to our ealthy raditions from C Chair an and resident
EALTHY TRADITIONS is not just the new magazine from the Alaska Native Tribal Health Consortium in partnership with Alaska Dispatch News; healthy traditions are what inspire Alaskans to play softball under the midnight sun, gather greens outside one’s door for a delicious salad, take care of our families and wake up to do it all over again. With this magazine, ANTHC is pleased to share the traditions of health that come from Alaska Native culture and are now being recognized and celebrated throughout the state. Our health traditions are happening in communities across Alaska in ways that go beyond exam rooms and doctor visits. We’re sharing our traditions with you, as our valuable partners in health. The Alaska Native Tribal Health Consortium is built around the idea of partnership to achieve our vision that Alaska Native people are the healthiest people in the world. We hope you enjoy the stories along the way and find some inspiration for your own healthy traditions.
3
safety PROTECT YOUR HEAD Bicycle safety tips to help you roll safely through summer
4
teamwork FOR THE LOVE OF THE GAME i e r ral illages nd co nity thro gh summer sports
6
profile FRIENDLY COMPETITION athletes rica ec el and Casey erg son on reaching pea perfor ance at the games
8
wellness SLEEPING WELL IN THE LAND OF THE MIDNIGHT SUN good night s sleep does ore for yo r body than yo ight thin
10
new and notable ALASKA’S ONLY FIBROSCAN MACHINE ainless affordable diagnostic technology for patients with hepatitis C
12
prevention MAKING US SAFER he n ry re ention rogra is serio s abo t identifying and addressing ris s
14
recipe COASTAL BOUNTY n oy a eal fro the store o tside yo r door
Sincerely, Andy Teuber ANTHC Chairman and President P.S. New stories of health are happening each week at www.anthc.org. Connect with us online to learn more!
Alice Rogoff / Publisher Maia Nolan-Partnow / Editorial Director Aaron Jansen / Creative Director Jamie Gonzales / Editor Viki Spiroska / Production Coordinator Joshua Genuino / Art Director Rejoy Armamento / Graphic Designer Kelly Day-Lewis / Layout CONTRIBUTORS Ash Adams, Bailey Berg, Jody Ellis, Trisha Esmailka, Joshua Genuino, Nina Wladkowski 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
safety
bicycle safety tips to help you roll safely through summer by ALLISON MCINTYRE
OT ONLY IS BICYCLING a great mode of transportation, it is a healthy, fun, low-impact recreational activity that is great for people of all ages. While bicycling has many health benefits, accidents do happen, so it’s important to practice bicycle safety. When riding a bike it is crucial to wear a proper fitting helmet at all times. Your helmet should fit snug and sit level on your head. It should not rock back and forth. In the event of a crash, a helmet could protect you
from serious injuries including concussions, traumatic brain injury, paralysis or death. No matter what time of day it is, it’s important to make yourself visible. Wear bright, fluorescent or neon clothing and reflectors to ensure drivers can see you. When riding at night, wear flashing lights. An essential part of bike safety is ensuring your equipment is in proper working order. Make sure your bike chain is clean and lubricated; make sure your bike tires have enough air; and be sure to check your brakes. l
When riding your bike on the road, it is extremely important to pay attention and follow the rules of the road:
u Ride with traffic, not against it. u u
Stop at stop signs and intersections.
Look before turning and use hand signals.
