Hear how a Buckeye doctor helps Navajo Nation

Howling as if alive, the wind tears across the Arizona mesas with so much force that folks tie down their garbage cans with bungee cords. They put old tires onto their roofs to keep them from blowing away.

The wind’s high-pitched whirl sneaks through a window crack to become an unwanted guest in the 800-square-foot apartment of Dr. Christina Knight. At this moment, it is loud enough to take her back eight months to her first night in Chinle, Arizona, a dusty, two-stoplight town in the center of Navajo Nation.

That night was July 3, 2021 — her 30th birthday. Knight sat alone. There was no celebratory cake.

“I had mac and cheese because that’s all I had.”

She knew no one in Chinle, more than 1,800 miles from her family in Canton, Ohio. She was exhausted from driving three days and disoriented by the 5,500-foot elevation. It was 90 degrees inside the apartment thanks to a malfunctioning air conditioner.

“There was a moment of like, “What am I doing?” I’m like, “What is this?” I drove all the way out here to do this?”

Overwhelmed, Knight cried and climbed into bed. She was sweating underneath a buzzing fluorescent light that she kept on out of fear. Outside, through the curtainless window, the front gate banged over and over.

“It woke me up that night and I thought, for sure, somebody was in here.”

It was a trick of the wind.

“What am I doing? I should just turn around and go home,” Knight thought.

Ohio’s comforts teased her mind, but her heart had put her in Chinle. She was inspired by experiences while a medical student at Ohio State, where she earned an undergraduate degree in 2013 and a medical degree in 2017.

Knight made a two-year commitment to the HEAL Initiative. HEAL stands for Health, Equity, Action and Leadership – and it’s a fellowship program that places health care professionals in underserved communities around the world.

“Underserved” is a polite way to describe Navajo Nation, which stretches 27,000 square miles throughout Arizona, New Mexico and Utah.

“There’s hardly any jobs. There’s hardly any housing,” says Joseph Gregg, a senior officer with the Navajo Nation police department. “There’s really not that much employment so people are definitely in a poverty level.”

At least a third of its 400,000 citizens – almost half of who live on the reservation – suffer from diabetes, heart conditions and lung disease. Medical funding and resources are scarce.

“As indigenous people, we’re always at the bottom,” says Wanda Begody, a Navajo woman who lives in Coal Mine Canyon, Arizona. “We don’t have enough doctors.”

Knight came to Chinle to help address this need. Still, she couldn’t fully grasp the range of hardships faced by the Navajo people until she witnessed them.

“I think to them it is kind of just the way of life and they’re used to it. But if you come from like any sort of suburban city anywhere and you come here, it can break you really quickly.”

A well of strength got her through that first night, and then she went straight to working 12-hour shifts at the Chinle Comprehensive Health Care Facility.

Knight had completed her residency at Indiana University just a month earlier. She had no introduction to the Navajo culture or community, which the year before had logged the highest rate of COVID-19 infections per capita in the United States.

“I felt very much like I am so incompetent. I shouldn’t even be here. I’m doing more harm than good being here. And so, I used that as my justification to be like, ‘I should leave. I should just be done. I should go.’ ”

But then, at the first week’s end, she was assigned to care for an elderly Navajo patient. The old man’s mind was sharp, but a bout with COVID had severely scarred his lungs.

Knight explained to his daughter that treatments couldn’t help. Her father wasn’t going to survive. Making him comfortable should be the priority.

The daughter agreed and requested that his extended family – about 20 people – be with him in his hospital room. They feared the pandemic meant he’d die alone.

“I’m like, ‘No, that’s not going to happen. If we’re going this route, they’re getting whatever they want.’”

She arranged for her patient to have his own room. Family members, all vaccinated and masked, gathered by his bedside.

“After he died, his daughter who I had mostly been talking with, she came out and she said, ‘Thank you.’ She said, ‘You gave us something we didn’t think we’d be able to have.’”

Knight returned to her apartment that night and she cried. The omnipresent wind blew.

“It almost broke me, but then it ended up saving me as well. I could advocate for people. In anything I do, if I can advocate for somebody to get something that they were afraid they would otherwise not get, I will stay and stick it out and do that if it will make that person’s life better or give them something that they will value.”

