Viral hepatitis impacts Indigenous peoples around the world at much higher than average rates, harming their physical, spiritual, emotional, social and economic health. This is the result of historic and ongoing colonialism, and includes significantly worse health determinants, inadequate access to immunization and treatment, and inadequacies in the provision of culturally safe and responsive healthcare to Indigenous people.
COVID-19 has further impacted Indigenous peoples, but many communities and healthcare practitioners are finding innovative ways of responding to the pandemic, while simultaneously trying to continue providing hepatitis care.
Many of these responses were shared in a virtual mini-conference hosted by the World Indigenous Peoples’ Conference on Viral Hepatitis on November 24, 2020. Researchers, doctors, nurses and allies brought together 125 people from around the world. Some were eating breakfast, like those in Australia, while others getting ready for bed, like those in Europe and Africa. All participants shared the common desire to learn more about how Indigenous people are responding to COVID-19 and viral hepatitis.
The conference featured a keynote presentation from Jessica Leston, clinical programs director at the Northwest Portland Area Indian Health Board, and David Stephens, ECHO clinic director at the Northwest Portland Area Indian Health Board, from Project ECHO’s Indian County ECHO. Their online telehealth clinics, which train primary healthcare providers in rural and underserved areas in hepatitis care, have expanded to include COVID-19 training. They realized their services were only treating about half the number of patients as usual because of the pandemic, but they were able to reach more patients again by addressing COVID-19. The work they do is largely by and for American Indians and Alaska Natives, and it helps decolonize the healthcare system and addresses social and health inequities.
Was there anyone with lived experience of viral hepatitis?
Yes! Leona Quewezance, a Saulteaux woman with lived experience of hepatitis C virus (HCV) who works for the All Nations Hope Network, which provides HCV support in Saskatchewan, participated. She said the COVID-19 pandemic poses other threats to Indigenous peoples, such as disruptions in hepatitis B viral (HBV) and HCV testing and care. Her organization realized that HCV testing wasn’t happening in the usual healthcare facilities because of COVID-19, so they started offering it as a new service at their centre, linking more people to care. She also said that the pandemic has led to an increase in deaths due to drug overdoses, and the overdose crisis continues to disproportionally affect Indigenous peoples.
What’s happening in Canada?
Margaret Kisikaw Piyesis, CEO of the Canadian Aboriginal AIDS Network, said Indigenous people need to look to their own traditions, ceremonies, medicines and histories to find solutions to problems that have resulted from colonialism, including higher hepatitis and HIV rates. “As Indigenous people, we have so many gifts to offer,” she said. She said research into hepatitis and other viral diseases, and solutions for them, is being done by Indigenous scholars, academics and ceremonial people. She reminded us of the need for Indigenous people and allies to work in cooperation to find solutions. “We have to lead as Indigenous people. We have to bring forward the solutions and bring our allies along, and use the best of both worlds,” she said.
What is going on in the U.S.?
In the United States, American Indians and Alaska Natives are more likely to be infected with COVID-19 than non-Indigenous people. Dr. Brian McMahon, director of the Liver Disease and Hepatitis Program at the Alaska Native Medical Center in Anchorage, Alaska, spoke of the situation in Alaska. COVID-19 is resurging in isolated communities in Alaska, which had managed to keep COVID-19 out early on in the pandemic. Now field trips to regional tribal health facilities have been cancelled and telehealth services are being used instead. For people living in remote communities, most are still able to get their six-month blood draws at village clinics for HBV monitoring. Most people with HCV are unable to travel to get treatment. Surveillance for hepatocellular carcinoma in patients living in remote communities has been extremely disrupted, too. In recent years, most Alaska Natives have been vaccinated for hepatitis A and B, but care for those who have HBV is reduced now because of COVID-19.
What about Indigenous communities in Central and South America?
Dr. Roberto Orellana, the associate dean for research and sponsored projects at Portland State University’s School of Social Work, and affiliate faculty in public health and Indigenous nations studies at Portland State University, said the arrival of COVID-19 in many Indigenous communities in Central and South America has exacerbated many factors that already harm their health and wellness. These regions are already plagued by poverty, corruption, inadequate healthcare, dysfunctional governments and natural disasters, and COVID-19 is just one more problem. He said infection rates among Indigenous people are currently higher than in the general population in most of the Central and South America countries.
Many communities have created innovative responses to decrease the spread of the virus. For example, in Guatemala and Amazon communities, there are community patrols to ensure people are using masks and quarantining. In the Amazon, some Indigenous people are using leaves as masks and blocking the roads to stop visitors who may bring in the disease. In Peru, the Shipibo-Konibo people are using Indigenous traditional medicine to treat COVID-19. While the statistics Dr. Orellana shared were alarming, it was inspiring to learn of the solutions Indigenous communities are finding.
What about in Australia?
Prof. James Ward, director of the University of Queensland (UQ) Poche Centre for Indigenous Health and professor in the UQ School of Public Health, told the conference that Indigenous people in Australia have survived the COVID-19 pandemic very well. They were thought to be at a higher risk of COVID-19, but responded well by isolating their communities and following all the recommended precautions. Australian medical data do not include Indigenous status, but it is likely that COVID-19 has impacted Indigenous peoples regarding care for viral hepatitis. They are more likely to get hepatitis than non-Indigenous people in Australia, and unfortunately, during the pandemic there were considerable declines in hepatitis screening and HBV monitoring and a decline in HCV monitoring and workup.
Culture and ceremony
This was a conference led by Indigenous researchers, so ceremony and culture were integrated into the conference proceedings. Elder Leona Tootoosis, a member of Poundmaker Cree Nation in Saskatchewan, opened and closed it in a good way by praying in Cree.
We also shared two cultural videos, one of a jingle dance by Cree powwow dancer Randi Candline, who explained that the dance originated during the Spanish flu pandemic and is believed to be healing, and one of a traditional Alaska Native blessing song. These were warmly embraced by the attendees, who flooded the chat box with praise and thanks.
High hopes for hepatitis and COVID-19 care
The conference provided a good overview of how different Indigenous communities around the world are faring with COVID-19, and how it has impacted hepatitis care. Whether it was the success of the Indigenous peoples in Australia at mitigating the effects of the pandemic, or the traditional medicines the Shipibo-Konibo people are using to treat COVID-19, there was much to be learned from what each person shared.
There was also a lot of hope and optimism about how Indigenous communities are decolonizing their healthcare and finding their own answers to problems. As Margaret Kisikaw Piyesis said, “We have to stand together in our ways as Indigenous people from this land and from other lands across this Mother Earth, as we talk about solutions and how those can be brought forth.”
You can watch the conference videos here.
Alexandra King (Nipissing First Nation) is the Cameco Chair of Indigenous Health and Wellness at the University of Saskatchewan and the chair of the World Indigenous Peoples’ Conference on Viral Hepatitis. Dr. King’s photo taken by the University of Saskatchewan.
Sarah MacDonald is the communications officer for the Indigenous Wellness Research Group at the University of Saskatchewan, which organized the World Indigenous Peoples’ Conference on Viral Hepatitis. Sarah’s photo taken by Emma Love Photography.