Category: Health

By Micheal Rios, Tulalip News

Native communities and diabetes. The two have been linked since colonization forcibly removed tribes from their ancestral lands and traditional food sources. Ever since it’s been a never ending struggle to battle one of the most challenging health problems of the 21^st century. According to the World Health Organization, each year an estimated 1.8 million deaths are directly caused by diabetes, while another 2.2 million deaths are attributed to high blood glucose.

It’s no question that diabetes is a nationwide health problem, but for Native people its life altering effects are felt at a much higher rate. Native communities have the highest diabetes prevalence of all ethnic groups in the United States. Nearly 1 out of 6 Native citizens has diabetes presently, and the Centers for Disease Control predicts that 1 in 2 Native children born since 2000 will have type 2 diabetes in their lifetime. 

Fortunately, Tulalip is excited to announce a vital new resource in its fight against the shared enemy. Dr. Kay Moua has joined the health clinic’s Diabetes Care and Prevention Program. An advanced diabetes management specialist, she brings a treasure trove of experience and cutting edge knowledge. She is well regarded for her expertise in the latest techniques and most effective practices for managing and preventing diabetes.

Dr. Kay was gracious enough to be interviewed by syeceb staff in order to introduce herself, her medical background, and what she hopes to accomplish in Tulalip. 

SYS: You have a unique cultural background. Can you tell us about it?

I was born in Laos, and my ethnicity is Hmong. My family migrated to a refugee camp in Thailand after the Vietnam War and came to the Unites when I was 11-years-old. I started learning English (e.g. the alphabet, colors, numbers) in 7^th grade.

My husband and I have been married for 30 years. We have 4 children, 3 boys and 1 girl. We are family-oriented people and love to host. My husband is the oldest of seven siblings, so we’re always surrounded with family and friends. My in-laws live on the same property, which is common for us to have multigenerational living in the same house. My mother-in-law is a Shaman, so we still perform traditional rituals and practices.  

SYS: Please describe your educational journey to become Doctor Kay. 

I’ve worked in the medical field since graduating High School. My first job was in a family practice where I started as a receptionist, then later trained in back office work, which included billing and rooming patients. I attended a community college while working full-time. After completing my AA degree in Medical Office, I continued school in the pursuit of a nursing degree.

Once I graduated with my Associate Degree in Nursing and earned my license, I went to work as a Registered Nurse (RN) at Providence hospital in Everett. Seeing so many people come into the hospital with poor diabetes control motivated me to pursue my Nurse Practitioner license to help people living with diabetes. After attending graduate school, where I received my Master’s Degree in Nursing (MSN) and Advanced Registered Nurse Practitioner (ARNP) license, I joined the Endocrinology team at the Everett Clinic to care for patients with diabetes. 

Even though I enjoyed my work very much, I knew that I need to get back to school to achieve my personal goal of having a doctoral degree. With hard work and dedication, I graduated with a Doctor of Nursing Practice (DNP) degree in 2015. I continued to take extra classes and trainings and was able to pass the National Board Certified-Advanced Diabetes Management (BC-ADM) certification the following year.

SYS: What motivated you to join the Tulalip Health Clinic and practice medicine for the Tulalip people?

Native Americans are one of the highest risk groups for the development of diabetes. I was surprised to find out that in the history of the Tulalip Health Clinic an Endocrinologist or someone like myself has not been available for the people of Tulalip without a referral to an outside facility. I am pleased to be one of the first contracted providers to manage patients utilizing devices like CGM and insulin pumps. These technologies have evolved over time and under my care and direction we will be offering these devices in 2021 to patients who have this interest in advanced diabetes management.

The Tulalip Health Clinic already has a successful Diabetes Care and Prevention Program. I love the fact that the program is able to provide so many activities to teach people about diabetes and keep the community engaged with the clinic. In fact, I’ve never came across another diabetes program that is so unique and able to provide so much for their patients. I want to work with the team to help expanding the diabetes program by offering advanced diabetes care to Tribal members, to ensure that their treatment is up-to-date with most current medications and have the option to use technologies to enhance diabetes management. Tribal members should not have to seek care outside the Reservation for diabetes treatments. 

