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Lights….Camera…..Action

The Making of a Documentary: Tuberculosis on the Navajo Nation Sarah Yazzie ; NN TB Program Manager Diana Fortune RN BSN; NM TB Program Manager. Lights….Camera…..Action. ETN/PEN Conference September 2012. Geography Lesson Where is the “Four Corners”?. Navajo Nation. Map of Navajo Nation.

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Lights….Camera…..Action

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  1. The Making of a Documentary: Tuberculosis on the Navajo Nation Sarah Yazzie; NN TB Program Manager Diana Fortune RN BSN; NM TB Program Manager Lights….Camera…..Action ETN/PEN Conference September 2012

  2. Geography LessonWhere is the “Four Corners”?

  3. Navajo Nation

  4. Map of Navajo Nation

  5. 2008 Navajo Nation population estimate was used for 2009 and 2010.; 2010 Navajo Nation population estimate was used for 2011. ** 2010 US TB case rate was estimated. • Epidemiology of TB • Four Corner States and Navajo Nation 66

  6. Sept 2010: TB Presentation • Northern Navajo Medical Center: Shiprock, NM • A germ of an idea…………..was planted! How it started?

  7. TB Mortality Rate in New Mexico: Jan 1, 2007 – Dec 31, 2009 • Out of 159 patients diagnosed with TB from 2007-2009, 25 (15.7%) patients who died with confirmed TB were included in the final study group

  8. A high TB-related mortality in a low-incidence state. • Approximately 2/3 of deaths due to TB-associated disease. • Disease often presents in the elderly • is difficult to diagnose. • Foreign-born and Native Americans most affected. • Patient and provider delays in recognition of disease. TB Mortality Study Conclusions

  9. Next Steps…..November 2010 • Meeting of the minds…..in Gallup • NM TB Program • Navajo Nation TB Program • Indian Health Services • “What can we do”? • Ideas were watered & fertilized…….

  10. Billboard designs: • Billboard_hyperlink.pptx • Posters : • Movie Ads – (run finishes October 2012) • Gallup (2) Theatres • 510,000 annual attendance • Movie Theater Ads_hyperlink.pptx • Public Service Announcements: • Navajo Nation • Documentary: • Tuberculosis on the Navajo Nation Took root and bloomed…..

  11. March 2011 • Press Conference held in Gallup • Article in Navajo Times & Indian Country Media Campaign

  12. Navajo Nation: TB & Annie Wauneaka“I’ll go and do more” • First woman elected to the Navajo Tribal Council, 1951 -1978 • Primary concern was to eradicate tuberculosis among Navajos. • She traveled across the huge reservation visiting the ill and encouraging those with tuberculosis to see physicians. • Traditional healers and medical doctors • Awarded the Presidential Medal of Freedom from John F. Kennedy in 1963.

  13. Navajo Nation: Present Day TB Efforts • Sarah Yazzie: • 40 Years as TB Program Manager • Dramatically decreased the rates of TB • Continues to work diligently with TB patients/staff

  14. Tremendous undertaking • Many months to produce • Ideas transformed/changed during production • Patient personal perspective • This made ALL the difference • Very courageous to tell his story • Joann King – Nurse that did the interview • Connected well with patient Four Directions Studio (Shiprock)

  15. Navajo Nation TB Control Program

  16. Navajo Nation TB Control Program • The Navajo Nation is the largest Indian Reservation and the largest federally recognized Indian Tribe in the United States. • Its diverse geographic, cultural and historic context makes it uniquely attractive to a variety of people. • The Navajo Nation is a Sovereign Nation located in the Southwest region of the United States. • The Navajo Nation (about the size of the state of West Virginia) encompasses a total area of about 27,000 square miles. • The population on the Navajo Nation is increasing. In 1998, the census population was 234,792 and per Navajo Area IHS active user population now is at approximately 300,000.

  17. The Navajo Nation is located within three states, New Mexico, Arizona and Utah. With about two thirds of the nation located in the state of Arizona. • The Navajo Nation TB Program consists of Ten TB Technicians and is Coordinated by Sarah Yazzie. • Each TB Tech. covers different service unit which consists of several communities.

  18. Dorothy Chee Jay Nez ZenaArviso Zena Ario Sarah Yazzie TB Control Coordinator

  19. Due to the extensive tuberculosis history of the Four Corners area, the health care community has responded by establishing a high standard of care for TB patients. The Navajo Nation TB Control Program collaborates with the Navajo Area Indian Health Services which includes a TB Medical Officer, a PHN/TB Coordinator and a DPHN/Nurse Consultant. The TB Program serves 110 chapters, satellite clinics, border-towns/cities, preschools, nursing homes, detention centers, public, parochial, BIA and charter schools.

