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.
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.
Health and Human Services Secretary Sylvia M. Burwell announced last week that individuals eligible to receive health care from an Indian Health Service (IHS), tribal, or urban Indian health program provider are now able to claim an exemption from the shared responsibility payment through the tax filing process starting with the 2014 tax year. This benefit was previously only available to members of federally recognized tribes (including Alaska Native shareholders). American Indian and Alaska Native individuals will continue to have the option of submitting the exemption application through the Health Insurance Marketplace.
Prior to this week’s announcement, only individuals who were members of a federally recognized tribe were able to claim an exemption through the federal tax filing process. Individuals who are eligible to receive services from an Indian health care provider are eligible for a separate hardship exemption but were required to obtain this exemption through the Health Insurance Marketplace by filing a paper application.
The availability of the online tax filing process to apply for the hardship exemption will save time and reduce duplication of effort. Qualification for the Indian exemption can be established by attestation of membership in a federally recognized tribe or eligibility to receive services from an Indian health care provider.
Secretary Burwell first announced this updated rule at the Secretary’s Tribal Advisory Committee meeting on September 18, 2014. This benefit of claiming the exemption through the tax filing process was initiated based on requests by tribal leaders. The IHS worked closely with the Centers for Medicare and Medicaid Services and the Internal Revenue Service to extend these options to individuals eligible to receive services from an Indian health care provider.
The IHS, an agency in the U.S. Department of Health and Human Services, provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who are members of federally recognized tribes.
PORT TOWNSEND — Lethal levels of marine biotoxins that cause paralytic shellfish poisoning have been detected in shellfish taken from Quilcene Bay, Jefferson County health officials warned Monday.
Quilcene and Dabob bays have been closed to the recreational harvest of molluscan shellfish — clams, oysters, mussels and scallops — since Sept. 8.
Paralytic shellfish poisoning, or PSP, concentrations have risen to more than 6,000 micrograms per 100 grams of shellfish.
That’s 75 times the 80-microgram closure level, and twice the levels detected last week.
“It keeps climbing,” said Michael Dawson, water quality lead for Jefferson County Environmental Health.
A combination of warm weather and calm water may be contributing to the elevated levels of PSP, Dawson said
Additional samples from Quilcene Bay and surrounding areas were collected Monday.
“Right now, we’re mostly wanting to check and see if it might be spreading,” Dawson said.
“So we’ve been checking down the Hood Canal.”
The state Department of Health is warning the public that eating shellfish with such high amounts of toxin is potentially deadly.
Symptoms of PSP can appear within minutes and usually begins with tingling lips and tongue moving to the hands and feet, followed by difficulty breathing and potentially death.
Danger signs have been posted at public beaches warning the public not to eat the shellfish, Dawson said.
Marine biotoxins are not destroyed by cooking or freezing.
The closure does not apply to shrimp.
Crabmeat is not known to contain the biotoxin, but the guts can contain unsafe levels.
To be safe, clean crab thoroughly and discard the guts, health officials say.
Commercially-harvested shellfish are tested for toxins prior to distribution and should be safe to eat.
Areas closed to the recreational harvest of all species of shellfish in Jefferson County are Quilcene Bay, Dabob Bay and Discovery Bay.
Kilisut Harbor, including Mystery Bay, and the Port Ludlow area are closed to the recreational harvest of butter and varnish clams only.
Jefferson County Public Health will continue to test affected beaches and will notify the public when shellfish are safe to harvest, officials said.
In Clallam County, the recreational harvest of butter clams is closed from Cape Flattery to Dungeness Spit.
Varnish clams are closed along the entire North Olympic Peninsula.
Sequim Bay is closed to all species of shellfish.
Seasonal closures are in effect for the Pacific Ocean beaches.
Recreational shellfish harvesters can get the latest information about the safety of shellfish on the state website at www.doh.wa.gov or by phoning 800-562-5632 before harvesting shellfish anywhere in the state.
Recreational shellfishers also should consult state Fish and Wildlife at www.wdfw.wa.gov.
Pam James, co-founder of Native Strategies Photo/Shannon Kissinger
By Kyle Taylor Lucas, Tulalip News
This is the second story in a series on the intersection of chronic health and addiction issues and Adverse Childhood Experiences (ACEs among American Indians. The series focuses upon contributing factors of high ACE numbers and substance abuse and behavioral and health disparities in American Indians.
The ACEs Study became a reality due to a breakthrough from an unexpected source—an obesity clinic led in 1985 by Dr. Vincent Felitti, chief of Kaiser Permanente’s Department of Preventive Medicine, San Diego. Dr. Felitti was shocked when more than fifty percent of his patients dropped out of the study despite their desperate desire to lose weight. His refusal to give up on them led to individual interviews where he learned that a majority had experienced childhood sexual trauma. That led to a 25-year research project by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. The landmark study linked childhood adversity to major chronic illness, social problems, and early death.
According to the CDC, “the Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being.” The study included more than 17,000 Health Maintenance Organization members who in routine physicals provided detailed information about childhood experiences of abuse, neglect, and family dysfunction. The ACEs Study links childhood trauma to social and emotional problems as well as chronic adult diseases such as disease, diabetes, depression, violence, being a victim of violence, and suicide.
