WHEN I FIRST ARRIVED in Navajoland 2 1/2 years ago to be a midwife to the Dineh (the Navajo’s name for themselves), I found myself immediately drawn to the land and the people, with such beautiful faces and colorful clothes, coming and going from the hospital, or herding their sheep up on the mesa.
I was told by many people (medical practitioners working in the small hospital and other midwives arriving with me to help create the obstetrics service), "Don’t expect to have much of a rapport with your patients; these people keep to themselves, will not share information about their lives, and have a totally different set of priorities about their health than you do."
Our first two weeks of work were organizational in nature. We were fortunate in having a Navajo nurse-midwife come to work with us and try to begin easing us into the culture, educating us to the myriad taboos surrounding pregnancy in this culture. She gave us helpful hints, such as suggesting that we always speak of potential or actual complications in the third person (in order not to be seen as wishing the condition on the patient), or informing us that a Navajo person will not usually look you in the eye while speaking, as this is considered disrespectful (quite contrary to "Anglo" custom).
We spent our first weekend at the summer camp of a local medicine woman and her family, where we were introduced first hand to Navajo family life. We helped to slaughter a sheep and make fry bread (a staple of the Navajo diet), took sweat baths, went on a herb walk, and participated in dawn prayers and a healing ceremony for a family member.
I threw myself into studying the birth traditions and taboos with genuine excitement and interest, and yet I found a sadness creeping over me as our organizational period was coming to an end and we planned for the blessing and opening of our obstetrics unit. I realized that this sadness stemmed from the pervasive attitude that one couldn’t create meaningful midwife-mother relationships with these people, that we would "blow it" in so many small ways culturally that we would never be taken seriously.
I felt very comfortable with the Navajo beliefs, and I could understand many of the birth taboos because of my involvement with alternative healing modalities and my belief in creative thought. (Many of their taboos were based on this principle.) I saw the beauty in the traditions and the pragmatic reasons for their existence in the "old days", when the women were birthing at home with no access to medical technology.
I wanted to support these women in their cultural traditions and beliefs, yet who was I to do that? A young Anglo woman, a bellagonna, who had hardly been west of the Mississippi.
As my first day in clinic approached, I wrestled with this sense of sadness, of futility, of uselessness. I had always enjoyed an excellent rapport with the women I had served in the past, some from different traditions than my own – Hispanic and Black women – and felt that the trust established was of paramount importance to a woman’s ability to surrender to labor. I briefly felt panicked, and then I began to examine the element in myself that created the ability to connect with people, and I saw that it was purely a matter of heart. The basis on which I have always related to the women I work with is our shared humanness. I look at them and see another aspect of myself looking back. I see that regardless of background or culture, we are all human beings with joys, fears, questions about life; we are made of the same stuff. Once I identified that, my panic subsided. All I could be was who I am. If I truly came to them from my heart, with a desire to be of service and to be taught, I felt sure that they would forgive me any cultural faux pas I might commit. And, indeed, this proved to be true.
Fortunately, all five midwives who had come to set up the service were committed to making our care culturally relevant. We asked a lot of questions of our patients and mentors here and found that people were genuinely willing to help, once they found out that our interest was genuine. We began to write booklets and handouts for our clients, having them checked for cultural relevance and accuracy by the Navajo nurse-midwife who was acting as our mentor. We, along with a couple of caring and involved MDs, organized a conference for the entire Navajo area on culturally relevant care of the expectant Navajo woman and her family. On the unit, we regularly smoked the rooms with cedar and had ceremonies as necessary to clear the unit after a stillbirth or difficult birth. We hung traditional sash belts from the ceiling for the women to use while pushing out their babies. Medicine people were welcome during labor and delivery, and often families would call them in if things were not progressing as they thought they should. Many of the medicine ways seemed familiar to me somehow. I remember a moment of surprise when a medicine man once pulled out a quartz crystal and laid it on a mother’s belly. Then I thought, "Why the surprise? Healing energy is the same everywhere. It is universal. All who work with it will eventually find the same answers, because it is consistent. We just look at it through different eyes."
As time passed, I even found myself explaining some of the traditions surrounding birth to some of the younger, more "westernized" women who came for care, saying, "Go home and talk to your grandmother." Turnabout indeed! Word spread through the community that here people and their beliefs would be respected, and we soon had a thriving practice.
There were also those in the community who opposed having the hospital here. (Up until a year before, there had only been a small clinic operating out of a double-wide mobile home.) But for the most part, the community accepted us and were happy not to have to travel three hours to reach the nearest hospital.
We wanted to create a means by which the traditional practitioners could have a meaningful dialogue with the allopathic practitioners, so that each would understand the other’s concerns and needs, and so that they could work more effectively together. Out of this desire grew the "medicine people’s forums", a series of gatherings focused on such topics as cancer, childbirth, and so on. At one of the early meetings, one of the native healers shared with us the contents of the various medicine bundles. There was a table full of exquisite rattles, fetishes, drapes, feathers, herb pouches, crystals, skins, pipes, etc., each with a specific meaning and for a specific ceremony. Then one of the allopathic physicians explained the contents of a "western" doctor’s black bag, pulling out the stethoscope, blood pressure cuff, otoscope/ophthalmascope, reflex hammer, tuning fork, etc. It was such a strong image for me, seeing the tools of the trade of the two cultures juxtaposed like that, the shiny silver "high prediction" technology of the Anglo way next to the colorful, soft, organic tools of the Navajo way.
It was clear to me that, in so many ways, we treat only the body, and they treat primarily the spirit/disharmony. We go for the symptoms, they for the perceived cause, according to their beliefs. The topic for discussion that day was cancer, the causes as perceived by the two cultures, and methods of treatment. Most practitioners on both sides would like to create more of an environment where the two traditions can work together. The feelings among Navajo practitioners ranged from wanting to work together side by side in the hospital with the MDs to the attitude expressed by one old medicine woman who stood up and said, in effect, "Why do you play God? Leave our people alone."
