Visual Book Report Project - Paola Alvarado

Visual Book Report Project

Paola Alvarado HEA 3305 Roncancio

Crownpoint, NM (Watson)

Darthmouth College (Gill, "Drone")

Stanford University School of Medicine ("Stanford")

Gallup Indian Medical Center ("Entrance1")

Works Cited

Image By vecstock

Dr. Lori Arviso Alvord

Dr. Lori Arviso Alvord is a general surgeon and a member of the tribe Dine, also known as Navajo, from Crownpoint, New Mexico. Her clans are Tsi’naajinii, the black-streaked wood clan, and Ashiihi Dinee, the salt clan, a common thing to include clans while identifying oneself in the Navajo culture (Alvord and Van Pelt 8). She is the first Navajo woman to become a surgeon.

Fig. 1. Dr. Lori Aviso Alvord (“Lori Arviso Alvord”).

Works Cited

“Acoma-Canoncito-Laguna Indian Health Center”. n.d., Indian Health Service, www.ihs.gov/albuquerque/health carefacilities/acoma-canoncito-laguna-indian-health-center/.Alvord, Lori A., and Elizabeth C. Van Pelt. The Scalpel and the Silver Bear: The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing. Bantam Books, 2000. Baker, Deborah. “Surgeon Operates in 2 Worlds”. Los Angeles Times, 1 Aug. 1999, www.latimes.com/archives/la-xpm-1999-aug-01-me-61475-story.html. Blackmore, Lars. The Mohegan Council of Elders Vice Chairwoman Beth Regan dances with the head man and woman of the powwow. 7 May 2022, Dartmouth Alumni, www.alumni.dartmouth.edu/content/powwow-and-l%C5%AB%CA%BBau-celebrate-indigenous-cultures. Carey, Harold, Jr. “PowWow Navajo Nation Fair 4”. 10 Sept. 2012, Navajo People, www.navajopeople.org/blog/ powwow-navajo-nation-fair-2012/powwow-004/.Carey, Harold, Jr. “Sante Fe Indian Market”. 15 Aug. 2014, Navajo People, www.navajopeople.org/blog/santa-fe-indian-market/santafeindianmarket_000/. Dartmouth College. “Dartmouth Indian Logo”. n.d., History 08.07 (Spring 2020): The Indian Symbol at Dartmouth: A Story of Voices and Silence, www.https://courseexhibits.library.dartmouth.edu/s/HIST8/ item/493.

Going Against Navajo Beliefs

Obstacles faced in medical school go against her Navajo beliefs:

• Touching/Dissecting a cadaver → Navajos do not touch the dead ever in fear of ch’į́įndis, also known as evil spirits, which can lead to madness and death (Alvord and Van Pelt 40).
• Touching and asking personal questions to patients → There is great respect for private and spatial boundaries which means no touching allowed, especially from strangers, and it is bad to ask personal questions (Alvord and Van Pelt 44).
• Performing surgery → It is a gross invasion of privacy (Alvord and Van Pelt 44).

Even though these are necessary for medical professional training, it does lead to discomfort and emotional difficulty for students, especially while working in the beginning with cadavers, but also the discomfort of going against the very beliefs Dr. Alvord learned to follow. Despite knowing performing surgeries goes against some of the Navajo philosophies, it does not sway her mind in knowing with certainty that she wants to become a surgeon while it is one of the hardest things and the most disturbing as a Navajo (Alvord and Van Pelt 44).

Gallup Indian Medical Center

Gallup, New Mexico

Combining Both

It became a journey in its ever-gradual and evolving cooperating Navajo philosophies into her medical practice and learning to unlearn things taught in her medical training.

• Hózhǫ́ne háaz’dlíí or Walking in Beauty
• A key concept that means living in balance and harmony within yourself (mind, body, and spirit) and the world including relationships with family, community, the animal world, and the environment (Alvord and Van Pelt 186).
• The Navajo view is a macro view as it considers a person’s whole life into account, while Western medicine sees a micro view of only the person themselves and their illness (Alvord and Van Pelt 187).

