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Integration of Navajo Culture Values in Primary Care Setting by Rose Saltclah, RN/MSN/CFNP School Based Health Clinic Coordinator Crownpoint HealthCare Facility – IHS Crownpoint , NM . Disclosure Statements. I have no financial arrangements related to the content of this presentation.
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Integration of Navajo Culture Values in Primary Care SettingbyRose Saltclah, RN/MSN/CFNP School Based Health Clinic CoordinatorCrownpoint 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
Navajo Family – Home Need for: • Counseling • Empathy • A prayer, a song • Educational support • Love
Kinaalda Ceremony • Ceremony performed at puberty; first menstruation • Signifies transformation from childhood into womanhood • Four (4) day ceremony • Re-enact changing women 1st ceremony
Kinaalda Teachings * Clan System * Exercise * Good Health* Good prosperity* Motherhood* Adequate Nutrition* Sharing * Education
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 Blessing others Sharing
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.
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 annually College 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
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.
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 Depoprovera • 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
Integration of cultural teachings in Primary CareSocial - Case Scenario • Derek, 17 y/o male comes to teen clinic for immunization • A depression form completed • Result positive
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 role • Understand others culture • Help Native youth weave cultural values with its teachings into their life • Education is the latter to success
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