Sherman Alexie Wins Pen/Faulkner Fiction Award

Sherman Alexie has won the PEN/Faulkner Award, the PEN/Faulkner Foundation announced Tuesday morning. Alexie's 2009 novel, "War Dances," came out on top of a list of finalists that included literary greats Barbara Kingsolver and Lorrie Moore, along with Coleson Whitehead and Lorraine N. Lopez.

Sherman Alexie has previously won the National Book Award for Young People's Literature, awarded in 2007 for "The Absolutely True Diary of a Part-Time Indian," as well as the Native Writers' Circle of the Americas Lifetime Achievement Award in 2010 for his contribution to Native American writing. Alexie's writing, which includes four novels, three short story collections, and poetry, focuses on Native American characters and issues, though he is well known for making these topics widely accessible and relatable.

PEN/Faulkner judge Al Young commented on choosing "War Dances":

"War Dances" taps every vein and nerve, every tissue, every issue that quickens the current blood-pulse: parenthood, divorce, broken links, sex, gender and racial conflict, substance abuse, medical neglect, 9/11, Official Narrative vs. What Really Happened, settler religion vs. native spirituality; marketing, shopping, and war, war, war. All the heartbreaking ways we don't live now--this is the caring, eye-opening beauty of this rollicking, bittersweet gem of a book.

Sherman Alexie recently turned heads when he appeared on "The Colbert Report" in December and spoke out against eBooks and the digitization of reading. "The localized appreciation of books is gone," he said in the interview.

Lessons at Tuba City Hospital, Run by Navajos, About Births - NYTimes.com

By DENISE GRADY
Published: March 6, 2010


TUBA CITY, Ariz. — After less than two hours in the maternity ward, with her boyfriend, his mother and a nurse-midwife by her side, Jacquelynn Torivio gave birth to a five-pound, five-ounce son with his grandmother’s dimples and a full head of shiny black hair.

A 3-day-old girl, Allisyn Dohi, who was born at the Tuba City Regional Health Care Corporation hospital in Arizona.
As she held him, Ms. Torivio’s spirits clearly matched her Hopi name, Nuquahynum — “a feather flying high.”

It was the kind of birth that many women in the United States could only wish for. Ms. Torivio had a vaginal birth, even though her previous child had been delivered by Caesarean section. Because of that prior surgery, many hospitals would not have let her even try to give birth vaginally, but would have required another Caesarean.

The Tuba City Regional Health Care Corporation is different. Its hospital, run by the Navajo Nation and financed partly by the Indian Health Service, prides itself on having a higher than average rate of vaginal births among women with a prior Caesarean, and a lower Caesarean rate over all.

As Washington debates health care, this small hospital in a dusty desert town on an Indian reservation, showing its age and struggling to make ends meet, somehow manages to outperform richer, more prestigious institutions when it comes to keeping Caesarean rates down, which saves money and is better for many mothers and infants.

This week, the National Institutes of Health will hold a conference in Bethesda, Md., about the country’s dismal rates of vaginal birth after Caesarean, or VBAC (pronounced VEE-back), which have plummeted since 1996. “I think it’s the purpose of this conference to see if we can turn the clock back,” said Dr. Kimberly D. Gregory, vice chairwoman of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in Los Angeles.

Tuba City will not be on the agenda, but its hospital, with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery.

Changes in malpractice insurance would also help, so that obstetricians would feel less pressure to perform Caesareans. (The hospital and doctors in Tuba City are insured by the federal government, and therefore insurance companies cannot threaten to increase their premiums or withdraw coverage if they allow vaginal births after Caesarean.) Patients, too, would have to adjust their attitudes about birth and medical care during pregnancy and labor.

The national Caesarean rate, 31.8 percent, has been rising steadily for the last 11 years and is fed by repeat patients. Critics say that doctors are performing too many Caesareans, needlessly exposing women and infants to surgical risks and running up several billion dollars a year in excess bills, precisely the kind of overuse that a health care overhaul is supposed to address.

Even the American College of Obstetricians and Gynecologists has acknowledged that the operation is overused. Though there is no consensus on what the rate should be, government health agencies and the World Health Organization have suggested 15 percent as a goal in low-risk women.

“VBAC” has become a battle cry, with fierce advocates on both sides—women who insist that they should not be forced into surgery versus doctors and hospitals who insist on repeat Caesareans, citing the risks of labor and concerns about liability and insurance.