Flags snap in the wind, and the aroma of fry bread, roast mutton and leather wafts through a flea market on the outskirts of Gallup, New Mexico.

“So we are at the Gallup flea market, and essentially this happens every Saturday where a lot of local artisans or bakers, food makers all come and participate in this very large flea market.”

Hundreds of booths line four rows on a gravel and dirt patch lying between train tracks and U.S. Route 491. Knight is browsing along with thousands of visitors who traveled from throughout Navajo Nation.

“This is a great opportunity for me to learn more see more of the culture. So I really enjoy taking time on the weekend to do that.”

Knight credits her time at Ohio State for teaching her the importance of understanding cultural context.

“It definitely opened perspectives, especially if you’re seeing medicine in a variety of locations.”

Her education abroad experiences included a summer in Guatemala, where she was born. That was her first visit to her home country since Canton residents Susan Parker Knight – a 1981 Ohio State graduate – and husband James Knight adopted Christina at 4 months.

“When I was in Guatemala between that first and second year of medical school and really seeing medicine in a different country for the first time, I was very intrigued. I’m like, ‘I love doing this.’”

Knight noticed that her patients in Guatemala responded well if she spoke Spanish – their native language – and if she listened carefully to them. She learned in the Central American country that getting to know people helps her provide better care for them.

“You need to have cultural humility,” Knight says. “I’m not from here. I don’t necessarily know a lot of the cultural beliefs or values or things like that. And so, I have to come in and be ready to learn those things.”

In Navajo Nation, Knight has learned always to address the oldest family member first. And with poverty and unemployment rates both at about 40%, she has come to ask two questions of every patient:

Do you have electricity?

Do you have running water?

“Most of them don’t have either,” she says. “You have to take that into account when you’re making decisions about a lot of treatments.

“Our society says to you, ‘If you’re going to be healthy, you have to do this, this and this.’ It’s not practical in Navajo Nation. It’s just not going to happen. I think that’s another big thing that I’ve learned as well is that you’re not here to be like, ‘I know better than you; we’re going to do it this way.’ It takes so much collaboration. That’s what yields a successful result.”

Getting results also is challenged by a lack of resources. There are few medical specialists and surgeons for the reservation’s 12 health care facilities, which together accommodate only 200 hospital beds.

That is one bed per 900 residents – about one-third the U.S. rate.

“Where you live impacts your health care, and this is a stark reminder,” Knight says.

She thinks of that when driving along the plains, mesas and mountain passes of Navajo Nation — larger by area than 10 U.S. states.

Occasionally, you’ll see a home sitting off in the distance – like a lone raft lost on a brown ocean.

Phoenix is 300 miles from Chinle. Flagstaff, Arizona, that’s 170 miles away. It’s 230 miles to Albuquerque, New Mexico.

“I knew it would be a rural site, and to me, I lived in Ohio. I know some rural areas. I did not know this degree of rural. It’s a different level of rural.”

She has since learned about a child who died from a heart ailment because an ambulance took an hour to get to her family’s home. One of Knight’s first patients was a construction worker who walked more than 40 miles every day because he didn’t have a car to get to work.

So yes, sometimes her patients don’t show up for scheduled appointments. Knight understands.

On this blue-sky Saturday, she traveled 90 miles from Chinle — with wind gusts sometimes shaking her car — to visit the market outside Gallup. Here, she mingles as merchants sell traditional silver and turquoise jewelry, hand-woven rugs and blankets, western wear, tools, birds, rabbits, NFL merchandise. Pop songs mix with indigenous music.

“This is a big part of the weekend is coming to the market. And that helps maintain a lot of those connections, family connections, friends, traditions.”

Strolling among thousands of market-goers, she encounters one of her patients, herb seller Yeii Yazzie. They hug.

His friend’s grandson — a 2-year-old in a cowboy hat and boots — stands next to Knight, who is wearing an Ohio State sweatshirt. The little boy reaches up and grabs her index finger.

He doesn’t let go.

