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Learning from the Zuni

Francois and Jessica Rollin came to New Mexico looking for adventure and a place to practice medicine. What they found was a community.

By Jessica Rollin | Photos by Jessica and Francois Rollin

Francois and I met my first year of medical school at Emory. He was doing his MPH in between his third and fourth year. We spent a week in Haiti together providing medical care to people who otherwise would not get it.

We did the same thing the following year, and Francois went again as an attending physician after he had graduated. We both loved that experience and knew that providing care to the underserved was a passion for us.

After graduating, we decided to pursue jobs through the Indian Health Service because we wanted to provide medical care in a new, challenging setting and in an environment that was far away from the pressures and demands of urban, academic medicine. We wanted to have an adventure and explore a brand new side of medicine.

So we  moved to Zuni, New Mexico, in September 2015 after I finished my psychiatry residency at Emory and Francois had done two years as an attending at Grady Hospital. We packed up our belongings and our 14-month-old daughter and headed west.

The Zuni are a tribe of Pueblo Indians who have lived in this part of the world for more than 900 years. The reservation is near the Arizona border, about 2½ hours west of Albuquerque. We are surrounded by red rock mesas and other rock formations, Juniper trees, and piñon pines. Our house looks out onto a vast expanse of nature, and we are greeted by magical sunrises and sunsets. On our first walk after arriving here, we saw a tarantula in the middle of the path. We've seen lots of jackrabbits, elk, snakes, roadrunners, and beautiful western birds. We often go a week or more here without using our car—or our credit cards.

We serve a population of about 15,000, and see both Zuni and Navajo patients. The Zuni Comprehensive Health Center is an Indian Health Service facility with 12 inpatient beds, obstetrics capabilities, an ER, and a large outpatient practice. There is a dental clinic, physical therapy, optometry, and audiology. Francois did his residency in internal medicine but here he practices as a full-spectrum family physician and sees kids, pregnant women, and ER cases.  

As the only psychiatrist in 150 miles, I do mostly outpatient work, and consult on ER and inpatient cases. I also see children, despite not having a child or adolescent fellowship. At first this made me nervous and I felt inadequately prepared to offer care to such vulnerable patients. I soon realized, however, that there was no one else and that my services were better than nothing—a lot better.

We feel lucky that we landed in this spot. The Zuni have one of the best-preserved cultures and religious traditions of all Native American tribes. They are generally very private about their traditions, but in clinical settings, our patients tell us stories about their history and traditions. We've seen knee pain in an 85-year-old that was "worse when I ride my horse," and frostbite in a man out shepherding. We've treated someone who quit drinking because of his initiation into an important religious group, and learned that babies have reflux because their mothers "left things half-eaten" during pregnancy. In fact, we had our second child three months into being here, and learned a lot about Zuni traditional wisdom as applied to babies. First, it is frowned upon to learn the gender of your baby before it is born (luckily for us, we had also wanted to wait to find out). Then, my son had reflux and I was told it was because I had snacked too much during pregnancy and didn't have enough full meals, but if I drank a large glass of juice quickly the issue would be resolved. We were also advised to rub apples on his head to cure his baldness.

The Zuni have high rates of diabetes, obesity, and kidney disease as well as higher than usual rates of rheumatoid arthritis and cystic fibrosis. (There is a specific Zuni CF mutation.) Some older Navajo have lung disease related to working in uranium mines earlier this century.  

We see a lot of the effects of poverty. In this regard, it is not too different from our work at Grady. Poverty has a profound impact on the health and well-being of entire families, and here we see that much more intimately than we did in Atlanta. There's a lot of trauma here as well as depression, alcoholism, and suicide. Francois' first patient on his first day was a teenage boy who had tried to slit his throat. This was a shock for both of us.

The sense of community, however, is strong and ever-present. We know our patients' lives more closely than in the past. In small-town medicine, you see your patients at the grocery store, post office, and elsewhere. Francois and I coached a soccer team of six- to nine-year-olds through the Zuni youth enrichment project (named "Team France" because of Francois), and we would see parents and kids we knew from there in the clinic. At community-sponsored walks and runs, it is amazing to see patients we're treating for depression or diabetes out there doing what we encouraged them to do. At night dances, amid the drumming, chanting, and visits from special kachinas, we run into patients, the pharmacist, and public health nurses—all in 10-degree weather at 10 p.m.

Ultimately, though, we are visitors, and we feel fortunate to be here. This land and place belongs to the Zuni, and for now they are sharing it with us.

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