Gathering Story, Pictures and Priorities, Start on Page 5

Volume XIII No. 4 • April 15, 2008 Gathering story, pictures and priorities, start on page 5

Paningayaq Dyment and Canaar Charlie from Angass’aq Samson’s kindergarten class at Ayaprun Elitnaruvik salute for the Pledge of Allegiance at the Tribal Gathering’s opening ceremonies. Photo by Michael Faubion. INSIDE: Future Nurse, p. 3 • Smile Style, p. 11 • Blackhawk Rescue, p. 16 Volume XIII No. 4 • April 15, 2008

YKHC Board of Directors Unit 1 Unit 5

Raymond F. Waska, Sr. Bill Kristovich Chuloonawick Kotlik Unit 11 P.O. Box 46 P.O. Box 1037 Emmonak Billmore Slough Alakanuk Hamilton R Emmonak, Alaska 99581 Bethel, Alaska 99559 Grayling E Nunam I V Iqua Unit 1 R 907-949-1514 907-543-4151/2212 O McGrath Anvik K Paula Ayunerak Henry Hunter, Sr. Mountain Village Shageluk O St. MaryÕs N Scammon N

Paimute I P.O. Box 5 P.O. Box 632 Bay PitkaÕs Andreafski Point Chevak Pilot Station Alakanuk, Alaska 99554 Bethel, Alaska 99559 Hooper Bay Holy Cross Marshall YUKON RIVER 907-238-3212 907-543-7963 Unit 9 Unit 2 Russian Mission Ohogomuit Crooked Creek Georgetown Gloria Simeon Upper Kalskag Aniak Stony River Unit 2 Unit 6 Lower Chuathbaluk Newtok Red P.O. Box 308 Kalskag Napaimute Sleetmute Ray Alstrom Unit 8 KUSKOKWIM RIVERDevil Bethel, Alaska 99559 Nunapitchuk Tuluksak Tununak Kasigluk R Akiak E P.O. Box 8 Mekoryuk Toksook BayAtmautluak Bethel Unit 3 907-543-5676 Umkumuit Akiachak Unit 4 I V Lime Village Nightmute Napakiak Kwethluk R Marshall, Alaska 99585 Oscarville A Joseph C. Bavilla Napaskiak N Unit 5 T 907-679-6320 I P.O. Box 6011 Chefornak Tuntutuliak L James C. Landlord Eek Unit 10 O Napaskiak, Alaska 99559 Kipnuk H P.O. Box 32168 Kongiganak 907-737-7665 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 Elmer G. Simon Kathy W. Chase P.O. Box 54 PO Box 78 P.O. Box 64 P.O. Box 41 Upper Kalskag, Alaska 99607 Kwigillingok, Alaska 99622 Hooper Bay, Alaska 99604 Holy Cross, Alaska 99602 907-471-2490 907-588-8484 907-758-4109 907-476-7162 Unit 4 Unit 8 Seat Vacant Honorary Board Member James Nicori James R. Charlie, Sr. Unit 10 Paul John P.O. Box 41 P.O. Box 37012 Sam W. Alexie P.O. Box 37067 Kwethluk, Alaska 99621 Toksook Bay, Alaska 99637 P.O. Box 57 Toksook Bay, Alaska 99637 907-757-6837 907-427-7114 Eek, Alaska 99578 907-427-74l4 Moses Peter James Sipary 907-536-5428 P.O. Box 57 P.O. Box 37134 Tuluksak, Alaska 99679 Toksook Bay, Alaska 99637 907- 695-6426 907- 427-7816 Numbers to Call

YKHC Main Operator ...... 543-6000 Subregional Clinic Appointments Toll Free ...... 1-800-478-3321 Aniak ...... 675-4556 Public Relations ...... 543-6038 Emmonak ...... 949-3500 Media Services ...... 543-6030 St. Mary’s ...... 438-3500 Ofﬁ ce 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 XIII No. 4 • April 15, 2008

YKHC Board High school & Committee student Meetings takes 2008 up-close April 22 Finance Committee look at April 23–25 Semi-Annual Full Board Meeting nursing May 27 Finance Committee career May 27–28 Hospital Governing Body Nikki Pollock is a student who loves science... August 19 Finance Committee She is the daughter of Helen Kinegak of Bethel and Nick Pollock from Nunn, Colo- rado. She is one of eight local high school students participating in job shadow expe- August 20–21 riences at YKHC this year. Executive Board “I love to help and meet people,” said Pollock. “I wanted to see what it would be like being a nurse.” September 23 Finance Committee Pollock shadowed Donna Hutcherson, RN, for several months at Obstetrics (OB) to see the nursing profession up-close in a clinical setting. “It was great,” said Pollock. September 23–24 “I met so many new, interesting people and got a lot of new information.” Hospital Governing Body Obstetrics Nurse Manager Tania Thomas, RN, said the OB staff enjoyed having Pol- lock at their unit. “Nikki was like a sponge absorbing information,” said Thomas. “She October TBA (@AFN) really raised our expectations of what having a student here meant. Her passion to Finance Committee & be useful inspired us to invest our time and knowledge in her. We worked hard to Executive Board expose her to as many experiences as we could.” November 18 Pollock concluded her shadow in December to start pre-nursing college courses at Finance Committee KuC and to complete her fulltime studies at Bethel Regional High School. In addition to college and high school studies, Pollock is also involved in the RRANN program November 19–21 (Recruitment and Retention of Alaska Natives in Nursing) as a pre-nursing student. Full Board of Directors “I’ve learned from job shadowing at OB that nurses are the fundamentals of the unit, they’re a very important aspect of keeping things running smoothly,” said Pollock. “I December 16 got ﬁ rsthand experience in what my future holds for me.” Finance Committee

The Messenger is produced by the Yukon-Kuskokwim Health Corporation’s Public Relations Department as a report to Tribal Members. It is published monthly on-line Look for the next Messenger Quarterly at www.ykhc.org/messenger and printed quarterly. For questions, comments, submis- sion of articles, or subscription information, write to Public Relations Senior Editor, Yukon-Kuskokwim Health Corporation, P.O. Box 528, Bethel, Alaska 99559; to arrive in your mailbox June 15 or call 907-543-6035. E-mail: [email protected]. Deadline is the last day of the month preceding publication. Publication is on the 15th of every month. Anchorage Office: 4700 Business Park Blvd. Suite E25, An- The Messenger is published monthly online at chorage, Alaska 99503. 907-677-2232. Please ask permission to reprint www.ykhc.org/messenger articles or pictures. © 2008, Yukon-Kuskokwim Health Corporation. 3 Volume XIII No. 4 • April 15, 2008

A Future Free of Diabetes Annette Coyle tests Board Member Bill Kristovich’s blood glucose at Tribal Gathering. Photo by Danielle Dizon. By Annette Coyle, RD LD, Clinical Diabetes Educator

