Health News & Notes

A Publication of the Northwest Portland Area Indian Health Board

April, 2007

Our Mission is to assist Northwest tribes to improve the health status and quality of life of member tribes and Indian people in their delivery of culturally appropriate and holistic health care.

Remembering Rodney E. Smith

Rodney E. Smith May 1, 1950 - March 9, 2007 Article on page 6

In This Issue Chair’s Report 2 IHS Budget 8 Locks of Love 16 Executive Director’s Report 3 Natl HIV AIDS Day 10 Identiy Theft 17 NPAIHB New Website 4 Injury Prevention 12 Research Results 18 Remembering Rod Smith 6 New Employees 14 Resolutions 20

Health News & Notes • April, 2007• Page  From the Chair: Linda Holt

Northwest Portland Area Indian Health Board

Executive Committee Members January through April always seems tees. The emphasis of my remarks Linda Holt, Chair to be the most important for Indian highlighted the inequities associated Suquamish Tribe Andy Joseph, Vice Chair health matters and this has certainly with the health facilities construc- Colville Tribe been the case this year. It has been tion in the Indian health system. Our Janice Clements, Treasurer particularly important as the new hope is that Congress will provide us Warm Springs Tribe Pearl Capoeman Baller, Sergeant-At-Arms Democratic controlled Congress some relief on this issue by amend- Quinault Nation sets its legislative agenda for Indian ing a section of the IHCIA to provide Stella Washines, Secretary health issues and takes up appropria- for the establishment of an Area Yakama Nation tion bills that will affect our health Distribution Fund. Our proposal Delegates programs. By the time this issue is would bring equity to a system that released, the Board will have testi- is completely unfair to those Areas Barbara Sam, Burns Paiute Tribe fied before Congress on at least three with small, CHS dependant user Dan Gleason, Chehalis Tribe Leta Campbell, Coeur d’Alene Tribe occasions and conducted a number populations. We have had follow up Andy Joseph, Colville Tribe of lobbying visits to the Hill. meetings with the Indian Affairs and Mark Johnston, Coos, Lower Umpqua & Sius- law Tribes Resources Committees and are hope- Kelle Little, Coquille Tribe This past quarter saw four Congres- ful that our proposal will be included Sharon Stanphill, Cow Creek Tribe Jim Sherrill, Cowlitz Tribe sional hearings conducted on Indian in the bill. Cheryle Kennedy, Grand Ronde Tribe health issues. The Senate Indian Af- Felicia Leitka, Hoh Tribe Bill Riley, Jamestown S’Klallam Tribe fairs and House Resources Commit- The SCIA also held a hearing on dia- Darren Holmes, Kalispel Tribe tees both conducted hearings on the betes issues in Indian Country which Nadine Hatcher, Klamath Tribe Velma Bahe, Kootenai Tribe reauthorization of the Indian Health highlighted the need for reauthoriza- Rosi Francis, Lower Elwha S’Klallam Tribe Care Improvement Act (IHCIA). tion of the Special Diabetes Program Barbara Finkbonner, Lummi Nation Congressman Frank Pallone (D-NJ) for Indians (SDPI). The SDPI will Debbie Wachendorf, Makah Tribe John Daniels, Muckleshoot Tribe introduced a bill (H.R. 1328) in the expire in October 2008. Efforts are Julia Davis Wheeler, Nez Perce Nation House to reauthorize the IHCIA, underway to renew the program for Norine Wells, Nisqually Tribe Molissa Leyva, Nooksack Tribe which the Resources Committee will an additional five years and increase Shane Warner, NW Band of Shoshone Indians mark-up on April 24. The Senate the authorization from $150 million Rose Purser, Port Gamble S’Klallam Tribe Vacant, Puyallup Tribe Committee on Indian Affairs (SCIA) to $200 million per year. The Na- Brenda Nielson, Quileute Tribe is expected to introduce a bill in the tional Indian Health Board is leading Pearl Capoeman-Baller, Quinault Nation Billie Jo Settle, Samish Tribe Senate any day. The Senate Finance the reauthorization effort and part- Ronda Metcalf, Sauk-Suiattle Tribe Committee also held a hearing on ners include the Area Health Boards, Marsha Crane, Shoalwater Bay Tribe Vacant, Shoshone-Bannock Tribes Indian health and child welfare is- the American Diabetes Association, Jessie Davis, Siletz Tribe sues in Indian Country. Our former and the Juvenile Diabetes Research Marie Gouley, Skokomish Tribe Chair and Quinault Delegate, Pearl Foundation. Vacant, Spokane Tribe Francis De Los Angeles, Snoqualamie Tribe Capoeman-Baller will testify in April Whitney Jones, Squaxin Island Tribe on the IHS budget before the House We also completed regional and Tom Ashley, Stillaguamish Tribe Linda Holt, Suquamish Tribe Interior Appropriations Subcommit- national Tribal consultation sessions Leon John, Swinomish Tribe tee. this past quarter. This year’s Region Marie Zacouse, Tulalip Tribe Shawna Gavin, Umatilla Tribe X consultation meetings in Portland, Marilyn Scott, Upper Skagit Tribe I was fortunate to testify on be- Janice Clements, Warm Springs Tribe half of the Board before the House continued on page 13 Stella Washines, Yakama Nation Resources and Finance Commit-

Page  • Northwest Portland Area Indian Health Board • From the Executive Director: Joe Finkbonner

