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Montana comprehensive health planning news (Volume 1973 VOL 4 NO 7) online

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VOLUME ONE. NUMBER SEVEN FEBRUARY. 1973 .... , „„

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James Foley. Executive Director of the Southwestern Areawide Health Planning
Council, was one of 357 persons to take advantage recently of a Head, Neck and
Oral Cancer Project, jointly sponsored by his group and the Intermountain Region-
al Medical Program, Dr. John Soderberg, Director of the Oral Cancer Division of
IRMP, tested Foley during the day-long program. A great number of Helena area
dentists participated in the testing, conducted at St. Peter's Hospital. It was the
16th such project conducted in the intermountain region. Several persons were
referred to their personal physicians for further testing.

MONTANA STATE LIBRARY
930 East Lyndale Avenue
Helena, ^Aon»ano 59601



Joins Staff




Cathy Campbell joined the state
staff as a Health Planner on January
22nd. Miss Campbell comes from
Washington, B.C. where she worked
part time for a hospital consulting
firm while a graduate student in Com-
prehensive Health Planning at the
George Washington University. Her
hobbies include backpacking, cross-
country skiing and fishing.



Montana Comprehensive Health
Planning News is published
each month
by
Comprehensive Health Planning
Division of Montana State De-
partment of Health and Envir-
onmental Sciences, 510 Logan,
Helena, Montana 59601.



PAGE TWO

Provide Workshop on Group Process




WARREN BRASS (Standing, center), Areawide Coordinator for the state CHP staft
officially opened the two-day seminar at Helena's Travelodge January 22-23 by
introducing Roberta Wallace, M.A., and David Gustafson, Ph.D. (University of
Wisconsin). Roberta and David, both pictured at the right, presented a program
entitled 'The Program Planning Model in Comprehensive Health Planning.' The
two-day event provided some 42 in attendance with a first-hand experience in the
Nominal Group Process of problem identification. The process will be utilized
by areawide councils and state CHP staff members in identifying health priorities

Committee Probes Ravalli Health Needs



Reprinted from the Missoulian

HAMILTON - The greatest health
needs of Ravalli County was the sub-
ject of discussion at a meeting spon-
sored by the Ravalli County Compre-
hensive Health Planning Committee
in Hamilton.

Some of the most important needs
identified by the group included sew-
age and water systems, clinic facili-
ties in conjunction with new hospital
being planned, more county support
for the sanitarian in the form of sala-
ry and staff, and home health aids
for senior citizens.

Mrs. Amy Felix, cochairman of the
local CHP group, explained that the
Ravalli County Health Council and
the health and geriatrics committee
of the RC&D had merged with the
CHP in an effort to avoid duplication
of activity.



The amblyopia eye-scieening clinic
and flouride brush-in sponsored each
year by the Health Council will be
continued under the CHP, she said.

Committees dealing with environ-
ment, health care facilities and per-
sonal health services were formed in
order to bring together people with
similar interests. Ed Shepherd, coun-
ty sanitarian, will be chairman of the
environment committee and John
Muir will head the health care facili-
ties committee.

State CHP workers from Helena
present at the meeting were Carl
Helding, executive director of the
northwest area, Warren Brass, area-
wide coordinator, and Miss Mary Jane
Crigler, health planner.



South Central Report

by Jim Toner, Executive Director,
South Central Health Planning

I am happy to report that progress
is being made in all areas, except
one:

1. The activity where progress is
needed the most — at this time — but
realized the least — is in getting Vir-
ginia Mitchell, our Secretary, back
healthy and happy. She has been con-
fined to Deaconess Hospital for all
but five days of this year. We have
been fortunate in receiving as much
help as possible from the State CHP
Office and the Billings WIN program.
Both agencies have been able to pro-
vide temporary secretarial help over
the past month. Such help has been
invaluable in maintaining the sanity
of the Executive Director.

2. We are presently accepting ap-
plications for the position of Health
Training network coordinator. This
has involved numerous hours of inter-
views and information dissemination.

3. A Yellowstone Council for Com-
munity Services' Committee has re-
commended the Council assume the
responsibilities of a local CHP unit.
The recommendation will be voted on
by the Council as a whole sometime
this month.

