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These six weeks have been a whirlwind.  I now have, not only a job for next year, I have my dream job.  I showed up in New Mexico exactly five weeks ago and bought a car on my second day here.  I knew what I wanted and planned accordingly.  In the week leading up to the residency selection, I thought,

My god, Vishnu Shiva and Brahma.  What am I doing?  I bought a car.  I jumped through hoops to register it in New Mexico.  What am I going to do if I don't get this?

But I got it.  I'm moving back to Gallup in July.

People are people no matter where you go.  I've lived in the bay area, Boston, and soon Gallup, New Mexico.  Despite the differences in geography, not only are we all human, we are all American.  But there are some interesting differences of interests between places.

For example, people in Boston like cranberries, rotaries, shell-fish (including lobster), the Red Sox, saying "wicked", and mis-prounouncing words in general.

So far, I've noticed that people in New Mexico are all about keeping their headlights on at all hours, looking at rocks, talking about rocks, biking, potlucks, large belt buckles, and anything silver and turquoise.  There is also much more of a "do it yourself" attitude out here.  I'm not sure if that is only representative of pharmacists in New Mexico, but my coworkers all like to brew their own beer, grow their own vegetables and hops, sew, and one of the pharmacists even mentioned wanting to start making his own soap.

I told him not to go all fight club on me.

I have a lot to learn about the history here.  I ask my 65 year old roommate a lot of questions.  I'm not really sure what he does.  He seems to maybe do something with park maintenance and was a pilot for a long time.  Maybe he still is one.  He was also telling me about some of the Navajo customs through his eyes.

We talked about medicine men.  He told me that he had found a religious set up of children's shoes, toys, feathers and rocks over the hill above the school that was meant to put a hex on the kids at the Rehoboth school.

He says,

You know, they're white when its better to be white and they're Indian when that works out better for them.  They come off with all this crap about caring for the land but I tell you what Marie.  You go to the res and see what they're doing with their land.  And all the crap about land ownership... jeez.  It makes me laugh.  They certainly believe it now.

Disheartening.

Gallup is on the eastern border to the Navajo Nation.  The largest reservation in the United States.  I can't say that cultures collide because the Navajo are mostly westernized today.  But if you dig a little, you most likely will be able to find some animosity on both sides.  Had history been different, the Navajo would probably have assimilated into western culture on their own.  The difference is that they were forced to.

My roommate told me that Navajo comes from the word for "horse thief".  Long ago the nation had called themselves Dine.  The people.  According to wikipedia, "Navajo" comes from "tewa navahu" or "fields adjoining a ravine".  Whatever the meaning of the word, the tribe recognizes themselves as "Navajo" today.

The Navajo also believe that if a person has something that they are not using, it is ok to take it to make use of it.  They also believe that if no one sees you take it, it is not stealing.  There are no words for "sin" and "forgiveness".

The Navajo language is not progressive.  New words are not made for new concepts of things; rather other words are used to describe the concept or item.  When I hear many Navajo translating for their grandmothers, I also hear English words mixed in.  Which isn't surprising.

The Navajo seem to have a good sense of humor about language.  My other roommate (a 29 year old male working at the Christian school) said that the direct translation of the word for "cell phone" is something like, "that thing that makes you walk up the hill".  Cell phone service is poor on the reservation.

What a culture emphasizes becomes apparent once you begin to learn the language.  I think learning some Swahili helped me to gain a better understanding of the cultures in East Africa.

At the present, I know two words in Navajo and I pronounce them poorly.  I have my work cut out for me.

Yeah Yeah New Mexico.

Its a mad house.  This modern life.


Its a mad house.  My faithless bride.


Art Star.

My god Karen O is just the best.  I recently went through another blog that had written praise about her saying she was great because her wardrobe, stage presence, and that she didn’t care about being beautiful.  I have disagree with the last statement.  It's not that she cares or doesn’t care about being beautiful.  She just is.  She knows she’s  awesome and grooves to her own tune.  I love Karen.

I drove through the Hopi/Navajo reservation to Tuba City today.  Vast open spaces.  Beautiful.  So all my interviews are done.  All I need is a job.

I was flipping through radio stations and found a native religious chanting station.  Probably Hopi.  Maybe Navajo.  Awesome.  

Even the concept of the reservation is strange.  I was talking with some of the physicians at lunch yesterday about culture and socio-economic problems of our patients.  Many of the problems mirrored the troubles of the Maasai.  There’s no work on the reservation, but people are encouraged to stay there because they get money from the government.  Unemployment is 65%.  Unheard of.

