Baby Trail?

I went with Elsie, a Navajo nurse, and about 10 other nurses and doctors down Baby Trail, one of the many "trails" that go down Canyon De Chelly.  Trail is much too mild a word for Baby Trail as it descends 1000 feet down a series of ropes and ladders.  The trail is not for the faint of heart and although "Baby" may make it sound easy it could me Evil Knevil swoon.

The trail is called "Baby Trail" because a native woman was trying to escape the roundup of Navajo in the canyon by soldiers over 150 years ago. She had a baby on her back and was caught against the wall of a seemingly unclimbable cliff. She took the baby off her back, attached the baby to a board and climbed up the canyon pulling the baby by rope until she made it to the safety of the top of the canyon.

The trail is now a bit easier because of a few strategically placed ladders and ropes. It still is a challenge with the potential to slip and meet ones doom. My body and mind were saying with every bit of common sense I could muster "Turn Back" but as my wife knows, I have little common sense so I was able to press on and complete the down and up trip.

Teenage Drivers

Of the many surprises I have encountered here are the number of teenage drivers ( and sometimes pre-teen) drivers.  The need for teenagers to drive is due the need to arrive at a bus stop early in the morning, the need to follow sheep and cattle as they roam over the dessert, and sometimes to act as an emergency driver when a parent or grandparent is incapacitated due to illness or drug and alcohol use.  It is not legal of course and I have interviewed 10 year old children who can drive and do so on an almost regular basis.

Unfortunately one of the more common reasons for the teenagers to drive is that a parent/relative is too drunk to drive. There are no taxis out here and it is an accepted fact of life that teens will drive when the parents cannot.  Most of the time the teenagers try to stay off the state highways and keep to local roads but now and then there are accidents involving teenagers without a license.  Is it better to have a sober teen driving illegally or have a parent who is incapacitated driving? Of course the best thing would be for the family group not to be driving at all.

This has given me pause when I drive here at night and makes me reluctant to drive the roads after darkness. The driver coming my way may be drunk, inexperienced,  a teen under 16 , or all three combined. It is abusive of the teenagers to expect them to drive before they are ready but it is a fact of life here.  There are many wonderful aspects of the extended family here, unfortunately the burden placed on teenagers is not one of them.

Two Weeks Left

I have two more weeks working in Chinle before heading  back to Portland.  I could stay longer but I need a conjugal (spousal) visit as well as a doctor and dentist visit. I hope to stay in Portland at least a month and God willing much longer if I can land a job in Portland.  I will miss being here but know I can always come back. I will miss the horses and cows eating my front lawn in the morning, the feral horses on the roads, the incredible thunderstorms almost every afternoon, and especially miss my patients.  I love how accepting the Navajo are of children with disabilities and how the loving extended family is always pitching in.  I love the spectacular sunsets and the quiet. It will all be missed.

I ran another 10K race today and it was what I have come to call " A survival race".  As the race began you could see the rattlesnakes scatter in all directions from their morning sun bath.  The race climbed only about 600 feet but the path was mostly sand which made for slow footing. The sun was beating down and the race temp was 75o at the start and about 85o at the finish.  The lizards that line the path have a good time running along with you as the snakes have all crawled away for cover. The fastest time was 47 minutes which is unbelievably slow for 10 K races but about par for a "Navajo 10K".  It was fun nonetheless and I had the distinction of being the "oldest" runner.  This is something I am not exactly proud about. 

Lone Ranger Rides Again

Last weekend I went to Farmington NM and on the way I stopped by for the filming of "The Lone Ranger" at Shiprock.  This is a 225 million dollar production that has been filmed around here for the past year.  The security was tight to get on the set and since I did look like one the extras (Native American on horseback) I knew it would be hard to enter the set. I used my Sklar chutzpah and put on my doctor clothes with my official Public Health Service ID.

When the security people looked at me I said, "I'm Dr. Sklar from the Public Health Service and I need to inspect the set." It was not a lie but I was stretching things a bit.  It got me in and a front row seat to see Johny Depp riding around with a bunch of others.   What impressed me was all the "stuff" they had there.  The had on full size truck trailer that was an air conditioned kitchen.   They had another trailer that was a large dining hall with all kinds of food and drink. This was not cheep food but New York restaurant quality food.
They had cranes to carry camera men for those high aerial shots and cameras on tank like vehicles. There were makeup and costume people running every which way while most people were sipping water to keep from getting sunstroke. I had a great time watching the filming and left after a few hours of "A public health inspection".

Unfortunately there was no need for extras to play short Jewish doctors so once again I was out of luck to get into the movie.  Someday somebody has to make a movie featuring aging doctors and my luck will change and I will be ready.

Shiprock

 Maybe if I went to Israel I would have better luck getting into films.  I heard about a great film that took place there called "Torah, Torah, Torah".......... or was that about World War II?

Apache County

This weekend I drove to Farmington, New Mexico, a city of about 20,000 two hours from Chinle.  I went through the communities of Round Rock, Tsaile, and Lukachuki on my way to and from Farmington. These communities are some of the poorest in the state as well as the nation in terms of per capita income.  The county where I live, Apache County, is ranked 10th poorest in the nation.  It  is also one the largest in terms of area and includes a good chunk of the Navajo Nation as well as an Apache Reservation.

In this county which is 80% Navajo ethnically, we have some unusual statistical aberrations.  It is one of the few counties where neither English nor Spanish is the most common language spoken at home.  It has the highest fertility rate as well as family size in the state.  About 25% of the homes have no running water and a slightly smaller percentage have no electricity.  To say the roots and burden of poverty runs deep here is an understatement.

The implications on public health are great.   Rare is a child I see without dental carries (cavities), their own bed to sleep on, or clothes that are new.  One can never be sure if a child will return for follow up of a medical problem as things such as clocks are not found in many homes.  However, the immunization rate for children is almost 100% for those about to attend school, thanks to a very strong program supported by tribal leadership and the public health service.  We monitor, audit, and check every child's record once a year and is  there are any deficiencies we get them in to the clinic quickly.

Canyon De Chelly has great rainbows!

One final tidbit for those statisticians in the crowd.  The poorest town in the United States is Kiryas Joel, a Chasidic Jewish community of 20,000 in New York. Go figure?

Skin Walkers and Witches

The skin walkers are evil witches that many Navajo believe can assume the shape and body of animal.  Some call them "shape shifters" in English. After assuming the shape of an animal the witches can cast spells and harm humans.   These witches are known when in human form to have eyes that glow in the dark like an animal but lose that glow when in the shape of an animal.   The witches pray on the weak and the young who are judged to more easily affected by the witches power. The most common animal they assume is the coyote and great is the fear when one sees a coyote after dark.  Because of the power of these witches Navajo avoid the skins of dead animals unlike my other Native American groups.

This year a bus full of teenagers was traveling after an athletic event at night when a few students felt they saw a skin walker.  There was mass hysteria on the bus and the driver immediately headed for the hospital.

White House Ruin and Rainbow

Thankfully we have traditional healers "medicine men" on our staff who were able to quickly assess the situation and begin a healing ceremony.  It was not until after the ceremony that the teenagers calmed down so that we were able to send them home.  Any physician who discounts the power of traditional healers in the Navajo Nation will have great difficulty in helping those sick of both mind and body.

