Growing up, my knowledge of American Indians was limited to what I learned in school and stereotypical portrayals in a few movies. The general impression was one of a conquering colonial empire called the United States and the long history of indigenous people in America before the time of Columbus.
My perception began to change in 1978, the year that I accepted my first professional position at the University of Arizona. I had developed an interest in cancer prevention, although most of my training had been in medical oncology and basic laboratory research.
During my first few years in Arizona, I traveled around the state giving talks on cancer prevention. I spoke at many public and professional events, both in small towns and large cities such as Tucson and Phoenix. (The Arizona Sun Awareness Program, an education and awareness effort for sun protection and skin cancer prevention, eventually developed from these efforts.) As I traveled from place to place, I would occasionally hear someone make a derogatory comment about the Indians in that area, but at the time I was not able to process these statements. This was all to change in 1981.
One very memorable day I began attending on a new service that was to last one month. I was participating in clinical rounds with the medical team when we came to the third patient of the morning. Lingering for a moment outside the patient’s room, the resident hesitated and then said, “This is a very unusual situation, Dr. Meyskens.” He went on to share that this patient was a young Navajo man who had been sent to our center for screening and evaluation from the Central Federal Screening Program in Phoenix. It had been determined that he had a possibly treatable testicular cancer that might benefit from chemotherapeutic agents that had just become available.
We entered the young man’s private room to find eight to ten men awaiting our arrival. Fortunately, the hospital had been able to locate a translator since those in the room were Navajo and did not speak English. I did my best to describe the potential benefits and risks of the proposed therapy. The room grew silent. It was then made clear that the tribe’s senior Healer, who was based in northern Arizona, would need to be brought into the discussion. If the decision was made to move forward with treatment, a ceremony would need to first be performed.
A few days later I was again called to the patient’s room and was met by the Navajo Chief and the tribe’s senior Healer, two very imposing figures. They had informed my resident that, indeed, a Navajo ceremony would have to be performed before therapy could be initiated. We learned that the ceremony involved singing, dancing, fire, and smoke. We obviously could not do this in the patient’s room, and I was not even certain we could do it at all on the cancer center campus.
By then I was largely respected for my empathetic approach to the patients under my care. Hoping that this would legitimize the somewhat unusual request that I was about to make, I showed up unannounced at the office of the hospital CEO, a tough no-nonsense lady from New York. I proceeded to briefly appraise her secretary of the situation. The secretary walked into the inner office and discussed it with her boss, who promptly came out and said, “What now, Dr. Meyskens?”—a response I had become used to hearing from her. I explained the situation and said that I thought that we could safely fulfill this request, but obviously had to do it outdoors in a semi-contained area, since the Navajo were very protective of their customs. She sighed again, but, to her credit, agreed that we could proceed as long as proper precautions were taken. Of primary concern was how the wind would be blowing when the event was to take place, as the last thing we wanted was for the smoke to blow into the emergency room. I then consulted with the cancer center and environmental safety staff to determine the optimal location and time of day for the ceremony.
It was decided that the ceremony would take place on the grassy area outside the cancer center in the late afternoon when the wind was minimal. I let the cancer center director know and he sighed his approval. On the day chosen there were about 20 members of the Navajo tribe in attendance, all in colorful traditional garments. There was a short speech, then the singing and dancing began, and the smoke began to rise. There were perhaps 25 physicians, nurses, and others gazing upon this event, and I could see that a couple of them also began to dance.
After about a half-hour, as we were nearing the end of the ceremony, a giant gust of wind came up from an unexpected direction and blew some smoke into the emergency room. I quickly signaled to the Chief that they had to finish the ceremony, or they would be stopped. He made a motion, the dancing stopped, there was silence, and finally the fires were extinguished.
He then came over and thanked me. Spontaneously, I bowed slightly to the Chief. He seemed surprised but bowed slightly in response.
The young man had the first course of chemotherapy for his testicular cancer, which lasted about a week. Fortunately, there were no major complications. I inquired at the Central Federal Screening Program in Phoenix, and they were able to identify an appropriate oncologist located north of Phoenix who could safely take over the administration of the therapy.
The next morning the young man was discharged. The Navajo Chief, the Healer, and the members of the tribal clan thanked me and departed by bus, and I assumed that I would not see them again. But two years later I unexpectedly received a call from a colleague in Phoenix. He had been asked by the Navajo Chief if I might be able to join their tribe for a ceremony at their tribal site. This was quite unusual because I had been told that, in general, the tribe preferred to remain private.
I drove far north to the Four Corners region, where Arizona, Colorado, New Mexico, and Utah meet. I waited at the edge of a dirt road, where I was met by a member of the Navajo tribe. I then traveled on horseback to their village, which was quite large. The Chief and Healer were there to greet me. The patient that I had helped two years earlier was present and I was pleased to see that he looked healthy. Over the next few days, I observed and participated in a number of Navajo ceremonies, including one expressing gratitude to me for the care I had provided. On the last day, before the evening activities began, I talked with a group of tribal leaders and healers who were expert in the Navajo way about prevention and health. They discussed their tribal approach to illness which was quite sophisticated and based on a philosophy of healing, exercise, natural herbs, and a healthy diet of fish and other natural sources.
When I returned home, I spoke to my cancer center director about my experience. He was bemused because I had suggested that perhaps we should set up a program to provide care for the Navajo Nation. He said that if I wanted to pursue this, it was fine, but it would take a lot of effort and time. Considering my growing family and the demands of my career, I was ultimately unable to pursue this effort.
Several years later I was again invited to visit the Navajo in northern Arizona. During my previous visit we had spoken about prevention and vaccines, and they seemed genuinely interested in learning more. But this time I declined the invitation as my family had made the difficult decision to leave Arizona and we were in the process of relocating to southern California.
I have by now learned a great deal about the Navajo culture, having read much more about their painful history. After so many years in southern California, I thought I would never hear about them again. But in the spring of 2022, I came across a flood of reports from the CDC regarding the generally low acceptance of the Covid vaccine by various demographic groups, including American Indians. Overall, the acceptance rate was about 40%. However, as I read further, I saw that there was one notable exception to this statistic, and that was for the Navajo tribal nation based at the Four Corners, where the acceptance rate was over 80%. This information was conveyed to the tribal members by the weekly Navajo-Hopi Observer newsletter, the only non-tribally controlled vehicle available that addresses issues and concerns of many northern Arizona Native Americans.
I took a deep breath and pondered whether my visit all those years ago, and my insistence on culturally appropriate and sensitive care that respected my patient’s beliefs, could have played a role in this positive effect. This early proponent of preventive medicine would like to think so.
Culturally respectful care makes a difference and is an essential part of working toward health equity. Recently, a detailed report involving cancer statistics and health disparities for American Indian and Alaska Native individuals was published.1 The report notes that this population has higher overall rates of cancer mortality compared to white patients, despite lower incidence and available screening tests—an injustice that we as an oncology community must not allow to continue. The report concludes, “Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.”
- Kratzer TB, Jemal A, Miller KD, et al. Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early onset colorectal cancer. CA Cancer J Clin. 2022 Nov 8. Epub ahead of print.