Alaska Apostille

In honor of Better Speech and Hearing month, I felt it appropriate to discuss something that everyone faces on a daily basis – noise. Noise can range from laughter to crying, to an annoying “drip, drip, drip” of the faucet to a soothing symphony. Noise was created to add dimension and bring color to life.

Although noise can enhance our lives, too much noise can also cause us to lose our hearing. Prolonged exposure to noises and/or brief exposure to intensely loud noises increases the likelihood of noise induced hearing loss (NIHL). The NIOSH (National Institute for Occupational Safety and Health) Web site states “NIHL is caused by exposure to sound levels or durations that damage the hair cells of the cochlea. Initially, the noise exposure may cause a temporary threshold shift – or a decrease in hearing sensitivity that typically returns to its former level within a few minutes to a few hours. Repeated exposures lead to a permanent threshold shift, which is an irreversible sensorineural hearing loss.”

NIHL is tremendously impacting the younger generations and the impact appears to only be increasing. A study completed in 2001 by Niskar et al. revealed “the incidence ofNIHL among children and adolescents in the United States hasbeen reported to be 12.5 percent.” Although this appears to be a low percentage, when you stop and think that this data are taken from children and adolescents, it makes you wonder what their hearing will be like in their early 20s, mid 30s, and so forth. When you put it into numbers, we're talking millions of children and adolescents. As medical advances are prolonging the average American life, more and more people are faced with this dilemma. We need to take action now to ward off the long-term effects.

Even as I say this, I recognize that I need to follow my own advice. I served on the worship team at my church for two years and stood directly in front of the drums. We weren't given any earplugs or headphones; we just turned the monitors up louder to help drown out the drums. As result, I experience tinnitus several times a week and have a mild NIHL. Although this may be a small part of my job as a speech-language pathologist, I have to turn the volume up when testing audiometers for hearing screenings. Although it's a little embarrassing to admit that I was negligent and became party to my own NIHL, I also realize that many of us have hobbies that are impacting our hearing, too.

Think about all the wonderful things Alaska is known for: moose, bear, birds, etc. One of the biggest draws to this great state is all the game you can hunt. Shotguns produce painfully loud explosions, and how many of us are wearing ear protection? What about riding four-wheelers or snow machines and motorcycles, listening to loud music for long periods of time, or using mixers and blenders when cooking? It may seem that I am stretching the boundaries of reason, but each and everything we do affects our ability to hear. Not a single one of these hobbies is bad, but not wearing the proper protection, however, is bad. I'm not here to give a lecture, but to emphasize the importance of having and using ear protection. It's as vital to your health as brushing your teeth, putting lotion on dry skin or using medication to clear an infection. There are many resources available that provide useful information to tolerable volume levels and the appropriate amount of exposure time, including: http://www.gcaudio.com/resources/howtos/loudness.html.

Let this Better Speech and Hearing month jumpstart a commitment to yourself to protect the hearing you have now and your ability to hear in the future.

Works Cited

Fligor, B.J. (2009). Risk for Noise-Induced Hearing Loss from Use of Portable Media Players: A Summary of Evidence Through 2008. Perspectives on Audiology, 5 10-20.

Meinke, D., & Dice, N (1985). Supplement: Comparison of Audiometric Screening Criteria for the Identification of Noise-Induced Hearing Loss in Adolescents. American Journal of Audiology, 16, S190-S202.

Niskar, A. S., Kieszak, S. M., Holmes, A., Esteban, E., Rubin, C., & Brody, D. J. (2001). Estimated prevalence of noise-induced hearing thresholds shifts among children 6 to 19 years of age: The third national health and nutrition examination survey, 1988-1994, United States. Pediatrics, 108, 40-43.

http://www.cdc.gov/niosh/docs/98-126/chap2.html. Retrieved May 19, 2009.

http://www.gcaudio.com/resources/howtos/loudness.html. Retrieved May 19, 2009.

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Melody Martin, M.Ed., CCC-SLP is a speech therapist at All For Kids Pediatric Therapy.

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February 23, 2009

Early morning in Malawi is my favorite time. Just before 5 a.m. and the break of day an infinite variety of sunbirds sing you awake, most prominently the ringed neck and cape turtledoves.

The new day begins with the unpredictable happenings that fill each of our days. Most are related to the villagers who live within a half-mile of our lakeshore thatched roof cottage. Yesterday, it was the 3-year-old boy with an abscess on his scalp, which when I opened it, produced a small rice size pupa of some flying insect. The other day, it was a 7-year-old girl who had a normal left leg to her knee and then a dangling, useless and withered lower extremity seemingly unattached except for the skin, blood supply and a few ligaments. It was reported to have happened after an injury several years ago. She will need an amputation available at a volunteer orthopedic hospital 4 hours from here.

Then of course there are the daily requests for food, which soon should end because of the ripening maize. The only complication is – monkeys and elephants. Monkeys are easy enough. You station monkey guards in the maize fields and man them 24 hours a day. Elephants are a different issue. The villagers plant pumpkins between the rows of maize and elephants love pumpkins, even more than maize. This morning we heard there is a nearby herd of 12 and they are destroying hectors of maize in their marauding search for pumpkins. Folks never win out here.

There is some progress, however, and some good news. We noticed on this visit improved roads around Mangochi. The two separate stretches of sand and mud and dirt that connect us with our closest town of Mangochi 15 kilometers away have been paved. This was promised 10 years ago and has just happened. I cannot tell you what a joy a paved, smooth road is out here. Our battered little Toyota is very pleased. Telecommunications have continued to improve. Cell phones greeted us 10 years ago, which was a great surprise. This time the national telephone provider added an Internet modem that you attach to your computer, which works surprisingly well. Never in my lifetime did I imagine to be able to send email from our cottage. It is now possible.