School Admission

At 16 years old, Dr. Alvord got accepted to the University of Dartmouth in Hanover, New Hamshire. There is a sense of fear in moving away from the sacred mountains and coming back as someone who is broken and lost or even as someone who has forgotten the Navajo ways (Alvord and Van Pelt 27).

Fig. 4. Final year in High School (“Lori Arviso Alvord in High School, ca. 1975”).

Dr. Alvord soon became homesick, missing events back at home. Some familiar events she used to go such as the Navajo tribal fairs, the Zuni Shalako, the Laguna feast days, the Santa Fe Indian market, and the Gallup ceremonial, and missing watching the Apache Devil Dancers and the Pueblo Buffalo Dancers (Alvord and Van Pelt 29).

Fig. 8. A powwow dance at the Navajo Nation Fair (Carey).

Fig. 9. The Santa Fe Market (Carey).

Adjusting the Approach to Patient Care Cont.

• Always staying aware of the harmony of the whole person—their organs, mind, and spirit—while performing surgery.
• Her mindset is that while accessing a patient’s most personal territory, she tries not to disrespect it and instead honor the trust her Navajo patients place in her (Alvord and Van Pelt 111).
• Letting patients keep any bodily tissue removed during surgery
• It is to help patients feel at ease having possession of their being because it is believed that Navajo witches can use objects directly connected to someone’s body and use them in ceremonies to cause them harm (Alvord and Van Pelt 114).

• Open and suggesting seeing a hataałii or medicine man to help patients’ mental and spiritual health, even adjusting patients’ surgery schedule when necessary to accommodate time.
• A traditional ceremony or “sing” is sometimes crucial for patients to receive for their survival because they believe he could heal them, as it is hard to heal someone who does not think they will get better or does not want to (Alvord and Van Pelt 77, 94).
• Dr. Alvord has attended traditional events such as ceremonies like the Night Chant, experiencing its magic that leaves her feeling different and even curing her as well and connecting back to her tribe’s medicine again (Alvord and Van Pelt 101). After witnessing a medicine man perform a blessing ceremony over the new ICU to help Navajo patients feel safe to be treated and led her wanting to improve her surgical skills, requiring her to know more about traditional medicine (Alvord and Van Pelt 105).

At a Crossroads

Growing up, Dr. Alvord had always lived at the reservation up until her senior year in high school. Like many before her, she has thought of her future and needs to make an important decision about whether to leave her home and the reservation to pursue higher education or to stay (Alvord and Van Pelt 25). It means considering if getting an education can outweigh the loss of her home and community but also leaving the traditional ways.

Recurring Issues

Dr. Alvord continues to face the same issues she had at Dartmouth. The feeling of being an outsider continues, as she is away from her sacred mountains often feeling lonely and unsettling, and avoids bringing attention to herself and participating in class (Alvord and Van Pelt 39). It continues to be hard for her to fit into an environment with different social expectations than she is used to. Despite having her sister near, the first years at Stanford were difficult (Alvord and Van Pelt 39).

Coming Back Home

After finishing her residency, Dr. Alvord requested to join the Indian Health Service and work among the Dine people at Gallup Indian Medical Center in Gallup, New Mexico near her hometown (Alvord and Van Pelt 56). Returning home helped her strengthen her connection to her roots and on a more personal level, and the new environment was still familiar with what she left behind.

Fig. 15. Dr. Alvord a the Center in 1992 (Miller).

Fig. 16. Gallup Indian Medical Center ("Gmic").

Works Cited Cont.

