Nothing survives easily in the sweltering heat of Monument Valley's desert. Cradled in the arms of the valley's red rocks, the Monument Valley Hospital is no exception.
After 37 years of fighting financial droughts, the hospital again finds itself on the brink of extinction. Advent Health Systems West, an arm of the Seventh Day Adventist Church, which owns the hospital, had planned to close the facility for good on July 1 because of a $500,000 deficit in its operating budget.A minor miracle from a most unlikely source - a promised (but as yet unrealized) $400,000 reimbursement from Indian Health Services, will keep the doors open until at least the end of the year.
It's an ironic twist since IHS rules and regulations play a large role in the financial difficulties plaguing Monument Valley Hospital. The money will come from patients the hospital treated but didn't get paid for.
Because the hospital is not an IHS-contract facility, those with the most to gain from close-to-home medical care, Navajo Indians living on the Utah portion of the reservation, are encouraged to take their business to the Kayenta Clinic 30 miles to the south in Arizona. For hospital care, the American Indians are often sent to Tuba City, also in Arizona, a 120-mile roundtrip for Navajos living near Monument Valley.
But many of the Utah Navajos opt for care at Monument Valley Hospital and end up paying for services that would be free at the IHS facilities.
The old man selling jewelry in a plywood shack is a typical example. As he wipes his forehead and replaces his worn cowboy hat, he talks about the medical clinic at Kayenta.
"That one down there (at Kayenta) . . . is no good," he says. "I go here."
He's not alone in his decision to pay for his own health care so he can go to the clinic and hospital close to his Utah home.
But many of those wanting to stay close to home for medical care haven't enough money to pay those costs out of pocket. And that makes it difficult for Monument Valley.
"We have to call an IHS facility first, and if there aren't any beds available they can admit elsewhere," said Sue Sidmore, Monument Valley Hospital's director of nursing.
Since emergency care is exempted from the call-first regulation, many wait until their conditions are dire before going to the hospital.
"Many women, for example, want to have their babies here," Sidmore said, a situation that has prompted Monument Valley to build a new birthing center. "Many women wait so long before coming in that the baby's head is crowning. Women shouldn't be putting the lives of their children in danger for an IHS policy."
And, there is more at stake.
Closing Monument Valley would not only leave the 4,000 people living in the area with no hospital or clinic, but nearly 400,000 tourists that visit the area each year. Sidmore points out that the church also runs the post office, the fire department and the ambulance service, the loss of which would leave San Juan County in a bind.
The closest ambulance service on the Utah side would be in Bluff, 55 miles away. An ambulance could respond from the Kayenta clinic in Arizona, is 25 miles closer, but Sidmore said the clinic won't send an ambulance to the Utah side if the patient isn't Indian.
"It's truly a critical situation if this hospital closes," she said.
In a May interview, Sidmore said she believed in miracles and thought the hospital would stay open. It had been threatened with closure in the past but survived with the help of large donations.
But this time was different. The board wanted to see the hospital find a permanent solution to the problem of budget shortfalls. That would mean a change in the way IHS viewed the facilities.
Sidmore said if IHS would refer just 200 more patients a year, the hospital could stay open and cover it's operating costs. She's hopeful and says talks with IHS officials are going very well.
Officials can point to many reasons for keeping the hospital and clinic open, but the most compelling are those sitting in the waiting rooms.
Bernadette Salt's mother lives just a mile from the hospital but travels 120 miles to Tuba City three times a week for dialysis.
"She doesn't have any time for herself," Salt said. "By the time she gets back, she's so tired."
Salt's mother and others going to the hospital for treatment ride a bus provided by IHS. Transportation is a problem for many of the Navajos living on the Utah side.
"Some people don't have a vehicle or gas money," Salt said. She said families rely on each other to help with transportation costs.
Family support is something many Indians rely on when trying to heal their bodies. So Salt and many others opt to pay for medical care out of pocket and travel just minutes from home to the Monument Valley facilities.
Despite being nestled in the middle of nowhere, the hospital is able to attract very qualified doctors and nurses, many who stay for years.
Staff members live in housing originally constructed for movie sets. In addition, Sidmore said the rural setting offers adventurous doctors more opportunity.
"It's the variety," she said "It's being able to see all aspects of life from birth to death. I love the rural environment - knowing the people."
That relationship of trust has many of the areas residents loyal to the hospital and its doctors. And why shouldn't they be - the doctors really care about them, Sidmore said.
"We've even delivered lambs and cows in our parking lot. The hospital makes a major difference here. Even if we're just a safety valve, that's crucial here."