>>GOOD AFTERNOON, EVERYONE.
THANK YOU FOR JOINING US
BEFORE WE GET STARTED, JUST
PLEASE NOTE THAT TODAY'S WEBINAR
IS BEING BROADCAST ON NIH
VIDEOCAST AND BEING RECORDED.
IF YOU ARE A PRINCIPAL
INVESTIGATOR OR NIH SUPPORTED
RESEARCHER, WE HOPE YOU JOIN US
HERE ON ZOOM WHERE YOU WILL BE
ABLE TO ASK QUESTIONS DIRECTLY
DURING THE Q&A PORTION OF THE
SESSION.
IF YOU'RE UNABLE TO JOIN ZOOM,
PLEASE JOIN US VIA THE NIH
VIDEOCAST EVENT DESCRIPTION
LINK.
THANK YOU.
NEXT SLIDE.
FOR EVERYONE VIEWING TODAY,
CLOSED CAPTIONING HAS BEEN
AUTOMATICALLY ENABLED.
IF YOU'RE UNABLE TO SEE THE LIVE
TRANSCRIPT, IT WILL BE AVAILABLE
IF YOU SELECT CLOSED CAPTION ON
ZOOM AND CC ON THE NIH
VIDEOCAST.
AMERICAN SIGN LANGUAGE
INTERPRETER IS ALSO SUPPORTING
THIS BROADCAST.
THE INTERPRETER CAN ONLY LISTEN
TO THE WEBINAR AND CANNOT
COMMUNICATE WITH THE AUDIENCE.
PARTICIPANTS JOINING THE SESSION
THROUGH ZOOM WILL NOT BE ABLE TO
UNMUTE THEIR AUDIO OR TURN ON
THEIR VIDEO.
YOU WILL, HOWEVER, BE ABLE TO
SUBMIT QUESTIONS IN THE Q&A
PORTION OF THE ZOOM ON THE
SCREEN.
ALL RIGHT, WITH THAT, NEXT
SLIDE, PLEASE.
TODAY'S SESSION, WE ARE EXCITED
TO BRING TO YOU FROM THREE NIH
EFFORTS THAT NIH RESEARCH IN
COVID TO ENHANCED RECOVER
INITIATIVE, OR WHAT IS KNOWN AS
NIH RECOVER.
IN PARTNERSHIP WITH THE
COMMUNITY ENGAGEMENT ALLIANCE,
CEAL, AND WITH OUR TRIBAL HEALTH
RESEARCH OFFICE AT NIH.
FOR MORE INFORMATION ABOUT ANY
OF THESE THREE INITIATIVES,
PLEASE VISIT THEIR WEBSITES
WHICH WE ARE PUTTING IN THE CHAT
NOW.
AND WE'LL PROVIDE A LITTLE MORE
DETAIL AT THE END OF THIS
PRESENTATION.
I'D LIKE TO JUST SHORTLY RUN
THROUGH TODAY'S AGENDA.
TODAY WE'LL START WITH A WELCOME
AND INTRODUCTION.
THEN WE'LL MOVE INTO THREE
EXCITING PANELISTS WHO WILL
PRESENT SOME OF THEIR WORK AND
THEIR EFFORTS.
AND THEN WE'LL OPEN IT UP AND
OUR MODERATOR WILL ENGAGE IN A
PANEL DISCUSSION AND WE'LL ALSO
TAKE Q&As -- YOUR QUESTIONINGS
THAT THE TIME.
NEXT SLIDE.
SO, WITHOUT FURTHER ADIEU, I'M
PLEASED TO INTRODUCE MY
COLLEAGUE, AS TODAY'S MODERATOR.
MOSE IS SENIOR ADVISOR OF THE
TRIBAL HEALTH RESEARCH OFFICE.
HE IS A MEMBER OF THE SAINT
REGIS MOHAWK NATION, TURTLE
CLAN.
PRIOR TO COMING TO NIH, HE
WORKED FOR THE INIAN HEALTH
SERVICE AS THE CEO FOR THE HOPI
HEALTH CARE CENTER IN THE
PHOENIX AREA.
HE ALSO LED PLANNING AND
EVALUATION, RESEARCH AND
BEHAVIORAL HEALTH DIVISIONS AT
THE IHS HEADQUARTERS.
MOSE HELD CLINICAL POSITIONS AT
THE VETERANS HEALTH
ADMINISTRATION AND THE INDIAN
HEALTH SERVICE URBAN INDIAN
HEALTH PROGRAMS.
AND ALSO SERVED AS AN ADJUNCT
FACULTY POSITION AT BOSTON
UNIVERSITY AND THE FITCHBURG
STATE COLLEGE.
HE WAS THE PUBLIC HEALTH
DIRECTOR FOR THE FRANKLIN COUNTY
HEALTH DEPARTMENT IN NEW YORK
STATE AND IS A GULF WAR VETERAN
HAVING SERVED AS A NUCLEAR
PROPULSION PLANT OPERATOR ON THE
U.S. NAVY FLEET BALLISTIC
MISSILE -- EXCUSE ME.
BALLISTIC MISSILE AND FAST
ATTACK SUBMARINES.
SO THANK YOU FOR YOUR SERVICE,
MOSE.
MOSE IS AN UNDERGRADUATE DEGREE
IN PSYCHOLOGY FROM CLARKS BERG
UNIVERSITY, MASTERS IN SCIENCE
DEGREE IN NEUROSCIENCE FROM
BRAND ICE UNIVERSITY AND AN NPH
IN ENVIRONMENTAL SCIENCE FROM
BOSTON UNIVERSITY SCHOOL OF
PUBLIC HEALTH.
WITH THAT, I'M EXCITED TO TURN
TODAY'S WEBINAR OVER TO YOU,
MOSE.
THANK YOU.
>>THANK YOU VERY MUCH
DR. JOHNSON AND WELCOME
EVERYBODY.
I'M REALLY EXCITED TO BE HERE
TODAY TO MODERATE TODAY'S
WEBINAR AND I LOOK FORWARD TO
HEARING FROM OUR GREAT PANEL OF
SPEAKERS.
OUR OBJECTIVES TODAY WE HOPE TO
SPOTLIGHT SUCCESSFUL APPROACHES
USED DURING THE COVID-19
PANDEMIC TO ENGAGE TRIBAL
COMMUNITIES BY HEARING FIRSTHAND
FROM EXPERTS ABOUT BEST
PRACTICES FOR ENGAGEMENT.
WE ALSO HOPE TO SHARE INSIGHT
INTO HOW TO BUILD RELATIONSHIPS
BETWEEN TRIBAL COMMUNITY MEMBERS
AND THE RESEARCHERS AND
COMMUNITY ORGANIZATIONS INVOLVED
IN THAT EFFORT.
AND WE ALSO WANT TO HEAR FROM
YOU, THE PRINCIPAL INVESTIGATORS
AND RESEARCHERS AT NIH RECOVER
AND CEAL, TO BETTER UNDERSTAND
WHAT CONCERNS, EXPERIENCES AND
QUESTIONS IN COVID-19 AND LONG
COVID RESEARCH YOU MAY HAVE.
TODAY'S WEBINAR WILL COMPRISE A
SERIES OF PRESENTATIONS FROM
EACH OF THE PANELISTS FOLLOWED
BY AN INTERACTIVE DISCUSSION
WITH ME AND THEN QUESTIONINGS
AND ANSWERS WITH PARTICIPANTS.
RESEARCH ON THE LINE --
RESEARCHERS ON THE LINE, WE
ENCOURAGE YOU TO SHARE YOUR
ENGAGEMENT EXPERIENCES AND ASK
QUESTIONS TO PANELISTS.
PLEASE ADD ANY QUESTIONS YOU MAY
HAVE TO THE Q&A.
SO LET'S GET STARTED.
I WOULD LIKE TO TAKE THE
OPPORTUNITY TO INTRODUCE OUR
PANELISTS.
FIRST WE'LL HEAR FROM LIEUTENANT
SHAW NEL DAMON, MPHMS.
THE GRANDDAUGHTER OF THE LATE
MOLLY DAMON, THE LATE CODE
TALKER AND THE DAUGHTER OF
LUCINDA DAMON FROM OLD SAWMILL
ARIZONA.
SHAW NEL WAS BORN FOR THE ASHE
HE AND HER PATERNAL CLANS ARE
BILLA GHANA, [ SPEAKING NATIVE
LANGUAGE ] SHE IS THE ACTING
PUBLIC HEALTH DIRECTOR OF THE
NAVAJO AREA INDIAN HEALTH
SERVICE AND SHE WORKED TO
IMPLEMENT HEALTH PROMOTION,
DISEASE PREVENTION PROGRAMS THAT
INCLUDE TEACHING AND TRAINING
THROUGH PUBLIC HEALTH ACTIVITIES
AND EVENTS WHICH FOCUS ON SELF
AWARENESS, HEALTH LITERACY AND
CULTURAL COMPETENCY THROUGHOUT
THE NAVAJO COMMUNITY.
WE WILL THEN HEAR FROM DR. LAURA
HAMIT, THE DIRECTOR OF
INFECTIOUS DISEASE PROGRAMS AT
THE CENTER FOR INDIGENOUS HEALTH
AND ASSOCIATE PROFESSOR AT THE
JOHNS HOPKINS BLOOMBERG SCHOOL
OF PUBLIC HEALTH.
SHE HAS BEEN ON THE FACULTY
SINCE 2011.
SHE HAS OVER 20 YEARS OF
EXPERIENCE STUDYING VIRAL AND
BACTERIAL RESPIRATORY INFECTIONS
AND WORKS IN PARTNERSHIP WITH
NATIVE-AMERICAN COMMUNITIES IN
THE SOUTH WEST UNITED STATES TO
UNDERSTAND AND ADDRESS
INFECTIOUS DISEASES IN A
CULTURALLY-INFORMED MANNER.
WE WILL THEN HEAR FROM CAPTAN
HOLLY VAN LOU.
SHE IS AN ADVANCED PRACTICE
PHARMACIST AT THE INDIAN HEALTH
SERVICE.
A NATIONAL TRAINER FOR MULTIPLE
PHARMACISTS AND PHARMACY
TECHNICIAN IMMUNIZATION
CERTIFICATE PROGRAMS.
HAVING TRAINED OVER 1500
PHARMACISTS, STUDENTS AND
TECHNICIANS TO ADMINISTER
VACCINES.
SHE WORKS AT THE LOCAL, REGIONAL
AND NATIONAL LEVEL TO EDUCATE
PHARMACISTS, PROVIDERS AND
NURSES ABOUT IMMUNIZATIONS WITH
A FOCUS ON ADDRESSING PATIENT
VACCINE NEEDS.
OUR FIRST PRESENTER TODAY IS
LIEUTENANT DAMON.
OVER TO YOU.
>>LIEUTENANT DAMON: HI, GOOD
AFTERNOON.
SHAW NEL DAMON -- [ SPEAKING
NATIVE LANGUAGE ]
I'M THE PUBLIC HEALTH DIRECTOR
FOR THE NAVAJO AREA INDIAN
HEALTH SERVICE AND ACTING
CAPACITY.
THANK YOU FOR COMING ON TO THE
WEBINAR AND GO TO THE NEXT
SLIDE, PLEASE.
SO JUST TO GIVE YOU SOME
BACKGROUND.
THE NAVAJO NATION, WE ARE THE
LARGEST TRIBE IN THE UNITED
STATES.
WE COVER THREE GEOGRAPHIC
STATES, UTAH, ARIZONA AND NEW
MEXICO.
AND THEN ALSO WE HAVE 27,000
SQUARE FEET MILES WITH FIVE
DIFFERENT SERVICE UNITS AND THEN
THE FEDERAL SERVICE UNITS ARE IN
[ SPEAKING NATIVE LANGUAGE ] AND
THEN THE TRIBAL ONES ARE [
SPEAKING NATIVE LANGUAGE ] JUST
TO GIVE YOU SOME BACKGROUND OF
OUR GEOGRAPHIC LOCATION.
NEXT SLIDE, PLEASE.
SO, ON MARCH 17, WE HAD OUR
FIRST CONFIRMED CASE OF COVID-19
COVID-19.
THE TRAVEL TO TUCSON ARIZONA AND
THEN TRAVELED BACK.
AND FROM THAT ONE CASE BY THE
END OF THE WEEK, WE WERE UP TO
ALMOST 100 CASES.
AND THE NAVAJO AREA IMMEDIATELY
REACHED OUT TO THE NAVAJO
EPICENTER AND VICE VERSA TO MAKE
SURE THAT WE WERE ABLE TO
FINALIZE PIECES AND START
SURVEILLANCE PROJECT OR OUR
ACTIVE SURVEILLANCE WITH ONE
ANOTHER.
THEN WE ALSO STARTED OUR DATA
SHARING.
EVERY DAY DAILY, WE WOULD GO
STRAIGHT OVER TO NAVAJO
EPICENTER.
SO WE HAD PATIENTS THAT WERE
SEEN ALL --
[ AUDIO DIFFICULTIES ]
SO HERE WE HAVE OUR FIRST PIECE
AND THEN YOU CAN SEE OUR
SURROUNDING SERVICE UNITS.
A FEDERAL SERVICE UNIT AND
TRIBAL SERVICE UNIT.
FROM THIS ONE EPILOCATION, OR
EPICENTER, A LOT OF PIECES
ACTUALLY HAPPENED TO TRAVEL AND
THEN OVERFLOW PATIENT CARE WENT
OTHER AREAS.
THESE WERE THE MOST AFFECTED
PLACES AT THE BEGINNING OF THE
FIRST SEARCH.
NEXT SLIDE.
HERE YOU CAN SEE OUR EPICURVE OF
THE PANDEMIC.
SO FAR AT THE FIRST CURVE IN THE
FIRST SURGE, WE SEE THAT WE HAD
AT THAT TIME, WE HAD NO MASK.
WE HAD TO GET DONATIONS FOR
MASK.
WE HAD JUST ENOUGH TO WHERE WE
UTILIZED SURGICAL MASK AND
REUSED THEM AT THE TIME.
WE HAD TO MAKE SURE THAT WE
DIDN'T HAVE ENOUGH TEST KITS.
THERE WAS A BOTTLENECK AT LAB
CORE WITH OUR COMMERCIAL
CONTRACTS AND THEN ALSO A
BOTTLENECK WITH THE STATE.
SO WE HAD NOT ENOUGH TESTING
CAPACITY DURING THE FIRST SURGE.
WE HAD TO MAKE SURE THAT IF ONE
PERSON WAS POSITIVE, THAT WE
COMMUNE CALLED TO THE WHOLE
FAMILY TO STAY HOME.
AND WE TREATED THE WHOLE FAMILY
AS POSITIVE CASES.
YOU CAN SEE THROUGH THE FIRST
SURGE.
AND THEN THE SECOND ONE, IT
HAPPENED IN THE FALL.
WE ARE SEEING RIGHT NOW WITH
COVID-19.
SO WE ARE -- IN THE SECOND
SURGE, WE ARE PREPARING FOR THE
VACCINE, PREPARING FOR THE
GUIDELINES OF WHEN THIS VACCINE
IS GOING TO COME OUT.
WHO IS GOING TO HAVE PRIORITY?
WHERE ARE WE GOING TO GET IT?
HOW WILL WE GET IT OUT ACROSS
THIS GEOGRAPHIC LOCATION?
AND THEN YOU FINALLY SEE THAT IN
DECEMBER AND THEN JANUARY, THE
VACCINE COMES AND WE ACTUALLY
HAVE A SLOWING AND SPREAD THERE.
AND THEN WE HAVE OUR THIRD SURGE
IN THE FALL AGAIN.
AND THEN OF COURSE THE OHM CRON
SURGE THAT TOOK PLACE IN JANUARY
OF LAST YEAR.
SO THROUGH THESE SURGES, YOU CAN
SEE THAT WE DEFINITELY HAD TO
MAKE SURE THAT WE KNEW THE
SURVEILLANCE DATA OF WHAT WAS
GOING ON ON THE NAVAJO NATION.
WHO WAS POSITIVE?
HOW MANY PEOPLE WERE WE LOSING A
DAY?
AND THEN WE WERE AFFECTED
EXPONENTIALLY AT THE BEGINNING
OF THE PANDEMIC.
NEXT SLIDE, PLEASE.
SO WE DEFINITELY HAD SOME
CHALLENGES BEFORE THE PANDEMIC.
THERE WAS NO REALLY LIKE EPITEAM
AT NAVAJO AREA.
I HAVE BEEN DELEGATED AS THE
EPIDEMIOLOGY CHIEF BECAUSE I
WORKED FOR THE STATE AND HEALTH
SERVICES IN TEXAS AS A
EPIDEMIOLOGIST AND THE WEST
TEXAS FOR 36 STATES.
I GOT DELEGATED TO BE THE NAVAJO
AREA EPIDIRECTOR AT THAT TIME.
AND WE HAD NO STATISTICAL
SOFTWARE.
WEIDES EXCEL.
WE DID MANUAL DATA EXTRACTIONS
FROM OUR E HAD.
R AND WE KEPT A DAILY LIST THAT
WE SHARED OVER WITH THE NAVAJO
EPICENTER AND THEIR DATA WAS
SENT BACK AND FORTH TO ONE
ANOTHER.
AND SO BEFORE COVID, THE WAY THE
DATA WAS SHARED WITH THE NAVAJO
EPICENTER IS THAT THE HEALTH
CARE CENTERS WOULD SEND DATA TO
THE STATE AND THE STATE WOULD
SEND THE DATA TO THE NAVAJO
EPICENTER.
WHEN WE HAD OUR FIRST MEETING,
WE SAID WE WERE GOING TO BY PASS
THE STATE AND FEED DIRECTLY INTO
THE NAVAJO EPICENTER.
SO THAT WAS LIKE ONE OF THE BEST
PRACTICES IN DATA SHARING SO WE
COULD REPORT OUT HOW MANY CASES
OF COVID WE HAD ON A DAILY BASIS
THROUGHOUT THIS WHOLE PANDEMIC.
NEXT SLIDE, PLEASE.
SO OUR STRENGTHS, WE PARTNERED
WITH THE CD R AND WE WERE ABLE
TO CREATE A DUPLICATION TOOL
THROUGH EXCEL.
WE STILL USE THIS TOOL EVERY DAY
TO MAKE SURE THAT WE ARE ONLY
COUNTING ONE CASE OF NEW CASES.
ALSO, WE HAVE AND STILL UTILIZE
A DATABASE THAT HOLDS ALL OUR
CASES.
AND THEN FINALLY, WE WERE
TRAINED IN SAS.
HERE IS OUR TEAM HERE.
