Learning Curve

Michael Caputo: Welcome back, ladies and gentlemen, to Learning Curve. It's the podcast of the Health and Human Services Department's Public Affairs Office. I'm Michael Caputo, the assistant secretary for Public Affairs here at HHS, and I have the great pleasure of learning all about healthcare and the response to the coronavirus from the nation's experts. I'm surrounded by them here in Washington, D.C. I'm really quite impressed by the array of experts that the president has put together in public health, but at the same time we were caught, of course, by this COVID virus and here we have this group of people who are really quite incredibly good at their jobs in really key places. And I just wanted to introduce you to each and every one of them.

I've interviewed Secretary Alex Azar, I've interviewed NIAID director, Dr. Tony Fauci, even talked to Dr. Peter Marks who's the chief regulator who's going to be deciding on the vaccines that are coming out of Operation Warp Speed. We've talked to Moncef Slaoui, the senior advisor of Operation Warp Speed. And that learning curve for me has been a vertical leap, and I hope I'm helping you understand the people behind the president's coronavirus response, the people here working for Secretary of Health and Human Services, Alex Azar, and the work that they're doing to respond to this pandemic. And today on the Learning Curve podcast, I'm going to be talking to Rear Adm. Michael Weahkee. I'll tell you, the rear admiral is the head of the Indian Health Service and it's something that I knew nothing about when I came here. I can't wait for you to hear from Rear Adm. Weahkee. We'll be, I guess, right back in one second.

Again, here we are with Rear Adm. Michael Weahkee. I -- first of all, I want to say to thanks to Timmy Z and the Timmy Z band for providing their original music behind the Learning Curve podcast. Great rhythm and blues guitarist I've known for many, many years. A Buffalo guy. Nothing like Buffalo blues.  I wanted to first of all thank Rear Adm. Michael D. Weahkee who is the head of the Indian Health Service. Rear Adm. Weahkee, thanks a lot for joining us.

Michael Weahkee: Thank you, Mr. Caputo. It's a pleasure to join you.

MC: Well, I -- you and I don't really know each other very well. I'm -- you're so busy with the very far-flung organization, the Indian Health Service. I know you are on the road. When I attend these meetings, you're mostly calling in because you're on the road a lot.

MW: [affirmative]

MC: But I don't think the American people understand what the Indian Health Service is and they don't understand much about the rear admiral who leads it. And, you know, I think people don't understand also what your -- what your duties are. You're -- but your background is very interesting. You're an enrolled member of the Zuni tribe, and as the director of the Indian Health Service, you lead this agency within the United States Health and Human Services Department. It's the principal federal healthcare advocate and provider of healthcare services for American Indians and Alaska Natives. That's a pretty big deal.

MW: That's right. Well, and it is very much an honor to be entrusted with this responsibility. Being a member of the community myself, it's a sacred trust. So I very much enjoy my job and the places that it takes me, and I get to see the bottom of the Grand Canyon, I get to see islands in Alaska, I get to travel all over the country to some of the most beautiful spots.

MC: Well, we know that the -- some of the scenery and the -- and the beauty on these reservations, Native American reservations, is indescribable. But it's also some of the, you know, the underserved communities that live on those reservations, they have a lot of requirements that you need to attend to. In fact, you know that very personally, don't you? My understanding is you were born at an IHS hospital in New Mexico. Is that true?

MW: That's right. Shiprock, New Mexico, which is the northwest corner of New Mexico on the Navajo reservation. Although you noted I'm a member of the Zuni tribe, I was born on the Navajo reservation and that's home.

MC: Is that like being from Michigan and being born into Ohio state hospital, I guess?

MW: Something like that, yes.

MC: Well, you know, and you've -- and since you've been working in the Indian Health Service, have you been back to Shiprock?

MW: I have in fact just recently. Probably three months ago. I had the opportunity to go and see the Shiprock Hospital's COVID-19 response, thank the staff on the frontlines for the hard work, really hear directly from them their challenges and what they're facing. But the most important purpose of that visit was to thank our frontline staff for the hard work that they're doing over now seven months of COVID response.

MC: Yeah. And the Native American community has really been disparately hit by that. I want to talk about that in a minute. But did you actually grow up on the reservation?

MW: I grew up in a border town just off of the Navajo reservation in Farmington and Aztec, so it's literally 20 miles from the border. And growing up on the border town, I did receive all of my healthcare growing up in the Indian Health Service facility, so you get a different flavor being just off than being directly on but it's still very much a different upbringing.