The theme of this year’s Tribal Unity Gathering was “Our Chil- feeling very tired, and losing weight without trying. Dark skin on dren – Their Future.” We hope that our children’s future will be the neck or under the arms is also a warning sign. If you have one free of type 2 diabetes. However, as Michael Steele said, any of these risk factors or signs, make an appointment at your “Without action, hope passively waits on others to solve prob- local health clinic for a blood glucose screening. lems. Without action, hope looks to next year instead of doing Kids can lower their risk of developing type 2 diabetes by eating the hard work required today. Without action, hope is powerless traditional Native foods, whole grains, and lots of fresh, frozen or to transform lives.” canned vegetables and fruits. Limiting Kool-aid, soda pop, candy As community leaders, elders, teachers, health care profes- and junk food will help kids maintain a healthy weight. Most sionals, parents, grandparents and friends, what can we do to importantly, kids can lower their risk of developing type 2 dia- reduce the chance that our children will develop type 2 diabetes? betes by being physically active. Get involved in school sports. Help with the chores. Run! Jump! Dance! Play! We need to understand who is at risk and what can be done to lower that risk. We also need to be aware of the warning signs If you have questions about type 2 diabetes, please feel free to of type 2 diabetes. We need to set a good example for our chil- call us at 543-6133 or 1-877-543-6133. We will be happy to send dren by embracing a healthy lifestyle. Finally, we need to work you educational materials about how to prevent type 2 diabetes together to transform our communities into places where tradi- in children. tional foods and values are cherished and where healthy foods Lets all work to make our children’s future free of diabetes. and healthy activities are available for everyone. Kids with type 2 diabetes are often overweight and not physically Call Diabetes Prevention & Control: active. They usually have a close blood relative with diabetes. 907-543-6133 or 1-800-478-3321 ext. 6133 Warning signs of diabetes include increased thirst and urination,

Risk factors for type 2 diabetes: Symptoms of type 2 diabetes: • over 40 years of age • feeling very thirsty • overweight • feeling very hungry • physically inactive • unusual weight loss • family history of diabetes • feeling very tired • history of impaired fasting glucose or impaired glucose • frequent urination tolerance • weight loss • history of gestational diabetes • blurry vision • giving birth to a baby over 9 pounds • sores or wounds that are slow to heal • being Alaska Native (Other ethnic groups also have a higher risk).

4 Volume XIII No. 4 • April 15, 2008

Tribal Gathering XV YKHC’s Krystal Henry and Ivan M. Ivan of Akiak work together to prioritize health concerns for focuses on healthy children Unit 4.

By Danielle Dizon, Public Relations Staff Nearly 100 tribal leaders gathered for the Yukon-Kuskokwim Long Term Care facility. “We need to take care of our Elders and Health Corporation’s 15th annual Tribal Unity Gathering held we need to take care of them here at home,” said Peltola. April 1 and 2 at the Yupiit Piciryarait Cultural Center in Bethel. Lastly, Peltola revealed YKHC’s intent to invest the nearly $33 The conference is hosted in Bethel each year, uniting Tribal rep- million federal court-case settlement from the Indian Health Ser- resentatives and YKHC management to discuss health related vice (IHS). “This investment will lock in ﬁ nancial viability for our topics and priorities. Based on a health care priority session held organization to address the ever growing health care needs in on the last day, YKHC the future,” said Peltola. plans program and service improvement efforts for Senator Murkowski joins the coming year. delegates through video teleconference Special opening presen- Among the special guests, Senator Lisa tations by Bethel High Murkowski joined delegates through a live School’s JROTC Color video teleconference from Washington D.C. Guard and Ayaprun Elit- naurvik (Bethel’s Yup’ik She commented on several rural issues immersion school) high- facing the YK Delta people, including lighted the conference sanitation projects, behavioral health and theme: “Our Children, immunization programs, and new scholar- Their Future,” or, in Yup’ik, ship programs to encourage more children “Irniamta Ciunerkaat.” into health careers. Delegates listen during a presentation. All Gathering The theme, developed photos by Public Relations staff. “Our children will only be able to participate by YKHC President/ in this economy if they receive an educa- CEO Gene Peltola, focused the two-day conference on raising tion and stay healthy,” said Murkowksi, who delivered encourag- the healthiest children. “Children of today are the leaders of ing words focused on health disease prevention. “We would not tomorrow,” said Peltola in his welcome address. “We can make have FAS if women did not drink during pregnancy. We need to a signiﬁ cant positive impact on the health and wellbeing of our teach our children good habits such as more exercise and less people.” pop.” Peltola also announced the acquisition of the CT (Computer Senator Murkowksi assured tribal leaders that she would dedi- Axial Tomography) Scanner, which is set to be operational July cate efforts to bring more funding to IHS. “We know that IHS 1, and an $8 million legislative appropriation being sought by needs more funding and Senator Stevens, Congressman Young- Senate Finance Committee Co-Chairman Lyman Hoffman for a man, and I will work with you to try to secure the funding.” 5 Continued on p. 6 Volume XIII No. 4 • April 15, 2008

Dr. Ros Singleton, ANTHC, and YKHC Public Relations Director Bob Herron.

supports independent living and may be what best ﬁ ts our Elders’ needs,” added Lee.

Bessie Green of Eek, with a two-handed Greg McIntyre, Vice President for Support Services, announced swing, battles her way to the fi nal round completion of two new village health clinics this fall and various of the Wii Nintendo Bowling competition. construction projects underway, which include the Hooper Bay Subregional Clinic, set to open in January of 2009, and the new Prematernal Home, which has an identifi ed site and 95 percent Priority Report Highlights complete architectural drawings. YKHC leaders delivered the annual priority report based on A special report by Laura Baez, Behavioral Health Administrator, the top 10 priorities voted by delegates in 2007. The reports and Bob Herron, Public Relations Director, addressed the alarm- included accomplishments and challenges addressing the fol- ing number of alcohol-related visits to the Emergency Room lowing issues: CT Scan, Long Term Care, Sanitation, Alcohol (ER), currently challenging staffi ng and wait times in the ER. and Substance Abuse, and Outpatient Clinic Operations. “The ER at the Yukon-Kuskokwim Delta Regional Hospital has Liz Lee, Senior and Developmental Disabilities Administra- had more than 1,200 alcohol-related admits each year over tor, informed delegates of the exploration of a “Green House” model dwelling for elderly care. “We had initial plans to build and operate an assisted living home,” said Lee. “However, due to construction and operation dollar shortfalls, more Peter Elachik, Kotlik; Peter Miller, Tuntutuliak; John Nicholas, Kasigluk; and David Jimmy, Sr., Chefornak. viable options such as the Green House model are being considered,” and with the last four Senator Hoffman’s help during this legislative session, the $8 years,” said David O. David, YKHC Board Member from million request is now on Governor Palin’s desk for approval.” Herron. Kwigillingok. “Twenty per- Green House living facilities are self-contained dwellings for cent are minors, the youngest being 10 years old.” 7–10 residents that are constructed to look like a private home, with specifi c design elements that include an open kitchen and “YKHC is currently working with the Yukon-Kuskokwim Correc- dining area and private bedrooms and bathrooms. “The model tional Center and with the Alaska Department of Correction’s 6 Continued on p. 7 Volume XIII No. 4 • April 15, 2008

Lauri O’Brien, Executive Director of YKHC’s Area Health Educa- tion Center, spoke of the various opportunities available through YKHC for youth to gain exposure to health careers or health related jobs. “We are currently focusing efforts on expanding the Job Shadow Program to subregional clinics, targeting recruiting for Nursing, Physician Assistants and Dental Health Aide Thera- pists.” “We must encourage our youth to successfully ﬁ nish high school or earn their GED and plan for more education and training, encourage children to avoid drugs and alcohol, and related legal issues, and lastly, model health choices,” said O’Brien. Highlighting the development of the Dental Heath Aide Program, Lillian McGiltton, DHAT, spoke about her training and experience as a DHAT at Toksook Bay’s subregional clinic.

