No Hands

Today was the first day of Be Hopi, Be Health, round two. Since the Hopi villages are so spread out, there are several sessions of camp, which each one catering to a particular area. This group of kids seemed equally as a charming as the last.

We took the campers to the same historical site as last time (Awatovi), but there was a different guide showing us around. It was nice to hear another perspective on the destruction of the city, and I'm starting to think that this is a litmus test for Hopi religions. The Christian Hopis tend to frame the story as a Sodom and Gomorra redux. The city was destroyed because its residents were living in sin. Period. The traditional Hopis seem to imply that the city was destroyed because it had sold out its sister cities by accepting the Spanish, and adopting their religion. Two divergent takes on what is clearly a difficult subject.

After camp, I went to a second volunteer gig; I'm coaching youth soccer (I know, I was just as surprised as you). But it didn't go quite as expected. The weather was pretty crappy, and this was the first time that soccer was being played at the site that I was assigned to. I think that the combination of the two conspired against me, and no one showed. Not a one. Not even the other coach, who happens to be the former Miss Hopi. I think that once I get back under Verizon's digital umbrella, there will be a message waiting for me about canceling practice.

And speaking of the former Miss Hopi, I actually already knew her from a couple of years ago. I had been booked as the MC for the Public Health diversity talent show. That is, I was booked, until I got bumped at the last minute, so that a certain current Miss Hopi could have the job. We have an old beef. A lot of good jokes died that day.

Anyway, after I was pretty sure that no one was showing (since there was zero chance that anyone would have not seen a 6'6" white guy with a soccer ball), I called off the practice of one. And I was hardly disappointed, since I had a little panic on the drive over. I realized that I didn't know the first thing about soccer. Or coaching. And to make matters worse, I kept shanking the ball out of the field every time I tried to kick it during warm up.  It was not going to be pretty.

I got back in my car, and I went over to the other site that soccer was being played at. This site was much more established, and had been hosting the informal league for several years. There were players galore, and a ton of parents cheering and laughing on the sidelines. Seeing the grownups on the side of the field made me think about two things: 1) These are some very supportive parents, and 2) there is not much to do in this town. But the level of soccer was pretty adorable, and I'll take some pictures to show you next week.

-M

P.S. It's official, I'll be spinning some Tucson favorites on the radio this Thursday from 3-5pm. That's right, no 2am slot for this guy. You can listen online here.

Window Rock

Bonus two-fer today.

I had planned on spending the day casually nursing my post-volleyball muscles back into working condition. However, my roommate, Corinne, wanted to take a little road trip to Window Rock on the Navajo reservation, and I couldn't pass that up.

We drove east out of the Hopi reservation, and into Navajo territory. The Hopi definitely have an edge on scenery.  The drive was pretty flat until just before the site. But we did get to see some Navajo political signs, which was a unique twist on an old classic.

The entry to Window Rock has a monument honoring the Navajo Code Talkers.

I'm sure that most of you remember learning about them in history class, but they were a group of less than 200 Marines and Soldiers that used variations of their native language to convey messages ("potato" meant bomb, "tortoise" meant tank, etc.). It was extremely effective, since less than 30 Non-Navajo people knew the language at the time, and the sounds were completely unintelligible to people that didn't grow up around it. The signal officer stationed at Iwo Jima said that US troops wouldn't have been able to storm the beach without them. And although the Navajos got most of the glory, several other Native American tribes were involved in the effort, including the Hopi, Cherokee and the Choctaw.

P.S. Notice the shoes that I'm wearing. That will become signifiant in just a moment.

The park is a collection of dramatic red rock spires, with the signature feature being the "Window Rock" in the background of the last photo. We knew that it was possible to climb to the top of the arch, but we weren't quite sure how. And as you can tell by my shoes, we were hardly prepared for a hike.

We saw a small trail heading around the back of the cliff, so we followed it to see if it went anywhere. With every step, we were less sure that it was the right way to go, but we couldn't see any other option. The trail dead ended at a canyon wall, but we saw a little rock pile that looked promising, so we climbed it out of the canyon. We landed on a ledge about twenty percent of the way from the top, so we still had plenty of climbing to do, but there didn't seem to be an obvious way up.  And to make matters worse, getting back down wasn't an option.

