Expanding Horizons: A Month at Zuni Comprehensive Community Health Center

I had the privilege of spending the month of October rotating at an Indian Health Services (IHS) site in Zuni, New Mexico called Zuni Comprehensive Health Center. Since starting medical school, I have dreamt about serving with the IHS after residency. The opportunity to provide culturally humble care while learning about a new culture in a rural area appeals to both my desire to learn through experience and my passion for service. My month at Zuni Pueblo did not disappoint.  

A:shiwi

Descendants of the Ancestral Puebloan peoples, the A:shiwi (Zuni) and their ancestors have inhabited their ancestral home in the Zuni River Valley of New Mexico where they remain today, for over 2,000 years. They call their homeland, Halona Idiwan’a—the Middle Place. Except for 12 years in the late 1600s, when the Zuni were violently driven from their land by Spanish forces led by Francisco Vasquez de Coronoado, they have lived on this land since their origin. Unfortunately, a majority of their original territory has been stolen from them, and their acreage today is about 450,000 acres. Despite this, the Zuni still reside in their ancestral home and have steadfastly preserved much of their religion, tradition, and culture—including their language.

Acknowledging My Implicit Biases

My time at Zuni provided me with the opportunity to transform some of the implicit biases I didn’t realize I had regarding Indigenous Americans.

Growing up exclusively in New England, the breadth and richness of indigenous cultures were largely hidden from my view and my understanding of the ethnic and cultural make-up of the place in which I was raised. Though I did eventually learn that the white-washed Thanksgiving story that so many of us are taught is not accurate and is, in fact, quite malignant, I was ill-informed regarding the vast and varied diversity of Native peoples and their histories. To the degree I was exposed (ex. An elementary school field trip to the Mashantucket Pequot museum in Connecticut), Native culture and life had consistently been portrayed as a thing of the past, to be found in museums not in daily life (in hegemonic white United States culture that is).

Over the years, I have come to understand that perpetrations of trauma and violence by those who hold power are not always physical or emotional in nature but can also be socio-cultural. We should not underestimate the insidious nature of media and cultural narratives that promote certain stereotypes as a way of removing power from marginalized groups. I have been able to integrate this understanding into questioning my beliefs around different groups and cultures but it was not until my arrival at Zuni that I realized how deeply that narrative had rooted in my psyche around Native peoples. Throughout my childhood, I was explicitly and implicitly taught perspectives on Native American communities that centered stories of struggling tribes plagued by sorrow.  From my first day at Zuni, the great joy and vibrancy of Zuni culture was immediately evident, as was the false narrative that permeates much of mainstream, white-dominated culture.

Through spending a month at Zuni, I was able to reshape my understanding of what it means to be Native American in the present-day United States. A recognition of the trauma done to Native American peoples does not preclude the ability of present-day tribes to thrive. I can hold both realities to be true.

As the Zuni put it themselves, in defining their museum and heritage center, “We define our institution as an ecomuseum: in harmony with Zuni’s environmental values and dedicated to honoring, cultivating, and nurturing dynamic Zuni culture.” They are dynamic and alive.

Learning About Zuni Culture & Tradition on a Home Health Visit

As an outsider, I was keenly aware of my (appropriate) inability to fully grasp and experience the wealth and breadth of Zuni culture and tradition. At the same time, I wanted to learn as much about Zuni holidays and observances as I was permitted to—although some are openly shared with non-Zunis, many are carefully protected – the knowledge and experience of them a privilege reserved for Zunis only.

I had the privilege of spending a day with the home health provider as she visited her patients’ homes. Driving around Zuni Pueblo having sites pointed out to me, I was awed by the multitude of stories contained in each landmark and turn of the street. One home we visited was particularly representative of the importance of stories in Zuni life. On our drive, the home health nurse I was shadowing gave me the background on the patient we were going to see. On the land which she lived, three generations of her family also resided. Some in separate homes but all near one another, a very common set-up among Zuni.

As soon as we crossed the doorstep of the patient’s home, the smell of delicious food flooded my nostrils. Once inside, it was evident that a massive cooking production was underway. Bowls of beans, flour, homemade treats, and drinks covered every surface. I was informed that it was Grandmother’s Day, which, during non-COVID times, is celebrated with a Rain Dance. As we got our medical supplies set up and readied to give an injection, the patient, a grandmother herself, started to share with me information about another Zuni holiday—Shalako, the most sacred Zuni religious event of the year. Her family had been chosen to build a home for Shalako this year and she was looking forward to the sweet smell of wood-fired cooking.

This story is just a single example of the vibrancy of Zuni culture and the vital nature of its integration into daily life. Initially I felt surprised at my experience of those moments of awe because I had subconsciously expected to encounter conformation to the narrative of struggling tribes and individuals. Reflecting on this surprise, I recognized my own bias and the space there was to learn from my faults.

Intentionality

While at Zuni Pueblo, it was important to me that I not be a mere cultural tourist, and I set out to learn how the non-Zuni doctors had prioritized that value themselves while practicing medicine in a place that was not their own.

I was impressed by the intentionality with which the docs emphasized investing their energy and time in the community and a non-paternalistic approach to providing care. Paternalistic models of care emphasize control belonging to the provider and providers making decisions for patients without full transparency or explicit consent of patients given. Widely accepted as the ideal model of care for generations, in recent years a push towards non-paternalistic medicine has become mainstream. Non-paternalistic models emphasize shared decision making and providers valuing patient autonomy to guide treatment to align with patient goals and values.¹ At Zuni, the doctors clearly practiced the latter approach. The strength of their relationships with patients, Native American staff, and community members was clearly rooted in a deep respect for Zuni culture and the autonomy of Zuni Tribe. Witnessing the relationships between the providers and their patients plainly evidenced the ethos of “our patients are our greatest teachers,” a truism oft quoted in medical training. The bi-directional nature of the relationships and the curiosity with which providers engaged with their patients illustrated a desire to learn and an emphasis on cultural humility.

Why IHS?

My interest in medicine is driven by an interest in people and their stories.

I am actively pursuing a career in Family Medicine, a specialty that I chose for its emphasis on community integration, empathy, and viewing patients as whole human beings with diverse circumstances and backgrounds.

I learned of Zuni through my time participating in the University of Vermont Larner College of Medicine Longitudinal Integrated Curriculum (LIC), during which time one of my mentors (who had worked at Navajo IHS) introduced me to his two children. Both of his children were family medicine physicians working at Zuni and this connection ultimately led me there.

A future working with IHS aligns with my interest in practicing rural medicine after residency. In more rural places, I find there is a strong sense of community and unique type of relationship building that happens. The varied roles of a family medicine physician are more easily realized in a place with such strong community ties. Also, the opportunity to practice full-spectrum family medicine is a career aspiration of mine. My partner, an intern in medicine-pediatrics, is also well-suited for a rural practice setting and having the privilege to pursue such work together feels extra meaningful.

I plan to go back to Zuni during residency, this time with my partner, and continue to enrich my understanding of culturally humble patient care and the uniqueness and richness of the Zuni culture.

Until then, I will continue to reflect on my increased and growing understanding of what it means to be Native American in the present-day United States.