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wellness HEALTHY PARTNERSHIPS FOR HEALTHY FUTURES Kids across Alaska are learning the rewards of an active lifestyle
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teamwork TEENS WORKING HARD TO CURB TOBACCO USE The power of peer advocacy in creating tobacco-free spaces and communities
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profile PALLIATIVE CARE Empowering patients to make choices about their own care and treatment
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feature HOPE AND HEALING One Alaskan's journey to recovery
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new and notable INNOVATIVE RENOVATIONS Alaska Native Medical Center is redesigning space to better serve patients
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prevention THE FLU A how-to guide for keeping you and yours healthy this season
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prevention KEEPING ALASKA'S KIDS HEALTHY The 'what' and 'when' of childhood immunizations
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recipe A HEALING DIET Alaska's nutrient-rich wild foods can be a smart choice for those undergoing cancer treatment
Alice Rogoff / Publisher Maia Nolan-Partnow / Editorial Director Aaron Jansen / Creative Director
CONTRIBUTORS Bailey Berg, Bridget Dyson, Catalina Dengel, Jody Ellis, Joshua Genuino, Kirsten Swann
Jamie Gonzales / Editor Catalina Dengel / Assistant Editor Viki Spiroska / Production Coordinator Joshua Genuino / Art Director Rejoy Armamento / Graphic Designer
To advertise, call (907) 257-4242 Alaska Dispatch News P.O. Box 149001 Anchorage, Alaska 99514
This publication was produced by the special content department at Alaska Dispatch News in collaboration with Alaska Native Tribal Health Consortium. The ADN news department was not involved in its production. Send letters to the editor at jgonzales@alaskadispatchnews.com
wellness
Kids across Alaska are learning the rewards of an active lifestyle
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HAVING AN OLYMPIAN IN OUR SCHOOL WAS A GREAT OPPORTUNITY FOR THE KIDS TO HUMANIZE PEOPLE WHO HAVE ACCOMPLISHED SO MUCH AND BE ABLE TO ENVISION THEMSELVES DOING THE SAME THINGS.
HETHER PLAYING BASKETBALL, running or cross-country skiing, Alaska’s youth are getting outside to play in growing numbers. At nearly 200 elementary schools statewide, children are learning to account for their own good health by logging activity hours and participating in sponsored events as part of the Healthy Futures Challenge program. Healthy Futures was founded in 2003 to “empower Alaska’s youth to build the habit of daily physical activity.” The program was created in response to the rising epidemic of childhood obesity in Alaska, by the late Bonny Sosa Young and her husband Sam Young. They saw a problem that couldn’t be overlooked. One out of three Alaska children is overweight or obese, a number on par with the rest of the United States. However, for Alaska Native children specifically, the rates are higher. The program encourages youth to avoid this epidemic by logging their daily physical activity in exchange for prizes. In 2011 Healthy Futures partnered with the Alaska Sports Hall of Fame to become their signature program. Since then, Healthy Futures has experienced tremendous growth. In just the past four years,
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wellness
partnerships with organizations such as the Anchorage School District, Alaska Native Tribal Health Consortium, United Way and the State of Alaska Department of Health and Social Services Play Every Day campaign have expanded the program to more than 15,000 participants in 190 schools across Alaska. “The program started Anchorage-centric, then moved along the rail belt to Mat-Su and the Kenai Peninsula. Partnerships with the ASD and ANTHC have facilitated that growth,” said Harlow Robinson, the program’s executive director whose involvement began as a board member in 2006. When talking urban versus rural, 34 percent of participating elementary schools are now in rural Alaska. So what does the program do to reach beyond Alaska’s most populated metropolises? “We work hard to build relationships,” said Robinson, who traveled to Kotzebue in August to participate in an in-service where he will have faceto-face contact with every teacher in the Northwest Arctic School District. Connecting with kids and getting them excited about physical activity is key to gaining interest in Healthy Futures. Last year, Olympic cross-country skier Holly Brooks, who participates with the program as a Healthy Hero, and Sam Hill, who grew up in Kotzebue and ran cross country for the University of Oregon, visited June Nelson Elementary School in Kotzebue. Prior to these visits, the school had not participated in the Healthy Futures program, but as a result, they signed up and became one of the top three participating schools in the state. “Having an Olympian in our school was a great opportunity for the kids to humanize people who have accomplished so much and be able to envision themselves doing the same things,” said Jake Stoops, physical education teacher and Healthy Futures coordinator at the school. Each participating school has a designated coordinator, usually a physical education teacher, who collects the monthly logs from students. The coordinator then reports the information to the Healthy Futures program. Students logging at least 60 minutes of activity, 15 days or more a month, are eligible for prizes. Fall 2016 prizes include a slinky, a foam rocket and an expandable flying disc. Toys are not the only motivation children receive to participate in Healthy Futures. “We’re very fortunate to have great support from our administrators John Crabb and Patrick Henry,” Stoops said. “Every student at June Nelson Elementary has P.E. every day at school. Not every school has the same opportunities we do and as a P.E.