3
4
teamwork
N A RAINY SUNDAY
afternoon in June, the Galena women’s softball team took to their home softball field for their fourth game of the weekend. It was the 24th and final game of the double-elimination tournament. Over the course of the threeday weekend, the rain beat down relentlessly, the wind roared through the pitch and the mosquitos swarmed the newly rebuilt field (the original was swept away by the 2013 flood). Jennal Burgett, one of the Galena team members, said her team won, though she didn’t remember the score. That wasn’t as important. What was important was that five communities—Galena, Nulato, Koyukuk, Huslia and Kaltag—could be together to play, even if the weather wasn’t ideal. “I grew up watching these tournaments, so they’ve been a big part of my life,” Burgett said. “It’s fun to be competitive, but what people seem to really like is getting to spend time with friends from the surrounding villages.” That tournament was just one of five that occurs throughout the summer. For the last 49 years, the five villages have alternated hosting the men’s fast pitch and women’s slow pitch softball tournaments over the course of the summer. Athletes and fans will take off on a Friday to boat down the Yukon to the hosting village, where there will be ballgames, road running and bike races, raffles, potlucks and other community celebrations. The teammates, Burgett said, like to stay active throughout the year—whether they’re cross country skiing, running or engaging in any number of other weather-dependent activities— but they really start to practice softball and baseball in earnest in the weeks leading up to the tournaments. Often, they’ll practice every night the week before. Burgett said everybody in town contributes leading up to the games to make the weekends as fun and successful as possible. Residents donate food, chip in for the cost of jerseys or practice fielding their pop flies and ground balls. “It’s a really good time,” said team member Nancy Pitka. “I love it, because it’s a fun way to stay healthy in the summer and to spend time with my friends.” l
Five rural illages nd co nity through summer sports 5
6
profile
RICA MECKEL is one of Alaska’s top high kickers. She tied the record for traditional one-foot high kick at the 2015 World EskimoIndian Olympics with a height of seven feet and has a number of second and third place finishes in other categories, but she doesn’t really remember the first time she was introduced to the sport that has consumed much of her adult life. Meckel’s mom, she explained, usually had beading tables at the athletic events which kept her too occupied to watch the athletes. It wasn’t until Meckel was attending college that she was recruited to do a demo for the Northern Inuit Show. As a former gymnast with training in jumping and flexibility, she seemed like a natural fit. “Initially I wasn’t interested in it, but after they called me every other day for a few weeks, I finally agreed to try it,” Meckel said. “After that, I was hooked.” Since then Meckel has competed in one-foot high kick, two-foot high kick, scissor broad jump, triple jump and Alaskan high kick, which has competitors starting in a seated position, jumping up, kicking the ball and landing on their kicking foot. Meckel said her goal isn’t as much about winning as it is setting a personal record. Granted, she’s currently in a three-way tie for the one-foot high kick state record. At this year’s WEIO games she’s hoping to best her personal record by two inches, which, if she wins, would make her the sole record holder. To train, Meckel gets up at 5 a.m. She lifts weights and does plyometric workouts in the gym she’s built for herself in her house. After work, she’ll spend more time practicing the various games with a traditional seal skin ball that’s strung up in her home gym. Though Meckel can’t devote as much time to practice as she used to—she’s since graduated and is working a full-time job—stopping isn’t something she’d consider. “When you’re incredibly passionate about something, it defines you,” Meckel said. “Those are the people you associate with. When people ask me about myself, that’s the thing I talk about, because it’s part of who I am.” While Meckel said she enjoys the competitive aspect, it’s the atmosphere that brings her back. “The other athletes I’m competing against are really encouraging,” Meckel said. “All my best friends come from kicking and they are the people I compete against. That’s not common in sports. The people I’m competing against are the people that are there cheering me on and wanting me to do my best.”
