that Paul and Jim demonstrated needs to live in our current movements.

Oftentimes health professionals are not the ones challenging these systems, but HEAL believes that staff and health professionals are in a unique position to call attention these blind spots and work to address them.

A huge issue that came up is ICU care—critical care in a lot of our settings is nonexistent. One of the Haitian nurses from HEAL talks about this—critical care and trauma care that you don’t generally see in high volumes or high quality in these settings.

Was there any discussion about what’s happening in health care in America right now?

There was a parallel discussion of how do we solidify funding structures that don’t rely on the whims of donors? It was remarkable that Paul and Jim’s early work was essentially privately funded, but how do we get our systems in a place where we aren’t reliant on this?

There’s frustration amongst global health professionals around how the donor community calls a lot of the shots. What we see in Haiti is impressive, and in Rwanda with Dr. Agnes [Binagwaho]—there’s a level of self-determination in calling the shots that comes from within the community.

There was a sense of not wanting to be at the whims of the government or USAID that was definitely discussed.

Were there any action steps that came as a result of the discussion?

The main outcome on that front was getting a lot of our groups together in terms of advocacy. There were groups that formed around health professionals and Standing Rock, the approach to climate change and what that means for health care, issues within Haiti, and U.S. health policy (mobilize around fighting Trumpcare). There were 4-5 advocacy groups that emerged partly from conversation around the film.

BTA normalizes advocacy as a hat that health professionals should be wearing. This is one of the essential parts of the toolkit. Often people feel like they’re a clinician, but being an advocate is outside their wheelhouse, or they’re discouraged from being involved. So a really positive outcome of the discussion was empowering people to be advocates for health care across a number of issues.


To learn more about the HEAL Initiative, visit their website.