4. After a meeting involving the
Yellowstone County Commissioner,
Charles Searle, Executive Director
of the Billings Chamber of Commerce
and John Manley, Health Affairs Com
mittee Chairman of the Chamber and
SCRHPC member. Dr. R,C. Nelson
was tentatively appointed to a pro-
posed five-member Board of Health.
This board is to agree on organization
and finding of a City-County Health
Department and make a formal propos
al to the governing bodies.

5. Work is progressing on establi-
shing criteria and an application form
for review and comment of Health fac-
ilities' capital expenditures. The
Board of Directors are presently re-
viewing proposed criteria and a pro-
posed application form.

6. The following SCRHPC members
attended the two-day seminar on Nom-
inal Group and Delphi Techniques in
Helena: Miriam Sample, Genevieve
Dyche, B^^ Kaasch, and Al Littler.
Also in attendance were Jeri Meeks
from the Yellowstone Council for
community services and Jim Toner,
SCRHPC Executive Director. Those
attending had nothing but praise for
the program.

7. I attended a meeting of the Mon-
tana Commissi oi for Nursing and Nur-
sing Education at Ft. Harrison. New
members were elected.



jr Column



PAGE THREE



iy Robert Johnson

One of the major philosophical tenets upon which Comprehensive Health Plan-
ning is based is the importance of consumer participation. The term 'consumer'
as it is used in the CHP program is somewhat of a misnomer because we all must
purchase health care services.

The federal government, however, has defined 'health consumer' as any indivi-
dual who does not directly receive financial support from the provision of or man-
agement of or the payment for, health care services. This is interpreted to mean,
for example, that a voluntary member of a hospital board can be considered a
health consumer member of a CHP council, but a secretary who works in a hospi-
tal or doctor's clinic cannot be considered a health consumer.

The above operational definition is meant to depict a life situation in respect
to the health care delivery system and not a specific level of knowledge of the
inner mechanics of how that system works. The term 'health consumer is not
meant to imply any particular level of income, class of occupations, ethnic or
racial background, or social position within the community. It is meant to provide
an adequate working definition of that segment of our population which, through
necessity, must approach the purchase of any health care service from the point
of view of an outsider or layman.

Enabling legislation and regulations mandate all CHP decision-making and/or
advisory bodies must be composed of a majority of health consumers while insur-
ing that there is broad representation from the health professions — geographic,
socio-economic and ethnic representation. In addition, there must be broad and
adexfuate representation from health providers — government, business and indus-
try interests.

Unfortunately, there exists considerable misunderstanding of the role the health
consumer fulfills in the health planning process and in relation to the types of
consumers upon which some people feel CHP places undue emphasis.

In order to insure that the plans CHP produces, the health decisions it influ-
ences, and the activities it undertakes are the result of interaction on the part of
a group of people representing the WHOLE community, CHP must make the effort
to form a truly representative organization. Y/hile attempting to accomplish this
feat, it has been noted that various segments of the community are more reticent
to become involved than others. It is these unrepresented groups of people which
sometimes need special consideration and encouragement in order to enable them
to participate with interest and effectiveness on CHP councils and boards.

One of these groups is the lower socio-economic segment of our population.
This group experiences more health problems, more difficulties when attempting
to receive health care and has less power to effectively deal with these problems
than most other members of the community. The term 'low-income' is not synony-
mous with the term 'health consumer.' They are only one group to be represented
with many others within the consumer segment of any CHP organization. These
people, along with all other members of CHP organizations, are not called upon
to make administrative decisions relating to the delivery of any specific health
delivery situation. These people, along with all the other CHP members, are ask-
ed to relate their own feelings and experiences which help to identify priority
health needs and determine alternative solutions to those needs.

Health Consumers perceive their health needs differently than the providers;
this varied input is needed in health planning endeavors. In addition, various
segments within the consumer ranks perceive health needs differently than others
because of differing life styles. Some consumers may be aware of barriers to get-
ting good health care that other consumers and providers are not. No individual
in the CHP program is called upon to undertake technical planning tasks for
which he is not qualified. But all participants are asked to relate their own life
experiences in such a manner that health needs determination and solution deve-
lopment can be accomplished from the basis of total community involvement.

