COMMITTED TO EXCELLENCE IN TRIBAL PUBLIC HEALTH
T R I B A L
E P I D E M I O L O G Y
C E N T E R
NEWSLETTER Journey to Standing Rock
A LESSON THROUGH STRUGGLE AND SOLIDARITY Melanie Johnson, our OKTEC SPF-PFS Project Manager, recounts the impact of being part of a historic gathering of tribes, allies, and people from all walks of life standing in solidarity.
JANUARY IS NATIONAL GLAUCOMA AWARENESS MONTH
FEBRUARY IS AMERICAN HEART MONTH
MARCH IS NATIONAL NUTRITION MONTH
06 14 1) Healthy Artery
Normal Artery Lining Normal Blood Flow
2 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
JOURNEY TO STANDING ROCK: A LESSON THROUGH STRUGGLE AND SOLIDARITY Melanie Johnson, SPTHB/OKTEC SPF-PFS Project Manager, vividly describes her experience at Oceti Sakowin encampment standing side-by-side with tribes and people from all walks of life advocating for the right to clean water, free speech, and the right to assemble.
9TH ANNUAL TRIBAL PUBLIC HEALTH CONFERENCE The Southern Plains Tribal Health Board and the OK Area Tribal Epidemiology Center are proud to announce the 9th Annual Tribal Public Health Conference - “Public Health Evolution in Indian Country”.
HEART DISEASE AMONG AMERICAN INDIANS AND ALASKA NATIVES There are many forms of heart disease. The most common type is coronary artery disease where the blood vessels that take blood to the heart become narrow or blocked. When there is not enough blood flow to the heart, a person can have a heart attack.
TOOTH DECAY EXPERIENCE AMONG AMERICAN INDIANS AND ALASKA NATIVES Tooth decay affects a large portion of American Indian/ Alaskan Native (AI/AN) children before they start school. According to the 2014 Indian Health Service Oral Health Survey, tooth decay continues to be a significant health concern with 5 out of 10 AI/AN children between 1-5 years old experiencing tooth decay.
JANUARY IS NATIONAL GLAUCOMA AWARENESS MONTH
FEBRUARY IS AMERICAN HEART MONTH
MARCH IS COLORECTAL CANCER AWARENESS MONTH
In this issue: Contents 2–3 National Health Observances
Journey to Standing Rock: A Lesson Through Struggle and Solidarity
9th Annual Tribal Public Health Conference
Helping Make Your Community A Healthy Community
Heart Disease Among American Indians and Alaska Natives
Tooth Decay Experience Among American Indians and Alaska Natives
TOTS Brief - The Oklahoma Toddler Survey Discrimination in Accessing Health Care
TOTS Brief - The Oklahoma Toddler Survey Oklahoma Toddlers: Child Care Arrangements and Costs
OSDH Provides Tips for Winter Driving Safety
Our NEW Website is LAUNCHING SOON! 27
JANUARY/FEBRUARY/MARCH 2017 | 3
SUBMITTED BY: ERIN HODSON, MPH, CHES OKTEC EPIDEMIOLOGIST
Cervical Health Awareness Month
American Heart Month
January is the month to highlight issues related to cervical cancer, HPV [Human papillomavirus] disease and the importance of early detection. No woman should die of cervical cancer. The most important thing you can do to help prevent cervical cancer is to get screened regularly starting at age 21.
Heart disease is the leading cause of death for men and women. Along with gifts for Valentine’s Day, give your heart the gift of heart health. Small changes can make a big difference. Add exercise to your daily routine, increase healthy eating, quit smoking, and take medication as prescribed. Make a difference for your future and those around you and be heart health aware.
For more information regarding cervical health awareness month, please visit:
For more information regarding american heart month please
Glaucoma Awareness Month
Teen Dating Violence Awareness Month
Currently, more than 3 million people in the United States have glaucoma. The National Eye Institute projects this number will reach 4.2 million by 2030, a 58% increase. Glaucoma is a group of eye diseases that gradually steal sight without warning. Although the most common forms primarily affect the middleaged and elderly, glaucoma can affect people of all ages.
One in three young people will experience some form of abuse in their dating relationships. The repercussions of teen dating violence are impossible to ignore. They hurt not just the young people victimized, but also their families, friends, schools and communities. Throughout February, organizations and individuals nationwide are coming together to highlight the need to educate young people about dating violence, teach healthy relationship skills and prevent the devastating cycle of abuse.
For more information regarding glaucoma awareness month, please visit:
National Blood Donor Month Every two seconds someone in the United States requires a blood transfusion. Supplies for blood are always low and it is vitally important for people to generously donate blood. Donating is a way to help out the community as well as individuals who are in need. If you are eligible, go out and help save someone’s life today!
For more information regarding teen dating violence awareness month, please visit:
National Children's Dental Health Month This month-long national health observance brings together thousands of dedicated dental professionals, healthcare providers, and educators to promote the benefits of good oral health to children, their caregivers, teachers and many others. This year’s campaign slogan is “Choose Tap Water for a Sparkling Smile”.
For more information regarding national blood donor month,
For more information regarding national children's dental health
4 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
month, please visit:
National Nutrition Month
Colorectal Cancer Awareness Month
National Nutrition Month is a nutrition education and information campaign sponsored annually by the Academy of Nutrition and Dietetics. The campaign is designed to focus attention on making informed food choices and developing sound eating and exercise habits. The health guidelines for National Nutrition Month help the public make better choices which could help reduce risk for some chronic diseases, including cancer. The Academy of Nutrition and Dietetics recommends that people: Aim for fitness by exercising at least 30 minutes a day for five or more days a week; follow national dietary guidelines and choose food sensibly; drink eight 8-ounce glasses of water a day; limit fast foods and fried foods; prepare foods with less salt; and drink in moderation if drinking alcohol.
Colorectal cancer screening saves lives. If you are 50 years old or older, talk to your doctor about getting screened. Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it. For more information regarding colorectal cancer awareness, please visit:
Source: https://www.cdc.gov/cancer/dcpc/resources/features/ colorectalawareness/index.htm
World Water Day World Water Day is held annually on the 22nd of March as a means of focusing attention on the importance of freshwater and advocating for the sustainable management of freshwater resources. Every year highlights a specific aspect of freshwater, and 2017 is â€œWastewaterâ€? and how it needs to be managed both corporately and in the home. Water is the basis of life on earth and we need to take responsibility for it.
