Health News & Notes - Fall 2022 - Chronic Disease

Chair’s Notes

Nickolas D. Lewis Lummi Nation NPAIHB Chairman

Welcome everyone as we continue to pull together. Since July we have come a long way in physical, spiritual, emotional and virtual space. This time period is special as we uplift the 50 years since the board began in 1972. This time of reflection and honor of how far we’ve come together reminds us of our ongoing collective leadership across the Northwest Tribes, the advocacy of tribal leaders and community members that have helped guide the health and wellness along this period—truly a time to celebrate! As was mentioned during this year’s Dancing in the Square American Indian Day celebration: retaining, practicing and sharing cultural values and traditions maintain the health and well-being of American Indians/Alaska Native people. In this light, we continue to recognize the importance of reconnecting community and culture as we move forward.

When we last connected in July, we were busy advocating in different spaces including Washington, DC. We again were able to travel during the recent NIHB Conference in September where we advocated on the healthcare priorities of our communities – from supporting funding for dental health aide therapy education, addressing Indian Health Service funding to prioritizing the role of contract support costs in our tribal health programs. During this trip, we also had the opportunity to connect with other NW tribal leaders who were able to accompany the NPAIHB delegation into visits with Hill staff.

Publication of The Northwest Portland Area Indian Health Board

Chair’s Notes

Index Board & Staff

Indian Health Litigation Report Western Tribal Diabetes Project WTDP and The Native Fitness Youth Tour

Indian Day: Dancing In The Square

Enhancing Race and Ethnicity Data Collection and Reporting in State and Federal Public Health Monitoring Systems

Snag Bags New Faces

Off The Clock

BOARD & STAFF

EXECUTIVE COMMITTEE MEMBERS

Nickolaus D. Lewis, Chairman, Lummi Nation

Cheryle Kennedy, Vice Chair, Greg Abrahamson, Secretary, Spokane Tribe

Nate Tyler, Treasurer, Makah

Kim Thompson, Sergeant-At-Arms, Shoalwater Bay Tribe

DELEGATES

Twila Teeman, Burns Paiute Tribe

Denise Ross, Chehalis Tribe

Gene H. James, Coeur d’Alene Tribe

Andy Joseph, Jr., Colville Tribe

Illiana Montiel, Coos, Lower Umpqua & Siuslaw Tribes

Eric Metcalf, Coquille Tribe

Sharon Stanphill, Cow Creek Tribe

Michael Watkins, Cowlitz Tribe

Cheryle Kennedy, Grand Ronde Tribe

Lisa Martinez, Hoh Tribe

Brent Simcosky, Jamestown S’Klallam Tribe

Darren Holmes, Kalispel Tribe

Chanda Yates, Klamath Tribe

Angela Cooper, Kootenai Tribe

Francis Charles, Lower Elwha S’Klallam Tribe

Nickolaus D. Lewis, Lummi Nation

Nate Tyler, Makah Tribe

Jaison Elkins, Muckleshoot Tribe

Rachel Edwards, Nez Perce Tribe

Vacant, Nisqually Tribe

Lona Johnson, Nooksack Tribe

Hunter Timbimboo, NW Band of Shoshone Indians

Jolene George, Port Gamble S’Klallam Tribe

Herman Dillion, Puyallup Tribe

Douglas Woodruff, Jr., Quileute Tribe

Noreen Underwood, Quinault Nation

Dana Matthews, Samish Tribe

Tempest Dawson, Sauk-Suiattle Tribe

Kim Coombs, Shoalwater Bay Tribe

Sunny Stone, Shoshone-Bannock Tribes

Selene Rilatos, Siletz Tribe

Denese LaClair, Skokomish Tribe

Robert de los Angeles, Snoqualmie

Greg Abrahamson, Spokane Tribe

Kay Culbertson, Squaxin Island

Vacant, Stillaguamish Tribe

Steve Kutz, Suquamish Tribe

J.J. Wilbur, Swinomish Tribe

Teri Gobin, Tulalip Tribe

Althea Wolf, Umatilla Tribe

Marilyn Scott, Upper Skagit Tribe

E. Austin Greene, Warm Springs

Charlene Tillequots, Yakama Nation

ADMINISTRATION

Laura Platero, Executive Director

Sue Steward, Deputy Director

Patrick Greener, Ops Director

Andra Wagner, Human Resources Manager

Reshell Livingston, HR Assistant

Kadi White, Grants Management Specialist

Katherine Gorell, Grants Mngt Specialist

Tammy Cranmore, Finance Director

Mike Feroglia, Business Manager

Chelsea Jensen, Compliance Manager

Jackie Curtis, Accounts Payable

Olivia McPherson, Purchasing/Travel Agent

Michelle Harris, Accounts Receivable Specialist

James Fry, Information Technology Director

Jamie Alongi, IT Network Administrator

Katie Johnson, EHR Integrated Care Coordinator

Jonas Greene, Communications Director

Kira Rea, Communications Specialist

Roger Petersen, Website Adm & Design

LEGISLATIVE AND POLICY

Candice Jimenez, Health Policy Specialist

Liz Coronado, Senior Policy Advisor

Catherine Stensgar, Executive and Comms. Coordinator

ENVIRONMENTAL AND PUBLIC HEALTH

Celeste Davis, Environmental Public Health Director

Antoinette Ruiz, Environmental Health Specialist

Mathew Ellis, Institutional Environmental Health Manager

Holly Thompson-Duffy, Environmental Health Science Manager

Lela Rainey Brown, Environmental Health Specialist

Nicole Smith, EH Informatics Specialist

Melino Gianotti, Emergency Management Coordinator

Ryan Sealy, Environmental PH Project Scientist

Shawn Blackshear, Senior Environmental Health Specialist

NORTHWEST TRIBAL EPIDEMIOLOGY CENTER STAFF

Victoria Warren-Mears, Director

Alyssa Farrow, Special Projects Coordinator

Ashley Hoover, Communicable Disease Epidemiologist

Ashley Thomas, NW NARCH Senior Program Manager

Asia Brown, Sexual Health Communications Specialist

Birdie Wermy, Behavioral Health Manager

Bridget Canniff, PHIT Project Director

Celena Ghost Dog, WYSH Project Manager

Chandra Wilson, Tobacco/BOLD Program Manager

Clarice Charging, NWTEC Project Coordinator

Colbie Caughlan, RC/THRIVE/TOR Projects Director

Danica Brown, Behavioral Health Program Director

David Stephens, ECHO Clinical Director

Dolores Jimerson, BH Clinical Supervisor

Don Head, WTD Project Specialist

Eitan Bornstein, EIS Officer

Erik Kakuska, WTD Project Specialist

Grazia Cunningham, NARCH Project Manager

Heidi Lovejoy, NWTEC Substance Use Epidemiologist

Itai Jeffries, Paths (Re)Membered Manager

Jane Manthei, HNY Outreach Specialist

Jessica Rienstra, ECHO RN Case Manager

Jessica Leston, HIV/HCV/STI Clinical Services Project Director

Joshua Smith, Health Communications & Evaluation Specialist

Karin Dean, Behavioral Health Coordinator

Karuna Tirumala, IDEA-NW Biostatistician

Katie Johnston, Paths(Re)Membered Coordinator

Kerri Lopez, WTDP, NTCCP & BOLD Director

Larissa Molina, TOR Project Specialist

Maleah Nore, THRIVE Project Coordinator

Meena Patil, MV Biostatistician

Megan Woodbury, ECHO Project Coordinator Michelle Singer, HNY Project Manager

Morgan Scott, CDC PHAP (Public Health Associate)