teacher, it is really refreshing to see such an emphasis placed on physical education.” The log itself is also an effective motivator, Stoops added, “For the students to have a log that they can look back over and see the amount of activity they actually do is empowering.” The reach of the program extends beyond school into the home. Family resources listed on the challenge website include taking evening walks after dinner, sledding, visiting a new park each week and incorporating physical activity at family events. Stoops notes that it’s the students’ own excitement about the program that carries over to the parents. “We didn’t have to make any special effort or sell the parents on the program. The students bought in from day one,” he said. Healthy Futures is taking steps to expand the program beyond K-6 and reach middle school students as well. Through funding from United Way, a web-based pilot program is currently being conducted in Anchorage and Matanuska-Susitna area schools. “Middle school presents a whole new set of challenges,” Robinson said. “There’s a more structured setting in elementary school, all students go to P.E. In middle school, they’re making more independent choices. Asking students to track activity is challenging. It takes a strong champion of the program at school; a teacher willing to own it and administer it.” Robinson said the middle school program is still in the developmental stages and they are continuing to adjust it through feedback, especially from kids. “Middle school is an important age to build healthy life habits,” he added. “ It’s a time when kids start selfidentifying as active or not active.” It’s important to expand the program throughout the state and into middle schools, he said. “The overall mission is to reach all children. If we’re only reaching a portion of the population, we’re not meeting that mission. There are pockets that haven’t fully engaged.” He added that while maintaining relationships with school districts that have already signed on for the program is priority, partnerships and funding from organizations like ANTHC is what allows the program to grow. l The next Healthy Futures Challenge begins in September and runs through November 2016. To learn more about the challenge, visit their website, www. healthyfutures.org, for a list of participating schools, links to family resources and calendar of events supported by Healthy Futures.
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The power of peer advocacy in creating tobacco-free spaces and communities
ORN AND RAISED in Hooper Bay, Alaska, high school senior Menzo Bell is an avid cross-country runner and a vibrant member of the community, someone the other kids look up to. A strong athlete, one wouldn’t expect that Bell is also a former tobacco user. “I started chewing tobacco at age nine,” he said. “Smoking and tobacco use is common here, even very young children know what cigarettes are.” Bell chewed tobacco regularly until January of this year, when he decided he was tired of it slowing him down
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while running. He made a New Year’s resolution to quit and hasn’t looked back. “I have no desire to go back to that,” he said. “I can’t stand the taste of it now.” Starting tobacco at an early age is common in many Alaska Native communities. Alaska Native and American Indian teens use tobacco at a much higher rate than their peers. Dana Diehl, program manager for Alaska Native Tribal Health Consortium’s Tobacco Prevention Program, says they are working hard to change those statistics.
