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'Still Killing Us': The Federal Government Underfunded Health Care for Indigenous People for Centuries. Now They're Dying of COVID-19
Written by <a href="index.php?option=com_comprofiler&task=userProfile&user=56725"><span class="small">Dennis Wagner and Wyatte Grantham-Philips, USA TODAY</span></a>   
Thursday, 22 October 2020 12:36

Excerpt: "Melvina Musket stared at her dying father through the cellphone screen. His mouth hung open, his eyes were clamped shut and a beard covered his chin. She heard nurses crying in the background."

Derek Henio, Randy Chatto, Vernard Martinez and Jimmie Begay, from left, pose for a photo in front of the Ramah Chapter House, where they stage deliveries of supplies to at-risk residents on the Ramah Navajo Indian Reservation. (photo: Jasper Colt/USA TODAY)
Derek Henio, Randy Chatto, Vernard Martinez and Jimmie Begay, from left, pose for a photo in front of the Ramah Chapter House, where they stage deliveries of supplies to at-risk residents on the Ramah Navajo Indian Reservation. (photo: Jasper Colt/USA TODAY)

'Still Killing Us': The Federal Government Underfunded Health Care for Indigenous People for Centuries. Now They're Dying of COVID-19

By Dennis Wagner and Wyatte Grantham-Philips, USA TODAY

22 October 20

In reservation areas of New Mexico, health care is underfunded. In this six-part series, USA TODAY investigates links between racism and COVID-19.

elvina Musket stared at her dying father through the cellphone screen. His mouth hung open, his eyes were clamped shut and a beard covered his chin. She heard nurses crying in the background.

“Jesus is waiting for you,” she told him.

Musket, 52, had never seen her father with facial hair. Benjamin Musket, 80, was a former Marine, a retired machinery mechanic, a basketball coach and a board member at their church. He didn’t do beard

The family had been cautious when the pandemic arrived. Four generations of Muskets lived on a sheep ranch in McKinley County, New Mexico, and her father was an elderly diabetic on dialysis. They didn’t shop at their local stores, where too many people neglected to wear masks, instead driving nearly five hours roundtrip to Albuquerque for groceries. When they returned home, they wiped down every purchase and took showers.

The novel coronavirus came all the same. One day in May, Benjamin Musket started coughing. Twelve hours later, he was gasping.

In town, the understaffed Gallup Indian Medical Center, run by the federal government’s Indian Health Service, was filled with cases. When the staff saw Benjamin Musket had a heart infection and COVID-19, they flew him to a hospital in Albuquerque, over 100 miles away. A few weeks later, he was dead.

In the days after Benjamin Musket became ill, nearly everyone in the family tested positive.

Melvina Musket was hospitalized with a high fever. The medical center staff put cold compresses under her arms to cool her down.

Her mother was admitted to a hospital in Albuquerque, where she fell into a nonresponsive fog. Melvina Musket’s brother begged the hospital staff: “I can’t lose my mom this week; I already lost my dad.”

On June 11, their mother died, five days after her husband.

“We didn’t even know how profoundly sick they were,” Melvina Musket said. “It was just too much for their bodies.”

Few places in the world have been as scarred by the coronavirus pandemic as McKinley County, New Mexico. By September, the county ranked first in the state and sixth nationally for COVID-19 deaths per capita.

Roughly 74% of McKinley County’s 71,367 residents are non-Hispanic Native American, mostly Navajo and Zuni. The majority of land within the county’s borders is part of the Navajo Nation reservation. The Navajos, who call themselves Diné, are descendants of people who outlived colonization, smallpox, massacres and resettlement. They take pride in a history of resilience.

Then came the Big Cough, or Dikos Ntsaaígíí-19, as coronavirus is known among Diné tribal members.

The federal government, which oversees health care for Native Americans under treaty obligations, used a modified influenza plan to address the pandemic. And as the COVID-19 crisis began to overwhelm McKinley County, medical experts and others say federal authorities were slow to respond, a judgment call that cost lives and fueled the spread.