Since the ACEs Study, hundreds of published scientific articles, workshops, and conferences have helped practitioners better understand the importance of reducing childhood adversity to overcome myriad social and health issues facing American society. See the ACEs questionnaire, here: http://www.acestudy.org/files/ACE_Score_Calculator.pdf. Learn more about the ACEs Study here: http://www.cdc.gov/violenceprevention/acestudy/
The ACEs research is of significant relevance to American Indian/Alaska Native (AIAN) communities beset with behavioral and physical health issues—disproportionately high as compared to the general population.
Unquestionably, any discussion of social and health disparities in Indian Country must include historic trauma, and the political and economic realities affecting American Indians and tribes. Research into epigenetics subsequent to the original ACEs Study indicates that historic trauma is likely one of the primary contributors to disparate behavioral and physical health issues affecting AIANs. Subsequent stories will more fully explore the physiological brain changes that result from childhood adversity.
Native Strategies – Addressing Historic Trauma in Native Communities
Tribal experts in the area of historic trauma emphasize that while the ACEs Study is important, it is also important to ensure concurrent address of historical trauma on AIANs and tribal communities.
One of those experts is Pam James who is co-founder of Native Strategies, a non-profit organization established with her husband and partner, Gordon James, in 2009. Pam is a member of the Colville Confederated Tribes and Gordon is a Skokomish Tribal member. The two have been consulting on historic trauma and Native wellness in tribal communities for the past thirty years. Pam earned a B.A. Degree in Psychology and Native American Studies from The Evergreen State College and a BHA in community health from the University of Washington.
“Until we established our non-profit, we did freelance consulting. We worked with the Native Wellness organization, sought grant funding, and wrote a wellness book. Then we used our book to write a curriculum that we’ve applied in our work,” said James.
The non-profit allows better access to funding and resources to further their work empowering tribal people and communities. “We are able to provide training and technical assistance absent tribal politics,” said James who noted they are also free to be creative in designing a broad array of programs, training, services, and technical assistance. “We’ve helped several organizations start their own non-profits. We do a lot of grant writing. We do workshops around historical trauma, parenting, healthy relationships, and government-to-government training. We also do planning and program evaluations and help organizations get into compliance.”
James said one of the most sensitive and impactful of their workshops is healthy workplace training. “We look at it holistically, at interpersonal relationships, family relationships, and relationships to all things–earth and to all creation.” She asks, “How do you create a healthy workplace? You can’t do that until you begin to address the historic trauma.” In their work, James said they help to rewire the brain for positive impact, noting, “Behavior is just a habit. We have to change the habit. I do it from a cultural perspective and I blend in humor.”
However, James is mindful of her approach. She said, “every workshop, every training I do, people get triggered,” so she is careful with her audience. They try to unlearn negative behaviors. In the communities, she finds, “Though it doesn’t work, people do the same thing over and over again expecting a different result.” She said their training “takes people back to that value system that our people always had, treating people with honor and respect. We have a roadmap that asks, “What do you want in your life, spiritually, emotionally, and how do you start creating the life you want?”” She said repetitiveness in practice and training is critical and noted the impossibility of creating change in a workshop or two.
Asked whether training the trainer is part of their work, James replied that it was and that it is essential. “We help train the trainer for tribes so that they can teach it themselves. First, we do community training, then a three-day “train the trainer” workshop, and then we come back in 3-6 months to assist them with their first training. It’s very sensitive. What do you do when someone gets triggered? We help to prepare them.”
About their generational trauma and wellness work, James added, “In our training, we’re opening awareness. The second step is intervention. How do we implement and make change? The third step is continuing education and putting it into practice. It is developing new ways of coping, replacing behaviors, and doing it on a consistent basis. It’s a theory and it’s ongoing.”
However, she said, “Most of our tribal communities are in crisis mode by the time they call. I urge them to call us before that.” She noted three stages—prevention, emergent, and intervention. “I urge them to look at those areas and ask, “How do we get to the place where we’re doing prevention rather than intervention?” Tribes have to start looking at this type of training as ongoing. Just like computer classes. This is not a one-time shot.”
In their training, James said they often support eight-week parenting classes. However, she recommends to clients, “Before we do that, let’s do a healthy relationship class!” Again, she says it is a matter of steps, mentally, emotionally, and educationally. “First of all, we start with the parents to help them learn how to interact with each other. We are in a society that wants a quick fix, but there is no quick fix. It’s about awareness, learning new skills and behaviors, and then we have to practice, practice, practice. It’s not about the end result it’s the journey.”
James said she attended one of Laura Porter’s workshops on ACEs and thought, “Wow, this would have been great to know years ago! Oh my gosh, I wish we had been involved.” To date, only a few tribes have engaged with the state’s research work around the CDC ACEs Study and measurements. James believes “ACEs is one piece of the puzzle, one piece of the process for Native people.” She said her non-profit is looking at funding opportunities to develop a curricula based on their 30 years of work. They plan to work with an advisory team of Native people and the curricula will be designed for implementation by tribal communities, and culturally appropriate to their needs.
Specific to generational historic trauma, James believes “The ACEs information doesn’t go far enough. The State is a very good example of a sense of guilt. They don’t really want to acknowledge it. It’s painful to acknowledge what was done to Native people. There is a lot of effort being made to change it, but it’s still there.”
