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'I know I made a difference': A report from the frontlines of Alaska's fight against FASD

Marc Lester

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The Daily News will publish the next two installments of our ongoing fetal alcohol syndrome coverage on Saturday and Sunday, including a look at how, despite success in reducing rates across Alaska, the state has missed many opportunities to combat the disability. 

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Among the people featured in the story is Ellen Sovalik of Barrow. A former North Slope Borough health director and now a tribal judge, Sovalik was a newly sober 20-something when she left a job cleaning the hospital to pioneer a boots-on-the-ground effort to teach expectant mothers about the danger of drinking while pregnant.

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From knocking on doors to arranging for babysitters so pregnant mothers could get the prenatal care they needed, Sovalik describes the impact one person can make.

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Here is her story, adapted from an essay Sovalik wrote about the experience and shared here with permission.

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By ELLEN SOVALIK 

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Barrow

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I had been working for the North Slope Borough as a temporary hire in 1987, in various positions, first as a Residential Aide for the inpatient alcohol treatment center for six weeks, then as the Health Department janitor for another six weeks, and was placed in the Eye Clinic as an assistant when the Public Health Nursing Coordinator approached me and asked if I would be interested in working in a state-funded position as a Fetal Alcohol Syndrome Educator.

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I looked at her as if she had lost her mind.

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First of all the community of Barrow was just addressing Alcoholism, and the way I saw it the community was not very happy about being told they were alcoholics, or alcohol abusers or that they have drinking problem. Secondly, The NSB had just opened a six-week inpatient alcohol program a year before and most of the patients were court-ordered. So I can see and hear how angry the people of Barrow were to be placed in treatment “against their own will” or face doing time in jail. Not very good options to choose from.

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The nursing coordinator continued to visit me and each time gave a little more information of what may be expected of the position of FAS educator. Mainly she praised me for my personal choice of choosing sobriety and talked about how I can help my community with reducing FAS with my story of choosing sobriety in hopes others would also choose to be sober.

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I accepted the position in an agreement with the coordinator, who wanted me to get my GED and driver’s license. In return, I requested that I be able to see the Prenatal Patients during their Prenatal Care at the Barrow Hospital, as I knew no one was going to willing go to my office to be educated. I had to go where they were.

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For the rest of the year of 1987, I learned about the State of Alaska's vision for preventing Fetal Alcohol Syndrome, as this was a new outreach effort.

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I thought about how this could work culturally in Barrow. This was not an easy task for me, as I was in my early 20s and basically I was to educate my elders, who I considered anyone older than me. I was brought up to respect my elders, not to argue or talk back and -- mostly -- not to tell them how to live their lives.

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I did complete my GED in 1988 as well as obtained by driver’s license and began to join NSB Counseling Center staff training to better my counseling skills. I attended the Prenatal Care morning appointment and began educating the prenatal mothers on FAS, first in the lobby as they waited to be called in to see the doctor, and then I would wait in the doctor room with them to continue my education as they waited to be seen by the doctor after the nurse took their vitals.

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Soon the doctors gave me that time to do my complete education when they realized I was being very genuine in my position and respectful to their already busy schedule.

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I asked various questions that the State of Alaska required me to ask, such as how often, and how much people drank. I soon included questions of my own: Who were they drinking with? Friends? Relatives? 

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I came to the conclusion that I needed to also educate the mothers' spouse/partner as they seem to be the person the pregnant mother drank with most often. So I asked the pregnant mother to ask her spouse/partner if I could come to their house during the evening when he would be home for a 20 minute visit.

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I began my home visits and, using my cultural respect of asking to enter the home, began educating in a way that was not accusing the partner of producing a FAS child, but to help prevent the result of an FAS child. In this way I was successful in educating the spouse/partner as well.

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As I continued to be at the Barrow Hospitals during prenatal mornings I began seeing and hearing that not all prenatal patients would keep their appointments, so I requested and was granted the prenatal appointment list. I began calling the day or two before their schedule prenatal appointment to remind the patient of their appointment. During this time I also asked if there were any chance they would not be able to keep their appointment. I heard replies of “too early,” “no ride,” “no babysitter,” “I don’t need to see a doctor, I know what to expect."

