Integration of Navajo Culture Values in Primary Care Setting

by

Rose Saltclah, RN/MSN/CFNP School Based Health Clinic Coordinator

Crownpoint HealthCare Facility – IHSCrownpoint, NM

Disclosure Statements

• I have no financial arrangements related to the content of this presentation.

• I have no financial arrangements with the sponsors of this activity.

• I will not discuss off label use of any medications.

Objectives

By the end of this presentation participates will be able to:

• A. Discuss two examples of Navajo ceremonies• B. Discuss at least three unique values of

Navajo culture in relation to primary healthcare• C. Identify at four ways to integrate ceremonial

teachings into primary care setting

Many cultures exist today

Navajo Family – Home

Need for: Counseling Empathy A prayer, a song Educational support Love

Kinaalda and Beauty Way Navajo Ceremonies

Kinaalda Ceremony

• Ceremony performed at puberty; first menstruation

• Signifies transformation from childhood into womanhood

• Four (4) day ceremony• Re-enact changing

women 1st ceremony

* CLAN SYSTEM

* EXERCISE

* GOOD HEALTH

* GOOD PROSPERITY

* MOTHERHOOD

* ADEQUATE NUTRITION * SHARING

* EDUCATION

Kinaalda Teachings

Cont’d: Kinaalda Teachings

• Think positive thoughts• Watch behavior / actions• Negativity must be avoided• Take care of earth• Everyone valued, respect• Everything valued; animals & plants• Earth is mother of all life • Obedience; keep 4 days holy• Future motherhood, family

Process of Kinaalda

• Running / exercise• Mixing of corn mush• Blessing Kanaalda girl• Blessing of corn mush• Blessing others• Sharing

Process of Kinaalda & Teachings

Running Mixing of corn mush

Process of Kinaalda & teachings

Blessing of corn cake Open fire: baking of corn cake

Process of Kinaalda & Teachings

Sharing Blessing others

Navajo Beauty Way: Ho’zhooji’

Definition of Beauty Way

• Beauty way, blessingway or Ho’zhooji’• Beauty Way (Ho’zhooji’) ceremony is

performed to re-established balance, harmony and beauty in one’s life.

• A concept of well-being, worthy, success, pleasant and perfect.

Purpose: Beauty Way Ceremony

• For holistic restoration of beauty• A prophylactic approach to well being

Reasons>Family>Individual self>Employment>Preventive health>Post medical care (surgery)>Veterans

Closure of Beauty Way Prayer

• With beauty may I walk• With beauty before me may I walk• With beauty behind me may I walk• With beauty above me may I walk• With beauty all around me may I walk• It is finished in beauty, it is finished in beauty,

it is finished in beauty, it is finished in beauty

Summary of Kinaalda & Ho’zhooji’

• Physical: Exercise, strength, endurance, good health. Self care, healthy future children (clan system)

• Emotional: positive thoughts, mind, language – speak kind words, strong mind, intellect, education.

• Social: conduct one’s self well; watch actions, help others, share, parenthood, teach children.

• Spiritual: respect blessings from holy people, diety, prayers, songs, and meditation.

Teens

Young, resilient, daring, fun, giggles, playful, uncertain, energetic, free, etc.

More Teens

Navajo Nation (NN) Population 2005 – 06

*Total Navajo population: 298, 215*Navajo Nation residents: 180,462• Female NN residents: 51.8 %• Male NN residents: 48.2%• Navajo non-NN residents distribution: • > PHX: 10,143• > ABQ: 7,889• >Gallup: 6,279• > Farmington: 5,793• > Others: Flagstaff, Tucson, SLC, Utah & LA, Calif.

Education: 2005 – 06

Navajos graduating from high school• 75.5% females annually• 69.3% males annuallyCollege Education • 323 females earned bachelor degree / 4,960

enrolled in college • 102 males earned bachelor degrees / 2, 339

enrolled in college• 49 females earned master’s degrees• 17 males earned master’s degrees

Navajo High School Students Risk BehaviorNavajo Youth Risk Behavior Survey

High School Students 2000 2003 2005 2008

Sometimes or always wore a seat belt 90% 89% 88% 88%

During past month did not ride with a driver who had been drinking alcohol

61% 66% 67% 69%

During past month did not carry a weapon on school property

No Data

No Data

92% 89%

During past YEAR did NOT attempt suicide 84% 80% 80% 82%

During past MONTH did NOT drink alcohol 57% 61% 64% 65%

During past MONTH did NOT use marijuana 61% 32% 66% 67%

Never had sexual intercourse 61% 60% 63% 57%

Ate five or more fruits and vegetables per day 38% 38% 28% 32%

Objective #3: Integration of Cultural teachings & Values in Primary Care

• Physical• Emotional • Social • School Performance

Sports Physical Exam

• 17 year old has an appt to see a medical provider for Sports PE. He wants to play basketball and run track.

