INSIDE: Sleds & Snowboards, p. 4 Medical Families, p. 6 Nursing Grads, p. 14

Volume XIII No. 12 December 15, 2008 Wishing you warmth and happiness this Holiday Season from the YKHC Board of Directors INSIDE: Sleds & Snowboards, p. 4 Medical Families, p. 6 Nursing Grads, p. 14

2 Board of Directors Unit 1 Raymond F. Waska, Sr. P.O. Box 46 Emmonak, Alaska 99581 907-949-1514 Paula Ayunerak P.O. Box 5 Alakanuk, Alaska 99554 907-238-3212 Unit 2 Ray Alstrom P.O. Box 8 Marshall, Alaska 99585 907-679-6320 James C. Landlord P.O. Box 32168 Mt. Village, AK 99632 907-591-2531 Unit 3 Wayne Morgan P.O. Box 234 Aniak, Alaska 99557 907-675-4264 George S. Morgan P.O. Box 54 Upper Kalskag, Alaska 99607 907-471-2490 Unit 4 James Nicori P.O. Box 41 Kwethluk, Alaska 99621 907-757-6837 Moses Peter P.O. Box 57 Tuluksak, Alaska 99679 907-695-6426 Unit 5 Bill Kristovich P.O. Box 1037 Bethel, Alaska 99559 907-543-4151/2212 Henry Hunter, Sr. P.O. Box 632 Bethel, Alaska 99559 907-543-7963 Gloria Simeon P.O. Box 308 Bethel, Alaska 99559 907-543-5676 Joseph C. Bavilla P.O. Box 6011 Napaskiak, Alaska 99559 907-737-7665 Unit 6 Esai Twitchell, Jr. P.O. Box 121 Kasigluk, Alaska 99609 907-477-6309 Unit 7 David O. David P.O. Box 78 Kwigillingok, Alaska 99622 907-588-8484 Unit 8 James R. Charlie, Sr. P.O. Box 37012 Toksook Bay, Alaska 99637 907-427-7114 James Sipary P.O. Box 37134 Toksook Bay, Alaska 99637 907-427-7816 Unit 9 Patrick Tall P.O. Box 196 Chevak, Alaska 99563 907-858-7613 James Hoelscher P.O. Box 189 Hooper Bay, Alaska 99604 907-758-4616 Unit 10 Sam W. Alexie P.O. Box 57 Eek, Alaska 99578 907-536-5428 Unit 11 Marvin Deacon P.O. Box 45 Grayling, Alaska 99590 907-453-5195 Honorary Board Member Paul John P.O. Box 37067 Toksook Bay, Alaska 99637 907-427-74l4 Numbers to Call YKHC Main Operator... 543-6000 Toll Free... 1-800-478-3321 Public Relations... 543-6038 Media Services... 677-2232 Office of Environmental Health & Engineering... 543-6420 Technology Help Desk... 543-6070 Human Resources... 543-6060 Administration... 543-6020 Hospital... 543-6300 Emergency Room... 543-6395 Hospital Community Relations... 543-6350 Social Services... 543-6225 Family Medicine Clinic Appointments... 543-6442 1-800-478-3321 Appointments Dental Appointments... 543-6229 Optometry Appointments... 543-6336 Audiology Appointments... 543-6466 Subregional Clinic Appointments Aniak... 675-4556 Emmonak... 949-3500 St. Mary s... 438-3500 Toksook Bay... 427-3500 Public Health Nursing... 543-2110 Pharmacy... 543-6382 Travel Management Center... 543-6360 WIC Program... 543-6459 Health Services... 543-6024 Village Operations... 543-6160 CHAP... 543-6160 ICEMS... 543-6080 Community Health & Wellness... 543-6190 Behavioral Health Services... 543-6100 Phillips Ayagnirvik... 543-6700 Village Services... 543-6740 Home Care Services... 543-6170

Board honors Paul John at annual meeting Two new members sworn in The annual meeting of YKHC s Board of Directors was held Nov. 19 21 in Bethel. In a special ceremony on Nov. 21, the Board, by proclamation, named their Board Room in the Community Health Services Building the Paul John Board Room. Toksook Bay Elder Paul John has been a YKHC Board Member since the corporation was founded in 1969. By virtue of his service and dedication to the health of the people of the region, he was named Honorary Board Member for life more than 10 years ago. A permanent plaque mounted on the wall in the third floor board room reads, It is important to strive for health promotion and family wellness in our communities and to apply Native values and harmony to guide improvements in our health care delivery system. New Members Welcomed Two new members were seated to the YKHC Board of Directors at last month s full board meeting. Patrick Tall of Chevak will be replacing Elmer Simon of Hooper Bay, representing Unit 9. Unit 9 includes the villages of Hooper Bay, Chevak and Scammon Bay. Marvin Deacon of Grayling is new on the Board and will be representing Unit 11 Grayling, Shageluk, Holy Cross and Anvik. This seat was formerly held by Kathy Chase of Holy Cross. Executive Board, Governing Body and Committees Executive Board Ray Alstrom, Chair Bill Kristovich, 1st Vice Chair James Charlie, Sr., 2nd Vice Chair Esai Twitchell, Jr., Secretary Marvin Deacon, Treasurer Raymond Waska, Sgt.-At-Arms Board Chairman Ray Alstrom congratulates Paul John after the Board room dedication. Sam W. Alexie, 1st Additional Member Paula Ayunerak, 2nd Additional Member Gene Peltola, Ex-Officio Paul John, Honorary Member see COMMITTEES, p. 12 Patrick Tall of Chevak will represent Unit 9. Marvin Deacon of Grayling is the new representative from Unit 11. Volume XIII No. 12 December 15, 2008 YKHC Board & Committee Meetings 2009 January 20 Finance Committee January 20 21 Hospital Governing Body February 17 Finance Committee February 18 19 Executive Board March 17 Finance Committee March 17 18 Hospital Governing Body April 1 2 Tribal Gathering, Bethel April 21 Finance Committee April 22 24 Full Board of Directors May 19 Finance Committee The Messenger Quarterly is printed in December, March, June, and September. 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 Editor, Public Relations, Yukon-Kuskokwim Health Corporation, P.O. Box 528, Bethel, Alaska 99559. E-mail: messenger@ ykhc.org. 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 reprint articles or pictures. 2008, Yukon-Kuskokwim Health Corporation. 3

