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USU Faculty Member Leads COVID Medical Response at Navajo Reservation

COVID-19 mural in Shiprock, New Mexico, within the Navajo Nation. [Photo credit: Courtesy of CDR Witzard Seide, U.S. Public Health Service, USU]

By Vivian Mason

In the Navajo language, yá’át’ééh means “hello or welcome.” It was one of the first words that U.S. Public Health Service Cmdr. (Dr.) Witzard Seide learned as part of her cultural training when she deployed to the Northern Navajo Medical Center (NNMC) in Shiprock, New Mexico. 

Seide, the USPHS company commander at the Uniformed Services University’s (USU) Hébert School of Medicine and a clinical associate professor of pediatrics at USU, deployed to the Navajo Reservation at the beginning of the pandemic as part of a USPHS Strike Team. 

At that time, COVID-19 was especially difficult to combat on the Navajo Reservation. The NNMC, a 75-bed hospital located in the Four Corners area of the United States where New Mexico, Arizona, Colorado, and Utah meet, faced a surge in COVID-19 cases and clinical workforce shortages while the Navajo Nation struggled with high rates of chronic illness and limited resources. Seide served as both Chief Medical Officer and Chief Operations Officer throughout the NNMC deployment. The USPHS team consisted of more than 28 health care providers and support staff, all with the mission of operationalizing an alternate care site (ACS) and providing clinical support to the NNMC. 

Entrance to Northern Navajo Medical Center (NNMC). [Photo credit: Courtesy of CDR Witzard Seide, U.S. Public Health Service, USU]
Entrance to Northern Navajo Medical Center (NNMC). (Photo credit: CDR Witzard Seide, U.S. Public Health Service, USU)

Upon arrival in New Mexico, Seide and her team took part in a number of clinical training sessions. They focused on how to properly equip PPE (personal protective equipment) when taking care of COVID patients, performed mock and procedural drills on how to admit patients to the ACS and how to deal with emergency situations.  One of the most interesting trainings, Seide notes, involved learning about Navajo culture, a necessity when caring for that patient population.

“I got a lot out of it,” Seide says. “Not only health care specifics, but also information to take with me. I’ll be able to use that knowledge as I interact with my USPHS medical students. Maybe one of them might be stationed there and can come prepared with a small understanding of the Navajo culture. It helps being able to talk to students first-hand about what they might encounter.” Seide says that while no USPHS medical students were deployed to this area during COVID, many of them provided virtual assistance by working at IHS headquarters on COVID response activities.

Seide and the USPHS team also collaborated with the NNMC to ensure that the ACS was prepared to take on patients. “Being able to work alongside, and learn from, different healthcare workers, and gaining a familiarity of Indian Health Service healthcare was one of the most prized aspects of this experience,” she notes.

The ACS was set up as a place to help COVID-19 patients isolate and convalesce safely. In the Navajo culture, families often live in multigenerational households or in rural or tribal areas, which can make it difficult to take precautions for self-protection from COVID-19 or to isolate those who are sick, especially if the household has limited space.  This aspect of Navajo living made it easier for the virus to spread to elderly and vulnerable residents. 

A large section of the community live in large households located in remote areas with limited access to resources such as food, running water, or electricity. The concept of community and spending time with loved ones is highly valued in the Navajo culture. Many traditions had to be discouraged, and something as simple as embracing an elder could no longer be the norm. According to Seide, it could be a struggle to help some community members understand this new absence of interaction.

U.S. Public Health Service Task Force Team standing near the Shiprock rock formation at the completion of their deployment.  [Photo credit: Courtesy of CDR Witzard Seide, U.S. Public Health Service, USU]

U.S. Public Health Service Task Force Team standing near the Shiprock rock formation at the completion of their deployment. 

(Photo credit: CDR Witzard Seide, U.S. Public Health Service, USU)

The USPHS Strike Team was also in place to increase the health care capacity of the hospital and help provide health care to the community. The team partnered with public health workers at NNMC to conduct virtual home visits, and also set up in-person home visits if needed. They checked on patients, helped wean them from oxygen, referred patients to social work services, and made sure patients had what they needed by setting up food, water or medicine drop-offs. While these patients did not necessarily need full care at the hospital, they required additional support and monitoring. Thus, another goal of the ACS was to become an intermediary place for them to recover.

“Some of our staff also helped man the COVID tent where people were triaged. They called it the fever tent. Depending on what you came in for, if you had any symptoms that could have potentially been COVID, you were evaluated at the tent, unless you had to go right in, needed to be stabilized, or admitted to the hospital. We also had an amazing behavioral health team deployed with us who provided support to both the staff and patients. At the height of the pandemic, everyone was dealing with stress. So, the behavioral health team provided care for everybody.”

Seide shares her appreciation for the experience. “It was very rewarding to work with the Navajo people. It was a challenging deployment,” Seide concludes, “but it was great having that support from our team and the NNMC staff. At the end of our deployment, the Navajo leaders at the hospital performed an ahéheeʼ (thank you) ceremony and provided the task force members with small tokens to confer luck and good health. I gained invaluable insight into the Navajo culture and rural medicine while working in New Mexico with the Indian Health Service. It also reinforced my skills treating underserved communities in low resource settings.”