Wednesday, December 3, 2014

Navajo Basics History

The Navajo Indians are the largest federally recognized Native American Indian tribe in the United States. Their reservation is spread out through out the four corners of Arizona, New Mexico, Utah and Colorado.
The Navajo use the name Dine because it refers to a term from the Navajo language that means people. The first Navajo Indians lived in the western part of Canada a little over a thousand years ago. They belonged to an American Indian group called the Athapaskans. The Navajo Indian tribes began to travel south, and most settled along the Pacific Ocean. Their tribe today is called the Northwest Coast Indian Tribe.
The Navajo Indians who settled in southern Arizona and New Mexico then became the different Apache tribes. When they reached the Southwest, they began to learn a lot of things from the Pueblo Indians. They learned weaving, how to make clothing, and art. By the 1600s the Navajo had become capable of raising their own food, and making their own blankets, clothes etc. The Navajo Indians lived in homes called hogans, which were made from wooden poles, tree bark, and mud. The hogans were always made to face the east for sunlight. The Navajo Indian tribes made summer and winter hogans. The summer hogans would have one side of the home completely open. The winter hogans were built more weatherproof with mud, and partly stone.
Around 1610, Santa Fe, New Mexico was founded and became the most important town in the New Mexico colony. In 1851, the Americans built Fort Defiance, to stop the Navajo raids that took place between 1849 and 1851. General James Carleton became the commander of the American Troops in 1862. He had the plan to build a fort for the Navajo Indians and force them all to a reservation.
The fort became quite popular by the name of Fort Sumner. The Navajo Indians decided not to surrender, so by March of 1864 more than five thousand Navajos were being held by the soldiers as prisoners. They were forced to walk 300 miles to Fort Sumner in eastern New Mexico. This walk became a very important part of Navajo Nation history and is famously known as “The Long Walk.” The famous treaty of 1868 was signed giving them their own territory and freedom. Later in 1869, Fort Sumner was abandoned, and purchased by a rancher.
The Navajo Indian were hunters and gatherers until they came in contact with the Pueblos, and the Spanish. They then learned the techniques from the Pueblos and the Spanish to grow corn, beans and squash. They eventually got into trade, trading blankets they made from wool, clothing, and cattle. Navajo Indian men were the political leaders, hunters, and the warriors. The Navajo Indian women were the farmers; they tended the livestock, did most of the cooking and took care of the children.
The Navajos base their way of life on a belief that the physical and spiritual world blend together, and everything on earth is alive and their relative. They worship the winds, sun, and watercourses. The Navajo are also cautious about death, and rarely talk about it. The Navajo Indians have two big kinds of ceremonies; one is the Blessing Way, which keeps them on the path of wisdom and happiness. The second major kind of ceremony is the Enemy way. The Enemy Way is to discourage evil spirits and eliminate ghosts.
The Navajo reservation is currently the largest reservation in the United States, with over 200,000 people throughout their 27,000 acres. The Navajo Indian tribe is closely related to the Apache tribes. The Navajo Indian tribes are currently located in Arizona, New Mexico, Utah, and Colorado. Most of the tribes are still currently living in their traditional territory today. Today the capital of the Navajo Nation is located at Window Rock in Arizona. Window Rock currently contains the World War II memorial.
In the Navajo culture, shirts were not used. Men wore breechcloths, and women wore Yucca fiber woven skirts. Also, deerskin ponchos and cloaks of rabbits were worn by both men and women to keep them warm. And in the later days they wore clothes woven from the wool of sheep. In the colder weather, the Navajo Indians wore slippers that were called moccasins. The Navajos were very big into jewelry and weaving. The blankets they woven were often called Chief’s blankets because of their value. After the 1900s the Navajo silversmiths began to create Native American Indian Jewelry. Soon after, the silversmiths introduced turquoise into their jewelry making process. This process made Navajo jewelry pieces much more sought after by jewelry collectors. The primary source of silver for jewelry was American coins until about 1890. The American coins then got substituted for Mexican pesos in 1930.
The most common language spoken in the southwestern United States by the Navajo’s is Athabaskan. Athabaskan is the most spoken Native American language in the United States. Most Navajo Indians speak English because the Navajo language is very difficult to learn. The language was so hard to learn that it was used as a secret code in World War II. Athabaskan is conventionally divided into three groups based on geographic distribution: Northern Athabaskan, Pacific Coast Athabaskan, and Southern Athabaskan. Navajo and the five Apache languages are in the Pacific Coast category.

