Article

Exposing healthinequities: Surreal
snapshots from theGrand Canyon to global
COVID-19 pandemic

Qualitative Social Work
2021, Vol. 20(1–2) 90–96! The Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/1473325020973312
journals.sagepub.com/home/qsw

Jean E Balestrery
Spirit of EAGLES, Rochester, USA

Abstract
The story presented here is central to social work because it is about crisis.
Across diverse fields of practice, social workers regularly engage in crisis intervention.
The story that follows is about crisis in the area of health and healthcare. Specifically, it’s
about exposing health/care inequities on Indigenous tribal land in the Grand Canyon
and in the global COVID-19 pandemic.
Keywords
Social work practice, crisis intervention, indigenous, Covid-19, health inequity, indigenous health

Trail map
Circuitous is the word that best describes my career trajectory in social work.
What this means is I began my career in practice, then spent many years inresearch, followed by years in teaching and later back again in practice.
Currently, I do some of each.
Traversing these professional switchbacks situates me as a scholar-practitioner.
With each step, my horizon expands and reveals gaps in care. These gaps are seen

Corresponding author:
Jean E Balestrery, The American Indian/Alaska Native Initiative on Cancer, Spirit of EAGLES, Rochester,
MN, USA.
Email: jbalestrery@gmail.com

Balestrery91

through my interdisciplinary lens in social work and anthropology, in addition to
my LGBTTQþ, White, Euro-American, cisgender female and formally educatedperspectives. I am an applied anthropologist and peripatetic practitioner endeavoring to close the health gap – a Social Work Grand Challenge.
The story presented here is central to social work because it is about crisis.
Across diverse fields of practice, social workers regularly engage in crisis intervention. The story that follows is about crisis in the area of health and healthcare.
Specifically, it’s about exposing health/care inequities on Indigenous tribal land in
the Grand Canyon and amidst the global COVID-19 pandemic.

Breaking news
We are experiencing a global pandemic. Here in the United States (U.S.), we areunder national orders to practice “social distancing,” or physical distancing, andmany of us are under additional state orders to shelter in place: stay inside toprevent the spread of COVID-19 and save lives - literally save lives. These areunprecedented times on a global scale. In the U.S., we are repeatedly hearingthat “we are all in this together.” Our current lived reality is described as
The Great Adaptation, due to the current global public health crisis. How we
respond matters.

Reflection
My mind replays all that could have happened: could’ve drowned, could’ve hit myhead, could’ve lost my foot, could’ve bled to death, could’ve lost consciousness,
could’ve crashed – could’ve, could’ve, could’ve - but didn’t. None of these things
happened, but most certainly could have happened. The therapist I visited for a
few months after the accident told me during my initial session: “you got hit by aspiritual two-by-four . . .” I was flummoxed. During the initial post-accident
months, I cycled through a roller-coaster of emotions: feeling scared, powerless,confused, anxious, irritable, angry, sad, and grateful.
These sessions combined with physical therapy aided my post-traumatic growthfollowing a near-death hiking accident in the Grand Canyon. For years I had
been wanting to visit Havasu Falls on Havasupai tribal lands in the Grand
Canyon. The eight-mile hike into -and back out from- this international tourist
destination did not deter me (Collins, 2018a, 2018b, 2018c).
I’ll never forget the impact of seeing Native Elders with walking sticks appear infront of me as I lay on a stretcher, at the top of Havasu Falls trail. I locked eyeswith one of the Native Elders, then signaled “thumbs up” with my right hand andsmiled as tears rolled down my face. He signaled “thumbs up” in return, thenlooked at my hiking friend and said: “We call that area . . . ” -turning his headand pointing to the waterfalls area where I had fallen - “meat grinder.”92

Qualitative Social Work 20(1–2)

Breaking news
We are experiencing a global pandemic. It is surreal: the number of coronavirus
cases and deaths increases daily across the globe. Information about this grim
reality is never-ending and various news headlines read: “Coronavirus Pandemic‘Is a Call to Action,’ U.N. Secretary General Says” and “The United Nations
issued a report calling the coronavirus the most challenging issue the world
has faced since World War Two” (Reuters, 2020). We are in a war with aninvisible enemy - a virus, and the U.S. is now building field hospitals. How we
respond matters.

