Indian Health Service (IHS) Director's Corner Blog updates on important issues affecting the Indian Health Service.en-usAmerican College of Emergency Physicians Shares Emergency Room Expertise with IHS Staff, December 8, 2016 ]]>The American College of Emergency Physicians (ACEP) and Indian Health Services’ Work Session was held at the IHS Omaha-Winnebago Hospital in Winnebago, Nebraska on November 17, 2016, the day before our first snowfall in Nebraska. The meeting was attended onsite in person by over 30 IHS and AB Staffing physicians, nursing, quality and leaders from IHS facilities throughout the nation. Several sites called into the session individually and with colleagues from conference rooms. Overall this initiation of the collaboration between IHS and ACEP was well attended.

This work session allowed top-level physicians and emergency medical professionals the ability to share knowledge, training regarding emergency care.
This work session allowed top-level physicians and emergency medical professionals the ability to share knowledge, training regarding emergency care.

The agenda included opening remarks from Mr. Gary Wabaunsee, CEO Omaha Winnebago Hospital, Ms. Mary L. Smith IHS Principal Deputy Director, Dr. Lee Lawrence, Great Plains Area CMO and Dr. Vindell Washington, HHS National Coordinator for Health IT. Dr. Jay Kaplan provided a dynamic engaging presentation about leadership, responsibility and workflow in the emergency room. Dr. Robert Galli talked about the importance and capacity for emergency telemedicine. Dr. Thomas Wyatt a Native physician and past president from the ACEP Minnesota Chapter shared his experiences working in rural hospitals for IHS and other facilities. Dr. Wyatt offered support for the Comprehensive Advanced Life Support (CALS) as an appropriate training program for emergency medical education for rural and remote locations. Dr. Wyatt encouraged cultural training for providers and briefly reviewed EMTALA regulations. Finally, Dr. Vindell Washington offered a wrap up and next steps session to close the work session. The whole day stirred a lively discussion about key IHS Emergency Department and provider issues.

Participants from the American College of Emergency Physicians and Indian Health Service at the work session held on November 17, 2016 at the Omaha-Winnebago Hospital in Winnebago, Nebraska.
Participants from the American College of Emergency Physicians and Indian Health Service at the work session held on November 17, 2016 at the Omaha-Winnebago Hospital in Winnebago, Nebraska.

ACEP advocates for physicians, patients and the public for the highest quality emergency care. The ACEP and IHS collaborative work session brings together top physicians and emergency medical professionals to share telehealth information, training resources and emergency care knowledge. The goal of this innovative work will be to improve the quality of care and management of patient care in the 26 emergency departments at IHS operated facilities throughout Indian health communities in the nation which further advances the IHS mission to raise the health status of American Indian and Alaska Native people. Additionally, this collaboration will allow sharing of best practices, models of care and policies throughout the Indian healthcare system for stronger partnerships with Tribes, local communities and broader health care systems.

The Great Plains Area Office would like to express our appreciation for the ACEP contributors, the Office of the National Coordinator for Health IT and everyone who was able to attend the work session.

Dr. Lee Lawrence is the Chief Medical Officer for the Great Plains Area. He serves as the lead regional expert on IHS medical and public health services, providing technical leadership and guidance to facility CMO’s and clinical staff in the region.

Portland Area Mobilizes to Prevent Seasonal Influenza, November 23, 2016 ]]>Thanksgiving is almost upon us. As we prepare to gather together with family and friends, let us be mindful that one guest is not invited--influenza! Influenza has been shown to have a greater impact on American Indians and Alaska Natives and people with chronic medical conditions. The Portland Area IHS and Tribal clinics have been hard at work this year in vaccinating our communities against the flu. One strategy that we focused on last year was to vaccinate as early as possible. Because flu vaccine supplies are sometimes delayed by production or distribution factors outside of our control, we needed to add to this strategy. This year, clinics are focusing on not only vaccinating as early as possible, they are taking it to the streets by vaccinating in multiple sites outside of the clinic's four walls. Here are some examples of the great efforts our clinical sites are undertaking here in the Pacific Northwest:

