To keep health aides safe, Northwest Alaska’s Maniilaq Association is hiring security guards

During her 23 years working as a health aide in Northwest Alaska, Eunice Carter has responded to numerous dangerous calls. But the incident she remembers most happened when she was performing CPR on a child in a family’s home.

A member of the family told her and several other health professionals in the room, all women: “If you don’t save my relative, no one is gonna live,” Carter remembered.

Carter and her colleagues suggested bringing the patient to the local clinic to get the necessary medication, and the situation was defused. To protect the patient’s confidentiality, Carter didn’t disclose other details.

The incident is not unique: Health aides across Northwest Alaska often respond to emergency calls where they need to de-escalate the situation, and in many of those cases, they’re working without anyone who can protect them.

Over the last couple of years, the Maniilaq Association has noticed higher levels of violence in village clinics, said Kenneth Turner, Maniilaq Health Center safety officer. Elevated stress levels, staffing shortages during the pandemic and a rise in drug use were some of the factors that contributed to the increase, he said.

“Since the COVID-19 pandemic, we have observed an increase in public safety issues in most of our village clinics,” Turner said. “It has become evident 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 professionals working at the clinics.

“The aim is to make sure our health aides and other personnel can focus on providing quality health care without worrying about their safety,” Turner said.

Dangerous scenarios

Maniilaq Association provides health and social services to 11 Northwest Arctic Borough villages and Point Hope. About 100 Maniilaq employees work in rural communities in such roles as community health aides, as well as medical, dental, vision and behavioral health providers. Around 65 of them are assigned to specific clinics while the rest work on a rotating schedule.

The personnel frequently have to manage crisis scenarios while providing health care services.

“Our health care staff has recently dealt with issues involving domestic violence, hostile conditions, substance abuse incidents and mental health crises,” Turner said.

Ideally, health aides wouldn’t respond to calls outside of clinics that can pose a threat to their safety — they would call local law enforcement instead, said Maniilaq’s community health director, Chris Dankmeyer. But in communities without a public safety presence, that can be a challenge. The Northwest Arctic Borough strives to have 14 village public safety officers on staff but currently employs only four.

Carter is a Community Health Practitioner supervisor at Maniilaq who spent her career as a traveling health aide and now works in Buckland. In addition to the scenarios Turner described, Carter has been in a situation where she had to hide in a clinic because a person was shooting at the building. She has also assisted patients who were acting aggressively after a head injury.

“They happen at night, in the evening or at night, and who do you call? Who can respond right now real fast? And you’re alone in the building with them,” she said about attending to those patients. “We’re not allowed any weapons, any knives, guns, tasers, pepper spray — we’re not allowed anything that can protect ourselves. We’re supposed to walk away or run away.”

Warren Compton, who has been a health aide in the Selawik Village Clinic since 2006, recalled disruptions he’s seen at work.

“We’ve had a few incidences where people were not happy with what the doctor prescribed for them or whatever, and they lost their tempers. And there’s been some cases where we’ve had intoxicated people come in and cause a ruckus and scare other patients and scare the health aides themselves,” Compton said. “There is a need for security in the villages, at least in the clinics.”

[For families in Northwest Alaska, questions remain about unsolved deaths and ‘suicides’]

Increased violence during the pandemic

Violence against health care workers rose during the pandemic nationally and in Alaska.

In Northwest Alaska, Maniilaq saw a slight spike in the number of reported incidents of verbal attacks and physical violence in clinics. The other, more significant change they observed was an increase in violence intensity, Turner said.

Maniilaq uses the aggression spectrum to classify the types of violence, going from intimidation to offensive language, verbal abuse, verbal threats and then to various levels of physical assaults.

“During the pandemic, those aggressions went up on the spectrum,” Turner said. “We were seeing a lot less intimidations, and a little bit more verbal abuses, verbal assaults and physical assaults.”

The change in part could be tied to an increase in the use of illegal drugs that haven’t been as present in the villages as they are now.

“I’ve lived here 27 years and I’d never, ever seen methamphetamine come into the village,” Compton said. ”There’s been an increase in cocaine and methamphetamine and things like that, I think, in the whole Northwest Arctic region.”

The stress the pandemic caused also factored into the rise in violence, said Lisa Shindler, manager of the Community Health Aide/Practitioner program at Maniilaq.

“A lot of it did have to do with the stress and isolation of COVID that increased suicidal tendencies, alcoholism,” Shindler said.

The pandemic led to issues with staffing, Shindler said, which made responding to emergencies riskier. She said that in 2019, Maniilaq employed 76 health aides, and in 2022, the number was 40.

Over that time, the workload of a health aide also grew and became more challenging, Shindler said.

“We’re working so many hours that they were starting 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 family members died. It was really, really tough. We were scared to death,” she said. “They quit. They wore out. They retired.”

Increased aggression has also been driving health aides out, Dankmeyer said.

“It’s a factor for some of the staff that we’ve had (leaving) in the past year,” Dankmeyer said.

While Maniilaq has been steadfastly rebuilding its health aides program and has around 60 health aides now, there’s still room to grow. Their hope is that hiring security guards will help them keep the health aides they have.

“Having somebody there with you, in those times, may very well help retain staff,” Dankmeyer said, “to have a sense of safety, to maybe prevent a few of the traumatic events that might occur.”

Pilot program for security guards

On Oct. 1, Maniilaq kicked off 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 guards will be hired to work at clinics in Kiana, Kivalina, Noorvik and Selawik — some of the more populated villages in the region with documented incidents of violence, Dankmeyer said.

“We picked the ones that seemed to be in most need,” he said.

So far, the position in Selawik has been filled, and Maniilaq is looking to hire three more guards, as well as four relief security guards to address potential coverage gaps. The corporation dedicated $500,000 to the program.

While, according to Shindler, about half of the overall calls that health aides respond to happen out in the field and at people’s homes, the security personnel will only be present within health care facilities.

Turner said that deploying security guards to accompany health aides outside of clinics is legally complicated: It can lead to concerns regarding privacy intrusion, jurisdictional limitations and an ambiguous regulatory and insurance landscape.

“We limited (the security guards program) in concept, knowing that it’s not addressing the full thing, but the other piece, the outside-the-clinic safety, that should be law enforcement — it should be VSOs, it should be VPSOs or state troopers. And they’re missing, they’re not there. At least not there consistently, Dankmeyer said. “The burden of the lack of law enforcement out in rural Alaska is shifted on to our health system and our workforce, but we aren’t prepared to step into 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 said it would take a multifaceted approach, including hiring more village public safety officers, developing emergency medical services in the villages and providing CPR training and first responder certification to locals so they can assist health aides.

Hiring security guards for the four village clinics is one small step in that direction. Maniilaq plans to evaluate how effective the program will be at providing safety for patients and staff.

“If it does yield positive results, I can’t promise anything, but I’m pretty certain we’ll probably institute that at every clinic,” Turner said.

Carter is looking forward to that expansion.

“I can’t wait,” Carter said. “Just anticipation of getting a horrible call — it’s so stressful. ... And when you already go through something, you develop PTSD ... So it makes you fearful of the next call. You think, ‘I don’t know if I’m gonna do this anymore. I think I should quit my job.’ But having a security (guard) kind of buffers the blow. It makes you feel more prepared.”