For more information regarding national nutrition month, please visit:
For more information regarding world water day, please visit:
JANUARY/FEBRUARY/MARCH 2017 | 5
Journey to Stand A LESSON THROUGH STRUGGLE AND SOLIDARITY When she returned from the snow-scoured hills of the Oceti Sakowin encampment on the Standing Rock Sioux Reservation, one of the many questions we asked Melanie was, “What made you want to go to Standing Rock?” She answers this question in vivid detail and recounts the impact of being part of a historic gathering of tribes, allies, and people from all walks of life standing in solidarity. November 20, 2016
e arrived at the Oceti
Sakowin encampment to
begin our journey to fight
the Dakota Access Pipeline, not as
protesters, but as water protectors.
Little did we know, the next few days were going to become surreal and
life changing. I saw numerous tipis
and tents as we waited in line to come
through the main entrance of the camp.
flag. "Good sign," I thought, "I am meant to be here." We were then
greeted by another woman warrior,
“Frisky Otter” as we jokingly called her. We thought we had to have pseudo
names, so we gave ourselves new camp names. Yes, I chose to be funny and
introduced myself as “Snagging Fox”
and it stuck. I told Frisky Otter, “We are here! I am Snagging Fox, this is White Otter and Red Dingo!”
I was awe-stricken with the beauty of
I have learned over the years that it is
made me feel proud to be Native. We
other Natives. I suppose it is a coping
the main entrance who asked if we
to remain resilient during intense,
She welcomed us then proceeded to
humor to be universal. We weren’t
seeing so many tipis, and seeing this
good to have a sense of humor around
were greeted by a woman warrior at
mechanism that we have learned
were new or returning to the camp.
unpredictable, historical times. I believe
smoke our car off with cedar which is
always so stoic.
often used in ceremony or during times of prayer. Cedar is also used to cleanse and protect oneself from any negative influences.
Frisky Otter laughed, jumped in our
car and directed us to a camp next to
security also known as Hummingbird’s camp. It made sense now, all the
As we drove into the camp, I
pseudo names. This was how security
in the wind. It was a bit tattered but
radios. I was relieved to see that they
immediately saw my tribal flag blowing
communicated with each other over the
identifiable as the Sac and Fox Nation
had a large green army-style tent with a
6 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
generator and a wood stove. This was
STORY BY: MELANIE JOHNSON, M.ED., OKTEC SPF-PFS PROJECT MANAGER
PHOTOS BY: BUCKY HARJO AND MELANIE JOHNSON
Melanie Johnson, aka "Snagging Fox" at the Oceti Sakowin encampment on the Standing Rock Sioux Reservation.
JANUARY/FEBRUARY/MARCH 2017 | 7
Pictured above: How we were greeted. Pictured below: "Snagging Fox" and Lucie Longtree, aka "Hummingbird" enjoying a well-deserved day of relaxation in a hotel room at the Prairie Knights Casino & Resort.
important! Meals are the heart of the
originally made up of what is called the
universal Native custom for bonding
the largest peaceful resistance camps
camp and I believe that it is another with one another.
As the sun began to disappear,
temperatures were starting to drop and
to defend Native human rights, treaties, cultures and more importantly to sustain Mother Earth.
I am thinking to myself, "are you really
We were blessed to have met everyone
No time to think about it, we put our
important to me to acknowledge
ready for this frigid cold weather?"
camp dresses on and headed directly to the Sacred Fire after we ate. Again, I noticed there were universal Native
customs that made me feel at home like how elders eat first and why the women wear long skirts. The skirt is like a cover and is meant to shield and protect.
As we walked about, we noticed how many non-native campers colonized
the camp. It was like walking in another
world and it reminded us of a war zone. I saw a Mess Hall Tent, Medic Tent,
The Dome (where important meetings
were held), Message Boards and Media Facebook Hill. Oceti Sakowin was
8 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
“Seven Council Fires”. It had become
at Hummingbirds camp and it’s
Hummingbird because she treated
us like family. She was the matriarch
over her camp and became known as “Mamma” to some because she had a warm and inviting smile. You felt
protected with her by your side and she always thanked us for cooking.
Anything we did, she would thank us. She didn’t have time to worry about cooking or cleaning because she
protected water protectors on the front line, so while we warmed ourselves by her wood stove, we assumed kitchen duty without complaining. That’s just what you do.
That’s when it happened! That evening
there was something going on—
the 1806 Backwater Bridge, otherwise
were yelling, “Keep this path clear,”
water protectors began gathering on known as the “The Blockade”. A call
went out over the security radios, “Get to the Bridge!” and our camp mates,
Kane, Undertaker, Hummingbird, Bull Elk, and Red Dingo “the new recruit”,
jumped in the car and disappeared into the night. White Otter and I just stood there wide-eyed not really knowing
how to process what just happened. I was excited, anxious, and fearful. My
adrenaline was running high, and all we could do was just sit and wait.
After what seemed like forever, our
camp mates finally came back but one was missing… it was Red Dingo! After
White Otter and I asked where he was and what happened, no one seemed to know. One of the female water
protectors, Shyanne, said she saw him
up by the front lines of the protest. Our camp mates drove up to the Blockade to look for him. Meanwhile, we were
thinking, "Was he still on the hill? Did
he get arrested? Was he hurt?" So many thoughts raced through our minds.
Action had to be taken. White Otter
suggested walking to the Medic Tent
despite being warned to not leave the camp, but we felt compelled to find
him. We felt it was our responsibility even if it wasn’t; you take on that
mindset because after all, we are all relatives.
Once we made it to the Medic Tent,
we saw water protectors being walked back by others helping them because they had been blasted with water
cannons, tear gas, bean bags, and it
was unbelievable! I was in shock to see how human beings were being treated like animals. If you are not a witness to
these events, it can be hard for people to really understand the gravity of the situation. Every direction you looked,
ambulances were on standby, medics and people were running towards the Blockade while others were barely
walking back. We didn’t find Red Dingo
so we figured he was ok and decided to head back to our camp to wait for any word on his whereabouts.
