HEAL Solidarity Responses to COVID-19
UCSF dramatically expands our solidarity team in Navajo Nation to 35 health workers across 5 hospitals
The UCSF HEAL Initiative has been working in Navajo Nation since 2015, with 52 fellows + alumni working here before, during, and after the crisis. The HEAL Initiative is the largest global health fellowship in the US and formed to train, transform, and accompany front line health workers committed to the underserved. UCSF HEAL has 128 fellow and alumni spanning 19 partner sites in 9 countries and Navajo Nation (Diné Bikéyah). Since 2015, HEAL has partnered with Navajo Nation, the largest reservation in the US, to support the leadership and transformation of local leaders.
To amplify our efforts in the time of crisis and to respond to President Nez’s call for health worker reinforcements, UCSF & HEAL sent a solidarity team of 21 nurses and doctors on April 22 to serve for a month in 3 Navajo Nation hospitals. This team has been working for 4 weeks alongside HEAL and Navajo colleagues leading the response.
Today, UCSF & HEAL announce that a second team of 19 providers will head to Navajo Nation, alongside 16 health workers staying on, to further support during the surge. Together, these 35 nurses and doctors will work across the 5 largest hospitals serving Navajo patients.
The second UCSF solidarity team is composed of 13 nurses and 5 physicians who will be working in two additional hospitals – Tuba City Regional Health Care Corporation and Tséhootsooí Medical Center. Additionally, UCSF is supporting the request of 16 health workers from the first solidarity team to extend their service through the surge.
“The medical team from UCSF has been a blessing to the Navajo people. Their resources combined with our resources have certainly saved lives during the time that UCSF has been on the ground here in Navajo Nation. We are truly thankful to their team for the relief and compassionate work they are providing to help fight COVID-19.” – President Jonathan Nez
As we honor these many acts of solidarity, we recognize that this support, while critical in this moment, is a heartfelt bandaid on a much larger and wounded healthcare system. As our teams provide support during the surge, we must continue to ask why the pandemic is spreading so fast across the Navajo Nation, resilient through broken treaties and structural injustices. Why do our Navajo colleagues receive 30 cents on the dollar of other federal health funding per capita? Why do they have to work in 50+ year old hospital buildings? What structural causes result in 1 of 3 of Navajo families without water, electricity, or both in 2020? Why are there only 13 grocery stores on 27,000 square miles, the size of New England, and how does that underlie high rates of diabetes or obesity? Why are there still uncleaned uranium mines contaminating the drinking water of future generations? HEAL joins the chorus of Native voices linking genocide and history and chronic underfunding to this current moment.
We are not through this crisis yet. We are running the sprint alongside our Native, rural, and global south colleagues who are running the marathon. They are resilient and resolute. Together, we focus on accompanying locally led responses before, during, and after a crisis.
Together, we seek to work for a world where our first citizens are first.
We seek to shape a world where our health systems work for the most vulnerable.
We know that COVID-19 can be a portal into a different, more just world.
We welcome the 19 new solidarity members to Navajo Nation, as well as the 16 who are staying on, and thank each of them and their colleagues at UCSF for their contribution to this global community. We are grateful for all 35 health workers who work alongside our 52 HEAL fellows and alumni and alongside all of our local colleagues to serve the Navajo Nation.
Solidarity is a Verb: UCSF Teams Arrive at Navajo Hospitals
21 UCSF volunteers are settling into their new homes, where they will serve for one month alongside the tireless health workers who are leading the charge in the Navajo community. The team arrived Thursday in response to Navajo Nation President Nez’s call for reinforcement, building off of the deep partnership between UCSF’s HEAL Initiative and the Nation. This team of 21 stands in solidarity, alongside 49 HEAL fellows and alumni, half of whom are Native American themselves, as well as hundreds of health workers who are caring for the most vulnerable in this trying time.
In the first days orienting the volunteer team, nightly debriefs bubbled over with awe at the resilience, creativity, generosity, and larger-than-life responses already in place in Navajo Nation.
The strength of the Navajo Nation’s response can be seen in many different ways. In testing, Navajo Nation is far ahead of almost every other state. Public health nurses in the Chinle area are the bridge between facility and community, driving hours off main roads to check on vulnerable community members and provide one-on-one support, often in the Diné language and custom. The level of kinship is 100-fold stronger than most community health worker programs we have ever seen in the U.S. In Gallup, local health worker teams worked creatively and around the clock to set up 5 alternative facilities to care for people in rehab and without housing – some of the areas where UCSF volunteers and HEAL fellows will be providing support.
The local teams shift their work flows to orient those that just arrived. Credentialing colleagues work around the clock to help get the volunteers ready. Everyone juggles PPE shortages, finding appropriately sized masks, and integrating the new teammates. One volunteer celebrated her 30th birthday the day after her arrival. New friends bring groceries, bring makeshift candles, and give advice on where to get gas and water. Social networks open to welcome the additional hands with a generosity that cannot be put into words.
UCSF volunteers and HEAL fellows have arrived into systems led by everyday heroes. They work in hospitals where COVID cases overstretch already underfunded and understaffed facilities. Some units have been able to stay open and increase capacity as the UCSF nurses arrived. It is a sacred relay at a much needed time. The volunteers expressed awe at the way so few humans with such limited material resources have done so much.