Remember, I was wearing flip-flops, and my only survival gear was a digital camera and $3.55 in cash. (Afterwards, Corinne confessed that she had seriously considered calling the fire department.)

After sitting on the ledge for a few minutes, we heard some people coming our way. It was glorious. The new arrivals turned out to be a Navajo couple in their thirties that used to climb the canyon to hide out after ditching school. But when they climbed up to where we were sitting, one of them asked where the rope was.

"What rope?!"

So, without a rope--or a way down--we shimmied up a very steep cliff. At the time, it was moderately scary, but looking back at the photos, we should have been absolutely terrified.

Mom, you probably shouldn't look at this.

This was the cliff face that we climbed up.  For scale, see that spec of a person in the top right?  That's me!

But as always, the views were spectacular.

There was a group of Japanese tourists sharing the rock with us. Clearly, they found the right way up.

The tribal headquarters is at the base of Window Rock. Some of the buildings blended in nicely, but putting the tribal body shop at the base of a world-class natural structure was an interesting decision.

The area surrounding Window Rock has a few fast food restaurants, so we pulled over for a quick milk shake on the way home. When you've spent the last two weeks eating Trader Joe's boxed dinners, McDonald's doesn't seem quite as unappealing. I'm not proud.

And it's back to "work" tomorrow!

-M

Rez ball

I had the good fortune to be invited to a volleyball tournament on the reservation this weekend. Or should I say, I had the good fortune to be tall? The volleyball invitations tend to follow that.

The homemade court was just outside one of the several small villages that was set up by the Bureau of Indian Affairs in the 1960s. These villages of totally climate-inappropriate tract houses were set up in an effort to entice the Hopis off of the mesas. The early BIA agents thought that pulling the Native Americans away from their ancestral living areas would disconnect them from their traditions enough to start the insidious homogenization process. This was the same thing that the Spanish tried 400 years earlier, to similar effect. The Hopi culture is incredibly resilient, and has stayed mostly intact, despite the centuries of outside pressure. In the 1970s, the BIA finally changed its philosophy from one of assimilation to one of cultural support. At that point, the Bureau gave control of the housing authority over to tribal officials, and these ground level villages slowly started to transform themselves into more traditional living arrangements.

But I think that we were talking about volleyball.

The tournament was Friday night and all day on Saturday. It had a decidedly block party-like feel to it, and attracted teams from throughout the Hopi reservation and surrounding villages. It was a fundraiser to send one of the tournament organizer's nieces to the Midwest for club basketball Nationals.

The competition was surprisingly intense. The Hopis are not known for their hight (which was probably why I was invited as a ringer), but they definitely made up for it in strength and tenacity. Their culture has developed around long distance running, since this "moccasin telegraph" was their only method of delivering messages between all of the distant hopi villages. Running is still a big part of daily life here (there are community 5K and 10K runs on most weekends), and although obesity and diabetes are pervasive, there is still a decent percentage of the population that is in very good shape--which I found out. I could barely get out of bed today.

The gameplay went on all day, with the occasional break to chase a rez dog off the field.

Our team is below. We came in third place, and considering the competition, I'm pretty happy about that.

The woman on the far left is my coworker at the health care center. Her name is Samantha, and she runs the Health Promotion and Disease Prevention office. She is also in charge of the summer camp that I helped out with last week, and is directly responsible for the breakfast burrito fiasco. Her husband is right behind her, followed by one of her friends and her cousin. The woman to the right of me is the wife of one of the IHS doctors, and next to her is her niece. They are both originally from the Marshall Islands.

After the tournament, the family of the tournament organizer stuck around to celebrate his birthday. Since Sam is a cousin of his, I was also invited to partake in what could only be described as a feast. The Hopis are famously hospitable, and they also tend to have huge families. Plus, cooking for others is a tribal past time. We ate like royalty, but the nicest part was their family tradition of sharing stories about the person celebrating his birthday. I heard tales about ditching elementary school, selling crafts to tourists on the side of the freeway, and getting shot by an arrow.