“Entrance1 Gallup Indian Medical Center Gallup NM”. n.d., Rehab, www.rehab.com/gallup-indian-medical-center-gallup.“51st Annual Dartmouth Powwow.” YouTube, uploaded by Dartmouth, 26 May 2023, https://youtu.be/apXaAl H8m28?si=IEcjMS_SAHWJ-JQX.Gill, Robert. “CT River Drone”. 18 Aug. 2018, Dartmouth, www.home.dartmouth.edu/campuslife/ studentexperience/summer-dartmouth.Gill, Robert. “Drone RG”. 18 Aug. 2023, Dartmouth, www.home.dartmouth.edu/news/2023/09/views-green-september-2023. “Gmic”. n.d., Indian Health Service, www.ihs.gov/newsroom/pressreleases/2013pressreleases/firstihslevel3 traumacenter/. Kluetmeier, Heinz. “October 8th, 1966 Princeton-Dartmouth Game Program”. 1966, Adventuresome Spirit, www.e xhibits.library.dartmouth.edu/s/AdventuresomeSpirit/item/1317.“Lori Arviso Alvord”. n.d., Bulletin of The American College of Surgeons, www.bulletin.facs.org/2022/02/loriarviso-alvord-md-the-first-navajo-nation-tribal-member-to-be-board-certified-in-general-surgery/.

First Pregnancy

During her pregnancy, she followed many Navajo ways and advice in finding comfort and security over her health and her son's well-being, especially during times of worry.

• She avoided looking toward bad things as it is believed it affects one’s well-being (Alvord and Van Pelt 151).
• Experiencing pelvic pain has made her wonder if it is the result of disharmony from looking at bad things making her out of sync with fertility and maternity, then the pain is replaced with high blood pressure prompting her to visit a hataałii (Alvord and Van Pelt 153-154). After receiving a ceremony, it brought on a sense of peace and knowing everything would be okay.
• When it came to the birth, she wanted to integrate different traditional Navajo ways, including incorporating a Navajo sash tradition, and a medicine woman at the hospital came into her room and offered a prayer, resulting in her feeling relaxed and the sickness effect subside (Alvord and Van Pelt 175, 179).

These actions further strengthen her personal relationship with Navajo philosophies alongside Western medicine.

First Culture Shock

There was indeed a culture shock when first living in Dartmouth. People talked too much, laughed too hard, asked too many personal questions which there was also a lack of respect for privacy, and were overly competitive and caring for material things, which differs from the Navajos’ beliefs in valuing silence over words, reserving opinions until asked for, emphasizing the importance of relationships with others both human and nonhuman than material things, being humble and not draw attention to oneself, and favor in cooperating than competing with others (Alvord and Van Pelt 27).

Applying to Stanford Medical School

Dr. Alvord got accepted to the Stanford medical school. She decided to attend this school, attracted by its large and active Native American community, including a building with pictures, names, and tribes of its members, and provided support when or if things got difficult (Alvord and Van Pelt 38). She learned from her experience at Dartmouth that finding a community and support from others can help her feel less alienated in a world and culture very different from her own. This time, her sister even lives nearby also attending Stanford.

Works Cited Cont.

“Pueblo Buffalo Dance At Second Mesa.” YouTube, uploaded by JD Aragón, 8 Oct. 2017, www.youtube.com/ watch?v=TkVEkINK_9I. “Rosenberg Gary”. n.d., The University of New Mexico Health Sciences, www.hsc.unm.edu/directory/rosen berg-gary.html. “Scalpel12”. n.d., Somos Primos, www.somosprimos.com/sp2013/spdec13/spdec13.htm. “Stanford University School of Medicine”. n.d., Stanford University School of Medicine, www.med.stanford. edu/school.html.“Surgeon was champion of Indian Health”. n.d., Santa Fe New Mexican, www.santafenewmexican.com/news/lo cal_news/surgeon-was-champion-of-indian-health/article_5e351d52-3f02-5c01-9ceef895ed6cc 2c5.html.Vecstock. “Image”. n.d., Freepik, www.freepik.com/free-ai-image/silhouette-tree-against-yellow-twilight-sky-generated-byai_42649061.htm#query=desert%20night&position=10&from_view=search&track=ais& uuid=3cadf257-57f3-425b-8b26-d5bcd0f21690. Watson, Patrick. “Crownpoint, NM: Overlooking old PHS housing”. 12 March 2008, City-Data, www.city-data. com/picfilesc/picc42761.php. “Website5”. n.d., Crownpoint Chapter, www.crownpoint.navajochapters.org/links/.

