Extreme Cold!

Sunset over the snowy tundra

We are defiantly starting to experience temperatures lower than I have ever experienced before.  The other morning we woke up to -23 degrees, factor in the 15-20 mile per hour winds and the temp was about -45.  With these low temps comes a plethora of new experiences for us.  Here are just a few:
* Despite the fact that we have double pane windows there is a thick layer of ice on the bottom INSIDE of all our windows!  On several of our windows we taped plastic shrink wrap to the inside in an attempt to keep the cold out and the heat in.
* The other day I went to visit a friend and she had to use a hair dryer to defrost her door before she could let me in.  Her outer door had actually frozen shut!!

Snow drift

* There is a phenomenon that we have not yet experienced since we are able to park our car inside our heated garage, but I know several people who have... square tires.  That's right, square tires.  The temperature gets so low that the pressure drops in the tire and they flatten a bit.  Then the rubber freezes in the flattened shape.  The only way to get your tires round again is to warm them up, the only way to warm them up is to drive your car.  At first the tires and car clunk along, but apparently it doesn't take too long for them to warm up, round out and ride smoothly.  I almost want to leave our car outside one night just to see if our tires are square in the morning.
* Lately whenever you walk outside, after just a couple of inhalations through your nose, the inside of your nostrils start to freeze!  Its a very strange sensation.  The first time I experienced it I kept breathing in just to feel my nose.

Frozen Kuskokwim River

* A few nights ago, I took a walk out on the tundra to view a beautiful meteor shower and try to catch the northern lights.  It was about -45 with the wind and after about 10 minutes I could feel icicles on my eyelashes.  I didn't last too long outside that night, I don't have goggles yet and it didn't take long before my cheeks and bridge of my nose were burning.
* Lastly, we got a chance to take a drive on the river.  We didn't go very far, it was a much rougher crossing than I thought it would be.  Plus the wind was blowing the snow so much that it was quickly covering the previously made tracks.  Since we weren't at all familiar with the smoothest route we turned around rather than risk a flat tire in the middle of the river.

Driving on the Kuskokwim

Ice fishing

Blowing snow over the frozen river

So maybe its just the novelty of our first Alaskan winter that makes all the above so interesting, but if that's what it takes to help us get through the coldest winter we've ever experienced then we'll take it!
  

Becoming More Alaskan

Just one of the hind quarters we got

Back in the beginning of September moose season opened.  In that first weekend friends of our friends got not one but two moose!  It was kind of a sad story actually.  The two moose seem to have been brothers.  They were both wondering the tundra together.  The first moose got shot and the second moose didn't want to leave him there, so he got shot too.  (If it makes my animal loving friends feel any better, those two moose filled more than one freezer.)  Mark was asked to help quarter and pack the moose back to Bethel.  In exchange for his labor we would get to keep some of the moose.  It took the whole weekend.  The first day both moose had to be gutted and quartered.  Each moose probably weighed 700-800 pounds and had to be moved away from the gut pile to keep bears off their sent.  Mark didn't get home that night until about 3:00 am, got a few hours of sleep then headed back out to finish packing the moose back to Bethel.  In the end we got two hind quarters.  
We brought the meat to a processor here in town.  It took a little bit of time, but we finally got our moose back.  One hundred pounds of moose sausage, moose hamburger, moose roast... Our freezer is full of meat that will save us hundreds of dollars this winter.  

Our freezer full of moose!

Moose stew.  Yumm!

Tonight I made moose stew for dinner.  We had our good friends over to enjoy it with us.  (Dinner get-togethers are a way of life here.)  It was pretty delicious, if I do say so myself.  Not too gamey as I was afraid it would be, and very lean.  I do feel just a little bit more Alaskan now that my freezer is full of moose meat and I successfully cooked an enjoyable moose dinner.