Northwest Portland Area Indian Health Board

The Perfect Storm: Are conditions initiative is certainly gaining mo- Projects & Staff right for Universal Health Cover- mentum, but the fundamental issue is Administration age? financing of the health plan. Joe Finkbonner, Executive Director Verné Boerner, Administrative Officer Bobbie Treat, Controller It seems that every quarter I say that The “Healthy Washington Initiative” Mike Feroglia, Business Manager Debi Creech, Accounts Payable this quarter is busier than the last. includes measures to substantially Chandra Wilson, Human Resource Coordinator Elaine Dado, Executive Administrative Assistant A review of the Board’s activities increase access to care and contains Andrea Greene, Office Manager over the last few months confirms provisions to reduce unnecessary Program Operations it. This past quarter, I attended and emergency room visits by directing Jim Roberts, Policy Analyst Sonciray Bonnell, Health Resource Coordinator participated in the National Con- patients to local clinics. The Initia- James Fry, Information Technology Director gress of American Indians winter tive would also direct the Health Chris Sanford, Network Administrator session; the National Indian Health Care Authority to establish pub- Northwest Tribal Epidemiology Center Board in Washington DC; the Af- lic-private “connectors,” similar to Victoria Warren-Mears, Director Tom Becker, Medical Epidemiologist filiated Tribes of Northwest Indians the Massachusetts plan; however, Tam Lutz, PTOTS Director meeting in Portland, OR; the Tribal it stops short of mandating that all Crystal Gust, PTOT’s & MCH Project Specialist Carrie Sampson, PTOTS Project Assistant Consultation Advisory Committee in residents purchase insurance. Nicole Smith, Biostatistician Kerri Lopez, Western Tribal Diabetes Director Albuquerque; and an Oregon Tribes Rachel Plummer, WTD Administrative Assistant Don Head, WTD Project Specialist meeting in Lincoln City, OR. This movement for Universal Health Crystal Gust, WTD Project Specialist coverage is not unique to Washing- Katrina Ramsey, WTD & Epi Project Specialist Stephanie Craig Rushing, Project Red Talon Director The Oregon Tribes meeting was of ton or Massachusetts. The State of Lisa Griggs, PRT Project Assistant Doug White, NW Tribal Registry Director special interest due to its focus on a Oregon also has two options circulat- Matthew Town, Navigator Project Director discussion of resuscitating the issue ing in the State Legislature. One, the Jenine Dankochik, Navigator Project Specialist Bridget Canniff, Tribal EpiCenter Consortium & of Universal Health Insurance that Archimedes plan, is proposed by for- Data Into Action Director Cleora Scott, Data Into Action Project Specialist is becoming a broader discussion in mer Governor John Kitzhaber. The Birdie Wermy, Data Into Action Project Assistant communities, States, and the Na- second universal health coverage bill Jaci McCormack, TECC Project Specialist Linda Frizzel, Methamphetamine Data Director tion. With over a million people is co-sponsored by Oregon Senators Erin Moran, Outreach and Training Coordinator Michelle Edwards, Development Specialist un-insured or under-insured in the Ben Westlund and Alan Bates. There Clarice Charging, IRB & Immunization Project Portland Area (Idaho, Oregon, and Coordinator is also a considerable movement to Luella Azule, NTRC Project Coordinator Washington), the policy makers combine “the best” of both plans. Ticey Casey, EpiCenter Administrative Assistant representing the Region are focus- ing their efforts on remedying this The co-sponsored bill from Westlund Western Tobacco Prevention Project Jennifer Kovarik, WTPP Project Coordinator problem by working on establishing and Bates would establish the Or- affordable, accessible health care egon Health Fund program which, if National Tribal Tobacco Prevention Network Gerry RainingBird, NTTPN Project Director coverage for all. it passes, would be administered by Terresa White, NTTPN Project Specialist a Board whose membership is still Washington Governor Christine Gre- being defined. The Oregon Health Northwest Tribal Cancer Control Project Kerri Lopez, NTCCP Project Director goire has proposed a “Healthy Wash- Fund Board would be required to Eric Vinson, Survivor & Caregiver Coordinator ington Initiative,” which includes a develop enrollment procedures and five year plan to provide Universal a defined set of essential health Health Coverage for all residents of Washington and to all Washingtonian continued on page 5 children within three years. The

Health News & Notes • April, 2007• Page  NPAIHB’s New Website by Sonciray Bonnell, Health Resource Coordinator

On February 20, 2007, NPAIHB’s Information Technology (IT) crew launched our new website. Although the website address remains the same (www.npaihb.org), we hope the im- provements are obvious. In addition to a new look, improvements include consistent page format, a search tool, an upcoming events list that is automatically updated, a larger portion of the front page dedicated to policy and legislation, and content management software (CMS) that al- lows staff to easily update their web history and goals; data/statistics; The NPAIHB’s website was first pages. reports, publications, and media introduced in 1996, followed by materials; meetings and training upgrades in 1997 and 2002. We We are especially excited about the events; and related links. continually find ways to improve our content management software. Staff website, but the value of a website are able to update their web pages We’ve changed a few of the menus, is best determined by the benefits it by simply sending an email to the including the “Key Indian health provides to its users, so do provide Board’s IT staff, who are respon- Issues” and “Resources and Publica- feedback on what you like, don’t sible for authorizing updates and tions” menus. You may find NPAIHB like, or would like to see. then posting them on the appropriate projects under the health issues web pages. Updates occur as they menu. We have a wealth of informa- are received. In the past, staff who tion to share with the public and our were trained in the web software goal is to make our website more (Dreamweaver) could update their intuitive to the user. own pages, but the problem was consistent page format and correct use of the software. Centralizing web postings eases the pressure from projects to have someone from their staff versed in using web software, it provides consistent formatting, and provides needed management of proposed updates.

Many NPAIHB project web pages include additional information par- ticular to their project, but all project pages have a consistent format that contains: a brief project description;

Page  • Northwest Portland Area Indian Health Board • From the Executive Director: continued

continued from page 3

services. Certain persons would be In response, the Tribes formed the paying the amount saved directly to required to participate in the pro- Indian Health Commission in order workers as increased wages. Workers gram, including the uninsured whose to focus the discussion and shape the then would be required to buy health income is greater than 250 percent of impacts on the Tribes. insurance from a large pool of federal poverty levels and those who private plans. do not, would lose state income tax The Oregon influence extends exemption. beyond the exterior boundaries of Certainly, implementing a National the State. Senator Ron Wyden has Universal Health Care plan faces What is consistent among the plans championed Universal Health care numerous hurdles. On the other is that they propose to take existing at the national level by spearhead- hand, the proposed State level plans resources allocated to health care and ing the “Healthy Americans Act,” would allow for flexibility and create efficiencies and economies of which stems from efforts in 2003 coverage design to fit the States’ scale enhancing the affordability of in which he partnered with Senator priorities and demographics. For that health insurance. The plans call for Orin Hatch. Wyden’s proposal is an reason, I believe that if a workable reducing and subsidizing premiums outgrowth of work by the Citizens’ Universal Health Care system is to and providing incentives for the Health Care Working Group, a four- be implemented, it will likely occur plan’s use (or disincentives for lack teen-member panel that visited fifty through the implementation of State- of use). One advantage that the State communities around the country and level plans. of Oregon may have over the State heard from 28,000 people about how Universal Health coverage for of Washington is that if any waiv- to reform health care. either Oregon or Washington is ers are necessary to the Medicaid or Senator Wyden said his plan would definitely more likely now because Medicare programs, Oregon has two allow workers to carry their health of the steadily increasing numbers Senators in the Finance Committee insurance from job to job without of uninsured, rising premiums, and that can champion Oregon’s position. penalty and would cost the federal increased discontent by Americans government no more than it is paying about the state of the current market Unfortunately, also consistent in today for health insurance coverage. driven health care system. One of the plans being discussed in both Wyden’s plan would cover all the lessons learned from 1993 is that Washington and Oregon is the lack Americans except those on Medicare the Tribes must insert their presence of discussion with Tribes or the or those who receive health care early in the process to ensure that Indian Health Service. This is very through the military. the plans include its clinics as pro- much a déjà vu of 1993 when move- viders and maximize benefits to its ment toward health care reform in The plan would require employers tribal members to augment provided Washington neglected Indian accom- to “cash out” their existing health services. modations for Indian health system. plans by terminating coverage and

