New Mexico and Arizona, July 31, 2020—After two months of collaborating with community leaders, tribal health officials, service organizations, and health care workers on preventing and controlling the spread of COVID-19 among Native Americans from the Navajo Nation and Pueblos in the southwestern states of New Mexico and Arizona, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has handed over its infection prevention and control training activities to the Community Outreach and Patient Empowerment Program (COPE), a local group that works with the Navajo Nation.
Navajo Nation and the Pueblos people have been especially hard hit by COVID-19. Lack of access to running water and adequate infrastructure, in addition to lack of access to health care and decades of inadequate public health funding, have left people in the Navajo Nation and Pueblos extremely at-risk of contracting and suffering complications from this virus. Infection rates per capita have been some of the highest in the country.
At health facilities in the Pueblos of New Mexico, MSF provided logistical, structural, and technical medical support, including tailored infection prevention and control (IPC) measures.
“One immediate priority in a disease outbreak for any health facility is to ensure that access to medical care is not further hindered,” said Immaculata Bramlage, MSF medical coordinator. “At the Indian Health Service clinic in one of the Pueblos, we helped reorganize patient flow and designate spaces so staff can see both COVID and non-COVID patients, and carried out infection prevention and control trainings.”
For households in the Pueblos, MSF teams reached out to at-risk groups to provide face masks and conduct public health activities to promote precautionary behavior.
In the Navajo Nation, the largest Indian reservation in the United States, MSF teams carried out IPC trainings for social and public-safety workers who are in regular contact with at-risk populations. In addition, MSF trained the staff and residents of facilities where people live in close proximity to others, such as nursing homes, special education schools, and correctional and detention centers.
“IPC trainings gave frontline workers more confidence to proceed with their daily activities in a safe way,” said Bramlage.
MSF created a “training the trainers” program with COPE, which will respond to future requests for essential IPC trainings, especially for social services staff who serve residents of the vast reservations that extend across three states.
“We know that viruses start and stop in communities,” said Amy Segal, project coordinator for MSF programs in the Southwest. “Helping workers work safely means that we can halt community transmission. We followed the lead of tribal governments and health departments, who were doing an outstanding job working long hours and taking personal health risks to help their communities.”
The number of people infected on the reservations continues to increase as COVID-19 is still spreading across the US. Despite the stringent lockdown and mask requirements observed on the reservation, many residents must travel to major cities in Arizona and New Mexico for work. As essential workers they are at risk of bringing infections back to crowded households, where several generations live under one roof.
“The residents of the Navajo Nation have been complying with measures to control the virus and the community has worked hard to care for those most at risk,” said Segal. “But their hands are tied on the other factors that keep them at high risk. Decades of federal neglect of basic needs and infrastructure on the reservation— particularly lack of access to health care facilities, water, electricity, telephone, and passable roads—cannot be fixed in the short-term with an emergency allocation of restricted-use funds."
These Native American communities are served by a federal health system that has not been allocated resources adequate to meet the needs of patients. This health system receives far fewer resources per patient than the rest of the country.
“While this resource gap has been well documented, there is no defensible reason for it to persist,” said Segal. “The US has the ability and resources to improve the health system serving tribal nations. This is a solvable problem."
As a medical humanitarian organization, MSF stresses the importance of access to health care, having good infrastructure and adequate medical staff to be better prepared to manage outbreaks.
“We have seen enormous efforts by members of these communities to contain this virus and save lives,” said Segal. “We have provided some support to these efforts, but until the federal government does more to address core public health inequities, these communities will remain extremely at-risk to devastation from this virus.”
MSF is an international medical humanitarian organization with programs in over 70 countries. MSF teams are preparing every project where they work to be COVID-ready as the pandemic sweeps the globe. In the United States, MSF’s COVID-19 response teams worked with migrant farmworkers in Florida; helped people who are homeless and housing insecure in New York City; supported Native American communities in the Navajo Nation and Pueblos; and trained essential workers in nursing homes and adult foster care facilities for the elderly in Michigan. In Puerto Rico, MSF has two mobile medical teams to provide care at patients' homes or at pop-up clinics and is forming a third team to handle the rise in cases. These teams are also monitoring COVID-19 patients who are asymptomatic or have mild or moderate symptoms. MSF has started a new program in Texas providing IPC trainings to staff and residents in nursing homes and assisted living facilities.