S1E26 / Indigenous Peoples / Rebecca Nagle, Melissa Begay, Jamescita Peshlakai

Melissa Begay is a doctor living in Albuquerque, New Mexico.

I'm Melissa Begay, and I am a physician at UNM in the Department of Pulmonary, Sleep, and Critical Care.

But back where Melissa grew up near Canyon de Chelly, Arizona, she'd probably introduce herself this way instead. Melissa is a member of the Navajo Nation, the nation's largest indigenous tribe. The Navajo Nation's lands are about the size of West Virginia and cover the Four Corners region where Arizona, Colorado, New Mexico, and Utah meet.

Yeah, so I grew up on the North Rim of Canyon de Chelly, and in Navajo it is called Tséyéit. There are a lot of cultural teachings that happen there, a lot of traditional people still live in the canyon, and growing up there, You were definitely taught the importance of place, but then also the importance of history. And then for myself, as a young person, it really taught me a lot about our connection to land and our, my people's connection to the seasons. So it was a great place to live in it and grow up as a young child.

And handshakes are an important part of the Navajo greeting.

The Navajo greeting is very important, and it usually begins with a handshake to acknowledge your presence and their presence. And then also, you often say your clans. You often will teach your kids from a young age to shake hands when they're toddlers, and then as they're beginning to speak and go into kindergarten, they often are taught their four major clans. So it's important just to establish your lineage because it's very old and people often identify Navajos by region and by clan. So it often makes more sense, especially to the elders.

But the pandemic has made everyday gestures like handshakes dangerous, especially for the elders in Melissa's community. See, the Navajo Nation has the highest per capita infection rate of COVID in the United States. Even higher than New York City. Nursing homes are one of the hotspots for coronavirus, and elderly Americans are among the most vulnerable for severe COVID infections. Losing anyone to COVID is tragic, but there's even more on the line for the Navajo Nation and other Indigenous peoples.

The elders are the keepers of traditional stories. They are the keepers of that traditional knowledge of herbs, ceremony, language, history, and that is very important to us. If we lose these elders, we can lose hundreds of years of knowledge. And so when you have the passing of these elders, it's really, for Navajo people, like losing an encyclopedia. It's like losing libraries and museums.

In this episode of Epidemic, we're going to find out why the Navajo Nation has been hit so hard by COVID and what their communities are doing to protect everyone, young and old, during this pandemic. I'm Dr. Celine Gounder, and this is Epidemic. Today is Friday, June 5th.

Canyon de Chelly is now a national park, and so it's traditionally a very important spiritual place to the Navajo people because it houses a large spire rock called Spider Rock, and that Spider Rock is the home of a Navajo deity called Spider Woman who assisted the hero twins on their journey when the Navajo were going through the various emergence worlds in Navajo religious philosophy.

You should really look up pictures of Spider Rock. It's stunning. But besides the natural wonder of the rock formations in Canyon de Chelly, the area has another meaning for the Navajo. It's a stronghold.

And so in 1864, when the Navajo people were imprisoned by the US Army, They tried to get a lot of the Navajo people out of Canyon de Chelly to go on the Long Walk to Fort Sumner. And because of the rough terrain and the steep cliffs, they weren't able to get a lot of those Navajo families out. And so what happened is many of those Navajo families stayed and did not go to the Long Walk from 1864 to 1868 and remained in the canyon. So it's kind of seen as a Navajo stronghold.

The Long Walk was akin to the Trail of Tears, which forcibly removed the Cherokee Nation from Georgia to Oklahoma. Many Navajo were interned at Fort Sumner, New Mexico, for years. Once at Fort Sumner, illness struck. The Navajo died from exposure to the elements, hunger, dysentery, pneumonia, tuberculosis, and smallpox. The prison-like living conditions contributed to the spread of disease. Many Navajo died. Native Americans have a long and devastating history with infectious diseases, especially those brought in from the outside world.

A lot of the oral history of the Navajo is handed down by our elders that remember these hard times. The way they speak about it is They say this is not the first time that this has happened.

This is Arizona State Representative Jamesita Pashlocki.

I am Navajo, or Diné, what we call ourselves. And my clans are Tangle People Clan, born for the Red House Clan. Maternal grandfathers are Bitterwater Clan, and paternal grandfathers are Cliff Dweller Clan.

James Sita represents 8 tribes in her district, including the Navajo. She says that the elders in her community still have strong oral histories about how disease during the time of internment and before influenced their culture today.

