MONUMENT VALLEY, San Juan County — Marilyn Benally cannot even consider the possibility.

“I don’t want to think that far,” she said, emotion choking her into silence as a tear rolls down her left cheek at the thought of losing her 90-year-old mother to COVID-19.

The laughter of her grandchildren playing 50 yards away fills the void. She wipes away the tear, but another streaks down her other cheek.

“We still haven’t learned everything from our elderlies,” she says, almost pleading. “We still need their teaching.”

She inhales deeply, and then continues.

“It’s heartbreaking to see my people don’t realize what is really going on,” she adds, after explaining that only her brother, who lives near her mother, can visit or care for her. “There are a lot of people hurt already. We don’t know what it’s going to take for our people to realize what’s happening, what’s going on. ... That’s why I quarantine my mom. We want Grandma to be safe.”

The Navajo Nation in Utah, Arizona and New Mexico is one of the hardest hit areas of the country, but testing, tracking and monitoring for the new coronavirus are complicated by a myriad of jurisdictional issues that often leave the 8,000 tribal members who live on the reservation inside Utah boundaries feeling like an afterthought to those with the power to help them.

The Utah Department of Health sent its mobile testing unit to Monument Valley late last week and offered those often-overlooked residents and others an important lifeline. About 1,500 tests were administered with the cooperation of Utah Navajo Health Services.

Bobby and Marilyn Benally were among those who made the trip to the Monument Valley Community Health Center, and they brought their three grandchildren, who live next door to them in Halchita, San Juan County. The fear and anxiety of watching COVID-19 ravage their community was a powerful motivator for them, and hundreds of others.

Some drove hours to get to the clinic, and then endured long waits in their cars in lines that stretched back onto the highway in this scenic southern Utah valley, all for the chance to be tested for a virus they’d never heard of a few months ago.

“If we go to the Navajo Nation for help, they say, ‘Oh, you live in Utah, go to Utah’,” Marilyn Benally said. “We go to Utah, and they say, ‘You live on the reservation. Go to Window Rock.’ There isn’t enough of us living here to pay attention (to us). We don’t even exist to our chapter.”

Adds her husband, Bobby, who works for San Juan County grading roads, “We call it no man’s land.”

In just over a month in the Navajo Nation — where about half of the tribe’s 300,000 registered members reside full-time — officials have confirmed 1,321 confirmed cases (124 new since Sunday) and 45 deaths, including Jean DeJolie, 81, and her son, Douglas DeJolie, 58, who lived in Utah’s small Navajo Mountain community, but died in an Arizona hospital.

The Navajo Nation has a per capita infection rate 10 times higher than Arizona and the third-highest infection rate in the country behind New York and New Jersey, according to news reports.

As of Sunday, 6,579 tribal members had been tested, including those who live in border communities.

But before last week, only 60 of those tests had been administered at clinics on the reservation inside Utah because they had so few tests, said Kelly Carnahan, emergency response manager for the state’s public health laboratory who is in charge of the mobile testing unit.

55 new diagnoses

Byron Clarke’s daily duties include trying to secure more tests, or the materials needed to process the tests, which made last week’s mobile unit experience so crucial.

“Of the (6,579) total tests, 1,300 of those were done by us last week,” said Clarke, the chief operations officer for Utah Navajo Health Systems. “That’s 20 percent of the tests administered by the Navajo Nation.”

Statistics released Monday indicate 29 confirmed San Juan County cases, but Kirk Benge, the county’s health director, said he received notice of 55 new positive results from 824 of the tests, but they were still attempting Monday to verify that all those people live in San Juan County. Benge said he works with Utah Navajo Health Systems to determine where cases should be counted, but it’s his practice that anyone living in the county be included in the county’s totals, regardless of where they are when they’re diagnosed or treated.

“The 55 new cases was kind of in line with what we expected,” Benge said. “We knew we were doing expanded testing, and that we’d identify new cases.”

Carnahan said the mobile unit began testing the same day it was created, but traveling to the Navajo Nation was a unique collaboration.

“This is the first time the public health lab has done any kind of mobile response,” Carnahan said, as her crew suited up for the last day of testing Friday. “We wanted to be able to provide as much testing in remote locations for the populations who don’t have access — nursing homes, correctional facilities, homeless shelters and the Navajo Nation, and really all the Indian tribal nations, everywhere we can in the state.”