• Well appearing with no chief complaint.

PE: Anticipatory Guidance Education

Cont’d : Sports PE - Anticipatory Guidance Education integrated with Ceremonial Teachings

• Safety: car, use of seat belt, no bullying, etc.• Smoking, alcohol, Drugs prevention• Pregnancy Prevention • Nutrition• Sexual education, STIs• Physical Activity• Others

Emotional - case scenario

• Larae, 16 y/o, Navaho girl, comes to teen clinic. Interest in BCM.

• Tells you she is sexuality active, one partner x 6 mos, does not want to become pregnant.

Cont’d: Emotional - Case Scenario• Age at menarche; Kinaalda

done or attended one.?• LMP; regular• Cycle length• Any prior experience with

OCM• PMH: blood clots,

headache, DM, HTN. EYE problem, any pain.

• FMH: blood clots, migraine HA.

• Social hx: use of any drugs; e.g. smoking, ppd, frequency. Family / home setting, adopted? Lives with boyfriend?

• Confidentiality• Medications, allergies

Cont’d: Emotional - Case Scenario

• What to do: urine hcg• Variety of OCM• Methods, what are

they, how to use them, side effects, efficiency, back up method (F & C)

• Kinaalda teachings

Cont’d: Emotional - Case Scenario

• Larue decided to use Depo provera

• Busy life• Start depo today• Re-iterate kinaalda

teaching & prevention of pregnancy / STI.

• Priority - School • Confidentiality

• If method not started today; may not:

> RTC>have additional

unprotected sex> never start a method> potential for unplanned

pregnancy / could have been prevented

• Derek, 17 y/o male comes to teen clinic for immunization

• A depression form completed

• Result positive

Integration of cultural teachings in Primary Care

Social - Case Scenario

Depression Screening Form

Cont’d: Social Case Scenario

• 1. Little interest or pleasure in doing things.

• 2. Feeling down, depressed or hopeless

• PHQ – score: range 0 – 6.

> 0 – 2 is negative > 3 – 6 is positive, further

evaluation

• Depression form : PHQ-2 Version

• Over the past two weeks, how often have you been bothered by the following problems?

Cont’d: Social - Case Scenario HEADSSS

• Head – Home Environment

• E – Education / Employment, Eating / Exercise

• A – Activities & Peer Relationships

• D – Drugs, Cigarettes, Alcohol

• S – Sexuality• S – Suicide,

Depression, mood • S – safety • S – spirituality

Integration of Cultural Teachings & Values in Primary Care -

School Performance / Education

Cont’d: School Performance – cultural values; modern day

teachings

• Good prosperity • Good nutrition • Respect• Language • Behavior / action • Positive thoughts

• Good Health• Work hard • Excel academically • Remember clan

system• Career / life

planning

Educational student opportunities

• High School student summer opportunities>Examples: *AISES College Horizon * Nizhoni

Academy at NAU * U of A Med. Start Program * INMED: Indians into Medicine * NNAYI: National Native American Youth Initiative *Upward Bound available in every States.

• Need good grades, good behavior, letters of recommendation from teacher/counselor.

• Native teachings: good prosperity, good behavior, work hard, respect, life planning.

Scholarship availability

• Web site: www.nmsu.edu/~ird• Published by: New Mexico State University;

Indian Resource Development• Telephone: 575. 646. 1347• Title: 2010 Sources of Financial Aid Available

to American Indian Students

Native Leaders today

• Dr. Beulah Allen, 1st Navajo woman physician

• Dr. Lori Arviso Alvord, 1st Navajo surgeon

• Caudeen Bates-Arthur 1st Navajo Attorney & Chief Justice

• Virginia Ballinger; fashion designer

Our youth; our future

Our role

• Understand others culture

• Help Native youth weave cultural values with its teachings into their life

• Education is the latter to success

Thank you

References• Kinaalda; A Navajo Girl Grows Up. By Monty Roessel, 1993, Lerner

Publications• Kinaalda; A Study of Navajo Girls Puberty Ceremony, 1993. By Charlotte

Johnson Frisbie. University of Utah, SLC, Utah• Navajo Women; SAANI, 2007. By Betty Reid and Kenji Kawano. Native

American Culture Perspectives – Kinaalda: The Navajo Puberty Ritual• http://www.associatedcontent.com/article/106033/native culture

perspectives• Blessingway, 1970. By Leland C. Wyman, U of A Press, Tucson. AZ. • Getting into Adolescents’ Heads, 1998/99, Contemporary Paediatrics, pp

75-90. • A Pocket Guide to Managing Contraception, 2000. • Navajo Nation Facts and Figures, 2005 -06. NN Economic Development ,

NN Scholarship Office and Navajo Election Administration• Navajo Youth Risk Behavior Survey, 2003 – 08. Four Directions, Northern

Navajo Medical Center, Shiprock, NM