PROJECT JOURNAL

Wednesday, March 7, 2018

Tonight, we had our official pre-trip meeting to go job shadow in the four corners area with Utah Navajo Health Services. I got to meet Kasey Shakespeare from Dixie State University who is the RHS program for Dixie and is going to be our “tour guide” for our upcoming trip. He started the meeting by introducing himself through explaining his own educational pursuits and how he ended up working for RHS at Dixie State University. He mentioned that this is his first time leading this 4 corners trip. As of now, he said he actually hasn’t heard back from Utah Navajo Health Services (UNHS) confirming everything for our trip as to exactly where we are going to job shadow on which days. Lucky for me, I’m the only student with a dental discipline so there isn’t going to be a problem with having too many dental students and not enough places to shadow. Sounds like I’m going to be getting plenty of shadowing experience. Besides Kasey and me, there are 10 other students going on this trip, which is relatively small compared to when I went down to Las Vegas on a trip in my freshman year. Kasey handed us our tentative schedule for the week and important HIPPA forms that we would be learning about further from UNHS to make sure that we know the proper protocol when it comes to handling patient information, even though I don’t think we’re going to be getting any type of access to patient files, but we still need to be sensitive and not share things we hear. He also went over our packing list, making sure we bring things such as scrubs and nice dress wear for our orientation and shadowing. After, we discussed all of the needed immunizations and ensured we received them (there was about eight of them). Since we will be in direct contact with patients throughout the week, we have to be up-to-date on all of our immunizations. Finally, he took our pictures for our name badges and we concluded the meeting. Although I’m nervous about things not being resolved with shadowing, I am excited to go on this trip to get a better understanding of rural healthcare and how it needs to change for the future.

Sunday, March 11, 2018

Day number one. We started the day at 11:00 a.m. and met at the SUU motor pool. We all fit into three cars and headed off to Blanding, Utah. Our drive was planned to be five hours. Luckily for me, Rylan was willing to drive. As we were driving, I got to get to know him a little better and the other guys in our car, Shon-Paul and Landen. After our long drive and only stopping twice, we finally arrived at our motel, Stone Lizard Lodging. Initially, there would be a few of us that had to share beds, but things worked out where we each got our own beds, and in my case, my own room. My roomie for the trip was Kody, who plans on pursuing a career in pharmacy and is the only one on this trip in his own discipline as well. Seems fitting for us to be in the same room. Once we got settled, we went to eat dinner at one of the two restaurants in Blanding, and then met once more to review our plan and schedule for the week, and to go through all of our paperwork to ensure no forms were un-signed or missing.

Monday, March 12, 2018

We had an early start today and with everyone in best dress clothing, we headed down to Montezuma Creek, Utah where the headquarters or main office of UNHS is located. I’ve never been to rural parts of Utah before and I was shocked at how small this town was. As we drove into the desolate town, a sign stated the population was 507. I couldn’t believe it. We drove to the UNHS headquarters passing a large construction project on the way. When we got there, our worries were realized, they weren’t prepared for us to be there as the person in charge of our stay and shadowing didn’t finish the plans and was gone on vacation. Despite the setback, the staff was very accommodating and hurried to ensure that plans could be made. After settling the commotion, we convened downstairs and were greeted by Michael Jensen who is the CEO of UNHS. He welcomed us and let us ask him questions about how long he had been with UNHS and what he enjoyed about running the program. He mentioned his favorite aspect of the job is knowing how many people this program helps, specifically those from the Navajo Indian tribe who are very prominent in Southeast Utah as that is where their land is. After visiting with him, another staff person came in and started our necessary training. We first watched videos that discussed correct and incorrect ways to handle issues with customer and how to have the best customer service possible. The videos themselves seemed cheesy, but they struck on a good point that treating the customer with respect no matter what their circumstances or situation might be is the best plan of action to pursue. After that training, we discussed HIPPA which stands for the Health Insurance Portability and Accountability Act. This act essentially lays out the guidelines for sharing, discussing, and even viewing a patient’s insurance information and medical information. For any trained healthcare professional and even those like us we are just shadowing healthcare professionals, it is essential to learn and follow all HIPPA protocols as they not only keep us safe, but also secure the privacy of the patient. After finishing all of our training and before heading out to the clinics, we were given the opportunity to tour the new UNHS offices and clinic in Montezuma Creek from Byron Clarke who is the COO for UNHS. It was still under construction, but this facility was going to be nice. They had specifically designed the building to be more efficient when it comes to physicians, nurses, and physician assistants as their offices are organized so that communication can take place easier. They also showed us where offices would be placed and even a workout area for employees. Byron mentioned to us the importance of taking care of ourselves physically while in school and out in the field. We’re always willing to help take care of others, but then slack off when it comes to our own well-being which can lead to personal dilemma. Once finishing our tour, we all split up into groups to start shadowing. I was placed into a group headed to the health clinic in Monument Valley. As we approached the clinic, I couldn’t believe how beautiful the national monument was. Inside the clinic, I was paired with both Dr. Jorey, a full-time dentist at monument valley, and Dr. Kodaz who was just filling in for another dentist on vacation. While shadowing, I learned that the patients there had driven between 1-2 hours to the clinic to obtain great care. Many of those patients were native Navajo and some didn’t speak English. UNHS accounts for this issue by hiring dental assistants who speak Navajo. Many words used in modern dentistry don’t directly translate into Navajo, but in the end, the patient is able to explain their pain so that Dr. Jorey or Kodaz could correctly treat them. I can’t imagine how difficult it would be to practice dentistry and not be able to communicate with your patient. This is one great way that UNHS has helped the Navajo tribe in Southeastern Utah.

