Gathering— Regional Tribes Come Together to Review Health Care Improvements and Determine Priorities for the Future Page 5

Volume XV No. 4 • April 15, 2010 Gathering— Regional tribes come together to review health care improvements and determine priorities for the future Page 5

Photo by Rhonda Vanover, YKHC Public Relations.

INSIDE: Health Reform, p. 3 • Priorities, p. 9 • RPC in Kodiak, p. 12 • Botulism, p. 13 Volume XV No. 4 • April 15, 2010

YKHC Board of Directors Unit 1 Unit 5 Raymond F. Waska, Sr. Bill Kristovich Chuloonawick P.O. Box 46 P.O. Box 1037 Kotlik Unit 11 Emmonak Billmore Slough Alakanuk Hamilton R Emmonak, Alaska 99581 Bethel, Alaska 99559 Grayling E Nunam Unit 1 I V 907-949-1514 907-543-4151/2212 Iqua R O McGrath Anvik K Paula Ayunerak Glen Watson, Sr. Mountain Village Shageluk O St. MaryÕs N P.O. Box 5 P.O. Box 1874 Scammon N Paimute I Bay PitkaÕs Andreafski Point Alakanuk, Alaska 99554 Bethel, Alaska 99559 Chevak Pilot Station Hooper Bay Holy Cross 907-238-3212 907-543-4625 Marshall YUKON RIVER Unit 9 Unit 2 Russian Mission Ohogomuit Crooked Gloria Simeon Creek Georgetown Unit 2 Unit 6 Upper Kalskag Aniak Stony River P.O. Box 308 Lower Chuathbaluk Newtok Kalskag Red Sleetmute Unit 8 Napaimute Devil Ray Alstrom Bethel, Alaska 99559 Nunapitchuk KUSKOKWIM RIVER Tuluksak R Tununak Kasigluk Akiak E P.O. Box 8 907-543-5676 Mekoryuk Toksook BayAtmautluak Bethel Unit 3 Umkumuit Akiachak Unit 4 I V Lime Village Marshall, Alaska 99585 Nightmute Napakiak Kwethluk R Chris Larson Oscarville A Napaskiak N 907-679-6320 Unit 5 T P.O. Box 6051 I Chefornak Tuntutuliak L O James C. Landlord Napaskiak, Alaska 99559 Eek Unit 10 Kipnuk H P.O. Box 32168 907-737-7910 Kongiganak Unit 7 Kwigillingok Mt. Village, AK 99632 Quinhagak 907-591-2531 Unit 6 Unit 3 Esai Twitchell, Jr. P.O. Box 121 Goodnews Bay Wayne Morgan Kasigluk, Alaska 99609 Platinum P.O. Box 234 907-477-6309 Aniak, Alaska 99557 907-675-4264 Unit 7 Unit 9 Unit 11 George S. Morgan David O. David Patrick Tall Marvin Deacon P.O. Box 54 P.O. Box 78 P.O. Box 196 P.O. Box 45 Upper Kalskag, Alaska 99607 Kwigillingok, Alaska 99622 Chevak, Alaska 99563 Grayling, Alaska 99590 907-471-2490 907-588-8484 907-858-7613 907-453-5195 Unit 4 Unit 8 Eric Olson, Sr. P.O. Box 163 Honorary Board Member James Nicori James R. Charlie, Sr. Hooper Bay, Alaska 99604 Paul John P.O. Box 41 P.O. Box 37012 907-758-4068 P.O. Box 37067 Kwethluk, Alaska 99621 Toksook Bay, Alaska 99637 Unit 10 Toksook Bay, Alaska 99637 907-757-6837 907-427-7114 907-427-74l4 Moses Peter James Sipary Sam W. Alexie P.O. Box 57 P.O. Box 37134 P.O. Box 57 Tuluksak, Alaska 99679 Toksook Bay, Alaska 99637 Eek, Alaska 99578 907- 695-6426 907- 427-7816 907-536-5428 Numbers to Call

YKHC Main Operator...... 543-6000 Subregional Clinic Appointments Toll Free...... 1-800-478-3321 Aniak...... 675-4556 Public Relations...... 543-6037 Emmonak...... 949-3500 Media Services...... 543-6038 St. Mary’s...... 438-3500 Office of Environmental Health & Engineering...... 543-6420 Toksook Bay...... 427-3500 Technology Help Desk...... 543-6070 Public Health Nursing...... 543-2110 Human Resources...... 543-6060 Pharmacy...... 543-6382 Administration...... 543-6020 Travel Management Center...... 543-6360 Hospital...... 543-6300 WIC Program...... 543-6459 Emergency Room...... 543-6395 Health Services...... 543-6024 Hospital Community Relations...... 543-6350 Village Operations...... 543-6160 Social Services...... 543-6225 CHAP...... 543-6160 Family Medicine Clinic Appointments...... 543-6442 ICEMS...... 543-6080 1-800-478-3321 Community Health & Wellness...... 543-6190 Dental Appointments...... 543-6229 Behavioral Health Services...... 543-6100 Optometry Appointments...... 543-6336 Phillips Ayagnirvik...... 543-6700 Audiology Appointments...... 543-6466 Village Services...... 543-6740 Home Care Services...... 543-6170 2 Volume XV No. 4 • April 15, 2010 Health care reform includes passage of Indian Health Care Improvement Act By Andy Teuber Reprinted by permission of Alaska Newspapers No matter your feelings on the passage of the Patient Protection and Affordable Care Act, it is clear that its inclusion of the Indian Health Care Improvement Reauthorization and Extension Act is a positive step toward better health for Alaska Natives.

Andy Teuber is President For the past 11 years, leaders in the Alaska Tribal Health Sys- and almost four times as many and Chair of the Alaska Na- tem have worked tirelessly to pass these amendments to the suicides. Yet until now, there tive Tribal Health Consortium Indian Health Care Improvement Act. The law has promoted a has been little or no increase in and President and CEO of wide range of improvements over the years, but it was in need of federal funding for tribal health. the Kodiak Area Native As- sociation. updates, and the authorization to appropriate funds expired sev- Meanwhile, our population has eral years ago. These new amendments remove the first hurdle to continued to grow and health care costs have continued to rise. seeking additional funding from Congress, and require the Indian At the same time, our understanding of comprehensive health Health Service to consider care has evolved to focus on the whole person. For example, the adjustments for medical amendments now address services for behavioral health — the inflation rates and popula- IHS has funded programs for alcohol and substance abuse for 2010 Board tion growth. some time, but behavioral health programs now include services These changes are sig- for fetal alcohol spectrum disorders and domestic violence. Meetings nificant because the IHS The amendments streamline the youth suicide prevention grant has been dismally April 21 – 23 process for tribes — underfunded for These changes are significant Semi-Annual Full critical in Alaska, where basic services, and Board one Native person dies funding to expand because the IHS has been by suicide every eight or improve services May 19 & 20 dismally underfunded for basic days. Alaska Native has been extremely Governing Body males ages 15-24 are limited. The new act services, and funding to expand nearly nine times more improves the health June 23 & 24 likely to die by suicide status of Alaska or improve services has been Executive Board than other U.S. males Natives and Ameri- extremely limited. in the same age group. can Indians by elimi- July 21 & 22 The new act also facili- nating health disparities Governing Body tates the creation and expansion of programs for long-term care, through specific goals, pro- home health care, assisted living, and community-based care, grams and resources. August 18 & 19 especially important in rural Alaska. It allows escort travel to be Executive Board The health disparities covered for patients who need assistance during medical travel. between Alaska Native The new Indian health care act improves access by increasing September 21 & 22 people and the rest of the support for recruitment and retention of health care profession- Governing Body U.S. population are strik- als and incentives to use innovative cost-saving health facility ing — 30 percent more construction methods, which could make funding available for October 20 cancer, twice as many other long-awaited projects. Nearly $100 million in backlogged Executive Board unintentional injuries, twice November 17 – 19 as many infant deaths, see IMPROVEMENT ACT, p. 16 Full Board of The Messenger is produced by the Yukon-Kuskokwim Health Corporation’s Public Relations Department as a Directors report to Tribal Members. It is published monthly on-line at www.ykhc.org/messenger and printed quarterly. For questions, comments, submission of articles, or subscription information, write to Public Relations Senior Editor, Yukon-Kuskokwim Health Corporation, P.O. Box 528, Bethel, Alaska 99559; or call 907-543-6038. E-mail: mes- December 15 & 16 [email protected]. Deadline is the last day of the month preceding publication. Publication is on the 15th of every Executive Board month. Anchorage Office: 4700 Business Park Blvd. Suite E25, Anchorage, Alaska 99503. 907-677-2232. Please ask permission to reprint articles or pictures. © 2010, Yukon-Kuskokwim Health Corporation. 3 Volume XV No. 4 • April 15, 2010

