Healthy Directions. Tuba City Embraces Telehealth for Diabetes Prevention and Care. In this issue: Tuba City Regional Health Care Corporation

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1 Healthy Directions June 2015 FREE - TAKE ONE Tuba City Embraces Telehealth for Diabetes Prevention and Care In this issue: Tuba City Embraces Telehealth for Diabetes Prevention and Care The Just Move IT Series is back! June is National Safety Month In the Community: TCRHCC Public Health Service Commissioned Corps Color Guard The American College of Surgeons Designates TCRHCC as a Level III Trauma Center

2 Tuba City Embraces Telehealth for Diabetes Prevention and Care By Dominika Heusinkveld, MD In rural areas, telemedicine offers patients the opportunity to get specialty health services and physician consultations without the need for extensive travel. Rural telemedicine may be the great equalizer for rural populations, which typically experience reduced services and less favorable health outcomes compared to populations served by large medical centers. Diabetes care is one area which needs improvement in rural Arizona. Patients frequently have to travel 1-2 hours one way in order to visit their healthcare providers. Generally, physicians like to see patients with diabetes at least four times per year. These patients also need to see a Nutritionist regularly, have eye and foot exams yearly, have blood sugar screenings regularly, and must come in for medication refills. All of these trips place a huge burden on patients, due to both time and transportation expenses. A new project at Tuba City Regional Healthcare Corporation (TCRHCC) is expanding our telehealth services to include telenutrition and screening services for patients with diabetes, and hopes to also extend diabetes screening to far-flung communities on the Navajo Nation. The project, which will begin in the fall of 2015, will utilize a mobile telehealth van to conduct health screenings, telenutrition visits, blood sugar and blood pressure checks, as well as other health services. It was funded by a one-time grant from the Special Diabetes Program for Indians in Page 2 It is my hope that patients will be able to get some of their regular diabetes checkups and screenings done via telemedicine, so that patients can reduce their trips to the hospital and still meet the standards of care. Initially, patients will still need to visit with their physicians regularly, but the burdens of frequent screenings, eye and foot checks, and nutrition visits will be eased by providing these services at Houses. Continue on page 3.

3 The Just Move It Series is back! Tuba City Regional Health Care Corporation (TCRHCC) Health Promotion Program kicked off the Just Move It series, Tuesday, May 19, in Kaibeto, AZ. The Just Move It series is a non-competitive running and walking program, first started in 1998 in the Tuba City Service Unit area, was designed to challenge communites to get fit. TCRHCC Health Promotion Program host the Just Move It in Kaibeto, Tonalea, Coalmine, Cameron, Gap/Bodaway, Coppermine, Lechee, Tuba City, and other neighboring communities. The program promotes exercise, fitness and fun through recreational running and walking for families and individuals. Everyone who participates in a Just Move It event earns a t-shirt. The Navajo Area IHS Health Promotion Program believes it is up to each of us to shape healthier lives and communities. For 22 years, they have seen communities take action about health by Just Moving It! The Just Move It has grown in the number of communities and participants on the Navajo Nation. JMI began in 1993 with 20 communities and 482 participants. In 2014, JMI had events in 131 communities and 38,258 participants! Being physically active everyday can help you stay healthy and prevent diabetes and heart disease. For more information about the Just Move It in the Tuba City Service Unit area, call WINGS RUNNING CAMP July 21 & 22 AGES: 7 18 years old LOCATION: Greyhills Academy High School Gym REGISTRATION: TCRHCC HPDP Center INFORMATION: facebook.com/tchealth Page 3

