Flagstaff, AZ – Although swine flu has proven less deadly than originally anticipated it's taken a serious toll on American Indians. A report conducted by 12 states and released this week by the Centers for Disease Control says the mortality rate was four times higher among American Indians than any other racial or ethnic group. Arizona Public Radio's Laurel Morales visited the edge of the Navajo Reservation to try to find out why this is true.
It's a quiet morning at Phil Stago's home. He and his family live in a tiny house in the tiny town of Winslow, just outside the vast Navajo Nation. His two-year-old watches cartoons and snuggles with her dad, while the baby rocks in a mechanical swing. The mellow morning is quite a switch from the drama the family experienced in September. The Stagos were hit hard by swine flu.
PHIL STAGO: It just totally wiped them out for about a month the whole family was sick for about a month.
Stago says first his son got it - itchy throat, high fever and aches. Then two-year-old Alicia picked up the virus.
ALICIA STAGO: raspberries
She's feeling much better now. But when her newborn sister Gabriela caught swine flu, things got scary. Luckily there's an Indian Health Service clinic and a hospital nearby. The baby was taken to the hospital as soon as her fever broke a hundred.
PHIL STAGO: They secluded us from her and they put her in a little tent of oxygen. (We) had to wear the whole full isolation gowns and gloves and mask. That was pretty scary. I just wanted to hold her when she was crying late at night you know.
SFX: hospital beeping, ventilator
Flagstaff Medical Center is about an hour west of Winslow and during the swine flu pandemic it's become a referral hospital for nearby reservations. On this day the Intensive Care Unit is almost full of American Indian people on respiratory ventilators.
REIDY: We've seen a large percentage of Native Americans affected.
Pulmonologist Michael Reidy says the 20 Intensive Care Unit beds are full. And 15 of the patients are American Indians on ventilators whose swine flu had progressed into pneumonia.
REIDY: Patients can be very critically ill on mechanical ventilation for weeks at a time while we try and support them with our medications and with the mechanical ventilator getting enough oxygen into their blood while their body heals.
In Arizona of the 15-hundred people hospitalized for swine flu 20 percent have been American Indian. And American Indians only account for 5 percent of all Arizonans. Reidy says sometimes they spend up to a month in the hospital recovering. So beds become full and the hospital has to turn people away.
And it's not just an issue in the U-S. In Canada first nation groups and in Australia aboriginal tribes have reported similar disproportionate findings.
There are plenty of theories and speculation as to why indigenous people are more at risk. John Redd is an epidemiologist for the Indian Health Service.
REDD: I think that when we look at the disparate impact in indigenous populations around the world we can't ever forget about social conditions that exist in indigenous communities.
He's talking about poverty.
REDD: When you think of risk factors for influenza crowding for example, poor housing those are more present in many indigenous populations around the world.
Redd also points out that American Indians are prone to diabetes and asthma. When you combine the swine flu with these pre-existing conditions the outcomes are worse.
Access to health care is also an issue. There are a dozen Indian health care centers scattered throughout the Navajo Nation, but the reservation is the size of West Virginia.
While some point to social conditions, genes or access to health care, Native American Clinical Nurse Manager Cindy Galloway believes it's a cultural phenomenon.
GALLOWAY: They are more stoic people they don't complain frankly.
Galloway says it's typical for an American Indian patient to wait until their symptoms become severe before they seek treatment.
GALLOWAY: And that's what I've seen is that people will tolerate feeling bad longer and thinking it's going to go away. When finally after four or five days they can't even take a deep breath then they realize that this could be more serious.
The Stago family didn't wait to seek medical care. And baby Gabriela is well now. Her mom, who has mild diabetes and asthma, also caught swine flu. Fortunately she recovered after about a week of rest and fluids at home.
Indian Health Service officials say many people have been exposed to swine flu or have been vaccinated now. So there's hope that the second wave, which they expect any day now, won't be as severe as the first.
For Arizona Public Radio I'm Laurel Morales in Flagstaff.