Alt nh va \ 4 any f z WASHINGTON/ ALASKA REGIGNAL MEDICAL PROGRAM 500 UIVERSIT? DISTRICT BUILDING VOL.7,NO.2 A TLINGIT I tiada Aler i ! cabin ona nursing assignment arranged by VW//ARMP, J 4\x aa MAAS Two young Seattle nurses, Linda Morris and Pauline Werth, are back on duty at Seattle’s Virginia Mason Hospital after a year of duty in Sitka, Alaska. They’re happy to be back, and hap- piest of all to be among Mason’s ther- apists, dietitians, housekeepers and other hospital helpers. In Sitka the nurse is all these, and more. The year’s experience for Pauline and Linda was arranged by W/ARMP to provide additional skilled nurses for Sitka Community Hospital which was experiencing a rapid staff turnover. Pauline and Linda feel they bene- fited even more than they helped dur- ing their year up north. At first there PAO Sy RSES CAMS SEATTLE, WASHINGTON 98105 R. L. PETERSON GY 7 tf i # fi * Nonprofit Org. U.S. POSTAGE PAID Seattle, Wash. PERMIT NO. 62 RHPR REPS - PARKLAWN BLDG. / 5600 FISHERS LANE / 7 ROCKVILLE, MD 20852 Poof re tor ON SHA 82 ACH were some shocks. Even though they were warned, they ‘“‘couldn’t believe” Sitka’s prices, particularly apartment rents. They solved this by signing up for an Old World War Il coast artillery look-out cabin. Unheated, poorly wired and without water, it went for $50 a month. With help from a new friend the girls re-wired the hut, built a narrow loft for sleeping, added a stove and settled in for a year of carrying their water from the hospital in jugs. Housekeeping hardships were off- set by spectacular views, the sound of surf and berries ‘‘as big as our Continued on Page 2 APRIL, 1974 wat om ca Ah FUNDS RELEAS BY COURT ORDER After a year of uncertainty, contin- uation of the Regional Medical Pro- gram nationally is now assured through June, 1975, Donal R. Spark- man, M.D., director of W/ARMP, has been informed. RMP was one of 12 health agencies which the federal administration marked for termination after June, 1973. Although RMP was granted a year of grace by the Public Health Programs Extension Act signed last June, funds which Congress had ap- propriated for the program were not made available. The National Asso- ciation of RMPs, a private organiza- tion of the agency’s staff, volunteers and friends, subsequently filed suit for release of the impounded money. On February 7 the U.S. District Court in Washington, D.C. ruled that $126,000,000 in impounded federal funds be released and that RMP be permitted to carry out its Congres- sional mandate. The court order also removed restrictions which had limit- ed RMP’s activities to certain areas of health care. This restored to RMP its mission as stated in 1971 with emphasis on in- creasing availability of care, enhanc- ing its quality and moderating cost. The exact amount of funds available for Washington and Alaska will de- pend upon HEW approval of projects. Requests, to continue current major projects are now being reviewed by HEW. Requests for proposals for new projects have been circulated. Those selected for funding will be presented to HEW in July for approval. WEINDCHUEN WEKLo PRESS IN SEATTLE Caspar Weinberger, secretary of Health, Education and Welfare, head- lined a panel of his department’s lead- ers at a full day’s press seminar in Seattle February 7. This was part of the group’s nationwide swing through the headquarters cities of the 10 fed- eral districts. wes Discussing the $111 billion HEW * budget for F. Y. ‘75, Weinberger explained that this figure is 94 per cent uncontrol- able as that per- ss , centage goes to- By ward social secur- . ity and welfare Weinberger payments. The secretary spoke primarily about the proposed welfare reforms designed to provide direct cash assistance and encourage employment. Henry E. Simmons, M.D., deputy assistant for health, said, ‘Clearly we have moved beyond the point at which concerns about a shortage of physi- cians is paramount.”’ Warning that an increase in the number of physicians will result in an increase in health care costs, Dr. Simmons called for a man- power strategy aimed at geographic maldistribution, inappropriate over- supply of specialists and inadequate attention to physician productivity. He recommended “defining the pro- per role of physician assistants and other allied health profesionals.” Dr. Simmons said he would have favored a demonstration-type PSRO (Profes- sional Standards Review Organiza- tion) rather than the national program authorized by Congress. WENATCHEE HOME NURSES RECEIVE PORTABLE ECG W/ARMP has loaned a portable ECG machine to the Home Health Services based at Central Washing- ton Deaconess Hospital, Wenatchee for use in home visits to patients who have artificial pacemakers or are re- covering from a heart attack. This will be a pilot project similar to the one conducted earlier by King County Visiting Nurses. ULMER ELECTED TO RAB Eldon Ulmer, Anchorage pharma- cist, has been elected to the Regional Advisory Board of W/ARMP as the American Cancer Society representa- tive to the group. He succeeds Elmer Gagnon of Anchorage who died be- fore completing his term. page 2 CANCER SCREENING was the topic when William Pomerance, M.D., (left) of the National Cancer Institute met with Milton Evans (center), executive vice presi- dent of the American Cancer Society’s Washington Division, and Jess B. Spiei- holz, M.D., W/ARMP consultant in cancer control. NATIONAL CANCER INSTITUTE FOCUS ON SCREENING FOR The National Cancer Institute is fo- cusing on early detection of cancer of the lung, colon, uterus, breast, blad- der and prostate, according to Dr. William Pomerance, chief of the In- stitute’s diagnosis branch, who visited W/ARMP during February. Dr, Pomerance said that 75 per cent of cancer deaths are caused by malig- nancies originating in these areas. Continued from Page 7 thumbs” growing just outside the door. Artistic Pauline painted landscapes, took “hundreds” of photos and ex- plored the wilderness in mushroom hunts. Linda found it a special thrill to snowmobile and to skate on a real lake where she could look through the ice and see grass below. On the job they learned how to clean and maintain their own equip- ment and acquired some specialized nursing skills such as how to soak devil’s club thorns out of loggers’ feet. Linda had her first experience gavaging (tube feeding) a two-pound 12-ounce preemie who spent his first two months of life in the hospital struggling to reach discharge weight of five pounds. The two young women recommend Alaska for those who are resourceful. On only one point did they feel they failed. They planned to do without a car, but the perils of biking through Sitka’s rain, pursued by packs of Huskies, defeated them, and they sent home for their car. EARLY DETECTION Discussing ways in which W/ARMP might assist in cancer screening, he recommended use of self-adminis- tered pap tests or a mobile unit as the best means of reaching low income women who are unlikely to be tested otherwise. ns “HEALTH MANPOWER CLEARINGHOUSE OPEN Need a doctor?. Perhaps you only think you do. No- body is saying you aren't sick, it just may be that what you really need is not a doctor but a Medex, a nurse practitioner, a midwife or a psychia- trist. . W/ARMP'’s latest project, the Health Manpower Clearinghouse, will help match health providers with commu- nities that need them. The Clearing- house seeks applications from towns and neighborhoods that feel they are underserved. These areas will be helped to decide what sort of health care best suits their needs, The Clearinghouse also will recruit health manpower at all levels and work with providers seeking to enter the field or to relocate. The project will coordinate efforts already being carried on, and in some cases duplicated, by the state medi- cal, nursing, and hospital associa- tions, the National Health Service Corps, Medex, the federal loan for- giveness program and state and fed- eral agencies. . NEW CHICANO STAFFER TOURING WASHINGTON \ Paul D. Ward Soon to come before Congress are three similar bills all proposing some sort of merger of RMP, Comprehen- sive Health Planning (CHP) and the Health Care Facilities Service (Hill Burton). The measures are: the Roy-Hast- ings-Rogers Bill (HR12053); The Ken- nedy Bill ($2994) and the Administra- tion’s proposal (S3139). At an open forum which W/ARMP sponsored at the University of Wash- ington February 21, the advantages and disadvantages of such a merger were discussed, Emphasizing that he was not dis- cussing any specific piece of legisla- tion, Paul D. Ward, executive director of California RMP, opposed the theory of combining planning, regulation and implementation under one agency. He predicted that the debate on these measures will be “very, very healthy and very, very lengthy.” Ward warned that planners, imple- menters and regulators are “a differ- ent mix of people” and should be separated. Speaking for a merger of these x. i. eh THE ALASKA