Vol. XVIII No. 2 • April / May 2013

Working Together to Achieve Excellent Health

Tribal Gathering delegates set priorities

What of the Sequester?

With Congress’s failure to pass spending and tax reforms before the end of last year, across-the-board funding cuts have hit all federal programs and services, including the Indian Health Service.

These “sequester” cuts are expected to cost YKHC about $4 million between now and the end of the fiscal year Sept. 30. President/CEO Gene Peltola says there is now a hiring freeze on all positions except for those that directly affect patient care or are otherwise essential, and only essential business travel will be allowed.

Blood Bank CEO Visits

Blood Bank of Alaska (BBA) CEO Robert Scanlon visited YKHC April 25, meeting with YKHC CEO Gene Peltola and taking a side trip to the Toksook Bay Subregional Clinic.

For the past two years, YKHC has sup-ported a community-wide blood drive, partnering with the Blood Bank of Alaska, Alaska Airlines, and many other local agencies and individuals. YKHC’s Nabil Daoud is a principle organizer of the event and joined in planning discussions with Mr. Scanlon for the next blood drive, expected to take place in September.

More on the Web: www.ykhc.org

• Health Aide Session 1 Training• ALL the Tribal Gathering priorities• Health Aides of the Month• Link to nearly 250 job listings at YKHC• Service and Program information

Tribes say decreasing ER wait times top priorityThroughout the 20-year history of YKHC Tribal Gatherings, dissatisfaction with long waits to be seen at the Bethel Hospital—outpatient clinics as well as the Emergency Room—has been among the top 10 priorities for change listed each year by delegates representing the 58 Tribes that make up the YKHC service area.

This year the delegates voted decreasing ER wait times their number one priority.

The issue has not been ignored; YKHC leadership and hospital administrators have initiated new appointment procedures in the ER and outpatient clinics, such as Fast Track (see “Tired of Waiting?” below) in recent years and wait times have improved. Patients coming to the Emergency Room, however, are seen according triage—those whose needs are most dire are seen first. A patient whose illness or injury can wait, sometimes will have to wait. Never-theless, YKHC’s leadership teams will be taking a good hard look at how to make improve-ments.

Also on the tribes’ priority list: service improvements at the hospital and the subregional clinics, more cancer screening and research, support for Health Aides, and funding for vil-

lage sanitation projects (see “Top Ten”)

The YKHC Board of Directors, meeting just a couple weeks after the Gathering, consolidated the priorities list to three main areas for focus-ing improvement efforts in the coming year: Work on reducing the ER wait times, increase provider travel to subregional and village clin-ics to provide more services, and increase can-cer screening and prevention/education efforts.

YKHC Medical Director Dr. Joseph Klejka, who presented the Tribal Gathering report to

the Board, acknowledged that increasing services will be especially challenging in the com-ing year because of federal budget cuts, so it’s important to choose our “targets” wisely.

Why we “Gather”YKHC’s annual Gathering serves a two-fold purpose. The corporation reports on the status and progress of programs, facilities and services; the Tribal representatives identify health care concerns and determine their priorities for making improvements.

Nabil Daoud, left, with YKHC President/CEO Gene Peltola and Blood Bank of Alaska CEO Robert Scanlon in Toksook Bay.

Provider Profile

Our Provider Profile feature will return in the June/July issue of the Mes-senger with an article about another of our long-serving and popular family medicine practitioners: Dr. Daniel Hart-man. Dr. Hartman made a compelling presentation about the prevalence of pneumonia in our region during last month’s Tribal Gathering. We all look forward to getting to know him a little better.

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Many changes have come about as a result of Gathering priorities. Most recently, the skilled nursing facility now nearing completion in Bethel and a new Prematernal Home under construction. Add to the list: CT scanning at the hospital, regional medevac services, a Sobering Center, subregional health clinics and many service improvements designed to bring culturally relevant health care closer to home.

The Three-Day GatheringFollowing last year’s listing of Behavioral Health concerns such as suicide prevention and alcohol treatment at the top of the list, this year’s Gathering included an extra full day devoted to YKHC’s Behavioral Health programs and services.

Keynote Speaker Dr. Clyde McCoy of the University of Miami emphasized the importance of accounting for culture in scientific studies and medical research, and programs developed as a result.

