Home Care In Montezuma Creek, UT

Utah Food Bank is expanding in San Juan County, and has announced the opening of two new pantries that will help support residents of the Navajo Nation.

President and CEO Ginette Bott said despite the food bank serving San Juan County for about 30 years, it had been a challenge to meet the level of need in the area.

She said the Navajo Nation is considered a food desert, with an average driving time to food resources taking up to several hours, one-way. The new pantries will help enhance food accessibility.

"While there are a couple of small pantries in the area of San Juan County in different locations, they still weren't big enough, or still couldn't be opened every single day," said Bott. "People here will have to drive to Cortez or to Moab, it's not like you can jump in your car and run a couple of blocks and grab a gallon of milk."

Bott said the Montezuma Creek Food Pantry should be open in the next few days, while the Monument Valley Food Pantry will need a bit more time to tie up some loose ends before opening.

San Juan County residents face significantly higher rates of hunger compared with the rest of the Beehive State.

Seventeen percent of residents report food insecurity, compared with 10% statewide, according to Utah Food Bank.

While the pantries will help in addressing food needs, Bott said they'll also help provide needed job opportunities that help ensure that the pantries' operating hours remain regular and reliable.

She noted it is important to make sure those being served feel seen and heard.

"We want to be sure that we are respectful of all things that are important to the folks that we are going to be serving," said Bott, "and we want people to realize we are not coming in here to make a change, we are only coming in here to enhance them and their lives."

In order to address the specific needs of those who live in the region, Bott added, the pantries have had to learn more about the Navajo diet and preferences, while also aiming to increase available fresh produce and help mitigate the impacts of prevalent health conditions such as diabetes through diet.

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BLUFF, Utah -- Georgiana Simpson is an art teacher at Whitehorse High School in Montezuma Creek, Utah, a small community on the Navajo Nation.

But since March, She's been working from her home 20 minutes away in Bluff.

She set up a makeshift studio there full of art supplies in colorful drawers, and she hung posters on the wall behind her standing desk, she said. That's where she broadcasts video lessons for her students.

On a recent Monday morning, she introduced an art assignment related to evolution.

"I want you to imagine a bird-like animal, and it cannot fly, the food it needs is found in tall trees. What adaptations does that animal need to survive?" she asked her students.

She showed them an example of an animal she drew. It had a chicken head and a long, scaly body, along with bright green with yellow polka dots. And it stood upright on two legs. Then, she asked them to draw their own.

"Are you going to draw a local animal, or are you going to create a new animal that's adapted to droughts or wildfires?"

By the end of the lesson the students were excited to start. They posted ideas in the chat box, like a mule deer or a lion with hooves. But only 8 of her 18 students were able to get on the call.

Mortality due to covid-19 is around five times higher in San Juan County than in the rest of Utah. That's mostly due to a high number of deaths on the Navajo Nation. So parents there aren't ready to send their children back to school, despite the fact that poor internet access has made at-home schooling on the Navajo Nation difficult.

To fix that, the San Juan School District is working on a $4 million project. But until that's finished, teachers and parents on the reservation have had to find creative ways to help students learn -- and their efforts appear to be paying off.

Only around 30% of the 289 students at Whitehorse have reliable access to the internet, according to Whitehorse Principal Kim Shaefer, due to a combination of poverty and poor infrastructure in the area.

So, the school has been delivering paper packets to every student, twice a semester, since March. But Shaefer said the school isn't allowed to accept the packets back, due to safety concerns, so the students have to find a way to submit them.

"They're either texting photos, emailing photos, or in those times where they do go to town, then they are uploading their assignments," she said.

In some cases, she added, the students will even call in their assignments by phone.

"There's a fair amount of teachers and paraeducators accepting verbal responses, where they talk through the question, or they write down the answer and then read it to a teacher or paraeducator," she said.

Rowena Littlehat is one of those paraeducators. She's a school counselor at Whitehorse, and she said her job has always been to help students get their assignments done. But the pandemic has made that harder.

"Being in the school, interacting with scholars, it was way easier," she said. "I would stand in the hallway and greet them and make myself visible to let them know I'm there."

Now, she has to track her students down. She said in some cases, students don't have any way to connect with her or their teachers because their parents work and they don't have their own phone.

When that happens, Littlehat drives out to their houses, some of which are 30 or 40 miles away on dirt roads.

"I honk, and I tell them, 'How far did you get? Is there anything I can help you with?'" she said.

Then she'll go over the assignment with them through the window of her car and write down all of their answers on her phone.