ACEs and Physiological Rewiring of the Developing Brain
Asked about her knowledge of current scientific research on the relationship of childhood adversity and epigenetics—the study of physiological brain changes and potential application to the study of historic trauma in Native communities, James becomes animated. She noted a weeklong workshop she attended with Dr. Bruce Perry, the author of “The Boy Who was Raised as a Dog” and “Born for Love.” She said, “What an amazing man. His focus has been trauma.” She said he validated the tribal community’s long assertions of unresolved multigenerational trauma, and that the brain is actually hard-wired for empathy, but things happen to the brain when babies and children experience adversity and trauma.
James discussed the work of Dr. Patricia K. Kuhl who of the University of Washington, whose trainings she has attended. She co-authored the book, “The Scientist in the Crib.”
At one workshop, Dr. Kuhl presented studies of two children’s brains from newborn to age three–one child from a happy home and the other from a neglected home. They conducted CAT scans at ages 3, 6, and 9 months. At the beginning, their brains were identical, but by the time they were nine months old, the brain of the neglected child was visibly shrinking. Considered in the context of social and health disparities and life chances for AIANs, this is quite remarkable. The above study demonstrated that disparities begin in the crib, but as the ACEs Study and ensuing research has shown, it is intergenerational, and even in the womb. If the mother and father have high ACE scores based upon their own childhood adversity, the children are also likely to have high ACE scores unless there is intervention.
James is optimistic. She said that although the research shows adversity is generational, “It also validates that we can reverse it. It doesn’t have to be permanent. Some of it might be, but we can reverse much of it. Our ancestors adapted. We learned how to adapt for our environment; it is human nature to survive. Those are the pieces that are not happening in our community.”
Family and Community Roles and Traditions
Lamenting the negative impacts of technology, James said, “Televisions, iPads, Xboxes are the babysitters of today. They are impacting how our children develop, how their brains develop. Technology has disconnected us as people.” She grew up in Inchelium where they did not have a telephone until 1978. “All the grandmothers and everyone would come together, bring old clothes, and make quilts. They lined them with old army blankets. There was a spiritual part of that. Every newborn received a quilt. We’re not doing those kinds of activities that inspire and help our children to learn about community.” James is concerned that technology today limits human contact important to a sense of being part of something greater and of the responsibility accompanying it.
Another significant hurdle is overcoming the lateral violence that is a symptom of ACEs. James said that in her counseling work, she discovered, “We get addicted to pity, to negativity, and we become chaos junkies.” She believes people have forgotten about how just to be. “The Vision Quest taught us how to be alone, to be one with nature, to be alone physically and mentally. It taught us how to control our mind, our spirit, and our bodies.” She thinks some of those teachings can be built into the curricula to teach people how to, again, “sit quietly with themselves, to sit and listen.”
Applying the ACEs Study and Measurements to Native Wellness
James’ family of origin was not unlike many Native homes. She and her eight brothers and sisters grew up with domestic violence, alcoholism, and physical and sexual abuse. She began doing this work in 1986 when the Seattle Indian Health Board received a federal grant to put together a curriculum. She was among 40 chosen from different tribes to participate in a two-week intensive training that was life changing for her. “They stripped us spiritually and emotionally. We had to address our own trauma. We could not help others until we worked on ourselves and healed ourselves. There was no college that could give me what that training did!”
In the training, Jane Middelton-Moz, an internationally known speaker and author with decades of experience in childhood trauma and community intervention took part in the training. She addressed the pain of adult children of alcoholics (ACoA), a topic about which she has written extensively. “It was basically an ACE’s study done with Native people and it was all about the trauma.” James recounted Middleton-Moz’s journey to Germany where she worked with holocaust survivors and her later study of American Indian tribes. She discovered that they had developed the same trauma characteristics. “She was a psychotherapist and I felt blessed to have the opportunity to be mentored by her.” James noted that their work has essentially taken Middleton-Moz’s study of ACoA and applied it to multi-generational trauma among tribal communities.
Asked how the new research on childhood adversity can help Native communities, James said, “The ACEs Study is good in that it gives us the validation and affirms what we’ve known. This is what has been happening in our communities for hundreds of years.” She noted the mental and physical health issues evidenced by high juvenile suicide rates, 638 percent higher incidence of alcoholism than the general population, addiction, and disparate social, and health issues in Indian Country are all traceable to generational trauma and adverse childhood experiences.
However, James believes the survey mechanisms must be appropriate. She said, “The reality is that a lot of times when so-called experts go in and do the surveys, the tribal members don’t tell the whole truth.” Tribal communities are tight-knit and everyone knows everyone and their business. It may be that a special survey mechanism is necessary for tribal communities. James said, “It will be difficult to get reliable data if the members don’t trust enough to give accurate information, to tell the whole truth.”
Those involved in tribal wellness have said for years, and James echoes this, that it is important to put the disparate social and health issues in Indian Country into context. “We have people who have suffered such trauma in their lifetimes, in their parents, and grandparent’s lives!” said James.