Say hello to Chris Larson from Napaskiak (center). Evan The four students enrolled in the DHAT Program, in their last Williams of Napaskiak (left), and Harvey Anvil of Bethel stage of clinicals in Bethel, also joined McGilton to recognize the are in the background. training opportunity for future Alaska Natives. The four current students, Danielle Boston, Sheena Nelson, Christopher Evan, and Daniel Kennedy, received loud applause from delegates. Commissioner Joe Schmidt to explore a jail expansion that would include a 15-bed sleep-off detoxiﬁ cation center,” said Top 10 Priorities Herron. Highlights from a comprehensive report entitled Detox Each day, Tribal Council members collaborated within their units Alternatives outlines the need for more effective space and a to discuss health prevention and workforce development, voting new treatment model. lastly on health priorities. The number one priority was Alcohol & Drug Abuse Concerns, with ﬁ ve units voting it as their top con- Children’s Health Concerns cern, followed by Elder Issues. The second day of the conference focused attention on nutrition The conference ended in high spirits with various Tribal mem- and traditional diet, tobacco use and iqmik, and respiratory infec- bers emphasizing the need for community action and partner- tions. Well Child and Adolescent Exams were promoted to bring ship to raise the healthiest children in the world. attention to a unique holistic examination that can be provided by Health Aides. The following represents a comprehensive look at “Obesity among school-age children is increasing, nearly all the top ten priorities as a result of each unit’s vote: children contract Respiratory Syncytial Virus (RSV) by the age of two, 44 percent of Alaska Native youth use tobacco or iqmik, Percent of Unit Priority and just last year over 200 youth visited the Emergency for ranking alcohol-related issues,” said Peltola. “Our children face serious 191%Alcohol, drug abuse concerns health risks that we must address within our communities and work together to improve.” 288%Elder issues Special presentations by Dr. Rosalyn Singleton of ANTHC and Environmental concerns: water, 382% Douglas Kernak, of Tuntutuliak, addressed respiratory infections sewer, dust, dump and traditional diet and dance to increase health and wellness. 460%Village clinic & staff An exclusive presentation on RSV by Singelton cited a new vac- 547%Community Health Aide Issues cine that could prevent 75 percent of the Pneumo meningitis and blood infections in children. “YKHC is working on a proposal to 645%Medical providers offer a new pneumococcal vaccine, called Prevnar-13, that has been shown to be safe and responsive in hundred of children,” 739%Health education said Singleton. Hospital/clinic concerns, quality of 839% If approved by YKHC’s Research Review Board and Board of care Directors, the project will start this fall. 935%Pharmacy Alaska Native Workforce Development 10 33% Improve continuity of care Eva Malvich, Employee Relations Manager, discussed barriers 10% Elder empowerment to employment, which include drug, alcohol, assault and other criminal offenses. 9% Behavioral health

7 Continued on p. 8 Volume XIII No. 4 • April 15, 2008 Tribal Gathering XV Priorities 12 tribes were unable to attend: Pilot Station, Nunam Iqua, 6. Environmental Concerns: Shageluk, Red Devil, Anvik, Oscarville, Hooper Bay, Holy Cross, Water and Sewer, Dust, Hamilton (Kotlik), Georgetown, Chuloonawick (Emmonak), and Dump 6. (tie) Village Clinic & Staff- Aniak. Capitol Projects Improve- ment, Maintenance, Unit 1: Emmonak, Alakanuk, Kotlik, Bill Moore’s Slough Equipment & Supplies, (Kotlik) Clinic Transportation, 1. Alcohol/Drug Abuse Concerns Support Staff 2. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home 6. (tie) Medical Providers- 3. Environmental Concerns: Water and Sewer, Dust, Dump Hiring, Visiting Villages/ 4. Pharmacy/Medication/Refi lls SRCs 5. Community Health Aide Issues 6. (tie) Improve Continuity of Care System-wide/Quality Unit 2: Algaaaciq (St. Mary’s), Yupiit of Andreafski (St. of Care Concerns Mary’s), Marshall, Ohagmiut (Marshall), Pitka’s Point, 10. Bethel Hospital/Clinic Iqurmiut (Russian Mission), Asa’carsarmiut (Mt. Village), Related Concerns, Quality Pilot Station of Care, Case Managing 1. Alcohol/Drug Abuse Concerns Unit 4: Akiak, Kwethluk, 2. Elder Issues—Care, Neglect, Respect, Housing, Nursing Home Tuluksak 3. Health Education: Sex Education, Water Safety, Injury Preven- St. Mary’s SRC Manager Gail 1. Elder Empowerment Alstrom, Algaaciq Tribe, works tion 2. Environmental Concerns: 4. Environmental Concerns: Water and Sewer, Dust, Dump with other Unit 2 representatives Water and Sewer, Dust, during a break-out session. 5. Community Health Aide Issues Dump 6. Village Clinic & Staff-Capitol Projects Improvement, Mainte- 3. Elder Issues- Care, Neglect, Respect, Housing, Nursing Home nance, Equipment & Supplies, Clinic Transportation, Support 4. Village Clinic & Staff-Capitol Projects Improvement, Mainte- Staff nance, Equipment & Supplies, Clinic Transportation, Support 7. Pharmacy/Medication/Refi lls Staff 8. Improve continuity of care stystem-wide/Quality of care con- 5. Alcohol/Drug Abuse Concerns cerns 6. Health Education: Sex Ed, Safety, Water Safety, Injury Preven- 9. Medical Providers- Hiring, visiting villages, SRCs tion 10. Bethel Hospital/Clinic Related Concerns, Quality of Care, 7. Community Health Aide Issues Case Managing 8. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case Other: Managing • Pitka’s clinic is still closed. 9. Medical Providers-Hiring, Visiting Villages/SRCs • Marshall has no schedule airline fl ights to SSRC. 10. Improve Continuity of Care System-wide/Quality of Care • Don’t like new priority setting system. Categories mean some- Concerns thing different to each group; specifi c issues get lost; too short of time to set priorities. Unit 5: Bethel, Napakiak, Napaskiak 1. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home Unit 3: Lower Kalskag, Kalskag, Sleetmute, Chuathbaluk, 2. Alcohol/Drug Abuse Concerns Crooked Creek, Lime Village, Napaimute 3. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case 1. Alcohol/Drug Abuse Concerns Managing (Focus on patient travel) 2. Behavioral Health 4. Village Clinic & Staff-Capitol Projects Improvement, Mainte- 3. Community Health Aide Issues nance, Equipment & Supplies, Clinic Transportation, Support 4. Health Education: Sex Ed, Safety, Water Safety, Injury Preven- Staff tion 5. Environmental Concerns: Water and Sewer, Dust, Dump 5. Elder Issues—Care, Neglect, Respect, Housing, Nursing Home 6. Improve continuity of care system-wide/Quality of care concerns 7.Medical Providers- Hiring, visiting villages, SRCs 8. Health Education: Sex Education, Water Safety, Injury Preven- tion 9. Community Health Aide Issues 10. Pharmacy/Medication/Refi lls Other: • Speed up appointment visits. • Prematernal Home. Unit 6: Kasigluk, Atmautluak, Nunapitchuk 1. Alcohol/Drug Abuse Concerns 2. Environmental Concerns: Water and Sewer, Dust, Dump 3. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home 4. Village Clinic & Staff-Capitol Projects Improvement, Mainte- Unit 1 discusses top three children’s health concerns. nance, Equipment & Supplies, Clinic Transportation, Support Staff 8 Continued on p. 9 Volume XIII No. 4 • April 15, 2008

