Navajo had worst per-capita COVID-19 rates in US; infrastructure, water access crisis
19 Pueblos, Navajo Nation, Jicarilla and Mescalero Apache in NM; IHS underfunding
"New Mexico is simultaneously one of the most culturally rich and economically poorest states in the country. UNM trains physicians who understand that poverty is the most powerful determinant of health."
NM is majority-minority with large Hispanic population; northern NM village communities
NM consistently ranks 49th-50th in child poverty; poorest state in West
High desert communities, extreme distances, frontier medicine
Hózhó (balance/harmony), death avoidance taboos, traditional healing before dying
30% of Navajo homes lacked running water during COVID-19; arsenic, uranium mining legacy
Cold War uranium mining on Navajo land; lung cancer, kidney disease in miners and families
NM expanded Medicaid in 2014; high enrollment but rural access barriers remain
Spanish, Diné Bizaad (Navajo), Keres (Pueblo), Tiwa — multilingual clinical environment
Hózhó, death avoidance, home death wish, family consent, navigating traditional and hospital care.
Remote chapter house patient, no running water, IHS limitations, transport to Albuquerque.
Environmental justice, historical harm, community distrust, cancer care in former mining communities.
Child poverty, food insecurity, housing instability as clinical determinants in NM patient.
New Mexico ties, Spanish or Navajo language skills, Indigenous health experience, why UNM.
"Scenarios draw from New Mexico's layered communities: Navajo Nation patients navigating COVID-19's aftermath, Hispanic villages in northern New Mexico, Albuquerque's urban poverty, and rural high desert medicine."
"A Diné (Navajo) elder from a remote chapter house on the Navajo Nation presents to UNM with advanced heart failure. He refuses hospitalization because he is afraid that if he dies away from home, his spirit cannot rest on his land. His family supports his wish to return home, where there is no cardiologist and intermittent electricity. How do you approach this?"
Practice this scenario with AI →Diné philosophy of balance and harmony is central to understanding end-of-life care preferences and traditional healing.
the infrastructure deficits that made it catastrophic (no running water, multigenerational housing) still exist.
Cold War uranium extraction on Navajo land caused generations of lung cancer and kidney disease, and is active in shaping community distrust of federal institutions.
NM's child poverty rate is among the worst in the US; poverty is the upstream determinant of almost every clinical encounter.
"In 14 years of examining I have never failed a candidate for giving the 'wrong' answer. I have failed candidates for how they treated the person in the room with them."
Hózhó (roughly: balance, harmony, beauty) is the Diné philosophical framework for wellbeing. Disease is understood as disruption of balance; healing is restoration.
Death taboos in Diné culture mean that patients may refuse hospitalization to avoid dying away from their land and family — this is not denial, it is profound cultural meaning.
Traditional healers (medicine men, star gazers, hand tremblers) may be involved in care. Ask about this respectfully and integrate, don't compete.
During COVID-19, 30% of Navajo Nation homes lacked running water. This single infrastructure deficit drove catastrophic COVID spread — handwashing is impossible without water.
Uranium mining on Navajo land from the 1940s-70s created generations of lung cancer, kidney disease, and contaminated water. The federal government has acknowledged responsibility but remediation is incomplete.
Chapter houses (local community governance units) are the organizing unit of Navajo community life — they matter for understanding how healthcare information flows on the Nation.
New Mexico has consistently ranked among the worst states for child poverty — often 49th or 50th. Poverty is not background context; it is a direct clinical determinant.
Northern New Mexico Hispanic village communities have distinct cultural identities (Nuevomexicano) that are different from immigrant Latino communities — family-centered, land-connected, and with specific healthcare relationship patterns.
UNM sees the direct clinical consequences of poverty daily. Show that you can trace the causal chain from poverty to clinical presentation.
Diné patient refusing hospitalization because he wanted to die on his land. The question wasn't "how do you make him stay" — it was "how do you honor his wishes while providing the best possible care."
Know the uranium mining legacy. It came up in my environmental justice station. The federal government mined on Navajo land, left cancer behind, and largely walked away.
UNM is for people who want to serve New Mexico. If you're going to leave for a coastal academic center after residency, be honest about it.