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MS WordNavajo Maternal Child Health Coordinator: Diana Hu, MD
Links Of Interest 
Women's Health/OB-GYN in Navajo Area Indian Health Service(NAIHS):
Navajo Area Indian Health Service (NAIHS) delivers health care to almost 200,000 Native Americans - primarily Navajos, but also some Hopis and San Juan Paiutes on the Western Reservation.
The area of the Navajo Reservation is approximately the size of West Virginia - it has been broken up into 8 "service units" which serve 25,000-35,000 people each. Almost 50% of the Navajo population is less than 18 years of age. 6 service units are hospital based - 2 are health centers, 1 with admitting privileges at the local community hospital. There are 4000-5000 births per year in our IHS facilities, and the teen pregnancy rate is about 16% of all deliveries. High risk OB is very common- the obstetricians estimate over 50% of our deliveries would be classified as "high risk" -6-8% of our patients have gestational diabetes in addition to those with class B diabetes, almost 20% of patients have PIH, and preterm labor - while not common- is managed aggressively locally before maternal transport is initiated.
Gynecologic services at the 5 service units that are staffed with OB-GYN physicians include comprehensive well woman care, high colposcopy volumes, and the ability to perform the gamut of general gynecologic surgery including ambulatory surgery at most sites. Cervical cancer has a higher incidence than in the general population, and well woman health care is another focus of the OB-GYN service. The comprehensive nature of our services is evidenced by the voluminous "case lists" that our OB-GYN practitioners can generate as part of the board certification process.
We also have access to a wide variety of perinatal, surgical, and oncologic consultants in Albuquerque, Phoenix, and Flagstaff who provide on site as well as referral consultation.
We currently have 27 OB-GYN physician, 33 CNM positions, and 2 women's health nurse practicioner providers on Navajo at 5 different service units. We do over 1/3 of all the deliveries in the IHS in our Navajo facilities. For obstetricians, the service is primarily high-risk with little primary call, providing back-up to midwives, residents and family physicians. The midwifery services provide 24/7 coverage of labor and delivery as well as ambulatory services, well woman outreach, teen health services and a variety of other service related to women's health.
Dr. Jean Howe, chief of OB-GYN at Chinle Comprehensive Health Care Facility, is the Navajo Area Chief clinical consultant in OB-GYN, and Ursula Knoki-Wilson, CNM, is the Chief clinical consultant in Midwifery for both Navajo Area and the IHS.
The following is a brief profile of the obstetrical/gynecologic services at each of the Navajo Area service units.
CHINLE - Located in the center of the reservation, near Canyon de Chelly National Monument. Hospital based services, including level II nursery services/high risk OB/general surgery as well as gynecologic surgery. Extensive public health network and support services for the women's health program. Call is taken from home. Must live in government housing - walking distance to the hospital. 4 OB positions with 6 midwives -24 hour midwifery coverage. 3 general surgeons as well, full OR services. 600 + deliveries per year. Chief of OB-GYN: Jean Howe, MD ph (928) 674-7001 Chief of midwifery: Ursula Knoki-Wilson
CROWNPOINT - Family medicine women's health program with internal medicine and pediatric providers as well. low risk obstetric services only- No OB-GYN/midwifery positions. Consultation with Gallup Indian Medical Center. About 2 hours from Albuquerque. Famous for Navajo rug auctions. Women's Health services coordinator: Ann Reitz, MD ph# (505)786-5291
FORT DEFIANCE - Located 7 miles from the capital of the Navajo Nation (Window Rock). Brand new hospital opened in 2001. High risk OB done, Level I-II nursery capabilities General surgery and orthopedics as well as gynecologic surgery. 300-400 deliveries per year. 200 + surgical cases done plus large outpatient colposcopy practice. Must live in government housing - walking distance to hospital. More trees than other parts of the reservation because of altitude of >6000 feet. Chief of OB: Carl Opderbeck, MD ph (928)729-8000
