Health Care in Alaska Native Communities: Learning Firsthand of the Challenges
Credit: U.S. Census Bureau
Alaska Natives face many challenges in the arena of health and health care. For example, there is a need for culturally competent care (i.e., care that is appropriate in relation to the cultural characteristics of a specific group or individual). Many traditional ways of life that were supportive of health for Native Alaskans have been lost. Access to health care is often daunting; paved roads have not penetrated most of the state, and many villages can be reached only by plane or by hours on a snow machine (snowmobile). Harsh weather conditions have an impact on mobility, and communications are not always reliable.
A group representing 10 institutes and centers of the National Institutes of Health (NIH) learned more about these issues firsthand, as well as some practical solutions that are addressing them, when they traveled to Alaska in mid-February 2005. Irene Liu, M.P.H., public liaison officer at NCCAM, represented the Center.
The trip was arranged by the Southcentral Foundation (SCF). The foundation is an Alaska Native nonprofit health corporation formed under the tribal authority of Cook Inlet Region, Incorporated (CIRI). CIRI, which serves the Anchorage region and 55 villages, is 1 of 13 regional Native corporations in Alaska established by Congress under the Alaska Native Claims Settlement Act.
SCF's mission is to work together with the Native community to achieve wellness through health and related services. It oversees delivery of a wide variety of health care services, such as primary care, specialty care, home health care, programs for youth and elders, and residential programs. In addition to conventional medical care, a traditional healing program and a complementary medicine clinic are offered. The traditional healing program includes healing hands, prayer, cleansing, song and dance, traditional plant medicines, and culturally sensitive counseling.
The complementary medicine clinic offers chiropractic care, massage therapy, and acupuncture. It emphasizes the integration of complementary care with primary care, promptness of care, and customer satisfaction. Access to the clinic's services is by referral from a physician at SCF's primary care center. Complementary care is provided for a limited list of health problems that staff have determined are scientifically supported. This approach has reduced what was a 6-month wait for an appointment to 2 days. Staff have found that use of the clinic's services has reduced their patients' number of visits for primary care, urgent care, and emergency care.
NIH staff also visited Kotzebue, a Native village north of the Arctic Circle. At the Manilaq Health Clinic there, programs such as telemedicine, telepharmacy, and community health aides are helping to bridge the gap for access to care. Using telemedicine, a physician in Kotzebue can diagnose a child's ear infection, for example, using images and information transmitted live from 1 of 11 villages. In telepharmacy, pharmacists use computers, software, and special cabinetry to dispense drugs remotely in distant villages. In addition, the region has a model program for training community health aides to be the first line of care in the villages. These strategies are essential for delivering care in a region where the nearest health clinic could be 3 hours away by snow machine.
Ted Mala, M.D., M.P.H.
Credit: Southcentral Foundation
Ted Mala, M.D., M.P.H., is director of tribal relations (coordinating health initiatives for 53 villages) at SCF and director of its traditional healing program. Dr. Mala is also a member of the NIH Director's Council of Public Representatives, which advises the NIH Director on issues related to public input and participation in NIH activities, research priority setting, and outreach. Dr. Mala said, "For me, it is important to increase sensitivity to and understanding of rural America, especially tribal America. As NIH staff design outreach programs, educational materials, and research studies, I want them to think about conditions in tribal villages."
Irene Liu felt the visit will help NCCAM in its outreach to special populations. "I was inspired by the people in Alaska and their strength—the health care providers at SCF, the teens celebrating traditional culture through music and dance, and the college students considering research internships under NIH programs. This kind of field experience will prove helpful in many of our communications endeavors."
Ten Important Values in Alaska Native Culture
- Show respect to others --each person has a special gift.
- Share what you have --giving makes you richer.
- Know who you are --you are a reflection on your family.
- Accept what life brings --you cannot control many things.
- Have patience --some things cannot be rushed.
- Live carefully --what you do will come back to you.
- Take care of others --you cannot live without them.
- Honor your elders --they show you the way in life.
- Pray for guidance --many things are not known.
- See connections --all things are related.
Source: The Alaska Native Knowledge Network, sponsored by the Alaska Federation of Natives, the University of Alaska, the National Science Foundation, and the Alaska Department of Education