WE WERE ABLE TO HIRE MONIQUE
AFTER THE THE FIRST YEAR OF
COVID AND THEN DR. CAT REASON
AND I WERE THE ONES HOLDING DOWN
THE FORT.
AND THEN WE ALSO CREATED A GREAT
PARTNERSHIP WITH JOHNS HOPKINS
UNIVERSITY AND WE OBTAINED A
GREAT EPIDEMIOLOGIST WHO
ACTUALLY HELPED US WITH THE DATA
TESTING DATA ON A WEEKLY BASIS
WHERE SHE WOULD -- WE WERE ABLE
TO KNOW EXACTLY HOW MANY TESTS
WE WERE, LIKE TESTING, HOW MANY
NEW PATIENTS WE WERE TESTING,
HOW MANY PEOPLE WERE GETTING
REPEATED TESTING.
SO WE WERE ABLE TO REALLY WORK
TOGETHER WITH ALL OF OUR
PARTNERS TO STRENGTHEN OUR
EPISURVEILLANCE.
NEXT SLIDE, PLEASE.
ALSO, ONE OF THE BEST TECHNIQUES
THAT WE ALSO HAD WAS TRAINING
AND HIRING OUR OWN CONTACT TRACE
WORKFORCE, WHICH IS BEING
SUSTAINED TODAY.
WE WERE ABLE TO PARTNER WITH A
NONPROFIT THAT IS HELD OUGHT OF
NEW MEXICO.
OUR LOCAL COMMUNITY COLLEGE, THE
STATE OF NEW MEXICO AND THE CDC
TO SUSTAIN THIS CONTACT TRACING
TEAM.
SO THIS PICTURE YOU CAN SEE THAT
IT'S A COMBINATION OF CDC AND
NAVAJO NATION EMPLOYEES.
AND THEN WE WERE ALSO AT NAVAJO
AREA ABLE TO BRING ON YOUNG
WORKFORCE WHO BECAME CONTACT
TRACERS.
AND THROUGH THIS PARTNERSHIP, WE
WERE ABLE TO CREATE A HIPPA
COMPLIANT DATABASE THAT WE WERE
ABLE TO SHARE WITH OUR FEDERAL
SERVICE UNITS AND OUR TRIBAL
SERVICE UNITS.
WE WERE ABLE TO TRANSFER
PATIENTS TO ONE ANOTHER AND TALK
TO EACH OTHER DURING THE TIME OF
COVID AND NOT HAVE TO FAX AND
E-MAIL EACH OTHER THE DATA.
IT WAS SENT DIRECTLY TO ONE
ANOTHER.
SO NEXT SLIDE, PLEASE.
SO OUR BIGGEST STRENGTHS HERE
WAS COMING TOGETHER AS A ACOC
AND THAT IS A UNIFIED COMMAND
WITH THE NAVAJO NATION.
AND THROUGH THAT PARTNERSHIP, WE
WERE ABLE TO CREATE DIFFERENT
TEAMS.
SO WE HAD A PUBLIC HEALTH
MESSAGING TEAM THAT CREATED SOME
OF THE MOST CREATIVE MESSAGING
THAT YOU CAN SEE HERE ON THE
SCREEN.
WE HAD A COMMUNITY MITIGATION
TEAM THAT HELPED WITH SCHOOLS.
AND REALLY WORKED TO ADVOCATE TO
GET OUR CHILDREN BACK IN SCHOOL.
THEN WE HAD THE UNIFIED EPITEAM.
SO NOT JUST MONITORING THE
NUMBERS AND CARRY AND SHARING.
WE WORKED WITH AN EPITEAM FROM
THE NAVAJO EPICENTER AND THEN
WITH THE CDC AND JOHNS HOPKINS.
THIS TEAM IS REALLY POWERFUL
GROUP RIGHT NOW.
IT'S REALLY GREAT TO SEE ALL THE
ACTIVE SURVEILLANCE THAT IS
TAKING PLACE NOW.
WE MOVED OVER TO MONKEY POX, FLU
AND RSV.
SO NOW THIS IS A VERY DIMENSION
ALGROUP WE HAVE TOGETHER.
AND THEN WE HAD A BEHAVIORAL
HEALTH TEAM TO MAKE SURE THAT WE
ARE -- ONE OF THE BIGGEST LONG
COVID -- I THINK LIKE IT WILL BE
LIKE -- CODISPARITY OR PROBLEM
WOULD BE BEHAVIORAL HEALTH.
SO WE DEFINITELY HAVE A
BEHAVIORAL HEALTH TEAM TO MAKE
SURE WE ARE ADDRESSING A LOT OF
POST-COVID MISFORTUNATE
HAPPENINGS FROM LONG COVID.
SO SORRY.
AND THEN WE HAVE A CASE
MANAGEMENT TEAM.
THIS TEAM IS ACTUALLY WORKING
REALLY GOOD IN PARTNERSHIP WITH
THE NAVAJO NATION.
WE ARE ABLE TO GET FOOD TEST
KITS OUT.
FOOD AND HOME TEST KITS OUT TO
THE COMMUNITY.
WE ARE ABLE TO MAKE SURE THAT WE
WERE ABLE TO SET UP HOTEL AND
ISOLATION PLACES FOR PEOPLE TO
ISOLATE BECAUSE WE HAVE
MULTIGENERATIONAL HOMES.
AND THEN ALSO JUST TO SERVE THE
COMMUNITY AS A CAPACITY SO WE
COULD ANSWER THE PHONE AND BE
THERE TO ANSWER YOUR QUESTIONS
REGARDING COVID OR COMING INTO
THE CLINIC.
NEXT SLIDE, PLEASE.
SORRY ABOUT THAT.
SO, WE HAVE TO BE VERY
INNOVATIVE IN OUR RESPONSE.
WE DO NOT HAVE ENOUGH, LIKE I
SAID, ENOUGH FACE MASK, NOT
ENOUGH TEST KITS.
WE HAD TO MAKE AND USE REUSABLE
GOWNS.
WE SEWED GOWNS IN OUR HCOC AND
THEN ALSO WE USED FACE MASK AND
FACE SHE WOULDS AND A LOT OF THE
FACE SHIELDS WE GOT CAME LATER
IN THE PANDEMIC.
SO WE WORE WELDING FACE SHIELDS.
WE HAD TO RE-USE N95s.
WE RECEIVED TONS OF DONATIONS
FOR CLOTH MASK.
AND WE HAD TO PRIORITIZE OUR
HIGHEST RISK PATIENTS.
SO WHEN YOU CAME TO THE HOSPITAL
TO GET TESTED, IF WE KNEW YOU
WERE GOING TO BE OKAY, WE MADE
ACCOMMODATIONS FOR YOU TO GO
HOME OR TO ISOLATE.
BUT FOR OUR ELDERS AND OUR
IMMUNOCOMPROMISED, WE HAD TO
PRIORITIZE THEIR CARE AND GET
THEM IN.
AND THEN MAKING SURE THAT THERE
ARE DRIVE-THROUGH CLINICS.
THEY BECAME OUR BEST PRACTICE.
MAKING SURE WE CAN DO DRIVE
THROUGH TESTING, THRIVE THROUGH
VACCINATION CLINICS AND MAKING
SURE THAT WE CAN KEEP THE MOST
VULNERABLE INSIDE THE HOSPITAL
AND THEN PROTECT THOSE THAT
DIDN'T NEED TO BE IN THE
HOSPITAL.
SO THEY COULD JUST DRIVE
THROUGH.
NEXT SLIDE, PLEASE.
SO OUR COVID RESPONSE.
WE DEFINITELY HAD TO INCREASE
OUR CAPACITY TO SERVE OUR
INPATIENT.
AND SO WE HAD TO EXPAND OUR
ICUs.
WE ALSO HAD TO RE-TRAIN AND
RE-ASSIGN STAFF.
SO A LOT OF OUR DENTAL AND
PHYSICAL THERAPISTS BECAME
CONTACT TRACERS OR BECAME
VACCINATORS OR THEY HELPED
TRIAGE PATIENTS THROUGH THE
HOSPITALS.
SO WE DEFINITELY HAD TO WORK ON
EXPANDING OUR HEALTH CENTERS.
NEXT SLIDE, PLEASE.
SO, AGAIN, WITH THE CLINICAL AND
LAB TESTING, WE DEFINITELY SAW A
BIG, BIG BOTTLENECK WITH OUR
LABS DURING THE FIRST SURGE.
WE DEFINITELY ACQUIRED NEW LAB
TECHNOLOGY DURING OUR SECOND AND
THIRD SURGE SO WE COULD INCREASE
OUR CAPACITY FOR TESTING.
AND SO, WE WENT FROM 3000 TESTS
A DAY TO 165,000 TESTS THAT WE
WERE ABLE TO TEST THROUGHOUT
NAVAJO.
AND THEN ALSO MAKING SURE THAT
WE CAN DO OUR SURVEILLANCE.
SO THIS WAS ONE OF OUR BEST
PRACTICES TOO THAT CAME OUT OF
WORKING TOGETHER WITH THE NAVAJO
NATION AND THE CDC AND T GEN.
A NON-PROFIT ORGANIZATION IN
PHOENIX WHO WORKS ON GENOMICS.
SO WE WERE ABLE TO HAVE OUR FIVE
SERVICE UNIT AND OUR TRIBAL
SERVICE UNITS SEND OUR TEST
RESULTS TO T-GEN SO THEY COULD
TELL US WHAT STRANDS OF COVID
ARE CIRCULATING WITHIN THE
NAVAJO NATION.
AND SO, I THINK WE ARE THE ONLY
RESERVATION THAT COULD ACTUALLY
TELL YOU WHAT IS OUT THERE.
A LOT OF PEOPLE FOLLOW THE STATE
AND WHAT THE STATE DATA SHOWED
AND THEN THEY USED THAT TO
HYPOTHESIZED WHAT WAS
CIRCULATING IN THEIR AREA.
BUT FOR NAVAJO, WE KNEW WHAT WAS
GOING ON.
NEXT SLIDE, PLEASE.
ALSO, WE HAD A LOT OF TEAMS THAT
WE HAD TO ESTABLISH.
SO WE HAD A PATIENT MOBILIZATION
TEAM THAT MADE SURE WE TRACKED
ALL OF OUR PATIENTS WHO WERE
BEING ISOLATED IN HOTELS.
AND WE ALSO HAD TO MAKE SURE
THAT THOSE PEOPLE THAT WERE IN
HOTELS HAD NURSING STAFF AND
DOCTORS AVAILABLE FOR THEM TO
CHECK ON THEM WHILE THEY WERE
ISOLATING IN THE HOTELS.
AND UNFORTUNATELY, IN THE
HOTELS, WE HAD LOST A FEW OF OUR
TRIBAL MEMBERS WHO WERE --
DIDN'T MAKE IT THROUGH THE NIGHT
IN THOSE HOTELS.
SO WE DEFINITELY HAD TO MAKE
SURE WE HAD PROTOCOLS IN PLACE
AND STAFF TO STAFF THOSE PLACES.
AND IN PARTNERSHIP WITH THE NEW
MEXICO STATE.
SO WE ALSO WORKED TO WORK WITH
THE UNSHELTERED POPULATION AND
MAKING SURE THEY HAD HOTELS THAT
THEY COULD GO TO TO ISOLATE,
WHETHER THEY HAD COVID OR NOT.
AND THIS HELPED TO SLOW THE
SPREAD OF COVID WITHIN OUR HIGH
GEOGRAPHIC AREAS LIKE GALLUP OR
BORDER TOWN AREAS.
NEXT SLIDE, PLEASE.
AND THEN WE HAD TO WORK ON
VOLUNTEERS.
SO IF YOU WORKED FOR THE FEDERAL
GOVERNMENT OR GET A JOB WITH
FEDERAL GOVERNMENT, THERE IS A
LONG BACKGROUND CHECK.
SO WE NEEDED TO MAKE SURE WE
EXPEDITED HOW WE COULD BRING ON
PEOPLE.
SO, WE DID A VERY FAST WAY OF
EXPEDITING BACKGROUND CHECKS.
WE WERE ABLE TO RECRUIT AND
SUSTAIN AND BRING ON VOLUNTEERS
FROM A LOT OF DIFFERENT
AGENCIES, JOHNS HOPKINS, CDC,
DOCTORS WITHOUT BORDERS, ALL
HERE READY TO HELP AT OUR
SERVICE UNITS.
WE WEREN'T TERRITORIAL OVER WHAT
THEY COULD DO OR COULDN'T DO.
WE WERE ABLE TO PROVIDE ACCESS
FOR HR AND CREDENTIAL A LOT OF
THOSE NURSES AND DOCTORS HELP
US.
WE DEFINITELY HAD TO MOVE FAST
AND MAKE SURE THAT WE WEREN'T
TURNED DOWN IN ANY VOLUNTEERS
AND THAT IS WHAT ALSO HELPED TO
MAKE US SO SUCCESSFUL IN OUR
RESPONSE.
NEXT SLIDE.
SO HERE ARE SOME PICTURES THAT
KIND OF TELL YOU THE STORY THAT
HAPPENED ON OUR NAVAJO.
SO WE HAD A LOT OF OUTSIDE
TESTING.
WE HAD A LOT OF TEAM WORK.
AND THESE MAKE ME REALLY PROUD
OF US.
NEXT SLIDE, PLEASE.
WE ALSO HAVE TO WORK WITH OUR
STATE AND OUR TOWNS TO MAKE SURE
THAT WE WERE TRANSFERRING
PATIENTS OUT.
A LOT OF OUR CLINICS IN PHOENIX
OR UTAH OR NEW MEXICO, THEY WERE
FULL.
SO WE HAD TO INCREASE OUR ICU
SERVICES.
WE HAD TO MAKE SURE WE WERE
GETTING TRAINED AND UTILIZING
THE VENTILATORS WE RECEIVED FROM
THE NATIONAL STOCKPILE.
AND THEN ALSO MAKING SURE WE ARE
SURVEILLANCING WHERE THESE
PATIENTS ARE GOING AND WHERE
THEY ARE BEING TRANSFERRED TO.
DO WE HAVE ENOUGH BEDS TO MAKE
SURE THAT WE CAN GIVE THEM THE
BEST QUALITY SERVICE THAT WE
HAVE?
AND THEN WHEN WE NEED TO
EXPEDITE AND SEND PATIENTS OUT,
WHERE ARE THEY GOING?
SO WE WERE ABLE TO TRANSFER
PATIENTS OUT TO PHOENIX AND TO
OTHER SURROUNDING HOSPITALS WHEN
WE NEEDED TO.
NEXT SLIDE, PLEASE.
SO, AGAIN, OUR PARTNERSHIPS
HELPED US A LOT.
AND THEY BECOME SOME OF OUR BEST
PRACTICES.
WE WERE ABLE TO WORK TOGETHER
WITH OUR TRIBAL FACILITIES, OUR
FEDERAL FACILITIES, OUR NAVAJO
NATION GOVERNMENT, OUR NAVAJO
NATION EPITEAM.
AND THEN ALSO WITH THE
UNIVERSITIES THAT ACTUALLY
REACHED OUT TO US.
SO WE WERE ABLE TO ACCEPT
PATIENTS FROM OTHER AREAS INTO
OUR AREA.
SO WE WOULD TRANSFERASE TRIBAL
HOSPITALS TO FEDERAL HOSPITALS.
WE WERE ABLE TO ADJUST DURING
SURGINGS.
TO PREDICT WHERE DID THE
VACCINE, WHICH AREAS NEEDED MORE
ARE VACCINE.
WE WERE ABLE TO OFFSET EACH
OTHER DURING -- IF ONE AREA HAD
SUCH A GREAT VACCINE CLINIC, AND
THEY NEEDED MORE, WE WOULD
TRANSPORT VACCINE BETWEEN
CLINICS.
AND THEN ALSO WE WERE ABLE TO
PROVIDE SITUATIONAL AWARENESS TO
OUR NAVAJO NATION LEADERSHIP.
ON A REGULAR BASIS SO OUR
PRESIDENT AND OUR LEADERS KNEW
EXACTLY WHAT WAS GOING ON WITH
THE COVID-19 PANDEMIC.
NEXT SLIDE.
SO, WE PREPARED FOR THIS VACCINE
AND WE WERE VERY EXCITED FOR IT
TO COME TO NAVAJO NATION.
WE HAD TO TRAIN OVER 129 HEALTH
PROFESSIONALS SO THAT WE COULD
VACCINATE AND GET OUR VACCINES
READY AT A CENTRAL SITE AND THEN
DISBURSE TO ALL OUR SERVICE
UNITS THROUGHOUT THAT MAP I
SHOWED.
AND THEN WHO WERE YOU GOING TO
VACCINATE FIRST?
WHO ARE OUR MOST VULNERABLE?
OUR ELDERS AND THEN ALSO OUR
TRIBAL LEADERS AND OUR DOCTORS
AND NURSES.
AND THEN OUR HEALERS.
WE WANTED TO MAKE SURE WE HAD A
GUIDELINE TO PREPARE FOR THIS
VACCINE.
NEXT SLIDE, PLEASE.
SO, WE WERE DEFINITELY
ANTICIPATING THE ARRIVAL AND
ALSO ON DECEMBER 12, WE HAD THE
FDA APPROVAL.
AND THEN BY DECEMBER 14, WE WERE
GETTING THAT VACCINE PREPPED AND
READY TO BE OUT IN OUR SERVICE
UNITS.
AND WE ALREADY HAD OUR
GUIDELINES SET AND READY FOR WHO
WAS GOING TO HAVE ACCESS TO THIS
VACCINE AT THE BEGINNING.
NEXT SLIDE, PLEASE.
SO WE HAD MASS VACCINATION
EVENTS.
THERE IS PICTURES OUT THERE ON
SOCIAL MEDIA WHERE YOU SEE LINES
AND LINES OF CARS.
WE WERE ABLE TO ASSESS WHAT
WORKED BETTER, HOW MANY LINES WE
NEEDED SO THAT THE CARS WENT
THROUGH FASTER.
WE WERE ABLE TO LEAD THE COUNTRY
AND THE STATE WITH THE HIGHEST
VACCINATION ADMINISTRATIONS AND
WITHIN ARIZONA.
THE NAVAJO NATION AND WITHIN
INDIAN HEALTH SERVICE, WE LEAD
THE AREAS WITH A VACCINATING THE
MOST COVID-19 VACCINES.
AND I THINK THAT STILL STANDS
TODAY.
I'LL LET CAPTAN BAN LOU TELL US
WHETHER NAVAJO DID THE BEST OR
NOT.
BUT WE WORKED REALLY HARD TO GET
THAT VACCINE OUT.
NEXT SLIDE, PLEASE.
