PIERRE, S.D. – Tribes in North and South Dakota have partnered with the states to establish plans for any possible flu pandemic.
The Department of Homeland Security and related offices in each state are charged with developing overall plans, but within each state and reservation the planning has become a multi-tiered effort, with the health departments of each state most directly involved.
The offices of Emergency Services on the reservations and in the states are mostly ready to accept any emergency with the first response mechanisms that are currently in place. Locations for evacuations and hospitals have been identified in both states and on the reservations.
The Standing Rock Sioux Reservation is located in both states. Emmett White Temple, Standing Rock director for emergency planning, said two of the tribe’s communities – one in North Dakota and one in South Dakota – will act as distribution centers for vaccine, but the question that has not been answered is whether the vaccine will come from the state or the federal government. Both tribal governments work with the IHS on each reservation.
Standing Rock works with the North Dakota district health organizations to make sure that the distribution points set up on the reservation fall within some system, White Temple said.
“One thing we are concerned about is getting cut if the dollars are filtered through the states. The states are trying to be the middleman and are trying to dictate where money will go,” White Temple said.
“North Dakota threw it on the tribe to develop a plan and South Dakota is trying to get tribes to comply with their plan,” he said.
Standing Rock and the Cheyenne River Sioux Tribe have received $35,000 grants for planning and another $25,000 for equipment each. That $60,000 total does not include vaccines; as of yet, nobody knows where the money will come from for vaccines.
“The feds are not as organized as everyone thinks; they are relying on states to set up points of distribution once an emergency is declared and there is an outbreak.
“Each tribe has to come up with a community service plan. That means every aspect; that means food, not just medical, [and] involves all areas of modern conveniences. Our approach is to throw it back on communities and provide supplies. The remote districts will hurt the most. We want to get districts involved so the local guys are buying into the plan,” White Temple said.
Preparations include the agreements with agencies and the states with memorandum of agreements and understanding. Most federal agencies receive funding and guidance from Homeland Security. The tribes are directly connected to federal and state Homeland Security systems for funding and for organizational benefits.
One of the major problems with the South Dakota plan, according to White Temple, is regionalization. He said the state treats the Missouri River as a barrier that may prevent the spread of the flu should it hit one side of the state first, and the state of South Dakota assumes the responsibility to close off travel across the river.
The problem for Standing Rock and for the Cheyenne River Sioux Tribe is that one of the regional distribution centers would be located on the eastern side of the river. If isolation is ordered, two problems arise: the distance that must be traveled from either reservation is vast and, if the river barrier is used, access to the distribution center may be closed.
White Temple said he wants every district on Standing Rock to formulate a plan and to have distribution centers on the reservation. This would circumvent the South Dakota plan of regionalization.
The amount of vaccine allocated to the reservations at this time is determined by the membership of each reservation rather than the actual population living within the reservation boundaries.
White Temple said Standing Rock wants to count all people, American Indian and non-Indian, who live on the reservation. He said the tribe would be responsible for all people in its jurisdiction.
Should the movement of individuals be restricted, law enforcement will play a critical role. On the Standing Rock Reservation, only eight police officers are available to cover the 1-million-acre reservation. Cheyenne River does not have adequate law enforcement; nor do the other large land-based reservations in both states. The reservation plans must rely heavily on volunteers from each district.
The governor and the health departments of each state have the authority to regulate any individual’s movement in or out of their areas and to quarantine, an authority that will include the reservations. The state of South Dakota’s plan does specify that the tribes will have the primary responsibility for public health matters within their borders, including isolation and quarantine.
The plan is not specific regarding who the tribe’s authority would cover – whether it would have authority strictly over tribal members or for all residents within the boundaries of the tribal jurisdiction.
Law enforcement will be used to restrict movement of affected individuals and groups, and on the reservations law enforcement is limited and at times inadequate.
Within the federal guidelines for vaccination, vaccinations would be performed by professionals at various clinics. On the larger reservations those clinics can be located great distances from a community and transportation is not always available. The tribes plan to establish local, or community, preparedness plans to vaccinate with the least possible travel necessary.
Standing Rock and North Dakota should be ready for a possible flu outbreak, with the exception of a vaccine, by January 2007, according to White Temple.
