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Tribal Connections Project, Phase 1
Final Report:
May 1998 - April 2001

Project Description

Community Objectives

Initial community objectives, in every case, emphasized hardware and connectivity. The communities justified this emphasis by showing that access to the Internet was the major problem and that use of Internet resources could not be considered until the access problems were solved. Fourteen of the 16 communities wanted workstations; the fifteenth wanted just a server and the sixteenth wanted only connectivity installation. Most of the communities needed to provide some kind of internal networking on the reservation, since more than one building was involved in each plan. Communities wanted to network the health care department, the dialysis unit, the Head Start Program, the senior center, the computer training laboratory, the family service center, the tribal council, and the clinics. Nine of the sixteen sites wrote objectives about providing health information on their own tribal or community web sites. In particular, tribes have active education programs in areas including substance abuse prevention, diabetes treatment, and programs that address other chronic diseases.
Index to
TC Phase 1
Final Report
Staff
Overview
Project Background
Project Description
Lessons Learned
Accomplishments

Site Visits and Collaborations

In October 1998, Project Manager Roy Sahali began site visits. The purpose of each site visit is to 1) review each proposal's objectives, 2) make sure that the current situation is completely understood (that all input variables have been included), 3) consider, with the tribe, various options to achieve the proposal objectives, and 4) agree on a final plan for accomplishing the objectives. At the initial meeting Roy Sahali strongly emphasized collaboration and leveraging resources with other intra-tribal departments and with outside groups interested in health information on the Internet. During the initial discussions with tribal liaisons, we reviewed the proposals to confirm or add to the statement of needs. We asked the project liaison about other opinion leaders in the community. We found out about other related projects affecting the community. Some communities, such as the Nez Perce, were considering Internet connectivity in several different departments of the reservation; in those cases the resources of the two different departments could be combined for greater benefit. When possible, we immediately included important tribal members or agencies in the discussion. In the cases where a community already had a tribal Internet plan, we made sure that the Tribal Connections objectives fit well into that plan.

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Joint Planning Process

Based on the community's objectives and the site visit negotiation, final lists were drawn up for each tribe which were divided into 1) hardware, and 2) services or connectivity. Each American Indian or Alaska Native community was eligible for up to $25,000; the exact amount was determined in negotiation with the Project Manager and was based on the proposal objectives. The money was not earmarked for any specific piece of the picture. Sites could request computer workstations, servers, routers, printers, software, and licenses or could pay for network wiring, web site development, or connectivity charges. We made sure that each community agreed 1) to provide some level of public access to the Internet for health information, 2) to host training sessions taught by RML staff, 3) to plan for local systems support, 4) to plan for sustainability, 5) to provide a link from their web pages to the NN/LM PNR's AI/AN health resources, 6) to consider AIDS/HIV prevention information a priority in training, and 7) to provide evaluation input over time.

Equipment/Hardware

Choices for equipment were guided by 1) compatibility of equipment already present in the community, 2) working relationships with equipment vendors and maintenance staff, 3) preferences of systems staff and project liaisons, and, of course, 4) the objectives of the project. The RML negotiated with a Seattle supplier for an excellent price on a standard workstation that was adaptable to most of our settings, but the community's preferences were always put first. One community chose to put all of the funding into connectivity — with no money going toward hardware. Another community chose to use the entire funding amount for one high-end server to support networking within a health consortium. Tribes used a reimbursement process for their non-hardware expenses, but we decided to have the NN/LM PNR purchase hardware directly and then transfer that hardware to the sites.

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Connectivity

In the area of connectivity, we actively sought partners. The partners were often in the position of having an ongoing commitment to connectivity in the community, thereby increasing the likelihood of sustaining our project objectives.

  • Internet Connections via Indian Health Service (IHS):

    The IHS has more then 550 nodes nationally with bandwidths from 56K to 384K frame relay within a closed network system for shared administrative, patient, and financial data. This network also provides e-mail and Internet connectivity among the clinics, the 12 area offices, and to the IHS headquarters in Albuquerque, New Mexico. Eleven of the sixteen TCP participants have IHS clinics or health substations on their reservations. The objective in approaching IHS was for reasonably priced, sustainable, not temporary, Internet connections for tribal health departments.