Cultural relevancy is central to YKHC’s vision, and is embraced whole-heartedly by Behavioral Health programs. The McCann Treatment Center’s subsistence-oriented education component is a prime example. The program’s clients, Alaska Native boys who struggle with drug abuse and alcohol in addition to severe emo-tional trauma and behavioral difficulties, learn subsistence skills such as fishing and hunting in addition to the usual academic classes in math and science.

Traditional Yup’ik ways—ancestral wisdom and knowledge, skills, ceremonies, and subsistence living—are the basis of Behavioral Health’s Preventative Services’ approach to community and indi-vidual healing.

Behavioral Health’s day at the Gathering included informative explanations of YKHC’s varioius residential services, outpatient, counseling and emergency services. Links to the slideshows for these and all the other presentations shown at the Gathering are on the YKHC website at www.ykhc.org/tribalgathering.

The second day’s reports included a look at the region’s over-all health status, an update on clinic and hospital construction projects, care costs associated with the new nursing home, and the importance of vaccinations and prevention of disease.

YKHC’s biggest project of the preceding year was the electronic health record implementation—RAVEN (Records And Verification Electronic Network). President/CEO Gene Peltola said the $13 million cost of the project, mandated by the Affordable Care Act (Healthcare Reform of 2010), was drawn from operations profit of preceding years, not from YKHC’s savings funds. Over the past two years, nearly 1,000 employees have been trained with 14,000 staff time hours going into the effort.

The region-wide system went on-line on January 28, 2013, as scheduled. It turned out to be a smooth transition, with few prob-lems. With RAVEN, all providers in all facilities, from the clinic to the hospital, have access to the same patient record; the record is legible, the information is secure, the patient’s history and all

in the fight against Pertussisby Kateri Spinella, Immuniztion Coordinator

The staff at the Kwethluk Health Clinic has taken a pro-active stand in the fight against pertussis. Each person in the clinic helped to identify all the pregnant women in their community and screen them and their family members to ensure their vac-cines that protect against pertussis are up-to-date.

When the Kweth-luk health aides learned about the dangers of pertus-sis, they took it upon themselves to request additional doses of Tdap booster, and to begin making con-tact with the new mothers and family members who may come into contact with the newborn infants.

Working with doctors in Bethel to ensure the vaccine is administered safely to pregnant women, the clinic staff designates one Health Aide each day to adminis-ter vaccines to family members who will spend time around the newborn, this is called “cocooning”.

The entire staff exemplifies YKHC’s Mission: Working Together to Achieve Excellent Health.

STAYING HEALTHY

Why the fuss over Pertussis?Pertussis, also known as Whooping Cough, is a highly contagious illness caused by bacteria. It mainly affects the respiratory system. This is a very serious illness especially for babies and young kids, though people of all ages can get pertussis.

To help protect infants against the disease, pregnant women be-tween 28-36 weeks gestation can receive a Tdap booster (teta-nus, diphtheria, acellular pertussis). Pregnant women and family members are encouraged to talk to their doctors or Health Aides to receive the vaccine. All family members who could come in contact with the baby should be protected by vaccination before the baby is born.

For more information about pertusis and vaccine preventable ill-nesses please visit www.CDC.gov.

The Kwethluk Clinic staff: Top row from left to right: Olga Clark, Michelle Olick-Pavila, Alberta Fisher. Middle row: Martha Olick, Isaac Rivers. Third row: Martha Constantine, Jacqueline Alexie, Katrina Crane. Not pictured: Annie Sergie, Elena Larson.

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medications are listed and possible drug interactions are flagged.

The third day of the Gathering was dedicated to Tribal priority-setting and voting on the top issues for the com-ing year. See the results of the overall voting below. The complete listing of each election unit’s priorities is on our website at www.ykhc.org/tribalgathering.

Fast Track teams ER with Outpatient

Above: Ivan M. Ivan of Akiak and President/CEO Gene Peltola chat near the Diabetes outreach table. Right: Board Member James Sipary and Delegate John Andrews.

ER Fast Track was implemented July 1, 2012 to decrease waiting times in the ER by allowing patients who may have lower acuity to be seen sooner in an outpatient clinic.

The Fast Track opens between 5 p.m. and midnight and allows for the hospital outpatient clinic to see up to 20 percent more patients while alleviating some of the pressure and long wait times in the Emergency Room.