[When I heard that last one, I thought, "holy crap, you guys still use those?" But it turned out that the arrow came from a mechanized crossbow that a neighborhood kid was playing with. "Ahh..."]

Another great weekend. I just wish the Hopis had more hot tubs.

I'm sore.

Today was the second day of the Be Hopi, Be Healthy summer camp. We started off the morning with a two mile fun run, and it wouldn't have been so bad, if it weren't for what was bouncing around in my belly.

The village that we hosted the camp at was right next to Tuba City, which is in the Navajo reservation. For a change of pace, one of the other counselors took me "across the line" to try some Navajo food. I bought a breakfast burrito from a nice old lady, which turned out to be as big as she was. And to make matters worse, a Navajo breakfast burrito is apparently nothing more than corned beef and potatoes, wrapped in a huge piece of fry bread. It sat a little heavy. But, boy, was it tasty!

The village that we ran through was Moencopi. It is a pretty traditional Hopi village nestled in a beautiful canyon.

I know, right?! My head was sideways for the entire run. I almost forgot about the burrito...between burps.

(P.S. That's not my photo. It's one that I downloaded from Hopi.org. The website's innocuous name seems to be hiding the fact that it's hosted by a Christian ministry that is trying to convert the Hopi. I don't like that. Let's hope that they Forgive me for stealing their photo.)

We spent the rest of the morning doing kiddie aerobics. (Kiddie, my ass, by the way; I'm exhausted!)

This next photo's worth clicking on.  She's pretty adorable.

If you look closely at that last one, you might spot someone who is a bit too big for those scooters.

After lunch, we tried our hand at some craft projects. Who needs macaroni necklaces when you have buckskin paintings?

And I don't was to brag, or anything, but I think that I'm catching on pretty quickly!

By two or three o'clock, all of the kids (read: counselors) were starting to get pretty exhausted. Good thing we scheduled a couple of community health workers to come in and do some diabetes education. Diabetes is a serious problem in a lot of communities, but it seems to be hitting the Native American ones especially hard. The health workers hosted an engaging conversation, and played some CDC-produced educational videos.

The videos were geared towards a Native American audience, and were a little over-the-top with their cultural competency (the main character's name is Rain That Dances), but it was still very nice to see health materials that reflect the people that they're intended for. And the message of "sometimes foods" vs. "everyday foods" was spot-on for the age group.

We wrapped up the day by taking the kids to visit the bookmobile for some story time.

All in all, it was great program, and I was thrilled to be a part of it. Besides, it provided me with what is sure to be the best souvenir of the trip.

-M

Be Hopi, Be Healthy

Counselor Myles, here.

I took the day off from clinical work to help out with a camp run by the Health Promotion and Diabetes Prevention office of the health care center.  It's a two day program that serves the double purpose of getting kids active, and teaching them about their cultural history.  Today's activity was a hike through a protected ruins site.  It's normally pretty difficult to get a permit to explore them (since the Hopi are justifiably tired of people pilfering their artifacts), but an exception was made for the camp.  Needless to say, I'm one of the lucky few bahanas (Hopi for gringo) to get to see them.

The former village that we vistited was known as Awatovi, and has a pretty interesting history.  It was one of the original Hopi towns (circa 1000 AD, pop. 5000), and had distinct trade, defense, and farming advantages.  Because of that, it was also one of the first villages that the Spanish took over in the 1500s.  It regained its independence during the Pueblo revolt in 1680, but re-swore it's allegiance to the king in 1692.  This decision did not come easily, but the Hopi are a very peaceful people, and they didn't want a fight.  However, the people that did not want to see Awatovi suffer another long period of oppresive Spanish rule left the town to live in other nearby villages.

These Awatovi ex-pats fomented enough antipathy against their Spanish-obeying, Christianity-converting former home that the other villages teamed up to burn it to the ground.  In a particularly heinous attack, the other Hopi villagers killed most of the men, and sent the women and children to live in other towns.  This is a particularly dark episode in Hopi history, and one that stands out as an extreme anomaly.  Again, the Hopi have normally proven themselves to be an extremely peaceful people.  My best guess is that the relentless attacks from the Spanish (both militarily and culturally) finally pushed them to snap.

