Tribes Take Measures to Slow Spread of Coronavirus

By Felicia Fonseca, Associated Press

(Editor’s Note: Below this article, there are two accompanying stories.)

There are 574 federally recognized tribes, 229 presiding in Alaska. Many successfully manage their health care systems. 

Sharon Bahe has made her home on the Navajo Nation a refuge, placing cedar branches and burning sage to help purify the space and praying for protection for herself and her children home from boarding school and a toddler with severe asthma.

Her community of about 500 in northern Arizona has become a hot spot for the new Coronavirus, with several cases confirmed. While other kids play outside, she tells hers they can't “until the virus goes away.”

Officials on the Navajo Nation, the largest Native American reservation, broadened a stay-at-home order from Chilchinbeto to the entire reservation: No visitors in, and residents can't leave their homes except for essential tasks, including to get food and medical supplies.

The order is among the strictest yet in Indian Country, though tribes across the U.S. for weeks have been preparing amid worries that the outbreak could quickly overwhelm a chronically underfunded health care system and affect a population that suffers disproportionately from cancer, diabetes and some respiratory diseases.

They've shut down casinos, hotels and tourist destinations — often their primary revenue sources — and reminded citizens of the resiliency of their ancestors.

“Tribes are really just big families in a lot of ways," said Matthew Fletcher, a law professor at Michigan State University. "The threats to your family are something you're going to take seriously.”


Matthew Fletcher is a Professor of Law at Michigan State University College of Law, and Director of the Indigenous Law and Policy Center. (Photo Credit: National Public Radio)

Tribal elders, revered for their knowledge and cultural guidance, are the biggest concern, and outreach and other efforts are underway on the Navajo Nation, which spans three states in the U.S. Southwest. Many families there live miles apart in homes that hold multiple generations but can lack electricity, running water and reliable internet.

For most people, the Coronavirus causes only mild or moderate symptoms. But for the elderly and people with existing conditions, it can cause more severe illness. The vast majority of those who are infected recover.

A federal funding package in response to the virus included $40 million for tribes for epidemiology, public health preparedness, infection control, education and other things.

But the money hasn't reached tribes because there's no mechanism for the Centers for Disease Control and Prevention to get it to the Indian Health Service, the agency responsible for providing primary medical care to Native Americans. Tribes and tribal organizations run some hospitals and clinics under federal contract.

Dean Seneca, a member of the Seneca nation who has worked more than 18 years in the Centers for Disease Control and Prevention's Center for State, Tribal, Local and Territorial Support, told Indian Country Today that tribal epidemiology centers did not have the capacity to track the disease. (Photo Credit: UB Today)

“Everyone is on high alert right now. They're waiting, they're asking us,” said Stacy Bohlen, Executive Director of the National Indian Health Board who is from the Sault Sainte Marie Tribe of Chippewa Indians.

In the meantime, tribes are taking action to slow the spread of the virus.

In South Dakota, Oglala Sioux Tribe President Julian Bear Runner prohibited church groups from bringing volunteers to help repair homes on tribal land. The Rosebud Sioux Tribe canceled about 300 spring turkey and prairie dog hunting permits for non-tribal members.

In Montana, the Northern Cheyenne and the Crow tribes enacted a 10 p.m. curfew, partly to ensure law enforcement isn't bogged down, and restricted movement on and off their land. They also asked residents who attended hugely popular basketball tournaments off the reservation to self-quarantine.

The Bay Mills Indian Community has special hours for the elderly at a grocery store on the densely populated reservation in northern Michigan and a gas station with full service to limit exposure to the pumps, said tribal Chairman Bryan Newland.

It also is among tribes nationwide that have closed casinos and is paying its 400 employees. The National Indian Gaming Association has asked Congress for at least $18 billion in federal aid over six months to address shortfalls from closing casinos, which tribes depend on because they don't have a property tax base.

For others, it's tourism, but those operations, too, are shutting down. They include Monument Valley on the Navajo Nation and the famed blue-green waterfalls of the Havasupai reservation in northern Arizona.

 Waterfalls of the Havasupai Reservation (Photo Credit: Wikipedia)

Monument Valley (Photo Credit: Pinterest)

Tribal leaders say all tribes are at risk but some face unique situations. Of the country's 574 federally recognized tribes, 229 are in Alaska where supplies must be flown in or shipped on barges. Kevin Allis, chief executive of the National Congress of American Indians, said that could expose isolated Alaska Native villages and create a disaster.

The villages have clinics, but residents must travel to regional hubs or farther for serious medical issues.

