Sudden Infant Death Syndrome remains a mystery

BY CHRISTINA GOODVOICE
09/17/2009 07:16 AM
TAHLEQUAH, Okla. – Cherokee Nation citizen Angela Garrett remembers the cold day in January 1993 as one that began like a normal day.

She had just per her 2-month-old son, Blaine, down for a nap in his crib. She checked on him frequently, but despite that, one hour later Blaine died in his sleep. The cause was Sudden Infant Death Syndrome.

October is Sudden Infant Death Syndrome, or SIDS, Awareness Month. SIDS occurs at a rate of about 0.5 per 1,000 births. However, in American Indian and African American populations, the rate is around one per 1,000 births.

SIDS is considered the death of a child less than 1 year old that remains “unexplained” after a thorough investigation including an autopsy, review of clinical history and investigation of the scene of death, said Dr. Tom Kincade, chief of Pediatrics at the Cherokee Nation Three Rivers Health Center in Muskogee.

“I think it is important for our communities to know abut SIDS due to the increased rates in Native Americans and also to be aware of the factors that can help prevent SIDS,” Kincade said.

SIDS remains a leading cause of death in healthy infants less than 1 year old, and approximately 2,100 infants in the United States die of SIDS per year, he said.

Parents can reduce the risk of SIDS by placing babies on their backs to sleep.

“Studies show that over 90 percent of infants that died from SIDS were not sleeping on their backs,” he said. “Most were sleeping on their stomachs.”

Garrett said she put Blaine on his back for his nap, but when she found him, he was on his stomach and his face was in the crib mattress.

“Somehow, at 2 months old he rolled over,” she said. “He was already gone when I found him. I didn’t even call 911(immediately.) I called my mom because he was already gone.”

She said afterward she was in a state of shock, and since then she’s blocked out most of the memory of losing Blaine to SIDS.

“I don’t even remember them taking him out,” she said. “I thought he was still in the room after the ambulance got there and everything. It was a couple of hours later and I thought he was still there.”

Even now, 14 years later, Garrett said she’s stilly trying to understand SIDS.

“From the moment I found him, I don’t remember too much of anything else,” she said. “He wasn’t sick. He didn’t have a cold. There wasn’t anything wrong with him.”

Studies have also shown that letting babies use pacifiers while sleeping can reduce the SIDS risk, Kincade said. He added that infants should sleep on a firm sleeping surface, should not be overdressed while they sleep and stuffed animals, excess bedding and blankets should be avoided.

“When babies leave the hospital nursery they should be able to maintain a normal body temperature which means if parents feel comfortable in shorts and a tee shirt, their babies will too,” he said.

Educational materials about SIDS have been placed in the clinic and exam rooms at the Three Rivers Health Center, and other tribal clinics have been encouraged to do the same, Kincade said.