I also heard at Ft. Defiance that only 20% go away to college (ok this isn’t terrible I thought) but then only 5% of Native Americans (or just Navajo? not sure) will actually graduate.  I asked why.  My potential preceptor replied that it was geography.  For people that have lived their life only on the reservation, whose entire religion revolves around living between 4 mountain peaks, how are they able to finish college?  It is culture shock.

Was it the cure?

Hope not.

The physicians were also talking about differences in the Navajo between generations.  The older generation still has a stronger work ethic.  They wake up early to take care of the land, take care of the cattle.  The physicians opinion was that the younger generation tended to mooch off the elders.  

From what I have seen, it is very common for the grandparents to take care of their grandchildren.  There is a lot of teen pregnancy.  I can’t say right now if this has always been the case and is cultural, or if there has been a rise in teen pregnancy in the past 20-30 years.  Yesterday I counseled a girl who had come in with a toddler on her antibiotic.  She was born in 1992.  She was 18.  I didn’t ask if the child was hers.  I wouldn’t have been surprised.

In addition to the grandchild connection, through the grapevine I heard that it wasn’t uncommon for the children/grandchildren to take grandma’s check from the government every month.  This creates problems because when grandma’s meds go missing, it is GIMC policy that we can’t replace them, but we can call a script into Walmart.  Grandma replies that she can’t afford the $4 co-pay because her kids took her money.

They probably also took her pills, a doctor replied. 

The Navajo are historically not a social bunch.  Other tribes will live together in a common area with the land surrounding them.  The Navajo space themselves out around the land.  While ties to other members of their tribe may not be as strong, they have very close ties with their family members.

I heard one of my potential preceptors remarking that it was comical to hear the technicians asking for time off because some 3rd cousin was sick.  Only immediate family members.  In America, only your nuclear family matters.  

I can imagine that along with the close family ties comes the concept of what is mine is my children’s.  At the moment, I would prefer to think that children are not maliciously stealing grandma’s check from the government, but that grandma is offering it up freely.  What is hers is also theirs.

no fame

all there is 

all there was

Before my interview, I received a tour of the facilities at Tuba.  We passed through the ICU.  I asked the most common reason of admission to the ICU.

Honestly

my future preceptor replied

The Navajo have some strange beliefs about death.  It is taboo.  They don't talk about it.  They don't want to hear about it.  If someone dies, they have to burn the entire house down and rebuild.

The most common reason for people to come into the ICU is to die.

Sometimes I feel like we are more of a nursing home than anything else.  It is much easier for them to drop grandma and grandpa off here on their death bed than to have to destroy their home and rebuild. 

I thought that this was strange.  A few other people had told me of this custom of the Navajo, but in my experience, it is generally the westerner that considers death taboo and is unable to discuss it.  I wonder where this belief came from.

Modern things don’t die just stain

Try me out, find what I’m all about

and we can make some noise not like the other boys

I've also been wondering about the water quality on the reservations.  Most of my patients say they rarely drink water.  I don't know if it is in their best interest to recommend drinking more.  The taste of the water in Gallup is questionable; I can't imagine what it is like on the reservation.

Should I tell them to boil their water?  It makes no sense to suggest buying it.  

We were also talking about drug induced nephrolithiasis on Friday over lunch.  My conclusion is that the patient in question was more likely just dehydrated.  Drugs can cause kidney stones through either decreasing excretion of calcium or purine metabolism, or if the drug itself or its metabolite are renally excreted but poorly soluble.


Triamterene, sulfonamides, and indinavir are big offenders of being renally excreted but easily crystalizing in the renal tubules.


Carbonic anhydrase inhibitors, like acetazolamide, encourage formation of calcium crystals in the kidney.  Incidence of stones is up to 10%.  Topiramate and zonisamide, anti-epileptics also under other indications, also function as carbonic anhydrase inhibitors.

And baby I'm afraid of a lot of things

But I ain't scared of loving you.

Because all I see

is what's in front of me

and that's you.






for more information on drug induced nephrolithiasis, check out...

Daudon M et al.  Drug-induced renal calculi: epidemiology, prevention and management.  Drugs 2004; 64(3):245-275.

Matlaga BR et al.  Drug-induced urinary calculi.  Reviews in Urology 2003; 5(4):227-231.