May 16, 2025

Finding Solutions for Cancer Care through Partnership

A discussion with Community-Campus Partners Sheila Hammer and Tanya “TJ” Riggs

This month we’re observing National Cancer Research Month, a time to highlight “the importance of lifesaving research to the millions of people around the world affected by the collection of devastating diseases we call cancer.” Sheila Hammer and Tanya Riggs – who goes by TJ – are participants of SHERC’s Community Campus Partnership Support Program. Through their partnership, Sheila and TJ are identifying and addressing the psychosocial and emotional needs of Indigenous people who receive cancer care in the Flagstaff area.

About the Partners

SHEILA: I am a licensed clinical social worker and an assistant clinical professor in the Department of Social Work at Northern Arizona University. I’m also finishing up my second year  in the Interdisciplinary Health PhD program. I grew up in a military family so it’s always hard for me to answer where I’m from originally, but I’ve been in Flagstaff for about seven years now. Prior to that, I was in California. I was raised primarily in central California in a small agriculture town and went to college in Southern California. I started my career there before moving to Flagstaff.

I come to this partnership with an oncology/social work lens. I bring my experience with distress screening in a non-profit setting as well as in a large medical center to the partnership. I also hope to be an additional support to TJ as she has the large responsibility on her shoulders of caring for the Navajo population that come to the Specialty Care Clinic.

TJ: I’m Navajo and I am of the Mexican Navajo Clan born for the Edgewater Clan. My maternal grandparents are Red Running into the Water, and my paternal grandparents are the Bitter Water People. I reside in a little community called Moenave. In Navajo we refer to this as Teec’yaa’kin, which means houses under the trees. I serve as the Oncology Services Program Director at the Tuba City Regional Health Care Corporation located on the western Navajo Nation.

I have several roles within our partnership. I primarily serve as a healthcare professional focusing on comprehensive cancer services within my community. I share my experience in clinical operations and the needs of our service population. Secondly, as an acculturated Navajo woman working as a healthcare professional and living in a traditional Navajo setting, I’m able to share my thoughts on the cultural adaptation of different tools and approaches. Additionally, being from the community, I’m able to share information with Sheila about the existing resources and gaps in healthcare.

Meeting Community Healthcare Needs

The Specialty Care Center at Tuba City Regional Healthcare Corporation

Located on the Navajo Nation, Tuba City Regional Health Care Corporation (TCRHCC) provides services to members of the Navajo, Hopi and San Juan Southern Paiute tribes. TCRHCC offers a wide array of medical services and programs, including oncology specialty services through the Specialty Care Center.

TJ: We opened the doors to the Specialty Care Center in 2019 and have provided services to over 900 community members. Currently, we provide general medical oncology, hematology, infusion therapy, telegenetics, and a radiation exposure screening and education program. Additionally, we are a Cancer Support Community affiliate site and offer support at the House of Hope, which is located off our campus. We’ve been slowly building to a point where we’re now able to connect our community members to organizations that provide financial and community resources. It’s important to note that our resources are not only for patients who receive care at the Specialty Care Center. Patients who are referred off-reservation can also access our resources, particularly those that they might not have available through off-reservation care.

We’re very proactive in helping our patients and are streamlining our services to improve care coordination and continuity. In addition to our nursing, pharmacy, and lab teams, we are bringing on a patient navigator who will be able to support care coordination. We really encourage people to come in and see what we have to offer.

About the Partnership

Partnership Goals

SHEILA: Our partnership focuses on identifying factors that Indigenous individuals face when they travel off of the Navajo Nation to receive cancer care. In oncology,* there’s a field called psycho-oncology. This field focuses on providing social and emotional services to decrease the distress that cancer patients experience. Research has long shown that approximately one-third of cancer patients have clinical depression. Among Indigenous women, this number is even higher. Although it had a smaller sample size, a recent study with Indigenous women who had cancer found that almost two-thirds of them had depressive symptoms[1]. Coming from a background as an oncology social worker, when I read this study, I started wondering about the unique stressors that Indigenous people with cancer might face and potential protective factors** that might help them.

*Oncology: The study, diagnosis, treatment, and prevention of cancer.

**Protective factors: Conditions or attributes that help people and communities cope with stressful events.

TJ: Our collaboration is designed to further identify the emotional support needs of tribal members who receive cancer treatment in the Flagstaff area. I had the opportunity to get to know Sheila and found out about the Community Campus Partnership Support Program through the Center for Native American Cancer Health Equity team. I’ve been assisting as a board member on their Community Advisory Board for several years. When Sheila and I first connected, we both thought it was a really good fit. I was very interested in partnering because this work could really benefit our tribal members. This has been a wonderful opportunity for me to connect with somebody who is research oriented and has the skills to lead a potential study. Sheila is a wonderful researcher and academic resource.