“And then, the pain that you feel, is it mostly in the left?”

“Yeah, it’s right here. It hurts all over right here.”

A patient sits deep inside the maze of the Chinle Comprehensive Health Care Facility. He’s explaining to Knight how numbness in his legs – and mobility problems – have worsened in the two years since he was stabbed near the spine.

“When I walk, I kind of stagger around.”

“Yeah.”

“People think I’m drunk and stuff.”

“But it’s all from … ”

“Yeah, I don’t have balance. My legs will stiffen up. And I walk funny.”

Knight intently observes the man, who appears to be in his 20s. She’s a sponge for details. The two talk for 30 minutes, including his examination. Whenever she speaks, the patient leans toward her. To make certain she’s clear about one point, Knight draws a spinal cord on a piece of paper.

“There’s a couple things we can do, including physical therapy, definitely.”

After presenting her treatment plan, Knight asks: “Anything else you’re worried about?”

She asks this to each of the four adults and six children that she sees on this day during her 8 a.m.-to-5 p.m. shift at the hospital’s internal medicine clinic.

“Sometimes it takes one question to learn more about them,” Knight says. “In medicine, you can start to tunnel your diagnosis or solution because you assume so much. When you do that, you shove everyone into one group.

“I feel like, if I assume anything, then I failed my patient. You have to keep a curious mind — that’s what I always tell myself.”

Navajo patients have told Knight enough about their lives and circumstances in the past year that she has come to a realization: They’re concerned about being stereotyped.

“It’s this fear of society – that they’re just confirming society’s beliefs that, ‘Oh no, I just get everything for free, and I don’t have to do very much, or work very hard.’ ”

Knight saw the results of that fear play out months earlier while examining a young man who had fallen off a truck while unloading hay.

“He’s like, ‘I didn’t think anything of it.’ And I didn’t really either, just that he was a young guy, I thought he was fine… But his ankle was swollen. And I looking to not X-ray because he’s like, ‘Oh, I’m walking on it, it’s fine.’ I’m like, ‘Well, it looks a little, a little bruised there. Maybe we just x-ray it.’”

The results showed he had fractured and displaced both his fibula and tibia. Knight gasped.

“The way she practices medicine will be informed by those people she sees,” says Dr. Jane Goleman, an alum who mentored Knight at Ohio State while teaching in the College of Medicine.

“She will be in touch with people who have very little and know how to interact with them as a physician.”

Quiet by nature, Knight enrolled at Ohio State to become a biochemist. However, she began volunteering at Wexner Medical Center during her freshman year. She’d bring flowers, talk to patients and family members.

The enjoyable interaction convinced her to become a doctor — the type of physician appreciated in Navajo Nation.

“Our people being so welcoming and loving, they understand – they understand that life here is difficult. It is hard to sometimes get to the hospital as soon as they can. And when they get there, to be treated like a human, when a health care provider does treat them like a human and does truly listen to them is very important to them,” says Chinle resident Shaun Martin.

Knight’s soft skills helped Yazzie, the man she later saw at the Gallup market. In November of 2021, he had traveled 80 miles from his home on the Black Mesa in Arizona for a two-day hospital stay in Chinle.

Knight treated him for dehydration.

“I thought I was taking care of myself, but overall, I wasn’t,” Yazzie says. “Once I talked to her, I understood. She communicated different things about dehydration that I never thought were an issue.”

Four months later, Knight cradles a baby as the mother looks on at the Chinle hospital.

The infant whimpers, and the doctor softly pats his head.

“Oh now, it’s OK, kiddo,” Knight says.

The baby calms as the examination ends.

“He’s doing great, Mom,” Knight says. “You and Dad are doing a fantastic job.”

There’s a pause, and then – just in case – she asks another question:

“Is there anything else you’re worried about?”

The view is spectacular from the lip of Canyon de Chelly National Monument, where a March wind cuts hard and cold along sandstone walls.

Knight peers out from a south-rim perch about 1,000 feet above the canyon floor.

“You feel a connection to where you are,” she says. “You’re in a very special place to these people. Their profound history is here.”