Nancy Bennett, WA Tribal PH Improvement Mgr. Naomi Jacobson, Training and Outreach Manager

Nick Cushman, ECHO Pharmacy Case Manager

Nicole Smith, Senior Biostatistician 1

Olivia Whiting-Tovar, TIPCAP IPP Project Coordinator

Reshell Livingston, Asthma Project Coord.

Shoshoni Walker, TEC-IVAC Project Manager

Sonya Oberly, CDC Foundation Employee

Stephanie Craig Rushing, PRT, MSPI, Project Director

Sujata Joshi, IDEA-NW Project Director

Tam Lutz, Maternal Child Health Programs Director Ticey Mason, NTDSC Director

Tom Becker, NW NARCH Project Director & Medical Epidemiologist

Tom Weiser, PAIHS, Medical Epidemiologist, assigned to NWTEC

Tommy Ghost Dog, Jr., WeRNative Project Coordinator

Torrie Eagle Staff, Cancer Project Manager

Tyanne Conner, Native Boost Project Coordinator

Valerie Gaede, PHIT Project Assistant

ENPAIHB PROJECT STAFF

Christina Friedt Peters, TCHP Project Director

Carrie Sampson-Samuels, CHAP Project Director

Kaitlyn Hunsberger, BHA Student Support Coordinator

Sasha Jones, CHAP Project Manager

Laura Palomo, NDTI Project Coordinator

Sarah Cook-Lalari, BHA Project Director Miranda Davis, NDTI Project Director Pam Ready, DHA Education Manager

Lisa Griggs, TCHP Project Specialist

Chair’s NotesChair’s Notes (continued)

We want to uplift sharing these advocacy experiences together. Taking the time to listen to the priorities of more tribes helps us to go forward in creating strategies that are reflective of the broader NW tribes’ unique experiences including addressing this articles topic centered on chronic disease. Additionally, as we continue this work across the Portland Area and with national partner organizations, we want to continually seek feedback to how we can empower our people to be a part of the solution starting with the youth delegates to our seasoned tribal leaders.

This month’s issue of Health News and Notes is focused on chronic disease. In that light I encourage everyone to continue connecting culture and history to promote long-term health along the life continuum; from the new babies to elders. At the NPAIHB, there continue to be programs like the WEAVE-NW, the Western Tribal Diabetes Project (WTDP), the Northwest Tribal Comprehensive Cancer Project among many others at the NW Tribal Epidemiology Center, which focus on health promotion and disease prevention to uplift the health of all generations

Our ancestors have persevered and we can, too. They are walking with us and beside us. And, will continue to guide us for the generations to come.

Hy’shqe, Nickolaus D. Lewis

Lummi Nation

Chair, Northwest Portland Area Indian Health Board Secretary, Lummi Indian Business Council

NPAIHB Chair Nickolaus Lewis with Laura Platero, Councilman Nate Tyler, Norma Wadsworth, Taiitum DeGarmo, Kay Culbertson, Councilwoman Charlene Tillequots, Tempest Dawson, Sarah Grey, Councilman Wilson Wewa, and Councilman Andy Joseph

Indian Health Litigation Update

Major Developments in National Opioid Litigation

Four major settlements—including two tribal settlements—announced this year in the context of the sprawling national opioid litigation are expected to bring hundreds of millions of dollars in funding to help ameliorate the opioid crisis in Indian Country. Tribes will also see additional money set aside as part of the funds intended for public creditors in bankruptcy proceedings involving a separate manufacturer defendant. Meanwhile, some litigation continues against remaining defendants in courts around the country, although settlements are increasing in number. And, the company that started it all—Purdue Pharma—awaits the Second Circuit’s approval or rejection of its bankruptcy and settlement plans.

Johnson & Johnson, a major manufacturer of prescription opioids, and Big Three distributors AmerisourceBergen, McKesson Corporation, and Cardinal Health, reached tentative settlement agreements with tribal plaintiffs in the opioid litigation earlier this year. Johnson & Johnson agreed to pay $150 million to settle all tribal claims against it, to be distributed over two payments, while the three distributors agreed to pay nearly $440 million to settle all tribal claims against them, to be distributed over six annual payments. The Johnson & Johnson Tribal Settlement has been finalized, and the Distributors Tribal Settlement is expected to be finalized and implemented in the near future.

All federally recognized Tribes and Alaska tribal health organizations are eligible to participate in both settlements. Many Tribes and tribal organizations have already opted into the settlements, and those that have not will have three years from the effective date of the Johnson & Johnson settlement, and four years from the effective date of the Distributor settlement, to opt in. (However, the sooner a tribe opts in, the sooner it can begin receiving settlement distributions.) As these settlements are finalized, the defendants are expected to pay into the Opioid Trusts set up to administer the funds— known as the Tribal Abatement Fund Trusts (TAFTs). Be on the lookout for communications from the TAFT Trustees: Kevin Washburn, Kathy Hannan, and Mary Smith. A separate process to finalize the allocation formula for settlement funds will be carried out by court-appointed Special Master David Cohen and former federal judge Layn Phillips.

In late July 2022, Teva Pharmaceuticals and Allergan also announced tentative global settlement agreements with Tribes, states, and local governments. Teva is expected to pay up to $4.25 billion over thirteen years, with an expected $119 million for Indian Country. Allergan is expected to pay up to $2.37 billion over six years. The tribal share of the Allergan settlement is not known at this time. Both settlements are still in their early stages, but are expected to be administered through the use of TAFTs like with Johnson & Johnson and the Big Three Distributors.

