YKHC

I've completed my first week of work and I have learned so much! One thing I have learned for certain is that the people who work for this company love what they are doing.  After two days of orientation I listened to lectures from nearly every department at the hospital.  It did not matter if the individual has worked here for two weeks or twenty years, they all love this company.  Perhaps my favorite part of orientation was learning how the Yukon Kuskokwim Health Corporation, known just as YK to locals, came to be.  
Bethel was home to the only medical facility for southwest Alaska, an area about the size of Oregon.  In the 1950s this area  suffered a terrible outbreak of TB.  (To this day the area has double the rates of TB than the lower 48.)  So many people from the surrounding villages flocked to Bethel for treatment that the doctors soon got overwhelmed.  As the outbreak continued on tribal leaders offered to help the Bethel doctors by dispensing medicines and monitoring patients in their own villages.  Since these leaders had no formal medical training they would communicate back and forth with the doctors for advise via radio.  This system worked so well for both the doctors and the patients that we still use it today.
The region we serve has 58 nationally recognized Eskimo tribes ranging from 1200 to 50 people.  The average population per village however, is 300.  Out of these 58 villages 43 have small health clinics run by community health aides.  These health aides are professionally descendant of those original tribal leaders from the 50s.  Health aides come to Bethel for a crash course in basic diagnostic skills.  The course only lasts a few weeks and then the aide returns to his or her tribe.  They are the first point of contact for ANY medical issue that arises in their area.
We still communicate back and forth with the health aides, only we've upgraded from radios to fax machine and the internet.  Each patient seen by the health aides has a report faxed to the on call provider back in Bethel.  The provider evaluates the report and can either agree with whats being done, recommend alternate treatment or request the patient be seen by a provider.  
Just because a provider visit is requested does not mean the patient has to hop on a plane and fly to Bethel.  There are five sub regional clinics scattered throughout the region.  These clinics are run by physician assistants and nurse practitioners. They have x-ray capabilities as well as a small pharmacy.  They are sort of like all the urgent care clinics down in the lower 48.  
Patients who require more care come to Bethel.  The hospital has more imaging capabilities, an ER, OR, inpatient services and labor and delivery.  I work in the outpatient clinic within the hospital.  I also serve two villages, Russian Mission and Lower Kalskag.  A couple times a year I will travel to these villages and when people from these villages come to Bethel for care, they will see me.     


    

Settling In

We made it Bethel and are slowly getting settled in.  For those who don't know or haven't already looked it up, Bethel is a small rural town in southwest Alaska.  There are no roads in or out; it's only accessible by plane and for a few months in the summer, by boat.  The closest Walmart is in Anchorage, 400 miles away.  There's no McDonalds, no mall.  The hospital is by far the biggest employer and Yup'pik Eskimos make up the majority of the population.
We are in the tundra.  For the most part its flat and marshy.  Walking anywhere off road is like walking on a sponge and requires tall water-proof boots.  It's not the gorgeous, majestic mountains and glaciers so many people associate with Alaska, but it is beautiful in its own right.  

View out our back window

There are a lot of changes we have to make in order to prosper here.  Only a few houses in town have piped water - we are not one of them.  We get 1,000 gallons delivered to our holding tank once a week.  If we run out of water before the week is up, there is a gargantuan fee for early delivery.  We have to think about how much water we are using every time we turn on the faucet.  Cleaning, bathing, cooking... 1,000 gallons adds up real quick.  
Meal planning is another small area we need to work on.  Until our car arrives on the barge, 3-4 weeks, we must rely on the taxis.  The cost, per person, round trip to go to the grocery store is $20.  We've been here for one week and have already spent $100 on taxis.  Speaking of the grocery store, yes, everything is more expensive.  A gallon of milk is $7, a can of soup, $3.25, juice, $11, salad dressing is double what we paid in the lower 48.  Come July though, we will be able to place a barge order, where non-perishable items can be purchased at prices closer to normal, and delivered in September before the river freezes.  But, we are talking about serious bulk, the smallest size you can order is a half pallet!  
Another difference is no mail delivery to houses in Bethel.  There is one post office in town, and every Bethel resident gets a PO box.  As far as we can tell, no UPS or FedEx either.
Grocery bills and water conservation might all take some getting used to, but they are nothing compared to the long day light hours.  The sun officially dips below the horizon somewhere around 1:00 am and pops back up a little after 4:00 but it never gets completely dark.  Two in the morning looks more like 7:00 at night.

