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National Stalking Awareness Month spotlights shocking crime that strikes Native Americans more than others

By Terri Hansen

Nearly three and a half million people in the United States report that one or more people are stalking them, according to a 2009 U.S. Department of Justice report, “Stalking Victimization in the United States.”

Three people become victims of stalking every minute.

And American Indians and Alaska Natives are stalked more than any one other ethnic group.

“It’s a hate crime,” said Ann Dapice, Ph.D., a Lenape/Cherokee and director of Education and Research at T.K. Wolf, Inc., an American Indian stalking authority agency that works with victims.

“The biggest problem we have is no one who is stalked gets any help. No one will stop stalkers. And stalkers know that,” Dapice said.

T.K. Wolf is an Oklahoma-based non-profit counseling, research and educational organization. They began a Stalking Initiative ten years ago after learning there were so many American Indian stalking victims, and realizing their stalking clients were not receiving assistance from agencies or law enforcement.

“We kept referring stalking victims to domestic violence agencies, but they kept coming back saying, ‘They’re not understanding what we’re dealing with,’” Dapice said.

Stalking among Native Americans is mainly against the leaders–tribal attorneys, activists, artists, and tribal leaders, Dapice said. The only two ways to stop it, she said, are peer pressure, “Peers must tell them this is not appropriate behavior.” The other is the law.

Why can stalkers act with impunity? Less than one percent go to jail.

Agencies and the law usually categorize stalking as battering or domestic violence, where services are limited to ‘known intimates.’ Yet the Department of Justice report shows this group represents only 30.3 percent of stalking victims. ‘Known others,’ like co-workers, relatives, classmates, and neighbors account for 45.1 percent.

And a surprising one in four victims don’t know their stalkers.

‘Strangers’ make up 10.6 percent of stalkers. ‘Unknowns’ account for another 16.9 percent. Some forms of this stalking is organized, proxy or vigilante stalking – “cause” stalking similar to tactics once used by the Ku Klux Klan. Some perpetrators hire groups to stalk their victims.

“There are people who stalk relationships, people who stalk in order to do revenge, people who stalk political and entertainment figures,” says Dapice. “There is group and proxy stalking. There are different motives but whatever it is, it is always a power play.”

DOJ statistics show that in Indian country, most of the violence has been non-Native Americans against Native Americans. It’s not because stalking victims are on tribal lands, as is often assumed, Dapice said. “No one, Indian or non-Indian who is stalked gets any help.”

Worse, some people blame the victims so they’re afraid to come out of the closet.

Men make up 27 percent of stalking victims, “and are just as victimized as women, in some ways doubly so, because police will say ‘what’s wrong with you, why can’t you protect yourself?’” Dapice said the police blame the judges, and the judges blame the system. “Everyone blames everyone else and eventually it’s somebody else’s fault, and nothing gets done.”

Post-traumatic stress syndrome is a familiar term used with stalking victims. T.K. Wolf uses another: Continuous Acute Traumatic Syndrome. Victims think it has let up, only to have it start again.

Some people try moving to a new community to escape. “Stalkers are the first ones to make friends with the police in any community, so often moving makes no difference,” said Dapice. “Stalkers will walk around a neighborhood and tell lies and stories about the victim.”

The agency’s website indicates stalkers, from most to least often stalk by telephone, home surveillance, following physically, driving by home, appearing at workplace, sending letters and emails, spreading gossip and “gaslighting,” a term used when they try to make victims think they’ve gone “crazy,” damaging property, threatening to harm others, breaking and entering, sending unwanted gifts, physically and sexually assaulting victims, injuring and killing pets, kidnapping and arson. Dapice has listened to victims who have reported all these methods.

Stalking victims often report such bizarre behaviors that they have trouble convincing others that this is happening—including the professionals who are formally assigned to respond to them.

January is National Stalking Awareness Month. This year’s theme — “Stalking: Know It. Name It. Stop It.” — challenges the nation to fight this dangerous crime by learning more about it. They’re asking the public to promote the month with posters, Social Networking Status Updates, Sample Public Service Announcements, Certificates of Appreciation and Buttons, Magnets, Logos.

A Tides Foundation Indigenous Peoples Fund Award is funding a T.K. Wolf study that will assist tribes and agencies in providing better responses to victims and perpetrators, and an educational documentary that tells the story of stalking in Indian country.

T.K. Wolf is sponsoring an anonymous online survey through Integrated Concepts, Inc., that will contribute further information regarding the needs of Indian country related to stalking. To participate, visit www.iconceptsinc.com, select Services, select Stalking Survey, enter Password: Tides_Foundation, take Survey, select Submit.