After what seemed like hours, White
Otter and I finally decided to settle into our tent and wait. At least we had "Mr. Buddy". He was our propane heater
who kept us warm at night, and became our life saver. Just as we were about to lie down, we heard a voice, “Hey, I’m back!” It was Red Dingo.
As Red Dingo entered the tent, we
breathed a sigh of relief and White
Otter said, “I am so mad at you right
now, but I am glad you’re back, where
Edward Joseph Blackburn, aka "Red Dingo"at the Oceti Sakowin encampment. Photo by Randy Blythe.
were you?” Red Dingo explained that once the water protectors pulled up to the blockade, everyone jumped
out of the car and disappeared. White Otter told Red Dingo to let the others know he was back and to apologize
for getting lost because they had been out looking for him and were worried.
Red Dingo took pictures of the incident at the 1806 Blockade Bridge and told us what he saw on the front lines. He shared his photos of the events that had occurred which was the same
night that the Morton County Police
threw a concussion grenade at Sophie Wilensky, a 21-year-old female who suffered major damage to her arm.
Several other water protectors returned injured as well, but Red Dingo came back unscathed.
It was about 2 a.m. by the time we got
Every direction you looked, there was something going on—ambulances were on standby, medics were yelling, "Keep this path clear," and people were running towards the Blockade while others were barely walking back.
ready for bed and just as I drifted off
to sleep, I felt three taps on my back. It came from the outside of the tent and I thought, it was Frisky Otter messing
around. As I opened my eyes, I heard a noise that sounded like
JANUARY/FEBRUARY/MARCH 2017 | 9
Remaining prayerful at all times at Oceti Sakowin encampment.
fingers scraping across the outside of
I could hear a woman yelling, “Wake
that?”, but I was too sleepy to be scared.
She would make a sound like a bird all
the tent. I said, ”Ok, what the heck was White Otter said she heard it too and
we were told later that Oceti Sakowin was the location of the Sun Dance
ceremony and to not be alarmed by
the spirits. The Sun Dance is one of the most important ceremonies practiced by the Lakota (Sioux) as a time of
renewal for the people. I just accepted it and fell back to sleep only to be awakened a few hours later.
November 21, 2016
“Wake up, Water Protectors! Go to the
what was going on, but I immediately
one day without a shower and a warm
there until I felt comfortable with the
become on having these luxuries. Upon
ready to take action, but again we were
were camped out in the lobby. A sign
only the first night at camp, and we had
cold temperatures, where else could
the water protectors to come take a
up, Water Protectors, go to the bridge!” through the camp. I could hear a car and another voice of a man, yelling,
e were blessed to have
reserved a room at Prairie Nights Casino located off
Highway 1806 in Cannon Ball, North
Bridge! We need you!” I wasn’t sure
Dakota. Although it had only been
got up, put my boots on, and just lay
bed, I realized how dependent I had
situation. I finally got up, and I was all
our arrival at the casino, many people
told to remain at the camp. This was
was posted, “No Loitering”, but in these
five more days to go. What else could
you go that was close by? We invited shower in our room. It was the least we
could do. Hummingbird, Kane, Bull Elk, 10 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
People from all walks of life were there. We were asked to join hands, pray, sing, and at the end, offer tobacco to the water. In fact, that morning, it was said to have been the largest group of people at the Prayer Ceremony since Oceti Sakowin Camp opened.
just my humor. We also laughed about my GOGIRL, it was a female urination device. I know, I know what you’re
thinking, but when you’re camping in
20 degree weather in a portable toilet, you have to think about these things.
interview going on with an Oklahoma
news channel. Bull Elk and Red Dingo
gave their accounts of what happened
on the front lines. I asked Hummingbird if I could take a selfie with her, and
as I held up the camera, took off my
glasses, it looked fuzzy. I said, ”You look kind of fuzzy,” only to realize I had the camera backwards. It wasn’t even on her face, it was positioned towards a
chair. We all laughed so hard. You had to be there to appreciate the humor. I was amusing to everyone. At least I
had something to offer, even if it was
over the camp and told us, “Get
up, this is what you are here for. You
she wanted to try it out, so I told her
dresses and headed to the sacred fire.
worked. Still waiting to hear from that
We were asked to join hands, pray,
it, I gifted it to an elder lady who said
White Otter and I slipped on our camp
to Facebook me and let me know if it
People from all walks of life were there.
sing, and at the end, offer tobacco to
November 22, 2016
said to have been the largest group of
the water. In fact, that morning, it was
afternoon. You bet we slept
laughed, and yes, we even had an
came up, an elder's voice echoed
are here for a reason. Time to pray!"
Sakowin camp in the
in our room while we made jokes,
n the early morning, before the sun
Of course, I never got around to using
e arrived back to Oceti
Undertaker, and Frisky Otter relaxed
November 23, 2016
in at the casino and we had a buffetstyle breakfast. We had a chance to
slow down and take a break. The sun
was shining that day. We enjoyed our
people at the Prayer Ceremony since
Oceti Sakowin Camp opened. It was a
cold surreal moment, but memorable. As we engaged in deep prayer, I
couldn’t help but notice how this camp
was teaching non-natives how to pray in an Indigenous way.
day at the camp. White Otter braided
Later that day, we promised the lady
headed to the north side of the camp
Hummingbird's camp that we could
hit the clothes donation tent to pick
needed supplies. Hummingbird’s truck
screen printers to get a water protector
to get a quote. We stopped to fill up
waited in the back of the line, a lady
a lady who had pulled up in the stall
to move to the front of the line like
approached me. She said, “Are you all
are Indigenous, you got to move to the
"Ok she must be talking about
Frisky Otter’s hair and afterwards we
warriors who had been staying at
to check out the screen printing. We
take them to Walmart in Mandan. We
up shirts, which would be given to the
needed a part, so we went to O'Reilly’s
design to wear around camp. As we
the gas can for the generator. I noticed
approached us and we were told
next to us. As I exited the car, she
celebrities. We learned later, that if you
here for the thing?” "Thing?" I thought,
front of the line. It was a good day to be Indigenous!