People forget that generations of American Indians experienced breaks in the family unit caused by the government’s forcible removal of children placed into Indian boarding schools. Indian children were deprived of parental nurturing; many were physically and sexually abused. They did not learn how to parent and nurture their children, but at adulthood, they were returned to the reservation to start their own families and the same cycle was repeated.
In their workshops, James stresses traditions. “We’ve adopted behaviors that were not ours traditionally. Instead, we go back to the medicine wheel, it teaches you everything—body and mind. When you look at what is happening with our communities, we’ve lost touch with all of the ceremonies, languages, and the practices that kept us resilient. There is a veneer of positivity, but underneath there’s all this pain.”
Clearly passionate about her work, James makes the call, “Someone has to be the voice of our children, someone has to stand up and take the arrows, stand up and say this is not what our ancestors wanted. I really believe this is the core work if we can get it into our communities, we’re going to change, and it has to take place for our survival.”
Integration of ACEs Research in Tribal Family Services and Other Programs
As Sherry Guzman, Mental Health Manager in the Tulalip Family Services Department said, about the ACEs Study, “Most tribes were very leery at first, but I went forward with it because I saw the value of it. It enabled me to see the difference in average of Washington State versus Tulalip Tribes. I like the ACEs model because it gives a base to compare something to.” She, too, felt the ACEs measurements validated what she and others in Indian Country have advocated—that unresolved generational trauma is a significant contributor to social and health disparities among tribes.
Guzman’s department has scheduled an all-staff meeting focused upon the ACEs Study and Tulalip’s work with the statewide network a few years ago. They hope to re-establish a dialogue and consider the future direction the Tribe may take in applying the ACEs Study and measurements in its programs.
In communities utilizing the ACEs measurement across the nation, the subsequent application of community resilience building has consistently demonstrated success in lowering of ACE scores in community members, which in turn helps build stronger and more resilient communities. Imagine the possibilities if communities invested in families on the front end, supporting pre-natal work, pre-school and all day kindergarten, rather than building juvenile detention centers and adult prisons.
At least twenty-one states have communities actively engaged in ACEs work.
Future stories in this series look at that work and new developments in ACEs research, including neurobiology, epigenetics, and the developing brain. Also featured will be tribal organizations applying similar intervention and measurements to address generational trauma. Because ACEs extend beyond the nuclear family to educational and child welfare policies, and to racism in social, police, courts, and other institutions controlling the lives of Indians, those intersections are reviewed along with the economics. Finally, the series will explore the potential of ACEs measurement in prevention and for building resiliency for American Indian people and tribes.
Kyle Taylor Lucas is a freelance journalist and speaker. She is a member of The Tulalip Tribes and can be reached at KyleTaylorLucas@msn.com / Linkedin: http://www.linkedin.com/in/kyletaylorlucas / 360.259.0535 cell
September 19, 2014 – SNOHOMISH COUNTY, Wash. – The Centers for Disease Control and Prevention (CDC) has confirmed the presence of enterovirus D68 (EV-D68) in Washington state, including Snohomish and King Counties. The CDC testing confirmed that two children, one from Snohomish County and one from King County who had been hospitalized at Seattle Children’s Hospital has respiratory illness associated with EV-D68.
“The spread of EV-D68 reminds us how important it is to get back to basics: washing hands, covering coughs, & staying home when ill,” said Dr. Gary Goldbaum, MD, MPH, Director and Health Officer of the Snohomish Health District. “And although here is no vaccine for this virus, with flu season approaching, we also need to get vaccinated in order to protect all of us.”
The results of the testing also show that EV-D68 is not alone in causing serious respiratory illness. The tests indicated that a variety of common cold viruses that cause uncomplicated infections in most children can cause severe disease in asthmatics and those with underlying lung diseases.
Many people who get sick from EV-D68 have only mild symptoms, like runny nose or coughing with or without fever. Parents should be watchful for any signs of wheezing or worsening asthma and seek medical help promptly if breathing difficulty occurs. Children and adults with asthma should be sure to take their medications as prescribed and have an asthma control plan with their health care provider. They should contact their healthcare provider promptly if asthma symptoms worsen even after taking medication.
There is no specific treatment or vaccine for EV-D68 infections. Testing is done to determine when the virus is present in the community, but is not helpful for individual patients and is not needed or available in non-hospitalized cases.
Slowly but surely, tribal governments — especially those in Alaska — are receiving millions of dollars in decades of unpaid contract costs from the Indian Health Service and Bureau of Indian Affairs.
Liz DeRouen, 49, left, gets her blood pressure checked by medical assistant Jacklyn Stra, right, at the Sonoma County Indian Health Project in Santa Rosa, Calif.
WASHINGTON — Tribal health programs working to serve native people are not seeing funding of administrative costs keeping pace with need, and the Indian Health Service and the Bureau of Indian Affairs owe millions to tribal governments.
“The federal government has broken too many promises with tribes and though we have more work to do, I am pleased that we are seeing good progress with Alaska tribes receiving the money they are owed,” Alaska Sen. Mark Begich told the Alaska Native Tribal Health Consortium last month. “Failure to pay the full costs is unacceptable and I will continue to use my position on the Senate Indian Affairs Committee to keep up the pressure on the federal government.”