4 Kaydean Andrews, along with every other K-6 student got a sled. Photos (clockwise) by Phillip Duffy, Mae Pitka, and John Townsend. Daren Kozevnikoff discovers the thrill of snowboarding thanks to a Diabetes Prevention Grant used to purchase outdoor winter recreation gear for Russian Mission School. Preventing Diabetes with Snowboards and Sleds in Russian Mission By Jason S. Moen, Instructional Leader, Russian Mission School Thanks to a Diabetes Prevention Grant from YKHC, Russian Mission students are hitting the slopes to fight diabetes. The long winters of the Yukon-Kuskokwim Delta have long posed a problem for getting young adults out and exercising. While basketball and open gym have always drawn some students, the school was seeking ways to involve as many students as possible. Russian Mission s Winter Sports Grant included three components each geared towards different age groups and interests. The first goal was to put a sled in the hands of each and every student in grades K-6. Fifty-six Ski-Doo sleds were purchased at Costco one for each student in grades K-6. The next component was the purchase of snowboards. Rather than purchasing five brand new snowboards and bindings, teacher John Townsend visited several Cash Alaska pawn shops and purchased 15 lightly used snowboards with bindings for approximately $100 each. The sleds and snowboards were shipped out to Russian Mission with Frontier Flying Service and completely filled the Cessna 402. Upon arrival, students waited anxiously for the snow to fall. As the snow fell one February afternoon, students stepped away from the TV, unplugged the video games, turned off of their snowmachines and hit the slopes. Every student with a sled was running up and sliding down the hill. Older students shared the snowboards and other students brought out their own boards. Jumps were built, tricks were attempted and by the end of the evening, there were plenty of wipeouts and plenty of smiles. The biggest adventure of the year included an overnight snowboarding trip to the Kako Retreat Center 12 miles from Russian Mission. Students met up with college students on spring break for a week of fun on the Kako Hills. The third and final component includes adding to the school s cross-country ski equipment. Once all of the gear is purchased, the students and staff of Russian Mission School hope to spend a few days with the students and staff of Marshall Schools and share in the fun of sledding, snowboarding and skiing. Aaron Minock and his snowboard. Jeanette Kozevnikoff recovers from a spill.

Did you know? Second hand smoke found to impair childhood learning Secondhand smoke exposure impairs a child s ability to learn. It is neurotoxic even at extremely low levels. More than 21.9 million children are estimated to be at risk of reading deficits because of secondhand smoke. Higher levels of exposure to secondhand smoke are also associated with greater deficits in math and visuospatial reasoning. Source:Yolten, K. et al., Exposure to Environmental Tobacco Smoke and Cognitive Abilities of U.S. Children and Adolescents, Environmental Health Perspectives, 113(1): 98-103. http://no-smoke.org/document.php?id=212 FLU SHOT FACTS Who should get the flu shot? Anyone 50 years of age or older.. All children 6 months through 18 years of age. All women pregnant during flu season. Anyone with long-term health problems. Anyone with a weakened immune system. Long term steroid treatment. HIV/AIDS or disease affecting immune system. Cancer treatments. Anyone who lives with or cares for people at high risk for influenza related complications. Health care workers. Anyone who wants to reduce the likelihood of becoming ill with the flu. Who should not get the flu shot? Anyone who has had a serious reaction to the flu shot in the past. Anyone who is allergic to eggs (vaccine contains small quantities of egg proteins) or Thimersol (preservative). What are a few myths and facts about the flu vaccine? Myth The flu shot can cause the flu. Volume XIII No. 12 December 15, 2008 Thinking about stopping smoking or chewing tobacco? Here are some ways to get started: Ask for help from your doctor, health aide, nurse and from family and friends. Make a list of your reasons for wanting to stop using tobacco. Set a Quit Date the sooner the better. If you are not ready to set a date, begin to cut down on your tobacco use. Then, make a plan to stop all tobacco use in the near future. Get medication and use it correctly. Ask for stop-smoking materials and read them. Learn about your own tobacco use habit and plan ways to cope with urges to smoke or chew after you quit. Try the four D s: Delay, Deep Breathe, Drink Water, and Do Something Else. If you slip and go back to using tobacco, first find out what caused the slip and then keep trying to quit again until you make it for good. The only certain failure is if you stop trying. Contact the Alaska Quitline at 1-888-842-7848. They offer free patches for people over the age of 18. Or call YKHC Nicotine Control & Research at 1-800-478-3321 extension 6312 (or 543-6312) for more information. From the U.S. Department of Health & Human Services, AHRQ help for smokers and other tobacco users Fact The flu shot cannot cause the flu. Some people can get a little soreness or redness where they got the shot. It goes away in a day or two. Serious problems are very rare. Myth The flu shot does not work. Fact The effectiveness of the flu shot has ranged from 70 percent to 90 percent. Getting the vaccine is your best protection against this disease. Myth Only older people need the flu vaccine. Fact Adults and children with chronic health conditions need to get the flu shot. How does the flu spread? Flu is spread from person to person through coughing, sneezing, or nasal secretions. You can also get the flu through touching contaminated surfaces. When and where can I get the flu vaccine? In the village, people can get their flu shot at their local village clinic or subregional clinic. In Bethel, you can get the flu shot at YKHC 543-6000, Public Health Nursing 543-2110 or Bethel Family Clinic- 543-3773 5