Works Cited Cont.

“Lori Arviso Alvord in High School, ca. 1975”. n.d., Changing the face of Medicine, www.cfmedicine.nlm.nih.gov/ physicians/biography_7.html.“Maps4”. n.d., City-Data, www.city-data.com/city/Crownpoint-New-Mexico.html. Matlock, Staci. “Surgeon was champion of Indian health”. Santa Fe New Mexican, 30 Sept. 2017, www.santafe newmexican.com/news/local_news/surgeon-was-champion-of-indian-health/article_ 5e351d52-3f02-5c01-9cee-f895ed6cc2c5.html.Miller, Scott A. “Navajo_2207”. 1992, Scott A. Miller Photography, www.scottamillerphoto.photoshelter.com/image ?&_bqG=25&_bqH=eJxtT1tLwzAU_jXrc4tMZZCHLOc4z2yTkUtHn4K4davIlDovP9.cMrS4BfLlu.RLON0BPr 5M0a8.282GQn5TXtdt.3y_3u5mV8WsyHPeCSmCU.Llte8yig6kx8l0XlWTKYiRAcAGwMhq0mKTz2Tj_yqeV_FyVZFvhs98ipkoE7S3TSRnWBpLqFNGRrMkFy2WKB3CSa7G2hnrhZX6IRtGi1KDOCYeHNpIIAKPvTwcb dv8bsLeYpqsj7IMsoFatXwpSyqeaT0cKqeaPil9u6PVkyl8uJ9.9g_7bN6aC8GVIw_0fFxLw--&GI_ID=.Morris, Neal. “Sacred Mountains”. n.d., Crow Canyon Archaeological Center, www.lcontent.crowcanyon.org/Ed ucationProducts/peoples_mesa_verde/images/map_sacred_mountains.php.PerryPlanet. “Unm domenicihall”. 16 May 2010, Wikipedia, www.en.m.wikipedia.org/wiki/File:Unm_domenicihall. jpg.

Finding a Community

Being in a new place without knowing anyone, people tend to gravitate toward people and places that feel the most comfortable and familiar to them. During her undergraduate Dr. Alvord found the most comfort with other Native American students, who also shared feeling disconnected from other students, creating their own solid community that did almost everything together (Alvord and Van Pelt 31). It was a community that helped provide a support system and feel connected in being part of a group.

University of Dartmouth

Hanover, New Hampshire

Life After Undergraduate

After graduating from Dartmouth with a double major in Psychology and Sociology modified with Native American studies, she began to work as a research assistant for Dr. Gary Rosenberg at the University of New Mexico.

Fig. 11. Gary Rosenberg (Rosenberg Gary).

One day, while working with Dr. Rosenberg, he suddenly asked Dr. Alvord if she had ever thought of going to medical school and suggested that she should (Alvord and Van Pelt 36). After weeks of giving it some thought, she decided to slowly start taking premed classes, and not long after she quit her job and went back to school full-time to apply to medical school.

Fig. 12. Working in the labs in Domenici Hall at the University of New Mexico (PerryPlanet).

Adjusting the Approach to Patient Care

Eventually, Dr. Alvord begins to draw from Navajo beliefs and philosophies into her own views and practices on how to care for patients. The experiences she had with every patient have helped her shape how she communicates and behaves with her patients to gain their trust and acceptance, including during their surgery, to help create a better surgical outcome (Alvord and Van Pelt 74).

