COVID-19 among Indigenous communities: Case studies on Indigenous nursing responses in Australia, Canada, New Zealand, and the United States  

Abstract
Globally, Indigenous Peoples experience disparate COVID-19 outcomes. This paper presents case studies from Aotearoa New Zealand, Australia, Canada, and the United States of America and explores aspects of government policies, public health actions, and Indigenous nursing leadership for Indigenous communities during a pandemic. Government under-performance in establishing Indigenous-specific plans and resources, burdened those countries with higher COVID-19 cases and mortality rates. First, availability of quality data is an essential element of any public health strategy, and involves disaggregated, ethnic-specific data on Indigenous COVID-19 cases, mortality rates, and vaccination rates. When data is unavailable, Indigenous Peoples are rendered invisible. Data sovereignty principles must be utilised to ensure that there is Indigenous ownership and protections of these data. Second, out of necessity, Indigenous communities expressed their self-determination by uniting to protect their Peoples and providing holistic and culturally meaningful care, gathering quality data and advocating. Indigenous leaders used an equity lens that informed national, state, regional, and community-level decisions relating to their Peoples. Third, at the forefront of the pandemic, Indigenous nursing leadership served as a trusted presence within Indigenous communities. Indigenous nurses often led advocacy, COVID-19 testing, nursing care, and vaccination efforts in various settings and communities. Indigenous nurses performed vital roles in a global strategy to reduce Indigenous health inequities during the COVID-19 pandemic and beyond. Fourth, historically, pandemics have heightened Indigenous Peoples’ vulnerability. COVID-19 amplified Indigenous health inequities, underscoring the importance of high-trust relationships with Indigenous communities to enable rapid government support and resources. Holistic approaches to COVID-19 responses by Indigenous peoples must consider the wider determinants of wellbeing including food and housing security. Findings from these case studies, demonstrate that Indigenous self-determination, data sovereignty, holistic approaches to pandemic responses alongside with Governmental policies, resources should inform vaccination strategies and future pandemic readiness plans. Finally, in any pandemic of COVID-19-scale, Indigenous nurses’ leadership and experience must be leveraged for a calm, trusted and efficient response.

Te Reo Māori translation 

Ngā ariā matua 
He rerekē i ētahi atu rōpū tāngata ngā putanga hauora mō ngā Iwi Taketake huri noa i te ao, mō COVID19. Tā tēnei tuhinga he tāpae mātai tūāhua mai i Aotearoa, i Ahitereiria, i Kānata, me Amerika, e tūhura nei i ētahi āhuatanga o ngā kaupapa here kāwanatanga, ngā mahi hauora tūmatanui, me te mahi hautū tapuhi iwi taketake mō nga hapori iwi taketake i ngā wā o tētahi mate urutā. Nā te ngoikore o ngā tikanga a ngā kāwanatanga mō te whakatakoto mahere, rauemi hāngai tūturu ki te iwi taketake i whakataumaha aua whenua ki te pikinga ake o ngā pānga o COVID-19, me ngā pāpātanga matenga rawatanga. He wāhi matua te wātea mai o ngā raraunga kounga hira mō tētahi rautaki hauora tūmatanui, kei roto nei ētahi raraunga kua oti te kōwae, kia hāngai ki tēnā momo iwi, ki tēnā momo iwi, mō ngā pānga COVID-19 Iwi Taketake, te pāpātanga matenga rawatanga, me te pāpātanga whāngainga kano ārai. Mehemea kāore he raraunga i te wātea, kāore rawa e kitea atu ngā Iwi Taketake Me tino whakamahi ngā mātāpono mana raraunga kia noho tonu te rangatiranga ki te Iwi Taketake, kia tautiakina hoki aua raraunga. Tuarua, he mea tino nui kia tū pakari ngā hapori Iwi Taketake i runga i tō rātou tino rangatiratanga, nā te whakakotahi ki te tiaki i te taurimatanga matawhānui, hāngai ki te ahurea, nā te kohi raraunga kounga nui, me te kauwhau tikanga. I riro nā te whakaaro iwi taketake i ārahi ngā mahi a ngā kaihautū iwi taketake kia arahina ngā whakatau ā-motu, ā-rohe kāwanatanga, ā-hapori hoki e pā ana ki ō rātou Iwi. Tuatoru, kei mua rawa i te aroākapa o te whawhai ki te mate urutā, i tū ngā kaihautū hei kanohi e whakaponotia ana i roto i ngā hapori Iwi Taketake. I riro nā ngā tapuhi iwi taketake i hautū te tini o ngā mahi kauwhau tikanga, whakamātautau COVID-19, taurimatanga tapuhi, whāngai kano ārai hoki i ngā horopaki me ngā hapori maha. I kawea hoki e ngā tapuhi iwi taketake ētahi mahi hira i tētahi rautaki āao hei whakaheke i ngā korenga e ōrite o ngā āhuatanga hauora Iwi Taketake i te wā o te COVID-19, i tua atu hoki. Tuawhā, i roto i ngā mate urutā i roto i ngā rau tau kua hipa, kia noho whakaraerae ngā Iwi Taketake o te ao. Nā COVID-19 i whakapiki te noho whakaraerae o ngā Iwi Taketake, i whakaheke hoki te nui o ngā hononga whakapono tiketike ki ngā hapori Iwi Taketake, kia taea ai, kia horo hoki i te tautoko me tuku rauemi mai a te kāwanatanga. Me āta anga atu ngā ara matawhānui mō ngā urupare COVID-19 a ngā Iwi Taketake ki ngā āhuatanga whānui o te toiora, tae atu ki te nui o te kai mā te tangata, me te whare noho o te whānau. Ko tā ngā kitenga mai i ēnei mātainga tūāhua he whakaahua i te hira o te noho o te rangatiratanga Iwi Taketake, mana raraunga, ngā ara matawhānui ki te urupare mate urutā hei mea nui mō ngā rautaki whāngai kano ārai me ngā mahi takatū mō ngā mate urutā o raurangi, i te taha o ngā kaupapa here kāwanatanga. Hei kupu whakamutunga, i ngā urutā rahi pēnei i COVID-19, me tāpiri mai te hautūtanga me te tautōhito o ngā tapuhi Iwi Taketake mō tētahi urupare pakari, ka whakaponotia nuitia e te iwi, me te whai take anō.

Keywords / Ngā kupu matua
case study / mātai tūāhua; COVID-19; data sovereignty / mana raraunga; global / ā-ao; Indigenous / iwi taketake; inequities / ngā korenga e ōrite; leadership / hautūtanga; nursing / mahi tapuhi; self-determination / tino rangatiratanga