Once our shadowing was done, all of us students convened at Twin Rocks where we got to eat the famous Navajo tacos which are served on fry bread which is part of the Navajo history when they were forced to make a 300-mile journey by the U.S. Government and thus became part of their culture. As we ate, we also discussed the things we learned from our first day of shadowing, and it was brought up a lot how uneducated the people in rural areas are in regards to health, as many fight with obesity, diabetes, and even heart conditions. This all taught us how important it is to ensure everyone is taught proper personal health maintenance. After returning home, we all gathered together to watch the movie “Windtalkers” which is based on true stories of Navajo Indians that used their own language as a code during World War II to help hide communication from the enemy. Although dramatic, it was interesting to see how influential the Navajo were in the war, despite the fact that many of them were treated without respect. In the end, it was a full first day.

Tuesday, March 13, 2018

Today most of my time was spent at the Montezuma Creek health center. When I first got there, I noticed how full the waiting area was with patients waiting to get in. The daily schedule was absolutely packed full of patients and I wondered how they were going to see that many before day’s end. I was surprised to learn that in this one office, there was a team of 5 different dentists working together. Since they were all working on contract, they didn’t have a need to complete with each other over who saw more patients, and could just focus on seeing and helping the next patient. I spent the majority of the day with Dr. Vreeken who used to be the head of the dental program for UNHS when everything first started. I was able to learn much from him, especially pertaining to applying for dental school and also what life is like while attending dental school. In regards to dental work, he was so efficient and kind to every patient even if he couldn’t speak their language. Before treating, he would take a minute or two to get to know the patient or catch up with them if he had met them before. I noticed that with many patients, he would take the time to re-educate on proper oral health maintenance. He noticed that many of the oral health issues, especially with children, resulted from parents giving their young excess amounts of pop, juice, and sugary foods without showing them how to brush their teeth. There was one boy who came in who must have only been four years old and all of his teeth had cavities. He needed extensive work, but in order to not traumatize him, a finish was put over the teeth to stop the decay, and the parent was told that children that small don’t need drinks like soda, and need to brush their teeth daily or the cavities could progress and cause lots of pain. After a day of seeing dozens of patients, I was completely exhausted. I had to constantly maneuver my body to a position where I could see clearly without getting in the way. Dr. Vreeken was gracious enough to make room for me to see what he was doing and also explain his processes allowing me to know exactly how to treat different conditions. After the day was complete, we headed back to Blanding. Although we were exhausted and wanted to rest, Kasey insisted that we go on a small hike. Although I was tired, this hike through beautiful Utah was enjoyable. The trail was mostly over large boulders and led to ruins of a Navajo settlement that was located inside a cliff on a cave. I thought it was amazing how structures hundreds of years old were still standing, and that actual Navajo Indians lived in this odd location. Only being here two days, I had learned many things about the Navajo culture and was excited to learn more about a people I know nothing about.

Wednesday, March 14, 2018

This morning, we were all supposed to head down to Montezuma Creek and attend a large meeting with all of the providers for UNHS. After trying to make plans, Kasey determined that it would be too crowded and logistically complicated for us to attend. Instead, we were able to sleep in, and use the time to study. I used the time to study for the DAT that I was taking in May and was thankful for the time to work on that. After the meeting ended and the providers returned to their clinics, I headed to Monticello, Utah to shadow Dr. Goodwine. His position with UNHS was fairly new as UNHS had approached his practice the year earlier and offered to purchase his practice for UNHS while keeping him on as a contract dentist for their program. I was able to ask him how it was changing over to working for UNHS and he said that the only issue he had was in order to make a change or get certain supplies, he was required to fill out certain forms to get approved and it just didn’t happen as quickly as when he was in charge and could order any supply he needed and specifically the brand he preferred. Despite that, working for UNHS was a perfect situation for him that took some of the pressure off of running the entire practice by himself. While I was there, I noticed how important it was to have good assistants. In the other clinics, the assistants and dentists didn’t mesh all that well leading to minor complications, whereas with Dr. Goodwine, his assistants knew exactly what he needed and when and this helped things work like an oiled machine. His office out of all of the clinics was at a disadvantage since there were no Navajo translators, and when an older Navajo patient came in, they struggled to know exactly what care she needed. Procedure-wise, I was able to see many different procedures and conditions I had not yet seen. With one boy, he had a case where some hormone imbalance was causing his mouth to grow more copies of the same tooth, and Dr. Goodwine was able to create a treatment plan to remove certain teeth to make room for the new teeth growing, and most impressive was his technique to remove a tooth and do a bone graft to expedite healing to prepare a patient for an implant. He was very resourceful and very attentive to his patients. After returning to Blanding, we met with Byron Clarke, who had given us the tour, and his mother for dinner and a cultural learning activity. We headed to the mountains where we could see a beautiful sunset on the edge of a cliffside. After the sun had set and we had all eaten, Byron’s mother educated us on Navajo traditions, as she was part of a council to preserve and pass along these traditions. We learned such things as why corn is an important part of rituals, what types of ceremonial clothing they have, and my favorite, why they continue to weave baskets. I found it interesting that a basket is weaved for any Navajo wedding where in native berries are used to make a type of pudding that is passed around for everyone to eat as part of the wedding ceremony, and the basket is given to the couple after the ceremony. It reminded me of wedding cakes at traditional weddings and how they too are shared with the guest attending. It was great to learn all about the Navajo traditions, but it was sad to hear that some of those traditions were being forgotten. With each generation, these traditions are slowly being forgotten and aren’t accepted by current and rising generations, causing them to be forgotten, like how the Navajo language is slowly being forgotten.

