“Don’t forget about us.”
A simple request from the Tanana Chiefs Conference (TCC) Full Board of Directors that echoes in the back of TCC Chief/Chairman Victor Joseph’s mind every time he is making decisions about healthcare expansion in the region. In 2008, Chief Joseph was the Health Services Director when he stood before the Full Board seeking authorization to move forward with the construction of the Chief Andrew Isaac Health Center (CAIHC) in Fairbanks. The Full Board approved the proposal with only three stipulations – 1) Make sure the clinic isn’t designed as a square box, 2) When you expand services make sure you expand in the villages too, and 3) Don’t forget about us.
“I remembered that promise,” says Chief Joseph, “There needs to be balance. Everything can’t be centered on Fairbanks, we need to make sure we are providing the highest level of care in our villages too.”
So when the opportunity to build a new subregional clinic in the Upper Tanana subregion came forward, TCC kept their promise. Beginning in the summer of 2020, the Upper Tanana area will finally be able to receive comprehensive and integrated health care services all in one location with a brand new state of the art healthcare facility.
The need for a new facility has been a long awaited request from the tribes of the Upper Tanana. The current Upper Tanana Health Center was opened in 2011 and met the healthcare needs of the area at that time. However, it wouldn’t be long before TCC would have to step back and re-evaluate.
The first challenge came in 2014, when the Tok Counseling Center announced that it would be closing its doors, leaving those in the Tok area who could not receive health services under IHS without the help they needed.
“They approached us to see if we could take over their patients to ensure there wasn’t a gap in behavioral health services,” recalls TCC’s Executive Director of Health Services, Jacoline Bergstrom, “So we began offering behavioral health services to the greater Tok area that same year and had a seamless transition of services.”
Shortly after TCC started providing behavioral health care services to the greater Tok population, TCC was approached to take overall health care services in Tok. In order to maintain health care within the subregion the Upper Tanana leadership agreed that it would be in the best interest for TCC to take over the health care services in Tok. The Indian Health Care Improvement Act allowed TCC to provide routine care to non tribal members if it did not reduce the ability to provide care to beneficiaries. TCC applied for Community Health Center (CHC) funding, which allowed them to increase care to the tribes while expanding care for others.
In the fall of 2015, TCC started providing all health care services. In order to provide health care in Tok, TCC is operating out of three different facilities, which limits the ability to provide coordinated care to surrounding communities like; Eagle, Healy Lake, Dot Lake, Tanacross, Tetlin, Northway, Tok, and several others.
New Struggles Emerge
After the increase in services and an entire new set of patients, the need for an integrated health care facility became more evident and more urgent.
“The current facilities cannot manage the current patient volume,” explains Chief Joseph, “We are providing both family practice and emergency services in the same small area, which forces us to use rooms that should not be used for patient care.”
Joni Young, Director of the Upper Tanana Health Center (UTHC), talks about some of the struggles they have faced after integrating more services, “Right now we only have four exam rooms and two urgent care beds. There isn’t enough space for staff or for patients,” she described, “We saw around 1,300 patients last quarter and there are only about 30 staff in our three buildings.”
Another complication comes from Tok’s location. It is one of the first major communities on the road to/from the Canadian border, meaning there is more outside traffic which also results in more accidents.
“Several times there were multi person injuries caused by vehicle accidents that we had to tend to,” says Bergstrom, “You want to be able to stabilize all of those patients at the same time, and having only two urgent care rooms makes that a challenge.”
“None of the current facilities were originally built or designed to be medical facilities,” explains Bergstrom, “If you look at where the dental facilities are right now, they are not handicap accessible because they are in a basement. So those who need those services would have to go to Fairbanks.”
“We have two aging infrastructures, and both infrastructures lack adequate space,” summarizes Chief Joseph, “Additionally, operating out of three different locations makes it harder to integrate services.”
The current facilities provide no room for expansion either, and according to Bergstrom; “Looking at how health care evolves and requirements and regulations change, it’s important to be able to adjust and expand how you provide services in order to meet the needs of the people we serve.”
In 2016, the Upper Tanana passed a resolution supporting the purchase of additional land in Tok that would serve as the location for a new clinic and in 2018, the Full Board of Directors approved the purchase at the Special Full Board of Directors Meeting. In April 2019, TCC began tearing down the old structure to clear land for the new Tok subregional clinic. The new facility will provide solutions to the current issues being faced in Tok.
“It’s going to have all of our services under one roof,” says Chief Joseph, “The clinic will be large enough for us to bring in specialty care and other providers without people tripping over one another. The level of care is going to increase to something that the community had never experienced before.”
The facility will be approximately 15,900 square feet, and will be designed to support an additional 8,000 square feet for future expansion. The clinic will make it possible for TCC to provide primary care, dental, behavioral health, trauma, and triage functions, with full laboratory, radiology, and pharmacy services. All in one convenient location.
Much like CAIHC, TCC has brought on a special cultural committee, representing the communities and Tribes in the Upper Tanana subregion, who will work with the architect to ensure that the clinic is not designed as a ‘square box’.
“My hope is that we have a subregional clinic where we provide world-class services and are able to expand our current services in the subregion so people don’t have to travel to Fairbanks as much,” says Bergstrom.
Young also shares the same sentiment, “Having a facility is a big need here,” she explains, “I want people to be able to get their care locally, because it’s hard on a lot of us, especially elders. My hope is that this is a building that everyone can be proud of and believe in.”
For Chief Joseph, it all goes back to a promise made over a decade ago. “This is just another way we are incorporating the spirit of Ch’eghwtsen’ into our work, as well as following our new guiding principle,” says Chief Joseph, “I remember that promise, and it’s good looking back at all we’ve done to keep it.”