The novel coronavirus has ravaged much of the world, yet its impact has been particularly acute on the Navajo Nation, where it is pushing the tribe’s public health system to its limits. Decades of negligence and billions of dollars in unmet need from the federal government have left tribal nations without basic infrastructure like running water and sewage systems, along with sparse internet access and an underfunded Indian Health Service. All this compounds the life-threatening danger the virus poses to the elderly and immunocompromised. Front-line workers endure shortages of protective equipment like masks and gloves to help communities with already-dire health disparities, including high rates of chronic illness and lower life expectancy.
In response, relief efforts have sprouted to gather and deliver food, water, cleaning supplies, and other goods—all jobs the federal government is treaty-obligated to do.Chilchinbeto’s chapter house, church, school, and its over 400 housing units are nestled beside a modest mesa. Charleston and her team drove through town, making an initial field assessment for their difficult mission—delivering aid and isolating the community. For the next three weeks, the team would live in the hospital in Kayenta, just over 20 miles north of the unfolding outbreak. Charleston found refuge in Room 118, away from her family, emerging each day to face the virus.
“Yes, we were afraid,” Charleston told me over the phone in mid-April. “But there are some people who run away from fire and some who run toward fire.”As is true elsewhere, health officials suspect the outbreak was amplified by a “superspreader” event: a rally hosted by the evangelical Church of Nazarene in Chilchinbeto and attended by people from all over the Navajo Nation. From Singapore to the US, churches have been linked to outbreaks of Covid-19. In France, a five-day church event exploded into around 2,500 cases. In April, the Pew Research Center found that stay-at-home directives in 15 states had religious exemptions. Six of them were Western states, including Arizona.
The CDC specified only that the patient was in California; the California Department of Public Health announced that the patient was a resident of Solano County—which, as other reports have pointed out, is the location of one of the Air Force bases being used for quarantines of people who’ve returned to the US from countries with the disease.
Charleston faced a daunting task. She wasn’t familiar with Chilchinbeto, and yet she had to reach as many people as possible as soon as possible, keep them in isolation, and deliver aid—all without knocking on doors. She and her team decided the safest method was to call each household and have a member pick up food and supplies at the chapter house, one at a time, maintaining a zero-contact policy. The town’s officials and community health representatives, or CHRs, would prove invaluable.
The more than 140 CHRs monitor the health of community members and visit and assess the elderly, many of whom speak only Navajo, delivering medication and making hospital referrals. Many of their clients have chronic illnesses. “There are some anxieties within [the CHRs], because we don’t have all of the necessary personal protection equipment. But they know that they have to get out into the community,” Mae-Gilene Begay (Diné), the tribe’s CHR program director, said. “I have some CHRs that had to go into the self-quarantine for a week, but they got called back, so they returned to work.” Because of the coronavirus, home visits have become impossible, and long hours are inevitable.