The Skokomish Indian Tribe, People of the River, is located in a very rural part of Washington State. We have a long, vibrant history and culture and we are very concerned about our future and the impact the COVID-19 public health disaster will leave on our community as well as those around us. The COVID-19 public health disaster has had a daunting impact on tribal leadership and Directors as we quickly discovered how unprepared we are. Other departments are working to develop emergency response plans, apply for FEMA assistance and similar tasks. The Health Department is focused on disease prevention, preparation, response, mitigation of the impacts and recovery as opposed to the broader and all encompassing sectors which are impacted as well such as law enforcement, economic development, education, child care and similar. We have readily discovered that we are in no way prepared to provide healthcare including assessments, treatment, monitoring and follow-up for anyone diagnosed with or exposed to COVID-19. In addition, the provision of 90% or more of the healthcare community members usually receive at the Clinic is not available. As we do not have emergency preparedness and response plans in place and staff trained in proper response protocols we closed the Clinic on March 18th to ensure that it did not become a high-risk source for COVID-19 exposure for our patients as well as staff. This decision left our providers struggling to do they best they can to provide ongoing care such as assessments, filling prescriptions, ordering tests, providing referrals for specialists and similar utilizing communication platforms such as cell phones, Zoom, Splash, Google Meets and Google Hangouts. Our Health Director and Deputy Director have worked hard to ensure that care is being provided when possible and charting, requisitions and all the other activities required to approve and purchased healthcare outside of the clinic has been completed. This is
especially critical for the members who do not have health insurance as paperwork must be processed and provided to external providers approving the provision of care and ensuring payment for the services by the Tribe. The nearest healthcare providers are in Shelton, then Olympia which requires transportation and time coupled with the heightened risk of COVID-19 exposure in more populated areas. Funding this request will provide: the diagnostic equipment needed to assess needs and provide specialty care in the Clinic (community population 2,400 with no COVID-19 cases and no deaths) as opposed to external providers will greatly reduce COVID-19 risk and impact patients, and oftentimes staff or other individuals who must transport them, will not be required to travel to high-population cities to receive care. In addition to COVID-19 risk is the time it takes to complete a visit or test; COVID-19 Testing Contracted Position responsible for will collecting samples for COVID-19 testing at a drive-up facility on a weekly basis; Procurement and Coordination Specialist responsible for securing and coordinating goods and services; IT Technician responsible for providing the support required for telehealth, department and clinic's IT needs; Telehealth Consultant to provide expertise in additional telehealth areas and functions; Year-1 annual user licenses and maintenance fees for equipment in the clinic as well as loaner equipment; and the purchase of supplies and shelves to store and cart to distribute the items.