  • Yakama Service Unit: The clinic has scheduled weekly flu-shot clinics every afternoon. In addition, they have added one late evening clinic each week. On Thursday mornings, during Administrative Time when the clinic is closed, they are holding "drive-through flu shot clinics" where folks can get their flu shots without even getting out of their car. Flu vaccinations were also given during the Tribal Head Start screening clinic, which had about 50 children.
  • Western Oregon Service Unit (Chemawa): Clinic staff have given about 500 flu shots so far to community members. Among Health Care Providers, 99 percent have received a flu shot this year, according to the new mandatory policy for annual flu vaccinations of Health Care Providers. Angela Zimmerman, Public Health Nurse, is gearing up to vaccinate all 400+ students at the nearby Chemawa Boarding School before they travel home for the Thanksgiving break.
  • Colville Service Unit: The Colville Service Unit has been doing drive-through flu clinics for many years. The first one for this year was held at the main clinic location (Nespelem) on September 21 in which about 100 flu shots were given. A week later, they held another drive-through flu clinic at a smaller satellite clinic in Omak. This was the first time they had done this at Omak and they reported a good turn-out. Both clinics have a policy to vaccinate at all visits and anecdotally they report about 80 percent of those offered accepted the flu vaccine this year. According to Immunization coordinator Sadie Cano, over 90 percent of employees have been vaccinated for flu so far this year.
  • Wellpinit Service Unit: The first ever drive-through flu clinic was held this week reaching 24 patients. CDR Elizabeth Sachse, Public Health Nurse, reports that many of the people she usually sees at home or in elder programs have already gotten their flu shots and observed that the clinic nurses seem to be more active in giving flu shots in clinic because many of the folks she has seen have already gotten their flu shots.
  • Warm Springs Service Unit: Activities at the Warm Springs Health and Wellness Center have focused on making flu shots available at every visit throughout the clinic, including medical clinics, pharmacy and Community Health. In addition, flu shots have been offered at multiple locations and venues outside of clinic. These include many high traffic areas such as the Post Office, Administration Center, Community Center and Family Resource Center. They have also worked to coordinate with many tribal programs such as Corrections, Human Resources, Assisted Living and Children's Group Home. In each location, flu shots are provided for both clients and tribal staff. Nearly all Warm Springs Health and Wellness Center employees have received their flu shots this year!
  • Fort Hall Service Unit: The Ft. Hall Service Unit worked with Shoshone-Bannock Tribal Health Partners again this year to hold two successful drive-through flu clinics. Last year they gave 38 flu shots in just one hour, this year they gave 50! A second drive-through clinic was smaller (just 23 patients) but the Ft. Hall staff was dedicated, working outside in near freezing temperatures. Dr. Bernadette Corum, Acting Clinical Director, reports they have been increasing their use of media and advertising with messages in the clinic, Facebook and tribal newspaper. So far it has paid off with over 1,000 adults and 99 percent of employees vaccinated against influenza this year.
Drive-through flu clinic at the Ft. Hall Service Unit
Drive-through flu clinic at the Ft. Hall Service Unit

Tribal clinics in the area are also joining in the effort. One clinic reports starting to give flu shots earlier this year than before while another reports that they have vaccinated over 400 people so far. They held a flu clinic at the Elder's Center over lunch two different days and even brought their Clinical Director, Dr. Allison Spencer, to discuss the differences between regular adult and high dose flu vaccines. As a result of these activities, 55 elders were vaccinated. Two of our Tribal clinics have also adopted mandatory employee flu shot policies to help protect staff and patients from influenza.

Across the Pacific Northwest, clinical providers employ a number of "best practices" to get people vaccinated. These include:

  • Using Electronic Health Record reminders to help remind staff of who needs a flu shot.
  • Checking for and offering a flu shot at every clinic visit, including eye clinic, dental clinic and the pharmacy refill window.
  • Providing flu shots at out-of-clinic venues: elder meetings, day care and Head Start facilities, and drive-through flu clinics like the one pictured below at Ft. Hall Service Unit.
  • Making flu shots available at special walk-in flu clinics staffed by nurses.
  • Adopting extended-hour clinics on weekends and evenings specifically for providing flu shots.
  • Utilizing pharmacists who are authorized in most states to provide a variety of immunizations, including flu shots.
  • Providing community outreach through radio, newspaper and social media outlets to educate the community about the importance of getting a flu shot each year.

The Portland Area Office is extremely proud of the efforts being made by everyone across our three states. We believe that these efforts are important to prevent influenza morbidity and mortality among the patients that we serve. Learn more about influenza vaccination, prevention and disease surveillance.

CAPT Thomas Weiser, MD, MPH is the Medical Epidemiologist for the IHS Portland Area Office and is assigned to the NW Tribal Epidemiology Center at the Northwest Portland Area Indian Health Board.

Dr. Chris Percy: National Leader in Health Promotion Programs, November 22, 2016 ]]>Dr. Chris Percy is a valued family medicine doctor and a leader in health promotion not only in the Indian Health Service but throughout Indian Country. Dr. Percy is Bi'ké Ts'in Diné (Wooden Shoe or Dutch people), born for the Irish people. He and his wife, Carol, grew up in Wisconsin. They have been a part of the Navajo family for more than 30 years, residing near and working with the Shiprock Service Unit of the Navajo Area IHS in northern New Mexico. His two sons, Matt and Sam, got their start in Shiprock and are now doctors themselves.

