Seasons’ Greetings from the YKHC Board of Directors · April TBA Tribal Gathering XV April 22 Finance Committee April 23–25 Semi-Annual Full Board Meeting ... we must also be

INSIDE: CEO Message, p. 3 • Yuut, p. 6 • WIC@20, p. 10 • Clinic Changes, p. 12

Volume XII No. 12 • December 15, 2007

Seasons’ Greetings from the YKHC Board of Directors

2

Board of DirectorsUnit 1Raymond F. Waska, Sr.P.O. Box 46Emmonak, Alaska 99581907-949-1514

Paula AyunerakP.O. Box 5Alakanuk, Alaska 99554907-238-3212

Unit 2Ray AlstromP.O. Box 8Marshall, Alaska 99585907-679-6320

James C. LandlordP.O. Box 32168Mt. Village, AK 99632907-591-2531

Unit 3Wayne MorganP.O. Box 234Aniak, Alaska 99557907-675-4264

George S. MorganP.O. Box 54Upper Kalskag, Alaska 99607907-471-2490

Unit 4James NicoriP.O. Box 41Kwethluk, Alaska 99621907-757-6837

Moses PeterP.O. Box 57Tuluksak, Alaska 99679907- 695-6426

Unit 5Bill KristovichP.O. Box 1037Bethel, Alaska 99559907-543-4151/2212

Henry Hunter, Sr.P.O. Box 632Bethel, Alaska 99559907-543-7963

Gloria SimeonP.O. Box 308Bethel, Alaska 99559907-543-5676

Joseph C. BavillaP.O. Box 6011Napaskiak, Alaska 99559907-737-7665

Unit 6Esai Twitchell, Jr.P.O. Box 121Kasigluk, Alaska 99609907-477-6309

Unit 7David O. DavidPO Box 78Kwigillingok, Alaska 99622907-588-8484

Unit 8James R. Charlie, Sr.P.O. Box 37012Toksook Bay, Alaska 99637907-427-7114

James SiparyP.O. Box 37134 Toksook Bay, Alaska 99637907- 427-7816

Unit 9Elmer G. SimonP.O. Box 64Hooper Bay, Alaska 99604907-758-4109

Moses J. TulimP.O. Box 130Chevak, Alaska 99563907-858-7366

Unit 10Sam W. AlexieP.O. Box 57Eek, Alaska 99578907-536-5428

Unit 11Kathy W. ChaseP.O. Box 41Holy Cross, Alaska 99602907-476-7162

Honorary Board MemberPaul JohnP.O. Box 37067Toksook Bay, Alaska 99637907-427-74l4

Numbers to CallYKHC Main Operator ................................................... 543-6000 Toll Free ........................................................... 1-800-478-3321Public Relations .............................................................. 543-6038Media Services ................................................................ 543-6030Office of Environmental Health & Engineering ........... 543-6420Technology Help Desk ................................................... 543-6070Human Resources .......................................................... 543-6060Administration ............................................................... 543-6020Hospital .......................................................................... 543-6300Emergency Room ........................................................... 543-6395Hospital Community Relations .................................... 543-6350Social Services ................................................................ 543-6225Family Medicine Clinic Appointments ......................... 543-6442 .......................................................................... 1-800-478-3321Dental Appointments .................................................... 543-6229Optometry Appointments ............................................. 543-6336Audiology Appointments .............................................. 543-6466

Subregional Clinic Appointments Aniak ........................................................................... 675-4556 Emmonak ................................................................... 949-3500 St. Mary’s .................................................................... 438-3500 Toksook Bay ................................................................ 427-3500Public Health Nursing ................................................... 543-2110Pharmacy ........................................................................ 543-6382Travel Management Center ........................................... 543-6360WIC Program ................................................................. 543-6459Health Services .............................................................. 543-6024Village Operations ......................................................... 543-6160 CHAP .......................................................................... 543-6160 ICEMS ......................................................................... 543-6080 Community Health & Wellness ................................. 543-6190Behavioral Health Services ............................................ 543-6100 Phillips Ayagnirvik ..................................................... 543-6700 Village Services ........................................................... 543-6740Home Care Services ....................................................... 543-6170


The Messenger Quarterly is printed in December, March, June, and Septem-ber. The Messenger is published monthly online at www.ykhc.org by the Yukon-Kuskokwim Health Corporation as a report to Tribal Members. For questions, comments, submission of articles, or subscription information, write to Messenger Edi-tor, Public Relations, Yukon-Kuskokwim Health Cor-poration, P.O. Box 528, Bethel, Alaska 99559. 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, Anchorage, Alaska 99503. 907-677-2232. Please ask permission to re-print articles or pictures. © 2007, Yukon-Kuskokwim Health Corporation.

YKHC Board & Committee Meetings

2008January 23

Finance Committee

January 23–24Hospital Governing Body

February 19Finance Committee

February 20–21Executive Board

March 18Finance Committee

March 18–19Hospital Governing Body

April TBATribal Gathering XV

April 22Finance Committee

April 23–25Semi-Annual Full Board Meeting

May 27Finance Committee

May 27–28Hospital Governing Body

A Message from the President/CEO

From my family to your family, the very best wishes for a happy and safe holiday season!

With the calendar year about to change, the Yukon Kuskokwim Health Corporation can celebrate our many successes and learn from the several challenges that have come our way during these last 12 months.

While continuing to improve our patient-centered excellence, maintain focus on our employees, develop a dynamic Alaska Native workforce, and increase our community and partner satisfaction, we must also be vigilant in identifying the financial viability of our organization.

In other words, we must solve the puzzle of working together to achieve excellent health while not over-spending. Obviously, this is easier said than done.

We have much to appreciate this year. Together, we have opened two more village clin-ics with the current construction of a fifth subregional clinic, worked with funders to bring a CT Scan to the region, delivered portable mammography services to the Delta, provided 12,000 flu shots, worked with Yuut Elitnaurviat to open dormitories, created an Employee Assistance Program, upgraded the employee benefit package, acquired key properties near the YKHC campus necessary for future health delivery services development and embarked on other projects and services too numerous to list. You have done a great job.

