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Supporting Health Care Workers With Infection Prevention and Control

Learning Objectives
1. Explain how the National Council of Urban Indian Health (NCUIH) and Urban Indian Organizations (UIOs) serve Urban Indian communities
2. Describe the goals of infection prevention and control (IPC) as it relates to Urban Indian Organizations (UIOs)
1 Credit

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The National Council of Urban Indian Health (NCUIH) serves as a resource center for individuals and organizations dedicated to improving the health of American Indians and Alaska Natives living in urban areas. Learn more

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Audio Transcript

Vickie Oldman: Welcome to the National Council of Urban Indians Health podcasts on infection prevention and control education topics for our frontline warriors and health care team members, serving American Indians and urban Indian health organizations. Yá'át'ééh (Hello). my name is Vickie Oldman. Your host for these podcasts.

I am Diné (Navajo) a resident of New Mexico and have been working with Native communities and nationally for over two decades as an independent consultant in these broadcasts, I will be interviewing leaders, advocates, and practitioners with a focus on infection, prevention, control strategies, and urban Indian health care settings.

Ahéhee' (thank you) for joining us. Project Firstline is a national collaborative led by the US Centers for Disease Control and Prevention (CDC) to provide infection control training, and education to frontline health care workers and public health personnel. The contents of this podcast do not necessarily represent the opinions or policies of CDC or HHS. and should not be considered an endorsement by the federal government.

I am excited about bringing our first guests here to kick us off. I would like to introduce our first guest Francys Crevier whose current role is the CEO at the National Council of Urban Indian Health in Washington, DC. Francis has been serving Indian country for a little over a decade. She has served in various capacities from clerking and working for United nations, special repertoire for the rights of Indigenous people to representing tribes as in-house council and special prosecutor.

She joined the Indian health care field in 2015 to advocate for better health care in Indian country, as well as educate tribal members and communities on their alternative health care options. She joined NCUIH in 2016 as the Director of Governmental Affairs and in 2017 became NCUIH Chief Executive Officer. Francis received her JD from University of Arizona Law and certificate and a Indigenous Peoples Law and Policy. And her BA in Public administration from Florida International University. Francis, welcome. Thank you for joining us.

Francys Crevier: Thank you for having me, Vickie. It's wonderful to be here.

Oldman: Yes, I am excited that you get to kick us off on NCUIHs' podcast. How excited are you about this?

Crevier: Super excited. It's been a long time coming and lots of planning, and so I'm really, really excited. I love podcasts. And so I'm excited we're in this, in this scope!

Oldman: Yes! All right. Well, let's get started. Why don't you share with us a little bit about what NCUIH does and who does NCUIH work with?

Crevier: Sure. So, NCUIH stands for the National Council of Urban Indian Health, and we serve as a resource center for individuals and organizations to improve the health care for American Indians and Alaska Natives living in urban settings, and so, pretty much what NCUIH provides, we provide advocacy to Congress and agencies. As well as education, technical assistance and training and leadership to our Urban Indian Organizations across the country.

And so we work with a whole bunch of Native leaders from different areas and, you know, CEOs from our Urban Indian Organizations and, and really work with them on a lot of various issues to make sure that our people in urban areas are not forgotten.

Oldman: Wow! That's a lot. You all do a lot for the community.

Thank you so much for sharing what NCUIH stands for, and also it was a very unique acronym. Tell us a little bit about what NCUIH envisions as it relates to infection prevention control with the urban health organizations.

Crevier: Sure. Well, we envision infection prevention and control as those practices and procedures that were implemented and applied correctly and consistently reduces and or eliminates the threat of emerging or re-emerging disease threats within our UIO, such as COVID. And these practices are evidence-based and proven to be effective against pathogens and will protect our patients, our UIO staff and our community at large.

Oldman: So I'm curious about how much has changed in how you all are educating, messaging and really focus on like the infection prevention control. Does it kind of ebb and flow depending on what's going on in the world?

Crevier: Yeah. So I think like many people in many organizations, the COVID changed the trajectory of all the things we were doing. We definitely, when COVID hit, wanted to make sure that our people were the lowest hit and wanted to do anything to make that happen. And so we shifted all of our work and projects to this project. This is one of the projects like infection prevention and control to make sure are UIOs were, um, up to date with everything, but also they could provide CDC feedback that is necessary to make culturally competent protocols that, you know, work in our communities. And so, yeah, it definitely shifted a lot from the time prior to COVID. I would call prior to COVID BC now. Before COVID, after COVID.

