Danelle Smith: The Winnebago Tribe of Nebraska's Covid-19 Response

Center for Great Plains Studies Author

02/15/2021 Added

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The Center spoke with Danelle Smith, CEO of the Winnebago Comprehensive Healthcare System. Early on in the Covid-19 pandemic, the Winnebago Tribe of Nebraska formed a comprehensive, interdisciplinary task force to respond to the needs of the community, thinking through many issues from food distribution and protective equipment to housing and communicating the importance of protecting their elders. Special thanks to Margaret Huettl for providing a video land acknowledgement for this episode. To listen to the podcast version, visit: https://anchor.fm/gp-lectures/episodes/Ep--9-Danelle-Smith-and-the-Winnebago-Tribe-of-Nebraskas-Covid-19-Response-eqef7m

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[00:00:00.330]Welcome to Great Plains: Anywhere,
[00:00:01.940]a Paul A. Olson Lecture
[00:00:03.500]from the Center for Great Plains Studies
[00:00:05.170]at the University of Nebraska.
[00:00:07.400]Today, we're speaking with Danelle Smith,
[00:00:09.400]CEO of the Winnebago Comprehensive Healthcare System.
[00:00:13.450]Early on in the COVID-19 pandemic,
[00:00:15.730]the Winnebago Tribe of Nebraska
[00:00:17.600]formed a comprehensive interdisciplinary task force
[00:00:21.120]to respond to the needs of the community,
[00:00:23.640]thinking through many issues
[00:00:25.030]from food distribution and protective equipment
[00:00:27.870]to housing and communicating the importance
[00:00:30.230]of protecting their elders.
[00:00:31.406](gentle acoustic music)
[00:00:33.340]On behalf of the Center for Great Plains Studies,
[00:00:35.490]I would like to begin by acknowledging
[00:00:37.660]that the University of Nebraska is a land grant institution
[00:00:41.350]with campuses and programs
[00:00:42.900]on the past, present and future homelands
[00:00:45.200]of the Pawnee, Ponca, Otoe-Missouria, Omaha, Lakota,
[00:00:50.030]Dakota, Arapaho Cheyenne and Kaw Peoples,
[00:00:53.890]as well as the relocated Ho-Chunk,
[00:00:55.970]Iowa and Sac and Fox Peoples.
[00:00:58.560]Please take a moment to consider the legacies
[00:01:00.790]and more than 150 years of displacement, violence,
[00:01:05.170]settlement and survival that bring us here today.
[00:01:08.610]This acknowledgement and the centering of indigenous peoples
[00:01:11.620]is a start as we move forward together
[00:01:14.130]for the next 150 years.
[00:01:16.890]Hello, I'm Margaret Jacobs, I'm the director
[00:01:19.030]of the Center for Great Plains Studies at UNL.
[00:01:24.030]Hi, I'm Katie Nieland.
[00:01:25.060]I'm the assistant director
[00:01:26.140]at the Center for Great Plains Studies.
[00:01:29.240]Hi, my name is Danelle Smith,
[00:01:30.980]and I'm the chief executive officer
[00:01:32.510]for the Winnebago Comprehensive Healthcare System
[00:01:34.610]in Winnebago Nebraska.
[00:01:36.300]Can you tell us a little bit
[00:01:37.133]about what you do for the Winnebago tribe?
[00:01:41.750]Yes.
[00:01:44.020]Like I said, I'm the CEO
[00:01:45.530]for the Winnebago Tribe Healthcare System.
[00:01:47.460]And in this role, I am responsible
[00:01:51.040]for managing all of the tribe's healthcare programs.
[00:01:54.150]And we have two divisions that are part of the WCHS,
[00:01:57.597]and that includes the Twelve Clans Unity Hospital
[00:02:00.030]and the Winnebago Public Health Department.
[00:02:02.600]Can you tell us about the tribe's response to the pandemic
[00:02:05.747]in the very beginning of it last year?
[00:02:08.980]Sure.
[00:02:11.370]Well, you know, the pandemic,
[00:02:13.360]this whole past year, I guess,
[00:02:14.340]has been a very interesting
[00:02:16.970]and unique learning experience for us
[00:02:22.070]as it has been for everybody basically in the world.
[00:02:25.900]And in Winnebago, we really, you know,
[00:02:29.920]just tried to use all of the resources that were available
[00:02:33.360]to kind of learn about the pandemic,
[00:02:35.530]and just watching what was happening across the country
[00:02:38.450]and figuring out the best way to approach it
[00:02:42.730]for our community.
[00:02:44.850]In Winnebago, you know, it's the Winnebago Tribe of Nebraska
[00:02:49.590]and we're located here in the northeast corner of Nebraska.
[00:02:53.630]And our primary community in Winnebago
[00:02:56.380]consists of about 2,000 people,
[00:02:59.050]both tribal members and non-tribal members
[00:03:00.920]who live on the reservation.