YKHC has become a mecca for people with an interest in rural healthcare delivery. Other hospitals and health agencies, documentary film crews and medical/dental asso-ciations have come to our region wanting learn how we provide medical services to our customers in this unique place we call home. YKHC is recognized worldwide as a model health care organization.

As you know, this last year proved difficult as unpleasant decisions had to be made in order for us to remain sustainable. These included reductions-in-force, supplies streamlining and housing closures. Without these mid-fiscal-year adjustments, the 2008 budget reductions may have proven far more drastic. But the good news is that recent collection goals have been exceeded and, with cost saving measures now in place, the 2008 outlook is positive.

Can we relax now? No. I’m reminded of an old saying, “If you are drifting, use the oars.” Our level of success is completely dependent on our level of effort.

With Best Wishes for the New Year,

Gene Peltola, YKHC President/CEO

4

Small cluster of Tuberculosis confirmed in Yukon-Kuskokwim DeltaYKHC Office of Public Relations

A small cluster of tuberculosis (TB) is being monitored and treated in collaboration with the State Department of Health & Social Services (DHSS) Division of Public Health Section of

Epidemiology. For patient confidentiality purposes, the location area is being withheld.

Dr. Daniel Hartman, Tuberculosis Officer and Family Physician for YKHC, said, “We see no risk for community spread with the pres-ent case cluster and have conducted community-wide screenings in coordination with the Public Health Nursing Center.”

Tuberculosis is a bacterial disease caused by the Mycobacterium tuberculosis, usually attacking the lungs, however can potentially spread to other organs of the body such as the kidney, blood, and brain. The infection can cause permanent organ damage and death if untreated.

“Adherence to medication is extremely important in order to limit infections,” said Hartman. “If individuals stop taking medicine too soon, they run the risk of the bacteria growing back, developing drug resistance, and infecting others.”

There are a small number of people treated yearly for TB in the Yukon-Kuskokwim Delta. YKHC is currently involved in the treat-ment of six active and 10 latent TB cases

A person with latent TB has the bacteria existing in the body, how-ever it is inactive. Latent TB cannot be spread from person to person, however if the germ becomes active or if the immune system weak-ens, the bacteria can multiply and become active TB. Latent TB is treated to prevent active TB. Once active, the disease can spread through air transmission, usually through coughing or sneezing.

TB bacteria usually grows in the lungs, causing symptoms that include a bad cough that lasts three weeks or longer, pain in the chest, and/or coughing up blood or phlegm from deep inside the lungs.

Dr. Elizabeth Funk, Medical Epidemiologist for the State DHSS and TB Control Officer, has worked closely with YKHC and Public Health providers monitoring the treatment. She recently traveled alongside YKHC and Public Health officials over the weekend, pro-viding education and support for community members.

“We follow each case of TB extremely closely. As soon as a case exists, we are aware, working directly with the families and providers,” said Dr. Funk. “All cases are being treated through Direct Observed Ther-apy (DOT), an international standard of care targeted at ensuring cure of the disease, limiting the spread of the disease as well as the development of drug resistant TB.”

As a national system of care, DOT delivers the same treatment plans and medications to affected patients all over the country. YKHC works in collaboration with the State to ensure national standards of care are met.

“Our greatest concern is for our patients,” said Dr. Joseph Klejka, Medical Director for YKHC. “Tuberculosis is a preventable and treatable infection and it is through early diagnosis and medical treatment that we can reduce levels of bacteria. It is crucial that we raise awareness of the diagnosis and treatment of the curable infection. Medication is the only treatment for the bacteria, and if untreated it will continue to grow and spread throughout other organs of the body.”

TB screenings are done through skin tests and are available through school nurses, local health clinics, subregional clinics, and Public Health or YKHC.

In partnership with the State DHSS and Bethel’s Public Health Center, YKHC is continuously surveying TB cases and will inform the public of increased cases. p

If you have questions about TB, contact Dr.

Daniel Hartman at 1-800-478-3321 ext. 6286 or

543-6286 or the Bethel Public Health Nursing

Center at 1-800-478-2110 or 543-2110.


TB FactsFrom the Centers for Disease Control & Prevention:

What is TB?Tuberculosis (TB) is a disease caused by bacteria called Mycobacte-rium tuberculosis. The bacteria usually attack the lungs. But, TB bac-teria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

TB is spread through the air from one person to another. The bac-teria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some people with latent TB infection go on to get TB disease.

People with active TB disease can be treated if they seek medical help. Even better, most people with latent TB infection can take med-icine so that they will not develop active TB disease.

Why is TB a problem today?Starting in the 1940s, scientists discovered the first of several medi-cines now used to treat TB. As a result, TB slowly began to decrease in the United States. But in the 1970s and early 1980s, the country let its guard down and TB control efforts were neglected. As a result, between 1985 and 1992, the number of TB cases increased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB since 1992. But TB is still a problem; more than 14,000 cases were reported in 2005 in the United States.

How is TB spread?TB is spread through the air from one person to another. The bac-teria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB in the lungs or throat can be infectious. This means that the bac-teria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.

What is latent TB infection?In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can

become active later. This is called latent TB infection. People with latent TB infection:

have no symptoms•

don’t feel sick•

can’t spread TB to others•

usually have a positive skin test reaction or QuantiFERON-TB •Gold test (QFT-G)

may develop active TB disease if they do not receive treatment for •latent TB infection

Many people who have latent TB infection never develop active TB disease. In these people, the TB bacteria remain inactive for a life-time without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease.

What is active TB disease?TB bacteria become active if the immune system can’t stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason.

Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune sys-tems, too, especially people with any of these conditions:

substance abuse•

diabetes mellitus•

silicosis•

cancer of the head or neck•

leukemia or Hodgkin’s disease•

severe kidney disease•

low body weight•

certain medical treatments (such as corticosteroid treatment or •organ transplants)

specialized treatment for rheumatoid arthritis or Crohn’s disease•

Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause symptoms such as:

a bad cough that lasts 3 weeks or longer•

pain in the chest•

coughing up blood or sputum (phlegm from deep inside the •lungs)

Other symptoms of active TB disease are:weakness or fatigue•

weight loss•

no appetite•

chills•

fever•

sweating at night • p

6

Community & Partner Satisfaction

Yuut Elitnaurviat: Partnership spurs development

By Tiffany Zulkosky

Five years of planning and four buildings into the project, Yuut Elitnaurviat (YE) is laying the foundation for local and

regional vocational training opportunities in the Yukon-Kuskokwim Delta region.

As the shadow of the new Technical Education and Support Services (TESS) building raises over the tundra in City Subdivision, the two 22-bed dormitories are complete and ready to house their first occu-pants. Bethel Alternative Boarding School (BABS) will be the first set of students in residence on the YE campus.

“With the initial dormitories almost prepared for occupancy, the need for more dormitory space is already evident,” said LaMont Albertson, YE Executive Director, regarding the rapid growth of the YE campus.

The TESS building is currently scheduled to be ready for occu-pancy January 1, 2009. The 20,000 square foot building will boast numerous classrooms, a library, wet labs, and a clinic for Dental Health Aide Therapy (DHAT) students, complete with a waiting room area for DHAT patients.

Although the DHAT clinic in the YE campus has another year until completion, Bethel Community Services Foundation (BCSF) is sponsoring interim clinical space in the BNC Com-plex that will be equipped for students by the first of 2008.

“BCS Foundation’s commitment to the Delta is reflected in the board’s willingness to commit the largest single grant in BCS Foundation’s history to ensure adequate clinical space for the Dental Health Aide Therapy program until Yuut Elitnaurviat’s permanent space is complete,” said Jerry Drake, Business Manager at BSCF.

Above: Hands-on education for three future carpenters: Matthew Black, Michael Amik, and Leonard Patton IV. Top: The new dormitory is now open.


Did you get a

PRESS-GANEYsurvey?

Please fill it out and send it in.

These surveys are very impor-

tant for us to find out how

to serve you better!

Dr. Edwin Allgair, Dental Service Chief for YKHC, recognizes the magnitude of support the DHAT program continues to receive, as well as the development of career and training opportunities for local residents. He stated, “We’re very thankful to our spon-sors who have made it possible to bring the groundbreaking Dental Therapy program to this region so soon. We’re very proud of our Dental Therapists and Dental Therapy stu-dents for all the hard work they’re doing and their commitment to the oral health com-munity. We’re especially happy to be working with YE to develop career paths for young people, where they can contribute to other’s lives in a meaningful way.”

While much of the infrastructure is falling into place, Albertson emphasizes that all of it is just the beginning.

“It’s encouraging that we’re as far along as we are, but we have a long way to go,” stated Alb-ertson. “We are thankful to the agencies who have helped make this happen for the citizens of the Yukon-Kuskokwim Delta. We look forward to the continued development of this training/learning center.” p

Respiratory Virus Study Finishes Enrollmentby Lori Pruitt, YKHC Employee Health Nurse& Dr. Ros Singleton, Alaska Native Tribal Health ConsortiumThe Respiratory Virus (RSV) Study began in October 2005. The purpose of this study was to see what viruses were causing children less than 3 years old to be hospitalized with lung infections and what time of year these viruses were present. The study just finished enrollment on September 30th, 2007.

In the Respiratory Virus Study we tested nose samples on hospitalized children and healthy comparison children for several viruses: RSV, Human metapneumovirus, influ-enza, parainfluenza types, coronavirus and rhinovirus. We also tested for the pertussis bacteria that causes whooping cough. A total of 446 hospitalized children were enrolled in the study. Also, 648 healthy comparison children from many villages were also enrolled to see if they had any viruses. We would like to thank all the parents who con-sented to have their children in the study. Parents took time to answer questions and have their children’s noses swabbed to test for the viruses.

The most important virus in hospitalized children was RSV. Other important viruses were parainfluenza virus, human metapneumovirus and influenza. Rhinovirus, the main cause of the common cold, was found in nearly half of hospitalized children, but it was also found in one-third of healthy control children.

While enrollment is complete, the work for the study continues. We are just complet-ing the testing for all of the viruses. After all testing is done the results will be analyzed. From these results we hope to learn more about viruses in children of the YK Delta and find better ways to prevent and treat lung infections in children.

Thanks are also due to many people working on the study. These include the YKD Regional Hospital inpatient staff, providers, outpatient nurses and the laboratory and radiology staff. Without their help, we wouldn’t have been able to complete the study. Thanks to Dr. Joe Klejka and Dr. Mehran Mosley for their guidance. Thanks to Dr. Rosalyn Singleton for overseeing the project and the staff of the Centers for Disease Control and Preven-tion (CDC) Arctic Investigations Program (AIP) in Anchorage for the nurse travel to vil-lages, laboratory test-ing and study analysis.

We will send a sum-mary of the final results for this study in the Spring 2008. Our study goal is that the results of this study will help improve the health of YK Delta children! p

Above: Step-ping up to a new career.

Right: A new sign of the

future is here

8

YK Delta Preparedness Coalition has success with Second Annual Mass Dispensing Exerciseby Lori Pruitt, YHKC Infection Control

More than two years ago community organizations began meeting together in hopes of putting plans in place to

meet the need of the Bethel community if a pandemic event such as the flu occured.

Members of this coalition include Public Health Nursing, the Yukon Kuskokwim Health Corporation, the City of Bethel, Fish and Wildlife, Fish and Game, Bethel Family Clinic, and the Asso-ciation of Village Council Presidents (AVCP).

On November 3, a Mass Dispensing Exercise (MDE) was held at the Armory and met with great success! This is the second time such an exercise has been done in Bethel.