Originally, the mantra was “once a Caesarean, always a Caesarean” because of fears that the scar on the uterus would rupture during labor, which can be life-threatening for both the woman and the child. But after an expert panel in 1980 declared it safe for many women, vaginal birth after Caesarean had a heyday: in 1996, the rate reached 28.3 percent in women with previous Caesareans.

Then, there were some ruptures, deaths and lawsuits. The obstetricians’ group issued stricter guidelines, and the rate sank. It is now below 10 percent, and some experts think the pendulum has swung too far the other way.

In Tuba City last year, 32 percent of women with prior Caesareans had vaginal births. Its overall Caesarean rate has been low — 13.5 percent, less than half the national rate of 31.8 percent in 2007 (the latest year with figures available). This is despite the fact that more women here have diabetes and high blood pressure, which usually result in higher Caesarean rates.

The hospital serves mostly Native Americans — Navajos, Hopis and San Juan Southern Paiutes. Four other hospitals in New Mexico and Arizona, run by the Indian Health Service, also offer vaginal birth after Caesarean to some women (it is not safe for all) and have relatively low Caesarean rates without harming mothers or children, whose health in the first month after birth matches nationwide statistics. Doctors say there is no scientific evidence that Native American women are more able than others to have vaginal births.

“There is a significant lesson here about the ability of most women to deliver vaginally,” said Dr. Jean E. Howe, the chief clinical consultant for obstetrics and gynecology at Northern Navajo Medical Center in Shiprock, N.M.

Nurse-midwives at these hospitals deliver most of the babies born vaginally, with obstetricians available in case problems occur. Midwives staff the labor ward around the clock, a model of care thought to minimize Caesareans because midwives specialize in coaching women through labor and will often wait longer than obstetricians before recommending a Caesarean. They are also less likely to try to induce labor before a woman’s due date, something that increases the odds of a Caesarean.

In the rest of the country, nurse-midwives attend about only 10 percent of vaginal births, though their professional society, the American College of Nurse Midwives, hopes that will grow to 20 percent by 2020.

Dr. Kathleen Harner, an obstetrician in Tuba City, said: “Midwives are better at being there for labor than doctors are. Midwives are trained for it. It’s what they want to do.”

Dr. Amanda Leib, the director of obstetrics and gynecology at Tuba City, said: “I think the midwives tend to be patient. They know the patients well, and they don’t have to leave at 5 to get home for a golf game or a tennis game. As crass as that sounds, I do think it has some influence.”

Senecas See Comeback Over Sale of Cigarettes - NYTimes.com

By DAVID D. KIRKPATRICK
Published: March 5, 2010

There is a relatively short list of people who like mail-order cigarettes: teenagers, adults evading sales taxes and the Seneca Nation of Indians of western New York, which dominates the national market.

Even the big tobacco companies oppose the practice, in part to stamp out the Senecas’ competition. And with the industry’s strange-bedfellow backing, a bill to block the shipment of cigarettes passed the House of Representatives last spring by a vote of 397 to 11. A Senate committee approved it unanimously last fall.

But then the Senecas, who control a gambling and cigarette empire that brings in more than $1 billion a year, began a campaign of back-room lobbying and public political threats. That now appears to have shut down the legislation and kept the tribe in the cigarette business, a case study in the power of a well-financed special interest to thwart what had seemed to be a national consensus.

“Isn’t that the way things go in the American system?” asked Richard Nephew, co-chairman of the Seneca Nation’s foreign relations committee. “It is something new for us to actively get involved in the American political process,” he said. “But we are trying to learn what works in America, and I guess making political contributions is something that works.”

As recently as December, a ban on mail-order cigarettes called the PACT Act — for Prevent All Cigarette Trafficking — looked all but certain to become law. After the Senate Judiciary Committee approved the House measure, Senator Harry Reid of Nevada, the majority leader, prepared the bill for passage on the floor. No senator has publicly opposed the legislation.

But at the last minute, two or three Democratic senators told party leaders privately that they might block the bill, according to senior Senate Democratic aides. They spoke on the condition of anonymity because they were not authorized to speak publicly.

The Senecas and their lobbyists said they did not know who their Senate protectors were. Records of the tribe’s campaign contributions offered few clues; the only significant donation was a $15,000 check to the Republican Senatorial Campaign Committee.