teamwork
“Our program works across the state and within the Alaska Tribal Health System to offer training and technical assistance for tobacco prevention programs,” she said. They develop and distribute tobacco prevention education resources and work with health care providers to improve tobacco use screening and resource access. The program also shares what works, helping implement tobacco-free workplaces. The ANTHC program partners with communities and organizations throughout rural Alaska to support evidence-based interventions such as tobacco-free school policies, tobacco tax increases and tobacco prevention media campaigns to prevent use among teens. “We also keep our organization abreast of youth tobacco trends,” said Diehl. “We review the use of emerging tobacco products such as electronic cigarettes in order to help inform decision making at the patient-provider level.” Other state programs working in tandem with ANTHC include the Alaska Tobacco Control Alliance (ATCA) Youth Leadership and Growing up Tobacco Free in Alaska (GUTF) programs, both part of the Rural Alaska Community Action Program (RurAL CAP). “ATCA Youth Leaders is a statewide coalition that gives Alaska youth the tools and skills they need to make Alaska a tobacco-free state,” said Anna McGovern, wellness education coordinator at RurAL CAP. “Research has shown that engaging young people in tobacco control issues is an incredibly effective strategy in changing social norms and preventing youth tobacco use.” The program provides training and support for both youth and adults, so they can advocate for themselves and their communities. Bell recently joined the ATCA program, attending his first meeting this February. “It teaches us to advocate for the restriction of tobacco use in public places,” he said. “We’ve restricted it in Hooper Bay around some public places such as schools already, and I would like to see it prohibited in all public places.” Bell’s training also led him to facilitate a gathering at the local school, which more than 150 residents attended. “I told them that I quit using tobacco and if I could quit, so could they,” said Bell. “Afterward a lot of people approached me and said they were inspired to quit. A lot of my friends are quitting now too.” Based on recent research the programs are working. According to Alaska’s Department of Health and Social Services (DHSS), Alaska has seen a large decline in overall youth smoking rates. More
than half of Alaska’s federally recognized tribes have adopted tobacco-free or smokefree workplace resolutions. Alaska DHSS’s Alaska Tobacco Quit Line also provides resources like web, text and phone counseling, as well as providing youth under the age of 18 with print materials. Current statistics from DHSS show overall youth smoking rates are down from a high of 37 percent in 1995 to 11 percent in 2015. Alaska Native youth smoking rates have dropped from a high of 62 percent in 1995 to 20 percent in 2015. While statistics still show a slightly higher percentage of Alaska Native youth smoking as opposed to youth in general, the drop is still monumental. “Some of the reasons we at ANTHC believe smoking rates remain higher among Alaska Native youth include the tobacco industry targeting youth,” Diehl said. “They do point-of-sale advertising at places like gas stations and grocery stores, especially in lower income neighborhoods.” She adds that tobacco use is still widely accepted as normal and in the health care setting, there’s still inconsistency in how young people are screened for tobacco use and advised to quit. All of that contributes to higher numbers. McGovern sees the tobacco industry as actively seeking out teen smokers. “The tobacco industry has been targeting youth for decades as the replacement smokers,” she said. “They know that once they get a young person addicted, they have a customer for life.” Alaska’s coalitions are determined, however, to prevent this from happening. ANTHC’s Tobacco Prevention program works at the policy level too. They advocate increased taxes on tobacco products, smokefree workplace laws, and implementing promising strategies such as the Tobacco 21 law, which raises the legal purchase age from 19 to 21. “A 10 percent increase in cigarette prices can reduce smoking among youth under the age of 18 by up to seven percent,” said Diehl. RurAL CAP also supports the increased taxes and laws, as well as facilitating interventions and peer education. “...The most important part is including young people in prevention efforts,” said McGovern. “We must provide opportunities for them to spread their message to others and listen to what they have to say.” For Bell, there is perhaps a more direct solution in preventing teens from ever using tobacco. “I have an aunt who developed jaw cancer from chewing tobacco,” he said. “Maybe knowing her life story and what she has gone through could help people better understand and get them to quit.” l
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Empowering patients to make choices about their own care and treatment
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profile
IFE CHANGES IN AN INSTANT. One
moment you’re surrounded by the familiar comforts of life at home with family, friends and work, the next you’re sitting in a paper-thin robe at a doctor’s office being handed the most difficult news of your life. You have so many questions, ranging from will I survive to can I return home? You’re overwhelmed by the doctor’s matterof-fact diagnoses and all the snap decisions to make. Then, you’re introduced to the Palliative Care Team, and you feel a little glimmer of hope. “An extra layer of support,” that’s how Alaska Native Medical Center’s Palliative Care Team describes themselves. The three-person Palliative Care Team includes medical director Chris Piromalli, D.O., MPH, nurse Rona Johnson, RN, BSN, OCN, CHPN, and clinical social worker Karen Hollar, LCSW. Their goal is to make sure a patient who has been diagnosed with a serious illness knows they are not alone in their medical care journey. “It’s about living,” said Piromalli. “It’s how you want to live—and exploring goals, what’s most important to you and what brings you joy. Those are the things that allow us as a palliative care team to discover what the goals are in your life, and how do those goals match up with the type of care you receive.” Often, patients’ mental and emotional needs get lost in the whirlwind of doctor’s appointments, lab tests and rigorous treatment plans. For Alaska Native people, this is especially difficult when core values like family and subsistence lifestyle are often not incorporated during the decision-making process. The palliative care team’s role is to amplify the patient’s voice, liasoning with the entire health care team, to ensure the patient’s goals are honored. “Due to the unique population of Alaska and our Alaska Native people, we traditionally don’t see patients in our hospital system until they’re really sick,” Johnson said. For her, providing palliative care is personal. As an Alaska Native who grew up on the Kenai Peninsula, she understands the delicate balance between culture and care. “In 1998 my grandmother died here in this hospital and I had an epiphany and realized that the way that I felt about her—about her dying—was really strongly related to the nurses who were caring for her,” she said. “Sometimes I felt very included, sometimes I felt very scared and uncomfortable about it and it had a lot to do with how the nurses were caring for her.”
