January/February 2004 THE PERMITNO. 630 U.S. POSTAGE PAID … · (IHS-EHR) will display RPMS data...

ANTHC Staff Report

About 300 people attended the Alaska Native Tribal HealthConsortium annual meeting held on December 8, 2003 inAnchorage. Participants heard presentations from board chair-man and president Don Kashevaroff, chief executive officerPaul Sherry, and directors of the five divisions of ANTHC.Those divisions are: Alaska Native Medical Center (ANMC),Division of Environmental Health and Engineering (DEHE),Community Health Services, Information Technology andHuman Resources. Tribal members were invited to provide comments during anopen microphone session, or by filling out comment cards. Thisprovides the Consortium a wealth of ideas on ways to improveits programs and services. Here someof the comments and the answers staffoffered.

Comment/Question: Sometimes yougo to the Emergency Room and yousit there and sit there. Answer: (Don Kashevaroff) Onething to know is that Saturday,Sunday, and Monday are the busiestdays of the week at the emergencyroom. We get a lot of people comingin those days. Also, we see the mostseriously ill patients first, requiringthose not as ill to wait. I know that weare faster than the other two hospitalsin town but we would like to get evenbetter. The way to reduce waits is toadd staff. If you add more folks, itcosts more money. We want to get ourfinances lined up before we startadding a lot of new people. That’swhat we’re working on right now.

INSIDE

MUKLUK TELEGRAPHT H E

The Voice of the Alaska Native Tribal Health Consortium

January/February 2004 PRESORTED STANDARD

U.S. POSTAGE PAIDPERMIT NO. 630ANCHORAGE, AK

Volume 7, Number 1

Alaska delegation winsMedicare payment increases for Alaska tribalhealth organizations.Page 6

Alaska Native Tribal Health ConsortiumHealth Report

Board members of a nationalNative health advocacy organizationhave elected Sally Smith, of theBristol Bay Area Health Corporation,as their chair. The National IndianHealth Board (NIHB) advocates forthe improvement of health caredelivery on behalf of federally recog-nized tribes.

“We’re working on re-authorizationof the National Indian Health CareImprovement Act, and increasedIndian Health Service funding, plusthe changing needs of a growing andaging population.” said Smith. “It’san exciting time to be NIHB chair.”

NIHB presents the tribal perspec-tive on federal legislation and net-

works withother nationalhealth careorganizationsto engage theirsupport onIndian healthcare issues. Itworks toinform tribesabout policydecisions atthe federallevel and changes in mainstreamhealth care management so tribescan make effective and sound healthcare policy decisions. It also seeks tomanifest progress in health care andto further strengthen tribal sover-eignty.

H. Sally Smith elected to chairNational Indian Health Board

Consortium annual meetinggenerates valuable feedback

H. Sally Smith

File photo

From left to right: Alaska Native Tribal Health Consortium board membersLincoln Bean, representing SouthEast Alaska Regional HealthConsortium; Christina Westlake, representing Maniilaq Association; EmilyHughes, representing Norton Sound Health Corporation.

Kashevaroff to headnational committeeon self-governance

ANTHC Staff Report

A national advisory committee onself-governance has elected DonKashevaroff as its new chairman.Kashevaroff is board chairman andpresident of theAlaska NativeTribal HealthConsortium, andpresident of theSeldovia NativeAssociation. “I’mhonored to havebeen electedchairman of thisgroup,” saidKashevaroff. “Alaska tribes were thefirst to take on tribal management ofhealth services and have a lot of expe-rience to share with other tribes.”

The Tribal Self-GovernanceAdvisory Committee (TSGAC) has18 members, all tribal chairpersons orelected officials. Committee membersrepresent IHS areas with tribes exer-cising control of health programsthrough self-governance. The commit-tee provides recommendations to theIHS director for consideration on vari-ous issues and funding methodolo-gies. The TSGAC meets regularly, atleast quarterly, and holds specialmeetings as needed.

The committee was formed underthe auspices of Michael H. Trujillo,MD, former director of the IndianHealth Service (IHS), and held itsfirst meeting in 1996. TSGAC hascontinued to work with Dr. CharlesGrim, the new IHS director. The IHSOffice of Tribal Self-Governance(OTSG) works with the TSGAC in aliaison role. The TSGAC is alsoidentified in the IHS ConsultationPolicy as one of the entities that willbe included in consultation activities.TSGAC requests input from andprovides information to the 286tribes exercising their sov-ereignty under P.L. 106-260, Title V.

Don Kashevaroff

See Annual Meeting, page 8

To ensure we provide the high-est quality care, Alaska NativeMedical Center needs your helpto make sure that we provideservices only to those peoplewho are eligible for care here.Starting in January, 2004 ANMCwill begin checking to make sureeveryone receiving care hasproof of eligibility on file.

Why is that necessary?Alaska Native Medical Center

(ANMC) provides pre-paid med-ical services to eligible AlaskaNatives and American Indians.

To ensure the highestquality of care...

See Eligibility, page 7

Paul Sherry, chief executive officer.

ANTHC Staff Report

The Alaska Area Annual DiabetesConference held on Dec. 3-5, 2003,drew about 250 health care profes-sionals from throughout the state.The aim of the conference was toupdate clinical skills and share infor-mation on primary and secondarycommunity prevention strategies,according to Carol Treat, Dietician,Alaska Native Tribal HealthConsortium Diabetes Program.

“It was excellent. We look forwardto it every year,” said LoisSchumacher, BSN, CDE, Diabetes

Program Coordinator, Bristol BayArea Health Corporation (BBAHC).“The data, the information the presen-ters share, is very pertinent to oureducation program.”

BBAHC sends people to the con-ference from several departments,said Schumacher. “It brings ourwhole team closer, so we all areworking toward the same goal andall know the importance of diabetesprevention and best ways to treatdiabetes related complications.”

Participation included people froma range of medical disciplines,including community health

aide/practitioners (CHAP), doctors,nurses, nurse practitioners, dieticians,physical therapists and pharmacists.

The conference featured a presenta-tion by Kelly Acton, MD, Director forthe Indian Health Service NationalDiabetes Program, who gave anoverview of special diabetes grant pro-grams for American Indians and AlaskaNatives. The Alaska Area DiabetesProgram also hosted a special apprecia-tion luncheon for CHAPs to thankthem for all the hard work they do.

Please mark your calendarsfor next year’s conference,Dec. 1-3, 2004.

January/February 2004

“I would like to eat lots offruit but I live far away forgetting fresh fruit. I hadweight loss surgery so I’mwatching what I eat.”

Esther Dzawa and 1-year-old son, Eric,

Sitka

By Howard Hays, MD, MSPH, Indian Health Service-Electronic Health

Records Clinical Lead

Electronic medical records are com-ing to Indian Health Service and trib-ally operated health care facilities.The Indian Health Service has longbeen a pioneer in using computertechnology to capture clinical andpublic health data.

The IHS Resource and PatientManagement System (RPMS) is a verypowerful database that containsdecades of clinical information aboutAmerican Indian and Alaska Nativepeople. Now IHS is moving to the nextlevel of clinical technology, by makingthe RPMS database even more capableand more accessible to clinical users.

The IHS Electronic Health Record(IHS-EHR) will display RPMS datain a graphical user interface (GUI),or Windows® program. This meansthat clinicians will be able to enterand retrieve clinical information suchas orders, test results, and notes, in away that is more familiar and intu-itive to the typical PC user.

The idea of keeping medicalrecords on computer instead of in apaper chart has been around formany years, and the technology hasbeen steadily improving. A numberof RPMS applications have beendeveloped that allow for on-lineentry of laboratory and radiologyorders, consults and referrals, and forposting of X-ray and test results.

Many Alaska facilities are alreadystoring such results in their computersystems instead of on paper. TheIHS-EHR will add to these capabili-ties with such enhancements as com-puterized provider order entry formedications, allergy tracking, clinicalreminders, and template-based clini-cal note authoring, all in a GUI envi-ronment. A fully capable EHR will

eventually eliminate the risk andinconvenience of misplaced or inac-cessible charts, and the need for fil-ing and storage of the paper record.

There are many reasons to use anelectronic record, the chief of whichis patient safety. Many studies haveshown that on-line entry of medica-tion orders is much safer than writtenprescriptions, and greatly reduces thechance of medication errors.

In addition, users at many locationscan simultaneously access an elec-tronic record and every provider willbe able to see the full record.Providers in outlying clinics withnetwork connections also will haveaccess to the same information.