“This is a very scary situation for them,” Allis said.

Some health care clinics and hospitals that serve Native Americans have closed or scaled back services to focus on the Coronavirus. Community health representatives on the Navajo Nation have been driving long distances to people's homes to teach them about the virus and what to do if they exhibit symptoms.

They're using a new Navajo phrase that translates to “a step above the big illness,” said Mae-gilene Begay, who oversees the program.

The Navajo Nation had at least 14 confirmed cases as of Friday evening. Others have been confirmed at health care facilities for Native Americans in the Portland, Oregon, area and in the Great Plains. The Cherokee Nation of Oklahoma said one of its citizens has died from COVID-19.

Bills in Congress seek to create parity for tribes, giving them direct access to a federal drug repository and gear if they exhaust their supplies, and the ability to apply directly to the CDC for a health emergency preparedness program. A federal funding package gives $64 million to IHS.

But Democratic U.S. Sen. Tom Udall of New Mexico said that "can't be the end of the work.”

Bahe was busy getting supplies to stay home for the long term. Her children kept themselves occupied on electronic devices while she stressed frequent hand-washing and general cleanliness. She said she already had enough oxygen and medication for her toddler.

“I was telling my kids we have to keep doing what we're doing because we're not sick yet,” she said.

Navajo Nation President Jonathan Nez declared a public health state of emergency on March 11, two days before the Administration announced a national state of emergency. He stated, “We call upon our Navajo people to stay home and remain calm to prevent the spread of the virus among our communities,” said Navajo Nation President Jonathan Nez in a release. “We also ask the public to be vigilant and respectful of first responders, health care workers, and emergency management officials who are responding to these cases. Please continue to pray for these individuals, their families, and all of the people of our Nation as we get through this together.”

Navajo Nation President Nez urged tribal members to listen to authorities and leadership throughout the crisis. (Photo Credit: Navajo Nation, Office of the President and Vice President )

Navajo Nation President Jonathan Nez wore a mask and gloves while addressing tribal lawmakers. He said the tribe was preparing food packages for elders and will take over all billboards on the 27,000-square-mile (69,930-square-kilometer) reservation to enforce CDC guidelines. It's also considering roadblocks.

President Nez presiding over a recent Tribal Council meeting. (Photo Credit: Navajo Times)

“I love you, Navajo Nation, but please listen to authorities, leadership when they say, ‘Stay home,’” he said. “That's the best way to fight this virus.”

The Indian Health Service is talking weekly with tribes to keep them informed. The agency said all of its facilities can swab patients for COVID-19, though supplies are depleted nationwide, and testing is done at outside labs. Chief medical Officer Michael Toedt highlighted a drive-up testing location in northwestern New Mexico and the replacement of office visits with calls and video conferencing.

Newland and other tribal leaders said they're still not assured they will get needed resources that should be guaranteed through acts of Congress and treaties with the U.S. from generations ago.

“What we really want to know is where can we get our test kits, where do we get economic relief, and we want information as close to real time as possible about how closely we are affected in terms of concerned cases,” Newland said. “Other than that, we can figure it out.”

“I love you, Navajo Nation, but please listen to authorities, leadership when they say, ‘Stay home,’” he said. “That's the best way to fight this virus.”

The Indian Health Service is talking weekly with tribes to keep them informed. The agency said all of its facilities can swab patients for COVID-19, though supplies are depleted nationwide, and testing is done at outside labs. Chief medical Officer Michael Toedt highlighted a drive-up testing location in northwestern New Mexico and the replacement of office visits with calls and video conferencing.

Newland and other tribal leaders said they're still not assured they will get needed resources that should be guaranteed through acts of Congress and treaties with the U.S. from generations ago.

“What we really want to know is where can we get our test kits, where do we get economic relief, and we want information as close to real time as possible about how closely we are affected in terms of concerned cases,” Newland said. “Other than that, we can figure it out.”

Associated Press writers Stephen Groves in Sioux Falls, South Dakota, Paul Davenport in Phoenix and Rachel D'Oro in Anchorage, Alaska, contributed to this report. Fonseca is a member of the AP's Race and Ethnicity team. Follow her on Twitter at https://twitter.com/FonsecaAP

ABOUT THE AUTHOR

Felicia Fonseca is a correspondent for the Associated Press, and her works have been published worldwide. Based in Arizona, she studies and writes about Native American tribes and their efforts to build sustainable economies.

Lead Story Image: Web MD

To learn more about Native American health programs and organizations, visit Native America Today’s Community Resources Section.

