Navajo Nation's Monument Valley Park, Arizona.
Elmer Guy and Nonabah Lane.
Credits: Navajo Technical University, left, and Diana Levine
Nonabah Lane: The COVID pandemic is really highlighting a lot of ways in which we are lacking, and that's especially true here in our tribal community, because the first thing you need to even address where we are in this science and technology space is the internet. There's a considerable gap between the haves and the have-nots in terms of internet. The Navajo Nation is roughly the size of West Virginia, but we don't have anywhere near the broadband and internet access that other "states" this size would have. Some of the more glaring reasons for this go back to historical policies, lack of funding for infrastructure on tribal lands, and current rights-of-way issues, and a lot of it has to do with the fact that larger corporations aren't as willing to take risks in doing business on a tribal trust land. When you don't have the internet, you don't have access to information, you don't have access to what is going on in the world or science or technology, and you can't keep up with work or school.
Dr. Elmer Guy: That's right. In this pandemic, as we're being forced to go online, I see school buses parked outside for students who don't have internet at home. The buses are equipped with Wi-Fi, so if students can find a way to get to where those buses are parked, they can get on and do their homework. But only then.
Internet has long been an issue, and the Navajo Nation's telecommunications department created a cyber task force that we at Navajo Technical University (NTU) are members of. One of the things we recently did was to petition the FCC for special temporary authority of an EBS [Educational Broadband Services] 2.5-GHz spectrum that was available but not being used. So now we have that and we're using it to set up hot spots for students to connect. We're also working with the four internet-service companies: Cellular One, Navajo Tribal Utility Authority, Sacred Wind, and Frontier. As Nonabah was saying, the Navajo Nation is quite large and has five agencies. NTU is in the eastern agency, but Navajo Tribal Utility Authority doesn't have a footprint here, so we partnered with Sacred Wind as well as Frontier to broaden our bandwidth.
We've also been collaborating with the Navajo Cyber Team on developing a Navajo Nation broadband policy, and we're almost done with that. The Navajo Nation received some CARES [Coronavirus Aid, Relief, and Economic Security] funding, and part of that is being used to address broadband. One of the things we're trying to do is see if tribal colleges can qualify for E-Rates [educational rates], since schools are eligible for E-Rates. And so some of the schools are getting connected.
What's also happening is that the Navajo Nation is trying to expand water lines to families so that they have water to wash their hands during this pandemic. We're recommending that if they're going to dig for the water lines, they might as well lay down conduits, too, so that later we will be able to install fiber as well. We happen to specialize in wireless technology here at NTU, and that is making a significant impact. In the past, it used to be about point-to-point, and when you're trying to serve a community in the valley, you'd have to find a water tank or something high and then get down and into that community from there. But with newer technology, they can bend now into those valleys. We keep reminding the state that they need to address rural communities. We've reached out to congressional members to push them to address broadband issues with Indian communities, and there are a couple of bills out now addressing that.
Of course, there are other things we're looking at in terms of scientific priorities: artificial intelligence, robotics, and climate change. We're in a high-desert environment, and the sand dunes are increasing because of overgrazing and other factors. Water sources are limited, and air pollution doesn't really help, so robotics could be promising. For example, we're looking at the water-filtering systems for wells so that both animals and humans have access to safe water. We're beginning to see the reach of technology in places like grocery stores, where people can check themselves out without the need for cashiers. So we try to look ahead and project what kinds of jobs will and will not be needed on the Navajo Nation, then have our faculty think about ways of adjusting the curriculum to stay in line with where the world is headed.
"One of the biggest challenges for us is how we make sure there's a connection between the students who want to go into science and how they can continue to contribute to Navajo communities—to their parents' and grandparents' way of life."
NL: Since we're talking about the internet and A.I., I think one of the key issues that isn't addressed in tribal communities is data: data security, privacy, and, ultimately, ownership. It's such a gray area. Take this pandemic, for instance, and the numbers and the data that's being collected: who's taking all of this information out of our communities and who's accounting for it? It's an important component being extracted seemingly covertly. Our tribal communities don't necessarily understand how valuable it is to keep that data within our communities.
I know there are various data holders who are not Navajo who have studied Navajo people and our environment, from soil samples to diabetes rates, and it's just not information we fully have access to as a population—our own information. It's critical to get everyone on the same page and to understand the importance of that.