DECONSTRUCTING PALLIATIVE CARE The team launched in October 2015 and since then they have focused on oncology patients, although there are plans to expand to non-oncology patients and provide palliative care education for health care providers statewide. Palliative care, in Alaska and in the country, is still a relatively new subspeciality of care. Piromalli says many doctors and nurses, although they receive extensive medical training, often lack training in primary palliative care, which takes into account the patient’s emotional, social and spiritual well-being. This approach is a comprehensive, whole-body concept. The initial goal is to provide patients with a palliative care assessment at the diagnosis of a serious illness. The assessment provides the time to better understand how a person’s illness affects their lives, both mentally and physically and customize a treatment plan based off their unique set of goals and
IT’S HOW YOU WANT TO LIVE—AND EXPLORING GOALS, WHAT’S MOST IMPORTANT TO YOU AND WHAT BRINGS YOU JOY. needs. The care team assists with communication between physicians, nurses and other health care professionals who may not otherwise connect during a person’s treatment. “The medical system is designed to really prolong life,” Johnson said. “A lot of times, if somebody is really sick, maybe it’s more important for them to be home with their family for their time—feeling as well as possible for as long as possible. A lot of times, in our medical systems, we don’t give them that option.” If she and her team went solely off the doctor’s assessment of a patient and their needs for treatment, they might end up missing something that is really important and meaningful to a patient. “Just because I believe something is right for a patient, doesn’t mean it is,” said Johnson.
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BUILDING A NETWORK “We are building a program not just for Alaska Native Medical Center, but for the Alaska Tribal Health System,” Piromalli said of his vision for expanding his team’s reach. He hopes to build a program that supports the Alaska Tribal Health System with resources, tools and expertise to promote primary palliative care throughout the state. In just a little under a year, ANTHC’s care team has developed resources from educational pamphlets to trainings for health care providers across the state. “Everyone should have palliative care skill sets,” Piromalli said. Good communication skills, the ability to address symptoms and the savviness to address goals of care and advanced care planning, these are all key to providing the best care for patients statewide, according to Piromalli and his team. “We’ve got a very stoic patient population, who are a very strong and resilient people—and it’s a long distance to travel,” Johnson said explaining the
PALLIATIVE CARE PLAYS A CRITICAL ROLE IN THE HEALTH CARE CIRCLE BECAUSE IT OFTEN GENTLY NUDGES THE DOOR OPEN TO A VULNERABLE POPULATION WHO MIGHT OTHERWISE NOT SPEAK UP. challenges of working with rural patients, who are hesitant to travel to receive medical care. Palliative care plays a critical role in the health care circle because it often gently nudges the door open to a vulnerable population who might otherwise not speak up. She hopes that her team’s work will bridge some of the cultural challenges they face.
