Navajo Nation’s health care system strained by COVID-19

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• Judy Woodruff:

  The Navajo Nation is in a health emergency, as COVID-19 cases spike for a second time. Strict curfews and a mandatory mask policy have only gone so far in stopping transmission on the largest tribal reservation in the country.

  Stephanie Sy spoke to two doctors on the front lines treating Navajo patients, even as hospital capacity runs out.

• Stephanie Sy:

  The Navajo Nation, home to more than 170,000 Navajo, is under a three-week lockdown that ends on December 6. That means nonessential workers must stay at home unless there's an emergency or an immediate need for food.

  Since COVID found its way to the vast territory that spans parts of three states, more than 600 Navajo have died of COVID. And, in recent days, daily positive cases have reached an all-time high.

  The Navajo president, Jonathan Nez, says the uncontrolled spread of the virus is impacting all communities on the Navajo Nation, including Gallup, New Mexico, where Dr. Daniel Mays has been seeing COVID patients at the hospital where he works.

  Dr. Mays is a fellow with the University of California, San Francisco's HEAL program, which has helped to provide health care on the Navajo Nation since 2015.

  Dr. Mays, thank you so much for joining us.

  Describe what you're seeing there in Gallup, New Mexico. Are you seeing another surge, as in many parts of the country?

• Daniel Mays:

  Absolutely.

  What we're seeing is both a surge in new cases, new diagnoses of COVID-19, as well as hospitalizations. What we saw in the spring was a wave. What we're looking at right now looks like a tsunami.

• Stephanie Sy:

  I know that area hotel rooms were being used to isolate COVID-positive patients from the Navajo Nation. Is it true that those rooms are also being used as de facto hospital rooms?

• Daniel Mays:

  Yes. This is a huge source of stress.

  The reality is, the health system here in Gallup and in many other parts nearby is just too weak to begin with. When you introduce a pandemic like this, it puts too much strain. I mean, we're putting people in the hotel who should be in the hospital.

  I think our biggest need right now is staffing and space to provide care. If we could get a huge influx of support for those things, I think we'd have a lot better outcomes and we would save lives.

• Stephanie Sy:

  Are you also, in order to free up more beds, perhaps having to release people earlier than you might ordinarily want to?

• Daniel Mays:

  Absolutely. We are having to discharge patients at a much more aggressive rate, sending people home.

  Many folks in the Navajo Nation don't have great home infrastructure, unfortunately. And that's due to decades, over a century of socioeconomic exclusion. And we're trying to think about a safe home discharge plan. We run into barriers, sometimes all the way down to someone not having electricity for the oxygen machine.

  There are chronic issues facing Native people both here in Navajo Nation, as well as the surrounding Pueblo tribes and across the United States. Right now in the state of New Mexico, Native Americans account for 23 percent of COVID cases, 41 percent of COVID deaths, but they only make up 10 percent of the state's population.

  And that's not a statistical anomaly. This is inequality killing Native people. And that is something that needs to be responded to immediately to prevent more loss of life.

• Stephanie Sy:

  Dr. Daniel Mays with the University of California, San Francisco, joining us from Gallup, New Mexico.

  Thank you, Dr. Mays.

• Daniel Mays:

  Thank you.

• Stephanie Sy:

  We turn now to Dr. Sophina Calderon, the deputy chief of staff at a tribal hospital in Tuba City, which serves a 6,000-square mile area on the Northern Arizona side of the Navajo Nation.

  Dr. Calderon, thank you so much for joining us.

  I know your hospital has been at capacity since May, when that area had one of the highest COVID-19 infection rates in the entire country. Are you experiencing another surge now?

• Sophina Calderon:

  There is another surge going on right now, worse in numbers right now compared to what we were experiencing in the spring.

  So, we are really buckled down, working very hard to really get ahead of this. But it's becoming quite overbearing. And it's — the numbers are increasing every day.

• Stephanie Sy:

  I know that a nursing shortage is a chronic problem at rural hospitals, including yours.

  Is that a continuing issue?

• Sophina Calderon:

  We do have a very huge nursing shortage.

  Back in the spring, we were surging while the rest of the United States was OK, and we were able to get a lot of nursing help from all over the United States. But now it's a huge problem, because everywhere across the U.S. is surging, and we can't pull nurses from other places where they're already needed.

• Stephanie Sy:

  The Navajo government, as you know, Dr. Calderon, has enacted very strict protocols for gathering. There aren't a lot of bars and nightclubs and restaurants on the Navajo Nation anyway. And there's even very good contact tracing compared to other places.

  So, what do you attribute the continued transmission of this virus on the Navajo Nation to?

• Sophina Calderon:

  So, most of our contact tracing is leading us to see many spread — spread in many areas in terms of family clusters and family gatherings, so, birthday parties funerals.

  Especially here in the Navajo Nation, funerals are very, very close-knit and people gather in small spaces and grieve together on a continual basis several nights in a row. And it's just sort of a traditional way that we carry out and mourn.

  And so there are a lot of gatherings still happening.

• Stephanie Sy:

  Is part of the problem that folks are still going off the Navajo Nation, where protocols aren't as strict, and coming back into those family gatherings and bringing the virus with them?

• Sophina Calderon:

  Yes, I do believe so.

  We don't have extensively large grocery stores and places to get supplies for things for our homes and for our families. So, we have to leave the reservation sometimes and be able to do some of our shopping off the Navajo Nation. All the restaurants are open still off the Navajo Nation, and you find it a little bit harmless to be able to eat in a restaurant and then come back home back to the Navajo Nation, and then not know that you might have brought the virus back.

• Stephanie Sy:

  You are Navajo, of course, and you were actually born in the same hospital where you are now a physician.

  Dr. Calderon, how has that helped you understand the health care challenges currently facing the Navajo Nation?

• Sophina Calderon:

  It's been very, very instrumental for me to understand where the community is coming from and a lot of the fear that the community faces.

  It's been very important to me and very useful to me to understand both aspects of both traditional Navajo medicine and Western medicine and to sort of deliver messages and education to the community in a way that they can understand.

• Stephanie Sy:

  Dr. Sophina Calderon, deputy chief of staff at the Tuba City Regional Health Care Corporation, thank you.

• Sophina Calderon:

  Thank you.