ANCHORAGE: NURSING SUMMIT, WEATHER AND FAMILY

The flight that Bertrand, Liliana and I were on Monday night landed at 11:25 pm in Anchorage.  With an approximate 50 degree positive temperature change from Barrow, it did really feel like the tropics…20 degrees Fahrenheit was a welcome temperature.  We learned that with recent high temperatures and rain, followed by freezing temperatures and a snow fall, that the roads were icy and extra care was required when driving.  

Our hotel was in downtown Anchorage, around six blocks from where the 30^th Annual Health Summit was being held at the Captain Cook Hotel. Because of the icy conditions, Darlene, Liliana and I took a shuttle to the conference in the morning where Liliana and I registered and learned of events taking place that day.  Bertrand was in search of a Star Bucks, so walked and Julie had arrived earlier.  Bertrand, Liliana and I had missed a full day of the conference including the welcome and comments by the Summit Chair and the Lieutenant Governor of the State of Alaska as well as a plenary session of the History of Public Health in Alaska.  I would have loved to have heard this, knowing that my Grandma Swanberg was a public health nurse in Nome for 25 years and would have identified with much of what was shared. 

It was interesting reading about the other concurrent Monday morning sessions that we had missed…they all sounded informative and interesting:      

o   Community-based Nursing and Public Health

o   Enhancing Professional Skill and Development:  Evaluation of Health Promotion - Disease Prevention and Management (HP-DP) Programs

o   Smoke-Free Housing In Alaskan Communities and Developing Organizational Tobacco Free Policy

o   Get Out and Play and Let’s Move! in Alaska

o   Head Start and Culture Camps:  Two Ways to Work with Youth on Health in Rural Alaska

A lunch-time plenary session:  Morningside Hospital and the Alaska Mental Health Trust

Concurrent early afternoon sessions included:

o   Traumatic Brain Injury - A Growing Public Health Crisis

o   Beyond Focus Groups and Surveys - Enter Biometrics: What the Body Tells Us About the Effectiveness of Health Promotion Media

o   Change Yourself, Change the World - Central Peninsula Change Club

o   Update: Progress on Improving Water and Sanitation Services in Rural Alaska

o   Past, Present, and Future of Public Health Nursing in Alaska, Lessons Learned and Inspiration for the Future

And the concurrent afternoon sessions were:

o   Preventing Alcohol-Exposed Pregnancies in the Arctic

o   The Quality and Utility of Alaska's Unintentional Poisoning Data: A Descriptive Analysis

o   Hmong Refugee Behavioral Health: Lessons Learned from Group Therapy

o   Tobacco Tax Increases and Community-Based Initiatives that Increase Systems to Address Tobacco Use: Working Together to Prevent Chronic Disease and Premature Death

o   Intimate Partner Violence, Sexual Violence and Child Maltreatment: Perspectives within Alaska

We met many people including other public health nurses from around Alaska and enjoyed mingling.  Julie wrapped us in warm hugs with laughter, her tiny flock having made it out of Barrow and to the summit. 

The Tuesday morning plenary session was excellent.  Many people shared later that they could have listened to the presenter, Dr. Gabor Mate', all day.  His topic was:  The Hungry Ghost:  A Biospsychosocial Perspective on Addiction, from Heroin to Workaholism.  Here’s what was written in the program about his talk: 

“For twelve years Dr. Maté was the staff physician at a clinic for drug addicted people in Vancouver’s Downtown Eastside, where he worked with patients challenged by drug addiction, mental illness, and HIV. In his bestselling book In The Realm of Hungry Ghosts, he shows that addictions do not represent a discrete set of medical disorders, but reflect the extreme end of a continuum of addiction that runs throughout our society. Contrary to popular belief, the source of addictions is not found in genes but in the early childhood environment where the neurobiology of the brain’s reward pathways develops and where the emotional patterns that lead to addiction are wired into the unconscious. Stress creates the predisposition for addictions, whether to drugs, alcohol, nicotine, shopping, or sex. More than a disease, the addiction is a response to a distressing life history and life situation. Once we recognize the roots of addiction, we can develop a compassionate approach toward the addict, one that stands the best chance of restoring him or her to wholeness and health.”

I took detailed notes as all he shared resonated with me so strongly.  His book sounds well-worth reading for anyone struggling with addictions of any kind or those who are concerned about someone with an addiction.