ASEY FERGUSON likes the two-foot high kick for several reasons. First, because it’s a connection to his culture. When he was raised in Chevak, he was told the game originated as a way for hunters to quickly communicate between neighboring villages that there had been a successful bowhead whale hunt. Second, because he’s really good at it. During the 2015 WEIO games, he beat his personal record by over two inches with a height of eight feet, five inches. Ferguson, now 28, originally started competing when he was in the eighth grade. His basketball season had just ended and he was looking for something to occupy his time after school. After seeing a flier for the local team, he joined and was soon captivated by the games. “I went to practice one day and just never stopped going,” Ferguson joked. “I liked that because it was so new to me that it gave me a challenge.” After moving to Anchorage, Ferguson spent a few years instilling that love for the games in the Anchorage A Team, a group of competitive Native Youth Olympics athletes, as a coach, a job he liked even more than competing. “I liked getting to see my athletes accomplish what they didn’t think was possible,” Ferguson said. “The best thing about coaching was seeing them exceed their expectations at the state competition and to see how happy they were with their successes.” Right now, Ferguson has put coaching on pause until he can finish his rural development degree from University of Alaska Fairbanks. But given the chance post-degree, he said he’d be interested in getting back into coaching. “When I coach, I improve myself, too,” Ferguson said. “I learn more about the games as both a coach and an athlete.” While Ferguson still competes in a number of other events—one-hand reach, Alaskan high kick, one-foot high kick, knuckle hop, scissor broad jump and occasionally the kneel jump—he doesn’t spend much time practicing his events. Sure, he’ll spend a few days a week lifting weights and doing plyometric exercises to stay healthy, but he largely reserves his event skills for when he can do them with his friends during the competitions. Though he’s often competing against his friends, he said it’s always a positive atmosphere. “Something I’ve learned through competing and coaching is that culturally these games are all based on helping each other,” Ferguson said. “That’s what we’re still doing today by cheering each other on.”
7
8
wellness
a good nights sleep does more for your body than yo might thin
S THE DAYS get longer in Alaska in late spring and early summer, locals who were in pseudo hibernation all winter spend more time outside. Bright summer days (and nights) bring an explosion of energy that make late night hikes and all-night fishing endeavors seem like smart ways to soak up as much summer as possible before the weather turns cold again. But those late nights in the sun give Alaskans more than a tan. With the midnight sun comes sleep problems, which can lead to a slew of other health problems. “The main way light affects your sleep is that it throws off your circadian rhythm,” said Dr. Matthew Hirschfeld, a pediatrician and the medical director for maternal child health services at the Alaska Native Medical Center. He frequently encounters kids and parents who are having trouble sleeping in the summer. Your circadian rhythm, also known as your internal clock, responds to changes in light to release melatonin— increases the amount at night and decreases it during the day—which helps us fall asleep and stay asleep. Simply put, sunlight puts the brakes on the sleep chemical, so people don’t feel as tired as they would when the days are shorter. Hirschfeld said disrupted sleep is especially problematic for kids, because sleep is a big part of growth and development. “Not getting enough sleep affects a lot of things, the biggest being brain development,” Hirschfeld said. “Kids that are chronically deprived of sleep may not hit their developmental milestones correctly. If their brain development is affected, it may not allow that kid to reach their maximum potential. It’s a bigger deal for kids than adults in that way, because it can be difficult to get that development back on track.”
Adults, on the other hand, see marked decreases in work performance when chronically tired, a problem that’s exacerbated by coffee products and energy drinks. “Substituting coffee for sleep only puts your body into unhealthy sleep patterns, which causes additional stress on your body,” Hirschfeld said. Beyond general midday sleepiness and lack of focus, according to the CDC, insufficient sleep has been linked to the onset of and correlates with a myriad of stress-related chronic diseases and conditions ranging from diabetes and cardiovascular disease to obesity and depression in both children and adults. To help fall asleep—particularly in the summer—Hirschfeld has a few suggestions: dark shades in bedroom windows to keep the room dark, a comfortable bed, a consistent bedtime and wake time for all family members and, if all else fails, talk to your family’s medical provider to discuss sleeprelated issues. “If you’re already sleep deprived, you need to set up a routine around sleep and prioritize it,” Hirschfeld said. “The big problem in the U.S. is that sleep isn’t a priority and there are now many studies about how chronic sleep deprivation can lead to bigger problems.” Hirschfeld explained that sleep deprivation is a form of chronic stress. Anything that puts your body under constant stress can lead to increased risk of health problems like heart disease, depression and obesity, just to name a few. “When people are getting good sleep, we see a decreased rate of doctor visits and health problems,” Hirschfeld said. “You’re supposed to spend a third of your life asleep, but most of us don’t get that. You need to make sleep a healthy part of your lifestyle.” l
