Download American Indian Alaska Native Outreach Program

American Indian
Alaska Native
Outreach
Program
Promoting a
Healthier
American Indian and
Alaska Native Community
MISSION STATEMENT
Patient Advocate Foundation (PAF) is a national
non-profit organization that serves as an active
liaison between the patient and their insurer,
employer and/or creditors to resolve insurance,
job retention and/or debt crisis matters relative to
their diagnosis through professional case managers,
doctors and attorneys. PAF seeks to safeguard
patients through effective mediation assuring
access to care, maintenance of employment, and
preservation of their financial stability.
PATIENT ADVOCATE FOUNDATION
AMERICAN INDIAN/ALASKA NATIVE
OUTREACH PROGRAM
MISSION STATEMENT
The PAF American Indian/Alaska Native (AI/AN)
Outreach Program is designed with the goals of
reducing healthcare disparities among underserved
communities and by providing them the resources
necessary for the best quality of life. The program
targets high risk health areas for the American
Indian and Alaska Native Community such as
cardiovascular disease, stroke, heart attack,
diabetes, along with specific types of cancer:
breast, lung, colorectal and prostate cancers.
CO-PAY RELIEF
MISSION STATEMENT
PAF’s Co-Pay Relief (CPR) program provides
co-payment assistance for pharmaceutical
products to insured Americans who financially
and medically qualify. The CPR program provides
direct financial assistance to qualified patients to
assist them in the ability to afford the co-payments
their insurance requires.
The Program offers personal service to all patients
through the use of CPR call counselors.
ACKNOWLEDGEMENTS
Promoting a Healthier American Indian
and Alaska Native Community
has been prepared by the
Patient Advocate Foundation (PAF).
PAF is a national network for healthcare reform
and patient services stationed out of
Newport News, Virginia.
PAF would like to acknowledge and thank
the many resources that provided
invaluable information for this
publication revised October 2009.
Principle Writing:
Courtney Jones
LiveStrong Partnership Program Director
Patient Advocate Foundation
Jamilla Williams
Virginia Cares Uninsured Program Director
Patient Advocate Foundation
Judith Storey
Case Manager
Patient Advocate Foundation
Michelle Shanks
Survivorship of Cancer in Underserved Populations
Program Director
Patient Advocate Foundation
Tammy Neice
Senior Clinical Case Manager
Patient Advocate Foundation
Principle Editing:
Kendra Bluhm
Chief Program Management Officer
Patient Advocate Foundation
Tami Lewis
Training Coordinator, CM Services
Patient Advocate Foundation
NOTES
TABLE OF CONTENTS
Introduction ........................................................ 2
Heart Disease ...................................................... 3
Stroke .................................................................. 3
Heart Attack ....................................................... 4
Colorectal Cancer ............................................... 6
Lung Cancer ....................................................... 7
Breast Cancer ...................................................... 8
Diabetes ............................................................ 10
Conclusion ........................................................ 12
Resources .......................................................... 13
INTRODUCTION
Heart disease and cancer are the leading causes of
death among American Indians/Alaska Natives
(AI/AN). The prevalence of diabetes among this
population is more than twice that for all adults in
the United States. It is significant to note that
American Indians and Alaska Natives frequently
contend with issues that prevent them from
receiving quality medical care. These issues
include cultural and/or language barriers,
geographic isolation, weather factors, inadequate
or no running water, low incomes/decreased jobs,
and lack of health education.
The shortage of health care professionals working
in Alaska Native communities (less than 90 doctors
per 100,000 people) compared to national statistics
(229 for every 100,000 people), makes health care
access an even more challenging issue.
Risk factors such as age, gender and family history
cannot be changed. It is important to control the
risk factors where you have control.
These basic health habits are the foundation of
lifelong health and well-being:
♥ Eat right.
♥ Physical Activity
♥ Maintaining a healthy body weight.
♥ Be tobacco-free.
♥ Avoid drugs and/or alcohol to include
tobacco
♥ Manage stress.
♥ Take care of your teeth, brush regularly.
♥ Stay up to date with immunizations and
♥ Health screenings.
♥ Practice safety.
♥ Practice good hygiene.
♥ Love and respect your body, mind, and
spirit.
–2–
HEART DISEASES
Heart disease includes coronary artery disease,
heart attacks, stroke, and high blood pressure.
These conditions are quite prevalent among the
Alaska Native population and are major causes of
early death.
High Blood Pressure is a silent killer and occurs
when the pressure of blood against the walls of the
blood vessels increases. Poorly controlled high
blood pressure is a leading cause of heart attacks
and strokes.