[00:03:02.950]And at the healthcare system,
[00:03:05.280]we of course play a very primary role
[00:03:09.340]in a response effort to a pandemic such as this.
[00:03:15.240]We met first internally at the hospital
[00:03:18.840]and started a work group, probably around early February
[00:03:24.020]soon after the first case was discovered
[00:03:26.710]in the United States
[00:03:28.500]just to kind of figure out our processes,
[00:03:30.210]make sure our plans and our response plans
[00:03:32.520]that we had in place
[00:03:34.620]in anticipation of such a thing,
[00:03:36.570]which is something that you have in a healthcare system
[00:03:38.840]is to try to anticipate when things like this might happen.
[00:03:42.470]So we started an internal work group,
[00:03:44.650]and then very soon after that,
[00:03:47.470]it expanded to the whole tribe.
[00:03:50.350]So, you know, we met, myself and others,
[00:03:53.770]other tribal leaders in the community,
[00:03:57.190]started meeting with the Tribal Council
[00:03:59.280]which is basically the governing body for our tribe
[00:04:03.010]to try to figure out the best approach
[00:04:04.430]and what kinds of things we needed to have in place
[00:04:06.340]in order to respond.
[00:04:08.520]And so that all kind of came together
[00:04:10.910]in February and March of last year.
[00:04:14.890]The tribe actually declared
[00:04:18.010]a public health emergency in March,
[00:04:21.770]which sort of activated a lot of things
[00:04:25.210]like, you know, funding and coordination
[00:04:27.230]across tribal entities and so forth.
[00:04:29.890]So that was really an important step.
[00:04:33.800]I think that the tribe did and everybody who is involved
[00:04:38.360]has really done a remarkable job
[00:04:40.510]in terms of just coordination and communication
[00:04:44.770]and all of the things that you need
[00:04:47.730]in order to have an effective community response
[00:04:50.855]to something as big as a pandemic.
[00:04:53.660]I wonder if you could speak a little bit
[00:04:55.230]about what does a pandemic like this mean
[00:04:59.480]as an indigenous nation
[00:05:02.030]that has faced so many health crises in the past.
[00:05:07.060]I think that's a really good question and a good point.
[00:05:09.640]As a tribal community,
[00:05:12.210]you know, we've had a long history of this type of thing,
[00:05:16.750]you know, with the whole smallpox
[00:05:18.910]just really being so devastating to tribal nations
[00:05:23.570]throughout the country in the earlier years.
[00:05:30.190]As a population, we typically have
[00:05:33.700]a much higher rate of chronic disease.
[00:05:37.200]And so when things like this happen, you know,
[00:05:39.640]there's definitely a concern
[00:05:41.700]that it will have more of an impact
[00:05:43.970]in terms of just the number of people who are positive
[00:05:47.020]and then the implications of that on somebody's health,
[00:05:50.400]you know, just overall because of those types of conditions.
[00:05:54.040]So it's definitely very much a concern.
[00:05:57.030]The other concern that we always kind of keep in mind
[00:06:01.100]is that as a tribal nation,
[00:06:03.020]we have a very unique circumstance
[00:06:05.960]in terms of our relationship with other jurisdictions,
[00:06:10.190]both in the state, at the local health department levels
[00:06:13.950]and with the nation.
[00:06:15.540]So when something like this happens in the United States,
[00:06:20.170]things don't flow in the same way that they do
[00:06:22.480]for everybody else in terms of how resources are accessed,
[00:06:25.650]how PPE, you know, supplies are accessed
[00:06:28.500]and how money is accessed.
[00:06:30.540]So we really have to be proactive
[00:06:34.280]and pay very close attention and be very engaged
[00:06:38.020]to make sure that those kinds of resources
[00:06:40.270]reach our community.
[00:06:41.510]And I think that is something that we have been able to do
[00:06:44.090]through this pandemic, and so I'm really happy about that.
[00:06:47.860]You know, just we've learned a lot
[00:06:52.340]and I think really have done a pretty good job
[00:06:54.830]given the circumstances in managing it.
[00:06:57.440]But I guess, you know, getting back to your point,
[00:07:00.431]it's a scary thing, you know, to have a pandemic
[00:07:03.720]and not knowing exactly how it's going to play out,
[00:07:07.480]how it's going to, what kind of impact
[00:07:09.130]it's gonna have on your population.
[00:07:11.090]You know, all of those things are important for us to know
[00:07:14.340]and understand to the best that we can
[00:07:15.960]with the information that's available.
[00:07:19.090]The other thing that has been of paramount concern
[00:07:23.670]for us in our community is the fact
[00:07:25.240]that we are a very small close knit community.
[00:07:28.940]And as a tribal community, we also have a very high value
[00:07:32.580]on family and connectedness and gatherings.
[00:07:37.270]And we have large families, you know, who all
[00:07:42.420]for the most part stay in our community.
[00:07:45.470]And so there's a much higher risk in terms of just exposure,
[00:07:51.470]you know, to others.