This failure was no accident, experts said. It was the direct result of centuries of systemic racism that has left McKinley County’s health care system chronically underfunded, understaffed, ill-equipped and outdated. And all in a community grappling with multigenerational housing, preexisting medical conditions, substance abuse and poverty, where many live without running water, electricity or enough food for their daily nutritional needs.

During the peak of the pandemic, doctors at the Gallup Indian Medical Center were forced to reuse personal protective equipment. An emergency room and intubation tents were set up in the parking lot. Mothers in labor were diverted to other hospitals to make room for coronavirus patients.

As the federal facility filled up, some overflow patients went to the one private hospital in the area, which also was overcrowded, prompting nurses and doctors at one point to protest in the street against unsafe conditions. For weeks, critical care patients were flown daily to better-equipped facilities in Albuquerque. Delayed medical care can, in some instances, lead to complications or death.

“I am sure if the federal government had intervened a lot quicker, things would have been a lot better. It’s obvious there was a lack of support,” said Jonathan Nez, president of the Navajo Nation.

The U.S. Civil Rights Commission, National Indian Health Board, Government Accountability Office, congressional committees and tribal leaders warned for decades that Native American health care was anemic and primed for catastrophe. Yet, year after year, Congress failed to allocate cash to meet the medical need. Centuries after the United States traded land for health care and other services with sovereign, Native nations, federal officials spend nearly three times as much per person on non-Indian medical care than on health services for Indigenous people.

More recently, when Congress passed a $2.2 trillion economic stimulus package to help the country get through the beginning of the pandemic, only $714 million was earmarked for the Navajo Nation. That amounts to $4,552 per each Diné on the reservation, compared with $6,703 per capita in stimulus funding nationwide. And most of the money didn’t arrive until months later.

“It’s really an unbelievable chain of oppression — it’s still squeezing us, it still has its grip,” said Anna Marie Rondon, executive director of the New Mexico Social Justice and Equity Institute in McKinley County.

“And it’s still killing us.”

After decades of health woes, coronavirus spread easily

Jamie Barboan could barely hear her mother over the sounds of an oxygen machine.

Whoosh-gush. Whoosh-gush. Whoosh-gush.

The noise dominated their phone calls, overwhelming her mother’s soft mumbles.

Barboan, 44, knew the equipment was helping her mom stay alive. But she worried she would hear the sound for the rest of her life.

Barboan’s mother, a certified nursing assistant, was the first in the family to be hospitalized for COVID-19. The virus then spread to Barboan's father and younger brother, sending all three to the Gallup Indian Medical Center. They received dedicated care there, but the facility was soon filled with COVID-19 cases. Barboan’s mother and brother were transported to hospitals in Albuquerque. Officials quarantined her father in a local motel.

Her brother, Andreas Tolth, was 39. She thought he would be OK. He never drank or smoked. He loved horror movies and always took care of his family.

But she had heard others warn, “Once they’re in the hospital, you won’t see them (again).”

For Tolth, that was the heartbreaking truth. After a month-long battle, he died from the coronavirus in July.

“Our hopes were so high,” Barboan said. “Then all of a sudden, one day you get the phone call that they’re not here no more — and it hurt.”

Her parents recovered from the illness but had lost a son.

“They still cry,” she said. “They still struggle.”

The Navajo reservation is the biggest in the nation at 27,000 square miles. It sprawls across Arizona, Utah and New Mexico, from the Grand Canyon to Monument Valley. It’s a vast, arid outback of red mesas, occasional villages and bone-jarring dirt roads leading to sheep ranches.

COVID-19 spread like a high desert wind in McKinley County, one of the nation’s poorest and unhealthiest communities — with high rates of alcohol-related deaths, diabetes and food insecurity, and where many tribal members live with three or four generations in a single-family dwelling.

