Sitting in a hogan, warming ourselves by the fire, Stephen Begay told me a story about his journey from childhood to Navajo Medicine Man. He spoke about learning to chant healing ceremonies at the knee of his grandfather and how each aspect of a ritual has a specific order in which it must be sung.

He described the clash between the customs he observed at home and the norms he learned in organized school. For example, as a child he was taught to sit quietly during a storm; however, at school, such weather was seen as a chance to run around and play inside. Then he talked about his role as a Healer.

It is a Navajo belief that if you live your life in a righteous manner, you can live to be 102 years old. Wrong decisions or poor choices that disturb your life’s balance can negatively affect your lifespan and the lifespan of others who are close to you. This imbalance leads to illness, and it is the job of a traditional Healer to try to restore balance.

This core Navajo belief forms the basis of Stephen Begay’s work. He is the Native Medicine Program Coordinator at Gallup Indian Medical Center in Gallup, N.M. He was kind enough to share his perspectives on health and his role as a health care practitioner. Our discussion gave me a better understanding of the population I served as a volunteer physician in the emergency department of an Indian Health Service hospital.

How many miles does this patient live from town? Does she have a mode of transportation? Is rain predicted tomorrow? These are questions you need to ponder when 32% of the population you serve lacks indoor plumbing, 60% have no telephone, and 80% of the roads are unpaved. If it rains, many roads become muddy. Rivers are impassable by ambulance or pickup trucks trying to get the sick or injured to a health care facility.

Three-quarters of people in the United States living without electricity are part of the Navajo Nation, the largest land-based Native American tribe. That’s more than 18,000 households. So when it is time to discharge a patient you have to consider their resources and their ability to get back to the hospital should the need arise.

It was not until I saw the Navajo Nation and visited people’s homes that I realized how vast, arid, and spread out it is. Seeing how far a family may live from its nearest neighbor was surprising for a city girl like me. I realized how difficult it might be to get help or travel back to town.