But the best news is the Malawi Children's Village. This home-based orphan support center for the 37 surrounding villages has now almost completed its expansion. There is the village outreach and bed net program, irrigation and agriculture projects, the clinic, library, vocational training program and now the newly completed four-year secondary school. The twenty thousand dollars that the U.S. Board has annually spent on paying secondary school fees for students to attend school elsewhere are now used for Gracious Secondary School on the MCV campus. The 245 students are a combination of self-pay students and the 84 orphans who are qualified to attend. This year the required exam to continue your studies taken at the end of your sophomore year(Form II), there was a 100 percent pass rate. The average pass rate in government schools is less than 50 percent.

Because of the tuition paying students, this MCV project should not require external funding in several years.

There is progress in the villages. A recently completed survey compared the average weight for age (for under 5) of orphans and non-orphans in the MCV Villages. The averages for both groups were identical, measuring 14 percent below ideal weight. The government reported average for this district is 22 percent below ideal weight. All children in the 37 MCV supported villages are better off than in the large Mangochi District around the lakeshore. Orphans are just as well off as non-orphans, which has been one of the goals of the MCV program.

Since the beginning of the program in 1998, five thousand, seven hundred and nine orphans have been served. This number does not include the support that has been given to the guardians and grandparents in the form of housing repairs, treadle pumps, seed packets and fertilizer. The adopt-a-school program for primary schools is also benefiting

all students in the MCV area.

The need continues, but with the help of all of you, there is an improving village infrastructure, and institutional programs at the Malawi Children's Village that will continue into the future.

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February 13, 2009

The big problem – The secrets of the village

Usually the conversation starts with “Bwana, I am suffering too much.” Most often the issue is not enough food or a thatched roof that is leaking. The requests most often come from one of the villagers who live nearby.

It was a bit unusual to have one of our favorite teachers whom we have known for the past 10 years, greet us saying she had a very big problem that she did not want to discuss just yet. We had stopped for a school visit to one of the schools adopted by a sister school in Anchorage. After meeting with all the teachers, passing out pens and pencils, hearing their requests for the school (doors for the classrooms, chalk boards, bicycles to transport the teachers from their homes, and assorted other items), I left Ruth alone with the teacher. She did not want to discuss the issue in school, but instead walked Ruth to her home and handed her a small piece of paper. It was a laboratory result. She was HIV+. It was too difficult for her to say she was positive.

Ruth asked about treatment and the story became more complicated.

A bit of history is in order. AntiRetrovirals (ARVs) only became available to the general public in Malawi two years ago (they have been available in the U.S. for more that 20 years). As a consequence, no one was ever tested. In fact, the government under the dictator of Kamuzu Banda denied that there was any HIV in the country until he was removed from office in the mid 90s. We now know that the first documented cases were in the 1985-1986 time period.

So HIV/AIDS has been a relatively new issue for the general public. I remember the secrecy and stigma that surrounded HIV testing and treatment in the late 1980s in the States. Separate hospital patient charts were kept. The one documenting a HIV positive test and treatment were kept in a special locked file in medical records; the other medical record was used in the clinic and hospital. We had endless meetings about how to handle this information.

The Malawian public is at the stage of understanding and acceptance that we were 20 years ago. Dr. Banda's denial held back international support for HIV education, testing and treatment. Malawi was and is behind the rest of the Sub Sahara countries (with the exception of Zimbabwe) in their approaches to this devastating disease.

For our teacher the issue is privacy. She could go to the HIV clinic at the District Hospital and now receive free treatment although she would be waiting in the outpatient line for most of the day. However, and most importantly, the entire community would know that she is HIV positive.

Instead, she travels to a private clinic on a monthly basis, pays MK 200 (MK= Malawi Kwacha) for transport and MK 500 for the HIV medication. This is a significant percentage of her monthly salary. In fact this month she had to borrow her HIV medication from one of her friends.

HIV/AIDS is still a secret here. When people die, it is from TB. Keeping HIV secret gives it power, but change is coming, albeit slowly.

In the personals section in the national newspaper, one now sees: “24 yo male seeking educated 20 something female, loves to read, and willing to have an HIV test.”

This would have been unheard of several years ago. In the MCV villages, we are aware of 37 people on ARVs. There was none two years ago. If tomorrow every HIV positive person in the 36 MCV villages were on treatment, there would be only a few new HIV orphans. The current medications are very effective in reducing the viral load in the bloodstream to almost zero, so that the chance of transferring HIV even during unprotected sex is significantly reduced.

There is hope!

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February 11, 2009

The time of Njala

Hunger is nasty! It robs the spirit, zaps your strength and makes you vulnerable. There are pockets of hunger in the States, here in Malawi it is part of the daily conversation. January and February in Malawi is the Njala (hunger) time.

No government subsidies here. You eat what you raised in the last rainy season. If you did not raise enough, or the rodents ate it, or maize weevils invaded, or it was not stored properly, you go hungry. Last year it was the first problem-unreliable rains resulted in a poor harvest.

When we left Malawi last February, we saw some of the healthiest and robust maize fields that we have seen. The maize was just in to the tassel stage, then there was no rain for two weeks and the results were disastrous. Wilted maize stocks resulted in poor harvest. This all happened two and three miles from the tenth largest lake in the world. Not possible you would think! You need to travel to this part of the world.

Here is the note on the scrap of paper a villager brought to the house two days
ago. “Hie Mr. and Mrs. Tom. I have come hire to tell you about my problem. For my
house, have no maize flour, two days not eating food, my children are craying with
hungrey, so madam please asisnt me money for buying maize flour.”

