Health Archives - Page 47 of 89

Tribe and district work to help heal the community

A wave of support offered in the wake of the MPHS shooting

By Niki Cleary, Tulalip News

Immediately following the MPHS shooting, crisis management teams from around the nation and local, mobilized. Cheri Lovre, Executive Director of the Crisis Management Institute was one of them. She specializes in helping communities deal with the aftermath of school shootings and similar tragedies. She spoke at a November 5^th, trauma recovery working session between the Tulalip Tribes and the Marysville School District.

November 5^th was the first day students at MPHS got back to a typical class schedule following the October 24^th tragedy in which a Tulalip boy, Jaylen Fryberg, opened fire on his close friends in the cafeteria, killing 4 of them and himself. Lovre acknowledged that while it was the first regular school day, it will be a long time before anyone affected by the tragedy feels “normal.”

“I followed Jaylen’s schedule,” she said, explaining that she attended all of his scheduled classes. “We had kids in classes so they could see where the empty desks were, the rooms where Jaylen’s desk would be empty. That meant there were times during the day where I was a in a class with four empty desks.”

Acknowledging the loss and the range of emotions is important for teachers, students and even the community, Lovre explained. Right now, many people, adults and children, are still processing the event.

“The first day back we acknowledge it. We told the kids that we don’t have to move today. There was only one class that asked for a new seating chart. I’ve seen more chaos in schools where a child simply died in a car accident than we had in this school,” she said.

“They [the kids] need to see everything unchanged,” she described artifacts of the shooter as well as the victims, photos, school projects that might hang on the walls, even name tags that might be posted, “Taking it down is part of a process.”

For the first day back, the District had 30 grief counselors and therapy dogs at MPHS, and two grief counselors in each other district school. Counselors in the schools are just a piece of the total recovery effort, Lovre said. Much of the healing, or lack of healing will happen at home.

“Kids can only recover as much as the adults in their lives,” she pointed out. “We can’t expect our kids to behave in a way that is not modeled. I’ll say it again. Kids can only get as well as the adults around them.”

Providing overall community outreach and opportunities for the community to grieve and express emotions is one way to move forward after tragedy. The district, Lovre said, may look into greater outreach in order to help kids heal as much as possible.

“In other places one of the things we created were one-stop-shops where parents who needed counseling [also had access to other services],” she recalled. “IF a parent had an issue with food stamps, they could talk with someone at the school and deal with that issue at the same time.”

It’s important to provide wraparound services because as stress adds up, people are less able to deal with it. She also illustrated the types of behavior, including suicides, that current trauma might trigger. Trauma can also cause learning disabilities, which for a senior in their final year of high school, can derail their graduation goals.

“About 25% of your students have passing thoughts or have attempted suicide,” Lovre said. “Anytime the world is de-stabilized, it bumps those kids a little closer. You end up with kids sleeping in class because they can’t sleep at night, then they don’t have enough credits to graduate. The biochemistry of trauma leaves us on-edge, irritable and easily provoked.”

Every district deals with these issues differently. Lovre explained that the fact that Marysville School District is having the conversations so early, is a positive sign.

When asked about the mixed emotional reactions, Lovre said there is no right or wrong way to deal with the shooting. Some people will react with anger, some with grief, some will have no reaction at all, or will block out the violent act and focus on what came before. Still others will pass from one emotional reaction to another depending on the day, or even the moment. All are common reactions and none are abnormal.

“We often, particularly with a suicide or murder, get stuck on that moment and forget how that person lived. Part of my message is that we need to acknowledge that we lost someone in the fabric of our community. We need to acknowledge that we loved him. Some of you are conflicted about how you feel about him, you loved him but you cannot fathom the event that he did. It’s important that we say out loud that we have both feelings.”
Lovre continued, “There’s a difference between moving on and moving forward. I think it’s a wonderful thing that no one has vandalized the memorials to Jaylen. We are still in the honeymoon stage [of the crisis response]. But we’ll be tipping over that hill soon. The adults in your community will be moving to less tolerant places.