[00:07:52.690]It's not like we have, you know, husband, wife,
[00:07:55.640]two kids and a dog living in one household.
[00:07:57.900]Very oftentimes we have multi-generations
[00:08:00.140]living in a household where the families are very large
[00:08:02.850]and include extended family.
[00:08:06.550]And on top of that, you know,
[00:08:08.710]there's also in our native culture, a very heightened sense
[00:08:12.100]of, I guess, responsibility to each other
[00:08:16.835]and helping each other in the community,
[00:08:19.500]even if it's people that are outside
[00:08:21.060]of your immediate family.
[00:08:22.650]So all of those kinds of things
[00:08:24.050]that are wonderful about our culture
[00:08:27.420]also, you know can lead to some unintended consequences
[00:08:32.220]when you're dealing with a pandemic.
[00:08:34.420]I should also mention that I am a member
[00:08:37.010]of the Winnebago Tribe,
[00:08:38.530]and I was born and raised in Winnebago.
[00:08:42.710]So I have a very obviously strong connection
[00:08:46.370]to my community and to my role
[00:08:48.430]and to the patient population and everybody that we serve,
[00:08:53.460]you know, through my position at the healthcare system
[00:08:55.290]but also just throughout the tribe.
[00:08:58.090]And my family is here.
[00:09:03.155]It's just, I think it adds context
[00:09:06.670]to the value of the work that we're doing.
[00:09:09.030]And, you know, being a part of the community,
[00:09:11.010]it's not for me and for most of us in these types
[00:09:13.880]of roles in our community, it's not just a job.
[00:09:16.360]You know, these are our relatives,
[00:09:18.790]and which is you know, in a literal sense, my relatives,
[00:09:23.130]but also in a broader sense in terms of the connectedness
[00:09:26.220]and way in which our tribal culture is.
[00:09:35.390]In I believe it was March,
[00:09:40.240]right, you know kind of pretty early
[00:09:42.790]in the time period of the pandemic,
[00:09:45.550]as the tribal council was meeting
[00:09:49.460]and trying to figure out what to do,
[00:09:52.460]it became very apparent and important to us
[00:09:56.510]to coordinate and collaborate
[00:09:59.360]throughout our tribal organization.
[00:10:02.100]So this was not an issue
[00:10:03.550]that was just for the healthcare system.
[00:10:05.310]It was not an issue
[00:10:06.150]that was just for the tribal government to address.
[00:10:09.170]You know, it was something that was going to have impact
[00:10:11.710]throughout our entire community.
[00:10:14.000]So what the Tribal Council did was to form
[00:10:17.930]Winnebago Pandemic Preparedness Task Force.
[00:10:22.110]And that task force consists
[00:10:25.520]of the CEOs of all of the major tribal organizations
[00:10:30.660]in our community.
[00:10:31.890]So that includes the tribal government,
[00:10:33.630]but myself as CEO of the healthcare system,
[00:10:36.880]the CEO of Ho-Chunk Inc.,
[00:10:38.470]which is our tribe's economic development corporation
[00:10:41.040]and is one of the larger employers in our community,
[00:10:44.450]and the general manager for WinnaVegas Casino
[00:10:47.030]which is also one of the other large employers
[00:10:49.290]in our community.
[00:10:51.220]And the fifth person was
[00:10:52.650]the chief financial officer for the tribe,
[00:10:54.810]because obviously, you know,
[00:10:55.860]we needed to have good fiscal management
[00:10:58.400]in order to deploy all of the resources
[00:11:00.460]that we needed to effectively respond.
[00:11:02.770]So it was a five-member, it is a five-member task force.
[00:11:07.870]The Tribal Council also designated John Snowball
[00:11:11.480]who is a member of the Tribal Council
[00:11:15.040]as sort of the liaison and the point person
[00:11:17.160]to be the chairperson of that task force.
[00:11:19.950]And what we have done is, one, meet regularly,
[00:11:24.350]virtually of course.
[00:11:25.870]And we've been able to use the technology
[00:11:30.510]such as we're using now to communicate
[00:11:33.630]and to coordinate and that type of thing.
[00:11:36.670]So we started meeting on a weekly basis
[00:11:40.140]just to brainstorm, strategize, inform, educate,
[00:11:45.570]all of those things, both with each other.
[00:11:48.990]It has helped us to keep a pulse
[00:11:51.120]on what's going on in our community
[00:11:52.830]and what's going on in all of our organizations as a tribe.
[00:11:56.260]And it also brings basically brainpower.
[00:12:00.730]You know, not any one of us can know everything.
[00:12:03.270]And so bringing together our leadership in this way
[00:12:07.140]has allowed us to be creative
[00:12:09.590]in terms of what kinds of things
[00:12:11.280]we needed to do as a community.
[00:12:13.360]And so that's been really, really helpful.
[00:12:17.840]And then one of the things that the task force then did
[00:12:20.810]was to create a number of sub-committees.