High blood pressure can be treated effectively with
medications, and the basic good health habits to
decrease risk factors for the disease.
Coronary Artery Disease
Coronary Artery Disease is a narrowing of the
blood vessels that supply blood and oxygen to the
heart. This is caused by a build-up of plaque that
narrows the blood vessel causing decreased blood
flow or clot formation. This can lead to a heart
attack or stroke if too much of the vessel
is damaged.
Monitoring your diet, maintaining a healthy
weight and regular exercise can help minimize
the risk factors for developing the disease.
Stroke
Strokes result when a blood vessel that carries
oxygen and nutrients to the brain is either
blocked by a clot or bursts. The affected part
of the brain starts to die because it cannot get
the blood and oxygen it needs.
When a portion of the brain dies, the area of the
body it controls is affected. Strokes can cause a
complete or partial loss of movement or sensation,
effect speech or vision. Side effects of a stroke may
be permanent or temporary and will be different
with each patient.
–3–
Recovery is dependent on the severity of the stroke,
location of the blood clot, and how soon treatment
is received.
Signs and Symptoms:
♥ Sudden numbness or weakness of the face,
arm or leg, especially on one side of the
body
♥ Sudden confusion, trouble speaking or
understanding
♥ Sudden trouble seeing in one or both eyes
♥ Sudden trouble walking, dizziness, loss of
balance or coordination
♥ Sudden, severe headache with no known
cause
Heart Attack
Heart Attacks occur when the blood supply to a
section of the heart muscle is severely reduced or
stopped. This happens when one or more of the
coronary arteries supplying blood to the heart
muscle is blocked.
If the blood and oxygen supply is cut off for
more than a few minutes, heart muscle cells
suffer permanent injury and die. This can kill
or disable someone, depending on how much
heart muscle is damaged.
If you experience any of these symptoms or have
risk factors for heart disease, do not ignore them.
Signs and Symptoms:
♥ Discomfort or mild pain in the center of
the chest. The pain can come and go and
is often described as pressure, squeezing,
or indigestion
♥ Pain can spread to one or both arms, neck,
jaw, back or stomach
♥ Shortness of breath, sweating, dizziness or
nausea
–4–
Risk Factors:
♥ Family history
♥ Tobacco use
♥ High cholesterol
♥ High blood pressure
♥ Physical inactivity
♥ Overweight/obesity
♥ Drug and/or alcohol use
♥ Diabetes
♥ Stress
New treatments are available for heart attack and
stroke victims. It is important that you do not
delay seeking medical care when symptoms appear,
since treatment must be given as soon as possible to
be effective.
CANCERS
It is difficult to accurately present comprehensive
cancer data for American Indians and Alaska
Natives (AI/AN) due to limitations such as
undercounting, racial misclassification and
coding errors.
However, according to the National Cancer
Institute (NCI) American Indians/Alaska
Natives continue to have the poorest survival
from “all cancers combined” than any other
racial group. Colorectal cancer, lung cancer,
and breast cancer are among the leading types
of cancer in the American Indian/Alaskan
Native population.
It is important to review the signs and symptoms,
risk factors, and prevention methods of these
cancers that plague the AI/AN community.
–5–
Colorectal Cancer
According to the American Cancer Society, Lung
and colorectal cancer incidence rates for AI/AN
(both men and women) are significantly higher
than they are for Caucasians.
Colorectal cancer is highly preventable and is
curable when caught early. Most cases of the
disease begin as non cancerous polyps, which are
grape-like growths lining the colon and rectum.
These polyps can become cancerous. Upon
detection, removing the polyps, can prevent
colorectal cancer from ever developing.
It is difficult to detect colon cancer in the early
stages, because there are few symptoms. Someone
could have colon cancer and not know it. This is
why it is extremely important to be tested regularly.
Signs and Symptoms:
♥ Rectal/anal bleeding
♥ Blood in or on the stool (bright red)
♥ Change in bowel habits
♥ Stools that are thinner than usual
♥ General stomach discomfort
♥ Diarrhea or constipation
♥ Recurrent gas pains
♥ Weight loss for no apparent reason
♥ Fatigue
♥ Vomiting
Risk Factors:
♥ Personal or family history of colon cancer
♥ Personal or family history of inflammatory
bowel disease (Ulcerative Colitis or
Crohn’s disease)
♥ Lack of fiber in the diet
♥ Age
♥ Heavy alcohol use
♥ Smoking
–6–
Prevention/Best Defense:
♥ Diet high in fiber, fruits and vegetables
♥ Increased fluid intake of non-alcoholic
beverages
♥ Screening tests beginning at age 50
♥ Limit intake of red meat to once a day
♥ Smoking cessation
Lung Cancer
The American Cancer Society (ACS) reports lung
cancer as the leading cause of cancer death. Lung
Cancer is the most common type of cancer death
in eight of the nine Indian Health Service (IHS)
areas.
