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College of Medicine Alumni Magazine: Winter/Spring 2023 Inside Looking Out

Loretta Christensen, MD, HU ’84

An Interview with Loretta Christensen, MD, HU ’84, Chief Medical Officer of the Indian Health Service

When you grow up in a small town, you grow up looking out upon the whole world. Loretta Christensen, MD, HU ’84 — Lori, as loved ones called her back then in Gallup, New Mexico, long before her time at Harvard, at Hahnemann, at posts from the Jersey shore to the Indian Health Service — remembers the natural and cultural richness of the Southwest. The years and an adaptive, admirable career in medicine would prove those riches enough not only to prepare Christensen for the future but also to bring her back to where it started.

“I loved the country. I loved the desert mountains. We used to do a lot of outdoors stuff growing up — freshwater fishing, hiking, camping — things that were just part of growing up in rural areas. I live in such a rich area,” Christensen recalls over the phone from Phoenix, Arizona, where she is duty posted as chief medical officer of the Indian Health Service. Rural, of course, does not mean monocultural. In Christensen’s experience, growing up near Navajo, Zuni and Hopi land, it was quite the opposite: “Our area is a very blended area. For my background, I’m a member of the Navajo nation. On my mother’s side I’m Mexican, and on my father’s side I’m Navajo and Danish. I had all that mix in me, so I always valued that blend quite a bit.”

One of the curious things about being a child in the same place one will someday be a major medical officer is that first impressions are liable to be a little funny. As a kid, when Christensen would go to Gallup Indian Medical Center — constructed not long after her birth, a state-of-the-art marvel and a symbol of medicine in the region — it was to pick up laundry for the family business, which serves the whole Navajo area. What started as a weekend dry-cleaning client, though, would also become her introduction to medicine when, for two pivotal summers during high school, she worked at the medical center for a pathologist, a colleague of her aunt’s, named Dr. Doris Herman.

“Dr. Herman let me do so much,” says Christensen. “I was taught how to make pathology slides, how to dictate cases, and I was just in my teens. She really put a lot of trust in me.”

When the time came to make a decision about college, a connection came through a Harvard student recruiter, who Christensen remembers as her aunt’s sometime babysitter and a fellow member of the Navajo nation. “I would love to tell you how I decided I wanted to go to Harvard, but I’m not exactly sure. Maybe I didn’t realize how daunting that was when I made the decision to write away to them,” Christensen says. “I always wanted to go somewhere. I am an avid reader; I read constantly. And that was my connection with the world, being in such a small town: I just read everything. And I thought, ‘There’s just so much out there.’”

And so Christensen turned down basketball scholarship offers from a few schools in the Southwest and headed off to Cambridge, Massachusetts, to study anthropology, a discipline that built on the deep cultural heritage of her home region. They’d have a team she could play on too, she figured. Christensen has always loved the feeling of the last shot in a basketball game.


As life would have it, what one studies is rarely the limit of what one learns. Remembering her time at Harvard, Christensen is impressed by the presiding value of service. “When I look back, I see that there were so many that are learned and academic, but their goal in life was to be of service, as teachers or doctors or in social programs,” she says. “As academic as it is, what I always loved is that they made you think outside the box. Not about what was in front of you, but what you could do with that, how you could make it work for others.”

After graduating from medical school at Hahnemann, Christensen went on to her residency in surgery at Monmouth Medical Center. “The reason I went to Hahnemann is that they were geared toward getting you into the hospital sooner and to getting you with patients sooner. It was heaven for me, because I got to take care of patients right away,” she explains. “It was the same thing with Monmouth; because the staff was smaller, you got very involved even as an intern.”

Christensen credits fortunate rotations and good mentors for the professional smittenness that followed. “Trauma ended up being my love. I love critical care. I loved being in the ICU,” she says. “I consider trauma care to be public health. Anybody that comes through the door, we take care of.”

Before her residency was through, she was tapped by Dr. Carl Marchetti, a “visionary” and another professional guide, to help start a trauma center in New Jersey. Then, a rotation at Jersey Shore University Hospital turned into a surgical post in trauma from 1990 until 2013. All the while, Christensen found herself looking for ways to work more systemically. “I thought, ‘As much as I love this, I can only make so much difference here at this level,’” she says. During her time on the East Coast, Christensen started attending courses on leadership training and fought for motorcycle helmet laws. She earned a master’s in business administration in 2010 and another in jurisprudence in 2013, combining long-time interests with her ongoing mission of equipping herself to create the best care for people from a high level. “I kept studying different things to strengthen my knowledge base of what it takes to run a system,” she says.

Life on the shore, Christensen says, was breathtaking and beautiful — a home on the bay, a hobby in sailing, work that she loved and ample opportunities to grow. And then, one day, it was time to go home.

It wasn’t anything magic, she says. “One day, I was driving up to Newark, and I said, ‘When I finish this [master’s in jurisprudence], I think I’m done. I’m going home.’ It just comes to you that it’s time.”

Christensen’s love of trauma care had kept her from pursuing her longtime goal of working for the Indian Health Service, which didn’t have opportunities for her in trauma. As she started looking toward her late-career goals, though, she began to see a path to make a difference through an administrative role. “I thought, ‘Maybe now I can go back. I feel like I’m ready to be a chief medical officer.’”

Or perhaps there is a sort of everyday magic in the way that capital-H Home calls us back irrespective of the intervening time and space. “I missed the Southwest. One of the things about being Navajo is that your heart always beats there, and you will come back at some point. And it just was time,” Christensen says. “I missed the desert mountains. You look at Monument Valley, Shiprock, Canyon de Chelly, Chaco Canyon — it’s so miraculous what happened before us there.”


