An aerial view shows construction progress on the Cherokee Nation’s Outpatient Health Center in Tahlequah, Oklahoma. The facility will be four stories and approximately 470,000 square feet. It’s located on 45 acres east of W.W. Hastings and is expected to open in September 2019. COURTESY
Health facility construction, employment planning underway
An aerial view shows construction of the Cherokee Nation’s 470,000-square-foot outpatient health center in Tahlequah, Oklahoma. The facility will serve as the primary health care access point for American Indians and Alaskan Natives residing in the Tahlequah service area. COURTESY
TAHLEQUAH, Okla. – With construction following a February groundbreaking on the Cherokee Nation’s new health facility near W.W. Hastings Hospital, tribal officials are now planning for employment for when it’s completed in September 2019.
The outpatient and primary care facility, which Indian Health Services awarded to the CN, is one of the largest joint venture agreements between a tribe and IHS, according to a CN press release.
Once completed, the facility will be the largest health center of any tribe in the country at approximately 470,000 square feet and four stories high. It will serve as the primary health care access point for American Indians and Alaskan Natives residing in the Tahlequah service area.
The facility will feature five surgical suites and two endoscopy suites inside its ambulatory surgical center. It will house a specialty clinic and feature 33 dental chairs, six eye exam rooms and three audiology-testing booths. Space will also be expanded for rehabilitation services, behavioral health and a wellness center.
During the past several months, construction crews have transformed 45 acres into the health center’s beginning stages. So far concrete foundations have been poured and steel structures are going up. As a result, 350 construction jobs have been created.
“I don’t think we can overstate the amount of payroll dollars this thing has. We are working with our TERO (Tribal Employment Rights Office) contractors and TERO sub-contractors to keep as much of that payroll in our community as we possibly can. You can see the number of trucks going in and out of here and the impact it has,” Brain Hail, W.W. Hastings Hospital CEO, said.
Hospital officials meet with architects and contractors monthly for construction updates, and Hail said the expansion is being designed to “accommodate” staff and patients.
“The staff has done a really good job of responding to questions quickly during the design phase, so we can get the design phase completed. We also have done mockups so the facility will be constructed to accommodate the staff that is using it,” he said. “We also try to be very focused on the patients’ experience to make sure they don’t have to walk any further then absolutely necessary, especially our elders.”
With regards to a proactive patient experience, he said parking would significantly increase at the facility. Hospital officials are also in the planning phase for hiring staff. With a larger facility and additional services, the facility will require an additional 800 health care professionals.
Hail said the hospital is working with the tribe’s Education and Career Services departments to prepare a work force for the facility’s opening.
“We are trying to be proactive with Education and Career Services to make sure they’re aware of the needs that we are going to have when we open the new facility so they can start adjusting their scholarships, start adjusting the training they provide and start getting ready to prepare our workforce for the facility. We also have our offices of professional recruitment and retention aware of what we are going to need, so they can be recruiting people now and getting them ready to join us when we open,” he said.
While the center’s opening less than two years away, positions in certain areas will be needed as early as six months to a year prior to the opening. Those areas include information technology, environmental services, facilities management and security. To ensure those positions are secured before the opening, Hail said officials are requesting early funding.
With Hastings Hospital being more than 35 years old and approximately 180,000 square foot, it was designed to serve 60,000 patient visits annually. However, in 2016, the hospital saw nearly 400,000 patient visits, and in 2017 it handled more than 500,000 patient visits.
As patient visits increase, Hail said officials are planning for the future with the new facility.
“The current facility is in need of expansion and modernization to serve current and future demands,” he said. “We are basically working for a 20-to-25-year timeline to try to anticipate what we need for the next 20 to 25 years in health care and the community.”
Officials are also planning for the future through recruitment and a partnership with the Oklahoma State University Center for Health and Sciences to expand its medical school to Tahlequah.
Inpatient operations, emergency services, labor and delivery decks, diagnostic imaging and pharmacy will remain at Hastings Hospital. And the medical school will occupy Hastings’ remaining space after the new facility is finished.
“We are doing everything that we can to try and expand the number of professionals that will be available to us. What everyone sees is where people train is where they tend to stay, so we want to train as many people in our area so they stay in the area,” he said.