SO FROM THE DATA, AS OF NOVEMBER
25, WE CAN SAY THAT AMONG ALL
NAVAJOS RESIDING ON THE NAVAJO
NATION, THAT 68% HAVE RECEIVED
AT LEAST ONE DOSE.
AND THEN 70% HAVE RECEIVED THEIR
PRIMARY SERVICE SERIES, WHICH
MEANS THEY ARE FULLY VACCINATED
ACCORDING TO THE CDC.
NOW SINCE THEN, WE HAVE HAD
OTHER VACCINE AND BOOSTERS.
SO AMONG THAT, 70% -- 17% OF OUR
TOTAL POPULATIONS ARE
UP-TO-DATE.
THAT MEANS THEY HAVE RECEIVED
ADDITIONAL BOOSTERS.
AND THEN ALSO WE ARE WORKING ON
REALLY GETTING OUR YOUNGSTERS
ALSO VACCINATED.
SO FAR, WE HAVE 16% OF OUR TOTAL
POPULATION HAVE RECEIVED THE NEW
BIVALENT BOOSTERS.
WE ARE CONTINUING TO WORK HARD
ON MESSAGING AND MAKING SURE
THAT WE ARE VACCINATING OUR
POPULATION.
NEXT SLIDE, PLEASE.
SO, THIS IS OUR NAVAJO NATION
PRESIDENT RECEIVING HIS FIRST
PRIMARY SERIES.
AND THEN ALSO A DEAR FRIEND OF
MINE, COMMANDER PARKER WAS THE
MASTERMIND WITH OUR EOC WITH
GETTING THE DISTRIBUTION OF
VACCINE THROUGHOUT NAVAJO
NATION.
THEY HAD A PARTNERSHIP WITH THE
NAVAJO NATION PD SO THAT THESE
VACCINES WENT OUT TO ALL THE
SERVICE UNITS AND WERE NOT
WASTED.
NEXT SLIDE, PLEASE.
SO I JUST WANT TO GIVE YOU AND
SAY THANK YOU TO ALL OF YOU FOR
LISTENING TO ME.
HOPEFULLY I GAVE YOU GREAT
INSIGHT OF HOW WE WERE ABLE TO
RESPOND TO THE COVID-19 PANDEMIC
ON THE NAVAJO NATION.
THANK YOU.
>>MOD THANK YOU FOR SHARING
YOUR EXPERIENCES WITH US TODAY.
NEXT, PLEASE WELCOME DR. LAURA
HAMIT.
>>THANK YOU VERY MUCH AND IT
WAS GREAT TO HEAR THAT
PRESENTATION FROM CHANNEL AND I
APPRECIATE THE OPPORTUNITY TO BE
HERE TODAY WITH EVERYONE ON THIS
WEBINAR.
IF YOU COULD GO TO THE NEXT
SLIDE, PLEASE.
AS WAS MENTIONED IN THE
INTRODUCTIONS I'M WITH THE JOHNS
HOPKINS CENTER FOR INDIGENOUS
HEALTH.
AND I WANT TO START BY
ACKNOWLEDGING THAT JOHNS HOPKINS
IS LOCATED ON THE TRADITIONAL
AND UNCEDED LANDS OF THE PA SCAT
WAY PEOPLES.
AND I ALWAYS WANT TO ACKNOWLEDGE
I LIVE AND WORK IN SOUTHWEST
COLORADO.
I'M IN BALTIMORE THIS WEEK.
BUT WHERE I LIVE AND WORK IS THE
ANCESTRAL LAND OF THE YUTE
PEOPLE AND ALSO COMMUNITIED TO
THE CEREMONIAL SPACES OF A
NUMBER OF DIFFERENT TRIBES.
I THINK THE NARRATIVES OF THESE
LAUNCHED IN RECENT TIMES, HAVE
LONG BEEN TOLD FROM NON
INDIGENOUS PERSPECTIVES WITHOUT
FULL RECOGNITION OF THE ORIGINAL
LAND STEWARDS WHO CONTINUE TO
OCCUPY THESE SPACES.
NEXT SLIDE, PLEASE.
I WANT TO DISCLOSE THAT I HAVE
RESEARCH SUPPORT THROUGH MY
INSTITUTION FROM THE DIFFERENT
ORGANIZATIONS THAT ARE LISTED
THERE.
NEXT SLIDE, PLEASE.
JUST A LITTLE BIT OF HISTORY
ABOUT OUR CENTERS, THE JOHNS
HOPKINS CENTER FOR INDIGENOUS
HEALTH WAS FOUNDED IN 1991
FOLLOWING 10 YEARS OF WORK WITH
SOUTHWEST TRIBES.
IT WAS LED BY -- AND WORKING IN
PARTNERSHIP WITH NATIVE
COMMUNITIES TO RAISE HEALTH
STATUS AND LEADERRERSHIP TO THE
HIGHEST POSSIBLE LEVEL.
WE HAVE THE INFECTIOUS DISEASE
TEAM WHICH I LEAD AND THEN
BEHAVIORAL HEALTH AND MENTAL
HEALTH TEAMS AS WELL AS TRAINING
TEAM.
WE HAVE A MOU WITH THE INDIAN
HEALTH SERVICE SINCE 1991.
I ALSO WORKED CLOSELY WITH THE
NAVAJO EPIDEMIOLOGY CENTER.
BUT WE ALSO HAVE LONGSTANDING
PARTNERSHIPS WITH THE WHITE
MOUNTAIN APACHE TRIBE AND NEWER
HUBS IN THE GREAT LAKES AND
DAKOTAS REGIONS.
NEXT SLIDE, PLEASE.
AND AS CHANNEL MENTIONED DURING
HER PRESENTATION, IT WAS OUR
HONOR TO WORK IN LOCK STEP WITH
IHS AND TRANSCRIBED PARTNERS
WHEN THE PANDEMIC STARTED.
-- TRIBAL PARTNERS.
INITIALLY WE HAVE A LONGSTANDING
RESEARCH COLLABORATION AND A LOT
OF PERSONNEL BASED LOCALLY.
SO WE IMMEDIATELY JUST ALL
RESEARCH OF COURSE STOPPED.
SO WE PIVOTED OUR RESEARCH
PERSONNEL TO BE ABLE TO SUPPORT
THE PUBLIC HEALTH RESPONSE,
INCLUDING WORKING ON TESTING.
THIS IS ONE OF THE TESTING BLITZ
THAT IS CHANNEL MENTIONED
SUPPORTING CONTACT TRACING,
VACCINE EFFORTS, AS WELL.
IF YOU GO TO THE NEXT SLIDE,
ALSO SUPPORTING AS CHANNEL
MENTIONED, EARLIER ON WE
REALIZED WE NEEDED TO START
TELLING PEOPLE THAT -- ADVISING
PEOPLE WHO ARE INFECTED TO
ISOLATE AND THOSE WHO WERE
EXPOSED TO QUARANTINE.
BUT IN THESE VERY RURAL AND
RESERVATION-BASED COMMUNITIES,
THAT COULD BE REALLY HARD TO DO
IF YOU DON'T HAVE FOOD AND WATER
AND FOOD FOR YOUR LIVESTOCK AND
OTHER SUPPLIES YOU MIGHT NEED.
AND SO, SUPPORTING THOSE EFFORTS
REALLY, AS SORT OF THE PUBLIC
HEALTH INFRASTRUCTURE WAS
GETTING UP TO SPEED.
WE WERE ABLE TO COME IN AND
SUPPORT THAT AS THE LOCAL PUBLIC
HEALTH INSTITUTIONS WERE COMING
ON LINE WITH THEIR RESPONSES AS
WELL.
THE NEXT SLIDE SHOWS A NUMBER OF
DIFFERENT COMMUNICATIONS
MATERIALS THAT WE PARTNERED WITH
IHS AND OTHER ORGANIZATIONS TO
HELP KEEP THE COMMUNITY UPDATED
AND INFORMED, IN ADDITION TO
PRINT MATERIALS.
SOCIAL MEDIA MATERIALS, ALL
RADIO PSAs THAT ALL COULD BE
FREELY AVAILABLE ON OUR RESOURCE
LIBRARY WHICH IS SHOWN IN THE
LOWER RIGHT-HAND CORNER.
AND ADAPTED FOR USE IN TRIBAL
SETTINGS AS WELL.
THE NEXT SLIDE TALK ABOUT SOME
OF THE TESTING COORDINATION
ACTIVITIES.
WE WERE PRIVILEGED TO BE ABLE TO
BE PART OF THE NAVAJO NATION
HEALTH COMMAND OPERATIONS CENTER
ON THE CASE MANAGEMENT TEAM AND
TO SUPPORT THE TESTING
COORDINATION ACTIVITIES WITH
TRYING TO UNDERSTAND AND DEVISE
WHAT WOULD BE AN APPROPRIATE
TESTING STRATEGY FOR THE NAVAJO
NATION DEVELOPING WHEN HOME TEST
KITS CAME OUT.
DEVELOPING INSTRUCTIONS THAT
WEREAISE EASY FOR PEOPLE TO
UNDERSTAND IN TERMS OF HOW TO DO
THE TEST AND CONNECTING PEOPLE
TO CARE AND MAKING SURE PEOPLE
HAD ADEQUATE SUPPORT FOR
ISOLATION AND/OR QUARANTINE.
GENERATING GUIDANCE FOR AND BEST
PRACTICES FOR SCHOOLS WHICH I
CAN TALK ABOUT MORE LATER ON.
AND ESTABLISHING A TESTING
COMMUNITY OF PRACTICE WHICH IS
AN OPPORTUNITY, VIRTUAL SPACE
FOR PEOPLE TO COME TOGETHER FROM
ALL OF THE DIFFERENT SERVICE
UNITS ACROSS NAVAJO NATION TO
SHARE BEST PRACTICES, DISCUSS
EMERGING ISSUES, TROUBLESHOOT
SUPPLIED CHALLENGES OR WHATEVER
IT MIGHT BE.
AND JUST FACILITATE
COMMUNICATION ACROSS VARIOUS
GROUPS THAT ARE INVOLVED IN THE
RESPONSE.
AND THAT CONTINUES EVEN TODAY
BECAUSE I THINK THESE VARIOUS
DIFFERENT STAKEHOLDERS HAVE
FOUND TO BE REALLY VALUABLE TIME
TO SHARE IDEAS AND BEST
PRACTICES.
AND CHANNEL MENTIONED ALREADY
THE NAVAJO NATION AS FAR AS
COV-2 STRAIN SURVEILLANCE
PROGRAM TO ASSIST IN IDENTIFYING
THE VARIANTS CIRCUMSTANCE LATING
LOCALLY.
IF WE GO TO THE NEXT SLIDE,
PLEASE.
-- CIRCULATING LOCALLY -- I'M
GOING TO TALK MORE ABOUT THE
RESEARCH ACTIVITIES THAT WE HAD
THE OPPORTUNITY TO BE INVOLVED
IN.
AND I THINK YOU HAVE GOTTEN A
SENSE ALREADY FROM WHAT WE HAVE
TALKED ABOUT THAT THE NAVAJO
NATION RESPONDED TO THE PANDEMIC
REALLY QUICKLY IMPLEMENTING
LOCKDOWNS AND OTHER MEDICATION
ACTIVITIES.
AND AT THE JOHNS HOPKINS CENTER
FOR INDIGENOUS HEALTH, WE WORKED
ALONGSIDE THOSE EFFORTS.
AND IN THOSE COMMUNITY SPACES
WHEN WE WERE OUT DOING CONTACT
TRACING OR DELIVERING FOOD AND
WATER, PEOPLE STARTED ASKING
WHAT ABOUT THE COVID VACCINES?
THE NEWS HAD STARTED SHARING
INFORMATION ABOUT UPCOMING
CLINICAL TRIALS FOR COVID-19
VACCINES.
AND IT WAS SOMETHING THAT IN
THIS COMMUNITY ESPECIALLY THAT
WAS BEING INCREDIBLY HARD HIT BY
THIS PANDEMIC.
PEOPLE KNOWING JOHNS HOPKINS AND
OUR HISTORY, HAVING DONE VACCINE
RESEARCH IN THE COMMUNITY IS
SOMETHING THAT WHERE COVID
VACCINES WILL BE SOMETHING THAT
WAS AVAILABLE TO THE NAVAJO
NATION IN TERMS OF THESE
CLINICAL TRIALS THAT THEY WERE
HEARING ABOUT.
THE NEXT SLIDE JUST SORT OF
BRIEFLY SUMMARIZES SOME OF THE
CONSIDERATION ITS FOR TRIBAL
PARTICIPATION IN COVID-19
TRIALS.
FIRST AND FOREMOST I THINK THIS
IS IMPORTANT BECAUSE IT CAN HELP
PROMOTE HEALTH EQUITY.
IT ALSO ENSURE THAT IS PRODUCTS
LICENSED AND RECOMMENDED FOR USE
NATIONALLY HAVE EVIDENCE FOR USE
LOCALLY.
AND IT PROVIDES THE FOUNDATION
FOR EQUITABLE ACCESS AND
WIDESPREAD ACCEPTANCE OF UPTAKE.
THESE TRIALS HAVE TO BE DONE IN
A WAY THAT IS RESPECTFUL OF THE
COMMUNITY AND ACKNOWLEDGES
TRIBAL SOVEREIGNTY AND FOLLOWS
OBVIOUSLY LOCAL REGULATIONS.
SO THAT MEANS THAT THE STUDY
NEEDS TO BE SUPPORTED BY
PARTNERSHIP WITH THE COMMUNITY,
APPROVED BY LOCAL OVERSIGHT
COMMITTEES WHETHER IT IS ETHICAL
REVIEWS OR IRBs, HEALTH
BOARDS, OTHER ENTITIES.
AND IMPLEMENTED BY A TRUSTED
PARTNER WITH LOCAL TEAMS WHO ARE
EXPERIENCED IN THE CONDUCT OF
CLINICAL TRIALS.
AND IN THIS SETTING, REALLY
IMPORTANT TO WORK VERY CLOSELY
WITH THE LOCAL INDIAN HEALTH
SERVICE OR TRIBAL HEALTH OR 638
FACILITIES.
THE NEXT SLIDE.
I JUST WANTED TORCHED SCORE THE
IMPORTANCE OF ALL RESEARCH
STARTING FROM A STANDPOINT OF
RECOGNIZING AND RESPECTING
TRADITIONAL WELLNESS MODELS.
THIS SLIDE SHOWS DEPICTION OF
THE NAVAJO WELLNESS MODEL, WHICH
REALLY EMPHASIZES PERSPECTIVES
OF SELF CARE, FAMILY HEALTH,
COMMUNITY HEALTH, ENVIRONMENTAL
HEALTH.
AND OUR APPROACH TO THE WORK WE
DO IS REALLY GROUNDED IN RESPECT
FOR TRADITIONAL WELLNESS MODELS.
AND STRIVING TO PROMOTE
WELL-BEING THROUGH COMMUNITY
INFORMED INTERVENTIONS ROOTED IN
TRIBES RICH IN CULTURAL
KNOWLEDGE, STRENGTHS,
UNDERSTANDING AND WITH THE FOCUS
ON BUILDING AND SUPPORTING
RESILIENCY AND SELF
DETERMINATION.
THE NEXT SLIDE TALKS JUST MORE
BROADLY ABOUT THE CLINICAL
TRIALS PARTNERSHIP PROCESS.
WHICH FOLLOWS CLINICAL TRIALS
EVERYWHERE FOLLOWING A NORMAL
PROGRESSION FROM PHASE I, PHASE
II, PHASE III CLINICAL TRIALS.
BUT WHEN CONSIDERING CLINICAL
TRIALS WORK IN TRIBAL
COMMUNITIES, REALLY IMPORTANT TO
ENGAGE EARLY WITH COMMUNITIES TO
UNDERSTAND WHAT ARE THE HIGH
PRIORITY CONCERNS IN THAT
SETTING.
AND TO HAVE COMMUNITY ENGAGEMENT
ON THE POTENTIAL INTERVENTIONS
THAT MAY BE AVAILABLE AND
DISCUSSION WITH POTENTIAL
SPONSORS ABOUT THOSE
INTERVENTIONS.
THERE ALSO NEEDS TO BE A
COMMUNITY APPROVAL PROCESS,
FACILITY APPROVAL PROCESS THAT
THE WORK IS BEING DONE IN
COLLABORATION WITH IHS OR TRIBAL
HEALTH FACILITIES AND THEN IRB
APPROVAL FROM THE COMMUNITY AS
WELL DEPENDING ON WHAT THE LOCAL
PROCESS IS.
AND THEN DEVELOPING THE
RECRUITMENT PLAN WITH THE
COMMUNITY AND FACILITY PARTNERS,
FOLLOWED BY APPROACHING
POTENTIAL PARTICIPANTS, MAKING
SURE THAT YOU GO THROUGH A VERY
COMPREHENSIVE AND INFORMED
CONCEPT PROCESS.
WE OFTENTIMES WILL USE CONSENT
FLIP CHARTS TO SUPPLEMENT THE
LONGER WORD DOCUMENT CONSENT
FORMS TO MAKE SURE THAT WE ARE
DESCRIBING THE STUDIES AS
COMPREHENSIVELY AND COMPLETELY
AS POSSIBLE.
AND EVEN AT THE END OF THE
CONSENTING PROCESS, DOING
ASSESSMENT OF UNDERSTANDING TO
MAKE SURE THAT WE HAVE
COMMUNICATED THE CORE ASPECTS
CLEARLY AND THE PARTICIPANTS
KNOW WHAT THE STUDY ENTAILS.
AND THEN ELIGIBLE VOLUNTEERS
OBVIOUSLY GO THROUGH THE STUDY
PROTOCOL RECEIVING WHATEVER THE
INTERVENTION IS.
REALLY IMPORTANTLY, THE PROCESS
DOESN'T END THERE.
WE CONTINUALLY FOLLOW-UP TO THE
COMMUNITY, DISSEMINATIONFUL
RESULTS, TO ALL THE GROUPS THAT
WERE ORIGINALLY INVOLVED IN THE
APPROVAL SEEKING PROCESS,
KEEPING THEM ABREAST THE STEADY
PROGRESS ALONG THE WAY AND THEN
AT THE END AS WELL.
AND THE NEXT SLIDE JUST, I THINK
PEOPLE WHO DO RESEARCH IN
CLINICAL TRIALS WILL BE FAMILIAR
WITH ALL OF THE DIFFERENT STAFF
THAT ARE REQUIRED FOR CLINICAL
TRIAL.
AND I SHARE THIS AS -- IT'S NOT
EVEN A COMPLETE LIST.
BUT I SHARE THIS BECAUSE I THINK
IT CAN BE DIFFICULT.