The no-cost testing was available to anyone willing to wait. Those who showed up to be tested ranged from an elementary school principal to tribal members from Arizona who were sick or who’d been exposed to the virus and many Utahns who just wanted peace of mind.

The mobile unit traveled to Navajo Mountain, where the crew tested 200 people on Monday and Tuesday, leaving another 50 tests behind with clinic personnel, and then they traveled to Monument Valley where they tested 580 on Thursday and 479 on Friday at a drive-thru testing site just a stone’s throw from the Arizona border. They left the remainder of the tests for health care workers who planned to test the nurses at Montezuma Creek clinic and the police department in Shiprock, Arizona.

While many of the Navajo tribe who live in Utah feel overlooked regarding some issues, they are lucky in one respect, according to many of those from Arizona who came to Monument Valley for testing. They have the Utah Navajo Health System, a unique collaboration between tribal members and the state of Utah that has become a national model for delivering health care to tribal members.

A number of tribal members living in Arizona said they seek treatment at Utah clinics as often as they can.

“We know, ‘Go to Utah’,” said Jo Ward, who came with her 20-year-old daughter, Utah, to be tested on Friday. “They take care of the Navajo.”

‘Good humanity’

Seeing what people endured just to be tested was sobering for Carnahan and the other members of her team.

“It actually makes my heart hurt,” Carnahan said. “So being able to be here and provide this testing, it’s just good humanity.”

It’s also good public policy because, as many patients and health care workers pointed out — the virus doesn’t respect tribal or state boundaries.

Clarke wasn’t surprised at the large number of people who show up for the free tests.

“We knew people were anxious to get tested,” he said. “Some people have been calling for several weeks, but they didn’t meet the criteria to get tested. The clinics, up until now, had less than 20 tests each. ... So we had to focus on those who had serious symptoms or had been exposed.”

More than half of those who drove through the mobile testing site were from Arizona, so Clarke said they’re planning to take their collaboration further south in a couple of weeks. Before the health department created the mobile testing unit, they were, like most local governments, trying to get tests from whatever source they could.

“We were promised tests for three weeks, a month, and it was always next week, and that went on for about a month,” said Clarke, who is on the phone constantly trying to secure resources to serve those who seek help at one of their four clinics. “It’s just a nationwide shortage.”

Family fears

It didn’t take much more than some social media posts for news of the mobile testing to spread hundreds of miles from the sites where health department staff worked alongside Utah Navajo Health Systems employees until they ran out of tests.

Ward, a business owner from Kayenta, Arizona, who drove to Monument Valley with her daughter to be tested because her community is one of the hardest hit, said a neighbor who was sick was repeatedly turned away from the Indian Health Services clinic in Kayenta. Eventually she convinced doctors at the Chinle Comprehensive Health Care Facility, which is 70 miles away, to test her. She was positive, and ended up staying at the facility for five days while her children fended for themselves at home.

Grid View Bobby Benally and his granddaughter, Sophie Hunt, sit outside of their home in Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Benally and Hunt are asymptomatic but got tested earlier in the day to be safe. Kristin Murphy, Deseret News

Bobby Benally shows where his grandchildren are home-schooled and learn the Navajo language as part of their education during the COVID-19 pandemic in Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Benally got tested earlier in the day. Kristin Murphy, Deseret News

Jarett Hunt sits on the back of a truck outside of his home in Halchitain Halchitain Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Jarett is asymptomatic but got tested earlier in the day to be safe. Kristin Murphy, Deseret News

Sophie Hunt and Jarett Hunt play on a trampoline outside of their house in Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Sophie and Jarett got tested earlier in the day. Kristin Murphy, Deseret News

Jarett Hunt, Nesbah Hunt and Sophie Hunt ride on a dirt road near their house in Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. The Hunt siblings are asymptomatic but got tested earlier in the day to be safe. Kristin Murphy, Deseret News

Jarett Hunt and Nesbah Hunt play outside of their home in Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Hunt siblings are asymptomatic but got tested earlier in the day to be safe, due to the high number of per capita COVID-19 cases in Navajo Nation. Kristin Murphy, Deseret News