There's a water project I'm working on that came out of the Gold King Mine waste-water spill of 2015, which was a major environmental catastrophe in New Mexico that affected the run-off from the San Juan Mountains. The water contamination really hurt agriculture, especially Navajo farmers on the San Juan River. We still feel it, even if the pandemic has kind of overshadowed it, and before the pandemic, my organization, Navajo Ethno-Agriculture, adopted a lot of the hard-science data that was taken by the University of Arizona. We've been working with New Mexico State University in continuing to collect and share data with the community in order to build back confidence with Navajo consumers about our farm produce. We have an ongoing partnership with New Mexico State University where they come out and do soil testing, and Navajo Preparatory School students are developing a curriculum around this as well. The point is to get easy-to-use, low-cost technology so that farmers can do this testing on their own and not have to wait for and rely on a university or the government agencies to come out and test it. This initiative would not have been possible without the support of the MIT Solve Indigenous Communities Fellowship.
Of course, you're always going to have the people in the community who don't believe in science and don't believe that the water is, in fact, okay, but it's essential that we have that scientific data. It's about empowering farmers to be able to relay that message as well—and finding a bridge between our longstanding traditions and modern science. A lot of the farming among the Navajo is deeply traditional to this region, and, as a culture, we're focused on the traditional aspects of the food. That's really why we felt like it was important to be proactive about this—because if you lose one more generation of farmers who don't produce these heritage foods, it's not just your food, it's your whole culture and way of life—your heritage—that could be gone. So it's important to preserve that tradition, but also alongside Western science—and data is critical.
EG: Nonabah is right about tradition, and I think one of the biggest challenges for us is how we make sure there's a connection between the students who want to go into science and how they can continue to contribute to Navajo communities—to their parents' and grandparents' way of life. A lot of the time, you have to create those opportunities. For example, we're trying to develop an environmental laboratory at one of our sites in Chinle, Arizona, where we want to be able to test the water, soil, air, uranium, etc. We have people who can run that facility mainly to help with the uranium mine clean-up. There are over 500 abandoned uranium mines, and what might usually happen is that funds would become available and outside entities would get those grants and they'd come in and do the work. Then, as soon as the grant is up, they leave and everything disappears, but the problem remains. It's these kinds of situations where we say, Why can't we do that ourselves? And the only way is to train and prepare engineers ourselves, from our community.
A lot of our students intern with the U.S. Army and Air Force Research Labs Faculty Fellowship or with Boeing or NASA, and, when they graduate, those groups grab them for themselves. So I keep asking the Navajo Nation where they are in all of this. A lot of times we are the ones who create the barriers that only end up hurting us. When the Navajo Nation puts out job vacancies, they require candidates to have so many years of experience, and our students don't qualify. There is a tremendous need for our graduates, but everybody except the Navajo Nation ends up hiring them.
NL: As Dr. Guy says, creating opportunity is so important. My family's non-profit organization, Navajo Ethno-Agriculture, actually came about for that particular reason. We had people coming in and doing workshops and telling us how we should plant and do this or that. It was absurd—how can you come from Washington State and tell us how to plant when you don't know what native crops have been planted in our home region for centuries? And so, because of my family's background in the sciences and the traditional upbringing we all share, we built this program ourselves. We incorporate the science into our program, and we encourage students to pursue a career in science, while trying to create those job opportunities for them here. I find that more than 75% of the Navajo students I interact with—whether in high school or college—want to come back home. They just don't have the work or career opportunities to do so.
EG: NTU also has a partnership with the Navajo Nation's economic department, and we run their business incubator program. We encourage people to go into businesses here on Navajo. One of the challenges is that, even though the Navajo Nation may be the size of West Virginia, we don't own the land. So you have to deal with leases or homesite land-use permits, and it's daunting. We streamline that process and help people put together business plans, set up payroll taxes, figure out marketing strategies, and so forth.
One of the challenges is resistance, and that's something you have to deal with. For example, when I was pushing my faculty to develop an engineering degree, no one could understand why. So I told them about the national goal—that the United States has set a goal for itself that by the year 2026 or whenever, it wants to have 100,000 engineers. But what about the Navajo Nation's goals? We don't have a goal, but we should, and you have to push people to get there. Eventually everyone sees the benefits of these kinds of decisions.
