Recovering addict Judith Anderson figures if she hadn't entered a program that caught and treated the hepatitis C she contracted after years of intravenous drug use, she wouldn't be alive to convince others to get checked out.
The 74-year-old resident of Sallisaw, Oklahoma — near the Arkansas border — said the potentially fatal liver disease sapped her of energy and "any desire to go anywhere or do anything."
"It was like living with a death sentence," she said of the infection that the U.S. Centers for Disease Control and Prevention said in 2016 killed more people than HIV and tuberculosis combined. "You're just tired all the time."
But things changed for Anderson, a citizen of the Cherokee Nation, because she took advantage of the tribe's aggressive program to test for and treat hepatitis C. Federal officials say it could serve as a national model in the fight against the infection.
The Cherokees, the second-largest tribe in the U.S. after the Navajo Nation, started the program three years ago looking to screen 80,000 of its 350,000 citizens, mainly targeting those 20 to 65 because of their statistically higher chances of having the disease. More than half of the target group has been screened, with more than 1,300 citizens testing positive, and a 90 percent cure rate among those who have started treatment, the tribe says.
CDC official John Ward, whose agency is providing technical assistance to the tribe, said the Cherokees are the first community to set such an ambitious goal to eliminate the disease.
"It's a trailblazing project for the entire country," Ward said.
The Cherokees, who operate the largest tribal health care system in the U.S., are shouldering the cost of the program. The Tahlequah, Oklahoma-based tribe is also capitalizing on medical advances that have seen the cost of the antiviral drugs used to treat the disease plummet from around $90,000 per patient just a few years ago to between $15,000 and $20,000.
"We're running the health system, why not take care of them early and give them a much better, longer quality of life?" Cherokee Nation Principal Chief Bill John Baker said. "It's less stress later on by us doing it ... it's a model for all the other tribes to be able to follow."
Hepatitis C is spread through infected blood, and hundreds tested positive for the disease in the Cherokee program after injecting drugs with unclean needles. Tribal health officials blame the nation's opioid crisis for the increase in those cases. When prescription pills run out, many addicts turn to the streets for cheaper and more readily available drugs such as heroin, which is often injected directly into veins.
The Cherokee Nation is suing several major drug distributors for what it claims is the companies' failure to prevent the flow of illegally prescribed opioids to its citizens.
Dr. Jorge Mera, the tribe's director of infectious diseases, is on the front line of treatment.
"In the last two years, I started hearing the word heroin more and more, every day," Mera said in a recent interview at the W.W. Hastings Hospital in Tahlequah, where the tribe is based. "Now we are seeing a younger population coming (with hepatitis C) that's predominantly due to IV drug use."
In addition to battling the drug epidemic and statistics that show they are 2.5 times more likely to die from hepatitis C, many Native Americans already must contend with rampant poverty and high unemployment that has plagued tribes for generations.
"For Native Americans or any other group that undergoes a lack of nutrition, more violence, lack of opportunity — those kind of group experiences can change the biology of groups of people to make them more prone to addiction," said Judy Grisel, a professor of psychology and neuroscience at Bucknell University and a recovering drug addict and hepatitis C survivor who has been sober more than 30 years.
To be sure, the tribe is unique in that it is absorbing the costs of treating its citizens, but Ward, the CDC official, said communities can learn from the Cherokee Nation's program by "involving a local champion and setting a goal for eliminating the disease."
"These efforts can inspire a community, help to develop partnerships and encourage accountability," Ward said. "The Cherokee Nation was successful in part because it developed strategies to finance testing and treatment.