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“In Alaska, our communities are so far away and in such remote places that the use of technology has really helped us bridge that gap,” Piromalli said. Video teleconferencing allows his team to work directly with community health aides and patients. The team has just started using direct video teleconferencing (Direct VTC), allowing them to talk to patients in their homes. “Often when people have serious illnesses they don’t want to come in and out of doctor’s visits,” Piromalli said. “So, we actually see them at home— through their computer. Even our patients in Anchorage or very far places...we’ve done VTCs in their home setting to provide care.” The beauty of the Direct VTC is that Piromalli, Johnson and Hollar don’t always have to limit themselves to serious medical calls. They can call their patients just to check-in, see how they’re feeling or sing them happy birthday. “It’s just cool! It’s a lot of fun and they appreciate it,” Johnson exclaimed. “It’s a virtual home visit,” Piromalli chimed in. “Sometimes the things that make the biggest difference are the simplest things.” The team’s next big launch is Project ECHO, an internationally recognized collaborative model of medical care education and care management. The Palliative Care Team is looking forward to using this model to develop a network of interdisciplinary health care providers educated through virtual trainings in primary palliative care. Building a supportive statewide network will ensure patients receive meaningful end-of-life care. “The advance communication skills will be taught so that all of our patients will know what is happening in their bodies and what treatments are being offered so they can make decisions that best meet their needs,” said Hollar. l
feature
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feature
ERTHA JACKSON’S NEW LIFE began
with a pair of diagnoses. First, hepatitis C. Then cancer. For years after she got the news, she battled for her life, facing a seemingly endless train of treatments, hospital stays and surgeries. She never surrendered. Now well on her way to recovery, the symptoms are gone, but her new perspective remains. “I’m so thankful to be alive today,” she said. “I’m so thankful that I have a second chance in life.” For other Alaskans undergoing their own medical struggles, she has words of guidance: Don’t give up. Listen to your doctor. Fight. Live. According to the Centers for Disease Control, hepatitis C is a viral infection which attacks the liver. It is spread through blood. In 2014, doctors reported about 30,500 cases of acute hepatitis C across the country. Nationwide, as many as 3.9 million people live with the disease. Untreated, it can become fatal. The Last Frontier is hardly immune. Between 20112015, the Alaska Department of Health and Social Services recorded an average of 1,189 new cases of hepatitis C annually. The actual number of new cases has climbed steadily since 2011, according to DHSS. Baby boomers (persons born between 1945 and 1965) like Jackson account for 75 percent of all chronic hepatitis C infections among adults in the U.S. They have a five time higher prevalence of hepatitis C than adults born in other years and the majority of them do not know they are infected. That can change. In 2012, the CDC amended its screening guidelines for hepatitis C and recommended that all baby boomers be screened one time for hepatitis C, regardless of risk. The screening test is covered by Medicare, Medicaid and insurance companies. Jackson was first diagnosed with hepatitis C about five years ago. She had been suffering with liver troubles for some time, conditions exacerbated by a former drinking habit, she said. Still, her doctor’s determination came as a shock. At first, the treatment was nearly worse than the disease itself. Currently, the U.S. Food and Drug lists 17 approved hepatitis C treatments. Jackson’s course— more than six months of treatment—left her feeling sick and weak. And it didn’t work. When they tried
a second course of treatment, Jackson couldn’t see it through. The medicine was too hard on her body already weakened by illness. She was losing hair and weight; unable to eat or sleep. That’s about the time she got her second diagnosis. Liver cancer. “I didn’t hardly get a break,” she recalled. “My body went through a whole lot.” Data shows American Indian and Alaska Native people are disproportionately affected by hepatocellular carcinoma, otherwise known as liver cancer. Alaska Native people have among the highest rates, according to research published by the National Institute of Health. When Jackson received her diagnosis, she almost gave up, she said. She thought about keeping quiet about it; forgoing treatment; letting the disease run its course. Then she thought about her husband. She thought about her children. She thought about her grandchildren, her friends and neighbors. “Then I started thinking—‘I’m being selfish right now. I have people who love me; I have more to live for,’” she said. “Most of my kids are grown up, but they still need their mother.” Jackson’s cancer was found on the underside of her liver. Removing it meant cutting into her stomach. By that time, she was making regular trips to see doctors in Seattle. And while her body still battled the cancer, it was winning the fight against the hepatitis C. “I was very glad—that kind of took care of the tiredness,” she said. “Cause your life is never normal when you’re battling through that sickness.” The illness that seemed to drain the energy from her body drew a sharp contrast between the world of the healthy and the unwell. As Jackson watched people go about their daily lives, she longed to return to the familiar routines; simple things like berry picking and babysitting. Her sickness gave her a new outlook on life, she said. She gained a renewed sense of empathy and appreciation. “Until you go through something yourself, you never know what it’s like; what it feels like,” she said. On the list to receive a replacement liver, Jackson waited patiently for the call that could save her life. When the first call came, though, she was hundreds of miles away in the Western Alaska community of
I’M SO THANKFUL TO BE ALIVE TODAY. I’M SO THANKFUL THAT I HAVE A SECOND CHANCE IN LIFE.