Many Diné (Navajo) families know Dr. Percy as a Family Medicine doctor at the Northern Navajo Medical Center where he has provided care for multiple generations - sometimes delivering babies while also taking care of their great-grandparents. He has been welcomed into many families and appreciates all the things his patients have taught him over the years. He enjoys working together with a caring team of doctors, nurses and other health professionals at Northern Navajo Medical Center. He also serves as the Director of the Division of Community Health in the Shiprock Service Unit and is the Director of the Shiprock Health Promotion Program.

Dr. Chris Percy (second from right) and his wife Carol (second from left) take time to take a photo with Northern Navajo Nation Fair parade attendees.
Dr. Chris Percy (second from right) and his wife Carol (second from left) take time to take a photo with Northern Navajo Nation Fair parade attendees.

Dr. Percy is a local and national leader in health promotion and wellness activities- working with people and communities to stay healthy and prevent illness. He is a role model in carrying out the mission of the Shiprock Health Promotion Program, which is Working Together to Build and Strengthen Healthy Families and Communities.

Traditional Navajo philosophy defines a healthy family or community as balanced with appropriate attention being given to stages of life and issues represented by the four directions -east, south, west and north. The Navajo Health Promotion Program is based on this positive model of wellness and partners with a variety of innovative programs.

Dr. Percy commented that to make a difference in prevention, it takes a whole group of partners working together. This is very evident in the Shiprock region where it is common to see people of all ages learning about their language and culture at a Restoring and Celebrating Family Wellness event, or thousands of people walking and running together at Just Move It events in every chapter, young people seeing a counselor or provider at a school-based clinic, a family making healthy food choices, or elders connecting to the next generation with storytelling.

Dr. Percy's energy and commitment was recognized in 2003 by the Director of IHS when he was asked to convene a group to strengthen prevention efforts for the entire IHS, including federal, Tribal and Urban health programs. He worked closely with Tribal leaders throughout the U.S. to bring about results such as sharing best and promising prevention practices, the growth of the national "Just Move It" physical activity promotion campaign, the establishment of a Healthy Native Communities Fellowship, and sharing community wisdom through a series of regional Community Wellness Champion Forums.

Through the efforts and leadership of Dr. Percy and partners in Shiprock, the programs Dr. Percy started have grown successfully. Each of the 12 IHS Areas now has a Health Promotion Coordinator. The Just Move It campaign reaches more than 350 Native communities across the U.S. and Canada. More than 300 Healthy Native Communities Fellows work together for wellness in their communities from Alaska to Maine. Hundreds of Native Digital Storytellers create and share authentic stories about wellness and hundreds more program partners have joined regional Native Wellness Networks in Alaska, California and New Mexico. These efforts are sustained across the country through tribal and community partners and the non-profit Healthy Native Communities Partnership.

Dr. Percy, a much beloved family medicine doctor at the Northern Navajo Medical Center, was the Grand Marshal for the 105th Northern Navajo Nation Fair parade. Shown here with his wife, son and grandchildren.
Dr. Percy, a much beloved family medicine doctor at the Northern Navajo Medical Center, was the Grand Marshal for the 105th Northern Navajo Nation Fair parade. Shown here with his wife, son and grandchildren.

Bringing together community members, local, State, Federal, Tribal agencies, private sector partners and traditional healers to implement the national IHS Health Promotion program is only the latest step in Dr. Percy's career-long commitment to social justice through empowerment for underserved populations. Whether it has been working with the Miskito Indian people of Nicaragua as a University of Wisconsin undergraduate, the local Health Boards of Boston's Neighborhood Health Centers while at Harvard Medical School, the Navajo people, or tribal members from Alaska to Maine, his path shows a focus on partnerships for wellness by building on local strengths to meet local needs.

Recently, this year's 105th Northern Navajo Nation Fair in Shiprock celebrated the foundation of wellness in traditional teachings and blessings. Chris and his wife, Carol Percy, were honored to be recognized as the Grand Marshals of the parade. Hundreds of spectators, including many of Dr. Percy's patients and wellness champions, cheered them on the parade route.

Dr. Percy is a graduate of Harvard Medical School, in Boston, Massachusetts. He completed his undergraduate degree at the University of Wisconsin in Madison. He did his residency at the University of Washington in Seattle, Washington. In addition, he has received numerous awards, including the American Medical Association's Dr. Nathan Davis Award for Outstanding Member of the Federal Executive Branch in Career Public Service and the National Indian Health Board National Impact Award.