Using an EHR, prescriptions andother orders go directly to the rightdepartment, potentially reducingwaiting times for medications orother services. Billing information istransmitted immediately to the busi-ness office, which means more accu-

rate invoices and faster turnaroundtime for payments. Privacy of healthrecords is ensured by restrictingaccess to only authorized users andby keeping track of who is enteringor viewing information.

Because the IHS and VHA computersystems are similar, the IHS-EHR willbe very much like the VHAComputerized Patient Record System(CPRS). IHS and VHA have a long his-tory of working together on computerapplications, and will continue to col-laborate on future EHR development.

Formal testing of the IHSElectronic Health Record is expectedto begin this winter, and IHS expectsto release the first version of theEHR by next summer. Using an elec-tronic record means big changes forhow just about every department in ahealth care facility does busi-ness, so it is not too early forinterested sites to begin plan-ning.

The Mukluk Telegraph is published bi-monthly by the Alaska Native Tribal Health Consortiumfor patients, employees and associates of ANTHC statewide.

To receive a copy of the Mukluk Telegraph, send your name and address to:4141 Ambassador Drive, Anchorage, AK 99508,

Attention: Mukluk TelegraphFor more information, or to send us news or announcements, please contact us at:

Fax: (907) 729-1901 Phone: (907) 729-1900

Letters to the EditorYou are welcome to submit articles forpublication, or to comment on articlespublished in the Mukluk Telegraph.

If you have questions about sending inarticles or feedback, please don’t hesitateto call Selma Oskolkoff-Simon at (907)729-1900 or send an e-mail to:

[email protected]

The Voice of the Alaska Native Tribal Health ConsortiumEditorial StaffJoaqlin Estus

Public Communications Director

Selma Oskolkoff-SimonAdministrative Assistant

Marianne GilmoreExecutive Administrative Assistant

VoxVoice of the people

Do you have a New Year’sresolution on health?

“I would like to eat more tradi-tional Native foods such ascaribou, fish, whale meat andmuktak.”

– Darold Tuckfield,Point Hope

The IHS Electronic Health Record Project

“To quit smoking and drinking. I’dalso like to learn more about dia-betes because I’m here to see thedoctor about it.”

– Marie TickettSt. Paul Island

“I was born in Kiana and livein Wasilla. My New Year’sresolution is that I would liketo go on a diet.”

– Kitty DaleWasilla

Photo by Kraig HaverTribal health system providers rely on the computer Resource and PatientManagement System for access to medical records. Betty Ruuttila, right,uses RPMS to review Naomi Bahnke’s health care records. In 2003-04, allRPMS systems in Alaska are receiving major software upgrades.

MUKLUK TELEGRAPH

Preventing and treating diabetes in Alaska Natives

SEARHC staff recently respondedto a request from the City ofHydaburg to provide emergencytechnical assistance to that Prince ofWales Island community. Due to adelayed payment in state revenuesharing funds, the City of Hydaburgexperienced significant financialhardship resulting in the layoff of allcity employees. SEARHC staff metwith the City Council, the HydaburgCommunity Association, and othercommunity leaders. Staff helpeddevelop a plan to ensure the contin-ued operation of health services andthe community water, sewage andsanitation systems during this periodof financial uncertainty.

SouthEast Alaska RegionalHealth Consortium laboratoryaccredited with distinction

The SEARHC Mt. EdgecumbeHospital Laboratory was recentlygranted Accreditation withDistinction from the College ofAmerican Pathology. The laboratoryis one of a select group of laborato-ries that has been evaluated andfound to be in compliance with rig-orous CAP laboratory accreditationstandards designed to help ensurequality patient care. The laboratoryis classified as a "highly complexlaboratory” providing services to thehospital, outpatient clinic, and thevillage clinics around SE Alaska.

By Charmaine Ramos, Project Manager, Community

Health ServicesAlaska Native Tribal Health Consortium

On Dec. 9, 2003, Alaska NativeTribal Health Consortium hosted astatewide meeting to facilitate discus-sion and gather input on its Village-Based Health ProviderTraining/Education and EmploymentProject. The goal of the VillageProviders Project is to create 100self-sustaining village jobs in theareas of behavioral health, dentalhealth, and personal care assistance.Participants in the AnchorageSummit represented tribal health andnon-profit, state, and private organi-zations from across the state ofAlaska.

Beginning the Summit, ANTHCstaff provided an update on themulti-faceted project.

Each discipline is at various stagesof development and implementation

region by region. Then the Summit participants were

asked three questions to facilitatetheir thoughts and group discussion,the questions were 1) What is hap-pening in your region now?; 2)What is your strategic plan and pri-orities for the next two – three years;and 3) How may ANTHC assist withrealizing your strategic plan and pri-orities?

Summit participants’ responsescovered their hopes and dreams fortheir programs and services. Theyshared some of the wisdom theyhave gained through their experi-ences in planning and developingother programs. Participants’ com-ments will be used to shape theVillage Providers Project so it fitsthe needs of villages and tribal healthorganizations.

ANTHC sponsored the Summit onbehalf of a coalition called the AlaskaRural Community Health &Economic Solutions (ARCHES).

Members of this coalition includeAlaska Native Health Board, AlaskaMental Health Trust Authority,Denali Commission, RasmusonFoundation, and University ofAlaska. In addition to support fromthe ARCHES partners, private fun-ders of the Village Providers Projectinclude Ford Foundation, NationalRural Funders Collaborative, andPaul G. Allen Foundation and publicfunders such as Indian HealthServices.

Following the Summit, there wasa roundtable discussion on theplanning, development, and imple-mentation of the behavioral healthproject. Before the Summit, boththe dental health and personal careassistance projects met with man-agement of their respective disci-pline to discuss their projects. Tofind out more about the VillageProviders Project, contactproject manager CharmaineRamos at 729-4491.

STATEWIDENews and noteS

Yukon-Kuskokwim Health Corporation Media Services Staff Report

A feasibility study commissioned bythe Yukon-Kuskokwim HealthCorporation (YKHC) and other agen-cies recommends construction of an18-bed assisted living home in Bethelfor a growing population of elders.With resident trained staff of person-al care attendants and nurses, anassisted living home would offer atransitional stage between congregateliving for elders and a nursing home.The long-term plan includes this

first step of constructing an assistedliving center. The proposed facilitywould accommodate 18 elders, butwould be built to allow futureexpansion as the population of eld-ers needing the services is expectedto increase. Additional future stepsinclude the addition of a nursinghome on the YKHC RegionalHospital campus. The feasibilitystudy also looked at the Aniak sub-region and concluded that an eight-bed facility there should also bebuilt once the Bethel home is openand occupied.

From The Messenger, a newsletterof the Yukon-Kuskokwim HealthCorporation.

Study supports need forassisted living home in Bethel


ANTHC hosts village-based health provider summit

Alaska Federal Health Care AccessNetwork Staff Report

Health care providers working inthe most remote locations ofAlaska are able to overcome thebarriers of weather, landscape, andvast distances using technologiesdeveloped by the Alaska FederalHealth Care Access Network(AFHCAN) and MidmarkDiagnostics Group.

Four years ago, clinicians werelooking for a software programthat could transmit 12-lead elec-trocardiograms. The AFHCANproject office reviewed the possi-bilities before choosing theIQmark Digital ECG by MidmarkDiagnostics.

“We initially selectedBrentwood/Midmark based on thequality of ECG readings and porta-bility of the hardware,” saidStewart Ferguson, PhD, AFHCANDirector. “The real benefit, we laterlearned, came from the cooperativenature of their staff. They workedclosely with us, and worked hard toovercome the technical challengesof what we were trying to accom-plish.”

The resulting product is anAFHCAN Telemedicine Cart with asimple user interface, allowing clini-cians to select the ECG as one offour biomedical devices. After log-ging into the software, the user canaccess any of the biomedical periph-erals on the cart with no more thanthree mouse clicks or presses of thetouchscreen monitor.

The AFHCAN web-based soft-ware cleanly interfaces with theIQMark Digital ECG. The ECGsare saved as a case and sent fromthe server of one health care organ-ization…over satellite…to the serv-er of another health care organiza-tion. Active X Controls are usedinitially to display the cardiacwaveforms while the clinician isperforming the ECG; they are alsoused later for reading and interpret-ing the stored data. The telemedi-

cine cart and ECG are gaining pop-ularity among clinicians.