We are asked for food money almost every day. It is problematic to give out money
here, so Ruth stockpiles one kilo packets of rice, beans and sugar. This requests come not from strangers, but from folks who we know or recognize.

The simple long-term solution for other parts of the world would be a simple irrigation scheme. It might make sense in the North but you have to think Africa. Moving water takes energy, pumps and pipes, all in short supply, very expensive and beyond the means of those in the traditional villages common in Malawi.

Farming practices are also a problem in the Mangochi area. The same field is planted with maize year after year. There is no crop rotation in this sandy soil and the remaining nutrients are depleted and leached from the heavy rains. The historic solution has been the use of government subsidized fertilizer. Ask any farmer in the States about the increase fertilizer prices in the last few years and you will understand why even with the modest subsidy, fertilizer is out of reach
for the majority of Malawians.

Such is life here. The priorities are very clear. First is the next meal; next is a thatched roof that does not leak; then it is safe water to drink. Pretty basic, but even in 2009 for most people in Malawi and I suspect Africa as a whole, this is the reality.

Every visit here makes us think about what is important in life.

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February 5, 2009
Home again

My response was the same as Ruth's. This is surreal. Has it been a year since we have left Malawi? We landed at Chilaka Airport. It was if we had never left. Nothing much changes in Malawi. Swarms of people around the airport, 90 percent humidity, and seas of smiling faces with green country side because of the rainy season. No new buildings, roads, bridges nor traffic lights.

This trip from the States seemed shorter than usual, a 14 hour direct flight from Washington D.C. to Johannesburg … a quick overnight and another two hour flight and three hour car drive and you are here.

The cottage is the same, the road into our place with water filled pot holes that will swallow our small car, and the ringed neck doves demanding from the trees with their distinct song of “work harder, work harder, work harder”, yes all the same.

You are aware of the light here. The sun rises at 6 and sets at 6. There is barely a half hour difference all year long. And set it does. A half hour after the first sign of twilight, it is dark as only Africa can be. Someone switches the light off.

And so arriving at 5 p.m. we set about unpacking our 84 kilos (185lb) of luggage, (52lb of excess). There had to be questions when the luggage was screened by TSA in D.C.: there was window screening, a traveling pharmacy, a wheel chair cushion, blow-up bed, tools, printer, various ink cartages, toilet paper and soap, discarded sim card cell phones … plus a variety of uncategorized items like a rain gage.

At 6:30 the electricity went out- this is Malawi. Ruth did not miss a beat. I married the right person. In addition to all the other paraphernalia that she brought, she had battery operated closet lights-dim but adequate. No electricity equals no water being pumped from the lake to the small leaky storage tower that supplies our house. But our forward thinking housekeeper had stored 25 gallons in a garbage container and had it sitting in the hallway. A couple of pans of water over your head, after a day's travel in Africa is as good as a hot shower in any 5-star hotel.

And so the routine begins: in bed by 8 p.m., awake by all the birds at 5 a.m., a short run up our dirt road leading to the house and the first visitors to our porch at 6 a.m. On our morning run I am reminded of the old camp song which has the refrain: “I wave my hand to all I see and they wave back at me.” Malawi is known as the “Warm Heart of Africa” a testimony well deserved by these genuinely kind and
gentle people.

We feel privileged to be among them.

What you do not appreciate from the roads that winds through the hectors of hand tilled green maize fields, is the stories from the village.

Over the next few days, the stories of hardship and tragedy will begin to be told. These are the stories that a casual visitor to Malawi will never hear, but are as much a part of this world as safaris and sighting the “big five,” and the lure of the Dark Continent. We will share them with you.

–

February 4, 2009

Alaska to Africa

We touched down in JoBurg at 6:30 a.m. Tuesday Alaska time (4:30 p.m. here). We arrived
at the new Jan Smuts International Terminal that has been built for the August 2010 World Cup Games that will be held in Africa for the first time. Even the African Center Leisure Hotel in funky bright yellows, oranges and greens (where we have stayed before) has been upgraded including wireless (this is not the Africa I know).

It was a direct flight from Washington D.C. with no refueling stops. Fourteen+ hours in
the air, but the plane was not full so we could get some sleep and arrived at Joburg (at 5000 feet) in not bad shape.

We get to the “real” Africa tomorrow morning when we leave for Blantyre, Malawi. It is
always feels vaguely like “going home” since this country and these people have had such a dramatic impact on our lives for 45 years and recently in the lives of a number of Alaskans who have had a chance to visit. You can see some of their pictures by going to the Malawi Children's Village Web page: malawichildrensvillage.com

Malawi is much the same as it was in 1964 when Ruth and I started our work and lives together as newly married Peace Corp volunteers. It is rural, subsistence, and people still live is small villages that you see in National Geographic.

What is new, however, has been the devastating impact of HIV AIDS in this country of 12 million. Both the police and military are short of men between the ages of 19 to 30 because of this disease. And as evidence to the profound injustice in this world, the first HIV medications were not available to the general population until two years ago. It is a small country that has been largely forgotten.

Some people can only understand our yearly sojourns here as missionaries. I think the appropriate label is “emissaries.” We come from halfway around world to be present and let the Malawians know that in the far away place called Alaska, which they can only visit in their dreams, they are not forgotten.

So as we begin, Ruth and I want to let you all know that you are making a difference in the lives of the children served by MCV. They would say Zikomo Kwambili (thank you very much).

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Dr. Tom Nighswander is an Anchorage physician. His wife Ruth is a registered nurse. They first traveled to Malawi, Africa in 1964 as Peace Corp volunteers.