4 In the Community TCRHCC U.S. Public Health Service Commissioned Corps Color Guard Tuba City Regional Health Care Corporation (TCRHCC) U.S. Public Health Service Commissioned Corps honored and provided the Color Guard at the Our Heroes of the Past, Present, and Future: Honoring Our Nation s Women Veterans event hosted by the Navajo Hopi Honor Riders, Navajo Nation Hospitality Enterprise, and volunteers of Tuba City, May 13, at the Navajo Nation Hogan Restaurant Courtyard. The event attracted over 100 bike riders to dedicate and honor Women Veterans, including all veterans, active military personnel, and their families. The vision of the Navajo Hopi Honor Riders and volunteers is to provide assistance in various forms to deal with traumatic experiences, responsibilities on the home front, spirituality unique to the Native American communities to achieve a balance and enhance the quality of life for veterans, active military personnel, and their families. Invite TCRHCC to your next big event! Contact TCRHCC Community Relations at for more information. TCRHCC Health Promotion Promote Fitness In Tuba City Service Unit Area Tuba City Regional Health Care Corporation (TCRHCC) Health Promotion & Diabetes Prevention Program in May kicked off the 2015 Just Move It series. The Just Move It promotes exercise, fitness and fun through recreational running and walking for families and individuals at the House in the Tuba City Service Unit. You ll find at the Just Move It, TCRHCC s partners providing information booth about health, fitness, and more. TCRHCC partners include Navajo Nation EMS and Police Department, Navajo Nation Community Health Representative (CHR), Upper and Lower Moenkopi Village, San Juan Southern Pauite Tribe, NavajoNation Behavioral Health Services, and many more. For more information: For more information, call at or visit TCHEALTH.ORG. Right: TCRHCC U.S. Public Health Service Commissioned Corps Color Guard. Top: TCRHCC U.S. Public Health Service Commissioned Corps and CEO take a moment for a photograph. Page 4

5 June is National Safety Month: Tips to Stay Safe at Home As part of National Safety Month, Tuba City Regional Health Care Corporation (TCRHCC) is taking the opportunity to offer families and the community some tips and reminders about falls. These tips should also be used when visiting or assisting elders to assess their homes. Falls are often due to hazards that are easy to overlook but easy to fix. Here is a list to help you find and fix those hazards in your home. Make Your Home Safer Remove things you can trip over (like papers, books, & shoes) from places where you walk. Remove small throw rugs or use double-sided tape to keep the rugs from slipping. Keep items you use often where you can reach them without using a step stool. Have grab bars put in next to & inside the tub or shower and next to the toilet. Use non-slip mats in the bathtub & on shower floors. Improve the lighting in your home. As you get older, you need brighter lights to see well. Always wear shoes. Avoid going barefoot or wearing slippers. Other Things You Can Do to Prevent Falls Do exercises that improve your balance and make your legs stronger. Exercise also helps you feel better and more confident. Have your doctor or pharmacist look at all the medicines you take, even over-the-counter medicines. Some medicines can make you sleepy or dizzy. Have your eyes checked by an eye doctor at least once a year and update your glasses. Get up slowly after you sit or lie down. Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers. Improve the lighting in your home. It s safest to have uniform lighting in a room. Add lighting to dark areas. Hang lightweight curtains or shades to reduce glare. For more information about falls and hazards in your home contact TCRHCC Office of Environmental Health at Source: Centers for Disease Control and Prevention. (2015, May 20). Check for Safety: A Home Fall Prevention Checklist for Older Adults. Retrieved from steadi /check_for_safety_brochure-a.pdf Page 5 6 TCRHCC Community Health Center- Mobile Health Program Mobile Medical Unit July 2015 Schedule MONDAY TUESDAY WEDNESDAY THURSDAY Schedule subject to change. Mobile Medical Unit is on Daylight Savings Time Dinnebito Clinic 14 Coalmine 8:30-4:30 21 Coppermine Monkey Ridge 28 Cameron 8:30-4:30 NOTE: The last patient is registered 30 minutes before closing. Please bring all medications to your visit (prescription & over the counter medication). Visit your local chapter house for an updated schedule 1 8 Kaibeto Market 9:00-3:30 Tonalea 8:30-4:30 15 Cameron 8:30-4:30 22 Kaibeto Market 9:00-3: Gap/Bodaway For more information, call the CHC Mobile Health Program at Mobile Dental Service: Dental Care for School-Age Youth is available for the Tuba City Service Unit schools throughout the school year.