MC: What did you -- what kind of a life did your parents give you? What did your parents do?

MW: Well, we were transient. My father was in oil and gas, and so we traveled quite a bit doing seismograph work and a lot of oilfields in that region. So we would move around two to three different schools in a year.

MC: Wow.

MW: It gave me the ability to be flexible and meeting new people and being open. You wouldn't be able to tell that as I'm normally pretty quiet and reserved, but I tend to be able to plant myself and adjust.

MC: Focus. Yeah.

MW: Yeah.

MC: But at the same time, you had brothers and sisters as you grew up?

MW: I did. So I've got two younger brothers, one working in oil and gas now in Houston, and the other is also an IHS employee --

MC: Really?

MW: -- working in the Phoenix area.

MC: And that's where you rose in your career. First of all, you -- I understand you're a big Arizona State University fan.

MW: Oh, that's right.

MC: Your alma matter.

MW: Flash up my pitchforks there. Big Sun Devil fan.

MC: And did your brothers also -- are they -- they grew up in the Phoenix area as well?

MW: Mostly in New Mexico.

MC: Right.

MW: And since then --

MC: But they -- but they -- your brother is in Phoenix now?

MW: He is, yeah.

MC: Yeah.

MW: He eventually migrated and followed the rest of the family. And then, of course, the middle brother is the one who headed off down south for the Texas oilfields.

MC: Yeah. Well, I got to believe -- you have a master of health services administration and a master of business administration from Arizona State University. Did you do those one after the other?

MW: I actually did them concurrently.

MC: You did?

MW: There was a dual program that worked out just right for me. My undergraduate work was in healthcare management, so the master's in health administration seemed like the natural fit. But once getting in, I saw that the business aspect was equally important.

MC: It is, especially as an administrator. And -- but you can't -- how long have you been with the Public Health Service? Now, ladies and gentlemen, I know -- I didn't know this until I arrived at the building but there are thousands of men and women who serve in the Public Health -- the uniformed commissioned officers, doctors and nurses and elsewise, and they are all throughout the building here on Independence Avenue in Washington. And I -- my first day I got on an elevator, on my way up to have my first walkthrough on my new office, and there was Surgeon General Jerome Adams in the -- in the elevator in his full regalia. The -- how long have you been in the Public Health Service? Just a proud and longstanding tradition.

MW: Yes. Well, for me it's been 21 years.

MC: Are you serious?

MW: Yes, sir.

MC: I did not know that, sir.

MW: And I was fortunate to had been enlisted in the U.S. Air Force prior to that for four years, so I got to add those two together and I'm now getting close to my 25th year.

MC: Wow. We got to keep you around. No time for retirement now. Not -- certainly not during COVID, huh?

MW: It goes by fast.

MC: It does. It does. What was it like? Why did you choose the Public Health Service? One thing I've noted from all the people I see in uniform here, those in the Public Health Service, in the Commissioned Corps, is that they're so incredibly proud of it. It's like -- it's like you're a Marine but even more, especially when I talk to Adm. Giroir and others. They talk about the proud and longstanding tradition.

MW: Yeah. Well, definitely the ability to serve your own people, to provide service. Our core values in the Public Health Service are leadership, service, integrity, and excellence. But for me it was natural, you know, post military and then obtaining my training to be able to take that education and bring it back to the communities that we serve.

MC: So you were with the Indian Health Service all those years after the Air -- or after school?

MW: I -- that's -- yes, sir. That's been my only agency.

MC: Have you -- and you've done a tour of the different hospital like with the service in different places around the states?

MW: Yeah. I've definitely seen a good share of our IHS facilities. We have 605 them so I've not --

MC: Wow.

MW: -- seen any of them by any reach of the imagination. But I -- a pretty significant subset for sure.

MC: Yeah. I see the IHS mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. In fact, your agency, part of HHS provides a comprehensive health service delivery system for 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states. That's all hospitals, clinics, and health stations. That is a far-flung and important organization serving a very large number of Americans. And now they're more vulnerable than most to the coronavirus. After 21 years in this service, working at many different hospitals in the system, serving across the tribes, not -- certainly just not your own, this must be quite frightening for Native Americans. I heard it's like 3.5 times more likely that you're going to be infected with the virus if you're a Native American. That's significant.