Courtesy of http://www.navajoindian.net/

Time

In many communities, time may not be as direct and concrete as in general practices throughout the U.S. “Indian Time” challenges most of us who desire to keep to schedules by the clock and some may feel that those who don’t abide likewise are lazy, unmotivated, or irresponsible. However, for many, time is relative to the events and environment of the moment and reflects flexibility. For example, there is no time component in preparation for a community ceremony or event. Instead, once everything is ready, the event or ceremony takes place and concludes when it is finished. This philosophy may carry over into the daily life of the individual with regards to his/her health so that he/she believes they will heal when it is time to be healed.

http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Medicine Man/Woman

Many tribes acknowledge individual tribal members as healers and/or spiritual leaders. In the “old days” and today, many young men fast and seek visions through practices unique to their tribe. Through these practices, a man may be chosen by his medicine fathers as a person worthy to obtain medicine objects and healing ways. In this belief, the power comes through these sources but the ultimate power is in the Creator or Maker of All Things.
These chosen individuals may be called upon by tribal members to intercede on behalf of an individual in need. Often, these practices are conducted in the privacy of the individual’s home or designated place. If an individual is hospitalized, usually the prayer will be conducted at the bedside. Information is often shared openly but to inquire would be considered rude. This religion is not practiced by all American Indians/Alaskan Natives but is a way of life for many and has been around for thousands of years.
Medicine men and women are treated with the utmost respect throughout the American Indian/Alaskan Native community. It may be helpful to ask a coworker who knows the local customs or authorities what to do when such a person is in their presence. It is always important to acknowledge and respect their importance in the community and among the people.
The service and assistance of a medicine man/woman might be sought by a patient for many reasons. Typically, this is neither something the patient will tell you nor is it recommended that a provider directly ask the patient if they are having or have had a ceremony. Depending on the relationship you have with your patient, allow them to volunteer this information. However, there might be something unusual noticed with the patient that might catch a provider’s attention. Before directly asking the patient what is going on, we would recommend excusing yourself from the exam room or waiting until after the medical visit is completed. As a medical provider, you could seek a tribal community member who is on staff to inquire of what was seen—without breeching HIPAA. As with any form of healing methods, adverse outcomes can occur. However, because the spiritual and mental impact on the patient is unknown, we should not judge negative outcomes of these alternative healing methods. If you show respectful concern, tribally affiliated staff will be more willing to assist in your understanding of their culture and methods of healing.
One of our contributing pharmacists provides an intriguing example of the incorporation of cultural beliefs and practices along with “western medicine”.She mentions,
“Many tribes have cleansing rituals prior to ceremonies. In one particular patient I have been dealing with for over 20 years, each time he danced (and he loved to dance in ceremonies) he was hospitalized for atrial fibrillation, edema, and has since developed CHF, as we would have anticipated. However, he is 88 now, and still dances twice a year, with the full fasting and preparation of herbs. He is himself a medicine man. We developed an agreement over the years, that he would substitute herbs, for his meds. My job was to tell him exactly what his benefit was from the white medicine, and he would match it with his herbal remedies. We did pretty well, actually. He takes our medication, unless he is cleansing, and he understands that his herbs, although they give him about the same results, cardiac wise, impair his anticoagulation. We just discontinue his warfarin for fasting, after we have worked him up to the higher level of normal, and he restarts it immediately. He drinks more tea, with aspirin like qualities, the days he is fasting, as it is allowed. It took about 3 years to get to the sharing point, but I feel quite sure together we have made it possible for him to reach his soon to be 89th birthday, and still participate with dignity in his tribal rituals”.
She continues on to share,
“We did have another medicine man, who worked out of his car in the hospital parking lot, talking about what shysters and killers of Indians we were! … I just stopped by each evening and visited with him. We began talking, and once or twice I asked about a treatment and commented about his treatment that seemed to help one of the patients, and… about how I was SURE he was aware that anticoagulation drugs were affected by herbs and that caused stroke, etc. He educated me, and I educated him. We did not always agree, but we did communicate with each other and probably the most important thing was we were seen communicating. That meant I was NOT the enemy any more. He even offered to smoke my daughter’s horse prior to the national finals rodeo…This helped a great deal. People began to ASK if their medicine man medications would help or interfere, or could be a problem. When it came right down to it, few things are ingested, and there is lots of positive reinforcement through the medicine man”.
http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Food