6 The American College of Surgeons Designates TCRHCC as a Level III Trauma Center Tuba City and western Navajo Nation residents now have access to advanced trauma care in their community. In March, the Tuba City Regional Health Care Corporation (TCRHCC) was designated by the American College of Surgeons (ACS) as a level III trauma center. TCRHCC is the first hospital in the lower 48 states in Indian Country to be designated as an advanced Level III Trauma Center. Dr. Ralph Zane Kelley, a trauma surgeon and also the chief of surgery and trauma at TCRHCC, said the hospital was designated by the state of Arizona as a level IV trauma center. The designation by ACS is a national ranking. TCRHCC has a comprehensive team of surgeons, specialists, nurses and staff members who receive specialized training in trauma care. In the state of Arizona there were only 11 verified Level III ACS trauma centers. Tuba City is now number 12 on that list. By comparison, Flagstaff Medical Center is a Level I. The designation process ensures that proper procedures, staffing and processes are in place to best care for the most serious injuries, from ATV accidents, assault, gunshot and knife stab wounds to automobile accidents. As part of this designation, trauma surgeons, as well as other physician specialists, are required to be available 24 hours a day. Shannon Johnson, RN director of trauma program services, and Kelley worked the last few years for the current Level III designation with an initial visit by ACS in 2013 and the final visit coming a year and a half later. ACS specifically looks at the trauma patients an emergency department cares for - whether they are cared for or operated on at the hospital or whether they are shipped somewhere else. The organizataion also requires the facility to collect data for evaluation on an ongoing basis concerning trauma cases to improve outcomes and quality standards. Continue on page 7. Page 6

7 The American College of Surgeons Designates TCRHCC as a Level III Trauma Center Continued from page 6. It definitely increases the quality and competency of care that trauma patients receive here, Kelley said. Tuba City is probably the only place on the rez that has ER residency trained board certified ER physicians. Also we have general surgeons who are advanced trauma trained. Johnson added, the hospital has trauma nurse core curriculum certified nurses and emergency pediatric certified nurses as well. We re accredited by a national organization and we do care for a high level of patients and definitely care for and have a higher acuity of care than the majority of other reservation facilities, Kelly said. Tuba is constantly adding new services and new specialties to keep patients on the reservation rather than having to ship them to Flagstaff or Phoenix where it is an inconvenience for themselves but also their families. Don t wait in line; Apply Apply online at for: Medical Assistance (AHCCCS) Help with Medicare Costs Nutrition Assistance (SNAP) Cash Assistance (TANF) (HEAplus) is Arizona s fast and easy way to apply online for public assistance programs. With HEAplus, you can find out what assistance you might be eligible for and submit a single application, saving you time and effort. You can also: Check Your Benefits Renew Your Benefits Report Changes Manage Your Benefits Manage Your Account Customer Support Center Phone #: HEA-plus ( ) Why use HEAplus? Available weekends and evenings Safe, secure, fast and easy Manage your account on your own time from anywhere with an internet connection APPLY AT THE KIOSK LOCATED ACROSS FROM SECURITY OFFICE IN THE MAIN BUILDING Sacred Peaks Health Center Flagstaff, AZ Schedule An Appointment (928) Page 7