Health News & Notes • April, 2007• Page  Remembering

by Ed Fox, Assistant Health and Human Services Director of the Squaxin Island Tribe

I am Edward Fox, Assistant Health and Human Services Director of the Squaxin Island Tribe. I worked with Rod since 1995, first as the Northwest Portland Area Indian Health Board’s Policy Analyst and from 1999 to 2005 as the Execu- tive Director. During these years we worked together on many state, Indian health, and national health some at the Board, but left as a friend him to verbalize to a wayward fed- care issues. to all the staff. His experience, eral employee, congressional staff, intelligence, and friends he could or state employee words like “I’m Rod Smith taught many a health call upon for help was just what the starting to get mad” despite the fact director and program staff member Board needed. Rod understood the that his rising voice and redness of how to conduct oneself as a repre- basics of a good organization: infra- face had already communicated that sentative of a Northwest Tribe. By structure like finances, information fact. With Rod, “message sent and example and by direct verbal com- technology, and human resources message received” were a given. I munication he had a sense of what and the policies and procedures to don’t think any of us were ever con- was effective, what was respectful, manage them. His laughter filled our fused after listening and what was hallways and meeting rooms. He got to Rod make a point. true to his own to know and promoted the careers of By example and by direct ver- Although he made nature. That many of the Board’s current staff and bal communication Rod had many a person un- final point is the management team - a concept a sense of what was effective, comfortable with his an important he promoted while a delegate to the comments, he simul- one for those what was respectful, and what Board. taneously made them lucky enough was true to his own nature. a partner in getting to to know Rod After Rod left, the Health Board was work on a solution to Smith. Rod a quieter, but better place. I suc- the problem thus identified. had a big heart, a strong mind, and ceeded Rod as Director of the NPAI- a loud voice. It was his nature to HB and shared something with Rod Rod Smith and I once shared a job: be kind, to be respectful, but also that no one is born with but anyone we were appointed co-directors of to have an opinion and to have that with an open mind and experience the Northwest Portland Area Indian opinion heard. can learn. That is the knowledge that Health Board. I’m the only one working together is better than work- who thought we were co-Direc- Those of us fortunate enough to ing alone. And this was true at two tors. Rod was a heavyweight and I work with Rod were more effective levels. All Directors learn the truth a junior lightweight at the time. The because we watched him at work. that it can be lonely at the top and Board’s Director, Cheryle Kennedy, We counted on Rod being there lis- that bad things and the work of the had decided to leave the Board and tening, listening, thinking, thinking, organization does defy gravity and return to her tribe (later to become and if the time was right, speaking. roll uphill. The workload is great. It Chair of the Grand Ronde Tribe) and Rod’s emotions were self-evident; is wise to call on others, including Rod answered our urgent call to fill like his big heart his emotions were Directors, for advice and experi- in as Director while we conducted there for everyone to see. I guess ence. The other level is the strength our search for a permanent Director. he thought good manners required Northwest Tribes gain from working Rod rode in to Portland a stranger to together as tribes. Sometimes this Page  • Northwest Portland Area Indian Health Board • Rod Smith

