Pandemic heightens, magnifies long-existing issues in Indian Country
Food insecurity, underfunded health care programs, geographically isolated reservations and disproportionately high rates of diabetes have concerned tribal communities since colonization.
As coronavirus spreads, these issues are becoming even greater threats to their lives and well-being.
States across the country are scrambling to obtain masks, respirators, ventilators and testing kits. Tribal nations are having an even harder time obtaining supplies, as confusing bureaucratic processes have delayed the disbursement of federal aid.
“We don’t have any of that stuff you mentioned,” Walker River Paiute Tribe Chair Amber Torres said, when asked whether the tribal health clinic that’s 90 miles from Reno had access to ventilators, respirators, isolation rooms or negative pressure rooms, all of which are sparse even throughout the larger hospitals in the state.
“We are a small ambulatory outpatient clinic with very limited services, and we still manage our direct care services in a hundred-year-old building,” she added.
So far, the Pyramid Lake Paiute Tribe is the only community to have a confirmed case on the reservation. But as cases throughout the state continue to increase and national data for rural counties, near most reservations, shows a delayed but worrisome wave of cases, tribal leaders are preparing to tackle outbreaks.
Most Nevada tribes, 23 of 27, have declared states of emergency. Others have implemented preventive measures like establishing curfews for residents and closing their reservations to non-tribal members indefinitely. Those additional protocols are the strictest measures taken in the state, even more so than Nevada cities and counties.
Fast-growing outbreaks among other tribal nations, like one in the Navajo Nation, have become a cautionary tale for other tribes across the country.
The Navajo Nation is the second-largest tribal nation in the U.S., located across Arizona, Utah and New Mexico, and includes the Hopi reservation. Tribal leaders reported 558 cases and 22 deaths in a press release on Thursday.
A major difficulty for communities is that tribal clinics are only designed to provide primary care and do not have the staff, equipment or training to provide intensive care. The Walker River Paiute tribal clinic has one health care provider and one nurse practitioner “on a good day,” according to Torres.
Most tribal clinics are funded by the Indian Health Service, a $6 billion federal health agency within the Department of Health and Human Services responsible for providing health care to over 2 million tribal members across the country.
The federal health agency is also responsible for distributing federal funding and supplies for clinics. However, by late March, all the Indian Health Service had to offer clinics were expired respirators, Politico reported.
The health agency has a history of poor medical care that can be traced back to issues like low levels of funding, limited access to professional health providers, a high turnover rate in leadership and outdated technology and equipment.
Nevada leaders including U.S. Sen. Cortez Masto and Rep. Steven Horsford have both signed onto letters calling for federal agencies to take swift and efficient action to help tribal communities weather the pandemic.
“Every department of our federal government has a legal trust responsibility to American Indian and Alaska Native tribes established by hundreds of treaties between the U.S. and sovereign Tribes…” Horsford wrote in one letter. “In light of the current pandemic, it is more important than ever that we uphold this responsibility by making sure Tribes can access adequate, sorely needed resources in a timely manner.”
Testing kits unavailable for tribal health clinics
According to the Indian Health Service’s website, tribal nations are using test supplies, instead of collection kits, that then have to be sent to the nearest public health laboratory for testing and confirmation. This process can take up to seven business days or more, leaving communities in the dark as they wait for results.
Collection kits, referred to as testing kits, are not “needed” at tribal health clinics, according to the Indian Health Services website, because they lack the technology and certifications required to successfully use the kits.
Nevada Indian Commission Executive Director Stacey Montooth said only the Reno-Sparks Tribal Health Center has received tests, although it’s unclear whether the clinic received test supplies or actual collection kits.
The Walker River Paiute Tribe’s clinic does not have any test supplies available, like most other tribal health clinics in the state, and will instead send tribal members with symptoms to Reno for testing, an hour and a half drive from the reservation.
Torres said the tribe has only received a little more than 90 N95 masks from the federal government and a little funding that has gone to housing and senior nutrition programs.
