With eight cases of COVID-19 now confirmed in Fremont County, the Wind River Reservation's federally funded healthcare facilities are bracing for impact. Meanwhile, the Indian Health Service (IHS) has announced that $40 million in federal funds will be distributed to help tribes across the country combat the coronavirus.
"This is not a step we've seen in previous emergencies," said Jillian Curtis, director of finance and accounting for IHS. "I think it shows Congress recognized there are specific needs for tribes. Overall, I think this is a really positive outcome for Indian Country and that Congress is hearing directly from tribes."
The Eastern Shoshone and Northern Arapaho Tribes have a treaty right to government-provided healthcare. Thousands of tribal members rely on Wyoming's two IHS-funded facilities - Wind River Family and Community Healthcare (WRFCH,) which is run by the Northern Arapaho Tribe, and the IHS-operated Wind River Service Unit in Fort Washakie - for their medical needs. Many have no outside health insurance, and little flexibility to seek care elsewhere.
Clinics In Emergency Preparedness-Mode
There are currently no confirmed cases of COVID-19 on the Wind River Reservation, but both WRFCH and Fort Washakie's IHS clinic have pared down regular operations in recent days to prepare for a possible outbreak.
"These actions are designed to try to protect people who are high-risk," WRFCH Chief Medical Officer Paul Ebert told Northern Arapaho tribal employees on Monday.
WRFCH has closed its Ethete and Riverton clinics and centralized all medical services at its Arapahoe facility. Both WRFCH and Fort Washakie's IHS clinic have suspended services like optometry and dental care, and informed patients that other routine appointments may need to be postponed.
"We will try to meet those [routine] needs without you having to go into the clinic," Ebert said. "If you're someone who [the staff] feels needs to be seen that day for another reason, and you're not high risk for having or spreading [COVID-19,] they may take you into the clinic."
He added that some patients at high risk of contracting the coronavirus might be sent to the emergency room before being admitted into the clinic for routine care. But WRFCH's CEO Richard Brannan estimated that 40 percent of the facility's patients lack outside insurance to pay for an ER visit.
"I've seen a lot of people refuse to get on an ambulance or to go to the ER, because they say 'I can't pay for that, and I don't want my credit ruined,'" Brannan said.
WRFCH and Fort Washakie's IHS clinic have asked patients to call ahead before coming to their facilities to be screened for COVID-19 (307-332-7300 for the Fort Washakie clinic, 307-855-2966 for WRFCH). They have also developed systems for triaging patients in their parking lots.
Like all of Wyoming's medical facilities, Wind River's IHS-funded clinics have a limited capacity to test patients for COVID-19. During his address on Monday, Ebert said WRFCH was "down to about 15 tests" for a service population of 11,000.
"Despite what you're seeing on TV and what the feds are saying, we still do not have widespread testing," Ebert said. "We would like to test everybody that wants to be tested, we would like to test everybody that we want to be tested, but right now, we have to pick and choose."
According to the Eastern Shoshone Business Council, the Wind River Service Unit in Fort Washakie had 19 test kits available on Wednesday afternoon.
Federal Indian Health Service Response
The total number of confirmed COVID-19 cases in the nationwide IHS system reached eight by Thursday morning; three on the Lummi Nation in Washington, three on the Navajo Nation, one on the Yankton Sioux Reservation in South Dakota, and one in the Portland, OR. area.
The federal government has so far approved $8.3 billion for federal agencies, with $40 million set aside to help tribes and urban Indian programs combat COVID-19. But tribal leaders and advocates have called on the Trump Administration to allocate three times that amount.
"It really paints a dire picture of what you're not getting access to, what you don't have, what you're not being communicated," said Stacy Bohlen, CEO of the National Indian Health Board during a Tuesday roundtable hosted by her organization the National Congress of American Indians and the Native American Finance Officers Association .
It is not yet clear how much of that federal money will be allocated to facilities and programs on the Wind River Reservation.
According to Richard Brannan, CEO of Wind River Family and Community Healthcare, his facility was underfunded and under-resourced by IHS even before the coronavirus pandemic. He said his facility began rigorous preparations more than a month before Wyoming saw its first case of COVID-19, in part because he did not expect the federal government to fulfill its healthcare responsibility to Native people.
"On this reservation, we were promised healthcare. But the Indian Health Service only provides 35 percent of the funding needed to provide truly adequate healthcare," Brannan said. "Due to years of neglect and underfunding by the Indian Health Service, we have significant health disparities as opposed to the rest of the population. All I can attribute that to is that we're out of sight, out of mind."
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