• Begins using bits of Navajo with patients helps bring comfort.
• Her Navajo is improving, and takes classes even if she asks for an interpreter for patients who do not speak English to ensure no misunderstandings (Alvord and Van Pelt 140).
• Adjusting the levels of touching based on the patient’s comfort
• Using Navajo phrases to describe cancer
• Adjusting her conversations and body language to patients who experienced outside the reservation while still following Navajo customs.

• Consistently introduces herself, the names of her clans to identify herself, and where she is from.
• This information helps Navajo patients not only know where she is from but also whether they are members of the same clans (Alvord and Van Pelt 8). It creates an understanding.

Reflecting Back

Eventually, Dr. Alvord realizes during her surgical program how she had strayed away from her Navajo roots. During her time at Stanford, she did not discuss her background with others knowing they could not understand that part of her and instead focused on developing skills that would help her in the white world (Alvord and Van Pelt 52). She acknowledges that the longer she is away from the sacred mountains, the more she adopts “white” behaviors and, in turn, loses touch with her culture (Alvord and Van Pelt 52).

Hanover, NH vs Crownpoint, NM

Hanover is covered in lush green hills, ivied walls, a river nearby, and surrounded by trees, a contrast to the vast acreage sky and sand with the red ground leading to faraway cliffs with scrub bush, mesquite, chamiso, and pinon trees in between of Crownpoint (Alvord and Van Pelt 27). Despite such beautiful and threatening greenery, the horizon is nowhere in sight initially giving a feeling of claustrophobic (Alvord and Van Pelt 27). Even the weather is different, from the drastic heat of the desert to the cold frozen winters up north.

Fig. 5. Left: The Connecticut River is surrounded by lush greenery near Dartmouth (Gill, "CT"). Right: The Roadway into Crownpoint (“Website5).

Adjusting the Approach to Patient Care Cont.

• Voicing out loud to patients that the decision to have surgery is their choice to make
• It gives power back to patients in having control over the fate of their bodies and a show of respect (Alvord and Van Pelt 145).

Traditional Navajos people are against the idea of surgery, or na’agizh in Navajo, which means to cut open, as it is going against the philosophy of the sacred, natural order and beauty of the universe, and to cut open a human body and removing a part is disrupting the harmony (Alvord and Van Pelt 114). Even though Dr. Alvord is going against this philosophy partially because many Navajos already had surgery and many more will need it in the future, she is offering them an option to have a Navajo surgeon (Alvord and Van Pelt 114).

Stanford Medical School

Stanford, CA

Traditions on Campus

Her newfound tribe held a campus powwow each year filled with feathered fancy dancers and women in beaded and brightly colored fabric moving to the beat of the drums of Plains Indians mixed with their voices or songs from an invited singer from a pueblo (Alvord and Van Pelt 33). These powwows allowed everyone to come together and experience these ceremonies for students, reminiscing about their familiarity or enjoying something new. For a moment, two different worlds come together sharing the same experience and connection.

Fig. 10. A powwow dance at Dartmouth University (Blackmore).

Becoming a Patient

Residency was filled with constant stress, working long hours, little sleep, and poor eating habits. This unhealthy and unbalanced lifestyle had taken a toll on Dr. Alvord's health and directly went against the basic Navajo principles of living in harmony and balance (Alvord and Van Pelt 55). After recovering from her serious illness, she learned firsthand what it means to be a Navajo person receiving medical attention from being touched, looked into her eyes, and asked personal questions (Alvord and Van Pelt 54). This experience allowed her to understand how non-Indian medical personnel can make an Indian patient feel uncomfortable with a shift in behavior and expectations.

Crownpoint, New Mexico

Fig. 2. Crownpoint (Maps4).