Oldman: It's just interesting seeing how much we're using media and a different way to educate folks. I was just curious about, you know, how you all have been doing it and how you all arrived here and how much has shifted? And, and we'll get to later on to talk a little bit about what you all hoping for going forward, but let me just back up a little bit in terms of like you had, you know, cause this is NCUIH and it's focused on the Urban Indian Health.

So how would you define Urban Indian, and what sort of organizations exist and where are they located?

Crevier: Sure. So, you know, urban Indian has its own definition. And in Congress, you know, Natives are the most regulated of people, any other, any, any people existing. And so urban Indians are American Indians and Alaska Natives who live off reservations in urban and suburban settings.

And so. A lot of people, because we didn't, you know, wake up one day and say, oh, I'm an urban Indian, you know, nobody says that it can be hard to really understand that. But if you are in an urban area, you're currently an urban Indian and you know, and you're, you know, a lot of folks were probably wondering, you know, why?

Well, urban Indian organizations were created in 1972 following the Termination Era by Congress, which essentially was to “Kill the Indian, save the man” and to move us off of reservations and into urban settings. And so urban Indian organizations were created by Congress as tribal advocates had advocated that because they moved us off of reservations, the trust obligation follows us there and Congress agreed. And so to fulfill the federal government's health care trust responsibility for natives off reservations, UIOs were created and they're managed by a CEO or an executive director and a majority native board of directors. UIOs are represented by NCUIH.

And our mission is to, as devoted to the development of quality accessible and culturally sensitive health care programs for our native people in urban communities. And today there's currently forty-one UIOs um, that are authorized under the Indian health care improvement act, including American Indian residential treatment centers.

And they are in 22 states across the country and provide a multitude of services based on the community needs in that area. And that includes comprehensive primary care services, behavioral health services, and social services. Those UIOs are tasked with serving 70, over 70% of the Native population that lives in urban areas today.

And there's a lot of services that are tailored to combat specific health care disparities in the urban Indian populations, which is the key to preventing serious health problems and diseases. And those services provided besides primary care. We've seen behavioral health services that are desperately needed during this time, the traditional healing and medicine services and then social and community services.

So it really depends on what the community needs and our UIOs tailor those services based on the needs.

Oldman: Wow, and I know the demand is still high, but there's still not enough. Right?

Crevier: There's not enough. The Indian health service is only funded at 12% of need. And so, unfortunately, even though there are more resources coming down from the federal government and the build back better bill does have 3.5 billion.

In addition for IHS, which is historical to give you context, IHS was only funded at 6 billion, so almost half its budget, but our estimates are, it should be at 48 billion. And so there is a lot of need out there for sure. And that is part of our job is to know what's going on in the ground and to help decision makers, you know, make programs that are supportive for our, um, people.

Oldman: Thank you for that. I, and I'll just say that what I'm learning about the different facilities out there is that some of the facilities provide top-notch quality services. And that you all have, like having these facilities give you flexibility and creativity to do more and to provide different sort of modalities to help our community people. So, I don't know if you want to respond to that.

Crevier: Absolutely. You know, our UIOs strive very much to provide quality and culturally competent health care and they do a great job. We do have a lot of folks who come from different agency facilities, you know, such as the VA or, and they come to an urban Indian facility because they want that quality care.

They want faster care and they also, you know, want to feel. Like, you know, part of the community and even veterans, for instance, statistically speaking, Native veterans, don't go to the VA. It's a huge problem. And so, you know, but they will go to the Urban Indian Health Program where there are other, you know, community members are, their family is. And so, you know, it's really trying to make sure that it's accessible and high quality. Um, as much as we can.

Oldman: Beautiful. And I know why people probably go there is because they feel how the organizations, the health care facilities really try to have people like them serving them. They really make sure to weave in the cultural piece, that connection that's, what's important.

And so I've heard good things about that. So it's exciting. And I hope that there'll be more because there's a lot of our people that live in an urban setting, I for one. And so there's not enough. I'm curious about your partnerships. I know that you all have partnerships. I'm sure these facilities across the country, you know, have unique partnerships and where they're placed.

Particularly for NCUIH, how did you all come in to partner with the Centers for Disease Control and Prevention's national training, Collaborative Project FIRSTLINE?

Crevier: Yeah. So we've been in a partnership with CDC. We were in a five-year cooperative agreement and Project FIRSTLINE is part of that. And it was launched in year three last year in response to the current pandemic as a COVID-19 response, and so our CDC Project FIRSTLINE is a collaborative of diverse health care and public health partners in excess of 75, so we have lots of partners that we work with across the country, and that aims to bring engaging, innovative and effective infection control training for millions of US frontline workers, as well as members of the public health workforce.

