A Gown for Tuba

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On a chilly pre-dawn morning, Molly Brown pulled into Dr. John “Bull” Durham’s Flagstaff driveway and started to load her truck with six-foot-long rolls of blue fabric.

Brown the executive director of the Northern Arizona Volunteer Medical Corps, would normally be at Durham’s garage checking on medical supplies for one of the two trips her organization makes to Haiti each year to do orthopedic surgeries on locals without access to medical treatment. With the COVID-19 pandemic canceling those trips, NAVMC, led by Durham and Brown, has redirected its efforts to support healthcare workers on the Navajo and Hopi reservations with personal protective equipment (PPE).

That morning, Brown drove the fabric to Tuba City, where Durham works as an orthopedic surgeon for the Tuba City Regional Health Care Corporation. He had a team of volunteers from the hospital dental program who were waiting to convert it into reusable hospital gowns. In addition to the fabric, Brown had a plastic bag containing 44 neatly folded gowns that had been sewn in Flagstaff at the Threaded Together sewing cooperative under a contract paid for by NAVMC.

One gown in particular was going directly to Dr. Jarred McAteer, a physician at the Tuba City hospital who is working directly with patients battling COVID-19 in the intensive care unit and the respiratory care unit at the hospital.

NAVMC’s involvement with providing PPE on the reservation started shortly after the first cases arrived at Tuba City.

“Two months ago, the chief medical officer came to me and said we need PPE.” Durham said. “It turns out that across the nation and around the world, there has been a shift from medical staff using surgical gowns made out of fabric, which are laundered and reused, to using disposable gowns made from plastic. At Tuba City they were using 300-400 disposable gowns each day. No one in the country could get disposable gowns and Tuba was running out.”

In a bitter irony, most disposable gowns are made in China and as that country went into lockdown, factories were closed and even if there were supplies there was no way to ship them. One of the manufacturing centers of disposable gowns and N-95 masks is in Wuhan, China where the COVID-19 pandemic originated.

As hospitals and medical systems across the nation saw their supply of disposable gowns dry up, each came to the same conclusion that the solution was a return to making reusable gowns from materials that could be laundered. In Flagstaff at the outset of the pandemic, Susan Haefner, a pediatric intensivist at Flagstaff Medical Center, started a volunteer program sewing gowns out of TyVek house wrap. While those gowns filled an immediate need, they didn’t breathe and were uncomfortable to wear during a 12-hour shift caring for patients.

The race was on to source a breathable fabric that met certain medical standards where it could be used safely to protect against contamination.

“We started looking for fabric that met AAMI standards (Association for the Advancement of Medical Instrumentation), which is a way that gowns are ranked for what level of protection they offer,” Durham said. “When all of my elective surgeries were canceled, I had the time to start researching and to locate the fabric that we would need. We got 3,000 yards of fabric and were able to convert that and some other fabric into 1,200 gowns. I had done an assessment by calling all of the medical centers across the reservation to see what they needed.

“I spoke with a friend, Christy Thuet, a pediatrician who used to work on the reservation and who now works in Salt Lake City, about how we could help all of the different service units across the reservation from Tuba to Chinle to Fort Defiance, Gallup and Shiprock, and she had pilots who can fly stuff.

“Then we got a call from W. L. Gore to say that they had 8,500 yards of fabric in a warehouse and wanted to have it made into gowns to support both Flagstaff and the reservation. That material was sent to the Arizona Apparel Foundation and was turned into 4,700 gowns. NAVMC paid $11 per gown and was able to then take another 1,250 gowns up to distribute across the reservation.”

The sewing teams at Threaded Together in Flagstaff and the dental team in Tuba City are still cutting fabric and converting it into gowns to serve the needs of the medical centers on the reservation.

“The majority of NAVMC’s funds right now are going toward this project. NAVMC’s focus right now is more than 80% local,” Durham said.

“NAVMC’s mission has always been to help provide for the healthcare and welfare of the underprivileged and now we are doing that for our own people. … It’s been going on for eight weeks and it’s in no way slowing down. It’s not a surge, it’s just a slow, steady continuum. The gown program has created a paradigm shift for the healthcare workers being able to care for the sick.”