garden variety and greater personnel perhaps a bit weaker in constitution issues, financial issues and bureau- in a physical sense than was healthy. cratic roadblocks to getting health Rod tried to take a step back several care to the Puyallup people Rod times and revitalize that weakened Smith never became callous, never constitution and I was looking for- became rigid (set in his ways), never ward to our continued work together hid in his office to isolate himself, to share the load. Many of us saw had not an evil bone in his body, not Rod last month at the Affiliated a corrupt instinct or action, nor did Tribes of Northwest Indians meet- he retreat to the simple concerns and ing and he was pleased that he had pleasures of life while others did his received so many expressions of love work—the Puyallup’s were always from the Puyallup people and many means working through organiza- on his mind (Tulalip and the Health of us who have worked with him and tions (and no one is born to love Board can vouch for that), but also benefited from his hard work these organizations). all the Tribes of the Northwest, the many years. He was weak, but, we Indian people of our cities and Tribes hoped, on the mend. Rod was a stalwart contributor to the nationwide were on his mind. American Indian Health Commis- Rod’s smile, laughter, and the sound sion since its inception in 1994 and You see Rod Smith was a great of his voice was an embrace to all the Northwest Portland Area Indian leader who avoided the pitfalls of of his many friends. We ache now Health Board since the 1980s. He those who can’t take it in leader- for that expression, for the sound, was on the Executive Committee of ship and retreat into a shell of cal- for the fun that it was to work with both; a rare honor for a non-Indian. Rod, but we live with the knowledge With Rod on the committee, lunch —the Puyallup’s were always that his was a loving spirit that we meetings were wisely scheduled in on his mind (Tulalip and the were blessed to know. We thank a private room lest the good humor Health Board can vouch for those who had a rightful claim to and uproarious laughter result in his time and his company for shar- ruffled feathers among the business that), but also all the Tribes ing Rod Smith with thousands of us customers. Rod felt honored to serve of the Northwest, the Indian who work in the vineyards of Indian with chairs Julia Davis-Wheeler of people of our cities and Tribes health. We laughed and we cried; the Nez Perce Council, Quinault nationwide were on his mind. we worked and we rested. We are at Nation President Pearl Capoeman- peace with our friend Rod Smith. Baller, and the other members of lous disregard of the humanity of the Executive Committee. He was staff (even troublesome staff), who perhaps just as comfortable at the refuse to make changes to standard table with the other Board delegates operating procedures as the environ- listening, raising his hand, speaking ment around them changes, who out, volunteering to help, and visit- sink into a meanness of spirit in the ing with people who had become his face of criticism, and those who use friends. their access to resources to enrich themselves when the credit they may Executive Directors share many deserve is not sufficiently apparent. stories that we tell to no one else. I No, Rod was strong in character and can share this: through all the hard successful in leadership. Unfor- work, all the disappointments, all the tunately, he was all too human and Health News & Notes • April, 2007• Page  Final FY 2007 IHS Budget Operating Plan: by Jim Roberts, Policy Analyst The fourth and final Continuing CHS funding levels to these FY 2006 thresholds. This means there is no increase Resolution funds government opera- in the CHS program to cover inflationary costs, which are significant. In fact, the tions through the end of the current inflation costs associated with the CHS program are much more significant than the fiscal year, September 30, 2007. P.L. inflationary costs associated with other IHS budget line items. 110-5, the joint resolution passed by Congress, was signed into law by the The House (H.R. 1591) and Senate (S. 965) supplemental appropriation bills President on February 15, 2007. The each amend the IHS FY 2007 appropriation by making $7.3 million available bill requires that the Indian Health for health facilities, $18 million available for the Catastrophic Health Emer- Service (IHS) to submit an operat- gency Fund, and $525.1 million available for the CHS program. The House ing plan for how it would obligate bill also makes an additional $5 million available for Contract Support Costs. a $125 million increase in the final The language would allow the IHS to reprogram a portion of the $134.8 mil- continuing resolution, as well as a lion increase; however, it is not known which budget line items would be $13.6 million increase that was pro- tapped to cover the proposed increases. vided in the third continuing resolu- tion previously passed on December H.R. 1591 - U.S. Troop Readiness, Veterans’ Health, & Iraq Accountability Act: SEC. 3502. Section 20512 of the Continuing Appropriations Resolution, 2007 (division 9, 2006. This makes the total in- B of Public Law 109-289, as amended by Public Law 110-5) is amended by inserting crease for the FY 2007 IHS budget after the first dollar amount: `, of which not to exceed $7,300,000 shall be transferred $134.8 million; an increase of 4.4 % to the `Indian Health Facilities’ account; the amount in the second proviso shall be over the FY 2006 enacted level. The $18,000,000; the amount in the third proviso shall be $525,099,000; the amount in the law requires the IHS to provide the ninth proviso shall be $269,730,000; and the $15,000,000 allocation of funding under the eleventh proviso shall not be required’. House and Senate Appropriations Committees an operating plan within S. 965 Language - U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq 30 days after passage of P.L. 110-5. Accountability Appropriations Act, 2007 The details of this spending plan are SEC. 3502. Section 20512 of the Continuing Appropriations Resolution, 2007 (division just now becoming available and it B of Public Law 109-289, as amended by Public Law 110-5) is amended by inserting after the first dollar amount: `, of which not to exceed $7,300,000 shall be transferred does not look good for the Contract to the `Indian Health Facilities’ account; the amount in the second proviso shall be Health Services (CHS) program. $18,000,000; the amount in the third proviso shall be $525,099,000; the amount in the ninth proviso shall be $269,730,000; and the $15,000,000 allocation of funding under No Increase for CHS Program in the eleventh proviso shall not be required’. FY 2007 While the language in the supplemental bills is good news, the increase that While the IHS budget has received has been requested is less than adequate to cover inflation costs of the CHS an overall increase of 4.4%, there is program. The recommended $18 million for the Catastrophic Health Emer- no increase for the CHS program. gency Fund (CHEF) is the same amount that has been requested in previous The reason for this is due to the way the years. The CHS recommendation of $525.1 million is $7.8 more than what final continuing resolution (H.J. Res. 20) was funded last year. This is only a 1.6% increase over last year’s level and is is structured. The resolution requires significantly less than other hospital and clinic services accounts. The health the Agency to apply its increase based services accounts averaged an overall increase of 5.6%; while the Hospital/ on the language of the FY 2006 appro- Clinics line will see a 7.7% increase. If the CHS program were to be funded priation, which caps the level of funding at those same levels, the proposed increase in the supplemental bills should for the CHS program. The final enacted be at least $28 to $39 million. The President’s very own request included a FY 2006 amount was capped at $499.3 $37 million increase for the CHS program, so it is not known why a similar million for CHS and an additional $18 million for the Catastrophic Health increase wasn’t recommended to the Congress as it developed its funding Emergency Fund (CHEF). The Agen- thresholds. cy’s operating plan held the FY 2007 Page  • Northwest Portland Area Indian Health Board • No Increase Contract Health Service Program

