On Navajo Nation (left to right): Charles Deutsch, Harvard School of Public Health; Dr. Sara Selig, Associate Director, COPE; Christine Hammon, Program Coordinator; Dr. Sonya Shin, Director, COPE; and Dr. Bruce Struminger, Indian Health Service.

On one of her first visits to Navajo Nation, as a resident in the Division of Global Health Equity at Brigham and Women’s Hospital, Dr. Sara Selig went to the home of a young father in his late 20s with uncontrolled diabetes. One of his legs had already been amputated due to the disease, and Selig was concerned he was developing more complications.

Unfortunately, this young man’s plight is not uncommon among members of Navajo Nation. About 37 percent of Navajos live in poverty. Access to preventive health services is often limited since patients have to travel long distances to obtain medical care. The situation is made worse by a chronic lack of primary care physicians and specialists available to provide care to patients. As a result, life expectancy for Native Americans is six years shorter than for the general US population. Navajos also suffer much higher rates of obesity, diabetes, heart disease, mental illness, and substance abuse.

In response to the pressing health needs of Navajos, Dr. Howard Hiatt, associate chief of the BWH Division of Global Health Equity, founded the Community Outreach and Patient Empowerment Program (COPE) to help high-risk people with diabetes living in two areas of Navajo Nation, the largest tribe in the US. Today, COPE has expanded to cover the entire Navajo Nation and works across the spectrum of chronic diseases.

COPE partners with the Navajo Nation to improve the health of high-risk patients through interventions such as providing educational materials and training community health workers to help patients set and achieve goals.

COPE held a first-of-its-kind symposium this spring in Window Rock, Arizona, the capital of Navajo Nation. The event drew approximately 150 participants, from clinic-based physicians and nurses to community health workers and even drivers, who often act as translators for health workers making home visits. The faculty consisted of both local and international experts, many of whom were affiliated with COPE’s partner organizations, which include BWH, the Indian Health Service, Partners In Health, and Harvard University.

“We wanted to highlight what is going on in and around Navajo Nation, as well as bring in the global perspective,” said Selig, now a faculty member in the Division of Global Health Equity and associate director of COPE. “By connecting attendees to the larger national and international scene, we cross-pollinate with outside experts and let them know that the problems on Navajo Nation are also faced in other parts of the world.”

Most of COPE’s funding comes from the non-profit Rx Foundation, and the symposium highlighted the urgent need for more interventions and investments. With roughly 20 percent of people in Navajo Nation living with diabetes, one of the highest rates anywhere in the world, COPE’s work is greatly needed.

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