Mary J. Owen
A common refrain heard in Indian Country is “It’s not as if we haven’t been through this before.” Indeed, we have withstood much worse than COVID 19, and while anxious about potential losses, we know that our communities will withstand this latest assault as well. Between the 16th and 20th centuries, Native Americans experienced 90 separate epidemics, including smallpox, measles, tuberculosis, scarlet fever, influenza, bubonic plague, diphtheria, typhus, cholera, and gonorrhea, according to Charles Wilkinson.
While we’ve been taught that lack of immunity to disease was the primary cause of the massive decrease in our populations, Roxanne Dunbar-Ortiz points out that this is an oversimplification. Indigenous peoples’ susceptibility to disease wasn’t just because our ancestors lacked immunity, but also because they were living with constant stressors including war, disruption of trading routes, loss of land, malnutrition and starvation, all tactics in European warfare.
Though immunity to any given infectious disease is now similar among US populations, Native American communities continue to face stressors that weaken collective barriers to disease. An underfunded health care system, high rates of chronic disease and numerous socioeconomic factors increase the likelihood that COVID 19 will have a devastating impact on Native people.
Ironically, government health care for Native Americans began with attempts to contain the infection. In the early 1800s, military physicians treated Native peoples within range of army forts. Today we remain the only population with a legal right to health care, based on Article 1 of the United States Constitution. Despite the guaranteed provision of health care that is in part, payment for millions of acres of land, the Indian Health Service (IHS) is chronically underfunded.
Chronic underfunding necessitates that systems triage needs, with infrastructure second to patient care. Still, Tribal, IHS and Urban Indian clinics and hospitals suffer from a healthcare provider vacancy rate of 25%. Staffing includes members of the National Health Corps who are called out for national emergencies. COVID 19 is no exception, with 200 corps members recently deployed away from the IHS system.
High rates of chronic illness, including diabetes, lung and autoimmune disease increase our susceptibility to infectious disease, born out by statistics that reveal a mortality rate from infectious disease one to three times those of whites across all ages. Rates of infectious diseases remain high in Native communities. The incidence rates for tuberculosis, for instance, are five times higher in Native Americans than in whites.
Tuberculosis and infectious disease all have a greater impact among communities with increased poverty and homelessness. We, as a group, have higher poverty rates than any other population. And, like other marginalized groups, Native people suffer from disproportionate levels of homelessness, both in urban areas and reservation communities. Overcrowded homes are common as people attempt to provide for their family members in need of shelter. Additionally, according to the Indian Health Service, about 17% of Native American homes lack adequate sanitation facilities and of those, about 1.9 % lack access to a safe water supply, a critical factor in mitigating the impact of any infectious disease, but particularly COVID 19.
Despite these risk factors, however, Native people will persevere again. Leaders have never been more able than now to predict coming plagues and their potential impact. Recognizing the oncoming storm, Tribal nation leaders and Native advocacy organizations such as the National Indian Health Board, National Council of Urban Indians and the National Congress of American Indians ensured that Native Americans were included in the federal response to COVID 19. In the past couple of weeks, Native congressional leaders and their congressional allies secured billions of needed dollars to help shore up the Indian Health Service, including Tribal and Urban health clinics and to provide critical testing supplies, protective equipment and a communications clearinghouse.
Some Tribal nations began preparing their communities long before the federal government took active steps to address the epidemic. Nina Lakhani reported on the Lummi Nation’s early preparations for COVID 19. In late 2019, she notes, Lummi leaders and health professionals began reviewing their emergency response plans and ensuring they had enough COVID 19 test kits and personal protection equipment for healthcare providers. They have now implemented telemedicine clinics, drive through testing, home delivery for the elderly, and turned a fitness center into a back-up hospital.
As critical as all the preparedness is, however, it is Native peoples’ resiliency---our commitment and love of our communities, each other, and our collective memory of who we are, that always has and will remain our greatest protection from disaster. Across the country displays of these strengths are evident, from the on-line, Social Distance Pow wow on March 21, to the letter from the Lummi Nation Chairman to his community. Chairman Lawrence writes,
My dear people, as we expected,..... Please do not panic; we are prepared for this. Our objective is to take every measure and to ensure the health and safety of our families during this COVID-19 pandemic. We love our people. This resolution …….further emphasizes the necessity to protect our elders and youth and prohibits all gatherings of individuals within the Lummi Reservation. We cannot stress enough the value of each and every one of our Lummi members. It is important to have Sxwolowen at this time, one heart and one mind, one spirit for the work. Che Shesh Whe Wheleq Sen – we come from survivors of the great flood. Sqweshent-lh tse Xwlemi Elhta-lng-exw – we protect the Lummi People.
Joy Harjo captures Native resiliency well in her poem, “Anchorage.”
Everyone laughed at the impossibility of it,
but also the truth. Because who would believe
the fantastic and terrible story of all of our survival
those who were never meant to survive?
Indian Country faces another tremendous challenge in the days ahead. But, as we say, it’s not as if we haven’t been through this before.
Mary J. Owen, MD
Association of American Indian Physicians
Dr. Mary Owen is the Director of the Center of American Indian and Minority Health and an Assistant Professor of Medicine at the University of Minnesota Medical School, Duluth Campus. She teaches on issues in Native American health and mentors future Native American physicians. She is also a family practice physician for the Fond du Lac Band of Lake Superior Chippewa Indians in Duluth, Minnesota.