Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.


AMA Chief Experience Officer Todd Unger speaks with AMA past president, Barbara L. McAneny, MD, about the devastating impact COVID-19 is having on Native Americans. Learn more at the AMA COVID-19 resource center.

Speakers

  •  Barbara L. McAneny, MD, medical oncologist and hematologist, AMA past president

Transcript

Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we'll be discussing the impact of COVID-19 on Native Americans. I'm joined today by Dr. Barbara McAneny, AMA's immediate past president and a medical oncologist and hematologist in Albuquerque, New Mexico. I'm Todd Unger, AMA's chief experience officer in Chicago.

Dr. McAneny, you are on the front lines treating this vulnerable population and are witnessing firsthand the devastating impact COVID-19 is having on your patients and the surrounding community. Can you tell us what you're seeing?

Dr. McAneny: I have a cancer clinic in Gallup, New Mexico, which has been listed as the second most impacted city in America. One in 37 people there are positive for COVID. Our practice has stayed open because we think that it's our responsibility to our patients to treat their cancer, cancer doesn't wait for COVID, and to try to keep them out of the hospital where cancer patients have a threefold increased chance of dying.

We also know that the local hospitals are completely overwhelmed and are sending patients to Albuquerque and Flagstaff and other places because they cannot keep up with the number of people needing help for COVID. So we want to keep our cancer patients out of their way so they can focus. But it is tragic. We have seen entire families be affected. They are unable to cope with this disease.

Unger: We know this pandemic has only exacerbated existing inequities in health care. Why is this community in particular being hit so hard by COVID-19?

Dr. McAneny: Well, just as it was hit very hard for the H1N1 pandemic of several years ago, we know that this population has been underserved for many, many years. The Native American population has been given the least desirable land; we dig for the oil and gas and uranium on it. And then people there have a two to three times risk of having uranium in their blood, their body levels, and we know that it has a bad impact.

We also know that a third of people living on the Navajo Nation do not have running water. The rivers are diverted to Phoenix golf courses. Our patients must haul water to be able to wash their hands. So it's a scarce commodity on the reservation.

It's also traditional for people to live in multigenerational housing. Family is incredibly important to the Navajo Nation and to other Native American tribes. So elders and small children and everyone in between are all living in one communal setting, and that makes isolation completely impossible.

So we've seen an unfortunate natural experiment of people who are, through no fault of their own, unable to do social isolation, and compare that with Albuquerque. We know that in New Mexico, Native Americans are 11% of our population, but they are 57% of our COVID patients, and the death rate is three to four times everyone else. It is truly a tragedy.

One of my major hopes is that we will look at the infrastructure situation that we have created out on the reservation and in the Indian Health Service. I want to give a shout out to the doctors and nurses and other medical professionals who work in the Indian Health Service hospitals. They are chronically underfunded and these professionals are becoming the masters of the workaround to be able to take care of patients in underfunded, undersupplied situations. And my hat is off to them for the courage and the professionalism that they have shown.

Unger: How is your own staff doing?

Dr. McAneny: My staff is frightened. Patients are frightened. We have not yet had anyone positive with COVID in the office in terms of our staff. We are taking utmost most precautions to make sure that stays that way.

In addition, we recognize that as the entire city of Gallup closed and did not let people in or out except for people who are working there, like my doctor's traveling to Gallup to work in the clinic, people couldn't get food. So we made a donation to both the Gallup and the Zuni food banks, and we have supplied through our foundation food bags for patients, and even a way to give gift cards for food for staff, because people simply cannot shop.

One interesting thing I learned is that the Navajo are very proud and do not like asking for help. They're embarrassed to admit if they don't have enough money to buy food for the end of the month. So when we say, "If you're afraid to go to the grocery store, we have a food bag for you." They are our most grateful to take that.

Unger: Well, the figures you shared were astounding, and the challenges are immense. Can you talk about what the AMA is trying to do to help?

Dr. McAneny: The AMA has recognized that this is a severe example of the health disparities that we face. The average amount of money spent by the Indian Health Service per year per patient is $3,300. Compare that to the over $10,000 spent annually on every Medicare patient and the $5,500 spent annually on every Medicaid patient. We need to advocate not only to get this money that the resources, that the government has been made available out to the people. And the AMA has worked hard on that. We've written multiple letters and advocated for that money to get to the Navajo Nation, and it just got there last week, which is a terrible delay.

But I am hoping that that advocacy will not stop when this crisis starts to abate. We can't go back to where we were. We have to look at this population. And here in America, in the richest country on the planet, we have to do better at preparing people with just the social determinants of health so that they can survive the next pandemic and the next pandemic.

Unger: Lastly, most of the country is focused on reopening. What's the situation like in your area and what impact could eased restrictions have on your patients and your community?

Dr. McAneny: We know that the outbreak—people have to cluster together at health centers, at laundromats, at grocery stores, and that's what created this horrendous outbreak. We are very concerned that opening up too early would be a disaster in terms of another wave of infection. Our governor is being excellent at making sure that she follows the science of what the pandemic should happen. We're making sure that they stay closed and just open very, very gradually.

We will shut down again if we see another wave. And Michelle Lujan Grisham has done a great job in making sure that she protects all of the people of New Mexico, including those on the reservation. And she's working with the Navajo Nation to make sure that we can continue. The Navajo Nation has done a remarkable job of quarantining and of closing down, and it will be up to them, because they are a sovereign nation, of when they're ready to truly open again.

Unger: Well, Dr. McAneny, thank you so much for sharing your perspective from the front lines. Thanks to you and your staff for continuing to serve these patients during this incredibly tough time.

And that's it for today's COVID-19 update. Thanks again for being with us here and we'll be back tomorrow with another update. In the meantime, for resources on COVID-19 go to ama-assn.org/COVID-19.

Thanks for joining us and take care.

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