Copyright © 2020 Albuquerque Journal
CHINLE, Ariz. – Shortly after noon on Tuesday, Navajo Nation President Jonathan Nez, Miss Navajo Nation and top hospital officials gathered outside the Chinle Comprehensive Health Care Facility in Arizona.
After nine months of battling the scourge of COVID-19, they were eager to catch a glimpse of the much-anticipated vaccine.
Then, a UPS truck pulled up – it had arrived.
A delivery driver unloaded the knee-high box and it was carried into the facility as health care workers gathered around to watch. Staff worked fast – the vials sticking to their rubber gloves – to transfer the vials from dry ice to a freezer designed to keep the Pfizer-BioNTech COVID-19 vaccine at ultra-low temperatures. Some doses were separated out to be sent on to other facilities.
It was the second shipment Chinle had received of the vaccine to ward off the novel coronavirus. The first shipment arrived the day before and several health care workers were vaccinated immediately. Shipments of the vaccine were also delivered to Northern Navajo Medical Center in Shiprock and the Gallup Indian Medical Center as well as other facilities in Arizona.
The Navajo Nation, which spans parts of Arizona, New Mexico and Utah, had among the highest case rates in the country last spring but managed to tamp down the virus significantly over the summer. In August and September there were days where it was reporting single digit or even zero cases. Like much of the country, it is now in the middle of a dramatic surge – although there are some signs that the curve is starting to plateau or decline.
More than 700 residents have died and more than 20,000 have been infected. As of the 2010 census, 173,667 people lived on the reservation, meaning about 11.5% of the population has had COVID-19.
The tribe was allocated 3,900 doses of the Pfizer vaccine this week and it expects to get 7,800 doses of the Moderna vaccine in the next week or so as long as it’s approved by the Food and Drug Administration.
Like their counterparts across the country, Navajo health care workers were the first to be vaccinated so they can be – in the words of President Nez – “bulletproof.”
Addressing a Facebook live town hall, Nez said when thinking about this historic moment he was filled with emotion and his eyes started to well up. He says he will get vaccinated when it’s his turn.
In an interview with the Journal, he said he also recognizes that his community has a long road ahead.
“We’re still in a war, we’re still in a pandemic, but we want our physicians to get vaccinated to get protected because they’re going to be needed throughout the long run of this pandemic on Navajo …,” Nez said. “Yes, this brings hope but we are still in a marathon.”
In Chinle, the first in line was a traditional healer, Roland Begay.
Begay, the coordinator for the Office of Native Medicine, said he remembers his great-grandfather talking about the Spanish Flu of 1918 and how they didn’t have the hospitals or technology they do now. He said they would mix juniper and sage ash to spread on their bodies and then stay in one place for a full moon cycle – basically social distancing and quarantining themselves.
“He talked about it firsthand, it’s a method that had worked for us in the past,” Begay said. “He said by doing so this was the only reason why they’re all here.”
Begay, who comes from a long line of traditional medicine men, said after counseling, comforting and praying over patients and their families for the past nine months, the decision to get the shot was easy. Plus it was important for him to be an example for otherss
“People are skeptical, people that I talk to. And some of them say ‘I’m not sure whether to take it or not,’ ” Begay said. “But the uncertainties, the fear, whatever you feel there’s always hope on the other end.”
The community of Chinle – in the middle of the reservation, just west of the New Mexico border – has had the highest number of reported cases and health officials warned Tuesday that residents need to continue to wear a mask and stay away from those who don’t live in their household.
Nursing home residents and staff will also be receiving the vaccine this week. A spokeswoman for the Indian Health Service wouldn’t say how many people in Chinle will get the vaccine in this first round.
Like Begay, everyone who spoke with the Journal about getting the vaccine, expressed hope but also the knowledge that they had a long way to go and the pandemic is far from over. They all said they had slight soreness in their arms but no serious side effects.
Shortage of ICU beds
Although the Chinle hospital is the largest in the service area, it’s a far cry from urban facilities. When the pandemic began, the pediatric care unit was converted to a respiratory care unit with 21 beds for COVID patients. And while there are four Intensive Care Unit beds, generally only two can be used at a time, said Dr. Eric Wortmann, director of emergency medicine.
This means that when a patient takes a turn for the worse, they have to be transferred to another facility off the reservation.
“Our model has been basically when patients are sick enough to need to be intubated and put on a ventilator, we do that and then we transfer them out because we can’t handle 10 ventilators at the time,” he said. “We don’t have the nursing staff, the respiratory staff or the equipment necessary to do all that.”
Wortmann said there have been points – as recently as two weeks ago – where it looked like they were going to hit a breaking point and fill up. Sometimes the issue is less about their own facility and more about the fact that hospitals in surrounding states are also running out of ICU beds.
So far, each time, they’ve been able to figure it out, Wortmann said.
Still, there are moments that stick with him – like walking out to the parking lot to tell the wife of a relatively young patient he was critically ill. That man had to be transferred and ultimately didn’t make it.
“As health care givers, as physicians, normally we think we can maintain a certain emotional distance from our patients but when you get involved with someone like that you can’t maintain that distance,” he said. “It’s hard.”
So Monday morning, when his boss asked, “Do you want the shot?” Wortmann didn’t hesitate. He said he knows that the only way out of the pandemic is for as many people as possible to get the vaccine.
“It has taken a toll on everybody,” he said. “We try to be brave and we are and we try to do our work as professionals and we do but it has taken a toll on all of us, and it will continue to do so.”
Good for Navajo Nation
Dr. John Tisdale and his wife both work as physicians at the Chinle facility. So the first thing that went through his mind when he was asked about whether he wanted the vaccine was what to do about child care if he had an adverse reaction.
But ultimately he decided not to overthink it and just got it done as soon as he could.
“It has been a long stressful road for everybody so it feels like it’s taken a long time, but at the same time arrived very quickly,” Tisdale said. “So it was probably that balance of excitement and a little bit of hesitation. Here we go into the next step of things for everybody. I was happy to get it and excited for myself and my family and this community.”
Plus, he said, he liked to think about the same scene playing out all over the country this week – as hospital staff in cities around the United States received their vials of vaccine a couple of days after the FDA approved it.
“It was good to feel like it was happening here at the same time we were seeing it happen in big places like New York City,” Tisdale said. “It felt good for this community and Navajo Nation in general that it’s still remembered at the same time as the other places.”
Dennis Charley, an emergency medical technician supervisor, has worked for the Navajo Nation for the past 30 years. He’s nearing retirement.
He says the last nine months have been stressful in ways he couldn’t have imagined. For one thing, the service area his staff covers is massive, so at times they are spending two hours in the back of an ambulance transporting a COVID-19 patient.
The community of Chinle — in the middle of the reservation, just west of the New Mexico border — has had the highest number of reported cases and health officials warned Tuesday that residents need to continue to wear a mask and stay away from those who don’t live in their household.
Before the pandemic, he said they would run maybe 150 to 200 calls a month. Now, he said, it’s more like 250 with only one ambulance since the other is stationed at an alternative care site converted from a school gymnasium.
While he was relieved to have gotten the vaccine – and can’t wait until his wife can get it as well – Charley said the experience was bittersweet as he thinks about the relatives he’s lost to the disease.
The day after he got the shot, his cousin – in his 40s – died from the virus.
“It’s really hard because when that happens – when someone catches the virus – you just have to watch them from the sidelines, you can’t really do anything …,” Charley said. “We’ll look back and wish we had the vaccine way back then. If he had been vaccinated he would have survived.”