These underlying medical conditions combine to increase risk for severe illness from COVID-19, according to the Centers for Disease Control and Prevention.

“It’s a constant cycle of poverty that we deal with. Every single day we have to fight for survival,” said Krystal Curley, a Diné who is executive director of Indigenous Lifeways, a collaboration of nonprofits that support Indigenous communities.

Perhaps nowhere are the disparities more visible than in Gallup, McKinley County’s seat and only incorporated city. The town, nearly surrounded by tribal lands, is known as “The Indian Capital of the World.” The Gallery of Nations Pow Wow is held here, along with the Inter-Tribal Indian Ceremonial and several major rodeos.

As COVID-19 flourished in McKinley County in mid-April, New Mexico Gov. Michelle Lujan Grisham issued an order for bar closures.

The move may have set the stage for the explosion of cases, according to Kevin Foley, who heads the town’s detox center. Surrounding reservations prohibit alcohol. With bars set to shut down, Foley said, tribal members came to drink in Gallup, home to more liquor stores per capita than just about any place in the nation.

Foley, executive director at Na’Nizhoozhi Center, a 30,000 square-foot, cinder-block building, said 98 people arrived at the center that night to sleep off the hours of drinking. They were given metal-framed beds in large common rooms. Although screening for fevers had begun already, sickness crept inside.

Some staffers got sick or quit, forcing the detox center to shut down during the third week of April. At least 21 clients tested positive and were transported to Rehoboth McKinley Christian Health Care Services, Gallup’s other medical center. More clients who had been exposed to coronavirus were sent to motels or the streets. Homelessness is also a risk factor for COVID-19, according to the CDC.

Gallup’s two medical facilities filled as the virus spread. The hospitals are across the street from one another. The Indian Medical Center, with 99 beds, serves Native American patients under the federal government’s obligation to tribes. Rehoboth McKinley operates a private, nonprofit facility with 60 beds.

“We got hit hard and heavy all at one time,” Gallup Mayor Louis Bonaguidi said. “I’ve lost a few friends myself.”

At the Rehoboth McKinley hospital, terminal patients were hooked up to several IVs with multiple drip lines. Hospital chaplain Kris Pikaart said she saw 50 patients die during the first six months of the pandemic, mostly of symptoms related to coronavirus. There were so many drip lines that Pikaart would get tangled in them.

As the crisis grew, Pikaart set up final phone and video calls with families, becoming a conduit in the human tragedy.

The first fatality, in March, sticks with her: A young woman with several children, gravely ill and alone, refused for days to speak with her family. Then, near the end, the woman cried and said, “I want to talk with my kids.”

“She proceeded to tell each one goodbye and gave them instructions on how they should live without her,” Pikaart said. “She rolled out this beautiful, beautiful goodbye.”

It was, Pikaart said, the bravest thing she had ever witnessed.

As spring turned to summer, death came to more McKinley County homes.

For Gabriella Lee’s family in Gallup, it began with four days of coughing, sneezing. Then came the body aches.

Lee’s uncle got sicker and sicker until he could barely breathe. At the Gallup Indian Medical Center, staff put him on a ventilator and then flew him to an Albuquerque hospital for more care.

There, he spoke about an imminent recovery and going out with his wife and son for a “big old steak dinner” once he felt better. He lasted four more days.

The family gathered to say goodbye on video via Facebook Live. He was unconscious. A nurse held the phone to his ear as his relatives gave their final words.

“We said we loved him and everything, how we’re going to miss him,” said Lee. “And he never came home after that.”

Broken promises of health care funding

After the Civil War, when the United States had wrested New Mexico and California from Mexico and miners and ranchers continued moving West, the Diné’s ancestral homeland was besieged by a renewed campaign of violence.

Under an order from U.S. Army Maj. Gen. James H. Carleton, villages were burned, livestock was butchered, water sources were destroyed and more than 10,000 Navajos and Apaches were rounded up, starting in 1864.

