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UCSF Doctors Fight Covid-19 in Navajo Nation


Group of healthcare providers gathering at Gallup Indian Medical Center

Source: Nate Teismann

Dr. Jeanne Noble works worldwide as an emergency doctor. So her hospital, UC San Francisco, eagerly volunteered when she flew to Navajo Nation and asked if she could help with the outbreak of Covid-19.

Navajo Nation, which reported its first Covid-19 case in mid-March, has the highest per capita infection rate in the country. So far, there have been 8,000 cases with over 300 deaths. Inhabited by more than 170,000 people, this reservation spans various desert landscapes in Utah, Arizona, and New Mexico. People call themselves Dine.

Noble worked for a hospital in Navajo Nations, the Gallup Indian Medical Center in New Mexico. Part of the second group traveling from UCSF.. The first group arrived in April in response to a call from President Navajo Nation Jonathan Nezu calling for an increase in health care workers. Around the same time, a cohort of UCSF healthcare providers of similar size I went to New York.

A group of Noble arrived in May. She was immediately impressed with the steps she took to bring more patients to the scene. “They installed plastic sheets and barriers to double the capacity of the emergency room and then took over the old pediatric clinic,” she recalls. “There was also a tent outside for a mildly ill patient.”

Still, many Covid-19 patients had to be transferred to larger facilities in Albuquerque, NM or Flagstaff, AZ if their health deteriorated. Often, Noble had to call three to four different hospitals in these areas to find space for sick patients. Now, with the proliferation of cases in Arizona, Noble is concerned that it will be more difficult for patients to receive the intensive care they need.

Noble and her colleagues have returned to San Francisco for a few weeks, but her experience has always treated Cod-19 to be a “terrible illness” as she treated dozens of patients she was suffering from. I am making it.

But she also emphasized that it is an illness Affecting certain groups more disproportionately than others, Includes low-income and color communities.

Social and economic inequality

Navajo Nation, which has experienced decades of social and economic inequality, is particularly vulnerable.

Larger bands of the population at high risk of serious complications from Covid-19: Over a third suffer from chronic medical conditions such as diabetes and heart disease. According to the CDC, American Indians and Alaska Natives Highest prevalence of diabetes In the United States, it is more than twice as likely as non-Hispanic whites.

A group of providers wearing masks at the Gallup Indian Medical Center

Source: Dr. Nate Thaisman

But the lack of basic services, which many US residents take for granted, is another pressing issue.

Noble recalled how one of her patients, a man near the age of 70, fell ill with Covid-19 and was discharged from the hospital after recovery. His home was 30 miles away and there was no way to contact his family. So he started walking home in the heat of the heat and eventually collapsed from dehydration.

After being picked up by paramedics, the patient was checked in to the hospital where he had recently been discharged.

“He had neither a car nor a phone, and he was also diabetic and insulin deficient,” she said. “Unfortunately, this is relatively familiar.” Noble pointed out that there are services that provide transportation for Navajo patients, but it’s not perfect. In some cases there may be no dispatch available or the patient may not be given a phone number.

Many Navajos live with their families in overcrowded households. There the virus spreads rapidly and more than a third cannot access running water when it is important to wash your hands. In addition, drawing water often means breaking social distance guidelines. There are only about 12 grocery stores, so if you have basic food prepared, it will take 3 hours by car.

“Everything is worse in this community because many families lack electricity and tap water,” said Nathan Teismann, a UCSF emergency care physician.

“We also have a relatively large homeless population, a high incidence of chronic illnesses, and health problems that fuel Covid-19’s flames.”

All doctors and nurses have agreed that the government needs to do more to protect this population. Noble continues to worry about the lack of donations. At a minimum, she felt she needed to finance her mobile health unit so that health care providers could visit patients at home and have better access to clean water. She urges policymakers to consider housing solutions. As such, there are more options available to people using Covid-19 for safe quarantine.

“These may be expensive propositions, but we are talking about basic human rights for things like access to drinking water,” she said.

Dr. Tarasud, an emergency care specialist, recalled how one of her patients had a positive test, but was told to return home and recover.

After talking with him, she learned that he lived in a small one-bedroom unit with his wife and two others, making it almost impossible for him to isolate himself. ..

“Thankfully we prepared him a hotel room,” she said. However, Dr. Sud said “socioeconomic status” plays a major role in both exposure and recovery of Covid-19. “There were so many patients living at home with eight other people who had nowhere else to go,” she said.

Emergency Exit at Gallup Indian Medical Center

Source: Dr. Nate Thaisman

According to Noble, the hospitals serving patients in Navajo were doing a “heroic job” to make the most of what they had. The Gallup Indian Medical Center had a reuse program that used plastic sheets and a face shield to expand space in the emergency department. There were also creative solutions for devising gowns.

But the need for improvisation has revealed a fundamental lack of supply.

“We were always above supply,” said Teisman, who worked at a hospital in mid-June. “While I was there, I always wondered, “Will there be no more ICU beds today?” ”

Noble believes that long-term solutions are needed to ensure adequate access to protective equipment for hospitals in the poorest and most rural areas. Donations could be depleted, especially as the larger hospitals in America Competition for supplies..

Feeling of isolation

According to doctors and nurses, one of the hallmarks of Covid-19 is the sense of isolation that many patients experience. While in Navajo Nation, they met an elderly ill patient who couldn’t speak English well. And without an interpreter, it was difficult to communicate with them.

Many were isolated from their families and did not have cell phones. Some patients were taken to strange places, including larger hospitals in other states, only increasing their loneliness. Some of these patients were eventually ventilated and no one could visit them directly without proper protective equipment.

“It’s horrible, not the way we expect someone’s life to end,” Sood said.

“It’s incredibly resilient, strong-willed people, and they’ve fought for themselves for decades,” Noble said. “And there’s a strong sense of community,” she noted, adding that it just made it more difficult for people to leave close friends and family.

All doctors and nurses said patients in their 20s, 30s, and 40s needed to be hospitalized, but most were older. Few people died in the hospital as the sick were transferred elsewhere. But in one particularly tragic case, a Noble patient in his late sixties lost consciousness and died in a car on his way to the hospital.

“This pandemic is not determined by human taste.”

Doctors and nurses returning from Navajo Nation have a message to share with Americans. As of this month, authorities have reported a record Covid-19 incident, with the virus being particularly hard hit in some states. At the same time, people are itching to resume life as normal-and some researchers called it “Pandemic fatigue.” In some parts of the country, Resistance to wearing a mask is wide Or follow the social distance guidelines.

“If you are young, you cannot escape the serious illness,” Noble said. “Wearing a face mask needs to be taken seriously, and social distance needs to be taken seriously.”

“Just because I haven’t personally experienced (Covid-19) doesn’t mean that most of the population isn’t,” said Nurse Practitioner Sara Kaiser. Kaiser observed that the people of Navajo adhered to public health guidelines as much as possible and said many were very concerned about the health and safety of their families.

“People are getting tired, but unfortunately the course of this pandemic will not be influenced by human taste,” added Teisman. “Instead, it follows the biology of infectious respiratory viruses.”


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