Health

BY STAFF REPORTS
08/29/2016 12:00 PM
TAHLEQUAH, Okla. – The Cherokee Nation’s work creating healthier conditions for its citizens is now ranked among the best in the country, a first for any tribe. In late August, the CN Public Health received accreditation from the Public Health Accreditation Board. The PHAB serves as the national public health accrediting body. It is jointly supported by the U.S. Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. It sets standards for the nation’s nearly 3,000 governmental public health departments to improve the quality of their services and performance. Fewer than 200 public health agencies nationally have earned the title in the past five years. The CN is the first tribe to now hold that honor. “The Cherokee Nation joins the growing ranks of accredited health departments in a strong commitment to their public health mission,” PHAB President and CEO Kaye Bender said. “The peer-review process provides valuable feedback to inform health departments of their strengths and areas for improvement, so that they can better protect and promote the health of the people they serve in their communities. Residents of a community served by a nationally accredited health department can be assured that their health department has demonstrated the capacity to protect and promote the health of that community.” The Public Health team has worked on initiatives such as Zika Virus preparedness planning, launching community walking groups, funding school community gardens, implementing a cancer tumor registry database and conducting research with universities on issues such as triggers for childhood asthma. It also pays entry fees to 5K races and operates a gym with certified public health trainers for CN citizens and employees for free to promote healthier lifestyles. Public Health agencies, including the CN’s, promote healthy behavior; preventing diseases and injuries; ensuring access to safe food, water, clean air and life-saving immunizations; and responding to public health emergencies. The Oklahoma Department of Health, Oklahoma City-County Health Department, Tulsa Health Department, Comanche County Health Department and the CN are the only accredited entities statewide. “Our congratulations to the Cherokee Nation for achieving national public health accreditation,” Dr. Terry Cline, Oklahoma State Department of Health commissioner and Health and Human Services secretary, said. “As the first tribal nation in the country to achieve this accreditation, the Cherokee Nation continues a long tradition of excellence and quality in protecting and promoting health, and they are to be commended for this outstanding accomplishment.” According to the PHAB, a University of Chicago study found that more than 90 percent of health departments accredited for one year indicated that accreditation helped them better identify strengths and weaknesses and more than 80 percent found they improved accountability to stakeholders, while half reported it helped improve their chances for competitive funding. “Receiving national accreditation through the PHAB is a testament to the years of quality work by our public health team at the Cherokee Nation,” Connie Davis, Public Health executive director, said. “This seal of approval allows us to further improve upon our work in public health and on epidemiological issues.” Officials said Public Health leaders spent the past four years working on the accreditation, which involves meeting or exceeding a rigorous, peer-reviewed set of standards. “Achieving accreditation means we at the Cherokee Nation are cognizant of the crucial role of public health in our communities and demonstrates our ability to be a mutually-beneficial partner for all citizens,” Lisa Pivec, Public Health senior director, said. “We believe it communicates our serious commitment to both improving health and delivering quality public health services to all.”
BY STAFF REPORTS
08/29/2016 08:30 AM
TAHLEQUAH, Okla. – The Oklahoma Hospital Association recently recognized Cherokee Nation’s W.W. Hastings Hospital for vaccinating the majority of its staff with flu shots this past flu season. The hospital is among 49 in the state to meet the association’s challenge goal of a 96 percent or higher vaccination rate of health care staff for the 2015-16 flu season. More than 800 members of the Hastings staff received the vaccine this past flu season. “Cherokee Nation’s health department and our talented staff that operates the hospital and clinics routinely go above and beyond for the wellness of our tribal citizens,” said Secretary of State Chuck Hoskin Jr. “Administration and promotion of the annual flu shot means we are being proactive in ensuring our immunization rates trend positively. That’s important because every year the influenza virus often targets our most vulnerable Cherokee people, including elders and children.” OHA officials said influenza is associated with 36,000 deaths per year and commended the recognized hospitals with certificates for working diligently to protect their patients with vaccinations. “These hospitals have stepped up in ensuring their patients are protected and a number are joining a trend of hospitals nationwide in instituting mandatory vaccination policies,” LaWanna Halstead, OHA vice president of quality and clinical initiatives, said. Hastings Hospital was also recognized recently for receiving four out of five stars from the Centers for Medicare and Medicaid Services. This places Hastings in the top 4 percent of the more than 7,000 organizations it is