Sophie Hunt and Nesbah Hunt ride a dirt bike near their house in Halchita, San Juan County, which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. The Hunt siblings are asymptomatic but got tested earlier in the day to be safe. Kristin Murphy, Deseret News

Jo Ward walks into the empty dining area of her restaurant, The Blue Coffee Pot Restaurant, in Kayenta, Ariz., which is part of the Navajo Nation, on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Ward is asymptomatic but got tested earlier in the day to be safe. Kristin Murphy, Deseret News

People line up for COVID-19 testing outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, on Thursday, April 16, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Kristin Murphy, Deseret News

Ronnie Blackwater prepares to tape a triage tent closed outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, after testing for COVID-19 ended on Thursday, April 16, 2020. Kristin Murphy, Deseret News

Amber Rasmussen, a physician assistant who has been administering the COVID-19 tests to local patients prior to mobile testing and providing triage at Monument Valley Health Center in Oljato-Monument Valley, San Juan County, gets tested for COVID-19 outside center on Thursday, April 16, 2020. Kristin Murphy, Deseret News

Korene Atene, a certified nursing assistant with the Monument Valley Health Center, gets information from people lined up to get tested for COVID-19 outside of the center in Oljato-Monument Valley, San Juan County, on Thursday, April 16, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Kristin Murphy, Deseret News

Sophie Hunt gets tested for COVID-19 as she sits in the lap of her grandmother, Marilyn Benally, outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County on Friday, April 17, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Kristin Murphy, Deseret News

Modessa Hancock, a nurse with Utah Navajo Health System Blanding Family Practice Community Health Center, and Sylvia Buck, a registered nurse with the Utah Navajo Health System, package COVID-19 test samples in a trailer outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, on Friday, April 17, 2020. Kristin Murphy, Deseret News

Karsten Blackwater listens to instructions for his COVID-19 test outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, on Thursday, April 16, 2020. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Kristin Murphy, Deseret News

A team made up of nurses, an emergency medical technician, dental workers, an X-ray technician, a lab technician, administrative workers, maintenance workers and an emergency manager test people for COVID-19 outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, on Friday, April 17, 2020. They tested 1,060 people in two days. Kristin Murphy, Deseret News

Andy Byrnes, a contracted emergency medical technician with the Utah Department of Health, takes a sip of water after taking off his N95 mask and Tyvek suit after administering COVID-19 tests outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, on Thursday, April 16, 2020. The mobile testing team tested 1,060 people in two days. The Navajo Nation has one of the highest per capita COVID-19 infection rates in the country. Kristin Murphy, Deseret News

Andy Byrnes, a contracted emergency medical technician with the Utah Department of Health, rests on the sidewalk near the end of a second day of testing for COVID-19 outside of the Monument Valley Health Center in Oljato-Monument Valley, San Juan County, on Friday, April 17, 2020. The mobile testing team tested 1,060 people in two days. Kristin Murphy, Deseret News

The fear of some of those who drove for hours before dawn to wait for hours in long lines was palpable. One woman fought back tears, and asked that the Deseret News not use her name because she was afraid she’d lose her job.

She was exposed working for a company that was supposed to be shut down due to orders from the Navajo Nation. It was her employer who told her there would be free testing in Utah on Thursday and Friday. She and her father made the trip Friday, sitting in a line of cars two hours long before the testing began.

“I told him I don’t want to work, but he told us we have to,” said the custodial worker who has three children, including an infant she is still nursing. “There is nobody to talk to, no one to help us.”

She gets emotional as she considers that her exposure jeopardizes her family. Her children cried when she left the house in the darkness before dawn Friday because they’ve heard stories about people who tested positive for COVID-19 and weren’t allowed to go home.

“She said, ‘Mom, please come home’,” she said of her daughter while fighting back tears. “She saw stuff on the news about people not coming back to their families.”

Her father jumps in, “They need to test everybody. That way we’ll know who is sick and who is not sick, and there are a lot of people who are sick that don’t know they’re sick. And they’re the ones who are spreading it.”

Ward, who owns three businesses in Kayenta — a restaurant, a gas station and a laundromat — said a woman who works for her was repeatedly turned away from the Kayenta clinic, which is run by the federal government’s Indian Health Services, despite being extremely ill. The single mother eventually traveled 70 miles to Chinle, Arizona, where she tested positive in a clinic there.