The IHS, a Department of Health and Human Services agency, provides health service systems for about 2.2 million of the nation’s estimated 3.4 million American Indians and Alaska Natives.
Funds allocated by the IHS, currently $4.4 billion per year, go toward administering medical care to tribes or are turned over to tribes for them to administer the care themselves. The IHS had been failing to provide full payments of contract costs until the Supreme Court ruled in June 2012 that the government must pay, determining that the tribes had been underpaid “between 77 percent and 92 percent of the tribes’ aggregate contract support costs” during previous decades.
Yet, according to Jacqueline Johnson Pata, executive director of the National Congress of American Indians, “payment has not happened.”
“The class action lawyers recently reported to NCAI on the lawyer’s discussions with the Justice Department. Although they couldn’t share much information, they did explain that there are close to 9,000 claim years at issue involving about 500 tribes and 19 years worth of contracts (1994-2013),” she told the U.S. Senate Committee of Indian Affairs last year.
Sen. Begich introduced Senate Bill 2669 in July to the Senate Appropriations Committee
to mandate funding for certain payments to Indian tribes and tribal organization. Additionally, the federal government has treaty and statutory obligations under the Indian Self-Determination and Education Assistance Act of 1975, which requires the government to contract with tribes to operate BIA and IHS programs. The agreement between the government and tribes is embedded in Article I, Section 8, of the U.S. Constitution.
At the end of 2013, less than 1 percent of thousands of claims in more than 200 lawsuits filed by tribes seeking a combined $200 billion had been settled — just 16 claims of an estimated 1,600.
Of the 566 nations the federal government recognizes, 229 are spread across the vast 572,000 square miles of Alaska, where they occupy small villages in remote areas — many only accessible by air or boat. For these tribes in remote areas, seeing a doctor might be inconvenient, to say the least, and almost definitely costly.
Lead counsel in the cases establishing government liability for IHS’s failure to pay, Lloyd Miller, an attorney based in Anchorage, Alaska, said IHS is severely underfunded.
“IHS is a prepared health plan paid for with a lot of blood and millions of acres of land,” Miller said. “Because the government took away their lands, there’s a responsibility.”
IHS gets $4.4 billion from Congress annually for what’s estimated to be a $15 billion need to meet the costs, he said.
Miller represents about 60 tribes, each with several claims filed for the costs owed.
In an August 2007 letter to the Senate Committee on Indian Affairs requesting an oversight hearing, Alaskan tribal health care providers reminded the committee that the Indian Self-Determination Act requires money to provide federal trust responsibilities.
“We write to once again call your attention to the grave crisis we face as a result of insufficient contract support cost appropriations which, together with Indian Health Service policies, have left our tribal organizations with annual shortfalls running from $2 million to over $8 million. We respectfully request that the Senate Indian Affairs Committee convene an urgent oversight hearing this Fall, to review what has become a genuine crisis in Indian country, and a crisis that has seriously eroded the national policy of Tribal self-governance and the delivery of quality health services to Alaska Native people,” the letter stated.
By August of this year, 12 of Alaska’s tribal health providers received $449 million to resolve contract support costs disputes with the IHS. Another 11 providers were still in negotiations. The Alaska Native Tribal Health Consortium, serving more than 143,000 native people, received the largest payment, with a $153 million settlement that includes $115.5 for past-due costs and $37.7 million in interest. At about $128 million, Southcentral Foundation received the next largest settlement.
The NCAI has been working with tribes and the IHS on contract costs since the Indian Self-Determination Act went into effect.
The congress is hosting the annual Tribal Unity Gathering and Legislative Impact Days on Sept. 16 and 17 in Washington. During the event, tribal leaders and representatives will meet with their delegates to the U.S. Congress to encourage action on important delegation before this session ends. IHS appropriations will be among the issues discussed.
“There’s strong support from the House and Senate,” said Amber Eberb, program manager of the NCAI Policy Research Center. “There’s quite a few champions who understand that tribes administering their own programs to respond to their community needs is more effective than a federal agency.”
There’s still progress to be made, Eberb said.
“Contract costs and other treaty issues should not be considered discretionary but mandatory,” Ebarb said. “All program money that uphold treaty agreements should be mandatory. It’s morally correct to do. Perhaps a little difficult to do right now.”
Disparities in well-being
American Indian and Alaska Native (AI/AN) death rates were nearly 50 percent greater than rates among non-Hispanic whites during 1999-2009, according to a study by the Centers for Disease Control.
The study was carried out by the CDC’s Division of Cancer Prevention and Control, the CDC’s National Center for Health Statistics, CDC researchers, the IHS, and partners from tribal groups, universities and state health departments.
It revealed:
Among AI/AN people, cancer is the leading cause of death, followed by heart disease, while the opposite is true for other races studied;
Death rates from lung cancer have shown little improvement in AI/AN populations. AI/AN people have the highest prevalence of tobacco use of any population in the United States;
Deaths from injuries were higher among AI/AN people compared to non-Hispanic whites;
Suicide rates were nearly 50 percent higher for AI/AN people compared to non-Hispanic whites, and more frequent among AI/AN males and persons under age 25;
Death rates from motor vehicle crashes, poisoning, and falls were two times higher among AI/AN people than for non-Hispanic whites;
Death rates were higher among AI/AN infants compared to non-Hispanic white infants. Sudden infant death syndrome and unintentional injuries were also more common. AI/AN infants were four times more likely to die from pneumonia and influenza;
By region, the highest mortality rates were in the Northern Plains and Southern Plains, while the East and Southwest had the lowest.
