Indian Health Services Is Ill-Prepared for the Coronavirus Crisis. Indigenous People Will Suffer.

The Indian Health Service can barely keep up with broken bones and preventive care, according to Indigenous Women Rising.

[Photo: Three indigenous woman smile as they look at the camera.]
The members of Indigenous Women Rising—from left, Nicole Martin, Malia Luarkie, and Rachael Lorenzo—are guided by the traditional values they were raised with. Courtesy of Indigenous Women Rising

Most Native Americans rely on Indian Health Services (IHS), an agency within the U.S. Department of Health and Human Services (HHS), for their health-care needs. Since it was established in 1955, IHS has been crucial to Native American health care, yet it continues to suffer from several structural deficits, such as maintaining medical providers, operating from safe facilities, and funding—the agency’s most severe and life-impacting deficit—as it is chronically underfunded by billions of dollars each year.

If IHS can barely keep up with broken bones and preventive care, what makes our people across the country think IHS can handle the outbreak of COVID-19?

Native Americans across the United States who are the health-care recipients of IHS often do not have consistent, quality health care that build trust and satisfaction as a patient-provider should have. The agency’s contribution to this long-standing problem is often based on the lack of consistent providers and providers who are not culturally aware of their patients’ communities. IHS has been a source for newly graduated medical students who are looking for ways to pay off their student debt, which spirals into negative outcomes in care because providers’ stay and commitment to serving Native Americans is based on a debt service. Many medical providers come from the armed services and are routinely in their uniform while providing care.

It must be understood that there is no standardization of health care within IHS at any given facility. Tribes have taken it upon themselves to open their own clinics. Despite its shortcomings, IHS is still a lifeline for Indigenous people who may not be able to get care elsewhere due to factors like limited public transportation and access to the internet.

In the age of technology, the ideal use of telehealth services could be effectively promoted for our communities to take advantage of, but the infrastructure needs, including broadband, are only wishful thinking.

IHS patients who do have access to technology and can visit the IHS website and receive the most basic information on the outbreak. According to the website, 40 people across the agency’s jurisdiction have tested positive for COVID-19 as of Saturday, but there are likely many more cases given the pending test results. The website does not provide information in a culturally literate and responsive manner that explains ways to stay indoors, or contacts for Indigenous people, who on the West Coast were among the first to contract the virus, to reach out to with questions about accessing IHS under social distancing. This is a glaring example of the very little regard the federal government gives to the original inhabitants of this continent.

One of the primary functions at Indigenous Women Rising (IWR) is to be strong advocates for reproductive health, including abortion care. IHS is included in the Hyde Amendment, forbidding abortion care unless the health of the pregnant person is at stake, which we know is a ridiculous premise and means Indigenous people have this additional barrier to accessing abortion.

There is also no standardization to how providers respond to pregnancy-related care, from carrying the pregnancy to term, adoption, or abortion. Many IHS hospitals have varying administrative structures, too. Here are some stories about inadequate access at IHS that our staff has shared:

Rachael Lorenzo (Mescalero Apache, Laguna Pueblo, Xicanx)

“The IHS I grew up with, located in Acoma Pueblo, New Mexico, called ‘ACL,’ or Acoma-Canoncito-Laguna, does not have a consistently open ER, had a rotating dentist, and no OB/GYN to help deliver a pregnancy if needed. In some cases, people from Acoma Pueblo, Laguna Pueblo, Canoncito (part of Navajo Nation), Cubero, Seboyeta, and San Fidel (the last three are Spanish land grants) may need to travel about 30 miles west to Grants, New Mexico, or about 50 miles east to Albuquerque to get to an ER that’s equipped to handle emergencies, specialty care, and births.

“This scenario is not unique to the community I grew up in. These realities are concerning to me because IHS has proven ineffective to meeting as many needs as exist in the communities they serve. I have also been denied the removal of long-acting reversible contraception (LARC) and a change of method, so there is also a degree of coercion when it comes to our reproductive autonomy and a lack of trust that we know how best to care for our bodies.”

