Sunday, December 8, 2013

Zuni, New Mexico – A Special Place

I had heard a lot of good things, but really didn’t know what to expect upon arriving to work at the Zuni Comprehensive Community Health Center  – a 2 ½ hour drive from Albuquerque on the Zuni Indian Reservation in Western New Mexico, near the Arizona border.  I was welcomed with open arms to a beautiful community that is visually stunning, culturally unique and home to proud and amazing people.  The health center and its healthcare professionals were inspirational practitioners of healing.  They had found their calling working in Zuni and it came through in their approach to medicine and living life.  I could not have been made to feel more welcome to be part of a community and a practice of medicine.

Zuni Comprehensive Community Health Center serves approximately 10,000 Zunis and 4,000 Navajo who live on surrounding Navajo Nation reservations lands. The majority of Zunis are bilingual, with Zuni being their first language. Many Navajo over 45 years may not speak English. There are Zuni and Navajo employees who can assist with translation.  Silver-smithing is the main source of cash income and Zunis are renowned for their intricate jewelry work and fetish carving. Employment for others is through government or tribal organizations, the school system or our facility. The median Zuni family income (1999 data) is  approximately $21,000/year and approximately 50% of the population falls below the poverty level. Traditional ceremonies are the center of nearly all social activities and Zunis follow a calendar of night dances and rain dances which take place in the plaza at the center of the old village. Zuni society is divided into six fraternal kiva religious organizations, 10 medicine societies, and 12 matrilineal clans. Traditional medicine is also an important part of Zuni culture and many Zunis incorporate visits to medicine men, bone pressors, or traditional midwives along with seeking care at our facility.  

Dowa Yalanne (DY) A Sacred Mesa, a shelter to the Zuni People during their resistance to the Spanish (my wife and son)

Government Housing across from the hospital provided by the IHS
Looking out from housing to back of Zuni Comprehensive Community Health Center
Each day started with checking on any of my inpatients that I had ad
mitted on previous days and then attending morning rounds with the entire team of physicians, pharmacist, nursing, support staff, etc. to discuss admissions, transfers and a variety of patient updates.  That was followed by a variety of 2 day clinical sessions including an opportunity to participate in a variety of community/public health outreach programs.  The model of care was one in the model of family medicine where the majority of practitioners practiced the full spectrum of care including Pediatrics, Obstetrics/Women’s Health and adult medicine.  There are no ED docs and the catchment area for the Health Center is quite large so when you were the on-call physician you are expected to stabilize, evaluate and treat whatever may come through the door – a very different feeling and expectation than being in a large academic medical center such as MGH.  There is no ICU at Zuni Health Center; on average during my time there they flew out 2 patients a week to Albuquerque for a higher level of care.  In some respects the practice of medicine feels like rural medicine, but the major difference being you are part of a group practice of physicians that provide their support and expertise.  Given the close quarters of colleagues’ offices, the health center clinics and the group practice done at the hospital you always feel very supported and it fosters a sense of communication and learning between colleagues.  It certainly doesn’t feel rural or isolated to practice medicine in this environment.  There was a wide breadth of expertise and backgrounds at practicing medicine at the facility including pediatricians, family medicine and internal medicine physicians that had trained all over the country. 

Outside of work, there is an array of things to keep you busy.  There seems to always be a unique cultural event going on in the community – I was lucky enough to be in town for the annual Harvest Festival tribal dancing.  There is an array of amazing outdoor opportunities in the area including multiple national parks/monuments and the local scenery on the Zuni Reservation is also quite breathtaking.  It is the classic west with sunny days and bright blue skies where you can see for miles, filled with beautiful mesas.  During my time there I was lucky enough to make it to Sedona, Arizona (famous for its beautiful Red Rock formation and vortexes), Flagstaff, AZ (mid-size college town and base for trips to Grand Canyon) and the Grand Canyon.  I also visited friends on the Navajo Reservation and hiked Canyon de Chellay National Monument, a beautiful, sacred canyon to the Navajo.  I also made a day trip over to El Morro National Monument, a beautiful mesa with quite a history inscribed in its walls – also home to the highly recommended hang-out “Ancient Way Café”.   I only scratched the surface of outdoor activities as other co-residents made the way to Moab and many other surrounding parks in Colorado and Utah.

I leave you with an essay about the day in the life of a Zuni physician that I think illustrates the experience well.  It was written some time ago by the clinical director of the Zuni Comprehensive Health Center, Dr. Thomas Faber, a former graduate of the Harvard Med-Peds Program:
My family in front of a red rock formation in Sedona

My family and I at the Grand Canyon

Canyon de Chelly - Spider Rock; a sacred canyon and rock formation to the Navajo Indians

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