BETHEL - As head nurse at the state's public health center in the village of Bethel, Tim Struna is at the forefront of one of the most pressing health issues in Alaska.
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For the last 10 years, Alaska has had the dubious distinction of sitting at or near the top of a discouraging list: the number of reported cases of chlamydia. The largest increase in reported cases is in the southwest region, where Bethel, with a population of 5,960, is the largest village.
At the Bethel Regional Health Center, where Struna leads a team of six public health nurses, he allocates their time carefully because the center simply doesn't have enough nurses to lead a community-wide education campaign. The center has four public health nurse vacancies at present, and because of a national nurse shortage, has been unsuccessful in finding qualified candidates willing to work in remote Bethel. "That's a chronic problem," Struna says.
So when he and his colleagues at the Yukon-Kuskokwim Health Corp. venture out to teach the community about the risk of contracting the most prevalent sexually transmitted disease in Alaska, they go where they can find the group most at-risk: the classrooms of the community's high school and community college.
Once in the classroom, he might begin by asking, "Who here is between the ages of 15 and 24?"
"We have people raise their hands, and that's everyone in the room," Struna said. "It lets them know that they're the ones affected by the disease. It's not a talk and chalk presentation."
The lesson is so sobering, the giggling usually ends there. The state's Division of Public Health reports that the highest chlamydia rates were among females between the ages of 20 and 24, followed by females between the ages of 15-19. That's two and four times the rate, respectively, of males in the same age groups. Rates are also highest among native females.
In the village of Bethel, Struna is a member of an informal task force that has been meeting monthly, since November, for a serious discussion of its own. The impetus for these meetings, normally attended by eight to 15 local people who represent a number of local concerns including the Bethel Family Clinic, the Yukon-Kuskokwim Health Corp., and the local jail, was the region's chlamydia epidemic, but the group has begun to look beyond this singular issue.
"We really can't address this disease without addressing all of the other factors. And that's challenging. These other factors include domestic violence, alcohol and substance abuse, possible loss of cultural identity. There's a high suicide rate. There are a number of things we all need to look at that are all interdependent on one another," Struna said.
Public health experts say they are not certain why Alaska consistently has higher chlamydia rates than the rest of the nation, nor have they been able to explain why two regions recorded significant increases in the number of chlamydia cases.
The state's southwest region reported 592 cases in 2005, an increase of 256. In Anchorage and the Mat-Su Borough, health officials report 2,273 cases for 2005, an increase of 236 over the previous year. Chlamydia is a bacterial infection that is easily treated with antibiotics, but symptoms are present in only the most advanced cases.
In community health clinics, staff members do educate their clients about how to prevent sexually transmitted diseases. "We're trying to do a lot of education. I'd say a lot of the education is done one-on-one," says Jeanie Timmerman, a veteran public health nurse in the Dillingham Health Center.
While public health experts agree that the rates of incidence are exceedingly high in Alaska, the recent increases in case numbers may be caused by a number of factors.
In recent years, epidemiology labs in the United States have used a more sensitive testing procedure. In the clinics, a new, less invasive urine-sample testing method has also simplified the procedure, which means that more people are being tested. These factors may contribute to an increase in the number of reported cases across the nation.
"They've also seen an increase in positives but not at the number that we have," said Dr. Bernd Jilly, chief of state Public Health Laboratories. "It seems to be a bona fide problem and not just because we're looking for it."