Concurrent Tuesday morning sessions included:

o   Training Non-VA Rural Health Care Providers on the Behavioral Health Needs of Veterans 

o   Evaluation of the Fecal Immunochemical Test (FIT) for Colorectal Cancer (CRC) Screening in the Alaska Native Population

o   Breaking Isolation and Healing Through Culturally Responsible Group Psychotherapy

o   When the Body Says No

o   Infectious Disease Prevention and Response at International Ports of Entry in Alaska

I went to this session and learned about the required airline pilot or water vessel captain reporting process as well as those for quarantine and contact follow-up of people entering Alaska with infectious diseases.  I also learned that when a case of infectious disease occurs in Barrow, that public health is required to call State Epidemiology who will issue a “not allowed to board” (aircraft) restriction for those who are positive until they are no longer contagious.   

We were given an hour long break before lunch to take in all the many tables and displays set up by various health care related organizations.  Along with valuable information, all of the tables had free pens, stuffed animals, bags, pocket knives, reflectors, etc.  My favorite was a retractable ball point pen that looked like a syringe. 

The noon time plenary session was excellent as well.  Joe McLaughlin, MD, MPH, FACPM, State Epidemiologist, Department of Health and Social Services; Brian Yablon, MD, State Epidemic Intelligence Officer, Division of Public Health, Department of Health and Social Services; Karen Martinek, RN, MPH, Nurse Manager, Section of Epidemiology, Division of Public Health, Department of Health and Social Services presented a panel discussion of the past, present and future of tuberculosis in Alaska.  It was interesting learning about the history of tuberculosis, its prevalence in certain parts of Alaska and the sanitariums used in the past.  Although brought down dramatically by the current use of medications, the rates of TB are still higher in Alaska than in any other state.

Concurrent early Tuesday afternoon sessions included:

o   Growing Our Own in Alaska: Strengthening Interdisciplinary Leadership to Improve Services for Children with Autism and Their Families

o   Integrating e-Health Interventions into Diabetes Care

o   Community Health Needs Assessments in the New Health Care Ages

o   Population Health Monitoring…Why Bother? An Exploration of Alaska Native Health Status

I attended this one and found learning how health statistics in Alaska are gathered and used interesting.  I was impressed too that the presenters were able to articulate that although they work with numbers, that their focus is foremost on individuals.

o   Alzheimer’s, Healthy Aging, and Preparing Alaska for the Future

Concurrent late Tuesday afternoon sessions included:

o   Alaska's Health Workforce: Progress Today, Vision for the Future

o   Tobacco Use Prevalence – Disentangling Associations between Alaska Native, Socio-Economic, and Rural Disparities

o   Strong Women Healthy Hearts in Alaska

o   Healthy Alaskans 2020 – Overview

I attended this one, wanting to know the goals of this initiative.  I learned that there are currently 71 determinants of health and by the time the initiative is finalized, they will be narrowed down to 25.  We were all asked to do an online survey to help determine the most prevalent and important health care concerns in our given areas.

o   Addressing the Growing Epidemic of Hunger in Alaska: The Store Outside Your Door Initiative and Food Bank of Alaska

The final day of the conference opened with a plenary session entitled “Social Justice and The Neglected Epidemic: What Can Be Done?” by Myron Allukian, Jr., DDS, MPH, Director of Oral Health, Boston Public Health Commission.  Here is a brief write up of his presentation:   

“Oral diseases are a neglected epidemic. Almost everyone has the disease, resulting in unnecessary pain, infection, and for some, even death. It affects speech, nutrition, employment, personal relations, and education. There are three major social injustices. The food and tobacco industries promote disease-producing products and habits to the innocent and unsuspecting. Organized dentistry hampers access to dental care by impeding creative workforce solutions and supporting narrow state practice acts. Fluoridation is the foundation for better oral health, along with effective community prevention programs targeted for high-risk populations. Access to care may be improved through creative workforce programs such as dental therapists, expanded functions, and school dental programs. Oral health must be an integral component of all health programs and the healthy home.”

His talk was riveting and challenging as tooth decay is extremely high among the Alaskan Native population.  In some villages, 100% of all preschool and school age children have decayed teeth attributed to water not being fluoridated in some communities, the stores carrying and people buying large volumes of soda, and irregular tooth brushing.  Dr. Allukian talked about working with the legislature in Massachusetts to bring dental care to community clinics, being instrumental in instituting fluoridation, bringing down a very high rate of dental disease.  98% of Massachusetts’ residents are now covered by dental insurance and the rate of tooth decay has dramatically dropped.  It was comforting knowing that he was in Alaska, knows of the conditions and can and I’m sure will, encourage pubic health to overcome the challenges to oral health here.

