Bringing Brain Health Support to Navajo Nation

Last month, McCance Center’s Brain Health Clinic Director, Dr. Zeina Chemali. MD, MPH, volunteered with the Mass General Outreach Program with Indian Health Service to provide specialty expertise to the Neurology and Psychiatry units at the Northern Navajo Medical Center (NNMC) in Shiprock, New Mexico. Dr. Chemali’s journey comes out of a growing collaboration with the Indian Health Service and is the first of many such voluntary endeavors as the McCance Center looks to increase our offering within underserved communities.

With the Navajo community still reeling from the impact of COVID-19, the need for more specialized support in the region has never been greater. According to Ellen Bell, MBA, MPH, Director, Mass General Brigham Community Health Outreach and Training Programs and the primary liaison for this initiative, “There was a lot of death and disease, and in their small close-knit community, they had been caring for and watching friends, family and staff pass. They have come a long way in their recovery and healing and the presence of our faculty has provided invaluable support.”

For Dr. Chemali, this was an opportunity she has been waiting quite some time for. “I have always been so intrigued and inspired by the Native American people and their complex history. If we can support this vibrant and resilient community through partnership, we should do everything we can to make that happen.”

Learn more about this experience in the Q&A with Dr. Chemali below.

Q: What sparked this collaboration?

A: Even before I moved the United States, I’ve always been very intrigued by Native American history. I remember when my own children were in school learning about its complex nature; you look at these rich and beautiful tribes and to see where the communities are today is honestly quite painful. I came into medicine to help those who have not been helped. Initially the Outreach Program volunteer opportunity was only available through Brigham and Women’s, but when it opened to Mass General providers in 2022, I knew we had to find a way to engage.

Q: What was the main objective of this first trip?

A: This past journey I view as an initial start of what I hope becomes a long-standing relationship. My objective this visit was primarily a needs assessment. My initial focus was as a neurologist, working with Dr. Garrett Riggs in Neurology, but as the trip was forming, I connected with psychiatrist, Dr. David Durham, and was able to carve out time to help with his cases as well and learn from his experience serving this community for a long time.

Q:What were some of your biggest take-aways?

A: NNMC has very strong ancillary services – quite extraordinary really. Occupational services, in-house treatment, public health nurses, and extremely well-trained and astute pharmacists are truly doing tremendous work for that community, and often handling management of stable neurological cases they typically would not see elsewhere.

Beyond that, what became clear is just how deep the level of generational trauma is within this community. It is pervasive in ways that are almost unfathomable. Helping these patients work through that, and building their trust in the process, is paramount in any care. This will also help overtime build trust in the medical system as it meets the patients it serves where they are. It will take time and a lot of listening and learning from the people of the land what works best for them.

Q: A unique or special experience you would like to share?

A: Shiprock really is a majestic place, the spirituality is all around it. You see that in the people too, despite this deep trauma there is a sense of community and support of one another. Individuals are trying to get healthy for the sake of the community, rather than themselves, as evidenced in their “I walk for a stronger Nation” emblem for exercise effort. We can all learn from that. Meeting with Ms. Ida Bradley really stands out for me. I came as a student and she was a teacher about Navajo Nation, and how we as providers can help, and meet them where they are at. The providers at NNMC are true visionaries in many ways, and it is just inspiring to be around them.

Q: What’s next in this collaboration?

A: More collaboration! We plan to go back again, and hope to find a regular cadence. In addition, the Outreach Program has many opportunities outside of onsite visits. There is a robust remote learning program which we hope to tap into, it can include case sharing, grand rounds, or patient consultations. In addition, to further develop and nurture these longitudinal relationships, there are opportunities for MGB providers to host and mentor Navajo IHS physicians in Boston for shared learning. These week-long visits are powerful ways to educate us on their unique challenges and treatment methods and also for them to get a more focused training and education in their area of interest. In every way we can, we are committed to working alongside these extraordinary providers – in person and through technology - to develop meaningful professional relationships and a community of Mass General Brigham volunteers to help build capacity and sustaining programs.