April 15, 2009

Assembled delegates and guests listen to Diabetes Program Coordinator Annette Coyle speak on "Diabetes and Heart Health."

Tribal Unity Gathering XVI

April 1-2, 2009 - Bethel, Alaska

by Michael Faubion, YKHC Public Relations

Delegates from nearly all the Tribal Councils in the YKHC service area took part in this year's Tribal Unity Gathering, YKHC's 16th!

The theme, "A Healthy Mind & Heart," focused reports and presentations on behavioral health issues and cardiovascular disease prevention.

Delegates always take the work of Tribal Gathering seriously - listening to progress reports from YKHC admininistration and programs, evaluating the information to take back to their communities, and setting health care priorities on behalf of their villages to guide YKHC's service improvements.

But they also have some fun - visiting with old friends, fiddle dancing and drawing for door prizes.

First Day, April 1

Board Chair Ray Alstrom of Marshall and President/CEO Gene Peltola welcomed delegates, emphasizing the importance of the gathering for giving direction to YKHC's leadership. "It is you we listen to," Alstrom said.

Peltola said the the Gathering is the opportunity to "give us your concerns, your priorities," and also the time when "YKHC reports to you on what we have been doing."

Peltola noted that "2008 was a good year for YKHC," ending with a $3.5 million profit. He said the CT scan machine, which had long been a top priority of Gatherings past, went into operation in June and "utilization has far exceeded expectiations." Looking to next year, Peltola said economic stimulus funds are already directed toward a new roof for the hospital, which will save more than $100,000 on annual heat bills, and an oxygen generator so we won't have to ship heavy oxygen canisters back and forth to Anchorage.

Bob Herron, State House Representative for District 38, addressed the Gathering through a video sent from Juneau. He said he is working with Sen. Lyman Hoffman to secure an additional $8 million to construct an assisted living home for YK Delta area elders, another long-time priority of Tribal Gatherings. Additional funding for an enhanced sleep-off center to address the problem of inebriates should also be coming our way.

Health Status Scorecard

Medical Director Dr. Joe Klejka delivered the health status score card, taking a look at historical trends of several health indicators-causes of death, screenings for cancer and heart disease, prevention (immunizations, tobacco cessation), pregnancy care, and environmental factors. Adjusted for age and population density, the data show cancer (lung, colo-rectal and breast) to be the leading cause of death in our region, followed by heart disease, teen suicide and unintentional injuries. Screenings, which help identify some of these causes early are pretty well in hand, especially for mammograms and pap smears to detect breast and cervical cancer. Colo-rectal cancer screening rates are improving. Smoking has declined over the past 10 years, but smokeless tobacco use has increased.

Klejka said immunizations for prevention of flu and pneumococcal diseases has been "the great success story of the past 20 years," but with obesity, high blood pressure and changes in diet, heart disease and diabetes pose a growing risk.

Living up to YKHC's vision of striving to "be the healthiest people" means doing the following:

Increase physical activity
Decrease store bought food (especially sweets and fats) and increase traditional diet
Don't use tobacco
Decrease or eliminate alcohol consumption
Wear helmets on snowgos and ATVs and wear seatbelts in the car
Wear float coats in boats
Obtain cancer screens at appropriate ages
Make sure your vaccinations are up to date
Start Prenatal Care Early

2008 Priorities Update: Progress and Challenges

The rest of the morning was taken up with presentations responding to and reporting on past gathering priorities.

Capital Projects Update -- Greg McIntyre, VP Support Services

The Hooper Bay Subregional Clinic will be opening this spring as will village clinics in Kotlik and Tuntutuliak. These new clinics, as well as the 30 or more other new clinics that have been built in the past 12 years, are the result of successful funding partnerships between YKHC, the villages, and State and Federal agencies. All have been built using local labor. Next on the list: Kasigluk, Mountain Village, Nunapitchuk, Akiachak, Napakiak, Chevak, Tuluksak, and Kongiganak.

Many other projects and hospital improvements are in the works. To find out more, contact Greg McIntyre at 543-6558.

Water/Sewer Project Update-Karl Powers, Deputy Administrator for Village Operations

A little over half the homes in the Delta now have piped water and sewer. Funding for new water-sewer systems comes primarily from the Indian Health Service and the State's Village Safe Water program. One of the main criteria the funders consider is whether or not a village can pay for the operation and maintenance of the system once it's installed. For this, villages need to be organized and establish a good record of solvency and fiscal stability.

Long Term Care Facility -- Liz Lee, Home Care Director

The project to fund and build an Assisted Living Home in Bethel has been underway since 2001, and has been a top Gathering priority for even longer. An 18-bed facility has been design and half the $16 million funding has been secured.

The facility would have personal and health care services, including 24-hour supervision and assistance, to help frail and cognitively impaired Elders and people with disabilities maintain independence and dignity.