In some communities, you should not refuse food when offered, or ask for something that’s not offered. This is considered rude. Many tribes offer food or beverage as a courtesy to their guests. Many tribes share the same history of “feast and famine” so sharing food has become a cultural norm. Sharing also promotes the cultural understanding of “give and take”. For example, “If I share with you now, there might come a day that when I am in need then you will share with me.”
If you are providing education, be aware of the foods that are commonly prepared in that particular community. For example, if the individuals eat fry bread, you might suggest making the bread with ½ wheat flour and ½ white flour along with cooking in vegetable or canola oil instead of lard. You might also suggest smaller portion sizes. We do not suggest that you recommend changing their eating habits completely, for example telling them fry bread is bad and they should never eat this type of bread. Rather encourage healthy choices with their daily or ceremonial diet.
Be aware that some individuals rely upon commodity food and/or do not have fresh fruit and vegetables readily available. Consider attending local powwows or talking circles to see what they traditionally eat and how it’s prepared. Again, encourage individuals to do the best that they can with what is available to them.

http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Native Language

Many communities speak their native language when they are among each other. Although you might not understand the words, do not feel left out as this is their preferred method of communicating and for most, English is not their primary language. You may also find that some native languages intersperse English words while they talk because there are no native words to describe what they are trying to say. One pharmacist, speaking on behalf of her community says,
“Please do not become offended when a conversation is being carried out amongst one another in the Crow language. An unwritten understanding is that we speak our language to one another first, then translate for non-speakers who may be present. A Crow speaker does not intend to be rude or make one uncomfortable by speaking the language.”
Unfortunately, you might also recognize that the younger generation may not speak their language fluently or at all. If you find the need to use an interpreter, remember to address the patient NOT the interpreter. The interpreter is there to assist you and is not the patient in need of medical care. You’ll realize that some sites utilize the pharmacy technicians as interpreters even though the patient has a native speaking family member with them. This is done because sometimes the family member is not familiar with medical terminology or does not speak fluently and the pharmacist would not know what is being said by the family member.
http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Explaining potential outcomes/side effects

Many communities believe that by talking about a potential problem, it will make the problem come true. If you want to discuss a potential complication or side effect, we recommend that you use the third person dialogue such as, “In some peoplewho don’t control their blood pressure, their kidneys can get tired out from having to work so hard. This may cause the kidneys to stop working”, rather than saying, “If you don’t control your blood pressure, your kidneys will stop working”.

http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Questions

Questions
Most individuals realize that health care providers utilize questions to better understand medically related issues. However, be aware that asking additional questions that are not related to the medical concern can actually offend an individual who may perceive you as “nosey”. This may be true if you are asking about why a certain tradition is practiced the way it is or what goes on in the kiva, for example. Stay focused on the medical aspects of care, but if you need additional information, creatively unite it with the issue at hand.
In addition, pharmacists usually need to know a complete medication list and will often ask about herbal use. Some individuals might feel uncomfortable sharing that sort of information because it can be related to sacred ceremonies. Instead, one might say, “We try to get a complete medication list to make sure medications are not interacting or harming the body. Would you be comfortable sharing with me the names of any herbal or traditional medicines you might be using?” If the individual says, “no” then don’t pursue it. The person might not know the common name of the plant or may only know the native name in their traditional language. In addition, it may be taboo to discuss certain information or even say the names of the medicines outside of a ceremony or blessing.