[00:12:24.490]And so it sort of expanded the reach and the breadth
[00:12:27.450]and depth of our response activities,
[00:12:31.610]kind of similar to probably what
[00:12:37.010]like the incident command structure
[00:12:38.470]I guess, you know, in kind of emergency response
[00:12:40.860]that's pretty well known in the country and used everywhere.
[00:12:43.960]So it's sort of a modified version of that, I would say.
[00:12:48.050]And so those subcommittees,
[00:12:49.960]we identified all of the areas that could be impacted.
[00:12:52.820]So we have a subcommittee on IT
[00:12:55.540]to make sure our telecommunications
[00:12:57.050]and our IT infrastructure was effective for us.
[00:13:02.140]Health, of course, was another subcommittee,
[00:13:05.600]and then on communications infrastructure,
[00:13:09.890]so a number of different areas.
[00:13:12.000]Business and employment, because, you know, jobs
[00:13:14.190]and making sure that people remain employed
[00:13:16.430]and have a source of income
[00:13:17.730]and those kinds of things is also important.
[00:13:20.260]So there were a very broad ranging number of subcommittees
[00:13:23.730]who then also met separate from the task force
[00:13:26.210]and submitted reports back on a regular basis.
[00:13:29.950]The task force does continue to meet
[00:13:33.380]on a bi-weekly basis now,
[00:13:35.280]and we're just continuing to kind of manage
[00:13:37.040]and monitor the projects that are ongoing
[00:13:39.960]and any changes that might be taking place
[00:13:42.110]in just the pandemic.
[00:13:43.830]And, you know, variants that are showing up now,
[00:13:46.390]we're keeping an eye on that.
[00:13:48.190]So it's been really, really helpful
[00:13:50.190]in terms of our response efforts
[00:13:53.140]and just our ability to connect all the dots.
[00:13:57.130]I wonder what kind of lessons you've learned
[00:14:00.030]from the task force work that you've done
[00:14:02.500]or just the more general work
[00:14:04.850]that the tribe has done to fight
[00:14:08.580]and address the coronavirus in your community.
[00:14:12.800]The lessons that we have learned,
[00:14:14.990]I would say are primarily that communication is critical,
[00:14:21.774]and we have to talk to each other, we have to communicate.
[00:14:25.410]Additionally, coordination
[00:14:28.900]between our entire community,
[00:14:31.910]you know, there's just no way that you can be effective
[00:14:35.420]when you're on an island
[00:14:37.120]or you're operating in a vacuum, you know, or in a bubble
[00:14:40.080]separate from all of the other components.
[00:14:43.150]You know, communities are dynamic
[00:14:45.520]and just multifaceted.
[00:14:48.670]You know, there's so many things that go into a society
[00:14:52.600]which is what we are, a sort of a mini-society
[00:14:56.810]here, you know, within the tribe and the reservation.
[00:15:00.269]And I think that we had that before,
[00:15:03.730]but this really did
[00:15:07.350]push us to get better at it.
[00:15:10.240]And I think that it's been, one, it's been very effective
[00:15:13.720]for us in terms of our pandemic response,
[00:15:16.420]but I think that it is going to have
[00:15:19.170]long-lasting impacts on how we operate as a tribe.
[00:15:24.740]You know, it's strengthened relationships.
[00:15:26.810]It has demonstrated what kind of creative ideas
[00:15:30.560]that we can come up with when we have a problem,
[00:15:32.530]when we're faced with an issue in our community,
[00:15:34.760]and that there's no longer...
[00:15:39.420]there no longer can be
[00:15:40.930]and nor should there ever be, that's not my job, you know,
[00:15:45.020]that's so-and-so's responsibility.
[00:15:47.660]And even if it is a primary responsibility of someone else,
[00:15:51.710]you know, it's okay for the rest of us
[00:15:54.280]to provide, lend support and help and ideas
[00:15:57.080]so that it can bring us all together
[00:15:58.710]and absolutely serve our community
[00:16:01.910]in a much better way than we ever could.
[00:16:04.330]Now, as we move into sort of a vaccine dispersal phase,
[00:16:10.320]what sort of issues are you all facing
[00:16:12.410]with that upcoming challenge?
[00:16:15.370]With regard to the vaccine,
[00:16:18.850]we're actually well into vaccine administration.
[00:16:23.830]We, as a tribe, had the option
[00:16:27.120]to receive our vaccine supply
[00:16:29.510]either from the state or through the Indian Health Service.
[00:16:32.830]And we opted to go with the Indian Health Service,
[00:16:36.780]and that has worked out very well for us.
[00:16:40.620]So we receive direct shipment from, most of our vaccines
[00:16:45.430]is coming from Pfizer,
[00:16:46.590]and we have a small amount of of Moderna as well
[00:16:49.890]to supplement that supply.
[00:16:52.630]And so we kind of have sort of a two-pronged approach.