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I began picking up those patients who stated who needed a ride to and from prenatal care appointments, and working with those who needed a sitter to become more resourceful using family or friends to help them out. I would also pick up the sitter on my way to pick up the patient, if all resources were requested and not successful, we brought the kid[s] with us and I watched them in the lobby as the patient got her prenatal care done.

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For those that already thought they didn’t need to be seen by a doctor because they knew what to expect, I consulted with the doctors who came up with when the patient was due for lab work or ultrasound and used those reasons to get the patient in.

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For those who said it was too early, I worked with the Barrow Hospital appointment clerk, who began to schedule those ladies later in the morning.

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I had both PHN and Barrow Staff tell me I was enabling the mothers, that I was being taken advantage of, that I was doing more than my job requires, that I was setting them up to be dependent of this kind of service. Yet for each accusation, the end result is to get the prenatal patient in, not only for FAS education but for prenatal Care!

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I then began to realize that majority of the patients were coming in for their first prenatal care at second and third trimester, so that alcohol consumption was not being addressed early in pregnancy.

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I later began to call those patients who had a negative pregnancy test to discuss contraceptive options or pre-pregnancy health education.

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I worked with the NSB Alcohol treatment center to have pregnant ladies be a priority to become inpatient clients, and asked the prenatal staff to utilize this service when she could not stop drinking during her pregnancy, using the FAS knowledge and remainder of her pregnancy as a limit to stay sober. Meaning you don’t have to stay sober forever, just during the rest of your pregnancy. And if you can’t do that alone please utilize the free-of-charge service of the inpatient treatment facility. I figured if the treatment worked for her it could become a long-term recovery process for her, for now we needed to just focus on the short term of keeping her sober during her pregnancy and delivery.

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I also decided agencies needed to be educated on FAS so I began sending out letters to agencies about this free, one-hour FAS education beginning with the NSB Police Department, NSB school district, Barrow Hospital Staff, State of Alaska Court and Probation Office.

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I began extending my services with the agencies I was able to educate. For example I worked with the NSB police department that should they have a pregnant women be incarcerated for alcohol detoxification that before she is to be released that I be contacted so I can go visit her to educate FAS, and/or refer to the Inpatient Treatment center, and give her a prenatal appointment, if nothing else to get her name and how I can contact her for follow up.

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I began going into the Middle school to educate FAS to 6, 7 and 8th-grade prevention education, later adding Puberty and "Baby Think It Over" classes as I saw a need to add those into the early prevention component.

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An FAS coalition was also formed with various agencies involved and a grant written by our local radio station coordinator to air the reading of "The Broken Cord" written by Michael Dorris, for half an hour every week on the radio to get community educated as the radio station reached the 6 villages.

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I began flying to each villages, staying at the clinic to educate FAS with prenatal patient, school and community by inviting community to an evening of education with food and door prizes provided.

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As I began working close with Barrow hospital staff I began to learn more about prenatal and postpartum care, and began my expansion of Prenatal and postpartum education. The borough hired me on full time as their Maternal Child Home Visitor, traveling to each village at least twice a year, educating students on FAS, Puberty and "Baby Think It Over" in the schools, and talking about FAS and prenatal/postpartum care -- including contraception education -- with prenatal/postpartum patients at clinics and home visits. I preferred home visits to include family members.

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During those home visits, I saw other services that the patient/family could benefit from and did referrals for housing, domestic violence, higher education, Infant Learning Program, Women, Infant and child [WIC] program and so forth.

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In 2006 I left the borough knowing I did the very best I could with both Western and (Inupiaq) cultural skills to reduce not only FAS but Teen Pregnancies and increase healthy pregnancies and well child screening for the North Slope.

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I now know I made a difference.

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In 2010 I traveled to Point Hope as the Health Department Director and I was greeted by an elderly women who must have been in her late 80s and she greeted me as the “FAS lady”.

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Recently the NSB, Department of Health and Social Services released their Baseline Community Health Analysis Report.

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It said: “The prevalence of FASD in the NSB was more than three times the state average and 16 times the rate in non-natives statewide … The prevalence of FAS dropped almost 50 percent from children born in 1996-98."



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