compared with. The ratings come from patient satisfaction quality of inpatient care measures. Individuals can use Hospital Compare to compare more than 7,000 Medicare-certified hospitals across the country to compare the quality of care. “The W.W. Hastings Hospital health care providers and staff work tirelessly to ensure our patients receive the best health care possible,” Hastings Hospital CEO Brian Hail said. “Recognition of their efforts from organizations like the Oklahoma Hospital Association and high ratings from our patients on the Hospital Care system serve as validation of our staff’s dedication to first-class health care.” Hastings Hospital received more than 360,000 patient visits in fiscal year 2015. For more information, visit <a href="http://www.cherokee.org/services/health" target="_blank">www.cherokee.org/services/health</a>.
BY JAMI MURPHY
Senior Reporter – @cp_jmurphy
08/25/2016 08:15 AM
TAHLEQUAH, Okla. – Cherokee Nation citizen Pam Turtle will spend the rest of her life taking medication to help her live with a transplanted kidney. The transplant was needed because she’s had polycystic kidney disease since she was 24. Turtle, 49, is from Stilwell but lived in Kansas, Oklahoma, until five years ago. That’s when she got extremely sick and doctors told her the disease had progressed enough to necessitate dialysis. So she and her husband Mike Turtle moved to Tahlequah to be closer to a dialysis center. PKD causes cysts to take the place of normal tissue. They enlarge the kidneys and make them work poorly, leading to kidney failure. The disease also runs in families. As a child, Pam watched her mother suffer from PKD, so Pam carried a lot of responsibility, including helping keep the house and family together. “My mom was sick the whole time I grew up. In fact, I had to miss some school to take my mom to dialysis and to drive her back. When I was 24 years old I was going to donate a kidney to my mother. I had just had my second child – my last child – and they told me I couldn’t. They told me I had the same disease that my mom had,” Pam said. “They had found cysts bilaterally on my kidneys, and they told me that I would have to start seeing a doctor.” Pam said the disease progresses slowly and affects the whole body. “It took 20 years for this disease to progress. That’s the best thing about this disease, is that it takes years and years and years for it to become a problem.” As the years passed, Pam’s blood pressure increased to where she had to take several pills a day. Still her symptoms and disease progressed. About five years before her kidneys failed, she was referred to a nephrologist in Muskogee. “It got to where I would see him once a year, and then I saw him every six months. Then I saw him every three months, and then I saw him every month. It was just a process I had to go through,” she said. Then one day her nephrologist told her she needed a fistula and dialysis. A fistula is an abnormal connection between two body parts, usually the result of an injury or surgery. “So in November of 2010, I got my first fistula. It’s dead now. I have really bad veins, so they had to harvest a vein and pull it over so that I could use it,” she said. After a year of dialysis in that location, it clotted. “So they sent me to go get a catheter, and it would go straight into my heart, and I took treatment on it for eight months, and while I had this in they did another surgery and put a graft in my arm,” Pam said. The plan was to do dialysis off the graft, but six months later it too had clotted. So she was sent for vascular surgery. After cleaning that vein, it too died and again she had to have catheter. “In eight months I had 13 catheters put in. It’s really hard to do a treatment with them. You’re really prone to infection, and if you get an infection here it goes straight to your heart,” she said. “I’ve watched two people die on dialysis using a catheter.” After dialysis, she said her life changed greatly. “I did it three days a week. I went at 5:30 in the morning. I got through by 9 (a.m.)…There were things we couldn’t eat,” she said. Pam said the disease has a process, and that’s what she was going through. Her mother, grandmother, two uncles, two aunts as well as Pam’s daughter and granddaughter were diagnosed with PKD. Aside from one aunt, her mother, daughter and grandchild, the rest died from complications. “They all passed away with that disease. My aunt has a transplant. My mom’s transplant is the same age as my daughter. My daughter is 26 years old. Mine is four years old…I got it on Dec. 21, 2012,” she said. She said she and her family members with the disease wouldn’t be alive without the transplants. The organ donations, she said, gave her a new start because the disease doesn’t attack the new kidney. Pam said her daughter, Shaye, is 26 and was diagnosed when she was 10. “She hurts a lot and she has very high blood pressure. A migraine can set her back for days. She sees a doctor every six months for her kidney disease and dialysis is just around the corner,” Pam said. “My granddaughter was diagnosed while in the womb. She sees a nephrologist every year. She has some pain issues, but she’s doing great.” Pam said eventually they would need dialysis and transplants. “I encourage donation. If everyone could just understand what it means to donate. There’s a lot of misconception about donation. You don’t have to die to donate, and living donors are the best for kidney donation because they work immediately,” she said.
BY JAMI MURPHY
Senior Reporter – @cp_jmurphy
08/15/2016 04:00 PM
