The White Mountain Apache Tribe is using the Rural Tribal COVID-19 Response grant to expand its community health representative program. The grant enabled the tribe to hire a medical assistant and two certified nursing assistants, who have been valuable to conducting high-risk follow-up visits to quarantined members. 

The Georgia Health Policy Center recently spoke to J.T. Nashio, the program director for the community health representative program for the White Mountain Apache Tribe, about participation in the Rural Tribal COVID-19 Response Grant program. 

What is an early accomplishment as part of your participation in the Rural Tribal COVID-19 Response Grant program?   

A big accomplishment our program has had in responding to COVID-19 is being able to monitor our community, our people, our tribal members and having kept our death rate fairly low. We pulled together as a team with our local Indian Health Service and with the tribal resources that we have. We came together and showed a lot of collaborative efforts in different ways to monitor our people within a fairly huge geographical area.  

The service we provide is pretty much within the reservation line. Our community health representatives (CHRs) are pretty familiar with the community, with a lot of them born and raised here. Most tribes have a CHR program, but each one is built based on the needs of the community. Here in Whiteriver, we have one of the biggest programs, and we have grown from 16 CHRs to about 30 CHRs. We have a young team that got started last year, and we have been able to teach them how to do CHR work and be that bridge between the community members and the resources in the community.  

Our new hires were a part of the COVID-19 contact tracing team from the very beginning. As our caseload evolved and we learned to understand more about COVID, we eventually turned this team into being able to do high-risk follow-ups. They work very closely with the providers to identify those at high risk and do home visits for constant follow-up. We also purchased vehicles so that they can go to the homes. 

Another unique thing is being able to speak Apache, our native language, so that our community members understand what to expect, what they’re going through, and how to get in touch with certain resources. We heavily oversee the surveillance portion for all the COVID-positive patients. We follow them daily throughout quarantine — not only the individual diagnosed but also with the family members. We support them throughout the ten days so that they’re comfortable. We have connections with the schools, so we’re able to go to the school and pick up homework packets or get laptops if needed. We do grocery shopping, and we offer food boxes and cleaning supplies. We also do med pickup and delivery. It is not just about identifying those COVID-positive patients but supporting them and ensuring that we try to give them the best care while being in quarantine here on the reservation. 

What is a learning that you would share with others combatting COVID-19 in their community?  

Overall, my advice would be to identify your resources and remember to be a team player. Our department was not just one department that did a lot of services. We collaborated with the Indian Health Services, the White Mountain Apache Tribe Emergency Operations Center, the transportation department, and our division of health programs. I see my position as being a part of a team and understanding the key players on the team. 

How do you see participation in the Federal Office of Rural Health Policy’s grant program impacting your broader health improvement efforts?  

You have to understand how important this program is to the community, our Indian Health Service facility, and our people. This program is flexible. We adapt well. We are individuals who carry many hats. Before COVID, we had CPR and first aid, car seat technician training, food handler’s card, and prevention and injury prevention training. A CHR is not just focused on one thing, but focused on anything health-related. 

What will your tribe be doing differently in the future as a result of lessons learned from COVID-19? 

I think the growth we already started will continue. This program has been in existence for over 50 years. Being able to mold it based on the needs of the community is a strength, I believe. There have been many changes within our environment, even just within the pandemic. We want to get an understanding of what happened, historical trauma, who we are, and then also set goals to know where we are going.  

We will always have that perspective of being here for the community. I am very passionate about helping my people and being a community member. As a Native American woman, as a woman in general, you are taught to take care of your family. This is my family, and together we are able to adapt to almost everything. I believe that is one of the things that this program is very good at doing — being able to adapt to sudden changes. We just have to understand where we are now, what we are going to do, and how we are going to fix things moving forward? 

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