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I HAVE PEOPLE WHO LOVE ME; I HAVE MORE TO LIVE FOR. MOST OF MY KIDS ARE GROWN UP, BUT THEY STILL NEED THEIR MOTHER. Golovin, her hometown. Unable to make it back to Seattle in time, she missed her chance. The wait continued. Then she got another call; another liver. This time, the liver didn’t fit—and the wait continued. The final call came at the end of last February. Jackson flew down to Seattle and underwent the risky replacement surgery, hundreds of miles from her family and home. Convalescence was difficult. Liver transplants require careful monitoring and a regimen of anti-rejection medications. For Jackson, that wasn’t even the most difficult part. “I was very homesick at the time,” she recalled. “After the surgery, it was very hard for a while.” At first, she was expected to remain in Seattle for about three months. After two and a half, she couldn’t take it anymore. She missed her family, and her recovery had progressed to the point where she was able to return north. Finally, it was time to go home. Alive. Healthy. “It was a really hard few years for me, but I made it, and I thank God,” Jackson said. “Everything was through prayer, for me. It’s God—I really give the thanks to him.” She credits her faith for her recovery; that, and the support of all the doctors and nurses along the way. Back in Anchorage now, she says she’s still healing. She is free of hepatitis C and liver cancer. It will take another year to reach full strength. But despite the road that lies ahead of her, she faces the struggles with a new, clear sense of purpose. “I don’t take my life for granted anymore,” she said. For others facing the same challenges, she offers these words of wisdom. “The first thing that I learned is not to panic, not to get scared of what you may hear,” Jackson said. “Pray, and believe. Everything will come out alright.” l
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Alaska Native Medical Center is redesigning space to better serve patients
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new and notable
EEPING YOURSELF in tip-top shape
means scheduling regular trips to see your doctor. Whether that’s treatment for a chronic condition or getting your yearly exam, you know you’ll have to carve out time in your schedule to make the appointment. Now, new hospital designs may make trips to the doctor faster and easier than ever before. By reinventing the way they provide care in their clinics, Alaska Native Medical Center is streamlining and improving patient care. When a patient checks in at the new AMNC Healthy Communities Building (HCB) clinics, they will be ushered into an exam room where multiple departments are available to meet their needs. Patients who need a prescription, blood work, an ultrasound or even an X-ray can access those services in the same room where they meet with their provider. On big campuses like the Alaska Native Health Campus, it can be confusing and time consuming to send patients to different clinics or buildings. This new clinic model offers all the basic services in one centralized location. In the past, clinics in the ANMC Primary Care Clinic had exam rooms that were separate from the offices of their providers, nurses and case managers. Now, clinic renovations are co-locating the provider teams in one area, or as Medical Space Planner Abigale Kron describes the setup: pods. “Think of it as a race track, where the patients are in the middle of the track and the support staff are on the outside,” Kron said. By having the support staff encircle the patients, they’re available to step in when needed. From a provider's perspective, the goal is that they can interact with different clinical departments seamlessly while treating patients. If they have a question or want to confer with a pharmacist, lab technician or radiologist, they are literally steps away. When they need a consult, said Kron, “They don’t have to call another clinic and leave a message and wait for someone to call them back. For the most part, they have unlimited face time with those involved in the essential aspects of their patients’ care.” With one floor of renovations complete, another 20,000 square feet is currently being renovated for clinical space. Once complete, there will be 40,000 square feet of new clinical space in the HCB, located on the west side of the Alaska Native Health Campus. The areas that have been renovated and those that are under current renovation include the internal medicine and subspecialty clinics, podiatry, dermatology, neurology, radiology, pulmonology, lab, oncology and hematology and infusion center.
