PHOENIX —  On the Navajo Nation, among shallow hills where neighborhoods are scarce, the grand exterior of Sage Memorial Hospital stands out. 

Providing health care for thousands of Navajo people in small towns across the tribe’s land, the hospital in Ganado, Arizona, has proven itself critical to the community. However,  turning it into a working medical center faced considerable obstacles.

The hospital’s about 20-acre campus encompasses inpatient and outpatient units, a behavioral health center, a traditional sweat lodge, a teepee, staff housing, an emergency room and a hogan – a ceremonial Navajo wood and mud hut currently being built outside of the main hospital. 

On the campus also sits the legacy facility, a much smaller, older hospital, that used to treat fewer than half the new center’s patients. It closed in December 2024, when the new hospital facility opened. 

The new medical center has twice as many outpatient rooms and floor-to-ceiling windows overlooking the landscape in every room. But according to Sage Memorial staff, the process it took to get there was complicated. 

Constructing a medical facility on an Indigenous nation is challenging, not just due to accessing materials and staff, but also because of the nature of communication between the tribal council and the U.S. Indian Health Services, according to Kim Russell, the policy advisor for Sage Memorial. 

“We have to navigate three different systems: federal, state and tribal,” Russell said. “There is a multi-jurisdictional kind of approach that we have to take when we talk about policy. It can be complicated, but it’s necessary.”

The new hospital’s dialysis center, still under construction, exemplifies these complexities. 

The demand for an outpatient kidney failure treatment was clear. Patients sought it out in the hospital’s intensive care unit for emergency inpatient dialysis, according to Kenneth Anaeme, the chief medical officer at Sage Memorial.

“We know that once we open the dialysis center we’re building, (it) is probably not enough for the needs, but that’s what we could put right now,” Anaeme said, adding that the outpatient center will be able to serve about 40 to 50 patients. 

Ernasha McIntosh, a family nurse practitioner at Sage Memorial, said that right now, community members living nearby may have to travel up to 50 miles each way to get their dialysis treatment. And that doesn’t include the four- to six-hour-treatment.

Funding for the new dialysis center was diverted to install two traffic lights after the Arizona Department of Transportation required them off of the state highway near the campus. 

“When they told us that we were going to be responsible for building two traffic lights, we asked what the estimated cost would be. They came in around $1.2 million each,” said Jarom Prows, the director of facilities at Sage Memorial. 

But when the hospital team sent out the bids for the traffic light construction, their only choice was a contractor costing a little over $7 million, Prows said. “Anything new here is going to be a lot more expensive … versus if I was going to build a hospital in Phoenix.” 

Hospital staff lobbied at the state Capitol and were granted $3 million, enough to finish building the center by the end of this October, Prows said. 

“Just being in my hometown is more comforting,”said a Sage Memorial patient who asked to remain anonymous. Living only 4 miles away from the hospital, the commute still takes around 30 minutes when driving on the dirt road, but being relatively close means the patient’s family can visit often.

According to Prows, aside from the difficulties that come from building in a rural area, there is also an overall hesitancy to work with the tribal government: “A lot of companies, whenever they see that the project is going to be on Navajo, won’t even bid on it.” 

The few willing to work on the reservation  often mark up their prices, Prows said. 

In addition to the conventional medical care, Sage Memorial is still working to incorporate Navajo medical practices into the hospital’s campus. 

“The project would be a lot smoother if people fully understood the process from the beginning,” Prows said. “We had a lot of people that were non-Navajo. They had good intentions. They wanted to come out here and build a big, beautiful building.”

Lack of knowledge about Navajo traditions created some issues with the work of the non-Native contractors. 

One of the missing features is a birthing belt. The colorful sash usually hangs from the ceiling above a patient giving birth. Patients hold onto the belt during childbirth, as part of a spiritual tradition. 

Christian Bigwater, the chief patient experience officer at Sage Memorial, said that the hospital’s ceiling was not built to withstand the pull from the rope.

“There’s really no infrastructure in the hospital to support something like that,” Bigwater said. 

Several additional holistic medicinal structures, such as sweat lodges and a hogan, have been added to the campus since the new facility opened. 

The original construction team did build the hospital with its entrances facing east, in accordance with Navajo custom. 

“That’s an important part of the culture,” Bigwater said. “That’s primarily to greet the morning sun.”

Bigwater, who was hired after construction had already started, said there was originally no Native design within the hospital either. 

“If you come into the hospital, you want that feeling or the atmosphere is part of your healing process,” Bigwater said. “If we can somehow bring that land of imagery inside the hospital we very much try to.”

Bigwater put out a call for art proposals from the community, leading local tapestries and oil paintings throughout the entire facility. 

“I don’t necessarily want to come into a space where I don’t feel like I’m at home,” he said. 

Just as Navajo medicine and tradition is critical in the patient areas, it’s also key in the staff quarters. That’s used as an incentive for medical professionals to come work in the small town of Ganado, located over 250 miles away from Phoenix. 

Affordable staff housing was built along with the new facility, located directly next to the hospital. 

“That’s our biggest hurdle here at Sage and a lot of other health care entities here on Navajo,” Prows said. “You have a lot of qualified nurses and doctors that want to come here. But even if you are Navajo, it’s hard to get a house.”

According to Prows, an upcoming project for Sage Memorial is to build a 31-unit apartment building and develop a tiny home community.

“We’re taught to go get your education, but come home and help,” Prows said. “It’s really, really hard. You have people that grow up here, that love it here, that want to come home and help, but you have so many hurdles.”

Many Sage Memorial staff members, including Prows and McIntosh, originally left the area and have returned. 

“This is my whole purpose, is just to serve Navajo,” McIntosh said.

This article first appeared on Cronkite News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.