  20. The Navajo Nation TB Control Program has a strong quality assurance in place so that TB patients receive the best care possible. • The Navajo Nation TB Control Program has Policies and Procedures, Plan of Operation, a Strategic Plan, and a Memorandum of Agreements with all Navajo Area IHS Service Units as well as PL93-638 Programs. • The Health and Social Services Committee of the Navajo Nation Council serves as an Oversight Committee for the TB Control Program.

  21. • Due to the high standards of care provided, there have been no reported cases of multi-drug resistance to Tuberculosis on the Navajo Nation. • The Navajo Nation TB Control Program mandates 100% Direct Observed Therapy (DOT) for all TB Cases.

  22. New NAIHS Tuberculosis Cases in 2011 by Service Unit

  23. Figure 2- 2011 NAIHS TB Case Sex Distribution

  24. NAIHS 2011TB Case Age Distribution

  25. 2011 NAIHS Tuberculosis Casesby site of disease

  26. Navajo vs. US Tb Incidence Rates: 1990-2011

  27. 2011 Latent TB Indications for Treatment

  28. Navajo Nation TB Control Program • Since the inception of the Navajo Nation TB Control Program in 1972 the high number of Tuberculosis cases has decreased dramatically.

  29. Barriers to Achieving Objectives: • Distances between communities and homes are great on the Navajo Nation. • It is not at all unusual for a Navajo Family to live 50 to 100 miles from the nearest health care facility, and often, much of that distance may be a dirt road • impassible in times of bad weather

  30. May also be a barrier • TB Technician has to be fluent in both Navajo and English for the patient to understand their care. Communication

  31. Occasionally, a very traditional Navajo patient is reluctant to accept the use of western medicine to combat their TB illness. • Some IHS Hospitals within the Navajo Nation now employs Navajo Medicine Men as staff members for the purpose of counseling and promoting health for patients by combining traditional and western medicine.

  32. • GOAL: TUBERCULOSIS CONTROL : Reduce the rate of incidence/prevalence of Tuberculosis among our Navajo people. • OBJECTIVE: Design and implement tuberculosis control activities on the Navajo Nation through case finding, case prevention, case follow-up, monthly and/or bi-monthly TB clinic services, screening of high risk groups, contact investigations and community education.

  33. TASKS: I. Case Management: A. Manage and provide Direct Observe Therapy (DOT) two to three times a week to patients with or suspected of having TB disease.

  34. B. Manage and provide Direct Observed Preventive Therapy (DOPT) to selected patients who are at risk for developing active TB (e.g. Diabetics, substance abusers, close contacts, dialysis patients, nursing home patients, etc.)

  35. C. Collection of TB specimens are submitted to the State Laboratories for testing.

  36. II. Surveillance A. Tuberculin Skin Testing: Screen and identify close contacts of Active TB Cases and also target screening for high risk population.

  37. III. TB/ Chest Clinics A. Develop each TB Patient’s Plan of Treatment and monthly reviews with the TB Medical Officer at the service unit TB/Chest Clinics.

  38. ∙ IV. Court Orders A. Protecting the health of the public State and Tribal Court Orders may be used to detain patients who are infectious, unwilling to receive treatment or who are at risk for becoming infectious again and acquiring drug-resistant TB.

  39. V. Referrals A. Initiate and accept referrals of TB clients for evaluation and possible treatment for TB.

  40. VI. Health Education A. TB Control Program provides education about Tuberculosis to health care providers, school health, and over-all communities.

  41. VII. Guidelines A. Observe the National CDC guidelines, State, and Navajo Area IHS Laws and Regulations. 1. Treatment recommendations 2. HIPPA- Privacy, Confidentiality 3. Contact Investigations 4. Reporting of TB Cases

  42. • The TB program has come a long way. • Before the TB program, there was a high number of TB cases. • Since the program was established in 1972 the number of TB cases has declined. • The last TB Sanatorium was closed 5 and 7 years after the program was started. • The high standard of care has made a positive impact, therefore the Navajo Nation does not have any reported MDR. • The Navajo Nation continues to collaborated with other National, State and Local entities to the rate of incident/prevalence of TB among our Navajo People.

  43. For your Viewing Pleasure…….. Documentary: TB on the Navajo Nation

  44. Questions?? “Cat Corner” Canyon de Chelly

  45. “I will go and do more……..” Annie Wauneka

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