“The ECG was received from thevillage health aide …the ECGshowed an acute myocardial infarc-tion,” describes Floyd EltermanMD of Chief Andrew Isaacs HealthCenter in Fairbanks, AK. “It waspossible to be very definite withthe patient, who had no healthinsurance, about the necessity forhospitalization.”

AFHCAN Clinical Director, ChrisPatricoski, MD, notes, “It’s all aboutease-of-use and durability. With thisdevice, they start pressing green but-tons and before you know it, they arecreating a case and performingECGs.”

About 150 sites are using theECG unit as part of the AFHCANtelemedicine cart. The sites havebeen deployed one after anotherover the past two years and in thattime, 671 cases have included anECG.

Each case normally includesthree ECGs, so approximately

2000 ECGs have been performedand sent. Most ECGs are per-formed by Community HealthAides in remote villages and sentto regional Family Physicians,who then may forward to a cardi-ologist in Anchorage.

“ECG transmission fromAlaska’s interior villages toFairbanks physicians…has provenbeneficial,” describes Gina PenderMD, staff physician for ChiefAndrew Isaacs Health Center. “Insome instances, the decision tourgently transfer the patient withacute ECG findings was facilitat-ed…In other cases, ECG telemedi-cine has prevented unnecessarytravel of patients to the acute caresetting. During physician medicalfield visits to the village, the 12lead ECG unit has been useful inevaluating patients…”

It is too early to tell what kind ofimpact this new technology ishaving on outcomes. But it isclear from practitioners in thefield that it is here to stay.

Performing electrocardiogramsin remote regions of Alaska

Photo by Kraig Haver

Telemedicine often speeds diagnosis and saves travel costs and inconven-ience. Using a telemedicine cart at the Dutch Harbor Wellness Center, IreneMcGlashan transmits electrocardiogram (ECG) results to a referral physi-cian in Anchorage.

SouthEast Alaska RegionalHealth Consortium helpskeep water, sewer, sanitationsystems going in Hydaburg

See Statewide News, page 4

By Sandra KlevensYukon-Kuskokwim Health Corporation

After many months of considera-tion, most village clinician positionswithin Yukon-Kuskokwim HealthCorporation’s Behavioral Health pro-gram have been filled.

A 90-day training and orientationperiod has begun. It includes bothclassroom sessions and days spentshadowing providers in the variouselements of Behavioral Health. Thisincludes time spent with the emer-gency “on call” staff, and days attwo facilities in Bethel: theResidential Diagnosis and TreatmentCenter (RDT) and McCann InhalantTreatment Center (MTC).

Valerie Warren offered this firstimpression of the Yukon-Kuskokwim Delta, “Words fail me.My impression developed over days.It was very different. It was wet andI found it interesting that no oneused umbrellas. I was getting wet.”In spite of this she says, “I was real-ly affected and moved by the friend-liness of the people.”

Valerie holds a dual position inpartnership with the Child AdvocacyCenter, housed at Tundra Woman’sCoalition, and YKHC VillageServices. It’s challenging to balanceboth roles, she said, “But it’s a fabu-lous job because the opportu-nities to make a differenceare enormous.”


By Leigh Hubbard and Kelly Leseman, Project Engineers

Division of Environmental Health and Engineering

Last summer, the Alaska Native Tribal HealthConsortium and the Native Village of Nanwalekworked closely together to remedy a water shortageafter low winter snowfall and an unusually warmsummer left the village reservoir nearly empty. Thesouthcentral Alaska village was forced to shut offwater service overnight, and sometimes to ration it toonly one hour each day.

Nanwalek is a small picturesque village located onthe southern tip of the Kenai Peninsula, approximate-ly 20 miles south of Homer, Alaska. Like manyAlaskan villages, its 220 residents have a school, achurch, a clinic, and a small store. What setNanwalek apart for much of the past year was itslack of a safe drinking water source.

Nanwalek began experiencing water shortages dur-ing the early summer of 2002. According to JamesKvasnikoff, the Nanwalek IRA Council SecondChief, the water level in the village dam decreasedconsiderably during this time.

The problem was that not enough water was enter-ing the watershed. Rain and snowmelt from thewatershed collects in the dam. The water is thentreated, disinfected, and stored in a water tank.Village residents believed an unusually warm sum-mer and low winter snow fall reduced the amount ofwater in the watershed.

This trend continued through July of 2002, whenthe dam water level dipped so low that village waterservice was shut off at night to conserve water. Bylimiting service and using water only for drinkingand cooking, the village managed to conserve wateruntil the fall rains arrived and filled the reservoironce again.

During the following winter, water flowed into thesystem. However, a warm winter left a smaller snowpack that melted sooner than previous years. Villageconcern that a second dry and hot summer wouldcause a water shortage led Council members to raisethe issue in the village and look for ways to avertanother shortage. However, shortly thereafter,Nanwalek began experiencing another water shortagethat forced it to shut off water service overnight.Water supply became so limited that at times waterwas available for only one hour each day.

In April, the Nanwalek IRA Council contacted theAlaska Native Tribal Health Consortium (ANTHC)Division of Environmental Health and Engineering(DEHE) and asked for assistance. In response, theANTHC acquired funding from the Indian HealthService (IHS) and began the search for alternativewater sources.

ANTHC Engineers Kelly Leseman and LeighHubbard traveled to Nanwalek and identified twopossible sources to supplement the watershed. Onestream, called Switchback Creek by local residents,appeared to be the most promising. It had the capaci-ty to supply the quantity of water needed and connectto the reservoir without using pumps. This and otheralternatives were presented to the Tribal Council,who agreed with the Switchback Creek option.

On July 30, 2003, the village water treatment plantoperator, Paul Swenning, informed the Council that thewater tank was empty. The Council declared an emer-gency and had 90 gallons of water flown in fromHomer.

Each household was rationed two gallons of water,beginning with the elderly, children, and diabetics.Later in the day, the Council and the English BayCorporation arranged for water to be delivered to thevillage in a manner never seen before.

A barge that normally supplies drinking water tocruise ships delivered 50,000 gallons of water.Together with a second delivery, the 150,000-gallonwater storage tank was filled to half capacity.

In the meantime, the village worked together onceagain to conserve water during the shortage. EmilieSwenning, First Chief of the Nanwalek IRA Council,explained that residents collected stream water anddistributed it among village households to use in toi-lets and to wash clothes. They also kept clean byswimming in a nearby lake. Neighboring village ofPort Graham also donated fresh water in bottles and5-gallon buckets, and local fishermen transported thewater from Port Graham to Nanwalek.

The Council notified DEHE the day after declaring anemergency. After consultation between the project engi-neers and the director of DEHE Regional FacilityServices, Ralph Hogge, a decision was made to designatethe pipeline project a priority. Despite the fact that fundswere still not available from the IHS, ANTHC forward-funded the project at its own expense.

To guide and oversee the project planning, a finaldesign meeting was held, and by the end of August aproject superintendent was selected, the pipeline routewas surveyed, design plans were completed, andmaterials had been ordered and shipped to Nanwalek.Construction began on Sept. 1, 2003.

ANTHC Superintendent, Roger Fuiten, along withLeigh Hubbard oversaw a local force account laborcrew of three that completed the construction. Locallaborers Martha Hetrick, Maurice Kvasnikoff, andEmerson Kvasnikoff provided invaluable help, whileengineer Kelly Leseman kept needed parts and mate-rials coming into Nanwalek.

With a concentrated effort by the local help and theANTHC DEHE, construction was completed in fivedays. The dam, which only weeks earlier almost randry, now overflowed only hours after the pipeline wasput into operation. The flow rate measured at anastonishing 40 gallons per minute, which was muchgreater than expected.

Because of the collaboration of the villages of PortGraham and Nanwalek, the English Bay Corporation,and the ANTHC DEHE, this project was a success. Inthis instance, the water shortage not only served tounite many individuals to see a village through diffi-cult times, but it also demonstrated thestrength and resiliency of the people ofNanwalek.


Nanwalek has water again

ANTHC Superintendent Roger Fuiten (right) pauses fora break with the local laborers who assisted with theNanwalek water transmission line project in September2003. The laborers, who are pointing to a water collec-tion box, are (from left to right) Emerson Kvasnikoff,Martha Hetrick, and Maurice Kvasnikoff.