The purpose of the MDE is to effectively and efficiently distribute vaccine in the event of an infectious disease outbreak. By practic-ing such an event, two goals are met. First, it helps the coalition determine how well its plan works. Secondly, because flu vaccine is used for the MDE, many people in Bethel are able to get a free flu shot.

This year, the MDE was again held at the armory. Of the 378 people who came to the armory, 338 received flu shots. Satellite groups also went into the community and flu shots were given for short periods of time at the Hageland and Grant terminals, AC Store, AC Quick Stop, Corina’s Case Lot, and Swansons. These areas were very effective; 102 shots were given at these sites.

Most people who came to the armory were able to go through in less than five minutes! Three lines were set up for dispensing the vaccine and an opportunity to complete an evaluation was given on the way out. There were also areas for medical and behavioral health help.

Over 75 people volunteered to help with the event. The wonderful volunteer crew certainly made this event successful. People from Bethel Alternative Boarding School (BABS), Bethel Regional High School, the City of Bethel, BFC, PHN, YKHC, YKCC, BYF, Health Aides, UAA School of Nursing students, and Bethel HAM radio operators were among the many organizations represented through the volunteers. Special thanks to Kathleen Stanton, Public Health Nurse, for being the clinic manager in charge of the MDE. People helped do everything from cleaning off the armory steps, to giving shots, to helping people through the line, to helping the volunteers get to where they needed to go.

Thanks are also due to the State Preparedness Office, who graciously gave flu vaccine for the MDE. Jim Mackin, Director of the Prepared-ness Program, was on hand during the event and was very compli-mentary of its organization and smoothness.

Donations for the event were received from AC, Corina’s, Swansons,

Emerie Fairbanks and Marilyn Saddler, Bethel Regional High School volunteers, help cooridinate the volunteer effort with Public Health Nurse Elsie Westman.

Sharon Kristovich, right, stands by as Michael Tunley, EMT, gives a flu shot to one of the 338 people who got flu shots at the Mass Dispensing Exercise.

See MDE, p. 13


Surgeon General pays special visit

to YK DeltaYKHC Office of Public Relations

Rear Admiral Steven Galson, Acting U.S. Surgeon General, traveled to Bethel December 4 and met with YKHC representatives to discuss health concerns and

challenges facing people in the Yukon-Kuskokwim Delta.

Joining Galson for the visit were two members from the IHS Area Health Office, CAPT Tom Coolidge, Director of the Office of Environmental Health and Engineering, and James Armbrust, Director of Tribal Affairs. The group toured the McCann Treatment Center and the village of Napaskiak, where they met with YKHC Board Member Joe Bavilla, who gave them a first-hand look at village life.

Acknowledging the brevity of his visit, U.S. Surgeon General Galson said he would like to return to spend more time with the people.

Galson’s concerns surrounded public health issues facing the region. A roundtable discussion allowed YKHC staff to bring these health priorities to light. The issue of sanitation needs, which includes water and sewer projects in the region, was a top concern. Alternative and renewable energy and Elder care were also mentioned.

Your children learn from watching you.Quit before they start.

YKHC Nicotine Control and Research 1-800-478-3321 or 543-6312 •

YKHC Commission Corps Officers with the Surgeon General. From left: Mardie Smitth, DDS; Jeff Conner, Assist. Safety Mgr.; Brek Steele, Environmental Health Officer; Rear Adm. Steven Galson; Ealsay Hastedt, Environmental Health Officer; Sue Hoeldt, Aniak SRC Manager; Jane Russell, Village Operations Adminis-trator; Karl Powers, Village Operations.

Rear Adm. Steven Galson, Acting U.S. Surgeon General, got an earful of health concerns when he visited Bethel in Decem-ber.

see SURGEON GENERAL, p. 13

10

Patient Centered Excellence

20 Years of WIC: Helping Delta families

get a healthy start

This year the Women, Infant, and Chil-dren Program (WIC) celebrates 20 years of providing food and nutrition educa-

tion to YK Delta families.

The YKHC WIC Program has seen an unprecedented growth in 20 years. In 1988, the YKHC WIC Program had a caseload of 400 participants and a staff of two, with part-time CHRs providing assistance for outreach in the villages. In March 2007, the Delta’s caseload was 2,470 and a staff of six.

The caseload growth represents a 69 percent increase in the number of participants served by the YKHC WIC Program in the Delta. Caseload growth and expansion in services has been achieved in the most cost-effective manner, mindful of the strict grants management guidelines established by the US Dept. of Agriculture.

YKHC’s WIC Program has the lowest per participant cost at $17.89 in the Federal Fiscal Year 2006, while the statewide aver-age per participant cost for rural programs was $26.

WIC is an important part of health care. It helps prevent nutri-tion and health problems and improves the nutrition and health of WIC participants in three ways—by providing nutritious foods for health, encouraging regular health care, and promoting good nutrition through education.

Nutrition education is an important part of the WIC program. Although people are only on WIC for a short time, the information they get from WIC lasts a lifetime. By learning about good nutrition from WIC, participants make changes in the way they eat. These changes help them stay healthy and feed their families long after being on WIC.

The YKHC WIC Program serves about 2,400 participants a month. WIC works closely with village vendors to make sure they are stocked with the foods WIC provides. In villages that don’t offer WIC foods in the store, WIC sends boxes of food to WIC partici-pants each month.

We are very proud of the positive impact WIC has in the health out-come of participants served. Among these are the reduction in the incidence of iron-deficiency anemia, baby bottle tooth decay, obe-sity, and diabetes. WIC increases immunization rates through refer-rals and improves a child’s growth and development. The program also helps promote increased consumption of fruits and vegetables and is credited with increasing the number of pregnant women who seek prenatal care thereby enabling a healthy pregnancy and birth outcome. p

Top and Below: WIC on the move, taking it to the village. Above: Young families get a healthy start with WIC foods.


WIC at a GlanceWomen, Infants, and Children (WIC) is a supplemental food program that serves a population during critical stages in life. WIC provides healthy foods, nutrition education, and referrals to other health and social services to clients for free.

