Monday, October 24, 2011


One of the benefits, maybe the only benefit, of having an endless list of difficult-if-not-impossible workplace problems is that there is much to write about. And, if you're unimpressed by the challenges that you might have anticipated, I can always find one that will mess with your mind. Say, for example...

Today we had a disaster planning meeting in anticipation of an upcoming statewide disaster "exercise" that will bring a very large number of complex casualties to Kayenta. I know it involves both natural and man-made badness and many, many victims. So, among the many considerations is what to do with the dead. No problem, you say, just implement the pre-existing mass casualty plan for handling many dead: temporary morgue, some cold storage, you know, the usual...

Well, no plan here. The traditional Navajo have a very different view of death, and the dead, than exists in the world outside. It's a long story, but included in the belief system is that there should be minimal contact with the dead, and that structures previously occupied by the dead should be abandoned (a challenge for a health care facility where people do die). Furthermore, it is believed that there is great power in the spoken word and that, regardless of the intent, speaking about death is likely to bring it on.

Planning ahead to handle a disaster as well as possible, even with the intent of saving lives and enhancing harmonious well-being, is viewed by some as a bewitching likely to cause great harm.

So, it's an ideal setting for disaster planning. Sometimes because of the individuals involved, but perhaps more because the individuals involved wish to respect the views of the community, there has been no in-depth discussion of this topic, and certainly no resolution. So, at the meeting, the Incident Commander was happy to see a white guy in my seat and said, "we'll see what the ER comes up with". No problem, good as done...

He's actually a delightful, sharp, and funny guy who, rumor has it, is also a medicine man. I spent almost an hour after the meeting getting some private cultural schooling from him. He is very committed to traditional ideals, but has as his job the coordination of disaster response. My sense is that he finds it pretty hurtful to be considered an instrument of death by some.

I asked about using the abandoned, derelict BIA school buildings as a temporary morgue, but apparently one of the reasons they are abandoned is that the lead paint lead abatement program was too expensive, so lead toxicity may rule that option out. Just another day at the office...

We had the biggest laugh over his description of some of the plans previously suggested by white people. These included storing bodies in the refrigeration units of local restaurants and schools. Out here, I'm thinking this would be a poor marketing strategy for the restaurants and would be unlikely to help with school attendance.

The death plan was only one of several new adventures today, but it's a hard to top that, so I'll sign off.

Tuesday, October 18, 2011

Just a pleasant quickie

Well, back in Kayenta again for a 2 week stint. Have spent day 1 and day 2 of the week mostly in new employee orientation, a mostly soporific and tedious ordeal, created with good intention, but clearly executed primarily to fulfill the requirements of the Policies and Procedures manual and the Joint Commission. Could the time be better spent? Well, off the top of my head, I can only think of about a gazillion things that would be more useful....

Not all time was spent listening to the presentations by every conceivable department, and then some - I was called out many times to address different whack-a-mole manifestations of a physician staffing problem that came up in the ED, but I'm still sorting that out. I'm confident that it will still be popping up tomorrow - yes, there is another half day of orientation also...

So, I did the only reasonable thing - returned to my modular home, grabbed the camera, and headed out for a quick sundownish scamper. Since both past and future posts are, and will be, often filled with stress and challenges, I decided to just send a few images from a warm, late afternoon near the Toes.

The way I see it, this is orientation. One of the few really helpful presentations today was about Navajo culture. Included was an overview of the direction, location, and spiritual importance of the sacred mountains that define the nation. Can't quite see them from here, but still very nice to climb up and try.

Also remarkable to go only a short distance from the Health Center, with all of its challenges and evidence of the ways in which the lives of people have gone wrong, to find immediately why they believe in the spiritual power of the land and why they draw strength from it.

Be well.

Tuesday, October 4, 2011


Well, it was the 50th Kayenta Monument Valley High School homecoming week this week, culminating in a 44-6 Mustang ass-whoopin' over the Tuba City Warriors in football. The highlight of the week was the annual parade which, much to the dismay of tourists en route to Monument Valley, resulted in the complete closure of the only highway through town for the 1 1/2 to 2 hours of the parade (followed by a lengthy bumper-to-bumper traffic jam of the delayed tourist cars, campers, and motor homes).
Candy-laden kids awaiting the next toss
The locals lined the entire 2 1/2 mile parade route and were treated to a fine show, including a small marching band, several groups on horseback, high school class royalty couples, and many floats ($1000 prize for best float) and other conglomerations. In a non-nod to the current obesity and diabetes epidemic in Native Americans, most parade participants threw handfuls of candy to the kids lining the street. I note that the parade entry instructions included proper technique for throwing candy (throw high with the wind, low against it) and safety instructions. In a community where many still ride around the rez unrestrained in the back of pick up trucks and kids very often sit on parents' laps without seat belts, it's no surprise that the rules were a bit more lax than one might find elsewhere.
Anti-diabetes banana trails the float
Among my favorites were the FFA float (KMVHS has the nation's largest Native American FFA program), and the diabetes prevention float (complete with banana costumes adorned with Navajo decoration). As another indicator of my tight department control, I was surprised to find that there was an Emergency Department float. Who knew? This small community managed to come up with enough participants to keep 'em coming for almost 2 hours...

The night before this Friday spectacle, I enjoyed the varsity volleyball match against the Chinle Wildcats. The Mustangs also put a hurt on that opponent, sweeping them easily in three straight. Volleyball is huge in Kayenta with, I believe, 17 girls on varsity as well as large JV and Freshman teams. Big community support with hundreds in the stands and everyone's small children running about and playing on the areas of the gym surface not used for the match. It was a refreshing sports experience; people playing as hard as they could throughout the whole match without any coaches screaming at them, lots of effort, lots of smiles. It was all about the game; just the excitement and pleasure of being the ones on the court and making the most of it.

Following that homecoming, I returned to Portland for another, spending a couple of weeks home to work on many administrative projects before returning to Kayenta later this month. A great pleasure to be home, but a great challenge to get things done from afar. We'll see how it goes.

At this point you're no doubt wondering if this tale is truly blogworthy and I share your concern... Here's as much profundity as I can muster -

When lucky enough to go someplace far outside my usual world, the first impression is always how wildly different it is from home. Then as people are met, ideas exchanged, life and families are observed, and the story unfolds, it becomes no less wildly different but one starts to understand how much is the same. Conclusion: People want life, liberty, the pursuit of happiness (hopefully aided by food, clothing, shelter, security, education, health, and the rule of law), and a good parade.