A series of community focus group discussions was held in San Juan County in October as part of the recent Community Health Needs Assessment survey, conducted by the National Rural Health Resource Center.
The survey, sponsored by Blue Mountain Hospital, Utah Navajo Health System, Inc. and the San Juan Health Services District, was conducted in August and September with 800 county residents receiving surveys in the mail. Survey participants were selected at random by Zip Code from the more populated communities. During the focus group discussions, participants were asked a series of questions, including questions about the overall health of the community, the strengths of health care and barriers to health care, as well as what new services participants would like to have available locally.
Kami Norland, Community Program Manager for the National Rural Health Resource Center, met with health care representatives and community residents in Monticello, Blanding and Montezuma Creek to gather additional information. Results of the focus groups and the survey will be further analyzed and compiled before Norland returns December 6. She will meet in the Blanding Arts & Events Center from 9:00-11:30 a.m. to discuss the survey findings and make recommendations. According to Norland, the purpose of the focus groups is to discover the best ideas to address the health care needs of the county, in partnership with Blue Mountain Hospital, UNHS and San Juan Health Services, and how to leverage those ideas for better health care.
In addressing the focus group in Monticello, Norland said participants were focused on the historical and current rates of cancer in the community attributed to the super fund designation. This group also encouraged hospital leaders to collaborate more with one another and the community, enhance access to care, address transportation issues and focus more on prevention and wellness.
During the Blanding focus group, Norland was told that San Juan County health care ranked 26th out of 29 counties in Utah, during a recent survey. The fact that San Juan County is the poorest and the largest county in Utah is a contributing factor. Among the items discussed were topics like new home health regulations and care for the elderly, drug and alcohol abuse, mental health treatment and concerns over transportation and the distances patients sometimes have to travel to receive care. The cost of having patients travel to the Wasatch Front and other areas for various types of treatment was also discussed. Other needs that were mentioned included better education about health care issues and programs like diabetes, wellness programs and life style choices.
Despite the concerns, it was noted that health care in San Juan County is now much better when compared to a time when there were only two or three doctors in the entire county. Norland was told people in the county are generally more healthy today with many doctors and other providers practicing at Blue Mountain Hospital, UNHS and San Juan Health Services. People are more aware of wellness issues. They are exercising and using the Wellness Center in Blanding, asking the city for more hiking trails and other services and taking responsibility for their health. They also mentioned the availability of Tele-health treatment in conjunction with the University of Utah in many areas, and efforts to let the public know what services are available.
Participants in Blanding also expressed concerns about better care for veterans, and the need for education about autism and working with autistic children in the schools. One father of an autistic child told the group he has had to personally educate teachers, medical providers and other parents about how to work with autistic children. He said there is a definite need for education in this area.
A number of other concerns were mentioned, including cost of health care, the difficulty in recruiting providers to practice in a rural area, unless they were born and raised in this area, and the need for more specialists. It was noted that many residents still leave the county to receive care for a number of reasons, including cost, privacy issues and more services in more populated areas.
Insurance issues and concerns over large fees and deductibles associated with the federally mandated Affordable Care Act were addressed. Norland was also told that if the proposed Bears Ears Monument becomes reality there will be a need for more Emergency Medical Services and Search and Rescue in the area, and that could be a challenge.
In Montezuma Creek, Norland heard different concerns over health care and community issues. EMS representatives from UNHS and local fire officials discussed items like poor road conditions and communications, and jurisdictional problems involved with fire protection. Poorly maintained roads have hampered the ability of UNHS Transportation drivers to pick up and transport patients, including elderly patients, to appointments and dialysis treatments. Washboard roads have damaged EMS and fire vehicles to the point they can’t pass safety in spections at times.
San Juan County Commissioner Rebecca Benally attended the Montezuma Creek group and explained to those attending that the road and communication problems are not all the fault of the county. She said the Bureau of Indian Affairs and Navajo Nation Division of Transportation are mainly responsible for the poor road conditions because they do not give adequate funding to the county to maintain roads on the Utah portion of reservation. She said the county needs BIA permission to maintain the 270 miles of roads on the Utah portion of the reservation, many of which are school bus routes. In all, there are 2,800 miles of roads in all of San Juan County that must be maintained and only one-tenth are on the reservation, Benally said. She told the group the county spends between $500,000 and $700,000 each year to maintain roads, but the BIA only gives the county $45,000 a year and the Navajo Nation allocates no money for Utah roads. The BIA only blades roads on the Utah portion of the reservation twice each year, while the county blades roads five or six times each year, but until the BIA and Navajo Nation give permission the county can’t maintain roads, Benally said.
Benally also explained that jurisdictional and risk management issues from the State of Utah prevent Montezuma Creek fire crews from crossing the state line to help fight fires. If county fire trucks were taken out of state and someone got hurt, the county would not be liable and who would cover Utah residents, Benally noted. The Navajo Nation policies were also blamed for the lack of communications and cell phone service in the Montezuma Creek/ Aneth area. It has monopolized all the cell phone towers in the area so only one carrier can use them, the group told Norland.
The welfare of children and families was a huge concern. Participants said there is no access to community facilities like schools for community functions, sports and other youth programs. Others said in remote areas the school is the hub of the community but in Montezuma Creek the schools close at 3:30 p.m. and are not available for the community. They also expressed concerns over the lack of services like local grocery stores with fresh fruit and vegetables.
Another major concern is that children in 7th and 8th grades are placed into Whitehorse High School with older kids and are often exposed to influences they are too young to understand. Drug and alcohol abuse, bullying and teenage pregnancy were examples of what younger kids have to deal with. Officials from the Aneth Community School said they fear for their students when they have to start 7th and 8th grades at Whitehorse because they know what’s ahead for them, and they pray these children can make the right decisions.
Norland was told that Utah Navajo Health System is the best thing that’s happened to Utah Navajos because it has put a very complete health care system in place. She was told that UNHS listens to the community, is open Monday through Saturday from 8 a.m. to 8 p.m. and they care about the people. She was also told that despite all these concerns, the Navajo people are very resilient, regardless of their circumstances. Commissioner Benally said every parent cares about their children and she’s never known a Navajo parent who did not believe in education or didn’t care for their kids. She told Norland heritage and cultural values are important and should be embraced. She said a lot of people talk about ‘those kids’ but she said it’s not ‘those kids’ people need to talk about, but ‘our kids’. “We need to get back to that,” she added.