Johnson, Navajo, PharmD, completed her pharmacy
practice residency with IHS and is currently a staff
pharmacist at Phoenix Indian Medical Center. When this
article was published she was in her last year of
pharmacy school at the University of Colorado Health
Preparing to Improve Her People’s Health Care
When Johnson was 12 years old, her mother took her to the Indian Health Service Hospital in Shiprock, New Mexico for outpatient medical care. “As we entered the hospital, I saw an elderly woman sitting in the pharmacy area, waiting for her medications,” Johnson remembers. “When my mother and I returned to the pharmacy about an hour later to get my medications, the elderly woman was still sitting there. My mother and I waited and waited. The elderly woman also waited. No one talked with her. She looked tired and sick.
“After a while I was so concerned that I told my mother that I wanted to talk to the pharmacist. My mother didn’t want me to do that. Finally, I couldn’t keep quiet any longer. I went up to the pharmacist and told him that the woman had been waiting more than an hour. I asked him what was happening.”
One of the technicians apparently heard Johnson. He came to the front desk and said that the medication had been ready for a while. Johnson sat down. The elderly woman was given her medication and left. But again Johnson was worried. She realized that no one had talked with the woman about her medication. She knew that her own grandmother was wary of Western medicine and needed help in understanding these medicines and how to use them. Johnson also knew there were medicines that could be harmful if they were taken in the wrong way.
It was then that Johnson decided that she wanted to become a pharmacist. Some day she wanted to return home and provide the highest quality care to her grandmother, other Elders, and all her people.
Johnson is now in her final year of pharmacy school at the University of Colorado Health Sciences Center. Her first rotation is at the Phoenix Indian Medical Center. Here she is having hands-on experiences under the supervision of a Navajo pharmacist, Jefferson Fredy, who graduated from the University of New Mexico School of Pharmacy in 2003.
Johnson was living in her family’s home just outside of Bluff, Utah when she and her mother traveled to Shiprock and witnessed the way in which the elderly woman was treated. “Our community has about 20 houses, and we’re all related, “says Johnson. After graduating from high school in Blanding, Utah, where she moved in her senior year, Johnson attended College of Eastern Utah. Then she transferred to the University of Colorado in Boulder and earned her B.A. in molecular cellular developmental biology. Throughout her schooling she felt the support of her family, particularly her mother, grandmother, and uncle.
Johnson was enjoying her first year in Colorado at pharmacy school when she learned that her grandmother, who she dearly loved, was gravely ill. “My grandmother had an infection that she didn’t tell anyone about because she was terrified and didn’t want to go to the doctor. She tried to treat herself. Then she went into septic shock. She was sick in the hospital for about two months. Our family was always there. I went every weekend from school. Sometimes I didn’t go to school on Friday. Finally she passed away. It was so sad. It didn’t have to happen.
“My grandmother is why I wanted to be a pharmacist. I wanted to take care of her and make sure everything went okay. When my grandmother passed away after my first year of pharmacy school, I almost quit. I thought I didn’t have any reason to be in school any more. My professors were very nice. They told me to not be so hard on myself. My mother convinced me that my grandmother wanted me to go to school. In our family it’s important to be educated. My mother has her bachelor’s degree and is a counselor. My oldest sister is an RN. Another sister is a teacher.”
Hanging in There
Despite her great sadness, Johnson stayed in school. Now reflecting on her first three years of professional education, she says that she likes the way that her school organizes the learning of pathophysiology and drugs around body systems. “That helps to tie everything together,” she says. She also liked getting a taste of the real world in Comprehensive Patient Care. In this course, she and the other students were given simulated patient charts and had to do such things as list the patient problems and do assessments and plans for each problem.
“We had to do evidence-based medicine. When we prepared cases we had to use the latest published guidelines and articles to back up what we were recommending. If we didn’t have evidence, we had to have a really good reason for what we were proposing.”
Starting in her first year, Johnson, as part of her coursework, shadowed a pharmacist. Observing the pharmacist at work helped her better understand the roles and responsibilities of a pharmacist. Also, in the second part of the third year, Johnson and her classmates each shadowed a physician. “I shadowed a dermatologist in Boulder, Colorado. It was really neat to be with him. He knows his patients well. I realized how hard physicians work. I never saw him take a break,” she recalls.
When Johnson completes her rotation at the Phoenix Indian Medical Center, she will spend the rest of the school year rotating through other settings, such as the Drug Information Center at the University of Colorado, a private pharmacy in Boulder, and a supermarket where she will be working in the diabetes care center.
After Johnson receives her PharmD, she is considering applying to the Indian Health Service for a residency experience. “IHS is where my grandmother and cousins and uncles and aunts and all go. I want good healthcare for my family and all Native Americans. When I was young, I was disappointed with IHS, but now that I’m working in pharmacy at the Phoenix Indian Medical Center, I see that they have made changes and are continuing to make changes for the better."
After completing her residency program, Johnson hopes to practice back home. But, regardless of where she practices, she wants to be available to people. “I don’t plan to leave my work at work. If people want their blood pressure or blood glucose checked at my house, I’ll say, ‘Come on over.’ Even now when my husband (who is a nurse studying to be a PA) and I go home to my community, we have little mini-health screenings.”
Johnson values traditional medicine. Her grandmother used to gather herbs and send them to her. “A lot of people use these herbs today,” she says. “I want to work with someone who has been taught the correct way to gather and administer traditional Navajo herbs, including how to sing the songs, how to do the whole process. We need to respect both traditional and Western medicine. But my focus will be to try to get Native people to use Western medicines along with their herbal medicines. My grandmother would not take her [Western] medicine. I wish someone could have told her, ‘This is from the earth. It’s just from the earth in a different way.’ My grandmother was stubborn.”
When Western medicines can be helpful and even life saving, Kristi wants Native people to be comfortable using them.
Johnson is eager to see more Indian people in pharmacy. “For those of us who go back to where we came from, we’ll actually be able to take care of our family. You will never have to stand by the sidelines and say, ‘This isn’t the best treatment. This isn’t the best drug.’ When you provide the care, you will give the best care possible.”
Although Johnson didn’t have an opportunity to shadow a pharmacist during high school, she recommends that high school students interested in careers in pharmacy try to do so. She also suggests doing volunteer work. “When you’re being interviewed for pharmacy schools, they want to see that you do things for other people.”
“During high school make sure you have a good background in the sciences,” she continues. If you feel that you’re not being challenged, don’t sit around and wait. Challenge yourself. I didn’t have a biology teacher who challenged me a whole lot. But I challenged myself. I started going to the local community college while I was in high school. I wanted to know more about biology. So I found ways to learn more. My mom taught me that you can’t expect things to come to you. You have to make things happen.
“Take one step at a time,” cautions Johnson. You can be overwhelmed if you think of the whole process at once. Keep at it. There are so many wonderful opportunities waiting for you. You can make a positive difference in other people’s lives”
This article was originally published in the Autumn 2004 issue of Winds of Change. (The cover artist is Clarrisa Hudson, Tlingit.)
Johnson is a staff pharmacist at Phoenix Indian Medical Center and also the director of the Pharmacy Anticoagulation Clinic at PIMC.