1.6.1 Population
Iñupiat mothers (aged 18 and older) residing in the selected Maniilaq Service Area (MSA) villages that gave birth at a regional hub or urban hospital in Anchorage, their families and communities were included in the study. Strategic sampling i.e. selecting candidates for participation based on desired characteristics was used to identify mothers willing to participate.
Buckland, population: 429 in 2011, was selected as a comparison study village, first, because people I had signed on for involvement in preliminary study lived here. The area also ended up serving as a perfect example of differing expressions of Iñupiat cultural values and. A Maniilaq village clinic serves this area, but it is not continually manned and services are not as extensive as those offered in the medical center in Kotzebue. This village has just recently started making provisions for access to running water beyond the washeteria (community laundry facility) and other public
buildings, including the school.
Kotzebue, population: slightly over 3,000 in 2011, is the regional hub where the Maniilaq Heath Center is located, and is also the location of a Pre-Maternal home that was used during the onset of the study but that closed near the end of the study
period. Its location and larger population, made for easier access; both in terms of travel logistics and (originally thought) garnering participation.
Point Hope, population ca. 680 in 2011, was also selected based on access to willing participants, and its unique identity as a coastal whaling community of northwest Alaska that still engages in pre-contact ceremonies and practices. The only village within the MSA that is not under the Northwest Arctic Borough jurisdiction, a Community Health Aide (CHA) from the North Slope Borough (to which Point Hope belongs) still serves this village.
1.6.2 Geography, climate, and transportation
The study population resides within the Maniilaq Service Area (MSA), located in northwest Alaska (Figure 1.4). Mostly within Alaska's Northwest Arctic Borough on the Chukchi Sea, Maniilaq8 Health Association's service area encompasses the Kotzebue Sound, Noatak and Kobuk Rivers, and portions of the Brooks Range and Seward Peninsula, along with North Slope Borough's far-west Village of Point Hope. The MSA experiences temperatures from about -10 degrees F. in February to highs in July about 60 degrees F., with rare low and high extremes of -82 to 86 reached at times. Snowfall averages about 47 inches per year. From June 2 through July 9 every year, the sun does not set, with the area experiencing almost full darkness during the long winters.
With no roads connecting the region to the rest of Alaska, and no roadways
connecting any of the villages, transportation can be an issue for residents of the MSA. Residents are limited to air services out of the Ralph Wien Memorial Airport in
8
Maniilaq Association is a regional, tribally-operated non-profit health corporation that provides health and social services to residents of the Maniilaq Service Area (MSA), comprised of the Northwest Artic Borough and the village of Point Hope. This protocol was in use as early as the 1970s in other Alaska Native health regions of the state.
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Kotzebue, which supports daily jet service to Anchorage and Nome, as well as smaller prop-driven aircraft to the villages. High winds can also shut down air travel and make any transport—especially for trips to deliver in Kotzebue or Anchorage—difficult.
1.6.3 NW Alaska Socio-political maternal health care governing bodies
Responsibility for maternal health care services for this population lies among several multilevel jurisdictions at the state and federal levels I will discuss the features of western-based US and Indian Health Service maternal health care as it pertains to this thesis in depth in later chapters, including the State of Alaska, Native Corporations, and Village level entities concerned with maternity care in this area.
State of Alaska Public Health and Alaska Native Tribal Health Consortium The State of Alaska funds a Medicaid-like public assistance program, Denali Kid Care, to provide prenatal and maternity care for expectant low-income mothers, along with infant and child health and medical care for their infant(s) for up to 18 years. Many Iñupiat women from the Maniilaq Service Area (MSA: Figure 1.4) are eligible for these benefits
Figure 1.4 Map of Alaska (Inset) and Maniilaq Service Area
provided through the State of Alaska Department of Health and Social Services Division of Health Care Services. State of Alaska public health clinics, including, in most cases, maternity clinics, are also available in some regional hub communities. Kotzebue is one such village.
Other mothers are provided similar benefits through their representative
Corporation's membership in the Alaska Native Tribal Health Consortium (ANTHC). This collective group pays for much the same health and medical services, transportation and lodging as the Denali Kid Care program. ANTHC is the parent consortium of all Alaska Native health care associations and corporations throughout the state. This
administrative body is responsible for use and dispersal of collective funding from Indian Health Service (approximately 30%) and Native Health Corporations (the remaining majority).
Those sick and injured among Alaska Native village residents who require more care than village clinics can offer must travel to regional Alaska Native medical centers or urban native hospitals in Fairbanks or Anchorage. Pregnant women are included in this arrangement. As noted above, pregnant “patients,” will likely remain in the Kotzebue or Anchorage area for longer periods than will other types of patients.
Northwest Alaska Native Association (and Arctic Slope Regional Corporation) The participant Iñupiat village residents are represented by Northwest Alaska Native Association (Kotzebue, and Buckland residents), and Arctic Slope Regional Corporation (Point Hope residents). These Alaska Native Claims Settlement Act (ANCSA)
corporations are more of a business-oriented body than political one. As such, they represent their shareholding members, with a for-profit mandate. Unlike typical business operations, however, these corporations can also form associations and enclaves like the health consortium to provide health care for their clients collectively. In addition, unlike other solely Indian Health Service-funded health care agencies operating among other Native American groups, Alaska Natives have access to Native Corporation supported services and facilities. A unique situation exists in which the NANA region-sponsored
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Maniilaq Health Association grants service and facility access to an Arctic Slope Regional Corporation village, Point Hope.
Northwest Arctic Borough
This political boundary is comprised of the same villages as those represented by the NANA Regional Corporation villages of the MSA: Ambler, Buckland, Deering, Kiana, Kivalina, Kobuk, Kotzebue, Noatak, Noovik, Selawik, and Shungnak.
Maniilaq Health Association/Health Center
Maniilaq Health Association is the health corporation formed and funded by NANA. Because of the closer proximity of the ASRC Village of Point Hope, however, this Alaska Native village is also included in the Maniilaq Service Area. The Maniilaq Health Center (MHC) is located in the regional hub Village of Kotzebue. The Health Center is "a primary care facility that houses an emergency room, with local and Medevac support for accident/trauma victims, as well as an Ambulatory Care clinic, Dental and Eye Care Clinics, a Pharmacy, a Specialty Clinic, and an Inpatient wing with 24 beds for recovering patients (Maniilaq Health Association 2003)." The present facility was constructed in 1995, replacing a building one-half its 88,000 square-feet size.
Maniilaq Association lists a Tribal Doctor program under their Cultural Services, adding that this holistic approach offers 'traditional medicine and healing techniques.' Maniilaq Association's Tribal Operations unit, under Native Services is able to reallocate funds and 'redesign, plan, conduct, consolidate, and administer programs to enhance the effectiveness and stability of tribal governments (Maniilaq Health Association 2003);' and lists goals to aid tribal government self-sufficiency and self-government.
Village Clinics and Councils
Maniilaq Health Association oversees the operation of 11 clinics, including 10 NANA village clinics and one clinic in the Village of Point Hope. Each are staffed with two to four aides from their Community Health Aide Program (CHAP). All clinics have connection and access to medical records at the Health Center in Kotzebue, as well as video and audio teleconferencing, and a computer telemedicine unit.
The Maniilaq Association Board of Directors consists of twelve full-time members, each of whom is elected to a three-year term by the Tribal Councils of his/her respective community. This governing body is formed with one representative from the Tribal Council of each of the eleven communities in the Northwest Arctic Borough, and a representative from the village of Point Hope.