SIOUX FALLS, S.D. (KELO) — On the floor of an emergency department bathroom on the Rosebud Sioux Reservation, a woman delivered her premature baby. No one was around. The doctor didn’t arrive for 20 or 30 minutes and none of the staff told the doctor what had happened.
That was just a few years ago, according to a report from U.S. Department of Health and Human Services Inspector General. It was just one of many examples that led to a temporary shut-down of the Emergency Department and a call from Congressional leaders to reform the Indian Health Service.
Now that hospital is one of several IHS hospitals in the area with an estimated 100 beds to fight the COVID-19 pandemic, according to a KELOLAND News analysis of hospital bed counts.
On the Rosebud Indian Reservation, a shelter in place order is in effect. A similar measure is in effect for Oglala Sioux Tribe members on the Pine Ridge Indian Reservation.
“The Tribal Council recognizes that Indian tribes and Reservations are among the most vulnerable populations and locations for this COVID-19 pandemic…. in light of the extraordinary threat posed by COVID-19, the Oglala Sioux Tribe must take extraordinary measures to prevent the spread of COVID-19,” the tribal council wrote in its shelter-in-place order.
Crow Creek Sioux Tribal Chairman Lester Thompson, Jr. wrote in a letter to state and federal leaders about concerns of people coming to the reservation to use boats and possibly spreading the virus.
“As you are very well aware, I.H.S clinics and hospitals are in no shape to handle any COVID-19 outbreak that could hit a tribal community,” Thompson Jr. wrote.
On Friday, the U.S. Army Corps of Engineers closed the boat ramps near Big Bend Dam, near Fort Thompson, South Dakota. This request coming from both Thompson’s tribe and the Lower Brule Sioux tribe.
Pandemics haven’t been good for Indian Country.
In the 2009 H1N1 flu pandemic, the mortality rate was 0.9 deaths per 100,000 people, but for Native Americans it was 3.7 per 100,000 people.
Looking at 12 states, including South Dakota, nearly 10 percent of the deaths were among the Native American population, yet they only accounted for three percent of the population in those states.
“Ensuring IHS facilities are adequately supporting South Dakota tribes throughout this crisis is critical, and it’s something my staff and I have been discussing since this outbreak began,” Sen. John Thune (R-SD) said in a statement. “As tribal members know all too well, IHS often struggles to provide requisite care even during the best of times.”
Just last year, a New York Times analysis found a quarter of the medical positions at IHS were vacant.
However, there appears to be extra funding and resources to fight the pandemic at these remote and understaffed hospitals and clinics, both from Congress and the executive branch.
In a Thursday briefing, Dr. Deborah Birx, the Coronavirus Response Coordinator for the White House’s task force, announced the rapid 15-minute tests developed by Abbott Labs would be heading first to Indian Health Service locations because they are in remote and rural areas.
“We’ve prioritized the presidential 15-minute test to the Indian Health Service and public health labs so that they can support nursing home testing and other areas where we think surveillance is absolutely key,” Birx said. “So at this moment they’re prioritized in that way.”
The same testing platform is being used to screen anyone who goes near President Donald Trump and Vice President Mike Pence to ensure continuity of government.
“These rapid tests don’t need to be sent into a lab—patients can receive their results within 15 minutes,” Sen. Mike Rounds (R-SD) said in a statement. “These are good steps to help prepare for COVID-19 on tribal lands. We’re continuing to be in contact with South Dakota’s tribal leaders as they work to identify needs in their communities at this time.”
This comes on top of an influx of money in the record-setting third aid package approved by Congress last week. $8 billion will be going to tribal governments and $1 billion will support IHS.
“Now is the time for IHS to rise to the occasion and ensure that the $1 billion in relief it received from the CARES Act goes to providing the support tribal communities deserve,” Thune said.
In addition, the CARES act provided:
- $300 million to the Native American Housing Assistance and Self-Determination Act (NAHASDA) to address housing uncertainties
- $900 million was provided to Low Income Home Energy Assistance (LIHEAP), which includes Tribal LIHEAP
- $4.5 million for tribal domestic violence shelters through the Family Violence and Prevention Services Act
- $100 million for the Food Distribution Program for Indians Reservations
Tribes and tribal businesses can also participate in the SBA Paycheck Protection Program and the CARES Act extended funding for a number of programs including the Special Diabetes Program for Indians (SDPI) and Temporary Assistance for Needy Families (TANF).
“I was thankful to see the CARES Act include relief that is specific to the needs of tribal communities in South Dakota,” Rep. Dusty Johnson (R-SD) said.
Johnson wrote a letter to leadership in the U.S. House of Representatives asking for IHS inclusion in the CARES act.
IN-DEPTH: Congressman Dusty Johnson’s staff put together a comprehensive list of everything in the bill related to Indian Country.
The leader of the IHS said a COVID Response Team is with working with the White House, CDC and FEMA to coordinate a response. Rear Adm. Michael D. Weahkee, Principal Deputy Director, Indian Health Service also said his agency is hosting weekly calls with tribal leaders.
“I want to recognize the people across the Indian health system who are working tirelessly,” Weahkee said in a statement. “We are fortunate to have a team of professionals dedicated to the health and well-being of our patients and tribal communities across the nation. Your commitment has never been more important or more appreciated than it is today.”
IHS has worked to use telehealth and postpone non-emergency procedures. He sent a letter to tribes across the country outlining what’s to come in funding.
“While many IHS facilities focus on outpatient primary care, IHS also has the capacity to provide care to patients in need of higher levels of care. We also have existing purchased/referred care agreements with a vast network of specialty care providers across the country, with multiple such contracts in place at each facility. IHS facilities are communicating and coordinating with their local and regional partners to ensure continued access to care for our patients,” he said.
In the Great Plains region of IHS, which includes South Dakota, North Dakota, Iowa and Nebraska, there have been 130 tests administered, with six coming back positive, as of Friday.
Any tests administered in South Dakota are reported to the Department of Health and included in the state’s official daily numbers.
In a Friday media briefing, Gov. Kristi Noem (R-SD) confirmed the state was accounting for IHS facilities in its surge planning. The state projects it will need 5,000 beds and 1,300 ventilators at its peak.
The state believes that peak will be in mid-June and between 30 to 70% of the population will become infected. A majority of the cases will be mild.
IHS has developed a website specifically for tribal communities on the federal response. The agency also partnered with Johns Hopkins Center for American Indian Health to develop specific information and public awareness information with IHS information.
Whether IHS will be able to handle the pandemic remains to be seen.
Navajo Nation President Jonathan Nez, which is already seeing an outbreak, held a town hall this week on Facebook and said he was afraid of what’s to come.
“There’s frustration from leadership – not just here on Navajo but all of Indian Country,” Nez said. “We feel that the United States government once again has ignored or even left out the first residents, the first people, the first citizens of this country: Indigenous people.”
KELOLAND News reached out to IHS to get information on plans to surge capacity. The agency did not respond. We will update this story when they do.