Recommended Increase fails to Maintain Current Services This year, the President recom- mended an increase of $49 million in FY 2008 for the CHS program. The Senate Committee on Indian Affairs (SCIA) further recommended an ad- ditional $51 million be added to the President’s request, for a total recom- mended increase of $100 million in FY 2008. Clearly, the President’s re- quest and the SCIA recommendation underscore the importance in funding legitimate increases for the CHS program. Unfortunately, the same funding to support operations in Iraq. bers sitting on the Conference com- priority was not applied in develop- At a recent press conference Presi- mittee. The Senate has announced ing recommendations in the supple- dent Bush indicated, “If either the to its conferees while the House has mental request for the CHS program. House or Senate version of this bill not. The Northwest Portland Area Indian comes to my desk, I will veto it and Health Board estimates that the level it is also clear from the strong sup- On March 29, the Senate appointed of unmet need in the CHS program port for this position in both houses their conferees to meet with mem- is at least $301 million. The Board that the veto would be sustained.” bers of the House, which included: recommended that it would take The White House has issued State- Robert Byrd (WV), Daniel Inouye at least $64.6 million to maintain ments of Administrative Policy to (HI), Patrick Leahy (VT), Tom current services in FY 2007. The both Senator Byrd and Representa- Harkin (IA), Mikulski (MD), Her- recommended levels will fall short of tive Obey that the President will veto bert Kohl (WI), Patty Murray (WA), maintaining current serves by $56.8 the legislation when it is presented to Byron Dorgan (ND), Russ Feinstein million and there is no guarantee that the White House. (CA), Richard Durbin (IL), Tim the language will even be approved. Johnson (SD), Mary Landrieu (LA), Because of the timing of the Easter Jack Reed (RI), Frank Lautenberg At this point it is questionable break and the Conference committee (NJ), Ben Nelson (NE), Thad Co- whether the language included in meeting, Tribes will have some time chran (MS), Ted Stevens (AK), Arlen the supplemental bills will be signed to advocate for the CHS program. Specter (PA), Pete Domenici (NM), by the President. Congress is cur- It is expected that the House and Christopher Bond (MO), Richard rently in recess for Easter break and Senate will pass the supplemental Shelby (AL), Judd Gregg (NH), when they return, will conference conference report on April 26 or Robert Bennett (UT), Larry Craig to reconcile the differences in the April 27, or possibly early in the (ID), Kay Baily Hutchison (TX), supplemental appropriation bills. following week—meaning that the Sam Brownback (KS), Wayne Allard The House approved amount is $124 White House will receive the bill (CO), Lamar Alexander (TN), and billion, while the Senate approved to sign or veto no later than May 1, Charles Grassley (IA). amount is $123.2 billion. Early indi- if not a few days earlier. If there is cations by the White House are that to be a respectable increase for the the President will veto the supple- CHS program, one that will maintain mental spending bill due to troop current services, it is imperative that withdrawal proposals and not enough Tribes contact Congressional mem- Health News & Notes • April, 2007• Page  National Native HIV/AIDS by Stephanie Craig Rushing, Project Red Talon Director

Stop The Silence. That is the mes- sage Indian Country will soon be seeing. For many of us, talking about sex is an uncomfortable topic. Because of this, we have remained silent. In turn, our children and grandchildren have grown up not knowing how to talk about these is- sues. The time has come. Our silence will not stop the devastating impact of sexually transmitted diseases on our tribes.

In response, the Red Talon STD/ HIV Coalition has come together to increase community awareness about the impact that sexually transmit- ted diseases can have on our Native communities.

The Campaign: To commemorate National Native HIV/AIDS Aware- ness Day, celebrated on Wednesday, March 21, 2007, the Northwest Port- land Area Indian Health Board and G&G Advertising launched a HIV & Sexual Health campaign targeting the Northwest Tribes. • A Website - Visit www.stopthe- Office of Outreach & Special Popu- lations, as part of the AIDS Commu- The Campaign includes: silence.org for more information nity Information Outreach Program • 2 Teen Posters about HIV, STDs, testing services, (Purchase Order Number: 467-MZ- • 6 Teen STD/HIV Magazines, and ways to improve community 501808). including three versions for younger awareness. teens, and three versions for older Media Dissemination: Project Red teens. All materials are available for down- Talon will distribute campaign prod- • 2 Adult Public Service An- load at: http://www.npaihb.org/epi- ucts to our current Tribal Health con- nouncements for placement in Tribal center/project/prt_reports_publica- tacts at each of the 43 NW Tribes. papers tions_media_materials/ If you would like additional copies • An Adult Tip-Sheet for talking to of any of the products (or are not on teens about sex and STDs Campaign Funding: Funding for our contact list), please contact Lisa • 2 T-Shirt designs this project was awarded by the Library of Medicine through their

Page 10 • Northwest Portland Area Indian Health Board • Awareness Day

Griggs at: [email protected] or • In 2004, American Indians were o High rates of sexually transmit- 503-228-4185 to determine product nearly five times more likely than ted diseases not only signify high- availability. non-Natives to have chlamydia, four risk behavior, but also indicate a times more likely to have gonorrhea, vulnerability to the transmission of Some startling statistics: and twice as likely to have syphilis. HIV. People infected with an STD • When compared by ethnicity, These infections compromise not are 2 to 5 times more likely to be- AI/AN men and women had the third only individual well being, but the come infected with HIV. highest HIV/AIDS rate in 2004. well being of the community as a o Untreated STDs can cause severe • Among American Indian and whole, and direct medical costs asso- health consequences for women, in- Alaska Native males, the HIV/AIDS ciated with STDs can cause a sub- cluding pelvic inflammatory disease case rate increased 2.4% from 2001 stantial economic burden to Tribal (PID), ectopic pregnancy, and infer- to 2004, the most significant increase healthcare budgets. tility. Up to 40% of females with un- observed among any reported ra- • Each year, 1 in 4 sexually ac- treated chlamydia infections develop cial/ethnic group. Among American tive teens will get an STD, and 1 in 5 PID, and 20% of those may become Indian and Alaska Native females, sexually active teen females will get infertile. the HIV/AIDS case rate increased pregnant. Two U.S. teens are infected 4.8% from 2001 to 2004, an increase with HIV every hour of every day. These are the kinds of statistics that that was second only behind Asians/ • STDs interact with reproductive Indian Country should not be apart Pacific Islanders (A/PIs). health on a variety of levels: of. We must stand up and have a voice -- StoptheSilence!

Health News & Notes • April, 2007• Page 11 National Tribal Steering Committee (TSC) for Injury Prevention Seeking Members and Alternates

