Straddling Two Worlds to Find Virus : Disease: Physician’s traditional Navajo upbringing meshes with medical training and helps her persuade victims to participate in the study of the deadly hantavirus.

The patient, a young woman in her 20s, was the model of health only the day before.

Now she’s running a fever of 100 degrees. Her back and shoulders ache. She feels nauseous and her throat is sore.

The doctor examining her must decide whether she’s just suffering from the latest flu bug or whether she’s in the early stages of a deadly hantavirus infection.

The answer might determine whether the patient lives or becomes a statistic. First recognized after a rash of cases in the Four Corners area two years ago, the rodent-borne hantavirus has infected 113 people in North America, killing 59.

Unlike the European and Asian hantaviruses, which infect the kidneys, the “sin nombre” (without name) hantavirus infects the walls of the tiny blood vessels in the lungs. When the body’s immune system attacks the virus, it destroys those capillaries, making them leak like sieves.

Patients can drown in their own fluids in as little as 24 hours.

Now, a Navajo doctor who leads a study group from the University of New Mexico School of Medicine, the Indian Health Service and the Centers for Disease Control and Prevention in Atlanta is hoping to find some answers. The study is funded by the university’s Research Allocation Committee and the CDC.

“Our main goal is identifying the signs, symptoms and lab findings to help the medical community decide if a patient has hantavirus or some other disease,” said Dr. Melvina McCabe, an associate professor of family and geriatric medicine at the university.

“It’s such a devastating disease because it lies dormant, then there’s a very short time to the critical phase,” said McCabe.

McCabe, who is from Iyanbito, a community of about 1,100 25 miles east of Gallup, asks a reporter not to tape-record her interview “for traditional reasons.” But she doesn’t hesitate to tell him her clans: born to Todik’ozhi (Salt Water People), her mother’s family, born for Kiyaa’aanii (Towering House People), her father’s clan.

This identifies her as a Navajo who respects her peoples’ traditions.

Although McCabe’s attitudes may seem strange in a university-trained physician, they are of vital importance to her hantavirus study.

Her research sites are two Indian Health Service Hospitals--the Gallup Indian Medical Center and the Crownpoint Health Care Facility about 75 miles northeast of Gallup.

Nearly one-quarter of all known North American hantavirus cases have occurred in New Mexico. Navajos in the Crownpoint-Gallup area, known as the Eastern Agency, in May, 1993, became the first recognized victims of the sin nombre hantavirus, then known as the “mystery illness.”

They also were victims of the media invasion that followed, as urban news crews swarmed over small, isolated chapters, asking the names of the recently deceased--a violation of traditional Navajo beliefs.

Once identified, sin nombre hantavirus proved to be colorblind. It has struck at least 75 whites, three blacks and 35 Native Americans, mostly Navajos.

The Eastern Agency remains a hot zone for the disease, probably because its largely rural residents live in close proximity to the deer mouse, a main carrier.

“We’re ideally located to look at hantavirus in all phases and aspects,” McCabe said. “This area addresses the mouse population, symptoms, treatment.”

She has stationed study coordinators, fluent in English and Navajo, to collect data from patients who enter the Gallup and Crownpoint hospitals with flu-like symptoms.

“There’s no coercion,” McCabe said. “We ask if they’re interested in participating in the study.”

If the patient agrees, procedures are explained in detail, consent forms are signed and additional tests, amounting to a thorough physical examination, are run.

These include extra blood work, X-rays and a nasal swab. Patients are encouraged to return in four to six weeks so their blood can be retested for hantavirus antibodies.

McCabe admitted that persuading sick Navajos to volunteer, let alone undergo extra tests, has proved to be a problem.

“The patients are very sick and impatient, but we still encourage them to join the study,” said Marlena Jaspers, project coordinator. “We’re not looking for patients with hantavirus.

“They think the minute we include them, it means they’ve got the hantavirus. The best thing we can do is let them know about the study, then let them decide whether to take part.”

Navajos also are suspicious of the institutions that serve them.

“American Indian people tend to carry a healthy skepticism about what the federal government is trying to do and what they’re telling us,” McCabe said.

“At one time, and the feeling still is on the reservation, that people were studied, then the doctors take off--’helicopter researchers,’ they’re called,” Jaspers said.

To gain more cooperation, McCabe and other members of the research team have made presentations about their work at Eastern Agency chapter houses, the seats of local Navajo government. They also are producing a short, Navajo-language video to show to prospective inductees.

A Navajo hataali, or medicine man, recently performed a traditional Blessing Way ceremony for McCabe and her colleagues, both Indian and non-Indian, harmonizing the study with the ways of the Holy People, the Navajo deities.

That’s important to McCabe, who wears her ancestral culture like the beads on her stethoscope.

As a Navajo, she was taught to believe that disease only can enter a person who has fallen out of a state of harmony with the environment.

“The Navajo view of health is that maintenance of harmony and balance--physical, spiritual, emotional, psychological,” McCabe said. “In the Western approach to health, we have specialties--physicians, psychologists, clergy--as if were broken down into different parts that don’t intertwine, don’t intermix.”

During her medical training, the difference between the two worlds caused McCabe what she calls “cognitive dissonance”--mental conflict.

“Now I’m able to comfort patients in both worlds,” she said. “So much can be learned from Indian cultures.”