Med Ed Reform
Photo by Graham Ramsay
The silk flowers, just to the left of the entrance of the hardware store,
burst from their shelves, brassy and garrulous. They defy shoppers to walk
on without noticing their unwavering cheer. The simple white crosses on the
shelf below, in contrast, are easy to overlook.
The Navajo Reservation roads are punctuated by these small white crosses, sometimes adorned with flowers, but just as often not. The Navajo Nation has high rates of alcoholism, poor-quality roads, limited seatbelt compliance, animals that range free, and rescue services that are few and far between. Memorials have become an accepted part of life in our small town—unremarkable items among other routine necessities for sale. As a doctor on the reservation, I have become all too familiar with the ashen families gathered outside our ER door, tensely awaiting their fate.
The advent of the pick-up truck altered Navajo life forever. Traditionally a nomadic people, they traveled to fertile ground in the summer and back to the sheltering mesas and canyons for the winter. Modern vehicles offered a range to their wanderings that was previously unimaginable. Although the Navajo of today are more settled than their ancestors, many still value a willingness to go anywhere at the drop of a hat. Travel plans are spontaneous, dependent on the availability of a working vehicle and gas money.
Letanya was driving to California when, in her 20th hour behind the wheel, she crossed the median. Her three children, riding in the back, miraculously escaped injury. But unbelted, she was ejected from the vehicle and broke her neck. She was left a quadriplegic. Her husband left her before she was discharged from her California rehab facility, and she returned home to her family on the rez. A picture of her from that time shows a young, slim woman lying alone on a mattress, arms crossed and frowning slightly. The room is bare, the floor concrete, the single window naked.
As her children grew older, she began to rely on them more heavily for her daily care needs. Her two sons lifted her in and out of her vehicle because they could not afford an adapted van. They cleaned her during her menses and spoon-fed her meals. At night, after they had put her in bed, she could hear them sneak out of the house to party with their friends.
Tragedy on the rez knows no bounds. Car accidents are only the most common cause.
Gwen was the director of our Health Promotion Program and was an active community leader, initiating programs to teach injury prevention and safety awareness. She was extremely talented, one of the few who managed to incorporate a Western education into a career dedicated to enhancing and preserving traditional Navajo values. After attending a meeting in Las Vegas, she decided to make the most of the evening and began the six-hour drive home well after midnight. Police believe that she fell asleep and drove off the road. She was not wearing her seatbelt and was killed instantly. The accident occurred just a few miles from her home, and many of our staff drove past the scene on their way to work.
All Fall Down
As Letanya’s children grew older, they longed for freedom from their crippled mother. They became more troubled, drinking heavily and partying hard. I intubated the younger brother for alcohol overdose one afternoon in our ER, and the older brother became a teen father. The younger brother left briefly to live with his father in California, and the older brother drove their van to Phoenix to make a future for himself and his young family.
A few months ago, Letanya’s two sons were in a car accident in Phoenix. They had both drunk heavily the night before, but had gone to sleep and woken early to report to their jobs. Their cousin was in the back seat. Still intoxicated, the older brother drove off the entrance ramp to the highway and rolled the vehicle. He was killed instantly. The younger brother suffered only minor injuries, and the cousin was hospitalized with severe brain trauma.
Letanya was sad to lose her son, but she was resigned to SheNeill’s death, as if she had expected it all along. The community mobilized and quickly put together a funeral—an apocalyptic minister who clearly had not known her son, a potluck meal to follow, and plenty of hot coffee. And that was it—he was gone.
Tragedy on the rez knows no bounds. Car accidents are only the most common cause. One of our nurses brought a family album to work, and in her commentary, she matter-of-factly identified the friends and relatives who had passed on. No one expressed surprise or regret. It was just part of the story.
The names used in this column are pseudonyms, and the opinions expressed are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.