Yukon Kuskokwim Health Corporation

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Yukon Kuskokwim Health Corporation

• Alaska Native Tribal Health System
• Bethel, Alaska

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Camai, Cangacit ernerpak-llu?

• Elitnauryuqtuten Western Alaska-ami,
  Mamterilleq, Yupiit Kuigpak-Kuskowaq-ami-llu!!

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Welcome! How are you today?

• I want to teach you about Western Alaska, Bethel,
  and the Yupik Eskimo people of the Yukon and
  Kuskokwim Rivers.

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Alaska Demographics

• Population 627,000 total statewide
• 1.2 persons per square mile
• Largest Alaskan Cities
• Anchorage
• 260,000
• Fairbanks
• Borough
• 82,000
• Juneau
• 31,000

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Alaskas Road System
 
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Rural Population 29.6
Urban Population 70.4
Source Alaska Dept. of Labor and Workforce
Development, Research and Analysis Section,
Demographics Unit
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Alaskas 10 Urban Cities, 1999, 1990
Source Alaska Dept. of Labor and Workforce
Development, Research and Analysis Section,
Demographics Unit.
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Our Native Cultures
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Alaskas Tribal Government Structure

• 227 federally-recognized tribes as represented by
  local village IRAs
• Government to government relationship with
  the federal government
• Local sovereign control and self-determination
• Treaty Rights and the Federal Trust Obligation
• Hundreds of Indian treaties have created a
  fundamental contract between Indian Nations and
  the United States. The U. S. Supreme Court has
  ruled that the United States owes a trust
  responsibility, "a moral obligation of the
  highest responsibility and trust," to protect
  Indian Nations, their resources and their rights.

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Alaska Native Regional Corporations
The Northwest Arctic Borough School District, in
1986, completed a student curriculum for ANCSA to
educate students. This map is part of the
curriculum, and can be found at
http//www.nwabsd.schoolzone.net/resources/ancsa/A
ncsa.htm
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YKHC / Indian H.S. Relationship

• PL 93-638 changed the way health care is
  delivered
• Prior to compacting, YKHC had less local
  control on programs
• After compacting, YKHC was directly involved in
  developing services culturally /environmentally
  relevant to our people

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YKHC

• Service Area 75,000 square miles
• Population Approximately 25,000
• 80 Alaska Native
• Yupik Eskimo
• Cupik Eskimo
• Athabaskan
• Indian
• 58 Villages
• (Federally recognized
• tribes)

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YKHCs Mission

• The mission of the Yukon-Kuskokwim Health
  Corporation is to achieve the greatest possible
  improvement in the health status of the people of
  the Yukon-Kuskokwim Delta Region of Alaska.
• We are committed to the development of culturally
  relevant programs for primary care, prevention,
  and health promotion in a setting that fosters
  Native self-determination in the control and
  management of health delivery.

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Environmental Conditions

• Tremendous Environmental Challenges
• Still areas of 3rd world conditions
• Lack of Running/Safe Water
• Housing Issues
• High Poverty
• Low Employment
• High Cost of Living
• Weather and Travel
• Issues
• 50-60 Medicaid-
• eligible

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Health Conditions

• Surgeon Generals Report
• Alaska Native / American Indians are under-served
  in mental health and substance abuse services
• One of the highest
• suicide rates in the U.S.
• Unintentional injury / death rates in U.S.
• High sense of hopelessness because of past trauma
  and loss.

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Source Healthy Risks in Alaska Among Alaska
Natives. Alaska Behavioral Risk Factor Survey,
1991-93. State of Alaska Dept. of Health Human
Services / Indian Health Service
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Alaska Native Wrap-Around HIV/AIDS Project

• Yukon Kuskokwim Health Corporation
• Amber Norgaard, Project Director
• Mark Anaruk, Evaluator

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Rural Health Care Delivery

• Primary Health Care 4 Tier System
• 48 Village Clinics- front line health care
• Staffed by CHA/Ps
• 3 Sub-Regional Clinics
• Staffed by CHA/Ps, Mid-Levels
• Yukon Kuskokwim Delta Regional Hospital
• Alaska Native Medical Center (Anchorage)
• State of Alaska Public Health Nursing

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Rural Health Care Delivery

• Behavioral Health Services
• Village-based Wellness Counselors
• Treatment Centers
• Health Education
• 4 Village-based
• Community Health
• Representatives

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HIV/AIDS Care in the Delta

• Current situation
• Testing availability limited
• High community stigma
• High number of individuals living with
  co-morbidities (STIs, DV/SA, Substance Abuse
  Mental Health Issues)
• Care limited on village level

• Small case-load of known HIV () clients
• Case management services established through
  former SPNS funding
• Current case management through Ryan White Title
  III
• UW TPED Provider Training
• Prevention efforts through YKHC and ANHB (CDC
  funding)

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Goal 1 Community-Based, Wrap-Around Case
Finding Approach

• Development of Community Advocacy Board
• Training and education of village-based Providers
• Outreach and testing through targeted agencies
  (Bethel-based) and high-risk individuals
  (village-based)

• YEAR 1
• Target 8 Villages (including SRCs)
• Increase referral and testing options on village
  level

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Goal 2 Enhance HIV Primary Care Services

• HIV Primary Care Pathway
• Front-line referrals and testing to
  multi-disciplinary care
• Established with input of ALL care providers
• Training of Providers on Multiple Levels

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Goal 3 Risk Reduction Behavior Modification
Strategies Integrated With Resiliency
Characteristics

• Increase knowledge of HIV prevention, risk
  reduction and negotiation skills through
  One-on-One HIV Prevention Curriculum for
  Positives

• Curriculum developed during Year 1 with
  collaborators
• Behavioral Health
• Cultural Consultants
• Begin implementation during Year 2

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Goal 4 Increase Adherence

• Development of Multi-Disiplinary Team
• Primary Care
• Traditional Healer
• Case Manager
• Substance Abuse
• Mental Health
• Dental Care
• Prevention for Positives

• Utilization of Personal Care Card
• One-on-one adherence education utilizing
  resiliency characteristics
• Same message on ALL levels

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Tua-i Quyana!