Who is qualified for WIC?A woman who is pregnant, breastfeeding, or just had a baby•

A child who is between the ages of 1 and 5•

An infant up to 1 year of age•

What are the requirements to be eligible for WIC?Meet income guidelines•

A State residency requirement (live in Alaska)•

Be individually determined to be at “nutrition risk” by a health •professional

A person or family member who participates in certain other pro-•grams (Food Stamp Program, Medicaid) automatically meets the income eligibility requirement.

How long will one be certified for WIC?A pregnant woman will be certified through pregnancy and up to •6 weeks after birth or after pregnancy ends.

A breastfeeding woman will be certified until the baby’s first birth-•day.

A non-breastfeeding postpartum woman will be certified up to 6 •months after the birth of an infant or after pregnancy ends.

A child will be certified up to their 5th birthday. A child will need •to be recertified every 6 months.

An infant will be certified until he/she turns one year old.•

What food does one get on WIC?Foods provided by WIC include: iron-fortified infant formula, •infant cereal, iron-fortified adult cereal, fruit or vegetable juice, eggs, milk, cheese, peanut butter, dried beans or peas, tuna fish, carrots, and salmon.

How does one receive food from WIC?WIC warrant can be picked up at the clinic in Bethel.•

WIC warrants can be mailed to the client.•

Warrants can then be used to buy food from approved WIC ven-•dors.

A WIC foods box can be mailed from Fred Meyer in Anchorage. •This usually takes about 1 to 2 weeks.

Nutrition ThemesAn important part of WIC, Nutrition themes provide a consistent message that is behavior specific. They also emphasize the need to reduce overweight and obesity among Alaska children. WIC has four nutrition themes a year. WIC’s nutrition theme for October through December is “Family Meals & Breastfeeding: The Heart of Good Eating.”

Some points to consider:Infants who are only fed breast milk the first six months have the •best start to healthy eating

Young children fed at the family table have better eating, self-feed-•ing, and language skills

Family meals help communication and build relationships•

Family meals help children eat better •

If you think you might qualify for WIC, call us

at 800-764-6459 or stop by the WIC Clinic in

Bethel. We are located at the West Wing.

Farewell To AllAfter almost 20 years, I am ready to move down another path. It is a mix-ture of happiness and sadness that I am retir-ing and leaving Bethel. I’m giving my final bow to all the WIC families I worked and served; you gave me the opportunity and I took it.

Thank you for all the wonderful years I spent in the YK Delta, certain periods of our lives are rich with experiences and opportunities. That is how the last 19 years have been.

I offer my heartfelt thanks to those in the Corporation who pro-vided support for my initiatives over the years. I have gained a great deal from working here, and I hope I have been able to return at least part of what I have gained in loyalty and value to the Corporation.

Gratefully,Ester C. Ocampo, RD, LD, LE

WIC has always promoted breastfeeding—the most nutri-tious of all natural foods.

Ester Ocampo, retiring after 19 years.

12

Family Medicine: Change leads to improvements

for Outpatient Clinicsby Danielle Dizon, YKHC Public Relations

In 2003, YKHC made significant improve-ments to provide continuity in care using a model referred to as “Advanced Access.”

This involved assigning each patient a specific medical provider and requiring appointment scheduling at the Bethel Hospital.

“Our patients were experiencing long wait times and we were hearing from our customers that they wanted to see the same pro-vider,” said Patricia Smith, Patient Care Services Administrator. “Since the inception of Advanced Access, changes resulted in con-siderable patient-focused improvements in our system of care.”

Now that patients are seen on an appointment basis and visiting with the same provider, satisfaction rates are increasing. Wait times have improved in the last two years, but turnover rates have caused a staff shortage, increasing patient care demand for each provider, causing longer wait times during high volume occa-sions.

In the last two years, eight providers have left, including Dr. Jen-nifer Scearce; Dr. Daniel Smith; Leanne Abernathy, NP; Janet Brindley, NP; Katrina McCoy, NP; Laura Whitman, NP; and Hazel Julius, PA-C. In 2006, the hospital experienced a 25 percent turnover rate in providers (including physicians, pediatricians and mid-levels).

Faced with provider shortages, system changes were made to align patients with providers and meet the patient care demand.

“To keep up with these changes we’ve had to reassign some of our village and Subregional Clinics and assign patients with medical providers who have recently joined our staff,” said Louise Reed, Outpatient Clinic Manager.

New providers who have joined family medicine staff: Dr. Kim Whitaker; Anne Komulainen, PA-C; and Beverly Burden, PNP.

Another adjustment in services involved the integration of Pediat-rics into Family Medicine. This change took place in August.

“The consolidation has helped balance daily supply and demand and will improve our overall patient care system,” said Jack Robert Crow, Vice President for Health Services.

For many years the Pediatric clinic treated children with chronic or complicated health problems. Pediatricians now team with current physicians and mid-level providers, allowing for better staff resources in the clinics and efficiency in overall patient care services.

“Our new way of work-ing brings Pediatricians and Family Medicine Providers together in each clinic to fully address the needs of children and adults in the same unit,” added Crow.

As a result of the integration, just during the month of October, the Pediatrics team has nearly doubled their patient volume compared to last year.

Many providers are seeing as many as 20 patients in one day and just in the past year YKHC has experienced 300,000 patient visits

As a result of the integration, just during the month of October, the Pediatrics team has nearly doubled their patient volume compared to last year.

Martha Flores, PA-C, talks with a patient.


system-wide, which includes Health Aide visits at village clinics and mid-level visits at our subregional clinics.

“Under such demanding staffing circum-stances, all our medical staff deserves utmost appreciation,” said Crow. “They continue to meet our patients’ needs while delivering exceptional service.”

YKHC wants to thank all customers for your patience as necessary changes are made to con-tinue to work toward our vision of becoming the healthiest people.

To schedule an

appointment, call 543-6442

or 1-800-478-3321, and you

will be transferred to the

appropriate clinic scheduler.

As a reminder, patients

should register 30-minutes

prior to scheduled

appointment time and call

to cancel an appointments.