GALLUP - Gallup Indian Medical Center (GIMC) is the largest hospital in NAIHS with over 75 full time medical staff. Largest OB staff on the reservation. 8 full time obstetricians, 6 midwives and rotating residents. Provide regular consultation services to Crownpoint and Tohatchi Health Center. High risk referral center for Crownpoint. About 900 deliveries per year. Level II nursery allows for care of high risk infants short of mechanical ventilation. Lots of gynecologic surgery: > 400 cases per year. General surgery, ophthalmology, ENT, ortho also in the OR. GIMC/Gallup is off the reservation so individuals must rent or buy their own house - housing readily available and affordable. 2 hours from Albuquerque by I-40. Chief of OB: Ouida Vincent, MD ph (505) 722-1000 Chief of midwifery:Martha Taquechi, CNM
KAYENTA - Kayenta is one of the two health center (AKA "clinic") based service units in NAIHS. No inpatient services - usually refer to Tuba City or Chinle. Family medicine based women's health services with extensive prenatal care, well woman care, and ambulatory gyn services. High risk OB consultataion visits with Tuba City staff. Located in the central northern reservation right next to Monument Valley. (Best place to live if you're into rafting or kayaking.) clinical director: Stellar Achampong-Anouye (928)697-4000
SHIPROCK - Located in the northeastern corner of the reservation near Farmington, New Mexico - about 40 miles from "Four Corners" (junction of Utah, Colorado, New Mexico, Arizona). New hospital opened January 1995. High risk OB done, level II nursery. 4 OB positions with full time midwifery service, 2 OB NP and 1 dedicated PA. Family medicine staff active in obstetric services including primary call. 800+ deliveries per year. Active gynecologic surgery practice with beautiful new Ors- >400 cases/year. 3 general surgeons and ortho on staff as well. Largest ambulatory care clinic of all the reservation hospitals. Provide on site consultation services for Dzilth-Na-O-Dith-Hle Health Center. Must live in government housing for call reasons but many people also have land/houses nearby off the reservation (like in Farmington/Durango/ Telluride). (Best place to live if downhill skiing is what you live for.) Chief of OB: Jonathan Steinhart, MD ph (505) 368-6001
TUBA CITY - Tuba City Regional Health Care Corporation (TCRHCC) is the referral center for much of the Western Reservation. Now operated by a non profit tribal authorized corporation, new employees will be direct employees of the corporation, not of the IHS. Unique patient mix in that about 25% of the patients are from the adjacent Hopi reservation. 5 OB positions, 7 midwives. OBs/midwives provide consultation services to Inscription House, Kayenta, Hopi Health Care Center and Winslow Health Centers and accept referrals for deliveries/ gyn services. 600-700 deliveries per year. Level II nursery available. Active gynecologic surgery program > 400 cases/ year. General surgery, Ortho, ENT and Ophthalmology also in OR. Must live in government housing - one cluster is walking distance, one is about 2 miles from the hospital. 75 miles from the Grand Canyon, Lake Powell, and Flagstaff, Arizona. Chief of OB: Dr. Holly VanDyk ph (928) 283-2406 Chief of midwifery: Barbara Orcutt, CNM
WINSLOW - Winslow Indian Health Care Center is operated by a non profit tribal authorized corporation. Ambulatory services are provided at the former IHS clinic, and staff have inpatient admitting privileges at the local community hospital - low risk OB only with backup from community obstetricians. Family medicine based women's health services with extensive prenatal care, well woman care, and ambulatory gyn services. No OB/midwifery positions -high risk consultation with Gallup OB staff. Winslow is off the reservation (immortalized in the famous Eagles song - "standing on a corner in Winslow, Arizona...") and providers either own their own home in Winslow or commute from Flagstaff (about 1 hour away). clinical director: Frank Armao, MD (928)289-4646
All service units have medical students and variable numbers of residents in family medicine with OB residents and midwifery students at sites with OB services.