Here's all that remains.

On a much lighter note, the kids spent the rest of the day exploring nearby mesas and gathering various items in a scavenger hunt.  As an interesting cultural side note, there was no "winner" in this scavenger hunt.  Every group that completed the hunt got a pat on the back, regardless of whether they were first or twenty first.

Can you tell which one is me?

I also swung by the radio station today to say hi.  It's a tiny operation, and everyone was very friendly.  They even let me hang out in the booth for a bit to get a feel for things.  I'll probably go on the air next Thursday.

-M

Radio Free Hopi

This is cool.  The community radio station up here was just awarded a grant to develop a live stream over the internet.  You can listen live here.

I'm currently talking with the radio station's manager to set up a time slot when I can guest DJ.  I'd love to share some great Tucson music.  If it works out, you'll be the first to know.  There is also a weekly call-in show hosted by one of the IHS doctors that discusses various health topics.  My people are currently talking to her people, as well.

I've volunteered as a camp counselor tomorrow for the Be Hopi, Be Healthy summer program, and I'm pretty excited about that!  It's a mix of cultural enrichment and physical activity for the local kids, and I think I'm looking forward to it as much as they are (if not more)!  I'll post about it tomorrow.

-M

Rocks, no ropes

I need to get a few school things done this weekend, so I'm going to have to stay in town. However, not one to waste an oportunity to get outside, I spent the morning exploring the mesa in front of my house.

It sure looked a lot less steep from far away. Once I got started, I realized that it wasn't going to be easy. And I didn't tell anyone where I was going.

At one point, I got stranded on the wrong side of a decent-sized slot crevice, and I was going to have to make a pretty terrifying leap of faith to get across. So I coached my testicles back out of my stomach, and I went for it. Of course, looking back at the photos, the crevice really wasn't that big. But at the time, it seemed enormous. I'm a little embarrassed to show you the photo.

Ok, fine.

This is me at the top. Don't let the face fool you, I was pretty ecstatic that I didn't kill myself.

The view from the top--as it almost always is--was worth the climb.

The top of the mesa was surprisingly green, for essentially being a huge pile of rocks. However, the rocks were soft enough that trees could actually burrow their roots in them (this also made the rocks pretty easy to crumble, which was part of why they were so scary to climb).

Of course, getting down after a hard climb is no picnic. But there weren't any hang-ups. Except for the horse that was staring me straight in the face when I got to the bottom. Apparently, I had accidentally descended right into a large horse corral. The horse, as most horses are, was plenty gentle, but I still don't trust them (see: here, here, and to an extent, here).

Now, it's time to cook some lunch, and get cracking on the school work.

-M

Nurse Gail

I was scheduled for the prenatal exam clinic today (Friday), but things were pretty slow. To pass the time, I started some small talk with Gail, a Navajo Nurse in her 60s. She asked me where I was from, and I said, "Tucson." I asked where she was from, and she spent the next twenty minutes describing one of the most interesting childhoods that I have ever heard.

She told me that she spent 2nd through 7th grade in a boarding school, but didn't dwell on that for very long. Her reluctance to talk about it was probably because she was sent there against her will. Our country has a long history of sending Native American children to distant boarding schools, far away from their people, their land, and their language. Out of a misplaced sense of charity, the US Government made a practice of rounding up children, and taking them out of the hands of their "uncivilized" parents. In Nurse Gail's case, this resulted in generations of Navajo children unnecessarily bouncing around the child care system.

[I want this post to focus on Gail, and not US history. If you'd like to know more of the backstory on Native American boarding schools, check out this short piece by NPR. The key phrase: "Kill the Indian...Save the Man."]

After 7th grade, Gail returned home from the boarding school, only to find out that her parents had signed her up for the Mormon Church's foster home network. She knew that this happened in seventh grade, because she could remember where she was "when Kennedy was shot."

Something about that last recollection caught me off guard. At times, it's pretty easy to feel like I'm in a different country (because on some levels, I am). However, events like the JFK assassination are big enough to transcend our separate histories. It's not about the Navajo story, the Hopi story, or the story of the many consecutive waves of immigrants. It's about the American story, and we need to remember that we're all in it together.

