1. 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

2. 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.

3. 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

4. Many cultures exist today

5. Navajo Family – Home Need for: Counseling Empathy A prayer, a song
Educational support
Love

6. Kinaalda and Beauty Way Navajo Ceremonies

7. Kinaalda Ceremony Ceremony performed at puberty; first menstruation
Signifies transformation from childhood into womanhood
Four (4) day ceremony
Re-enact changing women 1st ceremony

8. Kinaalda Teachings
* Clan System * Exercise * Good Health * Good prosperity * Motherhood * Adequate Nutrition * Sharing * Education

9. 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

10. Process of Kinaalda Running / exercise Mixing of corn mush
Blessing Kanaalda girl
Blessing of corn mush
Blessing others
Sharing

11. Process of Kinaalda & Teachings
Running
Mixing of corn mush

12. Process of Kinaalda & teachings
Blessing of corn cake
Open fire: baking of corn cake

13. Process of Kinaalda & Teachings
Blessing others
Sharing

14. Navajo Beauty Way: Ho’zhooji’

15. 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.

16. 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

17. 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

18. 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.

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

20. More Teens

21. Navajo Nation (NN) Population 2005 – 06
*Total Navajo population: 298, 215
*Navajo Nation residents: 180,462
Female NN residents: %
Male NN residents: %
Navajo non-NN residents distribution:
> PHX: 10,143
> ABQ: 7,889
>Gallup: 6,279
> Farmington: 5,793
> Others: Flagstaff, Tucson, SLC, Utah & LA, Calif.

22. 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

23. Navajo High School Students Risk Behavior Navajo Youth Risk Behavior Survey
2000
2003
2005
2008
Sometimes or always wore a seat belt
90%
89%
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
92%
During past YEAR did NOT attempt suicide
84%
80%
82%
During past MONTH did NOT drink alcohol
57%
64%
65%
During past MONTH did NOT use marijuana
32%
Never had sexual intercourse
60%
63%
Ate five or more fruits and vegetables per day
38%
28%

24. Objective #3: Integration of Cultural teachings & Values in Primary Care
Physical
Emotional
Social
School Performance

25. 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.

26. PE: Anticipatory Guidance Education

27. Safety: car, use of seat belt, no bullying, etc.
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

28. 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.

29. 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

30. 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

31. Cont’d: Emotional - Case Scenario
If method not started today; may not:
> RTC
>have additional unprotected sex
> never start a method
> potential for unplanned pregnancy / could have been prevented
Larue decided to use Depo provera
Busy life
Start depo today
Re-iterate kinaalda teaching & prevention of pregnancy / STI.
Priority - School
Confidentiality

32. Integration of cultural teachings in Primary Care Social - Case Scenario
Derek, 17 y/o male comes to teen clinic for immunization
A depression form completed
Result positive

33. Depression Screening Form

34. Cont’d: Social Case Scenario
Depression form : PHQ-2 Version
Over the past two weeks, how often have you been bothered by the following problems?
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

35. 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

36. Integration of Cultural Teachings & Values in Primary Care - School Performance / Education

37. 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

38. 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.

39. Scholarship availability
Web site:
Published by: New Mexico State University; Indian Resource Development
Telephone:
Title: 2010 Sources of Financial Aid Available to American Indian Students

40. 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

41. Our youth; our future

42. Our role Understand others culture
Help Native youth weave cultural values with its teachings into their life
Education is the latter to success

43. Thank you

44. References
Kinaalda; A Navajo Girl Grows Up. By Monty Roessel, 1993, Lerner Publications
Kinaalda; A Study of Navajo Girls Puberty Ceremony, By Charlotte Johnson Frisbie. University of Utah, SLC, Utah
Navajo Women; SAANI, By Betty Reid and Kenji Kawano. Native American Culture Perspectives – Kinaalda: The Navajo Puberty Ritual
culture perspectives
Blessingway, By Leland C. Wyman, U of A Press, Tucson. AZ.
Getting into Adolescents’ Heads, 1998/99, Contemporary Paediatrics, pp
A Pocket Guide to Managing Contraception, 2000.
Navajo Nation Facts and Figures, 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