Kawerak and NSHC hold joint meeting
Norton Sound Health Corporation and Kawerak, Inc. held a joint board of directors meeting on March 10 and 11 in Nome. The meeting was attended by representatives from several villages. The days included dancing, food and in-depth discussions. The first day of the meeting focused on physical health, the second day on mental health.
After the approval of minutes from last year’s meeting and a teleconference with Senator Lisa Murkowski’s office, Kawerak president Melanie Bahnke gave an update on Kawerak’s achievements, goals and initiatives. Bahnke reported that the Kawerak board met last summer and decided to adopt a new mission statement.
At that meeting, the board also set five major priorities for the corporation to focus on over the next five years.
The first priority is the preservation of culture and language. Bahnke mentioned the fall opening of the Katirvik Cultural Center as a step in the right direction towards this goal. Planning for the cultural center has been underway for twenty years. “We don’t intend for it to just be a museum of objects under glass cases, it’s intended to be a base camp for all kinds of cultural education and awareness and activities throughout the region,” Bahnke said.
The second priority is public safety and wellbeing. Kawerak has a Village Public Safety Officer program and a Child Advocacy Center that work to promote wellbeing on a family level. In order to help preserve Native culture and protect Alaska Native children, the Kawerak board decided to encourage foster parenting. If a Kawerak employee is a foster parent, he or she is allowed paid time off each quarter to attend to the responsibilities that come with the undertaking, including doctor’s appointments and Office of Children’s Services meetings. There are currently 10 Kawerak employees who are foster parents.
The third priority is Arctic resource management and protection. Kawerak’s Marine Advisory Program provided input to the U.S. Coast Guard regarding the routes ships should take as they pass through the Norton Sound region.
Regional capacity building is the fourth priority. Kawerak will give funding to its tribes for “one time” infrastructure projects. Kawerak is also seeking an energy grant, which would allow the corporation to hire an expert on alternative energy. The professional would share information with tribes about possible funding for alternative energy projects.
The last goal is internal capacity building. Bahnke said Kawerak will try to improve communication with its tribal members. To do so, the board approved the hiring of a public relations officer. “We’re behind the times when it comes to Facebooking and twittering and tweeting and all that stuff,” she said half-jokingly. The board also discussed how to improve culture in the workplace, but has yet to decide on specific ways to do so.
Bahnke said President Obama’s fall visit to Alaska was a highlight for Kawerak. Prior to meeting with international officials, Obama held a private, hour-long conversation with 16 tribal leaders about climate change. “He made a point of meeting with tribal leaders first,” said Bahnke, who attended the meeting.
Bahnke then briefly touched on company and employee achievements. Last fall, Kawerak held its first ever education summit. Administrators, teachers and school board members from the Bering Strait School District and Nome Public Schools gathered with representatives of the Alaska Native community to discuss how best to educate children in rural Alaska. “To me it was indicative of a paradigm shift that is going on, not just in our region, but statewide,” she said of the failure of schools to effectively teach predominately Alaska Native students.
Several ideas came out of the summit, including the need for culture to be reflected, not just taught, in schools. Bahnke quoted one student as saying, “don’t teach me about my culture, use my culture to teach me.” From this came the initiative “Growing Our Own Teachers.” Instead of having teachers from the Lower 48 come to Alaska to work for a few years, it would be preferable both for the villages and for the students to have teachers who were raised in the community. In order to do this, a college education needs to be available on a village level. Norton Sound Economic Development Corporation gave Kawerak $1 million towards the initiative.
Norton Sound Health Corporation President Angie Gorn reported that NSHC had accomplished several goals in 2015, including securing funding for St. Lawrence Island clinics. Other achievements included improving pharmacy operations and holding a health fair in every village. Over 1,845 people participated in NSHC health fairs in 2015, compared to 826 in 2014.
Gorn also listed NSHC’s goals for the upcoming fiscal year. The first is to continue to focus on Native hire and development. During Fiscal Year 2015 NSHC hired five Native employees but will continue to “ensure local people are securing the necessary training and development to move up into supervisory and management positions.”
Another large goal was to increase the level of education about the harms of tobacco. In 2015, NSHC hired Michelle Poust as their Tobacco Cessation Counselor. In 2012 zero patients successfully quit using tobacco, the number increased to seven in 2015.
Another top priority is to complete a community health needs assessment. To do this, NSHC will hold health forums, interview key leaders and analyze data. A report will be compiled next month to identify areas for improvement.
The last goal is to continue to collaborate with partnering agencies, including Norton Sound Economic Development Corporation, Northwest Campus and Kawerak. NSHC hopes to develop a regional Native Food Donation Program geared toward elders living at the Quyanna Care Center.
