SAN CARLOS APACHE INDIAN RESERVATION, ARIZ. — It's golden hour on an early December day at a cattle ranch on the San Carlos Apache Reservation. The sun is low, and the bulls have settled into their pen.
Houston Tye Hinton, resident stockman at the Anchor 7 Cattle Growers Association, is winding down after a long day of branding cattle.
He sits on a stack of hay bales, spurs jangling, and says he was raised to be tough. "Cowboying, you always get hurt a lot," he says. "I broke my collarbone in half one time, and just let it heal on its own. That's just the way I was raised."
Hinton is not one to see a doctor. But back in November, he started getting really sick. "I always felt like I had to throw up, but I still worked and I still kept pushing through it," he says.
On top of stomach issues, he started getting bad headaches and a fever that wouldn't abate. "By about the third day, when it didn't subside, I was like – 'something's got to be seriously wrong with me,' " he says.
With urging from his wife, Hinton headed to the reservation's tribal hospital, where he was diagnosed with Rocky Mountain Spotted Fever — the deadliest tick-borne disease in the U.S., and a particular threat in this part of the country.
There's been a decades-long outbreak here. Though cases continue, the community-led response has reduced fatalities and is widely considered a public health success, even more so given the resource constraints.
A deadly scourge on Arizona tribal lands
Rocky Mountain Spotted Fever was first identified in the late 1800s, in a valley of the Rocky Mountains in western Montana, though it's now found all over the country. From 2002 to 2022, an average of around 2,800 cases of spotted fever rickettsioses (a group of diseases that are indistinguishable on blood antibody tests) were reported each year, according to data from the Centers for Disease Control and Prevention.
In that time, it's become a scourge on some Native American lands in the Southwest. From 2002 to 2022, there were more than 550 reported cases and 25 deaths among Arizona's tribal communities. Residents on the hardest hit reservations have been 70 to 150 times more likely to catch it than in the rest of the country, according to CDC data.
Hinton didn't see the tick that bit him, but he developed the disease's signature rash on his foot.
Bacteria rupture blood vessels to cause rash
When an infected tick bites someone, it transmits Rickettsia rickettsii bacteria.
The bacteria attack the lining of the blood vessels, says Johanna Salzer, a veterinary medical officer and top expert on Rocky Mountain Spotted Fever at the CDC.
"It's called 'spotted fever' because it can cause a rash. When people become severely ill, [the rash is caused by] the busting of those blood vessels as the organisms are coming out," she says.
On the outside, it looks red and splotchy. "The rash you see on a person's exterior is also happening throughout their body," Salzer says. "So it's a multisystem organ failure that happens."
Doxycycline, a common antibiotic, is an effective treatment but only if it's used quickly — ideally within the first day or two of feeling ill. But the early symptoms can be as vague as having a fever and a headache, says Dr. Marc Traeger, a family medicine doctor and epidemiologist with the Indian Health Service who has seen many patients with Rocky Mountain Spotted Fever.
"If we started treatment on days 3-5 [of getting symptoms], we would start seeing patients that were ill enough to be hospitalized," Traeger says.
Rocky Mountain Spotted Fever can quickly progress into a severe illness that requires intensive care or results in death; those who go untreated can die within eight days of showing symptoms, he says.
A novel culprit: the brown dog tick
Rocky Mountain Spotted Fever first showed up in this area back in 2003, with the sudden death of a child on a nearby reservation. More cases soon followed. Doctors were puzzled by the onset of the new disease, and how it was strongly affecting children here, says Traeger, who has worked on Arizona tribal lands for over 20 years.
A new tick vector was the key.
In most of the country, the disease is spread by ticks in the Demacentor genus, which people tend to pick up while working or recreating in the woods, Traeger says.
Here in the dry desert, among the saguaro cactuses and tumbleweeds, investigators found a different culprit: Rhipicephalus sanguineus, commonly known as the brown dog tick, a species that thrives on the reservation.
Ticks, dogs, children: an unfortunate cycle
The San Carlos Apache Tribe's Department of Health and Human Services runs door-to-door campaigns a few times a year to try to reduce the tick population.
On a balmy Saturday in December, Josiah May and Timothy Nozie Jr., animal control workers with the health department, pull up to houses with two experts from CDC: Salzer and her colleague Maureen Brophy, an entomologist and epidemiologist specializing in brown dog ticks. They're suited up in field clothes — long sleeves and long pants, covered in tick repellant — and stocked with surveys and pamphlets to hand out.
Brophy crawls under a few porches to count ticks. She sets down a container filled with dry ice on a large white sheet, to better see the ticks that are attracted to the carbon dioxide emitted by the dry ice.
As she works, Brophy points out gaps between the porch slats, and patches of tall grass and old furniture in the yard — places where ticks like to hide.