Meet the New Family Medicine Providers

Anne Komulainen, PA-C

Certification: Graduated from Nova Southeastern University in Ft. Lauderdale, FL in 2004.

Specialty: Family Medicine

Experience: Previously, she worked in Internal and Family Medi-cine in Okeechobee, FL for two and a half years as a PA.

She loves to read, exercise and take care of her two-and-a-half year old daughter.

Kimberly Whitaker, MD

Certification: American Board of Family Medicine 2006

Specialty: Family Medicine

Experience: Came to YKHC in August 2006 after completing residency in Alberquerque, NM

She enjoys music, reading and ballroom dancing.

Spreading the message of prevention, Galson stated its importance in battling major health concerns facing the American people. “We view prevention as one solution,” said Galson. “We are focusing on prevention all over the country.”

Other health issues that were discussed included HIV, tobacco control, suicide and alco-holism. The Surgeon General also mentioned his special interest in underage drinking, expressing that it is a thread causing unintentional injury nationwide.

“I am impressed with the challenges facing your region and am amazed at how organized you are,” said Galson at the meeting.

Since October, Galson has served as the nation’s top public health physician as Surgeon General. He communicates the best science, evidence and data in order for Americans to make healthy choices that impact health, safety and security. Additionally, he serves as the operations Commander of the Commissioned Corps of the United States Public Heatlh Service, a uniformed force of health professionals, which includes a select group working here at YKHC.

SURGEON GENERAL, from p. 9

Ashton and Haven Simon, with their mother Jamie Simon, all from Hooper Bay. File photo by Katie Baldwin.

Bethel Car Rental and -Bethel Emergency Volunteers Services Association (BEVSA). Kilbuck and the National Guard also donated the use of their site for the event. Thanks to all these groups!

While we hope the need for such a mass dispensing doesn’t happen, we will be prepared for it. If you have questions about mass dispensing exercise, or would like to find out more about how to have one in your community please call Public Health Nursing at 543-2110. If you would like your flu shot and missed the opportunity, please go to your Village Clinic or, in Bethel, to YKDRH, Public Health Nursing or Bethel Family Clinic. Have a safe and healthy winter! p

MDE, from p. 8

14

Alaska Native Workforce Development

Career Pathways Program: Growing Our Ownby Danielle Dizon, YKHC Public Relations

While YKHC’s Recruitment office is busy attracting and interviewing potential health professionals from

all over the U.S., the Career Pathways pro-gram is recruiting young health care profes-sionals right here at home, building a work-force that in the next few years, Recruitment will be able to call upon.

YKHC’s Area Health Education Center’s (AHEC) Career Path-ways program is dedicated to promoting health careers and recruiting young health professionals in the Yukon-Kuskokwim Delta.

“We believe in growing our own health care professionals,” said Laurinda O’Brien, Executive Director of AHEC. “The philoso-phy behind this is that they are more likely to work long term, providing YKHC with a strong workforce and continuity of care for our people,” said O’Brien.

Partnering with school districts to offer health career fairs, school-wide presentations, luncheons and job shadow opportunities is just part of the mission.

“Our vision is to offer opportunities for young people to expand their horizons,” said O’Brien. Part of this initiative has involved a job shadow program that allows students to get first hand observation and experience working in health service departments including Radiology, Nursing, Optometry, and Technology.

“It’s a great opportunity for students to gain exposure to health careers and job opportunities with YKHC,” said Nancy Widrig, Career Pathways Manager. “It’s a valuable learning tool to see if it’s something they’d be interested in.”

Sixteen students have been a part of the job shadow and work expe-rience programs this year, including six seniors from Bethel Regional High School who are in a yearlong on-the-job training program.

97 sixth graders also made their way through the hospital during summer tour sessions, visiting the Emergency Room, Obstetrics Unit, Pharmacy, Diagnostic Imaging, Dental, Optometry and Nico-tine Control departments.

Six students from Quinhagak, Kasigluk, Chefornak and Tununak also spent a two-week long internship in various departments ear-lier this year. The Lower Kuskokwim School District partners with YKHC to offer the Work Experience program, which flies students to Bethel to participate in job shadowing.

“We offer the job shadow program all the time,” said Widrig. “All students need to do is call. Students can even do more than one shadow.” A student must be 16 years old to job shadow in a YKHC facility and must be 18 to job shadow in the Dental Dept.

Above: Three young ladies from Akiak check out the career opportunities at YKHC’s Career Fair earlier this year: Deliliah Nicolai, Charity Owen, and Erlene Jones. Top: Sixth Grade students tour the Hosptital, getting career ideas.


Hometown advantage is also a challengeRecruiting future health care professionals is not an easy task with other high demand workforce agencies calling upon local workers as well.

“We’re competing with the high growth industries like mining and construction, ” said O’Brien. “We want to educate our young people so they know about the different opportunities and career options in their community, such as becoming a nurse, doctor, health aide or lab assistant.”

Gail Alstrom, Stanford University graduate and St. Mary’s Subregional Clinic Manager of six years, spoke of the challenges involved in main-taining a full-staffed medical facility, which pro-vides services to four surrounding villages.

“I have a hard time filling my professional posi-tions. For our mid-level positions (Physician Assistants and Nurse Practitioners), there’s no one that’s locally trained to fill these positions so we’re having to hire outside,” said Alstrom.

However, it’s not just the professional positions that are difficult to recruit. “Health Aides are the hardest to recruit for because of the nature of their job, being on-call as the first responders in any incident.”

Alstrom described the challenges or working at home where everyone knows you. “It’s challenging but you learn to work in a confidential and profes-sional environment, caring for your people.”

As a mother of six, she proudly says she has no plans of leaving the community she grew up in. “We just built a new house and don’t plan on moving anywhere.”p

If you’d like YKHC Career Pathways

to visit your school or you’d like

information on local and regional

health career programs, please

contact Nancy Widrig, Career

Pathways Manager at 543-6986 or

1-800-478-3321. You can also email:

[email protected]

Become a Health AideTalk to your Tribal Council to find out if there are Health Aide opportunities in your community or you can call YKHC’s Community Health Aide Program at 543-6160 or 1-800-478-3321 ext. 6160.