AIRLINES ticket in Tommy Ongtooguk’s pocket was a gift trom W/ARMP, Ongtooguk, deputy di- rector of the Norton Sound Health Corporation, was one of 60 Alaska natives whose transportation to the Deceinber Alaska Federation of Na- tives Health Planning Conference in Anchorage was paid by W/ARMP, ‘ functions, Robert W. Day, M.D., dean of the U. W. Schoo! of Public Health and Community Medicine, favored combining these responsibilities. The present system, he said, “lacks focus” with no organization responsible for personal health care services. He credited Hill-Burton with achiev- ing improvement in building safety and fostering development of central- ized health care facilities. Both CHP and RMP, he said, suffer from a con- fusion of mission. HEALTH EDUCATION GROUP FORMED W/ARMP is funding a demonstra- tion project to provide training for nurses, technicians and other staff people of 18 hospitals in North Central Washington and the Columbia Basin. This will include paying salaries of a fulltime coordinator and part-time secretary, purchasing teaching mate- rials and bringing in experts to offer classes in housekeeping, office proce- dure, maintenance, purchasing, medi- cal records, laboratory techniques and nursing skills. Participating hospitals are those in Brewster, Chelan, Leavenworth, Omak, Tonasket, Wentachee, Repub- lic, Ephrata, Moses Lake, Odessa, Ritzville, Soap Lake, Quincy, Othello, Davenport and Grand Coulee. This Central Washington Consor- tium for Health Education has been organized with the aid of the state Hospital Association and Big Bend and Wenatchee Valley Community Colleges. RURAL HOSPITALS JOIN TO MEET PSRO RULES The Health Care Review Center, supported in part by a $19,000 grant from W/ARMP, sponsored a March conference for rural hospitals to dis- cuss cooperative arrangements for complying with the Bennett Amend- ment to the Social Security Act estab- lishing Professional Standards Review Organizations (PSRO). The Center presently is helping eight hospitals develop programs that meet requirements of the Joint Com- mission on Accreditation of Hospitals as well as PSRO. These hospitals are: Providence and Doctors, Seattle; Van- couver Memorial; St. Luke's, Spokane; Whidbey General; Island, Anacortes and St. Luke’s and St. Joseph’s, Bell- ingham. In addition to covering Patient Care Appraisal, the quality control audit developed with W/ARMP aid, Health Care Review also covers cost, utiliza- tion, nursing and pharmacy review. Francisco Tello has joined the W/ARMP staff as community repre- sentative to the Chicano population. He is making a spring tour of Washington, meet- ing with Spanish speaking groups in Mount Vernon, i Bellingham, Yaki- bi" ma, Toppenish, a Walla Walla, i Moses Lake and Wenatchee to dis- Tello cuss health needs and assist them in working with agen- cies offering health care assistance. He also will assist with a health ca- reers fair planned for May 5 in Wood- burn, Oregon. Born in Mexico, Tello is a graduate of Evergreen State College. JANE JONES HONORED Jane Jones, R.N., director of the W/ARMP stroke nurse clinician proj- ect, has been nominated for the Amer- ican Nurses Association honorary nurse practitioner award. She is spon- sored by both the Washington State and the King County Nurses Associa- tions. ‘PLUS YEARS’ IS BEST SELLER “The Plus Years,’ W/ARMP’s latest publication for senior citizens, proved so popular that the first printing is now exhausted. For those who are still awaiting their free copy, a second printing is in process. Also available is a bulletin explain- ing Certificate of Need laws. W/ARMP AND BATTELLE STUDYING AMBULANCES Ambulance systems serving 11 Washington communities will be ana- lyzed in a study by W/ARMP in co- operation with the Battelle Human Af- fairs Research Center. The report is intended to give other communities information on the many types of ambulance systems function- ing in this state with their cost and levels of personnel training. Tentatively selected for the study are three cities with Medic | type ve- hicles, Seattle, Bellevue and Wenat- chee, and eight with ambulances op- erated by the community, hospitals, private firms or volunteer crews. These are Spokane, Everett, Tacoma, Walla Walla, Duval, Twisp, Mount Ver- non and Sedro Woolley. RMP RESULTS is published by the Washington/Alaska Regional Medical Program 500 University District Building Seattle, Washington 98105 543-8540 Donal R. Sparkman, M.D. — Director Dee Jones — Editor rm “There is no resistant high blood pressure — only resistant patients.” With this premise, the Mason Clinic is teaching patients how to help moni- tor and control their own hyperten- sion. For the past three years the clinic has been referring patients to a two- day class where they learn physical details of thelr condition, are warned of possible complications and are ad- vised on following controlled sodium diets. Patients also learn how to take their own blood pressure readings twice daily. Dr. Richard R. Paton, director of the project, feels that the class helps the patient accept treatment and thus have better control. Around the state other physicians and institutions have introduced hypertensive patient teaching but usually on an individual basis rather than a classroom situation. Nurse Clinician Pat McDonald opens the class by issuing each pa- tient his own stethoscope and sphyg- momanometer. By the time everyone has learned to pronounce these, the atmosphere is reasonably relaxed. The instructor cautions patients not to confuse hypertension with “tension,” not to hold their breath while taking readings as this increases pressure, and not to be alarmed by occasional “spikes” in readings. Systolic is the reading on the sphyg- momanometer when the stethoscope picks up the first sound of blood rush- ing through the brachial (arm) artery. That is the highest reading and is writ- ten ‘on top.” Diastolic is the point at which the last sound is heard. It is the baselne indicating pressure exerted on the artery wall when the heart is re- iaxed. In a recent class patients’ read- ings ranged from 150/90 to 210/150. Miss McDonald shies from terming anything “normal,” but acknowledges that the old adage of normal systolic pressure readings being ‘‘100 plus your age” is fairly dependable. ok 1 Ps CONCENTRATING on the sounds was Lawrence L. Brown of Seattle. nade 4 oti Patients learn the possible compli- cations of hypertension. Some sound frightening — congestive heart failure. Others are practical —higher insur- ance rates. And she dispels some myths. Headaches, feelings of ‘“full- ness” and other symptoms are not re- liable signs of elevated pressure. Some 10 per cent of all adults (22-24 million persons) have hypertension. Only one- eighth of these are properly controlled, The condition affects more Blacks than Caucasians and frequent- ly is found among those Orientals fol- lowing a salty diet. Men encounter more cardiac complications, though women have more strokes before age 65. Equality is reached after 65! Effective drug therapy for hyperten- sion is relatively new, though ancient nostrums included watermelon and cucumber seed or mistletoe. Mason Clinic has found that those who follow a controlled sodium diet can be man- aged on lower dosages of medication. Most in the classes are on a 40 mEq or 920 milligram sodium diet. Theoretically this would allow them three-eights of a teaspoon of salt daily. Since many foods contain some sodium, they must learn to shop and cook in a different way. Prior to the class each patient receives individual diet instruction. During class the dieti- tian conducts a general discussion on food selection with emphasis on what is forbidden. She gives tips on diet foods, shows packages and advises on where these foods are sold or how similar dishes may be prepared at home. NSTRUCTION in taking blood pressure raadings was given E. T, Ashworth (lott) of Federal Wey and John G, Fowssr of Darrington by Pat McDonald, R.N. Emphasizing that salt-free foods need not be bland, she recommends other flavorings. The low sodium dieter may choose whether he wants his meal spiced with peppermint, chili, horseradish, cinnamon, rosemary, tarragon or some 50 other spices. Hard liquor is limited to two ounces daily. Four ounces of wine may be substituted. Since cigarettes have not been proved to affect blood pressure, smoking is not forbidden, but also not condoned. Coffee is allowed in moderation. Tips on dining out include carrying your own salt-free bread or crackers, selecting a fruit dessert, avoiding sauces and gravy, using lemon and vinegar on green salads. At the close of each day’s session a physician joins the group to answer questions, check BP readings and in- sure that patients are scheduled for return visits, W/ARMP is interested in helping offer similar classes in other areas in Washington and Alaska. WRAPPING the cuff demands three hands, Matthew Chen of Seattle dis- covered,