Canyon de Chelly, on the eastern outskirts of Chinle, has been occupied by indigenous people for nearly 5,000 years. Small farms are still tilled below its red cliffs, among the cottonwoods. The land is beautiful, but harsh.

“Life is hard. And our culture has endured not just historical trauma to have to understand how to overcome obstacles, but life in general, here pre-contact, was harsh. There were droughts. There were times of famine. There were diseases that came through that took out herds, that took out life ways, and we had to overcome those things.”

The land’s dichotomy is further evident a couple of miles away, where a grandmother cooks dinner for nine. Their Chinle trailer that has a wood-burning heater, no running water, tires on the roof.

“Some people probably look at us like we’re poor, but we’re not,” says Vergie Yazzie, no relation to Knight’s patient.

“It’s just life for us. We enjoy it. We love our life and the way we live. And yeah, it looks like that we’re poor, but we have each other and we have our land. We have our lifestyle.”

People like Knight who come into Navajo Nation to help don’t have the benefit of growing up with the local customs or having family around to lean on.

“It’s incredible, because she’s here to help our community. She’s here to heal our people. She’s bringing medicine,” says Chelsey Samuel, a resident of Chinle. “I would like to thank her for that. Having to come a long way from her home and to being here to give medicine, to treat our people. Because we are in desperate need.”

Knight still struggles with the isolation, which she sometimes compares to solitary confinement. A counselor helps her maintain her mental health. So, too, does reading, listening to podcasts and watching movies on DVD.

She goes on hikes and – occasionally at night – she even exercises by walking in circles inside her apartment. Sometimes she covers up to 6 miles in two hours.

Knight is glad she didn’t quit her fellowship. She’s proud of being resilient when lonely here in Navajo Nation, where community well-being is valued over individual needs.

“I do love doing this,” she says.

“We have to make a requirement that there’s always at least one health care provider who can cook.”

(Laughter)

Knight isn’t alone on this day after her hospital shift ends.

She sits with seven co-workers — each of them here on health care stints from throughout the U.S. — around a dining room table.

They’re in the home of nurse practitioner May Tanay. They meet once each week for a potluck dinner, an outing that they call “Wednesday Night Fellowship.”

The gatherings have bonded the former strangers.

“It’s just really nice to have that group of people who is also here in the very similar situation. We can sympathize with each other and help each other.”

Filipino cuisine is shared amid a circle of nonstop conversation. They discuss how not all of the reservation’s feral dogs are dangerous. How “Dan the Postman” at Chinle’s only post office is so friendly. How tickets have gone on sale to see singer Harry Styles in Phoenix — a five-hour drive away.

“What is this guy’s name?” asks Tim Frey, a radiologist from Boston.

Incredulous, his dinner mates explode in laughter.

For two hours, eddies of topics swirl around the table: tattoos, favorite TV shows, comfort food, mosh pits. Knight is swept up in communal laughter.

Their joy is so loud you can’t hear the wind.

“You know what I had last night? I was craving, too. I had Lucky Charms.”

(Laughter)

Sometimes at night, when the Chinle weather cools and the wind calms, Knight stares at a sky bursting with brilliant stars.

The Navajo have their own constellations, created so their people could gain understanding about the passage of time, growth and aging. Their stories share principles and values for living.

“There’s a spiritual component that grounds Navajo people in their culture. We believe that every day is a blessing. The birth of that day is a blessing, just like the birth of a baby. Of a child or any life.”

Knight also finds purpose in gazing at the nighttime kaleidoscope of light. She thinks about how those same stars create a connection with her birth mother in Guatemala — a single mom and maid whom she never knew.

And also connects her with her adoptive parents in Ohio.

She thinks of choices they made — and ones awaiting her in the future.

“My life started with nothing. I was less than – I had no value in the country I was born in. I was a female. I had indigenous heritage and born during the end of the Civil War. Like, there was no value to my life there.

“And here I am, because my mom was like, ‘No, this isn’t the life that I

want for my child,’ and changed everything. Just one decision. And that’s how I think. I’m like, I can change something with just one decision.

“She made that decision and completely changed her life, completely changed my life. Why can’t I do that for somebody else?”