Other Cases

Despite the settlements, litigation continues around the country. The Cherokee Nation bellwether case now continues against two major pharmacy chains in state court after the Cherokee Nation announced on October 5, 2022 that it has reached a settlement with Walmart. CVS and Walgreens remain parties to the case. Several states also continue to pursue litigation outside of the federal multidistrict litigation. Further, generics manufacturers Teva Pharmaceuticals and Anda Inc. will soon face a damages trial after a New York jury found the manufacturers liable for creating a public nuisance in Suffolk and Nassau Counties. The New York Attorney General also recently alleged in that matter that Teva made intentional misrepresentations to the Attorney General and the court. Companies like Johnson & Johnson, Rite Aid, Walgreens, and the Distributors, also continue to reach settlements to avoid disposition at trial.

Geoff Strommer

Hobbs, Straus, Dean & Walker, LLP

Proposed Settlements with Johnson & Johnson, Big Three Distributors, Teva Pharmaceuticals, and Allergan

Indian Health Litigation Update (continued)

Bankruptcy Proceedings: Mallinckrodt & Purdue

Courts have finally approved a bankruptcy plan proposed by Mallinckrodt Pharmaceuticals, a major manufacturer of generic prescription opioids. The Mallinckrodt plan would create a $1.75 billion opioid abatement trust, from which tribal claimants would receive approximately three percent (3%) of dedicated government abatement funds. The plan reached its Effective Date on June 16, 2022. For ease of administration, Mallinckrodt is likely to begin payments into the TAFTs following the finalization of the Johnson & Johnson and Distributor Settlements, which will be managed through a similar process. The total payout to Tribes is expected to be in the $20-30 million range, over approximately eight years.

Although Mallinckrodt is the first tribal opioid settlement to become fully effective, Purdue Pharma—the manufacturer of OxyContin—was the first opioid Defendant to declare bankruptcy. Its proposed bankruptcy plan was initially approved by the federal bankruptcy court, but in December of 2021, U.S. Federal District Court Judge Colleen McMahon reversed the approval. Among other things, that plan would have created multiple opioid abatement trusts for state, local, and tribal governments using a $4.3 billion cash contribution from members of the Sackler family (the shareholders of Purdue) and other company assets. Judge McMahon’s reversal of the plan was based on her holding that the civil liability releases that were negotiated by the Sackler family in exchange for their cash contribution to the plan are not authorized by the bankruptcy code. That reversal decision has been appealed to the Second Circuit, where the parties are still awaiting a decision. Subsequently, Purdue and the objecting states reached a new agreement that would increase the Sackler family contribution up to $5.5 billion—but implementation of that agreement still hinges on the Second Circuit’s ruling, which is expected to be released sometime this summer.

Additionally, Endo International filed for bankruptcy in August 2022. Tribes are expected to get a share of the total settlement amount, currently estimated to be $465 million.

McKinsey MDL

On February 4, 2022, global consulting firm McKinsey & Co. announced a $573 million settlement with the Attorneys General of 47 states, the District of Columbia, and 5 territories. Thereafter, hundreds of local subdivisions and tribal governments brought suit against McKinsey as well, alleging that it played a key role in the development and implementation of the fraudulent and misleading marketing practices that led to the opioid epidemic through its work with clients like Purdue Pharma and Endo Pharmaceuticals. That case is still in the relatively early stages of discovery.

McKinsey has nevertheless been the subject of a number of recent news articles addressing McKinsey’s role as a consultant for the Food & Drug Administration (FDA) while the FDA was meant to be formulating regulations for opioids, and detailing reports that McKinsey used its experience leading the FDA’s opioid regulation discussions to better solicit McKinsey’s opioid clients for business, based on the firm’s contacts and experience with the industry regulator.

Settlement Updates Available on Public Website

As the opioid litigation continues, Tribes and members of the public can obtain updated information about tribal specific settlements on the public tribal settlement website, https://www.tribalopioidsettlements.com. You are encouraged to check the website frequently, and use the “Contact Us” links for any questions, including questions for the court-appointed Trustees of the tribal settlements.

Contract Support Cost Legislative Fix and Third-Party Revenue Claims

A major issue being litigated is whether the Indian Health Service (IHS) owes contract support costs (CSC) for health care services funded by third-party revenues that Tribes generate under their Indian Self-Determination and Education Assistance Act (ISDEAA) agreements with IHS. The additional services made possible by the collection and expenditure of third-party revenues—or what the ISDEAA refers to as “program income”—require tribal providers to incur additional administrative and overhead costs that meet the definition of CSC. In the 2016 Sage Memorial decision, a federal court

Indian Health Litigation Update (continued)

In the 2016 Sage Memorial decision, a federal court in New Mexico ruled that program income expended on additional services is part of the “federal program” entitled to CSC under the ISDEAA. Since then, however, all courts to address the issue have sided with IHS, holding that only funds appropriated to IHS and transferred in the ISDEAA agreement generate CSC requirements. Two of those cases are on appeal: the San Carlos Apache case in the Ninth Circuit, and the Northern Arapaho Tribe case in the Tenth Circuit. The Northwest Portland Area Indian Health Board signed onto amicus briefs supporting the Tribes in both of these appeals. Oral argument in Northern Arapaho took place on January 19, 2022, and the San Carlos argument took place on March 7. Decisions could come any day. If either appeal is successful, it would create a conflict with the D.C. Circuit, which ruled against the Swinomish Indian Tribal Community last year. Such a “circuit split” would increase the odds of the Supreme Court granting a petition to decide the issue. In the meantime, several similar cases have been filed in the lower courts, some of which are on hold pending the appeals.

A recent court decision has thrown into question the very definition of CSC. In Cook Inlet Tribal Council, Inc. v. Dotomain, the D.C. Circuit Court of Appeals held that any costs associated with activities IHS normally carries out in direct service must be funded (if at all) through the Secretarial amount and are not eligible to be paid as CSC. Since most costs currently reimbursed as CSC are also incurred by IHS when it operates programs directly, this ruling has the potential to drastically reduce CSC payments—as demonstrated in a recent IHS decision cutting the Fort Defiance Indian Hospital’s CSC by almost 90%, from $18,515,007 to $1,887,739. The Hospital has challenged that decision in court, and in June won a preliminary injunction restoring full payment on a prorated monthly basis until the litigation is resolved.

In the meantime, tribal advocates have been working toward a legislative fix to overturn the Cook Inlet decision. On April 8, 2022, Rep. Tom Cole (R-OK) introduced H.R. 7455, the “IHS Contract Support Cost Amendment Act.” The bill would make simple technical amendments to the ISDEAA to essentially overturn the Cook Inlet decision and clarify that administrative and overhead costs normally incurred by IHS (or BIA) but not fully paid in the Secretarial amount can be paid as CSC. This would restore the status quo, not expand the CSC entitlement. The bill has a long, bipartisan list of cosponsors but has stalled in the House Committee on Natural Resources.

