July 5, 2016 - THHN Partner Profiles

Tribal Healthy Homes Network Partner Profile – Carolyn Kelly, Quinault Tribe

Please tell us about your public health response during previous wildfire or smoke episodes, including what has been effective in reaching the public and reducing their risk, and what you would like to see done in the future.

C, Kelly picThere are many public health responses we use when trying to address the threat of wildfire and subsequent smoke hazards. Our first step entails educating the community about what to expect during wildfire season and keeping them up to date with the latest wildfire information from fire smoke professionals. Additionally, these professionals are available throughout the season, which helps boost community morale and preparedness. We also partner with our local air agency, who lends us a monitor and helps us set it up in our community. This enables us to better monitor the smoke to determine how our community is affected and which parts need more immediate attention and action. We also have a permanent monitor established at our school, though that area is rarely effected by wildfire smoke.

Our next step is developing a smoke management and community outreach plan. Unfortunately, our smoke management plan does not keep public health as a priority, as we have a small window when our community is dry and when rainy season begins. In order to protect those who are vulnerable to smoke, we have a comprehensive community outreach plan that informs community members about when and where the burns are held (prescribed burning). We also work with our business community members to see if there are opportunities for tribal members to stay at the casino instead of having to stay in their homes or a place nearby.

I’ve also had the opportunity to work as an air resource advisor, which entails going out to wildfires and measuring their impact through monitoring, modeling and messaging for communities affected by smoke. This is incredibly beneficial because when you know that wildfire season is coming you can take action to protect those most important to you; your family, friends and your home. Especially those who have children with asthma, or mom or dad or somebody who is on oxygen or has an underlying illness. So by being able to provide outreach and information, that’s been a tremendous help in helping our community members stay safe.

As someone who works for a tribe, I thought it was really important to have people with that kind of background able to work with our community. When tribes like Colville or Yakama and Spokane are affected by smoke, people outside of tribal areas often don’t know that the tribes have their own air quality programs, or how tribal governments work. Yet a lot of tribes have really great information, have monitors running, are aware of the smoke-impacted areas, and are aware of who is at risk in the community. All of that tribal knowledge is just tremendous information for trying to help our communities stay safe.

air resource advisorWhat are the specific communication channels you use to reach out to your community during a wildfire or smoke event? 

On reservation, we can post in public places if it’s advanced notice. We also have our monthly newsletter and an internet E-Board where we can give people updates. So it’s everything from “here’s some upcoming bad weather” to “happy birthday” to the smoke thing. Word of mouth is a big way spread things around, so if I just talk to people in my department or in my division, then word will certainly spread.

And then on a broad scale, we’ve done public meetings, inviting community members to participate. Our community is really interested in what the incident management team has to say about how to manage fires. So we try to add on to their information by giving a quick update and providing a list of resources available. One of those resources is the Washington smoke blog with updates and forecasts. They have similar blogs in Oregon and Idaho and are a really good way for people to stay up to date, every day. And we usually add photos and have a link to a webcam where viewers can see what the smoke looks like. Then there are public information officers who forecast and post photos.

Do you work with your health clinics?

We have the common issue here of information being in silos and in different departments. Though I think our health clinic and I have done a really good job of trying to work together. I also work with our environmental health specialist and we’ll send each other articles and create fact sheets together. We haven’t worked much on smoke or fire yet, but have started collaborating on presentations for tribal staff on wildfires and health impacts.

July 5, 2016 - THHN Partner Profiles

Tribal Healthy Homes Network Partner Profile – Dr. Tony Ward, University of Montana

What are the specific measures you recommend to people when they are inside their home? The best thing you can do is to get away, but that’s really not an option for a lot of people. So you know if you’re in a home with AC we suggest that you put it on circulate so that you’re not drawing in air from the outside. If there is a good day where the sky is finally blue and the air is clean, you want to air out your house as best you can. Try and get your errands done on those days as well.

We also talk about possibly finding cleaner air shelters, which can be anything that’s been set up for that purpose or to just going to a mall or library. It could be a church or any other building that you might be familiar with to go to. We have also talked about using masks.

The big thing is just to plan ahead as best you can and when the time comes to limit your exposure to smoke. If you have someone in your home with asthma, just be prepared with what can happen. Limit your exposure to the smoke as best you can. Any little bit will help.

Tony 2What are the health effects that can result from long term exposure?

Many studies link cardiovascular disease and respiratory disease with long term exposure, especially at high concentrations. You wouldn't get cardiovascular disease with short term exposures, it's more in line with long term and high concentration exposures.