But back to Gail's story. In seventh grade, she got on a bus to Utah, and was taken in by a series of Mormon families. Gail's stories of the Mormon foster homes took a very familiar pattern. A nice family took her into its home for a few years, until the host parents went back to college, moved to California, etc. But what struck me the most was what she did for work during that time. She described a farming system that would send busses to the junior high on the weekends, and pick up any child that wanted to work. The busses would drive out to the farms, and drop the kids off for a full day of picking crops. Harvesting sugarcane was alright, but picking potatoes was torture.

The most interesting job story, however, came from her time in the Butterball turkey plant. As she describes it, the boys would go up into the mountains, and bring back the live turkeys. Each kid in line would kill, de-feather, or prep the turkeys. Gail's job was to remove the gizzards. She described the process in full detail, even acting out the turkeys' clucking as they went through the machines. Good thing we didn't have many patients today.

Kind of puts "Tucson" in perspective, doesn't it?

-M

Nice old ladies, pliers, and testicles

I wasn't planning on writing today, but each day gets crazier than the last.

I woke up in a surprisingly somber mood this morning, and I think that a lot of it was due to yesterday's unsuccessful delivery. That stuck with me a lot more than I thought it would. However, I talked with the doctor that went with her to Tuba City, and everything turned out fine. The biggest concern, of course, was that she would deliver in the ambulance. But, thankfully, that didn't happen. She actually delivered vaginally when they arrived, which was a big surprise to everyone involved. The one hour ambulance drive either relaxed the mother-to-be (or jarred the baby) enough to shift everything into place.

My first patient of the day was a nice old lady who came in to the ER with swollen legs. I was convinced that it was a pulmonary embolism, a deep vein clot, or something equally serious. Then my attending physician came in, looked her over, and told me that this was a nice old lady with swollen legs. Motrin should do the trick. Apparently, not everyone who comes into the emergency room is suffering from an actual emergency. Who knew?

The next patient was a woman who stubbed her toe. ER. Stubbed toe. I was sure that this was someone looking for some free narcotics. I was way wrong. Here's how our conversation went.

Me: "Hi, how are you doing?"

Her: "Well, my toe is killing me."

Me: "I'm very sorry to hear that. There's not much that we can do for a broken toe, though. Would you like something for the pain?" (Knowing full well what the answer would be.)

Her: "Not really" (Huh?) "Could you just remove the toenail?" (Double huh?!) "Oh, and I have to be back at work by 4" (Where's the hidden camera?)

I did not see that one coming. However, both sides of the woman's toenail were so ingrown that they nearly formed a circle as they wrapped around. The upward pressure from the bruise under the nail must have been excruciating. So I told my attending, and we got the toenail kit.

The toenail kit was essentially a small spatula and a pair of pliers. The spatula went between the toe and the nail, and the pliers did exactly what pliers do. I nearly passed out.

The afternoon was spent giving school sports physicals to teenagers. I had to ask a kid to turn his head and cough today, and believe me, it is no less awkward being on the other end.

Let's see what tomorrow's got in store.

-M

Doctor

Today was my first patient care day, and it was a doosie. Two broken bones, a well baby check up, a stool sample (quite runny), gangrene and an almost-delivery. And most of that was before lunch.

The day started out with the usual 8am grand rounds, where the inpatient doctor (aka the hospitalist) goes through all of the people that are currently staying overnight in the hospital. It's a small facility, so that's rarely more than three or four people. After that, all of the doctors (maybe six or seven), broke off into their assigned departments. I was in the ER for most of the day.

When I arrived in the department, there were already a few patients waiting, so we had to hit the ground running. Most of the cases followed a similar format. My boss doctor (the attending) would hand me a thick paper chart (usually that days notes that hadn't been entered into the computer yet, plus a paper summary of what's in the electronic medical record). He gave me a quick overview of why the patient came to the hospital, then he introduced me to him or her, and left me to play doctor. It was similar to practice cases in med school, but it actually mattered this time. It's a whole different ball game when the real doctor is counting on your information to make a real diagnosis on a real patient.