CAPT Brian Johnson is the Acting Area Director for the Navajo Area Indian Health Service and serves as Director of the Office of Environmental Health and Engineering, IHS Navajo Area.

Public and Environmental Health Improves with the First Vacuum Sewer System on the Navajo Nation, November 16, 2016 ]]>Every autumn, farmers in Shiprock, New Mexico harvest, steam and dry their Indian corn to make traditional nas chizhi stew, a delicious and popular soup made with dried corn and meat, usually mutton or lamb. Fertile soils and irrigation canals make the town’s Mesa Farm area great for farming but problematic for on-site wastewater disposal. Over 300 homes in the area use septic tanks with drain fields to dispose of wastewater on-site. Irrigation raises the water table, preventing many drain fields from emptying properly. Instead, wastewater accumulates and then surfaces in yards or homes, causing serious environmental health concerns.

Mrs. Marilynn Johnson-King and 82 other families in the Mesa Farm area of Shiprock, New Mexico are grateful for the new vacuum sewer system that was completed in 2015, the first of its kind on the Navajo Nation. She lives in the same area where her grandparents lived and farmed for many years. Prior to the vacuum sewer system, the families in the area had water back-ups in the septic tanks. She commented that they couldn’t wash or use the washer because of the water and raw sewage was coming out of the homes and pooling.

Mrs. Marilynn Johnson-King and her neighbors in the Mesa Farm area near Shiprock, NM are thankful for the sewer system installed by the IHS Division of Sanitation Facilities Construction program.
Mrs. Marilynn Johnson-King and her neighbors in the Mesa Farm area near Shiprock, NM are thankful for the sewer system installed by the IHS Division of Sanitation Facilities Construction program.

Now, with the vacuum sewer system her family is able to do a lot of things that they didn’t do before and they don’t have to worry about getting sick. Mrs. King-Johnson says that her neighbors also like the idea of being connected to a sewer system because it feels healthier and it feels cleaner.

The project began in 2004 when Shiprock’s community leadership requested that the Indian Health Service Sanitation Facilities Construction program plan a community sewer system to eliminate the use of drain fields in the Mesa Farm area. The goal of the IHS Division of Sanitation Facilities Construction program is to improve the health of Native American people by improving access to sanitation facilities like water and wastewater infrastructure.

Initially, the IHS project team began planning a gravity sewer system. However, several obstacles were encountered in the rocky terrain of the Mesa Farm area. Flat topography required sewer depths exceeding 20 feet in some areas. Narrow roads and existing utilities like high voltage power lines and aging asbestos cement water lines provided little space for excavating the proposed deep trenches. The water table was near the surface in some places and the soil was unstable for trenches. The construction costs for a gravity sewer were too expensive.

The vacuum sewer system allows proper drainage and lowers environmental health concerns.
The vacuum sewer system allows proper drainage and lowers environmental health concerns.

Other types of sewer systems were investigated and the vacuum sewer system was determined to be more cost effective than a gravity sewer system. Vacuum sewer systems assist wastewater movement with the use of vacuum pumps and air valves. A vacuum sewer system usually allows for more line placement options, shallower trenches and easier field alignment changes. The capital costs for the vacuum sewer system can be significantly lower in areas where high groundwater, unstable soils, congested utilities, flat or difficult terrain, right-of-way restrictions or other challenges exist. Operations and maintenance costs may be higher for vacuum sewer systems unless one vacuum station can replace several proposed gravity lift stations. A vacuum sewer system may be the most economically feasible solution when site constraints make gravity sewer prohibitively expensive.

Other partners assisted in making the project a reality. The design of the vacuum sewer system was finalized in August 2013 and the Navajo Engineering and Construction Authority Exit Disclaimer: You Are Leaving, a tribal enterprise and contractor for the project, began construction that same month. The $2.8 million dollar project was completed in August 2015. The Navajo Tribal Utility Authority operates and maintains the system. The project successfully eliminated 83 septic tank and drain field systems in the Mesa Farm area. Several hundred homes in the Mesa Farm area are waiting for subsequent phases of the sewer project. This successful project will serve as a case study for other communities on the Navajo Nation seeking to extend community sewer services into areas where gravity sewer systems may not be feasible.

Although the families have to pay a small fee for the vacuum sewer services, Mrs. King-Johnson stated that the benefits far outweigh what one would have to pay for it and just having that peace of mind that one knows that you are safe and you are healthy. It also assures the community of Mesa Farm that there will be less disease due to water-borne illnesses in this rural Southwestern region, thanks to the Indian Health Service.

Colin Daly, P.E., Field Engineer, Office of Environmental Health and Engineering, Shiprock Service Unit, Navajo Area Indian Health Service.