New behavioral healthclinicians on board

The lab has experienced significantworkload increases over the pastyears. Volume, based on "billableunits", runs approximately 40,000/year. Seven years ago, there were28,000 billable units, representing a43 percent workload increase in thepast 7 years.

New Angoon clinicunder construction

North Pacific Erectors of Douglasbroke ground on the new 8,000square foot Angoon Clinic inSeptember. Finally under way,SEARHC has been planning theconstruction of a new clinic in theSoutheast village for more than sixyears.

The new facility will provide overthree times the space of the currentclinic and will have expanded den-tal, behavioral health, primary carespace, a very efficient emergencyroom and X-ray services.Construction of the facility is sched-uled to be completed in July 2004.

Statewide News …From page 3

A new water transmission line project was completed inNanwalek in September 2003.


By Phyllis Boskofsky, RNDirector of Nursing Services

Oct. 16, 2003, marked a milestone for the Maniilaqregion. That day was the first clinical day at the ManiilaqHealth Center Acute Care Unit for Mary Viveiros andSusan Walker, students in the first remote distance-deliv-ered Licensed Practical Nursing program in rural Alaska.

Viveiros and Walker had already spent many hours inclinical instruction and practice in the nursing laboratoryat the Alaska Technical Center. The students learnedunder the watchful eyes of the clinical instructor fromManiilaq Health Center registered nurse (RN) NicholeVetter, and the oversight of Dara Whalen, RN, MSN(Masters of Science in Nursing), from Maniilaq’s PublicHealth Nursing Department, in preparation for caring forreal patients.

More than two years ago, Maniilaq formed a partner-ship with the University of Alaska Fairbanks ChukchiCampus at Kotzebue, the Alaska Technical Center, andUtah’s Weber State University, to deliver LicensedPractical Nurse and Registered Nurse programs in theNorthwest Arctic Borough. In spring 2001, the Directorof the School of Nursing at Weber State, Debra Huber,RN, and Pam Hugie, Outreach Coordinator, came toKotzebue and conducted a feasibility study to see if itwould be possible to bring the university program to aremote area.

The community greeted them in a unified showingof community support and commitment from busi-nesses, organizations, community members, the localsecondary education schools, and communicationorganizations.

Maniilaq proposed a plan for Weber State to deliver theclassroom portion of the courses, with a local clinicalinstructor overseeing the students in the clinical practiceportion of the program at the Maniilaq Health Center.The Alaska Native Medical Center at Anchorage alsooffered support in the form of additional clinical experi-ence for some areas. The Weber State representativesalso met with a group of approximately 15 individualsinterested in becoming nurses.

As a result, Weber State decided it was possible todeliver the program, and the cooperating agencieslaunched the project. Students took pre-requisite col-lege courses in math, English, anatomy and physiolo-

gy, chemistry, microbiology, and nutrition in prepara-tion for the course. Through the efforts of theUniversity of Alaska Fairbanks Chukchi Campus, theAlaska Technical Center, and the Maniilaq HealthCenter, the group located local, qualified, masters-pre-pared instructors who provided the needed courseslocally.

In August 2003, two students, Susan Walker and MaryViveiros, who had successfully completed all the pre-req-uisites, began the Licensed Practical Nurse program.They will graduate in May 2004, and will have theopportunity to continue in the Registered Nurse programwith an anticipated graduation in May 2005.

That will fulfill Maniilaq’s long-held vision of provid-ing local, licensed Native nurses to provide health care tothe predominately Inupiaq people of Maniilaq’s servicearea. This is the ground breaking first step in movingtoward a medical facility professionally staffed by localpeople.

For more information, contact Rebecca Ormsin the Maniilaq Human Resources Departmentat: (907) 442-7661.

Milestone Day for nursing in the Northwest Arctic Region

“It is a race against time…”

You’re first at the scene of ahorrible, terrifying wreck. Peopleare screaming in pain and fear,writhing in agony and despair.You freeze; you want to run, somany hurt people, where do youSTART? The woman with a bro-ken femur sticking out of herthigh? The kid choking on hisown blood, the other kidssquirming like a bucket of black-fish? You feel overwhelmed andyour mind is overloaded.

This is a problem all respon-ders may face, sooner or later.Too many patients and too littleresources, you will need totriage; (from the French word “tosort”) and you need to do it fast.

In 1983 the Newport BeachFire Dept. developed the STARTsystem. This stands for SimpleTriage and Rapid Treatment.This triage system has beenupdated and has rapidly become“state of the art” for triage in theUnited States. The system comesin a red fanny pack, with about35 colored and numbered triagetags along with some paramedicshears and tie wraps and somered reflective adhesive“Immediate” stickers. It is sim-ple; it was designed for rescuerswith basic first aid skills and ithas been proven in the field.

First, as with any scene, ensureyour safety! Then you want tomove the “walking wounded.”They get green tags. For exam-ple, Aeromed Delta did this inthe April 2001 Nelson Island air-craft crash. Gene Wiseman,MICP, shouted, “everyone whocan walk come over here.” Allbut two of the patients then gotup and walked over. He thenknew which patients were themost serious.

• Open the airway. If thepatient is not breathing after ahead tilt/chin lift and an oralpharyngeal airway insertion(OPA), this patient will get blacktags (dead/dying).

Remember R.P.M. Respirations,Pulse, Mental Status.

Then you check respirations. Ifrespirations are over 30 aminute, the patient gets a red tag(immediate).

• Check the patient’s radialpulse. If they have none, theyget a red tag (immediate).

• Check the patient’s mentalstatus. If they are unable to fol-low simple commands, they geta red tag (immediate).

• Otherwise, all patients willget a yellow tag (delayed).

All red-tagged patients get theadhesive reflective sticker placedon them. This helps the respon-der keep track of the immediatepatients in low light situations.

More information can be founda www.start-triage.com

Reprinted from The Messenger,a newsletter of theYukon-KuskokwimHealth Corporation.

START – SimpleTriage and RapidTreatment

Left to Right, Nichole Vetter - Clinical Instructor, SusanWalker - Nursing Student, Helen A. Bolen -President/CEO Maniilaq Association and Mary Viveiros- Nursing Student

Why is it important to get DenaliKidCare, health insurance or other

resources?1) It brings alternate resources into our Alaska tribal health system.

2) It’s easy, and happens at no cost or inconvenience to you.3) Our Family Health Resources team at the Alaska Native Medical Center are willing to help

determine if you are eligible for any resources such as Denali KidCare.

Alaska’s Covering Kids presents:Facts on how Denali KidCare helps children, teens, and pregnant women

in the Alaska tribal health system.

1) Children and teens receive a full range of prevention and treatment services such as doctor’s vis-its, check-ups, vision exams, eyeglasses, prescriptions, medical transportation, and more!

2) Enrollment in the Denali KidCare program helps bring resources into our Native healthcare sys-tem—making us stronger!

3) Enrollment is easy, and we have Family Health Resource staff available to answer any questionsyou may have or assist you in enrolling or renewing your insurance. Please call them at 729-3254to find out more about what you’re eligible for! If you would like to request a Denali KidCare mail-

in application by phone, call 269-6529 (in Anchorage) or 1-888-318-8890 (toll-free Statewide).

By Joaqlin EstusDirector, Public Communications

The Alaska tribal health system willsoon see increases in Medicare reim-bursements, thanks to the newMedicare law enacted on December 8,2003. Medicare is the national medicalcare program for people over 65.

During negotiations over the finalHouse-Senate compromise, the Alaskacongressional delegation added severalAlaska-specific items. The new lawadds drug benefits to Medicare, increas-es the reimbursement amount for doc-tors’ care of patients on Medicare, anddirects Medicare to pay remote clinicsfor patients’ overnight stays.

“These changes will bring much-need-ed additional revenues to the Alaskatribal health system,” said Consortiumchairman and president DonKashevaroff. “We have an outstandingcongressional delegation. SenatorMurkowski is a great addition to theteam and really went to bat for us.”

H. Sally Smith, chair of theNational Indian Health Board, agreedwith Kashevaroff’s assessment.

“She’s compassionate, intuitive, aquick study – and works well withSenator Stevens,” Smith said. Smithalso praised Brian Gavitt, Murkowski’s

health legislativeaide for closelyshepherding sev-eral key provi-sions throughcongressionalnegotiations.

The new lawincreased the rateat which doctorsare reimbursed.Doctors now receive about 37 centsreimbursement for every dollar. Underthe new law, they’ll get about 55.5 centson the dollar. U.S. Senator Ted Stevenssaid the new Medicare rates equal thosepaid by the Department of VeteransAffairs to doctors who see veterans inAlaska.

