A building has sat empty for years, looking over a bend in the Tongue River outside of Sheridan, Wyoming. During the past month, members of the Northern Cheyenne tribe have knocked off the dust that had caked on windows, wiped down counters and replaced light bulbs. The multi-room facility has electricity, but no running water.
Originally known as the Thunder Child Treatment Center, the building has gone through several periods of use and abandonment. The crews who cleaned the center in September were preparing it for its latest guests: Northern Cheyenne tribal members who have tested positive for coronavirus.
Reopening the center has been just one of the solutions from within and without of the Northern Cheyenne Reservation resulting from a staggering number of COVID-19 cases and deaths among its members. While the rest of the state grapples with possible lockdown orders from local health officers, hospitals congested with patients and strained medical staff and resources, the Northern Cheyenne have already seen the worst of what the pandemic can do.
Rosebud County, where the majority of the reservation sits, has tallied more than 700 cases of COVID-19 and 20 deaths since the virus reached Montana in March. Neighboring Big Horn County has reported more than 1,000 cases and 32 deaths.
Like the wildfires that lit up the eastern part of the state in September, COVID-19 brought the attention of the Montana’s Disaster and Emergency Services Division, and personnel from the CDC. Additional contact tracers were soon operating out of Lame Deer as well.
Of 240 deaths in the state attributed to COVID-19, as many as 10% have been Northern Cheyenne.
“My count is 26 deaths, and it’s pretty frustrating," said Dana Eaglefeathers, a member of the Northern Cheyenne Tribal Council who helped secure funding to rehabilitate the rehabilitation center. "Myself and Councilman [Waylon] Rogers decided that we were done just waiting around.”
The Northern Cheyenne, who have more than 5,000 people living on the reservation, were unique in their limited number of cases through the early months of the pandemic and most of the summer. While the virus swept through the rest of the country bringing the current number of cases nationwide to nearly 8 million, it had a particularly devastating impact in Indian Country.
For the members of tribes and nations throughout the United States, their own ethnicity is a risk factor for COVID-19. A morbidity and mortality study released by the CDC in August showed that despite comprising just 0.7% of the U.S. population, Indigenous people had a COVID-19 infection rate nearly three times that of whites. According to a later update, they were more than five times more likely to end up in a hospital.
In a letter sent to Congress in September by leaders from the National Indian Health Board, National Congress of American Indians and the National Council of Urban Indian Health, those serving the 574 federally-recognized Tribal Nations called on both the Senate and the House of Representatives to recognize the stark figures of COVID-19 in Indian Country in its plans for additional coronavirus relief.
“Without sufficient additional congressional relief...these shocking upward trends will more than likely continue as COVID-19 restrictions are eased, schools and businesses reopen, and the potential threat of a more severe flu season coincides with this pandemic,” the letter read.
In Montana, the state’s Department of Health and Human services reports that as of Oct. 17, 2,978 Indigenous people have tested positive for COVID-19, about 14% of overall cases. Indigenous people in Montana account for about 7% of the population, according to the U.S. Census Bureau.
While nearly half the current positive cases are still under investigation, cases of COVID-19 among those in the state who identify as Native American in Montana peaked at 37% of total cases. That peak came in September, nearly every tribe in the state saw a rise in both cases and deaths due to the virus.
It wasn't until June, as statewide restrictions eased and new cases peaked at 56 in one day, that the Northern Cheyenne confirmed its first case of COVID-19. In July, as COVID-19 cases began to spike throughout Montana, only four total cases were reported within the 444,000-acre Northern Cheyenne Nation, according to updates from the tribe’s Incident Command Center. Within five days, the number of active cases within the tribe jumped to 11.
“The spread is internal. It is here,” read an announcement from the Northern Cheyenne’s ICC.
Despite the tribal government imposing a stay-at-home order that extended through the summer, and consulting with the CDC, August ended with 139 tribal members infected, 12 in the hospital and the first four having died due to the pandemic.
Forming a plan
Frances Altekruse came into her job as the acting director of health promotion programs for the Northern Cheyenne Board of Health in the second week of September, with active infections hovering at more than 120 and 18 tribal members hospitalized. By that time, agencies from across the state had mobilized and zeroed in on the reservation.
