Editor’s note: The Women in Surgery Committee of the American College of Surgeons (ACS) hosted a session at Clinical Congress 2021 on Breaking Barriers: Minority Women Pioneers in Surgery. The Bulletin is pleased to publish a two-part series of the presentations given during this program. In this first installment, the authors chronicle the achievements of Dr. Sylvia M. Ramos Cruz, a Puerto Rican surgeon, and Dr. Lori Arviso Alvord, a Navajo Nation Tribal surgeon.
Lori Arviso Alvord, MD, is an author, mentor, general surgeon, and the first member of the Navajo Nation to be board certified in general surgery. She was raised in Crownpoint, NM, which is located approximately 130 miles from Albuquerque and is fairly remote. Descriptively, Dr. Alvord is of the Tsinnajinnié (also known as the Black Streaked Wood or Ponderosa Pine clan) and the Ashi’hii,’ or Salt People clan of the Diné, or Navajo Nation people. Tribal members will introduce themselves in this fashion, paying homage to their maternal and paternal lineage.*
Dr. Alvord attended Dartmouth College, Hanover, NH, graduating cum laude in 1979 with a double major in psychology and sociology, modified with a focus on Native American studies. During childhood, she wasn’t exposed to any Navajo physicians or other professionals, and her parents did not have college degrees. She entered college as a first-generation student, but her tiny reservation high school had not prepared her for Dartmouth College.
After receiving several low grades in science courses, she believed she was not intelligent enough for a STEM (science, technology, engineering, and math) career. A neuroanatomy course sparked a strong interest in neurology, and Dr. Alvord returned to New Mexico and joined a neurobiology research team as a research assistant. They urged her to consider a career in medicine, and so she tentatively resumed taking science courses, but this time did well and was accepted to Stanford University School of Medicine, CA. At this time, she met a Native American general surgeon, Ron Lujan, MD, from the Taos and San Juan Pueblo Tribes. Dr. Lujan taught Dr. Alvord how to care for surgical patients and about general surgical procedures, all before her formal surgical rotation. When Dr. Alvord completed her core surgery clerkship, she impressed the surgeons at Stanford, received honors, and was invited to apply to their general surgery training program.
An Inclusive Approach to Care
Dr. Alvord went on to graduate from the Stanford University School of Medicine and completed her general surgery residency there in 1991. She then joined the Indian Health Service at the Gallup Indian Medical Center (GIMC), NM, for 6 years, completing the circle of her educational journey and returning to care for members of the Navajo Nation. There she identified some of her first cultural challenges in caring for her own tribal members.
She valiantly tried to improve the cultural competency of her fellow providers. Western medicine made it difficult to provide care that respected the Navajo culture. She understood the properties of Navajo ceremonies that promoted mental and physical wellness and understood how ceremonies were effective in delivering a better state of mind in patients enduring a medical condition.
Dr. Alvord approaches traditional medicine with an understanding that a stressed mind can impair the immune system, and the use of ceremony was needed to restore harmony, balance, peace, and an interconnectivity that allows patients to heal personal relationships and thus create stronger communities around us. Respecting nature as sacred and allowing the family of Mother Earth and Father Sky to intermingle with the development of western societal norms was the philosophy Dr. Alvord was trying to administer.
Dr. Alvord’s memoir, The Scalpel and the Silver Bear, one of her most notable accomplishments, tells of her cultural journey from reservation to the operating room and of her work to combine traditional Navajo philosophies of healthcare with that of Western medicine.†
In her memoir, Dr. Alvord writes about the philosophy of the sacredness of the human body. “They allowed us to operate in a sacred, secret space, the inside of a human body…and I was becoming more and more careful not to disrespect this territory.”† Dr. Alvord extended these principles into her clinic and operating room by creating welcoming environments with collaborative and supportive relationships between team members. Dr. Alvord also wrote about the mind states of surgeons, believing that a mind out of balance could affect the operation. “I cleared my mind of all thoughts, letting balance and peace take their place.”†
In a YouTube video of her commencement address to the University of Utah Medical School, Salt Lake City, in 2016, Dr. Alvord summarizes her philosophy on medicine and culturally respectful care.
Finding Her Path
Dr. Alvord’s career took her back to the Upper Valley in Hanover, NH, in 1997 when she accepted the position of associate dean of student affairs and multicultural affairs at Dartmouth Medical School, and assistant professor of surgery, serving for 12 years.
Dr. Alvord was awarded honorary degrees from Pine Manor College, Chestnut Hill, MA; Drexel University, Philadelphia, PA; and Albany Medical College, NY. Dr. Alvord has given commencement addresses at five medical schools, and the baccalaureate address at Dartmouth College in 2017. In 2013, Dr. Alvord was nominated for the position of Surgeon General of the US, and in 2018 she received the Wallace Sterling Lifetime Achievement Award from the Stanford Medicine Alumni Association. The Navajo Area Health Board also honored Dr. Alvord for her “dedication and concern for the quality of healthcare on the Navajo Nation.” The Scalpel and the Silver Bear is on the list of selected readings at universities including the University of New Mexico (Lobo Reads) and Georgia College and State University (Circles Book Award).
Clinically, after GIMC, Dr. Alvord has provided surgical care to Navajo patients in Page, AZ. In 2017, she completed a mini-fellowship at the Cleveland Clinic, OH. She is currently with Astria Sunnyside and Astria Toppenish Hospital, WA, as chief of staff. Her research interests focus on American Indian and Alaska Native (AI/AN) healthcare with publications in surgical outcomes and decision-making in AI/AN patients. Dr. Alvord has published two articles in the Journal of the American College of Surgeons and has served on many National Institutes of Health study sections with Native American Research Centers for Health (NARCH) grant awards. Dr. Alvord has served on the ACS Division of Education’s Committee on Preceptorships for Practicing Physicians since 2018.
Dr. Alvord finished training at a time when only 6% of surgeons were women and only a handful were Native American. Her career has inspired many Native Americans to enter the field of medicine.
Tying It All Together
At present, Dr. Alvord continues to focus on surgical care that includes the patient’s native culture—understanding the properties of native ceremonies that promote healing and positively affect the state of mind. Using this approach, she reminds us that the mind can restore the Navajo “hozho”—in other words, restore the beauty, harmony, balance, and peace that brings a wholeness to the patient. This wholeness then creates a patient who has stronger personal relationships that contribute to a stronger community that will promote continued wellness for all.‡
In a recent conversation with Dr. Alvord, she summed up her priorities and asked that we respect nature, as it is sacred. She emphasized protecting the environment, as it may impact the global climate and affect our world.
Dr. Alvord is committed, confident, and willing to give back in order to live in beauty, harmony, and balance; reduce stress; and improve healing to fight disease and empower the mind.
She has truly brought Western medicine together with Navajo cultural healing.
*Wikipedia. Lori Alvord. Available at: https://en.wikipedia.org/wiki/Lori_Alvord. Accessed December 27, 2021.
†Alvord L. The Scalpel and the Silver Bear. Summary and study guide. BookRags.com. Available at: http://www.bookrags.com/studyguide-the-scalpel-and-the-silver-bear/#gsc.tab=0. Accessed December 27, 2021.
‡US National Library of Medicine. Biography. Dr. Lori Arviso Alvord. Available at: https://cfmedicine.nlm.nih.gov/physicians/biography_7.html. Accessed December 27, 2021.