- The Navajo Nation, already hard hit by the COVID-19 pandemic, is experiencing a second surge of cases.
- Experts say the nation’s caseload can be attributed to a lack of healthcare services, cultural obstacles, and a distrust of the U.S. government.
- Nonprofit organizations and volunteers have stepped in to help.
- They say the COVID-19 vaccines are providing some hope to Navajo communities.
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When Donna Pierce rolled up her sleeve to receive one of the first COVID-19 vaccinations given to members of the Navajo Nation, she did it with a purpose.
She thought of saving lives everywhere — but particularly in Navajo Nation, where the pandemic has been taking lives at a fast clip.
She’s lost five immediate family members to the disease.
Pierce also thought of easing the angst and worry for a community struggling even more with poverty, lack of access to medical care, and even basic utilities.
But most of all, Pierce said she thought of preserving the stories, traditions, and ways of life that make the Navajo who they are.
Pierce explained that as the pandemic takes the lives of the older adults in her nation, it also erases the vital oral history that has been the thread in the Navajo generational tapestry for centuries.
“I was like ‘wow’ when they asked me [to be one of the first in the area to get the vaccination],” said Pierce, who works as an EMT. “It gives me some hope, but I did it to set an example. I really want [those in the Navajo Nation] to get it. But there’s always that mistrust.”
The Navajo Nation is a rural setting, spanning more than 27,000 square miles with 260,000 residents scattered throughout the area.
The region lacks many basic utilities. In some cases, there’s no internet or cell service. In many places, there’s no running water or electricity.
The nation is also a culture that clings tightly to family and a deep-seated mistrust of the U.S. government.
All those factors combined to make the Navajo Nation a COVID-19 hot spot last spring.
And while the nation was able to flatten their curve for a period of time, their numbers are rising again.
With the start of vaccinations, some new administration appointments, and an influx of volunteers and social action groups helping, members of the nation have hope.
But it’s a tempered and uneasy hope, Navajo officials say.
“It’s a grain of hope, but we need a lot more,” said Katherine GeeBah Footracer, MS, a NCCPA-certified physician assistant and a Navajo whose father grew up in the nation.
The challenge is this: Beyond trying to save the lives of their people, they’re trying to save their culture.
“Here’s the worry,” Footracer told Healthline. “While the majority of people who are getting COVID (on the reservation) are under 60, the highest death rate we are seeing is over 60.”
Older adults, she said, are the carriers and translators of the oral history of the Navajo. With their stories comes an understanding — and embracing — of the spiritual side of their lives.
Ceremonies, practices, and other customs are many times entombed in a language that only those elders speak.
“I’m worried because our traditional culture is dying,” Footracer said. “It’s terrible to witness and to think we could lose it all from a pandemic. I just feel so helpless watching it.”
First, there’s the physical challenge.
The Navajo Nation, the nation’s largest Native American tribe, lives and exists by treaty on land that spreads communities far apart, but clusters families in groups.
In the vast Navajo Nation, there are only 6 hospitals, 7 health centers, and 15 health stations. They have fewer than 20 intensive care unit (ICU) beds.
That hasn’t been enough for the Navajo Area Indian Health Services to handle the nation’s more than 23,000 COVID-19 cases and more than 800 deaths.
In addition, residents only have a handful of food markets over all those square miles, meaning they often need to leave their land to get food.
That’s a challenge in lockdowns, as well as a barrier for those who lack decent transportation.
Poverty is also rampant, leading to a lack of resources overall.
There are also less tangible challenges.
First comes family and community beliefs.
Pierce said the Navajo lean heavily on family and on being together. Suggesting they physically distance or even not see one another goes against their most basic of values.
Pierce said she begged her mother to not get together with her siblings and the rest of the family, but it’s so ingrained in the culture, they gathered anyway.
An uncle who had to leave the reservation to work brought back the virus and it quickly ripped through her family, taking three lives and nearly killing her mother.
It took that, she said, for her family and others to begin pushing against their natural way of living, at least for now.
The way the virus gripped — and killed — so many Navajo may also have something to do with health disparity.
The Navajo Nation, like many Native American communities, has a disproportionality high amount of people with type 2 diabetes and obesity, two of the at-risk comorbidities that can make COVID-19 more deadly.
That intertwines with culture and how it relates to medicine.
“It’s a component of being a Navajo to go and see a medicine man,” Pierce said. “Not all our elderly trust doctors. They have their traditional beliefs, and they have to satisfy them spiritually.”
Getting them to see COVID-19 as something that needs a different type of medical care, Pierce said, has been a challenge as well.
“They don’t understand this is a completely different thing than [what] they’ve seen before,” she said.