My role would generally be to interview the patient, perform a quick physical exam, and report back to the doctor. Since the staff is usually pretty busy, they count on medical students to cut down the list of possible diagnoses to two or three. This allows them to have more meaningful interactions with the patients, since they already have a pretty good idea about what they're looking for.

There's a saying that rural medical teams live up to the full capabilities of their licenses. And that couldn't be more true. Medical students, nurses and doctors all operate at the peak of their capabilities, since there are no specialists or back up staffers to toss patients off to. Long story short, I had tremendously more responsibility than I did just a week ago. It's a little empowering, and a little terrifying.

But back to the patients. My first one today was a shy, half Navajo, half Hopi teenager that injured her hand playing basketball the day before. She was very pleasant, but was clearly in a lot of pain. It was my job to walk the fine line between a detailed exam, and bringing her to tears. I think that I did alright for my first time, but she may disagree. It turned out to be a small fracture below her thumb, so we splinted her, and asked her to check back in next week.

The next patient was a huge firefighter that had injured his ankle in a traditional dance over the weekend. The exam routine was the same, but I was WAY more hesitant to push my luck in the tears department. Something about his tree-trunk biceps kept me from seeing just how far he could bend his ankle.

The next patient wasn't actually mine, but the attending called me into the lab to check out a stool sample. Gee, thanks. You could tell that this was a rural family doc, when he put on a glove, and poked at the poop himself. No need for them fancy lab-or-a-tor-ies that those swanky city slickers use. [Ed. Note: There actually is a very well appointed lab in the IHS hospital, but there's no humor in that.]

The next patient was a bit more serious. She was a young pregnant woman brought in by ambulance. She was clearly going to deliver soon. Thankfully, she was being seen regularly by the IHS doctors, so they knew that she would be a minimal-risk delivery (higher-risk deliveries are usually sent to the bigger hospitals in Phoenix or Tuba City). After nearly an hour of obvious discomfort, the woman's water still hadn't broke. The delivering doctor (another family physician) manually opened up her amniotic sac to let the water drain. This relieved some pressure on the woman's cervix, but she was still fighting back the tears. She was clearly terrified.

Her boyfriend and his mother were present in the delivery room, and the patient's mother was waiting outside. I got the distinct feeling that this wasn't planned. Abortions are exceedingly rare on the reservation, but unfortunately, teen pregnancies aren't. This particular woman was sweet and shy, but she did have some large scars on her wrist that didn't look like they got there by accident. But social factors aside, the delivery wasn't going very smoothly. After two hours of painful labor, the baby hadn't moved. It still had a strong heartbeat--and the mother was doing fine--it just didn't want to come out.

The delivering doctor was worried that the patient's pelvis was simply too small for the baby to pass through. Even thought the patient wasn't that young, she was still a small woman. The doctor called for an ambulance, and with the patient's consent, went with her to the larger hospital at Tuba City. If a surgical intervention would be necessary, that facility is much more able to handle it. I hope to find out tomorrow how the delivery went.

The attempted delivery was a little troubling to participate in. But because this is a busy hospital, I couldn't stay down for long. Just down the hall, I was scheduled to give a 14 month old child it's well-baby check up. We tested for developmental milestones, checked growth charts, and discussed when it's appropriate to feed a baby honey (any time after 1 year, if you're interested). The baby was doing just fine, and since there wasn't much diagnosing going on, she was pretty squarely my responsibility. That was a nice feeling, and it was a good patient to end on. I start again tomorrow.

-M

My commute

The twenty minute drive from my house to the hospital deserves its own post. And then some. Take a look.

This first photo is of the cliff face behind my neighborhood.

And this little gem is the view from my front door.


Some more shots from the road:

This is the local high school.

And this is the police station.

Here's a Christian church. The Hopi people have had an interesting history with the Catholic, Christian and Mormon religions. I'll talk more about it later, but long story short, the majority of their people have stayed true to their traditional religion.

Back to the road:

Not a bad drive, eh?

This was an incredible first day, and now I'm pretty exhausted. More to come in the next week.

-M