In mid-March, as the Seattle region grappled with a coronavirus outbreak, a community health center caring for the area's Native American population made an urgent request to county, state and federal health agencies: Please send medical supplies.
What it received almost three weeks later left staff members stunned.
"My team turned ghost white," said Esther Lucero, chief executive officer of the Seattle Indian Health Board. "We asked for tests, and they sent us a box of body bags."
The health board's center — serving about 6,000 people a year in Seattle and King County — still has the package, which is filled with zippered white bags and beige tags that read "attach to toe."
Lucero said the body bags were a mistaken — yet nonetheless macabre — delivery from a distributor via King County's Public Health Department.
Abigail Echo-Hawk, the health board's chief research officer, said she believes that the message it sends, even unintentionally, is resonating in Native American communities across the United States during the pandemic: There is a pressing lack of adequate resources and funding as promised.
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"The Navajo Nation is in a crisis with cases, and there are tribes and other Indian organizations across the country that are in similar crises and can use medical supplies and help instead of watching people die," Echo-Hawk said. "This is a metaphor for what's happening."
Her concern comes as the federal government announced Tuesday that it will begin distributing billions of dollars in desperately needed pandemic-relief funds to Native American tribal governments, money that was delayed for more than a month in a related legal dispute.
While Seattle and Washington as a whole have managed to slow the spread of the coronavirus after being the nation's earliest hot spot at the beginning of March, Echo-Hawk said she's worried about whether the center will be able to perform the necessary coronavirus testing or secure enough personal protective equipment, or PPE, as businesses reopen and if a second wave of the virus crops up later this year, as health officials have warned.
"My questions is: Are we going to keep getting body bags or are we going to get what we actually need?" Echo-Hawk said.
Research shared this month from Public Health — Seattle & King County suggests that social distancing efforts in the region have been effective, with the county's infection rate falling since early March, although the rate of infection among people of color is still four times that of whites.
The Seattle Indian Health Board is one of 41 urban health programs under the federal Indian Health Service, which provides health care access to about 2.5 million American Indians and Alaska Natives.
Lucero said receiving PPE or COVID-19 tests, and not body bags, back in March was critical while they were working to curb the spread of the virus. At the time, the Seattle Indian Health Board did not have the capacity to test, and although the Federal Emergency Management Agency did offer to provide testing for the center, the logistics involved didn't make the process feasible, Lucero said.
After turning down FEMA's offer, the box of body bags inexplicably arrived, Lucero added. The health board did not have a contact at the county health department to ask about the shipment. Meanwhile, Lucero said, the county did help deliver about 200 COVID-19 test kits through FEMA.
She welcomed those tests because unlike the earlier ones, the health board was permitted to use their own lab to process the tests and communicate the results to patients directly.
Public Health — Seattle & King County on Tuesday said it was looking into the health board's claims, but the county did not appear to receive or process any requests for COVID-19 test kits from the board, and referred inquiries to Washington's Emergency Management Division. The state could not immediately be reached for comment Wednesday.
While the Seattle Indian Health Board has the PPE and supplies it needs as of now, Echo-Hawk and Lucero said, they were disappointed in the lack of aid in those crucial, earlier weeks and have since relied on Native-owned business such as the retail brand Eighth Generation in Seattle for donations to adequately fill the void.
"We need to have the correct resources and be included at the state and federal level," Echo-Hawk said. "Until then, Native organizations like mine are going to push forward to create the resources needed for us and by us."
The Seattle Indian Health Board has previously received some federal funding, which has helped to set up an additional testing site and keep the center operating, Echo-Hawk said. But she added that the program could benefit further from funding set aside for tribes and federal Indian programs in the Coronavirus Aid, Relief and Economic Security Act, a $2 trillion stimulus package passed in March.
The U.S. government has an obligation to provide health care to all Native Americans as stipulated in longstanding treaties with Indian tribes.
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The Treasury and Interior departments announced the distribution Tuesday of $4.8 billion to tribal governments, divvied up based on their census figures. However, urban Indian programs are not part of this phase.
The stimulus money was expected to be released before the end of April, as mandated by the law, but a legal feud erupted when tribal governments denounced the idea that Alaska Native corporations, which are for-profit businesses that serve tribal villages, would be allocated some of the funding.
Tara Sweeney, the assistant secretary for Indian affairs in the Department of Interior and an Alaska Native, has been accused by some tribes of having a conflict of interest and trying to divert some of the funding for Alaska Native corporations.
The Interior Department said in a statement that Sweeney has acted ethically and that some are "seeking to sow division during a time of crisis with unfounded allegations of favoritism."
Some Native American tribes have filed lawsuits challenging the aid for Alaska Native corporations, and the Treasury Department said Tuesday that such funding will be "held back" until the litigation is resolved.
Sen. Tom Udall, D-N.M., the vice chairman of the Senate Committee on Indian Affairs, said the funds should have been out the door to help Native communities on the outset of the pandemic.
"Treasury's announcement is the definition of 'too little, too late,'" Udall said in a statement. "It comes weeks after the deadline and billions of dollars short."