STEVE INSKEEP, HOST:
Leaders of the Rosebud Sioux Tribe faced a hard decision. They had a chance to get people vaccinated, and this was the question - should they work with the state of South Dakota, which they feel betrayed them in the past, or work with the federal Indian Health Service, which they feel betrayed them in the past? The choice worked out better than they feared.
NPR's Kirk Siegler reports from the Rosebud Reservation.
KIRK SIEGLER, BYLINE: Lila Kills In Sight lost her 81-year-old mother to COVID-19 on November 23.
LILA KILLS IN SIGHT: I really don't know who to be mad at. Who do I take my frustration to? How do I deal with it?
SIEGLER: Kills In Sight is the first to say she's not dealing with it well. She had been keeping her mom sheltered at home as the pandemic raged in South Dakota. Her mom broke her hip, though, in September; then in November, she got hurt again.
KILLS IN SIGHT: She fell, and I had to make a really hard decision to take her to the hospital because I didn't know if there was anything broke.
SIEGLER: With mom in so much pain, Lila risked going to the doctor in nearby Nebraska, then later the Indian Health Service Hospital here in Rosebud. They both got infected. Her mom went downhill fast. She had to be airlifted to Sioux Falls, where she died two weeks later. Lila is grieving and wracked with guilt.
KILLS IN SIGHT: We lost so many elders this past year alone. We've lost a lot of Lakota speakers. And what they took with them, we're never going to get back.
SIEGLER: Twenty-five tribal members, most of them elders, have died from COVID on this isolated, long-neglected reservation. Hundreds more were sickened or hospitalized. Everyone knows someone who has or had it. So the arrival of the vaccines offers real hope.
UNIDENTIFIED PERSON #1: So write your name down, and then we take your temperature.
SIEGLER: The tribe is taking the pandemic very seriously. There are temperature checks everywhere. Unlike in much of South Dakota, masks are required here, and there are still nightly curfews.
RODNEY BORDEAUX: Yeah, my name is Rodney M. Bordeaux. I'm president of the Rosebud Sioux Tribe.
SIEGLER: Bordeaux says emphatically it's safer here than in the rest of South Dakota. But even tougher enforcement didn't keep COVID out. There are just too many pre-existing problems, from drug and alcohol abuse to dilapidated housing.
R BORDEAUX: Sometimes we have two or three families living in a house, maybe up to 13 members living in one- or two- or three-bedroom home. So it's overcrowded, and it's hard to keep it at bay.
SIEGLER: When the vaccines arrived, Bordeaux faced a tough decision - go through South Dakota and its long history of racism toward Indians or go with the perennially underfunded Indian Health Service. The tribe has a pending lawsuit over past appalling conditions at the local IHS hospital.
R BORDEAUX: We were afraid. Our people were a lot afraid. They were afraid because we didn't have the resources, you know. We thought we'd be getting left behind. So we had to ramp it up, you know, lobbying, talking all the time, you know, making sure that Indian Country was heard.
SIEGLER: They rolled the dice and went with IHS anyway. It paid off. It's been one bright footnote to months of tragedy. Vaccine distribution here so far has been fast and efficient.
AMANDA BORDEAUX: Second dose.
CALLIE RAYMOND: OK, come on back.
SIEGLER: The IHS hospital holds two mass-vaccination events a week, a traveling clinic and then one every Thursday here at the Rosebud Hospital. Amanda Bordeaux, a paraprofessional at the high school, is getting her second Pfizer shot.
A BORDEAUX: I worry about my family members. My aunt passed away from it, and she was young, so I wish that this would have came out sooner.
SIEGLER: She also lost her 91-year-old grandmother to COVID in November.
A BORDEAUX: When I first got my first dose, I was a little bit angry 'cause I wish it was sooner for them.
SIEGLER: They'll vaccinate more than 300 people today alone. Analysts say, it may not be perfect, but the IHS is at least a centralized system. There's a database here of the 15,000 people they need to reach, and they're practiced at immunizing people in tough conditions.
RAYMOND: You'll be next just as soon as we get a room open.
A BORDEAUX: OK.
SIEGLER: Some folks don't have cars or even phones. At first, the nursing director, Callie Raymond, had to drive 100 miles one way to the Pine Ridge tribe, which had an ultra-cold storage freezer. Out of some 4,500 shots they've gotten to date, only three have gone unused.
RAYMOND: Takes a lot of critical thinking in how we're going to utilize this vaccine so we don't waste it.
SIEGLER: Like on Super Bowl Sunday, when they had some no shows, Raymond drove to a supermarket where they got on the loudspeaker and managed to get all the extra shots into the arms of shoppers. Today, it's minus 6 outside, and there are ground blizzards. Still, the tribe is running shuttles to pick people up in outlying communities like St. Francis. Snowdrifts cover the yard in front of Francine Little Hoop's house. It's one of the few on this road that's not boarded up. She talks through her mask as some stray dogs jump up onto the car.
FRANCINE LITTLE HOOP: I just stay away from people. I only stay in my house.
SIEGLER: Little Hoop says she's scared of getting COVID.
LITTLE HOOP: This is my first time. I wanted to get my shot.
SIEGLER: The tribe has been vaccinating its population at almost double the rate of South Dakota and, for that matter, most of the rest of the nation. And it's not just here. This is the case across much of Indian country. Tribal leaders across the country say they plan to keep holding the Biden administration accountable to its treaty obligations to deliver health care. There's an obvious legacy of mistrust toward the federal government. And this is playing out when it comes to the vaccines, too, even though they've been proven safe.
WAYNE BEAR SHIELD: Most things they tell us have been studied for a long time. This has been rushed, and that's what puts the fear in a lot of people.
SIEGLER: Wayne Bear Shield is standing outside the Rosebud Tribe headquarters. He's showing me a huge banner that he just helped put up.
BEAR SHIELD: We call this the Sichangu Nation, the Oyate. And the circle is all our people.
SIEGLER: The sign reads, protect the circle, get vaccinated.
BEAR SHIELD: I know a lot of people out there are scared, but it's something that we as people need to survive.
SIEGLER: Even before the pandemic, this county had the second-lowest life expectancy rate in the nation; only Pine Ridge next door is worse. Pre-COVID wakes like this one in a high school gym for a mother and daughter killed in a car crash were all too common.
UNIDENTIFIED PERSON #2: (Speaking Lakota).
SIEGLER: It's here where I met Lila Kills In Sight, who we heard from in the beginning of this story. She was dropping off food. She told me she was hesitant to get the vaccine at first, too. She has survivor's guilt. But she knows her mother would have wanted her to get it. So she's been helping pick up surviving elders and driving them to get their shots.
KILLS IN SIGHT: I've been so adamant about telling people, take it, take it, we have to because that's the only way it's going to stop.
SIEGLER: Kirk Siegler, NPR News, Rosebud, South Dakota.
(SOUNDBITE OF UNWED SAILOR'S “GILA”)
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