For an idea of what the ER department sees, here’s a snapshot since the beginning of 2013 through March.

• January: 1,791 ER visits. Fast Track: 313 or 17.4%• February: 2,392 ER visits. Fast Track: 402 or 16.8%• March: 2,441 ER visits. Fast Track: 385 or 15.7%

Some reassuring news—scheduling is now fully staffed and schedulers are able to book appointments 90 days out. Al-though there are perpetual staffing challenges due to a contin-ued need for more providers, YKHC Health Services is current-ly working on a communication initiative to remind patients to call and cancel their appointments if they are unable to keep them as the Did Not Keep Appointment (DNKA) rates have increased recently.

This will allow waiting patients to get an appointmnt more quickly if someone is unable to show up for theirs.

“Working Together”…

Gathering Goes North to Emmonakby Jay Gandy, Emmonak Subregional Clinic

Last year, shortly after the Tribal Gathering in Bethel, a team of nine people donated a Saturday to travel to Emmon-ak for a Health Fair designed to bring YKHC and local community members closer together through understand-ing and fun.

This year, the Emmonak Sub-regional Clinic (ESRC) did it again on April 20 as 17 team members from Bethel en-thusiastically volunteered to participate. Visitors and staff spent the day between the clinic and the Emmonak High School.

Nolan the Colon, the world’s largest inflatable colon, gave Donna Warner, FNP, the opportunity to explain the importance of being screened for colon cancer.

Other displays informed and entertained on health care topics,

Lindsey Fletcher with the Jason Foundation at North Star Behavioral Health, paints Rhiannon Kameroff of Emmonak.

reinforced with gifts, fun, and free food. In addition to activities at the school, Immunization/Well Child Coordinator Kateri Spinella staffed and coordinated a daylong immunization clinic at the ESRC.

After the clinic closed, Staci Bruce, PHN3, our newest Public Health Nurse, stayed in Emmonak for four more days offering im-munizations.

Members of North Star Behavioral Health were among the visi-tors, and Emmonak’s newest Behavioral Health Village Clinic Supervisor, Deirdre Piotrowski, introduced herself while painting children’s faces.

TOP TEN: Overall priority rating 1. Decrease Emergency Room wait times.

2. More alcohol/drug abuse POST RECOVERY/Treatment ser-vices for all-ages.

3. Want more comprehensive services at first hospital visit (don't want to schedule 2nd trip) for diagnosis and pre-vention.

4. Increase Cancer Prevention Screening to SRCs and Villages.

5. Seek more funding for Health Services.

6. Increased doctor visits to villages and SRCs.

7. Increase number of health aides for population

8. Increased support for Health Aides from villages.

9. Research causes of Cancer.

10. Increase homes with piped sewer services/improve sewer lagoons.

YKHC NEWS April / May, 2013

YKHC Website: www.ykhc.orgYK Delta Regional Hospital .............................................. 543-6000YKHC main switchboard ................................................... 543-6000 Toll Free ................................................................1-800-478-3321Yukon-Kuskokwim Delta Regional Hospital ............................................................... 543-6300

APPOINTMENTSOutpatient Clinics (Yukon, Kusko, Delta) ................... 543-6442Dental ..................................................................................... 543-6229Optometry ............................................................................. 543-6336Audiology .............................................................................. 543-6466

SUBREGIONAL CLINICSAniak SRC ...............................................................................675-4556Emmonak .............................................................................. 949-3500St. Mary’s ............................................................................... 438-3500Toksook Bay...........................................................................427-3500Hooper Bay ............................................................................758-3500

SERVICESInpatient (North Wing)...................................................... 543-6330Pharmacy............................................................................... 543-6382Physical Therapy.................................................................. 543-6342Women’s Health.................................................................. 543-6296Inirvik Birthing Center ....................................................... 543-6346Behavioral Health Services ...............................................543-6100 Substance Abuse Treatment PATC ............................543-6730 Sobering Center ............................................................ 543-6830 Developmental Disabilities .........................................543-2762Emergency Room ............................................................... 543-6395Home Care.............................................................................543-6170Office of Environmental Health & Engineering Injury Control & EMS .................................................... 543-6420

ADMINISTRATION & SUPPORT Administration ..................................................................... 543-6020Human Resources .............................................................. 543-6060Public Relations .............................................................543-6037/38Travel Management ............................................................ 543-6360Facilities & Maintenance ................................................... 543-6203

BETHEL & REGIONAL RESOURCESPublic Health Nursing.........................................................543-2110Tundra Women’s Shelter .................................................. 543-3444Alaska State Troopers ............................................1-800-764-5525

RESOURCES

ARE YOU EXPECTING? CENTERING PREGNANCY for you and your baby

Groups of mothers-to-be meet for two hours every week at the Bethel Hospital, creating a stronger relationship between them and their provider, as well as learning from other moth-ers. They also learn how to track their baby’s growth as they

progress through pregnancy.