[00:16:57.740]First, we started, of course,
[00:16:59.650]in accordance with the CDC recommended guidelines
[00:17:01.990]with vaccinating our healthcare workers initially
[00:17:05.030]with the first doses that we received.
[00:17:07.670]And so all of our healthcare workers,
[00:17:11.290]anybody who works for our healthcare system
[00:17:13.000]has been offered the vaccine.
[00:17:18.190]And the administration of that have taken place.
[00:17:21.090]We're not mandating it for one thing,
[00:17:23.590]but a majority of our healthcare workers
[00:17:26.310]have opted to take it.
[00:17:27.790]And so we're very fortunate to have that resource.
[00:17:31.590]You know, and our goal of course,
[00:17:32.810]is to not hold onto that vaccine.
[00:17:36.460]You know, as we get it,
[00:17:37.320]we wanna get it out into people's arms
[00:17:39.250]as quickly as possible, because that is the tool
[00:17:42.300]that we have to combat this pandemic.
[00:17:45.270]You know, so it's been challenging,
[00:17:49.180]but also I'm just extremely proud of the work
[00:17:53.000]that our vaccine teams
[00:17:54.470]and our entire healthcare organization has done
[00:17:57.580]in putting together these plans
[00:17:59.530]and rolling it out into the community.
[00:18:03.010]And so the hospital had primary responsibility
[00:18:06.090]for administering the vaccine to our healthcare workers.
[00:18:09.430]And then we're also very fortunate
[00:18:12.350]to have a public health arm.
[00:18:14.440]And so within our public health department,
[00:18:16.190]we have a team of public health nurses who have
[00:18:19.940]their regular normal day-to-day jobs and responsibilities,
[00:18:24.230]but they have assumed responsibility
[00:18:26.650]for managing the administration
[00:18:28.840]of the COVID vaccine throughout our community.
[00:18:31.610]And so we've branched out.
[00:18:34.220]We set up a vaccine clinic
[00:18:36.380]at the local public school gym.
[00:18:40.580]And so our clinics have been running on Wednesdays.
[00:18:44.990]And, you know, we started out relatively small,
[00:18:48.770]and each week we're increasing the number of people
[00:18:50.900]that we can get through the vaccination clinic.
[00:18:54.400]And so that, you know, is in combination, of course,
[00:18:58.750]with education and communication to our community
[00:19:02.240]about the vaccine.
[00:19:04.200]You know, is it space?
[00:19:06.170]What are the differences
[00:19:07.003]between the Pfizer versus the Moderna?
[00:19:09.550]Do I have a choice?
[00:19:12.039]You know, who can get vaccinated?
[00:19:13.560]What are the side effects?
[00:19:15.820]There's just a lot of questions and a lot of fear around it.
[00:19:20.220]You know, there's just sort of mixed messages in the news,
[00:19:23.070]and social media has a major impact on that as well.
[00:19:28.370]So we've taken all of that into account
[00:19:31.114]and are really trying to address each of those things
[00:19:33.470]in order to just really provide accurate education
[00:19:36.170]for our community and to get the vaccine
[00:19:41.150]just distributed in our community as quickly as possible.
[00:19:44.060]I wonder, nationally we know that indigenous people
[00:19:48.500]have been really disproportionately affected by COVID,
[00:19:53.480]you know, higher rates of it, higher death rates, et cetera.
[00:19:56.810]And I wonder, is Winnebago faring somewhat better
[00:20:00.610]than some other indigenous communities
[00:20:02.510]due to the measures you've put in place?
[00:20:07.752]Yeah, I think so.
[00:20:10.580]You know, I think in the news
[00:20:13.050]and probably the situation that's most well-known nationally
[00:20:17.690]is what's happening at the Navajo Nation.
[00:20:21.140]You know, it's been devastating to their tribe
[00:20:24.350]and to many other tribes throughout the country.
[00:20:26.820]And they have a much larger population
[00:20:29.440]and a large geographic base
[00:20:34.100]and infrastructure issues.
[00:20:36.180]And so it's really brought out a whole host of issues,
[00:20:39.960]longstanding issues that have been exacerbated
[00:20:43.600]by the pandemic.
[00:20:45.000]And so I think, you know, I can't of course speak
[00:20:49.356]for their tribe or for any other tribes for that matter.
[00:20:52.760]But I think that our situation
[00:20:56.580]has allowed us to...
[00:21:00.290]the fact that we only have
[00:21:01.730]one primary community on our reservation,
[00:21:04.100]and we're relatively a smaller tribe,
[00:21:08.123]you know, it makes it a lot easier to manage.
[00:21:11.610]But again, really the same principles apply, I think,
[00:21:14.970]in any community, just on a bigger and broader scale.
[00:21:18.760]And so I think there's a lot of good things
[00:21:20.227]that can be taken in terms of lessons learned.
[00:21:27.520]Our whole tribe has a little over 5,000 members,
[00:21:32.060]but they're dispersed throughout the country.
