1. Life in the Rural Lab Constance Stager Maniilaq Health Center Kotzebue, AK

2. Maniilaq Health Center Kotzebue, AK Maniilaq Health Center (MHC) is located in Kotzebue, Northwest Alaska, 30 miles above the Arctic Circle. It is part of a System (MHS) owned and operated by the Tribal Health Organization of Maniilaq Association that serves the 3,500 residents of the native village of Kotzebue, Alaska, and the estimated 8,000 residents of the 10 villages of the Northwest Arctic Borough and Point Hope (North Slope Borough).

3. Challenges Personnel Quality Inventory Shipping Service

4. Personnel Staffing Training Retention

5. Staffing Maintaining a staff can be difficult Cost of living and location make the area unappealing High number of locums/TDY staff Living conditions and cost of rents

6. Training TDY staff often 50% or more of staff Staff have 13 week contracts Constantly training new staff Difficult to get qualified staff who do not require extensive training Maintaining quality standards very difficult with constant turnover

7. Quality M aintaining quality is a challenge Changing staff means retraining every few months Staff come to the lab with different levels of competency and commitment to quality Quality dips with each new batch of locums

8. Quality Must use creative means to ensure quality – Quality Calendars Very helpful for periodic maintenance, QC, validations, and correlations. – Structured Training and Competency – Heavily dependant upon management monitoring

12. Inventory Without the proper reagents and supplies testing comes to a halt Maintaining an inventory with changing staff can be difficult Orders take a long time to arrive and need to be ordered well in advance Delays: Weather, post office staffing problems, lost shipments, FedEx

13. Inventory Creative solutions – Synchronizing instrumentation and inventories – Borrowing from other hospitals on your flight schedule – Agreements with other hospitals to perform testing – Backup instrumentation for critical testing

14. Shipping Multiple specimens shipped from villages and to Quest, ANMC, or State Bags get lost Aged specimens Specimens frozen

15. Service Limits choice of instrumentation Not all companies will service Alaska Others will provide service but it may take 3- 4 days for a technician to arrive Others may decide that they no longer want to service Alaska and make getting service very difficult

16. Point of Care Testing MHC Lab oversees the POC testing program at Maniilaq Health Center and the 11 villages Challenges include: – Training and competency – Quality Control and Compliance – Distance to villages – Changes in staff

17. 17 Questions?

18. Credits 18 Special Thanks To: Maniilaq Association, Maniilaq Health Center Administration, and the Alaska Native Tribal Health Consortium

19. Time to Rest