Based on your research, please describe what actions are considered most effective in reducing a person's exposure during a wildfire or smoke events: I think often times you hear the message of "stay inside" but we've done a lot of studies that have shown that wood smoke concentrations are just as high inside of the home as they are outside. So one thing that we recommend people to do is to use air filtration units. Especially if they are a susceptible population, such as someone with asthma or an elderly.

Please describe, why and how the ambient air quality during an event can put a person at risk inside their home, office or school: Outdoor (or ambient) air pollution can infiltrate the indoor environment through cracks, open doors/windows and other small openings.  This can result in PM2.5 concentrations being just as high inside as they are outside during a wildfire event.

WardTony2013

In some of your research you found that use of standalone air filters can be highly effective in improving IAQ. Please share the highlights of this work: We've sampled over 100 homes throughout Montana, Idaho and Alaska and we've consistently seen about a 60% improvement in indoor air quality when using these filtration units. That said, our studies are more focused on residential woodstoves and using those all winter long as opposed to forest fire smoke effects in the home. In homes that do have residential woodstoves, our measurements often detect very high woodsmoke concentrations. When people use these filtration units however, we see about a 60% reduction in particulate matter.

July 5, 2016 - THHN Partner Profiles

Tribal Healthy Homes Network Partner Profile – AJ Salkoski, Alaska Native Tribal Health Consortium

How does ANTHC assist tribes in dealing with smoke episodes?

We don’t assist directly. What we do, is we help the EPA (Environmental Protection Agency) modify documents about safety when wildfires are in the area and when to evacuate. We don’t actually go out and monitor in cases of wildfires and we don’t set regulations about when people should evacuate, but we helped develop the guidelines to help tribes make their own decisions.

Last year was the first year that our Environmental Health office was involved. In our Tribal Air program, we try to align our priorities with the priorities of the tribes we are serving each year. Last year, we had over 500 million acres burn in Alaska and wildfires jumped up pretty high on the list so we became more involved.

This year we didn’t do anything to modify the guidelines but we did send out a survey and I think we’ve now received 60-70 responses from folks across the state about what resources they have in cases of wildfires. If they have a “clean room” or a safe haven for residents, especially elders and vulnerable populations, they are asked to go there if there is smoke in the area.

What messages would ANTHC like to get out to tribes about preparing for this year’s wildfire season?

AJ photoIf there is smoke in the area, then we need to take measures to try and limit our exposures to it. And, if the fires are getting close to a community, to evacuate when people say to evacuate and not just try to ride it out, thereby putting people in danger.

We are specifically focusing on the role of ventilation as a way to protect residents when they are indoors. Do you have specific measures you recommend around ventilation?

I always say we want to ventilate as much as we can. If we’re not getting fresh air in the house, then everything that we’re doing is staying in the house. In the same way that we have lungs for our body to help bring in fresh air and get rid of the bad air, we want to use our ventilation systems to bring in fresh air to the house and get rid of the bad air.

In the case of wildfires, it’s a little bit trickier. We want to make sure that if we are bringing new air into the house that it is clean fresh air and we’re not bringing in smoky air and contaminating the house and over exposing ourselves. Which goes back to what we were saying about making sure that there’s a “clean room” available…a place that people can go where they can get clean fresh air.

Do you have specific resources you want tribes to have in hand?

I think that tribes should have an emergency preparedness plan. That means having a plan in place about what to do if people are going to stay in the community or if the smoke gets too close and how they are going to evacuate.

July 5, 2016 - THHN Partner Profiles

Tribal Healthy Homes Network Partner Profile – Celeste Davis, Indian Health Service

Noteworthy Asthma Strategies from our Partners at Indian Health Service: Interview with Celeste Davis, Director, Division of Environmental Health Services / Emergency Management Coordinator, U.S. DHHS /Indian Health Service-Portland Area
CDAVIS.AWCER EVENTTHHN: From your perspective with Indian Health Service, what is a good starting point for tribes planning environmental health work?

Celeste Davis:   “A fundamental question tribes can ask is: what programs do we consider part of our public health authority? Which programs are responsible for public health matters as part of their official mandate? This question can be a launching pad for all kinds of public health conversations. Is it just the clinic? Some tribes may see the public health authority also including air quality and environmental programs, but perhaps not housing. Broadening public health infrastructure will help a tribe build partnerships for environmental health work.”

How might tribal air or housing staff partner with their clinic to target healthy home activities?

