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Volume 6, No. 8, August 2008
From Your Colleagues
Neil Murphy, MD Alaska Native Medical Center
Welcome Jean Howe, MD, MPH as the new OB/GYN Chief Clinical Consultant
Dr. Jean Howe took over the reins of the OB/GYN Chief Clinical Consultant role on June 1, 2008 and has yet to have her feet touch the ground. Jean has the perfect background and energy to do a great job as Chief Clinical Consultant, so we look forward to a wonderful future for the care of Native Women.
Many of you know Jean already, as she has been participating as the Deputy Chief Clinical Consultant since 2004. As such Jean has excelled in many of the national functions of the CCC and knows the territory. Originally from Vermont and trained at the University of Colorado, Dr. Howe has been an OB/GYN at Chinle Hospital for almost 11 years and department Chief for 10 years. She also currently serves as the Navajo Area OB/GYN consultant. Dr. Howe completed the Johns Hopkins Masters in Public Health program in 2005. Her areas of interest include preventive services, contraception, international health, and diabetes in pregnancy.
What does an OB/GYN Chief Clinical Consultant really do?
The OB/GYN CCC role seems to be a bit unique among the CCCs largely because of its close relationship over the years with the benchmark women’s health professional group, American College of Obstetricians and Gynecologists. In addition, the OB/GYN CCC has many national functions that you may interact with everyday and not realize it.
The OB/GYN CCC participates in the annual ACOG/IHS Area site visits which review the care of Native women and young children on-site. The OB/GYN CCC serves as consultant to the ACOG Fellows in Service Program that places ACOG Fellows in short term positions throughout Indian Country. The OB/GYN CCC also participates in the planning of the annual ACOG / IHS Obstetric, Neonatal and Gynecologic Care Postgraduate Course which is thorough multi-day primer and update on the basics of women’s health and early child health.
Recently the OB/GYN CCC has been the editor of the Chief Clinical Consultant Corner newsletter since its inception 6 years ago. In addition, the OB/GYN CCC coordinates the single most complete clinical website on the www.ihs.gov which has become a template for many other websites since 2000. The OB/GYN CCC has also been a lightning rod for increasing communication among the various staff groups by creating listserv(s) for maternal child health, the primary care discussion forum, midwives, and OB/GYNs.
What have OB/GYN Senior Clinicians / Chief Clinical Consultant done over the years?
The most unique aspect of the OB/GYN CCC is that the role is built on long standing relationships. The first relationship, as described above, is that between ACOG and the Indian Health system…the second relationship is with you. When is the last time that you heard that a former CCC, or Senior Clinician as they used to be termed, was coordinating the IHS Colposcopy Course, serving a member of the ACOG Committee on American Indian Affairs, or authoring a column in the CCC Corner national newsletter?
If you said, ‘just last month’, then you are right to all three. Case(s) in point are the active roles that Drs. William Haffner, Alan Waxman and Neil Murphy continue to play in improving the health care of Native women. Here is a brief history on the former OB/GYN Senior Clinicians / CCCs.
It all began with David L Hall. Dr. Hall was an OB/GYN in Shiprock and later at Gallup Indian Medical Center and served as OB/GYN Senior Clinician from 1972- 1980. These very formative years included the era when much of the care to Native women was provided by general medical officers with very little specific training in Women’s Health.
Dr. Hall’s successor was William Haffner, the IHS OB/GYN Senior Clinician from 1980 to 1994. Dr. Haffner’s central theme was to facilitate the transition from the era of the general medical officer to more completely trained women’s health providers. To that end Dr. Haffner worked at increasing the number, skills, and quality of OB/GYN and CNM providers throughout the IHS full-service OBG hospitals. Bill helped advance and promote a degree of standardization of obstetric care through education and development of a common prenatal record to meet U.S. standards of care at all IHS programs providing prenatal or full-service obstetric care. Dr. Haffner encouraged professional collaborations with ACOG and ACNM to maximize the quality of care and promote advocacy for Indian women's health.
Dr. Haffner was pivotal in the development a basic primer / update course in Native women’s health which became the benchmark for all Indian Health care providers. Ultimately, with the help of ACOG this became an annual course, ACOG / IHS Obstetric, Neonatal and Gynecologic Care Postgraduate Course, which included an excellent Reference Text of which he remains the Editor.
Dr. Haffner had worked in the USPHS 1971 – 2001 with 1971 – 1981 of that being at Gallup Indian Medical Center. Dr. Haffner was the PHS Chief Medical Officer 1990 - 1994. Dr. Haffner is a Professor and was Chair of the OB/GYN Department, F. Edward Hebert School of Medicine, 1992 – 2003. Bill has been the Acting Associate Dean for Faculty Development since 2006 and is in clinical practice at the National Naval Medical Center. In 2002 Dr. Haffner received the ACOG Distinguished Service Award.