Tammy Weaver, the director of Medical Specialty Clinics, said the changeover has made the staff more connected. “In the previous space there were segregated activities,” Weaver said. Patient phone calls and scheduling happened in the office area and clinic work in the clinic side. “Often times the work was being duplicated and communication was more cumbersome due to the physical separation of staff.” Jennifer Hamberger, who works in rheumatology in the Internal Medicine Clinic, echoed Weavers sentiments, adding that the designs have made her feel more informed about the clinic’s day-to-day operations. “I am more aware of what is going on in the clinic and with clinic staff and patients being so close,” Hamberger said. “If someone needs assistance or I need to speak to a patient, I am immediately aware. Communication is more seamless.” This, she said, makes it so patients’ needs are realized more quickly by the staff and the team is able to address them more efficiently. Karissa McLane, a case manager in the internal medicine clinic, said it’s resulted in more productive communication. “I know when my patients are coming in and can check in with them in person more easily if need be,” McLane said. Besides being innovative, the new clinic designs are flexible and efficient. “We have designed the exam rooms to provide the basic needs of most of the clinics that could operate in an outpatient environment,” Kron said. Because there are no walls separating the different clinics and there’s a central registration and reception area on each floor, there will be greater flexibility for future renovations. All the rooms are cloned to be the same, so any specialty can occupy the room, provided they bring whatever key pieces they need for their specialty. It comes in handy as clinics expand and contract to meet patient demand. If the oncology clinic needs more space, it’s as simple as transferring one exam room from one provider to another. Or if one clinic moves out, they can seamlessly move another one in, rather than gutting the room and starting from scratch again. “All of this is really about providing the best possible care to our patients,” Kron said. “By designing clinics that can provide all their basic needs in one place and encourage the collaborative process between providers, different departments and clinics, we are providing an environment for our patients to receive the best care.” l
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A how-to guide for keeping you and yours healthy this season
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prevention
ORE THROAT? Fever, achy muscles and wretched cough? All the symptoms of Influenza, more commonly known as the flu. The influenza virus has the ability to knock out even the strongest people, laying them up on their couches, wishing they had just gone to the clinic and gotten a flu shot. With flu season around the corner, we sat down with Alaska Native Tribal Health Consortium’s flu expert, Rosalyn Singleton, M.D., to get some tips on staying healthy this flu season. She busted some flu myths and gave us the 411 on why a flu shot is your best defense in preventing the flu. “The flu occurs in 10 to 30 percent of the population depending on the year,” says Dr. Singleton. “And every year it varies in how severe it is.” Her biggest reason for getting a flu shot? To not only protect herself from the virus, but also her loved ones. She recommends everyone in the family get a flu shot—including babies who are six months or older. She also recommends vigilant hand washing with warm water and soap.
MYTH BUSTERS: TRUE or FALSE? 1.
2. True or false: I can get the flu from getting a flu shot. False. You can’t get the flu virus from getting a flu shot. The flu-like symptoms associated with the flu shot may develop for a variety of reasons including other diseases such as the common cold. Some people may experience side effects like muscle aches and fever for a day or two after receiving the flu shot in response to their body producing protective antibodies. So, you may think you have the flu when you actually don’t. 3.
FLU PREVENTION AND TREATMENT TIPS: 1. At the end of September or early October head to your local clinic for a flu shot. Check ANTHC’s website (anthc.org) or call your local clinic to learn more about flu vaccine clinics. 2. Wash your hands with warm water and soap before you eat and every time after you cough, sneeze or blow your nose. 3. If you’re feeling flu symptoms, drink lots of water and head to bed early—your body needs all the extra rest it can get. 4. If you do come down with the flu, stay home from work, school and other social activities to prevent spreading it elsewhere. Also, make sure your family members are washing their hands and drinking plenty of fluids as well.
True or False: Flu is a just a mild illness and should not be taken seriously. False. Although each individual experiences a different severity of the viral illness, for some, the flu can be deadly, especially in vulnerable populations like young children and the elderly.
True or False: The flu virus occurs in other animals besides humans? True. The flu virus can occur in birds, like the avian flu (H5N1) or in pigs, also known as swine flu (H1N1).
4. True or false: I’ll get a flu shot once I have the flu—it will help me get over it faster, right? False. Getting a flu shot when you have already been diagnosed with the virus will not make recovery faster. That’s why it’s good to get a flu shot early in the season. 5.
True or False: The flu can cause other serious illnesses? True. Complications from flu can cause pneumonia—which accounts for many hospitalizations each season. Flu also leads to the worsening of chronic medical conditions such as asthma, congestive heart failure and diabetes. According to Dr. Singleton, between 30,000 to 100,000 hospitalizations occur nationally from the flu.
5. Lastly, if symptoms are worsening, head to your primary health care provider for assistance.
Dr. Singleton’s best advice for avoiding the flu this fall and winter season: ✓✓ Schedule a flu shot appointment for you and your family, including babies six months or older. ✓✓ Be vigilant about washing your hands with warm water and soap. ✓✓ If you’re showing symptoms of the flu, stay home, stay hydrated and get lots of sleep.
