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12857_thomas_weiser__session_2.mp3"]},"duration":7772.736,"width":640,"height":40,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/253/371/small/WEISERTHOMAS.jpg?1727840391","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/content/1","type":"AnnotationPage","items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-globalhealthchronicles.s3.wasabisys.com/collection_resource_files/resource_files/000/253/371/original/12857_thomas_weiser__session_2.mp3?1727840348","type":"Audio","format":"audio/mpeg","duration":7772.736,"width":640,"height":40},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371","metadata":[]}]}],"annotations":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445","type":"AnnotationPage","label":{"en":["Weiser, Thomas Session 2 transcript [Transcript]"]},"items":[{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e It is Friday, October 21st, 2022, and this is Mary Hilpertshauser for the\u003cbr\u003eCOVID Memory Archive History Project. I’m in Los Angeles and I am talking with\u003cbr\u003eDr. Weiser, who is still in Portland. Correct?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e This is our second session.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e We left off talking about Native Boost [Boost Oregon], which is a program to\u003cbr\u003eget people to trust vaccines. Is that correct?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e So, let’s start off with when the pandemic hit and the first iterations you\u003cbr\u003esaw of the pandemic.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,0.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Sure. I had been kind of paying attention to some reports from December\u003cbr\u003eand early part of January about this novel virus in China. And so far, we didn’t\u003cbr\u003ehave any cases here. I was already feeling nervous and a little scared because\u003cbr\u003eit sounded a lot like SARS-CoV original, which we only had one at the time. And\u003cbr\u003enow I call it SARS-CoV-1 but I think I’m the only person who calls it that. It’s\u003cbr\u003estill called SARS-CoV. In any case, I was kind of paying attention to that and\u003cbr\u003ewondering when we would need to make any kind of a response or you know, what\u003cbr\u003eclinicians in my region would need to know about that particular outbreak. I had\u003cbr\u003ebeen doing this for quite a while so our clinicians, we have a face-to-face\u003cbr\u003emeeting twice a year, and my spiel is to give the epi update. In that I talk\u003cbr\u003eabout the things that are of emerging importance in our area. Then I also will\u003cbr\u003efocus a little bit more internationally. For example, I’ve talked about MERS\u003cbr\u003e[Middle Eastern Respiratory Syndrome] to this group. I’ve talked about Ebola to\u003cbr\u003ethis group. Things that, you know, we never really dealt with, but I just\u003cbr\u003ethought these are the things that I’m watching. That was kind of usually the\u003cbr\u003etitle slide. We had our last face to face meeting with them in November of 2019.\u003cbr\u003eWe would have monthly updates by way of a web call, and I think I had already\u003cbr\u003ebeen thinking about, it’s time to start talking about this with them.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=0.0,1.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The first entry in my notebooks about this was on January 27th – Oh I need to\u003cbr\u003eturn that off, let me just turn off this real quick. So, the first entry in my\u003cbr\u003enotebooks about SARS-CoV-2 was on January 27th. You know, I didn’t look at the\u003cbr\u003edetails of why I made those notes. I’m sure it was an update of a webinar or\u003cbr\u003esomething like that, that we were getting information from. Then on January 30th\u003cbr\u003eis when I began what I thought would just be a series of weekly updates to my\u003cbr\u003earea clinicians, and I’ll read an excerpt from that because it’s probably kind\u003cbr\u003eof helpful. It starts off, “Welcome to the first weekly update from the Portland\u003cbr\u003earea IHS [Indian Health Service] regarding the novel— 2019 coronavirus outbreak.\u003cbr\u003eOur goal is to distill information for you on a weekly basis to minimize some of\u003cbr\u003ethe email traffic you receive, allowing you to focus on information that is most\u003cbr\u003erelevant to your clinical operations.” Well, one problem with that paragraph is\u003cbr\u003eit says we but it’s just me. [laughter] I don’t have a team necessarily. Then I\u003cbr\u003ehave a couple paragraphs giving the background, and then in each of the\u003cbr\u003esubsequent issues of this little newsletter I keep all of that at the front.\u003cbr\u003eThen I have a bunch of links from our state health departments, and then each\u003cbr\u003eweek as there’s something new added I would add those in and highlight them so\u003cbr\u003eyou had all the old information plus what was new. It could be readily gleaned\u003cbr\u003efrom looking at the highlighted information. One thing I noticed is that we have\u003cbr\u003ethree states that we work with. Oregon, Idaho, and Washington.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=1.0,2.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Each week there were more entries under Oregon and Washington. I don’t know if I\u003cbr\u003edidn’t pay close enough attention to Idaho or if I did— I don’t recall if I did\u003cbr\u003edue diligence to look every week at what Idaho’s updates were. In my newsletters\u003cbr\u003ethere were no updates from Idaho after the first one, which was just a health\u003cbr\u003ealert. Idaho, you know, unlike Oregon or Washington doesn’t have a port\u003cbr\u003enecessarily so it was less affected by I think any risks of international\u003cbr\u003etransmission or people coming into the country. Maybe they felt like they were\u003cbr\u003enot quite as affected early on. We tried to mostly link our clinicians to the\u003cbr\u003eupdates that were coming from the states because our clinicians are going to be\u003cbr\u003ereporting cases to the state or to the local health jurisdiction if they happen\u003cbr\u003eto have any kind of case. They need to really know what to do and how to do it\u003cbr\u003ein their context, their local context. Fast forward to March, where we had the\u003cbr\u003estay-at-home orders and all of that stuff, one of the issues that became a\u003cbr\u003estruggle for me personally and for us in our area was sort of a top-down\u003cbr\u003edirective that we were only going to share information from CDC [Centers for\u003cbr\u003eDisease Control and Prevention]. CDC was putting out the best information, I\u003cbr\u003ebelieve, that they had access to and available to them. As I said, our\u003cbr\u003eclinicians also need to know about the local situation and what to do locally.\u003cbr\u003eBecause that’s where they’re going to be reporting cases. That’s where any help\u003cbr\u003eis going to come to them. It’s going to be from the state or from local health\u003cbr\u003ejurisdictions. We had some heated discussions, let’s say, [laughs] about whether\u003cbr\u003ewe could only provide information that was from CDC or whether we had some\u003cbr\u003elatitude or discretion to provide information from these other sources. I argued\u003cbr\u003epretty strongly that we needed to do both. There was no reason for us to limit\u003cbr\u003eit. There was distinct reasoning – a distinct need for us to have local\u003cbr\u003einformation. Officially we were kind of bound. We could only repeat what CDC was\u003cbr\u003etelling us we could say or was happening. I looked for unofficial channels to be\u003cbr\u003eable to put information out. I think these newsletters stopped on February 28th.\u003cbr\u003eThat was the last one that I could find on my computer, I think it’s the last\u003cbr\u003eone I issued. Because by then it became impossible for me to distill all the\u003cbr\u003einformation and share it with everybody once a week. Things started to move so\u003cbr\u003emuch faster.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=2.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I was talking earlier about Idaho. One of the things that Idaho and Washington\u003cbr\u003ewere doing early on and making available was, they began reviewing newsfeeds and\u003cbr\u003ethe latest literature and things like that and putting out, initially daily and\u003cbr\u003ethen eventually weekly, distillations of that information. That was immensely\u003cbr\u003ehelpful. I think under the direction of the CEFO, the Career Epidemiology Field\u003cbr\u003eOfficer, in Idaho, these weekly or daily initially, kind of updates on\u003cbr\u003einformation from published articles, from various news sources and reputable\u003cbr\u003ewebsites, became really valuable. Because that was a place, like a little digest\u003cbr\u003eevery evening, I could get the digest and then kind of look through it and maybe\u003cbr\u003elearn something for the next day that I could then share with others.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Who prepared these? I mean, how did this information get shared? Also, when\u003cbr\u003eyou say we and they, who are you referring to?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Okay.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Let’s start with we and they.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Okay, give me just a second. Because I always have trouble with names.\u003cbr\u003e[laughter] Can you pause for a second?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"(pause)","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Alright. Go ahead.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,4.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Kris Carter. K-R-I-S Carter, she’s the Career Epidemiology Field Officer\u003cbr\u003eso she’s the CDC assignee to the Idaho Department of Health and Welfare. She and\u003cbr\u003eMichelle Griffin was the other person that was working with her I think, they\u003cbr\u003ewould send out these daily digests. And those were tremendously valuable because\u003cbr\u003ethat would come as an email right to my inbox and I could click on it and then I\u003cbr\u003ecould just scroll through and look at it. For Washington and I think Oregon was\u003cbr\u003edoing this too, it was a place on their website you had to navigate to. [laughs]\u003cbr\u003eIt wasn’t as readily available. You would have to go search for it. But this was\u003cbr\u003esomething that would show up in my email box that was really helpful. I have to\u003cbr\u003eadmit, I didn’t read all of them. Maybe only about ten percent, but when I did\u003cbr\u003eread them, I always learned really useful information. There’s just so much out\u003cbr\u003ethere. I think maybe they were working with some other site too, to put those\u003cbr\u003etogether. Maybe they were just passing on information from another source. I’m\u003cbr\u003enot sure. Wherever they got it from, it was extremely helpful.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=4.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e So, besides CDC giving you information, you got information from these sources.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e These are more local sources?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Well, what was produced on the digest from Idaho was actually, you know,\u003cbr\u003ethe latest research. So not just local stuff. It was national and international\u003cbr\u003eresearch. You know, links to articles and JAMA New England Journal and other\u003cbr\u003eplaces, MMWR’s [Morbidity and Mortality Weekly Report]— they always gave a\u003cbr\u003elittle synopsis of it too. The one takeaway from all that was each synopsis\u003cbr\u003ewould always have at the second or third last line, “The authors opined,”\u003cbr\u003e[laughs] about something and nobody uses the word opined really that much. Every\u003cbr\u003esingle one of those always said the authors opined about what this means, and I\u003cbr\u003ethought that was interesting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e How long did those last?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=5.0,5.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e They’re still coming out I think about once a week now. So less often\u003cbr\u003ebut still available. We recognize, and I say “we”— we, was myself and our Chief\u003cbr\u003eMedical Officer at the time, Andrew [J.] Terranella, and Andrew now works for\u003cbr\u003eCDC in their opioid prevention on the pediatric opioid response. So, Andrew was\u003cbr\u003eour chief medical officer. I was the medical epidemiologist. We also had our CDC\u003cbr\u003eassignee, Alex [Alexander] Wu, EIS [Epidemic Intelligence Service] officer. So\u003cbr\u003ethat was mostly the “we” that I refer to. Then the Northwest Portland Area\u003cbr\u003eIndian Health Board were, I was still going there every day to work. You know,\u003cbr\u003ewe also had a team of folks there as well. Mostly Celeste Davis, who was the\u003cbr\u003eEnvironmental Health Lead for the health board at the time. The four of us would\u003cbr\u003eshare information between ourselves and try and get together and discuss what\u003cbr\u003emight be important. This became kind of the way that we got information to the\u003cbr\u003etribes eventually. Once there was a total declaration of emergency and, which I\u003cbr\u003ethink was March 13th, then we had our incident command set up. That was for the\u003cbr\u003ePortland Area Indian Health Service.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=5.0,6.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In the weeks leading up to that, I did approach our area director to see if we\u003cbr\u003ecould have a combined incident command structure that would include myself and\u003cbr\u003eour counterparts. Plus, my colleagues at the Northwest Portland Area Indian\u003cbr\u003eHealth Board as well. Because I thought that would be the best way if we\u003cbr\u003ecombined into a single incident command, that we could have, you know, a better\u003cbr\u003eway of communicating information and keeping everyone up to speed. I don’t know\u003cbr\u003eif it was an internal decision or if it was directed from a higher level like\u003cbr\u003eIHS headquarters, but we were not able to have a combined incident command. The\u003cbr\u003earea office had its incident command and then the health board had its own\u003cbr\u003eincident command. I was on both [laughs] so I had my own combined incident\u003cbr\u003ecommand, but [laughs] we weren’t always acting together. Part of the difference\u003cbr\u003efor that is that Indian Health Service, the area office has its first and\u003cbr\u003eforemost responsibilities for the six facilities that we directly operate. Then\u003cbr\u003esecondly, to support the rest of the tribes as much as they can with whatever\u003cbr\u003eresources and funding was left to the area to distribute or to manage for those\u003cbr\u003etribes. Many of the tribes have taken portions of their funding to operate, for\u003cbr\u003eexample, behavioral health services or diabetes programs or other programs, and\u003cbr\u003eso those funds don’t exist at the area. We don’t have any ability to manage or\u003cbr\u003edirect any of that funding or those programs. Those are up to the tribes then.