Grow your community— Grow a garden! YKHC’s Diabetes Prevention and Control (DP&C) Program is pleased to announce that applications are currently being accepted for the 2010 Community Physical Activity & Garden Award.

The award is aimed at increasing healthy lifestyle choices and reducing the risk of chronic health diseases, such as diabetes, here on the Delta. Interested villages can apply for the grant if they would like financial assistance for implementing community programs that encourage physical activity and/or community gardens. A community garden is an excellent way to promote good health, The deadline to apply for this award is April 30, 2010. exercise and community spirit. Youth in Oscarville harvest the bounty in this Diabetes Program file photo by Debbie Michael. Requirements of maintaining the grant include: agreeing to spend the funds only as described; submitting vendor invoices and monthly progress reports to DP&C until all equipment is purchased/received and the program is fully functioning; and If you have you been diagnosed with Type providing pictures showing how the equipment is being used II Diabetes, we invite you to attend the by your community. Applications for the grant can be obtained by calling DP&C at 1-877-543-6133. Completed applications can be submit- ted to Deborah Michael or Greg Moses by emailing deborah_ Diabetes [email protected] or [email protected], faxing to 907- 543-6143 or mailing to the address below: Community Activity Award Applications Support Group Diabetes Prevention & Control Program Yukon-Kuskokwim Health Corporation every second Tuesday P. O. Box 528 Bethel, Alaska 99559 from 6 to 8 p.m. at the Paul John Boardroom on the 3rd floor of the “New YK” or Community Health Services Building. Diabetes Prevention & Control Hear about how others chose to manage their Direct line 907-543-6133 diabetes, how well it’s working for them, how they www.ykhc.org/diabetes are coping and living with their diabetes. 4 Volume XV No. 4 • April 15, 2010

Public Relations Director Donna Bach welcomes delegates to the Tribal Gathering on opening day. Live video at this year’s event made use of Story and photos by YKHC Public Relations Staff the big screen at the Cultural Center.

YKHC welcomed Tribal Council delegates from today for Wellness Tomorrow.” As Medical Director Dr. Joe Klejka nearly all of the communities in our service area, along with many noted in introducing his report on the Health Status Scorecard, YKHC employees, guest and visitors, to Bethel for the seven- prevention is not a new idea, but has been central to YKHC’s teenth Tribal Unity Gathering April 7–8. vision of “striving to be the healthiest people” since its incorpo- ration over 40 years ago. Nearly every seat available in the Yupiit Piciryarait Cultural Center was taken as people listened attentively to presentations about The scorecard tracks leading causes of death over time. the region’s current health status and the health corporation’s Although death itself can’t be prevented, causes of untimely efforts in preventing cancer, diabetes, injury, infectious disease, or unnatural death can be identified and addressed. YKHC and substance abuse. has instituted screenings for risk factors such as tobacco use, depression, and alcohol use in its patient exams and empha- After a day and a half of presentations, delegates reviewed their sizes tests and screenings for heart disease and cancer risks. ongoing concerns and presented their own set of priorities for The leading causes of death are still cancer, heart disease, unin- YKHC’s health care focus in the tentional injury and suicide. future. Presentations throughout the conference elaborated on the cor- In his opening remarks, YKHC poration’s prevention efforts. The presentation powerpoints can President/CEO Gene Peltola be accessed on our website at www.ykhc.org/messenger. acknowledged this two-fold pur- pose of the annual Gathering, Alcohol & Substance Abuse listing some of the many issues taken up and addressed by the Presenter: Jack Crow, Vice President for Health Services corporation as a direct result of Many preventable illnesses and injuries are attributable to alco- Gathering priorities—the medica- hol abuse. Protective custody holds, which place a great burden tion delivery system was rede- on YKHC’s Emer- signed last year because of con- gency Room, are cerns raised about lost or wrong most often the prescriptions; the CT scanner result of binge was brought on line two years drinking. Our alco- ago because Gathering dele- hol treatment mod- gates kept asking for one; parial els are more effec- funding toward an assisted living tive for the chronic home has been secured. Many alcoholic than other improvements have come the binge drinker. about, resulting in the “enhance- We are address- ment of the quality of life for our ing this with a Retired Aniak Health Aide Clara people,” Peltola said. new model called Greg Moses and the Diabetes Prevention Morgan remembers Aniak com- team offered blood glucose screening and The theme for the Tribal Unity SBIRT—Screening, munity leader Pete Brown, who Brief Intervention, information about preventing Diabetes. passed away this year. Gathering XVII was “Prevention 5 see GATHERING, p. 6 Volume XV No. 4 • April 15, 2010

GATHERING, from p. 5 Referral to Treatment. This begins with every patient encounter—a short series of questions to determine a patient’s alcohol use. If potential problems are indicated, the provider presents information about alcohol use, and if a more serious problem is indicated, the provider will refer the patient to counseling or treatment. The new city Sobering Center to be built this year will be a no-frills holding facility to allow inebriates to sleep it off without tying up the Emergency Room.

