To the Editor:
I spent a month on the same Navajo reservation as Gregory Raskin [Notes From a Navajo Winter, Fall 1997]. I found parts of his description disconcerting because it seemed at times as though he were looking down on the people he was treating. I must assume that the perceptions differ because I have been a clinician for 15 years, and he is still in the learning process. I was sad to leave New Mexico. The Indian Health Service, a branch of the U.S. Public Health Service, is medicine as it used to be practiced, as I believe it was meant to be practiced. It is completely patient-care oriented, with emphasis on the word care. Everything about the system is designed for the convenience of the clientele. Every clerk and secretary makes certain the "grandmother" won't wait in line and gets kind, courteous, efficient treatment. Each Navajo has a family practitioner overseeing the totality of his or her care. Sub-specialists are utilized appropriately, and all are represented on-site.

There is no insurance company involved—no denial of treatment, medication, hospitalization, or surgery if the clinician has deemed it appropriate. If a postop or postpartum patient needs a week to recover in-house before the long ride home, there is no utilization review worker to say otherwise. Social workers are amply available to be sure the home stay is safe. Medicines are dispensed directly in the clinic, eliminating middleman markup and another trip for the patient to get it as is the case with the pharmacy system. The full range of preventative and rehabilitative services are available on-site. This is government-run health care—the entity we all supposedly fear.

As far as the Navajos themselves, I found them to be marvelous patients. The majority are farmers and ranchers, living a busy and physically demanding outdoor existence. They are strong individually and communally, with good self-esteem. The translators pose no problem at all. It turned out that most of the elderly understood me perfectly, but preferred the comfort of speaking in their own language. Compliance was no better or worse than among patients anywhere else.

Because illegal drug use is so rare, there is very little of the crime, violence and secondary diseases related to the drug culture that so burdens our inner cities here. I learned much from their grace, dignity, cohesiveness and natural wisdom. I can't wait to return for another stint of service in March, and am taking with me another Yale medical student. My family only fears that I may not return.

Susan Richman, M.D., HS '79-83
Assistant Clinical Professor
Obstetrics and Gynecology