TAHLEQUAH, Okla. – Cherokee Nation Health Services officials said although the Affordable Care Act’s open enrollment begins in November, American Indians, Alaska Natives and their non-Native household members can enroll any month, and they are encouraging Cherokee Nation citizens to take advantage of this and other Native provisions in the ACA. Connie Dunavin, Health Services special projects officer and ACA lead, said the use of one’s tribal health care facility is not considered insurance coverage but a benefit by the federal government’s Indian Health Services. Dunavin explained “we get calls now that Cherokee Nation citizens think that because they have access to Cherokee Nation Health Services facilities, that they are considered covered by insurance.” But IHS is limited in certain services offered, Dunavin said, therefore having coverage under the Affordable Care Act (ACA) through the Marketplace will help insure things such as specialty care, or accidents that could occur out of state. “So we’re trying to encourage completing a marketplace application,” Dunavin said. “As a member of a federally recognized tribe, one of the special provisions for American Indian/Alaska Native is an opportunity to qualify for a zero-cost-sharing plan.” American Indian/Alaska Native households or individuals whose income falls between 100 percent and 300 percent of the federal poverty level can qualify for the zero-cost-sharing plan, she said. “That is no co-pay, no deductible and zero cost for medicines whether they’re name brand or generic. Many of our people qualify for that,” she said. “And that is an American Indian special provision.” Health Services has certified application counselors available in each health center and at W.W. Hastings Hospital to assist tribal citizens with applications, enrollments and exemptions. Without coverage or an exemption, people who are required to file income taxes will be assessed penalties called shared-responsibility payments. “We have another special provision, the American Indian/Alaska Native or AI/AN Exemption,” she said. After filing for this exemption the marketplace will issue a lifetime Exemption Certificate Number (ECN), Dunavin said, which is an indicator to the IRS that the filer is of American Indian status and has been confirmed by the federal government and not just claiming to be an American Indian/Alaska Native to avoid a penalty. She said this spring in Dallas, the Regional Center for Medicare and Medicaid/IHS meeting informed tribal officials that filing for the exemption would end soon and the last ECN would be issued in December 2016, but officials are still waiting for that official notification. “The only option then (without an ECN) will be to just check on your income tax form (8965) and claim to be Indian,” Dunavin said. “So the IRS has said, it’s not in writing, but they have told us that they will no longer audit you based on a claim of being Indian to avoid a penalty.” However, this year, Dunavin said she and other tribal officials attending the regional meeting reported accounts of families that were contacted by the IRS based on the claim of being Indian (not having an ECN), as well as accounts of citizens unknowingly claiming use of their tribal facilities as insurance coverage. With the ECN on tax form 8965, Dunavin said, the IRS knows that the federal government has confirmed a person to be a citizen of a federally recognized tribe and not just claiming Native status to avoid the penalty. “We are encouraging our citizens to come in before or by November and let us help you file for the ECN to confirm your status,” she said. For those wanting to file for the ECN or read more information, go to <a href="http://www.healthcare.gov/tribal" target="_blank">www.healthcare.gov/tribal</a> and follow the AI/AN Exemption links. Dunavin said applying for health coverage through the marketplace can be confusing and difficult and that many tribal citizens have tried the “Quick Estimator” for pricing that’s provided at healthcare.gov not knowing the estimator does not reflect the zero-cost-sharing special provision for American Indians/Alaska Natives. “So health officials are urging citizens to utilize the CN staff available that can help with looking at types of coverage one may qualify for at a zero or low cost.” Health Services has 24 certified application counselors to help tribal citizens, she said. “Call to set up an appointment, or come in and meet your community health center’s PBC (Patient Benefit Coordinator) and let us help you with applications, enrollments, to see if you qualify for those zero-cost-share plans, and to help you with the AI/AN Exemption,” Dunavin said. For more information, call your local CN health clinic or 918-453-5000, ext. 5657.
BY STACIE GUTHRIE
Reporter – @cp_sguthrie
08/15/2016 08:15 AM
