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Caring for Navajo Patients June 26, 2020

In New Mexico, the population most impacted by COVID-19 is the Navajo population. Of New Mexico’s 10,565 COVID cases, 53% are Native American, the greatest majority coming from the Navajo Nation. The Navajo Nation spans a four state area: north and western New Mexico, Arizona, Colorado and Utah.

The two New Mexico counties with the largest Navajo population have 2,183 (San Juan) and 3,073 (Cibola) COVID cases. CHRISTUS St. Vincent is serving as one of the hub hospitals for New Mexico, and because of the low numbers of people requiring hospitalization for COVID-19 in Santa Fe, we have been helping to respond to the significant need of Native Americans. Santa Fe is four to six hours away from Navajo country.

NavajoPatientsMural

Gallup, NM

One of our patients, a 65-year-old Navajo woman, has been hospitalized for 45 days at CHRISTUS St. Vincent. She comes from a remote area in northwestern New Mexico and lives with her family clan in close proximity. She had been previously hospitalized at another hospital and was sent home with oxygen. Another family member had been discharged from the hospital with oxygen which had to be run off of a generator. This did not work, and she became very ill, requiring re-hospitalization. The second hospitalization was at CHRISTUS St. Vincent.

We designated a nurse on our Patient Family Action Team to serve as the Native American liaison. She is the Nurse Manager for Cancer Research at the CHRISTUS St. Vincent Cancer Center. She is half Navajo, and is a graduate of Johns Hopkins School of Nursing. She grew up in Santa Fe and has family and many professional colleagues from throughout Indian Health Services and the Johns Hopkins Center for American Indian Health throughout Navajo country. Her familiarity with the geographic terrain, the addresses and knowing people has been instrumental in helping to connect with family members.

After a couple of weeks of attempting to locate family and challenged by the lack of phone or internet service and the need to rely on word of mouth and relationships to make connections, contact was made with the patient’s son. The first call required that the family convene in a location away from the home to be able to establish a connection.

Imagine what it was like for the family members to know nothing about the hospital where their beloved mother had been taken and knowing that she was very sick. The patient was intubated, so was not conscious and was unaware of where she was. The phone call was emotional, and the family members had many questions. We offered a video visit, but they declined because they did not want to see their mother on a ventilator.

Prior to the ending the call, our Manager of Respiratory Care, Scotty Silva, who had been overseeing her respiratory therapy, informed the son that he was going to bring a load of supplies to Shiprock, New Mexico the next day. Knowing that they lived in the Shiprock area, Scotty informed the son that they could send something back with him to their mom.

Knowing the plight of the people of the Navajo Nation, Scotty and his team have been organizing food and supply runs out to the Navajo Nation every few weeks. From throughout the organization, CHRISTUS St. Vincent associates are gathering food, cleaning supplies, hand cleaner, cotton masks, and water to donate. In many of the remote areas of Navajo, there is no running water, so washing hands and following sanitary processes to prevent Covid-19 is virtually impossible.

NavajoPatients

The next day, while Scotty was at the Shiprock Hospital, a truck driven by a couple of the sons and loaded with wood pallets pulled up. From the time of the call in the afternoon the day before until they met Scotty, they had built a structure and held a sacred blessing ceremony through the night to bless a blanket to be sent to their mom. Scotty took photos of them holding the blanket so that he could show the patient her sons sending the blanket to her. When he returned, the blanket was given to the patient and placed over her. Photos were taken and sent to her children. Several days later, another family member drove to Santa Fe and delivered sacred herbs that were placed in her room.

Like many people who contract COVID-19 and require ICU-level care, the patient had several co-occurring conditions including diabetes and a heart condition. She was very ill and showed little to no improvement over weeks.

Finally, after weeks on the ventilator, she began to improve to the point that she could transition to a tracheotomy. We learned from our regular family calls that there were concerns about potential damage to her vocal chords because she has a beautiful singing voice. Scotty was able to reassure the family that there was less potential damage with the tracheotomy than there could be if she were extended on the ventilator.

She is now awake, participating in physical therapy and has had two negative COVID tests! We are identifying a placement as close to home as possible, since she will need supportive services. It has honestly felt like a miracle to see her recover. Given how sick she was, all indications for recovery were not encouraging. Our clinical team was elated last Friday when they were able to hear her speak for the first time. The entire team is convinced that the blanket sent by her family has been a healing blanket. The outstanding clinical care, the true compassion of our team, the love of her family which we were able to make present to her -- all have contributed to the outcome we are now seeing.