The National Tribal Steering Committee for Injury Tribe in your area Prevention is seeking members and alternates to serve 2. Conduct at least 2 calls (phone or in-person) per on their committee. Currently members or alternates are year with Tribal contacts to obtain feedback on IP needed from: Aberdeen (1), Albuquerque (1), Billings programs and provide information on IP activities (1), California (1), Nashville (2), Oklahoma, (1) Portland and opportunities (1), Phoenix (1) and Tucson (1) Areas. TSC for Injury 3. E-mail or fax TSC minutes to each Tribal contact Prevention maintains open recruitment for enthusiastic new members and/or alternates for all Indian Health B. Work with IHS Area/Tribal Injury Specialists: Service Areas with vacancies. 1. Meet at least quarterly with the Area/Tribal IHS Injury Prevention Specialist to: Objectives: a. Review the Area IP budget; discuss feed- • On a national level: raise awareness of, and back from Tribal IP contacts; identify support for injury prevention (IP) activities in funding and training opportunities for Native American communities; Tribal IP programs • Enhance the ability of Tribes to address injury 2. Participate in the Area’s annual IHS/Tribal bud- problems in their communities; get formulation process to increase funding for • Provide advice and guidance to the Indian Health IP. Tribal leaders make recommendations at the Service (IHS) Injury Prevention Program; Service Unit/Health Board and Area Office levels. • Compile area-specific information on injury problems and activities for the IHS IP website, C. Participate on a regional/national level: and promote increased funding for injury 1. Participate in monthly TSC conference calls (1st prevention programs in Native American Thursday at 2:00 p.m. EST). communities. 2. Attend at least two national TSC meetings per year (Alternates attend in the TSC member’s Membership requirements: absence). The TSC covers members travel and 1. Be an enrolled tribal member. related expenses. 2. Not an Indian Health Service employee. 3. Timely respond to TSC communications. 3. Serve as tribal employee in any health arena (including police/EMTs/nurses) or tribal commu- For more information, please contact Angela Maloney, nity member with an interest in injury prevention Chair at (928) 283-2844, [email protected] as well as involvement with community injury or any TSC member. A list of all TSC members is avail- prevention activities. able on the Internet at: www.ihs.gov/medicalprograms/in- 4. Completed at least one course in injury preven- juryprevention. tion or have at least 2 years experience in injury prevention (e.g., as a project manager of an injury Please mail or e-mail application items to: prevention infrastructure grant). Angela Maloney 5. Submit a letter stating their qualifications, reasons Tuba City Regional for wanting to join the TSC, and commitment Health Care Corp. to fulfilling the core roles of the TSC. Include a Office of Environmental Health short biography. 167 N Main Street 6. Provide letters of support from the Area Injury PO Box 600 Prevention Specialist and a tribal official. Tuba City, AZ 86045-0600

Core Role of committee members Selection Committee members are: Dennis Renville, A. Work with Tribes: Luella Azule, Elaine Boyd , Jennifer Falck and Nancy 1. Make a list of Injury Prevention contacts for each Bill (Navajo), IHS Hdqtrs

Page 12 • Northwest Portland Area Indian Health Board • From the Chair: continued

continued from page 2

Oregon were well attended by Port- The release of the President’s FY with our Congressional delegation land and Alaska Area Tribes. Key 2009 budget next year will test the to address this issue and hopefully issues discussed during the session effectiveness of this year’s Tribal Congress will provide more funding included: Medicare like rates remain consultation sessions. for our programs in FY 2007. held up in the HHS, CMS, and IHS internal clearance process; the status Finally, we are very concerned about We should all be proud of the work of the Susanville case; continued this year’s IHS budget. At the time of our Board on behalf of Northwest shortfall of IHS budget appropria- of this writing, the appropriations Tribes and Indian Country. Our tions, and; the ongoing fight to get provided in the final continuing reso- invitations to testify before Congress federal agencies to consult with lution does not include an increase are a testament to the hard work tribes when making any changes for the Contract Health Service pro- and reputation that NPAIHB has as that might affect us (specifically, gram. This is very troubling since a national leader on Indian health federal regulations imposed on tribes the Agency did receive an overall issues. It is because of your work, without tribal consultation). I also increase of 4.4%. The comparable willingness to attend quarterly Board participated in the HHS Department- program to CHS’s is the services meetings, and commitment to par- wide Budget Consultation session provided under the hospital and ticipate in our process that allows us in Washington, D.C. testified on clinics line item, which received a to accomplish the things we do. CDC, HRSA, and SAMHSA issues 7.7% increase. Language in the Iraq affecting Tribes. The format of this emergency supplemental bills will Keep up the good work! year’s session was a bit different and correct this, however, the amount of seemed to allow for more dialogue funding is not adequate. The lan- In closing, I’d like to say good bye on issues than previous years. It guage provides an additional 1.6% to our dear friend and colleague, Rod was the first time in many years that for the CHS program and simply is Smith. Indian Country has lost a true Tribes actually got to meet with the not enough funding to maintain cur- champion. HHS Secretary’s Budget Council. rent service levels. We are working

Health News & Notes • April, 2007• Page 13 New NPAIHB Employees

Hello, I am Jenine Dankovchik, and I am very excited to have recently joined NPAIHB as a Project Specialist with the Northwest Tribal Cancer Navigator Program. I was raised on the Saanich Peninsula of Vancouver Island, Canada and attended the University of Queensland in Australia where I received a degree in Mathematics and Statistics. For the past few years, I have been working in Hawaii, conducting research in a wide range of studies with a local company. Some the projects I worked on included a comprehensive evalua- tion of the Ke Ola Pono No Nā Kūpuna program, which provides nutrition and support services to Native Hawaiian Kūpuna on all six islands. I have also been involved with the Hawaii Health Survey, particularly using the data to analyze trends, identify health disparities, and identify needs among Native Hawaiians. In my new role as Project Specialist with the Navigator program, I will be supporting Matt in the evaluation of the Cancer Navigator model in our Northwest Tribal communities. I am very happy to be back in the area in which I grew up, and excited to start work on this important project!

Hi, my name is Carrie Sampson and I am an enrolled member of the Confed- erated Tribes of the Umatilla Indian Reservation. I joined the NPAIHB as the Prevention of Toddler Overweight and Tooth Decay Study Project Assistant. My parents are Trisha, Ronnie Lansford, and the late Curtis Sampson of Pend- leton, Oregon. My grandfather is Carl Sampson, Chief of the Walla Walla Tribe.

I was born in Missouri and spent many endless summers in Pendleton, Or- egon. I graduated from Belle High School in Belle, Missouri in 2002. I attended the University of Missouri and East Central College. I received my Practical Nursing License in 2004. I am currently a student at Portland State University pursuing a degree in Community Health Education with a minor in Native American Studies.

Prior to joining the Board, I was employed as the Prevention of Toddler Over- weight and Tooth Decay Site Coordinator at Yellowhawk Tribal Health Center in Pendleton, Oregon. My previous experience also includes working as a Licensed Practical Nurse throughout Oregon and three years experience in at a long-term care facility.

I have always been interested in tribal health issues and I feel very honored to have this opportunity to give back to my.