6 Family Medicine: Outpatient Clinic improvements will enhance continuity of care By Louise Reed, Director of Outpatient Clinics The vision of Outpatient Clinics is, Providing Excellent Health One Patient At a Time. In an effort to maintain continuity of care for our patients, particularly throughout the turnover of Medical and Nursing staff, the Empanelment Committee has decided to give names to various village and patient groups. These groups, or medical families, will remain the same even if a medical provider leaves, creating as smooth a transition as possible. The Clinics will continue to be known as Delta, Kusko and Yukon. Villages assigned to each clinic have changed slightly. (See provider pictures and village distribution on page 7). Culturally relevant names have been assigned to the medical families. We are planning to bring these changes by the beginning of the New Year with as little disturbance to our routine as possible. A group of villages, including some Bethel patients, will now fall into the following medical families: Delta Clinic Patients regularly seen in Delta will be part of one of these medical families: Crane, Swan, Mallard, Ptarmigan or Pintail. Kusko Clinic Patients regularly seen in Kusko will be part of one of these medical families: Moose, Beaver or Caribou. Yukon Clinic Patients regularly seen in Yukon will be part of one of these medical families: Herring, Pike, Whitefish, King, Red or Silver. Our medical providers will be assigned to a specific medical family. For the most part, this change will make very little difference in which provider you see. For example, if your regular provider is Dr. Hartman, you will still be scheduled with him in Delta Clinic. However, now Crane will be on your registration sticker, because that is the medical family group he will work in. Also, there may be more than one provider caring for the patients of each medical family. Dr. Mondesir is also part of the Crane family and will be the pediatrician caring for many of the children in that group. When you need a clinic appointment, you will still call the same number, 907-543-6442, and hear the same friendly voice of your scheduler. Most people will go to the same clinic and see the same provider, unless their provider is off duty or out of town. The only difference will be that most of the stickers you will receive to take to the clinic will have a medical family name instead of the provider s name. Actual Provider names will be used only under special circumstances. One other change to be aware of is Dr. Al-Shaar is now working in the Specialty Clinic area. We thank you for your patience as we make changes in our Delivery of Care so that we may Provide Excellent Health One Patient At A Time. Patient Centered Excellence

Your Family Medicine Providers Delta CRANE Hooper Bay SRC Chevak, Scammon Bay SWAN Kwigillingok, Napaskiak, Oscarville MALLARD Emmonak SRC, Alakanuk, Kotlik, Nunam Iqua PTARMIGAN Akiachak Eek PINTAIL Tuntutuliak Quinhagak Kusko MOOSE Aniak SRC, Anvik, Chuathbaluk, Crooked Creek, Grayling, Holy Cross, Lower Kalskag, Red Devil, Russian Mission, Shageluk, Sleetmute, Stony River, Upper Kalskag BEAVER Kwethluk CARIBOU Napakiak, Tuluksak Yukon HERRING Toksook Bay SRC, Mekoryuk, Newtok, Nightmute, Tununak PIKE Kasigluk, Marshall WHITEFISH Kipnuk, Nunapitchuk KING St. Mary s SRC, Mountain Village, Pilot Station, Pitkas Point RED Atmautluak, Chefornak SILVER Akiak, Kongiganak Daniel Hartman, MD Family Medicine Cynthia Mondesir, MD Pediatrics Elizabeth Roll, MD Outpatient Clinics Service Chief Women s Health & Family Medicine Gulnara Aliyeva, MD Family Medicine Carolyn Lorenz, MD Pediatrics Suzanne Schawlb, DO Family Medicine Scott Davis, MD Pediatrics Beverly Burden, PNP Pediatrics Claire Lewis, WHNP Women s Health K. Jane McClure, MD Pediatrics Anne Komulainen, PA-C Family Medicine Volume XIII No. 12 December 15, 2008 We want you to be satisfied with the service we provide. In order to give you a direct voice to let us know how we re doing, YKHC has contracted with an organization called Press- Ganey. Each month Press-Ganey sends surveys Elena Herrera, FNP-C Paula Diamante, MD Pediatrics Ann Glasheen, WHNP Women s Health Kimberly Whitaker, MD Family Medicine Jean Brinich, FNP Family Medicine Note: Each medical family village group includes Bethel patients.. to patients who have been seen in our Outpatient Clinics, giving you a chance to tell us what we are doing right and also how we could do better. New encounter forms streamline patient care by Michael Faubion, Public Relations Over the past year, YKHC s hospital outpatient clinics and subregional clinics have begun using a new version of an old standby the patient exam form. The PCC, or Patient Care Component, form has been in use at at Indian Health Service and Tribal hospitals for a long time. It used to come pre-printed from the United States Government with three carbon copies attached. After each patient visit, employees would manually enter the information written on the form by providers into a computer database system called RPMS Resource and Patient Management System also managed by the IHS. YKHC has long since customized the old paper form to suit our own needs, and created many varieties for the different clinics and departments. These forms have been an improvement for gathering patient information at each visit, but weren t very helpful in getting existing see PCC, p. 19 7