TAHLEQUAH – Establishing healthy eating patterns tailored to personal, cultural and traditional preferences that are low in sodium and saturated fat is essential to a balanced diet for young adults between the ages of 20 and 35, Cherokee Nation Clinical Dietitian Tonya Swim said.
“All the food and beverage choices a person makes matters,” Swim said. “For most healthy individuals a balanced diet should have a variety of vegetables and whole fruit, low-fat or fat-free diary, half of their grains from whole grain sources, a variety of protein choices, including lean meats, seafood and vegetable sources.”
Swim said that while a single healthy eating pattern will not fit everyone, all foods high in saturated fat, sodium and added sugar should be limited. She recommends individuals inspect their food’s nutrition facts label when shopping, especially for those who may buy frozen foods such as microwavable meals.
“Most meals like this lack in fruits and vegetables, so adding a whole piece of fruit and a steamed bag of frozen veggies can help to meet a person’s daily fruit and vegetable needs. This is also a great way to add in extra vitamins, minerals and fiber,” she said.
A good method of comparing the nutritional values of two or more food items is to examine the label’s percent of daily value, Swim said. “Search for items with the lowest amount of saturated fat and sodium and the highest amount of fiber. Five percent daily value or less of a nutrient per serving is low, and 20 percent daily value or more of a nutrient per serving is high. One nutrient that we want to strive to get more of is fiber, so this nutrient on the nutrition facts label should be as close to 20 percent daily value as possible.”
That advice is especially important for those who choose to maintain a vegetarian lifestyle.
“If an individual chooses to go 100 percent vegan, please be aware of nutrients that may be lacking in their diet, including iron, zinc, protein, Omega-3 fatty acids, vitamin B-12, vitamin D and calcium,” Swim said.
She said food sources for proper iron nutrients include almonds, oatmeal and spinach, while hummus, some whole wheat breads and cashews are good zinc sources. Fortified foods are good vitamin B-12 sources.
For protein, Swim recommends peanuts, quinoa, edamame, chickpeas, lentils, black beans and kidney beans, while calcium can be worked into a vegan diet with turnip, mustard and collard greens, figs and kale. Fortified soymilk is also a good source of vitamin D in addition to calcium, while walnuts and flaxseeds are good for Omega-3 fatty acids.
“Following a plant-based diet or even a full vegan plan does have health benefits, such as a lower risk of heart disease, some cancers and type 2 diabetes,” Swim said. “If a vegan plan is something you would like to consider, please speak with your health care provider and registered dietitian before you begin.”
Young adults should also be aware of what they might be adding to their drinks, including coffee.
“It’s important to note that some coffee beverages can include calories from added sugars and saturated fat, such as creamers. So be cautious when getting your specialty coffees,” Swim said.
Coffee consumption should also be “moderate,” according to dietary guidelines.
“A moderate amount would be three to five 8-ounce cups a day,” Swim said. “This would approximately 400 milligrams of caffeine daily. The exception to this may be if a person has a medical condition in which their medical provider has reduced the amount of caffeine they should have, so talk to your primary provider.”
Swim recommends those eligible for services with CN Health Services and seeking more information about individualized diet plans should contact their primary providers and ask to schedule an appointment with a registered dietitian.
TAHLEQUAH – People tend to spend more time outdoors in warmer weather. But it’s important to remember that warmer weather brings ticks and the illnesses they can carry.
According to the Centers for Disease Control, Oklahoma ranks among the states with the highest ehrlichiosis, Rocky Mountain spotted fever and tularemia rates, and May through August is the stretch of months when ticks are most active.
The lone star tick is the primary carrier of ehrlichiosis in the United States. Symptoms include fever, headache, fatigue, chills, nausea, vomiting, diarrhea, confusion, rash and muscle aches. Usually these symptoms occur within one to two weeks following a tick bite.
Ehrlichiosis can be fatal if not treated correctly. The estimated fatality rate is 1.8 percent. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care.
The severity may depend on the patient’s immune status. People with compromised immunity caused by immunosuppressive therapies, HIV infection or splenectomy appear to develop a more severe disease and may also have higher fatality rates.
Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever ehrlichiosis is suspected. Use of antibiotics other than doxycycline and other tetracyclines is associated with a higher risk of fatal outcome for some rickettsial infections. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return.
