Our own third-world country

I have recently had a discussion with a friend of mine regarding international rotations during post-graduate medical training (A.K.A. residencies.) A great many programs exist that send residents all other the world on month to two-month long rotations when residents engage in local health care and do lots of teaching and learning. In some cases, these rotations are based in fairly advanced large hospitals, and in others, not so much. My friend had recently returned from such a rotation, during which she had an opportunity to practice in a hospital and teach local medical residents, and extensively travel the country. Not unexpectedly, such rotations could be a lot fun, and have large appeal for global health-inclined crowd.

During the last year of med school I wanted to go on such an international rotation. My partner was at that time working for Partners in Health, which is an organization delivering sustainable international health care for the poor in a dozen of countries. When she heard me talking about setting up an international rotation, she suggested that I would do a rotation in the US but at a place that closely approximates a third-world country, an Indian reservation. That was a great idea, and I spent a month at Gallup Indian Health Hospital working in general medicine and infectious disease clinics, and doing home visits on the Rez.

I wrote a little bit about health care and economic disparities on the Navajo reservation before. And to make it stick, here are a few telling numbers:

• Total population of Navajo Nation: 250,000
• Unemployment rate: 44%
• Families living in poverty: 30.5%
• Homes without complete plumbing facilities: 78.6%
• People living with diabetes: 55,000

Per Capita Personal Health Care Expenditures Comparison (Jan 2012):

• Indian Health Service expenditure on user population: $2741
• Total U.S. population expenditure: $7239

While a lot can be  (and will be) said on the sad state of health affairs on Indian reservations, it is only a part of a bigger picture. In my view the largest problem is essentially lack of sustainable economy on the Rez. With unemployment up to 50%, forty percent of incomes is less than $10K, 82% of incomes are below $50K. Only 11% of those living on the reservation travel less than 20 miles to a grocery store. A lot of money is spent in "border towns," which are not on the reservation. In 2011 Navajo Nation lost more than $200M in sales taxes in purchases in border towns. In comparison, total gross revenue projection for Navajo Nation in 2013 is $247M.

There simply no sustainable jobs because there is no economy as we know it. A brisk search for Navajo businesses returned a smack of links and a website of the Navajo Nation's division of economic development, which really looks paltry on data and initiatives. Similarly, a website of Navajo Nation's Department of Agriculture is a throwback to HTML1 era, which on the face of it has not been updated since September 2010 (but does have information on Department of Agriculture Fourth Annual Conference in 2013 if you look for it).

These are all very broad strokes, and I am sure all devils are in the details, as in any bureaucracy. All sort of politics are in play, not insignificantly between the Navajo Nation and the federal government over resources and land, and I don't pretend to know a first thing about. But what I saw on the reservation gives me a lot of hope.

What I saw one day traveling through a region with a small river was a lot of cultivatable land, lots of crops and greenhouses full of greenery. I saw lot of action in the fields. And this made me think then and now -- there is absolutely no excuse, political or otherwise, to prevent people of the Navajo Nation from making their own land fertile and prosperous. These are hardworking and proud people with fantastic work ethics.

And this is where I stumble, and don't really know what to do about it. One country that comes to mind is Israel. Essentially a desert country, Israel became an oasis, both agricultural and technological. I don't know the numbers, but I dare to guess that the US government invested heavily in Israel economy and infrastructure. Can we do the same here and get rid of a third-world country conditions here at home?