8 Arctic Care exercise returns to Western Alaska By Tiffany Zulkosky, Public Relations Arctic Care, also known as the Innovative Readiness Training exercise, will return to the Yukon-Kuskokwim Delta March 3 15, 2009, to provide no-cost veterinary and medical services to local residents. This exercise allows military reserves personnel to perform two weeks of training within the country, in sometimes extreme conditions, serving Americans. The Navy will be leading the 2009 exercise, but all branches of the military will be involved. Medical teams will be in place for 10 days in 11 Delta communities: Hooper Bay, Chevak, Toksook Bay, Alakanuk, Mtn. Village, Atmauthluak, Quinhagak, Kwigillingok, Kalskag, Kwethluk, and Military personnel bunk in the armory in Bethel before heading out to the villages during the 2001 Arctic Care exercises. (file photo by Michael Faubion) Specialist Freddie Ballesteros with new friends in Tununak during the 2001 Arctic Care training exercise. (YKHC file photo by Dana Hall) Newtok. Residents of nearby villages can travel to one of the 11 sites to receive services. At YKHC s request, Arctic Care will be providing veterinary services such as dog vaccinations and spay/neuter procedures for village pets. Because rabies is so endemic, we want to make sure we protect animals and the humans around them, said Dr. Joseph Klejka, Corporate Medical Director for YKHC. Expected medical personnel will include dentists, optometrists, physicians or mid-levels, and veterinarians. Specialists will also be at the Bethel hospital providing colonoscopies, dental procedures requiring anesthesia, and women s health services. Arctic Care has been to the YK Delta three times previously in 1997, 1998, and 2001. Each operation resulted in memorable experiences for those serving as well as those who were served. Because of the success of the previous operations YKHC welcomes all the military personnel to the region with appreciation and high expectations. The appreciation has worked both ways, as Cpl. Zachary A. Bathon wrote following the 2001 exercises: More than 180 servicemembers participated in the exercise and were able to complete their mission, help the local residents and maybe learned a little bit about their culture as well.

Volume XIII No. 12 December 15, 2008 9 First Alaskantrained Dental Therapists Graduate By Tiffany Zulkosky, Public Relations The original class of Alaskan-trained Dental Therapists include (from left) Daniel Kennedy, Sheena Nelson, Danielle Boston, and Christopher Evan. These four individuals are pioneers in this field. I see this as an amazing beginning for the Dental Health Aide Therapist profession, not only in Alaska, but throughout our country. Dr. Anthony Brusca, DDS The first cohort of Alaskan-trained Dental Therapists was honored during a Community Reception held Dec. 9, at the Yupiit Piciryarait Cultural Center. The students were graduated from the program during a ceremony at the Alaska Native Tribal Health Consortium (ANTHC) on Friday, Dec. 12. The four students graduating from the Dental Therapy program are: Danielle Boston of Chistochina, Christopher Evan of Russian Mission, Daniel Kennedy of Klawock and Sheena Nelson of Yakutat. As I sat through the reception and listened to the speakers address the crowd, I had the chance to reflect on the year and a half I ve spent with these students, said Dr. Anthony Brusca, DDS, an instructor with the program since its inception in 2007. I was filled with such an enormous sense of pride. These four individuals are pioneers in this field. I see this as an amazing beginning for the Dental Health Aide Therapist profession, not only in Alaska, but throughout our country. The graduates will provide dental services throughout Alaska s rural communities under the supervision of licensed dentists. The oral health services typically include basic fillings, simple extractions, cleanings, site visits, screenings, fluoride treatments, oral hygiene and education. This is the beginning of something we hope to do more of and to expand, said LaMont Albertson, Executive Director of Yuut Elitnaurviat. Regionally, there are overwhelming dental care challenges. Thanks to the vision of Gene Peltola, Valerie Davidson, and several other tribal health leaders, the Yuut Elitnaurviat Dental Training Clinic will be moving into a brand new facility on the Yuut Elitnaurviat Campus in March 2009, where we can begin to address rural needs in earnest. This truly introduces a new era of oral health care in bush Alaska. The state and nation s first-ever Dental Therapy program is a collaborative effort between several organizations, including the University of Washington DENTEX Program, ANTHC, YKHC, and Yuut Elitnaurviat. The two-year program is modeled after the highly successful New Zealand program. According to resident dental instructor Dr. Robert Allen, DDS, nore than 50 other countries worldwide provide Dental Health Therapy Training for their citizens. These programs prepare students in the art and practice of preventive and basic dental care.