The National Stalking Awareness Month site offers help and resources for Victims, and information on stalking for Service Providers, Law Enforcement and Prosecutors. Visit www.stalkingawarenessmonth.org/resources.

This article is a public service. Author encourages distribution of article in its entirety.

Wes Studi: Protect the Circle of Life, Get the Flu Vaccination for H1N1

Washington, DC – Wes Studi, the well known Cherokee actor, stars in new public service announcements that covers strategies to reduce the spread of flu and encourages Native Americans to get the flu vaccine.

“The virus has hit Indian Country especially hard,” said Health and Human Services Secretary Kathleen Sebelius at a press conference Jan. 10 introducing the new public service announcements.

It’s National Influenza Week, a national observance that highlights the importance of continuing influenza vaccination.

Last month, the Centers for Disease Control and Prevention released a study that indicated that the risk of dying from the H1N1 virus and its complications was four times higher for American Indians and Alaska Natives than for the population in general.

Sebelius said that Native communities suffer disproportionately from underlying health conditions like asthma, diabetes, and heart disease that may increase the risk of getting seriously ill from the flu. She added that poverty and difficulty in accessing medical care in remote communities increases the risk of serious illness and makes the risk of dying from that illness much higher.

“It’s really important for us to let people know how important it is to protect themselves from the flu. This message is really urgent in Indian Country. The new radio and TV Public Service Announcement is part of that outreach effort,” said Sebelius.

“We know that vaccines are by far the best means we have to prevent the flu. We’ve heard all the myths about vaccines being unsafe. That is absolutely not true and it’s really important at this critical time to set the record straight,” Sebalius said. She noted that every year millions of Americans are safely vaccinated against the seasonal flu.

“Right now vaccine supplies are excellent,” Dr. John Redd, IHS epidemiologist said. ”Up until very recently we’ve dealt with vaccine supplies that were relatively short, but that’s not the case now, and now is the time to get your vaccination.”

Redd said that if a person is reluctant to get vaccinated they have to think about not only their own risk but also their whole family, neighbors and the community. “People need to bear in mind that this particular strain in flu unfortunately has a big impact in children, especially ages 0 to four. The report found that the death rate in American Indian children is 7.2 times higher than for non-Indian ages 0-4. By getting yourself vaccinated you are helping your family and community.”

During the press conference IHS director Dr. Yvette Roubideaux said that all IHS areas are currently administering the H1N1 vaccine and the IHS meets weekly about H1N1. “All of our IHS Area Chief Medical Officers attend the weekly calls and are responsible for getting updated information out to local health facilities. There is also an every other week call for tribes to give them updates as well,” said Roubideaux.

Jessica L. Burger, RN, deputy director of the National Indian Health Board said, “NIHB is very pleased to see the elevation of this critical issue for Indian Country and the development of targeted messages for our communities. Indian Country’s population absolutely needs education regarding the severity of this disease along with increased availability of the vaccine to combat this devastating illness.”

NIHB said they were pleased with the commitment and timely response to the crisis mortality American Indian and Alaska Native populations are experiencing as a result of the H1N1 virus. “The ongoing efforts this Administration and Department of Health and Human Services’ outreach and education that is being done in Indian Country demonstrates the commitment President Obama has to improve Indian Health,” said Burger, a former health director of the Little River Band of Ottowa Indians. ”As a registered nurse, I strongly encourage that every Indian person seeks and receives the H1N1 vaccine to protect themselves and their families.”

For information about the H1N1 influenza virus, visit the CDC’s Flu website. The National Indian Health Board advocates on behalf of all Tribal Governments and American Indians/Alaska Natives in their efforts to provide quality health care.

First UN ‘State of the World’s Indigenous Peoples’ alarming

The first UN report on the state of the world’s indigenous peoples reveals alarming statistics on poverty, health, education, employment, human rights, the environment and more. Here’s the UN press release:

The United Nations today launched its first report on the state of the world’s indigenous people, with the Chair of the United Nations Permanent Forum on Indigenous Issues, Victoria Tauli-Corpuz, saying it offered a “daring and bold” description of the situation of indigenous persons in health, poverty, education and human rights, and should be fed into the upcoming review of the Millennium Development Goals.

Addressing journalists at a Headquarters press conference this afternoon, Ms. Tauli-Corpuz said the lack of disaggregated data on indigenous people often meant that goals set by Governments to tackle poverty and other social ills did not address the particular situation of indigenous persons.