Alan Waxman was OB/GYN Senior Clinician from 1994 – 2000. Dr. Waxman’s central theme was promoting a uniform standard of care for all AI/AN women regardless of what IHS or tribal facility they received care at. Dr. Waxman made sure that those standards were based on benchmark best practices, which often relied on ACOG Practice Bulletins and Committee Opinions. One great example is that Dr. Waxman developed, and continues to direct, the IHS Colposcopy Courses. This program emphasizes training primary care providers in advanced cervical cancer screening techniques. Ultimately, those primary care staff who participate in the IHS Colposcopy Courses can work toward providing colposcopy at their home service unit.
Dr. Waxman had worked in IHS 1976 – 2000, primarily at Gallup Indian Medical Center, but with two very rewarding years at the Alaska Native Medical Center. Alan had been the OB/GYN Chief Clinical Consultant for the Navajo Area IHS 1980-2000. Dr. Waxman is currently on the faculty of the University of New Mexico, Department of Obstetrics and Gynecology and is a Consultant to the ACOG Committee on American Indian Affairs.
Dr. Neil Murphy served as OB/GYN CCC from 2000 to 2008. As Drs. Haffner and Waxman had done most the ‘heavy lifting’ already, Dr. Murphy choose to increase access to evidence based information and improve communication in the widespread Indian Health system.
In 2000 Dr. Murphy began to create the MCH suite of websites that offers up to the moment evidence based resources to all tribal and Indian Health staff and patients. The MCH complex of websites, which now contains hundreds of pages and thousands of subpages, includes online continuing medical education modules, a monthly online newsletter, hundreds of frequently asked questions, and a wide variety of MCH specific content. The MCH site also serves as a portal for easy access to UpToDate, the Indian Health virtual online library, and the ACOG Postgraduate Course Reference text, to name a few others. In 2004 the monthly online newsletter added a printed version to increase access for staff without easy Internet access and for those whom a printed newsletter was more easily utilized in the moments between patients or while on the move.
Dr. Murphy initiated several listserv(s) to increase communication including the Primary Care Discussion Forum for more in depth discussion which was then posted online for others to benefit from. Dr. Murphy also transformed the biennial clinicians meeting from a small primarily business meeting of department chiefs to a large educational conference to include all the major stakeholders in Native Women’s Health. This meeting now regularly features internationally known speakers and in 2009 it will be held in conjunction with the international Native Child Health meeting to increase communication across borders on areas of joint clinical relevance.
Dr. Murphy remains a staff physician at Alaska Native Medical Center and continues to coordinate the Indian Health MCH web based resources.
Haffner Native Women’s Health Award
Another example of the unique value of the OB/GYN CCC role is the William H.J. Haffner American Indian/ Alaska Native Women’s Health Award. The ACOG Committee on American Indian Affairs is raising money for a new award that would recognize an individual who has made a major contribution to improving the health care of American Indians / Alaska Natives.
The William H.J. Haffner American Indian/Alaska Native Women’s Health Award is named after ACOG Fellow Dr. Haffner, an ob-gyn professor at the Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Haffner worked for the federal Indian Health Service for many years and has been involved with ACOG’s Indian health programs since their inception. (see above)
To donate to the Haffner Award Fund, please make checks out to "ACOG" and mail to Yvonne Malloy, ACOG, 409 12th St. SW, Washington, DC 20024, or by e-mail at YMalloy@acog.org.
Jean Howe welcomes your thoughts and input
Dr. Howe is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact her by e-mail at Jean.Howe@ihs.gov or by phone at 928-674-7422.
Theresa Cullen, MD, Chief Information Officer, IHS
2008 Indian Health Information Management Conference, “Managing Health Information Technology to Improve Performance and Outcomes”
December 15 – 19, 2008 ; Phoenix, Arizona
The Office of Information Technology is pleased to announce the Indian Health Information Management Conference for 2008. The IHIMC began as the IHS Technology Conference, and has been held annually since the mid 1980s. The purpose of the IHIMC and its antecedent conferences is to provide for the demonstration and discussion of Information Technology tools, as the IHS IT community supports health care delivery in Indian Country. IHIMC is a forum for technical leadership, direction and support in the promotion of quality health care through collaboration and active participation in the development of policy and national standards of care regarding the health of American Indian/Alaska Native people in Federal (IHS), Tribal and Urban settings (I/T/U). We hope to see you there!