IHS Offers Quality Continuing Dental Education, November 14, 2016 ]]>Dentists, dental hygienists and many dental assistants are required to complete a certain number of hours each year to maintain licensure by their state dental board. These educational courses are offered throughout the U.S., often at a substantial price. For dental staff in IHS and Tribal programs, attending outside courses involves not only the costs of the course but also travel expenses and, more importantly, time away from patients to meet these requirements. The Indian Health Service Division of Oral Health offers a Continuing Dental Education (CDE) program that allows dental staff to meet state licensure and certification requirements, often times without ever leaving their home dental program.

The art and science of dentistry is continuously evolving with the emergence of new technology and new approaches at addressing oral diseases. New and improved health care equipment combined with innovations in treatment and clinical procedures mean that Indian health dental professionals need to remain on top of such new developments. The IHS CDE program offers many opportunities for dental staff to be on the cutting edge of technology and advances in clinical interventions and offers the unique opportunity for IHS and tribal dental staff to receive culturally competent continuing education at the same time.

 Continuing Dental Education courses benefit IHS dentists, dental hygienists and dental assistants.
Continuing Dental Education courses benefit IHS dentists, dental hygienists and dental assistants.

In 2017, the IHS CDE program will consist of over 100 individual courses varying in length from one hour to one week, and an additional 50-75 courses are being planned for the year. While some courses are geared towards clinical dentistry, this year’s offerings include a strong emphasis on building public health leadership within the IHS by offering 15 courses for IHS dental leaders and those aspiring to be leaders in the future. A dentist who recently took the Area Dental Officer Concepts course remarked that as a result of his experiences, the course allowed him to foster working relationships with Area and National IHS leadership and provided him with an array of program resources to broaden his institutional knowledge base.

In recent years, the IHS has placed a renewed emphasis on utilizing expanded function dental assistants to provide clinical services. In 2016, the IHS certified more than 70 dental assistants to provide these clinical services, all who must go through intense training through a week-long course followed by additional work in their home clinic.  One expanded function dental assistant and dental assistant supervisor at the San Carlos Apache Healthcare Corporation located in Arizona benefited tremendously from the expanded function CDE offered. A dental assistant supervisor there, stated that the IHS CDE Program has had a phenomenal impact on her program. The courses that were made available to the dental assistants definitely helped them in increasing patient care, as far as their ability to place restorations or fillings. The courses also helped to build their confidence and enabled them to take pride in their work and services provided in the dental program.

The impact of this IHS CDE program extends to all dental staff in IHS and Tribal programs across the country. Dr. Joe Salamon, the Chief Dentist at the Seneca Nation of Indians in New York, noted that the CDE program strengthened his clinical competency and provided communication, collaboration and comradery with fellow early career IHS dentists along with more seasoned practitioners they serve with.  Similarly, Juanita Simpson, a dental hygienist at the Warm Springs Service Unit in Oregon, remarked that as an experienced IHS dental hygienist, she has learned ways to address the challenges of the many disparities that they treat on a daily basis such as access to care, treatment, prevention, grant writing, goal setting, accountability and last but not least networking. Furthermore, the dentists have increased access to quality care by attending IHS Challenges and utilizing dental assistants who because of IHS CDE can do restorations and assist with dentures.

Perhaps Dr. Todd Smith, the IHS National Periodontal Consultant who is based at the Phoenix Indian Medical Center in Arizona, summed it up best when he said that the one reason many serve a career with the IHS is the dedicated professionals he has met over the years at IHS sponsored face to face meetings and courses where friends are made, comradery established and best practices for patient care are shared. These CDE courses are critical as they fill a knowledge void regarding culturally sensitive, effective public health practices that can be implemented in our service areas.

IHS is committed to providing a high quality continuing dental education program that provides culturally competent education on the latest technological and clinical approaches to preventing and intervening in oral diseases. Learn more about the programs that are offered and upcoming deadlines. 

CAPT Timothy Ricks, DMD, MPH, is the deputy director in the IHS Division of Oral Health and the IHS Continuing Dental Education Coordinator.

Indian Health Service launches telehealth program to expand health care access for native veterans, November 10, 2016 ]]>The Indian Health Service has launched an exciting new program using telehealth to improve the health status of American Indian and Alaska Native veterans. The partnership will allow eligible veterans at IHS facilities to be seen and treated by physicians at VA medical centers through the use of technology such as videoconferencing, transmission of still images, electronic health records and remote monitoring of vital signs.

By working together to advance telehealth services, we can increase access to care for our native veterans. The IHS and the VA both face challenges in providing care in rural areas, including access to transportation. This program will allow patients to receive specialized care nearer to home instead of travelling long distances to see a specialist. By expanding access to specialty care, we are improving the quality of health care our patients receive.