Thursday, March 15, 2018

Today was our last possible day to shadow. Unfortunately, I woke up in the night quite sick, most likely due to some type of food poisoning that seemed to upset my stomach. Since I didn’t want to harm any other patients in Montezuma Creek, the clinic where I was to shadow, I chose to stay behind to allow myself to rest. Once I felt better, I spent some time studying for the DAT and answered question problems. Despite being sick, I made the most of my time. Once everyone had returned, we all prepared to meet with some graduate students from the University of Utah who were all working with UNHS. One was a pharmacy student, one training to be an OBG/YN, and the last a physician assistant. They were all on rotations working in rural Utah, also getting a better look into how a rural location can affect not only the health of the local population, but how healthcare is run. As we visited with them, we were able to ask them about their specific graduate programs and how their expectations about family relations, studying, and time management all changed once they started their programs. Overall, they each said how difficult graduate school in healthcare is. Then again, each of them also explained how they love the opportunity they have to help people, especially those in rural Utah who need it.

Friday, March 16, 2018

We finally came home. We started our journey early in the morning to ensure we arrived in Moab for our last activity as a group; horse-back riding. I’ve always loved riding horses and was really excited to do it again. Instead of a horse, I rode a pretty burley donkey. We took time to learn how to handle the horses and the safety precautions we needed to be aware of if we found ourselves in a frightening situation. One specific instruction we had was to discourage our horse/donkey to not eat as we rode along. We set out riding in a single-file line and took great care to listen to the instructions of our guide, to know how to handle the horses on a steep embankment, or how to speed them up when going uphill. As each of us did this, we were able to all travel without any issues. One thing that did make me laugh several times was how anytime we stopped, my donkey would try his hardest to grab at any of the nearby vegetation to eat. Even when I’d persuade him not to, he would “sneak” a branch here or there as fast as we could. I learned from this experience of riding horses that while even being a leader, there are certain situations where letting those with even greater experience give you pointers and suggestions can lead to the success of everyone. After our ride in Moab, we finished our journey back to Cedar City and concluded our week of shadowing.

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Thursday, March 22, 2018

My trip to the four corners area was all focused-on learning about healthcare in a rural and underserved setting. As Cedar City is also considered an underserved location, I wanted to finish out my shadowing experience by observing someone who works in private practice compared to the community-based practices of UNHS. I shadowed with Dr. Sorensen who, along with two other dentists, owns and operates Cedar Dental Center in Cedar City. After I shadowed him for a few hours, I noticed that although treatment is essentially the same, working with the patients can differ. In a private practice, the money that comes into the practice depends on how many patients come in each day for treatment. It is necessary for the dental provider to be so quick as to see as many patients each day to meet financial needs of the employees, dentist, and the practice in general. Despite the need for speedy efficiency, I noticed that Dr. Sorensen still took time to greet and converse with each of his patients, showing them the same amount of respect as those in Southeastern Utah. Although Cedar City has a larger population than Montezuma Creek, there are still issues with serving the underserved population and educating others on proper oral health maintenance. As I shadowed Dr. Sorensen, I noticed that similar cases are present here in Cedar City that result from a lack of proper oral health education. This showed me that no matter where I practice, be it in a rural setting or in a big city, there will always be a need to help underserved people improve their quality of health through oral care.

Trip Summary

This trip was eye-opening for me. I grew up in a city that wasn’t considered rural. Whenever I had a health-related issue, I always had quick access close by to a number of providers that could help me, and I always felt I was educated on how to take care of my health. Seeing the mass of patients without this health education and a diminished access to receiving care has shown me how important it is that I do what I can in my power to educate and reform healthcare to make it more accessible to people in rural locations. Through my varied experiences, I have come to understand the importance of serving all people including the underserved. As a dental professional, I will have learned skills that will expand my ability to serve others regardless of their background or economic standing. With my determination, I know that I will be able to consecrate my actions towards accomplishing my goal of becoming a compassionate dentist, constantly striving to help the served and underserved.