[00:21:35.160]Locally, I would say about 2,000 of our tribal members
[00:21:40.190]either live on the reservation or near the reservation.
[00:21:43.670]We're about 20 miles from Sioux City, Iowa.
[00:21:46.460]So that's the closest urban area.
[00:21:51.170]As of yesterday, we've had a total
[00:21:54.110]of 319 positive cases in Winnebago.
[00:21:58.870]So that's just Winnebago,
[00:21:59.840]not counting our patient population
[00:22:01.690]that's off the reservation.
[00:22:04.550]And we've had five deaths
[00:22:07.570]for tribal members who live on the Winnebago reservation.
[00:22:14.280]Five might seem like a relatively small number,
[00:22:17.930]but of course any death is one too many.
[00:22:21.420]And the fact that we are such a small community
[00:22:24.410]and in such a connected community and tribe,
[00:22:27.320]you know, that has, you know,
[00:22:31.500]it's been very difficult for our community to have lost
[00:22:35.810]that many tribal members to COVID-19.
[00:22:40.585]You know, one of our, also our major concerns is,
[00:22:43.830]you know, our language and culture,
[00:22:45.500]which, you know, we've desperately tried to work
[00:22:49.890]to keep intact and to teach and to maintain that
[00:22:53.210]because it really makes up who we are as a tribe.
[00:22:57.776]And so, you know, just really trying to do everything
[00:22:59.850]that we can to protect our elders,
[00:23:01.350]to protect our fluent tribal language speakers
[00:23:05.330]and our teachers, and that type of thing, you know,
[00:23:08.010]has been another important component of this.
[00:23:11.720]You know, one of the early education campaigns
[00:23:15.490]that we put into place was protect your elders.
[00:23:19.090]You know, just really trying to emphasize
[00:23:21.300]that even though you might be young and healthy,
[00:23:25.060]if you spread it and take it home to grandma,
[00:23:27.630]well you know, what's that gonna do
[00:23:29.260]to grandma, to you, to your family.
[00:23:31.850]And so it's just really trying to educate people about that
[00:23:35.480]and to personalize it because it is very personal.
[00:23:38.420]And you know, it impacts every single one of us.
[00:23:41.750]My final question is really I really feel like the tribe,
[00:23:46.100]and you in particular have so much
[00:23:47.780]to offer the rest of the nation
[00:23:50.860]in just your expertise.
[00:23:52.960]So I was thinking, you know, what if, you know,
[00:23:55.710]if Joe Biden were to call you up tomorrow
[00:23:58.050]and say I want you to serve
[00:23:59.150]on the coronavirus task force for the nation,
[00:24:01.820]what types of tips would you give him
[00:24:03.710]based on what you've learned
[00:24:06.800]in your position this last year?
[00:24:08.510]I think that the most important components
[00:24:12.450]of what we have done have been
[00:24:15.420]around having a coordinated effort and a unified message.
[00:24:21.890]I think that's been important and critical,
[00:24:24.841]for all of our leadership in our community
[00:24:27.320]to be on the same page
[00:24:28.590]with what are we doing and how are we gonna do it,
[00:24:31.910]and how do we reach our community members,
[00:24:36.440]in terms of education, in terms of safety precautions.
[00:24:41.070]Mask wearing, the tribe, you know, one of the early actions
[00:24:45.670]that it took, one of the first actions that it took
[00:24:48.460]was a mandate, a mask mandate in the community
[00:24:51.970]which applied across the reservation.
[00:24:53.760]Anytime you were in a public space
[00:24:55.940]where you are not able to social distance,
[00:24:59.290]you are required to wear a mask.
[00:25:01.230]And the tribe provided masks to anybody who didn't have one.
[00:25:05.470]We made them available at all of our public places.
[00:25:08.400]And you could call
[00:25:09.500]and we would send a community health worker
[00:25:12.010]out to your house to deliver masks to your home.
[00:25:15.120]And so, you know, something as simple as that,
[00:25:18.140]the importance of being unified,
[00:25:20.270]of being able to communicate in all different modes,
[00:25:23.160]because not everybody receives their communication
[00:25:25.260]and information in the same way.
[00:25:27.100]You know, it's really easy to revert
[00:25:29.470]or to rely on social media.
[00:25:31.860]But, you know, every grandmother doesn't have social media
[00:25:35.450]or care to have social media.
[00:25:37.470]And so you know, sending out mailers and flyers
[00:25:40.320]and just, you know, being creative
[00:25:42.830]and understanding how your community receives information
[00:25:46.490]and providing it in all of those forms multiple times.
[00:25:50.520]Because it takes multiple messages
[00:25:52.580]and in different ways, I think,
[00:25:53.690]to get that information out there.
[00:25:56.510]I guess the other component
[00:25:59.250]that has been very helpful to us is
[00:26:02.030]it's not just about the vaccine
[00:26:05.140]or it's not just about the masks.
[00:26:07.090]It's a whole host of things,
[00:26:09.570]that this has challenges that it has been created.