Colorectal Cancer Early Detection Presenters: Bill Eggiman, MD Physician; Glen Jorgenson, OR Charge Nurse; Charly Baird, OR Staff Nurse

Colon cancer is the second leading cancer killer Unit 6 representative Jimmy Stevens, Sr. studies the annual Report to the People. among Alaska Natives. If everyone over age 50 had screenings—colonoscopies—60 percent of colon cancer deaths could be avoided. A colonoscopy examines the colon with a scope and cutting instrument that allows the provider to see polyps and remove them before they grow and become cancerous. The number of colonoscopies done at the Gathering Presentations Yukon-Kuskokwim Delta Regional Hospital has increased from 225 in 2005 to more Informational Powerpoint presentations than 650 last year. An average of approximately 60-70 cases of colon cancer per year may be found on our website at www. are detected. YKHC can help with transportation costs for villagers who may not be ykhc.org. If you’re viewing this Messenger able to afford the trip to Bethel. on your computer and you have an inter- net connection, just click a title below to Women’s Health - Cervical and Breast Cancer Awareness download the presentation. Files are in Presenters: Dr. Elizabeth Roll, MD Outpatient Service Chief pdf format. & Luke Vanasse, Program Director Women’s Health YKHC Health Status Scorecard Women are at risk for breast cancer and cervical cancer, but early detection is very Capital Projects Update effective at stopping both before they become deadly. A mammogram is the best way Sanitation Project and Funding Updates to screen for breast cancer and pap tests screen Alcohol and Substance Abuse for cervical cancer. YKHC’s Women’s Health Pro- gram, through CDC’s National Breast and Cervical Direct to Patient Mailing of Cancer Early Detection Program provides access Pharmaceuticals to timely breast and cervical cancer screening 2010 Community and Partner and diagnostic services to low-income, uninsured, Satisfaction and underserved women. YKHC’s switch to digital Colorectal Cancer mammography has reduced the turnaround time Colon Cancer Screening for test results to less than an hour from the 10 Breast and Cervical Cancer days or more it used to take. Women’s Health / Cervical and Breast Preventing & Combating Infectious Cancer Awareness Disease (Flu & RSV) Long Term Care: Keeping Our Elders Close to Home Presenter: Lori Chikoyak, RN, YKHC Employee Preventing and Combating Infectious Health & Infection Control Disease: an Update on H1N1 Influenza The prevention of infectious diseases and commu- and RSV nicable illnesses is dependent on immunization Role of Behavioral Health Aides and and simple hygiene practices like handwashing. Mental Health Tiffany Zulkosky, Rural Liaison for YKHC has been a leader in providing immuniza- Critical Incident Stress Management Senator Mark Begich and former Bethel Mayor, presents an update tions for children and, thanks to pandemic pre- Public Health Nursing Then and Now from Alaska’s congressional paredness exercises, successfully dealt with the Prevnar 13 Update delegation. see GATHERING, p. 7 6 Volume XV No. 4 • April 15, 2010

GATHERING, from p. 6 Delegates try out ‘Instant Messaging’

The Public Relations staff introduced a new twist for the delegates in this year’s Tribal Unity Gathering,. An Audi- Medical Director Dr. Joe Klejka presents the regional ence Response System was featured. Delegates were Health Status Scorecard on day one. given hand-held remotes for voting on specific questions asked by presenters. Questions ranged from, “How would you rate our coffee?” to “Do you think there is value to your village by having various levels of Behavioral Health outbreak of swine flu this past year while simultaneously keeping up with regular seasonal flu vaccinations. Although there were more than Aides?” Audience members responded with a positive the usual number of people sick with both kinds of flu, there were no (yes) response (87%) to the Health Aide question. Our cof- deaths in our region, and many people were able to get their flu shots fee service needs work. Overall, delegates from the region when the vaccine finally became available. loved being involved in the remote voting process. “Being Prevnar 13 Update able to vote and have the results show up instantly.” “The Presenters: Dr. Ros Singleton, ANTHC Immunization Program Director question system.” “The Jeopardy stuff!” “Very organized. & Chris Desnoyers, Pneumo-13 Research YKHC Cool Technology with video polling devices!” These were Prevnar 13 vaccine is now approved and licensed by the U.S. Food just some of the comments. Public Relations looks forward and Drug Administration (FDA) and has replaced the Prevnar 7 vac- to bringing back the devices and adding new questions to cine as the routine pneumococcal vaccine. yet another successful Tribal Gathering next year. The pneumococcal bacteria causes brain, lung, blood, and some ear infections. The new vaccine is an improved Prevnar that protects against six more pneumococcal types. The vaccine is important to the YK Delta region because children residing here have had very high rates of pneumococcal infections.

Sanitation Project and Funding Updates Presenter: Brian Lefferts, REHS, Office of Environmental Health & Engineering Although handwashing is a simple and effective way of preventing infections disease, In our region frequent handwashing is not neces- sarily so simple, since many communities still lack running water and piped sewer systems. Of the 7,000 homes in the YK Delta, more than 3,200 still do not have piped water. In funding dollars, this represents an unmet need of about $350 million for our region. Historically, about half the water-sewer funding for Alaska has come to the YK Delta. About $68 million was allocated in 2009. Tribal Council delegates and guests listen to reports from see GATHERING, p. 8 YKHC program directors and administrators. 7 Volume XV No. 4 • April 15, 2010

GATHERING, from p. 7 Priority Updates Before determining priorities for the coming year, leadership reviewed progress on previous priorities—some of which have been high on the list for years:

• Assisted Living Home: Approximately half the funding needed for construction has been secured; we have hopes the other half will be included in this year’s state capital budget. Legislation is in the works that will allow for Medicare reimbursement based on actual costs—this will make operations, estimated to cost nearly $1.5 million more per year than revenue, much less problematic. • Prematernal Home: Still seeking funding. • Pharmacy Refills: The Direct to Patient project has been imple- Unit 9 representatives discuss priorities with Hooper Bay SRC mented region-wide and has proven successful. President/CEO Administrator Robert Filipczak (right). Gene Peltola said, “complaints to my attention about medication refills have been nonexistent.” are unable to determine the root cause of an issue. Should not have to call at 8:30 • Hospital remodels and equipment upgrades: Stimulus funds as well as other federal/ a.m. to make an appt. Even when the clinic state monies are helping with long-needed hospital and equipment upgrades: oxygen is called that early, the voice mail will usu- generators; a new CHSB electric generator; water and sewer line upgrades; hospital roof; ally pick up. If it doesn’t, they are already booked for the day. digital mammography units; OB, Radiology, OR, and Physical Therapy suite remodels, to • YKHC needs improved communication with name a few. tribal councils. Updates, etc. • Announcements should be made to vil- Setting Priorities lages when the SRCs do not have providers or radiology techs present. With progress reports completed, delegates and board representatives applied them- Patients from outside of the villages need to selves to the second aspect of Tribal Gathering work—determining priorities for the be worked into the schedule. future. Quite a few of the regional units this year found that the general priority catego- 4. Improve Continuity of Care ries used in recent years to rate the order of concerns were inadequate for identifying • It is not just elders that need home care. more specific needs and concerns in their villages and added these concerns ot their There are cases where middle-aged people lists. require assistance around the house and they should be able to receive home care. 5. Elder Issues Unit 1 Alakanuk, Bill Moore’s Slough, Chuloon- awick, Emmonak, Hamilton, Kotlik, Nunam Iqua 6. Village Clinic & Staff: capital improve- from the hospital. By the time the cause ments, maintenance, equipment and 1. Medical Providers—It seems like it was of their symptoms are determined, it is too supplies, transportation, support staff. better with a provider present. We are late, even if it should have been prevent- • Village clinics need to be renovated regressing instead of progressing. able, had there been adequate clinical • Need separate emergency room instead of treating the patient at the front entrance. 2. Community Health Aides follow-through. Health Aides and support staff should be • Health Aides get burned out because they • Patients need to be explained their rights in separate rooms during patient counsel- do not feel appreciated by the community: as a patient, most importantly: the right ing. Recommend a support committee in the to ask for a second opinion. Health Aides • Clinic in Alakanuk is sagging. When there village. Possibly rotate which village Health need to get a second opinion when they is an emergency, the rest of the clinic is Aides have a potluck thank-you shut down, , even when there is more than dinner. People in Alakanuk will one Health Aide. sometimes bring lunch for their • It should not take three or four health Health Aide and it seems to help aides to assist in an emergency. One her feel appreciated. Health Aides patient was sent home because of an often speak of quitting because emergency, and was dead a few days later. of low pay and lack of community • It is important for all staff in the clinic to support. We should look at their have a good attitude. pay, pension, and benefits. We • Physicians need to understand how to should also be more patient with communicate to patients. When patients them and demonstrate community are told that they will only live for a given support so we don’t lose another period of time, the patients often just give clnic like we did in Nunam Iqua. up. We need to tell the patients something 3. Hospital/Clinic Concerns: Qual- positive. ity of care/Case Managing 7. Environmental Concerns • Patients will be sent home sick Listing and arranging priorities for Unit 6. 8. Health Education 8 see PRIORITIES, p. 9 Volume XV No. 4 • April 15, 2010