Then there’s the trust — or lack of it — for the American government.
“There’s always that mistrust there,” Pierce said. “You know: Being lied to repeatedly for hundreds of years impacts you.”
All that combined, Pierce said, created a kind of “COVID bomb.”
When the first COVID-19 spike hit last spring, individuals such as Footracer took action.
The Los Angeles resident headed back to the Navajo Nation to volunteer her expertise.
All these volunteers found challenges but also found solutions they hope will help a struggling nation well after the pandemic recedes.
Footracer was among those individuals who raised their hands to help, heading back to take over spots in Nation hospitals and help the overworked and exhausted staff.
“There’s a geographical problem with getting good medical help here,” she said. “It’s hard to attract people long term because it’s so rural. So, most residents never get to know — or trust — a doctor or nurse. I felt like I had to do something.”
Footracer’s medical background and her lifetime of attending powwows and visiting for long periods each summer melded to help the hospital — and the patients — get through the crisis.
Project HOPE has been helping out hard-hit areas across the nation from the start, Harley Jones, who is the program’s U.S. COVID-19 response leader, told Healthline.
But the Navajo Nation created, in some ways, a unique set of challenges.
“What’s happening in Navajo Nation is extremely similar to what is happening in minority and other underserved populations,” Jones said.
What’s unique comes down to culture.
“Cultural competency (when coming in to help a community) is very important,” Jones said.
Since he had experience working with tribal leaders and programs for years, he was able to guide his volunteers to address the needs in a sensitive way to the Navajo.
Project HOPE focused on staffing and bringing volunteers to step in.
When the second surge started, Navajo officials reached out to Project HOPE for more help. They’re enlisting more volunteers now to assist at hospitals and medical centers as well as with vaccinations.
The Arizona Surge Line is a statewide public/private collaboration run by the Arizona Department of Health Service and powered by technology from Central Logic. The initiative, which includes all of the health systems in the state, load-balances patients and healthcare resources across Arizona.
Luke Smith, DNP, RN, a client operations analyst at Central Logic and director of the Arizona Surge Line, said working to transport Navajo Nation COVID-19 patients to hospitals that could help them and then back home has been successful.
“We took the time during the first peak to really get to know the staff [at the Nation medical spots],” Smith told Healthline. “They loved it and had not had that kind of help before. That developed a great relationship that has lasted.”
One key: A Surge Line physician had expertise on the Navajo Nation and guided the staff on how to address issues and work cooperatively in a way that was comfortable for tribal members.
“We did see mistrust [in general] early on,” Smith said. “There was a lack of buy-in to the pandemic.”
But once family members started dying, Smith said Navajo residents listened and acted.
Allie Young, a young Navajo citizen, also stepped up and created the Protect the Sacred program.
While she’s not sending volunteers to distribute vaccinations or drive, Young is focusing on the fear that a culture could be destroyed.
“Conservatives in this country, at the start, were saying ‘it’s OK for our elders to die,’” she told Healthline. “In Texas, I heard the elderly themselves saying they’d rather die [than quarantine and physically distance]. I was like, ‘No. That cannot happen.’”
“Our elders hold our history; our culture,” she said. “Tribe extinction wasn’t at hand, but I do believe our culture is threatened. And that’s a kind of death, too.”
So, she started the nonprofit Protect the Sacred.
Language is at the top of it, Young said, and most Navajo her age don’t speak their native tongue.
So, Young is working on linking today’s communication with those stories of the elders, using things such as TikTok, memes, and other tools to share the information.
She has hope that her efforts have impact.
“I really do think this is showing us how we can merge the old ways and the new,” she said. “Our children are eager to hold onto our traditions and culture. They are proud of who they come from and who they are. Maybe the language won’t be intact, but we’re finding a way to share it and honor it. It’s been really beautiful.”
Smith feels their work there is also helping long term.
“I think we’ve really broken down the silos and opened the doors to a long-term cooperative relationship,” he said.
Footracer sees hope as well.
“We need to push Congress to fund Indian Health Services properly and maybe this will prove that,” she said. “I don’t think people realize the extent of the situation there.”
As they continue to fight the latest COVID-19 surge and begin the process of vaccinating their population, those of Navajo descent hope they come through the pandemic alive, intact as a society, and perhaps even better off.
“We gave away our land for treaties that state we will get equal healthcare and education, and we were not and are not given that,” Young said. “The government needs to stand up to that promise.”
“For centuries this government has taken so much from us — not just the Navajo Nation but all nations,” she said. “We’re literally fighting for what little we have left. I hope that President Biden and Vice President Harris come out and really see what is going on here. That’s how change happens. Seeing what we need. I hope they do.”