\u003cbr\u003eThe health board then, the Northwest Portland Area Indian Health Board,\u003cbr\u003erepresents all forty-three tribes. Including those that have their operations\u003cbr\u003edirected directly by IHS. The tribal representatives, tribal delegates from each\u003cbr\u003eof those tribes are on the Northwest Portland Area Indian Health Board and so\u003cbr\u003ethe board is responsive to all of the tribes and has an obligation to provide\u003cbr\u003einformation, funding, direction, to all of the tribes. Now when I say direction,\u003cbr\u003eI use that term loosely because each of the tribes is a sovereign nation. They\u003cbr\u003edetermine their own priorities and how they’re going to respond to whether it’s\u003cbr\u003ea public health emergency or an ongoing program like the diabetes program. It’s\u003cbr\u003eup to them to determine how that’s going to be operated and how they’re going to\u003cbr\u003euse the funds that they’ve received for those operations. In my role as the\u003cbr\u003emedical epidemiologist, in general my role is more as a consultant to the tribes\u003cbr\u003eand to the Northwest Portland Area Indian Health Board.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=6.0,7.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"For our six directly operated clinical sites, I don’t really have a direct line\u003cbr\u003eof authority but under the ICS [Incident Command System] structure I guess and\u003cbr\u003ewith the backing of our chief medical officer, then I could say things that\u003cbr\u003epeople would have to do. I don’t generally give orders, which [laughs] some\u003cbr\u003emight expect since I have the rank of captain on my collar. If they see me in\u003cbr\u003epublic they think, well a captain (equivalent of Colonel in the land services)\u003cbr\u003ewould command an entire military installation in the Army or the Air Force. I do\u003cbr\u003enot [laughs] and I don’t have any staff that I direct other than my CDC\u003cbr\u003eassignee, my EIS officer. Which I’m extremely grateful for because having the\u003cbr\u003eEIS officer with me and available to me gave me like, it was a way to double my\u003cbr\u003ecapacity. I really appreciate having those colleagues.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=7.0,8.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e So, after those first couple of weeks and months, how did the rest of COVID\u003cbr\u003eplay out for you? One more question. Having so many incident command structures,\u003cbr\u003edid that create challenges in how you got your messaging out or —","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=8.0,8.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. I’ll come to that in a bit. I’m going to start with what else I was\u003cbr\u003edoing in February. So, I was putting out these weekly, or I had kind of slowed\u003cbr\u003ealready to like biweekly because I couldn’t keep up [laughs], updates to the\u003cbr\u003eclinicians. In mid part of February, February 11th, I traveled to Sacramento to\u003cbr\u003ejoin the California Rural Indian Health Board, another board like ours to meet\u003cbr\u003eand have a discussion for a couple of days about maternal mortality review\u003cbr\u003ecommittees. This is the kind of work that I was doing when all this happened.\u003cbr\u003eThen later in the month on February 25th I was at the ACIP [Advisory Committee\u003cbr\u003eon Immunization Practices] meeting, which I think was Nancy Messonnier’s last\u003cbr\u003epublic appearance, or maybe the weekend after that. At that meeting, there were\u003cbr\u003etwo things that happened and one of the things was Nancy gave us the straight\u003cbr\u003etalk about what we were facing. I think everyone in the room appreciated that\u003cbr\u003eand was already recognizing that that was the case. That we were in for a major\u003cbr\u003epandemic that we weren’t going to be able to readily control. The entire room\u003cbr\u003estood and applauded her presentation.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=8.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e They did?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Well, here’s why I’m not a great historian because yes, I think it was\u003cbr\u003eat that meeting. I’ll have to double check, but yes. I think they all\u003cbr\u003eappreciated her giving us the straight talk. That standing ovation may have\u003cbr\u003ehappened later, but I think it was at that meeting. It must have been because we\u003cbr\u003ehadn’t met face to face since and I haven’t been to a face-to-face meeting. It\u003cbr\u003ewas at that meeting.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e So, at the ACIP meeting?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e At the ACIP meeting after she gave her statement, everyone stood and\u003cbr\u003eappreciated her. It was kind of a moving moment because it was like, you know,\u003cbr\u003eokay it wasn’t as dramatic as Henry the Fifth’s St. Crispin’s Day speech\u003cbr\u003e[laughter] but it was maybe the closest you get in public health to that. It was\u003cbr\u003elike, okay we’re hearing what is coming and what we’re going to be in for.\u003cbr\u003eWhat’s that?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e How did people react to that? I mean, in the room?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e I think we all listened attentively, and I think the main thing we\u003cbr\u003eappreciated was hearing the truth. Which we were all suspecting was the truth\u003cbr\u003ebut hearing it from her. You know, most folks in the room are vaccine experts\u003cbr\u003ebut they’re also public health experts and many of them are epidemiologists.\u003cbr\u003eThis is the kind of thing that we’re all kind of prepared for. We know that\u003cbr\u003evaccines are going to be probably the most important tool that we get. I think\u003cbr\u003eat this time it wasn’t clear like how quickly a vaccine could be developed but\u003cbr\u003eone of the things, you know, is that within just like ten days of identifying\u003cbr\u003ethe virus we had it sequenced. That was a kind of a world record, because for\u003cbr\u003eSARS-CoV, that happened in 2003. It took three months to do that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Why was it so quick?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,9.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Well, I think the technology has improved in the period of time and so\u003cbr\u003eit was sequenced and shared within ten days. I think that was a real key thing\u003cbr\u003eabout being able to then take that sequence and be able to make vaccines using\u003cbr\u003ethat sequence and recognizing which of the areas that we need to focus on. The\u003cbr\u003escience moved really fast. I know there’s a lot of debacle and you know,\u003cbr\u003ecomplaining about CDC’s first tests not working properly. You know, at the time\u003cbr\u003eit was a huge setback and it really affected trust I think in CDC. But when you\u003cbr\u003elook now, two and a half years later, those first tests were so small compared\u003cbr\u003eto all the tests that we’re doing now. I mean, the millions and millions of\u003cbr\u003etests that happened. While it would have been really critical to have more\u003cbr\u003etesting earlier on, I’m not sure how much of a role that goof up made in the\u003cbr\u003eoverall ability to get testing developed and rolled out.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=9.0,10.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think there were for whatever reason— the supply chain issues began early on\u003cbr\u003etoo and I think that was in my weekly updates. By the second or third one, I had\u003cbr\u003ealready been communicating to our clinicians that PPE [personal protective\u003cbr\u003eequipment] is hard to find. They hadn’t released the national stockpile until\u003cbr\u003elater on but for our sites to be able to get updated PPE, N-95’s and things like\u003cbr\u003ethat, it was already becoming hard to find in early February. Testing supplies,\u003cbr\u003ewe began to have difficulty with getting the swabs and the transport medium and\u003cbr\u003ethat kind of thing. To be able to do the testing, which all had to be sent to\u003cbr\u003ethe state. The process for getting a test, in Idaho you actually had to call the\u003cbr\u003estate first before you sent any test because they were prioritizing testing. So,\u003cbr\u003eyou had to get it cleared that this was a priority patient and then you could\u003cbr\u003esend the test to them. And the other states didn’t require a call but they did\u003cbr\u003erequire this form or two forms to accompany each sample. Those would be\u003cbr\u003ereviewed, and if the patient met the criteria, then they would run the test. If\u003cbr\u003ethey didn’t meet the criteria, they wouldn’t run the test. Early on there was\u003cbr\u003every restrictive testing because it was an asset that we had in short supply. In\u003cbr\u003ehindsight, you know, it was that approach that really made all the difference in\u003cbr\u003eallowing the virus to spread unchecked. Because we were missing so many people\u003cbr\u003ethat could have been tested and might have been positive asymptomatically or\u003cbr\u003epre-symptomatically. The focus on only testing symptomatic people was one of\u003cbr\u003ethose things that really, if we could do it all over again that’s the thing that\u003cbr\u003eI think we would want to do differently. Is have our tests developed faster and\u003cbr\u003enot run into shortages of swabs and either the liquid viral transport medium\u003cbr\u003ethat’s required for the swab to reach the lab. Eventually we got permission to\u003cbr\u003euse just saline, which that was available. That was a game changer because it\u003cbr\u003eallowed us to test more people and get around that supply chain issue.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=10.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Testing was important because— why?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=11.0,11.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Our only tools in the first months of the outbreak were to identify\u003cbr\u003ecases and make sure that we got back to that case, found that case, and had them\u003cbr\u003eisolate so they would stop spreading the disease. If they were indeed not that\u003cbr\u003esick or not symptomatic at all, we needed to communicate that their test was\u003cbr\u003epositive and they needed to isolate. And then we needed to get the interview\u003cbr\u003eprocess going so we could interview them, find out who their contacts were, and\u003cbr\u003emonitor them. Put them in quarantine where we could monitor them for signs and\u003cbr\u003esymptoms. If they developed signs or symptoms, then we would test them. Our\u003cbr\u003eearly tools were identifying cases, isolating them, doing contact tracing,\u003cbr\u003equarantining those contacts, and all that depended on that test. That was the\u003cbr\u003efirst thing that we needed to have happen. Then for folks who may have been\u003cbr\u003earound someone, there were masking and social distancing recommendations that\u003cbr\u003ecame out. You know, about mid-March or so is when that really took on a greater\u003cbr\u003eimportance. We had the different stay-at-home orders from the different states\u003cbr\u003eand that sort of thing. It was in early March, I think a couple days before\u003cbr\u003ethat, maybe March 10th, I was planning to go on vacation with my family. We had\u003cbr\u003ea spring break planned. We had tickets to go see my wife’s family in Japan and\u003cbr\u003eit became quite apparent to me that I was not going. [laughs] It also became\u003cbr\u003eapparent to me, I think, that the best thing for my daughter and my wife to go.\u003cbr\u003eAnd my daughter’s a senior in high school at this time and I just had to tell\u003cbr\u003eher pretty frankly that, “Honey, your senior year is toast. Take everything with\u003cbr\u003eyou. You’re going to Japan with Mom. And I don’t expect you guys back very\u003cbr\u003esoon.” They left around March 10th and my daughter was gone until the summer, so\u003cbr\u003euntil I think it was July when she came back. My wife stayed there even longer.\u003cbr\u003eShe came back after eight months. It was later in the fall that she came back.\u003cbr\u003eYes. That was an added hardship for me in some ways to not have my family with\u003cbr\u003eme. It was also a relief because I didn’t have to worry about them or you know,\u003cbr\u003eI could focus full time on what we were doing. What I was trying to do. I could\u003cbr\u003ego to bed when I wanted to [laughs] and that sort of thing. I just didn’t have\u003cbr\u003ethe support of someone who could help with cooking and you know, things like\u003cbr\u003ethat. So, I was on my own for some of the daily essentials. I also didn’t have\u003cbr\u003ethe interruptions that I would have probably normally had and probably welcomed\u003cbr\u003eand maybe even benefitted from [laughs] by not having my family there. But also,\u003cbr\u003eJapan is a completely different case study. In Japan it’s not controversial at\u003cbr\u003eall to wear masks. It’s always been common if someone either feels ill or feels\u003cbr\u003elike they might get something from somebody, they’ll wear a mask to protect\u003cbr\u003ethemselves or to protect others. There is no stigma about wearing a mask at all.\u003cbr\u003eIn Japan when, for the most part, when the government would declare a lockdown\u003cbr\u003eor a quarantine or stay-at-home orders, at the beginning especially there was\u003cbr\u003eready 100% compliance. Everyone did what they were supposed to do. That’s pretty\u003cbr\u003ecommon in Japanese society in general. There wasn’t protesting and that kind of\u003cbr\u003ething. Even though Japan had cases, they also had I think more testing than we\u003cbr\u003ehad earlier on. They and South Korea and other countries in Asia learned from\u003cbr\u003ethe first SARS outbreak how important testing was and isolation and quarantine\u003cbr\u003eand rapid response to that. I think they did a better job in the early days of\u003cbr\u003edoing that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=11.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e So, did you feel a little isolated though?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=13.0,13.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, absolutely. Absolutely. Emotionally, it was difficult because yes,\u003cbr\u003eI didn’t have much social interaction. I will say however, I live in a\u003cbr\u003eco-housing community, which means that we’re like a condominium but we’re\u003cbr\u003eself-managed. I was also getting asked to provide guidance for my neighbors\u003cbr\u003e[laughs] as well. Like, can we use the common house? Are we still going to have\u003cbr\u003eour potlucks? Are we still going to have our once or twice a week community\u003cbr\u003emeals? Things like that. One of the worst was telling them masks are still not\u003cbr\u003erecommended, we don’t know if it helps or not. Then like an hour or two later,\u003cbr\u003e“Everyone make masks.” [laughs] “Go buy fabric, go buy elastic bands. Start\u003cbr\u003emaking masks. Here’s designs.” Then you know, maybe an hour or two later, “Well,\u003cbr\u003eit might not work that well.” [laughs] Whereas my wife in Japan is like, “You\u003cbr\u003eguys are so dumb.” [laughs] “Masks work. And even if they don’t work that well,\u003cbr\u003ethey don’t hurt anybody. Why aren’t you wearing masks?” I was like, yes. Like\u003cbr\u003ealways, my wife is always right. [laughs] Okay, yes, everybody just make masks.