Page 14 • Northwest Portland Area Indian Health Board • New NPAIHB Employees

Hi, I’m Dr. Linda Frizzell, and I am the new Methamphetamine Data Direc- tor for the EpiCenter. I have extensive practice in rural and Indian health care administration. I hold a Doctorate degree in Physiology, Education Adminis- tration, and Gerontology. My endeavors include a broad range of professional preparations both in medicine and education, dedicated to the improvement of the quality of life across the life span. I have provided numerous testimo- nies in regard to health care policy, health issues, and tribal consultation. My specialties include: Health Services Administration, Clinic Management, Ru- ral & Indian Health Policy and Legislation, Health and Education Research, Behavioral Health, Community Assessment, Evaluation, Exercise Physiology, Health Education, Physical Rehabilitative Therapy, Service Learning Admin- istration, Senior Corps Administration, and Therapeutic Recreation.

Additionally, I was chosen to be a part of the first class of Rural Health Fel- lows, a program initiated by the Office of Rural Health Policy. I continue to serve as a technical adviser for the Indian Health Care Improvement Act. I am currently the Co-chair of the National Rural Health Association’s Minor- ity and Multicultural Health Committee; Member of the International Suicide Prevention work group for American Indians and Alaska Natives (Canada- USA); Member of the National Medicare and Medicaid Policy Committee; Advisory Council member, State of Minnesota Minority and Multicultural Health; and a member of the Corporation for National and Community Ser- vice Tribal Advisory group.

Health News & Notes • April, 2007• Page 15 NPAIHB – Locks of Love Effort by Kerri Lopez, Cancer and Diabetes Project Director

5:00 p.m. usually marks the end of as a small operation in the garage the work day for most employees of founder, Ms. Coffman. In 1997, at NPAIHB. But, on this particu- it became a public non-profit orga- lar Thursday night, for three of the nization that provides hairpieces to Native women at NPAIHB, it was a financially disadvantaged children Kerri Lopez, Verne Boerner, time to get together, enjoy great en- suffering from long-term medical Clarice Hudson before hair cuts. chiladas, refried beans, and have ten hair loss from any disease. The pros- inches of their hair brushed, braided, theses provided helps restore self- and cut off. It is not a new idea. Two esteem and confidence to children, women have donated hair in the past. enabling them to face the world and Once again, the time was right and their peers. the hair was long enough to be cut. The number of hairpieces produced Motivated by circumstances of a has increased significantly since its colleague, Clarice Hudson, recently inception, from 21 the first year to diagnosed with breast cancer, it over 2,000. Locks of Love has recip- seemed like the right thing to do. In ients in all 50 states and Canada, and Clarice Hudson (and hairstylist) many Native cultures, there is cer- is working toward its goal to help displaying her newly cut braid emony and protocol established to every financially disadvantaged child brushing, cutting, and disposing of suffering from long-term hair loss. hair. People make their own deci- sion about this sacrifice, however, Special thanks to the stylist, Erin the personal choice of contributing Russel, who donated her time, skills, to a child in need of a wig just felt and hair products for the beautiful good. new hair-dos she gave Verné, Kerri, and Clarice. Erin would not accept It takes ten braids to make one wig, payment as she is a strong supporter a little known fact. All of the braids and believer in the Lock of Love were donated to the Locks of Love program. We presented Erin with a program In total, Kerri Lopez con- beautiful beaded necklace bag and Kerri Lopez (and hairstylist) tributed two braids, Verné Boerner earring set. Thank you Elaine Dado, displaying her newly cut braids contributed two, Clarice Hudson our own Executive Assistant who contributed one, Tam Lutz contrib- beaded the set, she loved it. uted two from a previous cut, and one braid from a friend Holly Guiter- For more information about the rez. Altogether, we sent eight braids Locks of Love program, please visit: - - darn, almost enough to make one www.locksoflove.org. wig. Next time!

The Locks of Love program has been around for a while. It began Verne Boerner (and hairstylist) displaying her newly cut braids Page 16 • Northwest Portland Area Indian Health Board • Identity Theft

by Chandra Wilson, Human Resource Coordinator

Identity Theft How can one avoid ID Theft What facts do you know about Iden- tity Theft (ID theft)? Have you heard First, most ID theft is considered “low tech”, meaning that the thief has re- any horror stories about Identity trieved your identify through a lost or stolen wallet containing your personal Theft? Maybe you are a victim of it! information. The thief has an opportunity to call credit card companies and conduct a change of address, which in turn prevents the victim from knowing Since 2004, ID theft has been the that any recent charges have taken place in their credit card or line of credit country’s number one consumer accounts. fraud issue. Recently, the Federal Trade Commission (FTC) issued new Here are some simple steps provided from the Society of Human Resource rules governing employer disposal of Management SHRM on-line toolkit that anyone can take to reduce his or her applicant and employee records Fair risk of ID theft . and Accurate Credit Transactions Act ( (FACTA) derived from consumer • Always protect personal information. reports under the Fair Credit Report- • Stealing wallets and purses to obtain credit card numbers is the most ing Act. 1 common way ID thieves get your information. For this reason, avoid carrying birth certificates, Social Security cards and passports. What are the outcomes of being a • Don’t give credit card numbers out over the telephone. victim of Identity Theft • Ask to have your name removed from credit card company solicitors. You can call the three main credit bureaus Equifax, Experian and Trans This type of fraud can be considered Union to make this request. the most vicious and damaging that • Always make an extra effort to destroy or shred, pre-approval or pre- an individual can experience. The re- screened credit card offers. percussion this action has on both the • Sign up with the Direct Marketing Association (DMA) to have your victim and the economy is a costly name and telephone number deleted from telephone solicitations lists. one in time, money and stress. • Reduce the number of credit cards you use. • Keep a copy of credit card numbers, expiration dates and customer It can take weeks or even months be- service numbers in a safe place in the event your wallet is lost or stolen fore a person might find out that they so you can notify the company immediately. have been a victim of ID theft. Once • Order a credit report once a year from each of the three credit bureaus the victim becomes aware that this to check for inaccuracies and fraudulent use of accounts. Some indi- crime has occurred, they must report viduals choose to stagger their request a few months apart from the the crime within two days. Generally, credit bureaus to keep tabs throughout the year. the victim is not responsible for the • Always take credit card receipts with you after a purchase. debts; however, the victim can be left • Memorize PIN numbers and passwords; do not keep them in your with bad credit ratings, and spend a purse of wallet. long period of time trying to recover • When thinking of a PIN or password, never use your birth date, moth- from the fraudulent transactions. er’s maiden name or the last four digits of your Social Security Num- ber. These are too easy for a thief to discover, especially if they have  your wallet or purse. Identity Theft Toolkit, Society for Human Resources • Ask your financial institution to add extra security protection to your (SHRM) Website April 2004 account. continued on page 19  Health News & Notes • April, 2007• Page 17 When Research Results Are Surprising