MW: It is. It is scary, and different regions of the country have been impacted harder than the others. The southwest where I'm from, unfortunately, has been impacted more significantly. Places like Navajo Nation; Whiteriver, Arizona; Phoenix, Arizona. We've really seen some high positive case rates and unfortunately the related deaths that have come with this pandemic.

MC: Is there also a higher death rate among Native Americans?

MW: We've not necessarily looked specifically at death rate. It wasn't until just recently that we began to collect racial demographic data. We do look forward to working with CDC on that analysis, but what we do know is that American Indians are being hospitalized at a higher rate. You mentioned the 3.5 percent higher infection rate. We also have about a 5.3 percent higher hospitalization rate.

MC: Oh no.

MW: Yes. That's --

MC: That's significant.

MW: -- it struck our communities very hard.

MC: So not only are Native Americans more likely to get the coronavirus. They're -- those who do get it are more likely to go to the hospital for it.

MW: That's right. And there were -- there are reasons for that. You know, many disparities existed before the pandemic hit. Our diabetes rate is three times that of the general population. We've had high upper respiratory illness rates, chronic diseases like cardiovascular disease. All of these were exacerbated when the pandemic came around. So those who were already ill were impacted even more.

MC: So you've been acting director of the Indian Health Service since 2016 and you were confirmed as director actually right after I arrived and you had been waiting for a long time. And I know that everybody here in the building was just like having little celebrations of their own. If they weren't able to attend when you were sworn in, they were certainly proud of you. And I remember the day after you were sworn in, it was the topic in the morning -- or the morning meeting. We were all very proud that that actually happened because, I didn't know this, but you're the first one to serve as a confirmed director for quite some time, right?

MW: It has been a number of years since Dr. Yvette Roubideaux left and we've had a series of actings, but it is definitely an honor to serve and I'm proud to do so. It was a long probationary period.

MC: So -- but why? Can you talk a little bit about that? Why did that take place? I know we have a lot of political issues. People don't get to confirm for a lot of reasons. But across administrations? It's an -- was there -- did it feel like there wasn't a priority? Or why did that happen? It's very difficult to lead an organization if you're acting.

MW: Yeah. Well, I think that our agency faces many challenges, funding aside. We have been embroiled in a number of quality-of-care issues and concerns. It's been impressed upon me by our tribal leadership the importance of maintaining the Indian Health Service as a nonpartisan entity that we're able to move forward and really reinforce the special and unique political relationship between tribes and the U.S. federal government, that no matter who is in power in the federal government, we need to maintain a strong relationship.

MC: When were you made acting director?

MW: I was actually made acting in June of 2017.

MC: I -- to me -- well, that was a moment of pride for the whole organization and I thought it was very unusual. I was struck by it, that there was just such an immense feeling of pride to have you sworn in because it seemed to me that a lot of the people, especially in the secretary's office and around, saw it as a real victory. It was a real victory for the United States that -- but also for the department and for the administration. And do you feel that it -- that it actually enhances your ability to drive forward?

MW: You know, I do. Before being confirmed, I felt like I was in control and -- but there was really, in the expressions from tribal leaders and other external stakeholders, there was this finalization. You know, we finally have a signified place in the federal government. We now have our federal advocate confirmed. And that in itself says a lot about how Indian health system and the tribal healthcare is prioritized amongst other priorities here in D.C. So I do think that the confirmation meant a lot, not only to me personally, but to all of Indian Country.

MC: I remember talking to the secretary that day or the day after, and he said it was especially significant because of COVID. I didn't know what he meant that day, but then it became clearer and clearer that the Native American community was suffering, was far more vulnerable than average in the United States and that it, you know, it became clear to me at that time that what the secretary meant was the Native American community is disparately impacted, and therefore, they need more than just acting leadership. They need the recognition from the federal level, from the -- from Washington, that they -- that this crisis demands confirmed leadership. I just -- COVID has been especially difficult for tribal communities. What do you see when you're out there?

MW: Yeah. Well, I see great leadership. I think Navajo Nation is a great example where they implemented tribally-driven public health orders early, 57-hour curfews where they locked down the borders and, you know, encouraged mask wear early. They pointed to the difficulties in washing your hands when you don't have access to clean water.

MC: Right.

MW: That these are items that need to be prioritized. And they existed again before the pandemic, but they've only exacerbated the problem. And it's not unique to Navajo. You go to Alaska. The same water access issues exist.