And so we want to make sure that, you know, the good information is out there and that our facilities and our partners are always getting good information, there's a lot of misinformation out there, these days. And so these partnerships are imperative to ensuring that as many people are protected as possible.

Oldman: How exciting. So when you're talking about the infection prevention control, why is this important topic to discuss with the UIOs the Urban Indian Health Organizations?

Crevier: Yeah. Um, well, our UIOs provide a myriad of health care services to urban Indians as you're aware. And so, and Native people are disproportionally affected by the COVID-19 pandemic. Not only this, but other diseases, threat, you know, other diseases exist. They have high percentages of that. And so as health care organizations it is vital to stay abreast of all, of all current infection prevention and control practices and procedures to keep our staff and patients and our community safe. And so the goal and infection patrol as it relates to uh, UIOs is to develop or augment and maintain a culture of safety, safety first, most important.

Oldman: Great. Thank you so much. So I wanted to transition just a little bit, and we're still going to be talking about the UIOs. I’m curious about the IPC systems champion, tell us a little bit about that and how are they chosen?

Crevier: Sure. Sure. Yeah. We love our champions our UIO infection prevention and control systems champions. Our UIOs, um, selected after they applied for an award to be champions to a pilot test, to pilot test the training modules that CDC was developing and evaluate the modalities that host these trainings.

So, these champions are also implementing the IPC trainings as part of the collaborative, and I know acronyms suit sometimes, and so IPC has always are short for “infection prevention and control.” And so, our champions were chosen through competitive award. And so, the last year it was $40 000. And this year it will be $60 000 to each champion that participates in this Project FIRSTLINE initiative.

Oldman: So, I know it's only been the first year and we're always learning. So I'm curious, just thinking about how you all have implemented this and, you know, looked at the applications. And I think you guys awarded like five, right. this first year, so what have you learned about this process?

Crevier: You know, we've learned that, you know, keeping our community at the forefront of this is extremely beneficial. You know, making sure that agencies are talking with our representatives and making sure that our changes are incorporated, is paramount. And so, I think it's been really great to the, this partnership has been really great and we've, you know, we've learned a lot and continue to implement changes as we find them, but it's really, really been a great experience.

Oldman: How exciting! So what's in store for year two, clearly, dollar numbers went up how exciting, right?

Crevier: Always more, any dollars to Indian country is a good thing. So yeah, year two. We'll focus on improving clinical and public health outcomes through our national partners. To prevent and control emerging and reemerging infectious disease threats.

There are trainings will be provided through four quarterly webinars and podcasts as well, as six project echo series that are open to all UIOs we do have our graduate fellows again, which is really wonderful in this program. And so, our graduate fellows will be on hand to support the champions and the implementation of the training projects within their organization.

And, you know, they will, they will be given $60 000. So that's a wonderful increase from the 40 when applications are now open. And so, we're excited for the next year and then supporting our activities. They will be supporting our activities, as experts from CDC to provide guidance throughout the trainings. And so it's, you know, it's just a really great program.

Oldman: How exciting, yeah, you all do have a lot going on, so folks can apply and we'll give more information at the end on where to go to apply. Do you all know about how many you all will be giving the awards to this year?

Crevier: Yeah. So last year we did have our five champions and this year we'll have up to ten champions. They will be selected and you can get more information on our website NCUIH.org or email IPC@NCUIH.org and yeah, for first year two, we'll be just focusing on the emerging and reemerging first. So definitely sign up. We're excited to have, to be able to double our champions.

Oldman: Can previous champions apply again?

Crevier: Yeah, absolutely.

Oldman: All right. How exciting! I only say that because I feel like it was a nice transition to go to our, our other guests.

But before I do that, any other final thoughts about launching this podcast, but also what you all are doing? Get the partnership with the Center for Disease Control and looking at the second year for the Project FIRSTLINE Collaborative Champions. So anything else you want to add?

Crevier: Well, we're always looking for, you know, allies that can help support our work, whether through this or through other means.

So, you know, signing up for our newsletter, you know, sometimes, you know, there's a lot of -activity and this current administration with health equity. You know, this is the first time I think that we've been in a place where health equity is, is a hot topic and who needs more health equity than Indian country.

And so just staying in touch with us and, uh, keeping, you know, keeping your eye on the prize. Talking to Congress, if you need to, when we ever, we get, send out things, you know, that's always very helpful. I think, you know, we just, we all need to work together to make sure that the future is bright. So really excited about all the stuff we're doing and, you know, hope to have more allies.

