When University Heart Center cardiologists first brought their medical skills to reservations in Northern Arizona, the Native Americans were skeptical.

However, during one of the first visits, "Navajo Joe," a Native American living on the Navajo reservation, had a heart attack. It was one of the first times the Native Americans had seen a heart attack, says Gordon A. Ewy, M.D., University Heart Center director and professor of medicine at The University of Arizona College of Medicine.

"At that time there was no coronary care unit in the hospital," Dr. Ewy said. "We hooked him up to a monitor and the group of cardiologists and cardiology fellows on that visit took turns of four-hour shifts taking care of him for the dangerous first 24 hours."

The visits started when two physician-residents from Georgetown University were assigned to the Indian Health Service at Fort Defiance and Chinle.

"When they got here, they called Frank Marcus, M.D., (the founding chief of cardiology) and me. They said many patients had heart murmurs and asked if we could come up and help," Dr. Ewy said.

That was about 30 years ago and the cardiologists, cardiology fellows and students from University Heart Center now make trips twice a year.

The University of Arizona now also has a regular presence with a cardiologist dedicated solely to cardiac care on the reservations. James Galloway, M.D., a University Heart Center cardiologist, was appointed by the Indian Health Service to provide cardiac care to those patients. Physicians on the reservations refer all questions about patients with heart disease to Dr. Galloway and, if necessary, patients are sent to University Medical Center, where he performs procedures, such as cardiac catheterizations or cardiac surgery.

Says Dr. Ewy: "The advantage of referring to Dr. Galloway is that he is dedicated to the Indian Health Service.

Dr. Galloway was stationed on the reservation for about six years and was a cardiology fellow with us for three years. But most importantly, he's an excellent cardiologist!"

To strengthen disease- prevention and health-promotion efforts, the Southwest Native American Health Unit of the Arizona Prevention Center has been established at The University of Arizona Health Sciences Center.

The Center for Native American Health is a collaborative effort among Arizona's Native American tribes, the UA College of Medicine, the Indian Health Service, University Medical Center and the Tucson Veteran's Affairs Medical Center.

"AHSC has a long record of serving our state's Native American communities. Creation of this center recognizes the pressing need to join forces with the Native American community and the Indian Health Service to further the development of a comprehensive approach to attack these health problems," Dr. Galloway says.

"Working in partnership with Arizona's tribal communities and the Indian Health Service, we seek to address Native Americans' serious health problems in a comprehensive fashion, focusing on culturally sensitive prevention and health promotion activities, as well as 'cutting-edge' clinical care and prevention-based research," he explains. The center will coordinate efforts with traditional healing services, which also are available for patient care, he adds.

The center "fosters collaboration among the many expert clinicians, nutritionists, tribal health experts, health promotion specialists, epidemiologists and medical researchers working independently."

Native Americans face many serious health threats: diabetes has become epidemic in tribal communities, end-stage kidney disease is seen with alarming frequency and heart disease (once rarely seen in Native Americans) has become the leading cause of death. Tribal communities also face a growing array of social health risks. "These problems require innovative approaches, as well as specialized attention," Dr. Galloway says.

Recently named "Outstanding Clinician of the Year" by the Indian Health Service, Dr. Galloway also developed the Southwest Native American Cardiology Program to provide high- quality cardiology services to the Native American cardiology patients in the Southwest. This program also has developed a registry program necessary for quality follow-up care, as well as research studies.

Besides seeing patients in Tucson, Dr. Galloway spends about a week of every month on the reservations meeting patients at the hospitals and clinics.

"The advantage to the UA College of Medicine as a teaching program is that it provides a valuable learning experience. Because the reservations had a higher incidence of valvular heart disease (as a result of rheumatic heart disease) the fellows, residents and students in a week could see more valvular heart disease patients than they would see in a year here."

This unique tradition is one many cardiology fellows remember as a highlight of their fellowships, Dr. Marcus says.

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