RACHEL MARTIN, HOST:
The Navajo Nation has one of the highest coronavirus infection rates in the U.S. Dr. Deborah Birx of the national task force told White House reporters that they are using the strike teams to respond.
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DEBORAH BIRX: They're really doing amazing work at their public health institutions with their governors and their mayors. And they're really - they are in full contact tracing.
MARTIN: Laurel Morales of member station KJZZ reports.
LAUREL MORALES, BYLINE: Contact tracing - or tracking all the people that COVID-positive patients may have infected - has been a challenge on the Navajo Nation.
SHAWNELL DAMON: We are doing the best we can.
MORALES: Shawnell Damon is the Navajo epidemiology chief for the COVID-19 strike force.
DAMON: There are some cases where a number of people have been exposed to some people. And so we're trying to find those people. And, yeah, that's where the shortcomings come from.
MORALES: Damon says the tribe has about 80 contact tracers. And they're working hard to do their job. Not everybody has a phone. And it takes hours to drive to one home. Damon is currently trying to train more contact tracers. Long-standing problems have contributed to the rapid spread of the disease on the Navajo Nation. Households lack clean running water and electricity. Hospitals are few and far apart for a reservation the size of West Virginia. All these issues, the tribe says, can be traced to broken promises.
JONATHAN NEZ: We are United States citizens. But we're not treated like that.
MORALES: Jonathan Nez is the president of the Navajo Nation.
NEZ: You can hear the frustration, the tone of my voice. We, once again, have been forgotten by our own government.
MORALES: More than 150 years ago, the Navajo and many other tribes signed treaties with the federal government giving up their land in exchange for funding of things like housing, infrastructure and health care. But for decades, that hasn't happened. And now the tribe is suing for what it calls its fair share of federal COVID relief money. Laura Hammitt is the director of infectious disease prevention at the Johns Hopkins Center for American Indian Health, which partners with the Indian Health Service - or IHS - across the country.
LAURA HAMMITT: Native American communities are often invisible in terms of their health inequities. When you look at IHS per capita spending, it is much lower than we see for veterans medical spending or Medicare spending.
MORALES: The federal government spends about $3,000 per person on health care in Indian Country, while it spends closer to $9,000 on veteran health and $12,000 on Medicare, according to the most recent data. That leads Hammitt to one conclusion.
HAMMITT: IHS is chronically underfunded.
MORALES: The IHS works off the motto, make the best of what you've got even in a crisis. So that's meant converting offices to patient rooms and relying on the National Guard. But there's still an acute nursing shortage. And the tribe is desperately lacking in equipment. So IHS Chief Medical Officer Loretta Christensen says they're forced to fly COVID patients to hospitals in Albuquerque, Flagstaff and Phoenix.
LORETTA CHRISTENSEN: Our goal is to get our patients to a higher level of care as quickly as possible so that we can get them stabilized.
MORALES: Which comes at a steep cost. As sovereign nations, tribes do have the ability to work government-to-government. For example, the Navajo president is working with New York's governor to get some of that state's unused equipment. In Tuba City, pediatrician Diana Hu says that's a huge advantage.
DIANA HU: The big disadvantage, of course, is they don't have a big public health infrastructure themselves. And they've had to learn real quickly. Their learning curve has been quite steep.
MORALES: And Hu, also a member of the tribe's epidemiology response team, says there are not enough strike teams or contact tracers to get a complete picture of how far COVID-19 has spread on the Navajo Nation.
For NPR News, I'm Laurel Morales in Flagstaff.
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