Mankiller Health Center’s dental clinic to close temporarily
STILWELL, Okla. – The Cherokee Nation’s Wilma P. Mankiller Health Center will be temporarily closing its dental clinic for remodeling starting June 18.
The clinic will resume operations and begin seeing patients again on July 2. Patients who have appointments during the time of temporary closure will be notified and rescheduled.
Fore more information, call 918-696-8800.
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.
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.”
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>.
TAHLEQUAH, Okla. – On Aug. 10, the Oklahoma Breast Care Center’s mobile mammogram unit will be at the Gadugi Health Center.
Any woman who has a mammogram due or has never had a mammogram and has health insurance coverage, call the clinic at 918-207-4911to see if you are eligible for this service.
The OBCC provides this service at no out-of-pocket cost to the patient after insurance pays. The American Cancer Society recommends that women over the age of 40 have a mammogram yearly. Regular mammograms can often help find breast cancer at an early stage, when treatment is most likely to be successful. A mammogram can find breast changes that could be cancer years before physical symptoms develop. Results from decades of research show that women who have regular mammograms are more likely to have breast cancer found early, less likely to need aggressive treatment such as surgery to remove the entire breast (mastectomy) and chemotherapy and more likely to be cured.
TAHLEQUAH, Okla. – The federal government’s Indian Health Services is changing its policies regarding opioid prescription, but patients at Cherokee Nation health clinics will see little change in their pain management options.
On July 6, CN citizen and IHS Principal Deputy Director Mary Smith announced that health care providers at Claremore Indian Hospital and other federally operated facilities are now required to check state Prescription Drug Monitoring Program databases prior to prescribing and dispensing opioids for pain treatment longer than seven days and periodically throughout chronic pain treatment for 90 days or more.
According to the Centers for Disease Control, the rate of opioid abuse-related deaths among American Indians and Alaska Natives nationwide has increased almost four-fold, going from 1.3 for every 100,000 people in 1999 to 5.1 per 100,000 in 2013.
Data collected by IHS also indicates that the rate of drug-related deaths among American Indians and Alaska Natives is almost double that of the general population.
With Oklahoma ranking ninth nationally in the number of prescription drug overdose deaths, the Legislature passed a measure in 2015 requiring all physicians to check the state’s prescription database before writing a scrip for schedule II-, III-, IV- and V-controlled substances, which includes oxycodone and hydrocodone.
State law also requires similar checks to be performed periodically after prescribing the medication if it is to be used for chronic pain management for more than 180 days.
Doctors, pharmacists and nurse practitioners at CN health facilities have been using the database since November.
“We are very cognizant of the drug problem in our communities,” CN Senior Pharmacy Director Jeff Sanders said. “Our formulary manages what we offer as options. With the high number of patients that go through our facilities…we try to limit access to certain medications while still addressing pain needs.”
Although CN Health Services officials said that it is too early to tell whether the new database policy has had any effect on the rate of prescription drug abuse or overall opioid prescription among CN patients, they did point out that it has sparked more conversations between patients and health care providers.
“This has facilitated many positive discussions on how they (patients) are taking their meds and in some cases, if the provider has concerns about abuse or diversion of their medication,” CN Health Executive Medical Director Dr. James Stallcup said.
“This provides valuable information. It’s taken a little time to get used to using, but it has been well worth the time and investment.”
TAHLEQUAH, Okla. – W.W. Hastings Hospital is informing women about the importance of early breast cancer detection. Dr. Tschantre’ E. Dorsett, the hospital’s chief of obstetrics and gynecology, said she and her staff are providing women with patient education and brochures regarding awareness.
Dorsett said it’s important to receive an exam because “the majority of breast cancers in the U.S. are diagnosed from abnormal screening studies.”
“The patient, who then seeks out further testing from their provider, first detects many of these abnormalities,” she said.
Dorsett said age and intervals for breast exams vary depending on what government-sponsored or medical societies recommend.
“This is the reason that there may be variations in the age and intervals,” she said. “The American College of Obstetricians and Gynecologists currently recommends a clinical breast examination every one to three years from age 20 to 39, and annually thereafter. Mammography starts at age 40 and continues annually, based on ACOG guidelines. These ages are given for patients who are considered low-risk.”
Dorsett said early cancer detection is important because if the tumor is smaller there is a “greater chance for successful treatment.”
“Also, the earlier detected there is a decreased chance of existing spread of the cancer to other parts of the body,” she said.
She said approximately 225 women visit the women’s clinic at Hastings monthly to receive breast exams. Dorsett said oftentimes women themselves are able to detect breast cancer.
“Approximately one half of all cases of breast cancer in women 50 years and older and more than 70 percent of cases of cancer in women younger than 50 years are detected by women themselves, frequently as incidental findings,” she said. “These findings are brought to the attention of the provider who can then order the appropriate follow-up tests and make referrals.”
Dorsett said breast cancer risk-reducing strategies include weight loss for obese patients and breastfeeding for mothers.
“Breastfeeding specifically becomes significant at six months and beyond,” she said. “For every 12 months of breastfeeding the risk for breast cancer is reduced by 4.3 percent. This can be from one child or added together for several children.”
Dorsett said there are tips when conducting breast self-examinations.
“The most important part is not the exact technique, but rather the observation of change in the breast tissue,” she said. “It is best to pick the same time of the month to preform the exam. For a woman still menstruating this should be a few days after the period ends to decrease the likelihood of swollen or tender breasts. In a postmenopausal female, the same day of the month will help the patient remember to preform the exam.”
For more information, call 918-458-3100.
<strong>5 Steps When Conducting Self-Exams</strong>
Look at the bare breasts in the mirror with hands on hips. Notice symmetry and report dimpling of skin or inversion of nipples. Also, redness, soreness or rash over the breast.
Raise the hands over the head, look for the same changes.
While lying down, use the right hand to examine the left breast and the left hand to examine the right breast. Using just the fingertips, move in a vertical motion from collarbone to top of abdomen and from the armpit to the cleavage. Small circular motions should be made to insure all breast tissue is covered. Use light, medium and firm pressure.
Repeat the same procedure sitting or standing.
Report any abnormal findings or changes to your health care provider.