“That means up to $1.2 millionmore a year for Alaska NativeMedical Center,” said Jim Lamb,director of patient financial services atANMC. “We get about $4.8 millionper year from Medicare for physicianfees,” said Lamb. “Depending on theregulations, under the new law, we’llget somewhere between $900,000 and$1.2 million more per year.”

The new law also clearly allowsMedicare to pay tribal or Indian HealthService pharmacies for prescriptioncosts. Tribal health organizations will

be able to chargeMedicare up to$600 per year forprescription drugcharges for peoplesigned up forMedicare.

“That’s a signif-icant savings andwill certainly helpoffset the cost ofmedications, whichhave been rising anywhere from 17 to25 percent every year,” said ANMCAdministrator Dee Hutchison.

Murkowski and Stevens also spon-sored an amendment that will directMedicare to pay remote clinics forpatients’ overnight stays. Gavitt saidMedicare currently will only pay forovernight stays in hospitals.

The Centers for Medicare andMedicaid programs are developingrules to implement the new law.Alaska Native Tribal HealthConsortium and other tribal healthorganizations are activelyinvolved in reviewing andcommenting upon thoserules.

Heather A. Resz contributed to this article.

The Alaska Native Health Research Conference is for :• Sharing Research ResultsPresentations featuring health research studies.• Putting Research into PracticePresentations on Alaska Native health promotion anddisease prevention programs developed based onAlaska Native Health research projects.• Research Panel DiscussionDiscussions with regional and statewide researchreview boards.


CALENDARUpcoming Events

January 2004

4 “Breaking the Silence” video,KTUU Channel 2, 9 a.m.5 ANHB Board of Directors, 1 pm,ULB Boardroom7 Alaska Tribal Health CompactTribal Caucus (tentative)9-23 Dental Health Aide Training –Expanded Function Dental HealthAide II, TCC, Fairbanks12-16 SEARHC Quarterly Meeting12-16 Dental Health Aide Training– Expanded Function Dental HealthAide I, TCC, Fairbanks19-23 Norton Sound Health Corpboard meeting, 9 am – 5 pm, PioneerHall, Nome19 NSHC Scientific AdvisoryBoard, 9 am – noon, Pioneer Hall,Nome20 Medicaid Task Force Meeting,10 am – 5 pm, ULB Boardroom20 NSHC Hospital ServicesCommittee, 9 am – noon, HR Conf,Nome20 NSHC CHS Committee, 9 am –5 pm, Pioneer Hall, Nome21 Sanitation Facilities AdvisoryCommittee, 11:30 am – 5 pm, YukonConf Rm, DEHE Bldg22 Sanitation Facilities AdvisoryCommittee, 7:30 am – 1 pm, YukonConf Rm, DEHE Bldg23 RASC Quarterly Meeting, 9 am– 5 pm, ANHB Conference Room23 Denali Commission quarterlymeeting, Sitka27 Alaska’s Covering KidsCoalition meeting, Anchorage, loca-tion TBA27-29 Tribal Self GovernanceAdvisory Committee, WashingtonDC Embassy Suites Hotel28 Clinical Directors meeting, loca-tion TBA

February 20043 Association of Tribal HealthDirectors Meeting, Centennial Hall,Juneau4 ANHB MEGA Meeting,Centennial Hall, Juneau5 Medical Services NetworkingCommittee, 10 am – 4 pm, ULBboardroom5 ANHB Business Meeting,Centennial Hall, Juneau9 Alaska Native Tribal HealthConsortium Board Meeting9 Village Services ManagementTeam, 11 am – 3 pm, SCFBoardroom16 Elizabeth Peratrovich Day.23-25 NCAI Executive CouncilWinter Session, Wyndham Hotel,Washington, D.C.(Info: www.ncai.org) 23-26 Indian Health ServiceAnnual Meeting of CombinedNational Councils of ClinicalDirectors, Chief Executive Officers,Chief Medical Officers, Oral Health& Nurse Consultants, Bahia ResortHotel, San Diego, CA (Info: 602-364-7777)24-25 Maintenance andImprovement Resource AllocationCommittee (MIRAC), 8:30am – 5 pm, ULB board-room

Bristol Bay Area Health Corp. launchesNicotine Dependence Treatment Program

The Bristol Bay Area Health Corporation (BBAHC) inDillingham has launched its new Nicotine DependenceTreatment Program. The new program offers cessation serv-ices to clients interested in quitting tobacco and includes theuse of state-of-the art counseling techniques and drugs.Many have already taken advantage of the new servicesoffered, with more than 60 people entered so far.

According to Shannon Fuller, a BBAHC NicotineDependence Treatment Counselor, clients are eligible forthe program if they are ready to quit tobacco in the next30 days. “Our clients are assisted by developing a per-sonalized treatment plan, including a personalized coun-seling schedule and nicotine replacement dosing if indi-cated. The program provides regular follow-up phonecounseling for up to one year.”

“By offering counseling services and nicotine replace-ment therapy, patients can gain the added support to helpthem through the quitting process” says MarilynnThorson, Program Manager of the new program. “Quitrates are shown to double if patients take advantage ofmedications available for treating tobacco dependencecombined with counseling services.”

If you’ve found quitting tobacco extremely difficult,you’re not alone. “Slipping and starting to use tobaccoagain is all part of the quitting process. We stress persistinguntil the client is successful. Sometimes it takes people fiveto seven quit attempts to stay quit for good. We’re here to

support clients until they are successful” said Fuller. Alaska Natives have a higher rate of tobacco use com-

pared with the national average (43 percent versus 23 per-cent). Quitting tobacco can greatly impact your health. Itis never too late to quit. Tobacco causes the highest num-ber of preventable deaths in the U.S. each year. 90 per-cent of lung cancers are from patients smoking. Smokingand chewing tobacco cause many other cancers and areassociated with many health risks.

Services are located in Dillingham at BBAHCKanakanak Hospital and can be contacted formore information at 1-800-478-5201 ext 6320.

Nicotine Dependence Treatment Counselor ShannonFuller and Marilynn Thorson, Program Manager coor-dinate Bristol Bay Area Health Corporation’s newNicotine Dependence Treatment Program.

W h o S h o u l d A t t e n d ?• Tribal Health Organizational Board Members• Research Review Members• Tribal Health Directors

SAVE THE DATE! March 30-31, 2004BP Energy Center,

900 E. Benson Blvd.,Anchorage, AK.

Alaska Native Health ResearchConference Task Force4201 Tudor Centre Drive, Suite 105Anchorage, Alaska, 99508

Fax: (907) 729-2924

For more information, send e-mail to [email protected]

Alaska delegation wins Medicare paymentincreases for Alaska tribal health organizations

U.S. Sen. LisaMurkowski

U.S. Sen. TedStevens


Indian Health Service funding coversonly part of the cost for everyone eli-gible for care at ANMC. Thus, it isimportant that ANMC provides serv-ices only to those people who are eli-gible for services at the ANMCaccredited campus. The only way tobe sure we are doing that is to haveproof. If we don’t have proof of eli-gibility on file, we will ask for yourhelp to get it.

How can you help? You can help by providing the

paperwork or documentation thatproves you are Alaska Native orAmerican Indian by being anenrolled member or a descendant of amember of a federally recognizedtribe.

The papers that may prove youreligibility include, but are not limitedto, the following:

• Bureau of Indian Affairs-issuedcard or Certificate of Degree ofIndian Blood.

• Tribal card or enrollment verifi-cation from a federally recognizedtribe.

• Birth certificates demonstratinglineage from an eligible beneficiarywith their proof of eligibility docu-mentation.

• A card or statement from yourAlaska Native Claims Settlement Act(ANCSA) corporation stating thatyou are a Native person listed on theANCSA roll (issued in 1971), or alineal descendant of a Native person

listed on the ANCSA roll.

What if you don’t have one ofthese?

If you don’t have the paperwork orissued card, ANMC can give you anapplication to the Bureau of IndianAffairs for a Certificate Degree ofIndian Blood (CDIB). Once you com-plete the application and mail it to theBIA office, they will send ANMC theCDIB.

Where can I get the papers Ineed to prove I’m eligible?