JUUL Litigation

In ongoing JUUL multi-district litigation (MDL), tribal governments are seeking to hold defendants Altria Group and JUUL Labs, Inc., along with several of JUUL’s executives (Defendants), liable for their role in defrauding tribal communities and creating an e-cigarette epidemic among tribal citizens, particularly tribal youth. To this end, Tribes and tribal organizations have filed Tribal Complaints which set forth violations of the Racketeer Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. § 1961, et seq., in addition to state public nuisance, negligence, and consumer protection law claims.

Specifically, the Tribal Complaints allege that Defendants knowingly or negligently marketed and promoted JUUL products to the Tribes within geographic areas controlled and occupied by the Tribes and that Defendants specifically and deceptively targeted American Indian and Alaska Native (AI/AN) communities with their highly addictive and damaging products. The Complaints uniformly allege that Defendants’ misconduct led to a vaping epidemic within AI/AN communities, resulting in very disproportionate negative impacts on Native American people. The Tribal Complaints seek equitable relief; injunctive relief; abatement; and statutory, exemplary, and compensatory damages.

Each party was allowed to select one Bellwether Tribal Plaintiff, in addition to a proposed Bellwether Tribal candidate for the Court’s consideration as a third Bellwether Tribal Plaintiff. As their designated first choice for the Bellwether Tribal Plaintiff case, Plaintiffs selected Fond du Lac Band of Lake Superior Chippewa v. Juul Labs, Inc., No. 3:20-cv-03995. Defendants designated as their first choice for Bellwether Tribal Plaintiff Klamath Tribes v. Juul Labs, Inc., Case No. 3:20-cv03987. On May 9, 2022, Judge Orrick determined that Defendants’ proposed candidate, the Cheyenne and Arapaho Tribes of Oklahoma (MDL Member Case No. 3:21-cv-05134), would be the third Bellwether Tribal Plaintiff.

Pursuant to the Court’s January 24, 2022 Order Entering Parties’ Proposed Tribal Case Schedule and Bellwether Selection Process (Doc. 2794), discovery continues for the three Bellwether Tribal Plaintiffs. Case-specific fact discovery in the Bellwether Tribal cases closes on March 6, 2023.

Indian Health Litigation Update (continued)

Haaland v. Brackeen U.S. Supreme Court Case

The Supreme Court is poised to hear oral arguments in a closely watched case, Haaland v. Brackeen, challenging the constitutionality of the Indian Child Welfare Act (ICWA). The case was originally brought in the Northern District of Texas by non-Indian families seeking to foster or adopt Indian children, an Indian mother seeking to facilitate the adoption of her Indian child by a non-Indian family, and the State of Texas. In the district court, the Plaintiffs argued that ICWA is unconstitutional on a number of grounds: 1) that ICWA unconstitutionally “commandeers” state governments to enforce federal law; 2) that ICWA improperly delegates Congressional lawmaking authority to Tribes; and 3) that ICWA violates Constitutional equal protection requirements by discriminating on the basis of race.

The District Court for the Northern District of Texas found ICWA unconstitutional, and the case rose to the Fifth Circuit Court of Appeals. A three-judge panel of the Fifth Circuit reversed the decision by the District Court, concluding that ICWA is based on political status and not race, and is not otherwise unconstitutional. However, the full Fifth Circuit later reconsidered the case en banc. The en banc Court of Appeals held that Congress has the authority to enact ICWA generally, and a majority agreed that ICWA’s definition of “Indian child” legislates on the basis of political status, not race. However, the 325-page decision reflected no majority opinion on a number of issues, and various aspects of the ICWA were thus deemed unconstitutional—including its placement preferences for adoption and foster care. Both Plaintiffs and Defendants petitioned the Supreme Court for a writ of certiorari following the en banc decision, and all four petitions were granted on February 28, 2022.

In their briefs before the Supreme Court, Texas and the Individual Plaintiffs doubled down on their arguments that the “Indian child” classification, as well as the placement preferences, discriminate on the basis of race and therefore violate the equal protection requirements of the U.S. Constitution. They also argued more broadly that Congress has only limited powers to enact legislation for the benefit of American Indian and Alaska Native tribes and people, arguing that the federal government’s powers are limited to enforcing treaty provisions and matters of trade or commerce as defined by the Indian Commerce Clause. The arguments reflect a radical departure from the Supreme Court’s centuries-old understanding of the scope of federal authority to act for and on behalf of American Indian and Alaska Native tribes and individuals, and as a result, the impacts of a decision in this case could extend well beyond ICWA itself.

Briefing before the Supreme Court has now concluded. Due to widespread interest in this case and its far-reaching implications for Tribes and Tribal organizations, hundreds of Tribes and several tribal and non-tribal organizations filed amicus briefs defending ICWA. A smaller number of amicus briefs were filed in support of Petitioners, Texas and the Individual Plaintiffs. The Supreme Court has scheduled arguments in the case for November 9, 2022, and will likely issue its decision after the new year.

Western Tribal Diabetes Project Activities Update

Dondi Head (he/him) WTDP Specialist

Western Tribal Diabetes Project Activities Update

This last spring, the Western Tribal Diabetes Project has sponsored training on the Diabetes Prevention Program (DPP) for Northwest Tribes. The DPP is an evidence-based program that introduces cost-effective interventions that help prevent the onset of diabetes. WTDP contracted with the Emory Centers’ Diabetes Training and Technical Assistance Center (DTTAC) to provide this training to interested tribal personnel in two different sessions in May 2022. More training can be offered if there is further interest in getting tribal personnel trained by a Master Trainer at the DTTAC. For more information, please contact the WTDP by emailing wtdp@npaihb.org

WTDP is also working with the Washington Department of Health (WA DOH) to determine the interest in and need of diabetes educational programs like the aforementioned DPP, the Wisdom Warriors curriculum, and other approved Diabetes Self-Management Education programs. WTDP has contacted several tribes in Washington to administer an assessment survey that was designed to determine this interest, although we need to contact several more for the most accurate picture of what the tribes want. The WA DOH has indicated that they are ready to provide resources and technical assistance to interested tribes and tribal organizations in getting accredited and reimbursed for their activities.

Going forward, the WTDP is planning a meeting with interested tribes and tribal organizations identified by the assessment survey. This proposed meeting will introduce and address obstacles and challenges to offering a diabetes educational curriculum, and also to hear from programs already running those curricula about their successes. Personnel from the WA DOH will also be in attendance, for technical support and collaboration. For more information on the Washington Tribes’ assessment survey, please contact wtdp@npaihb.org.