Believes Emergency Services Important

Denton Rancher Edward Morse be-
lieves emergency medical services is
of utmost importance around Montana.
Morse has served two years with the
North Central Areawide Health Plan-
ning Council and is a member of their
facilities committee.

Morse said, "I've come to the con-
clusion that people, generally, have



got to provide emergency services
personally and not rely on others to
get them to a medical facility."
The Denton cattle rancher said,
Montanans are generally a phone
call away from help - but a lot of the
problem could be alleviated if people
were provided with training sessions.
For instance, a good number of farms




have oxygen tanks on hand, but few
farmers know how to use them in an
emergency." He added, "One of the
problems is the lack of standardiza-
tion in the tanks themselves - some
guages read in pounds and others in
liters. If a quick chart could be pro-
vided to show them how to convert
pounds into liters, that would help.
Another problem is that it is difficult
to find people willing to go to first-
aid courses which are offered period-
ically."

Morse began his work with areawide
health planning when he accompanied
his wife to a CHP meeting in Lewis-
town. Mrs. Louise Morse was a nurse
who hadn't practiced for quite a while
but was interested in health planning
She was appointed to the areawide
council. "She wouldn't go without
me," he remembered, "I began atten-
ding and enjoyed it."

Mr. Morse said the facilities com-
mittee, which provides review and
comment surrounding capital expendi-
tures of hospitals and clinics seek-
ing to expand facilities, has had five
different requests for review recent-
ly. He commented, "We're trying to
develop a system to make the appli-
cant furnish material we can review.
To date the reviews have been favor-
able, with one exception."

He concluded, "We're still in the
learning process - learning what we
can do. This two-day seminar ( Mr.
and Mis. Morse attended a two-day
session in Helena January 22-23,
sponsored by Montana Office of Com-
prehensive Health Planning, South-
western Areawide Health Planning
Council and Program of Continuing
Education, American Public Health
Association) has helped me learn to
work with groups of people. This par-
ticular seminar provided us with some
good processes. I'd like to see CHP
utilize the process to detemiine what
people in Montana feel their health
needs are."



PAGE FOUR



Health Need List Headed by New Hospital



Reprinted from the Mineral Indepen-
dent, Thursday, February 1, 1973

Using a procedure which permitted
everyone present to take part, called
the Nominal Group Process, a team of
representatives from the state compre-
hensive health planning office obtain-
ed ideas on health care from persons
at a public meeting.

Monday night at the Senior Citizen
Center in Superior, Mary Jane Crigler
of Helena, and Carl Helding of Miss-
oula began the first in a series of
meetings which will be held in every
county in the state.

What do you see as the greatest
health needs facing Mineral County,
and you personally?

This question was asked for the
consideration of everyone. Each per-
son wrote their opinion on a piece of
paper, then reported their ideas to one
another in small groups. Then the
group ideas were presented to the en-
tire assembly for open discussion.
Some ideas were repeated by all
groups, and by several individuals in
each group. Others were unique sug-
gestions. The problem was to avoid
giving solutions before expressing the
needs.

Frequently in 'town meeting' ses-
sions the ideas of a few more vocal
persons tend to overshadow the
thoughts of the quieter persons. With
this system everyone gets to have his
ideas presented for consideration.

Helding and Crigler were introduced
by Edna Frey, who is a member of the
Seven County Health Planning body.
Attempts to turn the meeting into a
discussion of a new hospital were
forestalled by the mechanics of pre-
senting the health needs.

The primary need was felt to be lack
of availability of medical attention
locally at all times. Lack of a new
hospital was considered of equal im-
portance, but it was also a solution
to the first need. That is, by having
a new hospital the availability of a
local doctor on a 24 hour basis was
enhanced.

Helding attempted to spend two
minutes on each item in a list of ab-
out 50 things. He found that more time
was needed on controversial matters,
and every little on needs which al-
ready have solutions. Several items
were so similar that they were grouped
for discussion.