Having studied anthropology at Harvard has enriched Christensen’s experience of the Southwest, she says. But her familial ties to the region have plenty of layers in themselves.

“In the Navajo culture, clans are matrilineal,” Christensen explains. Affiliations start with the maternal clan, followed by the clan you’re “born for” — the paternal clan — and the clan of each paternal grandfather. “So, I am Naakai, which means Mexican, born for Táchii’nii, which is ‘red running into water.’ On my mom’s side, my grandfather, is my shicheii, Naakai, because he was Mexican also. On my dad’s side my grandfather, Shina’li’, it is Bilaga’ana, because he was Danish. And that tells people who you are.” Each name holds a story, a history with Dinétah, the homeland of the Navajo.

And those histories are alive and ongoing. “What’s amazing is that it’s still here. Despite all the boarding schools trying to change everybody, there is such a richness of belief,” Christensen says. “I work with amazing people who are highly intellectual and highly focused on their work. And you’ll turn around, and they’ll be in traditional dress for ceremony. They just go back and forth so easily, but they never give up that tradition. Many of them speak beautiful Navajo.”


Christensen describes the origins of the IHS as a part of a non-ideal treaty with the Department of the Interior. “It was one of those treaty issues where they said, ‘We’re going to take this land and do not-so-nice things to you. But, in return, we’re going to vow to provide your health care.”

Today, the mission of IHS is to care for all American Indians and Alaska Natives. With the advent of new self-determination policies in the 1990s, their footprint has shrunk as over 60% of tribes opt to assume responsibility for their own health care. “It has changed over time. We used to be it, and then we started empowering our tribes to take care of their own health care in a way that they felt works best for their tribes,” Christensen explains. Operating a health care system isn’t easy, of course. Some tribes, like the Chickasaw and the Cherokee in Oklahoma, run large and efficient medical systems, while other, often smaller tribes take advantage of technical advice from the IHS. “We always do everything to help them succeed, because that self-empowerment is very important. I think it is the right thing. Our goal is to make sure everybody is getting the best health care, whether we run it or the tribes run it.”

That mission comes in the face of challenges both profound and unique. The assumptions that physicians can generally make when prescribing home care in well-resourced suburban communities — that patients have access to a variety of dietary options, to running water, to electricity for medical appliances — are unwise in Christensen’s community, where the staff has to be especially conscious of their patients’ specific circumstances. “Definitely the disparities are profound, and when we think about the vulnerable populations of American Indians and Alaska Natives, it’s a collision of many things. One of the things we are doing for the first time — and I’m so proud — is actually quantifying the social determinants of health across our agencies. That gives us an opportunity to prioritize mitigation.”

In the case of food deserts, among other wellness challenges, traditional practices can shape mitigation strategies. “In the Navajo nation, we have 27,000 square miles and 14 grocery stores,” Christensen says. “So we’re trying to create a healthy population in this milieu. And we do that very much with indigenous foods in mind. We look at what they grow and what they’ve lived on and how we can incorporate that into a healthy diet.”

One of IHS’s initiatives is to help the new generation return to traditions of wellness that have served the Navajo community for many years. “These types of culturally appropriate endeavors are actually extremely important so that we can connect our provider and care staff with the patients, what they believe in, and what they need. And I’ll tell you, there are elders in the Navajo that are in better shape than I am! They herd sheep every day; they grow their own corn and squash; they don’t have TV and junk food. They’re the most beautiful people. They’re 90, 100 years old, and they’re perfect, because they live that Navajo wellness model their whole life.”

Traditionally passed on orally in Navajo, the Navajo wellness model is currently being translated into English by LT Shawnell Damon, IHS’s health promotion disease prevention coordinator and acting area diabetes consultant, and her team as a part of an IHS public health initiative for both Native and non-Native populations. “Public health is more than just what people think. It’s truly monitoring your patient population and looking at what over time creates good health. It’s food security and improving access to care,” Christensen explains. “We’re trying to reignite public health across our agency so that we have the readiness, the surveillance, the epidemiology, and the ability to intervene quickly and definitively.”

Another initiative, also headed by Damon, is the creation of a public health aid position designed to train an adaptable workforce of medical paraprofessionals that can pivot in the face of health care crises and worker shortages. “It empowers young kids and community members to get into the profession,” Christensen says. “Suicide screenings, safety follow-ups — we don’t have enough psychologists to send out to follow up with people, but we can send our aids out to make sure somebody’s okay. This is a huge project, which Damon is overseeing for the agency. There will be some definite gems in those workforces that might go to nursing school, might go to medical school, might become an epidemiologist, and we can keep them in our system and grow them into other positions.”

At the outset of the COVID-19 pandemic, those health aids served a crucial role as contact tracers, especially for Navajo-speaking populations. “We captured people that wanted to help,” Christensen says. “And God bless all the people that wanted to help.”

Christensen still loves basketball, and she still loves the energy of that last shot — the same energy that’s driven her through her career all these years. “I like that edge,” she says. “I can’t quite get rid of the trauma room, the absolute coordination of everything that has to happen.” These days, she shoots hoops with one of Damon’s daughters, showing a trick or two to a talented young athlete. “I can only jump in my mind now,” she laughs. Those backyard baskets are yet another offshoot of one of Christensen’s big philosophies: “If you can lift somebody up, you have to do it, every single time. You have to lift them up and see what they can do.”

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