“The value of this report is really going to be far-reaching, because now we have really very clear information, data and statistics that are also coming from United Nations publications,” she said, explaining that the data in the report ‑‑ which was also being launched today in Mexico, Colombia, Brazil, Russian Federation and Belgium, and in the Philippines in February ‑‑ was not the sort Governments could deny, since it was collected by the United Nations through a rigorous process.

She said the report contained “damning statistics” on poverty among indigenous people, who made up one third of the world’s 900 million rural poor even when living on lands that were resource-rich. It also described how States indulged in over-exploitation of resources without indigenous peoples’ consent.

“We live in territories which have the richest resources, whether this is oil, gold, forests, water,” said Ms. Tauli-Corpuz. “And yet you find this kind of poverty.”

She said pockets of poverty in the world’s developed countries were commonly made up of the indigenous population. Canada, for example, was perched high on the human development index, but its position would drop considerably if the situation of indigenous people were factored into the index, she said.

Speaking alongside Ms. Tauli-Corpuz, Myrna Cunningham, Director of the Centre for Indigenous Peoples’ Autonomy and Development in Nicaragua, said land-rights issues figured prominently in the report, which had repercussions even on health. One of the report’s co-authors and a trained surgeon, she said indigenous peoples’ loss of land had led to changes in diet and a disproportionate rise of diseases like diabetes in their community. The indigenous population also suffered higher rates of cardio-vascular illnesses and, in some countries, had an average life expectancy that was shorter by 20 years, compared to the wider population.

Offering more highlights from the report, Ms. Cunningham said indigenous peoples suffered from higher rates of human rights abuses, in the form of violence against women. And, the “commoditization” of indigenous culture risked impinging on the right of indigenous peoples to self-determination.

“It is very important that the report is coming at this time. For example, the United Nations Development Programme will be working on the human development report in which the concept of development will be analysed,” she said. “As indigenous peoples, we are offering an important tool with this report that should be considered in the discussions on new views of indigenous peoples’ development.”

Ms. Tauli-Corpuz said the next step was to publicize the report widely among Governments, stressing also the benefits of including indigenous peoples in the State’s search for solutions to global problems, like the economic crisis and climate change.

Asked to specifically comment on the role of indigenous people in tackling climate change, she said the indigenous community who were present at the recent Copenhagen Summit had managed to insert a reference to the Declaration on the Rights of Indigenous Peoples in the draft outcome document. Although the draft was not adopted at that meeting, she said the insertion of such language into the draft offered hope that an eventual international agreement would include indigenous people in the global process for dealing with climate change.

Aside from climate change, among the emerging issues highlighted in the report was the increased militarization of indigenous territories, which Ms. Tauli-Corpuz said was at risk of becoming worse because of the war on terrorism. A national security report published by the United States, for instance, had identified indigenous peoples as potential terrorists, which she said had come about because of their strong resistance against the exploitation of their territories.

Addressing the issue of United States army bases in Colombia, Ms. Cunningham said that indigenous communities in that country had been concerned by the placement of such bases on their land, and were now engaged in a dialogue with the Government. There was no outcome, yet, on those talks.

Encroachment on indigenous territories was not only at the hands of the military, but also corporations, she said, explaining that, in Guatemala, indigenous peoples had consulted mining companies numerous times to try to become active parties to decisions to mine their lands. The indigenous community there was now fighting to turn the results of those talks into binding agreements.

In Peru, however, arguments over mining on indigenous territory had turned violent, she said, causing 30 people to lose their lives in June 2009. The United Nations Special Rapporteur on the rights of indigenous persons had recommended that dialogue take place, but so far none had been held.

Ms. Tauli-Corpuz said the Permanent Forum on Indigenous Issues was currently exploring ways to work with the Special Representative on business and human rights to push Governments to adhere to the State duty to protect against human rights violations by third parties, including multinational corporations. It would also advocate for more corporate responsibility to protect rights, and for greater access to both judicial and non-judicial processes for indigenous peoples.

The report reveals:

Indigenous peoples make up one-third of the world’s poorest and suffer alarming conditions in all countries

First UN publication on the state of the world’s indigenous peoples reveals alarming statistics on poverty, health, education, employment, human rights, the environment and more.

Indigenous peoples all over the world continue to suffer from disproportionally high rates of poverty, health problems, crime and human rights abuses.

In the United States, a Native American is 600 times more likely to contract tuberculosis and 62 per cent more likely to commit suicide than the general population.