Feral Horses

There are many things different about Chinle.  There is no New York Times, no local paper, and not even USA today.  There is only one FM station (Country Music uggh!) and one AM station (Navajo).  There are few trees and nothing resembling a planned community. What really separates Chinle from many other small are the feral horses that roam the streets and highways.  These are somewhat wild horses that are one or two generations away from being domestic riding horses.  There is one herd that is always hanging out in the center of town feeding on what little grass there is and the leftover hay from daily hay sale lot. I do not know where they get water as there is no running water anywhere. There are other feral animal around town also such as dogs, cats, goats, and sheep but it is the horses that one sees most often. Apparently people try to do something about them after a horse encounters a car with both side losing. However, after a while things return to normal and the horses roam freely.

Part of the problem is the love that Navajo about animals and a desire to let animals be.  People like the fact that animals can roam free and not possessed by anyone. Navajo are traditional herders and have always lived among animals so the presence of animals is a comfort to them.  If you drive to Chinle, slow down as you approach town and watch out Seabiscuit, National Velvet,  and Trigger. 

The Judge

I spent the 4th of July with one of the local judges, Victor Clyde, at his family's ranch up in the Chuska Mountains.  This was about at the 7500 foot level and much cooler than Chinle at 5500 feet.  There was a stream running through the property and lots of Ponderosa pine trees.  While there I learned that the judges here have to be well versed in criminal law, civil law, and tribal law.  Tribal law disputes mostly deal with grazing and property issues as although the land is held in common by the entire tribe, the right to use the land is passed down from one generation to the next.  Up until recently the land was passed down maternally which made the Navajo Nation one of the few with maternal rights of inheritance. Land use is now passed down from family member to family member regardless of sex.  However, because of large families there are often disagreements over who gets to use which house or graze a specific plot of land. If the family cannot work out some agreement they end up in tribal court where judges like Victor have to use the wisdom of Solomon to decide who gets what. Victor also acts as justice of the peace and in a community with few church weddings he is quite busy. He also has to be elected every four years which helps to make him responsive to the community needs.

Tsaile Creek in the Chuska Mountains

It rained the night of 4th of July. Although it put a damper on the celebration I still have all my fingers and eardrums from not being able to set off fireworks.  I guess there is always New Years Eve.

Narbona Pass

I just finished a 10K race that started and finished at 8500 foot level Narbona Pass, about 75 miles east of Chinle as the crow flies. The race was what I now call "Navajo Tough" meaning very steep with lots of sand and rocks on the trail  The course rose to 9500 feet at mile three with great views for a hundred miles in each direction. It was the largest of the Navajo Nation races to date with 400 in the 5K and 300 in the 10K.

Narbona Pass runs through the Chuska Mountains and is named for a Navajo Chief who defeated the Spanish coming through the pass about 1820.  Up until 20 years ago it was named "Washington Pass" which was named for a US Army major who came through the area in the mid 19th century and killed and enslaved many Navajo.  For the Navajo it was like the Israelis having a major street named after Adolf Hitler.  Thankfully the state of New Mexico gave the Navajo permission to rename the pass so that now on all official maps it is "Narbona Pass".   The pass is very scenic with alpine meadows and lots of Pondorosa Pine trees and a nice picnic are by the side of the road.  It is a popular place for the Navajo on the 4th of July but the rest of the year there are few people. It is usually 15 to 20 degrees cooler than the valley below which was over 100o today.

Monsoons

The "Monsoon" season has begun here.  This means that any afternoon thunderstorms can occur. Most afternoons there are only clouds and real rain only falls occasionally.  The rain can vary from sprinkles to over an inch in half an hour. The thunder and lightning can put on quite a show and one can watch the storms almost fifty miles away. Foolish people like myself drive up to the mesa just to see the display and watch nature in action.

Two nights ago we had our first real thunderstorm with thunder. lightning, and rain. There was even a double rainbow as an added attraction.   We lost electricity for a while as several transformers were hit.  There was not enough rain to help the drought or fill any of the washes but it was welcome anyway. There are many stories of people camping near a wash or canyon and being swept way by a sudden rainstorm

Chinle after thunderstorm

Thunderstorm in my backyard

Sad to say that I am losing my student physician assistant who is going back to North Carolina tomorrow.  She was a dietician for several years before going back to school.  She has been a joy to work with and has a great future ahead of her. She has a gift of working with all kinds of people in a positive way.  I so enjoyed teaching her and being taught by her.  Godspeed Laura.

The big bang theory!

Yesterday I did something that the American Academy of Pediatrics would cringe at. I bought and exploded fireworks with some male friends (of course). Here on the reservation it is possible to buy all manner of explosives from the small fire cracker to the "Please don't tell Homeland Security" variety. I was amazed at the great mortar fireworks the shoot balls into the air and explode just like the ones at the great displays in Portland with many colors and lights. As the evening wore on we were exploding larger and larger devices. I had one about the size a coffee can that was the called "The Big Bang". I knew it was dangerous when it said on the side to be at least one hundred feet away after lighting. It was impressive and left a nice crater in the ground after almost blowing out my eardrums. After that explosion one of my native friends goes back to his car and pulls out one the size of a wash bucket called "The Nuke". ( I still can't believe they make these things.). This time I put cotton in my ears and moved almost to the next mesa. There is a nice long fuse which allows one to run for good cover. "The Nuke" turned out to be a multidirectional display that shot rocket like balls in all directions and then ended with an explosion similar to the "The Big Bang". After that testosterone fueled event and counting our fingers we returned to town. The "Fourth" may be an anticlimax.

Class, Culture, and Customs

     This week I had for the first time a non Navajo patient.  One of the physicians brought in her baby for an exam.  I walked in with the medical student and immediately noted how different the interview was. There were lots of questions from the mother, an in depth discussion of breast feeding and an ease of presence that I have not seen since I left Portland.  The past difficulties of obtaining a history were gone and the parent and I could readily see a connection

     It brought to mind how much of a cultural and class divide I have with many of my families. I often find myself struggling to get answers to very simple history questions from the parents and children. I still feel this must be a better way for me to interact with my patients so I can make the connection that will help make a healthy child.   Perhaps if I were Navajo I would know better things to say or do that would help the therapeutic process along.  Having worked in clinic where half of the population were African-American was a snap compared to relating to the Navajo. It is not that I have had any bad interactions but that I have not been able to make the connection I find necessary for a successful visit.

Ancient Ruins from the Chinle Outback

      It brings to mind how difficult it must be for couple who come from different cultures to have a good relationship.  The Jewish-Christian,  Black-White, and Navajo-Anglo couples all must deal with great barriers to make the relationship last. We have a few physicians who have married Navajo and I would love to ask them how they make a go of things.  Meanwhile,  I will seek out other physicians who have been here a while to see what they do to relate better and bridge the cultural divide I see.