PRIORITIES, from p. 8

• Wilma, the PHN, said that she would love • test spring water teaching health education, but does not and other commu- have time to do the research. The del- nity water sources egates agreed to have it noted that they for contamination would like for YKHC to provide the public • Dust health nurses with program materials for • Annual flooding health education. • Dumps and 9. Pharmacy lagoons: Lagoon • Elders need help with medication counsel- discharge into riv- ing and ordering. ers • Elders need translators for med reviews, • Dog yards (feces, medication counseling, and ordering. Many etc) elders cannot simply pick up the phone Unit 3 Aniak, Chuath- and call Bethel. Assistance is needed. baluk, Crooked Creek, 10. Alcohol and Drug abuse Georgetown, Lime Vil- • Reducing alcoholism requires as much lage, Lower Kalskag, support from the community as it does Red Devil, Sleetmute, from YKHC. YKHC cannot do it alone. Stony River, Upper Kalskag Unit 2 Andreafsky, Marshall, Mountain Vil- Susan Murphy and Gloria Simeon ponder Unit 5 priorities. lage, Ohogomuit, Pilot Station, Pitka’s Point, Unit 11 Anvik, Russian Mission, Saint Mary’s Grayling, Holy Cross, 6. Pharmacy Issues Shageluk 1. Alcohol / Drug Abuse Concerns 7. Village Clinic & Staff/Capital Improve- • Underage drinking (Unit 3 & Unit 11 priorities are combined) ments • Domestic violence • DUI Hospital / Clinic Concerns 8. Hospital Clinic Concerns • Sexual Assault / Abuse • Access to care 9. Medical Providers • Child Abuse, Neglect 1. • Quality of care 10. Health Education • Elder Abuse, Neglect • Misdiagnosis • Homebrew and Bootlegging Medical Providers Unit 5 Bethel, Napakiak, Napaskiak, Oscar- • Alcohol related injuries • Hiring, visiting villages / SRCs ville • Alcohol containing products sold at stores 2. • Villages without Health Aides / Floats • Need safe homes for kids / family to go Village clinic & staff - Maintenance 1. Capital Projects (family break-up) • Assisted Living Center built is top priority • Equipment and supplies • Suicide prevention • Prematernal Home 3. • insufficient funding to maintain clinics 2. Elder issues • high infant mortality, ANTHC-TX of Prena- • need for travel for escorts for elders Environmental Concerns tals • elder neglect and abuse • water and sewer • low birth weight • need assisted living / nursing homes 4. • waste removal in river • prenatal visits • need translators Alcohol and drug abuse • tobacco use • lack of general follow-up • need home care / respite care Behavioral health • high turnover for home care workers or 5. 2. Water/Sewer Health education lack of workers 6, • No Water well in Oscarville • programs for elders: Get-togethers—go Elder issues • after OEHE approval - OEHE will get it run- places and do things together 7, Pharmacy ning, two years ongoing problem 3. Community Health Aides 8, • gathering water from river-ice Communication between YK Board • Lack of health aide / no floats 9, • need for H20/Sewer System • None in Pitkas or Marshall Members and tribal leaders • school has their own well • No adequate housing for health aides 10, • Testing water/filter on well, is it changed Unit 4 Akiachak, Akiak, Kwethluk, Tuluksak • high turnover of health aides enough? Send samples, heavy metals from water collected from rooftops • new HA training 1. Improve continuity of care • need quicker emergency response • ensure government does not reduce fund- 3. Behavioral Health/Alcohol Education to • need emergency transport vehicles ing to IHS/YKHC our people • Clinic staffing in emergencies: need more • patient transport to/from Bethel • STDs/Alcohol - after a few drinks, elder staffing to keep clinic open for other 2. Environmental Concerns abuse patients • hypertension/stroke related to STDs • Need translators for Health Aides and • local such as water/sewer, etc Elders • national issues such as oceans, fall-out, 4. Suicide Prevention—upcoming genera- etc tion trying to focus on the youth—AVCP 4. Patient travel travels to many villages, need more • Travel for patient escorts 3. Alcohol/Substance Abuse including Sui- man-power. Need for counseling in the • Slow getting travel approved / missed cide Prevention village—wish lots can come down for appointments 4. Community Health Aide outreach services, not just 1 person, 5. Environmental Concerns 5. Elder Issues maybe 2 people

9 see PRIORITIES, p. 15 Volume XV No. 4 • April 15, 2010 Protect yourself from FLOOD CRUD by YKHC Office of Environmental Health Spring is coming to the Delta! After months of below zero temps, blowing snow, and Spring Travel Safety Tips riding the sno-go, the weather should finally start warming up. It’s time to get your rain boots out of the closet; break up is just around the corner. Unfortunately, this time of year can also mean flooding. We all know floods can do some serious property damage when water seeps into the house or washes a boat downstream. But do you ever think about the kind of Those cold dark winter days are fading damage floods can do to our health? That’s right, floods can even damage us! Flood away. The sun is shining brighter, and tem- season means we may see overflowing sewage lagoons and contaminated water peratures are rising. wells. We have to be EXTRA careful this time of year to make sure our drinking water As these changes take place, the ice on the is safe. river is weakening. This makes it increasingly important to be alert when traveling on the Don’t let flood crud get you down! Be sure to follow these tips to pro- ice. tect yourself and your family from illness. As you make your last few trips before Standard Precautions breakup, here are some tips to help make your trip a safe one: 1. Do not use contaminated water to wash dishes, brush your teeth, wash and pre- Watch out for open holes along the pare food, wash your hands, make ice, or make baby formula. trails and be aware of different ice 2. Boiling water is the preferred way to kill harmful bacteria and parasites. The conditions Alaska Department of Environmental Conservation recommends bringing water Dark ice, brown ice, and purple ice is to a boil for two minutes before using to kill most organisms. always unsafe, and any ice covered by 3. When boiling water is not possible, you can treat water with chlorine tablets, water is extremely dangerous. iodine tablets, or unscented household chlorine bleach (5.25% sodium hypo- Always wear a Personal Floatation chlorite) Device! • Household chlorine bleach, add 1/8 teaspoon (0.75 mL) of bleach per gallon of Wearing a Personal Floatation Device water if the water is clear. may help save your life should you fall through the ice. It may also offer good • For cloudy water, add 1/4 teaspoon (1.50 mL) of bleach per gallon. Mix the hypothermia protection. solution thoroughly and let it stand for about 30 minutes before using. Always travel with at friend! 4. Electrical power and oil or propane tanks should be shut off to avoid fire, elec- trocution, or explosions until it is safe to use them. It is always best to travel in a group. Travel in a single-file line and keep a safe 5. Avoid any downed power lines, particularly those in water. All electrical equip- distance between each other. ment and appliances must be completely dry before returning them to service. File a travel plan with a responsible 6. Do not operate any gas-powered equipment indoors. person who will check up on you. 7. Always wash your hands with soap and water that has been boiled or disin- Your travel plan should include: fected before preparing or eating food, after toilet use, after participating in flood cleanup activities, and after handling articles contaminated with flood ♦ Everyone who will be traveling, what you water or sewage. are taking (equipment) 8. If you receive a puncture wound or a wound contaminated that comes in con- ♦ Where you are going and the route you tact with flood water, have a doctor or health aide determine whether a tetanus plan to take (if you change destination booster is necessary. or route be sure to inform the responsible person of your changes) Emergency Supplies ♦ How long you plan to be gone and when • Several clean containers for water, large enough for a 3-5 day supply of water you plan to return. • A 3–5 day supply of non-perishable food and a nonelectric can opener If you aren’t sure who to tell, you can always • A first aid kit and manual, prescription medicines and special medical needs. file your plan with the Alaska State Troopers. • A battery-powered radio, flashlights, and extra batteries Brought to you by • Sleeping bags or extra blankets YKHC Injury • Water-purifying supplies, such as clorox or iodine tablets Prevention see FLOOD PREPARATION, p. 16 10 Volume XV No. 4 • April 15, 2010