SYS: You specialize in advanced diabetes management. Can you explain what this means?

As I mentioned earlier, diabetes care has been my main focus from training during Nurse Practitioner school and my doctoral degree school. I’ve worked with patients with diabetes for over ten years. I continue to immerse myself with conferences and continuation education that’s specialized on diabetes to stay up-to-date with current medications and technologies and guidelines. 

I’m an Advanced Registered Nurse Practitioner (ARNP) by trait, with a Doctor of Nursing Practice (DNP) degree and national Board Certified-Advanced Diabetes Management (BC-ADM) specialist. Patients are referred if they need to improve blood sugar control or have interest in insulin pump or continuous glucose monitor. Diabetes treatment is complicated and has to be individualized. I make sure that patients are offered the best and most appropriate treatment options available to the individual. 

I also have extensive experience incorporating technologies such as continuous glucose monitors and insulin pumps to help patient improve diabetes control. Insurance requires additional documentations and special forms for approval. These technologies requires extra training and longer appointment time with patients that may not be feasible for general providers. This is why my service is required. I work with these devices every day and familiar with insurance requirements for quick approval.  

SYS: With your extensive professional experience, what do you consider the biggest challenges to minimizing the diabetes epidemic?

Unfortunately, diabetes prevalence continues to increase every year. There are many contributing factors to this epidemic. I think our current financial economy posts many obstacles in diabetes prevention and treatment. Budget is tight in most households, especially with more and more people losing their job during COVID, leading to even more unhealthy diet and lack of exercise.

We all know the importance of a healthy diet. However, it may not always be feasible when you have a tight budget. Fresh food costs 2-3 times more than process food. People are working longer hours and don’t have time to cook, so they are eating more fast food. Combining processed and high fat foods with eating late at night contribute to weight gain, leading to increased insulin resistance or worsening diabetes control.

Healthy diet and routine exercise are the cornerstone of diabetes prevention and treatment. As people are working longer hours to make ends meet, they don’t have time to do anything else. Exercise is unlikely to be a high priority after a long work day. Lack of exercise increases fatty tissue, which causes insulin resistance and high blood sugar. 

SYS: In your ideal scenario, how will your work positively impact the Tulalip community?

Diabetes management is complex and requires collaboration between the patient, their family members and the healthcare team to achieve best outcomes. As a new provider of the community, it’s important for me to learn the culture and incorporate the Tribal ways of living when making treatment plans. I believe getting to know the people, developing good rapport with patients, and building trust with the community are the key steps to improving diabetes control within the Tulalip community.

My understanding is that some tribal members have been going elsewhere for advanced diabetes care or have not been active in seeking diabetes care. My goal is to provide the most current diabetes treatment options for members living with diabetes right on the reservation. I will need to prove my knowledge and earn the trust of the community in order to draw members back to the Tulalip Health Clinic for diabetes management. 

SYS: A principle of Native culture has always been holistic care (mind, body and spirit). Considering this, what advice or best practices would you suggest to combat diabetes and pre-diabetes?

I’ve always believe in holistic care approach. It is crucial to access and address the individual’s mental and physical health that may impact their ability to maintain diabetes management. Successful diabetes care also requires taking the time to access and get to know the patient, their family, their environment, and cultural practices and incorporating this information into individual treatment plans. We all have different cultural practices and traditional food that should be respected. 

I’m so excited that the Diabetes Care and Prevention team has a garden to showcase and incorporate the Pacific Northwest native plants for natural medicines and herbal remedies. The Diabetes Program garden provides diabetes education and promotes traditional food, healthy eating, and activity. Healthy diet and staying active are important for everyone, but even more crucial for those who have diabetes or prediabetes.

My goal is to be a resource and provide guidance for patients who have diabetes or at risk of developing diabetes through obstacles like diet, exercise, blood sugar checking, or medication management. Uncontrolled diabetes can cause many unforgiving long-term complications. Diabetes can start to cause damage to internal organs in prediabetes state. Therefore, it is important to do everything you can to maintain good blood sugar control if you are considered high risk or as soon as you found out that you have diabetes.

