Gov. Palin announces healthy priorities

By Naomi Klouda
Homer Tribune

Gov. Sarah Palin’s plan to begin steps toward solving Alaska’s health insurance crisis was welcome news this week on the Kenai Peninsula.

According to a 2004 household survey, 20.4 percent of the peninsula’s residents were uninsured, compared to statewide figures of 19.1 percent for that year. Fairbanks fared better with 15.2 percent uninsured. Nationally, the number was 14.1.

For 2007, Central Peninsula Health Centers’ Executive Director Stan Steadman said 82 percent of his patients qualified for services at a benchmark of 200 percent of the poverty level. Thirty-one percent had no insurance, including not qualifying for Medicaid. The health center had 22,348 total “encounters” of patients seen that year.

New attention by the governor’s office to address health insurance is certainly welcome news, Steadman said. The public health clinic has already added staff, in anticipation of needing to treat higher numbers of patients due to Medicaid patients turned away by doctors, he said.

“Community health centers are positioned to address critical areas of concern. The U.S. Congress recently reauthorized a community health center program for the next five years, unanimously,” he said.

Insured patients who have a high deductible likewise may feel insecure and add to the client base the clinic sees, Steadman said.

Rep. Paul Seaton, R-Homer, noticed that an important obstacle facing better health for Alaskans was left out of the governor’s plan.

“I don’t see anything addressing the reduction of alcohol use and abuse, or cessation programs,” Seaton said. “Probably the No. 1 health problem facing Alaskans is alcohol and we don’t have adequate cessation programs.”

The governor plans to reveal more details of her health care hopes in her budget address Dec. 15, when she delivers her fiscal year 2010 operating and capital budgets.

As for health insurance for the general population, Seaton said it’s unlikely that will be seen anytime soon. First, the commission needs to do its work, including new studies.

Alaskans lacking health insurance and the many factors that cause it have been documented in several studies over the past decade. These were already funded through federal and state money. Those studies may have “come up with ideas, but if they didn’t have traction, then the idea didn’t go anywhere and the data likely grew old,” Seaton said.

“We’ll haves to start again, with some concepts that can carry over,“ Seaton said. “We have new models from other states. Massachusetts has had its mandatory insurance for two years. That’s enough time to see if it’s working or not. Hawaii has a health care model.”

Big changes likely won’t happen in the next two or three years, Seaton said, but the state may see elements of the plan in the works by a year from now.

For immediate needs, the governor did well to advocate for increasing eligibility guidelines for children, Seaton said. A movement in the Legislature last year sought to increase Denali KidCare to 200 percent of the poverty level, but faced too much opposition to pass.

One fear was that by raising the eligibility guidelines in a program receiving limited funds, the program would be depleted and then forced to turn away children who needed the medical help, Seaton said.

“A lot of kids in those guidelines got lost,” he said.

Governor’s wish list for a healthier future for Alaska

Gov. Sarah Palin on Thursday announced her goals to improve Alaska’s health and education through fiscal year 2010 budget requests. She proposes to:

• Establish the Alaska Health Care Commission to provide recommendations for and to foster the development of a statewide plan to address the quality, accessibility and availability of health care for all.
• Support legislation to increase income eligibility guidelines for Denali KidCare to 200 percent of Alaska’s federal poverty level. Such an increase would make about 1,300 more children and about 225 more pregnant women eligible for health coverage under Denali KidCare.
• Continue investment in the Tobacco Use Education and Cessation Fund to boost Alaska’s tobacco prevention and control program.
• Fund Alaska’s obesity prevention and control program.
• Spend $250,000 on early screening and diagnosis of autism and other neurodevelopmental disorders.
• Develop a statewide initiative called Live Well Alaska. The interactive Web-based campaign would provide the best recommendations for eating healthier, being more physically active and quitting tobacco use.
• Increase funding for Head Start preschool programs by $800,000. The additional funds would allow the program to serve 60 to 80 more children. Approximately 1,000 Alaska children remain on waiting lists for Head Start. This funding is in addition to $600,000 in increased funding that Head Start received last fiscal year.
• v Spend $2 million for the Department of Education to implement a pilot preschool program. School districts would receive the funding through grants. The half-day preschools would serve up to 500 children statewide.
• v Fund the University of Alaska’s Family Residency Program.

