Traditional knowledge and telehealth in the time of COVID-19

For more than 20 years, Elizabeth Sunnyboy has been gathering knowledge from Alaska Native Elders. Sunnyboy, a traditional healer at the Alaska Native Tribal Health Consortium, collects information, organizes it, and then goes back to the Elders who shared it to make sure she has it right. In this way, she has created a stockpile of traditional knowledge for future generations.

And now, as a global pandemic changes how we function in everyday life, she is teaching this knowledge through contemporary means -- namely, using the videoconferencing tool Zoom.

What she’s discovered is she is reaching more people than ever. And she’s enjoying the new platform, which she hadn’t used before.

“It’s starting to be fun,” Sunnyboy chuckled.

Virtual health, real healing

Unlike many places, Alaska has been well positioned to embrace a shift to telemedicine. The Tribal health care system already relies on telehealth to bring services to patients across Alaska, and with travel difficult and restricted, its use has increased and advanced over the past several months. As with other industries that are evolving in the face of the pandemic, some of these changes to Tribal telehealth have proven so effective, they will be sticking around for the long haul.

One such change is the creation of traditional talking circles using videoconferencing. Talking circles -- safe spaces where people can express their feelings, or just sit and listen -- are often used after a tragic incident or other trauma.

“It’s powerful and healing,” Sunnyboy said.

ANTHC will often be invited to a community to hold talking circles. But because of the pandemic, they have yet to be able to do so this year.

So Amelia Simeonoff, a program associate at ANTHC who is in training to be an Alaska Native healer, helped Sunnyboy set up traditional talking circles using Zoom. For now, they are small circles made up of ANTHC employees only.

The response has been overwhelmingly positive.

“Because we told (participants) that they didn’t have to say their name, they didn’t have to say where they’re from, it’s easier for them to share personal things, and that’s really good to hear,” Sunnyboy said.

There are other benefits, too. Talking circles can be difficult to coordinate, Simeonoff said. Travel can be difficult for many people, and those planning the talking circle have to arrange for lodging and other necessities. But now, people can join from the comfort of their own home, regardless of where in Alaska they may be. It is convenient and accessible. And it is helping some people open up who may not otherwise.

A new playbook for sharing traditional knowledge

Along with talking circles, other traditional knowledge sharing is now happening online -- programs that launched because of the pandemic but will stick around even as the state begins to open up.

Every week, Simeonoff and Sunnyboy have been hosting online “Traditional Tuesdays” presentations to folks across Alaska’s Tribal health system whose work includes any aspect of behavioral health.

One recent example: a presentation on loving yourself, informed by years of self-care knowledge provided to Sunnyboy by Alaska Native Elders. Among their teachings is the need to take time to pray, work, play and rest, Sunnyboy said. Ask questions when you don’t understand something. Take accountability for your emotions. And give yourself time to be quiet, all to yourself.

These lessons “are such a good reminder for every day,” Simeonoff said.

About 30 people sit in on the lessons each week. The presentations are recorded so they can reach an even wider audience. And they’ve heard great feedback in which participants have added weight to the teachings.

People will say ‘Yeah, I heard that before from my parents,’ or ‘My grandmother used to say that,’” Sunnyboy said.

Sunnyboy and Simeonoff don’t plan on stopping the lessons after the pandemic settles.

“ANTHC is highly recommending us to keep doing our traditional teachings and the talking circles,” Simeonoff said. “We work with rural Alaska, and this is a great way to reach people.”

Building on a foundation of innovation

Alaska’s Tribal health system was in a good spot to shift to online care thanks to a long history of innovation and collaboration.

“We’ve been doing telehealth for 20 years, so it was not strange to us,” said Dr. Stewart Ferguson, Chief Information Officer at ANTHC.

The Tribal telehealth initiative dates back to 1997, when a partnership with the University of Alaska Anchorage and the Alaska Native Health Board deployed telehealth equipment to four regional hospitals and 20 clinics. From there, funding was received to build a telehealth system, the Alaska Federal Health Care Access Network, to be used by all federal partners in Alaska. ANTHC took on management of the interagency project, and since 2001, more than 400,000 telehealth cases have been reviewed by 5,500 providers.

Fast forward to today’s pandemic, during which telehealth has taken on even greater importance for rural communities. In March, Alaska limited in-state travel to only the most critical needs. Travel to Alaska’s hubs became discouraged or severely limited for people living in rural communities.

In mid-March, the Centers for Medicare & Medicaid Services relaxed rules around telehealth. Now, patients are allowed to be in their homes for virtual visits, instead of only in a clinical setting. They can also use a wider range of technology, such as Apple’s built-in FaceTime feature. And importantly, payers will reimburse providers for these visits.

“The biggest change is that we are now doing telehealth directly with patients in their homes using videoconferencing and phone calls,” Ferguson said.

Now, ANTHC is seeing close to 200 patients a day -- roughly 25 percent of normal patient visits -- using videoconferencing or phone calls. Wrap in other Tribal health care providers and that number jumps far higher, Ferguson said, likely many thousands of visits each week.

For Ferguson, who has championed telehealth at the national level for decades, the shift has been exciting to see.

“Suddenly, everything we have been advocating for decades to improve care, and access to care, (is) available to providers and patients,” Ferguson said. “The adoption by providers is through the roof, and the patients are extremely happy with the care we can deliver through this technology.”

Ferguson hopes that the rules around telehealth will stay relaxed moving forward, regardless of how the pandemic plays out.

“It feels like the genie’s been let out of the bottle and it’ll be very hard to put it back,” Ferguson said.

This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.