“Embarking on a journey toward optimal patient well-being requires more than personal commitment: it demands a collective dedication to health and equity."

In regions where healthcare disparities persist, fostering a culture of inclusivity becomes paramount. This blog delves into the intersection of health and equity, exploring their pivotal role in shaping a future where everyone can thrive.

My Journey:

‍I hail from Morenci Arizona, home to one of the largest open-pit copper mining operations in the global north, and yet the smallest populated county in our state. I attended UCLA and ASU for my undergraduate education and am currently applying for my master's in physician assistant studies (PA). As a first-generation college graduate from a Chicano/Indigenous family in Southeastern AZ, I understand the unique challenges of rural healthcare access. Our town is adjacent to my family’s reservation, and I am a third-generation child of mine workers. We live predominantly in a rural area, where specialized healthcare services are at least an hour's drive away. The nearest Indian Health Services (IHS) facility is two hours away. Tucson is three, and Phoenix is just over four hours. For much of my adolescence we were enrollees in Arizona’s Medicaid program, Arizona Health Care Cost Containment System (AHCCCS), and I was raised by my mother in my adolescence as she worked full time as a waitress at a local bar and grill. The only option for my siblings and I to get any sort of dental care was to travel to our reservation and seek out those services ourselves. Ironically, “access” to any sort of clinical care was anything but easy or affordable. Something as routine as my wisdom teeth removal was nearly crippling for me and my family. My mom, a mother of three and me trying to get by as a typical struggling college student required effort, steps, and headache much more than what would be experienced “in the city”. While thankfully I was able to receive services through my tribe, it’s widely known that medical costs burden families and can completely crumble financial longevity. My family and I have often traversed hundreds of miles to reach the nearest healthcare facility with the necessary services. This is the norm for families like mine and for so many communities across the state of Arizona. So having sought healthcare at various locations served by the Arizona Resource Equity & Access Coordination Hub (AZ REACH), I understand firsthand the importance of this initiative in identifying unmet medical needs across diverse and dispersed locations.  

The Impact of AZ REACH:

As I reflect four years after the first COVID-19 surge, much perspective has been gained. While the pandemic is no longer a national emergency, the coordinators at AZ REACH continue to witness the needs of rural and Indigenous communities across Arizona. Rural and Indigenous health access to care remains an unrecognized national emergency. There are spans of the country where there are no specialists like cardiologists, nephrologists, and even readily available OB/GYN services. Often it feels as though much of our rural and indigenous communities are forgotten about, left to figure out solutions for ourselves. Covid-19 quite frankly scarred entire communities and to this day many are still left putting the pieces back together. Often, we talk a lot about equity, and it seems that many conflate equity with equality, when the two could not be farther from each other. Equity is having Mobile Health Clinics available for our rural locations who were previously lacking services during the pandemic. Whereas equality is offering Covid-19 antibody testing regardless of individual circumstance. So, as a means of promoting equity, AZ REACH acts as a crucial communication line that supports areas like my home, which lack access to these healthcare specialties and services many patients require. AZ REACH plays a vital role in serving critical access hospitals, Indian Health Services (IHS), PL-638 facilities (tribally operated healthcare facilities), and locations with 20 or fewer bed capacities. AZ REACH provides a lifeline to my family, my community, and the greater sector of rural Arizona by being at the ready to assist in patient transfer referrals.

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A Story of Hope:

Indigenous people like myself are known to be storytellers which suits me perfectly as I progress through my journey in medicine. Information surrounding the patient transfer journey is collected, presented, and relayed to countless individuals. So, allow me to share a case that I found impactful.  

Patient: In custody with border patrol, currently suffering from severe dehydration, kidney failure, and imminent multi-system organ failure. Needs emergent medical attention at a larger facility for higher level of care. The patient, found in the desert after traveling for four days without food and water, is seeking placement near family. Upon discussing with the provider further, the primary reason for traveling to the U.S. was to access readily available retroviral treatment for a new HIV diagnosis, treatment that was not available in their home country.  

This story underscores the pressing need for healthcare across the spectrum of individuals AZ REACH serves. Regardless of stances or politics, human life is sacred. As an Indigenous person it is in these storytelling moments that I find myself furthering my position on how we can best serve not only people like this patient but entire populations. While this story intertwines themes of immigration and health equity, it resonates closely with the lived experiences of many Indigenous communities. As Apache, we are often travelers ourselves, and for all our cousins who span the four cardinal directions, the same can be said for our access to specialized health. HIV is not a death sentence, we have the means to treat it to undetectable levels, and yet this story demonstrates the lengths and distance to which individuals are required to go for their own healthcare.

The Burden of Distance:

‍The burden of traveling from our lands to Phoenix or Tucson for specialized care is exhaustive of the family’s resources. This again is not unique to just my home. Many communities across Arizona do not have reliable transportation. While some may argue that their tribe does have ways of getting patients home, many to my knowledge don’t and patients and their families are left to figure it out themselves. In conversations with providers, it was not uncommon to hear phrases like, “please attempt the closest facilities and keep retrying them. If this patient goes to Phoenix, I worry they won’t make it back home.” So, I often think about patients who travel miles away from their communities only to lack the resources or means to return home post-operatively. Let alone the additional trips that would have to be made for follow-up care that is crucial for the patient's ability to thrive or at times even survive. These instances make me acutely aware of the burden of traveling and the importance of having services closer and more readily available to patients' homes. I say all of this to give you perspective. While many grow up in urban areas, the true extent of what happens outside of major cities is a story largely untold.  

The Role of AZ REACH:‍

‍AZ REACH is a pivotal step in closing the healthcare gap experienced across rural areas today. Without it, providers would struggle to care for patients due to administrative tasks that take them away from the bedside. In the first year of the program in 2023, over 7,000 patients were transferred through AZ REACH. In January 2024 alone, during the yearly winter surge, over 800 patients were successfully transferred. Even the Summer of 2024 has shown to have 1.5 times more referrals than last year's numbers. This milestone fosters trust in AZ REACH’s effectiveness. To me, this innovative program represents advocacy for people like my family and places like my home. The data collected, stories shared, and urgent need for readily available medicine all tell a clear story. This collective mindset of storytelling is necessary to invoke real change. To show leaders across the state and even the country who they are supposed to represent.

A Call to Action:

‍Growing up in Southeastern Arizona, I recall walking with my grandmother as she took my cousins and I to the river, teaching us to pan for gold, catch catfish, and identify animal tracks. We are deeply connected to the places we come from; we participate in ceremonies, walk the land of our ancestors, and tend to the nature around us. As Indigenous people, we should stay connected to the places that heal us, like home.  

Much more is needed for all American Indian and Alaska Native populations (AI/AN), especially considering AZ REACH serves upwards of 70% of this population in Arizona and is home to 22 federally recognized tribes. AZ REACH is necessary for all our communities, and in this pursuit of equity, the needs of AI/AN in Arizona and hopefully the rest of the country can be met closer to home.  

As my Nana has always told me, we have a duty and a service to give back to the hands that fed us, the land that raised us, and the community that embraces us. I hope my time in healthcare allows me to bridge the gap for families like my own—Indigenous, rural, and needing the same access to medicine as everyone else.  

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