http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Eye Contact

Eye Contact Many communication courses teach that effective, engaged conversations include direct eye contact as a form of feedback from an individual who is interested in what you are saying. However, some communities engage with their ears and will look down or away as a form of respect and interaction. This is particularly true of elders and more traditional American Indians/Alaskan Natives. In fact, in some communities, to look directly in someone’s eyes while talking to them can be disrespectful. Actively assess your response with the individual and keep in mind that eye contact might be appropriate if the person is young and “modern”. Please keep in mind that everyone is different and up to 80% of communication can be non-verbal cues.

http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Greeting

Greeting
Each community has their way of greeting one another upon meeting. Most Navajos for example, will shake hands lightly or barely touch at all. Some communities might not shake hands or avoid non-medical contact altogether. The belief is that they do not know who you are and/or do not want “badness” to come to them. Other communities, once they know you, might embrace you and breathe in near your hands to reap “blessings” that have been bestowed upon you (e.g., intelligence, good health, etc.).

http://www.ihs.gov/pharmacy/index.cfm?module=awareness

Navajo Cultural and Medical Interactions

Childbirth

http://www.naho.ca/documents/naho/english/IG_Presentations2008/009KnokiWilsonUrsula.pdf


Communicating






http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495335/?report=classic



Basic Body Parts Navajo Language

https://www.youtube.com/watch?feature=player_detailpage&v=eNhToGB9O7c








 Courtesy of : http://navajowotd.com/post/45999044890/basic-body-parts-in-navajo
Here are a few parts of the body that are easily recognizable. These terms aren’t always applied to humans or animals. For example, chidí bitsiits’iin is literally “the vehicle, its head” and it refers to the engine. These are in the third person:
  • bíla’ - his hand
  • bigaan - his arm
  • bikee’ - his foot
  • bijáád - his leg
  • bijaa’ - his ear
  • bik’os - his neck
  • bigod - his knee
  • bikétsíín - his ankle
  • bitsiits’iin - his head
The first person and second person (i.e. “my hand” and “your hand”) are formed by changing the bi- particle to either shi- or ni-. So shikee’ would be “my foot” and nijaa’ would be “your ear”.
Here’s how to say the basic body parts in Navajo (pronunciation clip):