MC: I think, you know, for example, I -- somebody from your office told me that while -- for example, while many Navajo people have access to modern-day amenities, there are some without running water and without, you know, modern bathroom facilities, and some families actually may reside within multigenerational households.

MW: Yeah.

MC: It's these -- this congregate living that encourages spread, isn't it? And if it's --

MW: That's right.

MC: -- if it's a cultural norm, people are having real difficulty. And you can't wash your hands.

MW: Right. And it's not all cultural. Granted, it is very much within our culture for multiple generations to live under one household, but access to stable housing in our rural reservation areas is difficult. So it is one of those social determinants of health that we've been working on to partner with HUD and EPA and USDA and other federal partners to address these issues that have persisted for way too long in Indian Country.

MC: Right. We think about the pastural beaty of these communities but, you know, and we think about how the wide-open spaces. We also, along with that, like rural America, some of the Native American communities lack the infrastructure or even the capacity available to deal with this pandemic that we have in more densely populated areas and we just don't think of that. Is that an increasing -- I mean, how do we deal with that problem?

MW: Yeah. Well, I think that there are some very specific things that we can do. And again, the variation across Indian Country is huge. We have some tribes that have the organizational capacity to do anything that you can dream of, and others who really can't even afford to hire a grant writer. They may have a single administrator doing five different duties.

MC: Right.

MW: So what Indian Country needs is flexibility in the use of funds, not being required to compete for grants. Why would you need a grant writer if you could just have that money --

MC: Apply.

MW: -- directly allocated to you in the same way that it is provided to states and other levels of government? So these are the asks of tribal leaders is let's just put that funding into our Indian Health Service allocation, bring it to the community, and then allow for community-level decision-making since there is so much variation across our system, let us decide what's best for our people.

MC: It's interesting, you know, I talked to a friend of mine who is a filmmaker who spends a lot of time in Indian Country, and he said to me that -- I was talking about how I was going to be talking to you on Learning Curve and he said, "Ask him this question." And so I have to ask now.

MW: Okay.

MC: Or I'm not going to get him to buy me a beer. He said that the culture of Native Americans and many of the different tribes is different in every tribe, he said.

MW: [affirmative] Absolutely.

MC: That the doctor, the healer is someone of great merit, and that the Native American culture treats them differently than, you know, the average Americans do. We love our family doctor but, you know, even the way that, you know, suburban America treats their doctor is very different than it was 50 years ago but it's really still a position of honor in the Native American community.  And that he wanted me to ask you, if you spent 21 years in the Indian Health Service, how did -- how did you interact with your community? It must have been a pretty fantastic experience to walk into a room and immediately have a modicum of respect that's due a healer.

MW: Well, you know, wearing this uniform and being a administrator is probably a little different from the reception that a medicine man or a shaman or a, you know, local traditional healer would receive. But I do appreciate the respect that I receive from our tribal communities. It's something that goes both with the uniform and with the position that I encumber. But I have had traditionalists and healers in my family.

MC: Wow.

MW: In Zuni. And very much, they are respected and revered and people go to them for advisement and for ceremony and for cleansing.

MC: So there is a difference?

MW: There is definitely a difference. Yes, sir.

MC: Yeah. There -- it's a -- and the dividing line is the uniform, right?

MW: Well, yeah.

MC: Well, it's interesting because I think that, you know, there are different -- across generations and generations and generations, the Native American culture, they've approached medicine and healthcare differently than the suburban Buffalo does. And how -- as a person who is pursuing, you know, pretty traditional, you know, United States healthcare practices and bringing federal healthcare services into a community, has that ever presented a challenge, you know, tradition, you know, Native American tradition versus, you know, gold standard -- what we consider gold standard American healthcare?

MW: That is a topic of frequent conversation within our system. Western medicine versus traditional medicine. Evidence-based versus practice-based. I think as an agency we've done a really good job of integrating the ability for our patients to seek care from either western medicine providers or from traditional providers under one roof, under our facilities. When it presents a challenge is when a ceremony is present, let's say a smudging ceremony.

MC: Right.

MW: And sage or --

MC: What is a smudging ceremony?

MW: So that's when a natural substance like sage or cedar or sweetgrass is burned and the prayers are taken up but it's meant to cleanse.

MC: Right.

MW: And so we have to turn off a certain portion of our fire alarm when a traditionalist is in with a patient.

MC: Sure.

MW: So that that doesn't cause all kinds of other unintended consequences.

MC: Right. Sprinklers.

