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Bridging the Cultural Divide in Medicine

You might say that Lori Arviso Alvord (pictured left) was predestined to become a doctor. According to a Navajo tradition, parents bury their newborn's placenta and umbilical cord at a special site that represents their dreams for the child. Because Alvord's father was stationed at a military base in Tacoma, Washington, Alvord was born at one of the local hospitals, and there her placenta remained. Years later, Alvord became a regular presence in hospitals as the very first Navajo woman surgeon.

As an associate dean of student and multicultural affairs at Dartmouth Medical School in Hanover, New Hampshire, Alvord is attempting to bridge two worlds of healing: Navajo and Western medicine. Alvord believes in a system of health care, especially but not exclusively for Native Americans, based on both modern medicine and traditional wisdom. "My whole objective is to try to achieve a better way to deliver health care not just for native people, but for everyone," she explains. Alvord hopes, too, that such an approach will inspire young Native Americans to become physicians and address many of the conflicts between Western medicine and Native American traditions.

During her medical training, Alvord struggled because being Navajo and a female surgeon was rare. (It still is.) Making it through training meant going against some native traditions and adapting to some non-native ways. But these experiences gave her a pioneering point of view on how healing can be improved.

Separated for the First Time

Half-Caucasian and half-Navajo, Alvord grew up on a reservation in Crownpoint, New Mexico. As a child, her biggest dream was to get a college degree. Because Dartmouth College had a small and supportive group of Native American students, Alvord applied there and nowhere else. After being accepted at Dartmouth, Alvord started learning how to survive in a high-pressure academic world.

Leaving home for college was not easy for Alvord because it violated hozho, or "walking in beauty," a Navajo lifestyle that encourages balance and harmony. The Navajo believe the four sacred mountains that surround their traditional land provide protection and that moving away would cause disorder in the lives of the people.

Alvord, among the first women and Native Americans to attend Dartmouth College, had a difficult time adjusting as a result of the sexism and racism on campus. Male students generally disliked the presence of female students. The unofficial Dartmouth mascot resembled a Hollywood Indian, with war paint and fake feathers. She also had difficulty relating to non-Indian students because of cultural differences. Yet despite these problems, Alvord was grateful for the opportunity to be a part of Dartmouth's efforts to provide Native Americans with an Ivy League education. She graduated in 1979 with a double major in psychology and sociology and hoped to work on her reservation.

New Career, Bigger Challenges

Majoring in psychology fueled her interest in the human brain, and she landed a job as a research assistant in a brain physiology lab at the University of New Mexico (UNM). She had once given up on science after receiving a "D" in college calculus, a result of poor high school preparation. Dartmouth, however, quickly remedied her educational shortcomings.

Alvord's research experience prompted her to take premed courses at UNM. Soon she found resonances between science and traditional Navajo teachings. In her autobiography, The Scalpel and the Silver Bear (Bantam Books, New York, NY, 1999), Alvord described her new passion: "The way the white blood cells attack an intruding virus, the way too much or too little of anything disturbs the body functions ... it was all hozho, the beautiful balance of the universe, rephrased in scientific terms."

Alvord eventually attended medical school at Stanford University, but she continued to struggle with cultural differences. Alvord disliked attracting attention to herself and being competitive. She wasn't comfortable bombarding her patients with questions, touching them, or looking them directly in the eye. These actions violated Navajo notions of respect. She also feared dissecting cadavers because Navajos believe they harbor evil spirits. In time she dealt with these challenges and learned to place them in the context of Western medicine.

New Ideas to Improve Health Care

Alvord returned to serve her people whenever she could during her medical training and early practice. Being around other Navajo people benefited her by making her feel comfortable and raising her confidence as a surgeon. Ron Lujan, another Native American surgeon, showed her ways to do her job while honoring native traditions--a practice that put her and her patients at ease: touching patients respectfully and only when she had to, not rushing her patients for answers, treating them like family, and generally working to gain their trust. Alvord noticed that when patients felt cared for and respected by their caretakers, they seemed to do better during and after operations.

Alvord also learned that Navajo healers' ways of curing people were beneficial, so she worked to integrate them into her caregiving methodologies. "Science is beginning to catch up with Native philosophies," she says. "We now know that reducing stress and anxiety can have positive effects on how our bodies function and that the mind is able to help the body heal. [Navajo and other] healing ceremonies are designed to help the mind heal the body, through a variety of mechanisms."

Unlike non-Indian doctors who focus solely on the diseased part of the body, Alvord says, the healers examine the patient's entire life, looking for things that are unbalanced. In Navajo traditions, illness is seen as the result of being out of harmony or balance in some area of life.

In the long run, Alvord believes Navajo philosophies should be used to treat patients of any cultural background. She argues that many people feel that their doctors don't understand them and don't care enough about them. She also points out that Western medicine has been businesslike and based upon a history that has been dominated by white men. Converting old hospitals into "beautiful healing environments," rather than just having square, cold rooms with bare walls, will also help relieve patients' stress and accelerate healing.

The young woman who faced barriers from two cultures--her own and the dominant one--has evolved into an influential force in medicine and one who "loves breaking stereotypes." Today Alvord continues to "walk in beauty" with her husband and two children.

Edna Francisco is a contributing writer for MiSciNet and may be reached at

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