Russian Mission

My Room

Russian Mission Clinic

This past week I have been away on my second village trip.  Russian Mission is a village of just over 300 people, nestled in the mountains on the bank of the Yukon River.  It's about a 45 minute flight northeast of Bethel.  The first record of the village was in 1837 by fur traders.  Then, the village was known as "Ikogmiut" meaning "people of the point".  The whole town is less than 6 sq miles of land.

Main Street

Enough snow for sledding 

Moose quarters hanging in the cold

Russian Mission - mountain view

My trip started out a little rough.  I arrived early Monday morning only to find the health aide who was also supposed to be there was nowhere to be found!  I was on my own.  No nurse, no health aide, just me!  I didn't know where anything was located, and if there was an emergency I didn't know who I was supposed to call.  No 911 out there, just me.  The health aide who was supposed to be there that day had a full schedule of patients.  Most of those patients regretfully had to be cancelled, but I tried to squeeze some into my already booked schedule; I was frazzled to say the least.  That night I barely slept for fear that the on-call phone would start to ring.  

Trail up the mountain

The next morning however, things began to look up.  The health aide arrived on the morning flight and I was successfully getting my patients' blood on the first stick!  There were so many patients who needed to be seen.  I saw patients every day I was there from 8:00 in the morning till 8:00 or 9:00 at night.  

Airport

The Yukon River - frozen of course!

I managed to get out and around town for just a bit on my lunch break the last day I was there.  I went and had lunch at the school.  The kids were too cute.  Some of them I had seen earlier in the week as patients.  Many of the elders I saw as patients were there as well.  The school is the town's biggest employer, so I shouldn't be surprised I was seeing so many familiar faces.  One of my patients gave me a tour of the two story, two year old, K-12 school.  My favorite room by far was the Yup'ik room.  In this room, the elders pass on their knowledge of the culture.  They teach the kids how to make various arts and crafts, bead work, quilting, and sewing.  They also teach the kids how to trap fish and animals for fur.  The room was full of tradition.

I truly look forward to my next trip.  With any luck I'll be able to bring a nurse along with me and double the number of patients I see!

Painting of Russian Mission in the 1950s

Preschool

I can not believe how big my little man is getting!  We have mastered potty training.  His latest excitement is peeing like daddy - standing up.  This has lead to some interesting messes, but whatever keeps him out of diapers is just fine by me!  
This past week we hit another milestone with Luke.  PRESCHOOL!!  We got word that the school district here was opening up a new preschool class for 3 year olds.  Thankfully since Mark works for the school district Luke was bumped to the top of the waiting list.  It seemed to take forever, but Monday I got a call that Luke could start school Thursday.  We were a bit nervous about how Luke would react to the news that he wouldn't be going to Tata's house (the babysitter)anymore.  We spent the days leading up to Thursday talking all about how great preschool is going to be.  It worked because Thursday morning when we stopped at Tata's house to drop off Gianna, Luke just waved to his sister and announced that he wasn't going to Tata's because he was going to preschool.  
So we made 2 big mistakes that morning.  First, we didn't drive to the preschool the day before so we knew exactly where it was. Second, we looked it up on MapQuest.  The second mistake may not sound like such a big deal to all our friends in the lower 48, but I know all our Bethel friends are shaking their heads wondering what we were thinking.  MapQuest up here is NEVER correct.  But instead of just saying it is unable to map our location, it will pinpoint a spot.  Keep in mind the road map it shows is accurate, complete with most road names.
So we started driving toward what we thought was the preschool.  Luke was in the back seat repeating "I go to preschool, I go to preschool..."  We drove out almost to the end of town before we realized MapQuest had again lead us astray.  At this point we turned around.  At that point Luke thought he was no longer going to preschool and had a complete meltdown.  He started screaming at the top of his lungs "I wanna go to preschool!"  Mark was stressing because it was ten after eight and he had an 8:30 check in time at the airport.  I'm trying to use the not so reliable internet on my phone to look up a phone number for the school so we can find out where they are.  Finally we made it to preschool.  Luke hasn't mastered walking on ice (which is everywhere here) so he made Mark carry him into the school.
When we walked into the classroom I thought sure Luke would take off and never look back.  There were all kinds of toys and books and crayons.  But Luke clung to Mark and buried his head in Mark's neck like I have never seen that boy do before.  It took us about 10 minutes before he would finally go to the teacher and we were able to sneak out.
Thankfully we live in Bethel, and only in Bethel could Mark call the airport and check in over the phone so he wouldn't miss the flight, which was canceled about 2 hours later anyway due to the weather.
  