Deciding to leave for college

Dr. Alvord soon first becomes alienated from her Navajo roots in deciding to leave home and the reservation to pursue college. Leaving means leaving the safety of the sacred four mountains that bind the Navajo reservation and potentially invite imbalance to the body, leaving the Walk of Beauty, and breaking away from the tribe, all of which can lead to facing danger in an unknown and unguarded world outside the reservation (Alvord and Van Pelt 25).

Fig. 3. The Four Sacred Mountains of the Dine (Morris).

The Next Chapter

Dr. Alvord received a good job opportunity as an associate dean of student affairs at Dartmouth College. After taking part in interviews and putting some thought into whether the benefits gained from this experience were enough to move, she decided to leave again. However, this time, she carries her Navajo traditions and beliefs close to her to share them with the rest of the world.

Fig. 17. Dr. Alvord as a general surgeon at Dartmouth ("Scalpel12").

Returning Back as Someone New

Dr. Alvord returns home as a new person adopting many white mannerisms, wearing a white medical jacket and a stethoscope, and filled with knowledge of Western medicine that by appearance alone can make it hard to connect with Navajo patients as she is seen as different from them. She understood that becoming a doctor came at a price, one that she still has much to learn and unlearn to become the surgeon her Navajo patients need (Alvord and Van Pelt 58).

Navajo Beliefs

In the Navajo culture, there is a common core belief in hózhǫ́ni and living in harmony and balance. People believe in hózhǫ́ or hózhǫ́ni, which translates to “Walking in Beauty”, means that everything in life is connected and influences everything (Alvord and Van Pelt 14). There is an effort to live in harmony and balance because out of balance and losing one’s way to beauty will result in sickness (Alvord and Van Pelt 14). Dr. Alvord tries to "Walk in Beauty" as best as she can and be in harmony in all parts of her life, including her personal and professional life.

Unofficial Mascot

Dartmouth’s unofficial mascot has made Native students attending the university feel uncomfortable and view the stark contrast in how the outside world views them. The “Dartmouth Indian” is a tomahawk-wielding red man in whom white students will dress up wearing loincloths and paint their faces and hold their toy tomahawks, shocking the Native community and Dr. Alvord of this caricature (Alvord and Van Pelt 28). She describes that even though the university is stately, beautiful, and affluent it could still be intimidating and alienating (Alvord and Van Pelt 28).

Fig. 6. The Dartmouth Indian Logo (Dartmouth College).

Fig. 7. The unofficial mascot (Kluetmeier).

First Steps Returning Back to Navajo Roots

The first steps in returning to her Navajo roots started while doing rotations at the Acoma-Canyoncito-Laguna Hospital in New Mexico near the Navajo reservation. Under the guidance of surgeon Dr. Ron Lujan, a full-blooded Indian from Taos and San Juan Pueblo, who continued to help teach her what medical school did not prepare her in treating patients as an Indian physician treating a community of other Indians within Western medicine.

Fig. 13. Acoma-Canyoncito-Laguna Hospital ("Acoma").

Fig. 14. Dr. Ron Lujan ("Surgeon").

Beginning to Learn How to Treat Indian Patients

Dr. Alvord learned to relate to her patients, to touch them, and to ask questions while conquering her worries while meeting them. There is a sense of uncomfortableness with the process of taking patients’ histories as though she is being rude and performing physicals can feel uneasy (Alvord and Van Pelt 46).

In the Navajo ways, looking deeply into a person’s life and asking a lot of questions while staring into their eyes is considered rude as private information is a gift, and as a result, at Stanford she was accused of seeming remote and disinterested but was instinctively following Navajo customs (Alvord and Van Pelt 46). Dr. Lujan’s approach was to ask simple questions and through making conversations with his patients, he would learn the necessary information he needs while distracting patients from the examination process (Alvord and Van Pelt 46). Viewing this type of interaction teaches her firsthand how an Indian physician provides care for Indian patients. It all begins to make sense to Dr. Alvord, encouraging her to stay in medicine even if she still feels extreme discomfort with patients (Alvord and Van Pelt 47).