Become a Primary Dental Health Aide Call Kathy Balasko at 543-6229 or 1-800-478-3321 ext. 6229.

........?Who do I call911State Trooper 1-800-764-5525or Village VPSO

Life-threatening emergency...Active suicide attempt, overdose, incident involving weapons, possible serious harm to somebody, person threatening to kill or seriously hurt themselves or somebody else

543-6300or 1-800-478-2642YKHC Emergency Services for Behavioral Health on-call Clinician

Mental health situation...Somebody might need to be committed to psychiatric hospital in Bethel or Anchorage—acting bizarre, out of touch with reality, maybe seeing/hearing things that are not there, “talking crazy,” maybe talking about suicide

1-866-465-8930ComPsych Employee Assistance Program

Personal or family problems...A YKHC employee or family member needs help dealing with an alcohol or drug problem, depression, job stress, marriage or financial problems, grief issues, domestic abuse, or similar problems.

1-800-478-3321or 543-6100 in BethelBehavioral Health Critical Incident Stress Management Program pager #3203

After a disaster or tragedyThere’s been a terrible event in my village—a suicide, bad accident with injuries, multiple deaths, etc. and we need help coping with all of this

Working Together to Achieve Excellent Health

16

Employee Focus

Any of us could experience a traumatic event that affects us and our communities.

A Critical Incident is an unusually challenging event, such as a murder, suicide, fatal accident or a mass disaster that has the potential to create significant human distress, and can overwhelm us.

In the event of a critical incident, YKHC has a team of trained debriefers who can provide Critical Incident Stress Management (CISM).

“We traveled to seven villages this year in response to traumatic events, and coordinated responses in several other villages, some involving follow-up visits.” said program Coordinator Louis Mal-lette.

CHAP (Community Health Aide Program) Support Counselor Carl Evans provided ongoing support and counseling for health clinic staff and SIs during the year and has conducted group debriefings as well as individual interventions.

Along with direct services such as counseling and intervention, CISM staff also offer training courses. In March, the program organized a four-day Basic CISM training, in which 15 people were certified to provide Individual Intervention and group Criti-cal Incident Stress Debriefing services. Trainees included YKHC Behavioral Health Aides and Clinicians, an Alaska State Trooper, a psychologist from Anchorage, two YKHC nurses, a CHAP Supervisor Instructor, and a CHAP manager.

Discussing a hypothetical mass disaster and planning a response— Andrew Jasper from Akiak, Martha Simon from Hooper Bay, Maggie Harpak from Emmonak, all Behavioral Health Aides, and Louis Mallette, CISM Coordinator, from Bethel.

Critical Incident Stress Management:

Employees learn to help others in crisis

Another training was held in October—25 people from YKHC’s Behavioral Health Department, the YKHC Sexual Assault Response Team, the YKHC Women’s Health program, and the Alaska State Troopers were certified in Basic Group and Individual CISM.

“This training greatly increased the number of villages with CISM-trained individuals, and expanded agencies’ existing CISM capabili-ties,” Mallette said.

Some of these people who had received basic CISM training partici-pated in advanced training for certification in November. This train-ing was designed to prepare CISM team members to be response team leaders.

Further such trainings are in the works for next year. The program is also considering a Suicide Prevention, Intervention, and Post-intervention class. p

To request a CISM response, or for

more information, page the CISM

coordinator through the Hospital Operator,

1-800-478-3321 or 543-6000, and ask

for pager # 3203. If no response, page

Behavioral Health on-call or Admin on-call

through the Hospital Operator, let them know

what the situation is, and ask them to contact

the CISM program as soon as possible.


Financial Viability

Although YKHC receives government funding through the Indian Health Service, our financial viability depends on also being able to bill Medicare, Medicaid and health insurance companies for services we provide to patients who are eligible for such coverage or do not qualify as IHS beneficiaries. The more you understand about why we do this and how insurance companies operate, the better we can help you — while also keeping us financially healthy.

This is the first of a series of articles about health insurance, starting with the basics.

Health Insurance Basicsby Joan Carr, YKHC Revenue Supervisor

Understanding health insurance can be frustrating as well as frightening. This article will help you understand the basics.

Co-Pay — the amount you pay every time you get a medical service. Some insurance plans have different amounts for specialists and the emergency room. These amounts are usually printed on the front of your insurance card. It is important to bring your insurance card with you when you go to get medical care. The physician’s office or hospital will need the information on the front (group number and member number) as well as the correct billing information (usually found on the back of your card).

Primary Insurance — This is the first insurance that will pay on your claim. If you have more than one insurance, it is important for you to know the order in which the insurance plans will pay.

Secondary Insurance — This is the second insurance that pays. Most people think the husband’s insurance pays first and the wife’s insurance pays second; this is not necessarily true. Contact your insurance plans for the specifics. Some secondary plans will pay for the deductible from the primary insurance. In our previous example, the secondary insurance could have paid the $75 deductible. Do not assume this will happen, it is best to check.

Always remember that the best time to get this information from your insurance plans is before you are ill or have an emergency. Your employer and your plan’s benefit book or customer service department are your best resources. p

If you have specific questions about a YKHC bill,

our patient information line is available. Please

make sure you have your insurance information

with you when you call to discuss your bill:

Patient Accounts 907-543-6398

Health insurance information is most needed when someone is sick. This is not usually a time when anyone wants to take the time to understand it.

Here are some basic definitions, with understandable explanations:

Participating Provider — a physician or other healthcare provider that is part of your insurance plan’s network of providers. This pro-vider can be an ambulance company, a hospital, a pharmacy, optom-etrist, medical equipment supplier, physical therapist, etc.

Tip: Whenever you change insurance companies make sure your providers will be a part of the new plan’s network; otherwise, services may not be covered or may require higher payments from you.