“We start getting into disillusionment, ‘I thought this was a good community, but I guess it’s not.’ Then we get into real anger, blame, and mistrust. Eventually it starts to come back up but it’s not [a straight line], there are dips. But, eventually, the days get better as a community, a family and for each person.”

Keep reading the See-Yaht-Sub and Tulalip News for updates on crisis relief efforts, where to receive counseling and how to help the Tulalip and Marysville communities move forward from tragedy.

How to help children deal with trauma, grief

Source: King 5 News

In the aftermath of the shooting at Marysville-Pilchuck High School, the Washington Office of Public Instruction offered information for parents.

Children react to trauma differently than adults. Some may react right away; others may show signs that they are having a difficult time much later. Adults don’t always know when a child needs help coping. The Department of Health and Human Services offers the following tips and information:

Children and youth between 6 and 19 may have some of the same reactions to trauma as younger children. Often younger children want much more attention from parents or caregivers. They may stop doing their school work or chores at home. Some may feel helpless and guilty because they cannot take on adult roles as their family or the community responds to a trauma or disaster.

Children 6–10 years old may fear going to school and stop spending time with friends. They may have trouble paying attention and do poorly in school overall. Some may become aggressive for no clear reason. Or they may act younger than their age by asking to be fed or dressed by their parent or caregiver.

Youth and Adolescents 11–19 years old go through a lot of physical and emotional changes because of their developmental stage. So, it may be even harder for them to cope with trauma. Older teens may deny their reactions to themselves and their caregivers. They may respond with a routine “I’m ok” or even silence when they are upset. Or, they may complain about physical aches or pains because they cannot identify what is really bothering them emotionally. Some may start arguments at home and/or at school, resisting any structure or authority. They also may engage in risky behaviors such as using alcohol or drugs.

How parents, caregivers, and teachers can support children’s recovery

Parents, teachers, and other caregivers can help children express their emotions through conversation, writing, drawing, and singing. Most children want to talk about a trauma, so let them. Accept their feelings and tell them it is ok to feel sad, upset, or stressed. Crying is often a way to relieve stress and grief. Pay attention and be a good listener.

Ask your teen and youth you are caring for what they know about the event. What are they hearing in school or seeing on TV? Try to watch news coverage on TV or the Internet with them. And, limit access so they have time away from reminders about the trauma. Don’t let talking about the trauma take over the family or classroom discussion for long periods of time. Allow them to ask questions.

Adults can help children and youth see the good that can come out of a trauma. Heroic actions, families and friends who help, and support from people in the community are examples. Children may better cope with a trauma or disaster by helping others. They can write caring letters to those who have been hurt or have lost their homes; they can send thank you notes to people who helped. Encourage these kinds of activities.

If human violence or error caused an event, be careful not to blame a cultural, racial, or ethnic group, or persons with psychiatric disabilities. This may be a good opportunity to talk with children about discrimination and diversity. Let children know that they are not to blame when bad things happen.

It’s ok for children and youth to see adults sad or crying, but try not to show intense emotions. Screaming and hitting or kicking furniture or walls can be scary for children. Violence can further frighten children or lead to more trauma.3

Adults can show children and youth how to take care of themselves. If you are in good physical and emotional health, you are more likely to be readily available to support the children you care about. Model self-care, set routines, eat healthy meals, get enough sleep, exercise, and take deep breaths to handle stress.

PRESCHOOL CHILDREN, 0–5 YEARS OLD
Give these very young children a lot of cuddling and verbal support.
– Take a deep breath before holding or picking them up and focus on them, not the trauma.
– Get down to their eye level and speak in a calm, gentle voice using words they can understand.
– Tell them that you still care for them and will continue to take care of them so they feel safe.

