The Need to Improve
As YKHC approaches the age of 50, we can look back with pride on how we have grown from administering a few programs in 1969 to providing a full range of health care services for a growing population in a vast and roadless region. Our network of 50 village health clinics, five subregional clinics and the Yukon-Kuskokwim Delta Regional Hospital (YKDRH) in Bethel provides primary care, inpatient, emergency services, surgery, Dental, optometry, behavioral health, elder care, prenatal care and more, pushing these services as much as possible out to the villages where people live. We have been guided by priorities expressed by our customer-owners over 22 years of Tribal Gatherings. We have strived to achieve a vision of promoting wellness through culturally relevant programs and services within the framework of the Native Self-Determination and Education Assistance Act of 1975.
Although we’ve come a long way, our people still suffer with high rates of infectious diseases, dental disease, suicide, cancer, and death due to injuries. These challenges, and an increasing population, are too much for facilities built for a health care service model conceived more than 30 years ago—that was barely adequate for the needs that existed then. To prepare for the needs of the next 50 years, our Board of Directors knows we not only need to expand and modernize facilities, we also need to improve our services in a way that respects and utilizes the age-old traditions that kept the people of the region thriving for millennia.
Despite the utilization of advances in technology, including Internet communication, telemedicine, adoption of an electronic health record system, and the construction of 35 new village clinics in the past 20 years, there is still much to be done as we seek to realize our vision of becoming “the healthiest people.”
The Vivid Vision
In 2014 CEO Dan Winkelman initiated a region-wide survey of employees, patients and tribal representatives, asking what would you like to be able to say about YKHC in five years? With answers to these questions as a guide, plans for how to achieve this vision began to take shape.
A new Indian Health Service (IHS) program, known as the Joint Venture Construction Program, offered an opportunity to grow both as a facility and as a care provider. IHS would increase funding to meet staffing and operation costs for implementing patient-centered integrated model of care in a new facility financed and built by the tribal entity. YKHC applied in September of 2014 and was selected first among 37 others in the nation to participate in the program. The door opened, but much was yet to be done to demonstrate that we could meet all of the IHS requirements for final approval.
YKHC partnered with architectural firms Bettisworth North of Fairbanks, Jones & Jones of Seattle and ZGF of Portland to initiate design concepts to build a 130,000 sq. ft. primary care clinic in Bethel and a major renovation of the 1980s-era YKDRH—an expansion project that would accommodate the vision of a cultural-based patient-centered model of care focusing on the wellness of the whole person.In imagining a new facility and a better system of care, board and administrative leadership stipulated three guiding principles: the project would represent our culture and identity, promote customer-centered care, and be affordable in cost and sustainable in operations.
Culture and Identity
In order to represent the culture of the region in both the service model and the facility, the Board and Administrative Leadership turned to the teachings of the late Paul John, founding YKHC board member, story-teller and teacher. He authored several books recounting stories and experiences of a traditional way of life that still existed in his youth. The wisdom of elders still familiar with Native family values had also inspired YKHC’s Behavioral Health Preventative Services to adopt the Yup’ik teachings of healthy families and communities—Calricaraq: Living in Ultimate Purity. The Board of Directors named the new health care improvement initiative the Paul John Calricaraq Project.
To be sure this project would be inclusive of the whole YK region’s varied culture, the project leaders and architects continue to seek input from the people in the region—ideas for improving health care appropriate for the people, designing the new facilities to be welcoming, comfortable and familiar for all those who would be visiting here for health care.
Calricaraq — Living in Ultimate Purity
Yuuluaqauciq — To Live in Completeness
YKHC’s Preventative Services implements and disseminates the traditional and community-based program, “Calricaraq” in our communities throughout the YK region in partnership with regional, tribal and local organizations. This Yup’ik-based curriculum builds upon traditional and prescribed ways-of-living. The values that were orally passed down by Yup’ik Elders are developed into a curriculum that aims to strengthen families and communities in healthy living.
A three-day community gathering and workshop guides groups, individuals, and families to empowerment through understanding how the process of acculturation has weakened family systems, how accumulated grief has been transmitted across generations, how healing from these impacts can begin through reclamation of pride and value in traditional healthy living practices. The activities that strengthen participants include talking circles, healing ceremonies, traditional dancing, prayer circles, craft & tool making, storytelling, teaching of values & ancestral wisdom & knowledge, subsistence activities, and guidance of our elders.
The Preventative Services staff also provides trainings and presentations for all agencies and organizations serving our region’s population. Gaining understanding, continuing partnership efforts, and providing ongoing capacity-building continues to impact our region’s effort “To be the healthiest People.”
Calricaraq Facilitators Guide – Workshop training manual for presenters and community partners
This cycle is all-encompassing of our Yup’ik ancestral wisdom & knowledge, skills, values, teachings, ceremonies, activities and subsistence living. All put together, it is our holistic approach to instill the necessary tools and skills for survival and living a healthy, balanced life and to insure that it is passed on to the next generation in our journey of life.
Delivery of Calricaraaq/ Yuuluaqauciq
1. Invitation by Tribe – Followed by Tribal Council Meeting
2. Planning by Tribe and prevention staff for three-day gathering
3. Three-day gathering , follow-up and training activities