Oldman: Wonderful. Alright. So speaking of allies, partnerships, you know, excitement, I want to introduce our, our guests, our other guests here. And actually, as Francys had mentioned, there were five actual sites that were rewarded as champions last year. And today we have one of them, one of the champions here to, to share with us what they've learned, what they're doing and for us to get to know a little bit about this particular site.

So, we have here today, the CEO of Bakersfield American Indian Health Project, that's actually based in California. And so our guest is Mr Angel Galvez and he, uh, was born to immigrant parents. I'm going to ask them to tell us a little bit about his father in terms of his Indigenous roots, in terms of Angel though, our guest here,

He is passionate about this work. He has personal knowledge in the work of Indigenous communities in terms of public mental health and higher education has really prepared him to serve, to serve diverse needs of our Native American, American Indian, and Alaskan Native people. And he's spent his lifetime really, advocating looking at improving health care systems to better align with our communities and his interests in improving health status of our people, our Indigenous people. His impeccable moral ethical leadership really comes from the background of finances, leadership, management, development, and very well-rounded and a servant leadership, that has really brought parody to unserved and underserved populations.

And also want to just mention a little bit about his education. He earned a graduate degree in organizational leadership from Fresno Pacific university. He also obtained an undergrad in criminology and victimology, and then also earned a graduate research certificate in Indigenous studies. Wow, is all I can say is, wow!

So Yá'át'ééh, hello, welcome Angel. Please say hello to our listeners.

Angel Galvez: Sure, uh, Qi-she ne jaya’pate (I greet you with agape love) but there, uh, that's the tongue of my father. And I'll just talk a little bit about my father. My father is the last surviving sibling, but I'm glad to have my father, my father has taught me everything about our roots, our people, we, uh, we are mountain people.

My father's people are mountain people. They are farmers and swimmers. And my father was from a clan of swimming people and ceremony takes place underwater. They are from the Puherépecha Tribe, Tarascan people in the, um, area of the Paracuaro is one of the highest lakes in the state of Michoacan. The state is located in Central Mexico and the staple of the people there is fish.

So my father was a swimmer, a underwater creature as he, as he says, as he tells us. And so I'm very blessed to have my father still alive. He's 76 years old. He just had a birthday and you know, COVID has certainly, uh, Has certainly given us an eye-opener as to how lucky we are to have those who are still with us, still breathing, especially our elders.

And we're very blessed. I'm very blessed to still have my father and my mother around, but my father unfortunately has lost members of his own family to COVID. And it's been, it's been of course, very difficult for many of us, but, but at the same time, we, we, laugh and we, we joke and we get to spend our lives storytelling with each other.

I talk to my father every day. That we don't live close by, but I was on the phone with him last night. And anyhow, so that's just a little bit about my dad, a little bit about our people. The language has been preserved in its ancient form. So it's very, there is purépecha language that is very common dialect.

The language that I speak, I speak of the ancient land. Which is the only language that my father taught us. It wasn't, you know, speaking of language and I won't, I won't go too deep into this, but it was when my father migrated to this area in the central valley, San Joaquin valley to farm and to seek a better life.

He was the only, the only member of his clan that left, that left the tribe on a journey for new hope. And he came in the, in the, in the state in the days of the resettle program and that was in the early sixties. And so my father tells us stories of when, when they came here, they had to drop the language.

They were forced to speak a different language, and it was shameful to speak in any other language other than English and so Spanish as a second language. And when we were born, he began to teach us words. He began to teach us the history of the preservation, the preservation of words, of the ancient people.

And so, anyhow, I can go on and on and on talking about these stories, but I'm very blessed. I'm very thankful in that I am the man who I am today because of him. So I went off to school I’m the only, only sibling that went off to school and pursued education. I was just really, I think I was just fortunate to have a few good friends in my, in my adolescent life that their pursuit to happiness was going to be through school.

And, and so they became educated and I became educated as a result because I think it was by accident, not necessarily by virtue. So here I am. I'm very thankful to be sharing the space with Ms Francys. I honor her and her work. She has been a strong pillar, a strong woman in Native country, and we're very blessed and thankful to have her because of the programs and the partnerships that they bring to the table for all Native people across, across the nation, including us here in California.

Oldman: so beautiful. Thank you, ahéhee’ in my, in my language. I appreciate you sharing your roots, cause it, I really feel that when we hear about where we come from and who we are really weaves into our work. You know, so Francis this advocacy or passion to really represent it that tells a lot about her upbringing and her, her roots as well.

And so, I appreciate you giving us a little color into who you are. I just think it's so beautiful and kudos to Papa. Thank you, papa for doing such a good job. Yeah. So thank you for that. Well, let's learn a little bit about what you all did. So congratulations and being on the first round of being one of the champions, how exciting for you and your organization and your team.