“Many of the observed excess deaths can be addressed through evidence-based public health interventions,” the report concluded.
In November 2013 testimony before the Senate Committee on Indian Affairs, Alaska Sen. Lisa Murkowski said:
“I listened very intently yesterday at the tribal summit when the President spoke. I went there specifically to hear what he was going to say on the issue of contract support costs. What I heard him say is, we have heard you loud and clear, but we are still working to find the answers. I don’t think we need to work to find any answers. I think that the court laid it out very, very clearly. It said that full reimbursement will be provided. So we have to make that happen within that budget. We have to make that priority.”
Murkowski said she had listened to the stories of the impact of lack of funds, saying, for example, that the regional health provider in Juneau had to close its alcohol treatment facility. Further north, in the Yukon Delta, the regional health provider laid off 20 employees, permanently closed 40 vacant positions, and reduced services for elders, she continued.
The impacts of the sequestration, she said, also meant that tribes would not be able to reduce waiting times at emergency rooms or outpatient and dental clinics.
“The impact, I think we recognize, has been significant,” she said.
Murkowski submitted comments she received from Alaska Natives around the state, including the Association of Village Council Presidents.
Proposed Increase for IHS Budget
“Tribes have not recovered from sequestration that resulted in across-the-board cuts to all federal programs that tribes are reliant upon. Nowhere was this more impactful than to the Indian Health Services, where due to sequestration, continuing resolutions, and the 16 day government shutdown — healthcare to Indian people was jeopardized,” U.S. Senate Committee on Indian Affairs Chairman Jon Tester, of Montana, said in March.
Tami Truette Jerue, tribal administrator and director of social services for the Anvik Tribal Council in Alaska addressed the committee’s oversight hearing in February. The Anvik are an Athabascan village of about 275 members on the west bank of the Yukon River.
Jerue represented the 37 federally recognized tribes that make up the Tanana Chiefs Conference, an inter-tribal health and social services consortium that serves an area of Interior Alaska that is roughly the size of Texas.
She delivered a message from more than 200 tribes across Alaska:
“It is absolutely essential that, without regard to technical land titles and the technical Indian country status of lands or tribal communities, our Tribes must have the tools necessary to combat drug and alcohol abuse, domestic violence, and violence against women. Fighting these scourges in our communities and healing our people cannot be made to stand on technicalities. We need to get to work, and now. And we need Congress’s help to do that. The State is not the problem, because the State is nowhere to be found in most of our Villages….
“Today, the tribes of Alaska come to you, not as victims of a failed governmental policy, but as powerful and responsible advocates for our people. We are stepping up to do what we must do. But without equally firm action from Congress, our people will suffer, we will continue with decades more of litigation battles and loopholes will continue to be found which deny our tribes the funding necessary to improve law and order in our communities.”
In the budget for the 2015 fiscal year, the Obama administration proposed a 4.5 percent increase for IHS, representing a $200 million increase over the current level to $4.6 billion.
The 2015 budget request includes:
An additional $50 million to help obtain health care from the private sector through the Purchased/Referred Care program (formerly known as the Contract Health Services program). This program allows for the purchase of essential health care services that the IHS and tribes do not provide in their local facilities;
An additional $71 million to support staffing and operating costs at four new and expanded facilities;
An additional $30 million to fully fund the estimated amount of contract support costs for new and expanded contracts and compacts in fiscal year 2015. This will help tribes cover the cost of administrative functions for compacts or contracts established under the authority of the Indian Self-Determination and Education Assistance Act;
An additional $31 million to address medical inflation costs;
Additional funding to pay costs for new tribes and restoration of reductions in the fiscal year 2014 operating plan.
In his statement, Tester noted the “positive highlights” in the budget request.
“The Committee is pleased that the Administration finally understands its legal obligation to fully fund Contract Support Costs for the both the Indian Health Service and Bureau of Indian Affairs,” Tester said. “I am particularly encouraged by the $11 million increase for social services and job training to support an initiative to provide a comprehensive and integrated approach to address the problems of violence, poverty, and substance abuse.”
Covering IHS shortfalls with the Affordable Care Act
The Southeast Alaska Regional Health Consortium and more than 50 tribes wrote a letter to President Obama on Oct. 13.
In part, it said, “Among your administration’s most important achievements has been the development of historic settlements with Indian Tribes in several major litigations, its advocacy for amendments to the Indian Health Care Improvement Act and the Violence Against Women’s Act, and its commitment to critical appropriations measures. But when it comes to honoring the Nation’s commitment to the contracting and compacting Tribes who were historically, and illegally, underpaid, and who continue to be underpaid, the administration has permitted fiscal concerns to eclipse the imperative to do justice and to honor the nation’s obligations.”
In July the IHS reached a settlement with the consortium for claims during the years 1999 through 2013. The payment — $39.5 million plus interest — totals about $53 million.