In addition, the ACS indicates lung cancer as the
second most common cancer among AI/AN and
87% of all lung cancer deaths can be linked to
tobacco smoking.
The Center for Disease Control and prevention
data shows that adult smoking among American
Indians/Alaskan Natives is the highest (40%)
of the five racial/ethnic groups.
Signs and Symptoms:
♥ Difficulty breathing
♥ Chronic cough/coughing up blood
♥ Chest pain
♥ Loss of appetite/weight loss
♥ Extreme fatigue
♥ Chronic cough
♥ Fever without a known reason
♥ Wheezing/Hoarseness
♥ Repeated bouts of bronchitis and/or
pneumonia
–7–
Risk Factors:
♥ Tobacco use
♥ Age
♥ Family history
♥ Diet and lifestyle
♥ Exposure to asbestos, radon, or other
hazardous chemicals found in the
workplace (miners, etc.)
♥ Little/too much Vitamin A in diet
♥ Air pollution
Prevention/Best Defense:
♥ Don’t smoke/quit smoking
♥ Avoid second hand smoke
♥ Eat lots of fruits/vegetables
♥ Make your home/workplace safe from
harmful exposures (asbestos, radon)
♥ If symptoms exist, get screened/tested
Breast Cancer
Breast Cancer is the most common cancer among
women in the United States. Breast cancer affects
individuals in all ethnic groups; however, there is a
difference in mortality rates among these groups.
According to Susan G. Komen for the Cure, if you
are AI/AN, you are less likely than women of any
other ethnic group in the U.S. to be alive five years
or longer after a breast cancer diagnosis. Susan G.
Komen for the Cure reports only an estimated
Alaska Native Medical Center (ANMC)
Anchorage, Alaska
–8–
37% of AI/AN women age 40 and older get
mammograms, which could contribute to the
poor survival rate.
Signs and Symptoms:
♥ A lump is present/found, which is usually
firm and most often painless
♥ A portion of the skin on the breast or
underarm swells and has an unusual
appearance
♥ Veins on the skin’s surface become more
obvious on one breast
♥ The breast nipple can become inverted, develop a rash, change skin texture, or have a
discharge other than breast milk
♥ A dent/impression is found in an area of
the breast surface
Risk Factors:
♥ Family history of breast cancer
♥ Not having children, or having
them later in life
♥ Race and ethnicity
♥ Genetics
♥ Dense breast tissue
♥ Previous chest radiation
♥ Use of oral contraceptives
Prevention/Best Defense:
♥ Personalized risk assessment
♥ Early screening - Annual mammography
should begin at age 40 (or as directed by
doctor) and then as recommended
♥ Annual clinical breast exam by medical
professional beginning at age 20
♥ Monthly self breast exam
–9–
DIABETES
Diabetes is a condition in which the body is
unable to properly process blood sugar. Problems
can occur if blood sugar is too high or too low.
Diabetes occurs when the body is either unable to
make enough insulin or it becomes unable to use
the amount of insulin produced. Uncontrolled
blood sugar can lead to a number of damaging
conditions in the body.
There are two main types of diabetes.
♥ Type I diabetes or “juvenile-onset”
usually begins during childhood or
early adulthood. This type occurs when
the body does not produce enough
insulin. As a result, the patient will
need insulin injections.
♥ Type II diabetes, often called “adult-onset”
or “non-insulin dependent” diabetes, can
be diagnosed among children and teens
although is typically diagnosed in adults.
It is common in people who are overweight and has a tendency to run in
families. Usually the body makes enough
insulin but cannot use it properly.
Self-educating about the symptoms of diabetes can
aid in the prevention of developing this condition.
Educating oneself about the treatments of diabetes
can aid in maintaining this condition. If left untreated, diabetes can lead to kidney failure and/or
amputation of limbs.
Signs and Symptoms:
♥ Increased thirst and dry mouth
♥ Increased urination, especially at night
♥ Increased fatigue
♥ Increased hunger
♥ Blurry vision
♥ Unexplained weight loss
–10–
♥ Tingling or numbness in hands and/or feet
♥ Increased skin infections and/or slow
healing of wounds
♥ Recurring vaginal yeast infections
Risk Factors:
♥ Overweight/obesity
♥ Age
♥ Family history
♥ History of having a large birth weight baby
(over 9 lbs) or having gestational diabetes
♥ Low physical activity
♥ High blood pressure
♥ Poor diet
Prevention/Best Defense:
♥ Type I diabetes cannot be prevented
since this condition is usually linked
to a family history.