Sheep Blessing Churro Ceremony

https://www.youtube.com/watch?v=KKiafor7Lr8









Her instinct was very strong and she accepted her young with no problem,” says TahNibaa Naataanii of one of her Navajo churro sheep, which became a first-time mom this spring.
Naataanii serves as project director of Diné be’ iiná, Inc., (DBI) an organization centered on preserving the Navajo churro sheep and the related life ways of the Navajo people.
June 20 through 25, DBI hosts its 15th annual Sheep is Life Celebration at Diné College in Tsailé, Ariz.
Week-long workshops and weekend public programs will “teach (Navajos) to sustain life and further to use their product to bring money into the household and give it added value,” explains DBI President Ron Garnanez.
The Navajo churro sheep resulted when the Spanish brought Moreno and churra sheep to the new world in the 1500s. Morenos had beautiful but oily wool that required water to clean. The Morenos also produced meat, marbled with fat.
Churros had coarse fleece but lean meat that the Navajos liked. One of the earliest domesticated sheep and bred in the desert, churras were also hearty.
The Spanish refused to cross morenos and churras because churras belonged to peasants, and morenos to aristocrats, but the Navajos saw no problem with the mix, producing an animal with the churra’s lean meat and the moreno’s good wool in a double coat, minus the extra oil.
“It was the first North American breed,” says Garnanez. “You don’t have to card churro wool. You can take it right from the sheep to the drop spindle.”
The Navajo churro was also hearty like the churra.
“They bounce back to their wild ways if left alone,” says Garnanez.
Navajo churros have also bounced back from extinction three times when the U.S. Government took them away from the Navajos and tried to introduce new breeds. Weavers saved the churros.
“My grandmother was a weaver and she supplied other weavers with wool,” Garnanez recalls.
He doesn’t know why the ‘a’ in the Spanish word ‘churra’ became an ‘o,’ when the Navajos borrowed it, but he speculates that the ‘o’ comes from the word ‘Navajo.’
At the “Sheep is Life” celebration, participants can learn this history and more as they attend sessions on weaving, felting, butchering, herbal veterinary medicine, sheep related religious ceremonies, and many other subjects.
Children may attend a fiber camp where they will learn about many weaving styles. Public programs will allow visitors to hear lectures on sheep; and wool arts and crafts.
When people tire of talks and demonstrations, they can enjoy an outdoor museum, food vendors, and storytelling.
“Sheep is Life” includes the exhibit “Na’ashjé’ii Biyiin: Chant of the Spider,” a Holistic Journey into Diné Fiber Arts at the Ned Hatathli Museum on the Diné College campus.
“Chant of the Spider” offers its own lectures, panel discussions, and films exploring the interconnected spiritual and technical processes of Navajo weaving.
Fiber artists Roy Kady, TahNibaa Naataanii, and Gilbert Begay will share their personal stories, traditions, and relationships with the natural environment that inspire their creative process and artwork.
Ron Garnanez hopes people who see Chant of the Spider will learn to recognize designs such as the diamond shaped eye dazzler, the box, or the straight line as origi nal to Navajo weavers.
Other patterns like Two Gray Hills or Teec Nos Pos originated with traders, who wanted Persian rugs with a Navajo twist. Garnanez also hopes that by recognizing the differences and learning the history of patterns, Navajo weavers will better understand the design choices they make when they create a rug.
“Sheep is Life” will host a juried weaving show, which replaces the rug auction of previous years. The show setting will give weavers and buyers a chance to meet and talk to each other.
With the auction, with so many weavings coming in and out, they can go through 10,000 weavings,” TahNibaa Naataanii explains. “That type of sale is not part of our Navajo life way teaching. We want to continue the respect of our weaving and where they go from our loom to someone’s home.”
Garnanez adds, “We consider (a rug) as our child; our creation. We want it to go to a good home.”
“Sheep is Life” will also emphasize respect for the sheep by presenting a lecturer whom Garnanez calls “a sheep whisperer.” “Animals can read a person,” he says. “If you learn to read them, you can enjoy each other’s company.”
Lecturers will help people explore the Blessing Way chants which keep both animal and human spiritually healthy.
“The sheep have a special chant. So does the loom and each tool a weaver uses,” Garnanez explains.
TahNibaa Naataanii believes Navajo churro sheep and Navajo weaving have survived because of a strong spiritual connection to the Navajo people.
People hung on to their chants and to this day are still doing them, and DBI serves to reconnect the sheep with the people.”
The connection is strong. Young Navajos have begun joining DBI. The ABC Square Youth Group from Teec Nos Pos serves as the vice president of the DBI board.
“It was so moving when these young people were willing to come,” says Garnanez. He chuckles. “My grandmother — if a coyote killed a sheep, she’d say ‘Well! Now I paid my rent.’ And if a sheep died, she’d say ‘I’ll catch up to you later.’”
He laughs out loud. “At ‘Sheep is Life,’ we want to teach people about that.”

From: By Connie Gotsch at Four Courners Press
http://fourcornersfreepress.com/news/2011/061101.htm

Tuesday, December 2, 2014

Kinaalda Ceremony into womanhood

https://www.youtube.com/watch?feature=player_detailpage&v=WLiKvTQkc90

Kinaalda Ceremony-

 
 
The Navajo Puberty Ceremony celebrating maturity of girls among the Navajo is held generally on the fourth night after the first evidence of the maiden’s entrance into womanhood. On the first morning following the moment of this change in life the girl bathes and dresses in her finest clothes.
 
