THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
415 N. Washington Street, 4th Floor, Baltimore, MD 21231
p (410) 955-6931 f (410) 955-2010
Americanindian.jhu.edu
May 30, 2020
Melody and Hal Lindquist
The Beating Hearts
4542 E Camp Lowell Dr
Suite 200
Tucson, AZ 85712-1295
Dear Melody and Hal,
I am writing to you from 30,000 feet above the Rockies, as I am flying home from visiting our Center’s sites on the Navajo and White Mountain Apache reservations this week. I am brimming with indescribable gratitude for your support to mount an effective response to the COVID-19 pandemic ravaging Native American communities. Because of you, we will be able to tell stories of resilience, community collaboration and hope as we journey through this heart-wrenching time with our tribal partners.
Below, please find a report on our major activities to date. But first, I want to share two personal stories from the past week. Last Tuesday, in the tiny town of Tonalea on the northwestern side of the Navajo Nation, 15 of our Navajo staff joined forces with the Indian Health Service (IHS) to mount a blitz drive-through testing operation. Testing with simultaneous contact-tracing is the most powerful tool we have today to contain the virus. Jayme Biakeddy (pictured below), one of our Navajo research coordinators, had been trained as a “swabber,” to collect specimens.
When the day started at 7:30 am, hundreds of Navajo families’ cars had already lined up to get tested, some driving hours to the test site. When a car pulled up to the front of one of three testing lanes, an IHS doctor would ask the driver to roll down a window. Many cars had more than four, some up to seven passengers. People shook with fear as the doctor inquired about symptoms and exposures. Some cried saying how many family members they had already lost. Then Jayme would step up and calmly speak to them for a few seconds, with reassuring words, and ask them to focus their vision on the mesa in the distance and breathe deeply. She then counted softly to ten as she swabbed each nostril. If you haven’t been tested yet, it can be quite uncomfortable. Jaime’s touch was masterful in its gentleness. Her compassion and quiet strength gave people hope that there are modern-day Navajo warriors on the frontlines who are stronger than the virus.
Another story came from my visit to the White Mountain Apache community, and talking with my colleague there, Kamellia Kellywood. Last summer we all celebrated with Kamellia, her husband and children as she received her MPH degree, allowing us to promote her to a Johns Hopkins faculty member on our infectious disease team. Her work before COVID was to track and help treat respiratory illnesses among the Apache people, something our Center has been doing for more than 30 years. This winter, Kamellia’s precious husband, a police officer, was shot and killed in the line of duty, leaving her a single mother of their young sons, ages three and five. Since we have pivoted our work to COVID-19, Kamellia was retrained last month as a contact tracer and swabber. When a person tests positive, she goes to their home and helps test all of their household members. She continues to visit those without phones to check on their symptoms for a 14-day period. She explained to me this week that there had been an elder who tested positive, but no one could find her home location. Kamellia was determined to track her down and found her on a traverse dirt road in a remote area, living alone. When she arrived, the elder was in respiratory distress. Kamellia called 911 and activated a chain of events that flew the elder to Phoenix for intensive medical care. (Note: there are no intensive care units on most Indian reservations.) The elder survived, and an IHS doctor called Kamellia to tell her that she had saved the elder’s life.Kamellia ended this story by telling me that when she returned to work after her husband’s passing, she did not think she would be able to stay. She said she had felt empty and without purpose. However, after the event with the elder, she felt a sense of strength and empowerment she had never felt before. She said she was proud and inspired to be on the frontlines now, helping to save lives. Her story still brings me to tears. She is the embodiment of the immense resilience and courage that so many Native peoples possess in their devotion to their fellow community members and the survival of their peoples.In addition to addressing the very high caseloads on Navajo and White Mountain Apache, we are continuing broad-based prevention efforts in tribal communities across the U.S. I hope the rest of this report brings you a sense of satisfaction and empowerment as you see how your generosity is helping us save and protect lives.Resource Distribution: Wellness Boxes, Water and Personal Protective
Equipment
Families who are trying to obey “shelter at home” orders and isolated quarantine are often suffering without ample food, water and basic household supplies. We have been delivering to them truckloads of drinking water, nutritious food, cleaning supplies, sanitizers and an array of home health products. We are prioritizing elders, families with young children, families with a COVID-positive diagnosis and those with pre-existing health conditions, overcrowded homes and those dealing with significant poverty. For many families who lack running water (40% on Navajo), electricity, refrigeration or basic amenities like nearby grocery stores, these wellness boxes are a lifeline. The act of sharing with those in need, in such a simple and direct way, is also helping ease the fear and anguish associated with the quarantine. The gratitude expressed by families has filled our team with energy and endurance. They are now doing these deliveries seven days a week. In South and North Dakota, we are delivering radios with the wellness boxes because so few people have access to the internet. Community members there are eager to listen to daily updates from their local tribal leaders broadcast on local radio.