So tell us a little bit about Bakersville American Indian Health Project and the services that you all provide.

Galvez: Sure. I transitioned career from an Indian health center in the reservation and I came on to Bakersfield about, nearing two years ago. And I came to the urban side, as we say to each other, at those in the, in the reservation side, I came to the urban side and I came to Bakersfield because for one, it wasn't too far from where I'm from.

And two is that I wanted to understand the urban setting, you know, the urban health center study of population, because in reservations you typically only serve mostly members of the reservation, the Indians of the reservation. And although those health centers do open their doors to other Indians living in the service area, they typically, or predominantly, they focus on the membership.

And when I came to Bakersfield we're one of 11 urban Indian organizations in California We're in, we're located in Bakersfield, California, which is considered central valley. So it's, it's a fairly large city. It's one of the larger, one of the smaller cities in the state of California, but it's large enough to have a little over a million in population.

So countywise, the city of Bakersfield, I think it has a little over 600 000 in population. Of that population. There's about roughly 24,000 Native Americans, Alaskan natives that live in the current county and the current county area. And so, we serve a very small percentage of those Indians and we're, we're also, we're also, um, a outreach and referral urban Indian organization, meaning we're not limited or we're not full scope health centers.

Our budget is, is very minimal, very nominal to provide health care outreach and referral and transportation for the American and Indian population here in Kern county. When I first came on Bakersfield, Bakersfield's mission was outlined by just serving, the cities or outlining towns that had the highest concentration of American Indian & Alaska Native.

Which inadvertently created barriers because many other American Indian, Alaska, Native people could not, could not receive the services that others were receiving that were living close to the service area or were included in the service area. And since then, because of partnerships like NCUIH, we have been able to change that scope.

Oldman: I appreciate you being transparent about the transition, right? So two years is a blink of an eye. Like you came on right before COVID. Literally though that in itself is a challenge. I just want to just lift that up because I think when people had transitioned to new roles and leadership under COVID, that just affects how you connect with your team, how you connect with the community, how you connect with the partners, like it's all 2D, and not feeling and being in that same space.

I appreciate you also just noting that. Really your curiosity by understanding. Cause I think that is a foundation for all this work that you all are doing. The NCUIH the different organizations is really getting a good understanding before jumping in into the services. And I just think that's really exciting.

Galvez: One of the things that intrigued me about coming to Bakersfield was that there was already a sense-the board, the board of directors had shared, you know, cause I, I think as much as they interviewed me, I interviewed them and I asked a lot of questions. I wasn't just going to leave to leave, you know, I left a very good place and I didn't leave because I had to, I left because I wanted to.

And so it was very difficult to make that transition, but I was very, I was very intrigued because there, the board of directors had a lot of passion and they'd been serving on the board for a long time. And I think the challenge there, you know, COVID-19, they didn't have somebody here full-time and the previous CEO had had left and so I think there was, there was concern, there was community concern. There was a lot of work that needed to be done to really not only build the organization to, to have a, a minimum standard of quality assurance and quality improvement, but, but also to hear the voice of the people and they just didn't.

They had not conducted community assessments in a very long time. They had not, they had not done any of that through the organization. So that, that, that was an area that I had spent a lot of time doing for other organizations. And so I had a clear understanding. You know, in order for you to really build an organization, you don't, you don't build it from the inside out, meaning you build it from the outside in meaning that the community you serve are those who should dictate what those, what those programs and services should look like.

So, they reap the benefit and then you sort of kind of build from the outside in, and then inside out so that it mirrors what the community need is. And so that's what intrigued me the, that the fact that, you know, they didn't have a strategic plan that was very current and that there was a lot of work to be done with the community was going to be an opportunity for me to learn, from the community, and I guess in a sense, build that rapport and build that trust again, whether it was gone or there, mend those relationships. And so we spent early on, when I first came on, the focus was let's get, let's get our, our, our partnerships on board because we can't do it without partnerships, hence NCUIH and, and then let's get our board of directors to be the voice, but then let's work together to hear the community voice. And so we're able to do that very early on when I first came on.

Oldman: Beautiful. Thank you. So as you got onto the organization and start to build relationship and really get the lay of the land, you did mention a little bit about that. How, you know, where, who you were serving, where they were located in the barriers that you were faced with that in mind and thinking about Project FIRSTLINE this, this award that you received from NCUIH, what has that pot of funds, this opportunity allowed your organization to do what, what sort of changes have you seen? What, what did you guys implement in terms of the funding support?