Frustrated by confusing and conflicting communication between tribal governments and the state and federal governments, Torres wants a more efficient and direct relationship with the federal government, saying the state has become a “barrier” in accessing supplies.
According to Torres, Nevada tribal leaders learned on a conference call with the InterTribal Council of Nevada that the state government had received testing kits allocated for tribal nations, which were never disbursed.
“We cannot confirm nor deny yet from the state that that truly happened,” she clarified. “My biggest gripe is that there is nobody held accountable at that level. If that happened, nobody's saying anything.”
The Nevada Department of Health and Human Services’ tribal liaisons office did not immediately respond to a request for comment from The Nevada Independent.
Torres said tribal nations have a good working relationship with the state of Nevada, and are fortunate for that, but the federal government owes it to tribal nations to work directly with them through treaty responsibilities.
“Where is that government to government responsibility and relationship?” she said.
Another concern for communities is food security. Tribal communities face the unique challenge of living in remote areas where reservations may have just one small shop that provides a limited amount of groceries or produce.
Tribal members have reported traveling to the nearest urban areas, like Reno or Las Vegas, for groceries during the coronavirus crisis, only to find “ransacked” grocery stores there, too.
The Nevada Department of Agriculture has continued a distribution program for tribal communities during the pandemic, with some modifications. The food distribution program on Indian reservations was introduced in 1977 and provides commodity foods to low-income households and seniors.
The year-round program offers fruits and juices, vegetables, meats, beans, pastas and grains, dairy, cooking oils and traditional foods like bison, catfish and cornmeal.
“The Food Distribution Program on Indian Reservations (FDPIR) is continuing to provide food to program participants and certify new applicants,” program director Jennifer Ott said in a statement. “The distribution process has changed to a drive-thru model, where participants remain in their vehicles during the intake process and their food is loaded into their car. We’ve taken every effort to make our food distributions as safe as possible, including removing the signature requirements for returning participants.”
The program serves 11 tribal communities in Pyramid Lake, Dresslerville, Fort McDermitt, Winnemucca, Battle Mountain, Elko, Wells, Wendover, Goshute on the Nevada-Utah border, Ely and Duckwater.
According to the Nevada Department of Agriculture, there was a 37 percent increase in food deliveries in March with monthly food packages delivered to 570 participants.
The Yerington Paiute Tribe and the Shoshone-Paiute Tribe administer the food distribution program for other tribal communities in Nevada.
Aside from the distribution programs, communities are receiving food donations from food banks and other community members and others are turning to ancestral ways of living and providing food for their families and communities.
Pyramid Lake Paiute tribal member Autumn Harry, 27, lives only three miles from the lake and has been fishing, along with other community members, five days a week for a few hours in the mornings.
She catches seven to 10 fish each time, gutting the fish on the beach, so the pelicans can carry off stray pieces. She takes the fish home to clean and store. Then, she delivers them to community members while maintaining social distancing requirements by leaving them in a cooler outside their homes.
“It’s a lot safer to go fishing and get trout than to go into the grocery store for meat,” Harry said. “It’s really important that we try to develop ways of accessing ancestral foods and practice food sovereignty.”
Keeping track of coronavirus cases in Indian Country
As reporting and data collection ramps up throughout the country, outdated technology and a voluntary reporting system leaves tribal communities behind in the process of producing accurate information of coronavirus cases.
After receiving results from the state’s public health laboratory, tribal clinics can report confirmed cases to the Indian Health Service via the Resource and Patient Management System’s Electronic Health Record database to be counted in local and national data.
The Pyramid Lake Paiute Tribe issued a press release announcing the case on the reservation, but it is unclear whether others plan to issue similar releases for case updates or how that information will be released and recorded.
Voluntary reporting also could lead to gaps in the data. Tribal health facilities run independently from the Indian Health Service are expected to self-report data for confirmed cases directly to the federal government, but there is little information available as to whether that is happening, or who is keeping track.
