Oregon newsrooms have teamed up to share content to highlight the human impact of the 2010 pandemic. Our hope is that this collaboration captures this historic nature of the COVID-19 crisis. This article was contributed by Public broadcast from Oregon.
A truck entered the parking lot behind the Yellowhawk Tribal Health Center in the Umatilla Indian Reserve on a recent Monday afternoon. Nurse Rena Wickert grabbed a clipboard and three swabs to test each of the people in the vehicle for coronavirus.
After Wickert bumped six nostrils, the truck driver said goodbye and Wickert re-entered the clinic. Another nurse tightened the swabs and took them about 10 steps down the hall to the lab, which would give test results on an electronic device.
It takes 15 minutes for the result to return. If it is positive, it starts tracking contacts.
“Under no circumstances could this happen in a hospital or in an emergency,” said Steven Merrill, who is the laboratory manager and responsible for infection control at Yellowhawk.
Community clinics and health facilities, such as Yellowhawk, are essential to limit the spread of COVID-19. It is often found among sick patients and hospitals, especially in rural areas.
The speed and accessibility of a nearby clinic, Merrill said, are essential for the virus to stop early, long before a patient is ill enough to need emergency services.
“Clinics are very, very important for access to front-line patients,” he said.
Crisis mode
Since the coronavirus arrived on the reservation in June, Yellowhawk has become a COVID-19 crisis center for the Confederate tribes of the Umatilla Indian reservation.
The clinic plays a unique role in the health care system in the area and its response to the pandemic.
Yellowhawk is the primary care provider for members of the Umatilla tribe and other Native Americans in its service area. It serves a particularly vulnerable indigenous population to COVID-19 and is surrounded by Umatilla and Oregon Union counties, which have had some of the worst coronavirus outbreaks in the state.
The clinic has changed resources and staff to take over testing, tracking contacts and now vaccinations for the tribe.
In many ways, it is well positioned to fight the virus with access to tests and a laboratory to analyze the results inside. In other ways, Yellowhawk is like any other rural health clinic or hospital, working with limited staff and resources, which gives the feeling of always operating at a pace.
“We were overwhelmed,” said Yellowhawk CEO Lisa Guzman. “Our clinic was extremely tense because we had to ask many of our staff to wear multiple hats.”
Some staff members were forced to reduce their usual duties, if not abandon them altogether, in order to pursue contacts.
For the tribe to receive doses of Pfizer-BioNTech vaccine, it needed a freezer capable of ultra-low temperatures to store them. The tribe found one in its fishing department, which had used the freezer to store lamprey specimens for study, but no longer used it.
“I’m like, ‘Here, we want to be part of the solution,'” said Eric Gabriel, director of facilities and risk management at Yellowhawk. “Everyone wants to participate and be part of the solution, because it affects everyone.”
Now the large, gray freezer stands guard at the door of Yellowhawk’s bulkhead, the word “LAMP” still scratched on the side.
Scaling reduction
About 8% of the clinic’s tests came back positive. This is higher than the Oregon state average (5.8%), but even with the Indian tribal health service region (8.3%) and lower than the Umatilla counties (13.1%) and the Union (10,). 4%).
Hospitals are filling up across the state as cases grow, which has taken over rural health systems. These hospitals are the last line of defense against the worst cases of COVID-19, which is why health officials are closely monitoring their bed capacity. An outbreak anywhere could overtake rural hospitals everywhere.
Smaller hospitals such as CHI St. Anthony in Pendleton, west of the reservation, relies on transfers to larger hospitals in cities such as Bend, Portland or even Seattle when they do not have the beds or resources to treat an extremely ill patient. .
“If all these hospitals are full and can’t accept transfers, then we’re kind of stuck due to a lack of a better deadline,” said Emily Smith, marketing and communications director at CHI St. Anthony.
Smaller clinics play an important role in confronting COVID-19, Smith said. They help maintain the health of communities and also directly alleviate the pandemic burden on hospitals by testing and tracking contacts.
Yellowhawk moved to a new unit in 2018, with a robust set of offerings. Tribal members come there for everything from primary care to dentistry, behavioral health and pharmacy – all under a culturally sensitive roof. The clinic also offers transportation to specialized treatments or services that it cannot provide.
“Patients and the community use Yellowhawk for everything for their health,” Gabriel said.
However, reaching a relatively small number of coronaviruses meant reducing much of what the clinic offers. There are reduced hours. Optometry is closed and dentistry only accepts emergency appointments. Transportation is largely suspended.
“Members of our community who come to us regularly have to be extremely frustrated because they are trying to attend meetings, they are trying to follow the continuity of their care,” Guzman said.
“Yellowhawk needs to work to find a balance between providing day-to-day operational care to the community and then building a new COVID clinic to support the community.”
Guzman said he fears the tribe will not achieve many of its health goals set earlier this year for chronic diseases, which are spread across the reserve.
The goal right now at Yellowhawk and health facilities everywhere is to stay open and functional, while vaccines are launched en masse.
The beginning of vaccinations was greeted with relief and excitement (and questions) around the world, including at the Yellowhawk. The halls and the lamp freezer hum with news of their imminent arrival.