The COVID-19 pandemic has laid bare societal and structural inequities and exacerbated historic vulnerabilities that negatively affect health outcomes. Our nation’s people of color, immigrants, and indigenous groups face many obstacles as they fight COVID-19. We write from the front lines about our work with the Tule River Indian Tribe of California to improve the health and well-being of their community. The Tule River Indian Reservation is in Tulare County, California. The original inhabitants of the area were Native Yokuts people. Descendants today are the Tule River people, who strive for self-government and self-sufficiency to honor and carry on their unique cultural history and heritage.
When the pandemic hit the U.S., the Tribe had wisely stocked up on food, water, medical and cleaning supplies, and other resources to sustain the reservation in the event of a closure. The Tribe’s biggest challenges were securing COVID-19 tests and implementing emergency isolation and quarantine protocols. With elders as a high-risk group for coronavirus, leaders feared for the future of the Tribe since tribal heritage is passed down by their elders. Therefore, revising and implementing emergency protocols was their top priority. Recognizing the imminent threat of COVID-19, a fellow DrPH alumnus close to the tribe connected with a former classmate in the DrPH Coalition. In response, the Coalition created a task force composed of DrPH students and alumni nationwide.
Mobilizing for Tule River Community Health and Well-being
Many tribal members live in a nearby town but access medical services from the Tule River Indian Health Clinic (TRIHCI), which is on the reservation. The task force partnered with the TRIHCI Board of Directors to create emergency protocols to protect all tribal members. Our first task was to create a manual of operations for health information and measures specific to COVID-19, including testing information, social distancing, sanitation, and quarantine/isolation guidelines. As the number of positive COVID-19 cases in the Tribe increased, our task force was asked to consult on strategies to increase compliance with precautionary measures such as wearing masks and physical distancing. We are currently developing new strategies, including a survey to assess community members’ beliefs, values, and attitudes towards COVID-19 and a community forum, where community members will gather virtually to engage with task force members and the Tribal Public Health Officer, who also has a DrPH.
We hope our continued efforts will help to reduce the incidence and prevalence of COVID-19 among the Tribe. Every day that we work with the Tribe is an opportunity to learn. Understanding structural and contextual factors and respecting tribal sovereignty were particularly important lessons. The Tule River people, like many indigenous tribes in the U.S., have a lengthy history of violence, oppression, cultural erasure, and colonialist subjugation.
Not surprisingly, the Tribe was hesitant to open the door to outsiders. Despite our pent-up energy, we realized we could not simply parachute into the reservation in the name of public health. We had to check our academic egos at the door, and instead listen and learn. The TRIHCI Board told us where, when, and how they wanted our support. This kind of humility and openness helped us to establish a rapport and build trust with the local public health authority and tribal members. That trust, in turn, strengthened community buy-in. We also learned about flexibility in community health work during a crisis; the urgency of the situation forced us to be extremely strategic. We would have liked to do our work differently, but the reality of the situation required us to act smart but fast.
Leading Public Health with a DrPH Degree
Although we are outsiders to the Tribe, our experiences and training as DrPH-ers shaped our approach. Importantly, our training emphasizes collaboration with diverse stakeholders, from local and private entities, to community-based organizations, to state and federal government. It is critical to make space at the table for many voices. We bridge multiple worlds: science, academia, policymaking, and the communities we serve. DrPH leadership requires listening to the needs of our community partners, while also respecting their timelines, sacred traditions, and expertise.
Our experience with Tule River highlights the need for multi-sector approaches infused with diverse partnerships for the advancement of public’s health, and more broadly, social and racial justice. We are grateful for the opportunity to work with the Tule River tribal community, who, time and again, have demonstrated their strength and resilience during a crisis. As we continue our work, we know there are multiple paths forward, rather than just one. We walk behind others and listen to many voices, past and present. As scientists and public health practitioners, we must acknowledge and honor the experiences of these communities and walk together with them on the journey toward healing.
Tiffany Eaton, MPH received her B.S. in Biology at Spelman College, and her MPH in Community Health Sciences at SUNY Downstate School of Public Health. She has experience working in clinical research as part of the Women’s Interagency HIV Study at Downstate Medical Center. Her research interests include sociocultural and contextual factors that impact obesity in Black women, food insecurity and program evaluation. She is currently a graduate research fellow and DrPH candidate in the Department of Community Health and Prevention at the Dornsife School of Public Health at Drexel University. Tiffany also serves as the Director of External Communications on the Executive Board of the DrPH Coalition.
Jamile Tellez Lieberman, MPH is a graduate research fellow and DrPH candidate at the Dornsife School of Public Health at Drexel University. She also holds a BA in International Studies from Elon University and an MPH in Community Health & Prevention from the Dornsife School of Public Health at Drexel University. Jamile hopes to work in a non-academia setting, focusing on service-delivery, intervention development/evaluation, and community-based research in communities of color, specifically Latinx and Latinx immigrants. Her dissertation explores impacts of parental deportation on the mental health and well-being of U.S.-citizen Mexican immigrant children and adolescents. She is also interested in the use of arts in community health and immigration policy reform. Jamile serves on the Governing Assembly of the DrPH Coalition.
Cindy Delgado, MPH, CPH received her BA in Anthropology from the University of California Santa Cruz and her MPH in Health Management and Health Policy from the University of North Texas Health Science Center. She is an experienced program manager in chronic disease management. Her areas of interest are systems integration to improve organizational effectiveness, delivery and quality of care, and culturally tailored approaches to improve health equity for underserved communities. She is currently a research assistant at Claremont Graduate University School of Community and Global Health where she is pursuing her DrPH degree with an emphasis on Leadership and Management. Cindy serves on the Governing Assembly of the DrPH Coalition.
The mission of the DrPH Coalition is to create a community of DrPH students and alumni who leverage their expertise, diversity, and creativity for the advancement of the public’s health. The DrPH Coalition leverages the leadership and expertise of Doctors of Public Health in public health policy development and action, education and career development, and the promotion of evidence-based public health policies with a focus on factors and issues relevant to elevating trained public health leaders in public health debates, policy, and education. For more information, visit www.drphcoalition.org.