In Australia, an indigenous child can expect to die 20 years earlier than his non-native compatriot. The life expectancy gap is also 20 years in Nepal, while in Guatemala it is 13 years and in New Zealand it is 11.

In parts of Ecuador, indigenous people have 30 times greater risk of throat cancer than the national average.

And worldwide, more than 50 per cent of indigenous adults suffer from Type 2 diabetes – a number predicted to rise.

These are just a few of the startling statistics in the United Nations’ first publication on the State of the World’s Indigenous Peoples, a thorough assessment of how indigenous peoples are faring in areas such as health, poverty, education and human rights.

While indigenous peoples make up around 370 million of the world’s population – some 5 per cent – they constitute around one-third of the world’s 900 million extremely poor rural people. Every day, indigenous communities all over the world face issues of violence and brutality, continuing assimilation policies, dispossession of land, marginalization, forced removal or relocation, denial of land rights, impacts of large-scale development, abuses by military forces and a host of other abuses.

Alarming state of indigenous health

The publication’s statistics illustrate the gravity of the situation in both developed and developing countries. Poor nutrition, limited access to care, lack of resources crucial to maintaining health and well-being and contamination of natural resources are all contributing factors to the terrible state of indigenous health worldwide.

According to a second UN press release:

Indigenous peoples’ life expectancy is up to 20 years lower than their non-indigenous counterparts.

Indigenous peoples experience disproportionately high levels of maternal and infant mortality, malnutrition, cardiovascular illnesses, HIV/AIDS and other infectious diseases such as malaria and tuberculosis.

Suicide rates of indigenous peoples, particularly among youth, are considerably higher in many countries, for example, up to 11 times the national average for the Inuit in Canada.

Displacement and dispossession destroying indigenous communities

One of the most significant threats facing indigenous peoples identified in the publication is the displacement of indigenous peoples from their lands, territories and resources. The publication details several examples of displacement, separation and eviction, including in Malaysia, Indonesia, Thailand, Hawaii, Rwanda, Burundi, Uganda, Democratic Republic of the Congo and Colombia.

“When indigenous peoples have reacted and tried to assert their rights, they have suffered physical abuse, imprisonment, torture and even death,” states the publication.

The State of the World’s Indigenous Peoples was authored by seven independent experts and produced by the Secretariat of the United Nations Permanent Forum on Indigenous Issues.

American Indians at higher risk of H1N1 death, designated a priority group

A letter issued by Centers for Disease Control and Prevention director Thomas Frieden M.D. has advised the states that American Indians and Alaska Natives may be more vulnerable to severe illness from H1N1 influenza and should receive vaccine on a priority basis.

Frieden writes that indigenous populations from Australia, Canada, and New Zealand have a three to eight times higher rate of H1N1-related hospitalization and death, and that two states in particular, Arizona and New Mexico, observed a disproportionate number of H1N1 deaths in American Indians.

His letter urges state health officers to redouble their efforts with minority providers to increase H1N1 vaccinations among underserved populations.

A CDC report issued Dec. 11 indicates from April 15 to November 13, American Indians including Alaska Natives in 12 states died from H1N1 at a rate four times higher than other races or ethnicities.

The American Indian H1N1-related death rate was 3.7 per 100,000 compared with 0.9 per 100,000 for all other racial/ethnic populations. It said reasons for the disparity are unknown, but might include a high prevalence of chronic health conditions such as diabetes and asthma, and delayed access to health care. Many of the deaths occurred before a vaccine was available.

“We’ve been worried from the very beginning,” said Indian Health Service epidemiologist and report co-author John Redd M.D. “We knew from previous outbreaks that there was severe disease happening in AI/AN and other indigenous populations.”

Redd noted the report’s recommendation that there be an expansion of efforts to promote vaccination in American Indian populations, and said the IHS has an excellent vaccine delivery system.

The IHS suffered delays in vaccine distribution to the same degree the rest of the country did, and while current distribution varies state by state, “We know it’s widely available now, and we’re asking people to contact their health facilities and get vaccinated.”

Individuals can be vaccinated against both the seasonal flu and H1N1 influenza vaccine at the same time, and should ask their clinic for the pneumonia vaccine if they haven’t received that.

The report is recommending stronger efforts to increase awareness among American Indians and their health-care providers of the potential severity of influenza, and the current recommendations regarding timely use of antiviral medications. That is currently a problem for patients with health care providers unfamiliar with the report or IHS policies.