Meanwhile, the Centers for Disease Control and Prevention regularly collect data from public health labs and departments in all 50 states.
Tribal leaders also worry about their population’s health disparities, which reports higher rates of diabetes and respiratory issues, among other underlying health conditions. These conditions coupled with no immediate access to intensive health care make tribal communities especially vulnerable to more severe cases of the virus.
According to a Centers for Disease Control and Prevention study, American Indians and Alaska Natives died from the 2009 H1N1 swine flu pandemic at four times the rate of all other racial and ethnic groups combined.
Housing is another factor. Many homes on reservations are intergenerational, with up to three or more generations living in one house at a time. This living situation facilitates an easy transmission of the virus.
“The inability to isolate people who test positive for the virus is looming,” Montooth said.
Legislative relief for tribal nations
Tribal leaders' frustrations and concerns heighten as they anxiously await aid that was stalled in bureaucratic processes throughout March.
Tribal leaders have been participating in regular conference calls with the InterTribal Council of Nevada, the Indian Health Service and the Bureau of Indian Affairs, as well as a meeting last week that included Rosen and Cortez Masto.
The calls have covered topics like best practices for prevention, availability of supplies and, more notably, requests for feedback from federal government organizations on aid disbursement procedures.
“Together with the U.S. Department of Treasury, I seek your input on developing a methodology or formula to allocate this $8 billion to Tribal governments, as outlined in the CARES Act, and guidance on what qualifies as necessary expenditures incurred due to the coronavirus public health emergency,” the Bureau of Indian Affairs said in an email to tribal leaders that was shared with The Nevada Independent.
The funding from the most recent $2.2 trillion bill, Coronavirus Aid, Relief and Economic Security (CARES) Act, provides $10 billion for tribal nations that will be distributed by the U.S. Department of Interior and the Department of Treasury. That includes $1 billion for the Indian Health Service, half that amount for tribes that independently operate their own health care facilities, and $8 billion to reimburse tribes for “coronavirus-related expenses.”
The Bureau of Indian Affairs stated in the same email that the funds “will be distributed no later than April 26,” adding that “a compressed timeline is necessary.”
Stalled disbursement of relief
Torres said that $40 million offered in early March for tribal nations through a bill signed by President Trump was to be distributed by the Centers for Disease Control and Prevention (CDC), but larger tribes with existing contracts with the CDC were prioritized for the funding, even after the CDC consulted with the 574 tribes.
“They had given it to nine tribes that had a CDC grant with them… $40 million and no tribes were listened to,” Torres said.
Grants for relief funding through the Centers for Disease Control and Prevention are still available for tribal nations, along with grants from other government departments like Health Resources and Services Administration, Substance Abuse and Mental Health Administration and the Department of Justice.
However, applying for grants is yet another timely process, and another that may favor larger tribes that have grant writers on staff.
Torres said she and other Walker River Paiute officials will be applying for those grants, without a grant writer. The limited staff will combine their expertise and “try to wing it.”
The Walker River Paiute Tribe has received $743,000 in federal aid, but is still waiting to receive the most recent funding, according to Torres. Montooth, from the Nevada Indian Commission, said many tribes throughout the state are still waiting to receive any funding.
While they wait for action on the federal level, tribal members such as Harry are taking matters into their own hands and experiencing a new stillness that coronavirus-related closures have brought.
After the Pyramid Lake Paiute Tribe closed the lake to non-tribal members, Harry said her fishing days have been quieter without the noise of all the usual recreational visitors’ chatter and their vehicles.
She’s greeted by jumping fish who feed in the mornings. She said the privacy has allowed her community to reclaim the land and the lake, allowing them to practice food sovereignty by fishing for their families, adding that she’s not the only one fishing for the community. She sees other community members out on the water amid the stillness.
“We’re not really sure what this pandemic is going to look like a month or two from now,” she said. “Native communities in general are trying to figure out ways to return back to the land for our foods and medicines.”