On the night of the team’s arrival, one local Diné colleague shared a picture of a sunset over the hospital parking lot: “My view this evening as I finish up work and anxiously await your arrival. How beautiful it is outside and yet knowing that just downstairs, there are people who are sick, who are alone, and who are scared and fearful of what’s next. Safe travels.” A volunteer replied, “I cannot wait to stand alongside you, the team, and the Navajo Nation during this period in our collective History. Here’s to a restful night for us all in preparation for what is to come, much love.”
On Friday, our team met with Navajo Nation President Nez and discussed how to further support Navajo leadership’s response across the vast nation. “We are so honored to serve on this sacred land, at the invitation of President Nez and Navajo leadership. For 5 years our global health program, UCSF HEAL has worked closely with Navajo frontline health leaders, such as Dr. Adriann Begay and Dr. Paula Mora, to care for Navajo patients. In this moment of crisis, we know more than ever, we are interconnected and interdependent,” HEAL co-founder Dr. Sriram Shamasunder said.
We are reminded of the longer story that our efforts fit within, often beyond the soundbite. To understand the current moment of COVID-19 in Navajo Nation requires us to understand a history of Manifest Destiny, historical trauma, treaties made and broken, structural violence, and uranium mines left open – a history literally seen in the bodies of our patients. It requires us to ask why the First citizens of this country continue to be last with regards to federal funding and social support. It requires us to both celebrate this moment of solidarity, as well as recognize this moment is a bandaid on a much larger wounded healthcare system. We cannot look at this team, our COVID 19 patients, or this moment, without this wider lens.
As this moment lays bare the fault lines of historical and present day injustice, it challenges us not only to serve, but to ask why things are the way they are, to advocate and to enact deeper and longer-lasting changes.
It asks us to stay and to build long-standing, bi-directional relationships rooted in both righteous anger at injustice and deep humility in what it means to accompany those already doing the work.
That is why the HEAL Initiative was formed. Together HEAL shows up together in solidarity in Navajo Nation and around the world in Mali, Nepal, Mexico, India, and beyond to accompany the transformation and leadership of health leaders who courageously tend to the well-being of future generations. By showing up repeatedly in solidarity, we work towards change.
We look forward to a productive week ahead, together.
To amplify incredible efforts of our Navajo colleagues and the 49 HEAL Fellows in Navajo Nation, UCSF is preparing to send 21 health workers to Navajo Nation to further reinforce the health response.
As San Francisco is largely flattening the curve, due to remarkable collaborations, leadership, and early policy action, other communities are struggling. COVID 19 is tearing across the fault lines of existing injustice and structural marginalization, and has hit Navajo Nation at a rate higher than 48 states.
During this time, we are all asking ourselves, what does solidarity look like? It is time to reimagine health for all, including our most vulnerable patients everywhere.
As health workers committed to health equity, the UCSF HEAL Initiative, the largest global health fellowship in the US, exists to train and transform health workers serving resource-denied communities. One of the only programs that bidirectionally trains US trained MDs and local health workers, HEAL believes that local health workers will lead health system transformation that lasts. To date, 128 HEAL fellows and alumni span 19 partner sites in 9 countries and Navajo Nation (Diné Bikéyah).
Since 2015, HEAL has partnered with Navajo Nation, which is the largest reservation in the US and the home of the Diné people. The resilience of our Diné colleagues — surviving annihilation, forced assimilation, structural violence, and continuing atrocities — to continue to lead with sovereignty, kinship and grace has transformed the entire HEAL network.
As the devastation of COVID 19 on Navajo Nation rises, HEAL fellows and alumni, particularly our Navajo fellows, have been leading the charge. 25 Navajo health workers are part of HEAL’s program. Additionally, 45 physicians have moved to Navajo Nation to serve, and 11 of them chose to stay after fellowship to work in solidarity with their local colleagues, accounting for more than 48 physician years of service to Native patients.
As an act of solidarity, UCSF and HEAL are sending 21 health workers to Navajo Nation to further reinforce the local leadership. We stand inspired by the history of Standing Rock, Mississippi Freedom Summer, the anti-Apartheid movement, and many other moments where solidarity has not been a concept but a verb, enacted with courage.
We seek to send our people, our supplies, and our support to the local health systems as an act of solidarity and kinship. We must ask why the pandemic is spreading so fast across the Navajo Nation, resilient through broken treaties and structural injustices, and how to support a locally led response.
COVID has shown us that we are bound together, all of us. We are grateful for the UCSF teams who chose to go to New York, and now Navajo Nation, and for all the invisible hands who helped to make solidarity happen.
“If you have come here to help me you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together”
– Lilla Watson.
For more information, contact: Sriram Shamasunder (email@example.com), Sangeeta Tripathi (firstname.lastname@example.org), or Joseph Scarpelli (email@example.com)
Other Acts of Solidarity
Beyond Navajo Nation, HEAL fellows and alumni are leading responses that last around the world – leading ICU care in Haiti, driving an multi-sectoral response in Navajo Nation, building contact tracing systems in Mali, advancing social protection during lockdown in India, providing care in Seattle and right here at UCSF, advocating for the most vulnerable, and working on the front lines in Nepal, Liberia, Mexico, and beyond.