While Massachusetts has seen a decline in COVID-19 infections and has started to re-open, Navajo Nation continues to be ravaged by the virus. In the last week of July, Mass General Brigham sent the first group of volunteer emergency and critical care nurses and other clinical specialists to help support Navajo Nation during this unprecedented time.
Navajo Nation, the largest American Indian reservation in the United states, is spread out across Arizona, New Mexico and Utah. At over 27,000 square miles, it’s roughly the size of West Virginia. The Brigham and Women’s Outreach Program with Indian Health Service (BWOP) has collaborated with the Indian Health Service (IHS) since 2008 to provide support to Navajo Area IHS hospitals and the Navajo, Hopi and Zuni communities they serve. They collaborate with Navajo Area hospitals and clinics in a variety of ways, including in-person training sessions, virtual consultations, distance learning, and hosted conferences in Boston, among many other activities. But this March, once the pandemic started to spread, the services offered by the BWOP seemed dwarfed in comparison to the growing need to address the coronavirus.
“When COVID hit, we could see that the current model was not sustainable,” says Ellen Bell, MBA, MPH, Senior Project Manager for the BWOP. “It’s just been all COVID all the time. It’s hard to get out from under that.”
At the beginning of the pandemic, Mass General Brigham sent needed items for the community, such as care kits and iPads, to allow for safe communication between provider and COVID-positive patients. Clinicians also participated in a telehealth information-sharing system through Project ECHO to reach 400 IHS providers. In addition, the Outreach Program has established programs that allow virtual peer-to-peer resiliency and support groups to frontline IHS clinicians, ethical consultations, and designated on-call critical care physicians for urgent telephone consults from the IHS.
With only a handful of ICU beds and 50 percent vacancy rates for both emergency and critical care nurses, the Shiprock Northern Navajo Medical Center has been faced with extraordinary challenges. Because of the surge in Arizona, hospitals in Phoenix (where the IHS had previously sent some their sickest patients) can no longer handle the overflow. Bell explains that there are compounding social, economic, and cultural factors that have also made this disease more likely to spread in Navajo Nation.
“This population has high rates of poverty and underlying health conditions already,” says Bell. “Those risk factors are compounded by cultural norms—large gatherings and community congregation are deeply important, and many intergenerational families are living in close quarters.”
Bell says, “It’s a stunning statistic but 1/3 of people in Navajo Nation don’t have running water. How can you tell someone to wash their hands if they don’t have indoor plumbing?”
Teams of three to four volunteer emergency and critical care nurses, as well as emergency services assistants, from Mass General Brigham will fly out to Navajo Nation for a week at a time for the next few months.
Dylan Clark, BSN, RN, CCRN, a critical care nurse in the Brigham Cardiac Surgery ICU, was one of three staff deployed the last week of July in the first group of volunteers. He explains that Shiprock, where he was stationed, is a small community with roughly eight thousand people spread very far apart– a very different setting from what he is used to in Boston. The local nursing teams are deeply connected to their patients and often care for them over patients’ lifetimes.
“COVID-19 is challenging everywhere in different ways. The nurses at Northern Navajo Medical Center provide a lot of great care with less than what I was used to having, which was something to learn from,” says Clark.
Maddy Pearson, DNP, RN, NEA-BC, senior vice president of Clinical Services and chief nursing officer for Brigham Health, expressed her gratitude to the nurse and Emergency Services assistant volunteers.
“I am touched, yet not surprised, by the willingness of our staff to offer their time and skills for this critical work,” she said. “We are thankful for their profound commitment to making a difference here at the Brigham, in Shiprock and anywhere they heed the call to care for those who need it most.”
If you’d like to learn more about other ways Mass General Brigham supports American Indian communities, click here.