5. Pharmacy/Medication/Refi lls 6. Medical Providers- Hiring, visiting villages, SRCs 7. Community Health Aide Issues 8. Improve continuity of care system-wide/Quality of care concerns 9. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case Managing 10. Health Education: Sex Education, Water Safety, Injury Prevention Other • Village clinic lease needs to be increased to meet higher fuel and electricity costs. Unit 7: Kipnuk, Kongiganak, Kwigillingok, Tuntutuliak 1. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case Managing (Focus on patient travel) 2. Improve continuity of care system-wide/Quality of care concerns 3. Medical Providers- Hiring, visiting villages, SRCs Harry Maillelle of Grayling, discusess health priorities with Kathy Katongan, Project Manager for Performance Improvement. 4. Village Clinic & Staff-Capitol Projects Improvement, Mainte- Maillelle was the only representative from Unit 11. nance, Equipment & Supplies, Clinic Transportation, Support Staff 4. Alcohol/Drug Abuse Concerns 5. Environmental Concerns: Water and Sewer, Dust, Dump 5. Medical Providers- Hiring, visiting villages, SRCs 6. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home 6. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case 7. Health Education: Sex Education, Water Safety, Injury Preven- Managing tion 7. Pharmacy/Medication/Refi lls 8. Alcohol/Drug Abuse Concerns 8. Improve continuity of care system-wide/Quality of care con 9. Pharmacy/Medication/Refi lls cerns 10. Community Health Aide Issues 9. Village Clinic & Staff-Capitol Projects Improvement, Mainte- Unit 8: Chefornak, Mekoryuk, Newtok, Nightmute, Umkumiut nance, Equipment & Supplies, Clinic Transportation, Support (Nightmute), Tununak, Toksook Bay Staff 1. Alcohol/Drug Abuse Concerns 10. Health Education: Sex Education, Water Safety, Injury Pre- vention 2. Environmental Concerns: Water and Sewer, Dust, Unit 10: Eek, Quinhagak Dump 1. Environmental Concerns: Water and Sewer, Dust, Dump 3. Elder Issues-Care, 2. Pharmacy/Medication/Refi lls Neglect, Respect, Hous- 3. Alcohol/Drug Abuse Concerns ing, Nursing Home 4. Dental Care & Appointments 4. Village Clinic & Staff- 5. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home Capitol Projects Improve- 6. Health Education: Sex Education, Water Safety, Injury Preven- ment, Maintenance, tion Equipment & Supplies, 7. Medical Providers- Hiring, visiting villages, SRCs Clinic Transportation, Support Staff 8. Village Clinic & Staff-Capitol Projects Improvement, Mainte nance, Equipment & Supplies, Clinic Transportation, Support 5. Medical Providers- Hiring, Staff visiting villages, SRCs 9. Community Health Aide Issues (Focus on attitude, customer 6. Health Education: Sex service, and attendance) Education, Water Safety, Injury Prevention 10. Improve continuity of care system-wide/Quality of care Liz Lee calls Unit 5 to a work concerns 7. Pharmacy/Medication/ session. Refi lls Unit 11: Grayling, Anvik, Shageluk, Holy Cross 8. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case 1. Village Clinic & Staff-Capitol Projects Improvement, Mainte- Managing nance, Equipment & Supplies, Clinic Transportation, Support 9. Improve continuity of care system-wide/Quality of care concerns Staff 10. Community Health Aide Issues 2. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home Other: 3. Alcohol/Drug Abuse Concerns 4. Health Education: Sex Education, Water Safety, Injury Preven- • Specifi c comments on priorities: 1-Elementary age, sniffi ng, tion expectant mothers, hampers employments; 2-Without adequate cleanliness, leads to illnesses; airborne particles to lungs; 5. Bethel Hospital/Clinic Related Concerns, Quality of Care, Case 3- Source of existence: Yuuyaraq and Yuungnaqsaraq. Managing 6. Community Health Aide Issues Unit 9: Chevak, Hooper Bay Scammon Bay, Paimiut (Hooper 7. Environmental Concerns: Water and Sewer, Dust, Dump Bay) 8. Medical Providers- Hiring, visiting villages, SRCs 1. Elder Issues-Care, Neglect, Respect, Housing, Nursing Home 9. Pharmacy/Medication/Refi lls 2. Environmental Concerns: Water and Sewer, Dust, Dump ( 10. Improve continuity of care system-wide/Quality of care con- 3. Community Health Aide Issues cerns 9 Volume XIII No. 4 • April 15, 2008 Master Technology to Enhance Your Health by Claudia Dunn RN, BSN, PHN, Healthy Hearts Coordinator

Throughout the twentieth century articles were written about technology improving the lives of people around the world. Now the media tells us that industrialized nations such as the United States have high rates of obesity.

According to the 1999 National Health and Nutrition Examination After work many people decide to watch television or play com- Survey 61 percent of the U.S. adult population between the ages puter games. The combination of inactivity and prepared foods of 20 and 74 were overweight or obese. equals extra pounds of fat. Unfortunately, the state of Alaska does not avoid this national Bush Alaskans can break this harmful cycle for themselves and trend. In 2005, Alaska ranked 19th in highest rate of adult obe- future generations by controlling technology. Leave motorized sity at 23.5 percent. Alaska ranked 12th in the United States in vehicles parked unless you are traveling a long distance or car- the highest rate of obese and overweight adults. There are many rying a large amount of cargo. Avoid convenience foods. Drink health consequences related to being overweight; which include more water. Take time to exercise at least 30-45 minutes per premature death, heart disease, stroke, diabetes, arthritis, day. Eat at least 5–9 servings of fruits and vegetables per day. cancer, breathing Choose healthy protein sources such as poultry (bird), moose, problems, gall blad- caribou, fi sh or tofu (bean curd). Choose whole grain pasta, der disease, liver cereals and breads over enriched white products. When choos- disease, reproduc- ing calcium sources look at the fat content. Milk with two percent tive complications, fat content is a good choice for anyone over the age of two and urine incontinence, soymilk is an alternative for people who are lactose intolerant. stool incontinence, Besides eating healthy, get up and move. After dinner, take the depression and family for a walk. Walking is very good exercise and it is free. increased surgical If it is too cold to walk, then dance or play games like “Simon risks. Says.” If you choose to watch television, get up during every commercial break and march in place or run in place. How could this trag- edy occur? People You can master technology by are more seden- Classifi cation of Overweight limiting your computer game and Obesity in Adults by tary. Whether your Body Mass Index (BMI) and television viewing time ancestors were farmers, laborers, clerks or hunters, they were to no more than two hours a Classifi cation BMI, kg/m2 more physically active. Today we have four-wheelers, trucks and day. Leave the vehicle parked motorized boats. We do not walk one-eighth of the distances our Underweight <18.5 when possible. Use the Inter- predecessors did. Normal 18.5–24.9 net to fi nd easy, time saving Overweight 25–30 and healthy recipes to make. There is an increase in prepared foods. Regrettably, these time Obese >30 Also, new games, dances and saving foods fi ll our bodies with fats, extra calories, salt and very fun exercises can be found little nutrition. Sugary drinks are contributing to America’s obe- surfi ng the web. Do not listen to commercials stating you must sity. A 16-ounce bottle of pop can have 720 calories and many have prepared foods. Save treats for special occasions and people do not stop at one. Years ago pop was considered a monitor the portions you consume. party drink and people considered themselves lucky to have one eight-ounce glass per week. Cakes, pastries and candies were If you suspect you are overweight it is good to see your also special treats. These items were not consumed every day. health care provider. The physician or mid-level provider can calculate your body mass index (table 1) to determine your ideal Technology has decreased our physical labor at the job site. weight status, screen your blood pressure, check cholesterol People want to relax after work. Their jobs may not be physically levels and determine your exercise and dietary needs. stressful; however, the workplace can be mentally demanding. Sadly, many people choose sedentary entertainment to relax.

10 Volume XIII No. 4 • April 15, 2008

BTLB TUZ BM MF F 3 M 1 Smiles abound J 1 N 9 at YK Dental’s T

Z L n I b s D h E sp Prevention Event f Q o ub po m E ouj by Robert E. Ward, RDH, SAS 2008 Coordinator jtfbtf Qsfwf

YKHC’s Dental Disease Prevention Program celebrated its 19th Annual Smile Alaska Style at the Camai Dance Festival at Bethel Regional High School on Saturday, March 29.

