Responding to COVID-19 Through Relationships and Cultural Understanding

The COVID-19 cri­sis has dis­pro­por­tion­ate­ly affect­ed Native Amer­i­cans. By lever­ag­ing its rela­tion­ships and under­stand­ing of trib­al cul­ture, the Johns Hop­kins Cen­ter for Amer­i­can Indi­an Health is doing its part by pro­vid­ing food, water, per­son­al pro­tec­tive equip­ment and oth­er essen­tial home health items, as well as COVID-19 test­ing and con­tact trac­ing efforts.

The response effort, fund­ed in part by the Annie E. Casey Foun­da­tion, is deploy­ing the Center’s work­force, trib­al col­lab­o­ra­tors, rela­tion­ships with nation­al orga­ni­za­tions and providers that have adopt­ed Fam­i­ly Spir­it — the Cen­ter’s evi­dence-based ear­ly child­hood home vis­it­ing pro­gram devel­oped by and for Native Amer­i­cans — to chan­nel relief resources and cul­tur­al­ly mean­ing­ful com­mu­ni­ca­tions to trib­al com­mu­ni­ties across the Unit­ed States.

Pri­or to the coro­n­avirus pan­dem­ic, Native Amer­i­cans suf­fered high­er rates of infec­tious dis­ease sever­i­ty and death than any oth­er pop­u­la­tion in the Unit­ed States. Many of those served by the Cen­ter — which is based in the Johns Hop­kins Bloomberg School of Pub­lic Health — live in over­crowd­ed, mul­ti-gen­er­a­tional homes that make being iso­lat­ed a chal­lenge. An esti­mat­ed 80% of chil­dren in Native com­mu­ni­ties rely on receiv­ing break­fast and lunch from now-closed schools. In the Nava­jo Nation alone, more than 30% of fam­i­lies don’t have a tap or indoor plumb­ing at home, mak­ing hand wash­ing difficult.

Here’s how the Cen­ter is responding:

• Keep­ing chil­dren and fam­i­lies well-nour­ished. Because stay-at-home orders and a lack of at-home refrig­er­a­tion make it chal­leng­ing for fam­i­lies to have enough food on hand, the Cen­ter is pro­vid­ing box­es with famil­iar foods that are health­ful and non-perishable.
• Deliv­er­ing basic at-home health sup­plies. The Cen­ter is con­duct­ing reg­u­lar check-ins to gauge fam­i­ly needs and dis­trib­ute dis­in­fec­tants, dia­pers, wipes and ther­mome­ters. The Cen­ter also is deliv­er­ing hand-wash­ing sta­tions and bot­tled water to fam­i­lies that do not have run­ning water.
• Pro­vid­ing per­son­al pro­tec­tive equip­ment for respon­ders and com­mu­ni­ty mem­bers. The Cen­ter is dis­trib­ut­ing face masks, face shields, gloves and gowns to address a short­age of equip­ment for med­ical care providers, com­mu­ni­ty-based first respon­ders and com­mu­ni­ty members.
• Employ­ing Apache and Nava­jo staff. To enable ongo­ing pro­tec­tion, the Cen­ter is employ­ing reser­va­tion-based staff to sew cloth masks and reusable gowns, and to build and dis­trib­ute hand-wash­ing sta­tions. An addi­tion­al goal: plant­i­ng the seeds for sus­tain­able small businesses.
• Account­ing for men­tal and psy­cho­log­i­cal health inequities. The his­to­ry of infec­tious dis­eases — includ­ing those inten­tion­al­ly intro­duced as an act of geno­cide — and the loss of Indige­nous lands, peo­ple and cul­ture have result­ed in gen­er­a­tions of trau­ma that the COVID-19 cri­sis stands to ampli­fy. The Center’s pub­lic health approach address­es the psy­cho­log­i­cal toll of COVID-19, reduc­ing anx­i­ety and pro­mot­ing resilience.

Pro­vid­ing cul­tur­al­ly rel­e­vant health communications

For Native pop­u­la­tions, the effects of COVID-19 extend beyond phys­i­cal and men­tal health — they threat­en the endurance of his­toric tra­di­tions. In many Native com­mu­ni­ties, elders are the wis­dom keep­ers, respon­si­ble for edu­cat­ing youth on tra­di­tion­al lin­guis­tic and cul­tur­al prac­tices. ​“Over the past 30 to 40 years, and after many years of sup­pres­sion by non-Native forces, we’ve seen a large push among Native com­mu­ni­ties to revive lan­guage and tra­di­tion­al cul­tur­al prac­tices,” says Alli­son Bar­low, direc­tor of the Cen­ter. ​“COVID-19 threat­ens to inter­rupt this revival by tak­ing the elders.”

To inform a cul­tur­al­ly rel­e­vant response, the Cen­ter is using pro­grams like Fam­i­ly Spir­it — whose repli­ca­tion and adap­ta­tion Casey has sup­port­ed — to do more than dis­ease con­tain­ment. With a foothold in 140 trib­al com­mu­ni­ties across 21 states, Fam­i­ly Spir­it gives the Cen­ter an estab­lished net­work to reach Native chil­dren and fam­i­lies across the coun­try. Work­ing with a Native Amer­i­can col­lab­o­ra­tive, the Cen­ter cre­at­ed the children’s book, Our Small­est War­riors, Our Strongest Med­i­cine: Over­com­ing COVID-19, a re-telling of My Hero is You.

“Because of the reach and com­mu­ni­ty trust they’ve achieved over their long-term devel­op­ment of Fam­i­ly Spir­it, the Cen­ter was in a strong posi­tion to pro­vide the response crit­i­cal­ly need­ed dur­ing this pan­dem­ic, while con­tin­u­ing to build com­mu­ni­ty well-being after the imme­di­ate cri­sis ends,” says Cyn­thia Weaver, a Casey senior asso­ciate over­see­ing the Center’s grant.

The book is being dis­trib­uted to every fam­i­ly that Fam­i­ly Spir­it serves. The Cen­ter is also con­duct­ing sur­veys to gath­er fam­i­lies’ respons­es to the book, the results of which will be used to inform future Fam­i­ly Spir­it ini­tia­tives and psy­cho­log­i­cal aid.

In addi­tion, the Cen­ter is track­ing deliv­er­ies, assist­ing with expand­ed test­ing and con­tact trac­ing, and pro­vid­ing trib­al part­ners with data to inform safe re-open­ings. As the Cen­ter looks to the next phase of coro­n­avirus response, it con­tin­ues to expand efforts to address the impact of COVID-19 on behav­ioral and men­tal health. In addi­tion, the Cen­ter seeks to pro­mote devel­op­ment of infra­struc­ture to address access to food and safe water, while also engag­ing with youth, fam­i­lies and com­mu­ni­ties in devel­op­ing com­mu­ni­ty resources.

Learn how cul­tur­al­ly rel­e­vant pro­grams con­tribute to child wel­fare prevention