“A lot of tribes had to close down programs because of lack of funds,” Andrea Thomas, outreach and enrollment manager of SEARHC, told MintPress News. “Part of what the settlement can do is bring back what was lost.”
Alaska did not create reservations like the 48 contiguous states, and many Native communities formed consortiums, like SEARHC, to use IHS funding for health care to serve them all.
SEARHC is a nonprofit tribal health consortium of 18 Native communities which serves the health interests of the Tlingit, Haida, Tsimshian, and other Native people of Southeast Alaska. In 1982, the consortium took over operations at the IHS clinic in Juneau, and then took over operations at Mt. Edgecumbe Hospital, formerly an IHS-run facility, in 1986.
“In Alaska we have the highest cost of health care in the nation,” Thomas said. “There’s vast wilderness surrounding each place. In order for me to get out of my community, I’d have to fly or take a ferry. This gets incredibly expensive.”
Many Alaskan villages have a community health clinic, but complicated procedures such as chemotherapy or serious surgeries, require patients to go to hospitals at regional hubs or to the Alaska Native Medical Center in Anchorage. The burden is on the tribal health consortium to pay the costs of a commercial jet, float plane, ferry, or boat.
If a medical evacuation helicopter is needed, it would cost SEARHC about $95,000 — a cost that could be absorbed by the Affordable Care Act.
“The issue is that IHS only provides about half the money for services,” Thomas said. “We rely on other revenues like grants and billing Medicare and Medicaid. If native people enroll, it puts more money back and we could offer more services or expanded services.”
Further, a member of a federally recognized tribe can get a lifetime exemption. Alaska Natives and American Indians are exempt from Affordable Care Act tax penalties because they receive care through the IHS. But through the new health care scheme, they are eligible for subsidies from private insurance. Thomas said that those who fall between 100 percent and 500 percent of the federal poverty level pay a monthly premium, but no deductibles or out-of-pocket expenses.
Yet, of more than 100,000 self-identified Alaskan Natives or American Indians, only 115 had signed up for health insurance through the Affordable Care Act as of April.
“Not a lot of people realize what the Affordable Care Act does for Alaskan Native people,” Thomas said.
Coverage also extends to Native people who are not enrolled members of a federally recognized tribe and meet federal guidelines. Thomas said they can receive a lifetime hardship exemption, rather than a tribal exemption, and there may be some out-of-pocket expense.
A mussel is opened for analysis at the WDFW lab. Volunteers and WDFW used mussels to test for contaminants at more than 100 sites up and down Puget Sound. | credit: WDFW
SEATTLE — Scientists used shellfish to conduct the broadest study to date of pollution levels along the shore of Puget Sound.
And in some places, it’s pretty contaminated.
This past winter the Washington Department of Fish and Wildlife put mussels at more than 100 sites up and down Puget Sound.
After a few months, volunteers and WDFW employees gathered the shellfish and analyzed them for metals, fossil fuel pollution, flame-retardants and other chemicals. The WDFW just released the results.
“The biggest concentrations of those contaminants were found in the highly urbanized bays – Elliott Bay, Salmon Bay, in the Sinclair Inlet, Commencement Bay we found much higher contaminations than we did in the rest of Puget Sound,” said Jennifer Lanksbury, a biologist who led the study for the Department of Fish and Wildlife.
PAHs – or polycyclic aromatic hydrocarbons – were found in mussels at every single test site. PAHs come from fossil fuels – spilled oil, wood stove smoke and engine exhaust, mainly. The particles can be deposited through the air or get washed into Puget Sound when it rains. Some PAHs are carcinogenic.
Map of PAH levels in Puget Sound. Credit: WDFW
The mussel samples all contained PCBs as well. Flame retardants and DDT were found at more than 90 percent of the sites – with the highest levels in more urban bays.
“This is showing that these contaminants are entering the nearshore food web and they’re likely being passed up to other higher organisms and people eat mussels too,” Lanksbury added.
The state Department of Health does rigorous testing for toxic algae and bacteria in shellfish – the kind of stuff that makes you sick immediately. But it doesn’t regularly test shellfish for metals and other contaminants that can harm human health over longer periods of exposure.
“PAH is a difficult issue,” said Dave McBride with the Department of Health. “They are widespread in the environment. We probably get a lot greater exposure to PAHs from the food we eat on the grill, hamburgers or smoked salmon. It’s all relative. Some of the PAHs are considered carcinogens so it’s definitely on our radar.”
Shellfish harvest, in general, is limited in dense urban areas – where the DFW’s mussel study showed the highest levels of contaminants. However, this past winter China banned all imports of shellfish from much of the west coast after finding elevated levels of arsenic in some shellfish harvested near Tacoma.
Volunteers Jonathan Frodge, Chris Wilke and Paul
Fredrickson gather mussel samples at Discovery
Park in Seattle. Credit: Tom Foley
Lanksbury says that she still feels safe eating mussels and other shellfish from Puget Sound. And, she adds, there are things people can do to lower pollution levels.
“When they say, don’t let your car drip oil, support low-impact development where they’re having rain gardens, don’t wash your car on the side of the road – all of those kinds of things spare Puget Sound from contaminants that we produce on a daily basis by burning fossil fuels,” Lanksbury said.
