Goodbye South America, Hello American Southwest

I'm not sure if I mentioned this in my last post, but that trip to Atacama was the last thing I did in Chile before I came back to the United States for (?) good. I'm now halfway through a one-month rotation at Zuni Indian Hospital in Zuni Pueblo, New Mexico, population 10,350 (only around 1,000 non-Zunis). The hospital is part of Indian Health Services, and is on the Zuni Reservation. Sorry for the delayed update, but I have no internet at home and working for IHS means that my computers at work are government computers, so all interesting sites, including my blog, are blocked.

A little about where I am: Zuni is about an hour south of Gallup, New Mexico (which is on I-40), and is just 15 miles from the Arizona border. It's beautiful red rock mesas with tons of running, biking, and hiking, but it is pretty much the middle of nowhere. The hospital has about 15 inpatient beds (which usually are mostly empty), OB delivery capacity, an ER, and an outpatient clinic. Anything surgical or complex gets taken by ambulance or plane to a bigger center. There are 14 doctors, mostly family practitioners who do everything from delivering babies, pediatric clinic visits with kids, taking care of people with chronic diseases in clinic, to urgent care/ER and admitting and taking care of hospitalized inpatients.

Zunis are Pueblo Indians, and the old plaza in town is the oldest continuously-inhabited place in the United States. Almost everyone still speaks Zuni as a first or close-second language, the majority live on the reservation, and they very seriously maintain their ancient religious and cultural beliefs and practices.

A few nice statistics I found on the Zuni tribe to give you a snapshot of the community I'm treating in the hospital (The wife of one of the former physicians, an epidemiologist, did all these stats):
-They have relatively high birth rates and they die young, so overall the population is young. 1/2 are age 25 or under.
-The death rate is 15% higher in Zuni than the US.
-The average age at death is 60 years.
-68% completed high school, 11% college, and 1.1% a graduate degree.
-Median household income $22,000
-41.7% families have incomes below the federal poverty level.
-Unemployment was 12% in 2003 (probably more post-financial crisis)
-Health
--The most common chronic conditions:
---High blood pressure (28% of the population)
---High cholesterol (21%)
---Diabetes (20% of Zunis, but 64% over the age of 60!)
And super high rates of complication from diabetes--3.2% of diabetics have had a foot or leg amputated, 8.7% are on kidney dialysis, and an additional 36.5% have chronic kidney disease on their way to dialysis
---Past or current alcohol abuse (20% of people, and 2x as many women as men!)
--Overweight/obesity is high among both children & adults compared to the rest of the U.S.:
---Adults 37% obese, 45% overweight, only 14% healthy weight
---Children 31% obese, 22% overweight
--Leading causes of death:
---20% alcohol-related (10 times the national average)
---16% cancer (most colorectal) (this makes up 23% of US deaths)
---14% diabetes (6 times the national average)
---13% injuries (including homicide, suicide, and alcohol-related accidents) (US total is just 4.4%)
---10% cardiovascular disease (US has 29%: Half the national average for heart disease and just 1/4 the national average for stroke)
---4% kidney failure
--20% of births are to teenage mothers (2 times the national teen pregnancy rate) ---For pregnant girls ages 16-19, 33% of the fathers of their babies were over 40 years old!!
--The health stats they do have going for them:
---Higher rates of breastfeeding than national average
---Lower rates of smoking

So that's where I am and what I'm dealing with in the hospital. I'll update when I return to internet again. Meantime I'm going to hit the slopes in Colorado for some final spring skiing tomorrow!