I have arrived, and am here. My USPHS (http://www.usphs.gov) orders came through on Thursday, and the airline ticket was booked at 6 p.m. CST on Friday. As soon as the ticket was confirmed I burst into tears, mostly because I couldn’t actually believe that it was going to happen. I was actually going to Kayenta, AZ. And here I am, on the north-central part of the Navajo Nation.

I flew into Page, AZ, right on the edge of the amazingly beautiful Lake Powell, which is actually a flooded canyon (and a big environmental deal from the 50s). The nursing director of the Kayenta clinic drove two hours to Page to pick me up, and then we drove two hours home through some of the most unbelievable scenery – wide, red plains of scraggly light green brush; huge mountains that look black in the distance because of the thick dark scrub trees that cover the side; canyons that appear from nowhere and dive deep into the earth. The sky was the most pale shade of blue, without a cloud, and the sunlight was so bright it was actually painful. And it was hot. I’m talking 100 degrees hot. Every day so far.

I got a quick tour of the clinic (more on that later), and then we went grocery shopping quickly and came to my government housing – a trailer in a park just about five minutes from the clinic. My trailer/mobile home is one of the older ones – faux wood paneled walls, bars on the windows, sliding particleboard doors, brown shag carpet. It’s great. The couch is blue, green, yellow, and orange, and I am not kidding. My roommate for the next two weeks is a first-year Harvard Medical School student named Lisa, who is here teaching Navajo children about life sciences with a big group from Harvard. She leaves at the end of the month, and then I’m alone in the trailer until I leave on the last day of August.

The Trailer Park

1. Noises. There’s the air conditioner. Then, when the trailer gets too cold, there’s a deep rumbling whine, and then a huge “whoosh” and then the heat comes on. That’s right: freezing air pouring from the ceiling and hot air gushing from the floor. And me, on the bed, with freezing shoulders and boiling feet. Other noises include the Mysterious Intermittent Bathroom Whine (I’ve almost managed to tune it out), chain-link gates creaking, wind whipping through the park and screaming through the half-bend-off metal siding on the back of our trailer, and dogs. Barking. Continuously.
2. Rez Dogs. I counted 7 in the trailer park. And at least five dead dogs on the highway on the way here. They are scruffy, mangy, dirty, and not a little leery of humans. They have never bothered me on my morning walks. However, there is a cute blond puppy on my walk to the clinic, and he always stands at the curb and begs for love. I oblige. I’m a sucker. I still haven’t figured out what to do with Rez Dogs. Should I give them snacks? Ignore them? Get involved with community efforts to get them spayed?
3. Communication. Since the trailer park is housing for the IHS clinic, we’re hooked up to their phone system. So we can’t make long distance calls without a calling card. So, to obtain internet access, I had to convince this laptop to dial 9, then the 800 number to access the calling card, then the calling card number, then the number to access the UWM modem pool, and then to log me in. I am proud to announce that I got it to work. Hot diggity. That’s no small accomplishment, considering my cell phone is completely worthless out here. NO reception.

The Clinic
The clinic is a bunch of concrete buildings in the same area. There is an administration building, one for pharmacy and dentistry, on general health clinic/ER, a general services trailer, a nursing/business trailer, a Public Health Nursing trailer, and one for maintenance, and one for Environmental and Occupational Health.

Because my paperwork was late and confusing and messed up, I arrived one week after orientation, so I am as of yet not oriented, and therefore not actually able to work with real patients. So I’ve spent my time meeting lots and lots of people, talking to other PHS officers (mostly in Pharmacy), hanging out with some great Public Health Nurses, and reorganizing the bookshelves and reference books of the Nursing department. I’m getting obnoxious about telling people how bored I am. I came here to be a NURSE, dammit, not a secretary.

However, today I was allowed to ride along with an RN who works on the Hooghan Project, which is diabetes education project that sends nurses out into the boonies to give additional training to newly diagnosed diabetics in their homes. The end result of this is that the patients tend to have better outcomes, better health, lower HgA1C results, and keep their MD appointments more regularly. The RN and I drove out to Navajo Mountain, which is actually in Utah, about 1 hour and 40 minutes from Kayenta, including 30 minutes on dirt/sand roads. The patient was 82 years old and spoke only Navajo. Fortunately, many of the Navajo RNs also speak Navajo, and don’t require a translator. So I got to listen to Navajo for over an hour, and it was….I’m not sure yet how to describe it. It was beautiful, but too harsh to be beautiful, really. Musical, but fairly monotone. Now I sound sappy. I wish I could speak it. I don’t think I’ve got the linguistic capability to learn it.

Anyhow, when (IF) I get to work in the clinic, I’ll be in the outpatient clinic, where people come for physical exams, well-baby exams, prenatal exams, childhood vaccinations, checkups, and Elder care. It’s the “good news” wing. It’s preventative medicine, which is what I believe so strongly in. I also might be asked to work in the ER, which is the other wing, and is open 24/7. The ER sees everything, from babies to trauma. Kayenta has no inpatient beds. People requiring hospitalization are usually driven to Tuba City by ambulance (1.5 hrs away) or flown by helicopter to Phoenix or Flagstaff (9 and 5 hours away by car, respectively).

I’m itching to get started.

Kayenta

Kayenta is a “chapter” of about 2,000 people. Chapters are the equivalents of towns here on the Navajo reservation, and each chapter has a chapter house and a democratically elected board of directors that coordinate town activities and travel to Window Rock, the capital of the Navajo Rez, for general meetings. Kayenta is also (I think) the only township on the Rez, although other towns are busy applying.

Kayenta is actually a fairly significant tourist destination – if I look out my back window, behind a rock formation colloquially known as “The Toes,” I can see El Capitan. If you’re a rockclimber or a fan, you know about El Capitan’s famous nose. I’m also ridiculously close to a huge number of historic sites and National Parks: Petrified Forest, Grand Canyon, and Navajo Monument (the Anasazi ruins). Hence, Kayenta has the Anasazi motel, a Holiday Inn, a Sonic restaurant, and a Burger King with a cultural exhibit featuring a history on the Navajo Code Talkers of WWII. Kayenta also has a movie theatre, currently showing “War of the Worlds” and “The Fantastic Four.”

Every chapter of any size has a Trading Post, which is a grocery store with extras – Navajo jewelry, household items, Radio Shack. Kayenta also has a fairly large grocery store (Bashas), two Laundromats, several chiropractic offices, and the famous Amigo Café. If you want directions to somewhere in Kayenta, people usually start by saying, “OK, you know where the Amigo Café is?” Wells Fargo bank is here, as are typical government offices: Post Office (86033), Volunteer Fire Department, Courthouse. There was a Boys & Girls club of Kayenta, but B&G ran out of money and the building sits empty. Many of the clinic staff are trying to figure out how to get the building; many want to use it for a Wellness Facility (exercise room, nutrition classes, community classes, etc).

There is a boarding school for children who live too far away to travel by bus every day, and there’s a full school system, K-12, the Kayenta Mustangs. Basketball is apparently huge here. And there are churches. Pick a denomination, and they are here. Catholic, all flavor of Christian, LDS, Jehovah’s, etc. I haven’t yet seen the synagogue or the Buddhist temple, but I’m sure they’re hiding around here somewhere…

Next time maybe I’ll talk about people, how they dress, and water containers. Now I’m going to sleep.