Pandemic in reservations like the Indians fighting the coronavirus

Dr. gene noble worked as a doctor for urgent medical care. So when the hospital where she works, University of California at San Francisco, asked if anyone to fly to the territory of the Navajo nation and to help with the escalation of the outbreak COVID-19, she readily agreed. This writes CNBC.

Пандемия в резервации: как индейцы борются с коронавирусом

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The Navajo nation that reported its first case COVID-19 in mid-March, showed one of the highest incidence rates per capita. Today was 8,000 cases and over 300 deaths on the reservation, home to about 170,000 people scattered across the desert landscapes of Utah, Arizona and new Mexico.

Noble went to work in the hospital of the people of the Navajo Indian medical center Gallup, new Mexico — as part of the second group. The first group arrived in April at the call of the President of the Navajo nation Jonathan Nez on the reinforcement of health workers. Around the same time, the group of medical workers went to new York.

The group, which was noble arrived in may. She was immediately impressed by the steps taken for the reception of patients. “They installed plastic sheets and barriers to double capacity in the emergency Department, and then converted the old pediatric clinic, she remembers. — There was a tent outside for less sick patients.”

However, many patients with COVID-19 was to be transferred to larger facilities in Albuquerque, new Mexico, or Flagstaff (AZ), if their health ухудшилfсь. Noble often had to call in three or four hospitals in these regions to find place to patient patient. Noble is worried that with the increase in the number of cases in Arizona, patients will become even more difficult to get the intensive help they need.

Noble and her colleagues returned to San Francisco for a few weeks, but she says that their experience was a constant reminder that COVID-19 — “a terrible disease”. But she also stressed that it is a disease that disproportionately impact on some groups compared to others, including people with low incomes and representatives of different races communities.

Socio-economic inequality

The people of the Navajo nation, which for decades have experienced social and economic inequality, were particularly vulnerable.

Most of the population with a high risk of serious complications from Covid-19: more than a third suffer from chronic diseases, including diabetes and heart disease. According to the CDC, in the United States the highest prevalence of diabetes among American Indians and Alaska natives, more than two times higher than among whites.

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

Noble recalls how one of her patients, a man about 70 years old, fell ill COVID-19 and was discharged from hospital after recovery. His house was 30 miles (48 km), and it was not possible to contact his family. So he decided to walk home under the scorching sun, in the end, he became ill from dehydration.

Once they found him, the paramedics, the patient was returned to hospital, where he was recently discharged.

“He had no car, no phone, he also had diabetes, and he didn’t have insulin, she said. — Unfortunately, this is a relatively common situation.”

Noble noted that there is a service, which provides transportation of patients in Navajo, but it’s not perfect. Sometimes no trips are available, and sometimes patients don’t give the number so they could call.

Many of the Navajo live in overcrowded homes with their families, where the virus can spread quickly, and over a third do not have access to piped water at the time when it is important to wash your hands. In addition, the transport of water can often mean the violation of the principles of social distancing.

“All the worse by the fact that in this community a large percentage of homes do not have electricity or running water, said Dr. Nathan Teismann, the doctor in an emergency. — There is also a relatively large number of homeless, high levels of chronic diseases and health problems and this contributes to the spread COVID-19”.

All the doctors and nurses agreed that the government needs to do more to protect this population. Noble continues to worry about the depletion of the donations. It is suggested that, at least, funding is needed mobile medical institutions, to health workers could visit patients at home and also improve access to clean water. It encourages politicians to think about solutions for housing to people with COVID-19 had more options for safe isolation.

“This can be a costly proposal, but we’re talking about basic human rights to such things as access to drinking water,” she said.

Dr. Tara SOUD, specialist in emergency medicine, recalled how one of her patients was a positive test result for the presence of coronavirus, but was told to return home and be treated there.

After talking with him, she found out that he lives in a small apartment with one bedroom with his wife and two children, and it is impossible to isolate ourselves from others.

“Fortunately, we got him a hotel room”, she said. But Dr. SOUD noted that “socioeconomic status” plays a huge role in the impact COVID-19, and in recovery.

According to noble, the hospital serving patients in Navajo, was performing “heroic work” to the best of what they had. But the need to improvise has identified a major shortage in supply of medical equipment.

“We were always on the verge of exceeding supply, said Theisman, who worked at the hospital in mid-June. — I always wondered while I was there, “will today be the day will come when there will be no beds in intensive care units”.

Noble believes that it is necessary to find a lasting solution to ensure that hospitals in the poorest and most rural areas had adequate access to protective equipment. Donations can dry out, especially due to the fact that major US hospitals are also in need of materials.

The sense of isolation

According to doctors and nurses, one of the hallmarks COVID-19 is the isolation faced by many patients. During your stay on the territory of the Navajo nation, they met with old and sick patients who do not speak English. And it was difficult to communicate with them if an interpreter was not available.

Many were isolated from their family members and did not have mobile phones. Some patients were taken to unfamiliar places, including in the larger hospitals in other States, which only increased their sense of loneliness. Some of these patients were on the ventilator, and no one could visit them personally.

“It’s incredibly persistent and strong-willed population, which for decades has defended himself, noble said. They have a strong sense of community”. She added that people is becoming more difficult to be separated from close friends and family members.

All the doctors and nurses said that they have patients who were twenty, thirty and forty years, who had to be hospitalized, but most of them were older. Very few people died in the hospital, as the patients were transferred to other places. But one particularly severe case, one patient noble lost consciousness and died in the car on the way to the hospital.

“The pandemic will not be dictated by human preferences”

Doctors and nurses returning from the hospitals on the territory of the Navajo nation, I want to share with their fellow citizens, Americans, stories about their stay there.

“If you are young, you are not immune from serious diseases,’ said noble. — Need to wear masks and to adhere to social distancing”.

“The fact that you are sick COVID-19, does not mean that everyone else is healthy,” said Sarah Kaiser, nurse practitioner. Kaiser said she was watching the people of the Navajo nation, which followed the guiding principles of public health as they could, and many were very concerned about the health and safety of members of the family.

“People get tired, but unfortunately, the development of the pandemic will not be dictated by human preferences — added Theisman. Instead, it will follow the biology of an infectious respiratory virus.”

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