Ministry providers support efforts to reduce COVID's impact on American Indians
American Indians have suffered far worse health outcomes and experienced much higher mortality rates from COVID than Caucasians.
St. Vincent Healthcare staff place flags in the front lawn of the Billings, Montana, hospital to commemorate the lives of patients who died from COVID-19 while hospitalized at the facility.
The Indian Health Service and tribal governments have led the work to mitigate the impacts of the coronavirus upon American Indians, including with an effort to vaccinate against COVID. Ministry facilities have helped to address the needs of American Indians amid the pandemic.
Leroy "J.R." LaPlante, director of the American Indian Health Initiative, says "the most important thing Avera (Health) has done is to listen" to American Indians and then to respond. LaPlante is Sioux Falls, South Dakota-based Avera's primary liaison with regional governments of the 17 tribes within Avera's Great Plains service area, many of which are Sioux tribes.
Centers for Disease Control and Prevention studies show that "persisting racial inequity and historical trauma have contributed to disparities in health and socioeconomic factors" between indigenous populations and white populations. "American Indians and Alaska Native people have suffered a disproportionate burden of COVID-19 illness during the pandemic," Dr. Robert Redfield, who was then director of the CDC, said in an August press release.
A Kaiser Family Foundation report published in February said American Indians were among the elders of color who were nearly twice as likely to die of COVID-19 than older white adults. From Jan. 1, 2020, to Nov. 21, COVID-19 cases among American Indian Medicare beneficiaries were 1.7 times higher than among white beneficiaries. Hospitalization rates for American Indian beneficiaries were at least double the rate among white beneficiaries, the report said.
Doug Shephard is interim regional director of mission integration for SCL Health's Montana region. He says that during the pandemic the state has been "confronted with the realities of health care disparities in ways that we never imagined." While Native Americans make up just 7% of Montana's population, they account for 18% of the state's coronavirus cases and 35% of its COVID deaths. This is according to data from an August epidemiological study from the Montana Department of Public Health and Human Services.
Gordon Jackson is health disparities program coordinator and Kathleen Usuriello is infection prevention specialist at SCL Health's St. Vincent Healthcare in Billings. Jackson says that Native Americans' susceptibility to the virus, especially early on, was related in part to systemic racism and related social determinants of health.
For instance, the high poverty rates among Native Americans is linked to poorer health access and outcomes. Usuriello says that as compared with whites, many Native Americans have higher rates of chronic diseases, including diabetes, chronic obstructive pulmonary disease and kidney disease. Those comorbidities put them at higher risk of COVID complications.
Avera's LaPlante adds that many American Indians live in very remote areas, which makes it difficult for them to get health information and to access health services.
Also, due to poverty, many American Indians live in crowded, multifamily, multigenerational homes, so it is challenging for them to socially distance, isolate or quarantine, LaPlante says. The August CDC release said lack of access to running water may be an issue for Native Americans, more so than for whites. Water is vital to infection prevention hygiene practices.
LaPlante and Jackson say that tribes were reeling last summer and early fall from fast viral spread and high death rates. They say most of the tribes in the communities their health systems serve rallied to implement protocols that were much more stringent than state mandates. For instance, many tribal governments mandated mask wearing, social distancing, lockdowns and curfews. Some closed off their communities to outside visitors.
LaPlante, Jackson and Usuriello say the mitigation efforts have helped decrease those tribes' infection and death rates.
Since the pandemic's onset, Jackson and LaPlante have been part of coalitions involving tribal leadership, Indian Health Service representatives and public health departments in the states where their health systems operate. These coalitions' members exchange information on COVID infection and mortality rates, mitigation efforts, screening and testing activity and, now, vaccination work.
Jackson says in surveys upwards of 70% of indigenous Americans have expressed great openness to vaccination.
In both the Avera and SCL service areas, most of the COVID education, screening, testing, treatment and vaccination for American Indians has been provided on reservations by Indian Health Service facilities in conjunction with tribal leadership. Avera and SCL sites have supported that work. Avera has an extensive telehealth network and its telehealth specialists have consulted with those providing care on reservations, says LaPlante.
Indian Health Service has its own stream of vaccine supply, which is separate from state supplies. LaPlante says early in the vaccine distribution cycle when the limited supply was being distributed to seniors and other high-risk people, he advised many American Indians who normally may not access their health care from Indian Health Service sites to go there for shots. SCL and Avera hospitals and ambulatory care sites provide COVID testing and treatment for indigenous patients who don't receive care from Indian Health Service facilities.
Foundation of trust
Usuriello and Jackson say that SCL has deepened its relationship with local providers in the Indian Health Service during the pandemic. Usuriello says she and colleagues are in frequent contact with public health nurses who now are a vital link to Indian Health Service nurses in tribal communities.
LaPlante says Avera's regular communication with tribal groups and the Indian Health Service during the pandemic is built upon relationships strengthened by its American Indian Health Initiative. That initiative was established in 2015 at the urging of tribes. Avera has worked with tribes on developing school-based mental health counseling, telehealth and dialysis care, as part of that effort.
LaPlante, who was born and raised on a Cheyenne River Sioux Indian Reservation in north-central South Dakota, says trust building is central to the ongoing effort to address seemingly intractable health and social service challenges plaguing Native American communities. "There are no easy answers," he says.
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