EARLY CHILDHOOD TO ADOLESCENCE, 6–19 YEARS OLD
Nurture children and youth in this age group:
– Ask your child or the children in your care what worries them and what might help them cope.
– Offer comfort with gentle words, a hug when appropriate, or just being present with them.
– Spend more time with the children than usual, even for a short while. Returning to school activities and getting back to routines at home is important too.
– Excuse traumatized children from chores for a day or two. After that, make sure they have age-appropriate tasks and can participate in a way that makes them feel useful.
– Support children spending time with friends or having quiet time to write or create art.
– Encourage children to participate in recreational activities so they can move around and play with others.
– Address your own trauma in a healthy way. Avoid hitting, isolating, abandoning, or making fun of children.
– Let children know that you care about them-spend time doing something special; make sure to check on them in a nonintrusive way

Resources

Disaster Distress Helpline
Toll-Free: 1-800-985-5990 Text ‘TalkWithUs’ to 66746
Web Site: http://www.disasterdistress.samhsa.gov

National Suicide Prevention Lifeline
Toll-Free: 1–800–273–TALK (1–800–273–8255);
TTY: 1–800–799–4TTY (1–800–799–4889)
Web Site: http://www.samhsa.gov

National Child Traumatic Stress Network
Web Site: http://www.samhsa.gov/traumaJustice/

Tulalip Diabetes Day, Nov 18

Tulalip Diabetes Day is November 18 from 9am-3pm at the Karen I. Fryberg Tulalip Health Clinic

Native Firm Wins Prestigious Health Communications Award

By KAI Meida Release

Kauffman & Associates, Inc., an American Indian-owned communications and professional services firm, has won the 2014 National Health Information Award for its 2-year national campaign encouraging American Indians and Alaska Natives to sign up for health insurance under the Affordable Care Act. Other 2014 award winners include the American Association of Retired Persons, American Lung Association, Parents Magazine and the Mayo Clinic. The National Health Information Awards program honors high-quality consumer health information. The awards program is organized by the Health Information Resource Center, a national clearinghouse for consumer health professionals who work in consumer health education fields.

Working with its client, the Centers for Medicare and Medicaid Services’ (CMS) Tribal Affairs Group, KAI tested messages and images with American Indian and Alaska Native stakeholders throughout the United States and created radio spots, videos, billboards, bus signs, brochures, fact sheets and social media spots. KAI also recruited partner organizations from across the country and conducted outreach at large powwows, conferences, summits and sports events. KAI Vice President for Communications, Kim Blessing, reported “the campaign generated more than 100 million media impressions, recruited 113 tribal and organizational partners and distributed 23,000 informational brochures”.

“American Indian and Alaska Native people finally have the opportunity to ensure their health needs are fully covered, but they have to sign up. This is so important. It was a privilege to help CMS with this campaign,” said KAI President Jo Ann Kauffman, a public health professional and member of the Nez Perce Tribe.

The campaign also included a 7-minute video featuring former CBS News reporter Hattie Kauffman. This video, directed by Josephine Keefe, won the 2014 Telly Award earlier this year. The video is available online and is currently being played in Indian health clinic waiting rooms across the nation. Monthly radio public service announcements (PSA) were also produced by KAI, and featured both English and Native language speakers. Radio PSAs were sent to Native radios each month on topics about special benefits and protections for American Indians and Alaska Natives. These PSAs were recorded in English, Navajo, Lakota, Ojibwe and Yupik. Companion “drop-in” articles were placed in Native newspapers to reinforce the radio messages.

KAI has provided research and communications support to federal agencies, tribes, nonprofits and foundations in the area of public health, education, justice and community development since 1990.

Grant money to advance Native American cancer study

An educational partnership aims not only to fight the disease among the Native American population, but to engage more students of native descent

By Charly Edsity, 12 News & The Arizona Republic

There isn’t a word for cancer in most indigenous languages, yet it affects Native Americans at an abnormally high rate.

