Editor’s Note: A unique orthopaedic practice type and the wisdom gained by caring for indigenous people.
“My work with Navaho, Zuni, Hopi and Apache tribes has taught me the difference between ‘fixing people’ and healing them.” Medicine is an art more than a science. Traditional orthopaedic care focuses on science and mechanics. It is not wholistic, nor does it consider the patient as a complex person. This approach may be slowly changing.
In treating indigenous people, I have learned that healing is relational. Both the surgeon and the “medicine man” participate in treating an orthopaedic patient. A “disharmony” with nature is believed to help create their problem or injury in the first place. Unless this issue is addressed, a series of similar injuries or fractures may result.
In an Indian Health Service (IHS) Hospital, a team concept is used to address patients with orthopaedic and other sorts of maladies. Medical professionals, “traditional healers” and spiritual leaders team up to provide patient-centered care. The “team” includes the patient, relationships are developed, and there is shared decision-making.
In one of the hospitals where I worked, there were two medicine men. I, or the patient, would ask for a medicine man consult as seemed appropriate. There was also a “sweat lodge” on campus and “healing circles” were conducted in the hospital.
Orthopaedic clinic follow-up after hospital discharge was not common, so as much care as possible was rendered during the patients’ admissions. During my first stint with the IHS some decades ago, we could keep patients in the hospital for as long as we felt they needed care and observation. We could finish a course of antibiotics in the hospital and then determine if the patient could go home without fear of infection recurrence. Families moved into the hospital to provide emotional support, etc.
A few decades later, during my second employment with the IHS, prolonged hospitalization was no longer an option. We did definitive care acutely. We avoided use of external fixators for fractures if possible since we might never see the patient again. Medicine men were asked to follow the patient’s healing and wellbeing once they returned home.
One patient I especially remember was a Zuni woman in her 70’s. She was accidentally knocked over by the door of a pick-up truck and sustained a diaphyseal femur fracture. I did an intermedullary rodding and she was soon discharged. Around two weeks post-op, I decided to make the 30-mile trip to check on her. She walked without support to greet me. Range of motion at the hip and knee were full and she claimed to have no pain. Eventual radiographs demonstrated full healing.
The key here was that tribal customs were respected during her healing period. She was not placed on calcium or other medications in the post-operative period. Her culture provided what she required, and I respected that.
Zunis are pueblo dwellers rather than nomads meaning there is much community involvement and support. Healing ceremonies are common, and these are believed to summon healing spirits. Dietary practices are unique to the culture. Vitamin C comes from eating chili peppers. Comfrey tea is consumed for its bonehealing and anti-inflammatory benefits. Finally, “blue corn mush” is a breakfast standard. It is made of cornmeal and juniper ash which contributes calcium and other nutrients to promote bone health.
What did this sort of orthopaedic practice teach me? That I was only a piece of the healing picture but “not the whole deal.”
What can this teach others?
• Not only is it necessary to provide information and care to physically “fix” a person, but we must also consider how the patient’s culture interacts with them. Culture means family, community, spirituality, nutritional practices, etc.
• Many factors are involved in healing, it is not just “science and the mechanics.”