Stephanie Pretty

Volunteering for two weeks at Northern Navajo Medical Center (NNMC) in Shiprock, N.M., brought to light issues of poverty and privilege for Stephanie Pretty, BSN, RN, of the Cardiac Surgery ICU.

“It was a fantastic yet eye-opening experience,” she said of the experience, which was facilitated by the Outreach Program with Indian Health Service. “Witnessing such an intense level of poverty in my own country was extremely distressing, but what was even more disturbing to me was my own lack of knowledge and awareness about it.”

Pretty, who has volunteered on medical missions to under-resourced areas in the past, said the trip has inspired her to participate in more volunteer opportunities in the future. “I intend to use this realization of my own privileged status to do more,” she said.

Caring for patients in the NNMC intensive care unit provided a glimpse into some of the health disparities and socioeconomic challenges that disproportionately affect Native Americans, brought on by chronic underfunding of health care, lack of specialty care and poor infrastructure. Up to 40 percent of the reservation has no access to running water and electricity.

One young patient Pretty cared for was suffering from obesity hypoventilation syndrome, a type of breathing disorder seen in morbidly obese people. “When I tried to understand the patient’s home situation, I learned that there is no electricity to power the BiPap machine needed to push air into the patient’s lungs so the patient frequently returns to the hospital for care,” she said.

She and colleague Victoria Wroblewski, BSN, RN, cared for a young patient who attempted suicide after a traumatic event. “We struggled to get mental health resources for the patient,” she said. “We prayed we had said enough to the patient to help with the situation they were facing after discharge.”

Pretty said it was also humbling and gratifying to care for elderly patients, whom staff call “Grandpa” and “Grandma” as a sign of respect.

Many of the elders who served as uranium miners, a major source of employment for the Navajo people between the 1940s and 1980s, are now suffering detrimental health effects from the levels of radiation that still contaminate their water and air.

Given the hospital’s underlying capacity and staffing issues, Pretty reflected on how difficult the pandemic and surge in COVID-19 patients must have been earlier this year.

“The nurses were still clearly distraught by their experience with the pandemic, so we were glad to be able to give them some time off,” she said. “When we reflected on our own experience in Boston, we acknowledged how lucky we felt to have the leadership, staffing and resources we needed to handle a multitude of stressful circumstances, and that our situation was nowhere near as dire as other facilities.”

Pretty and the Brigham colleagues who volunteered with her are looking into ways to maintain a connection with NNMC staff. “At the very least, I want to be able to visit again, especially in the event that a second wave of COVID occurs,” she said.