Native American Tribe Takes Trailblazing Steps to Fight Covid-19 Outbreak

By Nina Lakhani, The Guardian

The Lummi Nation, a sovereign Native American tribe in the Pacific north-west, will soon open a pioneering field hospital to treat Coronavirus patients, as part of a wave of strong public health measures which have gone further than many world governments.

Tribal leaders have been preparing for Covid-19 since the virus first appeared in Wuhan, China, in late 2019, with medical staff beefing up emergency plans, reorganizing services and gathering medical supplies, including test kits and personal protective equipment.

The Lummi reservation is located in Whatcom county – 115 miles north of Seattle, Washington, where the first US Covid-19 case was confirmed in January, followed by the first death in February.

So far, the tribe has reported three Covid-19 cases, but expect numbers to rise as the pandemic progresses.

“We quickly recognized the need to make sacrifices for the greater good, in order to protect our people and the wider community,” said Dr. Dakotah Lane, medical director of the tribal health service, who is in strict self-quarantine after coming into contact with a Covid-19 patient.

Dr. Dakotah Lane (pictured above) in self-quarantine. (Photo Credit: Alan Berner / The Seattle Times)

As the Trump administration was weighing options, the tribe swiftly introduced mitigation and prevention measures such as social distancing, drive-through testing, telemedicine clinics, and a home delivery service for the elderly.

The tribal council declared a state of emergency on 3 March – 10 days before the Administration did the same – and approved $1m to prepare and respond for the evolving pandemic, which includes setting up the hospital.

A community fitness center, located next to the tribe’s health clinic, has been re-purposed into a makeshift hospital, with beds, protective gear and other essential equipment in place. It will open once the pharmacy is fully stocked. The 20-bed hospital will treat less critical inpatients, in order to free up intensive care units in nearby facilities, and prioritize Native Americans from any tribe.

“Our unique approach has piqued a lot of state and federal interest, we’re offering them a different model which shows that tribes are part of the solution in recovery efforts,” said the tribal chairman, Lawrence Solomon. “No private organization is going to try what we’re doing.”

Lummi Nation Tribal Chairman Lawrence Solomon reports the Lummis have created a health model that demonstrates tribes are part of the solution. (Photo Credit: Lummi Nation)

The tribe’s proactive response to the evolving global pandemic has been possible thanks to vast improvements to the quality and capacity of its community healthcare system over the past decade.

Like an increasing number of tribes, the Lummi Nation has opted for “self-determination” which enables greater financial flexibility and clinical autonomy – as opposed to depending on the federally controlled Indian Health Service (IHS) which has suffered decades of severe under-funding.

As a result, the Lummi Health Services raises substantial revenue by treating patients on Medicaid and Medicare – the third party billing program created by the Affordable Care Act in 2010. This extra cash has allowed them to invest in infrastructure and build capacity: the tribe now has eight doctors compared with just three in 2013, including three physicians with public health expertise.

A patient being cared for at an Indian Health Service facility. (Photo Credit: Pinterest)

CDC modeling suggests that anywhere between 2.4 million and 21 million people in the US could require hospitalization during the course of the pandemic, potentially overwhelming the hospital system.

The Lummi want to help. Dr Lane said: “The Lummi believe in controlling our own destiny. We don’t count on help reaching us, but the hospital is something we can do to help the community.”

ABOUT THE AUTHOR

Nina Lakhani is a British freelance journalist reporting from Central America and Mexico for The Daily Beast, The Guardian, BBC, Al Jazeera, Global Post and The Telegraph. In London, she worked for the Independent and Independent and Sunday. Before journalism, Nina was a mental health nurse. She can be found on Twitter@ninalakhani

To learn more about Native American health programs and organizations, visit Native America Today’s Community Resources Section.

Tribal Programs That Prepare for Public Health Crises Readying for Coronavirus

By EILIS O'NEILL, from KUOW

The Shoalwater Bay Reservation in southwest Washington is right on the Pacific Ocean. It's small and isolated, with about 100 residents, one gas station, and a small casino.

Kim Thompson is the tribe's Health Director. As she gave a tour of the clinic recently, she said they're not ready for novel Coronavirus cases yet — but they're trying to get there.

"This is where we have it set up so patients can come in through this back door," avoiding contact with other patients, she said.

Thompson said the clinic will soon be able to take swabs from patients and send them off to a commercial lab to test for the novel Coronavirus.

"We haven't set up the gowns or everything yet, since we don't have all the testing materials yet," she added.