\u003cbr\u003eWe had people who were, in the early days, were staying at home. We’re complying\u003cbr\u003ewith the orders. We want to do something, and so making masks for ourselves,\u003cbr\u003epart of it was making masks for healthcare workers who were running out of PPE.\u003cbr\u003eIt was like, should we be doing that for people at the hospital that’s down the\u003cbr\u003eroad from us? Or people always want to help the tribes and so they wanted to\u003cbr\u003emake masks that I could then send out to people. Actually, some of the best\u003cbr\u003emasks were made by some of the folks in tribal communities who also were making\u003cbr\u003emasks and are great at sewing. There’s a lot of traditional sewing that takes\u003cbr\u003eplace and so I think some of the best masks came from those communities anyway.\u003cbr\u003eThere was that confusion about what works, what doesn’t work, what should we do,\u003cbr\u003ewhat shouldn’t we do, you know? As individual citizens and officially as federal\u003cbr\u003eemployees and that kind of thing.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=13.0,14.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Why do you think there was so much confusion in the very beginning of the\u003cbr\u003emasking? Not masking, masking— yes, we’re masking, well maybe some masking?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=14.0,14.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Well, there were conflicting messages coming from CDC. Since that was\u003cbr\u003eour only source of information that we were allowed to share, you know, it was\u003cbr\u003ekind of like a lot of people felt like yes, masking makes sense. We should do\u003cbr\u003ethat. It doesn’t hurt. But CDC hasn’t said it yet officially. Then you know, it\u003cbr\u003ewas sort of a lukewarm recommendation of you could wear a mask if you wanted to.\u003cbr\u003ePeople may wear masks, rather than should wear masks. In our healthcare\u003cbr\u003esettings, that was different. That was a little bit more— well we weren’t\u003cbr\u003ewearing masks in the healthcare setting initially, everyone. Only in the area\u003cbr\u003ewhere we were seeing potential COVID patients, so seeing respiratory patients.\u003cbr\u003eThen it was, a mask or an N-95. Then OSHA [Occupational Safety and Health\u003cbr\u003eAdministration] regulates N-95 use for employees in healthcare settings and\u003cbr\u003eother employment settings. There are rules and regulations about wearing an\u003cbr\u003eN-95, it’s not a mask it’s a respirator and it’s regulated by OSHA. Our\u003cbr\u003eemployees who were asking to wear N-95s all had to be fit tested to demonstrate\u003cbr\u003ethat they are wearing the right size respirator, that it has a good seal, and\u003cbr\u003ethat it’s actually providing the protection that it’s supposed to. That’s why\u003cbr\u003ethey have these regulations. Because if you wear an N-95 that’s too big or too\u003cbr\u003esmall or doesn’t fit properly, it’s not providing you the protection that it’s\u003cbr\u003esupposed to.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=14.0,15.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The protection comes from filtering through the face mask, or the filtering part\u003cbr\u003eof this respirator. If it’s got gaps on the side or over the nose then the\u003cbr\u003epathogens are going to follow the path of least resistance and they’re going to\u003cbr\u003ecome in through those gaps, and you’re no longer protected. But we hadn’t done a\u003cbr\u003emass fit testing for our staff. We found that there are two ways to do it. Many\u003cbr\u003elarge hospital systems have a qualitative, testing systems and CDC has this,\u003cbr\u003ethey have a machine, you hook up a tube to the N-95 and you breathe through it.\u003cbr\u003eIt tells you, quantitatively, I’m sorry, how much of a seal you have and what\u003cbr\u003ethe pressures are and things like that. Most places, most small healthcare\u003cbr\u003eplaces, which we are, use qualitative testing. That means you wear the mask, you\u003cbr\u003eput on a hood, and you spray something and see if you can taste or smell it. We\u003cbr\u003eusually use saccharin spray, which will taste sweet if it gets into your mouth.\u003cbr\u003eWell very quickly, there was a shortage of those sprays that are used for fit\u003cbr\u003etesting. We had [laughs] that constraint as well. We had one of our six service\u003cbr\u003eunits had an extra set of sprays, and so we then mailed those around to the\u003cbr\u003edifferent sites. You know, sent it to one site, when they’re done with it, they\u003cbr\u003esent it to the next site, send it to the next site. Trying to rapidly get all of\u003cbr\u003eour staff fit tested that would need to be fit tested to wear N-95s.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=15.0,16.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We had a lot of N-95s in a stockpile from H1N1 [H1N1pdm09 virus] and these had\u003cbr\u003evariously gotten extensions of their shelf life for being still functional. They\u003cbr\u003ewere kind of running low [laughs] on their shelf life but the ones we had were\u003cbr\u003estill valid to be used. Those were what we were able to use initially, and we\u003cbr\u003ewere able to use our— IHS runs a national supply service center located in\u003cbr\u003eOklahoma City. That’s kind of our main clearing house for supplies and\u003cbr\u003emedications and vaccines and things like that. We were able to get some things\u003cbr\u003efrom them. Once stuff started coming out from the national stockpile, we could\u003cbr\u003eeither get them through that source or through our states. Both of them were\u003cbr\u003egetting allocations [from the stockpile], and so that was helpful. In short time\u003cbr\u003ewe had boxes and boxes of N-95s and one of the things I remember thinking was,\u003cbr\u003eyes, we need these for our staff but we’re not doing critical care for very sick\u003cbr\u003epatients. We stopped doing any aerosol generating procedures within our clinics\u003cbr\u003eso the need of having to wear an N-95 to avoid any kind of aerosolization was\u003cbr\u003ereally low. At that time, hospitals and things like that were really in need. I\u003cbr\u003efelt like, I wonder if we should redistribute some of these to our local\u003cbr\u003ehospitals. You know, we didn’t do that because if we gave those away, we\u003cbr\u003ewouldn’t know when we would get more back. We continued to use what we had for staff.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=16.0,17.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e You never experienced a shortage?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=17.0,17.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e No, I don’t think we ever experienced a severe shortage of N-95s, masks,\u003cbr\u003eor gowns. We were impacted by the shortages of vaccine transport medium for a\u003cbr\u003eshort time until they said, well you could just use saline if you have to. That\u003cbr\u003eallowed us to be able to do that. I think we did have short term shortages of\u003cbr\u003ethe swabs as well, but the folks in Oklahoma City at that center were able to\u003cbr\u003ereach out. We had additional spending authorities to engage in contracts that\u003cbr\u003eallowed us to reach out to other vendors that we hadn’t normally worked with.\u003cbr\u003eSometimes paying through the nose and then of course there were a lot of\u003cbr\u003eallegations of fraud from some of those vendors that jacked up the prices of\u003cbr\u003ethings in order to make them available to us. You know, we didn’t have much of a\u003cbr\u003echoice. If we really needed something and there was only one or two sources to\u003cbr\u003eget it from, we just had to pay the price.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=17.0,18.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"One of the other things that I spent a lot of time thinking about and not\u003cbr\u003eknowing really whether we could or how we could do something, was we were seeing\u003cbr\u003ethe pictures from China initially and then from New York City that these\u003cbr\u003epatients were being put into these temporary facilities. Temporary hospitals.\u003cbr\u003eField hospitals, if you will. In China, it was if you were exposed then you were\u003cbr\u003eput into these quarantine, mass quarantine centers, right? We didn’t have\u003cbr\u003eanything like that. In some of our pandemic planning there was allusion to being\u003cbr\u003eable to do that, but nobody really had concrete plans on how that might work.\u003cbr\u003eOnce we had the emergency declarations and FEMA [Federal Emergency Management\u003cbr\u003eAgency] was brought on board, we quickly learned that FEMA would be the resource\u003cbr\u003ethat we would turn to, to help us plan for setting up any kind of structure like\u003cbr\u003ethat and would provide the material and the funding for putting it together. But\u003cbr\u003ethey didn’t have a staffing package for it. That became, for me, the critical\u003cbr\u003equestion. Like I think we could probably build this if we needed to in a tribe\u003cbr\u003eor at one of our facilities, but who’s going to staff it? Who’s going to be\u003cbr\u003ethere twenty-four hours if someone is there and gets sick and needs to be seen\u003cbr\u003eby a provider? Needs to be transported somewhere? I mean, there were so many\u003cbr\u003equestions about that, and we didn’t have any experience or resource at that time\u003cbr\u003eto think through that. So, one of our—go ahead.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=18.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e In April, end of April, President Trump launches Operation Warp Speed and\u003cbr\u003ethat is creating a vaccine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Which is pretty early on, for April.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=19.0,19.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. Yes, I was part of that because I was on the ACIP representing IHS\u003cbr\u003eat the time. With that effort there were a lot more meetings that suddenly came\u003cbr\u003eonto my schedule. There was the COVID-19 work group for ACIP and I joined that.\u003cbr\u003eIn addition, I was on other work groups, those other work groups really slowed\u003cbr\u003etheir cadence, the pneumococcal vaccine work group and some of the other work\u003cbr\u003egroups kind of took a backseat to the COVID-19 work group. Because we were\u003cbr\u003emeeting like every week for a while and then every two weeks at some times. Then\u003cbr\u003ejust before any new change or considerations were coming, then we were meeting\u003cbr\u003esometimes twice in a week. We had the ability to have presentations from Pfizer,\u003cbr\u003efrom Moderna, directly to the work group so that we could learn what they were\u003cbr\u003edoing. All of that was held in the strictest confidence. It was a challenge to\u003cbr\u003ehear what they were working on and not be able to talk about it outside of the\u003cbr\u003ework group. You know, I could only say that we heard from, maybe I could mention\u003cbr\u003ethat we heard from them about the developments. But I couldn’t say anything\u003cbr\u003ereally about any of the details. Being on the work group allowed me to be able\u003cbr\u003eto listen to all of the CDC experts that were also on the work group and be\u003cbr\u003eprivy to their thinking. You know, what they were thinking about. What their\u003cbr\u003econsiderations were.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=19.0,20.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/53","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Early on, discussions about equity were an important part of what the COVID-19\u003cbr\u003ework group worked on. I really appreciated that because as we were by then\u003cbr\u003eseeing in April and May, how the Navajo nation was impacted early on by COVID\u003cbr\u003eand how it just rapidly spread through those communities. Which frankly was a\u003cbr\u003ebit surprising, because you know, I haven’t worked on Navajo but I’ve been\u003cbr\u003earound there and there’s large distances between the population centers on the\u003cbr\u003ereservation. Then many of the people live quite a ways from their neighbors. I\u003cbr\u003emean, miles apart sometimes. But the challenge is they don’t have running water.\u003cbr\u003eThey don’t have electricity. Communication is a challenge. They don’t have the\u003cbr\u003einternet in many of these places. There’s such a challenge of getting\u003cbr\u003einformation to folks in those regions. If you can’t wash your hands, if you\u003cbr\u003edon’t have a ready water supply, you can’t wash your hands, then a disease like\u003cbr\u003ethis is going to spread really easily. Even though there’s a large distance\u003cbr\u003ebetween houses out on Navajo, the houses are small and the families are large.\u003cbr\u003eThere are many people living under the same roof. That’s not unique to Navajo,\u003cbr\u003ethat’s true throughout Indian country and in our region too. I think that’s one\u003cbr\u003eof the issues that we faced early on with cases. That you know, sometimes we\u003cbr\u003ewould have outbreak clusters that were related to an event like a funeral or\u003cbr\u003esome other social gathering. Usually, it was related to household clusters,\u003cbr\u003ebecause there were ten people in that household. When one person got it, it very\u003cbr\u003equickly spread to the other people. On some level I thought, well I would have\u003cbr\u003ethought that maybe Navajo would have been more protected because of these large\u003cbr\u003edistances. It wasn’t really too much of a surprise how heavily they were impacted.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=20.0,21.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There were other stories we were hearing from other parts of Indian country.