Alvina Begay

Alvina Begay is a 31 yo runner from the Navajo Nation and a local woman who comes from Ganado near Chinle. Every great runner has a story of overcoming adversity and Alvina is no exception. She adapted from the not so academic life of Ganado to be become an academic all American at Arizona state. This year she qualified for both the US Olympic trials in the marathon (2:43) and the 10,000 meters (32:40 qualifier). She has given much to the community here and has infected many young people with running bug. Her mother is a pediatric nurse who heads up our outpatient clinic in Chinle. So when you watch the olympic trials in Eugene this week give a cheer for Alvina who makes all of us so proud here in the Navajo Nation.

Navajos Run Hard

The men's top three finishers.  Prizes included bicycles and Pendleton Blankets!

With the medal after the race.

Just ran a 10 k race about 40 miles from Chinle in a small hamlet called "Steamboat".  One of the toughest 10 k  races I have done due to : 1. The heat was 75o at the start. 2. It was at 7000 feet.   3. Lots of hills and steep inclines. 4. Deep sand at times. It was called the "Run for life" ( but was almost my death) and was organized by a 48 yo Navajo, Joe Curly Jr, on his family's ranch.  There were almost 100 runners and it was a well supported event with lots of water stops that were all staffed by members of Mr. Curly's family.  I have now become friends with members of the Navajo running community and the friendship has given me a window into the Navajo people.  Running as I may have said before is one the big sports for Navajo youth with many going on to run in college out of proportion to the general population.  The tradition goes back to the shepherding days when running was a survival skill as well as a way to communicate with others.  I am thankful I can join in with others and become part of the running fraternity. This event had lots of prizes and I got a nice Pendleton Bag for coming from the longest distance (Portland) as well as a medal for being third in the old farts age category. After the race I was even invited to a barbecue of a sheep's head and other ovine organs. I will have to save the barbecue story for another day as this was an event that not only sticks in my mind but sticks right now in gut.  Where is Pepto Bismol  when I need it??

The Setting Sun

As the sun sets I am reminded how lucky and privileged I am to be here. A hard day of work is over and although on call I can enjoy the warm Arizona sun. Every day is in the low 90s now and will be so through September. However, it does cool off here at night in the high dessert to the low 50s by about 0500. The practice of Pediatrics here include lots of "sports physicals" as the new school year starts on August 1 and no one wants to miss practice in July. The big fall sports here besides football are cross country and volleyball. The runners do very well in statewide competition as most practices you run through lots and lots of sand and wind. I have yet to master the art of "sand running" but the Navajo say to make like a lizard to run in the sand. Somehow I may learn the technique but it will take time.

Hope

Last week I participated in an 8 k race near the hospital that was more like a Sahara Slog or a game of capture the camel. We went over a number of sand dunes in 85 degree heat with water only in the mind. One of the toughest 8 k races I have ever done. I took it very slow and even with that I was a bit dizzy at the end. Thought I saw some camels on the course but I think they were just large dogs. Today we had a softball tournement which bought many local townsfolk. The field is dirt and sand which makes for some tough ground balls. There was also the obligate wind storm today which forced the umpire to delay the game many times until the dust died down. I felt sorry for the outfielders as the wind also made high fly balls a challenge.a The great thing for me was seeing all the people being physically active and having a good time. With all the health problems here due to obesity and diabetes there is also a group who keep active and healthy. I get a skewed view of world working at the hospital and am happy to know the local scene is not all made up of poor health habits. I am hopeful we can turn things around here as well as the rest of the country although it will take work. Next week I go back to the canyon for a Tuesday evening run sponsored by the Park Service. Should be fun.

Rocks

Shiprock

One of the oddities of the area are place names with "rock" in the name. As there are no rivers and few features to the terrain besides the rocks it seems like every other location has been named after a rock.  Near Chinle there is Window Rock, Shiprock, and Roughrock.  There is also Spider Rock, Round Rock, Red Rock, and Eagle Rock.  In Canyon De Chelly there is "Duck Rock" which is a location on the canyon floor that looks like a duck in flight. Most of the "rock" names come from the appearance of the formation to the observer. There is often confusion for the Fed Ex and UPS drivers who show up in Red Rock to find out that the package was going to Round Rock. I also have to be careful as I sometimes send public health nurses out to homes and if I get the rocks mixed up the nurses may drive 50 miles the wrong way.  The one "rock" name that does not cause confusion is Mormon Rock.  How it got named is only a guess as it does not look like Mitt Romney or any other Mormon I have known.

I'm back!

After a four week lapse I am back in Navajo Country.  It is warmer then the end of April and all the children are out of school.  As a result the problems I see are different.  There are a lot of "cowboy" injuries from the use of horses, cattle, and ranch equipment.  Today, I saw two horse rollover injuries where the horse has rolled over some poor child usually after bucking them off. There are also horse bite wounds, horse stomp wounds, and horse kick wounds.  Then there are all the cattle injuries from mad cows, brazen bulls, and crazy calves.  Toss in a few ATV and motorcycle rollovers and you have a paradise for the orthopedist.

I am staying in the motel now which is somewhat of a problem for me as there is no place to cook. I am not about to live off the high cuisine of Burger King, Church's Fried Chicken, and A and W so I must improvise.  I think I will buy lots of salads from the grocery and have cold cereal for breakfast.

With the heat, the cows which roam free in town have to find shade.  There are no trees so the cows like to use the telephone poles for the shade.  They rotate around the pole as the sun moves across the sky to maintain the shade.This produces a great time keeping device as you can use the cows as a sundial.  It is quite reliable as there are never any clouds and the cows are easily spotted around town. In my neighborhood if the cows butt is pointing at the motel it is nine in the morning, at the Laundromat it is noon, at the high school it is three and at the gas station it is six.  I am not ready to get rid of my watch yet as they try to keep the cows out of the hospital grounds but they do provide a great back up.  Well since it is about moon..., I mean noon, I must get back to work and that's no bull.

Italy

This is my first visit to Italy after visiting with my duaghter in Slovenia. We had a great time there in the four days we spent. Lubljana is what most cities aspire to be:clean, scenic, bike and pedestrian friendly, and fun. Italy is another story. We are in Florence now after a day in Venice. Italy is rich in history, art, and food. This is quite a change from Chinle, Arizona which has its own art, history, and food but of a different sort. The art of Michaelangelo vs. the petroglyphs, the history of the Renaissance vs. the Anasazi, and the food of Tuscany vs. the Navajo Taco all provide great contrast. I will keep each culture in mind as I tour what some consider the beginning of modern civilization and the height of its artistic efforts.

Diversion

I am visiting my daughter in Ljubljana , Slovenia. She has been here for the past year as a Fullbright Scholar and has a project dealing with how the country formed a democracy after many years of dictatorship under Tito. Ljubljana is a beautiful small city of 250,000 with a castle overlooking the old mideval part of the city and a small compact downtown . It is also a city where bikes rule. There are bike paths everywhere and most people get around on bikes and leave cars at home as parking is problematic. Many streets downtown are bike and pedestrian only which makes it a great walking city. There is a lovely and very large park just off the center of town called Tivoli which is the Slovenian equivalent of Forrest Park. The park has many trails and is always full of running fools like myself. This is a great diversion from the land of the Navajo and about as different as and environment as Portland is from Mogadishu.w

Don't tell Avis!

On the sandstone mesa road.

A "groovy" ruin.