THIS IS ONE OF THE CHALLENGES WE
SAW DURING THE PANDEMIC.
A NUMBER OF COMMUNITIES WERE
REALLY INTERESTED IN
PARTICIPATING IN SOME OF THE
CLINICAL TRIALS BUT LACKED THE
CORE PHYSICAL INFRASTRUCTURE IN
TERMS OF SPACE, EVEN.
BUT ALSO PERSONNEL, EXPERIENCED
PERSONNEL TO DO THIS WORK.
ALL STAFF HAVE TO BE TRAINED ON
RECRUITING AND CONSENTING
PRACTICES AND SPECIMEN
COLLECTION OR ANY PROCEDURES
THAT THE STUDY ENTAILS, SO IF WE
GO TO THE NEXT SLIDE, WE'LL SORT
OF TALK ABOUT HOW THIS WAS
TRANSLATED IN THE CONTEXT OF THE
COVID-19 VACCINE TRIALS THAT
WERE ONGOING.
SPECIFICALLY WITH THE PFIZER
TRIAL WHICH BEGAN OBVIOUSLY AS A
PHASE I, TWO, CLINICAL TRIAL IN
ADULTS AND EXPANDED TO A GLOBAL
PHASE II PHASE III STUDY.
AND AS I MENTIONED EARLIER,
BASED ON THAT FEEDBACK THAT WE
WERE HEARING FROM COMMUNITY
MEMBERS AND EXPRESSIONS OF
INTERESTS FROM PEOPLE WANTING TO
HAVE THE OPPORTUNITY TO
PARTICIPATE FROM THESE CLINICAL
TRIALS, WE CONVENED A LOCAL
ADVISORY COMMITTEE.
BECAUSE OF THE PANDEMIC NORMAL
TRIBAL APPROVAL PROCESSES WERE
INTERRUPTED.
A LOT OF THE STANDING COMMITTEES
CEASED MEETING BECAUSE EVERYBODY
WAS IN LOCKDOWN.
SO WE HAD TO SORT OF ADAPT THAT
COMMUNITY-BASED PARTICIPATORY
PROCESS A LITTLE MORE AND TO
THINK MORE CREATIVELY ABOUT HOW
CAN WE HAVE THAT COMMUNITY
ENGAGEMENT AND FIGURE OUT WHAT
THE RIGHT NEXT STEPS WOULD BE.
LOCAL ADVISORY COMMITTEE SORT OF
REVIEWED THE DIFFERENT STUDIES
THAT WERE ONGOING AND MADE THE
RECOMMENDATION THAT THIS SHOULD
BE SUBMITTED TO THE NAVAJO
NATION HUMAN RESEARCH REVIEW
BOARD FOR THEIR CONSIDERATION
AND APPROVAL.
SO WE WENT FORWARD WITH
SUBMITTING THAT PFIZER COVID-19
TRIAL TO BOTH THE NAVAJO
APPROVAL AND THE NATIONAL
IHSIRB, WHICH WERE BOTH
APPROVED.
AND THEN THE HOPKINS CENTER FOR
INDIGENOUS HEALTH SCIENCE JOINED
THE STUDY ON NAVAJO NATION AND
TRIBAL LANDS IN SEPTEMBER OF
2020.
THIS WAS AFTER MORE THAN ABOUT
20,000 PEOPLE HAD BEEN ENROLLED
IN THE GLOBAL MULTI-SITE STUDY
WHICH WAS ONGOING AND OVER 150
SITES.
OVER ALL, YOU CAN SEE AT THE
BOTTOM, THAT SLIDE, THE TRIAL
ENROLLED OVER 44,000 PEOPLE
GLOBALLY, 438 OF WHOM WERE
INDIGENOUS AND 277 OF WHOM WERE
ENROLLED AT SITES IN THE SOUTH
WEST AT THE CENTER FOR
INDIGENOUS HEALTH SITES.
AND OF COURSE THE NEXT SLIDE IS
DATA PEOPLE ALL KNOW WELL THAT
DOCUMENTED THAT THE VACCINE
AFTER TWO DOSES WAS 95%
EFFECTIVE AT PREVENTING
COVID-19.
YOU CAN SEE THE CHEWATIVE
INCIDENCES OF CASES FOR PEOPLE
WHO GOT THE PLACEBO IN THE BLUE
LINE AND MUCH, MUCH LOWER
ACCUMULATIVE CASES FOR VACCINE
RECIPIENTS IN THE RED LINE.
AND IMPORTANTLY, FOR OUR
COMMUNITY AUTO NEXT SLIDE, YOU
CAN SEE THAT WHEN WE LOOKED AT
THE EFFICACY THROUGH SIX MONTHS
AFTER DOSING, AS WE ALL KNOW,
EFFICACY WAYNES OVER TIME AND WE
SAW THAT HERE IN THE CLINICAL
TRIAL.
IMPORTANTLY IN THESE SUBGROUP
ANALYSIS YOU CAN SEE ON THIS
SLIDE, THE POINT ESTIMATE FOR
VACCINE EFFICACY OF 87% IN
AMERICAN INDIAN ALASKA NATIVES
WAS ON PAR WITH WHAT WE WERE
SEEING IN OTHER PLACES.
SO VERY REASSURING DATA TO HAVE
THESE DATA LOCALLY THAT SAID,
THIS VACCINE WORKS HERE T WORKS
FOR NATIVE PEOPLE.
THE NEXT SLIDE SHOWS THAT,
FORTUNATELY, AND VERY GRATEFULLY
WE WEREN'T THE ONLY ONES WHO
WERE ABLE TO STAND UP A CLINICAL
TRIAL FOR THE COVID-19 VACCINES.
THERE WERE TWO OTHER COMMUNITIES
WHERE THAT WORK WAS ALSO ABLE TO
BE DONE IN THE NORTH WEST ABLE
TO PARTICIPATE IN THE NOVA SAKS
COVID-19 TRIAL.
AND THE DAKOTAS THERE WAS ALSO
OPPORTUNITY TO PRESENT OR
PARTICIPATE IN THE NOVA VACS
COVID-19 CLINICAL TRIAL.
THIS CLINICAL TRIAL STARTED
SOMEWHAT LATER WHICH WAS HELPFUL
BECAUSE THEN THESE COMMUNITIES
HAD A LITTLE BIT MORE TIME TO
STAND UP ALL OF THE
INFRASTRUCTURE NEEDED TO SUPPORT
A CLINICAL TRIAL, PHASE III
CLINICAL TRIAL AND ALL THE
DIFFERENT REQUIREMENTS THAT THAT
ENTAILS.
AND THE NEXT SLIDE JUST WANTED
TO BRIEFLY TOUCH BASE ON OTHER
RESEARCH COLLABORATIONS THAT WE
ENGAGED IN IN PART OF THE
COVID-19 RESPONSE.
SO IN ADDITION TO THE COVID-19
VACCINE CLINICAL TRIAL, WE WERE
PART OF THE -- ONE OF THE
COVID-19 CONVALESCENT PLASMA
TREATMENT TRIALS WHICH
DOCUMENTED THAT USE OF HIGH
TITER CONVALESCENT PLASMA FROM
PEOPLE WHO RECOVERED FROM COVID
THAT HAS A HIGH CONCENTRATION OF
ANTIBODIES IS EFFECTIVE IN
TREATING INDIVIDUALS WHO ARE
EARLY IN THE COURSE OF THEIR
ILLNESS AND PREVENTING
PROGRESSION OF THE ILLNESS.
WORKING -- I HAVEN'T MENTIONED
MUCH TODAY HERE BUT ANOTHER PART
OF OUR RESPONSE AND RESEARCH
EFFORTS HAVE BEEN AROUND THE
MENTAL HEALTH IMPACTS OF THE
COVID-19.
PANDEMIC SUPPORTING
PSYCHOLOGICAL FIRST-AID.
AND IN THIS CASE SUPPORTING
FRONT LINE WORKERS AND
RESPONDERS WITH THE TREMENDOUS
STRAIN THAT WAS PLACED ON THEM
AS PART OF THE RESPONSE.
WE WERE ALSO HAVE A RESPIRATORY
SURVEILLANCE PROJECT THAT HAS
BEEN UP AND GOING SINCE 2019.
SO PRE DATING THE PANDEMIC WHICH
WE WERE ABLE TO AMEND TO LOOK
SPECIFICALLY AT COVID-19 AMONG
INPATIENTS AND OUTPATIENTS AND
WORKING REALLY CLOSELY WITH IHS
ON THAT AS WELL.
AND HAVING THE OPPORTUNITY TO
COMPARE WHAT WE ARE SEEING FROM
ACTIVE SURVEILLANCE THROUGH THIS
IRB-APPROVED RESEARCH PROJECT
VERSUS WHAT DO WE SEE THROUGH A
MORE PASSIVE SURVEILLANCE
THROUGH ADMINISTRATIVE DATA.
AND THEN WORK AS WELL ON LONG
COVID WHICH WE KNOW IS PLACING A
HUGE STRAIN ON INDIVIDUALS AND
ON COMMUNITIES RIGHT NOW.
ALL OF THESE THINGS THINK
MOTIVATED BY THE GOAL TO IMPROVE
COMMUNITY HEALTH.
THE NEXT SLIDE, I WANTED TO
HIGHLIGHT ONE OF THE RESEARCH
COLLABORATIONS THAT WASN'T
MENTIONED IN THE PREVIOUS SLIDE
BUT PROJECT SAFE SCHOOLS, WHICH
IS FUNDED BY THE RADx
UNDERSERVED POPULATIONS FUNDING
MECHANISM.
USED COMMUNITY-BASED
PARTICIPATORY RESEARCH TO HELP
UNDERSTAND THE FACILITATORS AND
BARRIERS TO SCHOOL REOPENING,
ENGAGING WITH MULTIPLE DIFFERENT
STAKEHOLDERS, DESIGNING
COMPREHENSIVE APPROACH TO COVID
TESTING IN SCHOOLS.
AND THEN EVALUATING THE
ACCEPTABILITY, FEASIBILITY AND
REACH OF SURVEILLANCE TESTING.
ONE OF THE PRODUCTS OF THIS
PROJECT HAS BEEN A TOOLKIT FOR
SAFE SCHOOLS, WHICH YOU CAN SEE
THERE AND IT IS LINKEDIN THE
REFERENCE AT THE BOTTOM OF THE
SLIDE.
BUT REALLY IMPORTANT KEY
FINDINGS THAT TESTING IN SCHOOLS
WAS FEASIBLE AND ACCEPTABLE AND
ALSO THAT SCHOOLS WERE NOT A
MAJOR SOURCE OF TRANSMISSION.
THEY WERE NOT DRIVERS OF
TRANSMISSION IN THE COMMUNITY.
SO IMPORTANT FINDINGS THERE TO
HELP REASSURE PEOPLE ABOUT
SENDING THEIR KIDS TO SCHOOL,
ABOUT KEEPING SCHOOLS EACH AND
PROMOTING SAFE AND IN-PERSON
LEARNING.
THE NEXT SLIDE, I'LL WRAP UP.
AGAIN THANK YOU FOR THE
OPPORTUNITY TO BE HERE.
I REALLY WANT TO -- I THINK
SHARE THE MESSAGE THAT RESEARCH
IS REALLY ESSENTIAL FOR TRIBES
TO UNDERSTAND AND ADDRESS HEALTH
CONCERNS IN THEIR COMMUNITIES T
HAS TO BE DONE ON TERMS.
OF TRIBAL COMMUNITIES WITH
RESPECT AND ACKNOWLEDGMENT OF
TRIBAL SOVEREIGNTY.
THE COMMUNITY ENGAGEMENT IS
REALLY CRITICAL.
AND THAT HAS TO START EARLY.
IT CAN'T START LIKE AFTER WE
HAVE GOT THIS GRANT AND WE WANT
TO DO THIS WORK.
IT NEEDS TO START IN THE
PROPOSAL WRITING PHASES OF THE
RESEARCH.
AND THE DESIGN OF THE CALLS FOR
FUNDING.
STAKEHOLDER PARTNERS ARE
INVALUABLE AND CHANNEL AND I
HAVE JUST -- WE HAVE REALLY
ENJOYED GETTING TO WORK WITH ONE
ANOTHER AS WELL AS ALL THE
VARIOUS OTHER STAKEHOLDERS WHO
HAVE BEEN CRITICAL TO RESPONSE
EFFORTS, AS WELL AS TO THE
RESEARCH EFFORTS.
AS OUR RESPONSE AS IRBs, WE
COULDN'T HAVE DONE THIS WORK HAD
IT NOT BEEN FOR THE IRBs BEING
WILLING TO REVIEW THINGS
PROMPTLY AND GIVE US FEEDBACK TO
BE ABLE TO MOVE THE STUDIES
FORWARD.
AND THAT'S A HARD THING TO DO
BECAUSE THESE ARE OFTENTIMES
UNDERFUNDED ENTITIES AND LOTS OF
OVERWORKED VIOLATES.
AND I THINK MY BIG TAKE AWAY
WOULD BE THAT WE REALLY URGENTLY
NEED INVESTMENT IN RESEARCH
CAPACITY BUILDING, NOT ONLY FOR
PERSONNEL BUT ALSO FOR DATA
SYSTEMS AND INFRASTRUCTURE.
ALL YOU THE THINGS THAT NEED TO
BE ABLE TO GO INTO DOING
RESEARCH SO WE CAN HAVE MORE
RESPONSIVE SYSTEMS, BE ABLE TO
SUPPORT RESEARCH AND TRIBAL
COMMUNITIES.
SO THANK YOU.
>>MODERATOR: THANK YOU FOR THAT
VERY IN NORMATIVE PRESENTATION.
WE WILL HAVE LOTS OF
QUESTIONINGS IN A BIT.
NEXT UP IS CAPTAN VAN LEW
MY NAME IS CAPTAN HOLLY VAN LEW,
A PHARMACIST WITH THE INDIAN
HEALTH SERVICE AND THE IHS
VACCINE TASK FORCE DEPUTY LEAD
HELPING TO STAND UP THE COVID-19
VACCINE PROGRAM ACROSS THE
INDIAN HEALTH SERVICE WHEN
NEEDED DURING THE PANDEMIC.
SO IT WAS REALLY EXCITING
TUNEDY.
WE WANTED TO REVIEW SOME OF THE
ACTIVITIES WE HAD ONGOING FOR
THE LAST TWO PLUS YEARS NOW.
WHICH IS REALLY CRAZY.
WE ARE COMING UP ON THE TWO-YEAR
TIMEFRAME WHERE WE LAUNCHED
VACCINE WITHIN THE INDIAN HEALTH
SERVICE.
SO IHS OVERALL AS MANY ARE VERY
WELL AWARE, IT IS AN AGENCY
WITHIN HHS.
OUR MISSION IS TO SERVE AMERICAN
INDIANS AND ALASKA NATIVES AND
RAISE OUR SOCIAL AND SPIRITUAL
HEALTH TO THE HIGHEST LEVEL.
WE NEED TO ADVOCATE FOR OUR
INDIAN PEOPLE AND ALL
INDIVIDUALS WITHIN OUR SYSTEM
AND OUR COMMUNITIES THAT MAY
INCLUDE NON-BENEFICIARIES AT
THAT TIME.
WE HAVE A SERVICE POPULATION OF
APPROXIMATELY 2.7 MILLION
INDIVIDUALS AND 1.7 MILLION HAVE
HAD A CLINICAL VISIT WITHIN THE
LAST THREE YEARS.
AND WE KIND OF USE THAT NUMBER
TO DEFINE HOW MUCH UTILIZATION
OF HEALTH CARE WE HAVE.
THERE ARE APPROXIMATELY 574
FEDERALLY-RECOGNIZED TRIBES
ACROSS 37 STATES.
THE VACCINE TASK FORCE
ACTIVITIES, WE'LL TALK SOON
ABOUT HOW SELECTION WAS MADE AND
WHO CHOSE VACCINE FROM THE IHS
VERSUS FROM THEIR STATE.
BUT, WE ARE NOW COVERING 36
STATES WHERE WE PROVIDE
VACCINES.
THERE ARE DIFFERENT VARIATIONS
úAS.
THEY ARE TRIBAL HEALTH PROGRAMS
IN INDIAN URBAN ORGANIZATIONS
AND WE HAVE SUCH VARIATION IN
INDIAN HEALTH SERVICE, INCLUDING
VERY URBAN, POPULATED AREAS OR
VERY BUSY MEDICAL FACILITIES IN
THE MIDDLE OF AN URBAN AREA.
AUGUST THE WAY TOUT REMOTE AND
RURAL LOCATIONS WHICH I'M SURE
YOU'RE VERY FAMILIAR WITH.
SO WE HAVE SO MUCH VARIATION
THAT WE HAVE TO BE ABLE TO MEET
THE NEEDS IN SO MANY DIFFERENT
WAYS, ESPECIALLY FOR VACCINES
AND DURING THIS TIME PERIOD.
NEXT SLIDE, PLEASE.
WE KNEW THAT -- THE HISTORY OF
MANY PANDEMICS AND OTHER
INFECTIOUS DISEASES THAT
AMERICAN INDIAN AND ALASKA
NATIVE MAY BE AFFECTED BY THINGS
LIKE COVID-19.
AND THAT DID COME TO FRUITION.
WE KNOW THAT AMERICAN INDIAN AND
ALASKA NATIVE INDIVIDUALS HAVE
HIGHER RATES OF BEING DIAGNOSED
WITH COVID-19, HIGHER RATES OF
HOSPITALIZATION AND HIGHER RATES
OF DEATH IN ALL AGE GROUPS.
AND EVEN AT YOUNGER AGE GROUPS,
WHICH IS REALLY TERRIFYING.
THIS IS SOMEWHAT COMMON FOR
OTHER MEDICAL CONDITIONS LIKE
INFLUENZA AND OTHER THINGS, BUT
WE KNEW THIS WAS GOING TO BE
PROBLEMATIC.
WE CONTINUED TO MONITOR THESE
THINGS AND WE HAVE SEEN THIS
COME TO FRUITION ALSO WITH
COVID-19.
SO WE KNEW THAT WE NEEDED A
COMPREHENSIVE CULTURAL
APPROPRIATE APPROACH TO ENSURE
THAT EVERYONE HAD THE
OPPORTUNITY TO BE VACCINATED AND
TO BE ABLE TO PUSH THE VACCINE
OUT TO THE LOCAL LEVEL TO
DETERMINE WHAT EXACTLY THEY
NEEDED.
HOW CAN WE MEET THEIR NEEDS?
WE UTILIZE A LOT OF TRUSTED
MESSENGERS AND WE REALLY WORKED
WITH FACILITIES, TRIBAL LEADERS
TO GET MESSAGING OUT.