\u003cbr\u003eWhere I started my public health service career with the White River service\u003cbr\u003eunit in Arizona, White Mountain Apache actually stood up their incident command\u003cbr\u003eand their response. They actually had some really early on great success\u003cbr\u003estories. A big part of that was being able to mobilize a team to be able to go\u003cbr\u003eout and visit people in their homes. They had an article in, I think it was New\u003cbr\u003eYork Times Magazine, if you haven’t seen that I think I have a copy or a link to\u003cbr\u003ethat I can send. You know, one of the stories they shared was that they would go\u003cbr\u003eto see a patient that they knew had been exposed or had a positive test and they\u003cbr\u003ewere following up on that person with a positive test to see how they were\u003cbr\u003edoing. As they made that home visit, they would look and they would see the\u003cbr\u003eelder in the kitchen in the corner who hadn’t come in for testing who looked\u003cbr\u003esicker than the person they came to see. They identified that very ill person,\u003cbr\u003ewere able to get them into care, and that was a big factor in the success of\u003cbr\u003etheir home visiting program. Yes, they were able to follow up on the people they\u003cbr\u003eintended to follow up, but they found all these other people who were also ill\u003cbr\u003eor maybe even sicker than the persons that they were trying to visit. We were\u003cbr\u003eall trying to set up some kind of outreach to the communities by partway through\u003cbr\u003eMarch and April.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=21.0,22.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Our cases were really slow in starting. We had trickling cases in March but then\u003cbr\u003eby April we started to have more and more cases. We were trying to get ready for\u003cbr\u003ethat because we had in our six service units, we have public health nurses in\u003cbr\u003ethree of them that we manage. In the other three the public health nurses are\u003cbr\u003emanaged by the tribes themselves. Those three service units that were tribally\u003cbr\u003eoperated, only one of them really had public health nursing capacity at the\u003cbr\u003etime. The other two did not. They had a couple of community health nurses, but\u003cbr\u003ecommunity health nurses are different. They’re the people who maybe help make\u003cbr\u003esure someone gets oxygen for their chronic lung disease or wound care supplies\u003cbr\u003eor ostomy supplies and things like that. They may be doing home visits to check\u003cbr\u003eon people with chronic illnesses. They weren’t in the job of doing contact\u003cbr\u003etracing and case investigation. Our EIS officer, Alex Wu, he got materials\u003cbr\u003etogether through working with the states and from CDC and from IHS. He went out\u003cbr\u003eand he did trainings on contact tracing and case investigation in these\u003cbr\u003ecommunities so that they would be able to have a workforce that was trained and\u003cbr\u003ecould respond. Early on, the states asked the tribes, do you want the local\u003cbr\u003ehealth jurisdiction to do these case investigations for your patients or do you\u003cbr\u003ewant to do it yourself? I was a bit surprised that the vast majority of our\u003cbr\u003etribes responded and said no, we want to do it ourselves. This was something\u003cbr\u003ethey hadn’t been in the habit of doing. Whether it was pertussis cases or\u003cbr\u003esexually transmitted infections or TB [Tuberculosis] or anything else, most of\u003cbr\u003ethe time those things were being investigated and followed up and contact\u003cbr\u003etracing done by the local health jurisdictions. The county health departments\u003cbr\u003earound those tribal lands. In some coordination and consultation, oftentimes the\u003cbr\u003ecounties are— they don’t feel like they have the ability or the right to just go\u003cbr\u003eon the reservation and talk to folks. They always want to try and coordinate and\u003cbr\u003eget permission to do that. In this case, the tribes were saying no. I think they\u003cbr\u003eprobably felt early on that this was an existential threat and they wanted to be\u003cbr\u003ethe ones to really take care of their people. There’s also some legacy from H1N1\u003cbr\u003eand some of the other past interactions with government that the tribes were\u003cbr\u003eunderstandably reluctant and skeptical the government would be able to take care\u003cbr\u003eof their needs.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=22.0,23.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I mentioned earlier about the ICS and the health board had its ICS and IHS had\u003cbr\u003eits ICS. In the health board ICS, they began a data collection of cases, testing\u003cbr\u003eand cases from each of the tribes. It was voluntary. Each day the tribes, and\u003cbr\u003ethis is still ongoing, each day the tribes were asked to fill out like this\u003cbr\u003esurvey— SurveyMonkey survey that gave the basic information about how many\u003cbr\u003epeople were tested, how many people were positive, how many were negative, how\u003cbr\u003emany were hospitalized, and how many had died. We didn’t have 100% reporting\u003cbr\u003efrom all of the tribes on that. Not on every day and not on any day. We only\u003cbr\u003ecollected information when we received it and it was voluntary. We couldn’t\u003cbr\u003ecompel that information collection. This was to support IHS’s effort to collect\u003cbr\u003ethe same information. What IHS set up at a national level was a spreadsheet that\u003cbr\u003ewould be completed every day and then forwarded to headquarters. Well, it’s\u003cbr\u003eforwarded to the area and the area person compiles it and then sends that area\u003cbr\u003ereport or area spreadsheet to national. At the national level I think there was\u003cbr\u003ejust one person who would receive these national reports and have to collate\u003cbr\u003ethose national reports into a daily report. The information is only based on\u003cbr\u003etesting. It’s only based on the patients who were tested in our facilities. A\u003cbr\u003esite could report on tests that were done elsewhere that they knew about. Like,\u003cbr\u003eyou know, we had three patients who got tested at the hospital this week and\u003cbr\u003ethis is their results. They could add in that information. It was really about\u003cbr\u003ecollecting on the testing that we were doing. We don’t know how many of those\u003cbr\u003etests were conducted by us and how many of those tests were conducted outside of\u003cbr\u003eour system. Moreover, the tool was designed to be as quick as possible and tried\u003cbr\u003eto be as low of a burden as possible. There was no information collected on\u003cbr\u003edemographic variables or risk factors or underlying conditions or, when they\u003cbr\u003ebecame available, vaccine status. Those kinds of things. To this day, that’s the\u003cbr\u003eonly information that IHS has.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=23.0,24.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Oh, really? They didn’t get updated or adjusted?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=24.0,24.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e No. No. In a recent conversation with someone at, you know, one of the\u003cbr\u003ehighest levels [laughs] in our agency, I confirmed this. I said, “So, if someone\u003cbr\u003easked you for the age breakdown or the sex breakdown of our patients, you\u003cbr\u003ecouldn’t tell them, could you? If they asked you how many of our patients were\u003cbr\u003ehospitalized or died, you couldn’t tell them, could you?” Because we don’t have\u003cbr\u003ethat information. This is probably, for me, the most vexing part of our\u003cbr\u003eresponse, what hampered me the most as an epidemiologist. CDC and NIH [National\u003cbr\u003eInstitutes of Health] use a system called REDCap [Research Electronic Data\u003cbr\u003eCapture], which is not that different than SurveyMonkey in the sense that you\u003cbr\u003eget a link, you open that link, and you have like a survey. You fill in the\u003cbr\u003esurvey and then it goes to a server. Then there are some tools within REDCap\u003cbr\u003ewhere you can do data analysis or you can export it to SAS [Statistical Analysis\u003cbr\u003eSystem] or [Microsoft] Excel or whatever you want to work in. However, complex\u003cbr\u003eyou are. You can do more analysis of that. You have certain functionalities. You\u003cbr\u003ehave fields that are validated. You can only put in information like yes or no,\u003cbr\u003enot a mixture of yes, no, plus signs and minus signs. P or N or [laughs] Y or\u003cbr\u003ethings like that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=24.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There are data quality parameters set for the field so that you get consistent\u003cbr\u003edata, so that you don’t have to spend hours and hours cleaning the data before\u003cbr\u003eyou can actually analyze it. Stop me if I’m getting too deep in the weeds of\u003cbr\u003ethis stuff. [laughs]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e It’s okay.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=25.0,25.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e But for an epidemiologist, these are the kinds of things that you know,\u003cbr\u003eit’s like talking to a carpenter about the right kind of wood or nail or screw\u003cbr\u003eto use. Or the right kind of chisel to use for this particular thing. We need\u003cbr\u003ethe right tools to do our job. So, NIH uses REDCap, they have used this for a\u003cbr\u003elong time for many of their research studies. It’s HIPAA [Health Insurance\u003cbr\u003ePortability and Accountability Act] compliant. It’s secure enough for NIH to\u003cbr\u003ecollect very detailed information about people participating in clinical trials.\u003cbr\u003eCDC uses REDCap. Many of our states when their information systems for\u003cbr\u003ecollecting cases, their usual systems became overwhelmed. There was just no way\u003cbr\u003ethey could handle the volume that was coming into their usual systems. They\u003cbr\u003eturned to REDCap to be a way that they could offset that load and more quickly\u003cbr\u003eget the information they needed. If you sign up with REDCap, it’s free. You have\u003cbr\u003eto have the server and infrastructure and stuff, but you design your own data\u003cbr\u003ecollection forms in this system to meet your needs. Then people put in the\u003cbr\u003einformation, and then you see the information. There were also some other, you\u003cbr\u003eknow, black box tools that were made available to in different jurisdictions to\u003cbr\u003ehelp with contact tracing and case investigation. None of those could be\u003cbr\u003eapproved by IHS to be used.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=25.0,26.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Do we know why?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=26.0,26.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. [laughter]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=26.0,26.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Are you willing to comment on why?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=26.0,26.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Absolutely. It comes down to, you know, a bureaucratic red tape issue.\u003cbr\u003eIt may have something to do with interpretation of rules and regulations. It may\u003cbr\u003eactually be, they were actually right on some level. When other HHS [Health and\u003cbr\u003eHuman Services] agencies can use this software to collect HIPAA protected\u003cbr\u003einformation and we’re in a pandemic, it seems to me that when it comes to\u003cbr\u003esecurity and those kinds of things, better funded agencies than ours have\u003cbr\u003ealready gone through this and determined that it’s okay. Our agency, which is\u003cbr\u003eseverely underfunded, determined that they weren’t secure enough for us to use,\u003cbr\u003enumber one. Number two, they determined that it would actually be considered a\u003cbr\u003esystem of record. Which is an OMB [Office of Management and Budget] term, or\u003cbr\u003eyes, I think OMB. You have to go through certain steps to be able to adopt a new\u003cbr\u003esystem of record. It has to meet like all the national archives criteria and\u003cbr\u003ethings like that. It’s a federal system of record and so it has to meet all\u003cbr\u003ethese specified criteria. You have to, you know, request that or apply for that\u003cbr\u003eand demonstrate that you have a need for this and that this meets that criteria\u003cbr\u003eand all of that. That probably takes a couple of years [laughs] for most\u003cbr\u003esystems, I would imagine. What they determined was that we had an electronic\u003cbr\u003ehealth record, which is our OMB authorized system of record. They felt that, you\u003cbr\u003eknow, we could not justify requesting a new system of record. Myself and several\u003cbr\u003eother people, we tore our hair out time and time again when we had these\u003cbr\u003ediscussions because we could not make any headway with the folks at headquarters\u003cbr\u003ewho were making these decisions. You know, our office of technology and it still\u003cbr\u003edefies logic for me. That a pandemic of this scale was not justification enough\u003cbr\u003eto have a system of record or that we could get some kind of a waiver from OMB\u003cbr\u003eto adopt this now and do the paperwork later or something. Of course,\u003cbr\u003ebureaucracy can’t operate like that, right? You can’t say let us have it now,\u003cbr\u003ewe’ll get back to you later with our promise to comply with all the rules and\u003cbr\u003eregulations. I understand that on some level, but no one was willing to go to\u003cbr\u003ebat for us. No one could look and say—Hey NIH, can we tag on, or CDC can we tag\u003cbr\u003eonto your OMB authorization for using this system? If they had one. Or if CDC\u003cbr\u003edoesn’t have an OMB authorization for this as a system of record, then why in\u003cbr\u003ethe hell do we have to have that? Are we being held to a different standard and\u003cbr\u003eis it a matter of people’s interpretation of those standards? These are the\u003cbr\u003equestions I still have. I don’t know the answers to these.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=26.0,28.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I tried working with our public health nurses. Particularly one of our service\u003cbr\u003eunits, the Yakama service unit which serves the Yakama Nation, was being really\u003cbr\u003ehard hit. They are the biggest of our service units. They’re user population is\u003cbr\u003earound 12,000. I think the enrollment of the tribe is even more than that. They\u003cbr\u003ewere having a lot of cases when this happened. We only had one of four public\u003cbr\u003ehealth nurses filled, so there were three vacant positions. So, she was working—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=28.0,28.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the one public health nurse, Marie Bastin, was working really hard to try and\u003cbr\u003eset things up and put things together. You know, she developed a spreadsheet and\u003cbr\u003ethat became her system of record for tracking cases and contacts. Eventually we\u003cbr\u003ewere able to establish an agreement with the tribe, but it took a long time to\u003cbr\u003eget this agreement through where the tribe would assist with the contact tracing\u003cbr\u003epiece. As a federal employee the public health nurse was primary in charge of\u003cbr\u003ethe case investigation. She had the information in the electronic health record\u003cbr\u003eof a positive test. She had their contact information in that electronic health\u003cbr\u003erecord. She would reach out by phone if she could and talk to them and do the\u003cbr\u003eclinical follow up a little bit. Like, give them guidance if they’re sick, when\u003cbr\u003ethey need to go to the hospital. Then she would each day provide information to\u003cbr\u003ethe contact tracers about the contacts that needed to be followed up. She was\u003cbr\u003eactually doing the case interviews and then she would collect the names of the\u003cbr\u003epeople that were contacts, and she would share that with the contact tracers.