The prisoners were forced on an up to 450-mile death march known as The Long Walk. Along the way, 200 succumbed to exhaustion and died. An estimated 1,500 more died at the internment camp from sickness and starvation.

Four years later, the federal government proposed a deal: The United States would provide basic services such as health care, housing and education — if it could keep much of the Diné lands. The 1868 Treaty between the United States of America and the Navajo Tribe of Indians allowed the Diné to return to only a portion of their ancestral homelands. The exchange was one of hundreds of American Indian treaties that have been ratified since 1778.

From the start, government officials refused to honor it.

In the 1950s and 1960s, the federal government passed legislation to terminate its legal obligations to tribes and launch an assimilation policy with Native peoples moving away from reservations and perceived dependence. In 1955, Indian Health Service began to oversee health care on tribal lands.

Two decades later, Congress reversed course, abandoning the assimilation model. The Indian Self-Determination and Education Act recognized tribal sovereignty and enabled Native nations to run their own hospitals, schools, police departments and other programs, funded by the federal government. About half the Indian country health care programs today are tribally operated. But still, the money did not come.

“The underfunding has specifically been in areas that would have helped the Navajo Nation deal with the pandemic,” said U.S. Sen. Tom Udall, D-New Mexico, vice chair of the Committee on Indian Affairs.

Ramah Chapter, one of 110 governmental sub-units of the Navajo Nation partly located in McKinley County, sued the federal government in 1990 for inadequate funding of tribal services. That litigation and dozens of parallel suits dragged on for almost three decades before ending last year. The plaintiffs won a series of Supreme Court decisions. All told, the federal government paid out roughly $2 billion to U.S. tribes and their organizations.

It wasn’t enough to make up for the decades of decay that left Indian health care starved for hospitals, supplies and staffing, said Lloyd Miller, who represented co-plaintiffs in the Ramah case.

“One of the terrible, continuing consequences to the disproportionate impact of the pandemic on Navajos is the historic underfunding of the entire Indian health system,” he said.

Today, Indian Health Service serves 2.56 million American Indians and Alaska Natives across 574 federally recognized tribes in 37 states.

At the end of March, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act that designated $8 billion for tribes, including $714 million for the Navajo Nation.

Most of the money was delayed, and all of it came with red tape and restrictions. 

CARES Act money, for example, can only be used to cover expenses “incurred due to the public health emergency." Tribes have until Dec. 30 to spend it — and even today, activists on the Navajo Nation stress that the money has still not trickled down to the communities that need it most.

The National Indian Health Board and tribal leaders contend the constraints are unrealistic. It’s impossible to provide effective COVID-19 relief without addressing overarching infrastructure, they said — and you can’t build a hospital, water lines or housing by late December.

They also said addressing the health care disparities within the Navajo Nation will cost far more than $714 million, with a planned replacement of the Gallup Indian Medical Center estimated to cost most of that amount, or $550 million. Providing safe drinking water and basic sanitation for everyone on the reservation would cost another $700 million, according to Indian Health Service.

“Is it any wonder we are in the space we are now?” said Dr. Mary Owen, president of the Association of American Indian Physicians and a member of Alaska’s Tlingit band. “Everybody says, ‘You have to make do with what you got.’ Do we? Really? Well, then, give us back those lands.”

Gregory Smithers, a history professor at Virginia Commonwealth University who studied the coronavirus assault on tribes, said infection rates, suffering and deaths are ultimately a result of systemic racism, from historical subjugation to contemporary poverty.  

“They really weren’t ready for this type of storm ... and the reason they weren’t ready is because of generation after generation of neglect,” Smithers said. “The virus isn’t waiting for governments to get their medical facilities ready.”

Joseph Kalt, co-director of the Harvard Project on American Indian Economic Development, said while there’s a public perception that Indians live on the public dole, the opposite is true. Indigenous people get fewer federal dollars for services than other Americans because they lack political clout. With Native Americans comprising fewer than 2% of the U.S. population, tribal members have little power at the polls, he said. And more than a dozen states have no reservations at all.