9
10
new and notable
Painless, affordable diagnostic technology for patients with hepatitis C
OT LONG AGO, a diagnosis of hepatitis C meant repeated biopsies to assess liver damage and determine treatment options. These biopsies were painful and invasive, as well as prohibitively expensive. With the advancement of modern technology, however, there are now treatments and procedures that make hepatitis C both curable and manageable. One of the newest options available for assessing liver damage is the Fibroscan machine. Originally created in France and licensed in Europe, the U.S. Food and Drug Administration approved Fibroscans in 2014. ANTHC was among the first hospitals in the U.S. to get one. The hospital got their Fibroscan just four months after FDA approval, and have performed more than 1,000 scans since that time. Dr. Brian McMahon, Medical and Research Director of the Liver Disease and Hepatitis program at ANTHC, sees this machine as a way to truly change the quality of his patients lives. McMahon, who has worked at the hospital since 1978, specializes in liver disease. “A Fibroscan is a type of ultrasound machine,” he said. “We use a probe on the right side of the patient, which shoots a powerful ultrasound wave into the liver and measures the force of that wave, which in turn measures the level of scarring.” Determining scarring levels helps doctors decide the treatment regimen for patients. “Our traditional
treatment for hepatitis C has been the use of high levels of Interferon, which was sometimes successful, but also created flu-like symptoms in the patient, as well as more serious side effects such as infection from suppression of the bone marrow, depression and hair loss,” said McMahon. In addition to the side effects, Interferon treatment only cured about half of those treated. New treatments cure 95 percent of those treated. “The new drugs available have fewer side effects, but are also more expensive, so insurance companies will not authorize their use unless a patient’s liver is at a certain level of scarring,” he said. “With the Fibroscan, we can assess that scarring without any biopsies.” McMahon said the scans are simple and patients are able to get in and out of the office quickly (usually 20 minutes or less). “I’ve been the guinea pig every time we demonstrate it or do a video,” he said. “All you feel is a thumping as the ultrasound waves go through the liver. It is painless.” The machine is also easy to use and does not require a radiologist or other technician to perform the scan; most of the scans are done by clinicians. This helps bring the cost down to a much more affordable level. The cost of a Fibroscan diagnosis is about $135 versus $4,000 plus for a biopsy. While the Fibroscan’s primary function at this time is to measure liver scarring for hepatitis C patients, McMahon feels that it is only a matter of time before it is used for other procedures. “They’ve already started looking at it for measuring damage to the spleen, and it is being used to help determine Non-Alcoholic Fatty Liver Disease,” he said. McMahon also cites the importance of getting screened for hepatitis C, as many people who have it don’t even know it. “Anyone born between 1945-1965 should get tested for it once in their life,” said McMahon. “There is no ethnic variation, anyone in that age group could potentially have it. And today’s drugs have a 95 percent cure rate. Coupled with this new liver scanning process, we are able to effectively treat patients and we want to screen as many people as we can.” As ANTHC continues to innovate and bring on board the most cutting edge technology, their focus remains on patient care and comfort. Added McMahon, “The Fibroscan has essentially made biopsies unnecessary for hepatitis C assessment. It only takes 10-20 minutes, no anesthesia, no pain and no side effects. We are very excited to be able to offer this to our patients.” l
11
prevention
n ry re ention efforts go a long way in eeping las ans safe ETWEEN 2002-2011, 16,141 injury-related hospitalizations occurred among Alaska Native people.1 How do we lower that number? That’s the question ANTHC’s Injury Prevention Program works each day to answer. The program coordinates with multiple associations and organizations throughout the state to reach out, assist and educate Alaska Native people on injury prevention as they live daily life. Hillary Strayer helps focus these efforts. Strayer is the Senior Injury Prevention Specialist in the Injury Prevention Program with ANTHC’s Community Health Services. She coordinates and leads trainings that range from fall prevention assistance for seniors to acting as a Child Passenger Safety Technician, teaching caregivers and community members proper car seat installation and use.