Kids are susceptible to getting infected and account for around 30% of the fatalities on Arizona tribal lands, according to CDC data. Traeger says it's related to behavior: Young children spend time outside in yards that dogs pass through and may even play with the pups.
"Maybe a rainstorm is starting, and they go under the porch for shelter, and there's a mattress that's been discarded where they cuddle up with their best friend, the dog," he says. "You can just see that transmission taking place," where an infected tick bites a child.
Beloved 'rez dogs' can harbor ticks
High season is typically in the spring and summer, though the ticks bite year-round. "It's like this perfect storm that happens when you have a lot of free-roaming dogs, infected ticks, and access to care that's limited by finances or geography," Brophy says.
So the tribe sees prevention as a year-round effort too. It's work led by a small, dedicated Animal Control team.
The team, led by tribal member Harty Bendle, tackles ticks by spraying pesticides around people's homes and providing tick collars for dogs. But the collars are expensive, and there aren't enough to go around.
Bendle says that a dog survey his team conducted a few years back found that each of the reservation's 2,200 or so households owns on average three or four dogs. That count doesn't include the many stray dogs that roam the reservation.
Around town, some cars sport bumper stickers that say "I brake for rez dogs." Those stickers were designed by Naelyn Pike, a local tribal member. "I care, and there's a lot of community members that care for these stray dogs on our reservation," she says.
But Pike — like many others here — knows that the thousands of dogs roaming freely between the desert landscape and people's homes serve as a superhighway for ticks. "The line is not to let them near your home or near your babies or your children, because of Rocky Mountain Spotted Fever," she says. "We do get cases, and we've lost community members to it."
In the past, tribal elders resisted efforts to control the stray dogs, but those attitudes are changing, Bendle says. In addition to Rocky Mountain Spotted Fever, the stray dogs have been implicated in cases of dog bites and rabies in people, and parvo and distemper in pets.
Success: Zero deaths for the past five years
The tribe's prevention efforts, along with raised awareness and vigilance among community members and medical practitioners, have yielded good results. For at least five years, nobody has died from Rocky Mountain Spotted Fever on this reservation, or the ones around it, according to data collected by health authorities.
It's the first public health achievement to be reached in the CDC's 2024 Vector Borne Disease National Strategy.
But no deaths doesn't mean no cases. Hinton, the cowboy, was one of four cases reported on this reservation in 2024.
When a patient shows up at the doctor's office with a suspected case of Rocky Mountain Spotted Fever, there's a protocol attached, says Natsai Chidavaenzi, deputy director of the San Carlos Apache Tribe's Department of Health and Human Services.
When a clinician reports a suspected case, "it triggers Animal Control to go and evaluate the [patient's home] environment and spray [for ticks]; it triggers a visit from the Public Health Nurse to follow up and assess; it triggers a follow-up lab test to confirm the case," Chidavaenzi says.
Still, she suspects some cases get missed, for instance if a clinician starts a patient on doxycycline "just in case" and sends them on their way without a formal diagnosis. It's less likely they're missing deaths from the disease, she says, since the misery and severity of the disease would cause most people to seek medical care.
Chidavaenzi doesn't fault clinicians for being careful — in fact, she's in favor of updating the treatment policy so that, in some cases, preventive antibiotics can be given before symptoms show. Still, it's important to her that each case be diagnosed and counted, so she can make an accurate case for continued funding and preventive measures.
There's long-standing tension between the tribe and the federal government when it comes to Rocky Mountain Spotted Fever and other community health issues. It plays out in the funding, says David Reede, a tribal leader and head of the San Carlos Apache Tribe's Department of Health and Human Services.
In the past 10 years, the tribe has taken on the responsibility for running the reservation's hospital from the Indian Health Service. That gives the tribe leeway to set priorities and policies — for instance, testing for Rocky Mountain Spotted Fever without prior authorization. But it also leaves them on the hook for services that go beyond the typical medical budget.
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. At one point, he says, they had more than a dozen people on staff. These days, it's mostly just him and his two-person field team, dealing with dogs and ticks from home to home, holding the line across all 1.8 million acres of the reservation.
It's making a difference. He takes us to a neighborhood where most of the Rocky Mountain Spotted Fever cases have occurred in the past five years. In past winters, he says, "you'd see dogs packed with ticks in their ears and under their bellies," he says. These days, the neighborhood dogs are sporting fresh tick collars, and there are no ticks to be found.
But Bendle knows the problem needs constant tending. Rocky Mountain Spotted Fever, he says, is like the common flu, HIV or COVID. "It's here," he says, "We just got to learn how to live with it."
There are no vaccines available to prevent the disease, for people or dogs. So the only way to protect those in Bendle's community from dying of Rocky Mountain Spotted Fever is to stop them from getting bitten by ticks.
Edited by Scott Hensley. Visual editing and production by Katie Hayes Luke and Carmel Wroth.
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