The Georgia Health Policy Center recently spoke to Hollie Strahm, the public health officer for the Yurok Tribe, about their efforts to establish an independent public health department that covers the reservation, which spans three counties in Northern California.
To date, what has been the biggest accomplishment or win in your COVID-19 program?
For the Yurok Tribe the establishment of an independent public health department is probably the biggest win. Before the pandemic, we did not have a public health department. Through this grant, combined with another, we were able to build out a public health response and exercise our public health authority for the first time as the tribe, independent of the three counties that the reservation spans.
Currently, we have four employees, and we have some open positions that have been challenging to fill in a rural area. Basically, we are trying to establish foundational public health services, so, a registered nurse, a lab tech, and a vaccine coordinator, and then being in a pandemic, a case investigator, but this will all expand beyond COVID-19.
We are also really interested in moving toward data collection for our own tribe, which is the largest in California. We really want to be able to collect information specific to our tribal community and people.
What is a tip or early learning that you would share with another tribal organization?
First and foremost, it is really important to establish a positive trusting relationship with county public health and state public health. The way that public health is set up in in the United States is that it is very governmental. Tribal public health definitely has a presence, and that presence has been growing with COVID-19. I know some of the large tribes did their own public health efforts even before the pandemic, but for those just getting in public health, it is critical to ensure that you have access to data and infectious disease information on your tribal members.
I come from county public health and working in tribal public health is different. I think that there is still a lot of work to be done in terms of advocacy for tribes and policy work and acknowledging and allowing tribes to respond as counties do. I am not unique in this perspective. During the pandemic, things like data reporting and other challenges came out for many tribes, especially tribes like ours that did not have an established public health department. I think continued work in advocating for this for all the tribes will help us move forward.
How do you see participation in the Federal Office of Rural Health Policy’s COVID-19 grant program impacting your broader health improvement efforts?
The initial grant allowed us to have a quick response and respond to the needs of the community. It is very rural here and we contract with a partner, United Indian Health Services, to provide our public health, medical, and behavioral health services. But there are definitely always going to be gaps given the remoteness of the tribe. We looked at where the gaps were and how to work with partners and leverage opportunities to fill the gaps. It was really micro work and then we looked at how do we expand from there.
There is certainly work to be done with population health and the health of the tribe as a whole. There are a lot of efforts being led independently, like opioid response, that are living in little silos throughout different departments. We are looking at how we can have a larger lens and do more coordinated work. Throughout the tribe we can leverage some of those smaller grants and identify where we want to go.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
I think that the Yurok Tribe having its own voice, establishing our own authority, and identifying our own needs within the tribe will strengthen us going forward. Our contracted public health service provider serves multiple tribes. But now we can really look at how the Yurok Tribe’s needs might be different from others. This grant has given us opportunities to have a bigger voice. We have been able to establish partnerships and come out strong with jurisdiction over our reservation.
It will be good for us to be able to make those determinations using the data systems that we are working to establish right now. Going forward, this will allow us to have a quicker response when needs come up and not have to rely on our community partners to get to where we need them when we can go out do it ourselves. This has been really critical, especially during COVID-19. If we need something or we have an outbreak and we need someone there this afternoon or tomorrow morning I can make that happen versus sometimes waiting a week or so for that response to come from the outside.