The Partnership for Native American Cancer Prevention (NACP), a joint effort between Northern Arizona University and the University of Arizona Cancer Center, is the recipient of a $13 million grant from the National Cancer Institute, that will be split between the both universities.

“People die of cancer in Native American populations higher than other groups,” said Jani Ingram, associate professor of chemistry and biochemistry at NAU and member of the Navajo Nation.

According to the Intercultural Cancer Council, cancer is the third-leading cause of death among Native Americans, but there is no conclusive evidence to determine why.

Since 2002, NACP has worked to understand the reason cancer affects Native Americans, specifically tribes in the Southwest, at higher rates and seeks to engage Native American college students in entering science fields to help further research.

NAU’s program has 10 student researchers working under Ingram, some whom have been personally impacted by the deadly disease.

“It started with my grandfather, who worked in uranium mines and he died from lung cancer,” said NAU senior Erik Peaches, who is of Navajo descent.

Erik Peaches, NAU senior, works in lab as part of the Native American Cancer Prevention project at NAU.(Photo: 12 News)

In recent years, cancer spikes among older Navajos have been attributed to uranium exposure, a mining industry that boomed on the Navajo Reservation during the 1950s. The radioactive element still threatens communities surrounding abandoned mines and even contaminates drinking water.

NAU senior Ethan Paddock’s grandmother battled breast cancer that he says was caused by uranium exposure on the Navajo Nation.

“My family is from Cameron (Ariz.) and I know there is a huge uranium deposit over there,” Paddock said. “And it’s actually affected my grandmother and (she) got breast cancer.”

After a round of chemotherapy, Paddock’s grandmother has been declared cancer-free, but most with the disease don’t have the same outcome.

The grant money will continue the research being conducted in the Hopi, Navajo and Tohono O’odham communities, work that Ingram said more Native American students should consider.

“If it is a native student, a Navajo student, a Hopi student working on an issue that’s really important to their community, the passion is just right there,” Ingram said.

American Indian Fry Bread Hints

Fry bread is an incredibly popular food; everyone who tried them loves them. You might love it, but did you know it originated in a painful way?

Source: Native American Encyclopedia

If you have ever attended a Native American PowWow you have probably noticed vendors selling a large doughy piece of bread called fry bread. Fry bread is an incredibly popular food, very much like an unsweetened funnel cake. American Indian fry bread might seem like a traditional food but it originated in a painful way. The most helpful hint that you can be given about Native American fry bread is to understand how and why this food came about. Native American fry bread may be a symbol of their culture. However, its beginning was steeped in tragedy.

History

Fry bread was first made approximately 144 years ago after the United States forced the Navajo to complete the “Long Walk,” which was a 300 mile walk where many people lost their lives. These Navajo people were moved to a land that was not fertile for traditional vegetables and beans. They were then forced to live on government canned goods: flour, sugar, salt, baking powder, powdered milk and lard. The Navajo people began using what they had and they created fry bread. Fry bread became a symbol of their survival and is always present at PowWows.

Ingredients

Fry bread is made from very simple ingredients. In order to make a dozen fry breads you will need: 2 cups sifted flour, 2 teaspoons baking powder, 1/2 teaspoon salt, 1 tablespoon shortening, approximately 1 cup water, and approximately one cup of oil. The recipe, as well as the style of cooking, has remain unchanged.

Preparation

First sift the flour, baking powder and salt together. Then add the shortening — a helpful hint is to use a pastry blender which will help incorporate the wet and dry ingredients. If you don’t have a pastry blender use butter knives. The next step is important, add just enough water to make a soft dough. If you add too much your dough won’t have the right consistency. Knead dough until smooth. Roll dough into small balls. Cover dough with a damp towel for ten minutes. Roll the ball in your hands until each ball flattens into a 4-inch round discs. It is important that you cook the dough in a skillet to keep the right texture of fry bread. Pour oil in the skillet and heat, ensure that you have at least an 1 inch of hot oil. Fry each round of dough until it becomes a light golden brown, turn it over once. The bread will puff up as it fries. Drain the fry bread on a paper towel when it’s done.

