Bringing health to hogans
(Times photo - Donovan Quintero)
Community Health Representatives do more than just watch over elders' health
By Cindy Yurth
CHINLE, Dec. 11, 2008
J udy Tsosie is part nurse, part housekeeper, part cook, part counselor and a darned good driver.
She's also a certified nurse's assistant and emergency medical technician.
But of all the skills involved with being a Navajo Nation Community Health Representative, the one you need the most, she says, is patience.
"You may be the only other person your client sees in a week," she notes as she carefully maneuvers her tribey between mud bogs on the back road to Spider Rock. "You can't be in a hurry."
What? A health care provider who's not in a hurry?
That seems like a throwback to the days of the small-town general practitioner who made house calls. Which, come to think of it, is a lot like a CHR.
Except the town doctor wouldn't sweep your floors or do your laundry, which Tsosie has found herself doing on more than one occasion for her clients.
"It's not in the job description," she shrugs. "But you see what the person needs and you do it."
All this for between $23,000 and $31,000 a year. And countless appreciative smiles on wrinkled faces.
At least the CHRs can't say they're unappreciated.
"I love her," gushes 79-year-old Lucy Brown of Spider Rock as Tsosie nestles beside her on her couch to take her blood pressure. "I care about her. I think about her a lot."
Even crusty old Hoskie Dedman, who has nothing good to say about tribal government, Chinle Chapter or his former neighbor President Joe Shirley Jr., has kind words for Tsosie.
"I talk to her, she talks to me," he says. "She shows me how to take care of myself. After she started coming to visit me, my living situation changed and I felt better."
Listening to Dedman in his cleanly swept but isolated hogan 12 miles from Chinle, you understand the need the CHRs fill.
"Lot of people out here, they have no one to visit them," he says. "In winter we have a hard time. Even the ambulance won't come out some days. Judy is the only person who comes out here."
Seven years ago, Dedman and his wife drove up near the canyon rim to cut wood. Dedman left his spouse, a victim of Alzheimer's Disease, in the truck while he went out with his saw and told her to stay put. She didn't.
Two weeks later they found her frozen body in the woods.
"Ever since that time, my happiness, my feelings are all torn up," Dedman says. "I look forward to Judy's visits. When she comes around, I feel better."
It's been about 20 minutes since Tsosie took Dedman's pulse and blood pressure, making notes on her omnipresent clipboard.
Since then, she's sat next to the 80-ish man and listened to him expound on how the tribal government is failing both the youth and the elderly ("We're worse off than the Anasazi") and why the Fire Rock Casino is a bad idea ("People are just throwing their money down a hole").
A major topic of Dedman's is that no one listens to the elders. But Tsosie does.
"That's all most of them really want, is to be listened to," she says as we drive to her next client, Brown.
Dedman, this time, didn't need anything. His blood pressure was fine, there was a roaring fire in his wood stove and he had a younger relative staying with him.
Brown, however, is complaining of heartburn. At 79, this could be a bad sign. Tsosie makes a note to schedule her an appointment at the hospital.
If Brown can't find someone to drive her to Chinle, Tsosie may do it herself. She often takes clients to appointments, or even to the bank or the supermarket.
Again, not part of her job description. But having enough food to eat is certainly part of good health.
She's also been known to chop wood, and even bring an elder's dog to the Navajo Nation veterinarian in Chinle to be spayed when the elder complained that her dogs were breeding out of control and she couldn't feed all the puppies.
Brown notes that Tsosie came with the food bank people to bring her a Thanksgiving turkey.
"I roasted it," she says in Navajo. "It was beautiful."
Back in the truck, Tsosie explains why she goes beyond the call - as do all her CHR colleagues, she believes.
"If you have any kind of heart for these people, you can't just turn away," she says. "I'm from here. A lot of these people are related to me by clan. It's like having a hundred moms and dads."
She admits she gets too attached. When one of her clients dies, she mourns. Two years ago, she went to visit one of her favorite clients and found him dead.
"It took me a while to get back on my feet after that," she says.
On the plus side, she's lost count of the lives she's saved by discovering a patient was taking the wrong dose of medicine, or coming by at a crucial moment and getting an ailing client to the hospital.
Tsosie's last visit of the day is a sad one.
Wilford Etsitty, 70, has a dangerously high blood pressure reading but refuses to go with Tsosie to the hospital.
"He says he's not clean, he's not dressed for it," she translates from his Navajo, her eyes tearing up.
Etsitty is one she worries about. He's blind from glaucoma and living alone, and sometimes he drinks.
Etsitty says he's mostly just bored.
"I have family around here, but nobody comes to visit me," he says. "I can't go anywhere because I can't see. I just sit here and listen to KTNN."
Today is a good day: He has five visitors at once, counting the Navajo Times reporter and photographer. The senior center folks have come by with a hot meal and an ax to split Etsitty's firewood.
Tsosie is sweeping his floor and stuffing his laundry into plastic bags so she can take it down to Chinle.
"I depend on Judy a lot," Etsitty says.
As long as she and the senior center people come by, he says, he's not going to the nursing home.
"My buddy tells me about it," he says. "It's like a prison down there."
It's hard to imagine it could be more prison-like than Etsitty's home, which he doesn't leave except to follow a strung rope to the outhouse and back. Tsosie brings up the nursing home option now and then, but doesn't push it.
Sometimes it's the only choice, she explains, when an elder can no longer take care of himself. But she'd rather it be the elder's idea.
Tsosie tells Etsitty she'll check on him later and heads back to the CHR office on the IHS in Chinle, where she's meeting with her fellow Central Agency CHRs to rehearse a skit for the upcoming Navajo Nation CHRs' 40th anniversary conference.
Oddly, all 15 CHRs of Central Agency are related by clan.
Tsosie's fellow CHRs, grouped around a table learning the Navajo lyrics to "Silent Night," are excited to hear their profession is going to be profiled in the Navajo Times.
Maxine Lewis of Low Mountain seizes her 15 minutes of fame.
"Tell Joe Shirley we need bigger vehicles," she says. "I can't bring coal to the elders in my Bronco."
In case you're reading this, President Shirley, the CHRs' Christmas list includes handicapped-lift-equipped extended cab pickups.
And a nice long staff retreat, courtesy of the Navajo Nation.
After all, the CHR program has been caring for the reservation's homebound elders for 40 years now, and 40-year-olds get tired.