MW: But our policies are developed to allow for the use of traditional medicine in basically all of our facilities, and many of them actually have traditionalists on staff.

MC: Does that affect the selection of treatments? Like, for example, somebody is offered a drug versus a plant-based remedy that's more traditional. Does it -- how do you deal with those differences?

MW: Yeah. Really, we try to be patient-based, individualized medicine, and taking a holistic approach. So we let the patient decide which form of treatment that they'd like to receive. If they specifically ask for a traditionalist, we'll -- we will do our best to make sure that that happens. But, you know, mainly we perform western medicine with that.

MC: Right. Do you have traditionalists in the Indian Health Service employ?

MW: We do.

MC: That's interesting.

MW: Yes, in fact. Yeah. And spiritual healers. We have chaplains.

MC: No way.

MW: Yes, sir.

MC: That's so interesting. Ah. Now, tell me what you mean the difference between evidence-based and practice-based medicine.

MW: Yeah. So evidence-based is peer reviewed that it's been vetted, tried and true, so it's that scientific-based evidence. And practice-based is this is the way that our community has always done it, this is the way that our healers have over time gathered knowledge of the roots and the medicines that Mother Earth provides, and that that practice base, although not studied scientifically, has proven to heal people.

MC: Right.

MW: So it's the confluence and, you know, over time you can get that practice-based medicine reviewed and perhaps through an FDA process.

MC: Really?

MW: But there is -- there is -- it's a beautiful setting to provide medicine in the Indian health system.

MC: That's great. I think that's -- is there special, like, FDA approvals that need to happen? Like we hear about the Emergency Use Authorization for emergency treatments for COVID. Is there something that's routine and similar?

MW: Well, you know, not that I know, but we could just take one example of medical marijuana, you know. It's the components of that get FDA's attention. So what is it in sage or what is it in sweetgrass or osha root that is the healing property that could be applied in a western medicine sense?

MC: Right.

MW: Yeah.

MC: Well, let's get at this. I want to -- I want to talk about the federal response to COVID in your community that you serve, in the Native American and Alaskan tribes. We've had real significant resources allocated through the Coronavirus Aid Relief and Economic Security Act, we call the CARES Act, to support the COVID-19 response across Indian Country. The -- I guess in fact you have actually allocated, through the Indian Health Service, $2.4 billion to IHS, Tribal, and Urban Indian Health Programs to prepare for and respond to the coronavirus. $2.4 billion. That's a tremendous amount of resources. That's hard to actually imagine how you distribute something that's so massive.

MW: Well, and keeping in mind there are 574 individual tribes and 2.6 million people that we're caring for across the diverse 37 states. So once you start to spread that money, the resources, you know, aren't as grand as they may sound as many states have received much, much more than that.

MC: But it's a huge -- it's just a huge lift from a program management standpoint.

MW: It is a large number. And it's definitely very much appreciated. We appreciate Congress, we appreciate HHS and the White House making Indian Country a priority for funding because it was very much needed. We've been able to test our population at a higher rate than the general population, which is vitally important since we're -- we've got these disparate impacts and we've had higher infection rates that we do test at a higher rate. So we've also been made the recipient of the Abbott ID NOW.

MC: Yeah. I see 470 of those machines.

MW: Yes. And --

MC: That's a lot.

MW: -- in many locations across our system, that is the only testing technology that we had, especially in places like the rural sites in Alaska, a hill station, you know, somewhere where you can't get to by road or by boat that you actually have to fly in or snowmobile or hike.

MC: Wow. And this is interesting because the Abbott ID NOW system, people may not know that this gives you result in minutes, like 20 minutes and a COVID test that just basically is a swab or your nasal passage. And the Indian Health Service actually has 470 of these Abbott ID NOW rapid point-of-care analyzers all around at your sites. This is the same technology they use in the White House.

MW: That's right. I had to go through that same swab to get into the Situation Room with the president. You have to have a negative test before you get in the same room.

MC: It is -- it's true. I've had to go through it myself and -- how does that go down? I mean, Admiral, how does it feel to be in the room with the president of the United States representing the Native American community in something so vital as a -- as a pandemic that is disparately impacting, killing more Native Americans than average? What is that -- it must feel like a really heavy weight to carry, to be in front -- the person for your community in front of the president like that.

MW: Absolutely. Which is why it's vitally important that I'm vocal at every opportunity about the challenges that exist and, you know, it definitely have made my family proud.