Freeze up on the Kuskokwim River

A quick up date on our weather.  The sun rises around 10:00 AM and sets around 5:00 PM.  It's strange going to work in the dark and coming home in the dark.  The temperatures have dropped considerably.  Our highs are often in the single digits and our lows below freezing.  Factor in the wind, which usually blows about 20-30 miles per hour, and we have had several days in a row of -25 degrees!  Tomorrow is supposed to drop even lower and drive the temp to -35 degrees!  Its hard to describe how cold that is.

All bundled up, but it was only about 25 degrees out this day

I mentioned earlier that we have ice everywhere.  We were supposed to get several inches of snow last week, but somehow with a temp of 26 degrees all we got was freezing rain.  The next day we managed to get a dusting of snow, but the temp rose just enough to melt it all, which then refroze that night and has remained frozen ever since.  Its a slippery world out there right now, and I don't think its going to change much till spring!   

Grandma's Visit

This week Grandma came to Bethel for a visit.  We picked her up on the evening jet last Friday.  After a long day of flying though, what better greeting than that of a squealing 3 year old?  Although there is not too much to do in Bethel, we did go out one night for dinner and she got to experience the prices that one can only find in Bethel (or a five star restaurant in New York City, but who's comparing?) 

She was here for our first Alaskan Halloween.  Gianna was my little flower, but she wouldn't keep her petal hat on for longer than 2 seconds, so she ended up being a fuzzy green stem most of the night.  Luke was Woody from Toy Story, and he thought he was the coolest kid on the block all dressed in his cowboy suit.
The temperature that night was in the high teens, but the wind was crazy and brought down the temp considerably.  Mark took Luke out for trick or treating while Grandma, Gianna and I stayed warm inside. 
Her week with us was great.  She got to reconnect with her grandkids and even nurse her son back to health.  For the last couple of weeks a nasty GI bug has been ripping through Bethel.  Mark was unfortunate enough to be affected, but fortunate enough his mom was here to make sure he stayed hydrated.    
Luke keeps asking if Grandma is going to be at his house when we pick him up from the babysitter.  We certainly hope she comes back for another visit soon!  (And not just because of the two fabulous bottles of white wine and bottle of vodka she brought with her!)

Northern Lights

And it's only mid October!

That's right!  Last night we got to see nature's best light show for the first time, or at least Mark and I did.  One of our good friends called around 10:00pm to let us know the northern lights were visible.  Sure enough, when we walked outside we could see the faint green glow low on the northern horizon.  At first they weren't much.  It looked more like a fog rolling in.  So we went back inside to watch a movie and warm up.  (The wind was strong and the temps in the 20s).  Throughout our movie we kept getting texts from friends about how much more active the lights were becoming.  Finally I couldn't take it anymore. The thought that it might be awhile before I get another chance to photograph the lights drove me to bundle up and tromp back out with my camera and tripod - and no idea how to photograph the northern lights.  
Apparently the northern lights, or Aurora Borealis, come from the energy of a solar flare.  As the energy from the flare rushes toward Earth it charges the atmosphere.  The charged atmosphere then creates sparks.  We see these sparks as the northern lights!  According to David Epstein, a New England meteorologist, scientists have even discovered that the lights have a sound to them.  
Eskimo tradition believes that the lights are torches to guide the recently deceased from this life to the next.  Southern Europe rarely get to glimsp the lights; it was believed that when the lights did display they foretold of war and destruction to come.  In fact just weeks before the start of the French Revolution, parts of England and Scotland reported an eerie display of the lights in fiery red.  Still to this day, Asian culture believes that to conceive a child under the lights will bring the child a lifetime of good fortune. 