8 Tuba City Embraces Telehealth for Diabetes Prevention and Care Continued from page 2. Challenges for Rural Telehealth Major challenges for rural telehealth programs include the lack of infrastructure such as paved roads, Wi-Fi signals, cell towers, and sparse populations. It can also take time for populations to get comfortable with a novel program and utilize services to their maximum benefit. With our mobile telenutrition program, the biggest challenge thus far has been the difficulty in assuring a reliable signal to accommodate video conferencing even in remote communities. We have run tests and simulations, but the ultimate test of signal strength will be when we drive the van out to the communities we intend to serve and attempt a stable video connection. A reliable and fast PLS DNT internet connection is a luxury that many on the Navajo Nation do not have yet. This lack of infrastructure has delayed the implementation of many worthy telehealth programs. Another challenge has been accessibility of distant sites. Many of the communities we hope to serve are reached via dirt roads, and we needed to ensure that our new van would be able to handle a bumpy ride despite its sensitive TXT + DRIVE A Public Service Announcement brought to you by your healthcare provider + other drivers. Page 8 equipment. Again, the big test of our success will be when the van arrives, and can be road-tested. These uncertainties with a major project always serve as a reminder of the difficulties of providing patients with the care they need despite the limitations in resources that are an unfortunate part of daily life in rural communities. Future Opportunities TCRHCC hopes to expand Tuba City Regional Health Care Corporation its telemedicine options in the coming years thanks to the improvement in facilities allowed by the grant. We have been offering telenutrition and telepsychiatry services to high schools in Tuba City, follow-up surgery and dermatology visits via telemedicine, and various educational opportunities for our medical staff. We are also establishing a telestroke program with the Mayo Clinic in Arizona. Rural health providers and their patients would greatly benefit from telemedicine-based collaboration with larger health centers. A great model for this type of collaboration is the University of New Mexico s Project ECHO. A similar project, which included pulmonology, rheumatology and other specialist care, would be of great benefit to Northern Arizona s rural communities. Source: Arizona Telemedicine Program [University of Arizona]. (2015, May 20). Tuba City Embraces Telehealth for Diabetes Prevention and Care Retrieved from edu/blog/tuba-city-embracestelehealth-diabetes-preventionand-care

9 Primary Healthcare for All. Find it in Your Local Community Health Center. Members of the Arizona Alliance for Community Health Centers provide top quality, patient-focused primary healthcare services for people in local communities througout Arizona, regardless of insurance status. Our network offers a range of urban and rural locations around the state. Each has an experienced, caring and compassionate staff waiting to welcome you and your family to your local healthcare home. To find a location in your community, visit AACHC.org Tuba City Regional Health Care Corporation Adelante Healthcare Canyonlands Healthcare Chiricahua Community Health Centers, Inc. Community Health Center of Yavapai Copper Queen Medical Associates Desert Senita Community Health Center El Rio Community Health Center Maricopa Health Care for the Homeless Maricopa Integrated Health System Mariposa Community Health Center MHC Healthcare Mountain Park Health Center Native Americans for Community Action, Inc. NATIVE HEALTH North Country HealthCare Page 9 Sun Life Family Health Center Sunset Community Health Center Tuba City Regional Healthcare Corporation United Community Health Center Maria Auxiliadora, Inc. Wesley Community & Health Center

