Even during these dark, pandemic days Native physicians are trying to see the light.
In Seattle, the first COVID-19 hotspot in the United States, Dr. Socia Love-Thurman, a Native physician, said she and Native relatives are “doing well” in the Pacific northwest.
“We are seeing that the curve is, at least at this point, sort of plateauing,” she said. She keeps track of the cases daily on King County’s website, which is where most of the cases come in. “And it seems like we're seeing about, you know, 100, a little over 100 new pieces a day, which kind of puts us at a plateau.”
She works at the clinic at the Seattle Indian Health Board, and the Swedish Medical Center. Health care workers at her clinic and the hospital have been fortunate to have enough personal protective equipment, she said.
One of the key points she talked about in this week's “Ask a Native Physician” COVID-19 Town Hall, hosted by the Association for American Indian Physicians, was the change in providing care to Native people in Seattle since the pandemic hit the country.
“I would gauge about 70 percent of our visits currently in the clinic are done through telephone visits, which has been a big adjustment for us, but it has gone pretty well,” she said.
If patients do not want telemedicine, the clinics provide space and availability for them. If they want telemedicine but don’t have access to a phone or a computer, they provide it too. Patients are also being seen for non-COVID-19 related reasons, like dental and prenatal care, and for testing related to the novel coronavirus.
“And then the last thing that we've been able to provide our Native community is outreach to a homeless shelter, called the Chief Seattle Club, which is for Native clients, only who are facing housing insecurity primarily, and we've been able to do twice a week, testing for both Native and non-Native people who are downtown Seattle,” she said. “This has also been a way to really open up our medical or medical service or behavioral health services to not only our native community but others in the area who are really finding difficulty with accessing medical care right now and so by us opening our doors and really being present.
Providing this type of service has actually brought them new patients. Dr. Love-Thurman owes it to how conservative Washington state has been with its public health orders.
“They have not reopened our shelter-at-home yet. They’re doing a very slow rollout,” she said. “And so that's that's been a good thing and I hope more places are slowly rolling out as that is the most crucial thing in this whole epidemic is social distancing.”
Down south in San Francisco, Native physician Dr. Luke Day said the city’s experience is similar to Seattle. Not only with the city leveraging its telemedicine, but in the curve flattening.
“Over the last three weeks, we've seen a flattening of our COVID-19 hospitalizations. If you look at the graph, it's a perfectly straight line for quite some time. This is what we had hoped to achieve with our shelter in place and it looks like it’s been really successful, but we haven't seen as we haven't seen a dip down in our hospitalizations, and so we think that this plateau will probably go on for at least another month or so.”
Expecting mothers and babies
Dr. Brian Thompson in Syracuse, New York, who works in obstetrics and gynecology, said expecting mothers voice concerns about passing COVID-19 to their babies.
“The evidence has shown that there hasn't been any transmission to the baby itself,” he said on the call. This type of transmission is called vertical transmission, where the mom passes it to the baby.
“However, once the baby's delivered, then you can have transmission from the mom, or someone that's with you, possibly to the baby itself,” he said. “There's been a case report of a baby that's had it only once, and matters for the child to actually be due to someone else in the delivery room, and not mom.”
Thompson said if the mom has COVID-19, the mom and baby have to be separated to protect the baby. The mom can still breastfeed.
“If you do have COVID-19, then you can breastfeed if you wear a mask and wash your hands and are very diligent and in terms of respiratory protection,” he said. However he recommends speaking with the providers as the protocols change quickly.
He’s right. Protocols, recommendations and guidelines are changing. So is the information.
Information for people is one of the unique challenges that Native physicians are facing during the pandemic, said Dr. Blair Matheson in North Dakota.
“There's so much information out, whether it's social media and then people become confused as to what's what, what guidelines that they follow,” he said. “Because it seems to change weekly, and I tell people because I work in the emergency rooms, and we're sort of a frontline that the basics of pandemic haven't changed.”
The basics, he says, are social distancing, wearing a mask and washing your hands for 20 seconds.