IHS Western Oregon Service Unit Director of Nursing Michelle Livingston, R.N., demonstrates the new telehealth system at the Chemawa Health Center in Salem, Ore. Livingston, a veteran, has worked with the Department of Veterans Affairs to develop protocols and implement the new telehealth service.
IHS Western Oregon Service Unit Director of Nursing Michelle Livingston, R.N., demonstrates the new telehealth system at the Chemawa Health Center in Salem, Ore. Livingston, a veteran, has worked with the Department of Veterans Affairs to develop protocols and implement the new telehealth service.

The first IHS facility participating in the new program is the Chemawa Health Center in Salem, Oregon. This is a comprehensive family health care facility serving American Indians and Alaska Natives from more than 100 tribes.

Individuals eligible for care from both IHS and the VA will receive specialized behavioral health care from VA providers in the IHS facility through telehealth. Collaboration between the IHS care team and VA specialists will strengthen the patient-centered care provided to veterans as they move forward. There are approximately 300 American Indian and Alaska Native veteran patients in the Chemawa Health Center service area. The new system is operational and we are getting the word out to native veterans in the area.

Telehealth services use electronic communications to facilitate the provision of health care, with clinical appointments provided remotely, as well as some nonclinical services such as provider training. In some cases, specialty care furnished through telehealth is supplemented by a nurse or assistant who is co-located in the room with the patient. Telehealth delivery is provided in a private office and the connection is encrypted to protect patient privacy. IHS has found that telehealth can be one of the best ways to get health care services where they are needed most.

IHS has a long history of using telehealth to meet the needs of patients:

  • The IHS TeleBehavioral Health Center of Excellence was established in 2009 to provide behavioral health services for patients across the Indian health system. The Center works to provide, promote and support the delivery of high quality, culturally competent telebehavioral health services to American Indians and Alaska Natives. Read more:
  • The IHS Teleophthalmology Program was established in 2001 to screen IHS patients across the country for diabetic retinopathy, the leading cause of blindness in patients with diabetes. Read more:

The new initiative builds on an existing IHS-VA partnership of coordination, collaboration, and resource-sharing between VA and IHS. Other examples of the partnership include the use of the VA’s Consolidated Mail Outpatient Pharmacy to increase efficiency and reduce cost for prescriptions, and reimbursement for services provided to eligible American Indian and Alaska Native Veterans.

Dean M. Seyler, a member of the Confederated Tribes of Warm Springs Reservation of Oregon, joined IHS in 1995. The Portland Area IHS serves more than 100,000 American Indians/Alaska Natives, primarily members of the 43 federally recognized Tribes in Oregon, Washington, and Idaho.

IHS Announces Awards for the Secretary's Minority AIDS Initiative Fund, November 7, 2016 ]]>The Indian Health Service (IHS) recently announced the distribution of fiscal year 2016 Secretary’s Minority AIDS Initiative Funds (SMAIF) totaling more than $3.6 million to several Tribal, Urban, and IHS facilities. These competitive funds, awarded to the IHS from the Office of the Assistant Secretary for Health, Office of HIV/AIDS and Infectious Disease Policy, will fund activities that complement existing efforts to address HIV/AIDS in American Indian and Alaska Native communities.

SMAIF programming supports the four critical focus areas of the National HIV/AIDS Strategy: 1) widespread HIV testing and linkage to care; 2) comprehensive care for people living with HIV; 3) universal viral suppression; and 4) full access to Pre-Exposure Prophylactic (PrEP) services. In FY 2016, there were 15 Tribal, Urban and IHS programs funded through IHS’s SMAIF award providing technical assistance, training, clinical support, increased screening ability and additional HIV/STD education.

One example of a program funded through the IHS award is the We R Native Project, based in Portland, Oregon. We R Native is a multimedia health resource project that has a goal to reduce new HIV infections among American Indian and Alaska Native teens and young adults. The service includes an interactive website, a text messaging service, a Facebook page, a YouTube channel, a Twitter account, and print marketing materials. Special features include monthly contests, community service grants, an “Ask Auntie” Q&A service, and medically accurate information reviewed by experts in public health, mental health, community engagement, and activism. There are nearly 4,200 active subscribers to their text messaging service along with 3,500 Twitter followers. Their YouTube project currently has 405 uploaded videos, with more than 60,000 video views, reaching an average of 62,000 people per week in August 2016.

Congress established the Secretary’s Minority AIDS Initiative Fund in 1999 as part of the Minority AIDS Initiative in response to growing concern about the disproportionate impact of HIV and AIDS on racial and ethnic minorities in the United States. SMAIF provides more than $50 million each year to support a wide range of activities that are designed to reduce new HIV infections, improve HIV-related health outcomes, and reduce HIV-related health disparities in racial and ethnic minority communities.