It is not unusual for folks to come to the hospital doctors for allopathic treatment and to also see a diagnostician and a medicine man for the restoration of harmony, combining the two approaches. The medicine people in Navajo culture do not diagnose. The diagnosticians (hand tremblers, stargazers, listeners) find out where one is out of harmony and prescribe a particular ceremony. One then finds someone who sings that ceremony. (Navajo medicine people specialize, as do allopathic doctors.) Unfortunately, since the coming of Indian Health Service to the reservation, a great number of people have abandoned traditional practitioners altogether, probably for a number of reasons: allopathic treatment is more "modern", it is often a "quick fix", it is free (they must pay their own practitioners, often a lot).
In the way we have chosen to help, I feel we may have done a great disservice. When a person is ill, s/he is "out of harmony", and if s/he comes only to a practitioner who "fixes" her/his physical symptoms and does not restore his/her spirit to harmony, s/he begins to be alienated from the earth, her/his community, his/her traditions. Then we begin to see the "caught-in-the-middle" syndrome. In most of the modern world, our passages in and out (birth and death) have been hidden behind closed doors for two to three generations, and there are nations of people caught in the middle between the old ways and this new way, not knowing quite where they fit in.
In a tradition like that of the Navajo, where one’s relationship with the earth is so immediate and, I think, genetic, where the stories of childhood and the traditions dictate ceremonies for remaining in balance with the earth/community, it can be devastating to draw away from that heritage and partially take on a system which doesn’t address the issue of remaining in balance and thus can never replace the traditions. The folks I have seen here who are more well-adjusted either still live very traditional lives or have made a pretty complete transition to the "western" way, including going off the reservation for schooling. There are also a much smaller number, and perhaps these are the most well-adjusted of all on the reservation, who have successfully combined the two traditions, taking the positive aspects of both. The majority, however, seem to be caught up in the same welfare cycle as many inner city populations, with limited resources, limited prospects, and general malaise of spirit. They are, for the most part, dependent on both federal and tribal welfare and food stamps and depend on supermarkets rather than growing their own food. Often they don’t have electricity or refrigeration to store fresh food, and they therefore subsist on canned items, or bread and potatoes. Many family camps are miles from stores, roads are non-existent, and transportation is a problem. They are teased with a few modern conveniences but not provided with the resources and education to really allow them to function well in the modern world.
I have seen many women in clinic who were victims of abuse by their spouses, or whose families were troubled by alcoholism. The men’s traditional roles have pretty much disappeared, while the women’s roles remain fairly intact. And it is by and large the women who are now entering the "modern" world and working as support staff and nurses at the hospital. With this loss of "place", the men’s frustration and anger builds and is most often taken out within the family.
I see the question of maintaining cultural diversity as an important one. I believe it is the cultural diversity that keeps balance on the planet, keeps it rich and colorful. Key to the personality of various cultures is the way they see/treat birth and death. I feel that if birth traditions are maintained intact, more of the cultural flavor can be maintained, and the child’s earliest memories and decisions about life are made within the context of his culture. This will remain. I have often seen a labor totally turn around and be given back to the body by simply employing the traditional sash belt, birthing beads, cedar smoke, or prayers. I always check in with the grandmas present to see what they think would help. The baby is spoken to in its own language. When birth is kept sacred within one’s culture, there is a feeling of oldness, of being connected to all women giving birth throughout time.
I think we would be of more service, especially when dealing with health care, birth, and death, not to drag people into our high tech world, but rather to work alongside traditional practitioners in supportive roles. For instance, we could share our knowledge with traditional birth attendants in the areas of hygiene, recognition of specific complications, and simple tricks of the trade, rather than trying to change their ideas about what is acceptable risk, or about the place and manner of care given.
This is asking a lot of modern medical practitioners, who are taught and encouraged, especially in the current malpractice climate, to value the prolongation of life above all else, even its quality. Supporting, or even allowing, another’s cultural beliefs when they conflict on a deep level with one’s own, can be difficult. The traditional cultures understand that the passage in and out of life contains both life and death. They live with the earth and know that nature regenerates itself, that from winter’s death comes the new life of spring, and they respect this. This is not to say that there is not grief at the death of a baby. If one is going to live and work within another culture, and support it, one needs to let go of wanting to control the reality and decision-making of the people in that culture. We can’t know what the reality of their life is.
How, and to what extent, does one keep one’s own cultural integrity while trying to work within and support another culture? People handle this dilemma in many different ways. One of my colleagues dealt with it by trying to "become" Navajo, elevating everything Navajo to a superior status. Any traditional belief was automatically "better than" the Anglo way. There are others who deal with this question by, in essence, pretending they are not here. They live and work in their own little world and do not even try to communicate on a cultural level. My own way has been to look for the pattern which connects, the place where we can meet. I try to understand and support their cultural view for them, while still maintaining a firm foundation for myself in my own belief system. It helps that I am very comfortable with the Navajo cosmology. If expressed in different words, many of our beliefs are the same.
Living here has had some of the misty, almost not-real feeling of a fairy story. An image that has come to me time and time again, when leaving the reservation and coming back, is that of the magic land that rises out of the mist every thousand years or so, a place with a time frame and a rhythm all its own. To get in, you have to know where the wrinkle in time is, to know where to step through the veil. When I’m here, the outside world doesn’t exist. When I’m off the reservation, it seems like a dream, shrouded in mist.
Once upon a time, in a land far, far away, there lived a colorful people, with skin the color of the earth…