A Tribal Home for Wellbeing
The tide is coming in on the Kenai Peninsula in Alaska—or Naqantughedul in the language of the Kenaitze Indian Tribe, who have historically occupied the area.
The coming tide is the tribe’s symbol of the cultural revival it is now experiencing—one that is attracting Alaska Native people to return to this large peninsula off the coast of south-central Alaska, a place the Kenaitze call Yaghanen, or “the good land.” The mission of the tribe is “to assure Kahtnuht’ana Dena’ina (the traditional name of its people) thrive forever.” And that of course includes wellness—wellness of the whole person: physical, emotional, social, and spiritual.
- CARE PROVIDERS: 1 pediatrician, 5 nurse practitioners, 4 dentists
- TOTAL STAFF: 157
- BENEFICIARIES: 40,000
- FOUNDED: 2014
- MEMBER SINCE: 2017
Initially, the Kenaitze had operated a small clinic for 35 years. It was always the tribe’s plan, however, to fully serve its members’ health needs.
Then a big opportunity arose: the tribe earned a highly competitive Indian Health Service Joint Venture Award in 2011 to cover a wellness center’s operational and maintenance costs for the next 20 years.
The tribe’s Dena’ina Wellness Center, a 52,000-square-foot facility built in 2014 in the city of Kenai, is a community cornerstone. It provides an array of health services, including medical, dental, and behavioral health care, chemicaldependency assistance, physical therapy, optometry, pharmacy support—even traditional healing, which addresses the natural, emotional, and spiritual elements of health. Traditional healing includes tissue, bone, and joint manipulation; prayer and guided meditation; traditional plant medicine; and traditional foods.
Focused on wellness and primary care, the center employs 157 staff members, including one pediatrician, four dentists, and five nurse practitioners. It contracts with temporary primary-care physicians and is now looking to add one or two full-time primary-care physicians to their staff. (For surgery or specialty care, patients access a hospital 10 miles from Kenai or travel to Anchorage, about 160 miles away.)
The population of Kenai is more than 7,000, and that of the immediate surrounding area is 12,000 and growing. The number of people on the entire peninsula—often called “Alaska’s playground” because of strong tourism, especially for hunting and fishing—is about 50,000. There are more than 4,000 Alaska Native and American Indian people who have access to all programs at the Dena’ina Wellness Center, while programs that receive state funding—primarily behavioral health—are open to the entire community.
CARING FOR THE WHOLE PERSON
“Our mission is to provide a culturally appropriate health system, integrated into all services of the tribe, to treat the person as a whole, to look at all the needs of beneficiaries who come to our clinic and make sure their health and wellness needs are met in a way that reflects our values and culture,” says Diana Zirul, who serves on the tribal council and is chairperson of the tribe’s health board.
According to Zirul, patients at the Dena’ina Wellness Center are called un’ina, “those who come to us,” and receive services according to the “Dene’ Philosophy of Care,” a holistic approach to care that addresses all contributing factors to overall wellbeing.
This philosophy is reflected even in the design of the building, which has integrated workspaces to allow various care teams to collaborate on treatment plans and customize them to each individual. The facility also features a gym, plus classrooms and a wellness kitchen for educational use.
Part of nourishing wellness is remembering history and celebrating the natural world, so that too is part of the architecture. Century-old Douglas fir planks reclaimed from a Kenai River cannery span much of the interior. The ocean is depicted in blue across the floor near the main entrance. Agates inset in the flooring were collected by tribal members. Dena’ina names are used throughout the facility. Outside the center is a ceremonial space called Raven Plaza, referencing the raven that brought light to the world in a traditional Alaska Native story.
The Kenaitze Indian Tribe even takes integration of medical services beyond the wellness center. The tribe, which is federally recognized as a sovereign, independent nation, delivers a variety of programs and services that it sees as crucial to promoting the wellness of its people and broader community—including a tribal justice system, early-childhood education center, an Elders center, and a social-services program. All are located on the tribe’s campus in the Old Town section of Kenai, which was an early Kahtnuht’ana Dena’ina village site.
An example of their community integration is the tribe’s joint-jurisdictional therapeutic wellness court, which accepts people—even non–tribal members—who are charged with a substance abuse–related offense. The charged person goes before a tribal and state court judge, sitting side-by-side in Kenaitze’s courtroom, for an 18-month program that includes behavioral health and substance-abuse treatment from the Dena’ina Wellness Center. Although this program is new—less than two years old, Zirul says it has been effective and the tribe hopes to expand it.
While many rural health centers throughout the country struggle with decreasing demand, the Dena’ina Wellness Center isn’t among them. Zirul says Kenai is seeing tribal members and others in Alaska move from remote areas to slightly larger ones such as Kenai, which is the rural hub of the peninsula. “I myself returned here 30 years ago,” she says. “People are moving here for the quality of life and to be closer to family.”
Additionally, she says, the school systems are good, and while the local economy has its ups and downs like any other, the job market is generally healthy.
But perhaps the biggest reason the Dena’ina Wellness Center is flourishing is simply because, as Zirul says, “People do better when they’re treated at home.”