The board members held a teleconference with Senator Donny Olson, who explained what is currently happening in the Senate. Two pieces of legislation he mentioned were the Medicaid reform bill, or Senate Bill 24, and Senate Bill 23. Senate Bill 24 combines two bills, the Governor’s Bill 78 with Senate Bill 24. With the current budget deficit, Olson said it was especially important for him to stand up for rural Alaska.“[We want to make] sure that we don’t have to bear the burden of these budget cuts,” Olson said.
Senate Bill 23 would legalize opioid overdose drugs. In the event of an overdose, these drugs can be administered to prevent death. In 2015, over 30 Alaskans died of heroin overdoses.
Myra Munson, a Juneau lawyer and former Commissioner of Health and Social Services, spoke about Medicaid reform in greater depth. The Federal Government reimburses healthcare providers 100 percent for Alaska Native patients if they are eligible for Medicaid and if the treatment is given at an Indian Health Services facility or by a tribe or tribal organization, such as NSHC. Currently, the reimbursement is limited to inpatient, outpatient and clinic visits. Through the reformed policy, Medicaid reimbursement would be available for additional costs, such as transportation.
Munson gave a presentation about how the expansion would increase the reimbursement for Medicaid eligible patients. “We put a lot of time and energy into this bill and I think it has a lot of things that would be good for everyone,” Senator Olson said. He expects it to eventually save up to $130 million in the state’s general fund over the next five years.
Rural Alaska Monitoring Program
Dr. James Berner spoke about the Rural Alaska Monitoring Program, or RAMP. The program monitors human and wildlife health threats that result from climate change in Northwestern Alaska. A combination of anthropogenic contaminants and climate warming lead to serious food and water safety concerns. Animal diseases can affect humans, but most doctors don’t suspect that the cause of a human’s sickness is from, for example, brucellosis, because it is not a common disease in the general population. However, the traditional diet in Alaskan communities includes marine mammals, and these animals are becoming sick due to diseases that come with the warming climate.
Normally, Berner said, animals and humans have strong enough immune systems to ward off the viruses and develop immunity in the form of antibodies. However, when immune systems are compromised, as in the case of elders and pregnant women, humans fall ill. Berner spoke about a study that monitored the blood levels of persistent organic pollutants in pregnant women’s blood. These pollutants are transported through wind and water, and can be passed down through the food chain.
Since the animals have developed immunity to diseases and toxins, they do not appear sick and people kill and eat them. The only way to determine if the animal contains a toxin is to sample its blood. Kawerak is partnering with RAMP to teach people in the villages how to sample the blood of marine mammals and to send it to get tested.
Berner spoke of the ill effects that occur as the Alaska Native population moves away from traditional food and toward processed, store-bought goods. Specifically, Alaskans have a Vitamin D deficiency. Vitamin D is most commonly absorbed through sunlight, which, as Berner pointed out, Alaska does not always have high amounts of in the winter months. Low vitamin D levels lead to higher rates of colon cancer, the most common cancer found in Alaska Natives. Another problem in Alaska is dental health. Vitamin D deficiency causes tooth enamel decay, which Berner said is the biggest health threat among Alaskans.
Effects of trauma
The second day began with a presentation about Adverse Childhood Experiences, or ACEs. ACEs are traumatic events that can potentially have lasting effects on health and wellbeing. The presenter, Pat Skidmore, spoke about how diseases such as diabetes can be linked to trauma through a phenomenon called epigenetics. Epigenetics, Skidmore explained, is the chemical process that “turns on genes.” In other words, every cell contains the same DNA sequence, but some cells form skin, others form heart tissue and so on. Epigenetics is how cells read the DNA code, or gene. Trauma can affect how cells read genes, and therefore victims of abuse have a higher likelihood of developing diseases such as diabetes. However, Skidmore said, epigenetics can be reverse.
Melanie Bahnke pointed out that ACEs don’t focus on trauma to a population, such as oppression, but such trauma can lead to individual trauma, especially when it is repressed. Anguish can be passed down, and therefore so can the gene. Angie Gorn, President and CEO of NSHC mentioned the Healthy Start Program, which works with women throughout their pregnancies and up to two years after their child is born. The program’s goal is to reduce the number of perinatal health problems. They provide home visits, health education classes and depression and substance abuse screenings.
Traci McGarry works for Kawerak’s Children’s Advocacy Center, or CAC. The CAC assists children who have been abused or neglected. McGarry noted the number of children brought into the CAC has increased from 22 in 2010 to 81 just five years later. McGarry says this is mostly due to increased awareness about the center, not necessarily an increase in abuse cases.