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Do you have a comment about this 2nd Opinion? Send it to: healthconnections@ktuu.comor use the comment feature below.

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First Steps to Fitness

“I'm ready to be fit.” “It's time to get back into shape.” Sound familiar? Perhaps you've never set foot in a gym before and you know you should be exercising…everyone says so. So what do you do? Where do you begin?

I'll give you my best recommendations for how to start and, more importantly, how to continue on a fitness program. I won't go into “why you should” because if you're reading this you already know why. If after reading this you want to know more about starting your own fitness program, I recommend you read “First Steps to Fitness: Secrets to Incorporating Fitness into Your Life,” at www.AlaskaFit.com.

What is the most common mistake that people make when beginning a fitness program? They jump into the three-day fitness implosion plan. It entails hitting the gym three days in a row as hard as you can, to the point of exhaustion. You end up so sore you can't move, you see no change in the scale after working so hard, so you decide to add dieting to this plan. In addition to being muscle sore, you now have no energy because you're eating just enough to avoid starving to death. It doesn't work. Your plan collapses all around you. You decide that health and fitness is for “other” people and not “regular” people like you. So, on the fourth day of your fitness plan, you recall the comfort of the couch, the taste of a real meal and somehow don't find the time to hit the gym. Your muscles recover, you no longer ache, your fitness plan has imploded and you're back to where you started.

Does this scenario sound familiar? We've all done it at some point. You might extend this scenario out to three weeks, perhaps even three months. Somewhere along the line you lose your enthusiasm, your drive and your optimism and revert to what you've always done. What can you do to make it different this time? How do you avoid the implosion?

Here are my best recommendations:

Start slow: Day 1 of your fitness program should inspire you to Day 2 of your fitness program. Go ahead and work up a sweat. Starting with 20-30 minutes of exercise on Day 1 will leave your feeling good and anticipating Day 2.Do something you enjoy!If you hate running don't do it! Your mind will perceive running as a punishment, not a fun activity that makes you feel good. This dooms you to failure before you begin. Take the time to figure out what gets your body moving and makes you feel good. Try a walk. Try a run. Rent a bicycle. Check out your local gym for classes or check with other fitness outlets…perhaps your church or your school offers a program. Set goals: Just make sure your goals are reasonable…dropping 10 pounds in two weeks before you go on vacation is not reasonable. One or two pounds per week are reasonable. Five pounds by the end of a month is reasonable. Reward yourself when you reach the goal: Buy new sneakers, go for a massage, take a long, hot bath. Make sure your reward inspires your success.Sneak activity into every day: Movement is your goal. Get up and get moving every day…take the stairs, use the phone book for biceps curls when you're on the phone. Fitness is not all or nothing. It's not two hours at the gym or all day on the couch. It's being active in some way every day.Build your commitment as you build your fitness. As you get stronger and have more endurance, up your goals, reach for something new. Get outside your comfort zone. It will keep you inspired and focused so you don't lose momentum. Vary your workouts: Now that you've gotten good at your chosen activity, what's next? Figure out a new challenge; change something to keep yourself interested.Make the long-term commitment then live it one day at a time. Keep in mind that fitness is not a short-term, few week thing. It truly is a lifestyle change and it takes place one day at a time, not overnight.

Keep in mind, you are the most important person in your life…not your significant other, not your kids, not your parents…you. Commit to taking care of yourself daily. If you don't, you will not have the time, energy or enthusiasm to take care of all of the other people who depend on you.

Don't think about tomorrow and how you'll find the time to workout for the rest of your life. Focus on today…just today. Pick your activity, do it for as long as you can, whether it's 2 minutes or 2 hours. Enjoy every minute of it. Breathe the fresh air, feel your muscles working, live it fully. It will inspire you to do it again tomorrow. And when you're doing good for you, it's easier to do good for others.

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Ginny Grupp holds a Master of Sciencein exercise science and health promotion. She is an ACE-certified personal trainer and NASM Performance Enhancement Specialist. She promotes healthy lifestyles through her personal training and fitness education company www.AlaskaFit.com.

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Do you have a comment about this 2nd Opinion? Send it to: healthconnections@ktuu.comor use the comment feature below.

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If you're like me, you dove into the story in the Anchorage Daily News regarding our local celebrity Kai Zwierstra. She did Alaska proud when she appeared two years ago on the “reality” show The Biggest Loser.

For those of you who aren't familiar, Kai dropped 118 pounds on the show. She came very close to being the first female to win the contest. Whoo-hoo…Alaska girls kick a**!

Well, 2 years after the cameras are gone and Kai has left “the ranch,” it's not all roses and sunshine.

Here's the reality that “reality TV” doesn't address.

Dropping literally hundreds of pounds in a few months is not safe, not healthy and sets contestants up for failure when they return home.Exercising every waking minute of every day is not possible in real life.Exercising until you puke is not healthy and certainly does not make you want to come back for more.Trainers making diet recommendations based on product endorsements are at a minimum unethical and worst case, dangerous!The Biggest Loser is a GAME! It is not a lifestyle choice.Lifestyle changes do not happen on television, they cannot be thrust upon you. They must evolve. They are conscious, daily choices that you gradually work into your life until they become your new habits.