The accident
The rushing water over the boulder rock face that I climbed onto was only a foothigh. Yet, as soon as I had all fours on the rock face, on my way to the other sideof the waterfall pool, a tsunami force took hostage of me! Luckily, the hand-holds
I grabbed were deep enough to hang onto while the raging water whiplashed myface. I gulped in air as much as I could as I hung on, then boom! The waterfall
current hurled my body down many feet and slammed it into the rock bottom of
the waterfall pool below.
Instinctively thrashing my arms, I saw shimmers of light above me then swam
upwards to air. A surreal snapshot: that was my life! resounded within me as blood
swirled in the water. I turned my head to locate the river bank and saw in the
distance my hiking friend running.
“Grab my arm! Grab my arm!” my hiking friend yelled. After jointly getting mybody up and over the three-foot river bank edge, we both saw my left foot dangling
outward from my ankle at about a 90-degree angle: a disturbing sight of deformity.
My ankle was cut – or sliced – and bleeding; later, I learned it was dislocated andthat I had a severe compound fracture. My friend, a professional backpacking
guide, hadn’t ever experienced an accident while leading dozens of trips to thistourist destination. Ironically, I had to direct him to go get help.

Breaking news
COVID-19 data reveal growing hostilities and inequities (Centers for Disease
Control and Prevention, 2020; Flitter, 2020; Godoy and Wood, 2020; Hooper
et al., 2020; van Dorn et al., 2020): across the U.S., hate crimes against Asian
American people have increased (Hong, 2020; Shen-Berro, 2020); Black people
comprise 13% of the population in the U.S., yet 24% of COVID-19 deaths
where race is known (Abassi, 2020); Black people have a COVID-19 mortality
rate that is more than double that of any other racial/ethnic group in the U.S.
(Caruso, 2020); the Navajo Nation had more confirmed COVID-19 cases percapita than every state in the U.S. (Silverman et al., 2020). We are all in thesame storm, yet each of us is in a different boat. How we respond matters.

Balestrery

93Fight, flight or freeze
It took approximately five and a half hours to get out of the Grand Canyon. Whenthe tribal clinic doctor finally arrived at Havasu Falls trailhead - where impromptu
helpers carried me, he told me “I’m not going to lie, it’s going to be hell riding backup the trail . . . ” Lying in a metal stretcher hanging off the end of an ATV, I prayed
my foot wouldn’t fall off.
I asked the doctor what hospital I’d be going to and he said “most likely
Kingman” – it was closest. I kindly let him know that I preferred to go to
Flagstaff because I knew that hospital would be able to handle my injury.
My years of working in rural and remote village Alaska -with Indigenous peoples
on tribal land- taught me that rural healthcare services are typically limited.
At the tribal clinic, the doctor told me I might need to stay overnight because
helicopter companies weren’t flying due to bad weather. Hiking out the eight miles
was not an option. In an instant, I sprung up in the clinic bed and with a selfdetermined force said to the doctor: “I have got to get to Flagstaff Medical Center!”This act of advocacy no doubt saved my foot. The social worker in me knew it andmy medical team confirmed it: “it could have been catastrophic.” The doctor mademore calls to get a rescue helicopter, which flew me direct to the Flagstaff hospital.

Breaking news
Many months into this global pandemic crisis, we are reminded to #stay home – yet
not everyone can - and #stay safe - yet, not everyone is. With an outpouring ofcommunity support and gratitude for front line and essential workers, there isalso foreshadowing of an economic crisis and mental health crisis – both arelooming. A COVID-19 vaccine is many months away. Social Work: Our current
call to action is #remaining resilient. Social work, the times we are in is thelegacy of our profession (Golden et al., 2020). #be brave, #be bold. How we
respond matters.

Living gaps in care
Gap 1: Missing Emergency Protocol. I was shocked to discover there was no emergency protocol at this international tourist destination on tribal land. As I lay on astretcher at the top of Havasu Falls trail, with my impromptu helpers brainstorming my exit, a tribal campground ranger arrived at the scene. I saw my hiking
friend approach this ranger and ask: “What is your protocol in an emergency likethis?”; the ranger then said “we don’t have one.”
Gap 2: Missing Medical Attention. I was shocked to find myself completely
alone in the tribal clinic for about 20 minutes as I lay on the (only) bed.
“hello? . . . hello? . . . is anyone Here? . . . Hello?? . . . HELLO????” No response.
I needed help to get to the bathroom, and later wondered what might’ve happened
if I had fallen unconscious. The researcher in me fixated on the wall clock,94

Qualitative Social Work 20(1–2)

watching the hands mark each eternal minute. Later, I learned that everyone in theclinic went outside to meet the helicopter as it landed.
Gap 3: Missing Social Worker. During the arduous journey of approximately
five and a half hours to get out of the Grand Canyon, there was no social worker.
Hence, there was no leader to manage the overall crisis response, no advocate for
my best interest, no coordinator for my care needs, no broker of resources andnobody to provide the emotional support and psychological first aid critical to aperson’s felt sense of safety during a crisis.