The 2022 Annual Diabetes Care and Outcomes Audit data will be released soon, and the WTDP will once more offer the Diabetes Health Status Report that shows data trends for each of the programs that submitted an Audit, and compares that data to the Portland Area as a whole. This year, the Diabetes HSR will undergo some changes, as some indicators will be making a reemergence, and the design of the charted data will be updated. The substance of the report, though, will remain the same: tribal data returned to the tribe. For more information on the Diabetes Health Status Report, please contact wtdp@npaihb.org

The Diabetes Extension for Community Health Outcomes (ECHO) is continuing into its third year this fall with more difficult diabetes patient case studies and helpful didactic presentations worth continuing education credits. The Diabetes ECHO meets every month, on the second Thursday at 1200p Pacific Time over the Zoom platform. For more information on Diabetes ECHO, please contact wtdp@npaihb.org.

And, as always, the WTDP offers Resource and Patient Management System technical assistance and training. The next Diabetes Management System training is scheduled for December 6-8, 2022, and will be an in-person training for the first time since December 2019! Interested participants will need to be vaccinated in order to attend training at the Northwest Portland Area Indian Health Board, and space is limited, although Northwest Tribal organizations will be given priority. For more information on the DMS training, please contact us at wtdp@npaihb.org.

WTDP and The Native Fitness Youth Tour

Erik Kakuska Zuni Pueblo WTD Project Specialist

With so many projects and activities happening here at the NW Portland Area Indian Health Board, it’s hard to hear about all the good being done in the Pacific NW.

Rather than writing statistics about the Chronic Disease of Diabetes, the Western Tribal Diabetes Project (WTDP) would like to talk to you about the many preventive trainings done throughout the year.

If you are unfamiliar with the WTDP, here’s a history lesson; The WTDP came to fruition through tribal consultation with IHS and the Northwest Tribes. Congress established the Special Diabetes Program for Indians (SDPI) in 1997, the Northwest Tribes recognized the need for technical assistance for diabetes data. Congress included a data set-aside of 5% of Area funding for technical assistance, and the Northwest Tribes elected to pool that funding to create the WTDP. The WTDP’s goal is to assist our NW Tribes by tracking and reporting accurate health data. The information is used to improve the quality of patient care. The WTDP is also available to gain additional resources, and to plan effective intervention programs and activities.

With the 2023 SDPI application already closed and submitted, the diabetes programs in the Northwest can once more concentrate on their activities, rather than worry about how they’ll receive those funds. And speaking of activities…

…Our most recent activity was a program created/inspired from by our annual Native Fitness events held at the Nike World Headquarters in Beaverton, OR. The program, called the Native Fitness Youth Tour was in collaboration with the Native American Fitness Council (NAFC) out of Flagstaff, AZ.

Four tribal diabetes programs in the NW (Coeur d’Alene, Tulalip, Suquamish, and Chiloquin) were selected to participate in WTDP’s first Native Fitness Youth Tour this past summer. The Youth Tour is a two-day event with youth ranging from ages 7-16 years old.

WTDP and The Native Fitness Youth Tour (cont.)

The youth were able to participate in a slew of exercise games such as Shiny (a Great Plains version of field hockey ), Kick Stick (a SW tribes game), Popé’s Run, Eskimo Olympics, and others.

Each host site worked alongside their diabetes care and prevention teams, youth services and wellness centers to insure a smooth event for community youth. The goal of the Native Fitness Youth Tour is not only to teach youth about functionality and proper form, but to hopefully spark or ignite a future leader within their community. We thank the Tribal Hosts for your hospitality, gratitude and partnership.

Indian Day: Dancing in the Square

Kira Rea Cherokee Nation of Oklahoma Communications Specialist

On September 30, 2022 – Northwest Portland Area Indian Health Board returned to some familiar activities – hosting the 15th annual Indian Day Dancing in the Square celebration after a two-year hiatus. Showcasing NPAIHB’s 50 years of Indian Leadership for Indian Health was a series of our own programs and projects including stalls by We R Native; THRIVE; Native CARS; Native Boost; Northwest Tribal Comprehensive Cancer Project and more!

Established in 1972, the NPAIHB has long been the gold-standard of tribal public health advocacy; introducing the first Tribal Epicenter in the United States in 1972. Portland area is home to the ninth largest Urban Indian population with NPAIHB supporting public and environmental health research and resources for more than 300,000 Tribal citizens across Oregon, Washington, and Idaho.

American Indian/Alaska Native peoples have been disproportionately affected by the COVID-19 pandemic. Emerging in early 2020, the virus quickly ravaged the American Healthcare system, putting its most intense strain upon Indian Country public health services and resources. For American Indian/Alaska Native populations, this unprecedented attack had greatest implications. During this time however, NPAIHB greatly expanded its resources and staff and program funding; adding more than 60 staff to our roster.

Indian Day: Dancing in the Square (continued)

Northwest Portland Area Indian health Board was joined by volunteer staff from Native American Rehabilitation Association (NARA) who distributed Narcan packs to attendees throughout the day. According to Centers for Disease Control (CDC), AI/AN peoples consistently face the highest opioid drug overdose death rates of any ethnic group in the United States.

Future Generations Collaborative also joined us on site with a free vaccine clinic – over 30 flu shots and more than 75 COVID vaccines and boosters were administered! More than 500 individuals from our Native communities and non-Native neighbors attended the event. That’s roughly one in 5 attendees receiving some form of immunization; a testament to the drive of Native communities. Statistics show AN/AN individuals make up the highest vaccinated ethnic population against the coronavirus. Around 75% of eligible Natives are partially vaccinated while more than 50% are fully vaccinated.

Dancing in the Square also fell on National Day of Remembrance for U.S. Boarding School Victims – also known as Orange Shirt Day – which brings awareness to the systemic and historical trauma which continues to affect Indian Country today. In which tens of thousands of Canadian First Nations and American Indian/Alaska Natives faced cultural genocide in state-run religious-based boarding schools.

The NPAIHB’s goal was to incorporate all of these elements into a single day of recognition and celebration, which would not have been possible without the support of our many sponsors, volunteers, and partners who joined us for the mutual goal of improving the health of Native peoples.