10 A Message from the YKHC Medicaid Office Prenatal Care assistance available through Denali Kid Care by Dorothy Chase, Patient Resources Coordinator Are you pregnant? Do you think you may be pregnant? Do you know someone pregnant? Did you know that Alaska s Denali Kid Care (DKC) Program offers coverage for prenatal visits and continues through the 6-8 week postpartum check-up? Denali Kid Care is also referred to as Pregnant Women s Medicaid. Coverage may include airfare, lodging, meals and taxi vouchers. This coverage is a benefit. It is strongly recommended that once a woman knows she is pregnant, she should apply for Denali Kid Care right away. This ensures that she will have coverage from the beginning of her pregnancy and avoid any delays in her prenatal care. The sooner an application is submitted the sooner the coverage begins. Once a positive pregnancy test is done, a Health Care Provider, Nurse, Health Aide or ANY health care official can fill out the Pregnancy Verification form and sign it. The YKHC Family Medicine Clinics and Village Clinics have these forms. This form will show proof that a woman is pregnant and the date she is due. Once an application is submitted the average wait time is approximately two to four weeks. When submitting an application, the following are required: Proof of Lawful Immigration Status (Birth Certificates), Identification (State ID or Driver s License), Proof of Income for the last 30 days (Copy of Pay Stubs) and a Pregnancy Verification Form. The application may take longer to approve if some of these documents are not submitted with the initial application. There are income guidelines for all applicants but it is important to complete the application to check if you are eligible. We all know that it is expensive to fly. Airfare for medical appointments can be paid if a pregnant woman has Denali Kid Care. Occasionally, a pregnant woman needs further testing and/or treatment in Anchorage. Pregnant women may also need to go to Anchorage to wait and deliver at ANMC or one of the other hospitals. DKC will cover airfare and housing in Anchorage or Bethel. In the past, YKHC has approved to pay for the first prenatal visit for village patients. The patient must have already applied for Denali Kid Care or they need to apply while in Bethel. It is important to notify the YKHC scheduling office in advance if you cannot make your scheduled appointment or if you need to reschedule your appointment. If you are traveling from the village you must attend all scheduled appointments. If you leave without being seen, the hospital may report this to DKC and your coverage may end. As a health corporation, YKHC promotes good health for everyone. It is extremely important for a pregnant woman to receive prenatal care early in her pregnancy and start taking vitamins, iron and calcium that will help her baby to be healthy. Please do your part in being healthy and having a healthy baby by getting prenatal care as soon as you know you are pregnant. Denali Kid Care also covers children in the household who fall within the income guidelines. Please contact the YKHC Medicaid Office for more information. If you need an application, need assistance with an application or would like to know the status of your application, please contact Dorothy Chase at 1-800-478-3321 Extension 6470, in Bethel 543-6470 or through email at Dorothy_Chase@ykhc.org.

Commitment to Quality Helping the Alaska Native Community with Third Party Payers Enrolling in health care programs can help you and the Alaska Native health care system Have you ever wondered if there was something you could do to help strengthen and enhance the services available for your children, elders, aunts, uncles and other relatives? Enrolling in insurance programs like Medicaid, Medicare, Disability or private insurance helps pay for medical bills and increases the flow of resources to expand YKHC s services. These resources benefit the entire Alaska Native Community. YKHC is a nonprofit health care organization that works with local communities Bethel and over 50 rural villages to treat illness and injury and promote wellness for the entire service area. To continue providing high-quality services for our vast region, we depend on more than just Indian Health Service (IHS) funding. The organization depends on an active partnership between health care providers, employees, and the customers who use and benefit from the system. With only minimal increases in IHS funding each year, the Alaska Native Health system must rely on a mix of other funding sources to provide its full range of services. Roughly 50 percent of all services would not exist if YKHC relied on IHS funding alone. Here s how you can help! In addition to grants and private insurers, there are third-party insurance payers such as Family Medicaid, Denali KidCare, Prenatal Denali KidCare, Under Twenty-One Medicaid, Elderly Assistance/Social Security, Medicare and Disability insurance. Every time a YKHC customer provides his or her insurance information to the hospital or clinic, additional funding for Native Health services is brought into the organization at no cost to the customer. All of this money is used to fund YKHC s clinics and programs, and to buy medical equipment, medicines, and supplies needed for our services. Third party insurance payments make a big difference in the services YKHC can provide, but there are many missed opportunities to access resources. When someone goes outside of the IHS system, does not volunteer to share insurance status, decides not to participate in screening, or does not apply for insurance or assistance they are eligible to receive, money is lost that could have supported Alaska Native Health care. Erica Srisanceha, project manager in the Anchorage Native Primary Care Center see THIRD PARTY PAYERS, p. 19 Volume XIII No. 12 December 15, 2008 11 Some Myths and Facts about Third Party Payments Myth: It doesn t matter if I apply for Medicare, Medicaid or Denali KidCare, or disclose my private insurance coverage I am entitled to Indian Health Service (IHS) coverage, free of charge! Fact: You are entitled to IHS coverage, but your Medicare, Medicaid, Denali KidCare and disability or private insurance matter a great deal. Customer/owners who enroll in other insurance programs help the entire Native Community by bringing in additional resources and freeing up IHS funds for improvements to services. Customers don t have to pay deductibles or copayments, regardless of what they sign up for. Myth: Applying for Medicare, Medicaid or Denali KidCare coverage is too complicated and isn t worth the time it takes to sign up. Fact: YKHC Family Health Resource Representatives can check a customer s eligibility for other insurance coverage during a quick screening, and then, if eligible, will help with the application process to keep it simple. There is no cost to the customer, and the benefit to the whole Native Community is significant. To contact the YKHC Family Health Resource program, please call 907-543-6470. Myth: I go to a medical center outside the Alaska Native health system because I have private insurance coverage. This way, I am freeing up a spot for someone without insurance who really needs the care. Fact: Customers and employees have created a world-class health system for all Alaska Native and American Indian people in our region. If you are eligible, using the Alaska Native health system for all of your health care supports it financially and honors the work that we do. Using your insurance in the Alaska Native health system brings in important funding needed to maintain and improve services for everyone.