MC: Sure.

MW: And our community members proud. But it is -- it is, as I mentioned earlier, a sacred trust responsibility that Indian Country not be forgotten and --

MC: Yeah. You and I talked about this because -- I haven't talked about this on Learning Curve but I've talked about it in the media a little bit. We're about to embark on a fairly sizeable public health information campaign, like a public service announcement campaign actually across many different platforms. Part of that, you and I discussed this, Admiral, is polling people, understanding what their attitudes are before we try to help them understand about COVID, you know, countermeasures, vaccines, and et cetera. And we have to -- in order to really -- to get an understanding of what we -- what different communities think, we have to get an understanding of what we should ask even. They call it human centered design. You and I talked about this, about how we need to poll the Native American community into not just "hey, go take a vaccine," but also to design the questionnaires that we ask in the -- in the town halls, you know, kind of settings where we have discussions. How important is it to get Native American voices into the actual planning of how to, for example, encourage -- discourage hesitancy on the vaccine?

MW: Yeah. Well, I'm going to approach this two ways. The first, somewhat flippantly, is nothing for us without us.

MC: That's right.

MW: You've heard that. But our agency has a --

MC: Can -- before we go in, can you tell -- I've heard this before. Nothing for us without us.

MW: Right.

MC: What is that?

MW: Don't try to come in and fix us from the outside. Come in, learn about us, hear from us, and let us make sure that you have a clear picture of what the situation is and how best to communicate with our community members, how best to treat our members or -- you need to know those local community norms, traditions, taboos, because each and every community is a little different. Even --

MC: Is this Native American saying or like a discussion in the community to help guide IHS? Where -- I've heard this before.

MW: Yeah. That's one that used often and it's typically used when it comes to research.

MC: Right.

MW: You know, nothing for us without us. Make sure that you're including us, make sure that we're engaged in every aspect of the study or the research. I think the same could be really attributed to communications planning. The unique thing about our agency is that we have a consultation policy and it's written into our law that we must consult with tribes in advance of any significant decision being made for funding, for policy, for regulation, that we formally consult with the tribes and get their opinion and their advisement and recommendations before moving forward with implementing a decision.

MC: Nothing for us without us. I didn't mean to interrupt but that's really profound and it really is -- it's actually broader. It should be driving everything we're doing for every community in the United States but it's especially true of a group like Native Americans who are so disparately affected. But I didn't mean to interrupt. You had a second point as well.

MW: Yeah. Well, I just wanted to go over the legal --

MC: Sure.

MW: -- framework of consultation.

MC: Sure.

MW: Which is written into our Indian Healthcare Improvement Act, our law.

MC: So the consultation is really -- it's actually codified?

MW: Absolutely. Yes, sir.

MC: Wow. I'm really going to enjoy putting together this messaging and, you know, doing the research and bringing the input from the Native American community into -- at the very base levels of this public information campaign. You know, we talked about it, you and I, before about how -- you're one of our most trusted communicators, probably not just because of your position but your 21 years in the Indian Health Service and your nature. You're very bright, you're very open about helping people understand things, you're soft-spoken. People trust you. Do you think it's important for trusted Native American community leaders to be among those who are helping the Native American community understand what needs to happen next in order for the community and the nation to heal?

MW: Oh, absolutely. And we have so many great examples. You know, Billy Mills who ran in the Olympics is a frequent speaker at many healthcare events. People listen to him, they like the message that he brings and they like the hope and his story, but we have many other leaders throughout Indian Country and you don't have to be an elected tribal official to be a leader in Indian Country to sway perception.

MC: Right.

MW: So I think having individuals engaged in public communication and to be able to use their voice to influence, that would be vitally important, and look forward to working with you on this project as it comes forward.

MC: I think it's going to be great.

MW: Yeah.

MC: I want to learn so much. I'm going to have to go on one of your trips with you.

MW: Oh, I would love to have you.

MC: We should probably do, you know, one of those kind of sessions where we interview -- you know, right after we survey, do survey research, we do focus group research to further hone the information we get from the broad survey of the vast population, then we do focus groups. We should do a focus group with -- in a community of your choice that we can get some further input.

MW: Oh, that would be great. And again, that variation from Indian community to Indian community is so broad but I would love to, love to engage with you in that type of activity.

MC: And I think -- I think we should. I think we should do it really soon. I think we should do it like within a couple weeks.  I'm going to talk to your office.

MW: Sounds great.

