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.