Raising awareness of the importance of good oral hygiene and its effect on lowering decay rates is the cornerstone of the event. YK dentists and assistants provided dental screenings and tooth brushing and ﬂ ossing instructions to participants. Every- one was eligible for the many door prizes, as well as ‘goodie bags’ with toothbrush, toothpaste and ﬂ oss. Mr. Molar was a hit with the crowd, especially the little ones. A good time was had by all. We look forward to the event next year and hope this year’s effort will have a positive effect on residents of The Delta. Mr. Molar gives a toothbrush to a little girl who seems a bit Thanks to all our local business partners and the staff at the YK skeptical of things. Dental Department for the success of this year’s event.

Smile Alaska Style role models Avery Hoffman and Izayah Liu. Yvonne Jackson. Isabel David.

Thanks to our Sponsors! Datu’s Restaurant YKHC Injury Prevention Wells Fargo Bank Video World Nicholson’s Auto Yute Air Alaska Commercial Co Edward Filangeri, DDS YKHC Administration Grant Aviation Brother’s Pizza YKHC Optical The Lumber Yard Stan’s Barber Shop Alaska Hovercraft Hageland / Frontier Aviation Alaska USA Credit Union Unicom Inc. VFW Ladies Auxiliary

11 Volume XIII No. 4 • April 15, 2008

Study links respiratory disease with inadequate water service

Many YK Delta villages still have honeybuckets and dumpsters like this one. YKHC fi le photo. By Joaqlin Estus, ANTHC Communications Director Released April 2, 2008 A study of modern water services and hospitalization yielded tion facilities. This study, the fi rst of its kind conducted in Alaska, surprising results: A lack of running water in the home is linked to confi rms that fl ush toilets and piped water lead to improved severe respiratory infections among Alaska Natives. health status. These fi ndings are a fi rst, to the authors’ knowledge. Health The prestigious American Journal of Public Health (AJPH) is professionals have thought the benefi ts of clean water were featuring an article about the study in its April issue. Publication primarily gastro-intestinal. This study shows that lung and skin in AJPH highlights the signifi cance of the fi ndings, and shows infections among Alaska Natives are also associated with inad- that peers have determined the study meets rigorous scientifi c equate water service. standards. The article was the product of a two-year collabora- “For decades, there hasn’t been enough money from federal and tion between the CDC Arctic Investigations Program (CDC-AIP), state sources to address the problem of clean water and sanita- the Alaska Native Tribal Health Consortium (ANTHC), and the tion,” said Alaska Native Tribal Health Consortium Chairman Indian Health Service. Dr. Tom Hennessy, CDC-AIP Director, and and President Don Kashevaroff. “It’s time to build the systems Troy Ritter, ANTHC Environmental Health Consultant, originated needed throughout rural Alaska.” the study. “The study highlights the need for sanitation infrastructure in They investigated whether availability of in-home water and fl ush rural Alaska, where about one third of the homes lack modern toilets is associated with lower hospitalizations for sanitation- sanitation facilities,” said Alaska Native Tribal Health Consortium related disease. Investigators compared levels of in-home water Chief Executive Offi cer Paul Sherry. “It confi rms that fl ush toilets service to hospitalization rates for acute respiratory infections, and piped water lead to improved health status.” skin infections, and diarrheal disease. They looked at areas with no, low, or limited in-home water service, and compared them to The study’s fi ndings are important because of the seriousness communities with higher rates of modern water service. and rates of respiratory illness among Alaska Native infants and children. About 75 percent of all hospitalizations for Alaska The study’s fi ndings are that lower water Native and American Indian children are due to respiratory services lead to: problems. The fi ndings may have international signifi cance as well because acute respiratory infections are the second leading • Significantly higher hospitalization rates for pneumonia and cause of child deaths worldwide where many communities lack influenza, skin infection and Respiratory Syncytial Virus adequate sanitation facilities. • Significantly higher hospitalization rates ó up to one third of The study highlights the need for sanitation infrastructure in rural infants hospitalized annually for pneumonia and RSV Alaska, where about one third of the homes lack modern sanita- • Higher rates of outpatient skin infections and hospitalizations

The full text of the report can be found at the American Journal of Public Health’s Web site, http:// www.ajph.org/. The article was the product of two-year collaboration between the CDC’s Arctic Investigations Program (CDC-AIP), the Alaska Native Tribal Health Consortium (ANTHC), and the Indian Health Service. Dr. Tom Hennessy of the CDC-AIP and ANTHC’s Troy Ritter originated the study. 12 Volume XIII No. 4 • April 15, 2008

Alcohol Awareness Month

April is alcohol awareness month. Alcohol abuse can affect anyone at any age, including students, pregnant women, and senior citizens. The focus of this article is on alcohol awareness and pregnancy. by Melanie Huett, MS, RD, LD; WIC RD Nutrition Educator

Alcohol’s Effects on Women In general, women do not process alcohol as well as men. syndrome (FAS), alcohol-related neurodevelopmental disorder This means that women become intoxicated faster than men. (ARND), and alcohol-related birth defects (ARBD). FASD is the Chronic, heavy drinking can cause menstrual problems, infertility, leading known cause of mental retardation. Each year, at least and even early menopause. Women who choose to drink should 40,000 babies, or about 10 in every 1,000 live births, are born do so in moderation, which is no more than one drink per day. with an FASD. Alcohol and Pregnancy Alcohol’s Effects on the Fetus When a pregnant woman drinks alcohol, it not only affects her, According to the Institute of Medicine Report to Congress, but also her unborn baby. Alcohol is a substance that can harm when compared to other substances of abuse, such as cocaine, a developing fetus. When a pregnant woman drinks alcohol, the heroin, and marijuana, alcohol produces the most serious alcohol crosses the placenta and enters the bloodstream of the adverse effects in the fetus. Defects caused by prenatal expo- fetus. The alcohol content in the blood of the fetus can equal or sure to alcohol have been identifi ed in almost every part of the go above that of the mother. Since the fetus cannot break down body, including the brain, face, eyes, ears, heart, kidneys, and alcohol the way an adult can, its blood alcohol level stays higher bones. for a longer amount of time. Alcohol can trigger cell death causing different parts of the Pregnant women and women planning to get pregnant should fetus to develop abnormally and can disrupt the way nerve cells not drink alcohol. Pregnant women who are drinking should stop develop. Alcohol interferes with blood fl ow in the placenta by right away to reduce the risk of harming their unborn baby. Alco- constricting the blood vessels, which delays the delivery of nutri- hol can harm a fetus at any time during pregnancy, even before ents and oxygen to the fetus. Alcohol metabolism can produce a woman knows she is pregnant. toxic byproducts that can become concentrated in the brain and contribute to the development of an FASD. Breastfeeding women should also not drink alcohol. Alcohol can pass through breast milk to the baby. No amount of alcohol is Because of the damage caused by exposure to alcohol in the safe during pregnancy or nursing. womb, babies with an FASD may be born small and underweight and have diffi culty nursing or eating. Fetal Alcohol Spectrum Disorders The most important thing to remember is that FASD is 100 per- Fetal alcohol spectrum disorders, or FASD, is a term used to cent preventable. describe effects that can occur in a person whose mother drank alcohol during pregnancy. Effects may include physical, mental, Choosing not to drink alcohol during pregnancy and breastfeed- behavioral, and/or learning disabilities, such as fetal alcohol ing is one the best gifts a mother can give her child. Source: Substance Abuse and Mental Health Services Administration; www.samhsa.gov