AND THAT WAS REALLY THE KEY TO
THE SUCCESS.
UTILIZING AND PARTNERING WITH
TRIBES AND TRIBAL LEADERS TO
KEEP MESSAGING ONGOING AND
MEETING PEOPLE WHERE THEY WERE.
SO MANY MESSAGES OF CULTURAL
PRESERVATION, LANGUAGE,
PROTECTION OF OUR ELDERS, WERE
REALLY KEY AND WE'LL TALK MORE
AND FOCUS ON THOSE AS WE WORK
THROUGH MY PRESENTATION.
NEXT SLIDE, PLEASE.
SO THESE EARLY ENGAGEMENT WAS
LITERALLY THE MOST IMPORTANT
CRITICAL ELEMENT.
WE WENT THROUGH TRIBAL
CONSULTATION.
WE WENT THROUGH URBAN CONFIRM TO
DETERMINE WHAT WAS THE PRIORITY?
HOW WHEN WE OPERATIONALIZE
VACCINATION, HOW WILL WE ROLE
TELL OUT AND THE WHAT DO THE
TRIBES NEED?
WHAT DOT FACILITIES NEED?
OUR TRIBAL LEADERS AND OUR
MEDICAL DIRECTORS NEED?
SO TRIBES AND TRIBAL COMMUNITIES
WOULD ASK FOR PRIORITY.
WE WOULD ASK THEM FOR THEIR
INPUT, IHS EMPLOYEES WERE ASKED
FOR INPUT AND WE FOUND A THEME,
THAT THEME IS THAT FACILITIES
AND TRIBES WANTED A CHOICE IN
HOW THEY RECEIVED VACCINES THAT
WERE DISTRIBUTED.
SO, THEY COULD EITHER CHOOSE TO
GET VACCINES THROUGH THE IHS OR
THEY COULD CHOOSE TO GO THROUGH
THE STATE OR LOCAL JURISDICTION.
AND THAT WAS BASED ON THEIR
HISTORY, RELATIONSHIP, THEIR
LOCAL NEEDS, HOW DIFFERENT --
EITHER IHS OR THE STATE MIGHT BE
ABLE TO MEET THEIR NEEDS OR
QUANTITY, AVAILABILITY,
DISTRIBUTION.
ALL OF THOSE DIFFERENT
COMPONENTS.
IT WAS REALLY UP TO THE LOCAL
FACILITY TO MAKE THOSE CHOICES.
ALSO, WE HEARD THAT PEOPLE
WANTED TO ESTIMATE THEIR OWN
POPULATION.
THEY DIDN'T WANT TO USE THIS
GENERALLY-ACCEPTABLE NUMBER OF
WHAT WE CALL THE USER
POPULATION, WHICH IS THOSE
PEOPLE WHO HAD ONE VISIT IN THE
LAST THREE YEARS.
THEY WANTED TO NAME THEIR OWN
POPULATION.
THEY WANTED TO TELL US WHAT
THEIR NEEDS WERE.
INCLUDING NOT JUST AMERICAN
INDIAN AND ALASKA NATIVE MEMBERS
BUT ALSO PEOPLE IN SURROUNDING
COMMUNITIES.
THEY WANTED TO BE ABLE TO
VACCINATE PEOPLE WHO LIVE AND
WORK IN THEIR COMMUNITIES TO
PROTECT THEIR COMMUNITIES.
THEY ALSO, THE TRIBES ALSO TOLD
US AND URBAN FACILITIES TOLD US
THEY WANTED TO DETERMINE THEIR
OWN PRIORITY POPULATION.
AND THIS IS ALSO REALLY KEY AND
CHANNEL TOUCHED ON THIS EARLIER.
THEY WANTED TO DEFINE WHAT IS AN
ELDER AGE.
IT'S NOT ALWAYS THE TYPICAL
DEFINITION OF 65 AND OLDER.
IN SOME TRIBES IT'S 55.
IN OTHER AREAS IT'S 60 OR 45.
SO MANY FACILITIES AND TRIBES
WANTED TO DETERMINE THEIR OWN
PRIORITY POPULATION, WHO WAS
DEFINED AS AN ELDER?
WOULD THAT INCLUDE THEIR
TRADITIONAL HEALERS AND
NATIVE-LANGUAGE SPEAKERS?
MAYBE IT WAS FOLKS WHO WORKED IN
CERTAIN ENVIRONMENTS.
SO IT WAS REALLY EXCITING FOR
SITES TO BE ABLE TO DETERMINE
THOSE PRIORITY POPULATIONS AND
WE WORKED VERY DILIGENTLY WITH
THE CDC AND THE ADVISORY
COMMITTEE ON IMMUNIZATION
PRACTICES TO INCORPORATE THEIR
RECOMMENDATIONS AND ALLOW THAT
FLEXIBILITY FOR DETERMINING
PRIORITY POPULATION.
AND THESE WERE THE ITEMS THAT
WERE CRIMINAL CALL AS WE
INCORPORATED THEM INTO OUR IHS
PLANNING AND IMPLEMENTATION.
-- CRITICAL.
NEXT SLIDE, PLEASE.
HERE SAY SNAPSHOT OF HOW WE HAVE
BEEN DOING AND WHERE WE ARE AT
RIGHT NOW.
IHS COVID-19 TASK FORCE WE HAVE
358 FACILITIES ACROSS 36 STATES
THAT WE DISTRIBUTE VACCINE TO.
IT'S ABOUT 75% OF WHAT THE IHS
HAS OVERALL.
IHS DIRECTLY DISTRICTS.
THE OTHER 25% FACILITIES AND
ADMINISTERED DOSES ARE THOSE
FOLKS WHO CHOSE THE STATE OR
LOCAL JURISDICTION FOR
DISTRIBUTION.
OVERALL, WE HAVE DISTRIBUTED
ABOUT 3.9 MILLION DOSES, THAT'S
GOING TO BE COMING UP PRETTY
SOON HERE WHEN WE HAVE A NEW
ROLLOUT OF A VACCINE FOR
PEDIATRICS, THE BIVALENT BOOSTER
IS COMING FORWARD IN THE NEXT
WEEK OR TWO.
WE ADMINISTERED OVER 2.3 MILLION
DOSES TO FOLKS OF ALL AGES.
SO ANYONE SIX MONTHS AND OLDER
IS COUNTING FIRST AND SECOND
DOSES, ADDITIONAL DOSES, BOOSTER
DOSES AND NOW BIVALENT BOOSTERS.
SO IT'S BEEN QUITE A WILD RIDE.
A LOT OF ACTION AND ACTIVITY AND
PERSISTENCE ACTION AND ACTIVITY
ALL ALONG.
SO AT THIS TIME, COVID-19
VACCINES ARE WIDELY AVAILABLE IN
INDIAN COUNTRY.
WE DO HAVE BIVALENT BOOSTERS,
WIDELY AVAILABLE AS WELL AND WE
ARE WORKING ON THE PREPARATION
AND LAUNCH FOR THOSE KIDS LESS
THAN 5.
WE DO CONTINUE TO HAVE A
RECOGNIZED VACCINATION RATE THAT
ARE SOME OF THE HIGHEST IN THE
COUNTRY FOR BASED ON RACE AND
ETHNICITY.
SO CDC RECOGNIZES AMERICAN
INDIAN AND ALASKA NATIVES HAVING
THE HIGHEST RACE OF SOURCE DOSE
COMPLETION AND SECOND HIGHEST
DOSE COURSE FOR SERIES
COMPLETION.
AND THEN WE CONTINUE TO WORK ON
ADDITIONAL BOOSTERS AND BIVALENT
BOOSTERS WITH INCREMENTAL
INCREASES OCCURRING IN ALL AGE
GROUPS.
AT THIS POINT, WE HAVE
ADMINISTERED OVER 110,000
BIVALENT BOOSTERS AND THAT
CONTINUES TO CLIMB EVERY DAY.
AGAIN, THAT CLOSE COMMUNICATION
WITH PARTNERS HAS BEEN REALLY
CRITICAL AND THAT INCLUDES ALSO
OUR FEDERAL PARTNERS WORKING
WITH THE CDC, FEMA, NATIONAL
GUARD, BUREAU OF INDIAN
EDUCATION.
THE BIA AND OTHERS, INCLUDING
US, SPECIFIC TRIBAL
ORGANIZATIONS INCLUDING
REGIONAL, TRIBAL ORGANIZATIONS,
STATE DEPARTMENTS OF HEALTH AND
OTHERS.
IT'S THOSE RELATIONSHIPS THAT
HAVE BEEN REALLY KEY AND
UTILIZING OUR TRIBES AND TRIBAL
LEADERS TO AMPLIFY MESSAGING AND
ENGAGING WITH OUR COMMUNITIES.
NEXT SLIDE, PLEASE.
FOCUSING ON PROTECTION OF
COMMUNITY.
IF IS SOMETHING THAT REALLY
RESONATED WITHIN INDIAN CREASE.
PRESERVATION OF CULTURE AND
LANGUAGE WAS CRITICAL.
TALKING ABOUT PROTECTING OUR
ELDERS BY CACOONING THEM,
INCLUDING NOT JUST VACCINATING
THE ELDER BUT VACCINATING OUR
FRIENDS, FAMILY AND YOU CAN SEE
ON THE RIGHT-HAND SIDE, THIS
PHOTO SHOWS A PICTURE ON THE MAP
THAT SAYS, BE A GOOD RELATIVE.
AND THAT IS REALLY SOME OF THE
MESSAGING THAT WAS REALLY
PROMINENT ACROSS INDIAN COUNTRY.
WE SAW A LOT OF MESSAGING AROUND
PROTECTION OF OUR FUTURE
GENERATIONS AS WELL, ESPECIALLY
WHEN VACCINATION ROLLED OUT FOR
THE YOUNGER AGE GROUPS,
ADOLESCENT AND YOUNG ADULTS AND
THEN REACHING COMMUNITY
IMMUNITY, INCLUDING PROTECTING
OUR FOLKS WHO HAVE UNDERLYING
MEDICAL CONDITIONS AND AT ONE
TIME, BEFORE CHILDREN WERE
AUTHORIZED FOR VACCINATION,
PROTECTING OUR CHILDREN WHEN
THEY COULDN'T BE VACCINATED, YET
ADULTS COULD BE.
NEXT SLIDE, PLEASE.
HERE ARE A COUPLE OF PHOTOS OR
MESSAGES, VISUAL MESSAGES.
SEVERAL OF THESE ON THE
LEFT-HAND SIDE WERE FROM THE
INTERTRIBAL COUNCIL OF MICHIGAN.
SO THEY ARE REALLY POWERFUL
MESSAGES HERE, PROTECT OUR
LANGUAGE, OUR CULTURE HOLDERS
FOR FUTURE GENERATIONS.
PRESERVE OUR CULTURE.
PROTECT YOUR TRIBE AND GET
VACCINATED.
SO WE JUST LOVE AND APPRECIATE
MANY OF THE VERY UNIQUE MESSAGES
THAT WERE CREATED LOCALLY OR
REGIONALLY THAT REACHED OUT TO
TRIBAL MEMBERS AND REACHED TOUT
OUR COMMUNITY.
ON THE RIGHT, WE SEE THERE IS A
LADY HERE HOLDING UP HER SIGN.
WE HAVE -- USE THESE A LOT,
ESPECIALLY AT MY FACILITY AND
MANY FACILITIES ACROSS THE
COUNTRY THAT SAYS, WHO IS THIS
VACCINE?
WHY ARE WE GETTING THIS VACCINE?
FOR MYSELF?
AND MORE OFTEN THAN NOT, IT'S
FOR OTHERS.
AND HERE SHE IS SAYING, MY COVID
VACCINE IS HER PEOPLE, NOT JUST
HERSELF.
NEXT SLIDE, PLEASE.
UTILIZATION OF TRUSTED MESSENGER
IS ALSO REALLY CRITICAL AND ALL
THROUGHOUT THIS PRESENTATION
KIND OF HONING IN ON THOSE
TRUSTED MESSENGERS.
THEY WERE KEY FOR THE ROLLOUT.
IT WAS AMAZING AND EXCITING TO
SEE TRADITIONAL HEALERS BEING
VACCINATED AS ONE OF THE FIRST
FOLKS TO BE VACCINATED,
PROMOTING THE SENSE THAT THESE
VACCINES ARE GOING TO BE HELPFUL
FOR OUR COMMUNITIES.
AND SAFE FOR OUR PEOPLE.
WE ALSO UTILIZED AND SAW MANY
TRIBAL MEMBERS, TRIBAL LEADERS,
PROMOTING THEIR OWN VACCINATIONS
ON SOCIAL MEDIA, IN THE NAVAJO
AREA.
THE NAVAJO PRESIDENT WAS OUT
PROMOTING THE VACCINATION IN
CLINICS, ENCOURAGING PEOPLE TO
ASK QUESTIONS, ENCOURAGING FOLKS
TO COME ON DOWN AND TO RECEIVE A
VACCINE.
WE ALSO USED TRADITIONAL
MESSAGING THAT IS OFTEN A LITTLE
DIFFERENT THAN THE REST OF THE
COUNTRY.
UTILIZING RADIO BROADCAST AND
THE LOCAL TRIBAL NEWSPAPERS TO
PROVIDE MESSAGING AS WELL.
AND HERE IS ONE OF THE TRIBAL
PRINCESSES RECEIVING HER
VACCINE, WHICH IS REALLY
EXCITING TO SEE IN THIS
TRADITIONAL DRESS, HOW BEAUTIFUL
SHE LOOKS WEARING HER MASK AND
RECEIVING HER VACCINATION.
NEXT SLIDE, PLEASE.
SO HOW DID WE LOCALLY IMPLEMENT
VACCINATIONS IN THERE WERE
MULTITIDES OF STRATEGIES.
IHS IS A HEALTH CARE DELIVERY
SYSTEM.
OF COURSE FIRST AND FOREMOST
CREATING VACCINES INTO ROUTINE
CARE.
IT BECAME COMMONPLACE FOR YOU IF
YOU WERE VISITING YOUR DOCTOR
FOR WELCHILD CHECK, PRIMARY CARE
VISIT, IF YOU WERE SEEING A
SPECIALIST.
YOU WERE OFFERED OR ASKED AND
OFFERED ABOUT THE OPPORTUNITY TO
BE VACCINATED WITH COVID
VACCINE.
WE ALSO IMPLEMENTED VACCINATION,
OFFERING VACCINATION OR REFERRAL
FOR VACCINATION AT THE CLINIC IN
OUR URGENT CARE FACILITIES, OUR
EMERGENCY DEPARTMENTS.
AN EXAMPLE WOULD BE IF YOU TWIST
YOUR ANKLE, YOU'RE STILL HEALTHY
ENOUGH TO RECEIVE A VACCINE
TODAY.
LET ME GIVE YOU INFORMATION ON
HOW YOU CAN BE VACCINATED.
INTEGRATION INTO IN-PATIENT
SERVICES.
MANY I HAD.
S FACILITIES HAVE INPATIENT
FACILITIES.
AT MANY OF OUR.
IF WE DO FULL IMMUNIZATION
REVIEWS AND ALSO VACCINATIONS
PRIOR TO DISCHARGE AS LONG AS
SOMEONE IS HEALTHY ENOUGH TO
RECEIVE THOSE VACCINES.
AND COMMUNITY VACCINATION EVENTS
WERE JUST ASTRONOMICAL.
THE MULTITUDE OF CITIES THAT
PEOPLE GOT TO -- AMAZING.
A QUICK REPRESENTATION OF THOSE
IN A MOMENT HERE.
BUT WE WERE ABLE TO PARTNER
PANDEMIC VACCINES, ROUTINE
VACCINES AND SEASONAL SUCH AS
INFLUENZA VACCINES TO MAKE SURE
OUR GROUPS WERE FULLY
UP-TO-DATE.
WE EXPANDED OUR POOL OF
VACCINATORS.
WE REALLY RELIED UPON NURSING
AND PHARMACY TO EXPAND OUR ROLE.
WE UTILIZED PHARMACY TECHNICIANS
IN ROLES.
WE UTILIZED DENTISTS, ALL KIND
OF FOLKS THAT WERE
NON-TRADITIONAL VACCINATORS TO
INCORPORATE THEM INTO THE
VACCINE EFFORT AND EXPANDED AND
CREATED ALL NEW VACCINE CLINICS.
SO IT WAS A REALLY EXCITING TIME
AND WE CONTINUE TO UTILIZE MANY
OF THESE METHODS.
NEXT SLIDE, PLEASE.
MEETING PEOPLE WHERE THEY ARE
WAS ABSOLUTELY ONE OF THE MOST
BENEFICIAL WAYS TO REACH OUR
COMMUNITIES AS WELL.
SO WE HAD OPPORTUNITIES TO GO TO
SCHOOL.
WE WENT TO HEAD START PROGRAMS,
CHILD CARE FACILITIES.
WE WORKED WITH BIE OR BUREAU OF
INDIAN EDUCATION, OFFERED TOWN
HALL EVENTS, PARENT
QUESTION-AND-ANSWER SESSIONS.
WE LOOKED TO TRIBAL COLLEGES AND
OFFERED VACCINATIONS ON SITE.
SO WE HAD SO MANY DIFFERENT
OPPORTUNITIES TO REALLY REACH
OUT TO THE COMMUNITY.
OUR PUBLIC HEALTH NURSES ARE
JUST SIMPLY AMAZING DOING HOME
VISITS, COMMUNITY VISITS,
CULTURAL EVENTS, ALL DIFFERENT
KINDS OF UNIQUE OPPORTUNITIES
WHERE WE CAN ENGAGE WITH PEOPLE
WHERE THEY WERE.
SO IF YOU'RE ATTENDING A
BASKETBALL GAME, HEY, LET'S
VACCINATE YOU.
GET YOU UP-TO-DATE.
AND NAVAJO HAS BEEN INCREDIBLY
SUCCESSFUL, ESPECIALLY BY
ATTENDING SCHOOL EVENTS,
INCLUDING BEAUTIFUL TOURNAMENTS.
THE RESEARCH IS PHENOMENAL WHICH
IS REALLY EXCITING.
WE ALSO WORKED WITH FEMA AND THE
NATIONAL GUARD AT SOME OF OUR
REMOTE RURAL LOCATIONS.
WE HAD MOBILE VANS IN GREAT
PLAINS, CALIFORNIA AREA AND
OTHERS AND THEN LARGE COMMUNITY
EVENTS UP IN NORTHERN ARIZONA.
I ATTENDED THAT ONE EVENT
PERSONALLY.
