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A Path Towards HopeBrad Armstrong

A Path Toward Hope (continued)

"THEY JUST FOUND HIM. I don't know if they have a pulse. They are working on him right now."

Novalene Goklish talks urgently on her cell phone to a colleague on a March afternoon, in Apache and English. A young man on the reservation has attempted suicide. Goklish stands on the porch of CAIH’s headquarters. It is in a portable building behind the Indian Health Service hospital in the town of Whiteriver, near the center of the 1.6-million-acre reservation. Behind her, a bright noon sun casts short shadows on the Ponderosa pines of Gold Butte.

Usually quick to joke or share an ironic aside, the senior field program coordinator for Celebrating Life has gone quiet. Her face is stilled with concern. Between calls, she confides, “Right now you’re hoping for the best. They’re doing everything they can to save him.”

As Goklish leaves to take another call, Francene Larzelere-Hinton sits pensively. The director for the White Mountain Apache site of the Native American Research Centers for Health, Larzelere-Hinton had expected a joyous day; she is going to a traditional ceremony in the evening, part of the multi-day “sunrise dance ceremony” that marks an Apache girl’s transition to womanhood.

“You can feel heaviness,” she says. “I don’t know if you can tell, but you can feel the heaviness.”

Concern for the young man weighs on them. So does worry that the suicide attempt may lead to others. Suicides can erupt like contagions, as happened here in the early 1990s when 11 young people died by suicide in less than a year. In response, some tribal elders were mobilized to visit people who were suicidal. The elders would talk and pray with them, staying at their homes for days, if need be, to guide them out of danger. The group was formally known as Apaches Helping Apaches, but people called them the “ghostbusters.”

“We’re there to listen, to make sure at-risk individuals are safe and to let them know that we care.”

—Novalene Goklish, with Francene Larzelere-Hinton

Tribal leaders knew more was needed so they turned to a friend they could trust.

Back in 1980, a young pediatrician and researcher named Mathuram Santosham had arrived in the dry, manzanita-dotted valley surrounding Whiteriver. Lupe and the tribe were wary; they had been burned before by researchers who took grant money, gathered data and then just left.

Santosham earned the tribe’s trust by confronting a lethal epidemic of diarrheal disease. “Truly, kids were dying of diarrhea just like in developing countries,” says Santosham, MD, MPH ’75, and now a professor of International Health. The tribe embraced his recommendations for widespread use of oral rehydration solution. Diarrheal deaths soon fell almost to zero.

Next, with the Apaches’ help, he proved the effectiveness of vaccines against Haemophilus influenzae type b (a leading cause of meningitis) and later, rotavirus (a cause of diarrhea), quelling epidemics and saving more young lives. Data from these efforts helped transform health care standards in the U.S. and the world. Along the way, Apaches received public health training to help their neighbors.

So when the suicides erupted in the 1990s, the tribe drew on Santosham and the CAIH. Apache leaders came to Baltimore to meet with researchers, and together they devised a public health answer to prevent more young deaths. They would train Apaches as paraprofessionals who would specialize in community mental health and preventing suicide.

Tribal leaders and the CAIH team (including Santosham, John Walkup, MD, Raymond Reid, MD, MPH ’81, Larry Wissow, MD, MPH ’84, Allison Barlow, MPH ’97, and others) knew they needed data and an understanding of the problem’s root causes. So the tribe mandated in 2001 that all suicide attempts, completions and even ideation be reported by first responders. Later, the reports were collected in a central registry. It is the first community-based suicide surveillance system in the U.S. “The tribe is very innovative in their thinking. They say, we are not going to stand for this suicide epidemic,” says Barlow, now a CAIH associate director. “They treat suicide as an infectious agent that is foreign to their community and have directed their collective will around containing it and getting rid of it.”


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