Friday, December 4, 2020

A Beacon of Hope on the Navajo Nation

This post was written in partnership with AstraZeneca. All opinions are my own.

2020 might be a mess of a year, but it is showing us some important truths about our world. I have talked a time or two about disparities in healthcare access and outcomes. Black women, for example, are 42% more likely to die from breast cancer than white women, even though incidence rates are mostly similar. These disparities are not new, but to the extent they weren’t widely known, they have become abundantly clear this year as we face a pandemic that has hit disadvantaged communities especially hard. 

When we think of disadvantaged communities, though many Americans don’t immediately think of Native Americans. Here’s why we should.

The Navajo is the largest reservation in the United States, about the size of West Virginia, extending from northern Arizona to southern Utah, and into Colorado and New Mexico. About 250,000 people live on the reservation. More than 50% of Navajo families live below the poverty line, up to 40% of households do not have running water (exacerbating the Covid-19 crisis), many Navajo live with several generations under one roof, and hundreds of miles of unpaved roads mean that it can take hours to get to medical facilities in larger population centers like Flagstaff or Phoenix. 
Over the weekend, the Nation instituted another lockdown because of “uncontrolled spread” of coronavirus on Tribal lands. Limited healthcare facilities make treatment options scarce when Covid does strike. In a six-part series on the links between racism and Covid-19, USA TODAY highlighted these disparities. “On the Navajo Nation, inadequate resources have resulted in widespread water poverty, food insecurity and high rates of illness. These daily realities were devastating long before the pandemic, but they’ve also helped fuel a high COVID-19 death rate.”
I was at a conference for cancer advocates in January (back when conferences were still happening), at which a woman from the Navajo nation spoke about how living conditions, poverty, pollution in the form of abandoned uranium mines, and distance to treatment facilities negatively affect cancer outcomes for Native Americans. The data backs this up. While Native American women are less likely than whites to be diagnosed with breast cancer, other cancers are on the rise – and frequently caught in later stages when fewer treatment options are available and the diagnosis is too often terminal.
Last week, I had a conversation with Lynette Bonar about the work she’s doing to make significant improvements for the Navajo community. She is the CEO of the Tuba City Regional Health Care Corporation (TCRHCC), a nonprofit organization that provides health care in the western part of the Navajo Nation in Arizona. Last year, Bonar’s organization opened the first cancer center within the boundaries of a Native American reservation. Not just the first on Navajo lands, but on any reservation in this country. The new oncology and hematology clinic, called the Specialty Care Center, received its first patient on May 14, 2019, and began giving patients chemotherapy infusions in June 2019. 

Bonar explained the years-long process of opening the Care Center’s doors. A nurse by training, Bonar saw firsthand the toll a lack of facilities was taking on her patients and neighbors. One woman didn’t want to burden her kids to drive her the 150 miles to Flagstaff, fearing they’d lose their new jobs if they took too much time off. Instead, she opted to forego treatment. People with very treatable cancers were not seeking treatment because of the barriers to care. Many diagnoses were happening in the Emergency Department, when the cancer had already spread and was causing physical symptoms. Bonar wanted to change that. 
In 2013, she started talking to two oncologists/hematologists, and asked them, “If I build this, will you come work here?” like something out of “Field of Dreams”. They said yes. The husband-and-wife team are not Navajo, but are dedicated to treating Native Americans. 
Working with local nonprofits and using the Tribe’s own capital, Bonar was able to raise the $2 million necessary to build the state-of-the-art facility. But she also had to lobby regulators to change the payment models for reimbursements to include cancer care at an Indian Health Services facility, something that wasn’t covered before. 
In the last year, Bonar estimates the Specialty Care Clinic has served more than 1200 patients, and their outcomes are far better than what they used to be. Patients can receive screening, chemotherapy, and other infusions at the Tuba City facility. For radiation and other specialty services, patients still have to travel to a larger medical center like Phoenix (about 250 miles away).
For her relentless efforts to level the playing field and erase some of the disparities that exist in this community, Lynette Bonar was recently awarded a Catalyst for Change Award, part of the Cancer Community (C2) Awards, created by AstraZeneca and Scientific American. The awards aim to honor the unsung heroes of cancer care, including healthcare professionals, researchers, caregivers, advocates, educators, and any individual or organization offering relief in extraordinarily difficult times. 
Bonar was chosen as the winner of the Catalyst for Change Award, for working to significantly improve the ability of underserved populations to receive high-quality cancer care. Not only did Bonar establish the first cancer facility on an American Indian Reservation, but she is also the first Navajo woman to helm a Navajo healthcare system.
I asked her what she would want her message to others to be, what the world should learn from her story. She said: “People don’t realize there are so many health disparities. What we have to go through to get to an equal playing field for healthcare is so much. COVID-19 has highlighted our struggles. With cancer, we’re not the only ones facing this. There are other rural communities without access to treatment. The United States needs to work to improve this.”