IT WAS REALLY EXCITING TO SEE
SUCH GREAT OUTPOURING SUPPORT
FROM THE CASINO, FROM THE LOCAL,
STATE, LOCAL FOLKS AND MANY
NON-BENEFICIARY COMMUNITY
MEMBERS WHO JUST WERE SO EXCITED
TO HAVE THE OPPORTUNITY TO BE
VACCINATED.
AND THEN AS MENTIONED BEFORE,
SOME OF THE PARTNERSHIPS WITH
BIE OR BUREAU OF INDIAN
EDUCATION.
WE DID LEADERSHIP TRAVEL TO MANY
SITES AND MANY BIE LOCATIONS AND
WE HOSTED LARGE-SCALE MEDIA
EVENTS AS WELL HIGHLIGHTING
THESE EXCITING OPPORTUNITIES AND
TOWN HALLS.
NEXT SLIDE, PLEASE.
SO HERE IS JUST A COUPLE OF
SNAPSHOTS OF DIFFERENT -- SOME
OF THE HUNDREDS IF NOT THOUSANDS
OF EVENTS HOSTED AROUND THE
COUNTRY.
MANY FACILITIES CREATED LARGE
DRIVE THROUGHS THAT ARE STILL
BEING UTILIZED.
SUPER EXCITING TO BE ABLE TO
MAKE THESE POP UP EVENTS
AVAILABLE TO OUR COMMUNITIES, TO
HAVE EASY ACCESS FOR THE ENTIRE
FAMILY TO COME AND BE
VACCINATED.
NEXT SLIDE, PLEASE.
SO HOW DID WE ENGAGE THE
COMMUNITY I?
I ALREADY TALKED ABOUT SO MANY
DIFFERENT WAYS WE HAVE.
DIFFERENT WAYS, JUST KIND OF A
SNAPSHOT AND I'LL HIGHLIGHT A
FEW OF THESE THINGS.
ONE, WE USED PERSONALIZED
REMINDERS.
WE HAVE ELECTRONIC TOOLS TO CALL
AND SEND LETTERS TO FOLKS.
WE CAN TEXT FOLKS.
COME ON DOWN, GET YOUR VACCINE.
YOU'RE DUE FOR YOUR SECOND DOSE?
COME ON IN.
WE HAVE THE OPPORTUNITY TO
VACCINATE INDIVIDUALS WE
PARTNERED WITH FOLKS AT THE ZOO.
WE WENT TO EXPOS.
WE WENT AROUND TO LOCAL
BUSINESSES AND ADMINISTERED
VACCINES.
WE WORKED WITH CASINOS TO OFFER
INCENTIVES.
THERE WERE OTHER INCENTIVES LIKE
GYM ACCESS.
IF YOU WERE VACCINATED YOU WERE
OFFERED THE OPPORTUNITY TO WORK
OUT AT THE GYM WHEN THEY WERE
CLOSED DOWN.
YOU COULD GO TO -- GET FREE
ENTRANCE A POWWOW.
YOU COULD -- WE ALSO HAD TROOPS
WE HAD A LOT OF FOLKS VISITING
FAMILIES AND VACCINATING THE
ENTIRE FAMILY AT THEIR HOME.
WE ALSO ATTENDED BOYS AND GIRLS
CLUBS ESTONES VACCINATE FOLKS.
HOMELESS SHELTERS, ATTENDANCE AT
CORRECTIONAL FACILITIES.
SO MANY DEDICATED AMAZING
OPPORTUNITIES TO ENGAGE WITH
COWER COMMUNITY.
NEXT SLIDE, PLEASE.
HERE IS ONE 689 EVENTS
HIGHLIGHTED THE BUREAU OF INDIAN
EDUCATION IN OKLAHOMA WHERE OUR
IHS DIRECTOR HALVED TO AND WE
HOSTED A TOWN HALL EVENT.
IT WAS PRETTY EXCITING.
MANY OF THE KIDS WERE SUPER
EXCITED TO BE VACCINATED FOR THE
FIRST TIME.
NEXT SLIDE, PLEASE.
WHAT ABOUT RESOURCES?
WHAT RESOURCES DO WE HAVE
AVAILABLE FOR THE INDIAN HEALTH
SERVICE?
WE HAVE A WIKI THAT HOSTS A
NUMBER OF DIFFERENT RYE SOURCES
UP-TO-DATE INFORMATION,
HISTORICAL INFORMATION ABOUT
CONSULTATION AND CONFER.
WE HAVE OUR PANDEMIC PLAN
PUBLISHED FROM THE INITIAL
ROLLOUT.
WE ALSO KEEP UP-TO-DATE
COMPETENCY EXAMS TO OFFER
TRAINING TO OUR FACILITIES
NATIONWIDE.
WE ALSO HAVE UPDATED DATA ABOUT
OUR VACCINE DISTRIBUTION AND
ADMINISTRATION LISTED BY THE
AREA THAT WE UPDATE WEEKLY.
SO, WE ENCOURAGE YOU TO UTILIZE
THOSE RESOURCES.
NEXT SLIDE, PLEASE.
AND WE HAVE BEEN REALLY FULL
WITH THE HHS.
WE CAN DO THIS INDIAN COUNTRY
CAMPAIGN.
THE NATIONAL CAMPAIGN.
THERE IS A LOT OF REALLY
TERRIFIC GRAPHIC, REAL-CREATED
MESSAGING AND DIFFERENT THINGS
THAT CAN HELP TO STRENGTHEN
VACCINE COMPETENCE, INCREASE
VACCINE UPTAKE AND HELP WITH
MESSAGING THAT IS AT A LORD TO
AMERICAN INDIAN, ALASKA NATIVE
COMMUNITIES.
THEY ALSO HAVE THEIR SOME TRIBAL
LEADER TOOLKITS AND OTHER
RESOURCES THAT ARE REALLY
HELPFUL SO WE DON'T HAVE TO
RE-CREATE THE WHEEL AT EACH
FACILITY WHEN WE ARE TRYING TO
GET THE MESSAGING OUT.
NEXT SLIDE, PLEASE.
HERE ARE SOME EXAMPLES ALSO.
SOME REGIONAL CUSTOMIZABLE
POSTERS THAT TALK ABOUT
MESSAGING THAT CAN BE CUSTOMIZED
TO THE INDIVIDUAL REGION AND
SOME OF THE UNIQUE DESIGNS THAT
ARE IMPORTANT IN THOSE AREAS AND
REGIONS.
NEXT SLIDE, PLEASE.
AND AIL TOGETHER, JUST WANT TO
SAY THANK YOU FOR THIS
OPPORTUNITY AND HOPEFULLY WE
PROVIDED A NICE OVERVIEW WITH
SOME OF THE ACTIVITIES ONGOING
WITHIN THE IHS.
AND SO MORE PHOTOS TO SHARE WITH
YOU OF THE EXCITING DIFFERENT
EVENTS WE HAVE CREATED.
SO THANK YOU SO MUCH.
I'LL TURN IT BACK TO YOU, MOSE.
>>MODERATOR: THANK YOU, HOLLY.
I THINK I RECOGNIZE A COUPLE OF
THOSE KIDS IN THOSE PHOTOS.
THAT'S REALLY GREAT.
I SEE THE HOPI MESSAGING IN
THERE.
SO I RECOGNIZE THAT.
THANK YOU ALL, GOSH WHAT GREAT
PRESENTATIONS.
SO, FOR THE FOLKS ON THE CALL,
WE'RE GOING TO OPEN THIS UP FOR
PANEL DISCUSSION AT THIS POINT.
WE ENCOURAGE RESEARCHERS ON THE
WEBINAR -- ANY OTHER ATTENDEES
ON THE WEBINAR, TO ASK QUESTIONS
OF THE PANELISTS AROUND HOW TO
SUCCESSFULLY ENGAGE WITH TRIBAL
COMMUNITIES.
I THINK WE HAVE HEARD A NUMBER
OF EXCEPTIONAL EXAMPLES DURC THE
PRESENTATIONS AND I THANK YOU
FOR SHARING THAT.
THOSE ARE REALLY HELPFUL
RECOMMENDATIONS FOR FOLKS TO
ENGAGE WITH TRIBAL COMMUNITIES.
THE VOICE FUNCTION IS NOT
ENABLED FOR FOLKS ON THE CALL SO
YOU'RE GOING TO HAVE TO TYPE
YOUR QUESTION INTO THE CHAT BOX.
SO AS SOON AS FOLKS START
PUTTING QUESTIONS IN THERE, I
WILL READ THEM AND I'LL RAISE AS
MANY QUESTIONS TO THE PANELISTS
AS TIME PERMITS.
WE DO HAVE SOME TIME LEFT.
WE HAVE ABOUT 45 MINUTES LEFT
FOR THIS WEBINAR, IF WE NEED TO.
AND WE ALSO HAVE OUR TEAM ON THE
LINE TO TYPE RESPONSES TO
QUESTIONS THAT CAN BE ANSWERED
SIMPLY.
PLEASE INCLUDE YOUR NAME AND
ORGANIZATION IF APPLICABLE AND
IF WE DO NOT HAVE TIME TO ANSWER
YOUR QUESTION, PLEASE FEEL FREE
TO REACH OUT TO RECOVER AT
NIH.GOV.
I'M NOT SEEING ANY QUESTIONS,
YET.
BUT I HAVE A FEW.
CHANNEL, I WANT TO GO TO YOU
FIRST.
AGAIN, THANK YOU FOR THAT
PRESENTATION, IT WAS REALLY
GREAT TO HEAR HOW YOU ALL
IMPROVISED AND OVERCAME IN A
VERY DIFFICULT SITUATION.
I KNOW NAVAJO AT ONE TIME THE
HIGHEST IN THE WORLD, AND IT WAS
A VERY CHALLENGING SITUATIONS.
I WONDER IF YOU COULD TALK ABOUT
COLLABORATING WITH TRIBAL
PROGRAMS, COMMUNITY
ORGANIZATIONS.
I KNOW YOU PROBABLY WORKED WITH
THE COMMUNITY HEALTH
REPRESENTATIVES.
I KNOW THERE ARE PROBABLY
COMMUNITY ORGANIZATIONS THAT
MOBILIZED AND REALLY IT WAS AN
ALL HANDS ON DECK TYPE OF
SITUATION, RIGHT?
SO CAN YOU SPEAK A LITTLE BIT
MORE ABOUT THE DIFFERENT
PROGRAMS THAT YOU WORKED WITH,
WHAT THE CHALLENGES WERE AND HOW
YOU OVERCAME THEM TO RESPOND
VERY WELL TO THIS PANDEMIC.
>>HI, YES.
SO WE HAD ASSEMBLED A WORK TEAM
REALLY FAST WITH OUR PARTNERS.
AND I WAS NOT FAMILIAR WITH A
LOT OF THE PARTNERS BECAUSE I
HAD JUST BEEN HIRED AT NAVAJO
AREA.
SO I WAS UNFAMILIAR WITH JOHNS
HOPKINS UNIVERSITY.
I WAS UNFAMILIAR WITH COPE.
I WAS UNFAMILIAR WITH A LOT OF
TRIBAL ORGANIZATIONS AROUND
NAVAJO.
SO WHEN WE CAME TOGETHER, I JUST
REMEMBER HAVING A MEETING WITH
THE NAVAJO NATION AND THAT WAS
KIND OF LIKE OPENING UP THE KEY
STAKEHOLDERS AND PARTNERS.
SO WITH THE NAVAJO EPICENTER,
THEY ALREADY HAD PARTNERSHIPS
WITH THE UNIVERSITIES AND THEY
ALREADY HAD PARTNERSHIPS WITH
THE STATE.
SO FROM ATTENDING MEETINGS WITH
THEM AND THEN GETTING OUR
AGREEMENT TO MAKE SURE THAT WE
ARE SHARING DATA DAILY, I THINK
THAT REALLY HELPED US ESTABLISH
A POSITIVE RAPPORT WITH OUR
TRIBAL COMMUNITY.
AND THEN ALSO IN THE LEARNING
WHO OUR PARTNERS WERE.
SO I BECAME FAMILIAR WITH JOHNS
HOPKINS AND I BECAME FAMILIAR
WITH THE CDC AND THEN OUR LOCAL
TRIBAL COMMUNITY BEFORE COMING
TO NAVAJO AREA, I WAS A CHR
COORDINATOR FOR TUCSON AREA.
SO I WANTED TO MAKE SURE WE WERE
UTILIZING OUR TRIBAL PILLARS IN
THE COMMUNITY.
SO WE WANTED TO MAKE SURE THEY
GOT ACCESS TO EHR.
WE WANTED TO MAKE SURE ONE OF
OUR PHN TEAMS, AT A FEDERAL
FACILITY, IS A 638 FACILITY
MEANING THE TRIBE HAS TAKE OWN
OVER THE FUNDS FOR PUBLIC HEALTH
NURSING.
SO IN ORDER TO REALLY HELP
COMBAT OR SLOW THE SPREAD, WE
HAD TO REALLY PARTNER WITH THE
PHN SO THAT THEY CAN GET THE
INFORMATION FROM OUR EHR SYSTEM
SO THAT THERE IS NO DELAY FROM
OUR CLINIC TO THEM SO WE CAN
RELAY BACK TO THE COMMUNITY THAT
THEY ARE POSITIVE OR THEY SHOULD
STAY HOME OR THIGHS ARE THE
GUIDELINES.
THE SO WE HAD TO LEARN THOSE
THINGS REALLY FAST AS A TEAM.
AND THEN JUST MAKING SURE THAT
WE LET DOWN BARRIERS.
A LOT OF TIMES WE ARE
TERRITORIAL OVER SOME OF OUR
DATA.
MAYBE TERRITORIAL OF OUR WORK.
AND JUST REALLY LETTING US KNOW
THAT WE NEED TO REALLY WORK
TOGETHER.
AND THAT IS WHAT REALLY HELPS
GET THROUGH EVERYTHING.
SO I THINK JUST HAVING THOSE
MEETINGS WITH PEOPLE WHO ALREADY
ESTABLISHED THOSE PARTNERSHIPS
HELPED ME A LOT AND THEN FROM
THERE, I WAS ABLE, OUR TEAM WAS
ABLE TO GROW AND THEN ALSO
BECOME, HOPEFULLY GOOD PARTNER
WITH ALL THE OTHER TRIBAL
MEMBERS.
THANK YOU.
>>MODERATOR: HOW IMPORTANT
WOULD YOU SAY THE REGULAR
COMMUNICATION WITH YOUR PARTNERS
WAS AND IS?
>>OH, MY GOSH.
SO AT THE BEGINNING, THERE ARE
STILL A LOT OF MEETINGS.
FOR THE MOST PART, MAKING SURE
THAT WE ARE MEETING AT LEAST
WEEKLY OR BIWEEKLY AT THE
BEGINNING.
TO REALLY GET AN IDEA OF WHAT IS
AT STAKE?
HOW MANY PIECES DO WE HAVE AND
WHAT DO WE NEED TO DO?
DR. HAMIT SPOKE ABOUT HOW DO WE
CONTAIN AND SLOW THE SPREAD?
WE CAME UP WITH REALLY STRICT
RULES SO THAT PEOPLE STAYED
HOME.
WE CLOSED DOWN THE NAVAJO
NATION, WHICH IT HELPED OR MAYBE
AT THE END OF THE DAY, MADE
THINGS HARDER FOR MAYBE OUR
PEOPLE BUT AT THE END OF THE
DAY, WE WERE ABLE TO SLOW SOME
OF THE SPREAD AND HELP THE MOST
VULNERABLE.
AND FOCUS ON THE MOST
VULNERABLE.
SO DEFINITELY THOSE WERE VERY
IMPORTANT THINGS THAT WE HAD TO
KEEP INTO ACCOUNT.
>>MODERATOR: THANK YOU.
FOR THE VIEWERS, SINCE TRIBAL
NATIONS ARE SOVEREIGN ENTITIES,
THEY CAN ISSUE THE STAY AT HOME
ORDERS.
AND I KNOW ON HOPI TOO, WE HAD
MULTIPLE STAY AT HOME ORDERS FOR
FOLKS TO STOP THE SPREAD OF
COVID.
SO THAT'S REALLY IMPORTANT TO
KEEP IN MIND.
I'M GOING TO TURN IT TO
DR. HAMIT.
FOR NEW RESEARCHERS, HOW MIGHT
THEY GAIN AN ENTRY POINT INTO A
COMMUNITY THAT THEY WANT TO
WORK?
I KNOW YOU SAID ENGAGEMENT IS
IMPORTANT EARLY AND OFTEN.
EVEN BEFORE THE PROCESS.
I THINK IT'S GREAT THAT YOU
MENTIONED YOU CAN'T COME TO A
COMMUNITY AFTER YOU GET THE
GRANT AND SAY WE'D LIKE TO DO A
STUDY HERE.
BUT HOW WOULD YOU ADVISE A NEW
RESEARCHER THAT WANTS TO WORK IN
TRIBAL COMMUNITIES HOW TO GAIN
ENTRY AND INTRODUCTION AND
STARTED TO EARN THE TRUST OF
THAT COMMUNITY?
>>THAT'S A GREAT QUESTION,
THANK YOU.
AND I THINK I'LL JUST START BY
SAYING THERE IS SO MUCH
IMPORTANT WORK TO BE DONE.
SO I THINK THAT WHAT I HEARD
OVER AND OVER FROM TRIBAL
COMMUNITIES, AS A NON INDIGENOUS
PERSON, IS THAT THAT THEY
WELCOME ASSISTANCE FROM ALLIES
WHO ARE TRYING TO SUPPORT GOOD
WORK BEING DONE.
SO I WOULD JUST ENCOURAGE PEOPLE
THAT THERE ARE OPPORTUNITIES.
THERE IS IMPORTANT WORK TO BE
DONE.
LET IT BE LED BY THE COMMUNITY.
IF YOU HAVE A SPECIFIC TOPIC
THAT YOU'RE INTERESTED IN
WORKING ON, WHETHER IT'S A
MENTAL HEALTH OR INFECTIOUS
DISEASE OR WHETHER YOU'RE JUST
MORE INTERESTED IN WORKING WITH
A SPECIFIC TRIBAL COMMUNITY THAT
YOU HAVE SOME AFFILIATION WITH.
I THINK HEARING FROM THE
COMMUNITY ABOUT THEIR PRIORITY
AREAS OF CONCERN, UNDERSTANDING
WHO THE STAKEHOLDERS ARE,
UNDERSTANDING WHAT THE COMMUNITY
APPROVAL PROCESS IS FOR
RESEARCH.
IT IS ALL REALLY IMPORTANT
STEPS.
AND ALSO, I THINK CONTRARY TO
SOME REPRESENTATIONS OF
INDIGENOUS PEOPLES AS A
HOMOGENEOUS GROUP RECOGNIZING
THEY ARE MEMBERS OF DISTINCT AND
DIVERSE TRIBAL NATIONS.
