Tribal COVID-19 Response Among Indigenous Populations

November 20, 2020

Perspectives in Primary Care (formally the Primary Care Review) features perspectives from practitioners and students representing organizations, practices, and institutions across the country and around the world. All opinions expressed in this article are owned by the author(s).

The COVID-19 pandemic presents American Indian and Alaska Native communities with the biggest public health crisis since the 1918 influenza pandemic. Tribal communities have experienced many major pandemics since European contact, some unintentionally spread, and some, like smallpox, intentionally used to wipe out our people. Because of this shared history, tribal communities in the United States have taken a hard line to protect tribal members and reservation residents from COVID-19.

At Seven Directions Indigenous Public Health Institute, the first tribal public health institute in the United States, our mission is to advance American Indian and Alaska Native health and wellness by honoring Indigenous knowledge, strengthening Tribal and Urban Indian public health systems, and cultivating innovation and collaboration. We do this by living and practicing our values, which include honoring culture and identity, focusing on family and community, respecting tribal governance and tribal sovereignty, integrating approaches towards holistic wellness, privileging Indigenous knowledge, and committing to service to our communities.

Our vision is that all Indigenous peoples will live long and healthy lives for generations to come. The current crisis underscores our commitment to this vision and informs tribal and Urban Indian approaches to combat COVID-19 by all necessary means.

At Seven Directions, we live our values by offering technical assistance to tribal communities who would like to discuss COVID-19 response options in relation to their funded programs by the Centers for Disease Control and Prevention (CDC) and/or the Health Resources and Services Administration (HRSA). Tribal public health and other program leaders can also participate in Gathering Grounds sessions, which serve as a shared space for a tribal and Urban Indian community of practice.

Our shared history

The proactive efforts of tribal nations during the current pandemic are informed by our shared history. In 1837, my great-great-great-grandmother lived through the smallpox epidemic that decimated our tribes’ villages. At that time, an American Fur Company steamboat brought passengers and trade goods up the Missouri River, to the Mandan and Hidatsa tribes, along with the smallpox contagion. Over 90% of the Mandan and 70% of the Hidatsa died of smallpox spread by the steamboat passengers. My sister found an audio recording of Emmarine Chase, one of our grandmothers, who relayed the story of her great-grandmother, a survivor of the 1837 smallpox epidemic:

[After the smallpox epidemic came, they] moved up to Fishhook Village, and she used to tell, she said they just left everything. All our winter food, she said, we didn’t even take time to try to carry anything ‘cause we all traveled on foot and there was […] very few that had dogs, you know. Even dogs were just dying off. It was really pitiful, she said. There was […] women that had their little babies in bundles that got that smallpox, and she said they were crying, and they took those babies and tied them up as high as they could on trees, strapped them so that no animal would eat them. And the babies were just crying, but they, the whole village was just, nothing but wailing, you could hear it, it was terrible. Gee, that was terrible… and she actually went through that.

We read about accounts like this in history books, which intellectualize and compartmentalize this narrative into something manageable and confine it to the past. With the advent of COVID-19 in our communities, we no longer have the luxury of relegating these to historical accounts. We are living through the same situation as our ancestors.

In the face of this new threat, it is heartening to witness the ways in which tribes across the country have met COVID-19 response head-on, with all the tools and resources they can bring to bear to best protect our people and prevent history from repeating itself. The Cherokee Nation, for example, has lost more than 20 fluent Cherokee speakers over the past summer alone. In spite of this tremendous loss, the Cherokee Nation public health team learned Tableau and has developed a phenomenal COVID-19 dashboard that tracks risk and offers information on how to best protect others from potential harm.

Despite our common losses from COVID-19, American Indian and Alaska Native communities remain resilient. The ability of the Cherokee Nation, in the face of major loss, to develop a public health tool to address COVID-19 risk exemplifies this resiliency. We see this resiliency throughout the shared history of disease and devastation. Even in the midst of the 1837 smallpox epidemic, Mandan and Hidatsa tribal members found ways to cope and survive:

My grandmother used to tell that—my mother told me this—she was so, just burning up with fever when they had this smallpox, they’ll break out with sores and they had a high fever, she was just about dead. And she decided, well, I’m not gonna lay here and just… I’m gonna go down to the river and take a bath and clean up, maybe I’ll feel better she said. So she made her way down to the river and she got in that cold water and took a good bath and everything, boy, it just brought her fever down and she felt real good, so she come back up and told the others… she said, go down and take a bath, you’re gonna feel good, she said, so different ones went down there and they took baths and they come up slow but I guess it must have brought their fever down or something, that cold water. (Account of Myra Snow)

In my own community, the Three Affiliated Tribes of the Fort Berthold Indian Reservation in North Dakota, home to the Mandan, Hidatsa, and Arikara tribes, we have felt the brunt of limited state public health mandates, and our tribal leadership has been on the forefront of implementing measures to best protect community health. Our tribe issued the third tribal mask mandate in North Dakota, joining the Spirit Lake and Turtle Mountain Chippewa tribes, along with the Standing Rock Sioux tribe, in requiring masks in all public locations.

One of the critical components of all tribal approaches we’ve seen is the reliance and privileging of tribal cultures and values. Protecting our elders, supporting our families, and empowering our youth have sustained our communities through some of the most challenging times. These values remain the cornerstone of tribal COVID-19 response. Lisa Pivec, Cherokee Nation Health Services Senior Director for Public Health, emphasized during her keynote address at Our Nations, Our Journeys virtual conference that the driving force behind the Cherokee Nation’s COVID-19 response is to prevent the loss of fluent Cherokee speakers. We know the power of language, within which lies our stories, our love for one another, the ties that bind together our families, communities, and cultures.

As we have learned from the past 500 years since European contact, not one of our communities can spare another elder fluent in our shared ways of understanding our world. We know our leaders, our colleagues, and our community members are facing food insecurity, economic upheaval, and are mourning the loss of dear friends and relatives because of COVID-19. We also know that we will not relax our vigilance and give up the fight for our future and the generations to come.

**Feature photo by Andrew James on Unsplash


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Myra Parker

Myra Parker (Mandan-Hidatsa-Cree), PhD, JD, MPH, is an Associate Professor in the Center for the Studies of Health & Risk Behaviors in the Department of Psychiatry & Behavioral Sciences at the University of Washington School of Medicine. She also serves as the Director for Seven Directions: A Center for Indigenous Health. Dr. Parker received her JD and MPH from the University of Arizona and PhD in Health Services from the University of Washington School of Public Health. She has worked for over 10 years on tribal public health program implementation and coordination with tribal communities in Arizona, Idaho, and Washington, as well as with tribal colleges  and universities across the United States.

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