Nutrition & Stress by Renee Legan, WIC Program Registered Dietitian

April is Stress Awareness Month and we all know that stress can sometimes lead to unhealthy eating habits— which leads to more stress! When we are feeling stressed, we tend to make poor food choices. Unfortunately, these food choices can create more stress in the long run and could lead to health problems.

Have you found yourself doing These unhealthy habits can affect our any of the following? bodies in many ways such as… Drinking Too Much Coffee: When burning the candle at both Blood Sugar Imbalances: When we don’t eat balanced meals ends, people often find themselves using coffee drinks all day and snacks (lean protein, whole grain carbohydrates and healthy long because they believe that caffeine gives them energy. fats) we can experience blood sugar fluctuations. These fluctuations can lead to mood swings, fatigue, poor concentration and Eating The Wrong Foods: Stressed people tend to crave foods other negative consequences in the short term, and greater high in fat, sugar and salt partially due to increased levels of cor- health problems like hyperglycemia in the long run. tisol, a stress hormone. Think about it: how often have you turned to your good friends Ben & Jerry after a long, stressful day or a Caffeine Side Effects: Too much caffeine can lead to poor bag of potato chips? concentration, decrease effectiveness, sleep disturbances, and increased levels of cortisol in the blood. Skipping Meals: Another thing overly stressed people tend to do is skip meals. Have you ever found yourself rushing out of the Poor Health Outcomes: Poor nutrition can also lead to lowered house without a healthy breakfast or not eating lunch because immunity so you’re more susceptible to illnesses, both minor you have important work deadlines? and major. This can lead to other problems, including increased stress levels. Mindless Munching: Stress also makes some people prone to emotional eating such as eating when we aren’t hungry or eating foods that are bad for us. Have you found yourself mindless Make the healthy choice snacking on junk food or eating when you aren’t hungry because There are several things you can do to make healthy food of stress? choices. Here’s a list that can work for even the busiest people. Try some or all of them, and you should find yourself feeling Forgetting Water: With busy lives, it’s easy to forget to drink your healthy, more productive, and—best of all—less stressed! water. In fact, many people drink no water, and get water only from soda, coffee, koolaid, or tang. Do you get a full eight glasses #1 Eat Breakfast: You may rationalize that you’re not hungry yet, of water per day, or even four? that you don’t have time, that lunch will come soon enough, or that you need to diet anyway. Skipping breakfast makes it harder Quick Foods: People in a hurry will often buy foods from the con- to maintain stable blood sugar levels and effective functioning venient counter at grocery stores, quick stops, or gas stations. during your busy morning. You can easily grab a hard-boiled egg, These foods are often deep-fat fried, greasy, high in calories/fat/ piece of fruit, or toast on your way out the door. salt and therefore unhealthy. #2 Carry a Snack: Having some protein-rich, healthful snacks Crash Diets: Because of weight gain from stress, some people in your office drawer or purse can help you avoid blood sugar try dangerous fad diets in order to lose the excess weight. Diets level dips, mood swings, and fatigue. Trail mix, dried fruit, gra- that aren’t balanced with fruits and vegetables, protein and nola bars, and whole grain crackers all contain good nutrition. healthy carbohydrates can often be bad for your health in the You should always have water handy, as it’s so vital to health and long run. proper physical functioning.

see NUTRITION, p. 16 11 Volume XV No. 4 • April 15, 2010 Rural Providers Conference to ‘Light the Lamp’ in Kodiak Angela Gonzalez, Communications Coordinator, Rural Alaska Community Action Program

[Anchorage] The Rural Alaska Community Action Program, Inc. State Dept. of Commerce, Community & Economic Development, (RurAL CAP) 27th Annual Rural Providers Conference (RPC) will Alaska State Dept. of Health & Human Services, and Elihu Foun- be held on June 7-11, 2010 at the Kodiak High School in Kodiak. dation Charitable Trust. Co-sponsor for the conference is the Kodiak Area Native Associa- tion. This year’s RPC theme is “Lighting the Lamp for Strength in Unity”. For registration and exhibitor information, contact Janice Berry, [email protected], or Keynote speakers include Amy Modig, formerly of Tanacross, Nick Pavloff, formerly from Karluk on Kodiak Island, and Gloria Gor- call 907-865-7354 in Anchorage, or toll free 800- man, formerly from the Navajo Reservation in Arizona. 478-7227, extension 7354. www.ruralcap.com. Modig, who currently resides in Anchorage, has worked in the fields of education, alcohol treatment and prevention, and pro- RurAL CAP, a statewide, 501(c)(3) non-profit corporation, has been working gram development. Pavloff is a certified substance abuse coun- to improve the quality of life for low-income Alaskans since 1965. RurAL CAP selor and visits tribal communities within the Prince William employed more than 850 people in 2009 with expenditures of over $26 million. Sound area. Gorman has a Bachelor and Masters Degree in It provides resources and services to enhance child and family development, Social Work and is presently the Human Services Director for the improve housing, reduce energy costs, develop leadership, protect traditional Bureau of Indian Affairs, Alaska Region in Juneau. uses of fish and game, promote environmental responsiveness, support health and wellness, develop and assist with community plans, and foster independent The RPC is an annual gathering designed by rural Alaskans who living. are substance abuse service providers, youth, Elders and family members interested in celebrating and encouraging the YKHC continual growth of the Alaska Native Sobri- ety Movement. The RPC embraces and unites traditional Alaska Native knowledge and modern treatment methods to find solutions for alcohol and drug abuse. The conference features ceremonies, talking circles and cultural events. Workshops and general sessions are geared toward clinicians working with rural Alaskans, those in recovery, as well as Elders, youth, and other adults. The confer- Now you can request your medicine directly ence is held for two consecutive years in dif- from YKHC’s Pharmacy and it will be sent to ferent rural communities. This is the second YOUR Post Office Box. You don’t have to year the conference has been in Kodiak. pick up your medications from the clinic! RPC was held in Bethel in 2005 and 2006. UAA-Kodiak College academic credit, Alaska Commission for Behavioral Health Certifica- tion, and continuing education (CEU) credits are available for conference attendees. The deadline for early registration is May 1, 2010. Registration fees are $55 for adults, $30 for youth (ages 13-18), and free for Elders, children (age 13 and under) and local community members not represent- ing an organization. After May 1, the registration fees are $85 for adults and $45 for youth. Exhibitors are being accepted on a first-come, first-serve basis. The exhibitor fee for the week is $30. The conference is funded by the Alaska 12 Volume XV No. 4 • April 15, 2010 Be aware of botulism risk in native foods YKHC Office of Environmental Health & Engineering

