TB OR NOT TB TRUSTED? ANTIBIOTICS, SURVEILLANCE, AND TUBERCULOSIS IN THE NAVAJO TRIBE
In 1952, tuberculosis (TB) ran rampant on the Navajo reservation in Many Farms, Arizona. Local health officials were unable to mitigate the spread of the disease amongst the Navajo people. Many members of the Navajo tribe were unfamiliar and unaccustomed to modern medicine and depended on Navajo medicine men or spiritual healers in their community. Dr. Walsh McDermott, a physician and researcher on antibiotics, received news of the Navajo TB epidemic and immediately planned to provide antibiotics to the Navajo people. When Dr. McDermott arrived at Many Farms he did not plan to treat the Navajo people with streptomycin, an approved and effective antibiotic against TB, but rather to test a new antibiotic known as isoniazid that had yet gone through the clinical trial phase.
Isoniazid tablets were administered to the Navajo people in order to test the effectiveness of the new antibiotic against TB. To ensure that the patients were on the proper drug regimen, and to determine the efficacy of isoniazid, many of the patients were given and tested with different technologies of compliance. One such device was the pill packaging calendar system that the Navajo people were instructed to take daily. Additionally, the Navajo people underwent several urine tests and unannounced home visits to confirm if they had ingested their antibiotics. Moreover, the Navajo were not informed on why or when these tests were performed on them.
The Navajo people did not recognize TB as a contagious disease, and believed that it could be cured with ceremonies performed by Navajo medicine men. The Navajo people had described TB as the withering of one’s heart and possibly resulted due to improper chanting. Throughout the Many Farms project, Dr. McDermott and his team reported that several of the Navajo patients were uncooperative in taking their medications. The Navajo patients may have misunderstood the instructions due to a language barrier and/or conflicting ideologies (i.e. having a different concept of time depending on their environment). Additionally, the Navajo people may have still upheld some of their traditional beliefs and forms of treatment in addition to the antibiotics they received.
Many of the Navajo people may have been initially reluctant to allow outsiders to intervene in their community, but accepted modern medicine in order to help save the lives of their tribe members. Based on the initial results of the experiment, isoniazid was seen as a promising antibiotic against TB. Many of the Navajo people recovered from TB and it was reported that the incidence of TB amongst children decreased from 50 percent to about six percent. Dr. McDermott gained international recognition and was awarded the Albert Lasker Award for his involvement and treatment of TB with isoniazid amongst the Navajo people. According to Dr. McDermott in regards to the Many Farms project, the Navajo:
were immensely pleased . . . for once the Navahos [or Navajo] got in at the beginning of something instead of getting in at the tail end the way they usually do in U.S. society.
Although TB was treated amongst the Navajo people with modern medicine, many still suffered from other preventable conditions such as pneumonia, diarrhea, measles, and ear infections. Dr. McDermott and his interdisciplinary team had taught the Navajo people about modern medicine and preventive care, but the Navajo people lacked social and economic resources to implement such changes in their community.
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Tuberculosis Among the Navajo. Directed by Edgar G. Ulmer, Springer Pictures, Inc., 1941.