A TEAM EFFORT
Strayer works directly with the regional Tribal Health Organizations, spreading the message of safety and injury prevention. Each region sends representatives to meet with Strayer and her team to learn injury prevention practices, and the representatives decide what’s most applicable in their own communities. For example, drowning prevention is critical in the Aleutians and Pribilofs, while promoting motor vehicle safety ranks high in the Interior. Whatever specific needs each region identifies, Strayer and her co-workers cover them all. “We provide the same kind of support [to all regions] and let [each region] choose what they need. To sometimes help them make decisions on things, we provide them things like the Alaska Native Injury Atlas and data,” she said. Working with Alaska’s Tribal Health regional organizations, the program has collected data on the most common causes of injuries resulting in death
12
and hospitalization. That data helps them create or adapt safety programs that can save lives and lower the rate of hospitalization from injury. They’ve identified the five leading causes of death and hospitalizations, both intentional and unintentional, as suicide, drowning, poisoning, falls and assaults.
funding for gun safes or lockers and locking medicine cabinets to keep guns and drugs out of easy reach for those contemplating suicide. Keeping guns secure also reduces the chances of assaults, another leading cause of injury-related hospitalizations.
SUICIDE
Drowning was the leading cause of unintentional death for many years and ANTHC funded many water safety programs. Their efforts played a part in reducing drowning deaths among Alaska Native and American Indian people by more than 56 percent.2 ANTHC’s Injury Prevention staff promote the State of Alaska’s Kids Don’t Float program, created to enhance statewide drowning prevention resources. “The PFD loaner board program started in Homer, Alaska, in 1995 by a concerned community member with three stations that had youth life jackets hanging on boards that could
DROWNING
ANTHC’s Injury Prevention program approaches suicide prevention by providing trainings and encouraging safe storage solutions for guns and medications. Community members can be trained to recognize the signs of distress and possible suicidal thoughts and how to intervene with potentially suicidal individuals with the assistance of Mental Health First Aid, ASIST and SafeTALK workshops, in collaboration with ANTHC Behavioral Health staff and external partners. They also work with regional Tribal Health Organizations to provide
be borrowed and returned,” Strayer explained. “Because of its immediate success, the Alaska Department of Health and Social Services, Alaska Office of Boating Safety, U.S. Coast Guard District 17 and Safe Kids Alaska Coalition partnered to expand the program statewide. By 2013, there were 634 PFD loaner boards in 216 communities around the state.”
TRANSPORTATION
ANTHC Injury Prevention also works to protect heads and bodies in and on motor vehicles like ATVs, snowmachines and cars. They provide funding for helmets and child car seats and train regional staff on proper helmet, car seat and seatbelt usage.
FALLS
“Over the past three years, ANTHC Injury Prevention has increased its focus on fall prevention, specifically for Elders, through a strategic initiative,” Strayer said. This initiative includes a PSA about fall risks and preventions, along with a Fall Prevention Summit for medical staff from around the state and in-person trainings. The program has also partnered with the Community Health Aide Program to develop an online training about fall prevention to help Health Aides earn continuing education credits. Understanding that winters in Alaska come with icy walkways, increasing the frequency of falls, this Injury Prevention program has also provided funding to regional Tribal Health Organizations to purchase ice cleats for the Elders in their communities.
POISONING
Recently, poisoning surpassed drowning as the leading cause of unintentional injury deaths. ANTHC is studying the causes and working to decrease the number of deaths. Keeping medications locked up is a good way to reduce unintentional poisonings because they are less accessible to those contemplating suicide or small children who could mistake pills for candy. Program staff promote safe storage and disposal of medications and raise awareness about the dangers of medication misuse and where to go for help if a poisoning occurs, in an effort to lower the number of poisoning injuries and deaths.
FIRE
“ANTHC had worked with the State of Alaska Injury Prevention Office and the fire marshal’s office to distribute smoke alarms and provide fire safety training around the state, in particular to Head Start programs serving rural communities,” Strayer said. The program has distributed carbon monoxide alarms, particularly to communities where woodstoves are commonly used for heating.