12 Governor Palin Announces Health Priorities From the Governor s Press Office On December 4, 2008, Governor Sarah Palin announced her goals to improve Alaska s health and education through fiscal year 2010 budget requests, the formation of a health care commission, support for legislation and an informational campaign to help Alaskans take better care of their own health. Governor Palin put a priority on children s health and development. Children are the most valuable resource in Alaska, she said. We have to do more to support health coverage and health care, because it plays such a big role in a child s success in school, and in life. Our state agencies are partnering to better equip Alaskans to lead healthier lives and to meet health care needs across the state. Governor Palin called for increased coverage of Alaska s children under Denali KidCare, state funding to reverse childhood obesity and improve diagnosis of autism, and increased funding for Alaska s Head Start preschool programs. The Governor joined Health and Social Services Commissioner Bill Hogan, Education and Early Development Commissioner Larry LeDoux, Labor Commissioner Click Bishop, Chief Medical Officer Dr. Jay Butler, and University of Alaska Anchorage Chancellor Fran Ulmer to announce health and education priorities. Highlights of the Governor s priorities in health and education: Establish the Alaska Health Care Commission to provide recommendations for and to foster the development of a statewide plan COMMITTEES, from p. 3 Governing Body George Morgan James Landlord Gloria Simeon James Sipary David O. David James Nicori Joseph Bavilla James Charlie, Sr. Board Standing Committees By-Law Committee Joseph Bavilla Marvin Deacon David O. David Moses Peter Ray Waska Policy Committee James Charlie, Sr. Gloria Simeon Paula Ayunerak James Landlord Joint AVCP/YKHC/Calista Gene Peltola, Ray Alstrom Finance Committee Marvin Deacon, Chair Wayne Morgan Bill Kristovich Ray Waska James Landlord Gloria Simeon Ray Alstrom, Ex-Officio Gene Peltola, Ex-Officio Audit Committee Bill Kristovich Moses Peter George S. Morgan Investment Committee Bill Kristovich, Chair Moses Peter Paula Ayunerak Wayne Morgan George Morgan Ray Alstrom, Ex-Officio Gene Peltola, Ex-Officio Dan Winkelman, Ex-Officio to address the quality, accessibility, and availability of health care for all citizens of the state. Support legislation to increase the income eligibility guidelines for Denali KidCare to 200 percent of Alaska s federal poverty level. Such an increase would make about 1,300 more children and about 225 more pregnant women eligible for health coverage under Denali KidCare. Continue our investment in the Tobacco Use Education and Cessation Fund to boost Alaska s tobacco prevention and control program. Fund Alaska s obesity prevention and control program and work toward reversing the trend of childhood obesity. Spend $250,000 to offer better access to early screening and diagnosis of autism and other neurodevelopmental disorders. Develop a statewide initiative called Live Well Alaska. The interactive web-based campaign will provide the best recommendations for eating healthier, being more physically active and quitting tobacco use. Increase funding for Head Start preschool programs by $800,000. The additional funds will allow the program to serve 60 to 80 more children. Approximately 1,000 Alaska children remain on waiting lists for Head Start. This funding is in addition to $600,000 in increased funding that Head Start received last fiscal year. Spend $2 million for the Department of Education to implement a pilot preschool program. School districts would receive the funding through grants. The half-day preschools would serve up to 500 children statewide. Fund the University of Alaska s Family Residency Program Board Appointments BH Advisory Board Paula Ayunerak Alternate Sam W. Alexie Health Aide Advisory Board Sam W. Alexie Loan Forgiveness Program George Morgan Home Care Liaison James Sipary ANTHC Ray Alstrom, 1st Gene Peltola, 2nd Bill Kristovich Human Studies Sam W. Alexie, James Nicori, Moses Peter, Ray Alstrom IDD, LLC Ray Alstrom, Bill Kristovich, George S. Morgan Gene Peltola, Gregory McIntyre ANHB Bill Kristovich, 2nd Gene Peltola Special Committees Housing Committee William Kristovich. James Sipary Gene Peltola Financial Policy James Nicori David O David James Landlord Gloria Simeon Gene Peltola, Ex-Officio Corp Compliance/Quality Assurance David O David Bill Kristovich Paula Ayunerak James Sipary, Sr. Moses Peter Gene Peltola, Ex-Officio Compensation Committee Ray Alstrom Wayne Morgan Joseph Bavilla Gene Peltola, Ex-Officio William Morgan Legend Award Ray Alstrom, Sam Alexie Gene Peltola, Dan Winkelman

Volume XIII No. 12 December 15, 2008 13 Safe Toys and Gifts Month By Melanie Huett, MS, RD, LD, WIC RD Nutrition Educator The holiday season is when most toys and games are purchased, so December has been set aside as safe toys and gifts month. Play is an important part of a child s development because it helps children learn. Most toys are safe, but they become unsafe if misused or given to children who are too young to play with them. Some toys may not be appropriate for all age groups. Falls and choking cause the majority of toy-related injuries and deaths in children. Choking alone causes one third of all toy-related deaths, usually from balloons. Children 4 years old and younger account for almost half of all toy-related injuries and almost 90 percent of deaths. Children younger than 3 years old are at the greatest risk of choking because of the small size of their airways and the tendency to put objects, especially toys, in their mouths. Dangerous Objects for Young Children The American Academy of Pediatrics advises keeping the following items away from infants and young children to reduce the risk of choking: latex balloons coins marbles toys with small parts toys that can be compressed to fit entirely into a child s mouth small balls pen or marker caps small button-type batteries medicine syringes The good news is that the majority of toy-related injuries are minor. The National Safe Kids Campaign, along with the National Safety Council, have made some recommendations for selecting safe toys for children. Tips for selecting safe toys Consider the child s age, interests, and skill level Look for quality design and construction Follow age and safety recommendations on labels Use a small parts tester, also known as a choke tube, to determine whether small toys may present a choking hazard to children ages 3 and under. The tube is about the same diameter as a child s windpipe. If a toy can pass through the tester, then it is too small for children this age and can cause them to choke if swallowed. Small parts testers can be purchased at toy or baby stores, but an easy and free way to tell if a toy is safe is to use the cardboard core of a toilet paper roll. Avoid toys with sharp points or edges, and projectiles, such as darts Avoid toys with strings, straps, or cords longer than seven inches. These toys may post a risk of strangulation for young children. Avoid electrical toys with heating elements for children under 8 years old. Avoid cap guns that use caps that can be ignited by friction because they can cause burns. Avoid latex balloons to eliminate the risk of choking or a latex allergy reaction. Tips to keep children safe from toy-related injuries Inspect toys regularly for damage and potential hazards. Make necessary repairs or throw away damaged toys. Watch children during playtime to keep them safe from toyrelated injuries. Use toys in a safe environment. Teach children to put away toys safely after playing. Toys can sometimes be recalled for safety reasons. Check the National Safe Kids Campaign website www.safekids.org or the U.S. Consumer Product Safety Commission (CPSC) website for updates and information on recent toy recalls or call CPSC s hotline at (800) 638-CPSC to report a toy you think is unsafe. The CPSC closely monitors and regulates toys. Any toy made in or imported into the United States after 1995 must adhere to CPSC standards. Choosing safe toys: Toys made of fabric should be marked as flame resistant or flame retardant. Stuffed toys should be washable. Painted toys should be coated with lead-free paint. Toys that are red, orange, or yellow may me more likely to test positive for lead because lead makes paint brighter. Art materials should be nontoxic. Crayons and paints should say ASTM D-4236 on the package, which means that they have been evaluated by the American Society for Testing and Materials. see SAFE TOYS, p. 16