While these doctors are the ones battling the pandemic each day, there’s also the future Native physicians to look to who will be filling their shoes. Even during a time when physicians are needed on the frontlines, most medical students are being instructed to stay home to finish their programs. But many of them may struggle to.
“The pandemic has had an effect on medical education,” said Dr. Walt Hollow of Puyallup tribal health in Washington and the current president of the medical association.
“And probably the foremost way that this has impacted the residents in training is we decrease face to face interactions at the clinic, as a way to minimize the spread of the virus,” he said.
This affects patients scheduled for well clinic visits, such as child care or a physical exam update on their chronic disease. Some of these visits were canceled or are done by telemedicine.
“But the point is that the number of face-to-face visits that the residents were seeing in the clinic, probably got reduced by about 60 percent and the impact of them is [residents in training] are required to see a certain number of patients in certain categories,” Dr. Hollow said. “And if you all of a sudden decrease your outpatient clinic visits by 60 percent. Some of those quotas are not going to be met, particularly by the residents who are about to graduate.”
One accommodation for residents in training is the organization overseeing the residency programs is “cutting back” on some of the requirements, he said.
“Now the good news is [residents in training] certainly learned how to do telemedicine much more effectively. And so that'll be a bonus in the future. And it has increased,” he said. “For those Indian patients that have a computer and are able to be online. That has worked very nicely and they've had a chance to experience that as part of their education.”
This pandemic does take a toll on health care and frontline workers. And it affects the human spirit. Earlier this week, the New York Times reported a top emergency room doctor in who died by suicide.
This brings up the issues of physician burnout and the repercussions of social isolation.
Dr. Day said, “We have not seen a significant uptick in suicide among either our native community or, or the San Francisco community.”
“We have seen more increases in terms of admission earlier substance abuse or substance abuse related injury or fatality,” he said.
He points to the shelter-in-place orders that are “very effective at flattening the curve” but the length of the order and social isolation that comes with it.
“And I think that's had a really tremendous impact on our community. I think a community that really relies on one another, relies on that social interaction that dependence, that speaking with one another, that sympathy community has definitely been also quieted as well while we've had the shelter in place. And so I think we have seen some increases in terms of healthcare related consequences as a result of that.”
Day said increasing telemedicine helps, trying to reach out to the community and elders and those with chronic diseases.
“And then also just setting up support groups as well to really ensure that everyone knows that they're in this together. And then really trying to sort of disseminate information but also really be frank and honest about having these discussions,” he said.
It’s been repeated in the last couple of months that this pandemic and current state of society is a marathon and not a sprint. This applies to physicians and health care workers on the frontlines who may face, or may have already experienced, burnout.
Dr. Thompson said they’ve been doing things that they recommend to their patients like eating healthy, exercising and getting adequate sleep is part of the equation.
“But I think the biggest component to preventing Native physician's burnout is having a strong connection with your traditions and your culture, and your community,” he said. It can be reacclimating and reintroducing themselves to culture and speaking with other Native physicians and community members.
Dr. Hollow echoed his sentiments. “The first thing that we would rely on is emphasizing the role of traditional medicine,” he said, referring to dealing with stress and anxiety.
Ceremonies can be done in isolation but also on the phone with patients if needed. “And there have been a number of healers that have been willing to work on the phone and conduct some ceremonies over the phone or in some cases, with a computer with video set up,” Dr. Hollow said.
For Dr. Love-Thurman and her husband, she said they stopped talking about all the trauma at home. Her family, including two kids, turned to daily gratitude practices taught by an integrative medicine physician who spoke about resilience in times of crisis.
Each day at the dinner table, the family of four goes around the table and says something they’re grateful for. Her two-year-old is “always grateful for food, whatever is in front of him.” The four-year-old gives thanks to getting to play outside - something many would be grateful for right now.
“I've had to learn new ways to adapt to the daily stress and knowing that this is not a sprint but this is a marathon,” she said. “And so we really have to take care of ourselves or we won't get through it.”
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