“How’re you doing, Mrs. Begay?” While volunteering during the second wave of the COVID pandemic at the Navajo Nation, I made my first telephone follow-up call for a patient recently discharged from the Northern Navajo Medical Center for COVID.
“The electricity just went off two hours ago and I can’t use my oxygen.”
“Are you short of breath?”
“No, I’m fine if I don’t move around.”
“Do you have another tank of oxygen?”
“No, I called the oxygen company a few weeks ago when it was empty but they didn’t deliver another tank.”
Since the patient did not have a tank of oxygen, I could not check her oxygenation on and off oxygen at rest and ambulation to gauge and adjust her oxygen requirement.
Her portable oxygen concentrator system required electricity to run. The oxygen company informed me that the patient was supposed to pick up the oxygen tank. There was no urgency or concern in her voice that this patient had run out of oxygen. The fact that there was no physical address also posed a problem. The patient described her home address to me as a blue house twenty feet from route 112 and two miles from Highway 64. There are 55,000 unaddressed homes and businesses, many rely on P.O boxes and hand-drawn maps.
In the afternoon I went outside in the parking lot of the hospital and ran the COVID Car Clinic, a section for asymptomatic patients and another for symptomatic ones. A two-lane shed where drivers with symptoms drove in without an appointment to be evaluated for a COVID test. More often than not they came in with a carload of family members to be tested. The clinic’s volume had decreased considerably from two months ago when the surge was at its peak, where the line of cars stretched out of the entrance of the hospital.
The Public Health Emergency (PHE) program for the COVID Car Clinic has evolved into a streamlined system whereby the patients are given education and handouts about the symptoms of COVID, its prevention within the household, and a work excuse if needed. They are swabbed for a rapid Abbott BinaxNOW COVID-19 Ag Card (BinaxNOW), results available in 15 to 30 minutes while they wait in the parking lot. If positive, they are given a home care package with food and other necessities and instructions to self-isolate. They are also swabbed for a PCR molecular test, a PHE nurse contacts them with the results, available in two to three days.
Oftentimes, phone reception in the Navajo Nation is spotty or non-existent and some patients are cut off from their telephone service, waiting for the stimulus check to bail them out; a real problem in the pandemic. Otherwise, the PHE system has worked well.
In this hard-hit remote corner of the Navajo Nation where there is a real shortage of long-term healthcare providers, continuity clinics with the patients’ primary care physicians (PCP) stopped as soon as the pandemic hit a year ago. At the walk-in clinic where I fill in, many patients ask to see their PCP but it is a hit or miss thing with their doctors’ schedules. Walk-in clinics are all that they have, waiting for hours or a whole day to be seen. Some patients’ hemoglobin A1C climbs from 7 % at the beginning of the pandemic to 14 % by the time I see them, they fail to pick up their prescriptions, lancets, or test strips or take their medications on a consistent basis. Not able to see their PCP in follow-ups may have played a role in the control of their diabetes.
Staffing issues are prevalent. The Navajo Nation is an underserved area. It is rare to meet staff members who have been here for ten years or more. The person I met who has been here for over twenty-five years was born here and his home is in the Nation. Most of the vacancies are temporarily filled with contract workers for a few months, they may then extend their contract or move on. It is hard to have continuity of care without a consistent cadre of healthcare providers.
During the pandemic, many of the existing staff are also repatriated to work in areas and under unfamiliar clinical situations and there is always a period of learning before they are being moved again to areas that need them most.
The Navajo patients often ask me where I am really from and how long I would be staying. They are grateful I come to help as a volunteer but what they are really looking for is someone who could call this part of the country her home and stay for a long time.
The Stay-at-Home (Shelter in Place) order and a daily curfew from 9:00 pm to 5:00 am has been imposed since April 2020, individuals are to remain at home during the curfew, except in the event of an emergency. The 57-hour weekend curfew starting from 8:00 pm Friday through 5:00 am Monday does not apply to essential employees. I carry my official identification and a letter allowing me to be out at curfew.
A bright ray of hope is in the vaccination rollouts which take place in schools and chapter houses. The weekend curfew is temporarily lifted for them. As early as six o’clock in the morning before the sunrise, a long line of cars already appears at the designated vaccination centers even before the nine o’clock appointed time. My Google GPS fails to locate these remote places for me but the lines of cars identify them. The logistical issues are slowly ironed out with at least eight vaccination lanes in a vaccination site moving efficiently. Those vaccinated would wait for 15 to 30 minutes in another section of the parking lot for observation of side effects. They are instructed to honk if they experience symptoms.
Vaccination rollouts have been ongoing in the Navajo Nation and by all accounts, they have been a success. Each time I deliver a jab in the arm of a vaccinee, I send a message to the coronavirus that we are slowly but surely winning the battle if not the pandemic war. As of February 11, a total of 113,345 COVID vaccinations had been administered in the Navajo reservation with an estimated population of 173,600, well beyond the goal of 100,000 shots by the end of February.
The remoteness of the Navajo Nation which does not attract and retain long-term healthcare providers, its lack of amenities such as running water and electricity, and broadband connectivity, all make the fight against the COVID pandemic that much more difficult.
The iconic Shiprock pinnacle which could be seen from miles away beckons, I visit it several times at sunsets and sunrises, each time the different colored hues reflected off its jagged surfaces exude a spiritual and symbolic essence of a better future. The success of the vaccination rollouts is the beginning of a beacon of hope for the Navajo Nation.
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