Breaking news
The U.S. government passes the CARES Act for economic aid, yet it ignites tension - between tribes and the U.S. government and among tribes. Congress allocates billions in funding relief to tribal governments, including the 12 regional
Alaska Native for-profit corporations generating more than $10.5 billion in revenues in 2018. The Navajo Nation joins other tribes in a lawsuit against U.S.
Secretary of Treasury advocating that funding go to tribes, not corporation shareholders (The Navajo Nation, 2020). #overcoming these divisions #it takes all of us(Balestrery et al., 2020) How we respond matters.

The recovery process“It’s your training and background, you knew what to do - most people wouldn’t
have,” my friend explained to me as I awaited my next surgery. Listening to mystory, she said in a definitive tone: “You managed your own crisis.” No doubt mybackground helped: I had researched Indigenous health disparities on and off
tribal lands, taught crisis intervention courses and as a practitioner had helped
many other people in crisis.
In total, I had three surgeries: two to prevent infection and one to reconstruct
my ankle. Once I was back home recovering, I googled “accidents at Havasu Falls”
and discovered there had been numerous accidents - and deaths - over many years
on Havasupai tribal land. This was disturbing to learn, particularly within context
of the reality that about 25,000 tourists a year visit Havasupai tribal lands.
Further, the tribal tourism business was yielding millions of dollars in annual
revenue for the Havasupai tribe yet all that was visible on the tribal land wasstark poverty (McGivney, 2017).
My recovery regimen was all-consuming. The initial non-weight bearing phase
was about three and a half months. However, I began daily physical therapy
exercises every hour on the hour as soon as a couple weeks after my surgeries.
Next, I attended physical therapy sessions regularly at an office location.
These sessions pushed my physical limits and helped improve my mental stamina.
My other option: a club foot. Once I could bear weight, I felt alive and free!

Balestrery

95

Breaking news
On May 25th, George Floyd dies after being pinned for eight minutes forty-six
seconds under the knee of a White male police officer on a street in Minneapolis,
Minnesota. We are now experiencing another pandemic: protests igniting against
police brutality. All are rising: COVID-19 cases and deaths, Black Lives Mattervoices and unemployment rates – along with discourse on systemic and structural
racism (Stolberg, 2020). The current pandemics are impacting everyone, either
directly or indirectly through collateral consequences. Collective Futures: #healing
trauma #rethinking #reimagining #restructuring How we respond matters.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publicationof this article.

ORCID iD
Jean E Balestrery

https://orcid.org/0000-0003-4375-9933

References
Abassi J (2020) Taking a Closer Look at COVID-19, Health Inequities, and Racism.
Medical News & Perspectives, JAMA Network, 29 June. Available at: https://jamanetwork.com/journals/jama/fullarticle/2767948?guestAccessKey=312dec32-1b0b-44668f70-b6e3f424e254&utm_source=silverchair&utm_campaign=jama_network&utm_
content=covid_weekly_highlights&utm_medium=email (accessed 3 July 2020).
Balestrery JE, Going H and Pacheco R (2020) Tribal leadership and care services:
Overcoming these divisions that keep us apart. In: Health and Social Work.
Washington, DC: National Association of Social Workers, pp. 1–11.
Bochner AP and Ellis C (1996) Introduction, talking over ethnography. In: Ellis C andBochner AP (eds) Composing Ethnography, Alternative Forms of Qualitative Writing.
Walnut Creek, CA: AltaMira Press, pp. 13–45.
Caruso C (2020) COVID-19’s disproportionate impact on people of color must be addressed,
UN rights chief says. Global Citizen, 3 June. Available at: www.globalcitizen.org/en/con
tent/covid-19-impact-people-of-color-un-rights-chief/ (accessed 28 June 2020).
Centers for Disease Control and Prevention (CDCP) (2020) COVID-19 in racial and ethnic
minority groups. Coronavirus disease 2019 (COVID-19). Available at: www.cdc.gov/corona
virus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html (accessed 3 July 2020).
Collins SS (2018a) NAU professor hangs by her fingertips near Havasu Falls. WilliamsGrand Canyon News, 24 April. Available at: www.williamsnews.com/news/2018/apr/24/
guest-column-nau-professor-hangs-her-fingertips-ha/ (accessed 12 April 2020).
Collins SS (2018b) Havasupai hiker healing after dangerous Grand Canyon slip. Flagstaff
Business News, 22 April. Available at: www.flagstaffbusinessnews.com/havasupai-h
iker-healing-after-dangerous-grand-canyon-slip/ (accessed 12 April 2020).