JANUARY/FEBRUARY/MARCH 2017 | 11
Pictured above: Living the old way Pictured below: Shyanne Abee, Tonya Wapkskineh, aka "White Otter", and Steela Robedeaux, aka "Frisky Otter".
the pipeline." I said, "well if you mean
enjoyed our meal, piled back in the
went on to tell me how she supported
problems. Again, I reflected on how
the water protection, then yes." She the protest efforts, that she noticed
a lot of racism in town, and that she didnâ€™t agree with the way Natives
were being treated. She said that she ran a not-for-profit organization for
women in recovery in town and had to be there; otherwise, she would be at
Oceti Sakowin supporting the cause. She thanked us for our support and
offered to pay for the gas. I said, "No,
thank you." We were only getting a few dollars anyway. She shook my hand, and we went our separate ways. It
did occur to me, that maybe she was
targeting us. Paranoia begins to set in when you're part of a movement. We decided to eat at Five Guys. Getting
away from the camp for a few hours is
needed to keep some type of normalcy in your life. I noticed two men seated in the back of the restaurant. They
could have been security guards, but again paranoia sets in and you begin
to wonder, "will we get harassed?" We 12 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
car, and headed back to camp with no my actions were making a difference.
In that moment, White Otter and I were helping these women warriors that we
just met, maybe we were bonding, and yes I believe we were making history. The short time we spent cooking,
cleaning, and organizing, we also
laughed, hugged and cared for one
another as if we were real family. Maybe that is what this was all about: feeling needed and having a purpose.
In the evening, Bucky Harjo, a seasoned camp warrior and an awesome
photographer would pray over the
meal that was prepared. I noticed the similarities of how a spirit plate was
preparedâ€”in much the same way the Sac and Fox and many other tribes
prepared theirs. This practice is just one of many ways that we remember the
past. Never had I witnessed what Bucky captured in his photo documentation of Standing Rock: living in the past,
present, and future, all at the same time.
November 24, 2016
he next few days were just as
memorable. Although I didn't
have a clue who he was, I would
it was a meeting of chance, or maybe I was meant to have a brief minute of Jane Fonda and Randy Blythe’s time. Only Karma knows.
Pictured left: White Otter, Red Dingo, and Snagging Fox with Randy Blythe and another band member of Lamb of God. Pictured right: Melanie and Jane Fonda at the Prairie Knights Casino & Resort.
end up crossing paths with Randy
Blythe, a vocalist for the band Lamb of God, thanks to Red Dingo. Red
Dingo invited him to eat with us on “No Thanksgiving”, and so I sparked up a
brief conversation with him. I saw him making his way to fix a plate and he
smiled, so to be funny I said, ”You better hurry up and eat or you all will miss out on the ribs and fry bread.” Next
thing I know, he mentions that brief
encounter in Rolling Stones magazine!
I am quoted as “one of the women told us..." Yeah, I took credit for that famous quote. He wrote an excellent article
about that night, including a photo of
Red Dingo and the dinner we all shared on that “No Thanksgiving” evening.
Next, I met Jane Fonda at the Prairie
Knights Casino & Resort at the buffet. I noticed her as she sat down, I walked towards her, and introduced myself. I asked her for a photo even though it
had been three days since I had taken
a shower. I had no problem with asking her. I figured, "I will probably never
see her again in my lifetime, so why
not." She obliged me and just like that I snapped a blurry photo on my cell
phone. I have yet to be star-struck by
celebrities, so I take it all in stride, like
The other day, someone asked me,
“What made you want to go to Standing Rock?” It finally hit me in that moment. I went because I had to see the truth.
Experiencing the camp reminded me of a dream I had years ago. I dreamt that I was walking with a group of Natives
along a dirt road. I was wearing a Native dress, and I knew that I was walking
with my Native relatives, but I didn’t
know why we were walking on this road. Perhaps I had a premonition of what
my purpose is for this life. It felt good
to walk with my brothers and sisters at Oceti Sakowin.
my resume. My hope is that my words, my experiences, and my existence can and will inspire others to go seek the truth for themselves, if they can. This
experience is about prayer and having
the heart to unite and to believe that we have the power to change the path for
future generations. We must protect the future for our children.
MNI WICONI! Water is life—without it, we will not exist. Standing Rock has a lesson for everybody. It’s up to all of
us to discover what that lesson is for ourselves.
My dad always told me that someday I should write a book about my life. I never really gave it much thought
As of December 27, 2016, concrete
beginnings. I am not a writer, a
nothing has changed. Please continue
status. I am a Native woman who cares
free speech, and the right to assemble.
until now. I come from humble
barriers and razor wire are still up—
philosopher, or anybody of celebrity
to advocate for the right to clean water,
about her people. Most of my career has been in public health serving
Native communities, specifically, in
the area of diabetes, heart disease,
cancer, substance abuse, and suicide prevention. I can now add activist to
For more information on how to support the Water Protectors and NO DAPL, visit:
JANUARY/FEBRUARY/MARCH 2017 | 13
SAVE DATE 9TH ANNUAL
TRIBAL PUBLIC HEALTH
CONFERENCE PUBLIC HEALTH EVOLUTION IN INDIAN COUNTRY
APR 11 – 13
14 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
RIVER SPIRIT CASINO RESORT
8330 RIVERSIDE PKWY • TULSA, OK 74137
River Spirit Casino Resort in Tulsa, OK.