here is nothing better than traditionally prepared • Use proper methods of fermentation where air will reach the food. tep’eq, tepnagaiyaaq, seal, seal oil or walrus. Whatever Do not use air-tight plastic, glass, or sealed plastic bags where your favorite native foods, it is always important to be the botulinum toxin will easily grow. aware of the risk of botulism if food is not prepared cor- • Salt any dried fish to prevent growth of the toxin. Trectly. Tradionally prepared fermented food does not create as much risk as foods fermented in plastics and sealed containers. • If you don’t know how your food was handled or prepared, do not eat it. Botulism is a rare but serious disease caused by toxin-producing bacterium called Clostridium botulinum. Botulism spores are There is a new treatment that can be used in the case of botu- found in soil throughout the United States, including Alaska. lism. The treatment is a heptavlent botulinum antitoxin (H-BAT) that contains antibodies specific for the Botulism toxin types. The There are three kinds of botulism. Foodborne botulism is caused State Epidemiology office has been stocking hospitals around by consuming food containing the toxin. Infant botulism is caused the state with H-BAT so it is ready for use in situations where by ingestion of the spores where the toxin forms in the intestines Botulism is confirmed. YKHC has H-BAT supplies in the Bethel of the infant. Wound botulism is caused by the toxin produced Main Hospital. There was a recent confirmed botulism case in when the wound is infected with Clostridium botulinum. The most Bethel and with quick access to H-BAT, no serious outcomes were important type of botulism is foodborne, because many people reported. can be poisoned from a single contaminated food source. Symptoms of botulism generally show 12 to 36 hours after the If you have more questions about the H-BAT toxin gets into your body. Common symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, supplies please contact Lori Chikoyak in difficulty swallowing, dry mouth, vomiting, diarrhea and muscle infection control at 543-6303. weakness. Muscle weakness may progress to paralysis of the respiratory muscles, which can be fatal. Any questions about food handling or preparation Botulism is usually associated with home-canned and fermented please contact the Office of Environmental foods. In Alaska, most cases are due to fermentation and drying foods. Botulism has been linked to a variety of native foods Health at 1-800-478-6599. including seal, seal oil, whale, salmon eggs, and fermented salmon heads. Botulism rates are higher in Alaska than any other state because of these native fermented foods. The only way to diagnose this disease is to Getting on a Boat? Be sure to Float! Wear your PFD! find the botulism toxin in the blood or stool. Personal Flotation Device If caught early enough, the illness can be Summer in the YK Delta means fishing, boating, swimming, travel, Float Coats & PFDs treated with an antitoxin to prevent the and recreation. This year, beat the symptoms from worsening. Extreme cases odds; get a PFD and wear it. Injury Control & EMS Sales usually require breathing machines and Today’s PFD’s fit better, look better, take several months to fully recover from and are easy to move around in. Safety Equipment Sales Shop the effects of the toxin. Some PFD’s are made to protect you from cold water. A PFD with bright YKHC’s Injury Control & EMS, Sales Shop offers a variety of Botulism can be prevented by cooking food colors is easier to see and may safety equipment such as: PFD’s, ice cleats, off-road helmets, increase your chances of rescue. properly. The toxin is destroyed by high snowmachine helmets, goggles, and first aid kits. A PFD must fit comfortably and snug. Make sure your PFD is made for The products we purchase are directly from the manufacturer. heat. There is no way to prevent botulism your weight and size. Which means we purchase the items at wholesale cost and when preparing fermented foods, but there But, no matter which PFD you choose, the best PFD is the one you wear. are a few steps you can take to decrease Remember, spending a little time now can save you a lifetime later. consumers buy them for less than what the stores charge! your risk of getting the disease: In Bethel? Call us today for product availability! Stop by and see what we have! • Wash your hands, containers, and food We are located at the “New YK” Building 1-800-478-6599 ext. 6085 before preparing or cooking the food. at the back of the first floor lobby or Open Monday–Friday, 7:30–11 a.m./Noon–3:30 p.m. 907-543-6085 • Ferment foods at a cooler temperature (usually less than 37°F) to inhibit growth of the botulinum toxin. USE OUR HANDY ORDER FORM ON PAGE 17

13 Volume XV No. 4 • April 15, 2010

The Community Health Aide Program is pleased to announce the award for Health Aide of the Month to Billy Rivers, of Scammon Bay. Rivers was nominated by Debbie David, SI and Ellen Hodges, MD.

Billy attended to an intoxicated patient that had taken an overdose. He remained calm trying to treat the ine- briated woman but the woman refused treatment and left with Village Police. The following morning, Billy fol- lowed up with the young woman and she decided on March, 2010— treatment. Not long after the incident, Billy treated another patient in a life threatening situation and Billy Rivers of pulled the young man through. As a result of remaining calm and thorough, Billy Rivers was named Health Aide Scammon Bay of the Month for March, 2010.

Community Health Aide Program Well Child They leave their families at Wednesdays any hour to help you and yours… For your children ages birth to 20

Start your child on the road to a healthier future! Call your village clinic today to schedule an appointment for a Well Child Wednesday Exam

The exam includes: Martha Yohak,CHP, Chefornak, examines young patient. Photo by Janet Erik, CHP. • Vision, hearing and dental • Immunizations (if needed) Health Aides – There for You • Health education Show you care. • Developmental screening Thank your Health Aide today for the work they do.

Working Together to Do you know an outstanding health aide? Contact the YKHC Field Supervision Prevention is the key to wellness Achieve Excellent Health Coordinator at 543-6357 to nominate your health aide for an award!