14 March of Dimes selects YKHC Women s Health NP as Nurse of the Year YKHC Women s Health Provider Claire Lewis was selected as this year s March of Dimes Nurse of the Year. The award was announced Novemeber 14 at the March of Dimes State Nursing Awards banquet at the Hilton Hotel in Anchorage. Claire s husband, along with six YKHC staff from the hospital s Outpatient Clinics were on hand to support and congratulate her when she won. Lewis coworkers, patients and friends throughout the YK region know well why she was chosen as Nurse of the Year in the Advanced Practice category, which includes clinical nurse specialists, certified nurse midwifes, nurse practitioners and nurse psychotherapists, and certified registered nurse anesthetists. But for the benefit of those in attendance who have not known her as long as we have, this was shared: Claire Lewis, NP, finished her training as a Women s Health Nurse Practitioner in 1997. She provides prenatal care and women s health care to the rural areas. She sees her patients well into the evening hours. She has been part of a major CDC research project studying the conditions that affect pregnancy. She has a passion for cooking and teaches young people how to bake and she cooks meals for folks recovering from surgery or an illness. She is genuine and described as a priceless friend. Claire Lewis, WHNP, March of Dimes Nurse of the Year. Nursing Students Graduate By Tiffany Zulkosky, Public Relations The University of Alaska Anchorage (UAA) School of Nursing Associate Degree Program celebrated the achievements of the Bethel Class of 2008 during a Pinning Ceremony held Sunday, Dec. 7. Over 140 community members attended the noon reception, honoring four local women who will soon join the state s nursing workforce. Evelina Achee, Danica Broerman, Mary Devlin, and Gracie Nelson received encouragement and support from a handful of educators and program partners who have seen them through the two-years of preparation. I am so incredibly proud of these students. I feel so honored that I have been able to participate in their progress over the last two years, said Mary Weiss, Assistant Professor of the UAA School of Nursing. It s really great for the students and really great for the community. These nurses are in their hometown and it will be a great benefit to Bethel and the state because we re growing our own. The students, who have completed all coursework, must still pass their state licensing exam before working as Registered Nurses. 2008 Nursing graduates Gracie Nelson, Evelina Achee, Mary Devlin and Danica Broerman, thank their instructor, Mary Weiss (center). The whole reason this program succeeded was because of the partnership between KuC, UAA, and YKHC, Weiss continued. It could not have happened without that collaboration. There was so much support and goodwill provided by a lot of people.

Volume XIII No. 12 December 15, 2008 15 Moses Fredrick: November 2008 Health Aide of the Month Moses Fredrick, Akiachak Health Aide. By Tiffany Zulkosky, Public Relations The Yukon-Kuskokwim Health Corporation s Community Health Aide Program recognizes Moses Fredrick of Akiachak as the November 2008 Health Aide of the Month. A Community Health Practitioner, it is Moses quick response to emergency calls and EMT skills that make him a stand out Health Aide. In early November, Moses received a call about a patient who was not moving. Relying on his years of experience and quality training, Moses and his fellow Health Aide Marsha, who is also his daughter, conducted a rapid assessment. Eventually the patient was transported to Bethel for further care and observation. Both Health Aides used their training and instincts when responding to this emergency, (from left) Karl Powers, Martha Attie, Jack Crow, and Jessica Horras recognize Moses Frederick (center) as the November 2008 Health Aide of the Month. said Martha Attie, Supervisor Instructor. He takes care of patients gently and has a good attitude. Moses is a good role model for the community and other villages. Moses, who will reach his 30 years of service in August 2009, was honored during a special luncheon at the Akiachak Clinic on Tuesday, December 9, 2008. The Health Aide workforce represents the sustainability of health care in the YK Delta. Each month, YKHC awards special recognition to an outstanding Health Aide. If you would like to recognize a particular Health Aide, contact the Field Supervision Instructor at 543-6160. SRC Labs achieve 100% certification Congratulations to YKHC s Subregional Clinic labs! In 2008 the Subregional Clinic laboratories achieved a staff certification rate of 100 percent. The formal certification process for laboratory professionals requires successful completion of educational requirements through UAA, on-the-job clinical laboratory training through the YKHC Lab Assistant Training Program, and successful completion of the Board of Registry certification examination through the American Society of Clinical Pathology. At this time, all four Subregional Clinic laboratory staff have accomplished this through hard work and self determination. Congratulations to Gerald Lamont, Emmonak; Elsie Chanar, Toksook Bay; Doris Turner, Aniak; and Eric Alstrom at St Mary s. Congratulations also to Leslie Boelens, the mentor who oversees the program and SRC laboratories.