WRITEN BY: PATRICIA YARHOLAR, MPH, CHES, OKTEC GRANT LEAD/PUBLIC HEALTH COORDINATOR
The Southern Plains Tribal Health Board and the Oklahoma Area Tribal Epidemiology Center are proud to announce and extend an invitation to the 9th Annual Tribal Public Health Conference - “Public Health Evolution in Indian Country”. The pre-conference will be held on April 11th with training on data, public health accreditation, traumatic brain injury, veterans affairs, diabetes, and others. The conference follows on April 12th and 13th, 2017. The conference will be held at the River Spirit Casino Resort, 8330 South Riverside Pkwy, Tulsa, OK 74137. The River Spirit Casino Hotel offers so much. They have many dining and entertainment options. The guest hotel rooms are immaculate and rise 27 stories high with a view of the river and free Wi-fi connection. There is also an outdoor pool, a fitness center, spa services, and gift shops. At this year’s conference you can expect breakout sessions and presenters to share information on current public health issues, networking opportunities, and a poster session. Special key note and plenary speakers will provide information
on public health issues and current information on American Indian/ Alaska Native health. Attendees are invited to the Cultural Evening event on Wednesday at 6:00 p.m. for an educational experience. For room reservations, please contact the hotel by March 12, 2017 (cut-off date) by calling 888-748-3731 (toll free). To receive the government rate please mention the 9th Annual Tribal Public Health Conference. All reservations will require a major credit card to hold. Check-in time is after 4 p.m. and check-out time is 11:00 a.m. A major credit card or debit card is mandatory at the time of check-in for incidentals. Shuttle services to and from the hotel are available at no cost for those registered at the hotel. You are invited to present your research at the conference. Research will be presented in a poster format on Wednesday, April 12th, 2017, at the River Spirit Casino Resort in Tulsa, OK.
Attendees from Southern Plains Tribal Health Board's 8th Annual Tribal Public Conference
ATTENTION Attention, Health Organizations and Arts & Crafts Exhibitors We invite you to be a part of this year’s 9th Annual Tribal Public Health Conference. River Spirit Casino Event Center-Tulsa, Oklahoma Dates: April 12th & 13th, 2017 Rate: $40 per day, includes lunch for 2 Now accepting 25 Vendors. Reserve your space soon. Payment due by April 1st, 2017. See our website for registration form. For more information contact, Janice Black: jblack@spthb. org or Phone (405) 652-9209 Should you have any questions pertaining to the Research Poster Session, please feel free to contact Jenifer LittleSun at jlittlesun@spthb. com or (405) 652-9201.
Those presenting in all fields of research pertaining to American Indian Health are encouraged to apply by 5 p.m. CST on March 31st, 2017.
JANUARY/FEBRUARY/MARCH 2017 | 15
Family and friends came to the Hanna Community "Back to School Fair" for school supplies, haircuts, head lice checks, and blood pressure checks
Helping Make Your Community A Healthy Community STORY AND PHOTOS BY: YONAVEA HAWKINS SPTHB PUBLIC HEALTH TRAINING COORDINATOR
Looking back on 2016, the Southern Plains Tribal Health Board (SPTHB) Caring Van had a busy year. We attended health fairs, conferences, and events in all four directions of Oklahoma. The Caring Van offers preventive health screenings and health information to assist and meet the needs of the community. Our preventive health screenings range from head lice checks at the back-to-school health fairs to oral cancer screenings at powwows. In partnership with the Veterans Administration’s “Inter-tribal Stand Down”, the SPTHB Caring Van had a podiatrist onboard who did diabetes foot checks for veterans. At the 2016 Indian Nations Powwow, the Caring Van assisted the Cheyenne & Arapaho Health Education Department with HIV/HEP-C screenings.
Meridian Tech student checking blood pressure at the Employee Wellness Day at Perkins, OK with Rachel Crawford of the American Heart Association looking on.
A big “thank you” to our communities, stake holders, and tribal partners for making 2016 a great year of preventive health screenings. The Caring Van’s goal as a mobile unit is to serve Indian communities with health screenings and health information for a healthier lifestyles; with your help we accomplished that!
To schedule the Caring Van, please contact the Caring Van staff.
We look forward to providing more preventive health services in 2017 and assisting you at your next health fair or community event.
Yonavea Hawkins – Public Health Training Coordinator, Phone: 405.652.9218, Email: email@example.com
16 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
Janice Black – Public Health Training Coordinator, Phone: 405.652.9209, Email: firstname.lastname@example.org
Below is a list of the 2016 community events the Caring Van attended. The graph shows the types of preventive health services and totals for 2015 and 2016. •
Go Red for Native Women – Okmulgee
Absentee Shawnee Tribal Health Fair – Norman
Iowa Tribe Casino Wellness Day – Perkins
Iowa Tribe Employee Wellness Day -Perkins
Cheyenne & Arapaho Oklahoma Indian Nation Powwow – Concho
Cheyenne & Arapaho Tribal HIV Screenings – Seiling
Hanna Indian Community Back-to-School Health Fair – Hanna
OSU N7 Event, Youth Health and Fitness –Stillwater
Clinton Community Hall – Clinton
TEC Annual Health Conference – Shawnee
Riverside Indian School Health Fair – Anadarko
Oklahoma City Indian Clinic Walk for Wellness – Midwest City
Cheyenne & Arapaho Powwow – Colony
Cherokee Veterans Enrollment – Tahlequah
Delaware Nation Summer Fest – Anadarko
Cheyenne & Arapaho Elders Conference – Clinton
Cheyenne & Arapaho Men’s Health Event – Watonga
Red Earth Parade – Oklahoma City
Veterans Administration Inter-Tribal Stand Down – Oklahoma City
Native Youth Preventing Diabetes Camp – Chouteau
Native American Wellness in the Workplace Summit – Tulsa
Iowa Tribal Health Fair – Perkins
Winter Fair for Kids – El Reno
Sac and Fox Nation Health Fair – Stroud
JANUARY/FEBRUARY/MARCH 2017 | 17
Heart Disease Among American Indians and Alaska Natives FEBRUARY IS HEART HEALTH MONTH
WRITTEN BY: SUSAN S. GAY, M. A. Ed., CHES, OKTEC PUBLIC HEALTH COORDINATOR
What is Heart Disease? There are many forms of heart disease. The most common type is coronary artery disease where the blood vessels that take blood to the heart become narrow or blocked. When there is not enough blood flow to the heart, a person can have a heart attack. Is Heart Disease a Problem Among American Indians and Alaska Natives? •
Heart disease is the number one cause of death among American Indians and Alaska Natives in the United States (based on 2014 data).
In Oklahoma, American Indians had the highest heart disease death rates of all races in 2012.
In Kansas, heart disease is the leading cause of death among American Indians.
In Texas, heart disease is the leading cause of death (based on 2010 data).