One of the cultural taboos about death is the handling of the body, the corpse, and a traditional way to bury a person is to, first of all, when they're ready to pass, you take them out of the home, and only one person is to prepare the body for burial and wrapped in a blanket. And that person is the only one to touch the body, not the rest of the family. The traditional way they used to place the body was in the earth or amongst rocks and stones. And then the person was not to be mentioned again or grieved for or to go visit the grave or touch the things of the person that passed. So there's cultural traditions that have become our way because disease has taken so many people in the past.

Those stories are also a source of strength. Melissa Begay says the traditional healers in her community tell stories about another big pandemic, the 1918 Spanish flu.

They talk about the time of a great sickness when a lot of Navajo people did pass away during the Spanish flu. Many communities had to abandon where they lived and families were basically decimated. But the stories that I've heard growing up are ones of resilience and strength.

With colonization of our peoples came pandemics of infectious diseases like smallpox. For Cherokees, it was in the 1700s where we lost large chunks of our population. I think there's always sort of like Indian humor with everything, and so there were a lot of people making jokes about Trump putting a travel ban in place to stop the spread of disease from Europe. A lot of Native people on Twitter and Facebook were commenting that it was a few centuries centuries too late.

This is Rebecca Nagle. Rebecca is an Indigenous rights activist, writer, and speaker, and she's a citizen of the Cherokee Nation. She's also the host of her own podcast, This Land. It's about a Supreme Court case on the land rights of Indigenous peoples in Oklahoma.

But I don't think we even have to go back, you know, that far to the era of Columbus to see that infectious diseases can have a disproportionate impact. On Indigenous communities.

The Navajo, Cherokee, and hundreds of other tribes ended up signing treaties with the United States as it expanded west. Native Americans agreed to sign over their land and end violent conflict, and in return, the United States agreed to provide education, housing, and healthcare to the tribes. To provide healthcare on reservations, the federal government set up the Indian Health Service.

Indian Health Services actually predates both Medicare and Medicaid. It's one of the oldest federal health programs, but it's not an entitlement program. So like, if you are eligible for Medicare or Medicaid, it's called an entitlement program because if you're eligible, you're entitled to that service. But IHS is funded through a discretionary budget. So instead of Congress looking at, all right, this is how many patients IHS has, this is how many tribal citizens will need to access healthcare, this is how many people qualify for this program, so this is how we're going to fund it. The funding of IHS is up to congressional politics, budgeting, and things like that.

The U.S. federal government hasn't been meeting these obligations for a long time.

So tribal leaders recently said that Indian Health Services, to be fully funded, needed $36.8 billion. And for 2020, Congress appropriated about $6 billion. And so, you know, Indian Health Services is funded at about 16% of its need. And, you know, sometimes people will use phrases like, oh, well, Native Americans get free this or free that. Or, you know, I've seen some reporting where people are talking about how Native Americans are supposed to have access to free healthcare. And I think it's really important to emphasize emphasize that it's not free, that we actually gave up billions of acres of land in exchange for these treaty obligations. That was land that had a high value at that time and continues to have a high value today. I interviewed Representative Tom Cole for the article that I wrote for Vice, and he had a great quote where he said, you know, I always tell people that if they want to not continue to meet these treaty obligations, they can always just give us back northern Mississippi. And he's talking about the lands of his tribe, the Chickasaw Nation.

Rebecca points out that the economic shutdown that came with the pandemic has hit Native Americans living on reservations especially hard. Because tribes don't have the right to levy property taxes, they have to use tribal businesses to raise money to supplement the meager funds the federal government provides them for education and healthcare and other services.

So in addition to money from treaty obligations from the federal government. A lot of tribes, we have our own businesses and our own enterprises, which are being dramatically hurt by this pandemic as well. I saw a report that all tribal casinos nationwide are closed right now. And so that revenue isn't sort of just a loss of profit like you would think of, you know, like an MGM Resorts or something like that. That money goes into healthcare, education, housing for tribal citizens. So there's also going to be a long-term need to really help tribes recover economically from this time to make sure that they're still in a position to provide those services for tribal citizens.

And that's not even taking into account unemployment. Representative Jamesita Pashlocki says on the Navajo Nation, unemployment was around 50% before the pandemic and the economic shutdown. With the loss of tourism and other service jobs, she estimates it could be as high as 90% today. Now, there was money set aside for the Indian Health Service in the third CARES Act.

You know, the National Indian Health Board and other leading Native organizations were saying that Indian Health Services needed about $2.3 billion in funding to weather the pandemic and to save lives. And about $1 billion was in the third relief bill. And so it's a good step. It's definitely a big win. But Congress definitely needs to do more.

