In a state with the nation's highest documented rate of fetal alcohol syndrome, many diagnostic clinics are struggling to survive.
Federal funding to Alaska's 14 diagnostic clinics ends on June 30. Although the state continues funding by giving a clinic $3,000 after each diagnosis, some clinics might not be able to sustain themselves in the new funding mechanism. The state's funding can pay for 200 diagnoses statewide each year.
"The state never intends to fully fund the services," said Diane Casto, prevention and early intervention services manager of Alaska Department of Health and Social Services.
"They are supposed to build sustainability," Casto said. "The communities should build the clinics into their current care system."
Clinics in Ketchikan, Sitka and Kodiak have secured their existence by integrating themselves in their local Native corporations. One unfortunate consequence of such arrangement is that some clinics can only accept Native clients.
Many Native corporations have recognized the significance of battling fetal alcohol syndrome. Infants born to Alaska Native women have higher rates of fetal alcohol syndrome than other races. Between 1995 and 1999, FAS prevalence among Alaska Natives was about five per 1,000 live births - more than 14 times that of Caucasians.
In Juneau, the Central Council of the Tlingit and Haida Indian Tribes will support the diagnostic team through December. But Ric Iannolino, the team coordinator, said he doesn't know whether the clinic will close after that.
Without an active Native corporation in town, Jean Kincaid, executive director of Mat-Su Services for Children and Adults, said she isn't sure if Matanuska-Susitna's FAS team will stop diagnosing people after June 30.
The state's 14 FAS diagnostic teams have been receiving federal funding since 2000. With the help of Sen. Ted Stevens, R-Alaska, the state received $29 million to initiate a five-year statewide approach to preventing and diagnosing fetal alcohol spectrum disorders - permanent birth defects caused by maternal consumption of alcohol.
People with fetal alcohol spectrum disorders may have learning disabilities, attention deficits, poor judgment, memory impairment and difficulties in perceiving social cues. People who are exposed to alcohol during the first trimester may have abnormal facial features such as short eye openings, a short nose, a thin upper lip and a small chin.
The latest study from the Alaska FAS Surveillance Project reports that about 163 Alaska children are born every year with some effects from maternal drinking during pregnancy.
"Early diagnosis is extremely important," Iannolino said. "With an early diagnosis, caregivers and educators can develop strategies to help children with FASD meet their highest potentials."
Iannolino said even adults with the disorder can benefit from an diagnosis.
"Their current caregivers will be gone one day," Iannolino said. "A diagnosis helps their future caregivers understand the extent of their brain damage."
Every month, Juneau's 16-member team diagnoses two cases. Team members include a physician, speech pathologists, a nurse and a psychologist.
As being a part of a Native corporation seems to be the only way to survive, Juneau's clinic is exploring the possibility of incorporating itself with the SouthEast Alaska Regional Health Consortium, Iannolino said.
David Sliefert, Sitka's diagnostic team coordinator, said if Juneau's clinic closes, people in the surrounding rural areas will suffer. Sitka's office is supported by the regional health consortium.
"In Southeast Alaska, there are just three of us to carry the whole region," Sliefert said. "We have been putting more and more efforts to bringing people in from rural areas and helping them. That is where the greatest need is."
I-Chun Che can be reached at firstname.lastname@example.org.