NL: I also believe we have to encourage the entrepreneurial mindset: If something doesn't exist here already, then ask yourself what's needed and create it. This is our community, and we can make that change. I'm really biased toward starting your own thing because that's what I do. Before COVID-19 hit, I was developing a water lab that would stand closer to the Southern Ute Reservation so that it could be at the opening to the tributaries that run into the Colorado River and downstream to the tribes. I wanted that specific site because it would allow us to monitor the water that's a priority for tribes—because everyone else already has their own resources. And all of the water scientists involved were Navajo. If people like us don't take the initiative for these kinds of projects, the absolute wrong person is going to do it, without understanding the community.
EG: Whether it's the environment or water or some other scientific need, it's important that we remember to develop the smaller steps necessary for achieving any goal. For example, if we need veterinarians, then we have to ask what the steps are to get us to that point. A veterinary or medical school probably won't happen at NTU, but we could begin by identifying and building the steps needed to get there. We did this by starting a veterinary technician program and then added an animal science degree and then a biology degree, which is designed somewhat as a pre-medical degree, so that students can go into either medicine or veterinary science. We know we can't always make a leap right away, but we can build the pathways that get us there.
NL: For everything we've been discussing, I think it's really important to understand that we're not talking for the whole of the Navajo Nation; the Navajo Nation is large, and its culture is regional. There are different priorities in different communities. Where I live, we have abundant water around us, so that is not a need, but if you go 100 miles south, there's no water infrastructure whatsoever. And there are other issues, from coal and oil and gas extraction, to the uranium issue, which are regional. Some people live close to large health facilities while rural communities only have access to a clinic. NTU is resource-abundant in terms of having that academic outlet for students while people on the other side of the reservation may not have that. I'm always very clear about this. I may be speaking from a tribal nation, I may be speaking from experience, but I'm not speaking for the Navajo Nation as a whole, and I'm not speaking for tribal communities as a whole. Yes, we are a community, and we can expose a greater picture in our area of expertise, but there are definitely different areas that have individual needs.
Still, I do believe in the promise of what the future can hold for us in terms of both science and tradition. The two can complement each other and are not at odds, even though we tend to think of sustainability in scientific terms. And yes, science can help us achieve sustainability through things like solar tech, health innovations, and natural sciences. But I'm talking about sustainability overall and of the Earth: sustainability of water, energy, and agriculture, but also of human capacity and Navajo culture.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]
Jessica Fitzjohn, a postdoctoral fellow at the University of Canterbury, demonstrates the novel breast cancer screening device.
Researchers at the University of Canterbury and startup Tiro Medical in Christchurch, New Zealand are hoping their new device—which doesn’t involve any radiation or compression of the breasts—could increase the accuracy of breast cancer screening, broaden access and encourage more women to get checked. They’re digging into clues from the way buildings move in an earthquake to help detect more cases of this disease.
Earthquake engineering inspires new breast cancer screening tech
What’s underneath a surface affects how it vibrates. Earthquake engineers look at the vibrations of swaying buildings to identify the underlying soil and tissue properties. “As the vibration wave travels, it reflects the stiffness of the material between that wave and the surface,” says Geoff Chase, professor of engineering at the University of Canterbury in Christchurch, New Zealand.
Chase is applying this same concept to breasts. Analyzing the surface motion of the breast as it vibrates could reveal the stiffness of the tissues underneath. Regions of high stiffness could point to cancer, given that cancerous breast tissue can be up to 20 times stiffer than normal tissue. “If in essence every woman’s breast is soft soil, then if you have some granite rocks in there, we’re going to see that on the surface,” explains Chase.
The earthquake-inspired device exceeds the 87 percent sensitivity of a 3D mammogram.
That notion underpins a new breast screening device, the brainchild of Chase. Women lie face down, with their breast being screened inside a circular hole and the nipple resting on a small disc called an actuator. The actuator moves up and down, between one and two millimeters, so there’s a small vibration, “almost like having your phone vibrate on your nipple,” says Jessica Fitzjohn, a postdoctoral fellow at the University of Canterbury who collaborated on the device design with Chase.
Cameras surrounding the device take photos of the breast surface motion as it vibrates. The photos are fed into image processing algorithms that convert them into data points. Then, diagnostic algorithms analyze those data points to find any differences in the breast tissue. “We’re looking for that stiffness contrast which could indicate a tumor,” Fitzjohn says.
A nascent yet promising technology
The device has been tested in a clinical trial of 14 women: one with healthy breasts and 13 with a tumor in one breast. The cohort was small but diverse, varying in age, breast volume and tumor size.