Enhancing Race and Ethnicity Data Collection and Reporting in State and Federal Public Health Monitoring Systems

Sujata Joshi, MSPH IDEA-NW Project Director

Ashley Hoover, MPH HIV Program Manager

Co-Authors:

Sara Chang, MPH, Kahuina Consulting

Sarah Scott, MSPH, Kahuina Consulting

Charlie Ishikawa, MSPH, Kahuina Consulting

Dan Chaput, MM, Kahuina Consulting

Marcus Rennick, MPH, Kahuina Consulting

Background

Northwest Tribal leaders have long recognized the importance of accurate and reliable data to improve the health and well-being of Tribal communities. These data help Tribes understand threats to their communities’ health and allow Tribes and the Northwest Tribal Epidemiology Center (NWTEC) to advocate for resources, implement interventions, and monitor changes in health over time. Accurate data on Tribal communities, however, are often difficult to obtain from state and federal agencies that routinely collect public health data, in part because these systems do not consistently or accurately document race and ethnicity information for American Indian and Alaska Native (AI/AN) people. AI/AN people, for example, are often misclassified as White or other races in state and federal public health systems. In some systems, nearly 50% of AI/AN records have missing or incorrect race information. The COVID-19 pandemic, and its disproportionate effect on Tribal and urban AI/AN communities, highlighted the need for complete and reliable public health data and improved race and ethnicity data collection. Building on NWTEC’s 20 years of work advocating for improved data collection and access for Northwest Tribes and documenting, measuring, and correcting the misclassification of Northwest AI/AN people in state health monitoring systems, NWTEC launched the Enhancing Race and Ethnicity Data Collection and Reporting Practices project to understand and enhance race and ethnicity data collection and reporting practices in Idaho, Oregon, and Washington.

Approach

The project team, led by staff from Kahuina Consulting, developed and implemented a three-pronged mixed methods discovery approach. We started with a policy scan to document Tribal, state, and federal policies that affect race and ethnicity data collection and reporting. We then conducted a survey of Tribal and Indian Health Service clinics to understand practices related to race and ethnicity data collection and reporting for COVID-19 and other notifiable conditions. Lastly, we conducted key informant interviews with Tribal and state partners to better understand the context, best practices, facilitators, and barriers for collecting and reporting accurate race and ethnicity data. The project team used an appreciative inquiry process to examine the value of race and ethnicity data to Tribal and state partners and utilized a strengths- and assets-based perspective to highlight accomplishments and opportunities for improvement. We also utilized a sociotechnical framework (Figure 1) to frame our questions, analysis, and organization of findings and recommendations. This framework emphasizes the interrelatedness of social and technical systems within and across entities, articulates the role of broader environmental factors like policies and culture, and demonstrates the importance of optimizing various facets of a system to improve the functioning of the whole.

Enhancing Race and Ethnicity Data Collection and Reporting in State and Federal Public Health Monitoring Systems (continued)

Findings

Some of our key findings from this project include the following:

• Identity among American Indians and Alaska Natives is complex, nuanced, and political, and often isn’t adequately captured by race and ethnicity checkboxes in standardized data collection forms. As one key informant noted: “One can identify with their ancestral lineage, and even within that you can be a part of multiple Tribes. This is seen in the ways in which Tribal members introduce themselves, naming their ancestral lineage before introducing their own affiliation and self. When people introduce themselves, they talk about their parents and grandparents. They share the name they call themselves.”

• Race and ethnicity are social constructs inherently difficult to categorize and capture. Race and ethnicity have historically been key demographic elements in public health surveillance, driven in large part by the Federal funding behind many programs. Unfortunately, race and ethnicity are often used as a proxy for the real factors that result in health inequities, including structural racism, economic inequality, and historical injustice and trauma.

• The COVID-19 pandemic reiterated the importance of demographic data in developing and mounting effective public health responses. Pandemic-focused funding improved race and ethnicity data collection and reporting capacity in Idaho, Oregon, and Washington. As one key informant interview participant explained, “there was never any demand to look at immunization [data] until COVID-19 came along. We didn’t even have a field to store race and ethnicity information.”

• Federal standards drive how clinical systems, providers, and patients capture data, which often differ from Tribal and state expectations and needs. Few federal laws provide national-level guidance on the collection and reporting of race and ethnicity data, and federal categories for race and ethnicity are not granular enough to adequately capture the nuanced ways in which people identify.

• Tribal and state health agencies’ systems and staffing capacities influence their ability to collect and report data.

• The unique intergovernmental relationship between Tribal and state entities is broadly recognized by state employees, but can sometimes lead to confusion about authority, communication, and data sharing.

Enhancing Race and Ethnicity Data Collection and Reporting in State and Federal Public Health Monitoring Systems (continued)

Findings (continued)

• Historical trauma and mistrust of government affects agencies’ relationships and data collection and reporting. As described during an interview, “in the past, Tribes have not always ended up well in political and government situations and agreements, so now everything is done in writing. There is [some sensitivity] in the trust relationship.”

• Tribal health agencies lack granular, real-time data access.

• Patients and providers also influence the completeness and accuracy of race and ethnicity data. Some patients refuse to answer race and ethnicity questions. Some providers are not comfortable asking questions related to race and ethnicity or fear such questions are “tedious” and “annoy” patients.

Recommendations and Next Steps

To enhance the collection of race and ethnicity data to benefit Tribal communities, Tribal and state health representatives recommend:

Strengthening relationships and coordination among governmental health agencies, Standardizing and automating data collection and reporting, and Engaging providers and patients to improve race and ethnicity data completeness and accuracy.

The Northwest Tribal Epidemiology Center is committed to continue its work improving the completeness and accuracy of race and ethnicity data for Tribal communities. Based on the recommendations of this project, our next steps include sharing the project’s findings with our member Tribes, state health partners, and other public health collaborators. We will also facilitate opportunities to identify and address the public health data needs and priorities of member Tribes, including convening a regional meeting for NPAIHB staff and Tribal and state health partners to discuss data and surveillance priorities and identify opportunities for collaboration and capacity building.

The full report developed as part of this project can be accessed through this link. To learn more about this project, or the regional data meeting we are planning, please contact Sujata Joshi at sjoshi@npaihb.org.

Thank you to the Tribal, state, and NPAIHB partners who provided their time and input during this project. Thank you also to our project funders at the Centers for Disease Control and Prevention through cooperative agreement number NU38OT000255.

Snag Bags: Free Condoms for PNW Native Youth and Young Adults

Celena J. Ghost Dog, MPH She/Her Navajo WYSH Project Manager

Hooking up, teepee creeping, snagging, one-night stands, Netflix and chill – no matter what you call it, it’s always good to be sexually safe. The Washington Youth Sexual Health (WYSH) Project is looking out for Native youth with our Snag Bags.

Snag Bags are free condoms mailed directly and discreetly to a desired address. Snag Bags weaves popular Native sexual ideology while working within local ideals of shame to distribute condoms and safe sex materials to sexually active young people and adults (Gilley, 2006).

Frequently Asked Questions (FAQ):

• Do they cost anything?

No cost, they are FREE. However, supplies are limited (only 1 order per household/address).

• Who can order?

Indigenous youth/young adults living within the PNW region (Washington, Idaho, and Oregon).

• What if I’m not Native and/or not from the PNW?

Due to limited supply, we are only fulfilling requests for Indigenous youth/young adults in the PNW at this time.