The Senecas’ apparent victory — at least for now — is a comeback of sorts. Five years ago, the Indian nation lost much of its business when Eliot Spitzer, then attorney general of New York, pressured private carriers like FedEx and UPS to stop delivering cigarettes in the interest of keeping them away from children. That forced the Senecas to rely on the United States Postal Service, which declined to join the ban. The tribe’s sales fell to about 12 million cartons a year from a peak of about 30 million cartons in 2004, according to the New York State Department of Taxation and Finance.

Despite its professed inexperience in Washington, the Seneca Nation is well represented on K Street. Last year, the tribe spent more than $300,000 in reported fees to three lobbying firms: the powerhouse Akin Gump; Holland & Knight, where its lobbyists include Ben Nighthorse Campbell, a former senator and American Indian; and Sonnenschein Nath & Rosenthal, which represents many Indian nations and led the Senecas’ side of the cigarette fight. Sonnenschein reported that its fees from the Senecas jumped threefold to $110,000 in the fourth quarter as the battle heated up.

The Senecas and their lobbyists won the support of other Indian nations and advocacy groups, including the National Congress of American Indians, by attacking the proposed legislation as an intrusion on Indian sovereignty. The Senecas charged that it would give states powers to police Indian land; its Congressional sponsors dispute that.

“Conferring jurisdiction to the states — that should be very troubling to every Indian tribe,” Mr. Nephew said.

On Capitol Hill, the lobbyists distributed memorandums painting the legislation as a ploy by big tobacco companies to scapegoat American Indians for teenage smoking, beating back low-price competition in the process. (The tribe’s online Seneca Smokeshop specializes in Indian-made and other “economy” brands.)

And in hard-pressed western New York, the Senecas warned that the proposed ban could cost 1,000 jobs in the cigarette business. “An attack on the Seneca Nation is an attack on the economy of western New York,” J. C. Seneca, who runs a tobacco business and is co-chairman of the tribe’s foreign relations committee, told The Buffalo News. With its cigarette sales and casinos, Mr. Seneca said, the Indian nation was “a $1.1 billion economic engine” that would use its tobacco profits for new investments and jobs.

By mid-December, the campaign had won two important converts. Two western New York congressmen, Brian Higgins and Eric Massa, both Democrats, wrote letters to the state’s two senators, Charles E. Schumer and Kirsten E. Gillibrand, also Democrats, urging them to block Senate passage. Mr. Higgins and Mr. Massa had voted for the bill in the House, but they said the Senecas’ arguments about the economic impact had changed their minds.

“I do not believe that western New York can afford any more job losses,” Mr. Higgins wrote to the senators. (Mr. Massa, who announced this week that he was retiring, echoed the sentiment.)

The next month, the Senecas sent a warning in the form of an electronic billboard along an upstate New York highway. “Don’t let the PACT Act destroy western New York’s economy,” the billboard declared. “Tell Senators Schumer and Gillibrand No.”

The nation, which has fought off years of New York State efforts to tax its cigarettes, had already dedicated a $1 million war chest for political retaliation against any New York State official who crossed the tribe. Also in January, the Seneca Nation’s foreign relations committee approved a proposal to spend $250,000 opposing Ms. Gillibrand’s campaign for election this fall; it will be her first statewide race because she was appointed last year to fill the seat left open by Secretary of State Hillary Rodham Clinton.

Both New York senators are sponsors of the bill, and both said through spokesmen that they had not worked behind the scenes to slow its passage. Matt Canter, a spokesman for Ms. Gillibrand, said she supported economic development but not at the price of enabling teenage smoking.

Seneca officials and their lobbyists said the tribe tried to prevent under-age sales, in some cases by requiring faxed proof of age. Critics said faxed identification was easy to fake or borrow. The Senecas noted that online wine merchants use private carriers like UPS and FedEx that allow them to require the signature of an adult, but the Seneca cigarette dealers must rely on the United States Postal Service, which does not offer that option.

“It seems very discriminatory, as if they were targeting the Seneca Nation,” Mr. Nephew of the Senecas said of the federal legislation.

Senate Democratic leaders could still revive the measure, perhaps by attaching it to some other bill. Republicans have talked of pushing forward, possibly to make trouble for Ms. Gillibrand. But even if it did pass, Mr. Nephew said, it would ban only cigarette shipments and not cigars. “I guess there are a lot of cigar smokers in Washington and places where powerful people hang out,” Mr. Nephew said. “It appears that they are protecting their own habit.”