In my first three days here, I’ve driven on a lake, had water delivered to my home in order to shower, and have flown in a small plane to a tiny village on the Bering Sea to pick up a patient. Already, this has been an adventure. (Sorry, no pictures yet, as it is too slow to download from here).
I’m in Bethel, Alaska for my six week rural medicine rotation. This is not just rural medicine – it is FRONTIER medicine. Bethel is a town of 6,000 people situated on the Yukon-Kuskokwim Delta (YK Delta) in southwest Alaska. It is only accessible by airplane.
My adventure started when I left Anchorage on the one-hour commercial flight out to Bethel, flying a little too close for comfort to the ACTIVE volcano, Mount Redoubt, that was puffing away. From the air, I could see the ash-colored snow below.
We landed in Bethel and I walked into the “airport” (a one-room building) where the signs are in both English and Yupik Eskimo. I was picked up and dropped off at my home for the next 6 weeks, a condo with my truck plugged in out front (so it starts; it’s not quite spring here yet). The water is delivered by truck every week, the sewage is pumped out of the holding tank every week, and the oil for heating delivered when we get close to running out. I also share a phone number with the neighbor in the condo next door, which is slightly comical as we knock on each other’s homes if the phone is for them! I unpacked my 4 LARGE boxes (50 pounds each) that I had jam-packed with food (it is REALLY expensive here) and my collection of many sized clothes (I’m going to be getting a bit bigger in these next 6 weeks, as I go from 22 weeks pregnant to 28 weeks pregnant).
I realized that my truck, an official hospital truck that “beeps” as I back up, was almost empty and went in search of the gas station. Luckily my neighbor (who is from France?!) offered to come along and show me to the gas station. After filling up with gas ($6/gallon), he gave me an impromptu tour of Bethel. There’s a combination of cement and dirt roads, houses on stilts (to avoid the melt/flood), two grocery stores, and six restaurants. Also, oddly enough, there are more taxi cabs here per capita than in New York City!!! It’s a $7 flat rate anywhere you want to go and, often, there are others sharing the cab with you. We drove around town. As I turned onto one “road,” he stated, “Go faster here; it’s a little soft when you first drive onto the lake.” Hmmm…so I was driving on a LAKE! The roads here tend to include rivers and lakes until May, when “break-up” happens.
My first day of work was in the ER, seeing many people from villages that I could not pronounce (though I definitely am trying!). Also, English is most people’s second language out here. The main culture is Yupik Eskimo (there is also a small number of Cupik Eskimos and Athabaskans). The people are quiet; I have to remind myself not to jump into "dead space" in conversations in order for them to talk. It’s difficult for me to leave silences in conversations, but I'm working on it. The people are also very friendly and genuine. When I was one dollar short on my cafeteria lunch, the lady smiled, took a dollar off the price, and said, “Welcome to Bethel. We help each other out here.”
My next day of work was an ADVENTURE! About half way through the day, there was a call from Hooper Bay about a woman who was having seizures. The ambulances here are airplanes, so a Medi-Vac plane was needed to pick her up.
Let me back up briefly and describe the health care system out here on the YK Delta. The Delta is the size of the state of Oregon (about 75,000 square miles). Bethel is the main hub, but it serves 58 tribes in 48 surrounding villages – a total of 27,500 people. The people are 90% Native Alaskan, mostly Yupik Eskimos. They are some of the poorest people financially, but are the richest land in terms of land and subsistence (fish, birds, game, berries, roots, etc). Only about 1/3 of the villages have running water. There is a hospital in Bethel (where I’m working). However, in each of the villages there are locally-trained Health Aides. If they have a really sick patient, they call Bethel. Bethel sends out an airplane to pick up the person (unless the weather is too bad). If the person cannot be cared for in Bethel, they get sent on to Anchorage or the Lower 48 (such as Seattle, Washington). Now that we have a CT scanner in Bethel, fewer people need to be sent to Anchorage for imaging. Additionally, all pregnant women in the villages leave their village and come to Bethel 30 days before they are due. They have their babies here and then are flown back to the village. It’s an amazing system of providing health care and employs over 1,500 people to do this.
So…back to the seizing woman in Hooper Bay… we took off in a Cessna Caravan. It was the pilot, two health care workers (EMS), and myself. We had room for two patients and one other person. We flew the hour-long flight to Hooper Bay (I was in the front with the pilot), flying over very FLAT land. There are no mountains out here! Every now and then we’d fly over a village, a group of homes in the middle of this flat expanse of land. When we landed in Hooper Bay, I noticed that we were quite a ways from the village itself. Locals on snow machines with sleds behind them had lined up to meet us as we exited the plane. We stashed our medical supplies in the sleds and hopped on, riding across the snowy frozen tundra with wind and snow lashing us in the face on our way to the clinic! We arrived at the small clinic, unloaded, then immediately went to work on the patient. We loaded her up in one of the sleds, then off we went again on snow machines, back to the airplane. An hour later we landed back in Bethel, loaded her into the ambulance, then brought her to the hospital. Total time from the initial call was about 3-4 hours. She did well. The entire experience was very rural Alaskan and I kept thinking to myself in disbelief, “How did I end up here?!”