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.