“If you’re a member of Congress in one of those states,” Kalt said, “what do you care?”

Shortage of doctors and nurses made pandemic worse

As the county's coronavirus outbreak peaked in April and May, federal authorities converted the gymnasium at Miyamura High School to a field hospital for patients who were improving.

Patients struggled to walk to the bathrooms in the locker room. Volunteers placed chairs along the way as rest stops and posted encouraging signs in English and Diné: “Gramps, you got this.”

Two older patients walked laps around the football field with their oxygen tanks, determined to build strength and go home to their families, said Sanjay Choudhrie, incident commander at the gym.

The gym never housed more than 10 patients at a time because a decision was made to assign nearly all available doctors and nurses to the two area hospitals.

“From the get-go, our problem was a shortage of medical staff,” Choudhrie said.

The Gallup Indian Medical Center was also short on resources. At one point, patient flights to Albuquerque were taking off hourly, with Indian Health Service paying for each trip and costly medical care.

Doctors said they provided the best care they could. Families with loved ones in local hospitals were called frequently with updates. And over 1,000 COVID-19-positive outpatients have been quarantined at area hotels and motels since March, where they’ve received both complex physical and mental health care, according to Dr. Jennie Wei and Dr. Mia Lozada of Gallup Indian Medical Center.

“I can't say we were perfectly ready, but we were building our system and learning as we went,” said Dr. Jonathan Iralu, the Indian Medical Center’s epidemiologist and chief clinical consultant for infectious diseases at Indian Health Service. “People did an amazing job. ... We were able to take on this huge public health threat. And I think it's inspired people.”

The hospital is the largest run by Indian Health Service for the Navajo area, handling 5,800 Native American inpatients and 250,000 outpatients each year. But the facility is outdated and undersized. Local officials said there has been talk of building a replacement medical center for two decades.

Even in better times, crucial health services were not offered. For example, the 50-year-old medical center has no dialysis center despite the fact that adult tribal members suffer from diabetes at nearly three times the rate of white, non-Hispanics. Diabetics are among the highest-risk coronavirus patients.

In 2018, the Gallup facility’s accreditation was threatened based on failures in multiple categories that posed “a threat to patients.” Among them: transfusion errors, medical labeling, use of safety alarms on medical equipment, risk of hospital-borne infections and hygiene. The medical center addressed the issues, and accreditation was granted.

Michael Weahkee, director of Indian Health Service and an enrolled member of the Zuni Tribe, described the Gallup hospital as a "dilapidated structure" that is nearly five times older than the average non-Indian medical facility.

Weakhee said IHS funding levels are 49 percent of what would be equitable using Medicare and Medicaid spending as a benchmark. Asked if the chronic under-funding of indigenous healthcare constitutes systemic racism, Weakhee replied, "The federal government resources its priorities, and Indian healthcare has not been a priority."

"We're doing the very best we can with resources provided to us," said Weakhee, who is married to a Dinè and was born in New Mexico just north of McKinley County.

Laura Hammit, director of infectious disease prevention with Johns Hopkins University’s Center for American Indian Health, said Indian Health Service and Navajo Nation employees were buying supplies with their own money, making PPE on days off and delivering provisions to tribal members in remote areas as the virus peaked in May.

"It is really unfair to chronicle their response as anything other than heroic,” said Hammit, who is based in Gallup and helped fight the Navajo Nation outbreak. “If we want to point a finger anywhere, it needs to be at the federal government."

Dr. Phillip Smith, 70, spent most of his career as a national Indian Health Service administrator before retiring to head Utah’s Monument Valley Health Clinic, which also got hit hard by COVID-19. He said Gallup Indian Medical Center has long lacked lab support, supplies, repairs and technology.

