As an internal medicine physician at the University of New Mexico Hospital in Albuquerque, Dr. Eileen Barrett has witnessed firsthand the devastating impact that the novel coronavirus has had on the Navajo Nation, the largest Native American reservation in the U.S.
She has cared for gravely ill COVID-19 patients transferred to her hospital from rural medical centers inside or next to the Navajo Nation — centers with little capacity to handle the enormity of the outbreak. She’s watched them grow sicker, and more scared. And she’s watched them die — sometimes alone, other times with a single family member at their side.
In some moments, she’s heartbroken. In others, she’s enraged.
“I’m really talking about it very calmly, but this is not how I feel about it,” Barrett says of her work. “I’m so angry about structural inequality and structural racism.”
The Navajo Nation, home to about 174,000 people as of the last census, has become the epicenter of the novel coronavirus in the country. As of June 8, the reservation reported 6,110 cases of COVID-19 and 277 deaths — up from 148 cases and five deaths in late March. By mid-May, the Navajo Nation had exceeded New York and New Jersey for the highest per-capita coronavirus infection rate in the U.S.
Experts attribute the startling transmission rates in the Navajo Nation to health and social inequities. And Barrett, who has worked closely with the Navajo for more than a decade, can tick off plenty of them: a lack of paved roads, inadequate access to running water, high rates of children living in poverty. She’s quick to point out that the Indian Health Service, for which she worked for nearly a decade, including as a doctor on a remote part of the reservation, is woefully underfunded.
In 2015, spending for patient health services through the Indian Health Service, an agency of the U.S. Department of Health and Human Services, was $3,136 a person, compared with the $8,760 spent per person nationally, according to a report from the National Congress of American Indians.
The entire Navajo Nation, which spans Arizona, Utah and New Mexico, is “very, very poor, under-supported and under-resourced,” she says.
Some people struggle to understand why the novel coronavirus is taking such a disproportionate toll on communities of color, Barrett says. But in the case of the Navajo Nation, she notes that a lack of running water and multiple generations living closely together under one roof make it particularly hard to curtail infections.
In 2015, Barrett boarded a plane to help respond to the Ebola outbreak in West Africa. When she came back, she was able to quarantine in a separate bedroom from her husband and use her own functioning bathroom. It’s not lost on her that many Navajo don’t have the same luxury. Relatives who check on their sick loved ones aren’t being “reckless and irresponsible,” she says, but rather making “gestures of solidarity and love.”
Barrett, who was primarily a medical educator before the pandemic, is now on the hospital’s COVID-19 team. That means all of her patients are hospitalized with the novel coronavirus. Most come from the northwest part of the state, either from the Navajo Nation or Gallup, a border town nearby.
There are several aspects of the COVID-19 pandemic that Barrett finds particularly challenging. First, there’s the patient suffering: seeing people alone and scared, some feeling as though there’s a “lead blanket” on their chest. Second, there’s the trauma of family members, who aren’t always able to visit their loved ones due to strict visitation rules. Then there’s the lack of treatment options and ways to ease patient discomfort, and the inability to predict just how the virus will progress.
“We don’t yet have a great idea who will get worse or get better,” she says. “With COVID, people can be so much worse in the second week. They can be doing OK and get better, and then they can go home and come back sicker.”
Despite the exhaustion, heartbreak and anger that have colored many of her days since COVID-19 hit, Barrett says there have also been moments of genuine human connection that she’s grateful for — moments that will be with her always.
One was after a patient who had been on a ventilator and sedated for weeks was finally well enough to come off life support.
“She was so tired and she could barely hold her head up,” Barrett says. “She couldn’t even talk — she was just whispering. After we spoke, I said something to her in Navajo — a term that another patient had said to me — and her face just lit up. It was a reminder that we have a real duty to remember that all over the world, when we talk about cases, we’re talking about people. We have a duty not to see them as cases, but people.”
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A Doctor Treating the Hard-Hit Navajo Nation Seethes Over Structural Racism originally appeared on usnews.com