I had a an almost free day today spent cleaning up the apartment for inspection.  They actually want the place to be "dust free" which around here is like asking an Eskimo to keep his igloo "snow free".  The red dust blows all the time and some gets inside of everything.  The inside of my car is even coated with dust even though I have never had the windows open.

I spent the afternoon seeking elusive Indian ruins in the huge expanse in back of the hospital I call the "Chinle Outback".  This area covers almost a  hundred square miles of " semi road less" area.  It is "semi road less" because the dirt roads often just end with a cow path.... or the end a cliff.  Today I took my black rental, which now is red-brown rental to find the ruins. After thirty minutes I found them going over a road that incredibly went on top the sandstone mesas.  The road turned from dirt to this shiny red rock that was only marked by piles of rock to show the way. I had to get out of my car numerous times as I came over a rise to make sure there was actually a road on the other side and not a place where lemmings like myself go to end it all. I knew a local school bus uses the road and it comes back to town every night so the road  could not be too, too bad. Although Avis and Hertz will be cringing in their rental booths when they pictures of the road I went on, I am publishing them for posterity.

There were many great ruins and the one I enjoyed the most was this "psychedelic" ruin that some ancient one built after a little too much of the peyote.

A long hike and a sad goodbye

Just finished a twenty mile hike through Canyon de Chelly.  We started at 0900 and the first part of the hike was a descent down a rock face about 1000 feet to the canyon floor.  I made the wrong assumption that because our leader was a Navajo women of about 62 that the climb down could not be too bad.

 Wrong...wrong..wrong.  This woman was actually a mountain goat disguised as a Navajo.  The first part of the descent was over a cliff face hanging onto a rope ladder and cable as one looked down over a very empty space to the river below.  Each portion of the drop involved either ladders, cables, or ledges to make it to the valley floor.  It was something like the Chutes and Ladders game in design but without chutes....... unless one slipped.  It was both a frightening and exhilarating that I hope to do again. 

Once on the bottom of the canyon our long hike began to the mouth of the canyon and our cars.  Most of the trip involved walking through a river bed  several inches of water deep. There were large numbers of Indian ruins along the way as well as petroglyphs. The canyon walls were mostly red sandstone with contrasts of black and white that dripped down from the tops of the walls.  Awesome is too mild a word to describe the scenes.

The ladders were the easy part!

Amazing colors on the canyon walls.

The river bed we walked through for miles.

Michael From, Pediatrician, and two of Elsie's Grandchildren.

The last five miles we were joined by the grandchildren of Elsie, our Navajo leader, as we no played in the water on way out, ending the trip at six in afternoon. This was a great ending to my first two months with the Navajo and I am sad to leave.  I will be back at the beginning of June for more adventures and experiences with a group of people little understood by most visitors.  So, stay tuned for part two in about four weeks and enjoy a few pictures of the hike.

Bear Trail

Went with Elsie, one our Navajo nurses, in Canyon De Chelly this evening. Elsie in her early 60s has lived in the canyon here whole life although now mostly spends her summers there.  Her family has farmed there since the time the Navajo migrated there perhaps 500 years ago. Elsie is in great shape and know a lot of canyon history as well as history of the area.  She loves the canyon and it shows.

There is only one trail (White House) that is open to the public and all other entries into the trail must be with a Navajo guide.  The Bear Trail, so named because of a bear that was once seen on the trail, is quite steep but very beautiful.  I would not even call it a trail as there are no markings and there is no dirt path.  It is just a route 1000 feet down into the canyon over sandstone.  There are many ruins along the way to see as well great rock formations. The Canyon is entirely different from the rest of Chinle as it has trees, flowers and even flowing water. The water is only inches deep and if fun to play in.  However, almost every year some yahoo drives up the stream and encounters quicksand. The car will sink into oblivion perhaps to be found by some archaeologist hundreds of years from now as evidence of not so intelligent life on the planet. For once in my life I avoided the quicksand even though I was tempted to see if people can really be swallowed up or is it just a western legend.

Rattlesnakes

In other parts of the country Spring is heralded by the coming of flowers and the birds migrating.  Here in Chinle where there are no flowers, trees, or birds Spring is signaled by the rattlesnakes coming out to take advantage of the warm sun. It is now in the mid 80s every day and it perfect weather for rattlesnakes.

Running like I do most mornings I find the rattlesnakes enjoy the sun of the dirt road I use. It has become so popular in the past few weeks the dirt road must be some sort of Waikiki for rattlers. They come for the sun but I also think the are coming for something more. It is rattlesnake mating season so the male snakes are strutting their stuff (Is this possible for snakes?) and the females are slithering by to show their sleek figures they have working on all winter.  I have not seen any rattlers hook up yet but it cannot be a very long time before there is some "action".

"Boehner"

My job is to avoid all the sunbathing beauties as they don't like the feet of humans interrupting their activities.  This has been easy so far as they are easily seen for 10-20 feet away.  They also seem to this coiling thing rather than just jumping out and striking so I have had ample warning.  The biggest snake I see is in the same place every morning just lying in wait for his pray.  I call him "Boehner" after the house speaker because they share so many characteristics.  Sneaky but predictable "Boehner" the rattlesnake has a smile on his scaly face (this snake can smile)  just as he is ready to strike.  There is also a squished dead one on the road now I call "Gingrich".  I think the name is appropriate. Thank God I no longer have to avoid him. I have not found any yet that fit Obama or Romney but I'm sure one will slither by some morning looking for a contribution.

A Cardiac Arrest

Another hard night being on call and seeing patients in the emergency room. After I admitted two patients from the ER, a woman came into antepartum(before giving birth) at 30 weeks pregnant and having her cervix open to 5 centimeters. For the un medical this means she was about to give birth to a baby 10 weeks early. I got everything ready to deal with a premature baby and then somehow her labor slowed to a stop. I had to stick around just in case she deliverd. It was 0300 and I was pooped so I asked if I could use one of the empty beds in post partum. "Sure" said the charge nurse. So I layed down for a nap. One hour later as I am dream about winning the Boston, Marathon or at least beating Marc Frommer, the door to my room comes crashing open and in charge a large number of nurses with the crash cart as the light is turned on. I bolt up to a sitting position as the code team and we look at each other. "Ooops we must have the wrong room" I hear as they scurry out of my room trying to find the patient with the cardiac arrest. That was it it for me. No sleep the rest of that night. And no more dreams of beating Frommer.

The Lone Ranger

After two weeks of filming in Chinle The Lone Ranger production company has moved on.  They filmed a number of scenes in Canyon de Chelly and used up almost every motel  room in town.  They pumped  several million into the local economy and left a generally positive impression on the community. Sad to say I did not catch a glimpse of Johnny Depp (Tonto), Helen Bonham Carter, or Armie Hammer (Lone Ranger).  I did see Jerry Bruckheimer who is producing and directing. I must say he worked hard to build bridges in the community and had only good things to say about the people of Chinle.

