Special to Indian Country Today
ANCHORAGE, Alaska – Polly Andrews knows the importance of having a health-care system that understands Alaska Natives.
Andrews, who is Cup’ik from Chevak and Lower Kalskag in southwest Alaska, is a traditional storyteller and performs Cup’ik songs and dances in her spare time.
The support she gets from her Native-owned, nonprofit health care organization goes far beyond a typical healthcare system.
“I’ve had the same provider for years now,” Andrews told Indian Country Today. “Very often, she sits down with me and really opens the door for me to share parts of my story. She asks how I’m doing, how the family is doing, and about areas where I could really use some healing in my life.”
The organization, Southcentral Foundation, known as SCF, provides health care to 65,000 Alaska Native and Indigenous people living in Anchorage, Matanuska-Susitna Borough, and 55 rural villages.
The focus is on holistic care from a team of available providers, including primary care physicians as well as behavioral health experts and specialists as needed. All are coordinated with a focus on services that are driven not by the diagnosis but by the person and situation, officials said.
The system offers a traditional healing clinic, a Native men’s wellness program, home-based services and an elder program, in addition to regular health care offerings. Special learning circles that offer a wide range of knowledge – from drum-making to beadwork and dancing -- bring people together to learn and share.
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Andrews has noticed the difference.
“Through sharing my story in these conversations is how I feel Alaska Native culture is really embraced,” Andrews said. “[The provider] and I talk about what healing looks like, what our family health care looks like, and what the path forward looks like.”
Southcentral Foundation was founded in 1982 under the tribal authority of the Cook Inlet Region Inc., and is the largest of the Cook Inlet nonprofits with more than 2,500 employees working in more than 80 programs, according to the foundation’s website.
In 1984, it signed a compact agreement under public law to provide dentistry, optometry, a community health representative and injury control services. Substance abuse treatment was added in 1987.
By 1994, the foundation had increased its capacity and was providing nearly half the primary care services for Alaska Native people in the Anchorage region. In 1997, it took over ownership and management of the Anchorage Native Primary Care Center.
In 1999, under an agreement with the Alaska Native Tribal Health Consortium, it took over joint ownership and management of the Alaska Native Medical Center, which includes a 173-bed hospital and serves the entire Alaska Native and Indigenous population in the state, estimated at more than 100,000.
Typically, the foundation manages the clinics and outpatient services while the consortium manages the in-patient services. The clients are known not as patients, but as customer-owners.
It is one of nearly 40 tribal health organizations in Alaska, according to the Indian Health Service web page, though there is some overlap, as with Southcentral Foundation, Cook Inlet Tribal Council, and Alaska Native Tribal Health Consortium.
Among the special services provided by Southcentral Foundation are about 80 support groups, or learning circles, that provide both in-person and virtual learning opportunities to support and strengthen the community, said Bobbi Outten, director of the foundation’s Family Wellness Warriors.
The family wellness program was given the Dena’ina name, Nu’iju, which means “returning to our true selves.”
The program is grounded in a conceptual model that recognizes the impact of trauma on all dimensions of health and recognizes that healing, a return to our true self, is possible.
The system is different from other health-care providers in several ways. They call it the Nuka System of Care, where customer-owners play a significant role in their health care as active participants, from the wellness services they seek to the way they care for themselves at home. The foundation uses feedback to support and drive significant decisions.
The care teams work to identify gaps in services, lead improvement initiatives, and customize services.
The Family Wellness Warriors use the strengths and values of Alaska Native and Indigenous culture to build healing relationships, community connection and resiliency to trauma. The program partners most often with primary care, behavioral health services, traditional healing, health education, the learning institute and the development center.
Drums, beads and sewing
The learning circles are a core part of the foundation’s missions.
The circles bring small groups of people together to talk, share stories and learn from each other in hopes of achieving physical, mental, emotional and spiritual wellness, officials said.
The learning circles include cultural activities such as Alaska Native dancing and song groups, beadworking, sewing, picking berries and potlucks. The Learning Circle schedule is extensive, covering a broad range of groups.
“As far as learning circles, they all utilized the cultural approach of circles and bringing people together from all walks of life,” said Dustin Bergerson, a citizen of the Cherokee Nation and a clinical supervisor for the foundation.
The circles are driven by peer leaders who are there not to provide counseling services but a non-hierarchical setting for the groups.
“We have a learning circle called Community in Connection,” Bergerson said. “That’s where people just come in to talk about what’s going on in their week or their day to find community support, because we know with COVID and there’s been a lot of isolation. This was developed to find a way to build community as we recognize that is a huge part of the Alaska Native and Native American Indian cultural aspects.”
Lu Anne Haukaas Lopez, who is Lakota and Chibcha, is the senior learning and development advisor at the foundation.
A recent learning circle, called Men’s Cultural Drum Making, was operated through a partnership with the foundation and Covenant House Alaska. They were able to include youths who had experienced homelessness, she said.
“One of the comments that came out of that was from a young man who is a customer-owner from the village in the Yukon area,” she said. “He commented that his Indigeneity, his identity, was something that he saw as more of a drawback, something that he might get picked on and that he wanted to hide and not express.
“But being in this circle and making a Yup’ik drum, and drumming, learning music, songs, and singing, he felt the same pride and identity that he felt as a child in his home village.”
‘A sense of pride’
The system marks a move from being managed for Alaska Native and Indigenous people to a policy that respects self-determination.
The health care services are provided to federally recognized tribes, as established by treaties through the special government-to-government relationships between the federal government and tribes.
Customer-owners who receive care pay nothing except for elective costs outside of the typical services.
The system is working for Andrews.
“I think that our health care system really does a good job at recognizing the beauty behind our Alaska Native cultures,” Andrews said. “You can see it expressed in so many ways. Like, during the opening of events with song and dance ceremonies. I think that SCF really embraces the beauty of our cultures.
“When you recognize yourself in your own health care, it makes you want to do better and pursue better health,” she said. “It gives you that sense of pride, and you know who you are.”
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