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COVID-19 and Indian Country: One health expert's take on the issue and possible solutions

Updated: Sep 14


Introduction


A report released by the Centers for Disease Control and Prevention shows that American Indians and Alaska Natives are disproportionately affected by COVID-19.

The study, which examined data from 23 states, found that COVID-19 rates among American Indians and Alaska Natives were 3.5 times higher compared to white non-Hispanic counterparts. Several organizations, individuals and institutions are working to change the health disparities among Indigenous peoples.

Nicolas Barton is one such individual. As the executive director of the Southern Plains Tribal Health Board Foundation (SPTHB), a non-profit organization based in Oklahoma City, Barton oversees the organization connecting a unified tribal public health policy among the 44 federally recognized tribes located in the states of Kansas, Oklahoma and Texas. The foundation’s role is to improve tribal public health outcomes for American Indians through partnerships, advocacy, education, data, and research, as well as training.

The Oklahoma Area Tribal Epidemiology Center (OKTEC) is a division under the Southern Plains Tribal Health Board Foundation. The OKTEC is one of 12 tribal epidemiology centers located across the United States. It was established in 2005 through core funding received from the Indian Health Service. As a public health program, the OKTEC works with area tribes, state agencies, tribal organizations, academic institutions, non-profits, and many other agencies to provide a wide range of resources to those we serve.


OKTEC provides a range of services and preventative programs covering health issues like diabetes, heart disease, cancer as well as program evaluation, cultural competency and grant writing. OKTEC also provides access to health data to help ensure reputable information for tribal leadership as well as other health organizations and agencies, both at the local, state and federal levels. Tracy Prather, raised in the Anadarko, Oklahoma, area, is the Tribal Epidemiology Center director.

Below, Nicolas Barton, a citizen of the Cheyenne and Arapaho Tribes from Clinton, Oklahoma, answers questions about COVID-19 and American Indians and Alaska Natives.


Question: What impact has COVID-19 had on Indian Country?


Nicolas: The novel coronavirus has impacted Indian Country in a variety of ways: conducting business, receiving healthcare, economic misses and opportunities, to name a few. This impact has had a profound effect on tribal economies as well as the health of the nation. Within our region, many of our casinos temporarily suspended gaming operations. Revenue from gaming sustains many essential services of tribal government, including administrative support, educational and welfare programs, as well as health services.


Question: How has Indian Country responded to the health effects of the pandemic as well as the economic repercussions?


Nicolas: As an organization, we have primed ourselves to be a hub of knowledge and information. One of our many activities includes gathering resources and developing reliable partnerships that can help provide aid in these trying times. We've also engaged in communication about COVID through several venues to reach rural individuals, including our main website, sharing through social media posts on Facebook and Twitter, and developing print and online shareable material. Tribal nations and tribal organizations have also stepped up communication and sharing of resources. For instance, our Indian Health Service area director has convened a weekly call for tribal health officials to receive the most current information from the IHS area office, which includes updates from the medical officer, financial resources and emergency contacts. The Oklahoma State Department of Health has made a strategic effort to include our tribal nations as part of the strategic response plan - this was accomplished after many consultations with state leaders.


At the beginning of the Oklahoma statewide response that mandated essential-only operations, tribal nations participated by temporarily stopping gaming operations. Gaming operations are a revenue-producing stream for tribal governments and programs. Tribal nations also halted community activities. We saw a shift of tribal nations supporting tribal citizens and employees working for those tribes and gaming facilities; some gaming facilities announced they would pay employees during the time off until they returned to work. Others stepped in by working with other community agencies to bring in resources such as food staples and personal protective equipment.


Question: BIPOC (Black, Indigenous, People of Color) communities have been hit harder by the pandemic. Can you explain why this is?


Nicolas: There are many reasons for this, some of which are listed below:

  • Institutional/medical/environmental racism

  • Low-income status/lack of job security for people who are BIPOC

  • Lack of access to necessities

◦  Fresh water, stable income

  • Food deserts

  • Lack of access to medical resources

  • Insufficient access to internet/wifi for telehealth options

  • Multigenerational households

  • Decrease in access to traditional healing practices/ceremonies for holistic health (which includes mental and spiritual health)

  • Intimate partner violence

  • Ongoing health disparities in the American Indian/Alaska Native populations

◦  Heart disease

◦  Cancer

◦  Diabetes

◦  Chronic lower respiratory disease


The lists can go on and on. But we must recognize that while our tribal nations are resilient and have progressed over time, our health could be better. A better funded health system for American Indians and Alaska Natives would certainly help improve health. On a per-capita basis, a Government Accounting Office report found that federal funding for a patient in the Indian Health Service program is less than $4,000, while a patient who uses the Veterans Health administration is about $10,000 and a Medicare participant has per-capita spending of a little over $13,000. In the area that the SPTHB serves, which is Kansas, Oklahoma and Texas, we have the largest population of American Indians and Alaska Natives, nearing 400,000 active users of the IHS/Tribal/Urban health system.


Question: Can you share a best practice that you've seen or heard about in regards to the pandemic?


Nicolas: During this crisis, we have seen the best of human nature helping fellow people cope the best we can. For instance, the Prairie Band Potawatomi Nation in Kansas opened up a temporary commissary to assist its tribal citizens by making needed food and paper supplies available locally. Items were sold at cost and it eventually led to being open to help assist the other tribes in close proximity in Kansas. The four tribal nations in Kansas are located in the northeast portion of Kansas in rural locations, so being able to help one another out was quite advantageous. The ingenuity and creativity to develop new patient processes and flows as well as developing alternatives to care were quickly realized by our tribal health clinics. Drive-thru testing for COVID-19, handling appointments through telehealth services, and curbside delivery of medication are a few ways our tribal health clinics met the needs of the patient.


Question: How can people stay safe and healthy during this time?


Nicolas: With the nations’ hopes based on the development and utilization of a vaccine, the best way to continue to keep yourself safe and healthy is to continue face-mask wearing when in public spaces, such as office buildings, indoor shopping, or when you’re with groups of people, and physical distancing is not practical. Technology is being embraced more and more by business operations, and online meetings and collaborations are being encouraged. Reducing the transmission of germs is greatly alleviated by proper hand washing and increased use of hand sanitizer. It is important to take care of your mental health during this stressful period. Find ways to stay connected to friends and family via the phone or the internet. Take a mental health break with an old or new hobby, and move your body to help keep your spirits up and your mind strong.


Contributors: Nick Barton, Marifrances Montell, Olivia Pewamo, Lexi Hill, and Casey Lyons

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