For a Certificate of Degree ofIndian Blood contact: Bureau ofIndian Affairs 3601 C Street, Suite

1100 Anchorage, AK 99508 Phone(907) 271-3519 or 271-3517 Toll-Free: (800) 645-8465, Option 1.

For Adoption, Birth or MarriageCertificates contact: Bureau of VitalStatistics Anchorage RecordingOffice 3601 C Street, Suite 128Anchorage, AK 99501, phone (907)269-0990.

For other eligibility questions con-tact: Eligibility Manager AlaskaNative Medical Center 4315Diplomacy Drive, 1st FloorAnchorage, AK 99508, Phone (907)729-2353 Fax (907) 729-4451 E-Mail [email protected].

Important notes: 1. Individuals may be required to

pay for services if ANMC deter-mines they are not eligible, or ifthey fail to provide the paperworkthat proves they are eligible.

2. ANMC now requires thatpatients to provide proof of eligibil-ity within 120 days of being askedfor it.

3. Starting January 1, 2004,patients will be required to showproof of eligibility before they willbe scheduled for any electiveappointments or surgeries.

The Alaska Native Tribal HealthConsortium and Southcentral Foundationjointly own and manage the AlaskaNative Medical Center under the terms ofPublic Law 105-83.

These parent organizations have estab-lished a Joint Operating Board to ensureunified operation of health services pro-vided by the Medical Center. AlaskaNative Medical Center 4315 DiplomacyDrive Anchorage, AK 99508.

DisclaimerThis information is solely intended as a

general tool to educate and empowerANMC patients on their rights andresponsibilities as eligible recipients ofpre-paid health care at ANMC.

This information is not intended in anyway to substitute, replace or alter thepolicies, procedures or contract commit-ments of the Alaska Native Tribal HealthConsortium, Southcentral Foundation, orthe Alaska Native Medical Center regard-ing ANMC medical service eligibility.

A complete copy of ANMC’s DirectCare Eligibility policies and proceduresis available on request. This informationis subject to change at any timewithout notice. Or online atwww.anthc.org.

Eligibility …From page 1

Alaska Native Medical Center (ANMC) is owned and operated by the peo-ple it serves. The Alaska Native Tribal Health Consortium and SouthcentralFoundation (SCF) jointly own and manage ANMC under the terms of PublicLaw 105-83.

Research suggests that exclusive breastfeedingcan reduce an infant’s chances of ear infections,

diabetes, becoming overweight, or getting asthma.

Breastfeeding guide for Native families available“An Easy Guide to Breastfeeding for American Indian and Alaska Native

Families” is now available in print and electronic PDF. The guide takes the readerthrough four sections: benefits of breastfeeding, how to get started, continuationupon returning to work, and frequently asked questions. The “Easy Guide toBreastfeeding” will be a useful tool. Please share this resource.

Bulk orders of the “Guide” can be requested at 1-800-994-9662. This is a DHHSsupported hotline for breastfeeding questions and concerns as well as for orderingthe guide. Pamphlets should arrive in two to three weeks.

For more information, or to see a copy, go to the Indian Health Service, Maternaland Child Health website at: www.4woman.gov/Breastfeeding/EasyGuide.NA.pdf

Produced by the U.S. Department of Health and Human Services, Office onWomen’s Health, the project also received funding from the National Institute ofDiabetes, Digestive and Kidney Diseases, and the Centers of Excellence atPhoenix Indian Medical Center.

Babies were born to be breastfed

Anchorage to host U.S. Public Health Professional Conference May 16-20The conference features U.S. Surgeon

General Richard Carmona and otherimportant public health leaders at athree-and-a-half day gathering open toall health care professionals.

It will include a full-day of profession-spe-

cific topics for physicians, nurses, pharma-cists, dentists, environmental health offi-cers, dietitians, therapists and others.

General sessions will feature national andinternational speakers on emerging trendsand issues in public health.

A significant number of continuing education credits will be available. For more information, call toll-free (866) 544-9677 or register online at www.coausphsconference.org.


Question: I had a friend come in and the doctortold him it was all in his head. And it wasn’t amental thing. He should have been able to seeanother doctor who could figure out what waswrong.Answer: (Dee Hutchison, ANMC Administrator)If you feel you need a consultation with a secondperson, you have a right as a patient to requestthat. Sometimes, if it requires a specialist that wedon’t have in our system, we can make otherarrangements for you. Sometimes we cannot payfor the cost of sending you to an outside specialist.In those cases, we have discussions with you aboutthat on an individual basis.

Question: I’m very happy with the services Ireceive and the expedience of them as well. I’mvery pleased with having a nurse coordinate get-ting you into all the various areas, to see the spe-cialists, is really great. I’ve received care all overthe western United States, I have never had that,and it’s a great help.Answer: Thank you for that comment.

Question: I’m from Grayling [in the Yukon-Kuskokwim region]. There’s some policy here thatyou can’t go to the emergency room. I’ve beenhere seven months. I went to the ER twice. Theysaid they have a policy that says I can’t do that. Iwant to know my rights.Answer: (Don Kashevaroff, Chair and President)If you’re in Anchorage and need service, youshould not be denied service. If you know ofsomeone who is denied service, call DeeHutchison at 729-1997. We need to know rightaway so we can help. Southcentral Foundation cre-ated a few services, like the chiropractor, that areonly for Anchorage residents, but those are veryfew.

Comment: We have some friends who were toldthey are not eligible for services here.Answer: (Dee Hutchison) I’m glad you broughtthat up because we are working on eligibility rightnow, but no one should be turned away. We have asituation where we have some people coming infor care who are not Alaska Natives or AmericanIndians. We are trying to make the best use of ourresources, which are just for American Indians andAlaska Natives. We are trying to make sure thatwe are serving only the people who are eligible forservices at Alaska Native Medical Center. Theboard has just updated our policy about who is eli-gible for care at Alaska Native Medical Center. The only way you can tell who is a Native is witha Certificate of Indian Blood (CIB) (from theBureau of Indian Affairs). So, if our chart does nothave proof of eligibility, you will be asked to pro-vide proof. We have a brochure that clearly out-lines who is eligible and what is needed to prove

it. We will work with people to gettheir documents. What we have com-municated to our staff is that no one isto be turned away and I will re-empha-size that to staff. If you know of some-one who is turned away, immediatelyask for someone (or me) from adminis-tration to help you. Eventually, if proof of eligibility is notprovided by a patient, that patient willbe sent a bill for medical services fromANMC.

Question: What if I have to see a spe-cialist and some ER nurse says no? Do Ihave to go back to Bethel to see a doc-tor? Answer: (Dee Hutchison): If you’refrom an area with its own hospital andprimary care center, you should receive your pri-mary care there. If you want to go directly to ourspecialty clinic, you need to be referred by yourprimary care provider in writing. If you are inAnchorage, you can come to our emergency roomfor care and we will not deny you services. Inorder to receive care at the Primary Care Centeryou have to be a resident of Anchorage for a cer-tain period of time before you can access services.It’s a result of the way funding is set up, alongwith policies and agreements. It’s important tounderstand how that works.

Question: When will the water and sewer in thevillages be completed, how much will it cost andhow much more money is needed?Answer: (Steve Weaver, Senior Director, DEHE)The sanitation deficiency system has identifiedAlaska’s unmet need at $640 millions. We arefunded at a rate of about $60-65 million per year.

So, if everything stayed equal, and there were nocost changes, no more births, no deaths, no morechanges in laws, we could do it in ten years. Butthose things do change. DEHE has a great deal ofinformation about specific villages and the workthat is needed or underway.

Question: Some of the requirements for gettingwater are too hard. You have to have electricity;you have to have a certain level of housing. I’dlike to have you look at that.Answer (Steve Weaver): Electricity is needed is sothat the pipes won’t freeze and burst when peopleare away during the winter. That takes a heatsource that’s controlled by a thermostat and keepsthe temperature above freezing. Housing require-ments help ensure that piped water and sewerlinesprovide good service throughout theirdesign life, so that the public health bene-fit is maximized.

Annual Meeting …From page 1

A few of the participants in theANTHC Annual Meeting Dec. 8, 2003.

Alaska Native Medical Center Nurse Executive LorraineJewett (left) receives the U.S. Public Health Service Nurse ofthe Year award certificate from Alaska Native Tribal HealthConsortium chief executive officer Paul Sherry.

Alaska Native Tribal Health Consortium 2003 highlightsAlaska Native Medical Center

Alaska Native Medical Center continues toexperience significant growth, up to seven percentin some services, due to Alaska Native populationgrowth and relocation from rural to urban Alaska.