PROGRESS
While the program’s work has contributed to a decrease in specific injuries—according to the October 2014 Alaska Native Injury Atlas, the number of hospitalizations among Alaska Native and American Indian people from assault-related injuries has decreased by almost 14 percent, while motor vehiclerelated injuries decreased by more than 30 percent and snowmachinerelated injuries decreased by almost 25 percent 2—the program still faces ongoing hurdles in the nation’s largest state. Getting materials and equipment to Alaska is a challenge Strayer understands well. Living in a remote state means factoring in above-average transportation and shipping costs. Most gear and educational materials coming from the Lower 48 is not meant to be used in tundra and Arctic waters, so ANTHC must adapt training materials for Alaska and ensure they’re culturally appropriate for Alaska Native communities. The Alaska program has had to be particularly innovative in adapting and creating training materials on ice and gun safety; those two issues aren’t high priority in training materials from other parts of the country. The program’s efforts are paying off. Four of the five leading causes of death and hospitalizations among Alaska Native and American Indian people have decreased over the past 20 years. Their work remains consistent with ANTHC’s vision: “Alaska Native people are the healthiest people in the world.” Learn more about ANTHC’s Injury Prevention efforts online: http://anthc. org/what-we-do/wellness/injuryprevention
1 - As reported in the October 2014 Alaska Native Injury Atlas from the Alaska Native Tribal Health Consortium’s Injury Prevention Program and Alaska Native Epidemiology Center. 2 - Data is for the years 1992-1995 and 2008-2011
13
en oy a meal from the store o tside your door 14
recipe
C C and rocky shorelines of Southeast Alaska during the early spring and you just may find your next meal. Young greens, such as yarrow, beach lovage and goose tongue (not to be confused with poisonous arrowgrass) can all be found among the stones and sands, while young bull kelp can be fished out of the water or among the tideline treasures that wash ashore. Watch the webisode (www.storeoutside.com/se-foraged-salad.html) presented by Store Outside Your Door and take notes as acclaimed Alaska Native chef Rob Kinneen collects ingredients and composes a foraged mixed green salad with bull kelp vinaigrette. Soon you’ll be ready to grab a pail and pick your own plants for a hearty and healthy meal.
BULL KELP VINAIGRETTE 1/4 cup of water 1 orange, zested and juiced or 4 tablespoons of orange juice 1/2 teaspoon mustard powder 1/2 teaspoon red pepper flakes 1 tablespoon chopped garlic
SALAD GREEN MIXTURE 1/4 cup yarrow 1/4 cup goose tongue 2 tablespoons mustard green 1/2 cup beach lovage
1 tablespoon chili sauce
1/2 cup romaine lettuce
1/2 cup bull kelp sliced 1/8 in. thick
Salt and pepper to taste
1/2 cup vegetable or canola oil 2 tablespoons of sesame oil
1. Mix all ingredients in a bowl. You may have more of other greens than others, please use whatever is harvested.
1. In a medium-sized pot add water, orange juice/
zest, mustard, pepper flake garlic and chili sauce over medium heat.
2. Add kelp and bring to a boil
2. Mix the vinaigrette, drizzle over the salad, and then add the salt and pepper. 3. Place in the center of a plate, top with
smoked clams or cooked seafood of choice.
3. Add oil and sesame oil. 4. Take off heat and cool. The Store Outside Your Door program was created after the nutrition research project “Helping ourselves to health” demonstrated a strong need for our Alaska Native People to incorporate more of our traditional foods to support efforts to decrease illness and disease that supports the Alaska Native Tribal Health Consortium’s vision: “Alaska Native people are the healthiest people in the world.” Visit anthc.com/traditionalfoods to learn more.
Follow us on Facebook www.Facebook.com/storeoutside
Watch recipe webisodes on Youtube www.youtube.com/anthcstoreoutside
15
One diverse workforce, a world of opportunity.
a world of opportunity. Did you know ANTHC is one of Alaska’s top employers? Be part of the dynamic team supporting the health and wellness of Alaska Native people, through specialty medical care, innovative technology, wellness and prevention services and clean water and sanitation systems.
Your next move can make a difference! anthc.org/careers To speak directly with an ANTHC recruiter, call (907) 729-1301 or email careers@anthc.org.