Dr. Charles Huntley, who is keep-
ing the office at Superior while Dr.
Fleck is on vacation, said, first
things first. It was proposed that 24
hour doctor service is needed, but he



said a modern medical facility is a
prerequesite in order to give doctors
the equipment they require for their
work, that is a hospital.

Voices grew shrill on the subject
so that items which might be needed
whether there is a new hospital or
not would have taken a back seat
without the system of reporting all
ideas in small groups.

Schooling for parents to prevent
child abuse was suggested. Dr. Hunt-
ley said legal machinery is needed to
permit officials to interfere in cases
of abused children.

Helding said tax money is predict-
ed for funding 'Well Child* clinics.
He was informed that only this week-
end the U.S. President had ordered a
cut-back on such government spend-
ing.

No more matching money for hospi-
tal building will be forthcoming, Betty
Johnson said she has been contacted
by the state office wanting to know if
Hill-Burton money for Mineral hospital
is going to be used by this spring. If
not, she said a number of other hospi-
tals are ready to grab it.

Family planning in this area is not
being carried on. This is an education
class by the doctor with young married
women. An agency program, financed
mostly for low income families pro-
vides this counseling. It also permits
giving contraceptive pills to young
girls, without the knowledge of their
parents. This the doctor does not care
to do.

Huntley, however, foresees an over
populated nation unless immediate
steps are taken to prevent and limit
pregnancies.

There should be a registered nurse
on duty at the hospital at all times.
This has been the case for some time,
Gwen Simkins, R.N. explained.

People should be given more know-
ledge of the laws on drug abuse. Why,
Dr. Huntley wanted to know, so they
can circumvent them? There is no
hope of rehabilitation for drug abuse,
he said, but drug prevention is need-
ed. Some drug education is explained
in high schools.

Services of a sanitarian are needed.
There is one here one day a week
checking restaurants. He should do
more checking on sewers. More infor-
mation is needed on how to contact
this service.

Dental needs education is a need.
Kalispell has a screening project
whereby all primary school students
are examined, and free dental care
given.

What is needed, here, Edris Magone



explained, is dental education for the
parents, so they see that the children
have good dental care.

Home health care for the elderly, a
system of daily checking to make sure
persons living alone are all right,
were items skipped over without dis-
cussion.

Home first aid training is widely
lacking. John Anderson said only a
few people attend first aid classes.
What would help is first aid tayght to
high school students for a starter.

More space needed for doctors offi-
ces (clinic). Huntley said the thing
which young doctors expect is having
proper equipment.

Doctors are attracted to an area like
Mineral county as a place away from
the dirt, congestion and pressure of
big cities. Huntley said Missoula is
number three spot in the world for the
number of doctors per patient, they
have 115 now.

Mention of an emergency the previ-
ous day caused Huntley to say that
taking patients to a centralized hos-
pital in Missoula is only compounding
the problem. Delay in transmission
is usually harmful and sometimes fat-
al.

A need for city-wide trash pickup is
a need. This service is now available
county-wide, Dick Hollenback explaii*
ed.

Helding suggested a catalog of ser-
vices which are available to local
people. Edna Frey read a long list,
most of which gave the services as
available, but first people have to go
to Missoula to get them.

Posting this information in public
places was suggested.

A poison center is needed. The in-
formation on poisons and their anti-
dotes is available from the Deaconess
Hospital in Spokane for this area. A
call to the Mineral hospital will put
them or the caller in touch with the
information center in Spokane, Gwen
Simkins explained.

Immunization clinics are a need.
Edris Magone said they are held ab-
out every two years. However the ser-



Continued




Continued

vices of a nurse in the St. Regis and
Saltese areas are not provided now
as they are in Superior and Alberton
schools.

A public health nurse is a need for
the entire county.

Venereal Disease education is need-
ed. Dr. Huntley, who had been county
health officer in Missoula before his
retirement, had a program for the ed-
ucation of parents. Helding suggested
this area put his ideas to work before
he leaves.

Clinics are needed for the elderly
as well as children. A lot of people
are not 'oriented' to regular health
care.