16 THIRD PARTY PAYERS, from p. 11 (ANPCC) administration, cautions customers about making assumptions regarding their eligibility. A lot of customers assume they are over the income qualifications and decline to speak with Family Health Resources (FHR) because of that, she said. They may still qualify! The best way to find out is to apply, even if they already have private insurance. Health Resource Representatives offer assistance Customers are encouraged to find out if they qualify for enrollment in a free insurance program. YKHC s Health Resource Representatives offer friendly customer service and can assist in the entire enrollment, re-enrollment or renewal process. Every six months, all customers receive information about the process, a screening for eligibility and assistance with the application, if eligible. Customers can also ask for help throughout the year. If a customer prefers to fill out the application without help, mail-in applications are available. The IHS s annual budget is set at levels below what is needed to fully meet the needs of the Alaska Native Community. The journey to wellness is traveled in shared responsibility. Customer/ owners play an important role in every part of YKHC s programs and services, including funding. So, the next time a YKHC customer service representative asks to speak with you about eligibility for outside resources, the best thing to do, for your family, your friends and your community, is to take a few minutes to find out how they can help. To contact the YKHC Family Health Resource program, please call 907-543-6470 Health Aides Deserve Your Appreciation! Martha Constantine, CHP, in Kwethluk clinic checking the ears of a young patient. Photo by Carl Evans. Thank your Health Aide today for the work they do. Your appreciation encourages health aides to continue their fine job caring for everyone in the village. ~ Stop by the clinic to thank your health aide ~ Tell others to appreciate their health aides ~ Bring them cookies or a small thank you gift ~ Nominate them for Health Aide of the Month ~ Have a community potluck celebration for all the clinic workers ~ Write them a nice thank you letter SAFE TOYS, from p. 13 Don t accept older toys. These toys may not meet current safety standards and may be worn from play making them more likely to break and become hazardous. Make sure toys are not too loud for children. The noise from a toy can contribute to hearing damage if it is put too close to the ear. The right toys at the right ages Always read labels to make sure a toy is appropriate for a child s age. Guidelines published by the CPSC and other groups can help you make buying decisions. Consider your child s temperament, habits, and behavior whenever buying a new toy. Think Prevention Children younger than 4 years old should stay away from eating foods that are easy to choke on, including nuts, raw carrots, popcorn, chewing gum, and hard candy. One should cut food, like hot dogs and grapes, into small pieces. Make sure children sit down, take small bites, and don t talk or laugh with their mouths full when eating. Pick up anything off the floor that might be dangerous to swallow, like deflated balloons, pen caps, coins, beads, and batteries. Keep toys or gadgets with small parts out of reach. Learn how to do abdominal thrusts and CPR, which usually are taught as part of any basic first-aid course. The best way to keep your child safe while playing with toys is to be there. Sources: www.kidshealth.org; Safe kids USA

Volume XIII No. 12 December 15, 2008 17 March of Dimes Nursing Scholarships To recognize and promote excellence in nursing care of mothers and babies, the March of Dimes awards several $5000 scholarships annually to registered nurses enrolled in graduate programs of maternal-child nursing. In 2008, with support from Evenflo and Pampers, the foundation awarded eight graduate nursing scholarships. Applications for 2009 scholarships are due on January 15, 2009. For more information, go to marchofdimes.com/nursing Injury Control & EMS Snowmachine and ATV safety starts before you ride! Be sure to follow manufacturer s recommendations for proper maintenance. Conduct a pre-ride inspection to check important components of the vehicle. Don t forget to check fuel and oil levels and carry extra fuel When riding, be aware of weather conditions, terrain, daylight/dark, and trail markings. Dress for the weather and wear personal safety equipment. Vehicles should not be operated while under the influence of drugs or alcohol. Always ride with friends or family when possible, and always advise someone you trust of your travel plan. When you complete a trip, don t forget to check in with your safety contact. F Frostnip or Frostbite rostnip is a relatively mild form of cold injury that goes away minutes or seconds after warming with no permanent damage. Frostbite is the term for damage to the skin and other tissues caused by freezing. Frostnip and Frostbite cases have steadily declined over the last several years due to better cold weather clothing and equipment. Frostbite How cold the skin or underlying tissues become does not determine permanent injury in frostbite, but how long they remain frozen. Temperature, windchill and moisture all affect how quickly exposed skin can become frozen. Wet skin or clothing on a windy day can lead to frostbite even if the temperature is not below freezing. Frostbitten skin should never be covered with ice or snow and should never be rubbed or massaged. There are two types of Frostbite superficial, affecting the outermost portion of the skin (yellowish or white tint to the skin with numbness and pain), and deep, affecting deeper skin layers as well as outer skin (blistering and dark blood spots form). Emergency medical help should always be sought if frostbite is suspected. Avoid thawing and refreezing. Wet tight clothing should be replaced with dry loose-fitting clothing if available. Since the extent of injuries cannot be determined at the onset of frostbite, medical protocols are the same for both types of frostbite. Working Together to Achieve Excellent Health To purchase helmets, goggles, and ice cleats call YKHC Injury Prevention & EMS at 907-543-6085 Medical treatment begins with warming of the affected area for 15 to 30 minutes in water at a temperature of 104 108 F. Aloe Vera is then applied to the affected area and it is splinted, wrapped and elevated. Antibiotic ointments and a tetanus shot may be used to fight possible infec- see FROSTBITE, p. 19