10 Tuba City Regional Health Care Corporation Diabetes Treatment & Prevention Services Health Promotion & Diabetes Prevention Center June 2015 Fitness Calendar JUNE TCRHCC DIABETES TREATMENT & PREVENTION SERVICES 2015 PLEASE CONTACT DTPS IF YOU HAVE ANY CONCERNS OR QUESTIONS MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30pm) 6:00am- TAPOUT: Cross Core Combat 12:00pm- Insanity Max 30: Max Out Cardio 1:00pm- Muscle Building & Toning w/ Frank 5:15pm Spinning w/ Sham 6:25pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30pm) 6:00am- TAPOUT: Competition Core 11:30am- T25 GAMMA: RIP T UP 12:00pm- Insanity Max 30: Max Out Cardio 1:00pm- Muscle Building & Toning w/ Frank 5:15pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30pm) 6:00am- TAPOUT: Cross Core Combat 12:00pm- Insanity Max 30: Max Out Cardio 1:00pm- Muscle Building & Toning w/ Frank 5:15pm Zumba w/ Clarence & Gen 7:30pm Spinning w/ Sham Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30pm) 6:00am- TAPOUT: Competition Core 12:00pm- Insanity Max 30: Max Out Cardio 1:00pm- Muscle Building & Toning w/ Frank 5:15pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30pm) 6:00am- TAPOUT: Plyo XT 12:00pm- Insanity Max 30: Max Out Cardio 1:00pm- Muscle Building & Toning w/ Frank 5:15pm Zumba w/ Clarence & Gen Balancing Your Life & Diabetes HLC Open (6a-7a/ 11:30-1:30pm) 6:00am- TAPOUT: Strength & Force Upper 11:30am- T25 GAMMA: RIP T UP 12:00pm- Insanity Max 30: Max Out Power Blue Hills w/10k Dugi Residence Registration(6:00pm) Start(7:00pm) DST Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30p) 6:00am- TAPOUT: Plyo XT 12:00pm- Insanity Max 30: Max Out Sweat 5:15pm Kickboxing w/ Sham 6:25pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 5pm-7:30pm) 6:00am- TAPOUT: Ultimate Abs 12:00pm- Insanity Max 30: Max Out Strength 5:25pm Spinning w/ Sham 6:30pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 4-6pm) 6:00am- TAPOUT: Legs and Back 12:00pm- Insanity Max 30: Friday Fight Round 2 5:00pm- Muscle Building & Toning w/ Frank Balancing Your Life & Diabetes HLC Open (6a-7a/ 11:30-1:30pm) 6:00am- TAPOUT: Strength & Force Upper 12:00pm- Insanity Max 30: Max Out Power Coalmine Canyon JMI Registration(6:00pm) Start(7:00pm) DST Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30p) 6:00am- TAPOUT: Plyo XT 11:30am-T25 GAMMA: SPEED :00pm- Insanity Max 30: Max Out Sweat 5:15pm Kickboxing w/ Sham 7:30pm Spinning w/ Sham Healthy Summer Grilling HPDP Center Open (6a-7a/ 11:30-1:30pm/ 5pm-7:30pm) 6:00am- TAPOUT: Legs & Back 12:00pm- Insanity Max 30: Max Out Strength 5:25pm Spinning w/ Sham 6:30pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 4-6pm) 6:00am- TAPOUT: Cardio XT 11:30am- T25 GAMMA: RIP T UP 12:00pm- Insanity Max 30: Friday Fight Round 2 5:00pm- Muscle Building & Toning w/ Frank Balancing Your Life & Diabetes HLC Open (6a-7a/ 11:30-1:30pm) 6:00am- TAPOUT: Strength & Force Upper 12:00pm- Insanity Max 30: Max Out Power Moenkopi w/10k Legacy Inn Registration(5:00pm) Start(7:00pm) DST Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30p) 6:00am-TAPOUT: Plyo XT 11:30am- T25 GAMMA: RIP T UP 12:00pm- Insanity Max 30: Max Out Sweat 5:15pm Kickboxing w/ Sham Open (6a-7a/ 11:30-1:30pm/ 5pm-7:30pm) 6:00am- TAPOUT: Legs & Back 12:00pm- Insanity Max 30: Max Out Strength 5:25pm Spinning w/ Sham 6:30pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 4-6pm) 6:00am- TAPOUT: Ultimate Abs 12:00pm- Insanity Max 30: Friday Fight Round 2 5:00pm- Muscle Building & Toning w/ Frank Balancing Your Life & Diabetes HLC Open (6a-7a/ 11:30-1:30pm) 6:00am- TAPOUT: Ultimate Abs 11:30am- T25 GAMMA: RIP T UP 12:00pm- Insanity Max 30: Max Out Power Cameron JMI Registration(6:00pm) Start(7:00pm) DST Open (6a-7a/ 11:30-1:30pm/ 5pm-8:30p) 6:00am- TAPOUT: Muay Thai 12:00pm- Insanity Max 30: Max Out Sweat 5:15pm Kickboxing w/ Sham Open (6a-7a/ 11:30-1:30pm/ 5pm-7:30pm) 6:00am- TAPOUT: Cardio XT 12:00pm- Insanity Max 30: Max Out Strength 5:25pm Spinning w/ Sham 6:30pm Zumba w/ Clarence & Gen Open (6a-7a/ 11:30-1:30pm/ 4-6pm) 6:00am- TAPOUT: Ultimate Abs 11:30am- T25 GAMMA: RIP T UP 12:00pm- Insanity Max 30: Friday Fight Round 2 5:00pm- Muscle Building & Toning w/ Frank June 13th DPP Hiking Series (6:45am Coalmine Canyon June 27th Just Move It Grand Canyon Nat l Park Registration (7AM) Start (8AM) **MST** Balancing Your Life & Diabetes HLC Open (6a-7a/ 11:30-1:30pm) 6:00am- TAPOUT: Ripped Conditioning 12:00pm- Insanity Max 30: Max Out Power Bodaway/ Gap JMI Registration(6:00pm) Start(7:00pm) DST Fitness Center HOURS: Monday Friday (6am-7am & 11:30-1:30PM) Monday Thursday (5PM-End of Last Class) Friday (4PM-6PM) Page 10