96

Qualitative Social Work 20(1–2)

Collins SS (2018c) Peak of health: With help of specialists, NAU professor recovering fromserious fall in Canyon. Arizona Daily Sun, 16 April. Available at: https://azdailysun.com/
lifestyles/health-med-fit/columnists/peak-of-health-with-help-of-specialists-nau-professorrecovering/article_1c2923ea-ca73-5f34-be25-fbff877e1dd1.html (accessed 12 April 2020).
Flitter E (2020) Black-owned businesses could face hurdles in federal aid program. The New
York Times, 10 April. Available at: www.nytimes.com/2020/04/10/business/minoritybusiness-coronavirus-loans.html (accessed 12 April 2020).
Godoy M and Wood D (2020) What do coronavirus racial disparities look like state bystate? Shots, Health News from NPR, MPR News, 30 May. Available at: www.npr.org/
sections/health-shots/2020/05/30/865413079/what-do-coronavirus-racial-disparitieslook-like-state-by-state (accessed 28 June 2020).
Golden R, Ewald B and Moro T (2020) Mitigating the pandemic – Social work was built forthis. The Hill, 6 June. Available at: https://thehill.com/opinion/healthcare/501474-miti
gating-the-pandemic-social-work-was-built-for-this (accessed 28 June 2020).
Hong CP (2020) The Slur I Never Expected to Hear in 2020. The New York Times
Magazine, 12 April. Available at: www.nytimes.com/2020/04/12/magazine/asian-ameri
can-discrimination-coronavirus.html (accessed 15 April 2020).
Hooper MW, Napoles AM and Perez-Stable EJ (2020) COVID-19 and racial/ethnic disparities. Viewpoint, JAMA Network, 11 May. Available at: https://jamanetwork.com/
journals/jama/fullarticle/2766098 (accessed 28 June 2020).
Levine PA and Frederick A (1997) Waking the Tiger, Healing Trauma. Berkeley, CA: North
Atlantic Books.
McGivney A (2017) Pure Land. Detroit, MI: AuxMedia, a division of Aquarius Press.
Reuters (2020) Coronavirus pandemic is ‘a call to action,’ U.N. Secretary General says.
Available at: www.nytimes.com/video/world/100000007065902/united-nations-coronavi
rus.html (accessed 24 November 2020).
Shen-Berro J (2020) Panda Express employees say they’ve faced racism amid coronavirus
pandemic. Available at: www.nbcnews.com/news/asian-america/panda-express-employ
ees-say-they-ve-faced-racism-amid-coronavirus-n1189161 (accessed 28 April 2020).
Silverman H, Toropin K, Sidner S, et al. (2020) Navajo Nation surpasses New York state forthe highest Covid-19 infection rate in the US. CNN, 18 May. Available at: www.cnn.com/
2020/05/18/us/navajo-nation-infection-rate-trnd/index.html (accessed 28 June 2020).
Stolberg SG (2020) ‘Pandemic within a pandemic’: Coronavirus and police brutality roil
black communities. The New York Times, 7 June. Available at: www.nytimes.com/2020/
06/07/us/politics/blacks-coronavirus-police-brutality.html (accessed 7 June 2020).
The Navajo Nation. Office of the President and Vice President (2020) Navajo Nation files
lawsuit against United States for fair share of federal COVID-19 funding. Available at:www.indianz.com/covid19/?p=3346 (accessed 24 April 2020).
van Dorn A, Cooney RE and Sabin ML (2020) COVID-19 exacerbating inequalities in the
US (pp.1243–1244). World Report, The Lancet, 18 April. Available at: www.thelancet.
com/action/showPdf?pii=S0140-6736%2820%2930893-X (accessed 24 April 2020).
Wan W (2020) The coronavirus pandemic is pushing America into a mental health crisis.
The Washington Post, 4 May. Available at: www.washingtonpost.com/health/2020/05/
04/mental-health-coronavirus/ (accessed 28 June 2020).