[00:26:13.890]And so you need to bring together people
[00:26:17.130]from all of those different industries
[00:26:19.140]and expertise and resources,
[00:26:21.760]and really just be creative.
[00:26:23.530]You know, from our standpoint,
[00:26:25.100]nothing was off the table in terms of ideas.
[00:26:28.140]You know, we would just really try
[00:26:29.800]to draw that out from our community
[00:26:34.300]and listen to not just the leadership,
[00:26:37.470]but listen to our community.
[00:26:38.860]Listen to our tribal members
[00:26:39.990]in terms of what they're feeling and what they're needing
[00:26:41.920]and what they're lacking
[00:26:44.540]and try to figure out the best way to address it.
[00:26:47.770]One of the ideas that came forward
[00:26:50.270]and was identified early on in terms of our ability
[00:26:54.500]to protect people is housing.
[00:26:59.480]We have a housing shortage in our community,
[00:27:04.320]and we also have a culture
[00:27:07.830]that has a lot of extended family
[00:27:11.120]and multi-generational families
[00:27:12.990]living in the same household.
[00:27:15.020]And in a situation with a pandemic such as COVID-19,
[00:27:18.710]of course, one of the strategies
[00:27:21.320]and one of the critical pieces
[00:27:23.180]is to be able to isolate and quarantine people,
[00:27:26.462]once somebody is identified as being positive for COVID-19
[00:27:31.270]or has been exposed.
[00:27:32.840]And that is very difficult to do
[00:27:35.070]if you live in a three-bedroom home with 12 people.
[00:27:42.700]We looked at that and tried to, you know, figure out how.
[00:27:46.900]Okay, so what are we gonna do about this?
[00:27:49.370]So one of the things that we did as a task force
[00:27:51.177]and as a healthcare organization was to create
[00:27:55.050]a quarantine and isolation housing program.
[00:27:58.720]And some of this work was made possible
[00:28:02.600]from the funding that the tribe was able to get
[00:28:05.360]through the CARES Act.
[00:28:07.080]So that was very, very helpful
[00:28:10.120]to be able to receive those fundings
[00:28:11.840]so we didn't have to really pick and choose
[00:28:14.070]about, okay, what can we pay for, what can we afford?
[00:28:17.120]And so having that kind of resource of course matters.
[00:28:20.660]But in addition to that, you know,
[00:28:22.510]coming up with these creative ways
[00:28:24.120]on how you deploy that quickly,
[00:28:27.010]because, you know, it needed to be done quickly.
[00:28:29.200]The problem was here.
[00:28:31.370]And so we started out
[00:28:33.570]by converting six hunting cabins
[00:28:36.720]that our Wildlife and Parks Department had
[00:28:39.080]into quarantine and isolation housing.
[00:28:42.090]They're pretty basic and pretty minimal,
[00:28:44.220]in fact don't even have, didn't even have bathrooms in them.
[00:28:48.130]And so we, you know, we got port-a-potties
[00:28:50.560]which was something we could do very quickly.
[00:28:52.350]And then as time went on, we were able
[00:28:54.860]to improve the resources and improve the housing options
[00:28:59.060]available to the community.
[00:29:01.250]And now we were able to over the course of 2020,
[00:29:06.660]actually build quarantine kind of tiny houses
[00:29:11.510]in the community that we can use
[00:29:12.960]for quarantine and isolation housing.
[00:29:14.960]And so those are ready now.
[00:29:17.030]They're done; they're being put into use.
[00:29:19.570]And so we've had a number of families and individuals
[00:29:22.430]who have utilized that quarantine isolation housing.
[00:29:26.060]And we made it available,
[00:29:27.620]you know, if you were positive
[00:29:28.670]and you couldn't isolate at home,
[00:29:30.340]then you could stay there
[00:29:31.660]for the duration of your isolation period at no cost.
[00:29:35.620]We provided, we provide food, supplies.
[00:29:40.550]If the person doesn't have a cell phone
[00:29:42.620]or a way to communicate, we gave them a phone
[00:29:45.950]and just, you know really just tried to identify everything
[00:29:48.400]that they might need in order to effectively isolate
[00:29:52.200]away from their family and prevent potential further spread.
[00:29:56.840]We also made it available
[00:29:57.970]for anybody who was exposed and then needed to quarantine.
[00:30:01.860]And if they couldn't do that effectively in their home,
[00:30:04.120]well, we have a place for you to go.
[00:30:06.540]And so we've had a number of families
[00:30:08.270]who have taken advantage of it,
[00:30:09.280]and I think that's been very, very helpful
[00:30:11.600]in terms of just being able to contain the cases.
[00:30:17.850]The other thing, I think, advantage
[00:30:19.530]that we've had too is just in terms of contact tracing.
[00:30:23.700]You know, we have a team of public health nurses
[00:30:25.780]who are already very engaged in the community.
[00:30:29.610]They know the patient population.