<strong>Rocky Mountain spotted fever</strong>
RMSF is transmitted to humans in the United States mostly by the American dog, Rocky Mountain wood and brown dog ticks.
Symptoms include fever, headache, abdominal pain, vomiting and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops. RMSF can be severe or even fatal if not treated in the first few days of symptoms. Doxycycline is the first line treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms.
Symptoms typically begin two to 14 days after the bite. The disease frequently begins as a sudden onset of fever and headache and most people visit a health care provider during the first few days of symptoms. Because early symptoms may be non-specific, several visits may occur before the diagnosis is made and correct treatment begins. It is a serious illness that can be fatal in the first eight days of symptoms if not treated correctly.
A classic case involves a rash that first appears two to five days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to include the trunk and sometimes the palms and soles. Often the rash varies from this description, and people who fail to develop a rash, or develop an atypical rash, are at increased risk of being misdiagnosed.
The red to purple, spotted (petechial) rash is usually not seen until the sixth day or later after onset of symptoms and occurs in 35 percent to 60 percent of patients with the infection. This is a sign of progression to severe disease, and every attempt should be made to begin treatment before petechiae develop.
The bacterium that causes tularemia can enter through the skin, eyes, mouth or lungs. In the United States, ticks that transmit tularemia to humans include the dog, wood and lone star ticks. Deer flies have been shown to transmit it in the western United States.
Symptoms vary depending on how the bacteria enter the body. Illness ranges from mild to life-threatening. All forms are accompanied by fever, which can be as high as 104 degrees Fahrenheit. Main forms of this disease are:
• Ulceroglandular. This is the most common form and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears where the bacteria entered. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
• Glandular. Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals.
• Oculoglandular. This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of the eye and swelling of lymph glands in front of the ear.
• Oropharyngeal. This form results from eating or drinking contaminated food or water. Patients with oropharyngeal tularemia may have sore throat, mouth ulcers, tonsillitis and swelling of lymph glands in the neck.
• Pneumonic. This is the most serious form. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.
• Typhoidal. This form is characterized by any combination of the general symptoms (without the localizing symptoms of other syndromes).
Tularemia is rare, and symptoms can be mistaken for common illnesses. It’s important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals.
Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for weeks, most patients completely recover.
While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months when ticks are most active.
• Avoid wooded and brushy areas with high grass and leaf litter.
• Walk in the center of trails.
• Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.
• Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5 percent permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.
• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats and day packs.
• Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.
• If the clothes are damp, additional time may be needed.
• If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.
TULSA (AP) – Oklahoma has high rates of death from heart disease, stroke, cancer and respiratory disease despite a decrease in smoking, according to a new report.
Less than 20 percent of Oklahoma adults smoke, down from 25 percent a decade ago, according to the State of the State’s Health Report that was released Monday, The Tulsa World reported . The teen smoking rate was 13 percent in 2015, down from about a third of teens smoking in 2005.
However, the state still has a high rate of health issues tied with smoking, such as lung cancer and heart disease, the report found.
The effects of smoking aren’t automatically reversed by quitting, said Leanne Stephens, a spokeswoman for the Tulsa Health Department. She said that according to the U.S. Department of Health and Human Services, cancer risks can be cut in half within five years of quitting and the risk of a stroke could be reduced to that of a nonsmoker within two to five years.
Increasing rates of obesity may also be contributing to high rates of heart disease, the report said. The state has seen its obesity rate more than double since the 1990s, the report found.
About a third of adults in Oklahoma and 20 percent of adolescents are overweight, the report said. Obesity also likely contributes to the state’s high rate of diabetes, with 12 percent of the population with the disease.
“The prevention of obesity is a complex problem and requires a multi-faceted approach,” Stephens said. “There are many factors that contribute to obesity rates, including poor diet and inactivity.”
CLAREMORE – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair from 10 a.m. to 2 p.m. on June 26.
Hospital officials said the fair is to assist their Native American veteran patients in applying for eligibility for health care services through the VA.
“We will have Claremore Indian Hospital benefit coordinators and representatives from the VA to assist with the application processes,” Sheila Dishno, Claremore Indian Hospital patient benefit coordinator, said. “We will also have Oklahoma Department of Veterans Affairs here to help with those that need help filing a service claim. Please make plans to attend and bring your financial information (income and resource information) and DD-214 (military discharge) papers.”