Serving

Fry bread is delicious by itself or you could serve it a multitude of ways. Drizzle the fry bread with a tiny bit of honey and powdered sugar or just add a little bit of jam. Many people cut a slit through the fry bread and stuff it with different foods including ground beef and beans. Another traditional recipe is the Indian Taco, the fry bread replaces the corn tortilla of a traditional taco. Fry bread is a very good bread but you should be mindful of what you are eating. Remember that this food is a story of resiliency and survival .

Ebola Poses Little Risk in the Northwest, Health Officials Say

By Amelia Templeton, OPB

Public health officials in the Northwest say Ebola poses little threat to the region, but they are prepared to isolate and treat infected health workers or travelers. There have been no suspected or confirmed cases in Oregon or in Washington.

The Ebola virus. CDC

Oregon state Health Officer Katrina Hedberg says that most people traveling between West Africa and the United States are aware of the risk of Ebola.

“Most people, we hope ,will self identify, will want to get evaluated, will not want to spread any infection to other people,” she says.

Hedberg says emergency rooms and hospitals have been reminded to ask patients about recent travel. If you’ve been in West Africa and develop a fever or diarrhea, share your travel history with a doctor. Hedberg says standard isolation protocols hospitals use to treat patients with highly contagious diseases like the measles would be adequate for an Ebola patient as well.

Washington’s state public health laboratory is among relatively few in the US that the CDC has certified to test for Ebola.

Scott Lindquist, the state epidemiologist, says so far no tests have been requested.

Ebola has killed more than 2,000 people in West Africa, according to the World Health Organization.

Tribes Get copy1.3 Million in Federal Grants to Combat Chronic Disease

Indian Country Today, 9/26/14

Twenty-two tribes and indigenous organizations in 15 states will receive a total of copy1.3 million in grants from the Centers for Disease Control to combat chronic diseases commonly plaguing Indian country, the U.S. Department of Health and Human Services announced on September 25.

The biggest winner is the Alaska Native Tribal Health Consortium, which got copy.1 million, HHS said in a release. The smallest award went to Santa Ana Pueblo, for copy20,000.

It is part of overall grants totaling about $212 million awarded to all 50 states and the District of Columbia “to support programs aimed at preventing chronic diseases such as heart disease, stroke and diabetes,” the U.S. Department of Health and Human Services said in a statement. “This new initiative aims to prevent heart disease, diabetes, stroke, and associated risk factors in American Indian tribes and Alaska Native villages through a holistic approach to population health and wellness.”

These are all prevalent problems in Indian country.

Indian National Rodeo Finals Launches Health Campaign; Declares Diabetes Awareness Day

The grantees will work within their communities using culturally appropriate measures to reduce exposure and use of commercial tobacco, improve nutrition and exercise, support breastfeeding, boost health literacy and strengthen team-based care by linking community resources with clinical services, HHS said. Half the awards are going directly to tribes, while the other half will be used to support tribal organizations that provide services, training, assistance and leadership in various areas to tribes and villages. The program is financed by the Prevention and Public Health Fund of the Affordable Care Act, HHS noted.