We also have sent to tribal communities a steady supply of Personal Protective Equipment (PPE) for frontline health workers, including masks, gowns, face shields and gloves, desperately needed by doctors, nurses and support teams. In addition, we have hired a small army of new staff who are sewing cloth face masks that are distributed in the wellness boxes.
Provision of Supplies, as of May 26, 2020
Navajo, White Mountain Apache, Ojibwe Assiniboine Sioux,
Lakota, Dakota, and more in AZ, NM, MN, WI, MI, MT, ND & SD
Water Access: New Partners, New Initiatives
Basic sanitation, including careful and frequent handwashing, is the primary personal prevention action one can take to avoid spreading or getting COVID-19. The Center is working in partnership with the Navajo Epidemiology Center, IHS and regional collaborators to build and distribute hundreds of low-cost portable handwashing stations directly to households in need, prioritizing homes with COVID-19 patients that lack running water. After the dire water situation on the Navajo Nation and the Center’s work was featured on the Today Show in April, we engaged in new partnerships with DigDeep and LifeStraw, two well-respected water-focused organizations with strong track records working to mitigate water insecurity issues around the world. We are also forming a new partnership with internationally renowned Waves for Water to find long-term, strategic solutions for Navajo tribal members who lack access to running water that are tailored to families’ specific needs.
Psychosocial Support for Children
Has a book ever offered you a new perspective or helped you put a confusing time into perspective? To address the potential mental health impact of the coronavirus pandemic on children, with a grant from the Johns Hopkins University Alliance for a Healthier World, the Center has produced a re-telling of the book My Hero is You, which was developed by the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings (IASC MHPSS RG). A Native American collaborative adapted the story and created illustrations representing Indigenous peoples, values and communities. The book portrays a sense of communal efficacy, strength and hope – with coloring pages to infuse a little fun. Last week, UNICEF reached out to us with a request to translate and share the book with Indigenous populations around the world.
Culturally-Meaningful Health Communications Materials
Since the beginning of the pandemic, we have been working to ensure accurate prevention information about COVID-19, effective quarantining, and recognition of symptoms reaches families and communities. Our health communications materials, based on CDC messaging and adapted for tribal contexts, have been a critical resource for tribal partners, used across radio, print and social media.
CORE Partnership: Testing, Surveillance, Contact Tracing and Wrap-Around
Support
In early May, we began a major collaboration with the Community Organized Relief Effort (CORE), founded by actor Sean Penn, to significantly expand COVID-19 testing and contact tracing with the Navajo Nation and the White Mountain Apache Tribe, which have some of the highest rates of infection per capita in the country. Simultaneous with diagnostic testing, it is critical to rapidly trace, test and support quarantine of close contacts of identified cases. Successfully mitigating the impact of the COVID-19 pandemic in Native American communities will require the provision of extensive wrap-around services, including delivery of prescription and over-the-counter medications, as well as food and water; guidance on best practices for quarantine; support for mental and behavioral health needs; and connections to necessary community resources. These strategies can serve as a model to other tribes and communities around the world.
In the meantime, we are putting together several state-of-the-science efforts with colleagues at Johns Hopkins. We will be one of only about 15 national sites to test a promising therapy, called convalescent plasma, which may be able to reduce mortality rates by up to 50%. In addition, we are in communication with colleagues about the best vaccine candidates and will be in discussion with tribal partners about their interest in participating in early trials.
In closing, please accept my deepest gratitude for your kindness, generosity and leadership. YOU are the only reason we can do this work. We would love to hear from you; please feel free to reach out.
Best regards,
Allison Barlow, PhD, MPH
Director