"When I'm done listening to them, I email the whole conversation we had to the teachers. And so they earn a grade that way," she said.

In other cases, parents are trying to find solutions to the internet problem.

Cheryl Johns has a son in 7th grade and a daughter in elementary school. The School District gave out wireless hotspots and Chromebooks to all of the students when schools closed last year, but Johns said they didn't work well enough to stream video.

"I felt so helpless because my kids were missing out on live sessions, and I was worried they could fall behind," she said.

To fix it, she and her husband bought them both iPads with wireless internet through Verizon. She said the iPads work well most days. She even set alarms on them to remind her children when they have a class.

But there are days when the internet on the iPads doesn't work, so Johns has to connect her laptop to a hotspot on her phone and let them use it.

"Out of a week, maybe once or twice I have to figure a backup," she said. "It's always trying to figure out what you can do to get them connected."

Tisheena Phillips has a similar problem. She also has a son at Whitehorse and a son at the elementary school. She said she was able to buy internet service for her home through a local provider, but the connection is spotty.

"There are days where the internet won't cooperate," she said. "Like yesterday, the internet was really slow and it was hard for them to get on."

When that happens, her children call her at the clinic where she works as a nurse. She said she can go online there and look up their assignments. Then, she either talks them through their work by phone -- or helps them when she gets home.

"It's been crazy," she said. "I work 12-hour shifts. And then it's late in the evening, and you don't want to bug the teacher, and you're like, 'Okay, we'll figure this out together.'"

Despite these challenges, Shaefer said around 80% of the students at Whitehorse are on track to be promoted or graduate. That's just 7% lower than the graduation rate in 2019.

She said they had to pare down the curriculum this year because of the internet issues, so they're not asking students to master the same amount of content. But she said there is a lot of growth this year that's not captured in grades or graduation rates

"Dealing with the pandemic, our teacher and paraeducator teams have become stronger," she said. "They are able to have honest, frank conversations about what's needed."

And the students are evolving too -- just like the animals Simpson asked them to draw.

Back in her studio, she went over the submissions for the assignment.

Johns' son, who excels in art, drew a lion-like animal with hooves and scales to deflect heat. Another student drew a human saving a koala from a burning tree, based on the wildfires in Australia last year.

"You see things like that and it just breaks your heart and endears you at the same time," Simpson said. "Because they're just so thoughtful in what they're trying to say."

She said some students texted her photos of their work and some turned it in online, while others talked it through with her on the phone, or in-person in their driveway from six feet away.

"We're seeing our students find these different pathways to their learning," she said. "You know, that there isn't just one way to show it. There's ways to do it visually, as well as with the language that they're developing."

So far, 12 out of 18 students have turned in the assignment. But Simpson said she's not worried about the rest, because they have her phone number -- and they know how to find help if they need it.

Even with three medical schools, Utah still has a shortage of primary care and rural physicians. And while the physician shortage isn’t new, the problem is growing across the United States. One-third of all Americans live in federally designated Health Professional Shortage Areas. It’s even worse for those in rural communities, and Utah has a lot of those.

Preparing Students to Work in Rural and Under-Resourced Communities

In 2020, the Spencer Fox Eccles School of Medicine at the University of Utah received a generous grant from the Health Resources & Services Administration (HRSA). With these funds, we created programs that encourage and prepare more medical students to choose primary care disciplines and work in rural and under-resourced areas. At the same time, we re- envisioned how we train doctors, developing a brand-new kind of medical school curriculum.

Thanks to a recent renewal of the original HRSA grant, that work continues at full strength. With the new funding, our goal remains the same: to recruit, retain, and prepare medical students to work in rural and other under-resourced communities. We do so in a variety of ways.

Pre-Matriculation Readiness for Ongoing Medical Student Success (PROMIS2U)

First, we review applications from students who meet our minimum GPA and MCAT standards but are not on track to be accepted into med school at that time. We invite qualified students who come from under-resourced communities in Utah to apply to the PROMIS2U program.

This yearlong program includes:

So far, the School of Medicine has accepted every student who completed the PROMIS2U program. They are performing just as well—sometimes better—than their peers.

Tribal, Rural, and Urban Underserved Medical Education (TRUE)

The TRUE program prepares and encourages medical students to choose primary care residencies and careers that will serve tribal, rural communities, and medically under-resourced communities after graduation and residency. It is open to all medical students.