Nicole Martin (Laguna Pueblo, Diné, Zuni Pueblo)

“At Indigenous Women Rising, I work on sex education development. My focus is on centering our ancestral teachings and stories regarding sexuality and creating a space where we can discuss and access reproductive care without shame or stigma. Recently, I scheduled an appointment for an STI and HIV/AIDS screening, and treatment for a yeast infection. When I called, I was told to come into their open clinic, which began at 8 a.m., and if I was fortunate to secure one of the 12 available spaces, I could only be seen for the yeast infection or the testing. I did back-to-back morning trips so I could be seen for both, otherwise I would have to make an appointment with my primary care physician, which was scheduled a month out.

“Here we are, a month later, my results came back from my tests, and they were negative. However, my primary care physician has been deployed, as most physicians within IHS are military members. I applaud IHS for their call to action to provide safe health care to their patients during this time, but I have yet again been rescheduled a month out—this time to replace the implant birth control in my arm. As a caretaker, community organizer, oldest of three, I have to be adaptable with my schedule, and this means choosing to put my reproductive health on the back burner from time to time.

“I am not alone in having been rescheduled a month out for birth control or basic health-care needs. I often take to social media to ‘rant’ about my access to Indian Health Services. I get a lot of feedback with the same consensus. As the sex ed lead in the organization, the impact I see from COVID-19 is my relatives and friends also deciding the importance of their basic or overall health, to be rescheduled or not to be.”

Malia Luarkie (Laguna Pueblo, Zuni Pueblo, Maidu)

“Unfortunately, many people in the surrounding areas know they can’t always depend on IHS. If they do, it could be months before they see results, like Nicole. I grew up with both Rachael and Nicole. In my family, we rarely ever went to ACL (an IHS provider). If we did, it was because we absolutely had too. In some cases, it was to pick up a prescription or maybe visit someone who worked there. In the past, when family members were seen, the physicians could do very little. They did what they could, but at some point, we were going to be referred out. There were situations when we would have to visit several times and we’d have a new doctor each time or for follow-up. This made appointments and follow-ups a hassle, having to re-explain each visit was very uncomfortable especially if visits were because of an urgent matter.

“As the birth and breastfeeding lead at IWR, it’s extremely disheartening when I hear and see pregnant people not being able to get the care they need at an IHS facility, especially if they have to travel far distances to receive a short checkup. Just like any other community, we love being with family and spending time with other relatives, but in times like these it’s extremely crucial that we take care of ourselves and each other. With COVID-19 circulating, pregnant people, elders, and others who depend on care from IHS are all at risk. These facilities don’t have the extensive care if an outbreak does happen in the surrounding areas.”

As the only Indigenous-led and Indigenous-centered abortion fund in the country, we haven’t heard from callers about their concerns about COVID-19—we are getting texts and calls about applying for funding for an abortion. And we continue to get invoices from clinics to pay our pledges to them for the patients who qualified for our funding. We are still collaborating with our sibling funds on how to continue to support each other, our callers, the clinics, and the support providers who are putting their lives at risk.

Abortion care should not be separated from the rest of health care, and the threat of abortion clinics closing during this time could have a dangerous impact on Indigenous people who are seeking abortion care. We know clinics are at risk politically, whether from their state government, Congress, or both, during this time, too. The American College of Obstetricians and Gynecologists and other groups have recommended that clinics stay open, and have cited the dangerous consequences that could come from delays in accessing abortion care.

At IWR, we are guided by the traditional values we were raised with and that culturally inform how we, as individuals and as an organization, are responding to this pandemic. We understand how dangerous capitalism is to our people, especially when it comes to land ownership and access to natural resources, including water, and we view reproductive health care as one part of our holistic well-being. We will continue to consider the mental, emotional, physical, physiological, and spiritual well-being of our collective Indigenous communities.