by David J. Brueggemann
During nearly 30 years as an audiologist with the Department of Health and Human Services (Commissioned Corps of the U.S. Public Health Service), I've worked in areas ranging from the tropical waters of Florida to the snow and ice of Alaska.
Since 1992 I have managed an Indian Health Service (IHS) audiology program at the Alaska Native Medical Center (ANMC) in Anchorage. Alaska is vast, at more than half a million square miles. If you were to overlay it on a map of the continental United States, it would stretch from South Carolina to California and from the Canadian border to Texas.
The IHS is the federal health agency for American Indians and Alaska Natives. IHS has seven audiologists in Alaska—four at the ANMC, one in Dillingham, and two in Nome.
Audiological services vary from site to site, including outreach treatment at schools and nursing homes. We provide comprehensive diagnostic audiology services, including auditory brainstem responses, electronystagmography, hearing aids, assistive listening devices, cochlear implant assessment, habilitation, universal newborn hearing screening, and telepractice. Our annual caseload at ANMC has doubled to nearly 5,000 visits per year. We also visit 1,000 or so patients in the bush—the remote and roadless areas of Alaska accessible only by plane.
Most of our patients are fluent in English, but in many areas, particularly in western Alaska, English is a foreign language, and we rely on interpreters to help with our testing and counseling. The statewide population of Alaska Natives is approximately 130,000, with about 45,000 living in the Anchorage area. We are experiencing a large influx of Alaska Natives moving into urban areas to seek employment, obtain health care, access better schools, and generally improve their standard of living.
Some patients arrive from 1,200 miles away, traveling by small planes, boats, or snowmachines (known as snowmobiles in "Lower 48" terminology). We try to provide as much care as possible on a single visit. Up to seven times annually, we fly to four regional hospitals or clinics, usually by commercial jet but occasionally by small plane.
Anchorage Program
Opened in 1997, the ANMC is a beautiful modern facility run by the Alaska Native Tribal Health Consortium, a group comprising all the Alaskan tribes. ANMC is the state's premier hospital, with a staff of four audiologists, two audiometric technicians, and two administrative staffers. We work with a team of seven to eight otolaryngologists and have affiliations with the otolaryngology residency programs at the University of Chicago and the University of Texas, Galveston.
ANMC is beginning the second year of cochlear implants; until last year, Alaska residents traveled to Seattle or points beyond for the surgery. We provide cochlear-implant mapping and follow-up services at ANMC as well as in the bush.
Nome Program
In Nome (pop. 3,500) a local native health care company—Norton Sound Health Corporation (NSHC)—contracts with IHS to provide audiology services. NSHC employs two audiologists and an audiology resident who travel by small aircraft up to 23 times per year to three- or four-day clinics.
The only way in and out of Nome, in northwest Alaska along the coast of the Bering Sea, is by plane, snowmobile, or boat. Patients from throughout northwestern Alaska generally fly to Nome for audiological services or await visits from an NSHC audiologist. Fifteen villages cover an area roughly the size of Louisiana, making remote audiology care a challenge.
Although remote geographically, the distance is transcended by participation in the world's largest telepractice program, the Alaska Federal Health Care Access Network, in Anchorage.
Since 2002 NSHC audiologist Phil Hofstetter and his staff have incorporated "store-and-forward" telepractice (see The ASHA Leader, June 17). In this practice, video otoscopy and audiometric data are all securely transmitted by satellite to the otolaryngology team at ANMC.
Hofstetter reports that telepractice has reduced by half the wait times for patients to see an otolaryngologist. Telepractice has been particularly useful in facilitating medical clearance for hearing aids, in surgical follow-up, in assessing urgency of onsite physician intervention, and even for remote supervision of the audiology intern.
National Collaboration
Nationwide, 14 federal audiologists work in the IHS; four or five are in the USPHS Commissioned Corps with the balance in the Civil Service. The tribes directly employ an additional 14 audiologists. The majority of the IHS audiology programs are in Alaska, Montana, Arizona, New Mexico, and Oklahoma. We try to meet for a national IHS audiology conference every year; we hosted the 2007 meeting.
The IHS has an annual budget of approximately $3.1 billion and employs nearly 16,000 people, who provide services ranging from health care to social and environmental services. Audiologists are found throughout the system.
For additional information about the IHS, please visit their Web site.
David J. Brueggemann, a captain in the U.S. Public Health Service, retired at the end of July. He can be contacted at dbruegge@mtaonline.net. For information about the Alaska Native Medical Center in Anchorage, contact Linda Erb, audiology program manager, at llerb@anmc.org.