14 Volume XV No. 4 • April 15, 2010

PRIORITIES, from p. 9 5. Sobering Center—More need for behav- 3. Health Education • Patient transportation from the airport, to ioral health services, are we prepared • Sex education presentations at schools: the hospital, and back to the airport for these people? With more $ and talk about prevention and responsibility 8. Continuity of care / Quality of care • Presenters should work with tribal mem- training for Sobering Center, we can 9. Health education assess and provide follow-up on ser- bers to share vices 4. Continuity of care with same doctors 10. Pharmacy • Medication refills 6. Sex Education—10-12 years since elimi- 5. Elder care issues nation of that department, there has • Not enough home care providers Unit 9 Chevak , Hooper Bay, Paimute, Scam- been an increase in STDs 6. Behavioral Health Aides mon Bay • Would like to see more talking circles that 7. Long Wait Times in ER—Need more pro- 1. Water & Sewer - Dust, Dump, Lagoon viders to see patients who get tired of involve the community 2. Behavioral Health waiting and just leave. There is more • People coming back from jail should have the name and number of the BHA for fur- • Alcohol and drug abuse than one doctor to see patients. ther counseling • Parenting issues Unit 6 Atmautluak, Kasigluk, Nunapitchuk 7. Water & Sewer • Suicide prevention • All unit 7 villages have no water and sewer • Behavioral health aides 1. Village clinic and staff services 3. Elder care - provide locally • Oxygen transportation concerns • Health issues 4. Health aide support / clinical support 2. Alcohol / Drug Abuse concerns Unit 8 Chefornak, Mekoryuk, Newtok, Night- • Equipment 3. Elder issues mute, Toksook Bay, Tununak, Umkumiut • Clinic hours 4. Behavioral health / suicide prevention 5. Communication between villages and • Title 47 rules 1. Hospital / Clinic Concerns Bethel • Patients are sent home sick from the hos- 5. Environmental concerns pital by the time the cause of their symp- 6. Access to care • Travel 6. Community Health Aide issues toms are determined, it is often too late, even if it had been preventable • Time of provider in villages 7. Improve continuity of care / Quality of 7. Medical Staff/Providers Training care concerns 2. Environmental Concerns - Water / Sewer • DHAT 8. Medical Providers • Water and sewer for villages • Provider / Health Aide • Visiting villages 3. Alcohol and drug abuse concerns 8. Parental Skills Training/Education 9. Health education • Sex education 4. Community Health Aides Unit 10 Eek, Quinhagak • Water safety • Specifically Behavioral Health Aide issues 1. Suicide prevention • Injury prevention 5. Medical Providers • Health careers promotion • Hiring 2. Pharmacy 10. Pharmacy • Visiting villages, SRCs 3. Medical Providers 6. Elder Issues Unit 7 4. Alcohol, Drug Abuse concerns Kipnuk, Kongiganak, Kwigillingok, • Care, neglect, respect, housing, nursing Tuntutuliak homes, 5. Community Health Aides 1. Alcohol and drug abuse (including inhal- • Some elders do not have someone to care •Office assistant ants. Specifically requesting presenta- for them in their villages 6. Appointments / Referral Process tions by councilors at the schools and 7. Village clinic and staff • Village to Bethel community • Capital improvements, maintenance, 7. Environmental concerns - Water / Sewer equipment, supplies, transportation, sup- 2. Health Aides port staff. 8. Elder Issues • Shortage of health aides • Village clinics need snowmachines and 9. Hospital clinical concerns • Shortage of float health aides ATV’s 10. Health education Watch for...

in your box June 15 15 Volume XV No. 4 • April 15, 2010

IMPROVEMENT ACT, from p. 3 FLOOD PREPARATION, from p. 10 health and sanitation facility construction projects may now be • Baby food and/or prepared formula, diapers, and other baby completed, especially with authorization to facilitate collaboration supplies and contributions by multiple federal agencies on these projects. • Disposable cleaning cloths, such as “baby wipes” in case We can now begin to ensure the health care Alaska Natives bathing facilities are not available receive reflects the modern delivery of health care. We are mov- • Personal hygiene supplies, such as soap, toothpaste, sani- ing toward parity with other federal agencies in bringing a high tary napkins, etc. standard of health care to our people. Cleaning Tips Yet our work is not complete. We cannot assume the federal government will provide the funding and resources we need to • Cleaning up after a flood should start with drying out. provide the quality of care Remove everything that is wet and start cleaning inside the our people deserve. We must We cannot house continually seek improvement assume the federal • Wall and hard-surfaces should be cleaned with soap and from the federal government water and disinfected with a solution of 1 cup of bleach to and our own programs to government will five gallons of water achieve better health. provide the funding • Wash all linens and clothing in hot water. For items that Alaska Natives and American cannot be washed, air dry them in the sun and then spray Indians are exempt from the and resources we them thoroughly with a disinfectant. insurance mandate included in the general health reform need to provide the If your well cap is covered with water: bill, though they may choose quality of care our • Don’t drink your water. to participate. While Alaska Natives are still eligible for IHS people deserve • Household bleach can be used as disinfectant if used prop- services, the tribal health sys- erly. tem depends on private insur- • Contact your local Office of Environmental Health at 1-800- ance, as well as other third-party revenue sources to maintain our 478-6599. They can give tips on proper ways to treat your services at appropriate levels. well For those of you who carry private insurance, or are eligible for Medicaid, Denali KidCare or Medicare, and who bring these NUTRITION, from p. 11 sources of payment to the tribal health system, you’re strength- #3 Healthy Munches: If you find that you absently munch when ening our system and providing much needed resources. This is you’re stressed, or have a pattern of snacking at certain times in one of the important ways we can help each other achieve overall the day or week, you can replace chips, ice cream and other less- health and wellness. When we share our resources, we’re helping healthy munchies with carrot or celery sticks, canned fruit, small our communities and maintaining our tradition of taking care of handful of nuts, or other healthier snack chip choices like pret- one another, as we’ve always done. zels or rice cakes. #4 Brown Bag It: Take a few extra minutes the night before to If you think you may be eligible for Medicaid, pack and bring a lunch from home. Even if you do this only a few days a week, it would be an improvement over eating every lunch Denali KidCare or Medicare, please contact out and will save you money. YKHC Medicaid Enrollment Department, toll-free: #5 No Caffeine After 11 a.m.: Since caffeine stays in the body 1-800-478-3321 or call 907-543-6470 for at least 6 hours, limit yourself to 2cups of coffee in morning. #6 Stock Your Kitchen With Healthy Foods: Purchase only SUBSCRIBE foods that are good for you and your family! The best way is to plan a menu of healthy meals and snacks at the beginning of to the Messenger! each week, list the ingredients you’ll need, and shop for every- Online Messenger: Published monthly on thing once a week. That way you know you’ll have what you want our website: www.ykhc.org. Enter your email address in when you need it, and you won’t have to stress over what to eat the “Messenger by Email” link. each night. Messenger Quarterly: Published in March, June, #7 Relaxation Activities: To reduce your stress-induced carv- September and December and mailed to all YK Delta vil- ings for unhealthy or excessive food you can use exercise, yoga, lage boxholders. Bethel residents and others: Subscribe journaling, or laughter to reduce your stress and bring your life by sending your name and mailing address to messen- into balance. [email protected] or call Public Relations at 907-543-6038 16 Volume XV No. 4 • April 15, 2010