[00:30:32.478]You know, because we are so connected and know each other
[00:30:35.976]or it's easy to, if somebody doesn't have a phone,
[00:30:39.720]they can figure out how we can track them
[00:30:41.340]down or send somebody to their house,
[00:30:43.950]you know, to provide that kind of extra communication.
[00:30:47.360]So our public health nursing team
[00:30:49.150]and other staff in our public health department
[00:30:52.170]have been very effective at conducting contact tracing.
[00:30:56.050]And we're pretty much able
[00:30:57.780]to turn that around within 24 hours,
[00:31:01.020]to complete the contact tracing,
[00:31:02.430]to get ahold of those people
[00:31:03.592]and to deploy those resources that they need.
[00:31:07.950]And even if somebody didn't necessarily need housing
[00:31:11.340]and they had to, if their household had to quarantine
[00:31:15.650]and they could do that effectively in their own household,
[00:31:18.160]we still provided grocery assistance, supplies.
[00:31:23.100]We had public health nurses calling
[00:31:25.600]and contacting the families, you know, on a regular basis,
[00:31:30.260]just making sure that they, again,
[00:31:31.960]just had the resources that they need
[00:31:33.360]so they could take care of themselves
[00:31:35.450]and take care of their families.
[00:31:37.340]One other program that we also implemented
[00:31:40.290]was a very robust expanded version
[00:31:43.570]of an existing food pantry that was in the community.
[00:31:47.320]And, you know, I think it had,
[00:31:50.790]has had multiple benefits.
[00:31:54.100]One, you know, if people were laid off
[00:31:56.630]or they were unable to work
[00:31:58.380]or they otherwise had their income impacted,
[00:32:01.830]they had plenty of food.
[00:32:04.228]We expanded the farmer's market
[00:32:07.610]and tapped into a USDA program
[00:32:10.180]so that there was fresh fruits and vegetables
[00:32:12.570]that were distributed, not just to low-income people,
[00:32:14.810]but to anybody in the community who wanted to access that.
[00:32:19.140]So that went on throughout the course of the summer.
[00:32:21.270]And like I said,
[00:32:22.870]we had a existing food pantry in the community,
[00:32:25.810]and the tribe supplemented that food pantry tremendously
[00:32:30.410]with funding from the CARES Act.
[00:32:33.610]And so I don't know the number off the top of my head,
[00:32:37.510]but there was a lot of food that was distributed.
[00:32:40.330]And it just helped families who needed it,
[00:32:43.050]but also it enabled families, I think,
[00:32:45.490]to reduce the number of times
[00:32:46.730]they had to go to the grocery store.
[00:32:48.330]So it's all these little things
[00:32:49.630]you know, that really, I think, made a difference
[00:32:52.030]and have made a difference for us.
[00:32:53.690]And in combination, it provided, has provided, I think,
[00:32:57.900]a pretty well-rounded pandemic response effort by our tribe.
[00:33:02.620]These are just a few examples.
[00:33:03.840]I mean, I could talk all day (laughs)
[00:33:06.094]about everything that's been done.
[00:33:07.897]You know, it's been a lot of work,
[00:33:10.793]but it's been, it's been
[00:33:12.160]really just an awesome response, I think.
[00:33:15.680]And, you know, we've had a number of positive cases
[00:33:18.550]and pretty much everybody in our community,
[00:33:21.370]really everybody in our community
[00:33:22.690]has been impacted by this of course,
[00:33:25.680]and some more so than others.
[00:33:27.320]And our hearts and prayers always go out to those
[00:33:31.980]that we have lost in our tribe, not just on the reservation,
[00:33:34.670]but throughout our tribe and throughout the country,
[00:33:37.710]'cause too many lives have been lost by this,
[00:33:39.520]and it's really important for us
[00:33:43.730]just to get a hold of it and manage it
[00:33:46.991]and bring an end to this pandemic.
[00:33:49.490]I'm just so grateful for you speaking with us.
[00:33:53.880]Thank you, I really appreciate you
[00:33:57.300]taking the time and resources to focus on this issue
[00:34:01.750]'cause it really is important.
[00:34:03.490]And I hope that the information that we've shared,
[00:34:07.189]can, you know, any piece of it can be helpful
[00:34:09.320]to anybody else.
[00:34:10.600]And we're always of the mindset that, you know,
[00:34:13.990]not one of us can do any one thing.
[00:34:16.850]You know, we have to collaborate,
[00:34:18.830]and we have to borrow and ask
[00:34:22.548]and just look at other ideas and other strategies
[00:34:26.210]and figure out what works for our community.
[00:34:29.300]And I think that's a good approach for anybody.
[00:34:32.430]We'd like to thank Danelle Smith
[00:34:33.850]for speaking with us today.
[00:34:35.550]Find all of our short Great Plains talks and interviews
[00:34:38.610]as videos and podcasts at go.unl.edu/gplectures.

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Danelle Smith: The Winnebago Tribe of Nebraska's Covid-19 Response

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