Galvez: Yeah, sure. We, we, you know, without, I guess what I will say is that when, as an outreach and referral Urban Indian Health, Program, you don't, you don't have the luxury of having, you know, like minimum standards that you, or, or guidelines that you can fall on.

I think, I think with Project Firstline and being a champion of Project Firstline and a recipient of these funds, it really allowed for us to hone in on what those minimum standards are. Right. Learn about what infection prevention and control is. And how we can become a safer environment for those we serve, because Francys is very correct in that, you know, urban Indian organizations are like the first place for the drop-in center that all American Indian, Alaska Native people seek out. They, they typically will come here first before they will go anywhere else. And so for an urban Indian health organization like ours, that was very, very small. The smallest of, of our counterparts here in the state of California, we knew that our, our minimum standards or any, any type of guidelines that we needed to follow, weren't really, there, there weren't really strong. Our policies were like five years old, six years old. And so none of that had been really strengthened. And so Project FIRSTLINE allowed for us to really strengthen those, those guidelines. Understand what infection prevention and control is.

To understand the research and receive the accurate literature to really guide the, the infection prevention and control trainings, the infection prevention control measures. And so I think that was like the, the, I, the big eye opener for us as an agency. It was to get exposed to some of this because, you know, NCUIH, you has strong partnerships with the CDC and who better to be getting the accurate information when it comes to infection, prevention and control.

They're very well connected with triple AHC. And so, you know, a small organization like ours didn't have the capacity nor didn't have the funding, to embark on some, something like that on our own, we needed the partnerships in order to do that. The technical assistance in order for us to put together a really nice framework.

And so I think that that was really key.

Oldman: So I'm hearing loud and clear, it's like, you it's almost bonus. Like you get funds and then you get additional support. Right? You get the network, you get the TA, you get the connection. So it sounds like a really great opportunity for others to consider even applying for a year or two.

Would you recommend that?

Galvez: I would strongly recommend that recommend that you become a or apply to become a champion. And here's why. When we applied, we didn't know, you know, and I'll be transparent at first it felt like it was going to be, wow, this is a lot of work. Right. You know, you fit, you know, we're a small team.

We felt like we need this, but also on top of everything else that we're doing, can we manage this, that appropriately. Can we meet the goals and the objectives? Right. And in a timely, in a timely manner, because obviously these grants come with timelines. And so early on, we were a bit nervous about that, but the end result led to-and even though, even though the partnership was very great and it led to, you know, during COVID, we were just soon after COVID, it led to a partnership where we were able to leverage our relationship.

Leverage what we have learned and create a COVID surge plan. That's a 70-page document, a living sustainable document that we incorporate as part of our COVID search plan as an emergent or emergency preparedness plan for any pandemic and or public health emergency. So, that is huge, you know, because an organization like ours now has a framework of how to respond without necessarily being at risk of closing because it has made our agency much more proactive in that we, the workforce is healthier. We have preventative measures. We're able to treat people with safety, you know, using all the PPE properly and that that's infection prevention and control. You know, when you don't know how to use.

You know, don and doffing and you, you're not, you don't understand the importance of safe masking shielding wearing the proper PPE. You yourself can become contaminated, thus leads to then closure of a clinic or closure of services for a period of time. And so, you know, these are the things I guess, that I would say why I would strongly encourage other partners to partner because you're really working with the subject matter experts, to pour into your organization. So that, so that your organization then becomes much more stronger and providing those quality improvement measures to serve the population that you serve, including those who just come from the community, who may not be patients, but rather looking to be partners. And you're treating everybody with that caution and quality of care.

Oldman: So not only are you highly recommending and shared a little bit about what you're doing, curious to know about Project FIRSTLINE year two. What are you all hoping to accomplish around in infection control training?

Galvez: Well, you know, I think year two will lead more into strengthening our, our partnerships. We've done a lot of great work together just in the, in the sub grant award. We were able to do a lot of echo community, community of learning sessions and share back. And, and also we implemented a training plan which has led to ongoing training at our all staff, ongoing training for our partners, ongoing training, that that offers just sort of that sustainability, of what we received and what we're going to do forward.

So I think for year two, where we're looking to be a champion or a coach for champions, so that, um, we can share with them the struggles we can share with them, maybe the areas that. The gaps, I guess you would say of, of, of what we experienced with that. They, those agencies don't experience the same barriers or gaps, and as such become stronger in their development with similar lifeplans.

Oldman: Hmm. So I'm curious to know everything that you've shared. I mean, I know you could, we could unpack in so many areas, but given that this is the first podcast and we're launching and really trying to emphasize them part of, you know, infection prevention control, but also encouraging other entities to apply for the Project FIRSTLINE, and so sort of where you're at now, anything else that you want to just add or emphasize? Because I definitely want to bring in Francys so we can have a dialogue as well.