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=28.0,29.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The difficulties around HIPAA and interpretation of HIPAA and trust between the\u003cbr\u003etribe and IHS were such that initially, we couldn’t share with them who the case\u003cbr\u003ewas. I’m not sure how this played out in other jurisdictions. You know, when\u003cbr\u003ethey’re doing contact tracing, are they saying, “You were exposed to Mary A.\u003cbr\u003elast week and we’re calling to follow up and see if you have symptoms or can you\u003cbr\u003eget tested or have you been tested?” I mean, usually in case investigation and\u003cbr\u003eparticularly if it’s a sensitive thing, you’re not going to disclose who the\u003cbr\u003ecase was. You would just say, “We know that you were exposed to somebody”. So\u003cbr\u003ethere really wasn’t necessarily a need for the contact tracers to know who this\u003cbr\u003eperson was. One of the issues was, in the communities everyone knows everyone.\u003cbr\u003eIf you know who the case was, you know that out of these three contacts you’re\u003cbr\u003egiven, you know the whole family and there’s ten more [laughs] that should be on\u003cbr\u003ethis list that aren’t on this list. You would know that if you knew who the case\u003cbr\u003ewas. There were reasons why I think the contact tracers probably should have had\u003cbr\u003ethat level of information. Eventually I think we did iron that out where they\u003cbr\u003ecould have that, but we had to really make sure that they were on board with,\u003cbr\u003eyou know, HIPAA compliance and not revealing that to other people. Either the\u003cbr\u003epeople they’re calling or anyone else that they might talk to about their work.\u003cbr\u003eFamily members, council members, things like that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=29.0,30.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There were pressures early on from tribal councils, not just there but other\u003cbr\u003etribal councils, where council members wanted a list every day of who was\u003cbr\u003epositive. Especially in the early days. Because you know, if they had one case\u003cbr\u003eor two cases, they wanted to know who it was. We had to like push back and say,\u003cbr\u003e“We can’t tell you.” [laughs] “We’re not allowed to tell you. It wouldn’t be\u003cbr\u003egood for that person, for you to know, for everyone to know that they have\u003cbr\u003eCOVID.” Right? Try and really explain the nuances of the stigma and everything\u003cbr\u003elike that that would quickly arise. On the other hand, when IHS is providing the\u003cbr\u003ecare and the tribes providing the support, including the home visits, and\u003cbr\u003edelivering food boxes and delivering oxygen sensors for family to have at home\u003cbr\u003eand thermometers and over the counter medications for someone who might have\u003cbr\u003eCOVID. They need to know where to go. [laughs] And as soon as they get the\u003cbr\u003eaddress, they’re going to know who lives there. You know, at some level we had\u003cbr\u003eto be able to share information and work together. It was a rocky road for many\u003cbr\u003ereasons initially.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=30.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Has that rocky road gotten a little bit smoother?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e The road’s closed now. [laughter] Right? We don’t do case investigation\u003cbr\u003eor contact tracing anymore. We do case investigation but not contact tracing.\u003cbr\u003eSome of the tribes have stopped almost all of their COVID activities.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Really?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Is that because the vaccine came out and everybody got vaccinated and\u003cbr\u003eeverybody’s complacent?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Part of it I think is that the funding has run out, so they’ve spent all\u003cbr\u003ethe COVID funding that they received. There isn’t any new or ongoing COVID\u003cbr\u003efunding coming, so there’s that. There’s also the desire to get back to normal.\u003cbr\u003eYou know, schools are opening up. Businesses are opening up. Things like that.\u003cbr\u003eAnd we do have the vaccines and we have treatments available. In many of these\u003cbr\u003ecommunities, like you know, there are still county and local health\u003cbr\u003ejurisdictions that are working to still track cases and provide guidance and\u003cbr\u003ethings like that. Almost everything now is such that, you know, yes, there’s not\u003cbr\u003emuch of a response left to COVID anymore. Anywhere you go.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Is that due at all the vaccine coming out and the lack of funding, I guess?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,31.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e The response has pretty much stopped because we have vaccines and\u003cbr\u003ebecause we have treatments. Because people are not dying at the rates that they\u003cbr\u003ewere dying initially. Of course, the economy can’t handle being closed for all\u003cbr\u003ethat time. As far as masking and some of the other social distancing things, in\u003cbr\u003emy opinion those should still be ongoing. Because they work. Because not\u003cbr\u003eeveryone is vaccinated. Because these variants keep coming out and because like\u003cbr\u003eit or not, COVID has an asymptomatic and pre-symptomatic period that that is\u003cbr\u003ethe, I don’t know what the right term is. The coup de grâce? I don’t speak\u003cbr\u003eFrench [laughter] but I mean, that’s the thing that sets this virus apart from\u003cbr\u003eflu or other things is that piece. Because people can be infected, not know it,\u003cbr\u003eand spread it. As long as that continues, we really should be wearing masks.\u003cbr\u003eEven I have been to gatherings recently where initially I wear my mask. I’m the\u003cbr\u003eonly person in the room wearing a mask, or one of five or something. I’m like,\u003cbr\u003eit feels safe, it could be safe. I’ve got all my boosters. I’ve got my bivalent\u003cbr\u003ebooster. I think I’m going to take my mask off. You know? Especially if I have\u003cbr\u003eto speak and I want to be heard. It’s hard to speak through the mask. I’ll tell\u003cbr\u003eyou in a week if I got COVID or not. [laughs]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=31.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Yes, same here. I’m probably one of the few people wearing a mask when I go\u003cbr\u003eto the large gatherings. If ever I’m on a plane, I’m probably the only one on\u003cbr\u003ethe plane wearing a mask.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=32.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, yes. Airports I do. Grocery stores I do. Because, you know, I don’t\u003cbr\u003eknow anybody at the grocery store. They don’t need to see me if I have a\u003cbr\u003emustache or not. [laughter] I’m here to buy stuff, you know? Gosh, especially\u003cbr\u003elike Costco or something. Yes. You don’t need to see my face. It’s okay.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=32.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Now I want to return back to vaccines, and you’re work. The ACIP and how you\u003cbr\u003ewere able, you were privy to what was going on and how that felt with that\u003cbr\u003einformation and not being able to share it. Thank God your family wasn’t there\u003cbr\u003ebecause you probably would have inadvertently said something.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=32.0,32.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. Related to that, IHS headquarters set up a Vaccine Task Force. When\u003cbr\u003eOperation Warp Speed was first announced, it was within the first weeks of\u003cbr\u003eOperation Warp Speed, IHS set up a Vaccine Task Force to prepare and plan for\u003cbr\u003ethis. We had staff who were embedded with ASPR [Administration for Strategic\u003cbr\u003ePreparedness and Response], the Assistant Secretary for Prevention and Emergency\u003cbr\u003eResponse. I’m a terrible bureaucrat. I can’t remember acronyms to save my life.\u003cbr\u003eWe had folks from IHS from, mostly these were pharmacists, from either the\u003cbr\u003eOklahoma City National Service Supply Center or from the Vaccine Task Force, who\u003cbr\u003ewere pharmacists from different parts of the country who were specifically asked\u003cbr\u003eto participate or take on leadership roles within the task force and stepped up\u003cbr\u003eto do that. These folks were embedded with folks at ASPR and in Operation Warp\u003cbr\u003eSpeed, so they were there with them as things were developing. Then they would\u003cbr\u003ereport back to the Vaccine Task Force about how things were developing. There\u003cbr\u003ewas this other channel too where some of the information that I was hearing\u003cbr\u003ethrough ACIP, you know, we were hearing it from these folks as well. From the\u003cbr\u003eOperation Warp Speed directly. You know, one of the main lessons that we learned\u003cbr\u003efrom H1N1 was when that vaccine was developed and rolled out, and the nature of\u003cbr\u003eH1N1 was such that it really affected younger people and middle-aged people more\u003cbr\u003ethan older people for whatever reason. We still don’t know why. When the vaccine\u003cbr\u003ecame available, the priority population was those younger and middle-aged\u003cbr\u003epeople. Not the elders. And in tribal communities, elders are like the most\u003cbr\u003erevered. Those are your traditions, your knowledge keepers, you want to protect\u003cbr\u003ethose folks. They’re usually the older, more vulnerable part of the population\u003cbr\u003etoo. It was completely opposite to anything that the tribal communities were\u003cbr\u003eused to or expected or planned for when H1N1 came out. There was pushback,\u003cbr\u003ebecause CDC said you have to use this vaccine in the way that its detailed and\u003cbr\u003eyou can’t deviate from that. They called them deviations. [laughs] If a tribe\u003cbr\u003esaid, yes, we’ll get the vaccine but we’re going to use it however we want to.\u003cbr\u003eYou can’t tell us what to do, we’re a sovereign nation. The sparks flew over\u003cbr\u003ethose issues with H1N1.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=32.0,33.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The other thing that happened was that as sovereign nations, they expected to\u003cbr\u003edeal directly government to government. Like tribe and federal government. That\u003cbr\u003elevel of government interaction. For tribes, it’s an insult to say, you have to\u003cbr\u003ework with your county. They are more and more willing to work with the state in\u003cbr\u003elieu of the federal government, but not the county. We heard this in every after\u003cbr\u003eaction, every emergency preparedness meeting we had after H1N1, we would have\u003cbr\u003ediscussions about this particular issue. It was really well known, particularly\u003cbr\u003ein Washington state, that if we’re going to have any kind of an asset delivered\u003cbr\u003elike this again to tribes, the state has to be the one that delivers it and not\u003cbr\u003ethe county. Because the state can maintain a certain level of responsibility and\u003cbr\u003einteraction with the tribes on a government-to-government basis. It won’t be\u003cbr\u003eleft up to some county person who might not have a good rapport with the tribe\u003cbr\u003eand might not have the same level of respect for tribal needs or tribal wishes.\u003cbr\u003eThat lesson was learned. I’m thinking particularly Washington state, which is\u003cbr\u003ewhere it came up a lot. When COVID vaccines were being readied for roll out, IHS\u003cbr\u003efor the first time was being looked at as a jurisdiction. In H1N1 we weren’t\u003cbr\u003ereally a jurisdiction. We got a little bit of extra H1N1 vaccine that we could\u003cbr\u003eallocate each week for our healthcare workers but we weren’t given a full\u003cbr\u003eallotment as a jurisdiction. This time, we were. I think our membership, our\u003cbr\u003eembedding of people with Operation Warp Speed, and our Vaccine Task Force and\u003cbr\u003eour headquarters incident command and the level of interaction there really made\u003cbr\u003eit possible for that to happen. There was a lot of skepticism at first because\u003cbr\u003epreviously IHS said the central Oklahoma City National Service Supply Center did\u003cbr\u003enot have the surge capacity to handle receiving from the Strategic National\u003cbr\u003eStockpile or from any other large federal repository, how to get that back out\u003cbr\u003ethen to the sites. We don’t have the ability to bring in 100 new warehouse\u003cbr\u003eworkers to do that work. They never really wanted to do that, but through the\u003cbr\u003ediscussions and how things were going to work out, you know, they took on a\u003cbr\u003eleadership role as well to dispense some SNS [Strategic National Stockpile]\u003cbr\u003esupplies. The vaccine was outside of the Strategic National Stockpile. So, the\u003cbr\u003evaccine was going to go to jurisdictions, which included states, territories,\u003cbr\u003eand federal entities like DOD [Department of Defense], VA [Veterans Affairs],\u003cbr\u003eand Indian Health Service. We were getting our own allotment.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=33.0,35.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Then we tried to have a— things were moving so fast we couldn’t do our usual\u003cbr\u003etribal consultation with tribes, which requires a certain amount of time of\u003cbr\u003enotice that there’s going to be a tribal consultation so they can prepare. Then\u003cbr\u003ethe tribal consultation occurs. Then the decisions that follow after that tribal\u003cbr\u003econsultation are then vetted and happen. That’s how it normally would work out.\u003cbr\u003eThere just wasn’t time to do that fully so they had tribal listening sessions, I\u003cbr\u003ethink they were called, convened by HHS and IHS to try and get feedback from the\u003cbr\u003etribes. One of the things was, do you want to get your vaccine from IHS, or do\u003cbr\u003eyou want to get it from the states? That was kind of the way we determined the\u003cbr\u003ebest we could do to honor tribes and recognize their level as sovereign nations,\u003cbr\u003eand yet not compel the vaccine distributors to have to ship, to make those\u003cbr\u003eagreement with all 574 individually recognized federal tribes and all the\u003cbr\u003estates. We have to somehow streamline this distribution to larger scales because\u003cbr\u003esome tribes are very small. Some tribes are very large. None of them is as large\u003cbr\u003eas the state. Well except Navajo nation, it’s probably as large as Montana\u003cbr\u003eperhaps. [laughs] That was sort of the decision made through Operation Warp\u003cbr\u003eSpeed and it took a lot of talking to the generals of Operation Warp Speed, to\u003cbr\u003ereally explain to them how IHS works, who tribes are, what their status is.