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Citizen Potawatomi nurse anesthetist combating COVID-19 in New Mexico

Tribal member Andy Pecore and Whitehead descendant works as an nurse anesthetist at the Gallup Indian Medical Center in Gallup, New Mexico. Due to the recent COVID-19 pandemic, Pecore and other hospital staff have developed and implemented strategic plans to mitigate the virus’s impact on Native American patients.

Andy Pecore wears protective gear to lessen the spread of COVID-19 within the Gallup Indian Medical Center. (Photo provided)

The hospital serves mostly citizens of the Navajo Nation as well as members of other federally recognized tribes. Gallup Indian Medical Center sits a few blocks south of I-40, and the city is one of the last major stops in New Mexico before reaching Arizona. Cross-country travelers often stop in Gallup, which increases the region’s exposure risk.

Native Americans are more likely to struggle with heart disease, diabetes and other respiratory diseases than their non-Native counterparts.
“And then you have all the co-morbidities of diabetic, very poorly controlled diabetics, bad obesity, and just a lack of great health standing in general,” Pecore said during a phone interview with the Hownikan. “That’s what puts this service area at such a large risk because we just have such an underprivileged population here.”

The virus could prove even more problematic on the Navajo Reservation due to its rural nature and shortage of infrastructure. The University of Arizona Office for Research, Innovation & Impact estimated that up to 35 percent of the Navajo — Diné as they are known in their language — who live on the reservation lack access to running water.

“Washing hands and hygiene is critical at preventing the spread of violent bacterial infections, and if you have a large percentage of your population who cannot cleanse themselves effectively, bacterial and viral infections can just be rampant throughout the population,” Pecore said.

The Navajo Nation and the Navajo Department of Health declared a state of emergency on March 11, 2020. By March 20, the Navajo Nation implemented a shelter-at-home order, and on March 29, extended it and implemented a curfew.

Part V of the Regulatory Authority by Public Health Emergency Order No. 2020-003 stated, “In a short and rapid period of time, COVID-19 has arrived on the Navajo Nation and the number of cases continues to increase at an alarming rate. Contact with contagious individuals and the subsequent high degree of exposure is evident by cluster and community spread throughout the Navajo Nation constituting a major public health disaster.”

Background

Pecore almost finished a bachelor’s degree in international business and German when he realized he preferred a different path.

“I was going into my senior year, and I just kind of came to the realization that business was not of interest to me. I didn’t really find it rewarding, but I also didn’t find it meaningful for me. I wanted to do something that I could have more of an impact — something that I felt like would push me to work harder,” he said.

As someone involved with sports most his life, Pecore decided to change his major to health and exercise science at the University of Oklahoma.

“I liked it, I did, but that program was more geared towards athletic training, physical therapy. And I worked a little bit as a physical therapist technician, and that just didn’t really feel like a calling to me as much as I thought it would,” he said.

After receiving his exercise science degree, he began the accelerated bachelor’s in nursing program at the University of Oklahoma where he utilized the Indian Health Service Health Professions scholarship to help fund his education.

“Nursing is such a massive career field. You can really take it anywhere: critical care, flight nursing — it goes on and on, and that appealed to me having a wide variety of options,” Pecore said.

Upon graduation, he worked as a nurse at the Chickasaw Nation Medical Center in Ada, Oklahoma, for three years. He then transferred to Kansas City where he served surgical trauma and intensive care unit patients.

“I got a lot of critical care experience, and I was actually very interested in anesthesia while I was working there because we did so much work with ventilators, mechanical ventilators,” Pecore said.

Because of his experience in Kansas City, he applied for a nurse anesthetist program in Minneapolis as well as the IHS Health Professions scholarship. After completing the program, he began looking for opportunities to use his knowledge and expertise across Indian Country, eventually settling on the Gallup Indian Medical Center.

“The facility out here in Gallup, New Mexico, offered a really good opportunity for me to continue to learn, and to not only learn and grow in my field but to be able to provide a wide variety of services to another nation. So, that’s why I accepted that position out here,” he said.

Changes

His first day at the Gallup Indian Medical Center was Oct. 27, 2019, and although he got into the swing of work fairly quickly, the COVID-19 pandemic created drastic changes in his day-to-day routine.

“Once you kind of feel like, ‘Yeah, I am just now comfortable with all of this,’ and then bam — that! And then pretty much everything that I’ve just built a routine around is now completely different overnight. So, that has been interesting,” Pecore said.

“I think that’s what gets
everybody on board
is that what’s the
alternative?
You don’t take any steps,
and then you basically
contributed to the spread.
I would rather be overly
cautious than not
cautious enough.”

Andy Pecore

To help lesson COVID-19’s impact, the hospital employed measures like closing entrances and implemented new admissions protocol to decrease exposure.

“If they do feel sick and they’re having trouble breathing, they get processed through a different entrance, and they’re kept in negative pressure rooms so the airborne, viral contaminants cannot be expired out of their lungs and be able to float up and down the hallway into other rooms,” Pecore said.

COVID-19 patients with difficulty breathing are often put on medical ventilation to help them breathe. To decrease risk of spreading the virus through the air, only specific staff, such as Pecore who have received training, can connect patients to ventilation systems.

“We’re on call 24/7 for if they need that, and then we have to take precautions to protect ourselves when we go in to intubate these patients,” Pecore said. “We wear the N95 masks that are being used to help prevent airborne spread. We have to wear protection, gowns, gloves, just to try to limit exposure because if health care staff catch it, then we’re going room to room to help patients, and well, then you expose the hospital.”

Pecore is thankful for the trauma ward experience he received while working in Kansas City, which prepared him for stressful work environments.

“I feel like a trauma situation is definitely easy to panic in, so kind of learning how to cope with that and still be able to make the correct, important decisions. So, that’s actually definitely helped me if this were to progress to be a massive problem,” he said.

Pecore hopes the Gallup Indian Medical Center implemented enough precautions to lessen the negative impact COVID-19 has within the Native American population it serves, including changing the hospital’s layout and preparations to expand outside the building with a negative pressurized tent.

“There’s a lot of structural changes that are in the works because we just don’t want to get to the point where we’re being reactionary instead of proactive,” he said.

“I think that’s what gets everybody on board is that what’s the alternative? You don’t take any steps, and then you basically contributed to the spread. I would rather be overly cautious than not cautious enough.”

Read more about the Navajo Nation’s response at ndoh.navajo-nsn.gov/COVID-19. For further information on COVID-19, visit the Centers Disease Control and Prevention website, cdc.gov/coronavirus/2019-ncov.