SO THE UNIQUE CULTURE OF A TRIBE
CAN IMPACT ALL ASPECTS OF
RESEARCH.
AND WHAT WORKS IN ONE TRIBE
MIGHT NOT WORK T MIGHT NOT BE
THE SAME PROCESS WHEN YOU WORK
IN ANOTHER TRIBE.
SO HAVING AWARENESS OF THAT
EARLY ON IS IMPORTANT AS WELL.
BUT I THINK LISTENING TO THE
COMMUNITY, REALLY INFORMING
YOURSELF, EDUCATING YOURSELF
ABOUT COMMUNITY-BASED
PARTICIPATORY RESEARCH AND
LETTING COMMUNITY STAKEHOLDERS
GUIDE THE WORK AND GUIDE THAT
PROCESS, IS A GOOD FIRST STEP.
>>MODERATOR: GREAT.
THANK YOU.
LET'S SEE IF THERE ARE ANY OTHER
QUESTIONS IN THE CHAT.
I'M NOT SEEING ANY OTHER
QUESTIONS.
CAPTAN VAN LEW.
I KNOW IT WAS A GREAT DAY WHEN
WE ALL GOT THE VACCINES AND WE
WERE ALL PLANNING TO ROLE THAT
OUT PRETTY QUICKLY.
I GUESS, MANY DISCUSSIONS THAT
WE HAD WITH TRIBAL LEADERS AT
THE TIME WERE AROUND VACCINE
HESITANCE.
AND I THINK ALL OF YOU ALLUDED
TO THIS AT ONE POINT OR ANOTHER
IN YOUR PRESENTATIONS.
BUT -- I SAW A LOT OF THE THINGS
YOU DID.
CAN YOU ELABORATE A LITTLE BIT
MORE ON ADDRESSING THE HESITANCE
AND HOW YOU EDUCATED THE
COMMUNITY ON THE EFFICACY OF THE
VACCINE?
AND SORTED OUT THE REALLY
COMPLICATED ADMINISTRATION
SCHEDULE.
BECAUSE A LOT OF FOLKS GOT
REALLY CONFUSED AROUND WHEN DO I
TAKE THIS ONE?
HOW MANY WEEKS DO I HAVE TO
WAIT?
SO COMMUNICATION IS REALLY
IMPORTANT AND KEY WHEN YOU'RE
TRYING TO MITIGATE A PANDEMIC.
SO WONDERING IF YOU COULD SPEAK
TO THAT A LITTLE BIT MORE.
>>THANK YOU FOR THE QUESTION.
VACCINE CONFIDENCE DOESN'T COME
IN AREN'TLY ESPECIALLY WITH A
BRAND NEW PRODUCT TWO YEARS AGO
BUT IT WAS REASSUREING TO HAVE
SOME OF THE DATA THAT WAS
WORKING SO HARD TO BRING FORWARD
TO THE COMMUNITY AS FAST AS
POSSIBLE.
IT WAS EXCITING TO BE ABLE TO
SHARE IN REALTIME.
SOMETIMES THE INFORMATION THAT
WAS AVAILABLE AND CONTINUED TO
PERPETUATE THAT INFORMATION
GETTING INTO OUR COMMUNITIES.
I THINK VACCINE CONFIDENCE WAS
BEST SERVED IN MANY OF OUR LOCAL
COMMUNITIES BY OFFERING TOWN
HALLS AND HAVING OPEN DIALOGUE.
OPEN QUESTION-AND-ANSWER
SESSIONS.
SPECIFICALLY IN THE NAVAJO AREA
THEY HAVE A Q&A PHONE LINE THAT
WAS UTILIZED.
AND REALLY APPRECIATED BECAUSE
FOLKS COULD DIAL UP AND ASK
QUESTIONS.
HOW DO YOU GET A VACCINE?
WHERE DO YOU GET A VACCINE?
CAN YOU TELL ME MORE ABOUT THE
VACCINE?
AND EVERYONE IS RIGHTFULLY SO,
SKEPTICAL WITH BRAND NEW
PRODUCTS COMING FORWARD.
THESE WERE BOLT PLATFORMS THAT
HAD BEEN STUDIED FOR LONG
PERIODS OF TIME.
IT'S BEEN EXCITING AND HELPFUL
TO GATHER INFORMATION FROM THE
CD R AND HAVE THESE MESSAGES
PERPETUATED THROUGH MULTIPLE
CHANNELS THROUGH OUR RESEARCH
PARTNERS, THROUGH OUR OTHER
AFFILIATES, FEDERAL PARTNERS.
AND THEN DOWN TO THE LOCAL
LEVEL.
SO I THINK IT WAS JUST A MATTER
OF TAKING AS MUCH INFORMATION AS
WE COULD WHEN WE HAD IT
AVAILABLE.
AND TRYING TO DISSEMINATE IT AS
QUICKLY AS POSSIBLE AND LETTING
PEOPLE KNOW THIS ISN'T A PROMISE
OF THE -- IT WILL BE PERFECT.
WE KNOW NO VACCINE IS 100%
EFFECTIVE BUT WE KNOW THEY
PREVENT SEVERE ILLNESS, DEATH
AND HOSPITALIZATION AND WE
CONTINUE TO COMMUNICATE THOSE
CRITICAL MESSAGES.
THIS IS JUST ONE TOOL WITH A
MULTITUDE AVAILABLE TO US TO
MAKE SURE THAT WE CAN HELP
PROTECT OURSELVES, OUR
COMMUNITIES, OUR FAMILIES AND
ELDERS AND OUR CHILDREN.
SO, AND THEN TOO, THE COMPLEXITY
OF COVID VACCINES AND SCHEDULES.
JUST EVERY DAY WHEN WE THINK IT
MAY GET EASIER T JUST GETS MORE
COMPLICATED AND WE THINK COULD
IT BE ANYMORE CONFUSING AT
TIMES?
RELY UPON YOUR HEALTH
PROFESSIONAL.
WE LIVE AND BREATHE IT EVERY
DAY.
WE KNOW THE MINIMUM INTERVALS
BETWEEN THE DOSES AND WHEN IS
THE LAST TIME YOU HAD A DOSE AND
WEATHER YOU'RE DUE FOR THE NEXT
TIME.
RIGHT NOW NEEDS A BIVALENT
BOOSTER IF YOU'RE 5 AND OLDER.
IF IT'S BEEN AT LEAST TWO MONTHS
SINCE YOUR LAST COVID VACCINE
AND YOU COMPLETED YOUR SERIES.
SO IS THAT IS SIMPLIFYING THINGS
RIGHT NOW AND WE ARE EXCITED
THAT IT IS HOPEFULLY IN THE NEXT
FEW DAYS TO A WEEK T WILL BE
BIVALIANT BOOSTERS, THOSE
BOOSTERS THAT INCORPORATE THE
ORIGINAL STRAIN OF COVID PLUS
SOME OF THE NEWER STRAINS THAT
HAVE BEEN CIRCULATING IN OUR
COMMUNITY.
SOY, HOPEFULLY THAT
SIMPLIFICATION WILL BE HELPFUL
AND CAN COMMUNICATE THROUGH OUR
COMMUNITIES TO SAY, JUST COME IN
AND GET YOUR FLU SHOT AND WHILE
YOU'RE HERE, LET'S GET YOU
UP-TO-DATE AND MAKE SURE YOU'RE
UP-TO-DATE - COVID VACCINES AND
ROUTINE VACCINES.
THAT'S WHAT I HAVE TO SAY.
>>MODERATOR: THANK YOU FOR THAT
EXCELLENT ANSWER.
APPRECIATE THAT.
I THINK ONE OF THE THINGS THAT
YOU JUST REMINDED ME OF WAS OF
ROUTINE CARE.
SO PATIENTS THEY -- IN MANY
FACILITIES HAVE TO REALLY SHUT
DOWN SERVICES AND LIKE THE
OUTPATIENT DEPARTMENT AND STAFF
WAS GETTING REASSIGNED AROUND
THE HOSPITAL.
CERTAIN DEPARTMENTS HAVE TO BE
SHUT DOWN.
THAT IS REALLY GOING TO HAVE, AT
LEAST A LOT OF PEOPLE WITH
EXPRESS CONCERN, MEDICAL
PROVIDERS THAT THIS IS GOING TO
HAVE A LONG TERM IMPACT ON --
SHORT AND LONG TERM IMPACT ON
MECHANICS HEALTH.
SO, I WONDER IF EACH OF YOU
COULD SPEAK TO THAT.
SPEAK TO SOME OF THE CONCERNS,
MAYBE SOME POSSIBLE SOLUTIONS OR
WHAT WE NEED TO DO.
BECAUSE FOLKS HAVE TWO-YEAR
PERIOD WHERE THEY REALLY DIDN'T
ACCESS PRIMARY CARE UNLESS IT
WAS AN EMERGENCY.
DO ANY OF YOU HAVE ANY INSIGHTS
AS TO WHAT THE LONG TERM EFFECTS
MIGHT HAVE ON A POPULATION AND
WHAT RESEARCH MIGHT HELP TO
TREAT, THOSE CONDITIONS AS WELL
AS LONG COVID?
I KNOW THAT IS A LONG QUESTION.
I THINK YOU KNOW WHERE I'M GOING
WITH THAT.
>>I CAN START AND THEN I'LL
TURN IT OVER TO MY COLLEAGUES
HERE.
I WOULD SAY ROUTINE CARE
CERTAINLY HAS BEEN AFFECTED AND
WE ARE GOING TO SEE LONG TERM
REPERCUSSIONS.
WE KNOW FOR A FACT IN OUR CHILD
IMMUNIZATION RATES, ADULT
IMMUNIZATION RATES FOR ROUTINE
VACCINES HAVE DECLINED OVER THE
L TWO YEARS.
AND EVEN THOUGH WE CONTINUE TO
TRY TO CATCH-UP, WE STILL ARE
BEHIND AND WE ARE TRYING AND
TRYING.
AND TRYING TO BALANCE ALL THESE
OTHER THINGS.
WE HAVE THE PANDEMIC WITH
COVID-19.
WE HAD A LOT OF THERAPEUTIC
MONOCLONAL ANTIBODY AND
TREATMENTS THAT ROLLED OUT AS
WELL, PREVENTION ITEMS SUCH AS
AN INJECTABLE MEDICATION FOR
CERTAIN HIGH-RISK GROUPS.
WE ALSO HAD THE M POX OR
PREVIOUSLY CALLED MONKEY POX
OUTBREAK OF 2022.
SO WE HAVE BEEN HANDLING AND
JUGGLING SO MANY DIFFERENT
PIECES OVER TIME.
YOU KNOW THE IHS IS REALLY
FOCUSED AND ALWAYS HAS BEEN
FOCUSED ON ROUTINE
IMMUNIZATIONS.
WE KNOW AMERICAN INDIAN AND
ALASKA NATIVES IN GENERAL OFTEN
HAVE MORE UNDERLYING MEDICAL
CONDITIONS AND MORE
DISPROPORTIONATELY AFFECTED WITH
INFLUENZA AND PNEUMONIA.
SO REMAINING DILIGENT WITH
ROUTINE VACCINES IS CRITICAL AND
VERY RECENTLY, WE HAVE RELEASED
OUR E3 VACCINE STRATEGY WHICH IS
A COMPREHENSIVE STRATEGY TO
ADDRESS EVERY VACCINE FOR EVERY
PATIENT AT EVERY ENCOUNTER.
SO IT'S A REALLY EXCITING
OPPORTUNITY REMINDING EVERY
FACILITY THAT WHEN SOMEONE COMES
FOR THEIR PRIMARY CARE VISIT OR
MAYBE THEY HAVE A RASH, LIKE
JUST A REGULAR OLD RASH ON THEIR
ARM, THAT WE NEED TO BE MINDFUL
OF GETTING THEM COMPLETELY
UP-TO-DATE WHILE WE HAVE THEM IN
HAND.
WHEN WE WERE DOING TELEPHONE
VISITS IT WAS DIFFICULT.
SO WE DID REALLY ENCOURAGE FOLKS
TO COME OUT TO OUR DEDICATED
VACCINE CLINICS AND NOW REALLY
FOCUSING ON ROUTINE CARE AND
THEN EXPANDING THOSE CLINICS AND
SEASONAL FLU VACCINES AND ALSO
ALL VACCINES.
SO IT'S A LOT.
THERE IS SO MUCH TO BE DONE IN
THE VACCINE WORLD RIGHT NOW.
SO THANK YOU FOR THE QUESTION.
>>MODERATOR: THANK YOU.
DR. HAMIT?
DO YOU HAVE ANY THOUGHTS ON THAT
AS WELL AS LONG COVID?
>>YES, THANK YOU FOR THE
QUESTION.
I COMPLETELY AGREE WITH THE
CAPTAN'S REMARKS.
WE THINK THERE IS A LOT TO BE
DONE FROM THE RESEARCH
STANDPOINT I THINK TREMENDOUS
PLACES HAVE DONE A TREMENDOUS
EFFORT IN TRYING TO SUPPORT
GIVING MESSAGES IN THE RIGHT WAY
WITH THE RIGHT MESSENGERS.
AND I THINK THERE IS RESEARCH
OPPORTUNITIES TO FIGURE OUT FOR
THE GROUP OF PEOPLE WHO HAVE NOT
YET HAD VACCINATION OR NOT HAD
THEIR BOOSTERS.
WHAT ARE THE REASONS THAT IT
THEY ARE HESITANT?
LOGISTICAL REASONS?
THEY CAN'T GET TIME OFF WORK?
DO WE NEED TO HAVE MORE SUPPORT
FOR OUTREACH EVENT.
OR ARE THERE SAFETY CONCERNS?
OR ARE THERE CONCERNS THAT THEY
JUST DON'T FEEL LIKE THIS IS
SOMETHING THAT REALLY APPLIES TO
THEM BECAUSE THEY ARE HEALTHY
AND THEY JUST DON'T NEED A
VACCINE.
SO I THINK MORE WORK IN TERMS OF
RESEARCH THAT REALLY WOULD BE
IMPORTANT IS UNDERSTANDING WHAT
ARE THE BARRIERS TO PROMOTING
UPTAKE?
WHAT ARE THE BEST WAYS TO
DELIVER THE MESSAGES?
IS IT SOMETHING THAT WOULD BE
WELL RECEIVED ON SOCIAL MEDIA,
BY RADIO?
PROBABLY DIFFERENT MESSAGES FOR
DIFFERENT AUDIENCES IF YOU'RE
TRYING TO TARGET PEOPLE WHO ARE
ELDERLY IN RURAL COMMUNITIES
VERSUS YOUNG URBAN MEN.
THEY PROBABLY WILL BE DIFFERENT
MESSES MOST EFFECTIVE FOR THOSE
GROUPS.
I THINK THERE ARE REALLY
SIGNIFICANT PHYSICAL AND MENTAL
HEALTH SEQUEL I FOR COVID WE ARE
LEARNING MORE ABOUT.
THIS IS ESPECIALLY HARD FOR
PEOPLE WHO SERVE AS CAREGIVERS
AND THEIR FAMILIES.
AND THE IT'S ESPECIALLY HARD
WHEN THE EXISTING HEALTH CARE
SYSTEM IS ALREADY UNDERFUNDED
AND GRAPPLING WITH TRYING TO
PROVIDE ROUTINE CARE.
BUT NOW HAS THE ADDED BURDEN OF
TRYING TO CARE FOR A VERY YET TO
BE FULLY CHARACTERIZED ENTITY OF
LONG COVID.
SO, WE NEED RESEARCH DOLLARS TO
FIGURE OUT THE BEST WAYS TO
PROACTIVELY -- WE NEED
RESEARCH -- HEALTH CARE DOLLARS
TO BE ABLE TO PROVIDE THE CARE
FOR PEOPLE AND RESEARCH DOLLARS
TO BE ABLE TO UNDERSTAND WHAT
ARE THE BEST INTERVENTIONS THAT
ARE GOING -- THAT WILL HELP
PEOPLE TO DEAL WITH THESE
SEQUELAE OF COVID.
>>MODERATOR: THANK YOU FOR THAT
RESPONSE.
THAT REMINDED ME OF SOMETHING
TRIBAL LEADERS HAD RECENTLY IN
ONE EVER THEIR PRIORITIES THEY
EXPRESSED ON ONE OF OUR
COMMIT -- A COMMITTEE I SERB ON.
AND THAT WAS ABOUT USING
TRADITIONAL MEDICINE TO TREAT
LONG COVID.
I MEAN, DO YOU SEE SOME PROMISE
THERE?
AND WHETHER OR NOT YOU KNOW OF
ANY SPECIFIC PROJECTS THAT ARE
ACTUALLY USING TRADITIONAL
MEDICINE?
>>I CAN ANSWER THAT FIRST AND
WELCOME OTHERS ON THE PANEL TO
CONTRIBUTE.
I THINK THERE IS DEFINITELY
PROMISE THERE.
I THINK THAT TRADITIONAL HEALERS
HAVE HAD GRAPPLED WITH DISEASES
FOR HUNDREDS AND THOUSANDS OF
YEARS AND HAVE A LOT OF
SOLUTIONS IN HAND THAT WE HAVE
NOT REALLY EVEN STARTED TO
EXPLORE, I DON'T THINK.
IN TERMS OF COVID-19.
SO I THINK THERE IS TREMENDOUS
POTENTIAL THERE.
I THINK ONE OF THE CHALLENGES
HAS BEEN FOR A LONG TIME, HOW TO
GET THAT WORK FUNDED.
AND I THINK THAT THAT IS WHERE
ORGANIZATIONS THAT CAN
APPRECIATE AND RESPECT AND
ACKNOWLEDGE ALL THAT TRADITIONAL
HEALERS HAVE TO OFFER.
WE COULD GAIN A LOT.
THERE IS A LOT OF WISDOM THERE
THAT I THINK HASN'T BEEN FULLY
APPRECIATED.
>>CHANNEL, YOU COVERED A LOT OF
GROUND IN YOUR PRESENTATION AND
GAVE A GREAT OVERVIEW AND REALLY
POINTED OUT A LOT OF THE
CHALLENGES THAT YOU HAD IN
RESPONDING TO THE PANDEMIC.
ARE THERE ANY -- WHAT
INFORMATION WOULD BE HELPFUL FOR
YOU AS WE PREPARE, HOPEFULLY WE
DON'T HAVE ANOTHER PANDEMIC.
BUT AS WE KEEP OUR PREPAREDNESS
UP, WHAT ARE SOME OF THE THINGS
THAT YOU WOULD LIKE TO KNOW FROM
A RESEARCH STANDPOINT THAT WOULD
MAKE THINGS, AT LEAST WORK A
LITTLE BIT MORE EFFICIENTLY?