“There are targeted opportunities when a case-by-case referral process is in place at the clinic. An example of this would be when a new case of asthma is seen, the health care provider can say, let’s refer this patient for environmental health services. The referral could be to trained air staff for a home health assessment, or even for green cleaning supplies handed out by the clinic to the patient’s family.

Other referral partners could be pharmacists, or public health nurses. There are many ways a case-by-case referral approach can look to target healthy home activities.”

What is key to making a referral process work?

“To make any referral process work the clinician has to buy-in. How do you get buy-in? Sometimes education works alone, but the next step is making an internal policy at the clinic.”

Without a formal referral program, or access to health data, is there any way an air quality or housing person can reach asthma patients who most need a home assessment?

“I would suggest they use self-identified (homeowner) data. They could reach out via survey or questionnaire to the public if they had the resources to respond to each individual. It may not be clinically confirmed data, but this type of data is used quite often in public health.”

Related to housing programs, we’ve heard of the concept of health-based prioritization. In theory, this would mean that the kids who need it most (ie with uncontrolled asthma) have repair work done to their house first or before a house where there are no patients with asthma. Yet in our research we haven’t found any formal method for doing this. What are your thoughts?

“If the Housing Authority does not have discrete criteria for prioritizing where they commit resources for existing housing rehabilitation and repairs, they risk being viewed as biased. Using health conditions of occupants as part of the criteria helps the Housing Authority as well as the health of the community.”

July 5, 2016 - THHN Partner Profiles

Tribal Healthy Homes Network Partner Profile – Tony Basabe, Swinomish Air Quality Program

Noteworthy Asthma Efforts in a Tribal Air Program: Interview with Tony Basabe, Air Quality Analyst, Swinomish Indian Tribal Community

THHN: You’ve said that your goal is to lead a health-based tribal air program. What does this mean in practice?

tonybasabeTony:    “I look at asthma trends in our community and use that data as one way to monitor indoor air quality. If I see that there is an uptick in asthma rates, then I start looking around for clues as to what the causes may be. We partner with our health clinic to get this data, which has been important to support our work. For example, during the years we implemented a woodstove change out program, I saw the asthma rates decline. Currently I’m working with our clinic to try and capture inhaler use rates to further identify asthma trends that potentially could be addressed.”

 Tell us about your home assessment program. How does your referral process work?

“I perform home IAQ assessments and also assess public buildings like our daycare. The referrals come multiple ways – an occupant can ask directly; the housing authority will call me in when needed; and sometimes our health clinic will encourage a patient to contact me if they are a new case of asthma or a repeated case. I try to respond quickly to these calls because I know that every day, exposure to an asthma trigger only makes things worse.

If I find a structural issue during a home assessment, I go to housing immediately if appropriate and try to turn it into a work order. If I am helping a homeowner, I try to recommend a low-cost way to fix the problem.

A big key to success in solving IAQ issues is getting down and dirty – you have to look into contaminants in crawl spaces and attics. Often, you find hidden things that may be affecting resident health. In my experience about half of the problems are in crawl spaces and attics.”

What advice would you share with other tribal staff incorporating healthy home activities into their work?

“When starting out, as opposed to identifying a specific target or trigger – spend some time getting to know your housing stock. This is paramount – every tribe will have unique circumstances that impact the indoor environment. It could be water issues due to the lay of the land, the age of the buildings, construction problems, or woodstove situations. Knowing what you’re dealing with lets you know where to focus.”

Can you give a specific example of how knowing the housing stock has informed your IAQ work?

“We found out we had a group of homes built in the 90s and those bathroom fans were never vented properly to the exterior. This unfortunately produced a lot of mold in our attics. Once we knew this was an issue we could coordinate the effort to change the fan venting, address the mold, and improve the air quality in those homes.”

 What kind of outreach does your program do?

“We take a multi-pronged approach to outreach. We’ve made Earth Day an annual event – bringing tribal members together at a community lunch and giving out green cleaning kits. We publish articles in our tribal newspaper, for example reminding folks we can do free home assessments, or that it’s time to start thinking about safe wood-burning ahead of the burn season. I also teach college level indoor air quality courses to the community, as well as train our housing authority, and public works employees.”

How do you know if the outreach is working?

“It’s important to have patience with this work – you have to wait till the community takes the information as their own. Over time you’ll hear the community giving advice: “Mom don’t hang that blanket against the window, it gets wet”. Maybe you only get a few hits every time you do a project, but those few hits grow over time and you can really make an impact.”