Building Trust in the Navajo Nation to Scale Up Covid-19 Testing

During a meeting with representatives from the Navajo Nation to discuss Covid-19 quarantine support for elderly, Ann Lee and her team from Community Organized Relief Effort (CORE), suggested building structures inspired by the traditional chaha’oh, a simple shelter to provide summer shade.

“The room went silent. They were so surprised—and pleased—that we used something in their vernacular, and not just in terms of language, but in terms of culture. That we’d been paying attention,” recalls Lee, CEO of the disaster relief organization she and actor Sean Penn founded in 2010.

So instead of supporting a plan to send elders away from the reservation to be isolated in hotel rooms, CORE will hire local workers, including a traditional healer to construct according to custom, and in this way support building more than 150 chaha’oh-type shelters while at the same time building community trust.

“Being taken away from the reservation would have been re-traumatization again for many of these elders, and a bad idea,” Lee says. Community-centered response has distinguished their coronavirus work and they’ve leaned on three tools: flexibility, cultural sensitivity and a desire to listen.

The actual operation of testing sites is not rocket science. You can hire hundreds of contact tracers but you must create trust before people open their doors and share information.
Ann Lee
CEO, CORE Community

Partnering with CORE as Testing Scales Up

CORE is part of The Rockefeller Foundation’s focused effort to increase testing and contact tracing throughout the country through a National Covid-19 Testing Action Plan backed by funding and regular convening of a Testing Solutions Group as a place to exchange and discuss best practices to scale up testing and deal with the unprecedented pandemic.

Covid-19 National Testing Solutions Group

Ann Lee working at a site offering free Covid-19 tests.

The Foundation, already a CORE partner, announced an additional $375,000 grant on June 18 to help support the organization’s work with the Navajo Nation and White Mountain Apache Tribe. CORE is also leveraging $6 million from private funding in an initiative that will reach an initial 15,000 people with diagnostic testing, provide serological testing for some 10,000 people, and offer food and hygiene packages along with the isolation shelters to over 20,000 families.

With a population of about 175,000, the Navajo Nation is the largest reservation in the U.S. and one of 12 communities where the Foundation is coordinating with public health authorities and state and local governments to expand testing. It has been severely affected by the pandemic with 324 confirmed deaths as of June 18 – more than 16 states including Kansas, Nebraska and South Dakota. The death toll equates to a death rate of 177 per 100,000, higher than any single US state.

The Navajo Nation also has suffered the effects of systemic racism. Some 22 percent of the population has diabetes, a condition which worsens the outcome of Covid-19 patients, compared with 10.5 percent of the population overall. The unemployment rate pre-Covid-19 was 42 percent.

CORE is currently operating 41 test sites around the country, including in Los Angeles, Bakersfield, Oakland, Chicago, New Orleans, Atlanta, New York and Detroit and Robeson County, North Carolina. Some 500,000 tests have been administered in CORE sites to date. They’ve also activated a team of 750 staff and volunteers.

CORE’s Blueprint to Scale Up Testing Support:

Billboard sign detailing ways to prevent the spread of Covid-19.

CORE is flexible about the kinds of tests offered, from nasopharyngeal to oral, and prepared to work with different labs and software platforms already adopted by communities.
CORE is experimental with testing sites ranging from static to mobile, drive-up to walk-through, pop-up to permanent, supersites to small community sites. “In Atlanta, we made use of a van that can pop up anywhere and offer both walk-up and drive-through services,” Lee says. “We don’t have a cookie cutter system…We target specific needs with different kinds of sites and types of testing.”
CORE plugs into the existing infrastructure, identifying community leaders and civic groups as partners. It also hires locally to support the community.
CORE is clear on the population it prioritizes: low income, communities of color, high risk and elderly, first responders, essential workers, and recently protesters. “When we need it, we’ve put together teams that, between them, speak ten languages,” Lee says.
CORE offers support services, both immediate and longer-term, sometimes in partnership with another Foundation grantee, World Central Kitchen. “Offering food in a community that has a lot of distrust has been a huge door-opener for us,” Lee says.
CORE thinks creatively about how to get the word out and make testing not only easy, but cool. CORE created T-shirts that read: “Protest. Pro-test” and is working with the musician Big Freedia to support music urging people to get tested.

A CORE team embedded in the Navajo Nation to help them meet the challenges of the moment, and Lee returns regularly to a hotel in Window Rock, the Navajo Nation’s capital city marked by stunning geography. At dawn, she often gets up to walk on the nearby hiking trail.

“Early, when it’s still kind of cold,” she says, “Everything feels so still and for a moment you forget this frenetic pace that we are keeping up. For a moment, it brings me a little calm and peace.”

CORE’s Philosophy in Action

CORE cut its teeth on relief work following the 7.0 magnitude Haiti earthquake, and refined its community-based philosophy. “We saw there that it is easy to make determinations from the outside, but that’s a skewed view,” Lee says. “There are very strong community structures that are not written down but are as important as any legal document. We have to go in and support them, be an extension of their team, not burst in saying ‘We got this!’”

Another example of this philosophy in action occurred during a meeting with a key official in Tuba City, within the Painted Desert on the western edge of the Navajo Nation. She was packing up hygiene kits while handling other strategic issues in her community’s fight against Covid-19 and was so overworked—“no time to breathe,” Lee recalls. Lee asked how CORE could help and the official responded that she was too worn down to even try to answer that question.

“I said how about if we hire you ten people from the local community who can help you with the logistics so maybe you have an hour to see your family or one day to rest? We were able to hire them up in two days, and they are reporting to her. We were able to support her where she was.”

CORE: Community Organized Relief Effort

CORE faces the realities of disaster fearlessly, working on the ground to not only rebuild communities in the face of emergency, but to also create programs that focus on preparedness and resilience.

Learn More

Building Trust in the Navajo Nation to Scale Up Covid-19 Testing

Partnering with CORE as Testing Scales Up

CORE’s Blueprint to Scale Up Testing Support:

CORE’s Philosophy in Action

CORE: Community Organized Relief Effort

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Building Trust in the Navajo Nation to Scale Up Covid-19 Testing

Partnering with CORE as Testing Scales Up

CORE’s Blueprint to Scale Up Testing Support:

CORE’s Philosophy in Action

CORE: Community Organized Relief Effort

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Expanding Access and Availability of Covid-19 Testing

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