What does work? Here are 5 simple steps that can help ensure you are successful in hitting your health and fitness goals and that you can maintain them for life:

Define your goals…what do you want to achieve? WHY do you want to achieve these goals and on a scale of 1-10, how committed are you to achieving these goals? Establish your base…Where are you today? Take some baseline measurements so you can track your progress. Make a plan. Be sure that your plan includes the following components: nutrition, resistance training, cardio, and flexibility. Get yourself a coach to help you with this. He/she should be able to provide knowledge, support and accountability to help you reach your goals. Take action. Implement your plan. The best plan in the world won't help you at all unless you put it into action. Assess your success. Every 4 weeks or so, track your progress, what's working, what's not, what can you change, where can you get help?

Most of all, don't be afraid to ask for help if you need it. Lifestyle change is a process and frankly, it never ends. There is no finish line. It's simply how you choose to live your life. If you have bigger issues that surround food, find a competent counselor to help you to address these issues.

Remember, it's not about getting into shape; it's about getting into life! And the better you feel, the more you will get out of life!

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Ginny Grupp holds a Master of Science in exercise science and health promotion. She is an ACE-certified personal trainer and NASM Performance Enhancement Specialist. She promotes healthy lifestyles through her personal training and fitness education company www.AlaskaFit.com.

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Do you have a comment about this 2nd Opinion? Send it to: healthconnections@ktuu.comor use the comment feature below.

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The health care reform issue is incredibly complicated as it affects 100 percent of the people in the U.S. The sheer volume of paperwork, now more than 5,000 pages including bills and amendments, is overwhelming.

The past few months I have read almost 2,000 pages of legislation as well as several books on the issues. The senators and representatives have good ideas but really do not understand how the bureaucratic mess they are creating will adversely impact our nation.

I agree with many of President Obama’s ideas and do think we need reform, but not the bills under consideration.Senator Grassley of Iowa came the closest thismonth when he made the statement that this bill is going to lead to $1.8 trillion dollars in increased federal administrative costs, cause billions of dollars in increased taxes and fees for all Americans, and still leave 25 million Americans (that is1 in 12 Americans) without coverage.

I think there will also be a physician shortagewithin the next few years if these bills pass in current form, because of increased bureaucracy and low reimbursement rates that pay us less than our costs.

The surveyconducted atProvidence Medical Center in Anchorage,Alaska this week arose out of concern that many of my fellow MDs have said they would retireif this legislation passes in its current form. The results of the survey, which represents 11 percent of MDs in the Anchorage area, were as follows:

1) Only 18 percent of MDs said they could continue to practice if paid at Medicare rates

2) Fifty five percent of MDs said they would consider retiring or opting out if the current bills pass (only 30 percent of MDs said they would stay in practice with 14 percent unsure) (this is higher than the national survey that said 45% of MDs would retire or opt out.)

3) Fifty two percent thought Alaska should try and opt outif any of the current bills pass

4) Sixty percent of MDs have written to their U.S. senators and representatives, which is an incredible number of MDs that are concerned about this issue.

Senator Murkowski was right in her analogy of giving people a bus pass (i.e. insurance) but then not having bus drivers (physicians) to take them anywhere.

We do need insurance, Medicare, Medicare audit and malpractice reform.

We need to allow seniors to opt out of Medicare, keep their private insurance and have HSAs with money that is going to their secondary insurance companies now. Letting the seniors instead of the government or insurance companies be in charge would dramatically lower fraud rates and administrative costs and decrease taxes on all of us.

We need to allow seniors who want to pay their primary care MDsat their full rates be allowed to do so without physicians being accused of fraud. And MDs should be allowed to discount their rates on a case by case basis to uninsured/under insured patients without fear of fraud accusations as the rules are so confusing it is hard to know what is correct anymore. The whole Medicare reimbursement system needs to change!

MDs should be allowed to write off Medicare/Medicaid/uninsured losses like any other business loss.($47,000 last year for me alone)

Medicare rate auditors should not be paid on commission and allowed to extrapolate over the practice for any fraud (mistakes) they find. For a simple charting error Icould face a $10,000 fine on a visit I lost $68 dollars seeing the patient. This could then be extrapolated so I would face a $100,000 fine for a simple charting mistake. It is fear over these audits (because none of us is perfect) that have driven more MDs away from Medicare than anything else. These bills are putting $830 million towards fraud audits and $50 million to training new MDs. The priorities are all messed up!

Malpractice reform,with special courts made up ofMD and attorney panels need to be set up in every state along with caps on damages and uniform statutes of limitations.

We need insurance reform as President Obama has suggested, but I disagree with the publicoption as we already have many public options now, none of which are working well as they are bankrupting the country.We need national catastrophic insurance over 3 million for everyone paid for by taxes on soda pop, alcohol ,candy and tobacco all of which are contributing towardsa less healthy population. We need HSAs for everyone, and to make insurance companies nonprofit, or if they are for profit make them use 10 percent of their profits to provide low cost or no cost premiumsthe poorest in our nation. We need to eliminate pre-authorizations for medicines and radiology procedures, eliminate the “preexisting” clauses, allow portability, and have simple forms used by everyone to decrease administrative costs. I do not agree with single payer systems (I do not want a government or insurance monopoly)but do agree with limited clearing houses to reduce costs.

My overhead is $450/hour and if paid at Medicare rates for all patientsI would be bankrupt in months. Electronic medical records increased my costs and dramatically decreased the number of patients I was able to see when I tried themand I think physicians should be allowed to choose whether or not to do them in their own practices and not be mandated by the government.

We also need to increase medical school slots in Alaska and also residency slots as we will be facing big shortages soon.

What we need is less bureaucracy, fewer rules and regulations, more control in the hands of the patients and their providers, less taxes, and people to take more responsibility for their health and healthcare bills.

Ilona Farr, MD

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Alaska's Pre-Med Summit

Editor's note: On April 1, 2006 the University of Alaska Anchorage held the first-ever PreMed Summit in Alaska. Two years later, the event drew participants from around the state. Director of the WWAMI Biomedical Program Dr. Dennis Valenzeno summarizes this year's event.