The Department of Fish and Wildlife hopes to keep the mussel monitoring program going, with the continued help of more than 100 volunteers and citizen scientists from around Puget Sound.
Bryan Kent Cooper, ARNP, FNP-C, Family Practice Provider and Clinical Leader of Family Practice Physicians
What is the flu shot?
The flu shot is a vaccine given with a needle, usually in the arm. The seasonal flu shot protects against the three or four influenza viruses that research indicates will be most common during the upcoming season. Flu viruses are constantly changing so it’s not unusual for new flu viruses to appear each year. Getting an annual flu vaccine does not guarantee that you will not get some type of influenza, however, if you do, the symptoms will be much less severe.
What are the risks from getting a flu shot?
You cannot get the flu from a flu shot. The risk of a flu shot causing serious harm is extremely small. However, a vaccine, like any medicine, may rarely cause serious problems, such as severe allergic reactions. Almost all people who get influenza vaccine have no serious problems from it at all. Typical side effects (which last no more than a few days) that may occur include:
·Soreness, redness, or swelling where the shot was given
·Fever (low grade, meaning less than 102)
·Mild body aches
When will flu activity begin and when will it peak?
The timing of flu is very unpredictable and can vary from season to season. Flu activity most commonly peaks in the U.S. between December and February. However, seasonal flu activity can begin as early as October and continue to occur as late as May.
What should I do to prepare for this flu season?
CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the seasonal flu vaccine is designed to protect against the main flu viruses that research suggests will cause the most illness during the upcoming flu season. People should begin getting vaccinated soon after flu vaccine becomes available, ideally by October, to ensure that as many people as possible are protected before flu season begins.
In addition to getting vaccinated, you can take everyday preventive actions like staying away from sick people, frequently cleaning commonly used surfaces, and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading flu to others.
What should I do to protect my loved ones from flu this season?
Encourage your loved ones to get vaccinated as soon as vaccine becomes available in their communities, preferably by October. Vaccination is especially important for people at high risk for serious flu complications, and their close contacts.
Children between 6 months and 8 years of age may need two doses of flu vaccine to be fully protected from flu. Your child’s doctor or other health care professional can tell you whether your child needs two doses.
Children younger than 6 months are at higher risk of serious flu complications, but are too young to get a flu vaccine. Because of this, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months of age, you should get a flu vaccine to help protect them from flu.
In addition to getting vaccinated, you and your loved ones can take everyday preventive actions like staying away from sick people, frequently cleaning commonly used surfaces, and washing your hands to reduce the spread of germs. If you are sick with flu, cover your mouth when you cough or sneeze and stay home from work or school to prevent spreading influenza to others.
Flu vaccines are currently available at:
Karen I. Fryberg Tulalip Health Clinic – 360-716-4511 ext 2
Which country has the highest percentage of hungry people? I’ll put the answer at the bottom. (Hint: it’s not located in Africa.)
The United Nations’ annual report on hunger has arrived bearing sobering factoids like this one, along with some remarkably good news: There are now 100 million fewer chronically hungry people than there were 10 years ago.
The improvements vary dramatically. In southeast Asia, 30 percent of people were undernourished in 1992; now it’s down to 10 percent, a stunning accomplishment. But in the Middle East (here labeled western Asia), the percentage of undernourished people has actually gone up. Worldwide, 11 percent of people still go through most of their lives hungry.
The UN’s Food and Agriculture Organization says that the Millennium Development Goals on hunger are within reach “if appropriate and immediate efforts are stepped up.”
What form should those efforts take? The UN urges everyone to remember that hunger is a fundamentally political problem:
Lack of food, as we’ve said, is not the problem. The world produces enough food for everyone to be properly nourished and lead a healthy and productive life. Hunger exists because of poverty, natural disasters, earthquakes, floods and droughts. Women are particularly affected. In many countries they do most of the farming, but do not have the same access as men to training, credit or land.
Hunger exists because of conflict and war, which destroy the chance to earn a decent living. It exists because poor people don’t have access to land to grow viable crops or keep livestock, or to steady work that would give them an income to buy food. It exists because people sometimes use natural resources in ways that are not sustainable. It exists because there is not enough investment in the rural sector in many countries to support agricultural development. Hunger exists because financial and economic crises affect the poor most of all by reducing or eliminating the sources of income they depend on to survive.
And finally it exists because there is not yet the political will and commitment to make the changes needed to end hunger, once and for all.
But how do you go about fixing those problems and mustering the political will? The new report suggests:
Hunger reduction requires an integrated approach, which would include: public and private investments to raise agricultural productivity; better access to inputs, land, services, technologies and markets; measures to promote rural development; social protection for the most vulnerable, including strengthening their resilience to conflicts and natural disasters; and specific nutrition programmes, especially to address micronutrient deficiencies in mothers and children under five.
In other words, the technical solutions can help with the political solutions and vice versa. This is a bit of a chicken and egg problem: Which do you do first: stop the war, or help farmers grow more food? If people are hungry, perhaps it’s better to send grain rather than soldiers. But if militants grab and sell the grain, we’re back to square one. The answer to the chicken and egg question seems to be: both.
As for the answer to the question I began with: Haiti is the nation with the highest percentage of hungry citizens. An astonishing 52 percent of people there are undernourished.
