Coronavirus Hits Native American Groups Already Struggling With Poor Health Care

As tribal leaders around the country gear up for the pandemic’s spread, they worry the federal agencies that are supposed to help protect them aren’t ready

The new coronavirus has found its way to Chilchinbeto, Ariz., a remote Navajo hamlet of about
500 in the high desert, a sign of the startling reach of infections in the U.S., and a worrisome
harbinger for all Native American communities.

As tribal leaders around the country gear up for the pandemic’s arrival, they worry the federal
agencies that are supposed to help protect them aren’t ready. The federal Indian Health Service
is already facing major shortages, and the Centers for Disease Control and Prevention is
expected to leave out some of the most vulnerable tribes when it announces new grants on
Monday, according to tribal leaders and government documents.

On Tuesday, Navajo authorities said they had identified the first two positive patients. By
Saturday night, there were 26, mostly near Chilchinbeto. Tribal officials have now issued a
shelter-in-place order for the entire Navajo Nation, a reservation about the size of West
Virginia, with more than 150,000 residents.

“People are afraid,” said Nathaniel Brown, a Navajo Nation council delegate who lives in the
area, a span of yucca-studded sand dunes that rises into the Black Mesa. “They want to get
tested. They want to know.”

Like everywhere, they mostly can’t, as testing kits remain in short supply around the country.
Mr. Brown said one local man in Chilchinbeto died Thursday evening of respiratory symptoms
without ever getting tested.

Native American communities like Chilchinbeto, often poor and isolated, have few of the
resources or medical personnel to battle a viral pandemic. Even in good times, tribes often get
inadequate care from the Indian Health Service (IHS), a yearslong investigation by The Wall
Street Journal has found. Compounding the risks, many reservations face housing shortages
that leave tribal members living in often crowded conditions.

“We are so unprepared,” said Tori Kitcheyan, a council member at the Winnebago Tribe of
Nebraska and chairwoman of the National Indian Health Board. “We’re like the perfect petri
dish for this virus to multiply and take us out without any services or even supplies,” she said.
Most of the Navajo cases involved people who sought care at the IHS’s Kayenta, Ariz., health
center, the Navajo tribe said in a statement.

The Kayenta facility, which only treats outpatients, had a 63% vacancy rate for doctors as of last
year, according to data provided by the IHS, making it one of the most medically understaffed
facilities in the federal agency’s network at the time. The IHS is charged with providing medical
care to 2.6 million Native Americans and has long struggled with recruiting doctors, meeting
regulatory requirements and providing adequate services.

The IHS’s chief medical officer for the Navajo area, Loretta Christensen, said in an interview
that Kayenta’s vacancy rate is now between 40% and 45%. She said the facility had been nearly
completely repurposed to fight the outbreak, with dentists and podiatrists triaging potential

The IHS couldn’t immediately provide a systemwide total of coronavirus cases, but
acknowledged it has a number outside the Navajo region’s 26 cases.

An IHS spokeswoman said the agency has 71 ventilators and 33 ICU beds at the 24 hospitals it
runs directly. Earlier in March, senior IHS officials cited smaller numbers of ventilators for its
625-bed hospital system in a briefing with congressional staff. The IHS said it hadn’t yet
collected current information at that time.

The IHS has said in congressional briefings that it expects to refer most seriously ill coronavirus
cases out to private facilities, aides who attended said.

“We could very well see a scenario where the needs outstrip our resources,” Michael Toedt, the
IHS’s chief medical officer, said in a call with reporters last week.

The IHS is also shipping out masks from a stockpile of 1.2 million masks it has in storage that
have passed their expiration dates, the agency told congressional staff. The Centers for Disease
Control and Prevention has said older masks can be used nationwide because of a shortage.

A federal government document shows a planned $40 million allocation by the CDC for tribal
pandemic response has excluded some of the poorest tribes in Nebraska and the Dakotas, where
the IHS has most struggled to provide adequate care. The move led to panicked conferences of
tribal leaders over the weekend as they absorbed the news and prepared for an official
announcement early this week, some tribal officials said.

The CDC is relying on existing bureaucratic pipelines to channel the funds to tribes, and
infrastructure doesn’t currently exist for the Great Plains tribes, said Jerilyn Church, the chief
executive of the Great Plains Tribal Chairmen’s Health Board, a group representing the health
interests of the excluded tribes.

“Unfortunately that resulted in leaving out some very vulnerable populations,” she said.
Groups representing those tribes could still apply for grants through a related program, the
document said, a suggestion Ms. Church called dismissive.

A Department of Health and Human Services spokeswoman provided a statement confirming
the grant recipients, which include the Navajo tribe.

IHS facilities are turning away anxious patients, citing a shortage of testing supplies, said Mr.
Brown, the Navajo delegate. The IHS’s Dr. Christensen said Kayenta is reserving test swabs for
the sickest patients and hasn’t run out, despite concerns about a national shortage.

Chilchinbeto, which before the outbreak proudly claimed to be home to the world’s largest
Navajo rug, is now effectively sealed off. Supply trucks must ferry in food to the area’s lone
grocery store, Mr. Brown said. Coal, firewood and water are also being hauled in, the tribe said.

Mr. Brown himself is in quarantine after developing a fever and cough last week. On Tuesday,
he drove to the Gallup Indian Medical Center to be tested, but he hasn’t gotten the results and
worries about passing the virus on to elders.

On Thursday evening, Mr. Brown said he climbed to the top of a sandstone rock formation and
wept as he shouted in Navajo into the wind.

“Mountains, I know you can hear me. Water, I know you can hear me. Holy people, I know you
can hear me. I know you will not abandon us,” he prayed.

By:  Dan Frosch and Christopher Weaver
Source: Wall Street Journal