It's no secret that local nurses have been some of the most important players in the fight against coronavirus. But a team from Mass General Hospital isn't just treating COVID-19 here in Massachusetts. They've been deployed to the Navajo Nation, the American Indian territory that spans parts of Arizona, Utah and New Mexico. The reservation has seen nearly 8,000 cases of COVID-19 and nearly 400 deaths. That's for a population of less than 200,000 people. One member of the Mass General team is Lindsey Martin, a nurse practitioner and Director of Global Disaster Response and Humanitarian Action at the hospital's Center for Global Health. Martin spoke with WGBH News' All Things Considered host Arun Rath. This transcript has been edited for clarity.
Arun Rath: Tell us about how the team that you're on ended up heading out to the Navajo Nation.
Lindsey Martin: Sure. So the team that I'm here with is four nurses, all critical care trained nurses. We've all been part of the Mass General response to COVID-19 over the past three months, so it was a team that had become deeply experienced in COVID-10. One of our partners with global disaster response, Project Hope, put out a call for critical care trained nurses to come and support a facility on the Navajo Nation that was in relatively desperate need of ICU trained staff.
Rath: The Navajo Nation has had the highest infection rate per capita in the whole country. Could you break down why that is?
Martin: Sure. So I think what we've learned while we've been here is that the first cases were actually imported cases. So the leadership in the Navajo Nation very quickly realized that coronavirus could be a real threat, and so they locked down the Navajo Nation pretty quickly. However, there were still some people commuting in from Arizona. back and forth. The people living on the Navajo Nation have very limited access to things like water resources. It's what they call a "food desert." There are 13 grocery stores for a territory about the size of several states in New England, and so people naturally have to go from their houses to places to access resources. So it's very hard for them to quarantine and to self-isolate and to socially distance in order to just access basic things. That was a limitation, and so people came into contact with each other. And so the virus initially spread very quickly.
The leadership of the Navajo Nation recognized this and were able to lock down the nation. And actually the rates of infection have been declining over the past couple of weeks, as well as the case fatality rate on the Navajo Nation.
Rath: That's good to hear. So while we've been hearing about cases spiking in other parts of the country, it's a downward trend there in the Navajo Nation?
Martin: Yeah, that's what we're seeing, and that's what what we're hoping to continue to see. However, as I said, a lot of the cases on the Navajo Nation are actually imported. So a lot of people live on the Nation and work in places like Flagstaff and Phoenix and have family in those places, so they transit back and forth. And then there's also a lot of transit between Arizona citizens and the Navajo Nation, particularly tourists coming to certain destinations here. So they're really trying to keep the social distance policies going and they're trying to keep very, very strict curfews in place in order to not see another sharp rise in cases.
Rath: Arizona is one of those hot spots right now, so I could see how that would be a concern.
Martin: Especially because a lot of the medical facilities here depend on Arizona as an onward referral site for patients who become very, very critically ill; particularly patients that require mechanical ventilators or who have some of the organ failures that we've seen related to COVID-19. So as the health facilities reach capacity in Arizona, the facilities is on the Navajo Nation are having to consider keeping the most critically ill patients here. That's another reason why we've deployed here to try to help support that in case that becomes an eventuality.
Rath: Given those very unique challenges on the ground there, is the approach to trying to contain and treat the coronavirus different than what we're following here in Boston?
Martin: It's similar to what we're seeing in Boston, at least in terms of the social distancing practices here. They're very, very strict and very, very well observed. I would say it's different than what we're seeing in some of the other parts of the country, which have pretty dramatically started to reopen despite rising cases.
On the Nation from 8 p.m. to 5 a.m. every single day there's a curfew, so you can't be traveling, you have to be in your home. And then every weekend from 8 p.m. on Friday to 5 p.m. on Monday, the same shelter in place curfew is in existence. There's very limited hours for businesses. There's no dine-in in any restaurants. There isn't the same eagerness to try to reopen. I think they're being very, very strict in terms of their precautions. And I think it's been effective.
Rath: We've seen a lot of reporting, particularly over this weekend, comparing the United States with other countries in the world. A lot of talk about how the United States seems to be lagging behind other countries right now. I'm sure you're sort of aware the broader context given your position. Is there anything from the response you've seen, the successes or challenges of the Navajo Nation, that might be instructive to our country as a whole?
Martin: What we see in the news when we think about the Navajo Nation is there's desperate poverty, people are lacking resources. But what we're not seeing on the news is the fact that they've really instituted a very community-based response instead of an individualistic effort. So there's not people here that are sort of chomping at the bit to get their hair cut or to get back into restaurants. People are taking this effort and really being protective, particularly about vulnerable populations. There's a lot of elderly citizens that live in the Nation. People are what they call "hauling water," so distributing water to those people so they don't have to leave their homes. They're nominating certain individuals to be the ones that go to the grocery store. So I feel like what I'm seeing here is a very community-based effort versus, as I said, a sort of individualistic focus on, how do I get kind of my freedoms back into place?
Rath: It's been about 20 years since I was in the Navajo Nation, but at the time, the people struck me as just exceptionally resilient.
Martin: Yeah. I mean, I would say what I see here on the ground is people who have lived with limitations in resources for hundreds of years, and they've adapted to those limitations. They're also adapting to the spread and the limitations imposed by coronavirus in a way that I don't know that we would be able to as sort of urbanite citizens of Boston or other parts of our country. What I'd most like to communicate is the effort here has just been overwhelmingly impressive.