The other tribal grantees were the InterTribal Council of Arizona, Inc., which got $850,000; the California Rural Indian Health Board, Inc., whose grant was $788,972; United Indian Health Services, Inc., in California, with $650,000; the Nez Perce Tribe in Idaho, which is awarded $200,000; the Kickapoo Tribe in Kansas, with copy94,876; the Sault Sainte Marie Tribe of Chippewa Indians in Michigan, which gets $325,000; Fort Peck Community College in Montana, with $317,039; also in Montana, the Montana-Wyoming Tribal Leaders Council, which got $648,124; the Winnebago Tribe of Nebraska, netting copy78,493; the Albuquerque Area Indian Health Board, Inc. of New Mexico, which received $850,000; Oklahoma City Area Inter-Tribal Health Board, with $850,000; two grants in Oregon, with $850,000 going to the Northwest Portland Area Indian Health Board and copy99,159 to the Yellowhawk Tribal Health Center; the Catawba Indian Nation of South Carolina got copy99,804; the Great Plains Tribal Chairmen’s Health Board in South Dakota netted $650,000, while the Lower Brule Sioux Tribe received $200,000. In Tennessee the United South and Eastern Tribes, Inc. (USET) got $849,998, the Great Lakes Inter-Tribal Council, Inc. in Wisconsin received $850,000, and, also in Wisconsin, the Red Cliff Band of Lake Superior Chippewa Indians got $200,000.

Tips for keeping your pets safe when natural disasters happen

By BluePearl Veterinary Partners

SEATTLE – The patient care team at ACCES (A BluePearl Veterinary Partners) specialty and emergency hospital for pets in Seattle and Renton is encouraging pet parents to include their pets when making family disaster plans. The Federal Emergency Management Agency (FEMA) is sponsoring America’s PrepareAthon! on Sept. 30, as part of the federal government’s National Preparedness Month. The event is meant to motivate individuals, organizations and communities to prepare in advance for natural disasters like earthquakes, floods, hurricanes, tornados, wildfires and winter storms.

“Disasters can happen with little notice and be devastating. But being prepared can save your life or that of your family members — including your pets, ” said Amanda McNabb, emergency clinician with ACCES in Seattle, Washington, and a member of the WSDA Reserve Veterinary Corps. “That’s why we strongly recommend pets be included in your disaster preparedness plan.”

Here are some tips recommended by the ACCES team:

CREATE AN EMERGENCY KIT FOR YOUR PET BEFORE A DISASTER

Keep current documentation of your pet’s medical records and vaccination history in the emergency kit.
Include your pet’s license information.
Have a current photograph of your pet in the kit.
Keep a checklist in the kit of items to pull together when a disaster is imminent, including these:Have an evacuation strategy: Have a list including addresses and phone numbers of specialized pet shelters, animal control shelters, veterinary clinics, and friends and relatives out of harm’s way who are potential refuges for your pet during a disaster. Familiarize yourself with the location of each so if you need to evacuate, you can plan your route accordingly.
- Collar: Make sure your pet’s collar has an identification tag with your contact information.
- Leash: Use a leash if you evacuate or bring your pet to a shelter because pets can become easily disoriented if they slip away from you.
- Carrier: Have a properly sized pet carrier for each animal handy. Carriers should be large enough for the animal to stand and turn around.
- Medications: Have a two-week supply of medications and care instructions to bring with you.
- Food: A two-week supply of food should always be kept on-hand in case of an emergency.
- Other: Make a list of other items to add at the last minute such as food, bowls, can opener, cat litter, water and cleaning supplies.

DURING A DISASTER

Gather together in one place all items on your pet’s emergency checklist. A laundry basket is easy to carry and a good size for this purpose.
Animals brought to a pet shelter may be required to have any or all of the following:Pet shelters will be filled on first come, first-served basis. Call ahead and determine availability.
- Leash and collar with identification tag
- Rabies tag
- Identification on all belongings
- Suitable carrier or cage
- Ample supply of food, water and food bowls
- Necessary medications and specific, written care instructions
- Newspapers, trash bags and other supplies for clean-up
Bring pets indoors well in advance of a storm. Reassure and calm them throughout.
Monitor your pets’ behavior, because animals can become defensive or aggressive due to the stress of the situation.

AFTER A DISASTER

Walk pets on leashes until they become re-oriented to the area. Familiar scents and landmarks may be altered and pets could easily be confused and become lost. Also, downed power lines, debris, snakes and other critters brought in with high water can all pose a threat for animals after a disaster.
If your pet is lost during a disaster, contact your local animal control office to find out where lost animals are being housed. Bring along the picture of your pet and information about the microchip.

