# Special Forces medics: A cultural change



## Boondocksaint375 (Jun 23, 2007)

Special Forces medics: A cultural change


By Kevin Maurer
Staff writer
FORT DEFIANCE, Ariz. — Spc. Cornelius Powell can’t understand a word Tillie Begay says about her swollen right knee.
The 87-year-old woman doesn’t speak English; only Navajo.
All of Powell’s questions are met with Begay’s smile — a smile that starts at her mouth and ends with her bright eyes. She turns to Yvonne Milford, an assistant in the Fort Defiance Indian Health Services hospital in Arizona, and waits for the translation.
“Ask her what her chief complaint is,” says Powell, a Fort Bragg-based Special Forces medic trainee.
Begay’s knee is about the size of a grapefruit.
“She is complaining about right knee pain,” Milford says. “The pain is not constant. Off and on.”
For Powell, treating the knee is the easy part. Learning how to work through an interpreter and navigating the cultural differences is harder. But, these are the lessons he was sent to Arizona to learn in his 30 days at the Indian Services Hospital.
Powell — a short but powerfully built soldier with tattooed biceps — is more than halfway through the one-year medic program for one of the toughest Special Forces specialties. His rotation to Fort Defiance is as close as the program gets to showing the students what an overseas deployment might look like.
“These guys have to be culturally aware when they interact with their patients,” said Special Forces Capt. Jerry Depold. He oversees the program. “This may be the last clinical training they get before they go down range.”
The first few days were culture shock. 
Powell didn’t know the customs. He’d never heard the Navajo language, which sounds a little like Spanish spoken with the clipped cadence of an Asian language.
“The language is unbelievable. They use a lot of sounds that are unpronounceable,” Powell says.
He grew up in South Dakota, where he was used to seeing Indians. But the Navajo nation is a new experience. 
The Navajo form the largest tribe in the United States. The 200,000-member nation stretches from New Mexico into Arizona, Utah and Colorado. Fort Defiance Indian Hospital is only a few miles from Window Rock, the Navajo capital.
The cultural aspect of the training is important, but the medics are also here to refine their medical skills. The goal is to get the soldiers as much experience as possible and give them the confidence to treat everything from severe wounds to an Afghan villager’s cough.
By the time the student medics reach the second hospital phase — they spend a month in emergency departments in Richmond, Va., and Tampa, Fla., during the first half of the course — they have had a lot of medical knowledge poured into their heads quickly. The first 30 days of the course, the students cover a lot of the ground that is the curriculum in the first two years of medical school.
Dr. Mark Hopkins, who works with Powell at Fort Defiance, is impressed by the training. “Their acumen as far as educational knowledge and skills is better than a fourth-year medical student, and even better than a family physician resident,” he says.
Warrior nation
Fort Defiance officials are glad to participate in the program, and they try to welcome the medic trainees.
“I think it is good to help the armed services,” says Dr. Franklin Freeland, a Navajo who is chief executive officer of the hospital. He served as a corpsman — the Navy version of a medic — in Vietnam. “We have the highest respect for the medics because the Navajo have always been warriors.”
The Fort Defiance hospital is nestled in a brown valley of scrub brush surrounded by rust-colored mountains that could easily double as southern Afghanistan. The sprawling hospital is a model of modern health care. Everything is digital, from X-rays to patient folders. In an instant, a doctor can write a prescription and send it to the pharmacy with the touch of a button.
The hospital hallways are a pictorial history of the area and Navajo nation. Black and white photos of the reservation and an old hospital decorate the brightly lit hallways. The building faces east, like traditional Navajo houses, and has an octagonal meditation room in the center of the building.
All the patients are Navajo.
It is the oldest patients who present the cultural challenge to the medics in training. The younger ones usually speak English and are less traditional. The older patients often speak only Navajo, even if they understand English.
Freeland said the older generation — the women are affectionately called grandmothers — are “receptive, but not expressive.” 
The older Navajo also tend to dress up for doctors’ appointments. Begay, the woman with the knee problem, is wearing a beautiful white skirt, and her wrists and neck are adorned with turquoise jewelry.
She, like other Navajo, is also modest. So Powell squats next to her, lifting the hem of her skirt just high enough to see her knee.
He is conscious that he is not just winning over Begay, but the staff of the hospital as well.
Fort Defiance has a family atmosphere. Many of the doctors and nurses — most of whom are not Navajo — live next to the hospital in a neighborhood that looks like it was plucked out of any major American suburb and set down in the desert of the Southwest.
Once a week, staff members hike the trails in the mountains surrounding the hospital. Powell and another medic trainee joined the group soon after getting to the hospital.
On a trek up Window Rock, a mountain with a rounded “window” at its peak overlooking the Navajo government officers, the soldiers chatted with their co-workers and played with the children of the hospital employees. 
“Anyone who comes to work here is part of our family,” Freeland says.
It’s a busy family. The hospital has 200,000 outpatient visits a year. 
By the time he sees Begay halfway through his 12-hour shift, Powell has already assisted in a surgery, performed physical therapy on a woman’s broken hand and cut the cast off of a young girl’s broken leg.
He is trained for the variety.
When the program is complete, Powell will join a 12-man A-team — the basic operational unit of Special Forces. He could be the only available medical care for his teammates in the field. He even has veterinary training, so he can treat the animals of the people who become the soldiers’ allies on deployments.
At Fort Defiance, says physician’s assistant Roger Martin, “We try and get them a lot of hands-on work.”
Standing next to Powell, Martin examines a digital X-ray of Begay’s knee.
“If she were younger, I’d recommend a knee replacement. She is 87,” Martin said. “You won’t find a surgeon in the country that will perform a knee replacement.”
Powell steps closer and looked at the joint.
“We can inject her knee?” Powell suggests. A shot of pain-killer should give the woman about three months of relief.
“That’s what she wants,” says Milford, the interpreter.
Powell and Milford return a few minutes later with a large syringe. 
“Can you tell her I am going to give her a shot?” Powell asks.
“She knows,” Milford says.
Drawing a small dot on the outside of her right knee with a marker, Powell slowly slides the needle between the bones in the joint. Begay doesn’t even flinch.
“There you go,” Powell says. “All done.”
Begay just smiles again.
_Staff writer Kevin Maurer can be reached at maurerk@fayobserver.com or 486-35_


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## surgicalcric (Jun 23, 2007)

SOC-T rotation was the better of the 2 IMNSHO, then again I had been a paramedic for 12 years before coming to the SFQC.  I was at Ft Defiance IHS as well.  

Dr Hopkins (who is an AF Reserve Flight Surgeon and Ortho Surgeon, as well as a former professor at the Harvard School of Medicine) was a great guy to study under.  He was very receptive and was willing to teach all that I was willing to learn.  He was also willing for us to take over his patients in the OR and would let us do whatever procedures we asked to do, providing we passed the "sniff" test and knew what the hell we were doing.

My time there was well spent and my future teammates will appreciate all that Dr Hopkins taught me.

Powell was actually in my SOCM class but was recycled 2 classes behind me.  Saw him graduate SERE this past Thursday...  Good guy

Crip sends...


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