The leader of a Native American health organization’s mother spent her childhood confined at the tuberculosis sanitarium in Rapid City.
Jerilyn Church, CEO of the Great Plains Tribal Chairmen’s Health Board, said her mother lived at the facility — now Sioux San hospital — in the late 1930s and early '40s, from the time she was six or seven until she was 13.
Church, a member of the Cheyenne River Sioux Tribe, said other Native Americans also have personal or collective links to their communities being impacted by contagious diseases.
And she says those memories — plus an awareness of socioeconomic health barriers — have led tribal governments, organizations and citizens in South Dakota to work to prevent COVID-19 in their communities.
Native Americans are “really responsive to heeding the advice of tribal leaders and our health professionals, we are seeing that they’re staying home,” Church said.
“The tribal leaders in South Dakota in particular have been absolutely zealous about encouraging their tribal members to shelter in place, they did that very early on. They have secured their borders, they have taken this virus very seriously and for good reason,” she said. “If we get community spread on the reservations, the outcome will not be a good one.”
“Our community has not always fared well” in past epidemics “from the beginning of European contact, from smallpox to tuberculosis,” said Church. “They remember how badly H1N1 hit, that’s not very long ago,” she said of the 2009 outbreak.
She said South Dakota statistics were similar to national ones that showed Native Americans were four times more likely to die of H1N1 compared to the general population.
Church also said that “our population understands that they’re at a higher risk” since there’s “much higher incidence of chronic disease” like diabetes and heart disease that make people more vulnerable to contracting and dying from the coronavirus.
A final challenge, Church said, is the difficulty of obtaining medical equipment and staff on reservations.
The Indian Health Service has 12 ventilators available at its South Dakota facilities, the agency said in an April 15 email. It has ordered 10 more that will be split among the entire Great Plains Area, which includes the Dakotas, Nebraska and Iowa.
There are 72 beds at IHS-operated facilities in South Dakota and “each facility has developed a plan to increase bed capacity in the event of a surge due to COVID-19,” the IHS said.
Will spread ‘like wildfire’
Native Americans are disproportionately becoming infected and dying of COVID-19 in some states.
About 4.6% of Arizonans are Native American but the population has accounted for 16% of COVID-19 deaths in cases where race and ethnicity are known, the Arizona Republic reported on April 12. About 11% of New Mexicans are Native American but make up 37% of the state’s cases, according to an April 14 story in the Albuquerque Journal.
Some Native American reservations are particularly hard-hit. The Navajo Nation has 1,197 cases and 44 deaths as of April 18. And Church pointed to the Fort Berthold Reservation in North Dakota that has seen 27 cases as of Monday.
The South Dakota Department of Health has not released race-based COVID-19 data so its unclear how many Native Americans who tested outside of IHS facilities have the virus. The Oyate Health Center in Rapid City, operated by Great Plains, has only tested two people, Church said on Friday. One test was negative and the other is pending.
So far, there are no major outbreaks on reservations in South Dakota. IHS-operated facilities in South Dakota have tested 93 people with just three positive results as of April 12.
But tribal government leaders agree with Church that an outbreak would be a horrible situation.
“I could see it just potentially coming in and spreading like wildfire,” said Harold Frazier, Chairman of the Cheyenne River Sioux Tribe. “If COVID-19 gets to the reservation it will have a devastating effect,” echoed Craig Dillon, a councilman for the Oglala Sioux Tribe.
On a personal level, Dillon said, he and his daughter are among the community members with underlying health conditions that make people at high risk for COVID-19. He said he’s been staying at home for more than two months, and only goes out to buy necessities.
Dillon said poverty makes reservation residents at high risk for the virus. Families may not be able to afford to buy enough food at once to prevent them from having to leave their house for repeated visits to grocery store and food pantries.
Poverty also means there's “a lot of families in one home,” Dillon said. Frazier said it's also common for people to share bedrooms on his reservation. Crowded homes are seen in Rapid City and other cities outside of reservations as well, said Church. Such living conditions make it easy to spread coronavirus and difficult to find a space to isolate if needed.
A “huge concern” on the reservations is a lack of medical staff to operate ventilators, Church said. Frazier agreed, and said the tribe worked with the IHS to hire a respiratory therapist and is trying to hire another one. He said one medical provider should only be overseeing two or three ventilators at a time.
“Prevention is the main goal” Dillon said. Limiting travel and protecting borders is “one of our first lines of defense,” echoed Frazier.
The Oglala and Cheyenne River Sioux tribes have both created border checkpoints to limit who can enter and leave the reservations. The Rosebud Sioux Tribe has also taken strict measures to keep people at home.
The tribes' actions are possibly more strict than any non-tribal government in the country, including the state of South Dakota, which is one of five states without a stay-at-home order.
Frazier said he speaks on the radio every day to update people on COVID-19 prevention measures, and so far, business and the 10,000 member and non-members on the reservation are doing a good job following rules. Chase Iron Eyes, spokesman for the president of the Oglala Sioux Tribe, also said that residents are respecting rules while police officers are doing a good job enforcing them.
The tribes are also preparing in case there is an outbreak.
The Oglala Sioux Tribe has a plan to bring food, supplies and medical care to quarantined people so they don’t risk infecting others while leaving the house, Dillon said. The tribe also purchased $1.1 million in medical supplies, including ventilators, testing supplies and protective gear, said Iron Eyes.
Frazier said the IHS in Eagle Butte only has eight beds so the tribe created 42 more in a dental office, veteran’s center and school dormitory. The IHS has four ambulances and is trying to obtain staffing for three more since patients who need advanced care would need to be transported to Rapid City.
The tribe has secured portable oxygen tanks and is working on identifying locations to quarantine people who don’t have the space to do so at home, Frazier added.
Great Plains operates the Oyate Health Center but also works to provide support and technical assistance to tribes within the IHS’s Great Plains region, said Church. The organization helps tribes apply for grants and is helping them calculate how much protective gear is needed for medical workers as well as those who work with seniors and other vulnerable populations.
Church said Great Plains will then order the protective gear from a $3 million grant from the Centers for Disease Control. The grant will also be used to create a regional operations center and support tribes' own emergency command centers, policies and plans.
— Contact Arielle Zionts at firstname.lastname@example.org.
Concerned about COVID-19?
Sign up now to get the most recent coronavirus headlines and other important local and national news sent to your email inbox daily.