Here are resources if you are outside our intended audience or reach:

Check out your local community, county, school, or nonprofit clinics and/or pharmacies (like planned parenthood) for availability of or guidance accessing free condoms, lube, etc. Visit: https://www.npaihb.org/wysh/

is in the

can

Snag Bags(continued)

• How will they arrive when I place an order?

◊ Packages will come in a non-descript manila envelope. Also, the name and address provided on the order form will be displayed on the address label.

**Please note: USPS will return the order if it does not match the legal address

• How long will it take to arrive?

◊ Orders will be delivered on a rolling basis through USPS. Therefore, please expect approx. 2 weeks delivery time.

• Can I cancel my order?

◊ Sure! If you’d like to cancel your order, email Asia Brown ambrown@npaihb.org with the name and address you used for your submission to cancel your order.

• Can I place a large bulk order? Such as for my school or community?

◊ Due to limited supply, packages are designed for individuals and NOT organizations at this time.

◊ If you are interested in a bulk order for your community, reach out to ambrown@npaihb. org and we can connect.

Contact Asia Brown at ambrown@npaihb.org

Text Sex to 94449: A text message service for Native youth and young adults designed to deliver sexual health information to prevent HIV/STIs. WeRNative – www.wernative.org

Internal Condom Instructions

demo: How do you use a condom?

How to Use an External Condom

Condom Shopping Guide

Text EMPOWER to 94449: A text message service is for parents and caring adults that offer culturally appropriate tips and resources, covering sexual health, pregnancy, STDs, and consent.

The Northwest Tribal Comprehensive Cancer Project

Torrie Eagle Staff Cheyenne River Sioux Tribe Cancer Project Manager

Our Tribal elders and health care planners clearly recognize the immense impact that cancer has in our tribes, and they have looked to the NPAIHB’s Northwest Tribal Comprehensive Cancer Project (NTCCP) for leadership in cancer prevention in Tribal communities. With Centers for Disease Control funding, our project has provided critical services for our constituent tribes for twenty-two years. As the first Tribal cancer control project in the CDC Comprehensive Cancer Control Project, we continue to set a high standard in delivering culturally appropriate services rooted within an Indigenous framework and governed by Tribal voice. There are now 7 tribally funded Comp Cancer Projects across the United States. This year we have been awarded comprehensive cancer funding for 5 more years.

NTCCP was the first program to develop a tribal comprehensive cancer plan, design a tribal behavioral risk factor survey, and collaborate with a wide network of partners including federal, state, academic, nonprofit, and private industry partners. The unique thing about the cancer plan is that the length of the plan is 20 years instead of 5 years in order to account for a whole generation and create a sustainable plan. Our mission in this plan is to envision and work toward cancer-free tribal communities by taking an integrated and coordinated approach to cancer control. In order to accomplish our mission, the NTCCP implements evidence-based interventions (EBIs) that align with the three priority areas of primary prevention, early detection and screening plus a focus on the health and wellbeing of cancer survivors. We seek to decrease cancer incidence and mortality, improve screening, increase community cancer education, reduce the time from appearance of symptoms and signs to diagnosis, improve treatment compliance, and lengthen cancer survivorship. The cancer focus areas that we cover are cervical cancer where our aim is to increase HPV vaccinations and increase screenings; Lung cancer where we aim to decrease adult smoking and youth who use commercial tobacco; Breast cancer and colorectal cancer which our aims are to increase mammogram and colorectal cancer screenings.

The NW Comprehensive Cancer Project (continued)

Our prevention program examples include smoke-free tribal housing policies, commercial tobacco cessation campaigns in tribal communities, youth summer camps where youth learn how to garden, cook traditional foods and the relationship between cancer and nutrition. Our detection programs include encouraging people to get their recommended cancer screenings in the clinic or receiving the HPV vaccine. We’ve assisted tribal clinics with improving their cancer screening programs, such as providing incentives for people to come in and get a mammography, or colonoscopy. We’ve helped clinics create HPV vaccine campaigns to encourage youth and their guardians to get the HPV vaccine. We always offer to set up Kiki the inflatable colon at events to share information about colorectal cancer and the importance of screening. Survivorship programs can include supporting community survivor groups, helping to educate survivors on how they can live well after cancer. Some of these examples with tribes include sending out cancer survivorship kits for survivors. We interviewed some cancer survivors asking what they thought was important to include in these kits, and we have them available at request. Lastly for survivorship, we developed an appointment companion for patients newly diagnosed with cancer to help them organize what is a very chaotic time in life. On top of three priorities areas, primary prevention, early detection, and screening, we also aimed to provide training for Tribal healthcare professionals in all of these areas. Our tobacco updates include bi-monthly calls, traditional tobacco summit, AI/AN Quitline promotion, tobacco cessation resources, and responses to tribal technical assistance needs.

Our most successful projects are local implementation funds provided to tribes to implement things on the cancer plan in a way that works best for them which include; fitness classes, community wellness gardens, breast cancer awareness walks, cancer survivor walks, wellness day and cancer information day for girls, increasing consumption of fresh produce, and providing gas vouchers for mammogram expenses.

What’s new with our cancer project is that we received an Oregon Health Authority contract on tribal tobacco prevention. We’ve partnered two National Cancer Institute 1-year pilot grants with the Knight Cancer Institute at the Oregon Health and Sciences University and Fred Hutch Cancer Center at University of Washington, where we target intergenerational evidence-based interventions and are creating an HPV toolkit for providers working with Indigenous communities. We’ve also partnered with NARA and OHA Screen Wise Program, OHSU Native medical students on various topics such as pancreatic, melanoma, CRC, and screening hesitancy. Other partnerships include immunize Oregon, Washington Department of Health, and Buffalo Nickel Creative.

Native American cancer data is different across regions of the U.S. and cannot be generalized. During 2013-2017, AI/ AN people in the Northwest Region (Idaho, Oregon, and Washington) had significantly lower rates of all invasive cancers compared to non-Hispanic Whites in the region. However, AI/AN people in the Northwest had significantly higher rates of colorectal and cervical cancer, and significantly lower rates of female breast and prostate cancer. Despite lower cancer incidence rates, AI/AN people in the Northwest experience higher cancer mortality rates compared to Non-Hispanic White people. During 2012-2016, AI/AN people had a 30% higher cancer mortality rate compared to NHW people. Cancer mortality rates have been decreasing for AI/AN and NHW people over the past decade.

The NW Comprehensive Cancer Project (continued)

Since the mid-2000s, AI/AN cancer mortality rates have decreased by about 15%. However, the disparity relative to NHW people in the region persists. In the last few years tribes and clinics have been drastically hit by the COVID-19 pandemic impacting the amount of screening, care, and immunizations that were dedicated to preventing and controlling cancer.

