During her 23 years as a healthcare assistant in Northwest Alaska, Eunice Carter has responded to countless dangerous calls. But the incident she remembers most occurred when she was performing CPR on a child in a family’s home.
A member of the family told her and several other health care workers in the room, all women, “If you don’t save my family member, no one will live,” Carter recalled.
Carter and her colleagues suggested taking the patient to the local clinic to obtain the necessary medications, and the situation was defused. To protect patient confidentiality, Carter did not reveal any other details.
The incident is not unique: Healthcare workers in Northwest Alaska often respond to emergency calls when they need to de-escalate the situation, and in many of those cases they are working without anyone to protect them.
Over the past few years, the Maniilaq Association has noticed higher levels of violence at village clinics, said Kenneth Turner, safety officer at the Maniilaq Health Center. Increased stress levels, staff shortages during the pandemic and a rise in drug use were among the factors contributing to the increase, he said.
“Since the COVID-19 pandemic, we have seen an increase in public safety concerns at most of our community clinics,” Turner said. “It has become clear that enhanced public safety and security measures are warranted.”
In October, the Maniilaq Association started a pilot program to bring security guards to Kiana, Kivalina, Noorvik and Selawik to assist health workers working in the clinics.
“The goal is to ensure that our healthcare assistants and other staff can focus on providing high-quality healthcare without having to worry about their safety,” Turner said.
Maniilaq Association provides health and social services to 11 villages in the Northwest Arctic Borough and Point Hope. Approximately 100 Maniilaq employees work in rural communities in roles as community health care workers, as well as medical, dental, vision and behavioral health care providers. About 65 of them are assigned to specific clinics, while the rest work on a rotating schedule.
Staff often need to manage crisis scenarios while providing healthcare services.
“Our health care staff has recently dealt with issues such as domestic violence, hostile environments, substance abuse incidents and mental health crises,” Turner said.
Ideally, healthcare workers would not respond to calls outside of clinics that could threaten their safety. Instead, they would call local law enforcement, said Chris Dankmeyer, Maniilaq’s community health director. But in communities without a public safety presence, that can be a challenge. The Northwest Arctic Borough aims to employ fourteen public safety officers, but currently employs only four.
Carter is a Community Health Practitioner supervisor at Maniilaq who spent her career as a traveling health assistant and now works in Buckland. In addition to the scenarios Turner described, Carter has also been in a situation where she had to hide in a clinic because someone shot at the building. She has also assisted patients who behaved aggressively after a head injury.
“They happen at night, in the evening or at night, and who do you call? Who can respond very quickly? And it’s just you and them in the building,” she said of caring for those patients. “We are not allowed to use weapons, knives, guns, tasers, pepper spray – we are not allowed to have anything to protect ourselves. We are supposed to walk away or run away.
Warren Compton, who has been a health assistant at the Selawik Village Clinic since 2006, recalled the disruptions he saw at work.
‘We’ve had a few incidents where people weren’t happy with what the doctor prescribed or whatever, and they lost their patience. And there have been some cases where drunk people have come in and caused a commotion and scared other patients and scared the health care workers themselves,” Compton said. “There is a need for security in the villages, at least in the clinics.”
Increasing violence during the pandemic
Violence against health care workers increased nationally and in Alaska during the pandemic.
In Northwest Alaska, Maniilaq saw a slight spike in reported incidents of verbal attacks and physical assaults at clinics. The other, more significant change they observed was an increase in the intensity of violence, Turner said.
Maniilaq uses the aggression spectrum to classify the types of violence, ranging from intimidation to offensive language, verbal abuse, verbal threats and then to various levels of physical violence.
“During the pandemic, this aggression has increased across the spectrum,” Turner said. “We saw much less intimidation and slightly more verbal abuse, verbal attacks and physical attacks.”
The change could partly be related to an increase in the use of illegal drugs, which are not yet as prevalent in villages as they are today.
“I’ve lived here 27 years and I’ve never seen methamphetamine come into town,” Compton said. “There’s been an increase in cocaine and methamphetamine and things like that, I think, throughout the Northwestern Arctic.”
The stress caused by the pandemic also played a role in the increase in violence, said Lisa Shindler, manager of the Community Health Aide/Practitioner program in Maniilaq.
“A lot of it had to do with the stress and isolation of COVID, which increased suicidal tendencies and alcoholism,” Shindler said.
The pandemic led to staffing issues, Shindler said, making emergency response riskier. She said Maniilaq employed 76 healthcare workers in 2019, and in 2022 that number was 40.
During that time, a health assistant’s workload also grew and became more challenging, Shindler said.
“We worked so many hours that they started to have anxiety and panic, and they were just exhausted. …It was overwhelming. And people just couldn’t keep going. And they got sick. And relatives died. It was really tough. We were terrified,” she said. “They stopped. They became exhausted. They’re tired.”
The increased aggression has also led to the displacement of health care workers, Dankmeyer said.
“It’s a factor for some of the staff that we (left) over the last year,” Dankmeyer said.
Although Maniilaq has steadfastly rebuilt its healthcare assistant program and now has approximately 60 healthcare assistants, there is still room to grow. They hope hiring guards will help them retain the health care workers they have.
“Having someone there with you during that time can really help with staff retention,” Dankmeyer said, “to have a sense of security, to maybe avoid some of the traumatic events that could happen.” prevent.”
Pilot program for security guards
On October 1, Maniilaq launched its pilot program to hire security guards who will ensure the safety and well-being of patients, staff and visitors without using weapons.
Initially, four security guards will be hired to work at clinics in Kiana, Kivalina, Noorvik and Selawik – some of the region’s more populated villages with documented incidents of violence, Dankmeyer said.
“We picked the ones that seemed to be needed most,” he said.
So far, the Selawik position has been filled and Maniilaq is looking to hire three more guards, as well as four assistant guards to address potential gaps in coverage. The company has spent $500,000 on the program.
While approximately half of the total calls that health care workers respond to occur in the field and in people’s homes, according to Shindler, security personnel will only be present in health care facilities.
Turner said deploying security guards to escort healthcare workers outside clinics is legally complex: It can raise concerns about invasion of privacy, jurisdictional limitations and an ambiguous regulatory and insurance landscape.
“We narrowed down the concept of the security program, knowing that it doesn’t address the entire case, but the other piece, the security outside the clinic, that should be law enforcement – it should be VSOs, it should be VPSOs or state troopers. And they are missing, they are not there. At least not consistently, Dankmeyer said. “The burden of the lack of law enforcement in rural Alaska is being shifted to our health care system and our workforce, but we are not prepared to take on that role.”
[From 2020: Can Alaska’s VPSO program be saved? A task force suggests big changes.]
To better address safety concerns in the villages, Shindler says a multi-pronged approach is needed, including hiring more village public safety officers, developing emergency medical services in the villages and providing CPR training and first responder certification to the local population so that they can assist health workers.
Hiring security guards for the four village clinics is a small step in that direction. Maniilaq plans to evaluate how effective the program will be in providing safety for patients and staff.
“If it produces positive results, I can’t promise anything, but I’m pretty sure we’ll probably implement that in every clinic,” Turner said.
Carter is looking forward to that expansion.
“I can’t wait,” Carter said. “Just the prospect of getting a horrible phone call, it’s so stressful. … And if you already experience something, you develop PTSD … So it makes you afraid of the next phone call. You think, ‘I don’t know if I’m going to do this anymore. I think I should quit my job.’ But having a guard (guard) cushions the blow. It makes you feel better prepared.”