FORT DEFIANCE, Ariz. ? It took nearly twenty years of local planning, political wrangling, design and construction, but the Navajo residents of Fort Defiance, Window Rock and surrounding chapters finally have what they have long awaited ? an ultra-modern, state-of-the-art new hospital.
The $132-million project will serve nearly 30,000 people in this remote region straddling the Arizona and New Mexico border. At 240,000 square feet, the thirty-six-bed hospital is two-and-a-half times larger than the one it replaces, built in 1938.
"In our old facility we were limited in exam rooms, we had a total of like 12 exam rooms," said Dr. Franklin Freeland, CEO of the Fort Defiance hospital. "Today we have 73 exam rooms. We had 10 dental chairs, now we have a total of 24 dental chairs. We'll have less waiting time, and we'll be providing a lot more services."
The new hospital also boasts a twenty-bed adolescent psychiatry unit, the first of its kind in an Indian Health Service facility. And new high-speed data lines have enabled the hospital to connect to the University of Arizona and other IHS hospitals, giving patients access to far-away specialists through a process known as "tele-medicine."
These improvements have been a long time coming. The old hospital, made of local sandstone blocks and shaded by huge cottonwoods, was built before World War II. More than three generations of Navajo babies were delivered on its third floor. While families will miss the old building, by all accounts it was cramped and outdated.
Efforts to replace it began in earnest in the early 1980s. Ft. Defiance councilman Elmer Milfred remembers the first planning meeting, attended by forty locals. "As time went on," he recalled, [the group] "dwindled all the way down to maybe six people, and people didn't believe that we were going to do it. But we stayed intact, and our dream that the community wished for finally did happen."
The twenty years it took the new Ft. Defiance hospital to be funded and built seemed like an eternity to Milfred and others. But that timeframe is not unusual for IHS projects. Taylor McKenzie, a physician and Vice President of the Navajo Nation, says the hospitals in Tuba City and Shiprock were also twenty years in the making.
"It appears it's so difficult to convince people in Washington that hospitals like this are needed," he said.
Across Indian country, hospitals are old and in quick need of replacement. According to Michael Lincoln, acting director of the Indian Health Service in Rockville, Md., the average IHS facility is 30 years old. In cities surrounding the Navajo Nation, from Albuquerque to Phoenix to Salt Lake, the average hospital is only about nine to 10 years old.
But despite what Lincoln calls the "tremendous need" for modern hospitals, the process of actually getting them built remains tedious. The IHS, at Congress' request, has developed a priority list of the top-ten inpatient and outpatient care facilities that need renovation or replacement. The ranking is determined mainly by the age of the facility and the need of the service population.
But to make it on to the priority list requires a tremendous lobbying effort at the local level. The Ft. Defiance chapter penned over 6,000 letters telling Congress of the urgent need for a new hospital. Navajo government leaders also logged many miles to plead their case to federal officials.
When a facility does finally take its place on the priority list, it still needs to win Congressional funding. This is often the most difficult task. In 1997 the Senate approved then President Clinton's request for $25 million to begin construction of the Ft. Defiance hospital, but the House rejected it.
Then in 1998, the House approved initial funding, but the Senate opposed it. Finally, in 1999, ground was broken on the new hospital. Its doors officially opened to the public on Aug. 1.
"The main obstacle is funding," said John Hubbard, who directs the IHS's Navajo area office. "The actual planning, development, planning and construction really don't take a lot of time ? once it becomes a priority."
What it boils down to, says IHS Director Michael Lincoln, is too many hospitals in need of replacement and not enough federal dollars. "There are limited resources in Congress," he explained. "There always really has been, it's not just a fact of today."
But Lincoln is encouraged that Congress has continued to fund new projects in Indian country. Two additional new clinics are in the works on the Navajo Nation. Across the country Lincoln says they're building about three or four new IHS facilities every five years.
But even at that rate, it will take thirty years just to replace the twenty facilities currently on the construction priority list.