MC: I also want to mention one thing that we hear a lot about around here. And I've had a lot of your time. I really appreciate it. It's -- in case you aren't familiar and you're just tuning in or you forgot, Rear Adm. Michael Weahkee is the head of the Indian Health Service, the first confirmed director of the Indian Health Service in many, many years here at the United States Department of Health and Human Services, and the Native American and Alaskan tribal communities were disparately hit by COVID, which is one of the reasons why I wanted the admiral on Learning Curve with me. But one thing that we've seen really very terrible things happen during pandemic, but buried in these terrible clouds is always something, and we have discovered that telehealth is really -- it's really emerged as something, an important thing, a capacity we built because we couldn't physically visit our doctors and oftentimes shouldn't have. So we were doing more and more telehealth. President Trump signed an executive order expanding access to telehealth services during COVID-19, especially in rural communities. And this built on the work of the CMS and such. How did telehealth impact Native American and Alaskan tribes?

MW: Well, the Indian Health Service has been using telehealth at some level for decades. However, when the pandemic hit, we had been able to expand the number of visits by tenfold from what we were doing previously. So that's a great success story. We'd been able to ensure --

MC: Tenfold? Wow.

MW: -- continuity of care for patients and keep our chronically ill outside of the hospital, you know, let's get them prescription refills without having to come in and potentially being exposed. We'd been able to utilize newer technologies to communicate with people in their homes. So that aspect is great. We do still have challenges though in Indian Country, you know, being in the some of the most rural and remote locations in the country.

MC: No internet access.

MW: Broadband access.

MC: Right.

MW: It's huge for us. And we really do need to solve that problem.

MC: Which you're making progress on that.

MW: We are making progress. I'd like to make quicker progress.

MC: Right.

MW: We don't want to be left behind as the rest of the country is now -- have a proven concept that, hey, this telehealth way of receiving care, not so bad. We've got indications from the secretary and HHS that they'd like to see many of the flexibilities that have been put in place temporarily remain permanent. We want to -- we want to stay on top of that wagon as well as see if we can ramp up even more of that tenfold. I think that tenfold can be tripled and doubled and we want to make sure that Indian Country doesn't get left behind.

MC: We hear a lot about data gathering and there has been -- they're building out a whole new system of data gathering here in HHS with the help of CDC and -- in order to track COVID hospital data. Is it a particular challenge for IHS or is it better for IHS because you're already integrated so closely with the federal government? I mean, the reporting on hospital data on COVID.

MW: Yeah. Well, unfortunately, for the Indian Health Service, we are at a little bit of a disadvantage because we're relying on an antiquated electronic health record. We use what's called a Resource Patient Management System which was based on the Veterans Administration's VistA system. V.A. is moving off of VistA and they purchased a Cerner product. We actually need to modernize our electronic health record to be able to report data in a more streamline manner. Unfortunately, now we're doing a lot of manual manipulation.

MC: Right.

MW: Manual data calls. And many of our tribes who have taken over the management operations of their healthcare facilities have made the investment to move on to commercial off-the-shelf systems that have better reporting functionality. So, many of them are in a better situation than we are as the federal government.

MC: Well, it's interesting because we need that data to distribute, for example, you know, countermeasures, treatments. And the Department of Health and Human Services provided the Indian Health Service with access to 20,000 vials of remdesivir, which is a leading treatment for COVID, and it's being supplied to patients at 44 IHS and tribal facilities across the country. And also, the president's Coronavirus Task Force has said an additional 6,400 vials have been transferred to the IHS from the Veterans Administration. How do you distribute that without data at your fingertips?

MW: Yeah. Well, fortunately we have strong communication lines in our clinical chief medical officer, clinical director.

MC: You guys have stood this up. That's been in existence for decades, right?

MW: It has been.

MC: And it's extremely strong because of the traditions of the IHS.

MW: That's right. That's right. And we do use that clinical data to make these informed decisions about where to -- where to place our resources so those patients who are hospitalized or in an intensive care unit who would benefit from remdesivir, that information is raised through a local clinical director to an area chief medical officer to the national level and those allocations are made.

MC: I wonder how being born in an IHS facility and spending 21 years in service to your community after your time in the Air Force serving this nation, how does it impact you to watch your community have 3.5 times more chance of an infection, five times more chance of hospitalization? How has that impacted you? Now, there's a lot of people who work in public health who don't have that, you know, just core level connection to their community. What does it -- what does it feel like to you to be in service to your community during such a dire and exponentially more difficult pandemic for your community?