In FY03, ANMC provided 341,420 clinic visits;6,422 inpatient admissions, 1,283 infant deliveries,and 10,595 surgical procedures.

Alaska Native Medical Center achieved MagnetStatus for Nursing Excellence, the 71st hospital inthe nation to receive this honor from the AmericanNurses Association, the nation’s largest such group.ANMC was certified as Alaska’s only Level IITrauma Center, the highest level possible in Alaska.

Division of Environmental Health andEngineering

The Division of Environmental Health andEngineering received the Academy ofEnvironmental Engineers grand prize inOperations/Management for a water and sewersystem project in the Northwest Alaska village

of Savoonga. Through DEHE:• 2,646 homes in 93 communities received

improved water and sanitation services at a cost of$55 million

• Eleven tribal health organizations received $10million for design and construction of 38 hospitaland clinic improvement projects

• Forty-two health clinic projects are in the plan-ning, design or construction phases

Community Health ServicesThe nation’s first dental health aides have been

certified after receiving training through theDivision of Community Health Services.Community Health Services (CHS) is working toplace 50 new behavioral health aide positions invillages, and to increase the number of personalcare attendants serving in rural communities aswell. CHS has a number of Native health researchprojects underway, and has improved the policiesand procedures for review and approval of Nativehealth research and publication.

Division of Information TechnologyThe Division of Information Technology pro-

vides quality health information and technicalservices to assist providers in giving the best pos-sible health care to Alaska Natives. These includetelemedicine carts at 235 sites in Alaska; 46 tele-radiology sites; and more than a million patientencounter records transported annually.

Division of Human ResourcesThe Division of Human Resources works to

improve employee recruitment and retention forthe Consortium and for tribal health organizationsstatewide. Professional recruiting staff recruited 98new employees to the tribal health system, includ-ing 25 physicians, 57 nurses, and 16 advance prac-tice nurses and physician assistants. Promotion andsupport of the Indian Health Service student loanrepayment program resulted in loan repaymentawards to 139 professionals in the tribalhealth system in Alaska. Those awardshave a value of more than $4.5 million.

By Liza Sarah Vent, RN, Chief Andrew Isaac Health Center

Tanana Chiefs Conference

As we prepared for the TananaChiefs Conference 2003 healthSummit, I noticed how quicklydiabetes is rising for younger peo-ple.

In a two-year time span, thenumber increased from 29 to 52for those people under age 40.This is close to a 50 percentincrease for this age group in onlytwo years.

A majority of these people werediagnosed with Type 2 Diabetes, inwhich the body makes too littleinsulin or the cells in the bodybecome insulin-resistant.

This type of diabetes accounts forapproximately 95 percent of diabetesnationwide. It was once called adult-onset diabetes.

A few of the risk factors for dia-betes are obesity, when your BodyMass Index (BMI) is greater than 30(sometimes due to an inactivelifestyle), being American Indian orAlaska Native, and having a familyhistory of diabetes.

Some of the symptoms to watchfor are increased thirst and urination,unusual weight loss, blurry vision,and fatigue.

Type 2 Diabetes is a preventabledisease. Health food choices andexercise are two of the best ways toprevent diabetes. Physical activityis powerful! It is also recommendedto get your blood sugar checked atleast once a year and find out whatyour BMI means, which is calculat-ed by your height and weight.

If you have any questions or wouldlike to set up an appointment, pleasesee your health careprovider. Be healthy, beactive, the “power is inyou.”


DEHE attends science and engineering conference By Darryl Alleman,

Northwest Regional ManagerDivision of Environmental Health and

Engineering

The Division of EnvironmentalHealth and Engineering had a boothat the Job Fair of the AmericanIndian Science and EngineeringSociety National Conference, held inAlbuquerque, New Mexico on Nov.20-22, 2003. DEHE also was a spon-sor of the annual event, whichattracts the nation’s brightestAmerican Indian students, as well asprofessionals in the fields of science,engineering and technology.

There were more than 2,000 partici-pants and 200+ exhibit booths at thisyear’s conference. ANTHC staffersDarryl Alleman, Jacob Hess, andPaul Bauer attended.

Many Native American studentsinterested in summer internships inAlaska visited the booth. The teamreturned to Anchorage with contactinformation and resumes for 26 stu-dents. Eighteen students are enrolledin engineering-related programs andeight are enrolled in medical orhealth-related fields.

A highlight of the conference was apresentation at the opening ceremonyby John Herrington (ChickasawNation of Oklahoma), the firstNative American astronaut to go intospace. More than 200 Americans

have flown in space, and now theseesteemed ranks include a NativeAmerican. Herrington served as theflight engineer on SST-113, whichflew in November, 2002.

During the conference, the AISESboard of directors presented ANTHCwith a pottery vase in recognition ofANTHC’s continuing sponsorship andsupport of AISES-related activities.

AISES is looking forward to bring-ing it’s 26th Annual NationalConference to the Egan Center inAnchorage, November 11-14, 2004.

The 3-day event includes a CareerFair, dynamic nationally-recognizedspeakers, panel discussions, andworkshops for students, teachers andprofessionals. Conference sessionsare provided by top trainers and aredesigned to benefit students and pro-fessionals alike.

For more information on theAISES National Conference, visitthe Web site at aises.org.

AISES Board Member Andrew Duff presents a pottery vase to ANTHCstaffers Darryl Alleman and Paul Bauer in recognition of ANTHC’s continu-ing support of AISES.”

Diabetes increasing rapidly for younger people


YKHC creates public relations department

A new department is being organ-ized to keep the public informedabout what the Yukon-KuskokwimHealth Corporation does to improvehealthcare in the region.

“Too often, the innovative pro-grams we develop and even theservices we provide on a daily basis,are not adequately communicated toour customers and partners,” saidSupport Services Vice PresidentHugh Short.

“We need to get proactive aboutcommunicating the positive, excitingthings we’re doing, not only to keepour own people informed, but peo-ple all over the state and the rest ofthe world as well,” saidPresident/CEO Gene Peltola.

YKHC’s media services and tribalrelations programs will be gatheredinto the new department, and otherfunctions will be added. Additions

See YKHC, page 11

Alaska Native Tribal HealthConsortium

Staff ReportThe Alaska Federal Health Care

Access Network (AFHCAN) hasbeen promoting videoconferencingfor two years. For example, Maniilaqand SEARHC are using the AFH-CAN network now to hold sometraining sessions. Two years ago, theVeterans’ Administration usedAFGHAN equipment to provide amedical ethics conference to theproviders in Kotzebue.

Earlier this summer AFHCAN hadtwo pilot videoconferencing sessionsfrom its office: One on HIV testingand the other on Denali KidCare.AFHCAN will be hosting a video-conferencing room that could beused for clinical sessions as well astraining sessions. AFHCAN isobtaining space and making theinfrastructure upgrades (painting,lighting, and network connections)so it can do this more regularly.

As for Community HealthAide/Practitioners (CHAP) training,AFHCAN is working on a project tocreate a telehealth/distance deliveryseries of programs in various for-mats, including video teleconferenc-ing, to augment CHAP training.Some of the health corporations sup-port and encourage telehealth sotheir CHAP are more savvy and con-nected users. Continued extensionand elaboration ofAFHCAN’s use acrossthe state is ongoing.

Community Health Aide/Practitioners (CHA/P)Directors have launcheda certification and training database and a Web site for statewide pro-gram use. The database is complete and on-site training has occurred inAnchorage, Bethel, Nome and Sitka.

The Web site, www.akchap.org, is hosted by the Alaska Native TribalHealth Consortium and is open to the public. The web-site also serves asthe access point for the database, although security protocolsapply. To get access to the Web site, call Rebecca Paulsen at729-3624, or email: [email protected].


AlaskaRural/Telehealth

ConferenceFrom Local to Global

A primary care/rural health conferenceMarch 1-3 in Anchorage

Highlighting primary care, rural health, and rural hospitals.

If you work in a village clinic, community health center or rural hospital, you will find valuable content at this conference for policy

makers, community clinic and hospital management and administration, and health care professionals including medical,

dental, and mental health care providers, and pharmacists

“Innovation and evaluationAn international telehealth conference

March 4-5 in AnchorageThis two-day conference will bring together people interested andinvolved in designing, using, and evaluating telehealth systems inrural and remote settings across the United States and the Arctic.