During her conversations with the CDC and DES, Altekruse and other Northern Cheyenne administrators crafted a plan to respond to the crisis that started with bringing awareness to the importance of social distancing, washing hands and wearing a mask. When the Northern Cheyenne families averaged nearly a burial a day throughout September, Altekruse said awareness shifted to informing tribal members what to do once they tested positive. The month of September came to an end with 261 active cases for the Northern Cheyenne on the 28th.
With many reservation homes being multi-generational, finding space to quarantine became another crisis for the tribe, along with supplying food for those needing to stay indoors and alone for two weeks. A food distribution network came courtesy of the Boys and Girls Club of the Northern Cheyenne and members of the Montana National Guard and Air National Guard.
“We’re doing the best we can,” said Tribal Council member Lane Spotted Elk.
Spotted Elk said the Board of Health, Indian Health Service and the Northern Cheyenne Housing Authority have about 20 “alternate care site” homes for anyone who needed them to stay for quarantine. He said those included both family members who needed to separate, and the homeless.
“We’re so far away from hotels, we don’t have that luxury of converting one into a quarantine space, and a lot of these units needed upgrades, and they needed to be furnished. These have been very instrumental in the progress that we’ve made, but at our peak, we didn’t have any of those units available,” he said.
Care packages of cedar, tea, and herbs used in traditional practices came courtesy of the People’s Camp, a collection of tribal volunteers who have poured money, time and tears into keeping COVID-19, which one member called the “enemy that can’t be seen,” out of the reservation since the spring.
That enemy crept into the home of Levonna Littlebird Graham, a member of the People’s Camp, in September when her husband tested positive. His head ached, and pain shot through the muscles in his legs, she said. Despite the resources poured into contact tracing and building an infrastructure of informing and housing, she and her husband needed to call the IHS’s public health nursing program to confirm his infection. However, food did come to their home through the Boys and Girls Club, and they received their own package of tea, cedar and bear root from the People’s Camp while her husband recovered.
She joined her father, Geofredo Littlebird Sr. in the recent cleanup of the Thunder Child Treatment Center. Although council members secured more than $10,000 in CARES Act funding to refurbish the facility, the building has still gone unused. Altogether, the Northern Cheyenne have been allotted nearly $19.5 million in CARES Act funds.
The homeless in Lame Deer, and throughout the reservation, have been particularity impacted by the outbreak both in terms of infection and the $500 fine imposed by the tribal government on those caught violating the curfew and lockdown order that began in September.
The division between members of the People’s Camp and tribal leadership regarding the most effective method of keeping the reservation secure from COVID-19 goes back to the start of the outbreak. Members of the People’s Camp took it upon themselves to aid overwhelmed Bureau of Indian Affairs officers in enforcing the curfew and maintaining a checkpoint, all without pay and without the endorsement of the Northern Cheyenne president. It took until the end of August, but the Northern Cheyenne launched a checkpoint plan through the end of year that brought on 30 paid staff members.
“If we [the People’s Camp] had that same support, I believe we’d still be at zero, because our herbs work, we’ve got care packages together and we had a plan before any of this,” said Littlebird Sr., who buried an uncle and an aunt, both of whom died due to COVID-19.
Once again, the Northern Cheyenne are against the statistical grain of COVID-19 in Montana. After seeing the virus run through the reservation like a wildfire, active infections are back to only a few dozen. An epidemiologist from the CDC working with tribal administrators and the Board of Health to determine how the situation became as bad as it did on the reservation, and National Guard and Air National Guard members will stay on hand through the end of October to assist in driving ambulances and packaging food for delivery.
Frances Altekruse, whose role with the Board of Health has her engaging in the best route to promote health for the Northern Cheyenne, said the tribe's position next to Yellowstone and Big Horn counties left it vulnerable, especially since so many need to leave the reservation for necessities like groceries and health care.
Those stepping into the Conoco in Lame Deer can now stop and look back at themselves on a tablet mounted to a chest-high stand. After a few seconds, they get a reading of their temperature. The same tablet system stands outside the Tribal Council chambers. Both are just a portion of the changes made on the reservation during the past several weeks.
“We’ve had so many great resources from the state and federal level, but this has to be dealt with on the community level, " said Spotted Elk. "With the lockdowns and stay at home orders, it’s like we just have to be patient and wait until the enemy passes.”
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