Since the wind was blowing so hard and I knew I needed to have my shutter open for several seconds (a very still camera) I set my tripod about as close to the ground as I could get it.  When I went to take the picture however, it was so dark that the camera (which was set in semiautomatic mode) couldn't focus on anything!  I needed to switch it into full manual mode, but it was too dark to see the buttons on my camera.  Finally, after several failed, frustrating attempts, I got the camera to focus on the tundra grass and then after it focused on the grass I angled it up to the lights.  Not the best pictures in the world, but there's no doubt about how awesome a sight it was!  
 

Biggest Grocery Bill Ever!

Last Sunday Mark flew to Anchorage for a week long seminar on asbestos.  While he was getting off early, eating at nice restaurants, drinking beer from a tap and shooting pool, I worked through lunch everyday just to get out by 5:00 so I wouldn't be late to pick up the kids.  The first two days were the worst by far.  Luke pushed every single button he could and ignored every punishment I could dish out.  My reward at the end of the week was to fly by myself with both kids right at their bedtime to meet Mark for the weekend.  What the hell was I thinking when I booked those tickets!  Amazingly Luke was great the whole flight and Gianna played peek-a-boo with someone sitting behind us almost the whole time.  
We managed to get a massive grocery shopping trip in the short time we were there.  First to Costco, $850 later we were on our way to Walmart.  Luke did get to enjoy the hotel swimming pool; it was by far the highlight of his trip.  Our last morning there we made a very quick trip back to Costco and spent another $350 on 100 pounds of meat.  One of the great things about flying within the state of Alaska is that every ticketed person can check three 50 pound bags each free of charge.  So between Mark, Luke and I we packed back 9 totes.  Alaska Air will even refrigerate totes containing items needing to be kept cold.
It may seem like a lot that we spent $1200 on groceries, but in the long run it will save us a lot of money.
Anchorage had its first snow while we were there.  When we woke that first morning we found several inches of snow on the ground.  Bethel too got its first snow earlier last week.  Nothing stuck to the ground but it won't be long before that's all we see on the ground.  The sun sets these days around 8:15 and rises close to 9:00.  Everything looks more brown, all but the cranberries are dried up.  Winter is on its way!   

Mom's visit

 
We have had such a great week.  Last Friday Nana flew in from Atlanta to help celebrate Gianna's first birthday.  It was an ordeal getting here for her.  She left Atlanta around 4:00 in the afternoon on Thursday.  After a short lay over in Denver she was on her way to Anchorage.  Landing in Anchorage around 1:00am her flight to Bethel didn't leave till 7:00.  After checking that the flight was on schedule I loaded the kids into the car and headed the mile and a half down the road to the airport.  We watched excitedly as the jet came in for landing only to begin ascending again at the last minute.  Back to Anchorage she went!  Apparently the pilot felt like the fog was too thick for a safe landing.  The next jet to Bethel wasn't until noon, however it was already full so she didn't get bumped till the evening jet that comes in around 8:00pm.  Thanks to some friends in Anchorage she did get to leave the airport for a few hours.  Finally, nearly 27 hours after leaving Atlanta she made it to Bethel, greeted by the squeals of a very excited 2 year old.  

The next day we celebrated Gianna's first birthday.  Mom made a Little Mermaid birthday cake and we had several friends over for a little party.  The next day we made Gianna's picture cake.  For Luke's first birthday someone had given me the idea of taking his picture while smashing into a cake with blue frosting.  

I loved 

the photos I got so I wanted to

do the same thing for Gianna's first birthday, but with pink frosting of course.  Gianna didn't quite tear into her cake like her brother did his first birthday, but she seemed to enjoy it in her own prissy way.