This week-long conference will be held in Anchorage, Alaska at theAnchorage Downtown Marriott hotel. To ensure the low conferenceroom rate, make your reservations now by calling 1-800-228-9290.

Use reservation code: Rural Health Conference.

New CHAP Database Web site

Video on CHAP programand need for funding getspositive reactions

The video “Alaska Rural HealthCare at Risk,” describing theCommunity Health Aide/Practitionerprogram and need for additionalfunding, was completed by AlaskaNative Health Board. Copies weredistributed to CHAP Directors forregional viewing by staff, tribalcouncils, and communities. Thevideo met a positive recep-tion at the CHAPConvocation and CHAPDirectors’ meeting.

Attention:Community HealthAide/Practitioners

Mark your calendars!

The 2004 CHAP Forumis set for April 19-23, atthe Hawthorne Suites in

Anchorage. The state of Alaska will

assist this year with plan-ning and organizing.

For more information,contact Torie Heart at

729-3642.Videoconferencingis a valuabletraining tool

Three new ambulances arrived inthe Bering Strait region inSeptember thanks largely to fundinggranted to Norton Sound HealthCorporation by the U.S. Departmentof Agriculture. The Nome Volunteer

Ambulance Service got a brand newambulance just in time to retire oneambulance that was 20 years old andanother that was 25 years old. Tenyears is considered the normal life ofan ambulance, according to NomeVolunteer Ambulance Service ChiefCharlie Lean.

Smaller new ambulances went toUnalakleet and St. Michael.

The ambulances were purchasedthrough the USDA’s Code Blue grantprogram. The funding program wasdeveloped with the RasmusonFoundation to help update Alaska’saging emergency medical equipment.USDA covered 75 percent of the costof the ambulances and the RasmusonFoundation contributed 20 percent.

The city of Nome paid the remain-ing five-percent for its ambulance.Lean thanked the Fagerstrom familyof Nome for raising more than enoughmoney through the annualIditawalk event to pay thatfive-percent.

From Kaniqsirugut News, anewsletter of the Norton SoundHealth Corporation

Norton Sound Regional Hospitaland Quyanna Care Center were putunder the microscope by inspectorstwice recently, and both times gotrave reviews. Two state inspectorsthoroughly scrutinized hospital oper-ations Sept. 22-25, then approved thehospital’s request to be designated a“critical access hospital.” The changewill not affect services but will boostMedicare reimbursements.

Then, on Oct. 8-9, an inspectorfrom the Joint Commission onAccreditation of HealthcareOrganizations went over the hospitaland QCC with a fine-tooth comb. Theinspector gave a glowing preliminaryreport, and final results are expectedin late November. “The preliminaryreport is the best report we’ve everhad in our history of being accredit-ed,” said Karla Homelvig, qualityassurance manager for Norton SoundHealth Corporation. The hospital willreceive a score of at least 95, with no

Type I deficiencies, the inspector said.The hospital is surveyed every threeyears and in the past decade hasalways scored in the mid-to high-80swith several deficiencies that neededto be corrected. Quyanna Care Centerscored an excellent 99 out of 100.“This demonstrates our ability to pro-vide and maintain quality care, espe-cially with all the different serviceswe provide,” said Charles Fagerstrom,vice president for Hospital Services atNSHC. “It proves our ability toachieve national standards, whichsometimes is difficult in a rural set-ting.” Joint Commission (JCAHO)accreditation involves evaluating thehospital’s performance inareas that most affect patienthealth and safety.

From Kanigsirugut News, anewsletter of the Norton SoundHealth Corporation.


include managing YKHC’s website,public events and VIP tours, as wellas maintaining the professionalquality of corporate publications andpresentations. One of the mostimportant functions of the newdepartment will be to act as liaisonto the news media. YKHC will soonfill two new positions, a PublicRelations Director and aPublic Information Officer.


YKHC …From page 9


Bering Straits region gets three new ambulances

Norton Sound Regional Hospitalscores high after tough inspection

Alaska Native Tribal HealthConsortium

Staff Report

On Nov. 12-14, three AlaskaNative Health Campus employeestraveled to Washington, D.C. forthe 2003 Robert Wood JohnsonFoundation (RWJF) Covering Kidsand Families (CKF)Communication Camp. EmilyJohnston, Lead Manager ofANMC’s Family Health Resourcesteam attended the three-day con-ference along with Donna Elliott,Statewide Project Coordinator forAlaska’s Covering Kids (ANTHC),and Joaqlin Estus, Director, PublicCommunications (ANTHC).

They heard from top-notch trainerson topics such as how to better pro-mote Medicaid and Denali KidCareprograms statewide for all popula-tions, and ways to get more people tostay enrolled.

“Some states invest heavily in pro-motion and others, like Alaska, havea relatively low level of funding foroutreach,” said Elliott. “So you see

everything from very sophisticated,well-tested ad campaigns, to somevery small creative efforts. You real-ly get a sense of the many possibili-ties.”

“They taught us some ways toencourage parents that they’re doingthe right thing by enrolling their chil-dren in Denali KidCare,” said EmilyJohnston. “It gives parents peace ofmind that if their child gets sick, theycan get the help they need, more helpthan the Indian Health Service cancover.”

Trainers included media strate-gists, communications specialists,and reporters from The News Hourwith Jim Lehrer (public TV) andABC News, as well as presentersfrom programs in states such asIllinois, Nevada, Wisconsin, andArkansas.

As the statewide CKF lead,ANTHC seeks to improve simplifica-tion, coordination, andoutreach/retention issues concerningall Medicaid and Denali KidCarerecipients. When children, teens, andpregnant women are signed up forany third-party resource such asDenali KidCare and Medicaid, itspeeds up access to health care serv-ices for patients, covers travel/lodg-ing costs, and frees up resources

coming out of IHScontract health rev-enues.

The AlaskaPrimary CareAssociation, alocal CKF grantee,addresses access tohealthcare cover-age issues for non-English speakingandImmigrant/Migrantpopulations.SouthcentralFoundation, anoth-er local granteeadministers thethree goals forNative and non-Native populationswithin theAnchorage ServiceUnit.

Under the leader-ship of the Alaska’sCovering Coalition,CKF grant staff works to address theincreasing needs of the uninsuredchildren and families in Alaska.

For more information about DenaliKidCare/Medicaid application tech-nical assistance and training, or tofind a way you can help address the

needs of the uninsured in your com-munity, please contact Donna M.Elliott at Alaska’s Covering Kids at1-877-292-7020 statewide toll-freeor 729-3954 in Anchorage.Check out our Web site atAlaskaCoveringKids.org.


Alaska Native Tribal Health Consortium

JobsWant to find out about job vacancies? Visit the ANTHC Web site,

at ANTHC.org. Tell your friends too! Here are just a few of the jobs now listed at ANTHC.org.

• Data Entry Supervisor • Administrative Assistant III & IV

• CHAP instructor • Telephone Operator

• Medical clerk• Neurosurgeon

• Case Manager Assistant• Pharmacist

• LPN• RN

• Mammography Technologist

Six Y-K Delta students completedtheir Licensed Practical NursingProgram and received a certificateand LPN pins from the University ofAlaska Anchorage Dec. 1. A ceremo-ny to celebrate this occasion washeld on Dec. 1 at the Cultural Centerin Bethel. The students also attendedthe UAA ceremonies Dec. 13 at theUniversity of Alaska Anchoragecampus.

Graduates are: Roy A. Alexie,Bethel; Alexandra S. Active,Kipnuk; Jeanne Santacrose Franklin,Bethel; Fannie Hernandez,Quinhagak; Dorothy L. Tuluk,Chevak; and, Shirley Walters,Mountain Village.

The Licensed Practical NursingProgram began in January 2003 andwas administered by the YKHCLearning Center staff. The programwas funded by the U.S. Dept. ofLabor, Employment and TrainingAdministration. Additional studentfinancial support was provided bythe Alaska Job Center Network andAVCP, Inc.

The students will take the nationalexam sometime within the next sev-eral months. In the meantime, sever-al of the students are seekingemployment with YKHC asLicensed Practical Nurses.

Six graduate from LicensedPractical Nursing program

Communications key to getting families signed up for Denali KidCare

EmilyJohnston and DonnaElliott visiting theSmithsonianMuseum of NaturalHistorybefore trainingstarts.

January/February 2004 THE PERMITNO. 630 U.S. POSTAGE PAID … · (IHS-EHR) will display RPMS data...

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