Galvez: Sure. Well, I think that, you know, like, I'll just, I'll just say this for Bakersfield, for example, for Kern county, there, there are two other, two other agencies and we have the, the Tejon Indian tribe, which is the federally recognized tribe here in Tejon.

But you also have four other non-federally recognized tribes that are, that are native to this land. And they also, they're also very active in The American Indians of their tribe and keeping them safe and keeping them, keeping them healthy. And then you have, you know, Owens Valley Career Development Center who also provides services.

The very same people we provide services to. So, you know, by being a champion and these, these organizations are much smaller than our organization, so you have to understand they might not have the capacity and, or the infrastructure to really, to really partner with agencies such as NCUIH and so I think they lean on us or at least that's what I've learned that, you know, in our collaborative partnerships, we have learned from each other and they have leaned on us to really be the, the, the beacon, if you will, of light in terms of infection, prevention and control, as well as you know, we were the first to provide the vaccine for COVID, you know, we were providing the Moderna and the Janssen vaccine, as well as testing and no cost to any American Indian, Alaskan Natives and, or their family members, whether they were Native or not. And so we were able to provide those vaccines to keep those home safe and to keep those families safe. And so when you have other agencies that are serving the same population, They will, they will lean on you for some of those things.

And you know, you, as a result will then benefit them indirectly. And so we're able to very quickly deploy plans that also, that also spilled over into those agencies. And so Owens Valley Career Development Center and the Tejon Indian tribe, they have a PRC, a very micro-PRC outreach and referral look alike like us.

We're able to let them know, “hey listen, we'll partner our programs and leverage each other”, so that we also serve your members, those folks you serve so that they receive the same, the same infection prevention and control resources that we give out to the people we serve. And I think as a whole, we were able to see how their communities across the board and reduce the number of deaths, even though we still had some.

But I think if we had not done that, or if we were not involved or proactive in these partnerships, It would have probably led to much more deaths or much more exposures of infection across the Native communities here in Kern county.

Oldman: Thank you. That just really underscores the importance of this topic. Thank you so much for that. Francys, I'd love for you to just sort of react to what you've heard Angel share, what really is sitting with you and all that he has shared with us.

Francis: Yeah. I mean, I just think it's so great. I, Angel is just an amazing leader. And I remember when he first started and you've done so many great things and so great to be able to partner with him on these things that have literally saved lives and improved the health of not only our people, but everyone's people.

And so it's just so nice to hear and, and just thinking about, you know, why you do the job you do. You know, when I joined, when I decided to apply for my position here, it was during a time where it was after the 2016 election and that, that party historically zeroed out UIOs and the IHS budgets. And I was determined that was not going to happen and I needed to step up.

And so just kind of hearing that, not only did that happen, but like, you know, I mean, Angel's literally saving lives every day. And even with this partnership, I mean, it's just, it really just goes to show, you know, they take a village and, you know, to really do all the things and make sure, and there's so many, so many people working in Indian country, trying to make sure that our people are okay. And so it's just, you know, in such a time of sorrow and loss. And it's just good to remember, like why you did it, what, you know, what we're doing and that, you know, there's so many good things happening to make sure that we don't lose more. And so it just brings the flutters to my heart.

Oldman: And I also wanted to just lift early on to Angel. And you had mentioned like you, like in all honesty, you know, being transparent when we got this, like, oh my gosh, this is a lot of work. And in the end, like where, where you're at now. So, you know, sometimes you have to go slow to go fast and the going slow means to be thinking methodically, right?

About what is this going to do? How's this going to work? You know, what if we did this, what would the outcomes be? And so to be in that space of vision, be in that space of hopefulness. So I just wanted to just also lift that as well.

Galvez: Sure.

Oldman: So I wanted to ask you both, you know, as we come to a close with our conversation here, and as you both launched, this is the first podcast in the series that are coming up.

What else are you hoping to hear from where are you most curious? And again, maybe just emphasizing the importance of this work I'd like to hear from both of you, just anything else in terms of some final thoughts about what you've all talked? Angel, do you want to tee us up?

Galvez: Yeah, sure. So I think the future, you know, we, we follow COVID very closely, obviously, because it's important to keep our community safe.

And we know that we're following very closely new variants, you know, The CDC, NCUIH and many other partners are really following this closely as well. And so I think, you know, in doing community assessment, not being afraid to really just put ourselves out there and hear the community voice for, for good or for bad has led to such an amazing success in terms of listening to them and learning from them and putting action plans behind it. Because one thing is just to do a community assessment, just to do it, to look you know, to, to hear what's going on in the community and what the needs are. But another another is to, to really do something about it.

