THe Facts
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A brain is easily injured by external forces such as a blow or whiplash. These injuries are called traumatic brain injuries or TBIs.
Brain injuries are a fact of life, and death, on the last frontier. Alaska leads the nation with 278 traumatic brain injuries per 10,000 residents. Our rate of traumatic brain injury death at 35 per 100,000 residents is more than twice that of any other state in the nation. An estimated 247 Alaskans will be permanently disabled due to a brain injury each year. Traumatic injuries can happen to anyone at any time and occur across all sectors of our population. The highest rates are seen in the Alaska Native population. The number of traumatic brain injuries varies widely within the state. The Northern region has the highest rate followed by South West (109 vs 89 per 100,000 residents. The interior has the lowest rates at 73 per 100,000 residents. |
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THe Problem of distance
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In addition to high numbers of brain injury, Alaska is a very large state which is sparsely populated.
Did you know that you can fit Texas into Alaska twice? Alaska also has 24 million less people than Texas with approximately 50% of the population living in Anchorage. This means that the remaining Alaskans are spread over a huge area which makes education, awareness, training and providing services very difficult. Furthermore, most of Alaska is not reachable by road. You cannot even drive to our state capitol! Fortunately, the areas where the most of the injuries are happening are more densely populated and on the road system. |
THe "What next" Problem
It is easy to think that the worse part of a traumatic brain injury, is actually getting it. But, in reality, once you survive the initial injury, the really hard part begins. This is the "what next" problem. While the physical damage from a TBI can continue for many months after injury, recovery from the effects of that damage can take years or even decades. For many people in Alaska, treatment of any sort is hard to come by and having access to it for the time needed to fully recover is next to impossible.
As a result, most people with TBI in Alaska go without treatment. This is not inconsequential. Study after study shows that once someone sustains a brain injury, they are much more likely to become unemployed, homeless, abuse substances or be put into jail. When someone is not properly diagnosed with, or treated for, a brain injury, the rates of these bad outcomes increases remarkably compared to the un-injured population.
Brain injury can be treated and the first step is identification of the injury which requires educating not only medical staff to recognize it, but also the communities themselves to know what it is , what it looks like and how to help someone who has a brain injury. Surprisingly, many people with a traumatic brain injury do not even know they have one. This is especially true if it happened early in life. As many as 75% of those with milder traumatic brain injuries never even seek care. So, we often cannot even take the first step to help someone with a TABI because we don't even know where these folks are in our expansive state.
As a result, most people with TBI in Alaska go without treatment. This is not inconsequential. Study after study shows that once someone sustains a brain injury, they are much more likely to become unemployed, homeless, abuse substances or be put into jail. When someone is not properly diagnosed with, or treated for, a brain injury, the rates of these bad outcomes increases remarkably compared to the un-injured population.
Brain injury can be treated and the first step is identification of the injury which requires educating not only medical staff to recognize it, but also the communities themselves to know what it is , what it looks like and how to help someone who has a brain injury. Surprisingly, many people with a traumatic brain injury do not even know they have one. This is especially true if it happened early in life. As many as 75% of those with milder traumatic brain injuries never even seek care. So, we often cannot even take the first step to help someone with a TABI because we don't even know where these folks are in our expansive state.
The "seagull" problem
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Another problem we experience in providing resources and care in rural Alaska is what is called the "Flock of Seagulls" problem. This occurs when a group of outside experts, sometimes in white medical coats, swoop into a community, dispense advice or services which may or may not be relevant or even comprehensible to the community and then leave as abruptly as they arrive. Like a flock of seagulls, they leave their mark behind and it is often not what they intended.
Furthering the problem, "experts" do not visit often and certainly not often enough, to build local expertise or sustainable systems of care. With the Brain Bus, more frequent visits will be possible and this will build momentum for local action and training to create sustainable local services. We can also circle back with the bus as needed when the community needs more help. To avoid the problems of inappropriate care and that which is not sustainable in the community, we need community-informed and community-based care so resources and treatment provided is culturally sensitive, applicable to the community, and sustainable. The goal of the Brain Bus is not to deliver seagulls, but to create community-based care models which are as unique as each community the bus visits. |