MW: It is difficult. Not only the impact on our communities, even our own team, our Indian Health Service team has unfortunately been impacted with the deaths of some of our employees working on those frontlines.

MC: You've lost employees?

MW: We have. Unfortunately, we have. And every single one of those deaths is --

MC: It's family. Have you lost family as well? Have you lost friends in the community?

MW: I have -- I have lost friends. I've lost close -- close coworkers, people who I know personally and I've had much dialogue with. My personal family, I have had a niece and several cousins who have fortunately been impacted but have now recovered. But, you know, unfortunately, many of our families out there aren't as fortunate as I have been on the family front.

MC: Have you attended funerals?

MW: I've attended a virtual funeral. I've not attended any in-person funerals, and that's again another aspect of this pandemic that's just been heart wrenching as our traditional way of doing things, our traditional ceremonies, our traditional rituals, we can't go forth with them, and that is concerning.

MC: You're actually -- your community, the Native American community is having trouble gathering for more than just funeral. It's -- and it's also kind of changing these rituals, isn't it?

MW: It is. And for many tribes, they feel strongly that the rituals that they are doing are cleansing the world, the entire earth.

MC: Right.

MW: And so what is the impact on these rituals not being done to Mother Nature and to the greater environment?  You know, many tribes out there feel that if it wasn't for their rituals and their annual ceremonial events that the world would not continue moving forward as it should, so.

MC: These rituals are very important too. I mean --

MW: Absolutely.

MC: -- I mean, we see, you know, all these political conventions are now being done a different way and it's like, oh, look how interesting and different it is. But in reality, if you can't cleanse the earth -- you don't do that on Zoom.

MW: Right.

MC: Right?

MW: Right.

MC: What -- how -- what kind of -- what kind of impact does that have on the community to know, for example, that their relative passed away and they couldn't be given rituals they might have been given or would have been given if it weren't for a pandemic?

MW: It's extremely hard. I mean, not being able to do what all of your ancestors have been able to do.

MC: For generations and generations.

MW: For generations. We don't yet know what that impact is, you know. I would probably say that we're going to see in hindsight that this is a significant trauma. Our American Indian populations have faced many traumas over the generations with forced removals and assimilation and boarding schools. We're sharing in this trauma with the rest of the world but it is something that we're all going to have to deal with in how we provide care in the aftermath with the related mental health and resiliency needs.

MC: We all talk about kids are going to be impacted, you know. My daughter graduated from high school in a parking lot, you know. She's probably going to go to college mostly, you know, remotely this semester like many people. But if you had anything at all to say as we end our discussion today to the Native American and Alaskan tribes about what's next, I mean, is there hope at the -- at this point in COVID?

MW: Yeah. Well, there's always hope, and that's the thing that we all need to do is to continue to look forward. And we've proven as native people that we're resilient or we would not still be here, and this is the latest challenge and it's a huge challenge but we will get through it and we will be stronger on the other side.

MC: Is there something to the Native American spirit like the way that they deal with life every day and for many, many generations that -- does it give them an advantage or a disadvantage in the COVID era?

MW: I would -- I would like to think so. I don't know that -- you know, I have my own personal spiritual beliefs.

MC: What is it?

MW: I carry a Zuni fetish in my pocket every day which is -- it's a bear and it's meant to provide protection, strength. And any time I'm feeling like I'm down or, you know, something is impacting me, I'll just feel and remember and --

MC: Put your hand on your pocket.

MW: Right. And this is something that was provided to me from my family as a reminder, any time that you're in that situation, remember where you came from.

MC: Right.

MW: Remember what is expected of you and your responsibilities, and we'll always be here.

MC: Faith in your ancestors and your heritage, hope for the future.

MW: Absolutely. And there are many people standing behind me wanting and relying on me to success.

MC: We're all relying on you. We really are.

Rear Adm. Michael Weahkee who is the -- an enrolled member of the Zuni tribe, director of the Indian Health Service serving millions of Native Americans and Alaskan Natives. Thank you very much, Admiral, for spending time with us here on Learning Curve. I'm Michael Caputo, assistant secretary for Public Affairs at the Department of Health and Human Services.  Learning Curve. We try to do it every week. We'll have somebody in almost as interesting as Admiral Weahkee next week. Have a great week, everybody. Stay safe.

[end of transcript]