And I think with our board, you know, having a very diverse board. We have a hundred percent Native American board, which is, which is very good. They're very diverse in their own ways. Two of the board members are veterans themselves when Francys is talking about veterans, you know, that is so true. You know, even our board member, both of our board members are patients of our clinic.

And one of them prefers to seek out services here versus going to LA because it's, you know, three hours away to go and receive the services. And so, you know, we're working toward becoming a limited, at least the limited health center, because the model of our return referral was, you know, that that was the model for 1972, I think it was that Francys mentioned many urban Indian organizations have evolved since then. Right? And you have large urban Indian organizations that are large scaled full ambulatory clinics. And then you have some that are limited and then you just have a few still like us and many across the nation.

There's still outreach and referral. And so if you look at the organization from that point of view, as an outreach and referral, it really doesn't serve the population as it should. You know, our, our folks should be able to come to an urban Indian health center and receive all of the services that they need for all of their healthcare, mental, spiritual, cultural language.

And we have service providers that provide language, but really more particularly medical, you know, if they're, if they're needing any, any, any of those essential services, they should be able to receive those here, or at any urban site to provide those services. And so I think that's the biggest barrier we're faced with, that's what we're aiming to do now is to really transition from outreach to referral to a more limited, and then work toward a full ambulatory status.

Crevier: And I would say, so, you know, kind of what's next, you know, we continue to try to support, I mean, programs like Angel to try to transition those facilities and grow and expand.

And fortunately, you know, under these last bills, we've worked hard with the UIOs to get UIOs into a lot of things. And I think, I think Angel is going to be primed to get to grow very quickly. So I'm looking forward to that. And, you know, I think one of the things that we hear the most is, UIOs love to hear what the other UIOs are doing.

We are such a small but innovative group and, and it's really, really important that they hear from each other. And so I'm excited for this new modality and to get, to get into a different place, you know, where we may not, we maybe we get more Indian health providers to listen and, and really join. But I think I'm really excited about, you know, this podcast and sharing this information in a new way.

And I'm hoping that, you know, we'll be able to have more conversations about that because we know that is the number one thing that UIOs want. They want to hear from other UIOs because they know exactly what's going on. They know all the struggles, all the barriers, even though Indian health service has UIOs in mind.

There's a lot of red tape at times, and a lot of, you know, pain pills that you have to swallow. And so it's good to have that camaraderie together. And, and so, yeah, I, I'm just really excited about this new podcast and I, and I were just so pleased.

Oldman: Beautiful, thank you. So you all heard, you all heard from these amazing leaders. What I'm hearing is the recommendations to be thinking about as you go forward and you're working in your community within your team and the terms of the organization that you're with is to you know, stay, stay aware of what's happening out there in, in other different forms that NCUIH is offering trainings, webinars, now, new podcasts.

And so use this as an opportunity to learn. I've also heard do community assessments. It's one thing to do it, but also put it into action. What is going on the ground here from the community? Listen to the community, even though it's hard, you know, sometimes it's hard to hear that, but taking it to place and really thinking about how do we put this into action.

And a couple of other things that I heard from our leaders here is also to support each other, to have conversations and connections. You know, this is about learning from one another. What did you do here? How did you do that? You know, how did you go over this particular situation? So, this is an opportunity for other entities to come on and share what you've learned, but also to reach out to your network and find out what's going on and to use this as a platform to learn from one another.

I just want to thank you both. Ahéhee’ in my language is thank you so much for taking time out of your day to connect. I've learned so much, and I also hope that folks that are listening have also taken away something from hearing you, at least even walking away from it being inspired, knowing that NCUIH is here to provide resources in different ways, but also that you have other folks out there, other units out there that are willing to connect, and so you just got to get out and do it. So thank you so much, Angel. Thank you so much, Francis. I really enjoyed our conversation. Have a beautiful day. Thank you. Thank you.

Today, we talked about the CDC national collaborative Project FIRSTLINE infection prevention and control training initiative and the work in the urban Indian organizations to prepare health care staff on the front lines to battle emerging and reemerging disease threats. To get involved or to become a UIO IPC systems champion contact NCUIH at IPC@NCUIH.org to submit an application, go to NCUIH.org/

Our next podcast topic will focus on “Addressing emerging infection control threats to Urban Indian Organizations” by CDC, Dr Abigail Carson.

That's it folks hágoónee' (goodbye) for now.

Audio Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Participation Statement: Upon completion of this activity, learners will receive a Participation Certificate.


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