1) Healthy Artery
Normal Artery Lining Normal Blood Flow
Data Sources: Centers for Disease Control and Prevention, Oklahoma State Department of Health, Kansas Department of Health and Environment, & Texas Department of State Health Services
1) Partially Blocked Artery Restricted Blood Flow
Plaque (Cholesterol mixes with rogue calcium to form hard plaque)
18 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
What Are the Main Causes of Heart Disease? •
Not being physically active
High blood pressure
What You Can Do to Lower Your Risk
Prevent and control high blood pressure. Lifestyle actions such as a healthy diet, regular physical activity, not smoking, and healthy weight will help keep your blood pressure normal.
Practice healthy lifestyle habits: Eat healthy foods such as fresh fruits and vegetables, drink more water and less sugary drinks, and use less salt.
Stop smoking. Cigarette smoking increases the risk of heart disease. Chewing, dipping, and cigarette smoking are non-traditional uses of tobacco among American Indians and Alaska Natives.
Prevent and manage diabetes. People with diabetes are at greater risk for heart disease. Exercise! Physical activity helps to maintain a healthy weight. Adults should be physically active for at least 30 minutes a day, about five days a week.
Prevent and control high cholesterol. High cholesterol can lead to heart disease. Eat foods high in fiber and low in saturated fat and cholesterol.
Maintain a healthy weight. Know what your BMI (Body Mass Index) should be based on your height and weight. An adult with a BMI of 30 or over is obese.
Prevent and Control High Blood Pressure
Limit alcohol use. Regular alcohol use increases the risk of high blood pressure and heart attacks.
Smoking Increases Heart Disease
Maintain Healthy BMI
No Cigarette Smoking
Eat Foods Low in Saturated Fats
Limit Alcohol Use
For more information on heart disease and healthy living, please check out these resources: https://www.ihs.gov/forpatients/index.cfm/healthtopics/EatingHealthy/ https://millionhearts.hhs.gov/learn-prevent/index.html http://www.cdc.gov/heartdisease/index.htm https://medlineplus.gov/heartdiseases.html https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/docs/fs_aian.pdf http://www.ok.gov/health/pub/boh/state/SOSH%202014-Indicator%20Report%20Cards.pdf http://www.dshs.state.tx.us/heart/Data-and-Surveillance.aspx http://www.kdheks.gov/hci/as/2015/2015_Annual_Summary.pdf
JANUARY/FEBRUARY/MARCH 2017 | 19
Tooth Decay Experience Among American Indians and Alaska Natives WRITTEN BY: JULIE SEWARD, RDH, M. ED., PUBLIC HEALTH SPECIALIST
uring this last year, I have had the pleasure of conducting oral health screenings in various tribal communities throughout Oklahoma.
I have enjoyed interacting with children and families, listening to their stories, all while being able to share my knowledge of good oral hygiene care and prevention.
Unfortunately, controlling tooth decay was a trending topic during my encounters. Children complained of discomfort and parents expressed concern of where to get treatment in their area, as well as how to prevent future decay. According to the American Dental Association, tooth decay is the destruction of the tooth enamel, the hard, outer layer of your teeth. Plaque, which is a sticky film of bacteria, constantly forms on your teeth. The bacteria in
20 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
plaque produce acids that attack In comparison, AI/AN children Recent studies have shown that baby tooth enamel when you eat or experience three times more tooth teeth erupt earlier among AI/AN drink foods containing sugars. The decay than white children. communities than in other populations, stickiness of the plaque contributing to an earlier keeps these acids in experience with tooth decay contact with your teeth among children. In addition, it I have enjoyed interacting with children and over time, the enamel is a concern that these early can break down, forming and families, listening to their stories, all erupting teeth might not be a cavity. as well developed, therefore, while being able to share my knowledge increasing the chances of Tooth decay affects a developing tooth decay. of good oral hygiene care and prevention. large portion of American Indian/Alaskan Native (AI/ Tooth decay is a complex, AN) children before they infectious, and contagious start school. According disease with many factors Tooth decay can cause severe pain that, to the 2014 Indian Health Service contributing to its formation. More if left untreated, could result in serious Oral Health Survey, tooth decay infection, in addition to other concerns. information is needed on how to continues to be a significant health Tooth decay can also affect the child’s control the disease - with AI/AN concern with 5 out of 10 AI/AN children and communities in mind. ability to eat, learn, and communicate children between 1-5 years old effectively. experiencing tooth decay.
Here are some ways to practice good oral hygiene and prevent tooth decay: • •
Brush 2 times a day with a fluoride toothpaste (pea-sized amount for children 2-6 years of age) Drink fluoridated water from a community water supply
Limit snacking in-between meals
Limit fruit juices (4 to 6 oz. per day for children 1-6 years of age)
Limit candy, soda, cookies, and other sugary foods
No sugary foods/drinks after bedtime tooth brushing
Find a dentist you're comfortable with and keep seeing him or her
Talk to your dentist or dental hygienist about dental sealants
JANUARY/FEBRUARY/MARCH 2017 | 21
The Oklahoma Toddler Survey Volume 9, Issue 1
Discriminaon in Accessing Health Care Inequies in the quality of health care paents receive are oen associated with unfair treatment felt while accessing care. Members of racial and ethnic minority groups and paents of lower socioeconomic status are more likely to report being the subject of negave atudes and discriminatory pracces during the health care process.1
survey asked mothers about unfair treatment due to seven reasons when seeking health care. Reasons recorded as “Other” were also included.
than high school), and married all experienced lower rates of unfair treatment.
Mothers reporng discriminaon while accessing health care had Overall, 11.8% of signiﬁcantly (p<0.05) lower mothers reported some rates of medical home form of unfair access for their toddler treatment. Ability to pay compared to those was the most reported mothers who reported no reason for discriminaon discriminaon (87.5% vs (Figure 1). 71.5%).