Through our partnership we’re talking about how to minimize gaps in our resources. We’re also trying to get our story out there so that more people are aware of the challenges we face, but also the amazing team we have. While we have a structure in place at Tuba City Regional Healthcare to support local patients and their families, I’m excited about this partnership because it offers an opportunity to address the disconnect in care for our patients who are referred off the reservation. We want to ensure that patients as well as their caregivers and families have connections and access to much needed resources.

Passion and Personal Connections

Sheila and TJ describe how their personal experiences inspire their work and help them find ways to address systemic and structural barriers to cancer care.

SHEILA: My passion is oncology, specifically around supporting people’s social and emotional needs when they’re experiencing cancer, or when a loved one is going through cancer care and its aftermath. This field resonates with me personally because when I was twenty-two years old, one of my three sisters – she had just turned nineteen – was diagnosed with a rare leukemia called chronic myelogenous leukemia. This usually affects older adults and her providers didn’t know whether to treat her as an adult or pediatric patient. My father had military insurance and my sister was really fortunate to receive excellent care because of his coverage, but the facility was three hours away from my family’s home. My sister traveled for regular appointments for over a year and eventually had to live away from home to receive a bone marrow transplant. The burden on my family was extreme. My mom had to drop everything to care for my sister. My family experienced job losses, mental health struggles, and bankruptcy. I remember feeling like our whole world was caving in around us and things were really difficult because we didn’t know if my sister would survive. Even with great insurance and care, I saw how the psychosocial and social emotional experience impacted everyone in my family.

Experiencing firsthand the toll that cancer has on patients and their families propelled me into my career in oncology social work. Through my work, I’ve seen the disparities that exist in cancer care. This continues to drive me forward. I’ve been able to work in incredible places that provide excellent supportive psychosocial care services and I want this to be the standard of care; the care everyone receives. Structural disparities and institutional barriers persist in our society and they keep patients and their families from receiving the care and support they need. Furthermore, one of my four children was adopted and is Navajo. I continue to witness how the Diné people face injustices, in part through structural barriers and systemic issues. Having a Navajo daughter and witnessing the unnecessary barriers is another reason this work is so meaningful to me.

TJ: When I think about the work I’m doing, and being from the community, I think about relationships. There have been so many people who have been affected by a cancer diagnosis within our community and many cases are due to environmental factors. There are over 520 abandoned uranium mines on the Navajo Nation that continue to expose people to radiation. As far as incident rates of cancer in our community, we have a high number of gastrointestinal, genitourinary, breast, prostate, and gastric cancers. These cancers are devastating. Knowing that my immediate and clan relatives are affected by this condition is something that continues to inspire my work.

Providing accessible and safe care is something I’m very passionate about and it’s really important to our community. We want tribal members to know about TCRHCC’s services and that they have a safe space in the community. We speak the Navajo language and we’re able to support them. As healthcare providers, having an understanding of how people live makes it possible for us to modify treatment schedules. For example, if it’s winter, we know that the roads are pretty bad. We can start the treatment schedule a little bit later and allow flexible scheduling  because we know that it’s often not an option for patients to reschedule if they’re thirty minutes late to an appointment because of a snowstorm. Many Navajo individuals have to travel great distances to receive cancer treatment. TCRHCC produced a short YouTube video, Going the Distance: For Life, that highlights this experience.

Additionally, many Navajo people keep livestock and are really involved within the community through traditional ceremonies and activities. We understand their needs and what’s going through their mind when they talk about taking care of livestock, hauling water, and getting the provisions they need. Over sixty-percent of our tribal members do not have running water or electricity and we’re very understanding of this. Many individuals choose this lifestyle and it’s where they feel most at home. Some people might be struggling to find adequate housing on the reservation. These are all things that we are very mindful of as healthcare providers. I have the capacity to improve services and ensure that they align with peoples’ lives. It’s important to me to do what I can within my role for my community.

Pooling Strengths and Building Relationships

Partnership building looks different for every team but often includes activities that facilitate learning together. TJ and Sheila discuss how important it is to establish respectful practices prior to and during partnership development and share some of the ways they’ve worked together during the CCPS program.

TJ: Prior to the kickoff of the partnership, we had a traditional practitioner provide a small blessing for our partnership. This was something that was really important to both Sheila and me because we want to be respectful of the people we’re helping. We want there to be a clear understanding that our intention is to improve services and help people.