The 3rd Annual Alaska PreMed Summit was held Saturday, March 29, 2008 in UAA's Rasmuson Hall – and, via live videoconference, at the University of Alaska Fairbanks and the University of Alaska Southeast. More than two hundred participants, speakers, and volunteers attended the event statewide.

Presented by Alaska WWAMI – Alaska's Medical School and the UAA University Honors College, the special focus of the 2008 Summit was the Medical College Admissions Test, the MCAT, which is administered by the Association of American Medical Colleges (AAMC). An AAMC representative, Dr. Steven Barkley, discussed the test and recent changes in its format and content, “The New MCAT.” His slide presentation is available at the Alaska WWAMI web site, http://biomed.uaa.alaska.edu/pre_med_summit.html.

The keynote was an address by Chief Medical Officer for the Alaska Department of Health and Social Services, Jay Butler, M.D., who discussed current issues in Alaska medicine and healthcare.

As with previous Alaska PreMed Summits a highlight was the discussion with panelists who represented stages in the career path toward becoming a physician – beginning undergraduate student, senior premed student, 1st year medical student, 3rd year medical student, medical resident/fellow and practicing physician. The latter position was occupied by Ross Tanner, D.O., president of the Alaska State Medical Association.

Students who attended had the opportunity to hone their communications skills through mock medical school interviews. Each student who was interviewed was given a written critique of the encounter to help improve those skills.

A host of other activities included tours of the Alaska WWAMI facilities at UAA, the opportunity to interact with representatives from other medical schools, healthcare organizations and several branches of the military that provide medical scholarships.

For more information about careers in medicine visit the Alaska WWAMI Web site:

http://biomed.uaa.alaska.edu/.

Alaska PreMed Summit information, current and past, can be found at:

http://biomed.uaa.alaska.edu/pre_med_summit.html

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Dr. Dennis Valenzeno is associate dean of Medical and Premedical Programs at the University of Alaska Anchorage and director of the WWAMI Biomedical Program. He is also assistant dean for Alaska WWAMI University of Washington School of Medicine.

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You're committed to improving your health. You've even hired a personal trainer. You don't know much about him, but he's in great shape and you want to look like that, too.

It's your first workout. You're excited as he sits you down at a machine, adds some weight and tells you to push. You try, nothing moves. You tell him it's too heavy. He says try harder and stop whining. So, you try harder, he helps you and you move the weights. Success! Your back hurts a little bit, but he says that's just because you're weak. You follow him to the next machine and it's the same thing. You push, he stands by and counts and reminds you that he's the expert, so don't complain, just do it.

By the end of the workout, you can barely walk out of the gym and that pain in your back is worse. The next day you call in sick to work because your muscles are so sore you can't get out of bed and your back is screaming. It's a true story, but it doesn't have to be your story.

Great benefits of working with a qualified personal trainer

Planned programsGoal setting and achievingObjective feedback about what your body needsAccountabilityDocumentation of progress

Dangerous hazards of working out with someone who is unqualified

Increased risk of injury”No pain, no gain” mentalityUnplanned workoutsLack of goal setting and progress trackingWasting your money and seeing no improvements in your body

How can you protect yourself from the dangers and find a professional to work with? Follow these top 7 tips to avoid hiring an unqualified trainer.

Research your trainer. Ask him what about his background. Is she certified? How long? Does she have to re-certify and take continuing education classes? Make sure all credentials are current.Research his qualifications. Make sure the certifying body is nationally recognized and accredited (more on this below). Talk to her clients, current and former. Every trainer should have clients that love them and are willing to give testimonials for them. If they don't, move on to your next candidate.Interview more than one trainer. There are dozens of trainers in your neighborhood. Interview them just as you would a potential employee and speak to more than one. It's always good to compare and contrast candidates and figure out who's best for you.Find the “chemistry” You should be able to clearly and honestly communicate with your trainer. You should respect, but never fear your trainer. If he intimidates you, the relationship is out of balance and you will be the loser.Observe trainers with their clients. If you are already a member of a gym observe who's around you. Is the trainer engaged in what the client is doing? Are they observing and correcting the client's form and movement to ensure their safety? Is the trainer more engaged with her gym buddies than with the client? These are all subtle hints about how you will be treated as a client. Ask around. Ask the gym management about the qualifications of their staff. What is the minimum standard that the gym sets for their trainers? There should be a definite answer to this question. If there isn't, change gyms.

Who certifies personal trainers? There are dozens, maybe even hundreds of companies that will certify someone as a personal trainer. Some of these require frighteningly little education to be certified. Your trainer should have a certification from a company that is accredited, and nationally recognized.

Some examples are: The American Council on Exercise (ACE), The National Strength and Conditioning Association (NSCA), The National Academy of Sports Medicine (NASM), The American College of Sports Medicine (ACSM), The Cooper Institute. There are a few others, but these are some of the biggest.

You can find quality trainers out there. There are many, but there are also many who are dangerously under-qualified. Protect yourself, do the research and look for the information we've given you here. Who you work out with is important. You are making a change in your lifestyle and you deserve only the best…go out and get it!

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Ginny Grupp holds a Master of Science in exercise science and health promotion. She is an ACE-certified personal trainer and NASM Performance Enhancement Specialist. She promotes healthy lifestyles through her personal training and fitness education company www.AlaskaFit.com.

