CDC Foundation Team Aids in Effort to Create Tribal Public Health Department

A poverty warrior and change agent. That’s how Joseph Eltobgi, MBA, an enrolled member of the Turtle Mountain Band of Chippewa Indians (TMBCI), describes himself. He’s worked for the betterment of the more than 32,000 members of his North Dakota community in various roles for more than a decade.

So, when he was hired to join the CDC Foundation as a senior public health advisor, he recognized it as “an exciting opportunity. I've never really imagined using my skill sets and experience to support the field of public health.”  

With the support of longtime public health professional Stephanie Jay, who heads up TMBCI's official public health initiatives, and other members of a team hired by the CDC Foundation to spearhead the effort, they’ve already taken some big steps as part of an ambitious, multi-part plan to create an accredited tribal public health department. These are its guiding principles:

  • To ensure the effective delivery of essential public health services with respect for the people and culture. 
  • To provide health promotion and disease prevention services/programs within the boundaries of the tribal nation. 
  • To achieve self-governance and establish government-to-government partnerships. 
  • To offer public health services provided by tribal members for tribal members.  

As part of the national effort to support jurisdictions’ response to COVID-19 and develop public health infrastructure, the CDC Foundation reached out to Jay at TMBCI in the fall of 2021 to ask if field assignees could be of help. And Jay was appreciative of the outreach. “We want to create our own public health unit,” she said. “We know that we’re a sovereign nation, we have inherent rights of public health, and we would like to continue creating our own programs with our own resources.”

Aside from Eltobgi who’s “amazing at strategic planning,” said Jay, the tribe requested and received a communications specialist, an environmental health coordinator, an administrative support specialist to gather data, and an epidemiologist to analyze it.

CDC Foundation Team members Cassandra Fonseca, Tristan DeCoteau, Christa Monette and Joseph Eltobgi at TMBCI's Anishanabe Roundhouse

TMBCI member Tristan DeCoteau atop the W'eel Turtle in Dunseith, ND

CDC Foundation's Joseph Eltobgi, Christa Monette, Tristan DeCoteau and Cassandra Fonseca at the Turtle Mountain Retirement Home

With input from advisors and other TMBCI members and staff, Jay and the CDC Foundation team came up with a wide-ranging strategy, involving everything from public health education and data access to tribal policy changes and workforce development.

Eltobgi immediately got to work drafting a tribal public health code, a key step in achieving formal recognition of a stand-alone department. That led to the development and distribution of a community health assessment questionnaire, led by experienced research assistant Christa Monette Davis, also an enrolled member of TBMCI. Completed by 640 tribal citizens, the results will be used to inform strategies to improve the community’s public health.

"We realized that providing data to our tribal leaders was absolutely essential to create the type of change we envision for our people,” Eltobgi explained. And that’s where CDC Foundation epidemiologist Cassandra Fonseca comes in. “She has done amazing work,” said Jay. “She just takes the data and tears it apart and presents the results, including detailed reports on COVID.”

Lorne Jay Jr., another member of the TMBCI, also serves as part of the team, as an environmental health specialist who leads a wastewater project to detect the coronavirus at sewage sites. Despite obstacles like six-foot-high snow drifts, he had three of the manhole testing sites set up in February. “This type of testing can detect changes as a signal for early action so if there’s a spike in coronavirus in your wastewater, there could be a spike in COVID infections coming within a week or two in your community,” Jay Jr. explained. “So the sooner we know about that, the sooner we try to keep people from getting infected and stop the spread.” That includes setting up additional antigen testing sites and vaccine pop-up clinics. “We are the only tribe in North Dakota that is doing wastewater surveillance,” Jay confirmed.

Joseph Eltobgi and Lorne Jay Jr. unpack the TMBCI wastewater surveillance system

Lorne Jay Jr., Stephanie Jay and Christa Monette examine the TMBCI wastewater surveillance equipment

The communications initiatives are another key part of the plan to bolster TMBCI public health services in preparation for establishing its own department. Enrolled tribal citizen Tristan DeCoteau keeps the tribe’s active Facebook account up-to-date and has also helped to develop an app that not only provides the latest on COVID and other important public health guidance, but will also feature push notifications to alert the community to important messages. “And you’ll get all of this in real time,” said DeCoteau.

The Tribe has created a pipeline for skilled public health professionals to support this growing area of work through the launching of a nine-month certificate program in public health offered through Turtle Mountain Community College. One group will graduate this fall, with a second cohort set to begin spring semester. Eltobgi isn’t satisfied with that, either. “The team is actually looking at resources to support advanced certification and bachelor's and master's degrees in public health as well, in partnership with other institutions across the state and country.”

We would not have been in the great position we are at our tribal health department if it wasn’t for my CDC Foundation team."

The establishment of a public health department still has to work its way through the tribal government system, but Eltobgi’s not leaving anything to chance. “I’ve already created and drafted all the legal documents necessary to create a tribally-chartered organization to achieve and maintain public health accreditation, which we’re unofficially calling the Agency for the Advancement of Public Health.”

Stephanie Jay is certainly appreciative of their efforts. “We would not have been in the great position we are at our tribal health department if it wasn’t for my CDC Foundation team. The work they’ve done in the seven months that they’ve been with me has been work that would’ve taken years otherwise,” she enthused, while providing a wish for the immediate future. “I can only imagine if I had them on staff full time to create and improve our public health policies to prevent disease and protect our tribal community.” Still, with the groundwork the team has laid, there’s no doubt TMBCI will continue to take strides toward establishing their own department, providing a footprint for other tribes around the nation to follow as well.

This story is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $200,000,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. Government.

Display Date