March 2014

What Does Public Health Look Like in Española?

Ana Malinalli X. Gutiérrez Sisneros

The heart of northern New Mexico, where cultures unite,” says the website for the city of Española ( It is where I have chosen to live for the last 30 years and raise my two children, now grown. Why did I choose it? Well, there are many living cultures here, and languages are still spoken that I was hearing less and less of in Albuquerque. I am comfortable in Española; it is like a perpetual South Valley. It’s rural, there are still dirt roads, life is at a slower (and lower, for the cars that make us famous) pace, and we can have farm animals in our yards. (I live just on the line of the city limits, where this is true.)

I first came to Española for a nursing job interview in 1983 at the PHS Española Hospital. I saw there that the patients in each room had several visitors, so I asked the nurse giving me a tour why that was. She replied that families are important for creating a healing environment, so four, five, six visitors per patient was not unusual. I liked that and got the job at the only hospital I have ever worked in during my 30-year career. This is how I got to see and know the health of the people, nuestros prójimos, whom I have come to love deeply. I gradually came to understand the many issues that affect health and the health disparities that continue today.

So, what does the health of the public look like in Española? The Río Arriba County (RAC) Health Profile Update (2008, RAC Health Council and RAC Health and Human Services Dept.) says: “We define public health broadly to entail all aspects of the well-being of an individual, family or community to include body, mind and soul.” All aspects of well-being, in the holistic sense, would encompass chronic illnesses such as diabetes, obesity, hypertension and diseases of the mind, such as depression, anxiety and trauma-related issues, often diagnosed as PTSD. The health of the soul is affected by culture-bound syndromes such as susto (magical fright) and ataque de nervios (a nerve[ous] attack), as I have come to understand from oral healing traditions, and in the DSM-IV, TR (American Psychiatric Association, 2000). What if a community member, for example, uses IV drugs to escape from incidents of incest and sexual abuse as a child (mind aspect of health) and contracts hepatitis C (physical illness), lives within the cycle of addiction, which is extremely difficult to heal from (mind and body), to a point that he or she is spiritually bankrupt (soul illness), only to die from cirrhosis a few years later?

In trying to combat this issue, I learned in a UNM Health Education class last fall that Canada decided to improve the health of the public that uses IV drugs by setting up a clinic in Vancouver where people can reduce the risk of harm (premature death from overdose, decreased HIV and hepatitis C rates) by having clean places where they can go to inject their drugs. This place is called “InSite.” It is North America’s only legal, safe, drug-injection center. A banner outside the clinic reads: “InSite saves lives.” There is a 2013 CNN article on this important, brave, ($3-million/year) endeavor at

Unfortunately, alcohol and drug abuse are found in nearly every community in the world, and if you look at New Mexico health data in the excellent NMDOH State of Health In New Mexico 2013 Report you’ll see correlations of low socioeconomic status and health (

So, what is the average per capita income for a person living in Española, where 10,224 people in 3,992 households reside (2012)? It’s $19,059, and 26.3 percent of these people live below the poverty level, compared to the New Mexico average of 19.5 percent, or the US average, whereas, “in 2010, 15.1 percent of all persons lived in poverty. The poverty rate in 2010 was the highest poverty rate since 1993”(National Poverty Center, 2014,

What is the average education level for a person living in Española? For persons age 25+ (2008-2012), 74.9 percent are high school graduates and 16.9 percent have a bachelor’s degree or higher (

To me, and to many, education is the answer to poverty, and only ending poverty will improve health, which is part of the reason I am a teacher. I am a teacher of nurses, at Northern New Mexico College, hoping to increase that 16.9-percent college degree rate in Española. Nursing is one of the most rewarding careers on the globe. Nurses have empathy for people, for social justice issues, and they work to create justice, to ameliorate the suffering of la gente.

To live well and thrive we must eat well. How is that possible if the per capita income is so low? Even with disappearing public assistance and few jobs, it is possible, with a return to farming, to growing our own food. We were agrarian people, with little time to be depressed, anxious, drinking or drugging when we were busy working the fields. “The end of that work outside was the end of our mental health, so to speak,” says my friend Ben Tafoya. This is why the model of farming, the temazcal (house of vapors), the use of curanderismo and animal tending was born, as part of the treatment modalities at the HOY Recovery Program in the Lyden Valley area. This is also how the Delancey Street Foundation in Alcalde and the Eight Northern Indian Pueblo Council’s New Moon Lodge in Ohkay Owingeh operate: treatment is based on values of traditional living, relearning that work ethic that was once strong, now changing in this generation. But in this generation, too, we are beginning again to grow our food, and we eat it fresh. Pues, gracias a Dios.

The heart of northern New Mexico is its people, millennia-strong, resilient to hardships, with many in good health. For those who don’t have health, they are still our familia, to be treated with dignity—this is how cultures unite. Río Arriba’s Health is Río Arriba’s Wealth.

Ana Malinalli X Gutiérrez Sisneros, PhD(c), ABD, MSN, MALAS, APRN, PMHCNS-BC, CCM, M.I.T., is a nursing doctoral candidate at NMSU. Her private practice in Española is called MalinalCo Nursing Consultants. She is also an adjunct faculty professor in NNMC’s ADN and RN to BSN Nursing programs and the !EXITO! Mental Health Counselor at NNMC, 505.690.0213, malinallix@nnmc 





Print Friendly, PDF & Email

Related Articles