Call 907-543-6346

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ESRC Dental Health Aide Therapists advanced preventative dentistry by applying fluoride treatments to children’s teeth and demonstrating the proper way to brush. Dental Assistants put on the tooth costume, which was a big hit with the kids.

Other participating departments included Community Health & Wellness teams addressing diabetes prevention and tobacco ces-sation, healthy hearts and WIC. Stephanie Rossland, YK’s Benefits Manager, showed visitors why YKHC is such a great place to work.

Session 1 Health Aides ready for the villageClick here to see the class picture of this Spring’s Session 1 class.

By Adeline Wiseman, Session 1 Health Aide, Chefornak

We are YKHC employees in the first Health Aide Training class of the year! We finished Session 1 on April 26, and then we returned home to start see-ing patients in our villages.

We were taught how to take care of people with different illnesses, such as sore throats, stomach pain, skin rashes, and pink eye. We were also taught how to start IVs, and what to do in emergencies, such as CPR, strapping trauma patients to backboards, putting on cervical collars for people with neck or back injury, and splinting broken bones.

Some of our favorite classes were learning how to care for com-mon respiratory and eye problems. I especially enjoyed drawing blood draw on my classmates! We were all really nervous about starting IVs and giving IV fluids through a patient’s vein but it was a great learning experience, and we were able to do it successfully. This is a procedure that can save the patient’s life!

We learned how to suture and take care of different types of wounds, such as animal bites, burns and cuts. We also enjoyed learning how to give immunizations and other kind of shots that can save a person’s life.

When we see patients, we get a full history and do a detailed exam of the problem. All Health Aides are required to use a book called the Community Health Aide Manual (CHAM). It is great guide that tells us what to do when caring for patients.

As a Session 1 Health Aide, we have to consult with a doctor, phy-sician assistant, or nurse practitioner for every patient we see. This process is called Radio Medical Traffic (RMT) because in the old days this communication was done by the old two-way radio.

Cindy Lawrence and Rena Tony practice IV insertion on dummy arms under the supervision of Basic Training Instructor Chester Mark.

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RMT is when we submit all the patient information we gather to medical providers in Bethel. They make sure we are doing every-thing correctly, and they recommend more tests or treatment, or they tell us to send the patient to Bethel.

In emergencies, some patients get transported by Medevac plane. Before the Medevac arrives, we are taking care of the patient and talking to the emergency room doctor by telephone. Many times it’s very scary because the patient can be a very ill baby who can’t breathe well or a trauma patient who is in a lot of pain. We may have to start an IV, give a shot of medicine, watch the patient’s blood pressure, pulse and respiratory rate every 15–30 minutes, or just comfort the patient before the Medevac team lands. We always breathe a big sigh of relief when the Medevac team arrives!

Seeing patients with RAVEN, YKHC’s new computerized medi-cal records, makes it easier to document everything, and it takes less time than paper charting. Also, we have access to all of the patient’s medical records from Bethel and sometimes Anchorage. Now we can help our patients better understand what’s happening with them.

We want to thank the health aide instructors for their time in teaching us. They are a staff of full time physician assistants and nurse practitioners at YKHC who are dedicated to teaching Health Aides all year round. They shared their wealth of knowledge with all of us. The instructors use a lot of different ways to teach us: lec-tures in the classroom, hands-on skills in labs, and seeing patients with us in the hospital or village clinic. We are also thankful for the patients who allow us to see them. It takes us longer to see them because we are just getting started. But it helps us to become bet-ter Health Aides.

As a Community Health Aide, being able to take care of a patient and treat their illness is a very rewarding career. I would do my job even if I didn’t receive a paycheck! To me it’s not about the money but being able to make someone’s life healthier and better. There is a lot of satisfaction in seeing the gratitude and smile in patients when you helped them through a hard time.

