Monday, April 20, 2009

Bethel posting #3: Radio Medical Traffic

One unique part of a family doctor’s job out here in Bethel, Alaska is answering “Radio Medical Traffic.” Before there were phones, docs would call the different villages by radio and check-in to see if there were any sick patients. They would treat, arrange transportation, and provide medical advice by radio.

Today, much the same process occurs with the addition of some new technology. I spent one afternoon answering radio traffic from the 48 villages for which Bethel serves as the healthcare hub for. Here are some examples.

First, a fax came through from the Village Health Aide about a sick patient that they she had just evaluated. Village health aides are usually a local village person who undergoes training to use a manual to diagnose and triage conditions. They do an extraordinary job. Back to the example…A health aide from one of the village faxed her notes about a 3 year old that they just evaluated with a high fever and cough. I looked at the list of villages and called by telephone to talk to the health aide directly, asking further questions to determine how sick the child was. The child was wheezing a bit, so I looked at a list of the medications available in the village and stated that the health aide should give the child albuterol nebulizers and Tylenol. I called back shortly after to see how he was doing. He was still having some difficulty breathing and was now requiring oxygen. At that point, because he needed oxygen, I activated the medivac system to send a plane to get him immediately. A plane flew out, picked him up, and brought him back to Bethel. He was evaluated in the ER and I admitted him to the children’s unit of the hospital. He had pneumonia and was doing much better after 24 hours of IV antibiotics and breathing treatments.

The next call was about an 86 year old woman who had been coughing for the last week, with a low-grade temperature. She also had underlying lung disease. The decision was whether to treat her there in the village or to have her come in to Bethel by regular commercial flight to be further evaluated. There are daily flights between each of the villages (unless there is bad weather). Because she was completely stable, we offered her the choice. Some elders do not want to leave their village, but others are more willing to come in. She decided to come in on the next commercial flight (in 2 hours) to Bethel, where she was able to get a chest x-ray and other labs completed. She was prescribed antibiotics for pneumonia and flew back to her village the following night after her follow-up appointment at the clinic the next day. I could have given her the antibiotics over the phone if she hadn’t wanted to leave her village, but it was better to be able to get the chest x-ray and blood tests. However, ultimately, it was up to her.

Then you add weather into the picture. I found myself advising one person to be taken by snow machine to the nearest sub-regional clinic with an x-ray; then having the clinic send the image by telemedicine system (they also send photos of rashes, etc by telemedicine). They couldn’t fly out (runway was covered with blowing snow) and this way we could at least start the diagnosis process and appropriate treatment.

Finally, I attended a birth by telephone. The woman had gone into labor in the village. Usually all pregnant women come into Bethel 3-4 weeks before their due date, have the baby in Bethel, then return to their village. However, this woman hadn’t come in and presented to the village health aide in active labor. It wouldn’t have been safe to have her deliver in the airplane on the way to Bethel. Instead, we coached the health aide about the steps on delivering a baby, all while listening over the speaker phone to the entire process. The delivery went well and the mom and new baby flew to Bethel a few hours later to be evaluated.

I’ve found that Radio Medical Traffic is quite tricky; it’s like running an ER for 48 villages over the telephone! There is an art to deciding who is really sick and whether or not they need to fly in from their village; then deciding whether that flight can be a regular commercial flight or a medivac flight. It’s a part of the job that I hadn’t anticipated, but that I’ve really enjoyed.


Maynard said...

Dr. Hyer, I'm so proud of you!! Words will never be able to explain how happy I am for you both (and the .5 on the way!)!!!! Miss you both tons! I'm going in for a Microdiscectomy on Tuesday 04/28/09, so a little nervous, but I have a really good neurosurgeon (Dr. Claudia Martin) and I know things will go well. You can see the pic of my MRI on my facebook page, it's gnarly!

Lots of love,

TedMary said...

As one Hyer to another Hyer it is great to here that the next generation of Hyer is on its way be sure to keep in touch as we would like to add to the genelogy of the Hyer family ---Ted & Mary Hyer ---