Results from the trial yielded a sensitivity rate, or the likelihood of correctly detecting breast cancer, of 85 percent. Meanwhile, the device’s specificity rate, or the probability of diagnosing healthy breasts, was 77 percent. By combining and optimizing certain diagnostic algorithms, the device reached between 92 and 100 percent sensitivity and between 80 and 86 percent specificity, which is comparable to the latest 3D mammogram technology. Called tomosynthesis, these 3D mammograms take a number of sharper, clearer and more detailed 3D images compared to the single 2D image of a conventional mammogram, and have a specificity score of 92 percent. Although the earthquake-inspired device’s specificity is lower, it exceeds the 87 percent sensitivity of a 3D mammogram.
The team hopes that cameras with better resolution can help improve the numbers. And with a limited amount of data in the first trial, the researchers are looking into funding for another clinical trial to validate their results on a larger cohort size.
Additionally, during the trial, the device correctly identified one woman’s breast as healthy, while her prior mammogram gave a false positive. The device correctly identified it as being healthy tissue. It was also able to capture the tiniest tumor at 7 millimeters—around a third of an inch or half as long as an aspirin tablet.
Diagnostic findings from the device are immediate.
When using the earthquake-inspired device, women lie face down, with their breast being screened inside circular holes.
University of Canterbury.
But more testing is needed to “prove the device’s ability to pick up small breast cancers less than 10 to 15 millimeters in size, as we know that finding cancers when they are small is the best way of improving outcomes,” says Richard Annand, a radiologist at Pacific Radiology in New Zealand. He explains that mammography already detects most precancerous lesions, so if the device will only be able to find large masses or lumps it won’t be particularly useful. While not directly involved in administering the clinical trial for the device, Annand was a director at the time for Canterbury Breastcare, where the trial occurred.
Meanwhile, Monique Gary, a breast surgical oncologist and medical director of the Grand View Health Cancer program in Pennsylvania, U.S., is excited to see new technologies advancing breast cancer screening and early detection. But she notes that the device may be challenging for “patients who are unable to lay prone, such as pregnant women as well as those who are differently abled, and this machine might exclude them.” She adds that it would also be interesting to explore how breast implants would impact the device’s vibrational frequency.
Diagnostic findings from the device are immediate, with the results available “before you put your clothes back on,” Chase says. The absence of any radiation is another benefit, though Annand considers it a minor edge “as we know the radiation dose used in mammography is minimal, and the advantages of having a mammogram far outweigh the potential risk of radiation.”
The researchers also conducted a separate ergonomic trial with 40 women to assess the device’s comfort, safety and ease of use. Angela was part of that trial and described the experience as “easy, quick, painless and required no manual intervention from an operator.” And if a person is uncomfortable being topless or having their breasts touched by someone else, “this type of device would make them more comfortable and less exposed,” she says.
While mammograms remain “the ‘gold standard’ in breast imaging, particularly screening, physicians need an option that can be used in combination with mammography.
Fitzjohn acknowledges that “at the moment, it’s quite a crude prototype—it’s just a block that you lie on.” The team prioritized function over form initially, but they’re now planning a few design improvements, including more cushioning for the breasts and the surface where the women lie on.
While mammograms remains “the ‘gold standard’ in breast imaging, particularly screening, physicians need an option that is good at excluding breast cancer when used in combination with mammography, has good availability, is easy to use and is affordable. There is the possibility that the device could fill this role,” Annand says.
Indeed, the researchers envision their new breast screening device as complementary to mammograms—a prescreening tool that could make breast cancer checks widely available. As the device is portable and doesn’t require specialized knowledge to operate, it can be used in clinics, pop-up screening facilities and rural communities. “If it was easily accessible, particularly as part of a checkup with a [general practitioner] or done in a practice the patient is familiar with, it may encourage more women to access this service,” Angela says. For those who find regular mammograms uncomfortable or can’t afford them, the earthquake-inspired device may be an option—and an even better one.
Broadening access could prompt more women to go for screenings, particularly younger women at higher risk of getting breast cancer because of a family history of the disease or specific gene mutations. “If we can provide an option for them then we can catch those cancers earlier,” Fitzjohn syas. “By taking screening to people, we’re increasing patient-centric care.”
With the team aiming to lower the device’s cost to somewhere between five and eight times less than mammography equipment, it would also be valuable for low-to-middle-income nations that are challenged to afford the infrastructure for mammograms or may not have enough skilled radiologists.
For Fitzjohn, the ultimate goal is to “increase equity in breast screening and catch cancer early so we have better outcomes for women who are diagnosed with breast cancer.”