AND YOU CAN BE MORE EFFECTIVE IN
THE BEGINNING.
I KNOW YOU MENTIONED DATA
SHARING AND THINGS LIKE THAT.
I WONDER IF YOU COULD TALK MORE
ABOUT THAT AND SOME OF THE AREAS
WHERE RESEARCH WOULD HELP FOLKS
ON THE GROUND AS THEY ARE TRYING
TO TAKE CARE OF PATIENTS AND
RESPOND TO THIS PANDEMIC.
>>I THINK THE WAY THAT WE CAN
ASSESS THAT WE DID THE BEST JOB,
IS MAKING SURE WE ARE ABLE TO
PREPARE AND BE PREPARED FOR
ANOTHER PANDEMIC.
AND NOT HAVE TO BE ON THE BACK
BURNER WAITING FOR MASK OR
WAITING FOR TEAMS TO SHOW UP.
SO MAKING SURE THAT WE
DEFINITELY KEEP OUR PARTNERSHIPS
GOING AND THEN FOR ME, AND OUR
TEAMS AND NATIONS, WE NEED TO
KNOW WHAT IS GOING ON IN OUR
COMMUNITY.
WHAT IS THE COMMUNITY
ASSESSMENT?
WHAT IS THE PULSE OF THE
COMMUNITY?
HOW CAN WE LIKED TAILOR OUR
MEDICAL CARE TO THE NEEDS OF THE
COMMUNITY?
AND SO WE, BEFORE COVID, WE
COULD SAY MOST OF OUR HEALTH
DISPARITIES ARE BECAUSE OF
DIABETES OR BECAUSE WE DON'T
HAVE ACCESS TO FOOD.
BUT I THINK NOW THAT WE HAD THIS
PANDEMIC, OUR PRIORITIES AND A
LOT OF OUR HEALTH HAS CHANGED
AND WE DEFINITELY NEED TO MAKE
SURE THAT WE ASSESS OUR
COMMUNITIES.
WHAT DO THEY NEED BESIDES -- WE
KNOW WE ARE GOING TO NEED SOME
MENTAL BEHAVIORAL HEALTH
THERAPISTS, SUPPORTS, OR MORE
KIND OF LIKE PEER-TO-PEER
SPECIALISTS, COMMUNITY LEADERS,
WITHIN THE COMMUNITIES TO HELP
OUR COMMUNITY HEAL.
SO I THINK MAKING SURE THAT WE
GET A PULSE OF WHAT IS GOING ON
IN OUR COMMUNITY, MAKING --
GOING BACK TO ASK, LIKE WHAT WE
DID RIGHT AND WHAT DO WE NEED TO
DO DIFFERENT AND WHAT DO WE NEED
TO SUSTAIN?
AND WHAT DO WE NEED TO CHANGE?
SO I THINK MAKING SURE WE ARE
GOING FORWARD, WE CONTINUE TO
EVOLVE AS A HEALTH CARE SYSTEM.
WE CONTINUE TO KEEP THE
COMMUNITIES VOICE AND HEAR IT
WHEN IT COMES TO THEIR NEEDS,
THEIR MEDICAL CARE.
AND THEN SEEING HOW ADVERSELY
COVID HAS AFFECTED OUR FAMILIES.
I THINK THAT WE COME FROM A LONG
GENERATION OF RESILIENCE.
I THINK THAT WE ARE HERE TO HEAL
AND STAY BUT I DEFINITELY THINK
WE DEFINITELY HAVE TO TAILOR THE
WAY WE DO BUSINESS WITH OUR
COMMUNITY.
WITH OUR PARTNERS AND THEN JUST
MAKING SURE THAT WE ARE ALSO
WORKING TO GET BETTER TO ASSESS
THOSE NEEDS AND THEN ADDRESS
THOSE NEEDS.
THANK YOU.
>>MODERATOR: THANK YOU.
GREAT ANSWER.
I THINK ONE OF THE ISSUES TOO,
THAT WE WERE GOING TO BE DEALING
WITH FOR A LONG TIME IS THE
WORKFORCE ISSUERS.
I THINK -- ISSUES.
JUST THE SHEAR LENGTH OF THIS
PANDEMIC PUT INCREDIBLE STRESS
ON OUR HEALTH CARE SYSTEM AND
OUR FRONT LINE WORKERS.
SO I MEAN, THERE HAS BEEN SOME
RESEARCH INTO THE WORKFORCE
ISSUES AND HOW WE CAN RESPOND TO
THAT BUT I THINK YOU BRING UP A
REALLY GOOD AND IMPORTANT POINT
ABOUT A LONG TERM MENTAL HEALTH,
BEHAVIORAL HEALTH AMONG
WORKFORCE AND OUR PATIENTED.
SO THANK YOU FOR THAT.
-- PATIENTS.
I DON'T SEE ANY OTHER QUESTIONS
IN THE CHAT AT THIS MOMENT.
>>I DID SEE SOME QUESTIONS IN
THE Q&A SECTION.
I'M NOT SURE IF THAT IS
SOMETHING YOU WERE HOPING TO
LOOK AT.
>>MODERATOR: I'M SORRY.
I DIDN'T HAVE THAT OPEN.
OKAY, I'M NEW AT THIS.
WE LEARN AND GET BETTER.
THIS IS TO ALL PANELISTS.
WHEN TRYING TO GET ALL THE
DIFFERENT PARTNERS FROM TRIBAL,
FEDERAL, STATE, COMMUNITY
ET CETERA TO WORK TOGETHER, HOW
WERE YOU ABLE TO GET THE WORK TO
MOVE FORWARD SO QUICKLY?
WERE THERE EXPEDITED MEASURES
THAT TOOK PLACE THAT NORMALLY
TAKE LONGER?
ANYBODY WANT TO TAKE A FIRST
STAB AT THAT ONE?
>>I CAN TAKE A FIRST STAB AT
IT.
I'M SURE THAT LIEUTENANT AND
CAPTAN WILL HAVE THOUGHTS ABOUT
THIS.
HONESTLY, THIS WAS SOMETHING
THAT CONSUMED EVERYBODY'S TIME
AND ENERGY 24-7.
SO PEOPLE WERE WORKING AROUND
THE CLOCK.
ESPECIALLY IN TRIBAL COMMUNITIES
WHERE THIS HIT SO HARD AND EVERY
FAMILY WAS TOUCHED.
AND PEOPLE WERE DYING.
LIKE YOU JUST WANTED TO DO
EVERYTHING YOU POSSIBLE I COULD.
AND I THINK EVERYBODY FELT THAT
WAY IN THE RESPONSE.
SO, IT DEFINITELY HAPPENED MORE
QUICKLY THAN IT NORMALLY DOES,
BUT THAT'S BECAUSE OF THE
ABSOLUTE URGENCY OF THIS
SITUATION.
AND I THINK IT'S A REAL
TESTAMENT TO SOMETHING THAT I
THINK WE ALL FEEL PROUD ABOUT.
BECAUSE THAT WAS -- IT WAS A
REALLY SCARY TIME BUT IT WAS
ALSO A REALLY INCREDIBLE
OPPORTUNITY OR TIME FOR PEOPLE
TO COME TOGETHER AND JUST FIGURE
IT OUT.
AND DO EVERYTHING THAT YOU
POSSIBLY COULD.
AND I THINK AUGUST OF THE
PARTNERS FELT THAT WAY.
EVERY ONE.
EVERYBODY WANTED TO DO
EVERYTHING THAT THEY COULD TO
TRY AND HELP THEIR COMMUNITY.
>>MODERATOR: I THINK THAT'S A
GREAT RESPONSE.
I CAN'T THINK OF ANYTHING TO
ADD.
THERE WERE SOME THINGS,
ESPECIALLY -- I'LL SHARE WITH
THE PANEL AND BECOME A PANELIST
FOR A MOMENT WITH MY PANELIST
HAT IF YOU DON'T MIND.
ONE OF THE -- THERE WERE SO MANY
THINGS AND ESPECIALLY AROUND
PRIVACY.
THE PRIVACY ACT AND HIPPA.
I KNOW A LOT OF THOSE
CONSIDERATIONS CAME IN AT THE
VERY BEGINNING.
BUT WE WERE -- THE PUBLIC HEALTH
EMERGENCY GIVES FOLKS DIFFERENT
AUTHORITIES THEY DIDN'T HAVE
BEFORE.
SO I THINK A LOT OF PEOPLE WERE
ABLE TO EXPEDITE AND JUST KIND
OF CUT THROUGH THE RED TAPE TO
GET THINGS DONE.
I THINK FOR US, THE KEY EXAMPLE
IS THE PUBLIC HEALTH AUTHORITY
FOR DATA SHARING.
SO EACH OF THE -- THE TRIBE HAD
TO ESTABLISH A PUBLIC HEALTH
AUTHORITY SO WE COULD LEGALLY
SHARE THAT DATA WITH THEM EVEN
UNDER PUBLIC HEALTH EMERGENCY.
SO WE HAD TO HAVE THAT IN
PLAGUES.
AND THAT NORMALLY, OF COURSE,
THINGS KIND OF TAKE LONG IN THE
FEDERAL GOVERNMENT SOMETIMES.
AND EVEN IN TRIBAL GOVERNMENT
FOR THAT MATTER.
AND THAT TOOK A LOT LESS TIME,
GIVEN THE PANDEMIC.
AND I THINK EVEN THE CHAIRMAN OF
THE TRIBE ON MY LAST DAY UP AT
THE HOPI HEALTH CARE CENTER, WE
TALKED ABOUT HOW CLOSE WE HAD
COME IN OUR WORKING
RELATIONSHIPS WHERE WE WERE
TALKING DALE I.
AND A LOT OF POINTS DURING OUR
RESPONSE AND THEN ALSO KEEPING
UM THE WEEKLY MEETINGS AND
SHARING INFORMATION, REALLY
WORKING HAND IN GLOVE WITH ALL
OF THE TRIBAL PROGRAMS,
EMERGENCY RESPONSE TEAMS FROM
THE TRIBE.
THEY WERE GREAT TO WORK WITH.
AND SO I THINK YOU SUMMED IT UP
REALLY NICELY THAT BY NECESSITY
WE HAD TO COME TOGETHER AND
REALLY JUST WORK TOGETHER AND
FIGURE IT OUT.
A LOT OF THOSE ADMINISTRATIVE
HURDLES YOU JUST FIGURE OUT.
THERE IS ANOTHER QUESTION IN THE
CHAT.
IT'S FROM -- SHE GIVES HER
NAME -- I DON'T KNOW IF I'M
SUPPOSED TO GIVE NAMES.
BUT SHE IS A RECOVER PATIENT
CAREGIVER REPRESENTATIVE WITH
LONG COVID.
WHAT MEASURES ARE BEING DONE TO
PROVIDE MEDICAL CARE FOR COVID
LONG HAULERS WITH CHRONIC
ILLNESS WHICH CAN BE A VERY NEW
AND EXTREME EXPERIENCE?
I'M NOT AWARE OF THE CURRENT
MEASURES BEING DONE FOR LONG
COVID.
CAN ANYBODY RESPOND TO THAT
QUESTION?
>>I'LL ANSWER REAL QUICK.
AT NAVAJO WE HAVE BEEN ASSESSING
LONG COVID EVEN DURING THE
PANDEMIC WITH OUR CONTACT
TRACERS.
THEY CALL OUR RECOVERED
POPULATION AND ASK THEM HOW THEY
ARE DOING.
AND THEN ALSO CONNECTING THEM
BACK.
SO WE ASK THESE QUESTIONS AND IF
THEY SAY YES TO ANY OF THOSE
QUESTIONS, WE TRIED TRY TO
CONNECT THEM BACK TO THE
PROVIDER SO THEY CAN COME IN FOR
FOLLOW-UP CARE.
SO THAT'S HOW WE ARE DOING IT AT
NAVAJO AREA.
I'LL TURN IT OVER TO CAPTAN.
>>THANKS.
I WOULD JUST SAY I KNOW THAT
IHS, CHIEF MEDICAL OFFICER
DR. CHRISTENSEN, LONG COVE ID IS
SOMETHING THAT IS IMPORTANT TO
HER AND SHE GENERATED A
WORKGROUP WORKING ON LONG COVID
WITHIN IHS.
SO I HAVE NOT HEARD OF THAT
INITIATIVE -- I'M NOT PART OF
THE INITIATIVE BUT IT'S A
IMPORTANT COMPONENT.
MYSELF, WE HAVE -- SO MANY
COLLEAGUES THAT ARE STILL
SUFFERING FROM LONG COVID AND
IT'S AN IMPORTANT THING AND
WE'LL HAVE TO CONTINUE TO GATHER
INFORMATION ABOUT, GATHER
FUNDING FOR RESEARCH AND
CONTINUE TO MONITOR.
THERE ARE SO MANY THINGS WE
PROBABLY DON'T EVEN KNOW YET
ABOUT LONG COVID.
SO I WOULD SAY, CONTINUING TO
HAVE THAT CONVERSATION WITH YOUR
MEDICAL PROVIDER.
CONTINUING TO ASK YOUR MEDICAL
PROVIDER TOILIVATE THAT YOU'RE
CONCERNED AND BE COMPREHENSIVE
ABOUT THINKING THROUGH
SOLUTIONS.
AND EVALUATING YOUR HOLISTIC
PERSON.
WHAT OTHER THINGS COULD BE
AFFECTED BY COVID THAT AREN'T
JUST SOMETHING YOU CAN MEASURE
WITH A BLOOD PRESSURE CUFF OR A
LAB TEST.
SO I THINK IT'S IMPORTANT TO
CONTINUE THOSE CONVERSATIONS
WITH MEDICAL PROVIDERS AND
HOPEFULLY WE'LL CONTINUE TO
ELEVATE INFORMATION ABOUT LONG
COVID AND AS AN AGENCY BE ABLE
TO MOVE FORWARD WITH SOME OF
THAT.
SO MANY UNKNOWNS AT THIS TIME.
IT'S A GREAT QUESTION.
>>MODERATOR: SURE.
THANK YOU.
WITH THAT, I SEE NO MORE
QUESTIONS.
AND AGAIN, YOU ALL DID SUCH A
WONDERFUL JOB.
I DON'T EVEN HAVE ANY QUESTIONS.
SO WITH THAT, I JUST WANT TO
CHK1 LAST TIME.
WITH THAT, I WANT TO THANK YOU
ALL.
YOU HAVE BEEN SO ENLIGHTENING
AND PROVIDING SUCH GREAT
INFORMATION AND RECOMMENDATIONS
FOR ENGAGING WITH TRIBAL
COMMUNITIES AND WORKING WITH
TRIBAL COMMUNITIES, WHETHER IN A
PANDEMIC OR NOT.
AND ALSO, RESEARCHERS AND
INVESTIGATORS THAT WANT TO
ENGAGE WITH THE TRIBAL COMMUNITY
CAN DO RESEARCH.
THAT'S IMPORTANT FOR THAT
COMMUNITY.
AND PROVIDED GREAT INFORMATION
ON THAT AS WELL TO ENGAGE WITH
THE COMMUNITIES EARLY.
TO HAVE THEM INVOLVED IN ALL
ASPECTS OF THE STUDY FROM THE
DEVELOPMENT TO DISSEMINATION OF
RESULTS.
I THOUGHT THAT WAS ALSO VERY
HELPFUL.
AND YOU ALSO SHARED SO MUCH
INFORMATION ACROSS THE SPECTRUM
OF THE RESPONSE OF THE PANDEMIC.
I THINK IT'S BEEN VERY, VERY
HELPFUL AND YOU HAVE ALSO
IDENTIFIED SOME GAPS IN SOME
AREAS WHERE WE COULD PUT SOME
RESOURCES TO AND TRY TO
UNDERSTAND BETTER SO WE CAN --
SO WE CAN BE PREPARED GOING
FORWARD.
AND UNFORTUNATELY, THAT IS OUR
REALITY.
SO, WITH THAT, I THINK WE ARE
GOING TO WRAP UP THE WEBINAR
HERE AND DR. JOHNSON, BACK TO
YOU.
THIS HAS BEEN A GREAT WEBINAR.
I'LL JUST HAND IT BACK TO YOU.
THANK YOU.
>>GREAT.
I JUST ECHO YOUR SENTIMENT AND
WANT TO SAY, APPLAUSE TO OUR
PANELISTS.
WE RECOGNIZE THE AMAZING IMPACT
THAT YOU'VE HAD IN THE TRIBAL
COMMUNITIES AND SORT OF CHANGING
THE LANDSCAPE FROM EARLY IN THE
PANDEMIC UNTIL WHERE WE ARE NOW.
SO JUST WANT TO RECOGNIZE
LIEUTENANT DAY MAN, CAPTAN VAN
LEW AND DR. HAMIT.
AND THANK YOU MOSE FOR AGREEING
TO BE THE MODERATOR.
WE ARE MUSH PETERED.
ON THE SCREEN YOU HAVE BEFORE
YOU ARE RESOURCES THAT ARE
AVAILABLE FOR THOSE
PARTICIPATING.
THEY ARE RESOURCES MADE
AVAILABLE BY THE SPOONSORS OF
THIS WEBINAR, THE CEAL ALLIANCE,
COVID-19 COMMUNITY.
YOU'LL FIND THOSE ON LINE.
ALSO PROVIDING SOME RESOURCES
FOR YOU AND THEN ANOTHER AIAN
RESOURCE IS AVAILABLE.
PLEASE TAKE THOSE AND WE LOOK
FORWARD TO WORKING MORE WITH
YOU.
THE RECOVER INITIATIVE, THE LAST
QUESTION THAT BESPOKE ABOUT,
LONG COVID.
I DID WANT TO CALL ATTENTION TO
THE RECOVER INITIATIVE, WHICH IS
UND IFED TO ADDRESS LONG COVID.
THEY HAVE RESOURCES AVAILABLE
FOR TRIBAL COMMUNITIES FOR
PARTICIPATION IN THE
OBSERVATIONAL STUDIES WITHIN THE
RECOVER INITIATIVE.
AND THOSE ARE AVAILABLE AS WELL.
A COUPLE OF CONTACTS JUST IN
CASE YOU WANT TO CIRCLE BACK AND
TOUCH BASE WITH US.
THESE ARE WAYS YOU CAN REACH OUT
AND GET FURTHER INFORMATION OR
CONTACT FROM RECOVER FROM THE
NIH TRIBAL HEALTH RESEARCH
OFFICE AS WELL AS THE CEAL
APPLIANCE.
WITH THAT, THANK YOU AND HAVE A
WONDERFUL AFTERNOON.