- The Washington Times - Wednesday, April 21, 2010

TUBA CITY, Ariz. | The hospital stands in the midst of a world of traditions: of Hopi clowns dancing around centuries-old villages, of Navajo elders tending their sheep, of customs as ancient as the winds that buffet the mesas and desert lands that stretch to the horizon.

And so, at this center of modern medicine on the 27,000-square-mile Navajo Nation, it’s not unusual to see American Indian medicine men attending the sick.

They might perform ceremonies to rid patients of bad spirits or offer song and prayer in blessing a room where someone has died.

Moving between the two worlds is Dr. Joachim Chino. A Navajo-Acoma, he grew up on the reservation, where the practices of medicine men often came first. He is well aware of how the cultural beliefs of his patients can affect what he does.

Dr. Chino, 37, is chief of surgery at the Tuba City Regional Health Care Corp., a major medical facility on America’s largest Indian reservation. He often avoids eye contact as he consults with his patients. And unless he is asked directly about the chances for survival, he doesn’t say.

Strongly held Navajo cultural tenets do not allow directly linking a person to an illness and its consequences. To do so could be interpreted as wishing harm. “It just delays their fear — not mentioning death and dying specifically in their situation,” Dr. Chino said. “I think it’s helpful.”

But cultural deference goes only so far, he said. Ultimately, “it’s just like going to see any other surgeon.”

That’s as it should be, said Navajo medicine man David Begay. Patients seek medicine men for encouragement and to restore their spirituality, but they also must put faith in modern doctors.

“Any way to get healed, any way to get help, I think that’s the ultimate thinking here,” Mr. Begay said.

Bridging the cultural chasm between physicians like Dr. Chino and traditional healers is seen as essential for improving care on tribal lands, where hospitals and clinics struggle to keep doctors. It is the oft-expressed hope of Indian elders that their talented students will leave the reservation to get an education, then return to help the people.

Tucked into the larger health care reform passed by Congress was reauthorization of the Indian Health Care Improvement Act. The bill addresses recruiting and retaining physicians and other care providers, including mentoring programs, workplace support systems for Indians in the medical field, and increased attention to scholarship and loan programs.

In the fall, a record nine American Indian students were admitted to the four-year program at the University of New Mexico School of Medicine. The gains in recruitment are small, given the program’s 300 students, but meaningful with the university’s proximity to Indian populations and its vigorous outreach.

The top American Indian and Alaskan Indian students are courted by the nation’s most prestigious medical schools. Those enrolled last fall, 623 nationwide, made up less than 1 percent of the 77,000 total medical students, according to the Association of American Medical Colleges.

University officials say the biggest barrier to getting more tribal members to pursue careers as physicians is persuading them to leave the reservation. American Indian physician role models can help.

Missy Begay, a young Navajo woman and second-year medical student at UNM who is not related to Mr. Begay, was in high school in northwestern New Mexico when Dr. Chino visited to encourage students to follow his lead. “He seemed just really passionate about what he was doing,” she said.

At UNM medical school, Miss Begay — the daughter of another UNM medical school graduate and the granddaughter of a medicine man — was prepared for the potential clash between cultural tradition and Western medicine. The first-year anatomy class, which calls for dissecting a cadaver, can be challenging.

Navajos are told to stay away from dead bodies and from burials. Miss Begay said her community at home conducted ceremonies to prepare her for the class. Her elders understood that the bad parts of taking the class would be outweighed by the good of her becoming a doctor, she said, and so they were willing to help her even though it pushed her further from tradition.

Although Dr. Chino has fulfilled his commitment to the hospital under an Indian Health Service (IHS) scholarship, he chooses to remain in Tuba City. The equipment at the hospital is not state of the art, and there are no private rooms.

American Indians and Alaskan Indians are three times more likely to die from diabetes, have a life expectancy of nearly five years less than other Americans and suicide rates twice that of the general population, according to the IHS.

Diabetes is the No. 1 condition treated at Tuba City along with its complications, including renal failure, vascular and heart disease and strokes, said chief medical officer Alan Spacone. Alcoholism, diseases related to uranium mining and contamination, and crash injuries sustained along the reservation’s poor roads also are prevalent.

The hospital treats an average of 320 patients daily. Sixty physicians are associated with the hospital, including five who are American Indian.

The Indian healers and physicians are hardly ever in the same hospital room at the same time and do not typically consult.

One exception is birth. A medicine man might be performing a ceremony to ease any complications and establish a foundation of beauty, harmony and strength for the baby. Meanwhile, a medically trained midwife is checking on the mother and may deliver the baby before the ceremony ends.

Family members might request the placenta and umbilical cord so that they can be buried on the reservation, establishing the baby’s residency and reaffirming a tie to the land.

Minor conflicts do arise. The most traditional of patients, for example, might not immediately schedule follow-up appointments as instructed by their physicians if they’ve had a ceremony with an Indian healer who has instructed them, for example, not to cross water. But, said Tanya Riggs, the hospital’s performance improvement director, they do return.

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