In addition to helping out with Gianna's birthday, Nana also set the stage for Luke to be fully potty trained.  He is now almost completely in big boy underwear!  Sure we still have a few accidents every now and then, and he still wants a diaper to do #2, but he is doing really well.

At least lots of rain makes for some beautiful rainbows

The weather was pretty typical Bethel most of her stay.  It rained 80% of her time here, but that was actually impressive that 20% of the time was nice enough to go out.          




We went berry picking out
on the tundra and collected enough blueberries, blackberries and cranberries to make a very tasty jam.
Saturday was definitely a tear filled day.  We were all sad to see Mom go.  It figures that on the day of her departure all the flights would be on time, no cancellations.  She is already planning her next trip back, but April won't come quickly enough.   

Maqii

Little did I know what I was about to do

       
















 As promised in my last post, this post is dedicated entirely to my first maqii experience which is Yu'pik for steaming.  As I said last time, while we were in Kipnuk we were invited to go steam.  The closest comparison I can give in our American culture is the sauna. 
The physical building the steam takes place in is just a little wooden hut.  It is divided into two rooms.  Like the houses, it isn't hooked up to any plumbing so all the water used has to be hauled in.  There is a wood burning stove in the center of the steam room which is topped with stones, and a water basin is attached to its front.  A tin can attached to a long pole is used to spoon water from the basin over the stones thus creating the steam.   
Steaming serves a couple of different purposes.  It is not only a social gathering, but a means for washing both your hair and body.  Different herbs can even be placed on the stones to help treat certain infections.  Because water is a most precious commodity and limited plumbing exists for most houses, steaming offers a water sparing way to bathe.
So we got to the steam on our second evening after a long day of seeing patients.  When we first walked in, the room we entered was like a small mud room.  There were shoes on the floor and clothes hanging on hooks up on the wall.  Two small, completely naked, little girls ran out of the steam room.  Anne looked at me, obviously excited, and I watched her for what to do next.  Then she started taking off her clothes.  I hesitated for a second then figured "what the hell?  When in Rome..."  

Cooling off

We ducked through this small door and entered into the steam room.  There were three other women, also naked, sitting on the wood floor which is raised a few feet off the ground, the stove sitting on the dirt floor ahead of us.  We brought in with us a water basin each filled with cool water so we could soak our wash cloths to cool ourselves off.  Alaskans like to steam very, very hot.  We found ourselves having to run outside to get a break from the heat.    

In my birthday suit on my birthday!!

After a refreshing run outside it was time to wash up. (No wonder Anne told me not to bother washing my hair that morning).  We filled our water basins with cool water, grabbed our shampoo and condition and body wash and ducked back into the steam room.  We added a few scoops of the hot water from the stove to our basins to warm up our cold water just enough to make it refreshing but not breath taking.  Following Anne's lead I began splashing water from my basin over my head to wet my hair.  Since my hair is so long and thick I had to dunk my hair into the basin to fully wet it.  Then shampoo, rinse, condition, rinse, body wash and final rinse.  We had to refill our basins once or twice, but all in all used considerably less water than a typical shower.  My first maqii was a great experience.  So relaxing!  Your skin just tingles after sitting in the hot steam for so long then going out into the crisp Alaskan air.  I've had a lot of people ask me if I would do it again, and the answer is "absolutely, yes!"  Really, what better way to bond with your patients and co-workers than getting naked and steaming?

Kipnuk

Kipnuk Clinic

Kipnuk was a whirlwind of exhausting fun!  We arrived at the Era hanger 8:00 am Monday morning. Yes, for those of you caught up on your Alaskan reality TV, Era Alaska is the Flying Wild Alaska airline.  We had to bring our own food, sleeping bags, medicines for the patients, and many of our medical supplies.  Even though we were 