  • Internet Connections via Intergovernmental Network (IGN):

    IGN is one of three state-wide network segments of Washington State's Department of Information Services (DIS). The IGN segment is dedicated to intra-state government connectivity for cities, counties and tribal governments. Another segment of the network is specific to state intra-agency communications, and the third is the K-20 education network. The three segments use TCP/IP and VOIP, the communications protocol for the Washington State DIS. By special permission tribal health can communicate with the state Department of Health and tribal police can access the Washington State Patrol. All Washington State Tribes are eligible for IGN for services.


  • Internet Connections via Bureau of Indian Affairs:

    The U.S. Bureau of Indian Affairs (BIA) is charged with enhancing the quality of life, promoting economic opportunity, education and other services. The BIA has the responsibility to protect and improve trust assets of American Indians, Indian tribes and Alaska Natives. Tribal education and some health services are directly impacted by The Office of Indian Education Programs (OIEP) which serves K-12 and Tribal Colleges. Out of 185 schools supported by BIA, 76 schools are connected to the Department of Interior (DOI)'s Internet service ("DOINET"). DOINET provides fractional and full T1 connections. The IHS is working on an agreement with the BIA to share data lines in an effort to reduce cost and replication. The Lummi Tribe is the only example among the TCP sites of collaboration with the Bureau of Indian Affairs (BIA) for Internet connectivity.


  • Internet Connections via ISPs:

    There are more than 6000 Internet Service Providers nationally offering connectivity and web hosting to cities towns and remote communities that include reservations. Internet delivery is available via satellite, cable and principally telephone lines. Downlink speeds vary from 3.5mbps on the high end to slower then 28.8 kbps. In AN/AI communities phone services are usually the barrier for homes (with 53% lacking phones) but most tribal departmental staff have telephone service. If a LAN is in place often a bank of dial up modems is used to access the Internet.

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Training in Using the Internet to Access Health Resources

The Regional Medical Library (RML) has a long history of training medical librarians and medical professionals in the use of NLM databases and, prior to the Tribal Connections Project had taught at several tribal sites and at Northwest Portland Area Indian Health Board meetings. For the time period during and following the Tribal Connections Project, RML outreach training staff oriented the majority of their outreach to project sites, providing classes and individual sessions for TCP site staff and clients. The RML librarians provided a broad scope of training in order to have as many different people and different departments involved as possible. In order to develop community capacity for information seeking skills, we tried to increase a pool of community experts through training.

Since AI/AN groups were our target for directed outreach throughout this period, we took as many opportunities as possible to train within this community. By working on the larger community capacity we hoped to ensure the long-term impact of the project. Although we saw a great deal of staff turnover during this time, in many cases staff we trained then went on to another tribe, so that the training was not lost to the larger community. We also taught at national and regional meetings in order to help create a knowledgeable support group for our target communities. For example, we worked extensively with the Association of American Indian Physicians and even developed many web pages for the Association. The content of the web pages is meaningful to the larger community, but also we reached deeply within the community of physicians working in AI/AN communities. We also developed a collaborative relationship with the Washington State Library (WSL) which was concurrently working to improve Internet access to electronic library information. WSL was providing every tribal library in Washington State with a standard workstation. We funded every tribal library to buy a two-year subscription to a set of 2000 electronic journals and books at a cost averaging $162 per tribe per year. Eight of our 16 TCP sites are in Washington State and were involved in both projects.

AI/AN Health Resources Web Pages

In an effort to encourage the use of Internet health resources to improve AI/AN health, health web pages are an important addition to the community website. TCP encouraged tribes to publish tribal health profiles for primary health concerns. Privacy and tribal image were prime considerations in publishing public access pages. Through the creation of a health web site, the community serves as the content producer of its own story instead of being only a consumer of other writer’s stories. The use of information and computer technologies presents significant interaction and information-sharing possibilities between AI/AN communities, especially to assist in communication with members who may live remotely from the reservation or village. We developed a web site for the project, with information about the project and also with links to AI/AN health resources. We then asked the communities to create a link from their own web pages to our page. We have committed to maintaining the health resources list of links and therefore, by linking to our page, the communities avoid having to all maintain a page of such resource links. We created a template in html that communities could simply copy and paste on their web pages that provides a link to the NN/LM PNR AI/AN health resources pages and to NLM web pages.

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