A large urban IHS-funded medical clinic told a patient stricken with the flu on Dec. 17 that they were not treating patients with antivirals unless they were in the hospital. The clinic said they were following the policy of the CDC but, “That’s not consistent with our policy,” Redd said.

While clinicians have latitude with their patients, the IHS policy is that antivirals are appropriate for people in risk groups both as outpatients and as inpatients, he said.

In addition to American Indians and Alaska Natives, those at highest risk of H1N1 complications are pregnant women and those with chronic conditions such as diabetes, heart disease, asthma or other conditions that reduce immunity to influenza. Other groups at higher risk of infection or who can spread the virus to vulnerable populations are health care workers, people between the ages of 6 months and 24 years and caregivers of children ages 6 months and younger.

Influenza is widespread in all 50 states, and 99 percent of it is the H1N1 strain. Nearly all cases respond well to the antiviral drugs oseltamivir and zanamivir if treated within the first 72 hours after symptoms appear.

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Naturopathic medical advice for staying well this flu season

By Terri Hansen
Environment, Science & Health Writer
As seen in Indian Country Today

Portland, Ore.—When naturopathic physician Dr. Orna Izakson looks at a plant she sees more than its stem, leaves or vibrant flower – she sees medicine. And naturally, she takes a natural approach to flu prevention and hastening a healthy recovery.

“Our bodies are trying to bring us toward health,” she says. “The responses we experience to outside stressors are our body’s intelligent response to that stressor. A fever is an intelligent response: It makes the body more responsive to invaders… and it makes us feel lousy so we slow down and go to bed so that our bodies can heal.”

So what can you do to stay well this flu season? “Keep things moving,” says Dr. O, as her patients call her. That means drinking clear fluids — especially water — and eating foods that are close to nature. You can get most of the pieces you need in your diet for good health from colorful vegetables, including fiber.

Avoid simple sugars they best as you can; they stun the immune system. “Each handful of berries you give your children is one less Twinkie, it’s a positive step.”

Cigarette smoking depletes vitamins and decreases natural immunity. “You need to cut back, smoke less and what you do smoke should be natural, or if packaged smoke American Spirits,” Dr. O says. “Make up for the extra cost by smoking less.”

Vitamin D, produced naturally in the skin by sun exposure, is critical to your immune system. Deficiencies are epidemic and darker-skinned people are more likely to have low levels. Depending on her patient’s lab assessments of their blood levels, she generally recommends 2,000 to 4,000 iu daily of D-3.

Probiotics support healthy gut bacteria, a barrier between you and the outside world. One 2009 study found regular use of probiotics reduced children’s cold and flu symptoms. Another found probiotics helped elders get more immunity from flu vaccines. Buy probiotics as supplements – acidophilus is one, and find them in traditionally fermented foods such as yogurt, sauerkraut, kimchee and uncooked miso.

Herbal steams are an old and effective tradition for any respiratory infection: Mix herbs with boiling water in a bowl and cover for a minute with a towel. Drape the towel over your head and the bowl, close your eyes and breathe the steam through nose and mouth into your nasal passages, throat and lungs to loosen mucous, strengthens mucus membranes, and disinfects your passages. Repeat as needed.

“You can use thyme, pine needles, cedars, eucalyptus, and chaparral. Orange peels can be effective too, but wash them well before using,” Dr. O says. “Talk to the Elders, they often know what’s best to use in your location. It could be herbs from the place your grandparents called home, or you may have a grandma in your head; listen to whose voice is louder.”

Lomatium and osha root are best taken as tea, tincture or by chewing on the root directly. “When you take it internally, you’re taking in the volatile oils. They want to volatize, spread out. They go into the bloodstream, their aromatics bubble out into and through your lungs and mucus, disinfecting.” Think of the flu as leaving junk stuck in your lungs, a perfect spot for breeding bacteria. Herbs move it out, disinfecting from underneath.

Garlic helps to fight many bugs that can make you sick, making it one of Dr. O’s favorites. Raw is best if your stomach tolerates it. Add a chopped clove or two, if you can, to any hot or cold food.
If you get sick in spite of these positive steps call your medical provider.

Home remedies Dr. O suggests for her patients include mustard plasters; to make your own grind yellow (or any) mustard seed and mix with water. Place a brown paper bag on your chest as a barrier, then smooth the mustard plaster on top. Use the plaster two to three times a day. How long you keep it on depends on your comfort level, but check frequently; if the skin starts turning red it’s time to take it off.