\u003cbr\u003eBecause they had never had to work with tribes before. We really had to fight\u003cbr\u003estrongly to get that in place, to say we need to provide this choice to tribes\u003cbr\u003eand if it comes to IHS, we’ll manage the orders and help with the distribution.\u003cbr\u003eThen if the tribes choose to go with the state, then the state will manage that.\u003cbr\u003eIn our area, I think overall in IHS about 300, it kept fluctuating so between\u003cbr\u003e330 and 350 or so, of the tribes in IHS of the 574 federally recognized tribes\u003cbr\u003echose to go with IHS as their point of contact for distribution.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=35.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e And the others picked their states?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=36.0,36.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, they went with their states. You know, and I don’t mean this to be\u003cbr\u003eflippant or disrespectful or anything, but it kind of came down for the tribes,\u003cbr\u003eit came down to which of these government entities do you trust the most? Which\u003cbr\u003eof these has harmed you the least in your recent memory or recent history? Or\u003cbr\u003eever? You know? It was a tough decision I think for tribes because you know, for\u003cbr\u003esome tribes, like they don’t trust the state or the national government or IHS.\u003cbr\u003eI think it was really tough for them. Some of them still really wanted to have\u003cbr\u003etheir own distribution and not have to go through state or IHS, but it was the\u003cbr\u003ebest plan that we could come up with to distribute a scarce resource in as\u003cbr\u003etimely a manner as possible in keeping with the goals of Operation Warp Speed.\u003cbr\u003eIt worked quite well. We got our first vaccine distributed in December along\u003cbr\u003ewith everyone else. We were part of the first allocation. The challenges of\u003cbr\u003ehaving the ultra-cold freezers to handle the Pfizer vaccine, that was one of the\u003cbr\u003ebig challenges. Like nobody had those— except one site, and that was the Lummi Nation.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=36.0,37.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The Lummi Nation is located up near Bellingham, Washington. They were pushing\u003cbr\u003ethe envelope through many parts of the earlier part of the pandemic. They struck\u003cbr\u003eout on their own to try and put together a field hospital on their land. I have\u003cbr\u003eto preface this to say, none of our tribes or IHS operate a hospital in our\u003cbr\u003ethree-state area. They’re all ambulatory care centers. To set up a hospital\u003cbr\u003ewould be unprecedented. I think in the distant past there were a couple of IHS\u003cbr\u003ehospitals, but none exist today. To set up a hospital would be something new and\u003cbr\u003eunprecedented. But the Lummi were so adamant about trying to protect their\u003cbr\u003epeople. They wanted to do everything they could. They were seeing what I was\u003cbr\u003eseeing, what we were all seeing on T.V. and stuff where we were like, you know,\u003cbr\u003eour local hospital in town might become overwhelmed. When push comes to shove,\u003cbr\u003ethey felt as Indian people that they would not get fair treatment. They felt\u003cbr\u003elike in case that happens, we need to be able to provide for our own. That was\u003cbr\u003ewhat was behind that. I think they purchased a modular building. They started\u003cbr\u003epurchasing equipment to put it together and set it up. They were trying to\u003cbr\u003edevelop policies and procedures. I can put you in touch with folks if you want\u003cbr\u003eto learn more about that. They also were participating initially in the\u003cbr\u003eAstraZeneca trial in the US. As part of that participation, they had an\u003cbr\u003eultra-cold freezer. That’s why the first vaccines in our area were shipped\u003cbr\u003edirectly to the Lummi tribe, or Lummi Nation. Nickolaus [D.] Lewis, who is a\u003cbr\u003etribal leader for Lummi, I think he was on the council but not necessarily the\u003cbr\u003echairman. He’s also the chairman of the Northwest Portland Area Indian Health\u003cbr\u003eBoard. He is the leader of this organization that represents all forty-three\u003cbr\u003etribes. He’s a busy guy [laughter] with all that going on. He personally picked\u003cbr\u003eup an allocation, a subset of that first allocation of vaccines, and drove them—\u003cbr\u003efirst to the Yakama Nation. Then on to the Confederate Tribes of the Umatilla\u003cbr\u003eIndian Reservation in Oregon. This week we had the fiftieth anniversary\u003cbr\u003ecelebration for the health board.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=37.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Is this the Indian Health Board?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, this is the Northwest Portland Area Indian Health Board. I’m just\u003cbr\u003egoing to take a moment.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e That’s fine.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"(Pause)","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, I may not be able to say everything I want to say but it was a\u003cbr\u003epretty emotional event. You know, because we were meeting at the Confederate\u003cbr\u003eTribes of the Umatilla Indian Reservation so out near Pendleton in eastern\u003cbr\u003eOregon. Nick Lewis, our chairman, was there to celebrate fifty years of being\u003cbr\u003etogether as a board and to joke that, you know, he wasn’t even born when the\u003cbr\u003eboard started. [laughs] Which made for some good laughter. I think he actually\u003cbr\u003ewasn’t born then. [laughter] He recounted that journey of driving those\u003cbr\u003evaccines. The first vaccines for tribes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Wow. That’s pretty powerful. I mean, I know it’s like, yes. I mean, getting\u003cbr\u003ethat first shot I think everybody almost felt that. I asked a lot of people what\u003cbr\u003ethey felt like right after they received their first shot. So many different\u003cbr\u003eemotions that come up. Some people were like, oh I really didn’t have time to\u003cbr\u003ereally think about it. Then there were people like, it felt like now this is a\u003cbr\u003ewhole other level of my protection. Then a lot of people felt guilt.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,38.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e For me, because I had been sitting on all of those COVID Vaccine Work\u003cbr\u003eGroup meetings and all of the ACIP deliberations and the public meetings, and I\u003cbr\u003ewas also part of the Vaccine Task Force for IHS. My role was in the\u003cbr\u003eprioritization sub-team, so we tried to figure out, you know, when we get this\u003cbr\u003evaccine, how are we going to roll it out? Who’s going to be our priority\u003cbr\u003epopulations? Will we be able to vaccinate the people that we think we need to\u003cbr\u003evaccinate? How to work with tribes to define that. Yes, it had all these other\u003cbr\u003elayers as well and it was more meaningful, I think to see the roll out of those\u003cbr\u003efirst vaccines for me than even my own vaccine. I mean it just really\u003cbr\u003eovershadowed it. You know, Chairman Lewis said that he’d never drove as\u003cbr\u003ecarefully [laughs] in his whole life as he did then. I was sitting next to our\u003cbr\u003enow area director, he was in a different role during that day, but now he’s our\u003cbr\u003earea director. He just became our area director about a month ago. His name is\u003cbr\u003e(CAPT) Marcus Martinez, he’s a Spokane tribal member. I was sitting next to him\u003cbr\u003eas we were hearing this talk from Chairman Lewis and CAPT Martinez told me that\u003cbr\u003ehe was the one who picked it up from Yakama and then drove it to Warm Springs,\u003cbr\u003e[Oregon].” Which is one of our federal service units. That one box of vaccine,\u003cbr\u003eand you know, we got the one shipping case of 144 vials or whatever, that got\u003cbr\u003edistributed up between I think these four clinics and service units. Two tribal\u003cbr\u003eand two IHS, and these were some of our biggest tribes and IHS facilities (in\u003cbr\u003ethe Northwest) that received the first shipments.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=38.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Was it easy for a lot of tribal members to get an appointment? Because I feel\u003cbr\u003elike in the community where my parents were, there was a lot of ageism on how\u003cbr\u003eyou would sign up for your vaccine. So much so that they’re not internet savvy\u003cbr\u003ebut they’re not internet, they’re in their nineties so it’s hard for them. It\u003cbr\u003ewas kind of an ageist way of rolling out the vaccine. They had no idea how to do\u003cbr\u003eit, so I had to do it for them.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=39.0,39.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, so being a federal agency [laughs] there are certain bureaucracies\u003cbr\u003elike the Privacy Act that prevent us from utilizing some of the most everyday\u003cbr\u003etools like making an appointment online. Talking to your provider about your\u003cbr\u003ehealthcare online. We still don’t have that readily available. We utilize\u003cbr\u003eFacebook. Each of our IHS clinics is able to advertise things like if the clinic\u003cbr\u003ewas going to be closed for some reason or, you know, we’re having a special\u003cbr\u003ecampaign about this that or the other, or we have the flu shot available. All of\u003cbr\u003ethose are messages that they put out on their individual Facebook pages. At that\u003cbr\u003etime, any message about COVID had to be cleared by our area PIO [Public\u003cbr\u003eInformation Officer] who then would send it up to the headquarters PIO.\u003cbr\u003eInitially they wanted to clear every single post, every single message. Finally,\u003cbr\u003ewe were able to get some reasonable accommodation [laughs] to say, well if it’s\u003cbr\u003ejust a message about you know, you have to close the clinic today because a\u003cbr\u003ewater pipe burst, you don’t have to get clearance for that. It was only COVID\u003cbr\u003emessaging. Then all the COVID messaging was still too much anyway. The way\u003cbr\u003epeople found out was through Facebook, through the tribal newspapers, through\u003cbr\u003etribal radio stations if they had it. Through tribal council, through\u003cbr\u003ecommunication between the clinic leaders and the tribal leaders. Everyone would\u003cbr\u003ebe made aware of how much vaccine we have or if we have it and who was the\u003cbr\u003eintended recipient audience at this time. A lot of that had already been worked\u003cbr\u003eout a little bit through discussions with the tribe. As I mentioned before,\u003cbr\u003eduring H1N1 for tribes, the elders are the people who are most revered. It\u003cbr\u003evaries from tribe to tribe when you become an elder. For some, it’s much younger\u003cbr\u003ethan getting the retired discount at Starbucks. [laughter]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=39.0,40.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e What is that?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=40.0,40.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e I don’t know. So, for some, it’s fifty-five. For some it’s fifty. It’s\u003cbr\u003edefinitely not sixty-five. When the first vaccines came out, I think we were\u003cbr\u003eactually trying to target more like seventy-five and eighty-five. You know,\u003cbr\u003eseventy-five and older and not even down to sixty-five yet. But each tribe\u003cbr\u003edetermined who would be in that first pool based on age primarily. When the\u003cbr\u003evaccines arrived, then the messaging would go out that we have vaccine and it’s\u003cbr\u003efor this group of people. Then we tended to do it not necessarily by appointment\u003cbr\u003ebut by drive up kind of mechanism. Because we were doing so much stuff outside\u003cbr\u003eanyway by that time. I mean, all of our testing was being done outside of our\u003cbr\u003efacilities. Some facilities, some tribes were so adamant that COVID will never\u003cbr\u003esee the inside of our facility that it became actually really kind of difficult\u003cbr\u003eto even have normal, any kind of care being provided. Because everything was\u003cbr\u003ebeing done outside.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=40.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e You mean outdoors?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=41.0,41.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Outdoors, yes. Building tents and temporary structures and things like\u003cbr\u003ethat for this care to occur. Because we were afraid that if we let people\u003cbr\u003einside, then they’re going to spread COVID around to other people and things\u003cbr\u003elike that. Like if you were coming in for chronic illness care, that could be\u003cbr\u003edone inside but anything acute, any kind of sick person care was being done\u003cbr\u003eoutside. Then for vaccines, we were like well we don’t have time to screen\u003cbr\u003eeverybody before they come in so how are we going to do this efficiently? In\u003cbr\u003esome places we set aside a part, like the Yakama has a really big clinic and\u003cbr\u003ethey had a whole south area that was being unused. They kind of turned that into\u003cbr\u003ewhere they were doing their COVID vaccines. People would come in and they would\u003cbr\u003edo their screening outdoors. If they didn’t have symptoms or anything like that,\u003cbr\u003ethen they would come in and they would get their vaccines. Everyone wore their\u003cbr\u003emasks indoors. Everyone complied with all of that. Had the six feet distancing\u003cbr\u003esigns and all of that. People would come in and it was first come, first serve\u003cbr\u003ebasically. Which isn’t really the most equitable way to do it, because if you\u003cbr\u003ewere connected, if you had transportation, if you had somebody to drive you, you\u003cbr\u003ewere going to be able to get in line first. We didn’t have a better way to\u003cbr\u003enecessarily do that. We didn’t do a lottery. Which I’ll mention in the ACIP work\u003cbr\u003egroup discussions, it came up that lottery was actually maybe one of the most\u003cbr\u003eequitable ways of actually distributing a scarce resource. At first it doesn’t\u003cbr\u003esound like that would be fair or equitable, but it is. It’s random chance. There\u003cbr\u003ewas a person who worked with us, an IHS employee, one of our statisticians who\u003cbr\u003ealso brought that up as actually maybe not the most nuanced way of distributing\u003cbr\u003eit but probably the most equitable way to distribute it. Everyone has a fair\u003cbr\u003echance to be in a lottery. In any case, we got enough vaccine early on that we\u003cbr\u003ewere able to vaccinate almost all of these priority populations and even earlier\u003cbr\u003ebe able to move to the next priority population. Before maybe our counties were\u003cbr\u003eable to do that.