The Lone Ranger movie is going to a fairly dark version of the story.  The movie starts with the killing of all The Texas Rangers except for one by some evil doers.  (I tried out for one of extras as an evil doer but was not evil enough) The Lone Ranger somehow survives the killing and is nursed back to health by Tonto which forms a bond between the two.   Instead of revenge The Lone Ranger dedicates himself to helping the downtrodden and less fortunate so that evil cannot take route.  This movie will be released sometime in 2013 and big bucks are being spent as well as Jerry Bruckhiemers personal touch.

I must apologize to my daughter for not getting Johnny Depp's promise of undying and intense love.  Perhaps he will film next near Slovenia where The Lone Ranger will bring all those Serbian  outlaws to justice.

Running Challanges

The challanges abound for the recreational runner. Since my arrival here the biggest impediment have been the dust storms that frequent the area. In order to avoid silicosis, asthma, and sand in some cracks where the sun never shines I avoid running in dust storms. It's not just the dust it's the trash that flies in your face. Anything from newspaper to Ronald McDonald's wrappers come my way. The second issue I commonly encounter are seeds from the the Goathead plant. (see picture) These seeds are increidbly sharp and spiny and stick well to the bottom of your running shoe. They also will come off in the carpet of your house and cause nasty holes in you feet. The dryness of the place coupled with the heat can make one thirsty in a few minutes and there are no fountains either around the corner or even in the next county. I bring water with me which is something I never do in soggy Northwest. The last issue are the animals. The dogs, horses, donkeys, cows, and crows leave me alone. Howver, sheep are another matter. The rams in each flock are protective and if I come between two parts of the flock they will chase me with their head down and their horns pointing right at my behind. When the rams chase me it gives the Navajo herders a great laugh and gives me impetus to run faster. One of the herders joked that the ram only wants to mate with me. I think the ram knows better than that.

Water and Disneyland

The snow falling outside my window after weeks of temperatures in the 70s and 80s reminds me of the water fight going on now between the local tribes and the federal government.  At stake is the use of the Little Colorado river that flows through the northern part of the state.  The tribal leaders have negotiated an agreement but the the tribal members feel differently.  Last week tribal members surrounded a car with the two US senators while they were attending a meeting in Tuba City about the agreement. Now tribal leaders state they will put the water rights treaty to a vote of the tribal members.  Many here are very suspicious of any treaties as they have watched so many of their ancestral rights given away for centuries. It is difficult for many to see the water they use for farms and livestock going to keep the golf courses in Phoenix green.

The other big issue going on is a proposal the Navajo have to build a tram and amusement park at one end of the Grand Canyon. Although Micky and Minnie will not be there it will still attract many tourists who come by in the summer.  Currently the Hopi and the National Park Service are opposed and although it would be on Navajo land the impact for others would be felt by many who visit the area.  The Navajo feel that many others benefit financially  from the Grand Canyon each year and they would like a piece of the pie.  Each year thousands of young people are hired to staff all the lodges and concessions in and around the Canyon while most Navajo youth are unemployed for the summer. Where this will go leaves the tram up in the air but if you see Aunt Edith and Uncle Archie with great pictures as they dangle over the Canyon, you heard it from me first.

Quality Survey

Today was  quality survey day at the clinic. It is the biannual survey of physicians and nurses that have patient contact.  Unlike at Kaiser, the survey is passed by the physician immediately after the visit to be filled out on the spot.  They are then collected in a folder in the examining room to be collected later.

Of course the survey is flawed for a number of reasons.  Not only do the staff know the day and time of the survey, but they actively participate in the process.  This skews the results as everyone can be on the "best behavior" for just that day and get great results.  Problem children like myself may create results that are at best inaccurate and misleading. There is even the potential to do the" Vladimir Putin and Takeout" ballot stuffing.  Nonetheless I do hope I am around to see the results as I have not had feedback in years and would like to know if I have become as senile as I seem.

The great problem here to do it in a more blinded fashion is that: 1. Few people have a mail box or home address. 2. Even fewer ever use the mail. 3. Almost no one has an Internet connection and email.  Toss in a significant illiteracy rate and few phones  and you have a kind of survey black hole. If one has mail it is with a P.O. Box and many people come into to town only once per week to check it. We have a number of PhD and MPH (Master of Public Health) people here who do this stuff for a living and know the the survey techniques are bogus but do them anyway to justify their salaries and give us something to talk about in blogs. I really do not mind the survey as long as after my patients vote on me I do not end up in the Iranian Parliament.

Johnny Depp Comes to Town

For the next few weeks they will be filming "The Lone Ranger" in and around town.  Johnny Depp and others are in town for the filming and they are using almost all the rooms in The Thunderbird Lodge, the big motel in town near Canyon De Chelly. Besides all the excitement and money it brings to town there was a call out for extras for non speaking parts.

Last week I saw the call for parts and figured this was my big chance to not only see Johnny Depp but break into Hollywood and become the next Dr. Kildare, Marcus Welby, or Ben Casey.  The call said: late afternoon and night work to play villains(check), must be able to ride a horse (check), and be between 18 and 60 (check, although barely). I show up for the casting and there is this guy who makes us all line up after we sign our lives away.  Then he goes through the line and starts separating us out like it was a pick-up baseball game.  I get placed with a large group of mostly nice looking Navajos and knew I was trouble. Sure enough I did not make the cut.  So I ask the casting director, "Whats wrong with me?"......  "You do not look evil enough to play a villain." was the reply.

"My wife would disagree."  I stated and this brought a big smile to his face but did not get me the part.

So there, my dear wife.  What you have been saying all these past 30 years about me looking evil is really not true and this comes from a professional!

Easter, Passover, and Navajo Nation

I just returned from my brother and sister in law's house in Albuquerque and had a great time. We had a Seder where we all read the Passover story from Hagadahs on I-Pads.  The story may be old but the technology was new.  We had Christians,Jews and even one Muslim.  I am so grateful to Deborah, my sister in law, for hosting the event.

It is Easter also and having spent almost as much time in a church as a synagogue in my life I like to think about Jesus, the gift of life, and resurrection. I look at resurrection as not just an individual rebirth after life but as the renewal and rebirth we as a group and society can seek and take part in.  No matter what we have done in the past there is always the possibility to seek redemption and a better life for all. The possibility is more than just hope but an active effort to rebuild from tragedy and disaster in the past. I look a Bosnia, which this week marked 20 years since the bloody civil war began, as the resurrection of a country.  I see the rebirth of Northern Ireland after centuries of hate and tragedy. Even Somalia is coming around with the start again of international flights into the country.

For many of the Navajo I hope and will work for them so that they can resurrect themselves as a tribe.  They have such great cultural traditions and identity that they can emerge from some of the desperation of poverty that is a part of the Navajo Nation to have  self-sustaining and independent lives. It is possible to blend old traditions with modern society so that all can look forward to a good life. A good education, health care, and employment will not weaken Navajo society but allow it thrive.

So today I think of God's promise of deliverance to the Jewish people and Jesus's  promise to mankind and will strive to use lessons of both in my daily work.