11 Tuba City Regional Health Care Corporation Main Telephone Switchboard (928) Navajo Nation Police Police and Emergency Medical Services (EMS) (928) Same Day Appointment Patients are encouraged to call ahead to make an appointment for a Same-Day Appointment if available, or schedule another day that works best for you. Call the Same Day Appointment from 8:00 am to 4:00 pm to schedule your appointment. Family Medicine Clinic Monday - Friday: 8:00 am - 5:00 pm (Some evening hours available.) Pediatric Clinic Pediatric Clinic Appointments-Call the clinic from 8:00 am to 4:00 pm to schedule your appointment a few days BEFORE you want your child to be seen. TO MAKE AN APPOINTMENT, Call the appointment desk at Outpatient Pharmacy Open 7 Days a week from 8:00 am - 7:00 pm 24-Hour Pharmacy refill line: Prescriptions are ready for pick-up with no waiting time for patients who call in 24 hours in advance. Pharmacy Drive-Thru is NOW OPEN for Refill Prescription Pick-Up Only from 8:00 am to 7:00 pm (midnight), 7 days a week, including holidays. Dental Clinic Tuba City: Tuba City Monday - Friday: 7:00 am - 5:00 pm (Thursday afternoons - urgent care only) Cameron: Cameron Monday, Tuesday, Wednesday & Thursday: 7:30 am - 5:00 pm Diabetes/Internal Medicine Monday - Friday: 8:00 am - 5:00 pm Some evening hours available by appointment only. Diabetes Education: Diabetes Healthy Living Center Appointments and walk-ins Monday - Friday: 8:00 am - 5:00 pm - Abdul Baco: Ruby Whitethorne: Health Technicians: Page Ear/Nose Throat (ENT) Clinic Monday - Wednesdays: 8:30 am - 5:00 pm (By referral only) Environmental Health Car Seat Day Every Thursday: 10:00 am - 3:00 pm Eye Clinic Monday - Friday: 7:00 am - 5:00 pm Health Promotion/Diabetes Prevention Health Promotion Program /1420 Diabetes Prevention Program /1420 Mental Health Monday - Friday: 7:00 am - 6:00 pm OB/Gyn Clinic (Women s Health) Monday - Friday: 8:00 am - 5:00 pm, except Tuesday start at 9:30 am Occupational Therapy /2594 Speech Therapy Monday - Friday: 8:00 am - 5:00 pm Orthopedic Clinic/Surgical Orthopedic Clinic Tuesday: 8:00 am - 5:00 pm, Thursday: 8:00 a.m. - 12:00 noon Urology, Podiatry & Surgery Monday - Friday: 8:00 a.m. - 5:00 p.m. (Call for specific clinic times) Physical Therapy Monday -Wednesday & Friday: 8:00 am - 5:00 pm, Thursday: 8:00 am - 12:00 pm Extended Hours (Evening Clinics) Selected nights, Monday - Thursday Diabetes Prevention: Diabetes/Internal Medicine: Emergency Room ANNEX For patients in need of medical care after normal, daily walk-in hours. Go to the Emergency Department to be screened and registered. No appointment necessary.

12 Healthy Directions Aurelia Yazzie Community Relations Administration - Office of the CEO 167 North Main Street P.O. Box 600 Tuba City, Arizona Tuba City Regional Health Care Corporation Health Facility, Arizona PHARMACY NOW OPEN 7-DAYS A WEEK Pharmacy Hours: Monday Friday Saturday & Sunday 8:00 am to 7:00 PM 9:00 am to 5:00 PM