Surgical problems of the Navajo and Hopi Indians.

For the past decade I have been a surgeon to the Navajo and Hopi Indians of Northern Arizona. The Navajo Reservation, occupying 25,000 square miles and containing about 110,000 Navajo and 5,000 Hopi Indians, is divided into eight Indian Health Service Units under the United States Public Health Service. Because of the isolation, the difficulties of transportation, and the scarcity of other medical facilities, the Indian population within that Service Unit uses the Indian Health Service facility almost exclusively. Thus, the data collected over the period of time give an accurate picture of the disease patterns of these people. During the years of this report, I was surgeon in two of the Service Units (Tuba City, on the more isolated western reservation, from January 1962 to July 1965 and July 1970 to the present; and Fort Defiance, 150 miles to the east on the more developed eastern part of the reservation, from July 1966 to July 1970). Each Service Unit has a central hospital (Tuba City 75 beds, Fort Defiance 125 beds) and provides direct and referral surgical service to approximately 20,000 Indians, covering a geographic area of about 8,000 square miles. The purpose of this report is twofold: (1) to portray the surgical disease patterns in the Navajo and Hopi Indians as personally observed and managed by myself; (2) to emphasize the direct relationship between the morbidity of the disease patterns and the harsh and hazardous environment of the Indian. In the ten years I have served the Navajo and Hopi, significant changes in the socioeconomic levels have occurred. Although the Indian still lives in, a condition of marked poverty, improvements in roads, water supply and sanitation, housing, and job opportunities have had a most important impact on disease patterns. The effects are most obvious in the changing patterns of infectious diseases (such as the