Note: This article is part of the project: "Indigenous Impacts: How Native American communities are responding to COVID-19." We invite you to view the entire project here.
ROCHESTER, Minn. -- In late March as COVID-19 was making its first imprint across the United States, its weight fell especially hard on Native American communities, which have reported some of the highest infection rates and death rates in the country.
Minnesota tribal leaders sought help from the state’s leading private health care and research institution, Mayo Clinic. Specifically, leaders asked Mayo’s top medical and administrative officials -- Dr. Gianrico Farrugia and Jeff Bolton, respectively -- for help with distributing tests and processing results across the state’s 11 reservation lands.
The ask came at an interesting time in the history of Mayo Clinic-Native American relations. Mayo has been actively seeking to reconcile its standing with Native American tribes in recent years. In 2018, Bolton formally apologized for Mayo’s use and public display of the remains of an executed Dakota leader, Marpiya te najin, or Stands on a Cloud, for many decades.
And in nearly the same breath, Bolton announced Mayo would start a scholarship program for American Indian students pursuing health care careers in the Mayo Clinic School of Health Science, Mayo Clinic Graduate School or Mayo Clinic Nursing programs.
The clinic has taken steps to educate physicians and other care providers about disparities in health outcomes for Native Americans, and some of the specific care considerations required by Native American patients.
And, significantly, Mayo created a position for a care provider specially to serve Native American patients. The idea came from a Dakota elder who wanted “someone on the inside to help our people” at Mayo.
Valerie Guimaraes fills that position. A registered nurse with two decades of experience, Guimaraes came to Mayo from Charter House, a Mayo Clinic-owned senior housing facility directly linked to the downtown campus. Since 2018, she has served Mayo as a patient relations specialist. “I only work with Native American patients,” she said.
Guimaraes’ family history is Native American through and through. On one side of her family, she says, she is descended from Little Crow, the Mdewakanton Dakota chief. On the other side, among her ancestors is Glory of the Morning, the last known female Ho-Chunk chief. She was raised in both tribal traditions, but is enrolled as a member of the Ho-Chunk tribe.
Bolton assigned Guimaraes and Dr. Wes Peterson to work at the heart of coordinating Mayo’s response to the tribes’ COVID testing request. Peterson is a researcher who coordinates Mayo’s Native American Research Outreach program, as well as its Native American Interest Group that hosts a monthly cultural exchange.
They were joined by Scott Beck, an administrator in Mayo’s Department of Laboratory Medicine and Pathology, to help arrange the shipment of approximately 2,500 molecular PCT tests -- the “swab” -- to the reservations. The cost of the effort was underwritten by private contributions. The value of one test is between $62 (the amount Mayo Clinic charges the state) and $99 (the amount charged to a Mayo Clinic client), Beck said.
Test kits were sent, administered to selected people by teams of volunteers at the reservations, and returned to Mayo Clinic laboratories. The labs processed the results and reported them to tribal leaders, who informed individuals of a positive or negative result.
Outside of Mayo Clinic’s own local testing, it was the largest testing operation Mayo conducted during the pandemic.
Some of those positive test results have brought patients from the reservations to Mayo Clinic, where they meet Guimaraes. Under pandemic rules, patients may have one caregiver (children may have two). Some come without any companion at all.
“That’s where my role comes in -- to help assure that Mayo cares about Native American patients,” she said.
In her years in her role, Guimares has helped patients from 35 tribes. She helps make sure not only that they have companions, but that their beliefs are respected, for instance the traditional practice of “smudging,” or burning sage or sweetgrass. There are designated smudging rooms at Saint Marys and Methodist hospitals in Rochester, or it can be done in any hospital room, with permission.
She placed a thatch of sweetgrass in one elderly patient’s hand.
“With tears in his eyes, he said, ‘Wopila,’ which means ‘Thank you,’” Guimaraes said.
Besides care and testing, Mayo Clinic has volunteers who made and collected hundreds of masks to send to the reservations, including Crow Creek and Pine Ridge, two reservations in South Dakota that are among the poorest locations in the U.S.
“My ancestors went there, so I have a very strong affinity for Crow Creek, knowing it is the poorest reservation,” Guimaraes said. “Pine Ridge is next.”
“When you don’t have enough funds for health care for your tribe and then a pandemic hits, it’s been very difficult for everyone,” she said.