Tribes say ER wait times top priority
Throughout the 20-year history of YKHC Tribal Gatherings, dissatisfaction with long waits to be seen at the Bethel Hospital—outpatient clinics as well as the Emergency Room—has been among the top 10 priorities for change listed each year by delegates representing the 58 Tribes that make up the YKHC service area.
This year the delegates voted decreasing ER wait times their number one priority.
The issue has not been ignored; YKHC leadership and hospital administrators have initiated new appointment procedures in the outpatient clinics in recent years and wait times have improved. Patients coming to the Emergency Room, however, are seen according triage—those whose needs are most dire are seen first. A patient whose illness or injury can wait, sometimes will have to wait.
Nevertheless, YKHC’s leadership teams will be taking a good hard look at how to make improvements.
Also on the tribes’ list of concerns: cancer screening and research, support for Health Aides, village sanitation, Behavioral Health services, and subsistence.
YKHC’s annual Gathering serves a two-fold purpose. The corporation reports on the status and progress of programs, facilities and services; the Tribal representatives identify health care concerns and determine their priorities for improving the programs, facilities and services that address those concerns.
Many changes have come about as a result of Gathering priorities. Most notably, the skilled nursing facility now nearing completion in Bethel and a new Prematernal Home under construction. Add to the list: CT scanning at the hospital, regional medevac services, a Sobering Center, subregional health clinics and many service improvements designed to bring culturally relevant health care closer to home.
Following last year’s priorities listing Behavioral Health concerns such as suicide prevention and alcohol treatment at the top of the list, this year’s Gathering included an extra full day devoted to YKHC’s Behavioral Health programs and services.
BH Services Administrator Raymond Daw began with an overview of the strategic planning and re-organization of the division that has taken place during the past year, and introduced Keynote Speaker Dr. Clyde McCoy of the University of Miami.
Dr. McCoy emphasized the importance of accounting for culture in scientific studies and medical research. He cited the example of learning how IV drug users shared needles when studying the spread of AIDS in the 1990s—and how targeting prevention education directly to that culture proved more effective than conventional approaches.
Cultural relevancy is central to YKHC’s vision, and is embraced whole-heartedly by Behavioral Health programs. The best example described at the Gathering was The McCann Treatment Center’s subsistence-oriented education component. The program serves up to 14 Alaska Native boys who struggle with drug abuse and alcohol in addition to severe emotional trauma and behavioral health needs. The average stay is about 18 months.
During this time, the boys go to school—the usual academic classes in math and English of course—but also the Yup’ik subsistence cycle: beginning with break-up and spring flooding, they gather driftwood; dip for smelt; drift for salmon; cut, hang and dry the fish at their own fishcamp. They pick berries. During fall and winter they hunt, trap, skin, and dress meat and supply the food not only for their own program, but also for YKHC’s annual employee picnic and other local causes.
McCann Program Director Jaime Kassman said the program has a commercial fishing license and the resident boys keep the proceeds for the fish and furs they sell, adding a practical economic component to the education and additional incentive for learning traditional skills.
Although there are program challenges—recruiting qualified staff, funding for the program, documentation and administration—the rewards are many: building self-esteem, cultural identity, practical skill development, financial education, high school credit and physical exercise to name a few.
Tribal Delegate Mike Williams, Sr., from Akiak, commented, “This is the vision of the tribes that we have been talking about for a long time. I want to commend you for the quality of the program that you are running.”
Healing through Tradition
Traditional Yup’ik ways—ancestral wisdom and knowledge, skills, ceremonies, and subsistence living—are the basis of Behavioral Health’s Preventative Services’ approach to community and individual healing. Guided by Prevention Services Director Rose Domnick as well as Sophie Jenkins, Ida Charlie and Mardy Hanson, the program promotes “Calricaraq”—Living in Ultimate Purity—to emphasize sobriety and a balanced, healthy life.
Preventative Services holds Healthy Family gatherings in villages throughout the region, noting a dramatic increase in partnerships and collaboration with tribes and agencies to reinforce traditional healing activities in their own communities. Among those who commented at the Gathering was Emmonak teen Natalie Jenkins, who credited the program with turning her life around, “Healthy Families helped me to move on with my life… I kept going to school and tried my best. We are meant to be strong.”
Behavioral Health’s day at the Gathering included informative explanations of YKHC’s residential services— the Philips Ayagnirvik Treatment Center (PATC) for alcohol treatment (a new facility is funded and will be built within the next two to three years), the Sobering Center, Crisis Respite Center, Bautista House and Morgan House—and Outpatient Services—counseling and clinical services. Links to the slideshows for these and all the other presentations shown at the Gathering are on the YKHC website at www.ykhc.org/tribalgathering.
The Gathering’s second day began with an introduction to most of YKHC’s clinical staff of doctors, mid-level providers, dentists and optometrists, and continued with Dr. Joseph Klejka’s presentation of the regional Health Status Scorecard and other reports on YKHC’s services, programs and accomplishments.
The Health Status Scorecard reviews the YK Delta Region’s causes of death and other national standard performance measures to compare our region’s overall health to the national index. Causes of death are primarily cancer, unintentional injuries and suicide. Dr. Klejka says we can become healthier and live longer by improving diet, increasing exercise, quitting tobacco use, staying sober, screening for cancer, wearing float-coats and helmets, and keeping vaccinations up to date.
YKHC’s biggest project of the preceding year was implementing our electronic health record—RAVEN (Records And Verification Electronic Network), which was referenced many times throughout the three-day event. President/CEO Gene Peltola said the $13 million cost of the project (to date), mandated by the Affordable Care Act (Healthcare Reform of 2010), was drawn from operations profit of preceding years, not from YKHC’s savings funds.
Over the past two years, nearly 1,000 employees have been trained with 14,000 staff time hours going into the effort. The system went LIVE on January 28, 2013, as scheduled, throughout the region—at the Bethel hospital, village clinics and subregional clinics.
There are many merits of electronic health records—all providers in all facilities, from the clinic to the hospital, have access to the same patient record; the record is legible, the information is secure, the patient’s history and medications are listed with possible drug interactions and allergies flagged. RAVEN allows a complete evaluation of the patient without any missing visit information.
The second day included a lunchtime workshop for Tribal representatives seeking help in planning and writing grants. Nearly 30 people attended the workshop. With funding at state and federal levels diminishing, there is increasing interest in ways to sustain financial support for healthcare programs, facility upgrades and improvements.
The third day of the Gathering was dedicated to Tribal priority-setting and voting on the top issues for the coming year. See the comprehensive priority results of the overall voting below. The complete listing of each election unit’s priorities is on our website at www.ykhc.org/tribalgathering.
Tribal Unity Gathering XX — 2013
Overall priority rating
1. Decrease Emergency Room wait times.
2. More alcohol/drug abuse POST RECOVERY/Treatment services for all-ages.
3. Want more comprehensive services at first hospital visit (don’t want to schedule 2nd trip) for diagnosis and prevention.
4. Increase Cancer Prevention Screening to SRCs and Villages.
5. Seek more funding for Health Services.
6. Increased doctor visits to villages and SRCs.
7. Increase number of Health Aides for population
8. Increased support for Health Aides from villages.
9. Research causes of Cancer.
10. Increase homes with piped sewer services/improve sewer lagoons.
For more information about the Tribal Gathering, call YKHC Public Relations at 907-543-6038.