Diabetes

Diabetes is one of the great health problems on the Navajo nation as well as the US. It is primarily a result of diet, obesity and lack of exercise. It uses up about a third of the health care budget in the Navajo Nation and for the most part can be prevented... But not always. Yesterday one of my fellow Pediatricians felt faint and weak in the middle of the clinic day. An alert nurse brought him into the treatment room and ran some fluid into him by vein. Even after all the fluid his blood sugar was 550(less than 120 is normal). The guy had never been sick and was not overweight. It is still difficult for me that he has diabetes as he is my age and in good shape. So diabetes can strike anyone. We all share in the problem through the lives we lead or the health bills we pay. The good news is that it is very treatable and most can avoid the complications of the disease. Even as a Pediatrican or should I say especially as a Pediatrician I can do much to avoid the disease by working with families to change diet and lifestyle. Today I am in Albuquerque enjoying my first latte in six weeks and the life of the "big" city. It is quite the cultural shock with stores of all kinds, restaurants, and the noise. I never realized how noisy a city can be after so much time with only whistle of the wind. I will join my brother shortly who I have not seen since last year.

Uranium Mines

A few days ago I was out exploring and came across some old cinder block buildings in the middle of the desert near a cliff. There were a few "Keep Out" signs which for me has the exact opposite effect. There was a lot old steel and metal equipment that had not been used for many years.  I thought it was some sort of a mine and thinking gold I did some further exploring.  I found nothing especially unusual and went on my way.  The next day I asked about it at the clinic and I got "Oh you mean the old URANIUM mine".

In the late 1940s through the 50s there were about 400 uranium mines started in the Southwest.  All now have been abandoned.  Many Navajo worked in the mines and many today suffer from high rates of lung cancer or have already died.  Only recently did the federal government begin to clean up the sites and pay reparations to the miners and their families.  Most  who worked the mines and knew nothing about the dangers of radiation.  Many did not even speak enough English to know exactly what they were mining.  It is a sad tale of our nuclear past that still haunts us in the present.

I am glad I did not remain at the old mine site long.   I was told the only danger there now is from exposure to Radon. However,  if the lights go out and you can see me easily, just keep a safe distance.

Communication

One of the more difficult aspects of working in  Chinle is communication with patients and families.  It is made more challenging by the fact that for many English is a second language and the cultural divide between conventional medicine and the traditional ways of the Navajo.

Illness is often viewed in families as a spiritual weakness or flaw no matter the cause.   If one is strong is spirit one does not get sick.   This has caused many parents to bring children in with the feeling on the part of parents that they have failed spiritually.  When taking a history one has to dance around what is really going on as parents and patients are reluctant to bring up past problems or health issues.  A child may have heart disease and been hospitalized in the past month and a parent will not mention that when they bring a child in with a fever. A  common feeling is that a good doctor will know what it wrong without knowing all the facts and even without examining the patient.  After all, the spiritual healers do this all the time.

With each patient and family I work hard to bridge the cultural gap.   I try to establish some common link I might have those I see.  I ask about other family members and where they live. Still, I find at times the reserved nature of those I see a bewilderment. After working  with the Afro-American community where being expressive and revealing information is almost an art form the Navajo are quite a contrast.   I do at times miss all the information and stories that I was told by my families in Northeast Portland. It is even more fascinating that some of the favorite television shows and movies for the Navajo are about Afro-Americans.

My Backyard

This is my backyard.  Only about five miles to the west of my apartment are these incredible sandstone formations.  Today during a windstorm I went exploring these formations and the canyons around them. These were quite spectacular rising almost 1,000 feet above the valley floor.  I rode my care as close as I could and prayed I would be able to drive out again as the "road" was not even worthy of a jeep. I had visions of someone finding the car and wondering where in the large expanse of sandstone some stupid doctor got lost. I did have my cell phone and knew I could always call my daughter in Poland for help.

I felt like I was in some futuristic movie like "Planet of the Apes" as all I heard was the wind and all I saw was the tumbleweed and sand.  I went up canyons with walls that blocked out almost all the light and squeezed through passages that would have made Twiggy squirm. Alas, Charlton Heston was nowhere to be found and I did not see the Statue of Liberty buried anywhere.  I will be back again some weekend when the weather is better and the time to the do the canyons justice.

Puppies

Yesterday while going on my run over the mesa in back of my house I came across two puppies sitting on the side of the road miles from any dwelling. I am sure they were left there by someone who could not or did not want to care from them any more. They were only a few months old and it broke my heart to see them there alone and without food or water. On my way back about thirty minutes later they were gone. I drove up there to the spot where I had seen them and could not find them. Perhaps a coyote got them or maybe they were picked up by a passing car.

Abandoned and feral animals abound here. There is no animal control officer and the local culture believes in letting them be. If they are smart enough to survive on their own than so be it. There are many, many, feral horses that are somewhat like civic pets. People will leave out food for them to supplement the grass they eat. With goats, sheep, and a few feral pigs there is almost a mini zoo in town. I have heard the mountain lion come down from the highlands to feast on the varied diet of Chinle. I cannot forget the puppies though. There must be a better way than simple abandonment. The Navajo have a love and respect for animals so there should be a solution that is consistent with the Navajo Way and humane to the animals.

Dedication and Retention

The Pediatricians I work with are a great group of people.  The have come out here to one of the most isolated spots in the lower 48 to deliver top quality care where the need is great.  The core group of Pediatricians are all young (at least relative to me) and within a few years of leaving their Pediatric Residency.  Coming here gives them an opportunity to practice a very broad spectrum of Pediatrics from the inpatient practice of sick children to the outpatient practice of well children who need immunizations. The Indian Health Service guarantees a good paycheck with a relatively low cost of living. It is an exciting practice at times with many sick children rolling into the emergency room and one does a lot more the average Pediatrician in Portland. I great admire and respect my fellow Pediatricians, especially the lead Pediatrician who is a woman who is headed to bigger and better things.

The down side is that living in Chinle is hard on the Pediatricians and other practitioners who do not have roots in the community. There is little intellectual stimulation nearby, little recreation opportunities, and not much shopping.  The hardest area for young physicians is the lack of opportunity to meet and romance other people. There are no sports clubs, book clubs, and cultural activities to meet others. There are very few active churches except for the LDS church in town.  There aren't even any bars. (Not a bad thing in my mind.)  Many of the young people feel isolated so after a few years move to large cities where they meet others with interests similar to their own.  I am not sure what the Indian Health Service can do to change this trend of people moving on after a few years. I love the mutton stew, the Navajo tacos, and the local color but I can so how it would wear thin after a few years.

Rollover

Last night there was a rollover accident outside of town where a family of five was traveling at three in the morning.  No one was wearing a seatbelt or in a carseat.  The parents were ejected out of the vehicle and the children were found in the car.   The parents died shortly after the accident.  The children were all injured with broken bones and multiple trauma but most likely will all survive. Unfortunately they are now all orphans.  This is a part of my job I do not like.

This is all to common an event in the Navajo Nation. We as physicians are partly to blame for not asking each and every time we see a family if they are using a carseat.  We supply every tribal member with a car seat when they leave the hospital. We get cooperation and help from the tribal police who will pull people over when they a child bouncing around in the car when they should be restrained.  Unfortunately some people feel it their right as citizens to refuse to wear seatbelts or use carseats.  I wonder where are the rights of the children who will now grow up without parents because of the carelessness of those they trusted.  Who will be there for their first date or their graduations?  This is really not a Navajo problem but a problem for us all.