Guest Editorial, Kathy Kinsey Guest editorial previously published in the “Minority Nurse” Winter 2007

Research is critical in the fight to eliminate racial, ethnic and geographic dis- basic quality and access measures. parities in health. But sometimes research can produce unexpected findings. The U.S. ranks 25th in life expectan- Chen, Fryer and fellow researchers in 2005 found that African Americans and cy and spends 42% of all worldwide Hispanics were more likely than whites to receive optimal cancer screening. health care expenditures on its 5% of This is surprising because African Americans and Hispanics are less likely to the world’s population. receive an annual physical exam or have optimal care for chronic illness. In her recent autobiography, Sen. Chung in 2006 identified that the economically vulnerable Hispanic commu- Hilary Clinton describes how she nity does not suffer from some of the same health disparities as other minor- once told then-President George ity populations. Infant mortality and overall mortality rates for Hispanics H.W. Bush that the U.S. was a great approach those for Caucasians—and are sometimes lower. This is surprising place for high-tech care but not to because: have a baby. The president did not * Diabetes is two to three times higher among Mexican Americans than in get her point. She told him the U.S. non-Hispanic whites and is one of the leading causes of death among Hispan- ranking in infant mortality. The ics. president did not believe her. He * Hispanics have the highest school dropout rate of all racial and ethnic was unaware of this statistic. I was groups. Higher education levels have been closely linked to positive health appalled that our national leaders outcomes. can govern without knowing this * The number of Hispanics living at poverty level with no health insurance is basic indicator of our nation’s health. almost This speaks volumes about why this one-and-a-half times that of non-Hispanic whites (40.8% compared to 29%). health disparity exists. When our national leaders are confronted with A study by Eberhardt and Pamuk published in 2004 revealed that rural resi- the facts about health disparities and dents and most urban residents share similar health disparities. This is surpris- their reaction is surprise, these are ing because on the surface these two populations seem very different. Another the kind of surprises we don’t need. paradox is that rural residents were found to have higher rates of obesity and to be more sedentary than their suburban counterparts. This is surprising be- Retired U.S. Public Health Service cause we often imagine rural residents as physically active, engaged in farm- Captain Kathy Kinsey, BSN, RN, ing, ranching, fishing and other outdoor activities. MPA, a Suquamish Indian, is cur- rently working on an online MSN/ Zuckerman, Haley et al (2004) found that over half of low-income uninsured MPH combined degree from Oregon American Indians/Alaska Natives (AI/ANs) have no access to health care Health & Science University. services through the Indian Health Service. This would be a surprise to the many people who believe that AI/ANs are the one minority group in the U.S. with universal health care access, and that all AI/ANs have excellent access to care because they have an established health system dedicated to meeting their needs.

Schoen et al (2005) identified that the U.S. ranks poorly in many health care indicators compared to other industrialized nations. This is surprising because we in the U.S. view ourselves as world leaders and we spend a significant por- tion of our gross national product on health care. Yet overall, we fall behind in Page 18 • Northwest Portland Area Indian Health Board • Identity Theft continued

continued from page 17

• Protect your Social Security Experian: (888) 397-3742, or Number P.O. Box 1017 Allen, TX 75013 What to do if you are a victim of Trans Union: (800) 680-7289, or ID Theft P.O. Box 6790 Once an ID theft crime has been Fullerton, CA 92634 reported to the authorities, it still can have a negative impact on the Report stolen checks or forgeries to victim. It is proven that ID theft will Telecheck: (800) 710-9898 destroy ones credit scores. Second, International Check Services: (800) 631-9656 the victim spends time and money Equifax: (800) 437-5120 on investigations with credit bureaus and government agencies working For removal from mail marketing lists, write on repairing their damaged credit. DMA Mail Preference Service Finally, the emotional affect that an P.O. Box 9008 individual privacy has been invaded Farmingdale, NY 11735-9008 creates an uneasy morale of trust on or society. Experian (marketing lists number): (800) 407-1088

Below is a list of Identity Theft To stop pre-screened credit card offers: (888) 567-8688 Resources for more information on credit report monitoring, reporting For removal of phone numbers from telephone solicitations, write fraud and other ID theft crime inci- DMA Telephone Preference Service dents. Some of these services may P.O. Box 901 require a fee. Farmingdale, NY 11735-9014

Credit reporting bureaus (to report Identity Theft Hotline fraud) Federal Trade Commission Washington, DC 20580 Equifax: (800) 525-6285, or (877) 438-4338 P.O. Box 740250 Atlanta, GA 30374 Social Security Administration: www.ssa.gov Fraud Hotline: (800) 269-0271 Verification of SSN: (800) 772-6270, or fax (410) 966-4407 Earnings reports: (800) 772-1213

Health News and Notes is published by the Northwest Portland Area Indian Health Board (NPAIHB). NPAIHB is a nonprofit advisory board established in 1972 to advocate for tribes of Washington, Or- egon, and Idaho to address health issues. Previous issues of Health News and Notes can be found on the NPAIHB webpage www.npaihb.org. Contact Sonciray Bonnell (503) 228-4185 or [email protected]., Health News and Notes Editor, to submit articles, comments, letters, and requests to receive our newsletter via mail. Health News & Notes • April, 2007• Page 19 Northwest Portland Area Indian Health Board

Resolutions

Resolution #07-02-01 Research on Rural Mental Health and Drug Abuse Disorders Resolution #07-02-02 Community-Based Participatory Research at the National Institute of Mental Health (NIMH) Resolution #07-02-03 Refining and Testing Mental Health Interventions and Services for Youth with Mental Illness who are Transitioning into Adulthood Resolution #07-02-04 Supporting the Dental Health Needs of Indian Country

NORTHWEST NON-PROFIT ORG. PORTLAND U.S. POSTAGE AREA PAID INDIAN PORTLAND, OR PERMIT NO. 1543 HEALTH BOARD 527 SW Hall Street • Suite 300 • Portland, OR 97201

Page 20 • Northwest Portland Area Indian Health Board •