♥ Type II diabetes cannot always be
prevented, however a healthy diet and
regular exercise can lower the risk of
developing this condition.
If you have diabetes:
♥ See your doctor regularly
♥ Check your blood sugar as recommended
♥ Eat a healthy diet
♥ Maintain a healthy weight
♥ Have your blood pressure checked often
♥ Take all prescribed medicines as ordered
♥ Do not smoke or use tobacco
♥ Limit alcohol intake
♥ Exercise regularly
–11–
CONCLUSION
In summary, research shows that most diseases
impacting the Alaska Native/American Indian
community can be controlled and/or prevented by:
♥ Maintaining a healthy lifestyle
♥ Exercising regularly
♥ Early detection of illness thru regular
medical exams and screenings
♥ Patient education
Understanding your condition and how to manage
it can increase your confidence in making changes
to improve and maintain your health. Any serious
illness can raise important financial and emotional
concerns for both the patient and their family.
It can be beneficial to seek financial assistance
or guidance through National and Local
organizations. For instance, the Patient Advocate
Foundation, the American Heart Association,
prescription assistance programs, Federal,
State and local Human Services offices.
Familiarize yourself with your health insurance
plan by obtaining a copy of the policy and reading
it over so you know the coverage and benefits
available to you.
The most important thing to remember is that you
are not alone. These diseases are manageable and
there are many people and organizations that care
and are available to assist you.
–12–
WHERE TO FIND HELP FOR SUPPORT
Alaska Native Health Board (ANHB)
www.anhb.org
1-907-562-6006
1840 Bragaw St, Suite 220
Anchorage, Alaska 99508
♥ Promotes spiritual, physical, mental, social,
and cultural well-being and pride of Alaska
Native peoples.
Alaska Native Medical Center (ANMC)
www.anmc.org
1-907-563-2662
4315 Diplomacy Drive
Anchorage, Alaska 99508
♥ Provides services, health information and
resources for Alaska Natives.
Alaska Native Tribal Health Consortium
(ANTHC)
www.anthc.org
1-907-729-1900
4000 Ambassador Drive
Anchorage, Alaska 99508
♥ Provides services, health information and
resources for Alaska Natives.
Prostate Cancer Resource • US TOO!
International, Inc.
www.ustoo.org
1-800-808-7866
♥ Provides support, counseling, and
education to assist men, their partners
and families, in understanding prostate
cancer.
Road to Recovery-American Cancer Society
1-800-227-2345
♥ Help find volunteers to drive people to
cancer related appointments in Anchorage.
–13–
Social Security Administration
www.ssa.gov
1-800-532-1223
♥ Federal benefits may be available if certain
criteria and guidelines are met. People that
have disabling conditions and can no
longer work because of a health condition
would need to go through an application
process with the SSA.
Southcentral Foundation (SCF)
www.southcentralfoundation.org
1-877-837-4251/1-907-729-4955
4501 Diplomacy Drive
Anchorage, Alaska 99508
1-907-729-4955
♥ Provides services, health information and
resources for Alaska Natives.
Stanford Diabetes Self-Management On-Line
for Native Americans
http://indiandiabetes.stanford.edu
1-800-366-2624
♥ Provides free diabetes self-management
materials and receive free lab tests.
Susan G. Komen Breast Cancer Foundation
www.komen.org
1-800-462-9273
♥ People supporting people who are
committed to fighting breast cancer.
National Indian Council on Aging, Inc.
Diabetes Educational Outreach Strategies (DEOS)
www.nicoa.org
1-505-292-2001
♥ Works with tribal organizations to plan,
design, and assess the feasibility of
implementing a culturally appropriate
Diabetes Prevention model for American
Indians and Alaska Native Elders.
–14–
National Indian Health Board
www.nihb.org
1-202-507-4070
926 Pennsylvania Ave SE
Washington, DC 20003
♥ Advocating on behalf of all Tribal
Governments, American Indians and
Alaska Natives in their efforts to provide
quality health care.
National Patient Travel Center
www.PatientTravel.org
1-800-296-1217
♥ This center provides free or discounted
medical air transport service.
Native Cancer Information Resource Center and
Learning Exchange (C.I.R.C.L.E.)
www.nativeamericanprograms.org
1-877-372-1617
♥ A cancer resource center for American
Indian and Alaska Native people.