Midnight on the Tundra

But the weather has been beautiful!  A nice heat wave has had the last few days in the low 70s.  We best drink it up now, because it won't be long before the weather everyone associates Alaska with will be here.   

Alaska Here We Come

We made it to Seattle!  Here we got a couple of days to relax.  Once we got the car dropped off at the barge and on it's way to Bethel, we decided to spend the remainder of the afternoon downtown.  Pike Place Market was awesome.  I could spend all day there.  So many photo ops!  I just didn't even have time to explore them all. 

 If I lived someplace where fresh flowers were so available, my home would never be void of their beauty and fragrance.  We even got to see the fish throwing the market is known for - that really can't be good for the fish!  After a couple hours spent at Pike Place we headed to the Space Needle, because what trip to Seattle is complete without a trip up the Space Needle?  Neat, touristy, glad we did it, but our next trip to Seattle, I'll gladly spend more time at the market.

Once we got to Anchorage the real work began.  We gave ourselves 2 days to stock up on supplies.  When flying in the state of Alaska, each ticketed passenger can check up to three 50 pound bags for free.  The reason for this is to help people in the more rural parts of the state squirrel away necessities they can't get in their villages, or that cost an obscene amount of money where they are from.  So off to Walmart we go.  We bought six Rubbermaids and headed to Costco.  What a money saver we were able to do this!  Even though we spent about $800 between the two stores, purchasing the same supplies in Bethel would have been close to double that.  I'm sure I will never fly anywhere else where Coscto sized packages of paper towels and toilet paper coming across the luggage belt in baggage claim is the norm - and don't think for a second that one of them wasn't ours ;-)

Headed West - Finally!

 Our trials didn't end when Mark got to Atlanta.  We had hoped to leave early the next morning, but packing the Forester became a huge challenge.  It quickly went from "how do we best pack all this stuff" to "ok, what can we leave behind?"  Luke's toddler air mattress - out!  Sleeping bag - out!  Container of non-perishable food - out!  And the list went on.  Finally we were packed, the Cruiser was ready for storage and we were off.
We rolled into Kentucky much later than planned, so we decided to head West on Friday instead of Thursday.  Friday morning came and we noticed we had a nail in the front tire and a pretty good chip in the windshield.  Into town we headed for repairs.  This is where the hard times end and the good ones begin.  

Mt. Rushmore

Even though we got a late start, we were finally headed West.  We rolled through St. Louis around 7:00 pm and pressed forward.  We had exactly one week to get to Seattle to drop the car off at the barge, and we planned to see as much of this country as we could in that time.  We drove that first night till almost 2:00 am to make up for the late start.  On day 2 we made a spur of the moment decision to continue North into South Dakota to see Mt. Rushmore.  After breakfast on Day 3 we continued to Mt. Rushmore for some sight-seeing, hiking and biking.  We were disappointed to find that there were no trails!  Although Mt. Rushmore itself was pretty amazing, we only spent 30 minutes at the monument.  We snapped our pictures, bought our magnet and loaded everybody up back into the car.  

Devils Tower

Our next            destination was Yellowstone National Park.  On the way however, we spotted signs for Devils Tower National Monument and decided "what the heck, the detour might be fun."  Devils Tower, the first national monument, was very impressive.  Unfortunately though, the kids both fell asleep on the way there, so rather than disturb a very peaceful nap, Mark drove in circles while I snapped my pictures and bought another magnet.  

Mammoth Hot Springs

We drove all day and stayed at a little motel 2 miles from the East entrance of Yellowstone.  Day 4 we took our time driving through the park to our campsite near the West entrance.  Yellowstone is breath taking to say the least!  We drove well under the speed limit in order not to miss a thing.  Bison were everywhere.  To add to that list we saw numerous elk, 2 bears, a fox, a bald eagle and a moose.  We arrived at our campsite, set up camp, then got back into the car and continued exploring.  That night got down to 35 degrees.  Mark, Luke and Gianna all slept great.  I got cold and once awake all I could think about were bears and I could swear I heard something big stomping around our tent.

Grand Canyon of Yellowstone

Lower Falls at Grand Canyon

Old Faithful

Day 5 was another awesome day.  We saw the Grand Canyon of Yellowstone and Mammoth Hot Springs.  That night snow was in the forecast and temps in the 20s, so even though we paid for 2 nights of camping, we packed up and headed to West Yellowstone, Montana.

Sure enough, the next morning a blanket of snow covered everything.  Two days was no where near enough time to see all we wanted to see in Yellowstone.  We will certainly return one day, but as for today we continue on to Seattle.