SHEILA: Over the course of this CCPS partnership we’ve attended several conferences together and were recently accepted to present a podium presentation to the National Annual Conference for the Association of Oncology Social Workers. This presentation will look at how to work towards building a partnership between a tribal health care entity and an academic institution by leaning on the strengths that both of the institutions bring to the table. It’s exciting to see that there is interest from people in the oncology social work field – and oncology in general – in building partnerships with tribal entities. We’ve also spent a significant amount of time navigating the various institutions to ensure that we’re following appropriate protocols and doing our best to do everything in a culturally respectful manner.

The Importance of Community-Campus Partnerships

TJ: What’s really important to me is the relationship we’re developing with Northern Arizona University. We are connecting with people who are well versed in this field and understand the processes for completing research with communities. They do their due diligence and know the questions that need to be answered and the groups to work with. Further, they have the bandwidth to do this kind of work. As a healthcare professional, my focus is completely different. My work is geared towards patient services. We have a small team and most of us are doing quite a bit just to ensure that services are available. My focus is the day-to-day operations and I don’t have the knowledge needed to conduct research. I can provide information, but our team doesn’t have the training or capacity to pursue research by ourselves.

Forming this partnership has given us a voice to shine light on some of the health disparities that our community experiences. We’re not only raising awareness but thinking about and identifying solutions and workable approaches. As we’ve discussed different models, I’ve started to pick up on things that we can do internally and we’ve started implementing some of the solutions that we’re coming up with through the partnership. Some changes are short term while others will be long term. Because of this partnership I have a better understanding of what long term solutions could look like.

SHEILA: Having been the boots on the ground while working in various healthcare organizations, I know what it’s like to think, this one program would be great, but we don’t have the people power, the finances, or resources to implement this. I remember what it’s like to be the one working with patients and to know what the needs are, but not have the resources. Now I have some financial resources and the training to apply for grants, but am leaning on TJ because she knows the needs of the patients and clinicians. She’s the boots on ground doing the really important work. By bringing our knowledge and resources together, TJ and I are working in a symbiotic relationship to improve services and care for people who have cancer.

We got this and Lessons Learned Together

TJ: A community health workshop was held with our other partners and it was surprising to learn that we all experience similar challenges when navigating community outreach, bureaucratic approvals, and understanding how local government works. We all come to our work with good intentions and are learning how to navigate these systems and identify who the experts are within different communities and cities. Once we learn who to connect with, we’re learning how to move initiatives forward.

This was really amazing to me because, when I first stepped into the workshop, I was focused on healthcare systems and what I do operationally. When I met with people coming from different backgrounds, it was really nice to hear ideas for overcoming challenges and who others have connected with. There were a lot of recommendations and it made me feel like we got this. The workshop gave me a better appreciation for how important it is to be connected to different entities, individuals, and experts. When we start collecting information for research, having these connections will make our work a lot easier. I was reminded that we don’t need to do this alone and we don’t have to start from scratch. We just need to dive into the existing information – researchers and experts have already done a lot of the legwork – so that we can adapt resources and make them our own.

SHEILA: What I’ve learned is that both partners really have to be passionate about the work. It’s not about chasing funding and dollars. It has to be about chasing a shared goal. For our partnership, the goal is improving care for Indigenous people who are impacted by cancer. There are multiple hurdles that we have to overcome, many of which require extra energy and time. If we’re not passionate, it’s going to fizzle out. When people hear about our work and see our passion, it gets them excited about the work too.

One of the things that came as a surprise to me is just how quickly the healthcare environment can change based on shifts in the political climate. I had to take a step back and consider the role I play in continuing to move this forward, because I know that there are people out there who deserve to have quality care, regardless of the systematic changes. I’m thinking about how we can continue to make improvements to care regardless of what’s happening in the world around us.

Next Steps for the Partnership

SHEILA: I’m really excited about our upcoming presentation with the Association of Oncology Social Workers. When I was working in a clinical setting, I would have loved this kind of opportunity. I would have loved it if someone had come to me and said, if you have interest, this is how you can partner with tribal nations. It’s exciting to me that there are oncology social workers who are interested in this important work. People see the need and get excited when they hear about this work.

TJ: I’m excited to see where our partnership takes us. Regardless of what direction we take, I will continue to assist and be there to answer the call for Sheila. She’s the person who is moving this forward and I’m going to provide as much support as I can. I’m really excited about it!

Good Intentions and a Safe Space

TJ: If you want to learn more about our organization, you can go to tchealth.org and see all of the wonderful things that we’re doing as far as improving the accessibility of services and providing quality health care services. Most importantly, we provide culturally sensitive services. That’s something that we always keep in mind. When we’re working with community members, it’s so important to have good intentions and the right energy. We know it makes a difference and that’s really important to me. I can’t emphasize this enough.

Interested in learning more about health disparity research at NAU and in the community?

Visit CHER’s social media for short stories that highlight SHERC researchers, students, lab spaces, and more! Look for “Fit it in a Minute” posts.