Experiences Working on the Navajo Reservation and Path to Public Health

New Mexico State University February 26th 2020

Shannon Saltclah, Pharm.D., PhC, BC-ADM, CPH Project Officer, CDC/NCCDPHP/Division of Population HealthAlbuquerque, NM, email oqk8@cdc.gov

QUESTIONS

What year student are you?

What healthcare profession are you interested in?

In one word or phrase, why do you want to purse a career in healthcare?

YOUR STORY IS IMPORTANT…

My Journey… Grew up in New Mexico ENMU – Undergrad, UNM – COP Family originally from Teec Nos Pos, Az

Spent summers with family on the Navajo Reservation

My path led me to be of service to underserved communities

IHS Vacancy Rates (2016): Pharmacist: 6.6% Physicians/Nurse Practitioners: 25%

https://www.cdc.gov/tribal/data-resources/information/chronic-diseases.html https://www.ihs.gov

PHARMACY-RUN CLINICS AT TSEHOOTSOOI MEDICAL CENTER (TMC)

• TMC’s Pharmacy Run clinics • Diabetes – Referral by PCP • Anticoagulation

• Referral • INR checks • New Warfarin starts – 1 hour apt • Bridging therapy • 30 minute visit follow-up

• Asthma• Referral from PCP and Pediatrician • 45 minute visits

• Tobacco Cessation• Referral (PCP and Dentists) and Walk-In

• Decentralized pharmacist: Primary Care, Pediatrics• Specialty Pharmacy: HIV/HepC, Renal (Medication

Reconciliation, Renal care team) , TB (Chest Clinic)

PHARMACY-RUN CLINICS AT TSEHOOTSOOI MEDICAL CENTER (TMC)

• Diabetes Clinic: Patients referred from PCP if Alc > 9% or Type 1 Diabetes

• 45 minute appointments • Titrations per protocol, glucometer teaching

• Example titrations for patients • Unique Challenges for patients living in rural

areas: transportation, distance, no electricity or running water, language barrier

• Overcoming barriers• Sync apts, telephone follow-up, safe ride,

RN home health, mental health, or wellness referral, family and social support

• “we are their support system” • Cultural Humility

INPATIENT PHARMACY AT TSEHOOTSOOI MEDICAL CENTER (TMC)

• ICU – 4 beds, MSU (adult/peds) –20+ beds, OB ward 7+ beds, OR and ER

• Attend morning rounds, discharge medication counseling, DI questions, make pediatric syringes

• Rapid Response: respond to codes, rapid sequence intubations

• Common reasons for admit: DKA, EtOH overdose, CAP, STI, UTI

• You are the expert! You are the Drug Resource go-to person.

• Solo shifts, Night shifts

STUDENT ROTATION AT TSEHOOTSOOI MEDICAL CENTER

Free Student Housing – located right by TMC hospital

Free $25/day stipend for meals at TMC cafeteria

Also serve traditional foods

Variety of clinical learning opportunities

Community Outreach opportunities

Hikes

Bike rides

5k/10k community events –volunteer

New Wellness Center: fitness center, wellness classes

Socials/Pot lucks

Meet other students; nursing, pharmacy, medical, flight medic students

COMMUNITY-CLINICAL (C-C) LINKAGE PROJECTS Created Healthcare Screening Team

1. Diabetes Screening Event in 2016

• 30+ employees scored high risk for diabetes, an on-site A1c test revealed.

• 296 total participated in the AADE 7 education booths: 161 employees and 108 community members.

2. Men's Health Screening in 2017

• Creating Community-Clinical Linkages Between Community Pharmacists and Physicians; A pharmacists guide (CDC, 2016)

• Pharmacists key players in community–clinical linkages (APhA, 2015) https://www.cdc.gov/dhdsp/pubs/docs/ccl-pharmacy-guide.pdf

https://www.pharmacist.com/pharmacists-key-players-community-clinical-linkages

LESSONS LEARNED

• 6 years serving the Fort Defiance, AZ community

• Ambulatory care clinics, Inpatient pharmacy, Community-Clinical linkage projects, UNM COP Preceptor

• Lessons learned/Advice

• If working in rural areas: experience what the community has to officer ie. JMI, pot lucks, social activities, cultural events, outdoors: hiking, camping, fishing

• Identify multiple mentors throughout your career – professional, personal

• Leadership - You are a leader.

