After a long and grueling drive down from Greeley, Colorado to Whiteriver, Arizona (about 12 hours), I was greeted with tall pine trees, cool mountain air, a multicolored sunset, towering cliffs, and distant tree-covered mesas. I was reminded once again that Arizona is more than a flat, arid desert with spiky green cacti. Only minutes before arriving, I even drove by some large blue lakes, painted aspen groves, and a cluster of wild horses. It wasn't difficult to understand how sacred this land is to the Apache tribe- I instantly felt grateful to have the opportunity to live and work in this space.
The emotions were mixed, however. Though I had lived in Arizona for more than 8 years, it didn't feel like I was "coming home;" instead, it felt a bit foreign. As I drove through the tribal land, I found myself contemplating why I chose to come here in the first place and what I hoped to learn during my time here. No, I still haven't figured out the answers to these questions, but perhaps in a few weeks I will have some answers.
My first day was mostly filled with orientation- meeting new people, learning my way around the hospital (known as Whiteriver Indian Hospital, a subset of the larger Whiteriver Service Unit), learning how to navigate another EHR, etc. Among the most interesting things I learned about the White Mountain Apache are: there are about 17,000 tribal members in total. The entire area, however, also includes people from Hopi and Navajo tribes, though these tribes make up a much smaller portion. The Apache revolve around a matriarchal system, where one's clan or kinship system is passed on from the mother's side. The four clans are: bear, butterfly, eagle, and roadrunner. What significance these animals have I still have yet to learn. An individual's upholding of native traditions and assimilation to the surrounding American culture is quite heterogeneous among the Apache, differences largely noticeable among younger and older generations and among those who have lived outside the reservation and those who have not.
For example, it is common for Apache people to not use direct eye contact when engaging in conversation, especially when interacting with those older than you. I noticed this today as a patient and her partner looked and talked toward the ground the entire postpartum visit. I was prefaced ahead of time that to many of the Apache, it is disrespectful to look into another person's eyes- I was instructed to focus on one's ear or forehead when it was apparent that the patient was not maintaining eye contact. This isn't true for everyone, however, especially most of the hospital staff. I was grateful that I was made aware of this ahead of time, or I might have jumped to conclusions. In our medical culture, we are taught that avoidance of eye contact is associated with difficulties with social interaction and autism spectrum disorder. In the Apache culture, one is taught that to avoid direct eye contact is to show utmost respect for the person with whom you are speaking. How easy it would be for a misunderstanding of one's culture to affect the doctor-patient relationship.
I learned that in Apache tradition, women carry their newborn infants on cradleboards. I embarrassingly admit that when I first saw these beautifully crafted "baby carriers" hanging on the wall of the birthing center, I thought they were oversized shoes (or old-fashioned snow shoes). I was taught that a baby is placed in the cradleboard, sinched tightly with the lace straps on either side, and carried around like one carries a lunchbox (not on one's back, as I mistakenly assumed again). I have attached a photo of a cradleboard below.
I also learned about the Sunrise Dance from a patient today- a dance to signal the "coming of age" of a woman in Apache culture. I likened it to the Mexican Quinceañera in my mind. Traditionally, this is a multi-day event celebrated by many people, the greater "family" of Apache, to help welcome a girl to womanhood. The physician with whom I was working asked the patient if she was going to have a Sunrise Dance for her daughter- she was unsure. In the early 1900s, the Apache began to be introduced to outside religious presence, initially in an effort to encourage Apache Indians to assimilate and relinquish native practices that did not conform to those of Christianity. The patient when on to explain that because her daughter attends a Lutheran school, that if she chose to have a Sunrise Dance for her daughter, her daughter would be required to leave the school for good. She went on to explain that she is a Christian as well, so this was a difficult decision. I began to feel a little uneasy being a Christian myself, mostly because I couldn't imagine how difficult it might be to have to decide between one's tradition and one's faith, and for her daughter- to have to leave one school for another if she had chosen to follow her native tradition. She stated some churches tried better to incorporate native practices within the framework of the faith- the example she gave was the local Catholic Church that used traditional Apache baskets for the tithe collection and Apache drums as people walked up for Communion. I appreciated her openness and honesty about the subject and wished I could have learned more. I don't mention this story to point fingers, but to reflect on the reality of this divisiveness. I would like to imagine a circumstance where both worlds could exist harmoniously- I think I will likely encounter this divisiveness again when balancing patients' adoption of allopathic medicine and traditional Apache medicine.
I think that's all for today!