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The use of personal health records as a corollary to current initiatives

Statement of Problem:

One of the fundamental necessities for the proper delivery of healthcare is the rapid and accurate dissemination of a patient's medical information to associated providers, laboratories, hospitals and other healthcare institutions. The lack of such services reduces efficiency, increases costs, impairs outcomes and can be responsible for increased morbidity and even mortality in the unforeseen instance.

Current initiatives by federal, state and local governments in association with charitable and not-for-profit institutions, hospitals, insurance companies and large physician practices are attempting to address the problem through specialized incentives and programs but are still in the process of establishing a common ground from which to build a foundation.

Target participants such as physicians, physician groups and midlevel providers, have expressed reluctance in the past to incorporating new technologies such as electronic medical records (EMR) or personal health records (PHR) due to fears of productivity loss, decreased revenue, legacy fees and perpetual dependence on established systems.

Government agencies, eager to utilize stimulus monies to facilitate adoption of these technologies by constituents, are in a good position to help introduce and overcome initial costs but may be unable to offer complete long-term solutions into the foreseeable future without continued dependence on grants, aid and other programs. At some stage in the process costs will need to be shifted to the end-user.

Individuals affected by this technology initiative, such as patients and families, have received little formal education regarding such things and are naturally skeptical of adoption.

The creation of a statewide medical records system/repository as currently envisioned is progressing but may be hindered due to discordant goals, objectives and expectations by participating member agencies, entities and individuals.

Solution:

As with most complex problems, GLIA believes that only through mobilizing and focusing resources from the private sector will this problem be eventually solved.

The desire to lower costs, increase efficiency, improve the quality of life and the expectation of a reasonable financial return will be the guiding tenants for the eventual completion of this effort.

Grants, aids, charitable donations and continued fiscal offering by government agencies can serve to raise awareness but cannot cover the costs of long-term hardware & software upgrades, security needs, maintenance and support; keeping in mind also that for an EMR to be successful a provider will demand nearly 24/7 uptime, security and accessibility.

Regardless of the complexity, any problem can be made manageable if reduced to its component parts and addressed accordingly. While more difficult to manage, it is not felt that any one company possesses all the necessary skills to meet this challenge.

Through identification and by-in from skilled companies and individuals each component can be completed then incorporated into the whole and the process moved forward.

An element of education, in the form of an integrated marketing effort, must be considered a key element of this project. The target of this effort must be the end-user(s): patients, providers and physician groups.

A designate project leader needs to be responsible for orchestrating the overall management of this effort.

Acceptance from government, industry, academics/education, healthcare and private citizens must be complete and unwavering.

Participants:

The role of government –

The Federal Government has already put in place stimulus money to be used as seed capital for providers looking to incorporate EMR's into their office settings. While this does not provide for covering the long-term costs of such technologies, it does offer a way to ease the burden of “making the leap” to computerized medical records.

The Federal Government has also begun the process of setting standards for information transfer, storage, utilization and security. This will, in time, prove useful by eliminating redundancy and increasing efficiency. However until such standards are created, the fear by many of committing to something that may eventually be found to be “out of compliance” is genuine and can hamper development.

The State Government in Juneau has begun to address this issue through agencies of its own. With stimulus money available the State may now be in a position to direct and oversee the introduction of these products to the marketplace (Senate Bill 133). It is also felt that their efforts could be utilized as a voice of awareness throughout the state of the need for this type of technology and as a force to address legal hurdles that may be encountered during eventually incorporation.

Native agencies supported by or affiliated with government can also serve their constituents through identification of their special needs arising from geography, lifestyle, funding, etc. and provide expertise in these key areas.

The role of industry –

Industry and the private sector, it is felt, should be the prime mover in this effort. Firms facile in the areas IT, storage, security, software generation, project management, telemedicine, communications and data transfer should be recruited as needed to address key elements of system design.

The role of academics -

The value of incorporating the academic community in this effort is two-fold. The first is the capability for specialized departments to augment key industry positions in the development process and also to introduce students to high-tech opportunities with Alaska in the hopes of increasing retention and the development of a strong technical infrastructure within the state and local communities.

The role of medicine -

The medical community; functioning as eventual end-users, are required partners at all levels of development to assure acceptance and compliance.

The role of the individual patient –

As with the medical community, the individual patient will also be a targeted end-user and therefore should be included. Education in the form of marketing and other initiatives should be used as tools for this acceptance. Means to overcome concerns about security, privacy, cost, control, etc need to be explored.

Conclusion:

GLIA believes that the creation of a statewide medical repository/distributed EMR system can only be accomplished through the development of a comprehensive program that calls upon many disciplines but is anchored firmly within the private sector. It is also felt that a two-pronged effort focusing on EMR's to hospital and physician groups and PHR's to individual patients will be the most efficient method for introduction.

SB 133 addresses the problem from the position of hospital & provider. Now what is needed is a corollary effort that focuses on getting the end-user (individual patient) “on the grid” as well. The more people that are willing and accepting users of this technology will make the eventual task of linking it all together a much simpler task.

GLIA also believes that while complex, this effort can be accomplished if broken down into its key elements then initiated by a coordinated push from many different levels and at the same time.

It is only through the meticulous process of introduction, education, agreement, consensus and commitment from the aforementioned groups that this will succeed.

GLIA, through product conception and design, is attempting to foster these commitments now.

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Mark W. Moronell, MD FACC is CEO of GLIA, LLC. He can be reached at morozea@hotmail.com

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Health care and Election 2008

Next month,Alaskans will cast their votes in this historic election. Along with the economy andIraq, health care remains a primary concern. Where does your candidate stand on health care?