SESSION 1, from previous page

Alaska Native Workforce Development

GOAL: Initiate YKHC Native “Management Training” program by May 1, 2013 and complete initial cohort by Sept. 30, 2013

Compass Manager TrainingIn alignment with our 2013 Alaska Native Workforce Development (ANWD) goal, we are proud to announce the launch of our Native management training program, COMPASS.

Nominations are in and the first cohort of candidates is being selected now.

Compass is a management program for Alaska Native employees not currently in management but who demonstrate management capability and leadership by going above and beyond what is asked or expected of them.

The 12-week training program will focus on key management com-petencies linked with our Napartet pillars:

Patient Centered Excellence – Customer Focus

Employee Focus – Human Resource and Workforce Planning

Alaska Native Workforce Development – Leadership Manage-ment

Community and Partner Satisfaction – Productivity and Program Evaluation

Financial Viability – Financial Acumen

Employees will be able to maintain their current positions at approxi-mately 50 percent time throughout the program.

YKHC’s strategic plan for achieving excellence in health care is called Napartet, a Yup’ik word for a ship’s mast, a trail marker, or a supporting pillar.

January 2013 Health Aide of the Month: — Story by Martha Attie, Supervisor Instructor

Theresa Twitchell, CHA II in Kasigluk, became a Community Health Aide in November, 2011. Since I’ve hired and known her, her skills as a CHA show that she works and cares for her patients.

She is also friendly, understanding, and asks questions when in doubt. She has children and is busy at home as well.

When I observed her work as a Health Aide, she was comfortable and her hands-on skills were professional. On the first of this year she was on-call and she gave her first peds IV. Dr. Bowerman sent this message to her supervisors, “I’m very impressed with Theresa who made a big difference in a dehydrated 8 year-old this morning at 2 a.m. by placing her first peds IV. It’s a pleasure working with these CHAs.”

Talented CHAs like Theresa are great to have in our clinics. They can save lives working with our providers and following their train-ing skills and CHAM. Thank you, Theresa, for your dedication to providing excellent health care!

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February Health Aide of the Monthby Agnes Changsak, Supervisor Instructor Lena Stewart, CHA II, is one of two Community Health Aides in Upper Kalskag and has proven to be a dedicated health care provider in her community. She continuously delivers exceptional patient care as demonstrated in a situation that was recognized by Melanie Boyer, a Basic Training Instructor here at YKHC.

“The first thing I wanted to do was to thank her for saving a young boy’s life. If it wasn’t for her caring for him and insistence on get-ting this boy into Bethel through strong advisement to the boy’s father and the RMT provider ASAP, he probably would not have made it,” Boyer said.

Our Emergency Department sent him to ANMC shortly after ar-rival in Bethel when they determined he needed more advanced medical care.

This Health Aide quickly realized the urgency of the situation and took appropriate steps to help this boy, a true example of focusing on patient-centered excellence.

Although Lena has other personal demands, she tirelessly goes out of her way to help her community when she is needed. Every time I talk with her she is very professional and calm. I always ask if she needs rest or anything she always refuses and responds with “No, I’m good.”

The people in this community, and the child she helped in particu-lar, can go on with their daily lives because of Lena’s dedication to the health and well-being of her community. There are not words enough to thank her for a job well done!

Please join the CHAP Department in congratulating Lena for Feb-ruary Health Aide of the Month!

CONGRATULATIONS WINNERS!

24th Annual Smile Alaska Style Campaign held March 23, 2013 at Camai Dance Festival, Bethel, Alaska

Best of Smile Alaska Style(Best Oral Health, Best Smile, Best Regalia)

Smile Alaska Style

identifi es individuals

who are role models

for good oral hygiene.

These folks will join the

Fourth of July parade

on the YKHC Dental

Dept. Float!

YKHCDental Dept

Best Oral Health: Charlee Korthius, Bethel

Best Smile: Aiden Nerby, BethelBest Regalia: Constance Samuelson, Bethel

Best Oral Health, Best Smile, Best Regalia: Kara Domnick, Bethel

Best Oral Health: Catherine Jackson, Quinhagak

Best Smile: Denise Nerby, Bethel

Best Regalia: Catherine Moses, Fairbanks