13 Volume XIII No. 4 • April 15, 2008

April is National Stress Awareness Month Stress can make people sick

Claudia Dunn, Healthy Hearts Coordinator By Claudia Dunn, RN, BSN, PHN, Healthy Hearts Coordinator The Mayo Clinic defi nes stress as an with people who disagree with you. It is OK to choose to disagree. If the disagreement is based upon an important issue, unhealthy response to the pressures of life. fi nd a way to negotiate rather than arguing. Compromising is a Commonly, people experience physical reac- better method in solution obtainment and it does not waste time compared to quarrelling. tions when they are stressed. Life balance is very important to prevent stress. Take time for The human body developed these responses to deal the threats yourself. Eat nutritious meals low in fat and salt. Have a serving of wild animals and warriors attacking. It is known as “The Fight of protein no bigger than the size of the palm of your hand three or Flight Response.” Unfortunately, the body’s ancient defense times per day. Make sure you have fi sh at least three times per is not successful in coping with modern day pressures such as week and plenty of unsalted nuts. Both these items enhance managing huge workloads and paying the bills. brain chemistry and reduce the bad cholesterol which clogs arteries and prevents adequate blood fl ow. Consume whole If the body’s response to stress is constantly activated, the grains such as oats, barley, brown rice and whole wheat instead person becomes more susceptible to life-threatening health of refi ned white grains and make sure you consume at least fi ve problems. When people become stressed the Fight or Flight to nine servings of fruits and vegetables a day. Response is activated. The adrenal glands increase your heart rate and blood pressure. Then Cortisol, the stress hormone, is Good nutrition assists the body’s nervous system and helps in released. This increases a person’s blood sugar and decreases regulating the Fight or Flight Response. Take at least 45 minutes the body’s ability to repair tissues. The immune system, which a day to exercise. Exercise improves blood fl ow and decreases fi ghts disease, and the digestive, growth and reproductive sys- stress. Exercise helps the brain make Serotonin. This chemical tems are also affected. decreases stress and depression. Enjoy a hobby, this is a won- derful way to relax. The Fight or Flight Response is self-regulating. Once the crisis stops, the hormonal levels return to normal. Long term activa- Make sure to add meditation into your life. There is not one cor- tion of the Fight or Flight Response leads to overexposure to rect form of meditation. A person must choose the form of medi- stress hormones which affects the entire body. Chronic stress tation that suits them best. The goal of meditation is inner peace. increases a person’s risk of obesity, insomnia, digestive prob- Some people repeat a mantra, a prayer or a positive saying lems, heart disease, depression, memory loss, chronic pain and aloud or silently. Some people listen to relaxing music or read immune problems such as susceptibility to infections or autoim- poems. Others select fl uid movements with good posture and mune disease where the body attacks it own healthy cells. It can controlled breathing such as Tai Chi, Yoga and Qigong. Recently, also cause a person to develop certain behavioral or personality the CANHR study from the University of Fairbanks discovered disorders, triggering asthma attacks and worsening many skin Eskimo dancing provided the same health benefi ts that Tai Chi conditions such as psoriasis, eczema, hives and acne. Regret- does, due to the fl uid movements. Therefore consider joining a tably, some people develop unhealthy responses to stress such local dance group. as overeating, smoking, chewing tobacco, over consumption of Remember to focus on the positive items in life to include love alcohol and/or the use of illegal drugs. These unhealthy practices and gratitude. No human being is an island. Make sure to social- increase illness and disease among people who are stressed. ize with people from work and outside of work. The support One of the major causes of stress is poor time management. system of friendship is a valuable tool in combating stress. Too many people feel overwhelmed with their workload and due Please note, if none of these methods assist you in decreasing dates. A great way to improve time management is to prepare your feelings of stress, make an appointment to see your medi- a master list of tasks. During the day scan your master list and cal provider and behavioral health specialist. They have wonder- work on tasks in priority order. Remember to avoid becoming ful tools to assist you in living a life fi lled with happiness and overburdened. It is OK to say “No” to people in a fi rm voice. decreased stress. Another source of needless pressure is arguing. Do not argue

14 Volume XIII No. 4 • April 15, 2008

Subsistence hunters asked to assist Delta’s Avian Flu surveillance effort When handling wild game, YKHC encourages the follow- by Kelsey Hustedt, YKHC Environmental Health Offi cer & YKHC Public Relations ing safe handling procedures: The US Fish & Wildlife Service (USFWS) and YKHC’s Offi ce of Environmental Health • Do not eat, drink or smoke while and Engineering (OEHE) will collaborate for the third consecutive year to screen for cleaning birds. the Highly Pathogenic H5N1 strain of Avian Infl uenza in migratory birds arriving on the Yukon-Kuskokwim Delta this spring. • Wash your hands and knife thoroughly with soap after cleaning or The goal is to collect 3,000 samples throughout the spring subsistence hunting handling any birds or eggs. season. Ten villages have been selected for the study: Chefornak, Eek, Hooper Bay, Kipnuk, Kotlik, Kwethluk, Mekoryuk, Pilot Station, Toksook Bay and Quinhagak. The • Cook wild birds or eggs thoroughly villages were chosen for a second year based on their geological location and the before eating them. species of birds typically hunted for subsistence. The USFWS identifi ed 29 priority species they are most interested in obtaining samples Be prepared, not scared… from. The species were selected based on their migratory patterns traveling through What YOU should know about bird flu areas known to have Highly Pathogenic • The “Bird Flu” in the news (H5N1) has not H5N1 Avian Infl uenza detected in domesti- cated birds. been found anywhere in America • It is OK to HUNT and eat wild birds Hunters in the selected villages are asked to bring subsistence-caught birds to their desig- • Do not go near or touch sick birds or ones that you find dead nated village testing manager. Two swabs will • Call 1-866-527-3358 (1-866-5 BRD FLU) to report be taken from each bird and then returned any large group of sick or dead birds to the hunter. For participating in the surveillance effort, two 12-gauge shotgun shells will be given for each bird sampled. Take care when cleaning There have been no cases of the Highly Pathogenic H5N1 strain of Avian Infl uenza and cooking birds & eggs virus detected anywhere in Alaska or the • Do not eat, drink or smoke when cleaning birds United States. In addition, there have been • Keep your hands away from your face and mouth while handling birds or eggs no cases of a person contracting the H5N1 virus from wild birds. The USFWS and OEHE • Wash your hands thoroughly after you touch birds and gathering eggs will continue their surveillance for any pos- • When you are done, scrub your knife, ulu, and work area with soap and water sibility of the virus surfacing in Alaska. • Cook birds to a temperature of 165’ F (cook until juices run clear) YKHC will provide regular updates to the • Do not eat raw, smoked or undercooked birds or eggs people of the YK Delta about the surveillance efforts, including prompt notifi cation of any Stay informed! positive identifi cation of the H5N1 virus. The news about Bird Flu is constantly evolving and advice may change.

