Everyone in the Navajo Nation Reserve knows who has swelled up with COVID-19.
At least, that’s how Melissa Begay, MD, a doctor of Navajo lung medicine at the University of New Mexico Hospital (UNM) that treats patients transported by plane from the reserve feels. There, it is not yet uncommon for several members of the family circle to occupy rooms adjacent to the ICU. I’ve never noticed so many tribal members in the hospital, he said.
Begay herself three parents.
“You feel mentally exhausted by the news of his death,” Begay told MedPage Today. “Every week, you know: a friend, a relative, a tribal officer, or one of the frontline workers. This news hasn’t disappeared since March.”
The Navajo Nation made headlines in May for a constant infection rate relative to any other U.S. state, and as of August 11, 9,334 cases and 473 deaths were reported. However, over the next 6 weeks, there have been an average of less than 50 new instances consistent with the day, and the curve has begun to flatten in the reservation. By contrast, there were an average of 1,178 new instances consistent with the day in neighboring Arizona during the following week, and the new instances exceeded 3,000 in July.
Although the Navajo network is facing a complicated war to succeed over the disparities that affected the tribe long before the pandemic, tribal leaders, fitness professionals and members of the network have combined to stem the spread of the tactics that other parts of the country have struggled to achieve. speaks to. Do.
“Other indigenous people have already faced tons of pandemics and we are seeing this resilience,” Begay said. “There are still many positive emotions in terms of seeing our tribe come out in the other aspect of this stronger.”
Background to inequity
Health disparities have been common currency in Aboriginal communities for decades. Nationwide, one in 4 positions in the comforts of the Indigenous Health Service (IHS) was vacant in 2018, and the vacuum rate is even higher within the Navajo Nation.
Compared to whites, Native Americans also have a greater threat of many chronic diseases, adding more than three times the threat of diabetes and 50% higher rates of obesity, either of which leads to an increased threat of severe COVID-19 infection and death.
These disparities are even greater among Native Americans living in rural areas, such as the Navajo Nation, relative to metropolitan areas, according to the effects of the national fitness survey published last week. In rural areas, 36% of Native Americans suffer from several chronic diseases, 35% suffer from high blood pressure and 19% of diabetes.
Last week’s COVID-19 report showed that Native Americans had an age-adjusted hospitalization rate approximately five times higher than that of white Americans. But some federal knowledge does not report the effects through race/ethnicity, and tribes are not required to report ON COVID-19 knowledge to the CDC. As a result, the figures on the government agency’s online page may not describe the extent of the problem as it should be.
According to a New York Times investigation of 1.5 million positive cases in the United States, the rate of COVID infection for Native Americans was 1.7 times higher than that of whites. At Begay Hospital in New Mexico, approximately 45% of patients are Native Americans, representing about 10% of the state’s population, he said.
Meanwhile, the IHS budget is $4,078 consistent with the capita, at $13,185 consistent with the Medicare beneficiary.
In the Navajo Nation Reserve, there are a dozen medical services serving a population of more than 173,000 in a domain about the same size as West Virginia. These services have a total space of 25 beds of extensive care, which means that many critically ill patients will have to be transported by helicopter to the nearest services to Phoenix or Albuquerque, where Begay Hospital is located.
Some seriously transported patients outside the reserve can only speak Navajo, which not only increases the threat of medical headaches in the air, but can also make discussions about the end of life and other important communications difficult once they land.
“It’s already such a complicated scenario and when you have that barrier where you can’t talk for other people to make vital decisions, it presents a challenge that doesn’t necessarily happen in other cases,” Begay said.
A mitigation model
For hospitalizations and ease of tension in overcrowded facilities, Navajo COVID-19’s reaction focused on providing resources to families to simply stay at home, said Laura Hammitt, MD, director of infectious disease systems at the Center for Native Americans. Bless you.
Hammitt attributes the recent decline in infection rates to tribal leadership and the fundamental principles of infectious diseases: hand washing, masking, social remoteness, and touch research.
But these methods are not imaginable for a giant component of the population. One in 3 families in the Navajo Reserve has no running water and many live in multigenerational homes that make isolation or quarantine a challenge, to say the least.
“In tribal communities and other communities heavily affected by poverty, others do not have the privilege of taking mandatory steps to curb the spread of the disease,” Hammitt told MedPage Today. “The reaction of the Navajo Nation is to give other people the equipment they want to stop the spread.”
Since April, the Navajo Nation has operated under a 52-hour curfew on weekends until last week, when it was reduced to 32 hours. More than a third of the population has been tested, allowing for a physically powerful tactile search.
Still, the curfew has been reduced to nearby cities, which is a challenge for many tribal members living in rural areas, Begay said.
In the northeast component of the reserve, for example, more than a dozen communities have a market in Shiprock, New Mexico, said Kyle Jim, who supplies care packages to the family circle with Arrowhead Lifeway.
“Most of our population has low incomes, so we can’t afford to store food for a long time,” Jim told MedPage Today.
He’s growing up.
To ensure that others have the materials, dozens of network organizers, adding Navajo Nation President Jonathan Nez have introduced coVID-19 aid efforts, collecting and distributing food, water, hand-washing stations, and medical supplies to reserve homes.
Zoel Zohnnie began outsourcing a COVID-19 relief effort, Water Warriors United, last April. He used the budget he raised to purchase a water tank and a pump, trailers and barrels to deliver to houses without plumbing. Every day, he and a dozen volunteers distribute barrels to 10 homes. Previously, their occupants would have probably had only a 5-gallon jug they had to fill.
“Once the networks and tribal efforts on the floor increased the water, food and equipment source, a formula was developed in which other people can stay home without having to leave,” Begay said.
While the pandemic has reduced people’s ability to seek water, especially older people and other high-risk people, the need for critical resources and increased infrastructure has been incredibly superior for generations, Zohnnie said.
“Once the virus appeared, it showed the world that these are the disorders they’ve been facing for a long time,” Zohnnie told MedPage Today. “If I had a team of 10 other people running all week, all year round, we wouldn’t even break up all the upheavals that want to be solved.”
Stronger on the side
Through the federal CARES (aid, relief and economic security against the coronavirus) act, the Navajo Nation earned approximately $700 million, a component of which was allocated through Nez to finance affordable housing projects in the reserve.
More Navajo translators have been hired at UNM Hospital in Albuquerque, so patients are now available 24 hours a day, Begay said.
“Boarding a Navajo medical translator in a universityArray … This is a wonderful victory for us,” he told MedPage Today. “When I did my residency at UNM, it wasn’t available and it wonderfully improved our ability to provide care.”
However, the CARES Act budget has a time limit and awning expenses incurred until the end of the year. Things like hiring suppliers take time, and the challenge now is to liquidate the cash before they disappear, Hammitt said.
The indirect effects of COVID-19, such as unemployment, will continue to be felt in the coming months, Hammitt said, stressing that “the virus is not gone” and that the mitigation measures put in place will have to remain in the autumn and winter. Months.
“People want to perceive that this cannot be a one-time investment in the short term; it will have to be a long-term investment in systemic change,” Hammitt said. “I hope this will remain the case after we have flattened the curve and that others remain committed to making mandatory adjustments to the suitability of tribal communities.”
Elizabeth Hlavinka covers clinical news and research articles for MedPage Today. It also produces episodes for the Anamnesis podcast. Follow
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