It’s been more than six weeks since President Trump signed the $2 trillion coronavirus bill into law, but Native leaders across the U.S. are just starting to receive some of the $8 billion promised to tribal governments.
While states across the country began receiving financial support from the Coronavirus Relief Fund, known as the CARES Act, Native tribes waited as the Treasury Department determined how to divide funding, and then as a lawsuit over the funding went to court. In that time, COVID-19 cases have exploded in Navajo Nation, which spans Utah, Arizona, and New Mexico. As of Tuesday, the Navajo government had reported 3,245 infections and 103 deaths from the disease. Navajo Nation now has a higher confirmed per capita infection rate than any state in the country, based on census data.
“This is by far, by far, the biggest impact on our people since our return from the Long Walk in 1868,” Navajo Nation Council Speaker Seth Damon said. “We needed medical help here for years, and we’ve been shamed by the federal government’s lack to actually produce that help.”
The Indian Health Service is funded at a rate far below that of other federal health programs, like Medicare. In 2017, the IHS spent $3,332 per person while federal healthcare programs spent an average of $9,207 per person. As COVID-19 has strained some of the nation’s best health facilities, long-underfunded Native medical centers have scrambled to supply healthcare providers with equipment to treat an unexpected influx of patients.
The Navajo Nation reported its first two COVID-19 deaths on March 27, the same day Trump signed the CARES Act. When the novel coronavirus struck, health centers quickly ran out of personal protective equipment and nurses were left to fashion gowns from trash bags. Damon described a “collapse” at the Kayenta Health Center in Arizona, as medical personnel struggled to provide for patients without vital equipment. Though the Indian Health Service lists 12 facilities for the entire Navajo Nation, an area larger than West Virginia, Damon said only half were “major hospitals.”
Across Navajo Nation, face masks, shields, and gowns disappear as soon as new shipments arrive. Midwives have worked without PPE. Supplies are running so low that police officers, ambulance technicians, and those checking on Navajo elders lack protective equipment. Medical personnel, whose ranks have been stretched thin by staffing shortages, work nonstop to treat COVID-19 patients. Over a seven-day period earlier this month, Navajo Nation reported at least 82 new cases each day. On Tuesday, 41 new cases were reported.
“The permanent staff have been running a marathon even before COVID,” said Sriram Shamasunder, an associate professor of medicine at the University of California, San Francisco, who has been providing treatment across Navajo Nation for nearly three weeks. “You definitely see the level of exhaustion.”
The White House, Indian Health Service, and Treasury Department did not respond to individual requests for comment. A spokesperson for the Interior Department said the agency “provided critical assets and deployed to their reservation two command vehicles, two support trailers, two satellite communication trailers and two decontamination trailers.”
In addition to $8 billion, the CARES Act included $500 million in additional funding for the Bureau of Indian Affairs, which provides services to American Indians and Alaska Natives. But with the majority of federal funds earmarked for tribes delayed, Navajo medical facilities are barely surviving. To help them manage, private entities have provided vital support.
Shamasunder arrived as part of a crew of 21 medical professionals from UCSF to assist health clinics in need of nurses. A Navajo-Hopi fundraiser has received more than $3.6 million in contributions from over 67,000 people. The University of Arizona has provided test kits.
In spite of the efforts of Navajo leaders, which Shamasunder described as “Herculean,” facilities in Navajo territory are unable to provide for the patients in need of critical care. Instead, these individuals are flown to hospitals hours away, in Albuquerque, New Mexico, and Phoenix. Exporting treatment has raised additional concerns.
“If Albuquerque and Phoenix or Flagstaff fill up, what is that going to look like here?” Shamasunder said. “That is the fear, because once you can’t send your intubated patients to a higher level of care, you’re managing them with potentially staff that haven’t had as much expertise.”
In addition to medical challenges, other systemic issues, some decades old, are contributing to the spread of COVID-19 on reservations.
Native households are 19 times more likely to lack indoor plumbing than white households, according to a report released late last year. An estimated 40 percent of Navajo Nation households lack running water, meaning that many can’t take precautions recommended by the Centers for Disease Control and Prevention.
“There [are] a good number of us that buy or haul from elsewhere, sometimes hauling water over 100 miles one way,” Crystal Cree, a Navajo tribe member, wrote in an email. She said that more than 10 family members and close friends have died from COVID-19.
The material conditions fueling healthcare struggles for the Navajo Nation are not unique to that community, with similar challenges affecting tribes across the U.S.
“There are many sites in Indian Country that only have 70 percent of the providers that they actually need,” Walt Hollow, the president of the Association of American Indian Physicians, said. “The Indian Health Service has been critically underfunded for decades. And that’s just been a way of life in Indian Country. And we lobby like mad in Congress and the Senate to get those budgets increased every year to try to rectify the situation, but it’s an uphill battle.”
The Navajo had conducted more than 17,000 tests as of Thursday. But, Hollow noted, although the Navajo Nation has conducted widespread testing, tribes across the Northern Plains, Southern Plains, and East Coast have not. Southern and Eastern tribes, which represent tribal communities in an area stretching from Texas to Maine, had tested just 3,084 people as of Tuesday, according to the IHS.
Similar testing issues have challenged health facilities serving urban Native communities, where more than 70 percent of Natives and Alaska Natives live. With limited supplies, the IHS rushed to provide assistance to rural communities, said Abigail Echo-Hawk, director of the Urban Indian Health Institute. Echo-Hawk said that Abbott Laboratories testing kits, for example, were delivered to rural tribal areas, while urban facilities received none. That left the 41 city-based health providers funded by the IHS to find their own resources for COVID-19 testing.
“The first people of this country are the last ones getting the resources that they need,” Echo-Hawk told The Appeal. “The people who have the highest health disparities that are direct contributors to mortality of COVID are the last ones getting the resources we need for prevention, intervention, and for care.”