TRUE-enrolled students complete 15 credits related to population health, health delivery science, and community health improvement in TRU (tribal, rural, underserved) communities. While in the program, they complete coursework, experience a clinical clerkship in a TRU community, and produce a community-oriented health improvement capstone project. TRUE students who complete the program graduate from medical school with both an MD and a graduate certificate in tribal, rural, and underserved medicine.

Tribal and Rural Medical School Experience

Medically Underserved Longitudinal Integrated Clerkship (LIC)

Longitudinal Integrated Clerkships (LIC) are an important new addition to the MD curriculum. Students who choose to experience a medically underserved LIC have the opportunity to care for patients in an under-resourced community for up to a full year. Initially, we hoped to have four students complete medically underserved LICs each year. But in only our third year, we have more than 40 students who will complete LICs in underserved areas across the state of Utah.

This would not be possible without our health care partners in medically under-resourced communities, rural communities, and tribal health systems throughout the state. Thanks to our partners, we will have nine students placed in rural LICs for 2024. Our goal is to grow that rural LIC cohort to 24 students per year by 2026.

Looking Toward a Brighter Primary Care Future for Utah

Medical school indebtedness is one of the determinants of residency choice. There is a perception that salaries in primary care are lower than those in medical subspecialties. We hope to diminish indebtedness and further incentivize students to choose primary care careers.

In 2025, we will launch our first dedicated primary care track, open to 15 medical students each year. Accepted students in this track will collectively receive up to $800,000 in scholarships annually.

Although we have accomplished much over the past three years, there is still a lot of work to do. We look forward to further establishing and expanding our existing programs and helping to meet the primary care physician workforce needs across Utah and the Mountain West region.

The programs described in this publication are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of two awards totaling $17.7 million and $15.3 million with 10 percent financed with non-governmental sources. The ideas expressed in this blog are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

Ty Dickerson is a clinical professor of pediatrics in the Division of Pediatric Hospital Medicine and an adjunct professor of family and preventive medicine. Dickerson serves as Assistant Dean of Global Health Education, directs the Graduate Certificate in Global Medicine, and co-directs the Ghana Global Health Learning Abroad Program at University of Utah Health. Additionally, he serves as project director for the Value-Based Medical Student Education Training Program funded by the HRSA Bureau of Health Workforce. Dickerson received an MD at University of Iowa and completed a residency in pediatrics at SUNY Upstate Medical University. He also received a master’s in public health at University of Rochester.

Shelley Gabriel is director of grants and contracts for the Spencer Fox Eccles School of Medicine at the University of Utah. Gabriel manages both HRSA Medical Student Education grants for the school. She received an MPA at the University of Utah.

Community Involvement

Some Navajo Nation families who have waited decades for electricity may soon have power in their homes for the first time, thanks to donated surplus transformers from an electric cooperative hundreds of miles away.

Moon Lake Electric Association trucked 20 10-kilovolt single-phase transformers more than 300 miles from its Roosevelt, Utah, supply yard to the Navajo Tribal Utility Authority’s Montezuma Creek, Utah, suboffice in January to help the agency overcome shortages that threatened to stall its Light Up Navajo initiative. The ongoing effort is aimed at bringing central station power to about 14,000 people who live in backcountry areas of the sprawling 27,000-square-mile Navajo Nation, which covers parts of three states.

“Twenty transformers might not be able to solve that, but it can make a difference, and that’s a difference we are proud of,” said MLEA CEO Yankton Johnson.

Johnson and members of his staff presented the idea to the co-op’s board early this year as an opportunity to practice the principle of concern for community.

MLEA and many other electric utilities have been grappling with a shortage of transformers for more than two years. The lack of availability threatened to stall NTUA’s efforts to relaunch its line extension program. That’s when the co-op stepped in to help.

With the board’s support, the co-op took inventory of its stock, which included about 60 new and reconditioned 10-kV transformers, too small to meet most needs on its current system. The donated units were released and, within weeks, arrangements were made for delivery.

The NTUA, a not-for-profit enterprise of the Navajo Nation, provides electric, water, wastewater, natural gas, solar energy and communications services to about 156,000 people who live on Navajo land.

“We see Light Up Navajo as mutual aid without a storm,” said Deenise Becenti, NTUA’s director of government and public affairs. “We have families who’ve lived in portions of Navajo Nation for generations who are still waiting for basic services. Before we can extend services to them, we have to follow government and environmental regulations and ensure that they meet Navajo Nation lease requirements for their homesites.”

Since 2019, about 1,000 families have been connected to power lines or solar arrays through the program. Connecting the average home can cost up to $40,000 for lines, household wiring and labor. NTUA often extends its existing power lines from 100 yards to as much as five miles to reach unconnected homesites.