Concurrent Wednesday morning sessions were:

o   Hot Topics and Controversies in Oral Health

o   Obesity: Influence of Nutrition in Select Alaska Villages and Alaska-Wide Health Costs

I attended this one as one of the goals of the North Slope Borough Health Department and the Wellness Center is to be able to counsel people about healthy choices that can help to reduce and prevent obesity in adults and children.

o   Health Impact Assessment in Alaska: Process and Evaluation

o   Applied Public Health Practice: An Overview of Two Statewide Programs

o   Population Health Research in Alaska: Survey of Projects at the UAA Institute for Circumpolar Health Studies (ICHS) - Part 1

The lunch time talk was a recap of the State of Alaska: Healthy Alaskans 20/20 and the Alaska Health Care Commission.  It was very well done and I found myself impressed, as I had for the past day and a half at the caliper of speakers and topics presented.

We were encouraged to take a placard for our place setting if we preferred a vegetarian meal, so mine was sitting in front of my plate when they brought Liliana’s which looked like it held a large piece of salmon topped by tasty looking accoutrements.  I quickly tucked my “Vegetarian” card onto my lap when Julie and Liliana said, “what are you doing?!”  I mentioned not wanting to miss an opportunity for a piece of Alaskan salmon when they laughed and said that it was a thick piece of pork I was seeing.  The card quickly made its way back onto the table in time to be served a wonderful dish of eggplant parmesan and greens.

Various awards followed with many people being commended on their work around Alaska to improve the health of all Alaskan’s, but in particular, Native Alaskans.

Concurrent early Wednesday afternoon sessions included: 

o   Role of CDC's (Centers for Disease Control and Prevention) Arctic Investigations Program in Improving the Health of Alaskans: Past, Present, and Future

o   Influence of Health Self-Management Courses on Health Outcomes and Medicaid Spending

o   Data and Strategies to Influence Adolescent Mothers to Choose Breastfeeding

I attended this one and gained valuable information for when working with adolescent mothers, understanding the pressures that prevent many of them from breastfeeding and learning of interventions that may be of help to them.

o   Frontier Extended Stay Clinics: A Frontier Model

o   Alaska Providers: Utilization of Clinical Practice Guidelines for Tobacco Use

o   Population Health Research in Alaska: Survey of Projects at the UAA

o   Institute for Circumpolar Health Studies (ICHS) - Part 2

The final session of the summit was a press conference followed by a panel discussion entitled Promising Practices: Building on Data for Prevention of Violent Deaths.  There is a high incidence of suicide in rural Alaska as well as a high rate of accidental deaths due to many snow machines and ATV riders not wearing helmets.  It was an interesting session and 

I appreciated all I learned.

When walking back to our hotel that afternoon, Bertrand and I talked about all of the sessions, pondering philosophies and questioning dynamics that lead to some health problems in Alaska.  We parted with him telling me that he felt as though he was talking with his grandmother, especially when we talked about children.  I’m honored as she sounds as though she had a positive influence on his life.  He is very intelligent and has a generous, and practical approach to working with the people we care for.  I had just one request…that if he was tempted to call me “Grandma” that he call me “Oma” instead.  I’m looking forward to offering to babysit his and Kim’s little one to arrive in May as well as their two year old son, August. 

I especially loved seeing three of my cousins while in Anchorage, Jill, Robyn and Joy and talking with Peggy as well.  They’re all strong, funny and wonderful people…is nice to live close to family again.

On the flight back to Barrow, I sat next to a young man named Josh and his seven month old daughter, Antonia, who he called “Toni the Tiger”.  It was wonderful sitting in such close proximity and learning that this was his first trip to Barrow.  His wife is the Bethel HS girls’ basketball coach and he was going up to watch the games as well as to see teachers that he had taught with in another village near Bethel five years earlier.  Antonia’s facial expressions led Josh to believe that her little tummy was manufacturing a diaper full.  By the time all of the passengers had boarded and the doors closed for takeoff, she was in need of a change.  Not wanting to delay the flight, Josh decided to change her diapers on his lap.  I offered to hold her head on my lap and was entertaining her when an older male flight attendant approached us and admonished me for not doing this in the rest room.  I was smiling inside as he looked at me and said that my decision was disturbing the other passengers and that I should keep this in mind next time.  Not wanting to betray my new friend, I said, “yes, of course, we’re very sorry.”  Another flight attendant walked down the aisle with a spray bottle of something aromatic and all during the flight the attendant who had scolded me referred to me as “Mom”.  “Would Mom like something to drink?”  “How about a snack, Mom?”  I had to laugh…Josh was probably in his 30’s.  How I transitioned from Oma to Mom in less than a few hours was delightful.  When leaving the plane, I told the flight attendant that he’d made my day by calling me “Mom” and that I’d just met Josh a few minutes before the diaper change.  We had a good laugh and he agreed that it might be a good idea to not make assumptions in the future.