The National Office of Native Cancer
Survivorship
www.oncs.org
1-800-315-8848/1-907-333-2071
13790 Davis Street
Anchorage, Alaska 99516
♥ Works as a liaison between providers and
patients to improve care and access to
cancer support services.
–15–
Patient Advocate Foundation
www.patientadvocate.org
1-800-532-5274
♥ PAF offers many programs and
educational opportunities for patients
nationwide including direct case
management assistance to ensure
access to healthcare, maintenance of
employment and preservation of
financial stability.
Lance Armstrong Foundation
www.cycleofhope.org
www.livestrong.org
1-866-235-7205/1-512-236-8820
♥ Provides information and resources for
people living with cancer.
National Alliance of Breast Cancer
Organizations (NABCO)
www.nabco.org
♥ NABCO is an information and education
resource.
National Breast and Cervical Cancer Early
Detection Program
http://apps.nccd.cdc.gov/cancercontacts/nbccedp/
contacts.asp
1-800-232-4636
♥ The Center for Disease Control launched a
major initiative in 1994 to fund American
Indian/Alaska Native organizations directly
to establish comprehensive screening
programs to improve our capacity to reach
American Indian/Alaska Native women.
–16–
National Cancer Institute
Cancer Information Service (CIS)
www.cis.nci.nih.gov/www.cancer.gov
1-800-4-CANCER /1-800-422-6237
♥ Provides accurate and up-to-date cancer
information and materials. Caring people
answer your questions about cancer, and
can mail you free brochures and posters
if requested.
National Diabetes Education Program
www.ndep.nih.gov
1-888-693-6337/1-301-496-3583
♥ Provides information and resources about
preventing and controlling diabetes.
Cancer Hope Network
www.cancerhopenetwork.org
1-877-467-3638
♥ Matches patients with trained volunteers
who have experienced cancer. Provides
support and hope for cancer survivors.
Centers for Medicare and Medicaid
Services(CMS)
www.medicare.gov
1-800-MEDICARE/1-800-633-4227
♥ Explains your Medicaid and Medicare
questions, new Medicaid and Medicare
services, and any questions regarding
Medicaid and Medicare services.
State of Alaska: Chronic and Acute Medical
Assistance (CAMA)
http://www.hss.state.ak.us/dhcs/cama/
1-888-804-6330/1-907-269-5777
♥ CAMA pays for select health care services
for adults and children who do not qualify
for Medicaid.
–17–
Colon Cancer Alliance, Inc.
www.ccalliance.org
1-877-422-2030
♥ The Colon Cancer Alliance battles
colorectal cancer through patient support,
education, research, and advocacy.
Diabetes Prevention Program
www.preventdiabetes.com
(505) 368-6345
Northern Navajo Medical Center
P.O. Box 160
Shiprock, New Mexico 87420
♥ Provides information and resources about
preventing and controlling diabetes.
IHS Division of Diabetes Treatment
& Prevention
www.ihs.gov/medicalprograms/diabetes
1-505-248-4182
♥ A system to assure quality diabetes services
for your community. Free materials and
publications.
American Cancer Society (ACS)
www.cancer.org
1-800-227-2345/1-907-277-8696
1057 West Fireweed Lane, Suite 104
Anchorage, Alaska 99503
♥ The ACS provides cancer information,
support services and has a program to
loan wigs.
American Diabetes Association
www.diabetes.org
♥ Provides information and resources about
preventing and controlling diabetes.
–18–
American Lung Association (ALA)
www.lungusa.org
1-800-586-4872/1-907-276-5864
1057 West Fireweed Lane, Suite 201
Anchorage, Alaska 99503-1736
♥ ALA works to prevent lung disease and
promote lung health through education,
community service, advocacy and research.
Awakening the Spirit: Pathways to Diabetes
Prevention and Control
www.diabetes.org
1-800-DIABETES/1-800-342-2383
♥ Organization established by the American
Diabetes Association created to improve
the lives on Native Americans with
diabetes. Provides advocacy, educational
materials, consultation, and latest research.
Cancer Care
www.cancercare.org
1-800-813-HOPE/1-800-813-4673
♥ Helps people face the many challenges of a
cancer diagnosis. Provides free telephone
education workshops.
This publication was supported by Cooperative
Agreement Number DP001705-01from the Centers
for Disease Control and Prevention. Its contents,
findings and conclusions are those of the authors(s)
and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
–19–
700 Thimble Shoals Boulevard, Suite 200
Newport News, Virginia 23606
Phone: (757) 873-6668
Toll free: 1-800-532-5274
Fax: (757) 873-8999
www.patientadvocate.org