Non-Hispanic (NH) Black This report used The mothers reported the Oklahoma Toddler highest rate of Survey (TOTS) data from discriminaon (20.1%), 2011-2013 to examine followed by unmarried self-reported unfair mothers, and mothers treatment when less than 25 years of age accessing health care (Figure 2). Conversely, and its relaonship to mothers who were NH health care access. The white, educated (greater
Nearly 93% of mothers not reporng discriminaon accessed a family doctor or pediatrician as the toddler’s personal doctor compared to 83% of mothers reporng discriminaon (Figure 3). A signiﬁcantly higher percent of mothers reporng
Figure 1. Self-Reported Reasons for Unfair Treatment while Accessing Health Care - TOTS 2011-2013 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0
In Oklahoma: • 11.8% of mothers of 2-year-olds reported some form of unfair treatment when accessing health care for their toddler. • Ability to pay was the most reported reason for unfair treatment/ discriminaon. • Non-Hispanic Black mothers, unmarried mothers, and mothers less than 25 years all reported higher rates of discriminaon. • Mothers reporng discriminaon had signiﬁcantly lower rates of medical home access for their toddler.
22 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
Race or Country of Ability to Ethnicity birth pay
Don’t know reason
Other An EEO Employer
“Sometimes I feel treated unfairly because of [ my] ability to pay for care.” -TOTS mom
Figure 2. Mothers Reporting Unfair Treatment while Accessing Health Care - TOTS 2011-2013 Hispanic NH-Other NH-American Indian NH-Black NH-White
Other Divorced or Separated Married
>HS HS <HS
35 and over 25 - 34 yrs < 25 yrs
10.3 9.3 0
discriminaon accessed a physician assistant (PA), nurse praconer (NP) or another type of provider for the primary care of their toddler (17% vs 7%).
unfair treatment inﬂuences the likelihood of connuing care and accessing needed services is an important step in improving the quality of health care for all.
Disparies persist despite considerable progress in the delivery of health care services and eﬀorts to improve the quality of paent care both naonally and statewide.
Improving the condions of health care sengs, from the intake staﬀ to the paent-clinician encounter, and the policies governing the pracces of health systems may also improve the eﬃciency and equity of care for all paents.
Raising public and provider awareness about exisng disparies, including how
Figure 3. Mothers Reporting Unfair Treatment by Type of Toddler's Personal Doctor- TOTS 2011-2013 93.0 100 83.0 90 80 70 60 50 40 30 17.0 20 7.0 10 0 Mother reporting no Mother reporting discrimination discrimination Family Dr/Pediatrician PA/ NP/Other
Reference: 1. Dara H, Sorkin P, Ngo-Metzger Quyen, MD, MPH, De Alba Israel., MD, MPH Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care. J Gen Intern Med. 2010;25(5):390–6.
The Oklahoma Toddler Survey (TOTS) is a two-year follow-back survey to the Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Mothers with live infants who respond to the PRAMS survey are sent a TOTS survey the month their children turn twoyears-old. TOTS is a mixedmode surveillance system. Two mail surveys are sent in an eﬀort to gain parcipaon followed by telephone surveillance for nonrespondents. The un-weighted response rate for 2011-2013 data was 67.8% (n=5,318; excluding women ineligible to complete TOTS). Data were weighted to represent the two-year-old's birth cohort for those years. Prevalence rates and signiﬁcant associaons were calculated using the CochranMantel-Haenszel Chi-Square (χ2) Test. Special assistance for this Brief was provided by: Binitha Kunnel MS, Alicia Lincoln MSW, MSPH; Ayesha Lampkins, MPH, CHES; Shannon Gormley, and Lindsay Betancourt. Funding for TOTS is provided by the Maternal and Child Health Bureau, Department of Health and Human Services, MCH Title V Block Grant. The TOTS Brief is issued by the Oklahoma State Department of Health, as authorized by Terry Cline, PhD, Commissioner of Health. Copies are available for download from the Oklahoma State Department of Health website at www.health.ok.gov.
JANUARY/FEBRUARY/MARCH 2017 | 23
The Oklahoma Toddler Survey
Oklahoma Toddlers: Child Care Arrangements and Costs Child care for many Oklahoma families with a two-year-old is a necessity. As a result, many of Oklahoma’s toddlers spend large amounts of me with providers other than their parents. Therefore, child care arrangements and their costs are signiﬁcant issues for parents, providers, and others concerned about children.1
In the 12 months prior to the survey, 12.4% of mothers could not ﬁnd child care for their two -year-old for a week or longer when it was needed. One in ten Oklahoma mothers in the 12 months prior to the survey reported that they or someone in their family had to quit a job, not take a job, or greatly change a job because of problems with child care.
The Oklahoma Toddler Survey (TOTS) asked mothers of two-year-olds about their child care arrangements in 2012-2014. TOTS deﬁnes child care as “any kind of arrangements where someone other than yourself [the mother], husband or partner, legal guardian, or child's stepparent takes care of your child on a regular basis.”
Overall, 48.4% of two-year-olds in Oklahoma were in child care. Of those, 1/3 spent 40 hours or more in child care each week. The primary child care providers for Oklahoma’s toddlers were grandparents (34.3%) and child care centers (31.2%; Figure 1).
Safety, stability, and nurturing are crical for children as they grow and develop. Stability includes the degree of consistency in a child’s social, emoonal, and physical environments.2 In the month prior to the survey, Oklahoma mothers reported an average of 5 mes that diﬀerent arrangements for child care had to be made at the last minute. Among racial and ethnic groups, Hispanic mothers had the highest average number of changes to child care arrangements (9.3), followed by Non-Hispanic (NH) Blacks (5.9), NH-whites (4.8), and NH-American Indians (1.1). Mothers enrolled in SoonerCare
t n e cr 20% e P
5% Small in-home child care (1 -7 children)
Large in-home child care (8-12 children)
Child care center (12 or more children)
Other relative(s) Babysitter/friend/ Mother's Day Out neighbor or similar program
24 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
In Oklahoma: • 48.4% of two-year-olds were in some type of regular child care • Grandparents were the primary child care provider for more than 1/3 of Oklahoma’s toddlers in care • Among mothers who received assistance to help pay for child care: -60.1% received help through a government agency -13% got help through a tribe -10.6% received help through other sources
• Average out-of-pocket costs for child care was $103.40 per week
-8.7% got help through relaves
Figure 1. Child Care Arrangements for Oklahoma Two-Year Olds, TOTS 2012-2014
Volume 9, Issue 2
• Mothers had to make diﬀerent child care arrangements an average of 5 mes in the month prior to the survey
An EEO Employer
Figure 2. Average Weekly Out-of-Pocket Child Care Costs by Arrangement Type for Oklahoma Two-Year-Olds, TOTS 2012-2014 $119.44
Average Weekly Cost
ts $100 o C ly $80 k e e W $60
“I want him to feel safe and have consistency and it is hard to find very consistent child care.” -TOTS mom
$97.48 $84.26 $71.16
The Oklahoma Toddler Survey (TOTS) is a two-year followback survey to the Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Mothers with live infants who respond to the PRAMS survey are sent a TOTS survey the month their children turn two-years-old. TOTS is a mixed-mode surveillance system. Two mail surveys are sent in an effort to gain participation followed by telephone surveillance for nonrespondents.