These competitive awards build on encouragement from community stakeholders to align activities supported by the Fund with the goals and priorities of the National HIV/AIDS Strategy while also remaining consistent with the purpose and spirit of the Minority AIDS Initiative, from which the fund is derived.

IHS is responsible for providing federal health care services to an estimated 2.2 million American Indian and Alaska Native patients. With support from SMAIF, IHS published a set of best practices for HIV screening that led to nationwide implementation of HIV screening recommendations for adults and adolescents at IHS facilities. Best practices include: clinical reminders in the electronic health record; having a local HIV testing policy in place; and standing protocols to allow nurses to order HIV tests. Some of the highest performing IHS facilities have achieved HIV screening levels at more than 70 percent for the eligible population.

Read more information on the IHS Office of Clinical and Preventive Services, National HIV/AIDS program.

Rick Haverkate is the deputy director of the IHS Office of Clinical and Preventive Services and a member of the Sault Ste. Marie Tribe of Chippewa Indians. He is the National HIV/AIDS Program Manager for IHS and was previously with the Office of Minority Health at the Centers for Disease Control and Prevention.

Open Enrollment for the Health Insurance Marketplace is a Great Opportunity for "Young Invincibles" to Gain Coverage, November 4, 2016 ]]>Open Enrollment for the Health Insurance Marketplace Exit Disclaimer: You Are Leaving started on November 1, 2016. American Indians and Alaska Natives are eligible to purchase coverage through the Health Insurance Marketplace and may also find out they qualify for Medicaid. The Marketplace is a destination where consumers can compare health insurance options in simple, easy-to-understand language. At the Marketplace, consumers are able to compare insurance options based on price, benefits, quality, and other factors with a clear picture of premiums and cost-sharing amounts to help them choose the insurance that best fits their needs.

An important population of focus this year is young adults. Young adults have the highest rate of uninsured of any age group. About 30 percent of young adults are uninsured. This population of individuals is often referred to as the "Young Invincibles Exit Disclaimer: You Are Leaving" Although young people are often healthy, they do need medical care for preventive treatment, regular check-ups, and occasional health hiccups.

It is estimated that more than 70 percent of consumers can find Marketplace plans for less than $75 per month. For American Indian and Alaska Native consumers, these plans are even more affordable as many will be eligible for special protections that provide options for plans with no out of pocket costs.

It is estimated that more than 500,000 uninsured American Indians and Alaska Natives now have new opportunities for coverage through the Marketplace and as many as nine out of 10 of those may qualify for financial assistance either through tax credits to purchase coverage in the Marketplace, cost-sharing reductions that will reduce or eliminate out of pocket costs, or through Medicaid if their state expands eligibility.

Remember, American Indians and Alaska Natives can get free, in-person help on applying for or exploring coverage options in the Marketplace or Medicaid from their local IHS, tribal, or urban Indian health program. You can find the closest health program using the Find Health Care tool.

To learn more about the Affordable Care Act benefits for American Indians and Alaska Natives, visit the Marketplace Tribal Resources Exit Disclaimer: You Are Leaving website and the IHS Affordable Care Act website.

Raho Ortiz is the Acting Director of the Office of Urban Indian Health Programs with the Indian Health Service. He provides national oversight and guidance for health programs administered by Urban Indian Organizations and funded by IHS. He is Navajo and Acoma Pueblo.

CHRs Embody the Local Community, October 31, 2016 ]]>Community Health Representatives (CHRs) are vital members of the health care team. At IHS, there are more than 1,600 CHRs across the country. They are members of the community, who serve as advocates, are familiar with the dialects and the unique cultural aspects of their patient’s lives, and know specific tribal health care needs. CHRs have contributed to lowering mortality rates through providing education and reducing tribal health expenses.

The Community Health Representative Program was implemented in 1988 to improve the health knowledge, attitudes and practices of American Indian and Alaska Native (AI/AN) people by promoting, supporting, and assisting federal and Tribal CHR Programs in delivering a comprehensive health care program. The efforts of CHR program staff have produced an American Indian and Alaska Native health service delivery system, which provides for follow-up and continued contact with the health care delivery system at the community level, thereby meeting the most basic needs of the tribal populations. The goal of the CHR Program is to address health care needs through the provision of community-oriented primary care services, including traditional American Indian and Alaska Native concepts in multiple’ settings, utilizing community-based, well-trained, medically-guided paraprofessional health care workers.

Community Health Representatives are key staff members who assist in cross-cultural communication.
Community Health Representatives are key staff members who assist in cross-cultural communication.