Deductible — a yearly out-of-pocket cost to you as part of your insurance plan. This amount must be paid by you before your insur-ance will pay. For example, if your deductible is $75 and the visit to your physician’s office was $100, you would have to pay the deduct-ible and your insurance would pick up the $25, if the $100 was the allowable fee.

Allowable Fee — sometimes called the contracted amount, this is what your plan will pay for a specific service, if the service is covered in your plan. For example, a covered service under most plans is an office visit for a sinus infection. An office visit for ear piercing is usu-ally considered a non-covered service and most insurance plans will not pay for this. In the previous example, as long as the visit is cov-ered, your insurance should pay the $25.

18

Bethel Detox Alternatives ProjectYKHC Office of Public Relations

In 2007, the Alaska Mental Health Trust Authority and the State of Alaska’s Division of Behavioral Health embarked on a project to

help communities that have significant public safety and emergency room problems with alcoholism to identify solutions to assist Alaska communities.

YKHC received a grant from the Trust through the State in August and in September entered into a contract with the Mary Elizabeth Rider Consulting Group to help the community and region assess its current status and options.

Their job is to interview key informants, conduct a literature review, identify and review data from YKHC, Yukon Kuskokwim Correc-tional Center, and the Bethel Police Department about inebriated people, facilitate meetings within the community and between the community and the State of Alaska—then in early 2008 deliver a plan of action including factors that outline the community’s preferences in addressing the inebriates and alcoholism.

In late October, the consulting team interviewed approximately 25 key people who deal with the issue of inebriated individuals, their safety, their health care, and their families to help understand the problem and how it directly and indirectly affects the community.

In November, 30 local residents gathered to review the preliminary report from the interviews and talk about the current ongoing situ-ation of inebriated people in Bethel. The report states that police are the first line of response in alcohol related incidents and are man-dated to address the problem under current Alaska statutes (Title 47.37), but do not have the necessary staffing available. They also get burned out by having to constantly deal with this social prob-lem, according to the report. It takes a half hour to four-and-a-half hours for a police officer to admit someone to the YKHC Emergency Room.

The need for safe pro-tective custody holding capacity is staggering. The ER at the hospital in Bethel has nine beds. It typically receives three to four people for protective custody each day, sometimes as many as 13 per day. Last year’s total came to more than 1,000 admissions. Additionally, many protective custody cases have other medical problems involved besides alcohol. These may include being suicidal or having physical injuries and may require additional special attention.

Since 2004, inebriate youth cannot be taken to the Bethel Youth Facility for sleep-off, so all youth must go to the YKHC ER. At least 300 minors are currently being admitted each year. The Yukon-Kuskokwim Correctional Center in Bethel does 12-hour pro-tective custody holds in two rooms—five inebriates per room. Those who are severely intoxicated must go to the hospital for medical care and clearance. Often, the women’s protective custody room at the jail is filled with men, which requires women to be referred to the YKHC Emergency Room.

Calling for action, the Bethel group that reviewed the consultant’s findings declared a crisis in emergency response, substance abuse treatment, and community health. They will research the issues and the response capacity surrounding this crisis, and hold another community meeting January 7, 2008, with key policymakers in state government, local governments, and regional agencies and with the Alaska Mental Health Trust.

Following the next meeting, the consultants will work with commu-nity members to prepare a draft report on the next steps for the com-munity. The draft report will be available for the community’s review in late January followed by a final report to be delivered by the first of March, 2008.

Armed with these locally-sensitive potential solutions, the com-munity can approach the Alaska Mental Health Trust Authority and State of Alaska about its plan to locally manage inebriates and alco-holism with their financial help. p

Alcoho-related admissions to the Emergency Room have been on the rise in recent years. With limited ER resources, the problem is nearing crisis proportions.

In 2006:1,171 patients admitted to ER for •alcohol-related incidentsvisits increased by 75 percent since •2001For every four adults, one minor •was seen


Got Air!Aneryaarvingqertukut!

Bethel — First in Alaska to Clear the Air: 1998-2008Ten years ago Bethel became the first city in Alaska

to clear the air. The city passed an ordinance

addressing clean indoor air and worker health.

In celebration of this event ATCA selected Bethel

as the site for the second annual ATCA summit.

Summit ‘08February 5–6, 2008

Alaska Tobacco Control Alliance


Non -Profit Org.US Postage

PAIDAnchorage, AK

Permit # 537

Yukon-Kuskokwim Health CorporationP.O. Box 528Bethel, Alaska 99559907-543-6000

A Holiday Message from Diabetes Prevention & Control

Angniq Alussistuaq! Slaaviqegcikina! Angniq Nutaaraq Allrakug!by Annette Coyle, RD LD, Clinical Diabetes Educator

Whatever our faith tradition, the early darkness at this time of year encour-

ages us to focus on the inner light that guides us. For many of us, giving

gifts is part of our holiday customs.

Giving can be done in many ways. Traditional Yup’ik and Cup’ik values

incorporate the principles of giving service to others, helping other people,

and being helpful to one another.

As the year draws to a close, we long to gather family and friends close as

we celebrate the season. Let’s each remember to share the warmth of our

hearth and home with someone in need and to share the holiday spirit with

everyone we meet.

For people with diabetes, the holiday season can be a time of increased

stress and difficult choices. Stress can increase blood sugar levels as can all

of those special holiday “goodies.” Think of positive ways to cope with the

stress and temptations.

Stick with sugar free and diet drinks • and just plain water.

Get some exercise after big meals.•

Before heading to a party or feast, take • a few minutes to decide how much you will eat. Plan ahead.

Drink a glass of water before going to a party or feast.•

Save the DVDs and computer games until after dark. Use the • daylight hours to enjoy outside activities.

Serve a sugar-free beverage and small pieces of cake after • Slaaviq caroling.

Documents

Seasons’ Greetings from the YKHC Board of Directors · April TBA Tribal Gathering XV April 22 Finance Committee April 23–25 Semi-Annual Full Board Meeting ... we must also be