If already enrolled, call 918-342-6240, 918-342-6511 or 918-342-6559 so a hospital official can update your file.
CLAREMORE, Okla. – Blue Cross & Blue Shield of Oklahoma will be at the Claremore Indian Hospital on June 11 to assist patients with signing up for free to low-cost health insurance.
The insurance company will be in Conference Room 2 from 9 a.m. to 3 p.m. to help people sign up for health insurance.
Sheila Dishno, patient benefit coordinator at the hospital, said people who attend the fair should bring their Social Security cards, pay stubs, W-2 forms or wage and tax statements, policy numbers for any current health insurance and information about any health insurance they or their families could get from an employer.
The hospital is located at 101 S. Moore Ave. For more information, call 918-342-6240, 918-342-6559 or 918-342-6511.
TAHLEQUAH (AP) – Recovering addict Judith Anderson figures if she hadn’t entered a program that caught and treated the hepatitis C she contracted after years of intravenous drug use, she wouldn’t be alive to convince others to get checked out.
The 74-year-old resident of Sallisaw said the potentially fatal liver disease sapped her of energy and “any desire to go anywhere or do anything.”
“It was like living with a death sentence,” she said of the infection that the U.S. Centers for Disease Control and Prevention said in 2016 killed more people than HIV and tuberculosis combined. “You’re just tired all the time.”
But things changed for Anderson, a citizen of the Cherokee Nation, because she took advantage of the tribe’s aggressive program to test for and treat hepatitis C. Federal officials say it could serve as a national model in the fight against the infection.
The CN, the second-largest tribe in the U.S. after the Navajo Nation, started the program three years ago looking to screen 80,000 of its 350,000 citizens, mainly targeting those 20 to 65 because of their statistically higher chances of having the disease. More than half of the target group has been screened, with more than 1,300 citizens testing positive, and a 90 percent cure rate among those who have started treatment, the tribe says.
CDC official John Ward, whose agency is providing technical assistance to the tribe, said the CN is the first community to set such an ambitious goal to eliminate the disease.
“It’s a trailblazing project for the entire country,” Ward said.
The CN, which operates the largest tribal health care system in the U.S., are shouldering the cost of the program. The Tahlequah-based tribe is also capitalizing on medical advances that have seen the cost of the antiviral drugs used to treat the disease plummet from around $90,000 per patient just a few years ago to between $15,000 and $20,000.
“We’re running the health system, why not take care of them early and give them a much better, longer quality of life?” Principal Chief Bill John Baker said. “It’s less stress later on by us doing it ... it’s a model for all the other tribes to be able to follow.”
Hepatitis C is spread through infected blood, and hundreds tested positive for the disease in the Cherokee program after injecting drugs with unclean needles. Tribal health officials blame the nation’s opioid crisis for the increase in those cases. When prescription pills run out, many addicts turn to the streets for cheaper and more readily available drugs such as heroin, which is often injected directly into veins.
The CN is suing several major drug distributors for what it claims is the companies’ failure to prevent the flow of illegally prescribed opioids to its citizens.
Dr. Jorge Mera, the tribe’s director of infectious diseases, is on the front line of treatment.
“In the last two years, I started hearing the word heroin more and more, every day,” Mera said in a recent interview at the W.W. Hastings Hospital in Tahlequah. “Now we are seeing a younger population coming (with hepatitis C) that’s predominantly due to IV drug use.”
In addition to battling the drug epidemic and statistics that show they are 2.5 times more likely to die from hepatitis C, many Native Americans already must contend with rampant poverty and high unemployment that has plagued tribes for generations.
“For Native Americans or any other group that undergoes a lack of nutrition, more violence, lack of opportunity — those kind of group experiences can change the biology of groups of people to make them more prone to addiction,” said Judy Grisel, a professor of psychology and neuroscience at Bucknell University and a recovering drug addict and hepatitis C survivor who has been sober more than 30 years.
To be sure, the tribe is unique in that it is absorbing the costs of treating its citizens, but Ward, the CDC official, said communities can learn from the CN program by “involving a local champion and setting a goal for eliminating the disease.”
“These efforts can inspire a community, help to develop partnerships and encourage accountability,” Ward said. “The Cherokee Nation was successful in part because it developed strategies to finance testing and treatment.”