TAHLEQUAH, Okla. – Nurses from Florida Atlantic University in Boca Raton visited Cherokee communities July 18-25 as part of a “cultural exchange” and spoke about health-related topics. Dr. John Lowe said he’s been bringing nurses to the area since 2004. “I looked at the curriculum at Florida Atlantic University and wanted to…have a way of contributing back to the communities here,” he said. “So in this program that these nursing students are in, it’s what we call a completion program. They have associate degrees in nursing, so they’re now coming back to the get a bachelor’s (degree). They’re practicing nurses. They have a lot of knowledge, but one of the things that they usually do not get in their associate degree program is a community-based type of experience. So we have a course in our curriculum that focuses on community-based experience.” Lowe said the Community Cultural Immersion Experience is a one-week class that provides students and community members with a cultural exchange. He said the 35 nurses were from various places, including Jamaica, Brazil, Syria and Nigeria. “The nice thing is that the majority…they were internationally born, and so they’re citizens down here and they live and work in Miami (Florida), but a majority were born somewhere else and raised somewhere else for the most part,” he said. “So they come and they interact with the tribal youth and the elders and the communities and they talk about where they’re from.” Melessa Kelley, a United Keetoowah Band and Cherokee Nation citizen who has a Ph.D. in nursing, helps with the class. She said aside from the cultural exchange the nurses also promote on healthy lifestyles. “The nurses are doing their topics on nutrition, diabetes, heart health and exercise, first aid and safety, and then we talk about nursing health careers and different health professions that the kids can go into,” she said. “Then they also do personal and dental hygiene, and then they do their…cultural presentation or exchange with the elders at the elder center. So we’ve kind of been all over this week. And we also do provide physical examines for them to do for their school physicals because some of the kids really need that service. It’s been really good for us to be able to do that.” Steven Boyd, a registered nurse who participated in the class, said he enjoyed the immersion experience while in Oklahoma. “I think it’s important for us because coming from south Florida we’re such a melting pot there, but we’re so far removed from much of what’s going on in the rest of the country, and so for us, a lot of us have never encountered anyone from the Cherokee Nation. So to learn sort of the rich history of the people has been absolutely fascinating,” he said. Lowe said at the end of the week the students gain “a lot” from the experience. “I open with a circle and then…close with a circle. Each student is given time to share what they experienced, and it’s really moving. They really get a lot out of it,” he said. “They feel really accepted by Keetoowah communities.”
BY LINDSEY BARK
Staff Writer
08/11/2016 04:00 PM
JAY, Okla. – The Cherokee Nation’s Women, Infant and Children program celebrated World Breastfeeding Week Aug. 1-5 at the Sam Hider Health Center to support breastfeeding awareness. WIC lactation coordinator Euphemia John said the program supports breastfeeding awareness by educating and supporting women who currently breastfeed or plan to breastfeed. WIC serves as an institution where mothers with newborns can get help and advice about breastfeeding. Peer counselors and consultants serve the WIC clinics in the tribe’s 14-county jurisdiction by visiting homes, placing routine calls to check on mothers and providing breast pumps when necessary. Jessica Green-Wagnon, a mother of a newborn, said she is learning how to breastfeed her second child. She said her first child was “tongue-tied” and was not able to nurse. “It’s a different experience for sure. I feel closer to her (newborn) just because I get to do that,” she said. Green-Wagnon said she is supplementing breastfeeding with bottle feeding because she plans to go back to work and the WIC program is teaching her techniques such as getting the “milk to drop,” expelling the milk, how often to feed and using a breast pump. WIC peer counselor Ashton Leach has two children and said she also went through the program. She said WIC lactation supervisor Twila Whitekiller helped her get through the nursing stage with her first child. Now Leach works with Whitekiller and assists mothers in the same process. “Twila told me that the ‘breast is best,’” Leach said. WIC employees advocate breastfeeding as a means for healthier mothers and babies. Whitekiller said nursing mothers have a decreased chance of getting certain types of cancers and babies are at a lesser risk for getting infections because they receive needed immunities from the mother’s milk. She said a mother’s milk releases antibodies and antibacterial agents specific to the baby’s needs. Breastfeeding can also help new moms lose weight by burning 350-500 calories daily, according to Women’s Health magazine. Whitekiller said 11 years ago when she started in WIC breastfeeding rates were low but that she’s seen a gradual increase during the years. “Our goal is to increase breastfeeding rates,” John said. Mothers who go back to work after having a baby, such as Green-Wagnon, need to pump milk in the workplace. And according to state law, they have the right to do so. A CN policy also supports and accommodates working mothers who wish to “express breast milk during her workday” when she is apart from her newborn child. Outside the workplace, there are different opinions when it comes to breastfeeding in public places. “Society and media has made it that breasts are a sexual thing. We have breasts to nurture our babies,” Whitekiller said. She added that breastfeeding can be a “beautiful thing.” “And when you see a mom who’s able to breastfeed her baby without pain and know that her baby is satisfied and drinking milk from her breast and she’s providing it, it’s this whole new confidence that comes over the mom. There’s this peace and it’s ‘I’m doing this,’” she said. For more information, call 918-453-5000 or email <a href="mailto: WIC@cherokee.org">WIC@cherokee.org</a>.