In May 2020, I found myself back within the four sacred mountains. In the Navajo language, this place is called Dinétah which translates to "among the Navajo." The landscape of Dinétah is filled with high plateaus, sandstone monuments, arid mesas, red desert, snow-peaked mountains, and the culture I know. When I received my deployment orders, I was happy I was going home to support the Navajo Nation's public health emergency response during the peak of their Coronavirus-19 (COVID-19) surge and on a personal mission for me, to preserve our language, culture, songs, prayers and way of life. The Navajo Nation and other American Indian and Alaska Native (AI/AN) populations were especially hard hit with incidence rates for AI/AN persons 3.5 times than white persons, according to the Centers for Disease Control and Prevention (CDC).
This would be my first deployment with the U.S Public Health Service Commissioned Corps and an opportunity to provide nursing care to my home community. The thought of returning to serve in this manner was heartfelt because it was a chance to fulfill another goal in my journey or what the Navajo or Diné (The People) call the corn pollen path. For me, the path was to serve my community the way shi cheii (my maternal grandfather) Daniel conveyed. He told me, "No matter the challenges, climb the education ladder, and learn as much as you can to be able to serve yourself, serve your family, serve your tribal nation and serve your country." Since I was a child, I have carried these words and they continue to resonate with me even now.
During my deployment, I was doing exactly what shi cheii told me to do, I was serving my community in their greatest time of need. On the COVID-19 ward at Northern Navajo Medical Center in Shiprock, New Mexico. I was hidden behind an oversized gown, wearing an uncomfortable N95 mask with a second layer of an overlying surgical mask. I also felt the pressure and the uncomfortable weight of the plastic face shield, the loss of my warm touch from being doubled gloved. This all served to remind me this was not business as usual. Although my patients couldn't distinguish me from my colleagues, to them I was familiar even behind the vail personal protective equipment they knew I was one of them. The patients appreciated the culturally sensitive care my colleagues and I provided and knew the time and effort it took them to learn about the Navajo way of life, language, and etiquette. For my colleagues it was a new experience but for me it was full circle.
While many U.S. communities have access to basic needs and can implement the #COVIDStopsWithMe campaign – launched by the U.S. Surgeon General, unfortunately, some tribal communities are living without running water and electricity and struggle with food insecurity. These conditions make it difficult to prevent the spread of COVID-19 and to combat and prevent chronic illnesses.
Understanding community-based challenges and having basic cultural and linguistic knowledge of AI/AN and other racial and ethnic minority communities can have a positive impact. An awareness of the history, philosophy, language, communication style, belief system and even some understanding of the political relationship with the federal government can provide important context, and that context fosters collaboration and helps providers navigate the needs of the AI/AN community more effectively.
As we continue responding, partnering and supporting the public health emergency in Indian country, it is important to know how to work efficiently and effectively with tribes. It is also imperative that we have cultural and linguistic competence going into AI/AN communities. For instance, being aware of the myths vs. facts, such as AI/AN people have physical characteristics that can be easily recognized or "all Indians are the same." Also, respecting traditional practices, displaying respect for the elders by listening intently because their storytelling responses have the information you need to appropriately assess and diagnose and simply learning to say hello in Navajo, Yá'át'ééh, or thank you, Ahéhee', brings smiles to faces.
When we approach any minority community from this perspective, it can build and strengthen relationships, enhance partnerships and establish trust, which are all a key part of providing healthcare and public health services to address health disparities during this pandemic. As an important tool in this effort, the HHS Office of Minority Health (OMH) promotes the use of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care to help providers deliver healthcare services that meet the needs of the communities they serve.
AI/AN communities are resilient and have persevered through a tumultuous history, but COVID-19 has exposed deeply rooted vulnerabilities within tribal communities and on tribal land. As I continue to respond to the public health emergency throughout the U.S., I hope my experience raises awareness among responders and partners supporting AI/AN communities and helps others recognize that cultural appropriate approaches can help address COVID-19 disparities in tribal communities.
While shi cheii's messages about service to community and country were directed to me, as the nation continues to work to end the pandemic, I am certain he would want me to share his important message so we can all continue to Walk in Beauty.