The good thing is that the community comes together in events like this and relatives are quick to take the children in and support them. The "It takes a village to raise a child." is nowhere more true than in the Navajo Nation. For my part I will do what I can as a Pediatrician to make sure this does not happen again.

McMutton

 While visiting Window Rock, capitol of the Navajo Nation, I noticed short sleeve shirts for sale with the McDonald emblem and "McMutton" on the shirt.  A few years ago the local McDonalds in a bow to the Navajo had McMutton burgers for sale.  The burgers made from old sheep were not very popular and the burgers were dropped quickly.  However, the shirts persist and are even a source of pride to the Navajo.

The Navajo cuisine is famous for Navajo Tacos and Indian Fry Bread but what really sets the Navajo apart is mutton,  Mutton is sheep older than two years and can be quite strong tasting,  The sheep to Navajo is what the buffalo was to the plains Indian, the camel to the Bedouin, and the horse to the cowboy.  A sheep is killed for feasts, to celebrate, and just to survive.  The wool makes the famous Navajo blankets.  It is as much a part of Navajo culture as the language. Almost every family keeps some sheep.  Liking the sheep is one thing, using its wool another, but eating mutton is an acquired taste. 

I hope to cook mutton stew some weekend.   I have many recipes from the elder grandmother types around here. I've been told to open the windows and be prepared for an all day adventure as it takes a while for the mutton to tenderize to the point that is edible.  So if you are driving through Chinle in the next few weeks and you see people fleeing the doctors compound you know what's going on.

Indian Route 7

Yesterday I went to Gallup NM to go shopping and enjoy time away from Chinle. Normally the route taken over paved highway lasts about two hours. I had heard about a "shortcut" over Indian Route 7 that goes over the mountains between Chinle and Fort Defiance. It is marked on most maps although it is shown as a dirt/gravel road for about 25 miles.

So began an adventure over Route 7. Route 7 climbs from 5500 feet of Chinle to over 8000 feet at the high point. After being paved for the first 15 miles through Canyon De Chelly National Monument it turns to dirt or at this of year mud. It narrows to one lane if you can call it a lane and is rutted with furrows and thick viscous mud. It must have been created before the Spanish came on wagons because this time of year one is much better off walking through parts of it. I should have paid attention to the fact there was no traffic in the other direction. I had two voices in my head: one (the angel) telling me to turn around now before I sank into the ooze forever: the other (the devil) saying to just keep going because it would soon get better. As my wife knows well, the devil usually wins.

 Up and down I went through muddy ruts and narrow passes. My black Mitsubishi was now coated in red. After an hour of this I saw a car up ahead that was stopped in the middle of the road before a water filled 20 foot long ditch. I stopped, got out and met a nice German couple trying to decide to go through the ditch. They had been using a GPS unit which stated that this route was the shortest between Chinle and Gallup. "We don't have roads like this in Germany!" they said. However, they do have fools like myself in the USA so as they watched I backed up to get some distance and speed and went right through the ditch mud flying everywhere (I may have floated a bit). They soon followed and made it through without problem. They asked if I minded having a follower and the fool and two naive tourists continued on slowly until we hit the pavement near Fort Defiance.

Window Rock

Window Rock, about an hour away from Chinle, is the Capitol of the Navajo Nation. The major administrative offices for the tribe are located there and the tribal council meets there regularly. The tribe has a president, not a chief, who serves a specified term. The tribe is self governing and pretty much controls daily affairs of the Navajo as do our federal, state, and local governments. Just as our goverment has its critics and supporters so does the Navajo Council.

Window Rock also has a tribal museum and a small tribal zoo. Although I did not quite qualify for the zoo I did go into the tribal museum which traces the history of Navajo. I learned who Chief Manuelito was and why he was important. (I currently live on Chief Manuelito Drive.) The Chief was born in the early part of the 19 th century and first fought the Spaniards who were taking Navajo as slaves and later the US goverment who were taking the Navajo land. He had many wives which was common among the Navajo of that time as they tried hard to keep everyone related to one another through the chiefs. Unfortunately, he was unable to prevent the "Long March" where many Navajo died on a forced walk hundreds of miles to central New Mexico. (more later about that)

I do recommend a stop in Window Rock if not only for the museum but also for the sandstone formation of Window Rock. The Navajo called it "hole in the rock" and soldiers used a term for the female anatomy but I like Window Rock just fine.

Navajo and Humor

Navajo have stereotype of being humorless. This simply is not true. The difference is that Navajo are much more selective about who they share humor with. Workplace humor is rare and since there are no bars in the Navajo Nation there are no bar room jokes. Humor is much more expressed with family members and not with acquaintances. So I was very curious the other night when they had a comedy group from the local high school perform at parent-teachers night.

There were many jokes I just did not get because they involved puns in the Navajo language which I had no clue about. It would have been like me telling a joke to Navajo with Yiddish puns such a "A schlemiel, a schlumuzel, and a schlump walk into a bar and and order a drink on Pesach..... " .

The Navajo language is full of puns and Navajo like to make liberal use of it. There were a few jokes I liked such as the one about an Arizona politician who came campaigning(true story) on the reservation and started talking about why illegal immigration to the United States was so harmful to Arizona. Each Navajo looks at each other and questions, "Where was he 200 years ago?"

There was also a story about the Navajo being worried when the wind blows hard not that their car might blow into their house but that their house might blow into their car. Other jokes that night dealt with the extended families that all Navajo belong to and the wisdom of the elders.
I enjoyed seeing people laugh at themselves and thought it was great for the mental health of the community as well as being entertaining.

If a Navajo shares humor with you consider that a sign of closeness and respect and know that it is a gift of good friendship.

Gallup NM

Gallup, New Mexico is a small city of 21,000 just outside the border of the Navajo Nation. It also borders on the Hopi and Zuni Reservations. Due to its location it serves as the commercial center for the different tribe. It takes its name from a paymaster and executive of the the Atlantic and Pacific Railroad when it pushed through town in the late 1800s, not from what a horse does when you say "Giddiup".

It contains a small shopping mall, several supermarkets, many restaurants of questionable quality and most importantly a Wallymart. The Wallymart (Wallmart) is the busiest in terms of volume per square foot in the state of New Mexico and one of the busiest in the country. This is due to the fact that so many people from the various reservations do the bulk of their shopping there. On the first of each month when paychecks, tribal checks, and welfare checks are issued it is near impossible to find a parking space there. Wallmart is popular because of the few groceries that are found on the reservation and the prices are substantially lower than on the reservation. A weekend trip to Gallup is almost a tradition in the Navajo Nation.

Depending on whom you talk to Gallup is either hick quaint small town or Sodom and Gomorrah. It is the closest town with alcohol sales for all the reservations. It also has gambling and places to find members of the opposite sex with questionable reputations. It also is on old route 66 and many business employ the "Route 66" in their names. Just five years ago they changed a state highway that ran north through town from Highway 666 to Highway 491. This was due to the number 666 being associated with the devil in some New Testament writings. In fact, prior to the change it was called "The Devils Highway" and thought to be unlucky for those who traveled it.