Additional conference information available at:
David Gahn, MD Kabul, Afghanistan
Afghanistan Update
Most of the readers of the CCC Corner know how much emphasis we put on preconception care, prenatal care, and postpartum care in the United States. We have special procedures and concerns when someone appears on L&D in labor with no prenatal care.
Imagine a city of 5 million people where >95% of the pregnant women have no prenatal care and the average parity a woman reaches is >7. These are the patients that the doctors and midwives at Rabia Balkhi Hospital in Kabul face daily.
Because recent data show a tremendous amount of maternal and perinatal mortality associated with cesarean sections, IHS has recently focused its efforts on improving the care delivered in the operating room as well as working on the decision process that sends a woman to the OR to have her baby. In collaboration with CDC, we are operating under the framework of a quality assurance collaborative on cesarean sections (QAC/CS) which will eventually involve all 4 maternity hospitals in Kabul. In July, IHS, with participation from the Department of Defense, conducted a Surgical Skills Training Workshop at Rabia Balkhi Hospital using a combination of didactics, skills labs, and practical training in the OR. IHS medical epidemiologist Dr. Mei Castor, MD is leading the operational research arm of the QAC/CS, and James Dickens, FNP from the Center for Medicare and Medicaid Services is focusing on training the OR staff in the basic principles of operating a safe and effective OR. Dr. Pat O’Connor, MD from Tuba City, AZ continues to head up the effort in the pediatrics department.
When a cesarean section is performed, every system in the hospital is involved: lab, blood bank, supply, housekeeping, facilities, etc. Using a quality assurance approach focusing on systems and not individual performance has allowed the Afghans to gradually make sustainable changes in their hospital with an understanding that quality assurance is a continuous process. With CDC also involved, we are working on being able to measure our processes through an improved medical record and a functioning Quality Assurance Department. We know that if we can’t measure what we are doing, we can’t manage it. And if we can’t manage it, we can’t change it.
IHS is working on the interagency agreement with HHS/Office of Global Health Affairs (OGHA) for FY 2009, and hopes to expand its clinical role in the Afghanistan Health Initiative ( AHI). With funding from OGHA, IHS will be able to continue to staff the AHI to make meaningful and sustainable changes to a national health care delivery system. Keep your eyes out for more opportunities to serve the people of Afghanistan, and feel free to contact me at any time.
Lois Goode, Chief Clinical Consultant-IHS Rehab Services; Whiteriver, AZ
Scott Gaustad named next Physical Rehabilitation Services Chief Clinical Consultant
It has been a pleasure and a distinct honor to serve with you on the NC4. The time has now come for me to “pass the baton”.
I am very pleased to announce CDR Scott Gaustad as the next Physical Rehabilitation Services Chief Clinical Consultant as appointed by Dr. Chuck North. CDR Gaustad brings to the Indian Health Service a wealth of clinical experience and knowledge. He has been at Whiteriver IHS since October 2006. He is a team-player and his leadership skills are exceptional. I am confident that you will enjoy meeting and working with Scott.
Elaine Locke and Yvonne Malloy, ACOG
ACOG/IHS Postgraduate Course on Obstetric, Neonatal and Gynecologic Care
September 14-18, 2008 ; Salt Lake City, Utah
This annual women’s health update for Nurses, Advanced Practice Clinicians, and physicians provides a four-day schedule of lectures, workshops, hands-on sessions, and team building. The large interdisciplinary faculty collaborates to teach clinical and practical topics as they apply in Indian health settings. Many faculty members are your colleagues in IHS and Tribal facilities; private sector faculty also bring a wide range of experience providing Indian health care. Learn the latest evidence-based approaches to maternal and child health services, and share problems and solutions with your colleagues from across Indian country. The course can also serve as a good foundation for professionals who are new to women’s health care or new to the Indian health system.
In addition to the basic course, you may sign up for the Neonatal Resuscitation Program, and come away with your certificate from this convenient pre-course program. The opportunity to fulfill continuing education requirements in a concentrated format is significant: With the optional NRP, we can document your participation in seven half-days of education.
Sign up early! You’ll have first chance for support from your facility and coverage for your time in Salt Lake City. Getting these benefits lined up takes time, so don’t delay and miss out! In addition, early registration holds your place, and puts you in line for possible availability of scholarship funds.
Watch your mail for the course brochure and registration form, or download it from here:
http://www.ihs.gov/MedicalPrograms/MCH/F/CN01.cfm?module=08&option=9#top
For more information on the Postgraduate Course or other Indian Health programs please contact ymalloy@acog.org ; 800-673-8444, ext 2580; or visit the ACOG website, www.acog.org ; under "Women’s Issues," click on "Indian Health Service"
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