Small in-home child care (1-7 children)
Large in-home child care (8-1 2 children)
Child care center (12 or more children)
Other relative(s) Babysitter/friend/ Mother's Day Out neighbor or similar program
through tribes, 10.6% through other sources, (Oklahoma’s Medicaid program), also had a and 8.7% from relaves (Figure 3). higher average number of changes to arrangements than mothers not on SoonerCare (7.8 versus 2.1, respecvely; data not shown). Among mothers receiving payment help, 28.4% were Hispanic, 21.2% NH-Black, 18.5% NHCost white, and 18.3% were NH-American Indian. In the U.S., child care remains one of the most Addionally, 83.5% of mothers who received signiﬁcant expenses in a family budget.3 payment assistance were enrolled in Oklahoma mothers reported an average out-of- SoonerCare (data not shown). pocket cost of $103.40 for child care each Additional Considerations week. However, 30.9% of mothers with toddlers in care reported not paying any out-of Child care subsidies and other ﬁnancial supports can help parents access quality care.4 -pocket costs at all. From June 1 to July 31, 2016, new enrollments for the Oklahoma Department of Human Figure 2 shows, by arrangement type, the average weekly out-of-pocket child care costs Services' child care subsidy were frozen due to a budget shorall. The program helps lowfor Oklahoma two-year-olds. Grandparents income Oklahoma families pay for child care. were the most ulized providers and the lowest out-of-pocket cost at $71.16 per week. Any inﬂuence related to this gap in coverage More than any other racial or ethnic group, NH may be observed in future data. -American Indian mothers used grandparents Expanding access to aﬀordable child care as providers (42.8%; data not shown). The opons (such as Head Start and Early Head Start highest out-of-pocket costs were associated programs), increasing awareness and with other providers such as nannies. availability of ﬁnancial supports, and In Oklahoma, 19.9% of mothers received connuously improving quality are all steps payment help for child care. Of these, 60.1% toward more Oklahoma families using safe, received it through a government agency, 13% reliable, and aﬀordable child care.
70% t n60% e cr 50% e P40% 30% 20% 10% 0%
Figure 3. Types of Financial Supports for Child Care Costs among Mothers Receiving Payment Help, TOTS 2012-2014 Government Agency 60.1%
Types of Financial Supports
The unweighted response rate for 2012-2014 data was 65.2% (n=5,641; excluding women ineligible to complete TOTS). Data were weighted to represent the two-year-old’s birth cohort for those years. Prevalence rates were calculated using SAS callable SUDAAN. Special assistance for this Brief was provided by: Binitha Kunnel, MS; Ayesha Lampkins, MPH, CHES; Peggy Byerly, MS; Diane Wood, MA (OKDHS); Shannon Gormley; and Alicia Lincoln, MSW, MPH. Funding for TOTS is provided by the Maternal and Child Health Bureau, Department of Health and Human Services, MCH Title V Block Grant. The TOTS Brief is issued by the Oklahoma State Department of Health, as authorized by Terry Cline, PhD, Commissioner of Health. Copies are available for download from the Oklahoma State Department of Health website at www.health.ok.gov.
References: 1. Child Trends. (2012). Child Care. Available at Available at www.childtrends.org/?indicators=child-care 2. Centers for Disease Control and Prevention: Division of Violence Prevention. (August 2014). Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments. Available at www.cdc.gov/violenceprevention/pdf/ essentials_for_childhood_framework.pdf 3. Child Care Aware of America. (2015). Parents and the High Cost of Child Care: 2015 Report. Available at www.usa.childcareaware.org 4. Forry, N. D., Tout, K., Rothenberg, L., Sandstrom, H., Vesely, C. (2013). Child Care Decision Making Literature Review. OPRE Brief 2013-45. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
JANUARY/FEBRUARY/MARCH 2017 | 25
Editor's note: this article was prepared to coincide with the holiday season.
Provides Tips for Winter Driving Safety The upcoming holiday season means Oklahomans may often be traveling during potentially dangerous winter weather conditions. The Oklahoma State Department of Health (OSDH) encourages the public to begin preparation for the upcoming holiday travel season. Proper planning can reduce the risk of injury and illness while also ensuring a family is prepared for a major winter weather event. OSDH Emergency Manager Darrell Eberly reminds travelers to check local television and radio reports of weather forecasts prior to making travel plans, and to know what the National Weather Service winter storm and blizzard watches and warnings mean. “It’s a good idea to minimize travel during hazardous conditions,” said Eberly. “If you have to travel, it’s important to ensure your cell phone is fully charged, keep emergency supplies in the vehicle, and let friends or relatives know about your travel plans.” Officials also recommend keeping the vehicle’s fuel tank full to avoid ice in the tank and fuel lines. For travelers who become stranded, it is recommended to stay visible by putting a bright cloth on the antenna, and raising the hood when snow stops falling. Residents are encouraged to stay tuned to local media reports about current watches, warnings and road conditions. To learn more about weather advisories, visit www.nws.noaa.gov.
Blankets Snacks/water atteries Flashlight/b les Booster cab
n ter for tractio Sand or cat lit ered radio
Battery-pow First-aid kit
*Source: Oklahoma State Department of Health
26 | TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
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IN THIS ISSUE: Melanie Johnson, our OKTEC SPF-PFS Project Manager, recounts the impact of being part of a historic gathering of tribes, alli...
Published on Jan 20, 2017
IN THIS ISSUE: Melanie Johnson, our OKTEC SPF-PFS Project Manager, recounts the impact of being part of a historic gathering of tribes, alli...