Safety Equipment at the Retail Shop YKHC’s Injury Control & EMS, Sales Shop offers a variety of safety equipment such as: PFDs, ice cleats, off-road helmets, snowmachine helmets, goggles, and first aid kits. The products we purchase are directly from the manufacturer. Which means we purchase the items at wholesale cost and consumers buy them for less than what the stores charge! Call us today for product availability! 1-800-478-6599 or 907-543-6085 In Bethel? Stop by and see what we have! We are located at the back of the lobby in the “New YK” Building. We also have coffee and espresso drinks so join us for a cuppa joe! Hours: M–F, 8 a.m.—5 p.m. ICEMS Sales Shop PFD Price List ICEMS Sales Shop Order Form MJ6214 Bomber Jackets $150 Item # Size Color Qty. Price Subtotal Sizes: Small—3X-Large Weight: Over 90 lbs. ______Colors: Navy, Green, Camouflage ______*NEW* $150 7007 Floating Jacket ______Sizes: Large – 2X Weight: Over 90 lbs. ______Colors: Red, Black Order total:______MA7136 Hood $20 Size: One Size Shipping: FREE! : Navy, Orange Color Total:______4142 Vest—Adult with Zipper $25 Ship to: Sizes: Sm/Med, Lg/XL, 2XL, 3XL, 4X/7X (navy only). Weight: Over 90 lbs. Name:______Colors: Navy, Green, “Wilderness” Camo Address:______s $20 5311 Vest—Adult with Buckle City, State, Zip:______Sizes: Universal and Oversize Weight: Over 90 lbs. Phone:______Colors: *NEW* Navy, Tan, Blue, Red, Yellow, “Army” Camo Method of Payment 3060 Vest—Youth $20 o Check o Money Order Size: Youth o American Express o MasterCard Weight: 50-90 lbs. o Visa o Discover Card Colors: Blue, Silver, Yellow, Barbie, Spiderman 3040 Vest—Child (no collar) $20 Credit Card #:______Size: Child Exp. Date:______Weight: 30-50 lbs Colors: Barbie, Blue, Silver, Dora, Diego, Spiderman, Name on Credit Card:______Red Billing Address:______3002 Vest—Child with Collar $20 ______Size: Child Weight: 30-50 lbs Signature:______Colors: Spiderman, Barbie, Ships Ahoy, ScoobyDoo Please make checks payable to: YKHC—ICEMS 3303 Vest—Infant/Child with Collar $20 Size: Infant/Child Mail payment and Order Form to: Weight: Less than 50 lbs. YKHC—ICEMS Sales Shop Colors: Blue, Red, Dora, Diego, Spongebob attn: Teresa Markham 3001 Vest—Infant with Collar $20 P.O. Box 528 Size: Infant Bethel, AK 99559 Weight: Less than 30 lbs. Credit Card Orders— Colors: Orange, Summer Friends, Skate Fax your order in for expedited service! FAX: 907-543-6425 17 Volume XV No. 4 • April 15, 2010

Osteoporosis by Nathaniel Zook, 2010 Doctor of Pharmacy Candidate, Philadelphia College of Pharmacy

Osteoporosis is a disease in which your Not all women develop osteoporosis after menopause but, for some the decrease in estrogen may result in a loss of bone den- bones become weak and you are at a sity leaving bones weak. With osteoporosis, even a minor fall can lead to a fractured bone. With proper screening and treatment higher risk for fractures. Osteoporosis is you can keep your bones strong and reduce the risk of an activity common in women after they experience limiting fracture. menopause. What is important for preventing osteoporosis? Calcium is important in keeping your bones strong. Those under age 50 need 1000 mg of calcium each day. Those over age 50 need 1200 mg of calcium each day. Calcium can be found in many foods including dairy products. However, in most people foods do not provide enough daily calcium. Vitamin D is essential for calcium absorp- Who do I call tion. Without vitamin D, your calcium will not be effective in keeping your bones strong. It also helps muscle performance and balance which helps reduce fall risk. Vitamin D Life-threatening emergency... 911 is mainly obtained through exposure to sun- State...... ? Trooper Active suicide attempt, overdose, incident light. Residents of Alaska may not get enough 1-800-764-5525 involving weapons, possible serious harm vitamin D through sunlight due to short winter to somebody, person threatening to kill or days. Those under the age of 50 require 400- seriously hurt themselves or somebody else or Village VPSO 800 IU per day and those over the age of 50 543-6300 Mental health situation... require 800-1000 IU per day. or 1-800-478-2642 Somebody might need to be committed to Exercise is an important part of building and psychiatric hospital in Bethel or Anchorage— YKHC Emergency maintaining bone density. Weight-bearing acting bizarre, out of touch with reality, maybe exercises such as walking, dancing, berry- seeing/hearing things that are not there, Services for Behavioral picking and trapping are a few examples. “talking crazy,” maybe talking about suicide Health on-call Clinician These should be performed at least 30 min- 1-866-465-8930 Personal or family problems... utes a day. Muscle-strengthening exercises A YKHC employee or family member needs such as lifting light weights done 2 or 3 times ComPsych Employee a week can help as well. Assistance Program help dealing with an alcohol or drug problem, depression, job stress, marriage or financial problems, grief issues, domestic abuse, or How can you tell if you have osteoporosis similar problems. and what can be done if you do? 1-800-478-3321 After a disaster or tragedy The gold standard in osteoporosis screening is a DXA scan. All women over age 65 and There’s been a terrible event in my village—a or 543-6093 in Bethel men over age 70 should be tested as well suicide, bad accident with injuries, multiple Behavioral Health deaths, etc. and we need help coping with all as women younger than 65 who have expe- Critical Incident of this rienced menopause. These should be per- Stress Management formed at least every 2 years in order to mon- Program itor disease progression and can be set up by your healthcare provider. Prescription medica- Working Together to Achieve Excellent Health tions can be given by your healthcare provider if your bone density is found to be low.

18 Volume XV No. 4 • April 15, 2010

Prevnar 13: Extra Protection Against Pneumococcal Infections

Prevnar 13 vaccine is now approved and licensed by the U.S. Food and Drug Administration (FDA) and has replaced the Prevnar 7 vaccine as the routine pneumococcal vaccine.

Staff members Chris Desnoyers, Addie Schonberg, Bessie Francis, and Christine Wis- combe worked with 60 Healths Aides and 20 Hospital Staff on the Pneumo-13 Vaccine Study.

he pneumococcal bacteria causes brain, lung, blood, There are many types of pneumococcal germs. The original Pre- and some ear infections. The new vaccine is an vnar® vaccine led to a 100 percent decrease in pneumococcal improved Prevnar that protects against six more pneu- disease from the seven vaccine types it contained, but types not mococcal types. The vaccine is important to the YK in the vaccine had increased in YK Delta. Delta region because children residing here have had very high Prevnar 13™ is made like Prevnar® but has protection against Trates of pneumococcal infections. six additional types of pneumococcal disease. These types have This brings to a close YKHC’s yearlong research study to provide causing most of the pneumococcal disease in the YK Delta chil- the vaccine in the year before licensure in our region where there dren in recent years. is high incidence of pneumo disease. “We want to thank the all When we started the study, the Pfizer was applying for a FDA of the participants the study and Community Health Aides and license for Prevnar 13™, to replace Prevnar®. Now that Prevnar Clinic Staff who worked on the study,” said Dr. Ros Singleton of 13™ has been licensed, it will become the vaccine routinely used the Alaska Native Tribal Health Consortium, who worked with for all YK children. YKHC Health Aides and staff for the duration of the study. According to YKHC’s Pneumo 13 study group, Pneumococ- Pneumococcal Disease cal infections in children have decreased since last year. It is According to a World Health Organization (WHO) 2002 estimate, expected that the new Prevnar 13™ vaccine will prevent many pneumococcal disease is the leading cause of vaccine-prevent- serious pneumococcal infections in children in the near future. able death worldwide in children younger than 5 years. Pneumo- More information about the study results and ongoing rates of coccal disease is complex and describes a group of illnesses, pneumococcal disease will be shared over the next two years as all caused by the bacterium S. pneumoniae. It includes invasive the study is wrapped up and data analyzed. infections such as bacteremia/sepsis and meningitis, as well as Why did we do the Pneumo-13 Study? non-invasive disease including acute otitis media. “This approval is a significant milestone for Pfizer and yet another Babies and children in YK Delta have one of the highest rates of expression of our mission to improve health and well-being at pneumococcal infections in the world. Because of the high rate every stage of life,” said Geno Germano, president and general of pneumococcal infections, YKHC doctors asked if we could use manager, Specialty Care Business Unit, Pfizer Inc. “Prevnar 13 is Prevnar 13™ early, before it was licensed, to help prevent serious an important priority for the entire Pfizer organization as we con- pneumococcal infections. tinue to expand our presence in the vaccine category.”