"If the group of people who started SEARHC had known what barriers we were facing, we might not have undertaken such a climb," said SEARHC President Emeritus Ethel Lund. "There were times that we were pinned to the wall for survival, but we hung in there and didn't give up. We kept our fingers crossed through a lot of very difficult times."
Just starting up the organization was a feat in itself. In the 1960s, native health care services in Southeast were provided by the Indian Health Service, a federal organization ill-equipped to deal with the needs of Natives in Alaska's villages. During an Alaska Native Brotherhood Grand Camp convention in Juneau in 1968, a resolution was passed to start the Native Board of Health, an advisory board that would work with the Indian Health Unit at Mt. Edgecumbe. This Board was designed to provide input from the Native community, as well as to allow board members to learn more about how the federal program was run.
"What we discovered was that there were great gaps in service, especially at the village level," said Lund. "Community health aides, who were the backbone of the healthcare system, were originally volunteers who might have had six weeks of basic training once funding was available. When they went to the villages, their 'clinic' might be an unheated basement without lighting or exam tables. Some of these aides even saw patients in their own homes because the clinic conditions were so deplorable."
To combat this, the Native Board of Health decided to incorporate so that it could become eligible for grants to provide much needed services. "When the Indian Self-Determination Act became law in 1975, it further supported our efforts because it enabled us to contract for services with the federal government," said Lund.
The only problem was that in order to provide these services under the Act, the Board had to get tribal clearance from the 19 villages it would serve. "Before we could contract for any services, we had to get a statement from each community, saying that they wanted these services provided by us," said Lund. "It took 10 years to get 19 resolutions...we'd pick up one and lose two, and pick up two and lose one. It was hard to convince people, especially those raised under the Bureau of Indian Affairs, that the quality of healthcare wouldn't slip."
In January 1986, a major milestone was reached when all of the resolutions were received and the newly named Southeast Alaska Regional Health Consortium, or SEARHC, took over the Mt. Edgecumbe service unit. Since that time, the organization has grown to encompass 14 different facilities from Yakutat to Prince of Wales Island, including 10 village-based clinics. "I laugh because I see people now who were opposed to us then, and they say that they supported us all along," said Lund. "They say that they knew it was a good idea!"
In 1994, a change in the Indian Self-Determination Act enabled SEARHC to provide services in a way that benefited even more Native Alaskans. "Prior to the change, we had to contract for services the way the government did; from the top down," explained Ken Brewer, SEARHC president and CEO. "We were able to reallocate our resources and redefine our priorities to take a grass-roots approach to healthcare; to focus on the needs of the communities first."
This new focus includes providing care in the villages instead of requiring patients to travel far from home. Last year, a state-of-the-art clinic was opened in Angoon, and in the next couple of weeks, a new clinic will open in Klukwan that will feature the latest technology and a full-time mid-level practitioner to provide service to the community 26 miles from Haines.
"We have raised the level of care for Alaska Natives, without a doubt," said Brewer, "and improved accessibility to high-quality care. We have created a network that is the envy of much of rural Alaska, and raised the quality of life in this area. Still, with a higher level of care comes higher expectations. The bar is always being raised."
Brewer says that instead of resting on its laurels in its 30th year, SEARHC is working to address shortcomings in the system, including providing more access to healthcare and finding more money to provide expanded services. "We are always struggling with funding mechanisms, and are challenged-just like every other health system in America-by cutbacks in Medicare and Medicaid," he explained. "We also have to deal with the political tension caused by our successes, which makes us a perceived threat to healthcare providers."
As SEARHC continues to grow, Brewer says that is will remain true to its goals of providing the best healthcare possible to people in remote environments. "We would not be here without the blood, sweat and tears of the people who dedicated themselves to this mission, and we will continue to keep our noses to the grindstone," he said. "We don't pat ourselves on the back, because we realize how much more there is to do. That's what keeps us going."
To learn more about SEARHC, visit www.searhc.org or pick up a copy of "Gumboot Determin-ation, The Story of the South-East Alaska Regional Health Consortium. The book was written by Peter Metcalfe in celebration of the organization's 30th anniversary.