Fighting for resources from Washington is hard enough, but Rebecca says the federal bureaucracy is its own hurdle when it comes to actually getting the money where it's supposed to go.

The first coronavirus relief package had a $40 million set aside for tribes that was held up in bureaucratic limbo for weeks because the CDC had no way to get that money from the CDC over to Indian Health Services. You know, tribes have to constantly remind departments in Washington how to work with us, how to partner with us, how to consult with tribes, how to treat tribes like equals and like partners in government. And I think that sometimes because the federal government isn't used to doing it, it's not very good at it. And so I think, you know, the sort of hangup with getting funds from that first relief package I think is a really good example of how, you know, agencies like the CDC have just not been wired to work with tribes, and then when a crisis hits, they see how incapable they are of doing that. Although they are, you know, making progress and moving forward.

On the Navajo Nation, Dr. Melissa Begay says that jurisdictions also complicate basic epidemiology, like tracking the spread of COVID And right now, what we're—

what the tribe is having difficulty with is contact tracing. So right now they have a lot— they only have about 80 contact tracers, and a lot of these tracers are finding difficulty in actually locating positive COVID patients out in the field because they don't have a phone or an email address. And a lot of the Navajo houses actually don't even have a physical mailing address. And so when you have lack of correct contact information, it definitely makes makes their job a little bit more difficult.

Phone and email seem so essential to a lot of people that it's hard to imagine life without them. But basic necessities and infrastructure are often lacking on Native American reservations. So this is a little complicated, but please bear with me. Because the land is technically owned by a trust administered by the federal government and not the tribes, Native Americans have to go through reams of red tape to do some of the most basic things. And on top of that, a land dispute in the 1960s between the Hopi and the Navajo resulted in a total ban on all development in the region. Electrical lines, water mains, even making basic improvements to your home wasn't allowed. That ban is known as the Bennett Freeze. It was named after a former Commissioner of Indian Affairs, Robert Bennett. That ban remained in place for 40 years, after finally being lifted in 2009. But the decades of underinvestment in the most basic of infrastructure are very much present today. Here's James Sita again.

And so when people return home, they have to return home to hauling water, using the same wash water for multiple family members, and then also being very conservative in bathing. And so these are things that have become a way of life for those that do not have this infrastructure. For my family, we have to drive 25 miles to deliver drinking water to my aunt at our family's sheep camp.

Access to water is complicated by other factors too. The reason Jamesita has to drive 25 miles to bring water to her aunt is because the well where her aunt lives is contaminated. Jamesita says toxic runoff from uranium and coal mining has left many water sources in the Navajo Nation undrinkable. And many of the streams and rivers that would otherwise provide water to the land where the Navajo live have been diverted for other purposes, like the Hoover Dam, which provides electricity and drinking water to cities like Las Vegas.

There is this basic lack of infrastructure. 30% without water, 30% without electricity, and 30% without plumbing.

Dr. Melissa Begay again.

The lack of water definitely presents an issue in terms of sanitation. When you are trying to tell people to wash their hands, that presents a problem. They are often rationing their water, trying to make it last. And so washing hands can't be performed as often. And so the public health message to wash hands, that's definitely problematic.

The lack of water also contributes to food deserts on the reservation, and that brings high levels of comorbidities like obesity and diabetes that can increase someone's risk for severe COVID disease.

Basically, the diversion of water created a lack of— in agriculture, that was sustainable. The Navajo diet basically was corn, wild game. There weren't very many carbohydrates in our diet.

Think those paleo or ketogenic diets that are in fashion right now.

So a lot of the traditional foods like blue corn, venison, deer, these food sources were basically made to be nonexistent. And so they were replaced by grocery stores that were basically not the best grocery stores. In 2014, a study found that a lot of these stores lacked basic fruits and vegetables and basic nutritious foods. They were often high salt, high fat, high calorie food sources. And so these grocery stores basically replaced the traditional food system of Navajo.

And how many such grocery stores are there on the Navajo Nation?

So there are 13 full-service grocery stores. That's for the entire Navajo Nation, which is basically the size of West Virginia. To have 13 grocery stores for an area that large is definitely problematic.

And Melissa says that many of the 175,000 people who live on the Navajo Nation have to drive 2 hours each way to reach one of these grocery stores.

If you don't have access to your essential supplies such as water, such as food, you are definitely going to have to break isolation and travel to these larger cities and these border towns to get your essential supplies. And so when the Navajo Nation is imposing a curfew, it makes it very, very difficult for families.