My vision for the Tulalip Diabetes Program is to expand diabetes care to Tribal members with prediabetes. Historical records show that at least 20% of these patients convert to full blown type 2 diabetes yearly. We need to focus our attention on preventing diabetes in order to decrease the diabetes epidemic. I hope that we will be able to offer routine educational group classes on diabetes disease and have activities to promote healthy eating and active living once it’s safe to have group classes again. In the meantime, I encourage everyone to find safe activities to stay active and practice meal portion control.        

SYS: Anything else you’d like to share to our readers?

Special thanks to Roni Leahy (Tulalip Diabetes Program Coordinator) for having the vision to expand the Diabetes Care and Prevention Program and entrusting me with this opportunity. I am grateful for the support from Dale Jones (Diabetes Program Advocate) and Brooke Morrison (Diabetes Program Assistant). I also like to thank the Tulalip Healthcare providers, Dr. Chad Cleven, Dr. Natasha LeVee, Dr. Howard Johnson, Dr. Rhonda Nelson, and Dr. John Okemah for welcoming me to the clinical team. 

It is an honor and privilege to have the opportunity working with the Tulalip Health System. I look forward to learning the Tulalip culture, earning the trust of each patients and the community, and collaborating care with the clinical team to improve the health and quality of life of tribal members suffering from diabetes.

By Kalvin Valdillez, Tulalip News

“There are a lot of overdoses during bonus and Christmas time,” said ODMAP (Overdose Detection Mapping & Application Program) Outreach Specialist, Tashena Hill. “People are feeling sad because they can’t be with their families or they are reminded of family members who passed on. ODs really spike during this time of year, so it is very important for us to get this information out.”

As overdose rates continue to climb nationwide, the Tulalip Tribal Court is taking action in an attempt to address the opioid epidemic on the reservation. Multiple studies from the likes of the CDC and the Washington Post report that Indian Country has been hit the hardest, claiming that from 2006-2014 Natives were 50% more likely to die from an opioid overdose than any other race in the country. Those reputable sources also released a disclaimer stating those statistics are more than likely under reported due to a number of factors. Most misreporting stems from hospitals and coroners indicating the incorrect race on the death certificates of overdose victims. 

The numbers reported on a national level are still staggering. After approximately 70,000 overdose related deaths occurred in 2017, the United States saw that number decrease to 67,000 in 2018. Unfortunately, in 2019, the CDC reports that the drug overdose rate rose by 4.6% in the course of a year to nearly 71,000 deaths nationwide. Early projections indicate that those numbers may have spiked yet again in 2020, citing the novel coronavirus as a key contributor to several overdoses throughout the year. 

In 2017, roughly 30% of deaths in Washington State were attributed to overdose with a large percentage occurring in Snohomish county, particularly the Marysville, Everett and Tulalip region. It would be extremely challenging, however, if you wanted to gather and analyze data regarding the number of overdoses and overdose related deaths at Tulalip alone, as reportings tend to vary based on jurisdictions and which emergency response team answers the call of distress. 

Tulalip Tribal Court Director Alicia Horne explained, “Right now, Tulalip has no central data to utilize to determine OD. This new program is going to create the database to track those statistics, that’s one of the objectives of this program. And prevention. If an emergency response team is responding to a 9-1-1 call and they issue Narcan, having that information will help this program go out to do intervention services and provide detoxing treatments, getting them set-up on a Suboxone or Methadone program. This will help us collect data to see what the overdose rate is in the Tulalip community and how we can provide prevention and intervention services.”

ODMAP, or the Overdose Detection Mapping & Application Program, is a service utilized by communities across the nation. Counties that have elected to use the company’s database have been able to significantly reduce the number of overdoses in their region.