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Candidates for Congress – U.S. Senate

Mark Begich

Alaska is blessed with resource wealth and unsurpassed potential, yet far too many Alaskans are struggling to find affordable, quality access to health care. More than 100,000 Alaskans don't have health insurance. Those who do have insurance have watched their costs soar; health care premiums rose 14.2 percent since 2001. Older Alaskans face a growing doctor shortage. As U.S. Senator, Mark Begich will fight for high-quality, affordable health care access for all Alaskan that they can count on for a lifetime, starting from birth and lasting through your older years. (Continued)

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Ted Stevens

It is important that every American have access to the health care that they need. I have worked hard to improve access to health care in our state. I have supported expansion of Denali KidsCare to provide health coverage to more young Alaskans. We need to continue to make sure that health care is available and affordable for all.(Continued)

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Candidates for Congress – U.S. Representative

Ethan Berkowitz statement

Thehealthcare system is broken and must be improved. Nearly 50 million Americans and 120,000 Alaskans are uninsured and risk bankruptcy from even the smallest of medical procedures. Getting sick shouldn't mean going broke, and in the wealthiest country in the world, people who need healthcare should be able to get it – and people who provide health care should get paid.

I've participated in discussions across Alaska about our health care system. The conversations usually begin as stories about life – about our families, our businesses. They're about the quality and availability of medical treatment. They describe the anguish of a parent unable to provide for children, or the desperation of an elder caught up against the crushing cost of medicine.

Providing health care for all Alaskans is a goal we must reach. In the short term, we can alleviate burdens on Alaskans by allowing small businesses to work together to pool their employees to make insurance affordable. We can expand the federal SCHIP – Denali KidCare — program to cover more children. Ultimately, this debate is about making sure doctors can deliver quality health care and that Alaskans have access to that care without going broke.

(Continued)

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Don Young

Congressman Don Young was re-elected to the 110th Congress in 2006 to serve his 18th term as Alaska's only Representative to the United States House of Representatives. First sworn in as a freshman to the 93rd Congress after winning a special election on March 6, 1973, Congressman Young is today the 3rd ranking Republican member and the 7th ranking overall member of the House of Representatives.(Continued)

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Candidates for president and vice president

McCain-Palin Straight Talk on Health System Reform

John McCain believes we can and must provide access to health care for every American. He has proposed a comprehensive vision for achieving that. For too long, our nation's leaders have talked about reforming health care. Now is the time to act. (Continued)

State of Alaska Health and Social Services press releases

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Barack Obama and Joe Biden's Plan

On health care reform, the American people are too often offered two extremes – government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that's why they've proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference. (Continued)

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Health care and Election 2008

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Last week the Municipality of Anchorage released a report on rape and sexual violence in the community. Standing Together Against Rape (STAR) would like to thank the Anchorage Department of Health and Human Services for compiling this data, and extend those thanks to the Anchorage Police Department, Forensic Nursing Services of Providence, and Alaska Child Abuse Response and Evaluation Services (CARES).

The data compiled outlines occurrences of reported rapes and sexual assaults within our city. There is a lot of information about who is being victimized, but very little about the offenders, unless to note they were drinking or using drugs at the time of the incident.

The sheer numbers are alarming, startling, and reflect a side of Anchorage not surprising to those of us at STAR. Sadly, behind each of the statistics is a story of pain, degradation, and trauma. By simply reviewing the numbers, it is easy to forget each person affected by rape and abuse has a lasting impact on all those around them, whether made aware of the rape or not.

Trauma is life threatening and mind-altering. One has to realize on some level during a traumatic event that the physical body and mind will never be the same again. Trauma changes a person’s life and forever afterwards, that person is struggling to find a “new normal” because frankly, their lives will never again be what they were.

So the vast numbers of those affected by rape are triangulated throughout the community of Anchorage. The traumatic event will have a very real impact on the person’s work, school, family, friends, and significant others. Even if the rape is never disclosed, it does not escape notice. One’s functioning cannot go on as it once did. Relationships cannot remain the same, even if that is one’s wish. That wish was denigrated along with the individual’s right to consent.

Fear, distrust, difficulty experienced in developing or continuing a meaningful intimate relationship, all compounded by a society which blames the victim for being vulnerable to attack.

A public health model as response to interpersonal violence is a good one. STAR has been welcomed in the Anchorage School District for years (thanks, Carol Comeau, for your foresight) providing age-appropriate risk prevention strategies to children and teens. The education effort is intended to help those most vulnerable for sexual assault and abuse, but also to provide alternatives to those at high risk for offending. Unfortunately, funding education around risk-reduction goes in and out of vogue like the tide. One year STAR’s Education program is funded, the next it faces a reduction in force.

The only word of caution for the Public Health Model is to refrain from even subtly blaming the victim for violence perpetrated by an offender.

Recent research shared with STAR* indicates only 3% of sex offenders are ever arrested. Of those, only about 5% ever spend a day in jail. Sex offender registries provide a false sense of security, since most sex offenders in our community are not known as such to the criminal legal system.

Other disturbing news comes from sex offenders themselves. A long-range study of convicted sex offenders subjected to polygraph testing in prison shows they admit to having a low average of 120 victims over the course of their lifetime, although they are generally in prison for an arrest associated with just one victim. They also report not discriminating much between genders, or between children and adults.

A public health model designed to prevent offending, instead of preventing victimization is the only way to see drastic reduction in the rates of rape in Anchorage.

*Russell Strand, chief of the U.S. Army Military Police School Family Advocacy Law Enforcement Training Program and nationally recognized speaker on sex offenders

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Keeley Olson is the program director for Standing Together Against Rape in Anchorage. She has worked in a variety of positions to assist survivors of domestic and sexual violence, both in social service and government agencies.

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