Kim Thompson (pictured above) is Health Director of the Shoalwater Bay Tribe. Thompson said the clinic will take swabs from patients and send them to a commercial lab for testing. (Photo Credit: KUOW)

Across the country, public health workers on Native reservations are scrambling to prepare for COVID-19. In South Dakota, an Indian Health Service clinic confirmed a case. And, in Washington state, one of those who died at the hard-struck nursing home in Kirkland was a member of the Cowlitz Indian Tribe. But tribes are expecting much worse to come, and they're trying to get ready.

At Shoalwater Bay, Thompson said getting supplies and the money to pay for them has been difficult.

"Funding is a unique challenge," she explained. "We have a budget that we're allotted every year by Indian Health Services. And, when that money runs out, we have to count on our third-party revenue" — that is, payments from insurance companies.

"The smaller tribes are the most hit," said Vicki Lowe, the director of Washington state's American Indian Health Commission, and a descendant of the Jamestown S'Klallam Tribe.

She said many tribal programs that prepare for public health emergencies like this one are strapped.

Some rely on less than $5,000 a year.

"So, when there's an outbreak, an emergency like this, it just stretches them even thinner," she said.

To avoid spreading the novel Coronavirus, some tribes are closing their casinos. Others are enacting rigorous cleaning procedures.

"If [tribes] have to shut down a business, they might lose some of their cash flow to help fund their [public health] staff," Lowe said.

The Indian Health Service is distributing additional Coronavirus funding, but it works out to only about $70,000 per tribe, and smaller tribes could get much less than that.

The American Indian Health Commission in Washington state was created in 1994 by federally recognized tribes, Urban Indian health organizations, and other Indian organizations to provide a forum for addressing tribal-state health issues. The Commission’s mission is to improve the health of AI/AN people through tribal-state collaboration on health policies and programs that will help decrease disparities.  They work on behalf of the 29 federally-recognized Tribes and 2 Urban Indian Health Organizations in the state.

Experts say that's a drop in the bucket compared to what's needed to pay for testing kits and for personal protective equipment for health care workers. And isolating and caring for infected community members will also require resources.

Lowe said, in some ways, Washington state's 29 tribes are better positioned than tribes in other states to respond to an emergency like this one, because of work the state's American Indian Health Commission has done.

In 2009, some local health jurisdictions didn't distribute tribes' allotments of H1N1 vaccines and antivirals to the tribes. Since then, the AIHC has worked to strengthen relationships between local health jurisdictions and tribes so they can coordinate effectively during public health emergencies.

But big obstacles remain.

Beyond funding, Lowe said, another challenge for tribes is that many of their members are medically vulnerable.

"American Indians and Alaska Natives do suffer from higher cardiovascular disease, asthma," she said.

"Those chronic diseases make them at higher risk if they do contract the virus," she added.

"And we could imagine a situation where every speaker of a language could pass away," said Tony Johnson, chairman of the Chinook Tribe, just next door to Shoalwater Bay.

"The fluent first language speakers of the languages of the Pacific Northwest are basically all in the demographic that is at really high risk," he said.

Johnson said memories of smallpox are also putting Native people on edge during this new pandemic.

"We live in a community where not very long ago more than 90% of our community died from imported disease," he said.

Chinook Tribal Chairman Tony Johnson. The Chinooks are just next door to the Shoalwater Bay Reservation. (Photo Credit: The Astorian)

Johnson said he wants to make sure that doesn't happen now. He's taking precautions such as not allowing his 9-year-old daughter to visit her grandparents. To protect the community's elders, Johnson has also cancelled all tribal events, including a big annual story-telling gathering and an event to encourage community members to participate in the 2020 census.

Many tribes have had to do that — and they're worried that their communities might get under-counted as a result, which would exacerbate funding problems down the road.

That said, "our real goal is to take care of our community that's endangered by this virus," Chinook chairman Tony Johnson said, "as long as it takes to get a vaccine."

ABOUT THE AUTHOR

Eilís O'Neill was the EarthFix reporter at KUOW Puget Sound Public Radio in Seattle. Eilís (eye-LEASH)  fell in love with radio as a 14-year-old high school intern at KUOW. Since then, she’s wandered the world recording people’s stories and telling them on the air. O’Neill worked at KALW in San Francisco and WAMU in D.C.; she’s freelanced for public radio programs such as The World and Marketplace from places such as Buenos Aires and Santiago de Chile; and she’s written for The Nation and other leading magazines.

To learn more about Native American health programs and organizations, visit Native America Today’s Community Resources Section.