“One crew set 50 poles for three families so we could connect power,” Becenti said. Sixty-nine line technicians representing 14 public utilities participated in Navajo Nation line extension projects in 2022.

For the thousands of homes not connected to power, water is drawn from wells by pumps or small gas engines. Fresh food is stored in coolers or at the home of nearby neighbors or family members who have electricity. Children study by kerosene lantern or get driven to connected locations where they can access the internet.

When Light Up Navajo was revived following the COVID-19 shutdown, MLEA employees wanted to help. Operations manager Robert Uresk and line superintendent Curtis Miles were familiar with NTUA’s transformer needs and sought Johnson’s support for the donation.

“Being able to support communities in need, whether our own or others, has been something I’ve always admired about MLEA and our leadership team,” said Johnson. Uresk went along for the transformer delivery trip just weeks before his retirement from the co-op after 42 years.

“Some families in the Navajo Nation drive as much as three hours round-trip once or twice a week to reach watering points where they can fill 250-gallon plastic tanks with water for cooking, cleaning and drinking,” said Johnson. “The typical 10-kV transformer could service up to two or three homes, but the homes are so spread out that they will most likely be one home per transformer.”

But a single transformer in the right location can make a world of difference.

“When the families have gotten connected, they have personally thanked the visiting crew members and have said their ‘burdens have been lifted,’” Becenti said. “Donations of equipment reduce the cost and certainly answer the prayers of families who have been hoping for electricity for many years.”

Derrill Holly is a staff writer for NRECA.

A project to bring broadband to southern San Juan County will move forward, after receiving permits from the Ute Mountain Ute Tribe last month. The much-anticipated project will bring faster internet to schools, clinics and libraries in Bluff, Montezuma Creek and White Mesa using underground fiber optics lines.

The Utah Education and Telehealth Network spearheaded the project in 2018 to ensure that schools in southern San Juan County don’t run out of internet bandwidth, according to the Network’s Associate Director Jeff Egly. The UETN currently provides internet to the schools through a microwave radio system, but that system has reached full capacity with the uptick in online learning in recent years.

“With fiber, when you need more bandwidth you can just add it,” Egly said. “It’s very scalable, where it's very finite with radio.”

The project has two phases. The first will bring fiber optic lines down from Blanding to connect locations in White Mesa, Bluff, and Montezuma Creek. The second phase will bring the lines down through Mexican Hat, Monument Valley and Navajo Mountain.

Emery Telcom, a nonprofit telecommunications company based in Orangeville, Utah, received a contract through the UETN to build the first phase of the project, which will cost $3.4 million. It is primarily funded through a Federal Communications Commission program called the Universal Service Schools & Libraries, or E-rate, Program.

The E-rate Program is funded through a tax paid by telephone and internet customers, and is meant to expand broadband to rural and low-income areas.

The Network, Utah Navajo Trust Fund, Utah Navajo Health System and Utah Department of Transportation contributed $1 million in matching funds to complete the first phase of the project. The second phase of the project will be paid for through federal grants as well as a $1 million appropriation from the Utah Legislature.

The first phase of the project is moving forward after a major permitting delay in White Mesa — the Ute Mountain Ute community between Blanding and Bluff. Emery Telcom has been seeking permits from the Ute Mountain Ute Tribe since March 2018, according to CEO Brock Johansen.

The process was complicated by the fact that the tribal land in White Mesa is split into allotments, which are assigned to tribal members, and 50% of the allottees had to sign off on the project in order for Emery Telcom to receive a right-of-way permit to lay fiber along the side of the highway in White Mesa.

Griselda Rogers is the director of the White Mesa Education Center, which contains a library and kindergarten. She helped collect signatures and rally support for the project.

“We’re hoping that having fiber optic will open doors for community members who don’t want to leave the reservation to go to work,” Rogers said.

The first phase of the project should be completed by the end of October, and will tie into a project underway within the San Juan School District to connect Navajo students’ homes to the internet. The second phase will be completed before June 2022, if there are no new delays.

While Emery Telcom is only connecting the fiber to schools and libraries as part of this project, other internet service providers, like Frontier Communications or the Navajo Tribal Utility Authority, can pay Emery to hook into the fiber and then connect individual homes to the internet.

Cell towers will also receive a boost from the fiber, according to Johansen, who said cell service providers in Bluff, Aneth and Monument Valley have already asked Emery about extending the fiber to their towers. Connecting to broadband through the fiber optic line would allow those towers to provide 5G and LTE cell service.