It’s important to get screened! October is breast cancer awareness month and we encourage you if you have breast and are over the age of 40 to please get your mammogram soon. Again, the AI/AN community experiences a higher mortality rates than their Non-Hispanic Whites counterparts due to barriers such as poverty and living in rural areas apart from major cancer centers and it’s important to catch any cancer at early stages.

New Faces

Jackie Curtis Accounts Payable Specialist

My name is Jacqueline Curtis, I am originally from Joplin, Missouri, and I am excited to join NPAIHB as the Ac counts Payable Specialist. I graduated from College of the Ozarks with a degree in History, so naturally I began a career in Finance, starting in annuities. My most recent job was Accounting Manager for the City of Lake Wales, Florida. In my spare time I enjoy drinking coffee with friends, spending time with my 15-year-old Shih Tzu, and writing. I look forward to exploring the Northwest and learning more of the diverse cultures in the area. In Springfield, Missouri I volunteered with the English as a Second Language program for five years and look for ward to getting established in the area and beginning to volunteer again.

Sarah Cook-Lalari Lummi Nation BHA Project Director

By the way of Introduction my name is Sarah Cook-Lalari. I have familiar ties to Lummi Nation (Washington) and the We Wai Kai Nation (British Columbia) I have lived my life between Bellingham Washington and Victoria BC.

I was fortunate enough to have attend the University of Victoria where I obtained a bachelor’s of Social Work with an Indigenous specialization and a Master’s of Social Work with an Indigenous Child Welfare specialization. My work history includes working for Aboriginal delegated agencies, Child Welfare Director (Lummi Nation), clinical pediatric social work and many other roles. I am eager to step into my newest role as the BHA Project Director.

Danner Peter Diné TEC-IVAC Project Manager

Yá’át’ééh! My name is Danner Peter and I’m Diné (Navajo) from a small town in New Mexico. I am Bit’ahnii (the Folded Arms People), born for Naakai dine’é (the Wandering People).

I have my MPH from the University of Hawai’i specializing in Native Hawaiian and Indigenous Health and my BS in Biology from the University of New Mexico. I was a postbacc scholar with the Wy’east Pathways Program at OHSU. After I finished that program, I started working with Lewis & Clark College as their Infectious Disease Specialist. Now I’m happy to be back working with y’all as the TEC-IVAC Project Manager! I still have my dog, Dekym von Peter, and my favorite ice cream flavors are lemon and lavender.

New Faces (continued)

Trelace Sigo Squaxin island BH Training Coordinator

My name is Trelace Sigo. I am a Squaxin island Tribal member. I was born and raised in Olympia /Shelton WA. I am a recovering addict, I have 5 years and 5 months clean and sober. I’m a certified peer counselor and trainer, recovery coach and trainer and a dialectical behavior therapy educator.

I’m currently the new Behavioral health training coordinator, I look forward to be able to begin this new journey and continuing to be able to serve my people.

Marches Armstrong IT Data and Applications Specialist

Aloha Kakou, (Greetings, may there be friendship/love between us)

My name is Marches Armstrong, and I am elated to be given the opportunity to join NPAIHB as an IT Data & Applications Specialist! I have been transplanted here from Hawaii, Maui to be exact along with my beautiful wife Destiny who is a Kanaka Maoli (Native Hawaiian) and my 3 gorgeous children (Jorge, K’ala, & Kapena). I did both my undergraduate and graduate education in Management Information Systems at my beloved alma mater University of Hawai’i at Manoa.

When I am not at work, you can find me and my family outrigger canoeing, paddle boarding, hula, hiking, or fishing. I look forward to what the future holds and can’t wait to be immersed in the culture and community at large. Mahalo Nui Loa (Thank you very much)!

Ashley Jean Day Diné ECHO Project Specialist

Hello my name is Ashley and I am a member of the Navajo Nation. I currently am living in the Willamette Valley but originally come from Las Vegas, NV. I received my Bachelor’s degree in Public Health from University of Ne vada Las Vegas. My husband Mark and I have one fur baby together, a spunky chocolate lab named Maple.

I have a strong background in administration with a passion for health education. I am looking forward to work ing towards a goal of improving the health of my community. I look forward to working with you all!

New Faces (continued)

Alicia Edwards

Colville Confederated Tribes HIV Program Manager

My name is Alicia Edwards, and my pronouns are she/her/hers. I am a member of the Colville Confederated Tribes, my family is a part of the Okanogan band, and I grew up in Okanogan County, WA. I live in Mesa, AZ, with my two dogs and my boyfriend, Moose. I am passionate about indigenous public health.

I have a bachelor’s degree in public health and a Master of Public Health (MPH). I graduated with my MPH in May 2020. After graduating, I worked for the Great Plains Tribal Leaders Health Board for two years in communica tions. My job primarily focused on creating health education materials and campaigns for the Tribes in the Great Plains Area. I am thankful for the experience I gained at GPTLHB. Still, I am excited about the opportunity to serve the Tribes of the Pacific Northwest as the HIV Program Manager.

In my free time, I enjoy being active, getting outdoors, and spending time with my family and friends. Fun fact about me, I am currently training for my first half-marathon. The half-marathon is taking place at Joshua Tree National Park. Any tips for the run are greatly appreciated.

Off the Clock: Fry Bread Mafia Plays First Season in Ten Years

Portland’s bonus Summer provided some great conditions for the NPAIHB’s employee softball team, Fry Bread Mafia (FBM). For the first time in years, the folks we count on to rigorously serve the board’s mission, graced the diamond at Erv Lind field at Normandale Park.

Though the season was not a winning one in terms of score, victories were notched with every laugh and cheer. Coach Erik Kakuska exclaimed, “Being able to smack the ball, thinking it will fly out of the park, only to find it dripple towards first. Ha! So many laughs and smiles.”

Though the FBM feels like the adult Native version of the Bad News Bears, they did in fact, get a few wins. Most importantly, co-workers and their families got to do something fun and healthy together.

2121 SW Broadway • Suite 300 • Portland, OR 97201

Return Service Requested

NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD OCTOBER 2022 RESOLUTIONS

2023-01-01 Oregon Tribal Community Health Aide Program Future Ready Oregon Youth Program Funding Opportunity

2023-01-02 Tribal Community Health Provider Project Building Capacity for Workforce Programs Funding Opportunity

2023-01-03 Washington State Healthcare Authority RFA# 2022HCA25: Statewide Recovery Organization Funding

2023-01-04 Condemnation of Harm to Indian Health Care System Caused by Disruptions in Federal Appropriations and Resultant Continuing Resolutions

Photo credit: E. KakuskaDancing in the Square Powwow 2018