Later she stretches herself face downward on a blanket just outside the hogán, with her head toward the door. A sister, aunt, or other female relation, if any happen to be close at hand, or if not, a male relative other than her father, then proceeds symbolically to remould her.
Her arms and legs are straightened, her joints smoothed, and muscles pressed to make her truly shapely. After that the most industrious and energetic of the comely women in the immediate neighborhood is called in to dress the girl’s hair in a particular form of knot and wrap it with deerskin strings, called tsklólh.
Should there be any babies or little tots about the home, the girl goes to them, and, placing a hand under each ear, successively lifts them by the neck, to make them grow faster. Then she darts off toward the east, running out for about a quarter of a mile and back. This she does each morning until after the public ceremony. By so doing she is assured of continuing strong, lithe, and active throughout womanhood.

The four days preceding the night of the ceremony are days of abstinence; only such foods as mush and bread made from may be eaten, nor may they contain any salt. To indulge in viands of a richer nature would be to invite laziness and an ugly form at a comparatively early age. The girl must also refrain from scratching her head or body, for marks made by her nails during this period would surely become ill-looking scars.
All the women folk in the hogán begin grinding corn on the first day and continue at irregular intervals until the night of the third, when the meal is mixed into batter for a large corn-cake, which the mother bakes in a sort of bean-hole outside the hogán.

The ceremony proper consists of little more than songs. A medicine-man is called upon to take charge, being compensated for his services with blankets, robes, grain, or other articles of value. Friends and neighbors having been notified, they assemble at the girl’s hogán fairly early in the evening.

When dusk has settled, the medicine-man begins his songs, singing first the twelve “hogán songs” of the Bahózhonchi. After he has finished, anyone present who so desires may sing songs taken from the ritual of the same order. This motley singing and hilarity continue until well toward sunrise, when the mother brings in a bowl of yucca suds and washes the girl’s hair.
Her head and hair are dried with corn-meal, after which the girl takes her last run toward the east, this time followed by many young children, symbolically attesting that she will be a kind mother, whom her children will always follow.
The hatál, or medicine singer, during her absence sings eight songs, generally termed the Racing songs. On her return the great corn-cake is brought in, cut, and divided among the assemblage, when all disperse, and the girl may once more loosen her hair and partake of any food she pleases.

Day Ritual Activities

First Day
Comb
Dress
Mold
Run
Grind Corn
Put pot of wheat near outdoor cooking fire (after the molding).

Second Day
Run
Grind Corn
Spread wheat in the sun to dry (after digging the pit).
Soak cornhusks (while working on the batter).
Third Day
Run
Grind Corn
Dig pit; build fire
Make mush
Put batter in pit; bless it
Cover pit
Gather soapweed root and white clay for morning (during the singing).
Fourth Day
Dawn
Run to east while four songs are sung.
One Twelve Word song, unless the ceremony is the first Kinaalda,
when this song is omitted.
Make offering to Mother Earth.
Prepare white-clay basket (during the Racing Songs).
Lift children (after the molding).
Girl goes back into hogan (after returning goods).
Retie girl’s hair.


Coutesy of : Navajopeople.org
http://navajopeople.org/blog/kinaalda-celebrating-maturity-of-girls-among-the-navajo/

 
 