“ODMAP is a system that emergency response personnel like the fire department, EMTs, and the police department can enter real-time data regarding an overdose,” said ODMAP Project Coordinator, Kali Joseph. “That includes a general location of the overdose, whether Naloxone was administered, how much Naloxone was administered, and whether the overdose was fatal or not. And then we have our outreach workers deploy the resources to those people who are susceptible to overdose or are suffering with substance abuse disorder.”

Having access to those reports is a major step in addressing the opioid and heroin epidemic on the reservation. Now TPD and other emergency response teams can pinpoint specific neighborhoods and areas that are affected most by drug overdose and can thereby, in theory, disrupt any activity when the numbers are on the rise. 

“Using the ODMAP app we can see a spike happen in real-time,” expressed ODMAP Social Worker, Cara McCoy. “When we have all these spikes and overdoses, we can warn the community that maybe there’s a bad drug and to be careful. The app is really easy to use so the officer or whoever has the app will be able to capture it immediately so we have more accurate numbers.”

In addition to tracking and monitoring overdoses on the reservation, the ODMAP team is focused on promoting a healthy Tulalip community and will provide outreach work, cultural activities, and endless resources for those ready and willing to leave their addiction in the past. 

“We’re working on getting a list of all the things that could be barriers in between someone obtaining their sobriety,” stated Kali. “That could be food, a driving abstract, Washington State ID, duffle bag, clothes, signing up for insurance, cell phones, or providing them with a ride. Sometimes the fees for a driving abstract or an ID, to be able to get into a detox center or treatment, can be a very big barrier for people trying to get clean and sober so we just want be able to help them break down those barriers.”

Added Tashena, “The biggest obstacle for any of our clients is having a place to go after coming home from treatment or jail. The Tribe doesn’t offer anything for short-term, so we’re working on trying to find a place for them to go in the interim. We need somewhere for them to go so they can be successful on their journey.”

The very first project for the ODMAP team is taking place on December 16, a virtual training session that will inform those who attend how to appropriately and effectively administer Naloxone or Narcan nasal spray, which can potentially save someone’s life in the event of an overdose. According to their research, 690 overdoses in Washington State were reversed with Naloxone in 2016.

“It first started with Cara setting up a meeting with the Swinomish Wellness Center, they have reduced their overdose rate by 50%,” Kali noted. “We asked them what type of things they’re doing to reduce their rate so greatly and they said that a big factor was distributing Narcan to the community members. We thought we should have a Narcan distribution for our community right before the holidays. It was actually Tashena’s idea to do it before the holidays, especially because we all get this big chunk of money. We are here for prevention and we think that sharing information and knowledge is a really good prevention method, as well as distributing the Narcan.”

In total, the ODMAP team will distribute 50 Narcan kits to the community by December 18. Those who wish to receive a kit will be required to sign-up and attend a GoToMeeting session on Wednesday December 16. The trainings will be split into two sessions, one at 10:00 a.m. and the other at 2:00 p.m., and will be limited to 25 participants per session. After attending the training, the ODMAP team will hand-deliver the Narcan kits to your doorstep, along with other resources, including information about the program as well as some fun holiday gifts. You must be at least 13 years old to attend the training and receive a Narcan kit. 

“Our team is driven to reduce the overdose rates here at Tulalip,” expressed Tashena. “This is important to me as a Tribal member who has suffered from this opioid affliction, being able to give back to my people and show them there is hope. If I can overcome such a horrendous obstacle then anyone can. There is help here for people that want it or need it. There are people who care and are more than willing to help our community members if they want it. The upcoming Narcan training is so important because if we can save anyone, even one person, that is a win. Every last person matters. That is our way, huyadad, to care for every one of our members. At least that’s what my grandfather Stan Jones Sr. taught me – to care for everyone.”

For further information and to register for the upcoming Narcan presentation and distribution, please contact Tashena Hill at (360)-913-7897 or tahill@tulaliptribes-nsn.gov, Melissa Gover at (360)-631-2668 or mgover@tulaliptribes-nsn.gov, or Cara McCoy at (360)-631-7443 or cmccoy@tulaliptribes-nsn.gov.