Alaska Dept. of Fish & Game: Printed April 12, 2008 Anchorage 907-267-2257 ∙ Fairbanks (907) 459-7206—or your local office. This information was de- For more information concerning Web site: www.wildlife.alaska.gov/aawildlife/disease/avian influenza.pdf veloped by local representatives of State of Alaska the surveillance effort, contact U. S. Fish & Wildlife Service Fish and Game, Public Toll free: 1-866-5 BRD FLU or your local refuge office. Health Nursing and Epide- Kelsey Hustedt, YKHC Avian Web site: http://alaska.fws.gov/media/avian_influenza/index.htm miology, in collaboration with the Yukon-Kuskok- Inﬂ uenza Coordinator, toll free Alaska Dept. of Health & Social Services, Section of Epidemiology wim Health Corporation, Anchorage: 907-269-8000, or your local health aide, clinic or hospital. Association of Village at 1-800-478-6599, or direct at Council Presidents, and US Fish and Wildlife Service. 543-6421. General Pandemic Flu web site: www.avianflu.alaska.gov

15 Volume XIII No. 4 • April 15, 2008

Blackhawk medevac saves infant’s life

Pilot CW3 Michael Edwards, Crew Chief Sergeant Robert Pike, and Pilot CW3 Nyle Harrison. By Danielle Dizon, Public Relations Staff In a service area the size of the state of “We had a mile and half of visibility,” said Edwards. “As we fl ew along the river, the conditions continued to worsen and turned Oregon without any connecting roads and one into blizzard conditions.” Even with Night Vision Goggles used by Emergency Room located at the regional hos- the pilots to amplify light conditions, visibility was poor. pital in Bethel, patient care involves a team of The Blackhawk crew made it as far as Napakiak before making the decision to turn around. According to Edwards, a mission is responders working together. only aborted upon determination that the fl ight may endanger of the lives of the crew. Despite weather conditions that challenged a health care workforce, the excellent patient care provided by Health Aides, Pedia- Back at the clinic, Evan noticed bruising in the hand of the tricians, Physicians, Paramedics, and a determined Blackhawk child and swelling in her fi ngernails. “Her condition was getting helicopter pilot crew, saved a young child’s life. worse,” said Evan, “but I stayed calm for the parents.” After several hours of conducting care management over the Evan, a Health Aide of seven years began treating the child at phone, Tuntutuliak Health Aide Nettie Evan, CHP, and Dr. 7 p.m. Thursday night, and for the next 13 hours talked back Mehran Mosley knew the fi ve-month-old child experiencing a and forth with Dr. Dayna Ferguson and Pediatrican Scott Davis, severe arm infection required critical medical care at the regional nightshift workers at the Bethel Hospital. Fellow Health Aide hospital in Bethel. Rhonda Simon took over at 10 a.m. the next morning. Unfortunately, the force of the weather complicated matters on Simon, a Health Aide since 2005, continued telemedicine over Thursday, April 3. Scheduled fl ights were canceled and YKHC’s the phone with physicians, while awaiting the medevac. “I con- Aeromed service carrier was unable to fl y. tinued checking vitals on her and hoped to hear the plane,” said Simon. “The infection was progressing each hour and unfortunately there was no way of getting this child out of the village due “The weather permitted us to attempt fl ight in the afternoon and to weather conditions,” said Mosley, a Pediatrician at the we were able to complete the mission,” said Edwards. The chop- Yukon-Kuskokwim Delta Regional Hospital. “If there is life or limb per landed near the clinic at 1:30 p.m. Friday afternoon, suc- at risk, and we cannot reach a patient through Aeromed, we acti- cessfully transferring the infant to the Bethel Hospital. vate the Blackhawk through the National Guard.” Tuntutuliak Village Police Offi cers, Wassille Lupie and Max Blackhawk crewmembers, Pilot CW3 Nyle Harrison, Pilot CW3 Joseph, Jr., assisted in transferring the young baby and family Michael Edwards, and Crew Chief Sergeant Robert Pike, were member safely into the chopper while Aeromed Paramedics the only pilots in air attempting the fl ight early Friday morning at Mark Stevens and Bill Jones stabilized her throughout the trans- 2:30 a.m. to transport the child. fer. 16 see BLACKHAWK, p. 17 Volume XIII No. 4 • April 15, 2008

Health Aide Appreciation Week April 21–25 Health Aides deserve your They leave their families at appreciation any hour to help you and yours…

by Carl Evans, CHAP Support Counselor Alaska is unique among our country’s 50 states in the way it provides health care to its citizens living in rural areas. The heart and soul of the program that provides quality health care to the 26,000 people spread over 75,000 square miles and the 56 communities of the Yukon-Kuskokwim delta is the Community Health Aide/Practitioner. Community Health Aides go through a rigorous training process, attending a pre-session and four full sessions. Each session lasts 3–4 weeks and requires that the Health Aides be away from their families and community for extended times. Upon completion of each session, CHA/Ps must practice a minimum of 200 hours before attending the next session. Once they pass Session 4, CHA/Ps are Martha Yohak,CHP, Chefornak, examines young patient. Photo by Janet Erik, CHP. eligible to complete a preceptorship to become a Certiﬁ ed Community Health Practitioner or CHP. This process can take up to two years. All CHA/ Ps must have current Emergency Medical Training Health Aides – There for You (EMT) since they typically are the ﬁ rst responders in a village emergency. Health Aides have the Show you care. responsibility of being the eyes, ears and hands for the doctors and other providers who may be hun- Thank your Health Aide today dreds of miles away. for the work they do. The job of a Health Aide can be very stressful. I’ve

heard them talk about feeling that they are not sup- Working Together to Do you know an outstanding health aide? Contact the YKHC Field Supervision ported or feeling that they are unfairly criticized. It Achieve Excellent Health Coordinator at 543-6357 to nominate your health aide for an award! is very difﬁ cult for them when they have to respond to non-urgent after-hours call-outs. When asked, “What is the best part of your job?” in a recent survey of Health BLACKHAWK, from p. 16 Aides, the most common answer was, “Helping someone and Upon arrival in Bethel, she was then transferred to ANMC and is being thanked.” now in stable condition. We would like to encourage you, as individuals and as a commu- “Without everyone’s support and teamwork, this child may not nity to express your appreciation for your Health Aides not only have survived the extensive progressing infection,” said Mosley. during Health Aide Appreciation Week April 21–25, but any and “The unusual conditions surrounding the care of this child and every day. the successful outcome due to this teamwork make Bethel what it is: a special place to practice medicine and make an immedi- You can contact Carl Evans at 907-543-6163 ate difference,” added Mosley. or toll free: 1-800-478-3321 ext 6163 YKHC commends the team of health care providers and honors the pilots of the Blackhawk helicopter crew who made the life- saving ﬂ ight. 17 Volume XIII No. 4 • April 15, 2008 What world will we leave for our children and our children’s children?