About Us: ACCES (A BluePearl Veterinary Partners Hospital) serves the Puget Sound region by offering the highest quality specialty, critical care, emergency medicine and specialty services to veterinarians and their clients 24-hours a day/365 days a year at locations in Seattle and Renton. For more information on ACCES, please visit criticalcarevets.com.

BluePearl Veterinary Partners employs 1,800 team members including more than 450 veterinarians. BluePearl hospitals offer referral-only, specialty care services and most offer 24-hour emergency care. BluePearl does not provide primary care. The company is one of the world’s principal providers of approved veterinary residency and internship programs. BluePearl also participates in clinical trials that investigate the effectiveness of new veterinary drugs and treatments, providing pet families access to cutting-edge medicine that is not yet commercially available. BluePearl is headquartered in Tampa, Fla. For more information on BluePearl Veterinary Partners, please visit bluepearlvet.com.

Feds funding ‘navigators’ to encourage signups

By Mike Dennison, Independent Record State Bureau

Once again, the federal government is funding “navigators” in Montana to help the uninsured buy private, subsidized health coverage this fall — with a new emphasis on Native American consumers.

Earlier this month, federal officials awarded $609,000 in navigator grants to three Montana groups: Planned Parenthood of Montana, the Montana Health Network and the Montana Wyoming Tribal Leaders Council.

“We had great, great success with the program last year,” Martha Stahl, CEO of Planned Parenthood of Montana, said Monday. “I think it’s a great way to continue our mission of connecting people with affordable health care, which is what we’re all about.”

Stahl said her group will be working closely with the other two grant recipients and other organizations to sign up more people for health insurance under the Affordable Care Act, as well as target Native Americans. Planned Parenthood and the Health Network had navigator programs last year.

Navigators, who must be certified by the state insurance commissioner, help people buy private health insurance through the online “marketplace,” a key part of the ACA, the federal health-care overhaul also known as “Obamacare.”

Individuals buying policies on the marketplace can get federal subsidies to offset the cost of those policies. Lower-income consumers also can get further discounts on certain marketplace policies.

Most consumers who earn less than 400 percent of the federal poverty level — about $79,000 for a family of three — are eligible for the subsidies, which are paid directly to the insurance company.

The Obama administration launched the marketplaces last October in 34 states, including Montana, initially with disastrous results. Beset with technical problems, the marketplaces barely worked.

However, by the end of March, more than 36,000 Montanans gained coverage through marketplace policies, out of 8 million people nationwide.

The marketplaces will open again this year Nov. 15. Customers can shop for and purchase new policies for 2015. Four companies will be offering policies on Montana’s marketplace.

Cheryl Belcourt, executive director of the Montana-Wyoming Tribal Leaders Council in Billings, said the group will use its $142,000 grant to hire some navigators and coordinate with other groups to encourage Native Americans both on and off reservations to buy marketplace policies.

Many Native Americans think the policies are not for them, because they expect to use the Indian Health Service and don’t face a tax penalty if they’re not insured, Belcourt said.

However, the affordable private policies and their low-cost coverage can expand health care for Native Americans, she said.

“This is an opportunity to address the health disparities of Native American people,” Belcourt said. “We want to be able to really make a difference in terms of the quality of life for Indian people.”

Chris Hopkins of the Montana Health Network, a consortium of smaller hospitals and health-care centers, said its $175,000 grant will be used to add nine new navigators to the 20 it already trained with last year’s grant. Most of them are staffers at hospitals and nursing homes.

“Our focus is to have local people providing services in their own community, rather than having someone come in from the outside, do a presentation, and then leave,” he said.

The Montana Primary Care Association, which represents federally funded health clinics, had a navigator program last year but did not get a grant this year.

Amanda Harrow of the association said clinics will continue to work with various groups to help people sign up for ACA-subsidized policies.