MARY LOUISE KELLY, HOST:
Rocky Mountain spotted fever is the deadliest tick-borne disease in the U.S. It's been a persistent problem on some tribal lands in the Southwest, where residents are at particular risk, but the community has made progress in preventing deaths from the disease. NPR's Pien Huang went to tribal lands in rural Arizona to see how they did it.
(SOUNDBITE OF CATTLE MOOING)
PIEN HUANG, BYLINE: It's golden hour at a cattle ranch on the San Carlos Apache Reservation. The sun is low, and the animals have settled in their pen. And Houston Tye Hinton - resident stockman - is coming down after a long day of branding cattle. He sits on a bale of hay, spurs dangling, to talk about a recent illness. First, he's clear - he is not one to go to the doctor.
HOUSTON TYE HINTON: Cowboying, you always get hurt a lot, you know? So I do go to the hospital, but not regularly. I broke my collar bone one time and - broke it in half - and just let it heal on its own. That's just the way I was raised, you know?
HUANG: He chases bulls on horseback and lassos them for work. But back in November, it was a different kind of job hazard that got him. It started with his stomach. He felt nauseous, like he needed to throw up all the time, and it wouldn't go away. On top of that, he started getting bad headaches and a fever.
HINTON: It was a couple days that I'd had the fever. And then, you know, about the third day and it didn't subside, I was like, you know, something - something's got to be seriously wrong with me.
HUANG: With urging from his wife, Hinton dragged himself to the reservation's tribal health center, where he got diagnosed with Rocky Mountain spotted fever. The disease was first identified in the late 1800s in the Rocky Mountains of western Montana, though it's found all over the country now. In more recent times, it's become a scourge on some Native American lands in the Southwest. In the past 20 years there's been more than 500 cases and 25 deaths on tribal lands in Arizona. Residents on the hardest-hit reservations have been more than a hundred-and-fifty times more likely to catch it than in the rest of the country. Hinton didn't see the tick that bit him, but he developed the signature rash.
HINTON: I did find a spot on my foot, that there was a rash that had started there, and I just didn't notice it, you know?
HUANG: When an infected tick bites someone, it transmits bacteria called Rickettsia rickettsii. Johanna Salzer is a top expert on Rocky Mountain spotted fever at the Centers for Disease Control and Prevention. She says the bacteria attack the lining of the blood vessels.
JOHANNA SALZER: You think about spotted fever because it can cause a rash when people become severely ill. It's all of the busting of those blood vessels as the organisms are coming out.
HUANG: From the outside, it looks red and splotchy.
SALZER: The rash you see on a person's exterior is also happening throughout their body. So it's a multisystem organ failure that happens.
HUANG: Antibiotics are an effective treatment, but only if they're used quickly. People can die within eight days of getting symptoms. Rocky Mountain spotted fever first showed up in these parts back in 2003, with the sudden death of a child on a nearby reservation. Soon, more cases came. This was puzzling to doctors because in most of the country, the disease tends to come from ticks in the forest. Here in the dry desert, among the saguaro cactuses and tumbleweeds, investigators found a different species as the culprit - the brown dog tick. Maureen Brophy is an entomologist with CDC.
(SOUNDBITE OF CAR HORN HONKING)
HUANG: She and Salzer are here on the reservation, going house to house with the Tribal Health Department. They're suited-up in field clothes - long sleeves and long pants, covered in tick repellent - and they're here to help with disease prevention.
MAUREEN BROPHY: All right, so I'm going to set my traps in the usual spots.
SALZER: Yeah.
HUANG: For Brophy, that means crawling under the porch to trap some ticks.
BROPHY: The dry ice emits carbon dioxide. And when the ticks sense carbon dioxide in the environment, they are attracted to it. They'll start crawling towards it.
HUANG: Brophy points out gaps between the porch slats where ticks like to hide. She also points out patches of tall grass and old furniture in the yard - places where dogs and children might pick up ticks. And while high season is typically in the spring and summer, Brophy says here, the ticks bite year-round.
BROPHY: And so here, and in the areas where brown dog ticks are transmitting, there's, like, this perfect storm that happens where you have a lot of free-roaming dogs, you have infected ticks, and you have access to care that's limited, either, you know, by finances or geography or whatever.
HUANG: So the tribe sees prevention as a year-round effort, too. They tackle ticks by spraying pesticides around people's homes...
BROPHY: I'm going to give this one a new collar. You don't have a collar.
HUANG: ...And providing tick collars for dogs when they can, though the collars are expensive, and there aren't enough to go around - because the way that Rocky Mountain spotted fever spreads here is tied up with the many dogs that live on the reservation. Each household on average has three or four dogs, and then there are the stray dogs that run the reservation. As we drove through town, we saw bumper stickers that say, I brake for res dogs. We tracked down the designer, Naelyn Pike, by phone.
NAELYN PIKE: I care. And there's a lot of community members that care for these stray dogs on our reservation.
HUANG: But Pike, like many others, knows that there are thousands of dogs roaming freely between the desert landscape and people's homes that serve as a super highway for ticks.
PIKE: I know that there's always kind of a line, and that line is not to really let them near your home or near your babies because of Rocky Mountain spotted fever. And, you know, at times we do get cases, and we've lost community members to it.
HUANG: In the past, tribal elders had resisted efforts to control the stray dogs, but those attitudes are changing. For five years now, nobody has died from Rocky Mountain spotted fever on this reservation or the ones around it. But no deaths doesn't mean no cases.
(SOUNDBITE OF DOG BARKING)
HUANG: Harty Bendle, head of animal control on the reservation, has been working to protect his tribe from Rocky Mountain spotted fever for over a decade. He meets us in a neighborhood he's been keeping a close eye on.
HARTY BENDLE: This area has been one of our target areas. Most of the cases that we see come from here.
HUANG: Bendle is on the front lines, dealing with dogs and ticks all the time. Most days, it's just him and his two-person field team holding the line across all 1.8 million acres of the reservation.
BENDLE: The difference I've seen in the past 12, 13 years I've been here, you know, I mean, like, this time of year, you'd see dogs packed with ticks in their ears and under their bellies and whatnot, you know?
HUANG: Today, the dogs in this neighborhood have tick collars, and there are no ticks to be found. But Bendle knows the problem needs constant tending even in the dead of winter because the only way to prevent people in his community from dying of Rocky Mountain spotted fever is to stop them from getting bitten by ticks. Pien Huang, NPR News, San Carlos Apache Indian Reservation.
KELLY: And that piece was produced by Megan Lim.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
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