One of many boardwalks

Every home on stilts

working at the Kipnuk clinic, there are no PAs, NPs, or docs there so many of the tests and procedures we needed to be prepared to do we had to bring with us.  One very key component us two PAs did not have with us was a nurse!  Neither of us have drawn blood or started an IV since school.  Neither of us have ordered labs or even gotten vitals on a patient in years.  I know, it's sad, but its true.  Thankfully we had a young girl training to be a health aid that was able to get vitals on many of our patients.  She sped things up for us more than she could know.
Kipnuk is right on the Bering Sea.  It has no real roads, no cars or trucks.  With a population around 1,000 everyone uses the boardwalks to get around.  In the summer you can take your ATV, in the winter snow machines.  As in Bethel all the houses and buildings are built on stilts because of the permafrost.  There is no running water to the houses in Kipnuk, all the water is either collected from the rain or hauled from the washateria.  In the winter people go out onto the ice and chip the ice into buckets that they bring back home to melt down.  It was hard at times to remember that we are still in America. 
We got into Kipnuk around 10:00 am and decided to start seeing patients at 11:00.  It sounds like we should have had plenty of time, but we had to print all of our patients' charts, set up our rooms, unpack our meds and supplies...  In reality we probably shouldn't have started seeing patients till after lunch, but we wanted to make the most of our limited time there.  

Me with our gracious host

After our first clinic a wonderfully nice family invited us to go out berry picking with them.  We jumped at the opportunity!  After a very chilly boat ride we arrived at our berry patch of choice.  It was great, salmonberries everywhere!  In Bethel salmonberries don't grow in great numbers.  I picked almost 3/4 of a gallon that evening, and would have had more if I hadn't eaten so many.

Oh yeah! I totally fell in the mud

Heading out

Salmonberry patch

Happy 30th!!

Day 2 just happened to be my 30th birthday.  We started early printing our patients' charts for the day.  We saw a full schedule of patients as word had begun to spread that two providers were in town.  After a full day of seeing patients both in the clinic and a couple at home, we got such a treat.  The same family that took us berry picking the day before invited us over for a steam.  It was very, very hot, and very awesome.  I will dedicate an entire post to my first steam experience in the near future.  After our steam they invited us into their home and surprised me with a beautiful birthday cake!!  All homemade, and where ingredients cost three times as much as they do in the lower 48 it was one of the most special birthdays I have ever had.  

Whale bones

That's one big vertebra!

                                           







Day 3 was another full day.  Early early start with printing charts (I think I forgot to mention that to print one chart had a 20 minute delay).  Today we started with blood draws an hour before regular patients started.  Thank God we had a float health aid who was staying with us!  We would give one good attempt at the blood draw and if we weren't successful we would pass it off to the much more experienced health aid.  Although I must say, for a couple of PAs who haven't drawn blood in 4+ years, we didn't do too bad.  After clinic and a home visit we were invited to dinner at a patient's house.  That night we feasted on tundra goose and homemade bread.  For dessert we had cake and Eskimo ice cream.  She was so happy that we came to have dinner with her.  She even baked us a loaf of bread to bring back with us to have in the morning.  After dinner she showed us a grass basket she was making and even worked on it a little for us so we could see how it was made.  The grass comes right out of their back yard.  The colored part of the basket she told us is dried seal intestines dyed whatever color they want to use.

First taste of Eskimo ice cream

Day 4 came with another early start and more blood draws.  We only saw morning patients so we could have time to pack up and get to the runway for our flight home.  The family that invited us berry picking and for a steam brought us some haddock they had caught earlier in the season.  All and all is was an unbelievable experience.  I loved my nurses before this trip but now I really really love my nurses.  I look forward to visiting one of my own villages in the near future, but will definitely be bringing a nurse with me!  We saw a total of 80 patients in those 3.5 days.  I know my HealthFirst friends are laughing at that number, but that really is a lot for this kind of trip.  It was good to get home to my family again, and I know Mark was happy to no longer be a single parent.  I can't imagine meeting a nicer, more welcoming group of people.  I'm quite jealous that Kipnuk isn't one of my villages. I hope one day I will be able to return with Anne for another trip.

Me and the other PA, Anne

Kipnuk