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=41.0,42.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Everybody was able to come to the clinic? There wasn’t any kind of in-home\u003cbr\u003evaccinations or mobile vaccinations?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=42.0,42.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e No, so we didn’t have, our IHS partners initially, we didn’t have any\u003cbr\u003emobile units to use. We didn’t have any staff to send out to folks initially.\u003cbr\u003eThen only one of our sites, Warm Springs, has a mobile unit. It’s owned and\u003cbr\u003eoperated by the tribe. The mobile unit was actually parked outside of the clinic\u003cbr\u003eand was a place where routine vaccinations were being done. Because it was a way\u003cbr\u003ethat, you know, was outside of the clinic so people could come in there and not\u003cbr\u003epotentially bring COVID into the clinic and they could get their vaccines. They\u003cbr\u003edid some other care there in the mobile unit, but it was their everyday set up\u003cbr\u003eand that’s what they used it for. I think there were community resources that\u003cbr\u003ewere used to help bring people in. Many of the tribes have a community health\u003cbr\u003erepresentative network and they also have a few transportation vehicles that\u003cbr\u003ethey would use normally to transport people to dialysis or to referral care and\u003cbr\u003ethings like that. I think some of those folks were able to be used to transport\u003cbr\u003epeople for their vaccines if they were having difficulty.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=42.0,43.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e I kind of want to get to more of a personal part of this. Your reflections on\u003cbr\u003ethe past two and a half years. It doesn’t seem that long to me. You said your\u003cbr\u003ewife and daughter traveled to Japan early on and you were managing your\u003cbr\u003eday-to-day household. I guess you would be teleworking as well?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=43.0,43.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right, so in March with the declarations both my usual office at the\u003cbr\u003ehealth board and our IHS Area Office went to telework 100%. I’m employed by the\u003cbr\u003eArea Office and prior to the pandemic, I spent probably ninety five percent of\u003cbr\u003emy time working on Health Board priorities and projects and maybe about five\u003cbr\u003epercent of my time doing IHS stuff. Maybe it wasn’t quite that dramatic. It felt\u003cbr\u003ethat way. My primary email address was my health board address, and I didn’t\u003cbr\u003ereally pay much attention to my IHS address that much. When the declarations\u003cbr\u003ecame out and we set up our ICS team, which was the IHS ICS team that I was now\u003cbr\u003eto be the public health lead for, that switched completely. I became ninety five\u003cbr\u003epercent IHS and five percent health board. I was still able to participate on\u003cbr\u003ehealth board meetings and things like that and be able to participate on things\u003cbr\u003elike the ECHO [Extension for Community Healthcare Outcomes] calls and the weekly\u003cbr\u003ehealth board calls to get the message out. That was a big change, is now my\u003cbr\u003efocus is all IHS and I had to drop everything else I was working on. Things that\u003cbr\u003eI was saying in February I was working on, now I actually did not remember until\u003cbr\u003eI had to look it up what that training was in February. It was for an MMRC, a\u003cbr\u003eMaternal Mortality Review Committee. I remembered being there but I didn’t\u003cbr\u003eremember exactly what we were there for. Yes, there’s a lot of things. We had\u003cbr\u003ehepatitis A cases at the time. We were doing a lot of work around hepatitis A in\u003cbr\u003ehomeless populations and people who use drugs. Because we were seeing pretty\u003cbr\u003esevere hepatitis A. People were dying from hepatitis A and getting hospitalized.\u003cbr\u003eThat was another focus that we were on I completely forgot about that until this\u003cbr\u003emorning when I looked at it again. Yes, I did feel a sense of loss about all the\u003cbr\u003ethings that I was working on but at the same time this pandemic to me felt, you\u003cbr\u003eknow, existential. Like this is a big deal. I grew really frustrated with the\u003cbr\u003eway some of the things that I talked about [were being done]. Like not being\u003cbr\u003eable to have a tool to do contact tracing and case investigation of our own.\u003cbr\u003eTherefore, I don’t know how I’m going to get information about what’s happening\u003cbr\u003efor our population around this epidemic other than maybe what other people might\u003cbr\u003ehave. What the state is telling me is happening or that kind of thing. I don’t\u003cbr\u003eknow. I just knew it was a big deal and I was really frustrated.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=43.0,45.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"At one point I did call my former CMO [chief medical officer], my former boss,\u003cbr\u003ewho at that time was working for headquarters in our office of quality. I gave\u003cbr\u003ehim an earful. I said, “What the heck is going on? Why can’t we do what we need\u003cbr\u003eto do? Why can’t we say what we need to say? Why does every single message that\u003cbr\u003ewe put on Facebook for our service units have to be cleared at these highest\u003cbr\u003elevels? I’ve never seen this before. Has it always been this way? Have I just\u003cbr\u003enever had to work so much with IHS before in the past that I didn’t realize that\u003cbr\u003eit was always like this? Or is this something new?” He tried to calm me down\u003cbr\u003e[laughs] and reassure me that, you know, we’ll get through this. I called\u003cbr\u003eanother friend of mine who was an internist that I worked with at White River at\u003cbr\u003ethe very beginning [of my career] and had risen through the ranks and was now\u003cbr\u003ethe area director for another area. I called him too and gave him an earful. You\u003cbr\u003eknow, and I thought that by calling these people that I had worked with in the\u003cbr\u003epast for a long time. I know them, they know me. We can speak openly. I couldn’t\u003cbr\u003eget a straight answer from either one of them either. It wasn’t that they didn’t\u003cbr\u003ehear the frustration and even share my frustration, but there was nothing they\u003cbr\u003ecould offer. You know? There was no work around that they could offer and there\u003cbr\u003ewas not much advice that they could offer. How to find any way forward with some\u003cbr\u003eof these roadblocks we’re having on the ability to get our messaging out quickly\u003cbr\u003eor the ability to utilize innovation in trying to get the information about\u003cbr\u003ecases we need. That was really hard.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=45.0,46.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e That didn’t change when there was a shift in leadership at the federal level?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=46.0,46.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e No, no it didn’t.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=46.0,46.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e It’s just always been that way, and it doesn’t seem to be wanting to change.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=46.0,46.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right. In fact, I don’t know how to attribute this necessarily. It’s not\u003cbr\u003emy personal experience, but I’ve been told that in dealing with the current\u003cbr\u003eadministration and the people that are now in ASPR at the highest levels around\u003cbr\u003emonkeypox, that some of the same frustrations are happening there too. Like they\u003cbr\u003edon’t understand tribes. They don’t know how to work with tribes. They don’t\u003cbr\u003eunderstand IHS at all. They think they can just tell us to do things that we\u003cbr\u003ecan’t do. That we shouldn’t do. That we know not to do. Our folks who are\u003cbr\u003einteracting with them are getting really, really frustrated because you would\u003cbr\u003ethink that we would have been provided with more competence when there was a\u003cbr\u003eshift. Instead, the incompetence seems to have gotten worse rather than better\u003cbr\u003eon some levels. It’s not true across the board.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=46.0,47.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Do you think there’s a solution to that or some sort of détente?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=47.0,47.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e [laughs] Yes, I don’t know. I mean, we are part of HHS Region Ten, which\u003cbr\u003eincludes my three states plus Alaska. Prior to the Trump administration, we had\u003cbr\u003ereally great regional administrators. Then we were given not so great regional administrators.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=47.0,47.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e So that changed?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=47.0,47.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e The actual Region Ten administrator. The current Region Ten\u003cbr\u003eadministrator addressed our health board meeting this week and I’ve heard her\u003cbr\u003etalk before. She’s new, but she gets it. She’s either got good staff who are\u003cbr\u003etelling her what she needs to know, and she’s a good study. Because she\u003cbr\u003eunderstands the issues. When she talks to the tribes, you can tell that she\u003cbr\u003eunderstands the issues and she’s tracking those issues. She knows what’s\u003cbr\u003eimportant to tribes and she’s working on it, and it seems sincere. That’s a huge\u003cbr\u003e180-degree difference from the last administrator. It’s not 100%. I mean, some\u003cbr\u003epeople come in and they have capacity, and they know what they’re doing. I think\u003cbr\u003ewe have some folks in ASPR who don’t know and who need to be educated. Maybe,\u003cbr\u003eyou know, part of it, we didn’t have an appointed IHS director, we had an acting director.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=47.0,48.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We just got our director of IHS confirmed. She’s been in for four weeks or six\u003cbr\u003eweeks. Her name is Roselyn Tso and she used to work in our area. I worked for\u003cbr\u003eher, so I know who she is. She actually came to our board meeting this week in\u003cbr\u003eperson and addressed the delegates and the board. You know, I got to say a quick\u003cbr\u003ehello. We didn’t have a director for the last two years. We were halfway through\u003cbr\u003ethe Biden administration, and we didn’t have a director confirmed. The same\u003cbr\u003ething happened with the last administration. We had an acting director for the\u003cbr\u003efirst two years and then finally we got a director confirmed. I think not having\u003cbr\u003ea director in place makes a big difference too because then you don’t\u003cbr\u003enecessarily always have the person who can educate other parts, other agencies\u003cbr\u003ewithin HHS to say here’s the deal. This is what IHS is. This is how you need to\u003cbr\u003ethink about us and remind them that we are funded at fifty percent of the need.\u003cbr\u003eSo, you’re asking us to do something with nothing and unless you give us\u003cbr\u003eresources, you know, we really can’t do it.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=48.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Plus, there’s that institutional memory that doesn’t stay with each director.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right, right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e There’s a re-learning each time.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right, so with our directors, they always— the last two have come from\u003cbr\u003ethe ranks. These are career IHS employees, so that’s helpful. Previous to that,\u003cbr\u003ewe had a director under the Obama administration who came from outside and who\u003cbr\u003ecould not get confirmed at all during the second Obama administration.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e I didn’t know it was so contentious.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right, so for six years we did not have a director. You know? Unbelievable—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Yes, that is unbelievable.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,49.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e —and unacceptable. There were lots of reasons to be frustrated with, you\u003cbr\u003eknow, government response and how things work. On a more personal level, I guess\u003cbr\u003egoing back to like how I felt at this board meeting that I went to, I was\u003cbr\u003etelling you about. Part of the thing that makes me choke up and made me choke up\u003cbr\u003ethere too was, you know, feeling like you’re watching a disaster roll out before\u003cbr\u003eyour eyes and you have some ideas about what could be done to make a difference.\u003cbr\u003eYou’re desperately trying to act on your training and what you know to do, but\u003cbr\u003eyou don’t have a way to do it. [laughs] You don’t have the resources. You know,\u003cbr\u003eif we wanted to set up isolation centers, we don’t have a way to staff them. No\u003cbr\u003eone seems to have money to do that. Even if you had money, there’s no one to\u003cbr\u003ehire. We got a lot of help from CDC Foundation, I’ll say. They were offering\u003cbr\u003ehelp to each of the states. In our region, some of the states didn’t really need\u003cbr\u003eit, and so they said, “You know what? You know who needs this help? The tribes\u003cbr\u003eneed this help.” We had an army of CDC Foundation folks that came to work at the\u003cbr\u003eNorthwest Portland Area Indian Health Board to help with the response. Which was\u003cbr\u003ereally tremendous. These were top notch people. Some of them continue to work\u003cbr\u003ewith us today as either foundation employees or they’re full-time employees now\u003cbr\u003eof the health board.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=49.0,50.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Yes, so I’ve seen this over the years that when there’s a huge emergency,\u003cbr\u003ethere’s a lot of money and people and personnel thrown at that one emergency.\u003cbr\u003eThen once that emergency is gone, so go the people. So go the funding. Instead\u003cbr\u003eof just continuously funding something appropriately so that you don’t have this\u003cbr\u003esurge, and response, surge, and response kind of thing. Is that something that\u003cbr\u003eyou’re seeing as well in your work?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=50.0,50.