The village of Kasigluk on the YK Delta. by Trish Naughton, PHN

th 2. Weather extremes such as heavy rains, fl oods, and disas- Monday, April 7 was World Health Day 2008. ters like Hurricane Katrina endanger health and property. Its theme: “Protecting Health from Climate Approximately 600,000 deaths occurred worldwide as a result of weather-related natural disasters in the 1990s. Nearly 95 percent Change.” Our climate is changing. Our world of these occurred in developing countries. is changing. We know this in Alaska. Our 3. Intense short-term fl uctuations in temperature can cause heat neighbors in places like Newtok know this stress or extreme cold and lead to increased death rates from heart and respiratory diseases. Unusually high temperatures in well. Western Europe in summer of 2003 were associated with nearly 70,000 more deaths than during similar periods in previous Climate change describes the changes in Earth’s global and years. regional atmosphere over time. The rise in the Earth’s average surface temperature, or “global warming,” is likely caused by a 4. Increasing global temperatures affect levels and seasonal pat- combination of natural processes and activities. The increase in terns of air-borne particles, such as plant pollen, which can trig- global warming is generally thought to be a result of increased ger asthma. Asthma deaths are expected to increase by almost manmade greenhouse gas emissions. 20 percent in the next 10 years if urgent actions to curb climate change are not taken. According to the World Health Organization (WHO), there is overwhelming evidence that humans are affecting the global 5. Rising sea levels increase the risk of coastal fl ooding. More climate. Impacts of climate on human health are not and will than half of the world’s population now lives within 27 miles not be evenly distributed around the world. Developing country of shorelines. Floods can directly cause injury and death, and populations, particularly on small islands, in very dry zones, in increase risks of infection from water and vector-borne diseases. high mountain areas, and in densely populated coastal areas, 6. More variable rainfall patterns may compromise fresh water are considered to be particularly vulnerable. supply. Globally, water scarcity already affects four out of every Although much of the health risk is avoidable through existing 10 people. health programs, climate change can cause death and disease 7. Water scarcity encourages people to transport water long dis- through: tances and store supplies in their homes. This can increase the Natural disasters, such as heat waves, fl oods, and droughts. risk of household water contamination, causing illnesses. Increase of diseases that are sensitive to changing temperatures 8. Climatic conditions affect diseases transmitted through water, and precipitation. and via vectors such as mosquitoes. Climate-sensitive diseases are among the largest global killers. Ten facts from WHO: 9. Malnutrition causes millions of deaths each year. Increasing 1. Over the last 50 years, the burning of fossil fuels and other temperatures and more variable rainfalls are expected to reduce activities has released enough carbon dioxide and other crop yields in many tropical developing regions, where food greenhouse gases to affect the global climate. Carbon dioxide security is already a problem. concentration has increased by more than 30 percent since pre-industrial times. Heat-trapped lower atmosphere can lead to 10. Steps to reduce greenhouse gas emissions or lessen the changes that bring health risks ranging from changing patterns health impacts of climate change could have positive health of infectious diseases to even deaths due to extreme high tem- effects. For example, promoting the safe use of shared transpor- peratures 18 see WORLD HEALTH DAY, p. 19 Volume XIII No. 4 • April 15, 2008

WORLD HEALTH DAY, from p. 18 dangerous with changing sea and river ice. Warming streams and increased silt from melting glaciers affect fi sh habitat. Boreal tation and active movement - such as biking or walking as alter- forests advance northward and to higher elevations, displac- natives to using private vehicles - could reduce carbon dioxide ing tundra. Invasive species compete with native vegetation. 1 emissions and improve public health. Humans, animals and plants may be exposed to new infectious A diagram helps to explain how this works: diseases as habitat changes. Forest fi res and insect infestations increasing in frequency and intensity. In the past decade, Alaska has witnessed a record loss of forests to fi res and spruce bark beetles. Some ways we can help: At the offi ce: To save energy and reduce greenhouse gas emissions at work, always activate the power management features on computers and monitors. Unplug laptop power cords when not in use. Turn off equipment and lights at the end of the day. Consider using a power strip that can be turned off when you’re done using your computers, printers, wireless routers and other electronics. 3 At home: Replace the conventional bulbs in your 5 most frequently used light fi xtures with bulbs that have the ENERGY STAR and you will help the environment while saving money on energy bills. If every household in the U.S. took this one simple action we would prevent greenhouse gases equivalent to the emissions from nearly 10 million cars. When buying new products, such as appliances, look for ENERGY STAR qualifi ed products in more than 50 product cat- What might this mean for Alaska egories, including lighting, home electronics, heating and cooling equipment and appliances. By report, 2005 was the warmest year on record, and global warming continues to touch Alaskans in a number of ways. Heat and cool smartly. Simple steps like cleaning air fi lters regu- These include melting polar ice, the retreat of glaciers, increas- larly and having your heating and cooling equipment tuned annu- ing storm intensity, wildfi res, coastal fl ooding, droughts, crop ally can save energy and increase comfort at home, and at the failures, loss of habitat and threatened plant and animal species. same time reduce greenhouse gas emissions. When it’s time to replace your old equipment, choose a high effi ciency model, and Melting glaciers, rising sea levels, and fl ooding of coastal make sure it is properly sized and installed. communities. Warming of oceans and melting of land-based ice increases the volume of ocean water. Loss of sea-ice cover changes habitat for arctic species and leaves coastal communi- For more information, and for numerous ties more exposed to larger waves generated by severe storms. additional links to resources: Thawing permafrost, increased storm severity, and related http://www.climatechange.alaska.gov/cc-ak.htm infrastructure damage to roads, utility infrastructure, pipelines http://www.epa.gov/climatechange/ and buildings. Extremes in weather patterns, precipitation and rising sea levels will affect safe water sources in villages, and http://www.who.int/world-health-day/en/index.html contributes to increased erosion along Alaska coasts and rivers and undermines Alaska boreal forests. 1 World Health Organization, http://www.who.int/world-health-day/en/index.html Loss of the subsistence way of life as animal habitat and 2 “Alaska Climate Change Strategy,” http://www.climatechange.alaska.gov/cc-ak. migration patterns shift and as hunting and fi shing become more htm 3 Environmental Protection Agency (EPA), http://www.epa.gov/climatechange/ wycd/home.html 4 Environmental Protection Agency (EPA), http://www.epa.gov/climatechange/ wycd/offi ce.html

19 Volume XIII No. 4 • April 15, 2008

April: Sexual Assault Awareness Month On April 30th from 9 a.m. – 2 p.m., a Sexual Assault Awareness table Community Team counters will be in the YKHC lobby. Please stop by to pick up your teal colored sexual assault with caring awareness ribbon to express support and competence for victims of sexual violence. You can meet representatives from YKHC and TWC and educational materials will be available.

By Colleen Palacios RN, SANE-A Sexual assault should not happen at all. When it does, however, cate accompany the patient in the ER. The Advocate provides it is important that victims call for help and report what has comprehensive support for the patient throughout the evaluation happened. The Y-K Delta’s Sexual Assault Response Team, or process. SART, is in place and always on call to provide immediate medi- YKHC’s Forensic Examiners perform thorough and appropriate cal, advocacy, and legal services to all victims of sexual assault. exams, collect, collate, and protect evidence, and ensure the The SART is a coalition of many community-based organiza- safety of the patient. They also play a pivotal role in providing tions, people, and groups, including Bethel Police Department, legal testimony in the courtroom. Alaska State Troopers, the Tundra Women’s Coalition, the All SART team members are trained to guide the patient in the Children’s Advocacy Center, various social and criminal justice most humane, careful, and compassionate way through the agencies, and the Yukon-Kuskokwim Delta Regional Hospital’s evaluation and legal process. The various members of the SART (YKDRH) Sexual Assault Forensic Examiners. function together to provide consistent and unbiased care to A law enforcement offi cer is normally fi rst to respond to an victims. assault call. After ensuring the victim’s safety, the offi cer will We encourage patients to share concerns, to receive informa- notify the Emergency Room (ER) that a sexual assault patient tion on available resources and to know what their options are will arrive soon and will request that a specially trained Advo- regarding their health, reporting and the judicial process.

Russian Mission Aniak Lab child wins Kusko Assistant passes Immunization Phlebotomy Raffl e Exam Dondi McPeaks III of Russian Doris Allain-Turner, Aniak Mission is the fi rst winner of Subregional Clinic Labora- the Kusko Winter Immunization tory Assistant, successfully Raffl e. Children whose immuni- passed the ASCP (American zations were up to date entered Society of Clinical Pathology) the raffl e to win a miniature Board of Registry Exam for Doris Allain-Turner at a Kusko stuffed animal. Phlebotomy Technician. This reception celebrating her certifi cation. Congratulations Dondi! is a national certifi cation for Dondi McPeaks III holds collecting and processing Kusko the Immunization Dog his new dog. Photo by blood for laboratory testing. Doris has been taking distance ed Matthew Greenberg. continues to promote immuniza- classes through the UAA Medical Laboratory Technician pro- tions among young children throughout the Delta in hopes that gram. The Aniak Subregional Clinic staff celebrated her accom- every child has their immunizations up to date. plishment with a dessert reception.