A reference number is needed to
call in an emergency, especially when
the doctor is not available. The hos-
pital staff is supposed to know where
he is_, when they don't, or he is not
available what should the caller do?
The meeting closed with a film on
public health nursing. The discussion
here will be put with other information
from meetings all over the state to try
and evaluate the average citizen's
ideas on health needs.



PAGE FIVE

WILL YOUR COMMUNITY BE WITHOUT A PHYSICIAN IN 1976? PLAN AHEAD!

CHP has received a letter horn a young man who will enter medical school this
fall and graduate in 1976. He states, "I am interested in establishing a service
contract with a Montana community having a doctor shortage. The contract would
involve senice to the community in return for financial aid to me from the com-
munity to help me meet the costs of medical school."

Since this might provide a useful, innovative approach to health manpower
shortages in Montana, CHP staff is available to work with any community inter-
ested in investigating the possibility of such a contractual arrangement. If your
community might be interested, please contact Mary Jane Crigler, Health Man-
power Planner. CHP.



Send if044A ideai
on lmpA<uuHCf, keaJik coAe to- -

SUGGESTION BOX:

5f0 lo^fOK Aue. cMeiena, Moniana 5960 f



Seeks Conversion of Manure to Methane



by Robert Scott, Missoula

The cattle population of Montana is
four times its human population. With
two and one-half million sheep, hogs,
and chickens and untold numbers of
horses, cats, dogs, and wildlife, Mon-
tana is naturally a large producer of
animal excrement. In fact, some 40
million pounds of excrement are de-
posited in Montana each day.

This manure can be used to produce
a fuel gas (similar to natural gas) in
tanks like those used by municipal
sewage treatment plants. If all the
manure in Montana were used to pro-
duce gas in such digesters (digester
because the manure is 'digested' by
microscopic organisms) the value of
the fuel would be $37 milliioa annual-
ly (propane equivalent).

Some of this manure would be better
left on the fields, of course, but much
of it (including 3.3 million pounds per
day presently accumulating on feed-
lots) should be put to such practical
use. Feedlots have grown tremendous-
ly in size and number in the last ten
years; 40 feedlots with over 2000 cat-
tle in 1971 versus eight feedlots of
such size in 1962. The gas could be
potentially produced at feedlots, with
a value of $3 million annually.

The digested material that is left
after gas has been produced, can be



used as a fertilizer. There are fewer
inorganic nutrient chemicals in this
fertilizer compared to commercially
available ones, but the chemicals
still have a value at least equal to
the value of the gas. In addition there
is an organic, humus-building portion
to the manure fertilizer.

Montana cannot go indefinitely with-
out using organic fertilizer on agricul-
tural land; long term studies in Eur-
ope have shown this. Therefore, com-
mon manure takes on the character of
a valuable natural resource and it
would be unwise to waste it.

Research will be necessary to pro-
duce methane recovery units that are
efficient and low cost. Current esti-
mates are for units that cost from
$1000 to $50,000, depending on size
and it is estimated that a unit would
pay for itself in five years. Research
will also be necessary to determine
the best way to package or transport
the fertilizer or to find on-site ways
of utilizing the liquid fertilizer, sach
as hydroponic gardening.

Proposals for research on methane
recovery units to be conducted in
Montana are currently being examined
in Helena and Washington, D.C. If the
research is approved, a side economic
benefit of research jobs and material
purchases would be given to the Mon-
tana region chosen.



Support Bills

by Ted Clack, Health Planner

During its December and January
meetings, the Environmental Health
Committee reviewed a large number
of environmental bills proposed by
the Department of Health & Environ-
mental Sciences, the Department of
Natural Resources, the Department
of Planning & Economic Develop-
ment, the Envirohmental Quality
Council, the Department of State
Lands and two bills proposed by
Representative Dorothy Bradley. Af-
ter consideration of all the bills, the
EHC voted to limit its support to 13
and to request the council to endorse
and support those bills. In an execu-
tive committee session, the council
agreed to endorse and support 12 of
the 13 bills, requesting that the 13th
proposal. House Bill 492, proposing
a three year moratorium on additional
leases of state land for coal strip-
mining, be submitted to a vote of the


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