Smith, who is Diné, said his diabetic sister, Florence Dick, tested positive for COVID-19 while staying in a Gallup nursing home. The Indian Medical Center quarantined her in a motel until her condition deteriorated and she was sent to a hospital in Albuquerque, where she died within days.

“We grew up together,” Smith said softly, recounting her death.

Hospital unprepared for surge in COVID-19 cases

The Navajo elder lay in his hospital deathbed and stared at the phone. About 20 members of his family lined up outside their hogan, a traditional dwelling, to pay respects through the screen.

When the last relative had said goodbye, the man died.

It was a “miracle moment,” said Pikaart, the chaplain at Rehoboth McKinley Christian Hospital who arranged the call.

For six months, Pikaart has been surrounded by critical illness and death.

High-flow oxygen pumps made it difficult to hear feeble patients even when they shouted. Pikaart knew she should stay six feet away to protect herself, but she couldn’t resist leaning in two inches away from patients’ faces to catch their final words.

“It was the only way I could hear them,” she said. “And they have things to say.”

As she helped patients and families, others on the Rehoboth McKinley hospital staff were overwhelmed by the patient surge, according to Dr. Rajiv Patel, who supervised the hospital’s eight-bed intensive care unit.

Patel said 17 nurses were laid off in March before the outbreak, leaving a staff short on experience to deal with the pandemic. The hospital has about 520 employees, according to David Conejo, the medical center’s former chief executive.

One night in early May, a ventilator alarm went off during the graveyard shift. The staff, unfamiliar with the device, couldn’t figure out what was wrong, Patel said. When Patel arrived the next morning, he said he discovered the patient’s tracheal tube had shifted and wasn’t delivering oxygen into the lungs.

The tube was reinserted. Two days later, the alarm problem recurred — and so did the confusion.  

“That’s when I decided we had to transfer people out. For this to happen twice was just unacceptable,” Patel said. “We were kind of in over our heads.”

The ICU was mostly shut down. All but one patient in the unit were flown to hospitals in Albuquerque.

The man with ventilator woes remained, too ill for travel.

Given the patient’s precarious health, Patel said it is unclear whether flawed medical care contributed to his demise, “but it didn’t help.”

A “statement of deficiencies” report by the Centers for Medicare and Medicaid Services, obtained by USA TODAY, describes repeated problems with a “maladjusted” ventilator tube that slipped out of the patient’s windpipe “rendering it useless for hours. The patient died in the following days.”

Patel, whose wife is Diné, resigned citing safety concerns. Other employees cast a no-confidence vote against Conejo, who was subsequently fired, according to court records.

Ina Burmeister, a Rehoboth McKinley spokesperson, said 15 contract nurses were laid off after the CDC recommended hospitals delay elective surgeries and other non-essential procedures because of the outbreak. Burmeister did not respond to questions about the patient’s death or Conejo’s dismissal, but she said under new management “we have strengthened internal controls and implemented new administrative policies to ensure the clinical quality.”

In a federal lawsuit against the hospital and some employees challenging his firing, Conejo alleges the Rehoboth McKinley board directed the nurse layoffs, and he blamed subordinates, including Patel, for accepting an overload of COVID-19 patients from the detox center.

In an interview, Conejo reiterated those points and portrayed himself as the victim of a “mutiny” by self-interested employees.

Medical officials got no clarity from federal authorities as the pandemic arrived in Gallup in March, Conejo said. Training was offered at a command center, he said, but after the session was over an instructor told him: “You realize I’m making all this up, don’t you?”

Conejo said about 20 key hospital employees got infected, were quarantined or quit, which compounded the staffing crisis.

At that point, Conejo said, he became the fall guy: “As soon as the shit hits the fan, everybody says, ‘The CEO did it.’ ”

Tribal members work to save their own

Randy Chatto navigated the long, dirt roads until he found it: a red, mobile-home-like structure in the middle of open desert. He hopped out of his truck and called out a Navajo greeting: “Yá'át'ééh!”