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Right now, the thing that’s really hard for us is staffing. You know,\u003cbr\u003eit’s not unique to us. There are hospital systems and healthcare systems all\u003cbr\u003eover the country that can’t find doctors, can’t find nurses and are paying\u003cbr\u003ethrough the nose for the few locum tenens that they can hire. Or you hear\u003cbr\u003estories about hospitals where the staff all quit and went to work for a locum’s\u003cbr\u003ecompany and now, they’re all working at the hospital down the street, and vice\u003cbr\u003eversa. It’s like staff just switched hospitals so they can work for locums so\u003cbr\u003ethey can get more money. Because the hospitals themselves couldn’t just pay more\u003cbr\u003emoney in the beginning. Of course, the IHS mechanisms for payment and things\u003cbr\u003elike that, you know, we’re stuck with the GS [General Schedule] system that CDC\u003cbr\u003ehas or the Commissioned Corps, which is harder to even bring on new folks. We’re\u003cbr\u003ereally having a tough time on getting enough staff to be here. That’s our number\u003cbr\u003eone threat. More money could help, because then we could offer more salaries.\u003cbr\u003eYou know, it’s so bad that, and actually this has been kind of part of the\u003cbr\u003eproblem throughout the pandemic, is we also lost support and administrative\u003cbr\u003estaff. Like our HR [Human Resources] staff and our acquisitions staff. The\u003cbr\u003epeople who hire people, and the people who buy stuff for us.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=50.0,51.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Yes. Where’d they go?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=51.0,51.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Some of them were gone too. They didn’t want to work from home. They got\u003cbr\u003ebetter offers to do the same thing with less stress, and so they did it. Even\u003cbr\u003ewhen we had more money from all the COVID funding, we didn’t have the people to\u003cbr\u003ehire the people. The hiring process is so slow and so arcane. It’s unbelievable.\u003cbr\u003eThere are so many things that need to change in terms of our hiring abilities,\u003cbr\u003ehow we buy things, the acquisitions, and so forth. You know, it was really\u003cbr\u003eridiculous some of the constraints that we had to try to operate under. All of\u003cbr\u003ethose frustrations would boil up, and so I would work really hard, you know,\u003cbr\u003eMonday through Friday and then Saturday or Sunday I would sleep in. You know, I\u003cbr\u003ewould do things like watch YouTube videos and catch up on the late-night\u003cbr\u003ecomedians. There were things that were just like, hit me really emotionally.\u003cbr\u003eLike there were music videos, like for me Playing for Change is that group where\u003cbr\u003ethey have people all over the world playing music together. They’re wearing\u003cbr\u003eheadphones listening to the track and playing an instrument or singing part of\u003cbr\u003ethe song. They’re doing covers of popular songs or things like that. I’d watched\u003cbr\u003eit before. I was always inspired by it. I thought this is such a beautiful\u003cbr\u003ething, people all over the world, well—that was just one of the things that\u003cbr\u003ewould just, you know—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=51.0,52.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e What did you do for your own mental health? You didn’t have your family’s\u003cbr\u003esupport for some months. What did you do?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=52.0,52.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e I’d get together with folks by phone or by, you know, FaceTime or\u003cbr\u003esomething like that. I had good communication with my family in Japan because we\u003cbr\u003ecould do FaceTime and talk readily and things like that. In my community where I\u003cbr\u003elive, we actually started having happy hour. [laughter] Usually all of us would\u003cbr\u003ego to work and we would come home. We’d do our thing with our families or\u003cbr\u003ewhatever. Most of the people that were still working, we have a lot of retirees\u003cbr\u003eas well, but between the retirees and the people working at home, we were all\u003cbr\u003ehome at five o’clock. We would start gathering outside and people would have\u003cbr\u003ehappy hours, and probably people drank too much. [laughter] My dog would come\u003cbr\u003ewith me to happy hour, and she loved to go out and meet all the neighbors and\u003cbr\u003estuff like that. Around about 5:00 or 5:30 most days she’ll come up and as I’ve\u003cbr\u003egot my mouse in my hand here, she’ll come up and nudge my elbow so I can’t do\u003cbr\u003eany work. [laughter] She just hits me with her nose and says like, it’s time to\u003cbr\u003ego out. Come on, let’s go, it’s happy hour. My dog was an important support for\u003cbr\u003eme in other ways too. Because we live in a condo setting, I don’t have a yard. I\u003cbr\u003ecan’t just open the door and let her go relieve herself. I have to take her for\u003cbr\u003ea walk. I did a lot of my conference calls and things like that, especially the\u003cbr\u003ethings I was just listening to while walking the dog.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=52.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e You’re living the life. [laughs]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e I was that guy.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e -- it can be freeing, aren’t they? I love being able to be outside listening\u003cbr\u003eto a call and still be outside with your dog walking.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, yes, it was great. That was a big support for me. Our church\u003cbr\u003estopped having mass in person, but they quickly went to online and so sometimes\u003cbr\u003eI would try to watch that. That was weird. [laughs] Then after a while it was\u003cbr\u003elike, this is actually kind of nice. I can just roll out of bed and sit in my\u003cbr\u003epajamas and go to church. [laughter] This is better, actually.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e -- but without community, the community is what you look for. Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. When I did actually go back to a service in person, it was\u003cbr\u003eremarkably like nothing had happened in a way. It was like, it was a place that\u003cbr\u003ewas so familiar to me, and it looked like it always did. Fewer people, and\u003cbr\u003eeveryone was wearing masks, but it looked the same. It was very familiar. It was\u003cbr\u003ealmost like it erased that whole period of time when we weren’t together in a\u003cbr\u003eway. I did find myself looking to see some of the familiar faces who would\u003cbr\u003eusually sit in the same area. Because people always sit in the same area. I\u003cbr\u003ewould be like, you know, who’s still here? That kind of thing.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Yes. Check in on everybody, yes. I feel like there’s a collective grieving\u003cbr\u003ethat hasn’t happened.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Where you have a period of time where you grieve for whatever that event has\u003cbr\u003ehappened, and I feel like that hasn’t happened yet here for us. For a lot of\u003cbr\u003epeople. At least for me. It’s more like an erased period of time.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, which—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Remind you of certain things and you’re like, oh my god that was only like\u003cbr\u003ethree months of time that went by but it felt like three years.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. Which I think might be an insight into some of the things I’ve\u003cbr\u003eheard about the 1918 pandemic. That there is this gap in information about\u003cbr\u003epeople’s actual experience during that time.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Right. I was going to ask you what you think the reverberations from this\u003cbr\u003ewill be like, because you obviously read those 1918.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,53.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes. I think I don’t know. [laughter] I think there’s so much more that\u003cbr\u003ewas happening too that affected me on a personal and emotional level. We’re in\u003cbr\u003elockdown, and then we had the murder of George Floyd. Then Portland was sort of\u003cbr\u003ea hotspot for the protests. A close friend of mine who teaches photography was\u003cbr\u003eout there many of those nights at the protests photographing. You know, really\u003cbr\u003ealigning herself with some of the leaders in the Black Lives Matter movement in\u003cbr\u003ePortland and documenting what happened. I could watch what she was seeing. I\u003cbr\u003efelt like I can’t stop for that, because I’m so focused on what I’m doing to\u003cbr\u003erespond to COVID, to keep the vaccine thing on track, and all the other things\u003cbr\u003eI’m trying to do to help our service units and our tribes. You know, this is\u003cbr\u003esuch an important thing that’s happening and I don’t feel like I can actually\u003cbr\u003estop for that. That was hard. Those happened throughout the summer of 2020 in\u003cbr\u003ePortland. Then at the end of summer we had this horrendous firestorm.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=53.0,54.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e That’s right.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=54.0,54.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e We had an east wind come through and blow-up fires in areas that I had\u003cbr\u003eactually hiked in, you know, a couple of times during the summer with my\u003cbr\u003edaughter when she was here. Like that whole area burned. There was that feeling\u003cbr\u003eof loss for places that I loved that were just destroyed, and the oppression of\u003cbr\u003ethe smoke that not only can I not go to the places I want to go, I can’t even go\u003cbr\u003eoutside because I can’t breathe the air the smoke is so thick. There are all\u003cbr\u003ethese dangers. [laughs] It was like, it really felt like the end of the world. I\u003cbr\u003edid tell people over and over again— this is a dress rehearsal for climate\u003cbr\u003echange in my opinion. You see what a cluster blank, blank, blank it is for us to\u003cbr\u003erespond to COVID. It doesn’t give me much hope that we’re going to do any better\u003cbr\u003efor climate change. You can already see that we’re not. You know, you would\u003cbr\u003ethink that when you’re faced with something so devastating and so important that\u003cbr\u003epeople would pull together. In a lot of places, they did. Our tribes are really\u003cbr\u003egood examples of pulling together to do what they can to protect their people.\u003cbr\u003eWe could learn from that. It’s really hard to see how we’re not able to pull\u003cbr\u003etogether to take care of things like climate change. Because I mean, if a virus\u003cbr\u003eis not tangible, it’s invisible, you can’t see it. One may or may not believe\u003cbr\u003ethat it exists. Even more so, this change in the entire climate and what it will\u003cbr\u003eor will not do to us, what we can or cannot do to make a difference in it. The\u003cbr\u003elevels of disbelief and misinformation and uncertainty around it. I mean, even\u003cbr\u003eif it’s not misinformation. Just uncertainty around what the impact is, will be,\u003cbr\u003eand what our ability to affect it is, is I think it’s such a huge challenge for us.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=54.0,55.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e It is. We’ve come to the end of our time and then some, again. [laughter] I\u003cbr\u003edon’t ever want to stop you. It’s been wonderful. I want to also say, what else\u003cbr\u003ehaven’t we covered that you would want to share for the historical record?","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=55.0,55.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e [laughs] Well I think—","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=55.0,55.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e I mean, you just said it like about three minutes ago. That was wonderful. I\u003cbr\u003eshould have just wrapped there. [laughter] I thought perhaps there was something\u003cbr\u003ethat has been on your mind throughout this whole thing other than some\u003cbr\u003echallenges that we’ve already spoken about.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=55.0,55.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes, no I think for my family sometimes I feel, and even for the work\u003cbr\u003eand the people I work for, feeling like I wish I could have done more. Kind of a\u003cbr\u003efeeling of apology that, you know, that there were limitations that we had to\u003cbr\u003edeal with. Then there were my own limitations too. The things I don’t do well\u003cbr\u003eevery day. I wish that on some level that I had been able to do more and do\u003cbr\u003ebetter. You know, I was doing all this, all that we did do, and working together\u003cbr\u003eto try and make a difference for our tribes. Try and make a difference for all\u003cbr\u003ethe people that we are with every day, and for our loved ones. For my family. In\u003cbr\u003esome regards, we had challenges that we couldn’t overcome. I have a son, too,\u003cbr\u003ewho lives nearby and lived mostly independently during that time, but who chose\u003cbr\u003enot to get vaccinated and still has chosen not to get vaccinated. He has had\u003cbr\u003eCOVID twice, most recently about two weeks ago. Fortunately for him he did okay.\u003cbr\u003eHe got through it without too much difficulty. You know, for him and other\u003cbr\u003epeople like him who have lots of different reasons for why they didn’t get\u003cbr\u003evaccinated, I feel like I wish we could have done more to get out ahead with our\u003cbr\u003emessaging and with the important information, and not be highjacked by all the\u003cbr\u003eother things that did happen.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=55.0,56.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Indeed.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=56.0,56.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/149","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eWEISER:\u003c/strong\u003e Yes.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=56.0,56.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/150","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\u003cstrong\u003eQ:\u003c/strong\u003e Alright, well I want to thank you for being and taking the time to record\u003cbr\u003ewith me today, and the other day as well. I’m going to end the recording now.","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=56.0,56.0"},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/transcript/71445/annotation/151","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"[END]","format":"text/plain"},"target":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371#t=56.0,7772.736"}]},{"id":"https://globalhealthchronicles.aviaryplatform.com/collections/2849/collection_resources/134498/file/253371/index/85716","type":"AnnotationPage","label":{"en":["Weiser, Thomas Session 2 Index 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