Sleepless Nights and Barriers

The Pediatricians here work all weekend from Friday morning until Monday covering all the Pediatric services with one doctor so that the others can have a weekend off. It is dreaded by most as there are many calls into the emergency room at night to admit babies and children as well as deliveries to attend to. There are many sleepless nights.

Last night we had a snowstorm in Northern Arizona. After a week of temps in the low 70s the winds came through with snow and temps in the 20s. It was in these conditions that I would trudge back and forth to the emergency room or Pediatrics ward to see patients. Unfortunately although I found the work exciting and interesting I had a bad encounter with one of nursing staff.

To preserve privacy I cannot go into the nature of the case of the encounter but I know encounters come up, and especially with locum tenens (temporary) physicians like myself who are viewed often as second class physicians or hired guns. There are also cultural issues at play. Many Native Americans just as with Afro Americans suffer from societal prejudice and I know Native
American nurses feel the sting of this prejudice. I too feel the sting of prejudice against the Native American hospital and empathize with the Native American staff. Most had to surmount barriers of poverty and education to achieve the positions they have. Most are reminded of the discrimination the moment they step off the reservation and encounter not so empathetic people in the four corners region. We here are working for the same goal of providing quality care for children and with that thought we (Native and Non Native) can come together to for the benefit of our patients.

The Weather and Air Ambulence

Everybody likes to talk about but nobody can do anything it. Yesterday it was in the 70s here and today it is snowing. Weather changes very fast here and the winds howl when it does. The weather is so bad now that we cannot use air transport so I am stuck here in the hospital with a sick baby waiting for the weather to clear so that we can use a unit to take the baby to Flagstaff or Albuquerque. There are so many transports by air of sick people that there is a private air transport crew and airplane based here in Chinle, a town of 5000. This is due to Chinle hospital that draws from an are the size of Rhode Island but does not have an intensive care unit for children or adults. There are also a lot of traumatic accidents in the area due to the rural life style. People use a lot of All Terrain Vehicles, Horses, and power tools. Everybody has a pickup truck which is almost a necessity. Although alcohol is not allowed on the reservation and even the transportation of alcohol is illegal there are many alcohol related accidents when people drive after drinking in Gallup, NM or Flagstaff, Arizona.

Chinle is located at 5500 feet and is in a broad valley between two high mesas of 7,000 feet. The valley produces a venturi effect such as the Columbia River Gorge. Wind here is similar to Hood River, Oregon. Too bad we don't have the micro brews, trees, or water that Hood River has. We do have a lot of dust and sand so if you look sand dunes you've come to the right place. March is also the big season for the winds as changes in pressure that spring brings also bring the winds and sand. I get demabrasion treatments everytime I walk outside and I think by nose has ground down to a nub.

Trailer Life

Most people in the Navajo Nation live in trailers or double wides including yours truly. This is due to a number of factors. Trailers cost less than conventional housing is the biggest reason. The other reason almost just as important is the process needed to build a house. All the land is held in common by the tribe so it sort of a commune without the hippies. Each family can only lease the land although the lease can almost be perpetual and passed down in families. If one wants to build a house the design and location must be approved by the tribal engineers and council. The land has to be surveyed and inspected by the tribal archeologists. Finally, the house has to be inspected and then re-inspected each year. If the house is not maintained the tribe can order it to be torn down.

Trailers have none of these restrictions as they are considered "temporary". Thus, there is a proliferation of trailers. The tribe is working to reverse this by building approved developments and slowly more people are moving into conventional housing.


My trailer is not unique in that it houses feral animals. A family of cats lives under me and although shy can be noisy when they have a disagreement. It seem like the floor comes alive. I guess it is a bit better that the chickens I slept with before I got married. At least the cats sleep late.

Hair

Yah' eh-teh or hello in Navajo. I am slowly picking up words in Navajo and it is nothing like Spanish. Also different is the Navajo concept of hair. Most Navajo, men and women wear their hair long. The is due to a belief that hair emanates from the brain and is an extension of the brain and thought. To cut the hair means to lose an important part of the brain and ones self. Navajo take great pride in their hair, probably more than any other part of the body. This is why it was such a great indignity and shame when white men would take the hair of Navajo in a raid or when young Navajo boys had their hair cut in missionary and "Indian" schools'

As a Pediatrician this has created problems for me as it is difficult to tell what the sex of a child is by either the name or the physical appearance as some many children could go either way at first glance. I will often say to a child among siblings, "What do you think of your sisters?" and get a reply back, "I have no sister....Those are all my brothers." "Oops" , I say.

Well there is no doubt when looking at me and the amount of hair I have that I don't many brains left so the Navajo take all my comments with a grain of salt.

Navajo Changes

In the past 20 years the Navajo have gone through many changes. One of the biggest is in the area of housing. In 1990 on 20% of Navajo were living in a home with running water, electricity, and heat. Today the number is 80%. . In 1990 90% of Navajo live in the land of the Navajo Nation while today it is 75%. The birth rate is still much higher than the Anglo population with most women having 3.5 children. (I don't know how you can have a half a child) The numbers of people fluent in Navajo is dropping also although the majority still speak it.

The demographics of the Navajo have made the life of the Pediatrician quite busy. We have seven Pediatricians to take care of an under 18 population of about 20,000. With many people using wood stoves or charcoal stove to heat their homes there are a lot of problems with asthma. I have been in some of the homes and the interior is smokier than a New York night club. With 20% living without running water there are a lot of problems with diarrhea and food born illness. There are also a lot of smelly babies.

Now is the season of Bronchiolitis caused by the Respiratory Syncitial Virus. This disease makes up 80% of our inpatient admissions this time of year and most are under a year of age. I am in charge of the inpatient Pediatric ward this week and I feel like we have a revolving door in the unit with babies being admitted as soon as I can discharge them. With electronic medical records and ordering systems I have become good friends with Mr. Microsoft and his little windows. I wish I could spend more time with my patients and families and less time with my mouse and keyboard.

The First Laugh

There are many ceremonies in the Navajo tradition. The Navajo celebrate the first laugh of a baby with a A'wee Chi'deedloh (The Baby Laughs) ceremony. This is a great event to be shared with relatives and friends and is somewhat like a baby shower but with very important differences.

When the baby laughs it symbolizes the passing of the baby from the heavenly world to the world of man. The heavenly beings had to coax the baby into taking a human form and the lack of speaking at birth shows the reluctance to leave the heavenly family. Laughing means that the baby will soon be speaking, and laughing is the first evidence of joining the human family. The Navajo do not have baby showers before a baby is born. In fact , to speak of the baby before birth is considered to bring bad luck.

Sometimes a sheep will be slaughtered for the ceremony and people all bring food to be blessed.
Each person will take the food in front of the baby and the baby will give the persons sweets and some salt ( with the help of a parent). This is believed to teach the baby to be generous and kind, very important traits for a Navajo. After the passing of the food everyone sits, eats, and chats.

A legend holds that the baby will take on the personality of the one who coaxes the first laugh. As this is something I do as Pediatrician almost daily, I have quite a bit of success with coaxing the first laugh. Unfortunately for the Navajo in Chinle they are going to be left with a generation of children with a love for the Red Sox and a very bad sense of humor.