Gilbert Martinez, a Navajo elder, has lived alone in this home for years. He has no running water and the closest store, a gas station market, is miles away. Freshly returned from herding his sheep, he was happy to see Chatto, mostly because he had run out of food and water that day.

Since February, Chatto and his team have worked with local nonprofits like Navajo and Hopi Families COVID-19 Relief Fund and McKinley Mutual Aid to bring supplies to people who live in Ramah Navajo land — where Chatto is from — in areas so remote that some die en route to the hospital.

Diné prophecies have for generations told of a devastating illness that would require the community to come together. Many tribal members said these stories predicted COVID-19.

After the pandemic hit, young children wrapped up bundles of medicine for their elders. Diné in other states sent medical supplies and food to relatives on the reservation. As for community leaders like Chatto, he said he knew better than to wait for federal relief.

“We said, ‘We have to start helping our people,’” Chatto said. “Time is crucial and lives are at stake."

Ira Vandever, incident commander for Baca-Prewitt Chapter of the Navajo Nation, said it was the community response — not government relief — that saved lives.

“That’s just resiliency — that’s just a reaction of our own culture to get through this,” he said. “We’ve been dealing with diseases and [injustice] since 1492, when Columbus came. And we’re still here.”

Diné activists like Dr. Crystal Lee, CEO and founder of United Natives, a nonprofit aimed at supporting Native American youth, stress the power of turning to the community for culturally competent answers while recognizing the need that persists.

“A lot of our solutions are within ourselves, within our communities,” said Lee, pointing, for example, to an intertribal quarantine site United Natives co-created as part of COVID-19 relief. “But what if we have the knowledge without any resources?"

Other volunteers from across the United States stepped in to make up for the lack of health care.

Doctors and nurses from the University of California-San Francisco, Johns Hopkins University School of Medicine, New Mexico’s Medical Reserve Corps, the state’s National Guard and elsewhere rushed to McKinley County to bolster medical staff and deliver supplies.

Gary Morsch, an emergency doctor from Olathe, Kansas, recognized the pandemic threat early and founded a nonprofit known as COVID Care Force. After bringing volunteer medical workers to New York City in early April, the former Army physician shifted to Gallup and Shiprock later in the month. Morsch said his teams filled in for doctors and nurses at Gallup Indian Medical Center who were sick or quarantined, helped remaining staffers who were exhausted and monitored patients in motels and nursing homes.

“It was tough – busy, busy, busy,” Morsch said, referring to conditions at the Indian Medical Center. “Every room was full.”

As money and resources arrived, the Navajo Nation and New Mexico adopted get-tough policies to enforce lockdowns and pandemic protections. Gallup was locked down May 1, with roads leading into town closed and nonessential businesses shuttered for 10 days. In the first two weeks of May, Navajo police issued nearly 500 citations to curfew violators, according to The Arizona Republic.

But, in recent weeks, cases have increased on and surrounding Navajo Nation land.

“Our health care system on the Navajo Nation cannot handle another large surge in cases,” Nez said in an Oct. 3 press release.

And for many families, the Big Cough has already wrought its destruction.

After Melvina Musket’s parents died, it wasn’t easy for family members to arrange a double funeral. There were so many deaths in McKinley County, the cemetery staff couldn’t immediately provide a date for the burial. As a safety precaution, there would be no service.

“None of the people at the funeral home wanted to touch him,” Musket said of her father.

When the time came, the family gathered at the Rehoboth Cemetery, a barren tableau of white crosses and sagebrush right outside Gallup. Only 10 mourners were allowed; other family and friends stood at the graveyard entrance, six feet apart and wearing masks.

In Navajo culture, when someone dies, there is a long wake where people gather, tell stories, eat, pray and make donations. But in light of COVID-19, that wasn’t possible. Musket placed onto the casket a small Bible her grandmother had given to her parents when they wed. The casket was covered with earth. Flowers were heaped on top. your social media marketing partner