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