One of the challenges facing the project is that it would most likely operate at a loss of about $1 million a year. Home Care Director Liz Lee says Tribal Councils should submit new resolutions of support acknowledging this cost by May 1, 2009. Contact Liz Lee for more information at 907-543-6123

Detox Alternatives/Enhanced Sleep-off Report -- Jack R. Crow, VP of Health Services

YKHC's emergency department is regularly overwhelmed by alcohol-related emergencies. Bethel is in desperate need of a facility to deal with these in a safe and humane way. YKHC, the City of Bethel, Bethel Community Services and the State of Alaska's Department of Corrections and Division of Behavioral Health are working together on an Enhanced Sleep-off project. This will include a facility in coordination with a community service patrol managed by the City of Bethel to transport inebriated individuals to services, therefore reducing the demand on police.

Funding to start the transport service has been secured, but until a facility can be built, the program will be based at the YKDRH Emergency Department with extra staffing dedicated to it. Call 907-543-6142 for more information.

Medical Refill & Pharmacy Report -- Patricia Smith, Patient Care Services Administrator

Recurring concerns and frustrations in getting timely medication refills in the villages led Patient Care Services to initiate a pilot project to determine if refills could be sent to patients directly by mail instead of by private carrier to the village clinics. The old way was taking up a lot of health aide time, pharmacist time, and was resulting in medications being late or lost. The Direct to Patient project proved successful in getting meds to patients more reliably in spite of some concerns about how the Post Office would handle sorting, transport and delivery to villages.

Due to the success of the initial study, planning for implementing this process for all villages is underway. Additional staffing and equipment and redisign of the Pharmacy workspace will be necessary, but the cost savings, and improvements in patient satisfaction, make the changes well worth the effort.

A Healthy Mind: Understanding the Importance of Mental Health

The afternoon presentations focused on Behavioral Health, primarily substance abuse issues. Gunnar Ebbesson of the University of Alaska Fairbanks and Project Educator Marvin Paul presented an update and overview of Elluam Tungiinun, the "Towards Wellness" Project.

This ongoing effort builds on research begun in the mid-1990s with the People Awakening initiative that sought to identify individual and community strengths that work to prevent suicide and substance abuse in rural Alaskan villages. Community groups including elders and parents plan activities that engage youth in traditional and subsistence work, reinforcing self-worth, identity and responsibility.

Behavioral Health Aides

In addition to Community Health Aide and Dental Health Aide Therapist training programs, there is now a Behavioral Health Aide (BHA) certification process. Recognizing that mental health is directly related to overall physical health, this certification process helps to insure that behavioral health aides have the training that they need to help people face serious health problems related to lifestyle choices, assist families dealing with disruptions related to abuse, neglect, and violence, and help communities cope with injury or death related to accidental or intentional injury.

SBIRT

Laura Baez, Behavioral Health Services Administrator, introduced "SBIRT"-Screening, Brief Intervention, Referral and Treatment. This is a new process that will become part of patient exams at YKHC. Answers to questions about alcohol use will alert providers to potential misuse issues and prompt further questions, advice and referral to counseling or treatment. A pilot project will be starting at the Emergency Dept. once staff is hired and trained.

Day 2. A Healthy Heart: Recognizing the Significance of Cardiovascular Health

Presentations by Dr. Ellen Hodges and Dr. Dan Hartman on the morning of the second day of the Gathering focused on heart health and high blood pressure. Hodges said it's high blood pressure, along with high cholestorol, obesity, phyical inactivity, smoking and excessive alcohol consumption that contribute to heart disease, the number one killer in the United States. Controlling these factors helps keep the risk of heart disease at bay, but there are factors that can't be controlled-such as age, sex (males are more prone to heart disease than females), ethnicity and family history-that also increase risk.

Dr. Hartman's presentation on hypertension-high blood pressure-cited some of the same behavioral and environmental factors as contributors, but it is a chronic condition for many that must be controlled with medication. Regular checkups and monitoring by the same providers is the best approach to keeping blood pressure under control.

Diabetes: Annette Coyle of YKHC's Diabetes Prevention and Control Dept. talked about the rising instance of diabetes in the region and how it is best prevented with exercise and diet. To emphasize this, the "Dance Away Diabetes" Yup'ik dance troup got the crowd on its feet to "Get Movin.'"

All the presenters agreed that a traditional Native diet with plenty of salmon, coupled with an active subsistence lifestyle is an effective approach to maintaining a healthy heart.

The conference wrapped up Thursday afternoon with delegates joining their fellow unit representatives to review the health issues in their communities and determine priorities for the coming year.

The results of priority deliberations is presented on the following pages. If you would like a copy of the Tribal Gathering XVI handbook, or a copy of YKHC's annual Report to the People, please contact YKHC Public Relations at 907-543-6038.

Quyana!

YKHC Public Relations gives a big THANK YOU! to everyone who helped make TG XVI a great success-our presenters, our Board Members, our guests, our translators, our information booth people and especially the delegates who traveled into Bethel from their homes to give us their input and wisdom.