• Work-life balance

• New goals/New interests: learn more about public health, focus on prevention of chronic disease, apply what I learned in the Fort Defiance community at next job

“ WE ALL HAVE TO START SOMEWHERE”

United States Public Health Service Continuing to fulfill its mission

“To Protect, Promote, and Advance the Health and Safety of our Nation.”

https://www.usphs.gov/

COMMISSIONED CORPS TODAY

*Health Services Officers Professions

Physician Assistant

Optometrist

Dental Hygienist

Computer Scientist

Psychologist

Social Worker

Microbiologist

COMMISSIONED CORPS TODAY

6,241 Active Duty Officers

~1,700 at IHS

~1,200 at FDA

https://www.usphs.gov/

• At least 1 year of study in a professionally accredited doctoral program in pharmacy, medicine, dentistry.

• Common duty stations as JRCOSTEPS: IHS, FDA, BOP

CDC HEALTHY TRIBES PROGRAMNATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

DIVISION OF POPULATION HEALTH

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Division of Population Health

TRIBAL PRACTICES FOR WELLNESS IN INDIAN COUNTRY (TPWIC)

https://www.cdc.gov/healthytribes/tribalpractices.htm

36 Recipients

TRIBAL PRACTICES FOR WELLNESS IN INDIAN COUNTRY (TPWIC)

1. Family and community activities that connect cultural teachings to health and wellness

2. Seasonal, cultural and, traditional practices that support health and wellness

3. Social and Cultural activities that promote community wellness4. Tribal, Inter-tribal, governmental, and nongovernmental collaborations that

strengthen wellbeing5. Intergenerational learning opportunities that support wellbeing and

resilience6. Cultural teachings and practices about traditional healthy foods to promote

health, sustenance and sustainability7. Traditional and contemporary physical activities that strengthen wellbeing.

TPWIC STRATEGIES

PUBLIC HEALTH ASSOCIATE PROGRAM (PHAP) –POST-UNDERGRAD OPPORTUNITY AT CDC

• Competitive, two-year, paid training program at the CDC for recent college graduates who are interested in a career in public health.

• PHAPs are assigned to public health agencies and nongovernmental organizations in the United States and US territories

• Gain hands-on public health experience in a variety of settings

• PHAP graduates are qualified to apply for jobs with public health agencies and organizations.

www.cdc.gov/phap or contact program staff at phap@cdc.gov or 404.498.0030.

https://www.cdc.gov/phap/experience_phap/associates-talk/index.html

INTERNATIONAL MEDICAL RELIEF KENYA, AFRICA 2012

AHÉHEE’ – THANK YOU EMAIL: OQK8@CDC.GOV

PUBLIC HEALTH AND PHARMACY INTERSECTIONS AT CDC

• CDC employees over 30 pharmacists through the United States Public Health Service, civil service, and contracts with other organizations.

• CDC pharmacists work in many different centers and programs:

• Division for Heart Disease and Stroke Prevention: Tailored pharmacy-based interventions based on strong evidence of effectiveness in increasing patient adherence to medications

• CDC Drug Service: Domestic surveillance, response, and treatment initiatives for rare and neglected diseases

• Public Health Emergency Preparedness Program; Medical Countermeasures: Advise state, local, tribal and territorial partners on best practices in medical countermeasure distribution and dispensing to ensure the health and safety of the nation in the event of a public health emergency

• National Diabetes Prevention Program: Develop national cooperative agreements that support pharmacist involvement in chronic disease management and prevention

• Medication Safety Program: National Adverse Drug Event Surveillance and PROTECT Initiative

• National Center for Immunization and Respiratory Diseases: Nationwide Data Exchange Supporting Vaccine Supply Chain Management

• National Institute for Occupational Safety and Health; World Trade Center Health Program: Pharmacy Formulary Management