CHRs are a role model for the community; they are the ones people can go to when they need someone to advocate their needs, provide guidance and help. Typical CHR duties may include the following:

  • Visit clients in the home and refer them to an appropriate facility
  • Explain available health programs, policies and procedures
  • Organize community health promotion and disease prevention such as immunizations, well-baby clinics, safety in the home, and medication usage and storage
  • Offer transportation to health facilities
  • Educate clients on behavior health topics such as alcohol use, smoking cessation, healthy eating habits or hygiene
  • Serve as a health advocate

CHRs are valuable and needed in tribal communities to provide culturally sensitive care. It is important for the health care provider to note that each tribal community has their own cultural preferences of relationships and roles. They are trained and encouraged to use the language of the patient, involve the family and extended family, respect tribal healing ways, support traditional healing by respecting the people’s ways and not degrade the beliefs of others and show respect.

In FY 2015 a total of 150,290 patients were referred by the CHR Program to medical staff; nursing; dental; eye; behavioral health; social worker and other Agency programs. Nationwide CHRs conducted 307,998 chronic disease patient care services and made 491,423 client contacts. The top ten CHR chronic disease management client contacts addressed the following health problem codes:  Diabetes Mellitus, Nutrition, Cancer, Blood Disorders, Hypertension, Heart, Dialysis, Arthritis, Renal Failure and other chronic conditions such as Respiratory, Mobility and Pain, etc. CHRs have a broad general knowledge base and scope of practice includes over 106 heath problem codes.

Learn more about this important program.

Georgianna Old Elk is the acting program coordinator for CHRs and public health advisor in the IHS Division of Behavioral Health. Prior to returning to Headquarters, Ms. Old Elk was the IHS Billings Area physician recruiter. She is an enrolled member of the Ft. Peck Assiniboine and Sioux tribes of Montana.

Injury Prevention Program Saved Lives of Two Children, October 27, 2016 ]]>On the afternoon of August 14, 2016, Ms. Ramon and Mr. Holloway were driving with their two young children to the store and their vehicle was struck at a traffic light where their car sustained significant damage after being side swiped by cross traffic. Both of the back tires were blown out, the axle was broken and the driver’s side doors were heavily damaged. Luckily, the children were secure in properly fitted and installed car seats. At the crash scene, their son was able to walk and jump around and their daughter was able to move freely as well. First responders reported the parents did a great job installing the car seats, making the parents feel proud, fortunate and extremely grateful.

Grateful for the services of Feliciano Cruz, Jr., a public health emergency preparedness and injury prevention coordinator with the Pascua Yaqui Tribe Exit Disclaimer: You Are Leaving, who had conducted a child passenger safety class attended by the parents and assisted the family to ensure everyone rides safe while in the car. The parents remarked that his instruction was very detailed and his advice stuck with them.

The Ramon and Holloway Family.
The Ramon and Holloway Family.

On October 11, IHS released the report, Indian Health Focus: Injuries 2015 Edition cataloging American Indian and Alaska Native-specific injury data. Injuries are the leading cause of death among American Indians and Alaska Natives between the ages of one and 44 years; especially among children. Unintentional injury deaths for American Indians and Alaska Natives decreased by 58 percent (1973-2008). Injuries cost IHS, tribes and contract health services approximately $350 million per year in the treatment of injuries and accounts for 44 percent of the years of potential life lost before age 65 for American Indian and Alaska Native populations.

The IHS Injury Prevention Program is the lead IHS program to address the injury disparities in American Indian and Alaska Native communities. Top program priorities include motor vehicle and unintentional elder fall prevention. The program’s approach is based on the same public health principles that have been applied to effectively control infectious diseases. Using the public health approach and focusing on the implementation of evidence-based injury prevention strategies can have significant public health impact and the program supports community-specific solutions.

The Pascua Yaqui Tribe of Arizona continues to build upon the IHS Injury Prevention funding they received ($50,000 annually, 2000-2005). Mr. Cruz, a member of the Pascua Yaqui Tribe, served as a former member of the IHS Injury Prevention Tribal Steering Committee member from 2004 to 2008 and has been a certified Child Passenger Safety Technician since 2000. The Pascua Yaqui Tribe was awarded funds from the IHS TIPCAP ($20,000 annually, 2015-2020) to expand their reach of injury prevention activities.

IHS’s collaborative partnership with the Tribe is one way we are proud to raise the health status of the Ramon/Holloway family and have them be able to spend another day as a family.

Read more about this program.

CAPT Nancy M. Bill, a member of the Navajo Nation, oversees the 12 national IHS regions serving the 567 federally recognized American Indian and Alaska Native tribes to ensure consultation, collaboration and partnership in injury prevention.