Special delivery — Rural nurse takes life lessons as they come

By Clark Fair
Redoubt Reporter

In 1939, actress Butterfly McQueen, as the character Prissy, said famously, “I don’t know nothin’ ’bout birthin’ babies” in “Gone With the Wind.”

That story was a work of fiction.

Ten years later, however, when itinerant public health nurse Shirley Denison had thoughts similar to Prissy’s, the situation was real, which could have been unfortunate for the pregnant women of Seldovia, where Denison was stationed.

Denison, now Shirley Henley of Kenai, had just arrived on the Kenai Peninsula in February 1949, following two years of field-nurse work in Birmingham, Ala., near where she was born and raised. Her work in the field had been preceded by studies at Maryville College and then a master’s degree in nursing at Yale.

Her plan, after Yale, had been to go to Alaska as soon as possible. However, to complete her agreement with the Cadet Nurse Corps, which had subsidized her degree, she owed two years’ work. On the day her two years were up, she headed north.

Henley said that she wanted to go to Alaska because it was “as far away as I could get from Alabama.” She said she wanted to escape the crowds and all of the rules and regulations, and she figured the Territory of Alaska offered her the most freedom.

“Up here, the closest any supervision you had was Anchorage, and I only saw my supervisor from Anchorage once a year,” she said.

Talk about autonomy: The Alaska Territorial Department of Nursing hired Henley and stationed her in Seldovia, where an absence of doctors had forced the city’s hospital to close its doors. When Henley arrived, she was the only medical show in town.

With the closest doctors in Seward and Anchorage, she said, “You had to do whatever you had to do.”
One definite drawback to doing it all was Henley’s lack of obstetrics training.

“When I was in Yale, one of the things I very carefully avoided was obstetrics,” said Henley, now 85. “And the first thing I knew I was having to deliver babies.” Three or four women in Seldovia were in the family way.
One of her first pregnant patients was Nelda Calhoun, who was not a first-time mother. Nelda and her husband, Red, had had a poor fishing season, Henley said, and they couldn’t afford to go to Anchorage for the birth. They also refused offers of financial aid because they saw them as charity.

“(Nelda) had had some problems with previous pregnancies, so I wrote to (the supervisor in) Anchorage and said, ‘I will go anywhere and do anything if you’ll just send a midwife down here,’” said Henley, who was only 25 at the time. “And they did have public health nursing midwives available, so I asked to swap places with them until they got these people delivered.

“What they did was send me a huge box of obstetrics books. And the more I read, the more frantic I became because, you know, these obstetrics books told of all these awful things that could go wrong, and I thought, ‘Oh, God!’

“I did some heavy praying.”

And she did the best she could.

“I had done all the prenatal work,” she said. “That was part of my responsibilities, you know — take your blood pressure and make sure your diet’s good and everything. So here Nelda’s in labor, and she says, ‘Well, aren’t you going to do a pelvic exam?’ And I said, ‘Nelda, I’d just as soon stick my finger in my mouth for what I know, so why make you more uncomfortable?”

Soon, though, the spring of 1950 arrived, and with it the inevitable delivery of the Calhoun baby. Henley said she dreaded the thought that any day Red Calhoun would arrive at her door and announce that the time had come.

“I’d lie awake at night and listen to people walk down the boardwalk (below her apartment),” she said. “And I’d think, ‘Oh, God, please don’t let it be Red. Don’t let it be Red Calhoun. I’m not ready for this.’”
Then one night it was Red Calhoun. Full of anxiety, Henley packed her bag and followed him to the Calhoun home.

In the end, everything turned out well — the baby, an 8-pound boy they named Dan, was delivered successfully — but there was one moment of special trepidation.

“When (Nelda) was in the process of delivering, she says, ‘Am I bleeding very much?’ And I said, ‘No.’ And she says, ‘Well, thank God. The last time I hemorrhaged.’ I didn’t want to hear that,” Henley said.

Throughout her short time as an itinerant public health nurse, she had many other adventures — when Yule Kilcher’s dog bit her on the butt the day she came to vaccinate his children, for example — and when she went into public education in Kenai in 1958 she had plenty more.

Henley, who continued as a nurse until her first child, Ruth, was born in 1952, said she never did get comfortable delivering other people’s babies.

“I’d read all those books, and I knew what could happen,” she said.