And Jamesita says this dynamic is contributing to discrimination.

Right now we have a lot of folks that are non-Native that are kind of lashing out at the people because the numbers on the Navajo Nation are so high in Navajo County and Coconino County. And I see people on social media saying the Navajos should shop in their own grocery stores. And pointing at us like we're the ones that started this. So that is really unfair. And a lot of people you see on social media are blaming Asians that are, you know, Americans here, blaming them. So that's unfair.

There are a lot of border towns that remain today still politically and racially discriminatory against Navajo people. And so I think a lot of tribal members today are still trying to figure out how we can prevent that.

Melissa Begay.

I think in my lifetime, I was able to witness as a young child the hantavirus outbreak that occurred in the Four Corners area in the 1990s. When they were first naming hantavirus, they wanted to call it something referencing the Four Corners or Navajo people, and a lot of the Navajo leaders did not want that because they did not want to be singled out or to be discriminated against. And so they ended up calling hantavirus the Sin Nombre virus, which means in Spanish, no name.

And so a lot of Navajo people today are still worried about that with COVID Melissa and James Sita say that despite all these challenges, the loss of traditional knowledge, generational trauma, chronic disinvestment, and the health issues that follow, the pandemic is inspiring their people to take action. And traditional Navajo beliefs are a big part of that. One is the idea of balance, or hozhon. Here's Jamesita.

In the Navajo teachings, there's always a negative and a positive. Everything in life is about balance, hozhon. And even in our ceremonies, There are ceremonies for good positive things, and then there are ceremonies where we are taken off the beautyway path, which is the path of harmony, and put on a path of what is called naaye, which is the enemy. And right now in the culture and traditional teachings, to understand our place concerning our relation to this COVID-19 is that it is the enemy. We have to think of it as a being that is coming to each door and knocking. So we have to think about it as an unseen monster, an unseen enemy. And we have to defeat it, we have to come to know it. And through teaching and listening to the news, science, facts, These are the tools with which we arm ourselves and our elders and our children. The world has to have a negative and a positive. That's life. And finding that balance now is more important than ever.

I think it's causing a lot of Navajo people to re-embrace the concept of hozho, and I think Through this positive thinking, Navajo people are going to experience a renewal of a lot of the traditional teachings and a renewal of agriculture, farming, language, and possibly a renewal of government and public health infrastructure to actually reflect some of these cultural values. Values of Ho-joa.

Just like in communities across the United States, the pandemic is exposing weaknesses in public health infrastructure and the inequities of our society like never before.

I think right now what we're seeing is a call to action, which is in place by the larger governments, but what you're also seeing is a resilience and a renewal of these grassroots organizations These grassroots organizations are getting out food, resources, water, traditional knowledge. They are relaying information. The positivity and the resilience that we, that we'll see after we're done with this pandemic, I think a lot of the Navajo leaders and Navajo people will request for this concept of hozhón to be placed in these new infrastructures that we're going to build.

Melissa says that the elders in the Navajo community tell stories about the past epidemics their people faced. Traditionally, these lessons would be shared by elders and traditional healers. They are the repository of the tribe's knowledge and history. Where Melissa works at the University of New Mexico Health Sciences Center, for example, they are finding ways for Navajo healers to practice their traditions alongside conventional medical care. In a community that is so remote and struggles to get access to critical public health information, new tools like social media and smartphones have become vital to curbing the rate of infection. And that's why James Seta sees a change in the time of COVID Maybe this time, the key to ending the pandemic in their community will come from the young.

We've always looked to our elders to have teachings for us to move forward. But today, this COVID-19, it is putting a very harsh teaching in the hands of our children, where our children are the ones that are saying, "Mom, Dad, Grandma, Grandpa, you cannot go into town because it's very dangerous." And so young people are being handed this harsh teaching for them to, to move forward into the future with. You know, when we started this interview, you asked me about what is the teachings that you've heard about from from our elders, and right now we're living through a teaching that will be that of our children and our grandchildren. I myself still have my grandmother. She's about 86, and she's at home, and her great-grandchildren are taking care of her, and the great-grandchildren are not allowed to go anywhere. Because they might bring something home to her. So it's like caring for a very, very rare flower. She's very delicate, and that's how we think— I think we should all think about our elders. And so these are part of the new teachings that I mentioned, new ways of caring for our elders. But I think one of the things that they need, they know, is that they are loved Epidemic is brought to you by Just Human Productions.

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