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prevention
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The ‘what’ and ‘when’ of childhood immunizations
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4-6
years
Hep B Protects against hepatitis B, which can lead to liver infection, liver failure and liver cancer. RV Protects against rotavirus, which can lead to severe diarrhea and dehydration. DTaP Protects against diphtheria, tetanus and pertussis (whooping cough), which together can lead to heart failure, coma, paralysis and pneumonia.
Hib Protects against bacterial meningitis, which can lead to intellectual disability, pneumonia and even death. PCV Projects against pneumococcus, which can lead to pneumonia, blood infection and meningitis. IPV Protects against polio, which can lead to paralysis and death.
MMR Protects against measles, mumps and rubella, which together can lead to brain swelling, pneumonia, meningitis and deafness. Varicella Protects against chicken pox, which can lead to infected blisters, bleeding disorders and pneumonia.
Hep A Protects against hepatitis A, which can lead to liver failure, joint pain, kidney, pancreatic and blood disorders. Influenza Protects against the flu, which can lead to pneumonia.
The U.S. Department of Health and Human Services Centers for Disease Control and Prevention, the American Academy of Family Physicians and the American Academy of Pediatrics all agree that immunizations give your kiddo his or her best chance for a healthy childhood.
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recipes
IET AND NUTRITION play essential roles in the healing process, providing a cancer patient with the energy and stamina to withstand grueling treatments. Eating the right foods, ones rich in nutrients, fiber and protein, helps patients maintain body weight, keep tissues healthy and fight infections. In some cases, treatments are more effective if the patient is getting enough of the right nutrients. Karen Morgan, program coordinator for Alaska Native Tribal Health Consortium’s Cancer Program, said beyond nourishment, food provides something else: comfort. These two recipes call for Alaska grown ingredients and according to Morgan, provide both comfort and optimal nutrition for those battling cancer.
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Blueberries come to mind when Morgan thinks about healing recipes. Fresh or frozen, the wild berries are rich in vitamins like vitamin C and fiber.
20
recipes
INGREDIENTS: 2 ½ cups fresh blueberries ¾ cup cold water 3 tablespoons all-purpose flour ½ cup sugar
INSTRUCTIONS: 1. Whisk together cold water with 3 tablespoons of all-purpose flour, set aside. 2. Place blueberries in a medium-sized pot on medium-high heat. Add enough water to nearly immerse the berries, add sugar and gently stir frequently as it comes to a rolling boil (it should start to thin out and become easier to stir). 3. Add the water and flour mixture. 4. Stir frequently to prevent lumps, pudding should begin to thicken as it comes to a boil for up to 2 minutes. 5. Cool completely and served chilled or at room temperature. Makes 8-10 servings.
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Moose meat is an excellent source of protein; it’s very high in nutrients,� Morgan said.
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recipes
Moose meat is low in fat and sodium. Three ounces of cooked meat contains 25 grams of protein and four milligrams of iron.
INGREDIENTS: 5 pounds ground moose meat (may substitute for other lean game meat) 16 ounces breadcrumbs 20 ounces 1% milk 3 ounces tomato paste 2 ounces fresh parsley, chopped 1 teaspoon ground black pepper 1 tablespoon minced garlic ½ yellow onion, finely chopped 1 cup grated carrot ¼ cup shredded parsnips 1 cup chopped broccoli crowns ½ cup cheddar cheese, shredded
INSTRUCTIONS: 1. Preheat oven to 350° F. 2. Mix the breadcrumbs, milk, tomato paste, parsley, black pepper and garlic. 3. Roast onion, carrots and parsnip. Blanch broccoli crowns. 4. Add bread crumb mix to meat by hand. 5. Prepare a sheet pan with plastic wrap covering bottom. 6. Spread meat over three quarters of sheet pan. Leave about 3 inches of one side unfilled. 7. Spread veggies over the meat, leaving about one inch clear on all sides. 8. Sprinkle cheese all over. 9. Pull plastic from edges and roll over, starting from top and working toward the bottom. 10. Transfer to sheet pan lined with parchment paper, placing folded side down at an angle. Be sure to remove all plastic. 11. Bake for 25 minutes. 12. Cut into 6-ounce portions. Serving size is two 6-ounce portions.
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