By: Adriana Zuniga, DDS

From beneath my face shield and the multiple masks on my sweaty face, I still got a waft of the burning sage from down the hallway as I was prepping a crown. Burning sage is a common practice called smudging and American Indians/Alaska Natives (AI/AN) have burned sage for centuries as part of a spiritual ritual to cleanse a person or space and to promote healing and wisdom. As I stopped for a moment to switch my burr and ask my patient if she was still doing okay she said, “Well, at least when I come here the sage helps remind me of my home. I can’t go back to my reservation because of COVID, and six family members and four old high school friends back home on the reservation have died because of it.” Time stopped for me as soon as she told me this. Hearing her story was my main priority and dentistry for the day was not as important in that moment.

Practicing dentistry in the midst of a pandemic was never on our radar as dentists! It is especially challenging because it has thrown us in the midst of the truly busy intersection of medicine, dentistry and behavioral health. What do you do when your patient has multiple underlying medical conditions, has a toothache that you are trying to resolve and the patient begins to cry during treatment because of so many lost family members and friends from COVID-19? For many of my AI/AN patients, these problems are accentuated due to many variables.

Many think that New York City was the epicenter of COVID-19. However, the Navajo Nation located in northeastern Arizona, southeastern Utah, and northwestern New Mexico has had more COVID-19 deaths per capita than any other place in the US. This could be due to the multi-generational living patterns of Native American families in one home, high poverty and the increased number of people with underlying medical conditions. Also, up to 40% of homes in the Navajo Nation do not have running water today (for proper hand hygiene) and that the reservation is essentially a food desert. There are approximately only 13 grocery stores in an area the size of South Carolina. Can you imagine the number of people at those grocery stores and the lack of availability of fresh, healthy food there? It can take up to three hours to drive to a grocery store and growing vegetables in the desert can prove to be challenging. With those challenges, convenience stores on the reservation are the only food sources. 

As for Colorado, the state has two federally recognized Indian tribes, the Ute Mountain tribe and the Southern Ute tribe. Denver, however, is one of the central hubs for many Native Americans in the southwest due to the increased availability of jobs. The elder generations tend to stay on the reservations and the younger generations come to Denver for opportunity. More than 70% of AI/AN families live in urban areas, like the metro Denver area. Many work in Denver and frequently travel up to eight hours to visit family and take care of their elders on the reservation or for spiritual practices back home. It is also common for the younger generation to travel to neighboring states such as South Dakota or Montana and bring their elders back to Denver for dental and medical care at the clinic where I work. Adrianne Maddux, Executive Director of Denver Indian Health and Family Services (DIHFS), reminds us that our federal government’s trust responsibility is to act in the best interest of American Indians/Native Alaskans (AI/AN). That responsibility goes beyond our reservations, and healthcare is part of a historical trust obligation that goes back to the earliest treaties. DIHFS’s urban programs are the only place our families feel safe because we can respond to their needs in culturally responsive ways where other health centers can’t. Yet as a nonprofit, we continue to struggle to get the adequate PPE we need to keep everyone safe. It is even more crucial that the US government step up and continue to honor its trust obligation to our AI/AN people.

For my patient who lost six family members due to COVID-19, I referred her to a behavioral health specialist and she has now started grief counseling. I cannot imagine losing so many family and friends in such a short time. Thankfully she is getting the emotional support that she needs. Her emotional counseling will slowly help heal and better enable her to focus not only on her dental health but her whole body health.

Please consider giving back to your community in any way that you can. Dedicating my life’s work to American Indians/Alaska Natives, our country’s first Americans is truly an honor that I approach with humbleness and reverence. I feel that through my work with Native Americans, I have learned to live with more gratitude and grace. Be safe and be well

Dr. Adriana Zuniga attended the University of Detroit Mercy dental school and worked in private practice in Chicago before moving to Denver with her family. She has been the dentist at Denver Indian Health and Family Services for the last six years and is Chair of the MDDS Community Outreach and Public Relations committee. Please contact her at azuniga@dihfs.org with any questions or comments that you may have.