The next treatment, like the mustard plaster, moves blood and helps immune cells get to where they’re needed most. Wet a pair of cotton socks with cold water; wring them out thoroughly. Put on well-warmed feet, cover with a pair of dry wool socks and get into a warm bed for the night. You can also do this with a cotton t-shirt and wool sweater.

Bottom line, Dr. O says, is it’s the simplest things that help the most: Eat simply. Exercise moderately. Get plenty of rest. Drink water. Cover your cough. Wash your hands. Get outside and breathe clean air. And find some way to cultivate joy in your life every day. “This is traditional medicine, the best memory of the traditional medicine. It’s practical, it empowers people.”

2009-H1N1 (swine) flu vaccine on its way to IHS clinics, ETA October 7

By Terri Hansen

Environment, Science & Health Reporter

The vaccine for the 2009 H1N1 influenza A (swine flu) virus makes it arrival at Indian Health Service clinics and facilities October 7. The seasonal flu vaccine is at the clinics now.

“We want people to get their seasonal vaccination as quickly as they can, and once the H1N1 vaccine arrives, get that as quickly as they can,” said IHS epidemiologist John Redd M.D. Those unable to make separate appointments can get both vaccines at the same time, he said.

Testing of vaccines for H1N1 shows they work with a single dose and quickly take effect.

Influenza is increasing in all 50 states, and 98 percent of it is the H1N1 strain. Most cases are occurring in children and young adults, Dr. Anne Schuchat of the Centers for Disease Control and Prevention said at a briefing. The viruses remain similar to those chosen for the 2009 H1N1 vaccine, and nearly all cases respond well to the antiviral drugs oseltamivir and zanamivir.

Clinic patients should not delay in calling their clinic to learn what the vaccination plans are, said Redd. Many clinics plan mass vaccination days.

Last month President Obama’s science advisory council released a report that said Native American populations are considered at elevated risk of severe outcomes from 2009 H1N1 infection due to their populations being “historically at high risk for severe respiratory infections,” and, “A cluster of severe H1N1 disease among First Nation people in remote Manitoba, Canada suggests these groups may be at high risk. Cases of H1N1 virus infection in these clusters have had rapidly progressive, diffuse, lower airway disease … resulting in development of acute respiratory distress syndrome and prolonged ICU admission.”

“We don’t think that American Indian and Alaska Native people strictly by virtue of being AI/AN are individually at higher risk for H1N1 disease,” said Redd. “But risk factors such as diabetes and obesity are known to be more common in American Indians and Alaska Natives, so the population may be at higher risk because of the risk factors.”

The CDC says pregnant women, health care workers, people 6 months to 24 years of age, those who care for infants and those with chronic health conditions are priorities for the H1N1 vaccination.

The IHS has a proactive approach to pneumonia prevention, a severe respiratory infection that can be a serious and sometimes life threatening complication of influenza. “We take pneumonia in itself and as a complication of flu very seriously,” Redd said. “We definitely want to stay on top of that. In 2008 we vaccinated 82 percent of the American Indian and Alaska Native population against pneumonia.” He said the IHS offers the pneumococcal vaccine, and encourages those who haven’t received the vaccination to ask for that vaccination, too.

He said IHS efforts regarding H1N1 have been vigorous. “We started the first weekend of the outbreak,” he said. “We’ve issued guidance involving use of the Strategic National Stockpile. We’ve spent a lot of time communicating with states to consider those tribal populations within their borders. We’ve done a lot of outreach to providers including community health representatives and public health nurses on getting the system ready to receive the vaccine.”

The SNS is a large stockpile of medicines and supplies designed to support public health agencies during a public health emergency. It is deployed, according to guidance issued by the federal government, as a joint effort among state, local, territorial, tribal and federal officials if the health of a community is threatened.

As far as the antiviral medications, those intended for the general population are distributed through the SNS by the states, said Redd. “In the Arizona outbreaks, we received the antivirals we needed from the state.” The IHS has some internal distribution for their health professionals if they fall ill.

Redd said a big goal of the IHS is what they call mitigation – minimizing the impact of sick patients who might overwhelm a health facility. “A small hospital could deal pretty well with taking two intensive care patients for 10 days, whereas it might be very difficult for them to take 20 ICU patients in one day,” he said. “So one of our goals is to minimize spread and slow the flu down.

“The second portion in all this is every clinic having a local flu plan. That plan includes contingency planning – if the hospital intensive care unit or the local capacity is overwhelmed, in a worst-case scenario, we’d continue to see people as outpatients.

“We’ve got all these issues very much in mind.”