Pandemic Exposes Health Care Inequities In Indian Country

By Laurel Morales
Published: Friday, April 24, 2020 - 5:05am
Updated: Friday, April 24, 2020 - 8:07am

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Navajo hogan
Laurel Morales/KJZZ
Long-standing problems have contributed to the rapid spread of the coronavirus on the Navajo Nation. Households lack clean running water and electricity.

After New York and New Jersey, the place with the highest coronavirus infection rate in the U.S. is the Navajo Nation.

Dr. Deborah Birx of the national task force told the White House press corps the tribe is using strike teams.

"They're really doing amazing work at their public health institutions with their governors and their mayors," Birx said. "And they really they are in full contact tracing."

Contact tracing — or tracking all the people that COVID-positive patients may have infected — has been a challenge on the Navajo Nation.

"We are doing the best we can," said Shawnell Damon, the Navajo epidemiology chief for the COVID-19 strikeforce. "There are some cases where a number of people have been exposed to some people, and so we're trying to find those people and yeah, that's where the shortcomings come from."

Damon said the tribe has about 80 contact tracers. And they are working hard to do their job. Not everybody has a phone and it takes hours to drive to one home. Damon is currently trying to train more contact tracers.

Long-standing problems have contributed to the rapid spread of the disease on the Navajo Nation. Households lack clean running water and electricity. Hospitals are few and far apart for a reservation the size of West Virginia.

All these issues the tribe says can be traced to broken promises.

Navajo Nation President Jonathan Nez
Navajo Nation President Jonathan Nez addresses the tribe on a Facebook Live Town Hall.

"We are United States citizens but we're not treated like that," said Navajo Nation President Jonathan Nez. "You can hear the frustration, the tone of my voice. We once again have been forgotten by our own government."

More than 150 years ago the Navajo and many other tribes signed treaties with the federal government giving up their land in exchange for funding of things like housing, infrastructure and health care. But for decades that hasn't happened.

And now the Navajo Nation is suing the federal government for what it calls, its fair share of federal COVID relief money. On March 25, Congress passed a $2 trillion package called the Coronavirus Aid, Relief and Economic Security, or CARES Act, which includes $8 billion to help tribes fight the coronavirus. The Navajo Nation along with 10 other tribes are suing the federal government because it said the tribes shouldn't have to share the funds with Alaska Native for-profit corporations.

"Native American communities are often invisible in terms of their health inequities. When you look at IHS per capita spending, it is much lower than we see for veterans medical spending or medicare spending," said Laura Hammit, the director of Infectious Disease Prevention at the Johns Hopkins Center for American Indian Health. "IHS is chronically underfunded."

The federal government spends $2,834 per person on health care in Indian Country while it spends $9,404 on veteran health and $12,744 on Medicare, according to the most recent data.

The IHS works off the motto: make the best of what you've got, even in a crisis. So that's meant converting offices to patient rooms and relying on the National Guard. But there's still an acute nursing shortage, and the tribe is desperately lacking in equipment. So IHS Chief Medical Officer Loretta Christensen said they're forced to fly COVID patients to hospitals in Albuquerque, Flagstaff, and Phoenix.

"Our goal is to get our patients to a higher level of care as quickly as possible so that we can get them stabilized," Christensen said. "We do realize there's finite capacity and that's why we've made plans that we may have to manage many of these patients here on Navajo and we have ramped up that service."

Diana Hu
Aurelia Yazzie/TCRHCC
Diana Hu, a pediatrician at Tuba City Regional Health Care Corporation and a member of the Navajo Epidemiology Response Team, says "it took a lethal pandemic like this to show the holes in our public health system."

Christensen said the tribe is putting together a critical care strike team. But up until now strike teams have only been used to deliver food and supplies to people who have been exposed to the virus.

"We need this administration to consult with tribes to listen with tribes to work in understanding them far more than they do," said Rep. Deb Haaland, a New Mexico Democrat who is a member of the Laguna Pueblo Tribe.

As sovereign nations tribes do have the ability to work government to government. For example, the Navajo president is working with New York's governor to get some of that state's unused equipment.

In Tuba City, pediatrician Diana Hu said that's a huge advantage.

"The big disadvantage, of course, is they don't have a big public health infrastructure themselves," said Hu. "And they've had to learn real quickly. Their learning curve has been quite steep."

And Hu, also a member of the tribe's epidemiology response team, said there are not enough strike teams or contact tracers to get a complete picture of how far COVID-19 has spread on the Navajo Nation.

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