The CAC works with the District Attorney’s office, the Office of Children’s Services and the Assistant Attorney General. McGarry described the CAC as a “one-stop shop,” meaning that the facility has ability to provide medical treatment and forensic exams and interviews.
When asked if the program has sufficient funds to accomplish everything they are tasked with McGarry said, “I’m going to say no. I’m always going to say no.” The main need is for funding for plane tickets for children and their non-offending parent or parents to and from villages. The plan is to transfer Victims of Crimes Act, or VOCA, funds to the CAC. When there is not enough money to fly the victims to Nome, troopers sometimes conduct interviews in the field, which is discouraged.
In her presentation, McGarry said that 80 to 90 percent of mothers who come to the CAC with their children reveal that they too were sexually abused as children. For most, it is the first time they are telling someone what happened. Many times, the perpetrator got away with the crime, and probably abused more children as well. “There are always more victims. If there’s one, there’s many,” McGarry said.
The Family Wellness Warriors Initiative works to stop the trend in abuse through sharing stories. The program will hold a five-day training session in Nome this April through Beauty for Ashes, a faith based initiative. Beauty for Ashes had a Nome based committee for the past three years. The program works with both victims and perpetrators, or “those who have been harmed and those who harm,” as the program puts it. One of the main questions Beauty for Ashes explores is how childhood experiences impact adults. Through sharing stories, the program helps the participants to move forward with their lives and relationships.
With respect to epigenetics, they have yet to discover if storytelling lowers the risk of cancer, but it is an avenue Bobbi Outten, who works with the program, wants to explore. Regardless, those who participate in the program are given valuable tools to communicate their issues and prevent the problem from spreading. “We carry trauma even from stories we don’t know anymore,” Kawerak’s Lisa Ellanna said.
The Wellness Warrior initiative has also worked with the Office of Children’s Services, and has helped parents regain custody of their children.
Substance abuse treatment needed in Nome
Lieutenant Devin Bodine and probation Officer Catherine Clarke gave an update on the Anvil Mountain Correctional Center. Many of the inmates at AMCC are held under Title 47. When people are too intoxicated to care for themselves, they are held until they are sober or under the supervision of a sober relative or spouse. Various medical conditions can arise when a person is dangerously intoxicated. However, AMCC does not have the funds to hire a full time nurse, so there is no medical staff in the facility after about 10 p.m.
Clarke said there is also a need for funding to send inmates to substance abuse treatment facilities. There is no such center in the region, so people wishing to seek intensive treatment must go elsewhere. However, AMCC is only allotted funds to send the inmates back home once they are released. Inmates are often ready to take the next step and receive treatment, but cannot because there is no funding available.
Clarke and Bodine also spoke of the need for mental health services at AMCC. Currently, the Department of Corrections is the largest provider of mental health services in the State of Alaska, which Clarke said was not ideal. However, the only way for AMCC inmates to receive therapy is through TeleMed, which is not as effective as face-to-face treatment.
Panganga Pungowiyi and Bertha Koweluk spoke about the Community Alcohol Safety Team, CAST for short. Pungowiyi and Koweluk stressed the necessity of keeping the Nome Youth Facility open. Lawmakers have proposed closing it in light of the budget deficit. They also addressed the need for local foster care as a way to keep children in the region, close to their families. Staying in the region helps young people maintain their identities, which helps to prevent suicide, they said.
Liz Medicine Crow of the First Alaskans Institute praised the board members for taking a stand for racial equity. It is necessary, Medicine Crow said, to have Alaska Native voices in government on both the local and state levels. “The legislative offices need representatives who understand who we are and who have our best interests at heart,” she said. Medicine Crow spoke of the importance of having a dialogue that “doesn’t shut the other side down,” because racism is a problem for all groups of people involved. “We need actions, not studies,” Medicine Crow said before going on to praise Alaska Governor Bill Walker and Lieutenant Governor Byron Mallott for their work in helping Alaska Native voices be heard.
Lisa Ellanna and Panganga Pungowiyi of Kawerak and Nome Methodist Pastor Charles Brower gave a presentation about the Nome Social Justice Task Force, SJTF for short, which is a local group for racial equity. The SJTF has held six community-wide conversations and one historic trauma training in Nome. These meetings focus on the effect colonization had, and continues to have, on Alaska Native people. The ramifications can include drug and alcohol abuse, domestic violence, suicide and child abuse, all of which were touched on throughout the two-day meeting.
The next NSHC and Kawerak joint board meeting will be in 2018.