Cross Culture Medicine

Cross cultural medicine offers unique opportunities for service and at the same time it offers individual growth for those serving. While new employees of the Navajo Area Indian Health Service may have been exposed to cross cultural environs as they grew up, during academic training, or previously in their professional careers, exposure to diverse peoples only partially prepares one for life among the Diné (the Navajo People). The subtleties of interpersonal relationships (which, when understood by health professionals make them more successful in caring for patients) are particularly important among the Navajo.
In NAIHS healthcare facilities the following situations or realities may be encountered.
  • Direct eye to eye contact with others is not common on the Navajo.
  • Handshakes (when a hand is extended to someone) is a touching of hands as opposed to a firm handshake.
  • The perception of time is different in that problems may have begun "awhile ago" and menses may be marked in their relationship to lunar cycles. The history of present illness for an acute illness may result in a story which relates the cause to events in the patient's personal life as far back as 50 or more years.
  • History taking is perceived particularly by Navajo elderly as unnecessary. Traditional healers "know" what the problem is without oral history taking sessions. Combining the history while a physical examination is underway can yield better results.
  • The review of systems can be particularly problematic in that if the patient felt they had concerns about a particular organ system they would have informed the practitioner of such at the outset of their interaction. Again, combining ROS with the P.E. can be helpful.
  • Most often the answer to a question like "you don't have a headache do you" will result in an answer of "Yes", which means "Yes, I do not have a headache".
  • Religious beliefs should be understood so that therapies of education can be appropriately tailored to each individual. Counseling emphasis for a prenatal patient is best given once religion is determined as the approach would be different for a Navajo who believes traditionally, for Navajo American Church members (who use peyote) and for Navajos who have converted to Christianity.
  • Providers should offer tissue to patients for disposal such as toenails (after removal), scalp hair (if removed to suture a laceration), and even normal placentas. Traditional Navajos know what is appropriate for the disposition of these.
  • Many Navajos still point directionally with their lips and not with their fingers and arms.
  • Family decisions regarding health matters are common place. This is particularly true of surgery and delays in surgery may be misunderstood by those not appreciative of the fact that families require time to gather and weigh the options with the patient.
  • Therapies may be delayed by the patient so that a traditional healer can be consulted and on occasion a ceremony performed in their hogán (home).
  • Practitioners should always ask (especially the elderly) before showing X-Rays with patients as some have strong beliefs about any pictures of themselves and X-Rays have certain meaning to some patients.
  • Assessing the home environment is essential before therapies are prescribed. Many people still have no electricity (no refrigerators) and no in door water source (no bathroom). Alternatives exist seasonally for ice/heat treatments and storage of medications and these should be appreciated by the practitioner.
  • Conversational "courtesies" which are common in non-Navajo society (thank-you, excuse me, etc.) are infrequently heard on the Navajo but appreciation is felt and expressed by patients particularly after they get to know their provider over time.
  • Translation into the Navajo language (which is descriptive) is extremely difficult and many health related terms have no single word counterpart in Navajo. A "simple" question when interpreted into Navajo takes much longer to ask in Navajo than in English.
  • Patients may arrive for healthcare with their skin blackened with charcoal which mean they have recently had a ceremony performed for them by a traditional healer.
  • After ceremonies, patients have to observe certain practices outlined by the healer (only eat certain foods, avoid anything dead, etc.). These do not generally interfere with prescriptions by non-Navajo practitioners.
  • Pinon tree sap and herbs may be placed on wounds prior to arrival in the E.R. and harsh criticism of this (which represents a belief system) will adversely affect the relationship with the patient.
  • Patient encounters with spider webs cause problems for some patients even though the non-Navajo practitioner may not be able to see a rash or believe that shortness of breath is a spider web induced.
  • Avoidance of the phrase "there is nothing wrong with you" is best. Advising the patient that one can't determine the nature of their problem at this time is better.
  • Many Navajo believe that by stating something may happen in the future (potential complications including death for example) will cause the event to occur. This has obvious implications for health education efforts.
  • Navajo concepts of being, health, disease, and the environment are deeply intertwined with Navajo religion.
  • There are many types of traditional healers (crystal gazers, herbalists, stargazers, hand tremblers) and the right one must be sought out for the patient (by the family) for specific problems. Navajo Area Indian Health Service employees must respect the patients served which includes their belief systems. Doing so will lead to mutually satisfying relationship among patients, families, community members and those who choose to live among and serve the Diné.
Courtesy of: http://www.ihs.gov/navajo/index.cfm?module=nao_cross_culture_medicine