Ward said they kept her in isolation there for five days, and as she didn’t have a cellphone, her five children were left to take care of themselves until she could call relatives — some of whom were too scared to help the kids — for assistance.

“She finally got a hold of me, and we were able to take food out there,” she said, noting that community leaders asked her to reopen her laundromat because people need to be able to clean bedding and clothing to mitigate the spread. “This is the reason I come to this hospital, sad to say.”

Denise Begaye lives in Kayenta with her husband and 7-year-old daughter. She normally works as an X-ray tech at the Monument Valley Clinic. But like most clinics and hospitals, most resources have been diverted to dealing with the COVID-19 outbreak, so she volunteered to suit up in a gown, glasses, gloves and a mask and helped administer the tests with the mobile unit.

“It’s overwhelming in some aspects,” she said, collapsing to the ground after the testing finished Thursday. “You see the anxiety the community does have, the fear that they have. Some don’t have symptoms, but they want to be tested for the peace of mind.”

Rudy Yellowhair drove to Utah from Chinle because he is a security officer at Rough Rock Community School and a co-worker tested positive. He was told about the testing by his human resources manager, because at the Chinle hospital they couldn’t be tested without symptoms.

“I have a 6-month-old daughter, 2-year-old and a 9-year-old, and the thing that scares me the most is them getting sick,” he said, acknowledging that he’s gone to extreme lengths to limit his exposure and maintain good hygiene. “I’ve been worried.”

The Navajo Nation’s curfew and weekend lockdown have done little to mitigate the spread, according to several people.

“People are just not listening,” said Marilyn Benally, who said she’s afraid driving a bus to deliver food and homework to students twice a week. “Last weekend we had a lockdown, and we saw people driving this road because they sell beer across the river. Why don’t they stop and just sell fuel? Just close the place down for the weekend. It’s not really helping because a lot of businesses are still open on the border towns especially.”

Couple that with strict rules about testing, and it’s the perfect environment to breed fear.

“I think a lot of people were frustrated,” said Begaye, who works in both Monument Valley and Navajo Mountain clinics, of the fact that people had to have pretty severe symptoms to be tested. “We wish we could help, but we have a limited supply. I see the fear in them, so when I knew this (testing) was going to happen, I knew a lot of people would show up.”

‘We fear each other’

The fear and distrust that accompanies the outbreak has caused fractures in the community, but it’s also exposed strengths. She said while some ignore the rules and downplay the danger, others have stepped up to care for those who are vulnerable. Last week’s mobile testing was one of those moments when the community came together in a really beautiful way.

“We’re very fortunate in the area that we got this chance to have this happen, and I can’t believe it myself,” she said, noting that health care providers are relieved to be able to be tested, as well. “As a health care person, I wouldn’t want this to take me out. I’m young. I’m just now starting my career, and this is not how I would want to go.”

Like Benally, she said she worries most about the elderly who are often dependent on younger family members who may unknowingly expose them as they try to continue working to support themselves.

“They are our history that we carry with us everyday,” she said. “Whether you know it or not, it’s there with you. ... We’re fortunate to live in a community where grandparents live with or near grandkids, and they give them teachings and history.”

Begaye, 36, said her husband, Spencer Holliday, 39, is a maintenance worker at the Kayenta Health Center, which is operated by Indian Health Services. That area is among the hardest hit by infection, and the situation has become so desperate, she said his employer taught him how to administer the COVID-19 test. When they get home, they take their clothes off in the same place and wash them immediately. They shower, and then they hope for the best, especially because their worst fear is that they’ll bring the virus home to their 7-year-old.

“We fear each other sometimes,” she said, noting that she was a little surprised at the number of police officers who came from as far away as Tuba City to be tested.

“I feel for them,” Begaye said. “They are exposed day in and day out. ...I get to go home, but they’re still out there. They still have a shift to do.”

Begaye said she and many of those she knows have been stunned by how quickly the virus has moved through the community.

“I think because of how fast it’s moving, we don’t think something like this will hit our reservation,” she said.

“We believe these four sacred mountains will protect us. ... The fact that it’s here, it’s a big deal, and it affects every aspect of our nation. I think that’s what is overwhelming to everybody.”