Subsistence Living

 Yesterday we took part in our first subsistence activity - berry picking.  For those who have no idea what subsistence living is (I didn't till we moved here), subsistence is literally living off the land.  The people who live out here don't hunt, fish and berry pick for fun, they do it to live.  A spring with low salmon counts means a really tough winter.  Right

now is berry picking season, the only subsistence activity we can take part in.  Once we have been here for a year, we can hunt and fish, but for now it's just berries.  The tundra is full of ripe blueberries and salmonberries.  Later this summer cranberries will be ripe.  There is no designated blueberry patch, you simply walk out onto the tundra and look down.  We

took advantage of a rain free morning yesterday and all 4 of us headed out, crossed the street, entered the tundra and started picking.  Walking on the tundra is hard work!  It's like walking on pillows.  You think you are on solid ground but then you sink 6 inches deep.  After 2 1/2 hours of walking we were all pretty tired (except Gianna who rode in her sling). 

Tundra Blueberries

          At first glance the tundra isn't very appealing.  There are no trees, it's mostly flat, and the standing water doesn't amount to much more than an oversized puddle.  But on closer inspection the tundra is really beautiful.  There are so many different mosses and flowers, and of course, berries.

Salmonberry

Fruit of our labor

So we are pretty slow berry pickers.  We have a lot to learn.  But we had a good time, we got some good exercise, and we managed to pick enough berries for a blueberry pie.
 

Home Sweet Home

OK.  So I know its been a little while since my last post, but its been a busy last week and a half.  Last Monday I started seeing my own patients.  For the last month I have been shadowing other providers trying to learn the YK system.  There are so many papers for each patient its sometimes hard to keep track of them all.  My entire PA career (all four years of it) has been with electronic medical record (EMR); now I start here and we have paper charts.  The irony is that in January we move to EMR.  I will just get used to these bulky, heavy paper charts and will then have to learn a new EMR.  Oh well.  My first week went well I think.  There were a couple of late nights and a few really frustrating days, but it can only get better.  The worst part has been only have one car and one cell phone.  This week I have been using my iPhone at work because it has a lot of my medical references on it, and Mark has been keeping the car so he can take the kids to the park if the weather is nice.  I've been trying to predict what time I will get done and be ready to be picked up, but twice I have been pretty off.  So off that Mark has gotten tired of waiting, left and gone home.  I think we are going to have to break down and get a home phone.
Also exciting this week, we finally got our permanent place and our stuff!!  We are in company housing which is great because our water, sewer, and heating oil are all included in our rent.  We have a pretty roomy duplex, about 1000 square feet, but we are a little ways from the hospital.  (A little being very relative.  People here complain about how far away our subdivision is from town, but really we are only about 5 miles away.)  Our rent is pretty much the best deal around, but rent is still $1700 a month!  Most places in the area have rents more than $1700 a month, plus the tenant is responsible for all utilities.  Nothing beats having our stuff.  It has been more than 2 months since we have slept in our own bed.  We couldn't be happier now that we can finally settle in.

Operation: Suture

Coming storm and we have to go straight through it

I got the awesome opportunity the other day to fly with one of the other PAs to one of our villages.  A call came into the ER that a 6 month old got a pretty deep cut on the face that was going to require stitches.  Normally the village health aide would be able to take care of this; however, this particular village didn't have a health aide.  Rather than having baby and mom medevaced to the ER, myself and one other PA got a charter flight to the baby.  We got to the airport around 3:00 with the expectation that we were going to be leaving right away.  However, in true Bethel fashion, there was a "miscommunication" and the plane wasn't going to be getting in for about an hour.  An hour came and went, and we were informed that due to a strong head wind the plane was running about 40 minutes behind!  So we waited, and waited.  Finally the plane arrived, was fueled and ready to go.  The lady at the desk asked me to stand on the scale.  I kindly let her know I didn't have any bags (we were just going there and straight back).  She smiled and said "no, I need YOU to stand on the scale".  So up onto the luggage scale I went!  I should have known then when we walked out onto the tarmac and the pilot would indicated this tiny little plane to be our ride.  With a max capacity of 4 it is by far the smallest plane I have been on.  

Yep, that's the runway ahead

That strong head wind that delayed our charter in the beginning also doubled our flight time to the village.  We landed on a dirt runway around 7:00pm in the pouring rain.

Russian Mission
one of the villages I will visit often

              We were picked up in one of the village's 3 trucks and brought to the clinic.  Although the laceration repair took us longer than we had anticipated (but really what hadn't up to this point) the cut closed up beautifully and the baby did really well.  We hopped back on the plane and made it home by 10:00. 

Alaskan Tundra - with all that water it's no
 wonder there's so many mosquitoes! 

Bethel - Home sweet home

It was such a cool experience!  For the most part the weather for the flight was very clear.  We could see for miles!  It was so strange to me to see so much land and NO human footprint!!  We flew over miles of open tundra, we even saw several moose!  The plane ride was bumpy, but not as bumpy as I thought it would be. I can't wait for my next village trip!

Taco Bell

 Many of you probably heard about the Taco Bell Hoax that fell on Bethel a few weeks ago.  Right about the time we were getting here, we heard whisperings that a Taco Bell was soon to follow us.  It didn't take long for these rumors to be dispelled.  Apparently, just before we got here, flyers were being circulated advertising a new Taco Bell complete with a phone number for those interested in employment.  It created quite a buzz, but unfortunately it turned out to be a prank.  Somehow, this joke gone bad made national news.  I've heard that it was some kind of research project; I've heard it was just some guy playing a joke on a friend.  Either way, the stir got the attention of the real Taco Bell.  I guess the powers that be at corporate Taco Bell decided this little town in the middle of Alaska deserved a day of tacos.  And if they were going to fly tacos to Bethel, why not make it big?  And if they were going to make it big, why not make it into a commercial?!    
We heard about free tacos and film crews yesterday.  The action was supposed to start around 1:00pm in front of the Cultural Center and we were promised we wouldn't be disappointed.  
I think 3/4 of the town showed up for the chance to be in a commercial and get a taco they may have never tried.  The whole affair had Hollywood stamped all over it.  So its true that there are no roads in or out of Bethel, but we do have roads within the town.  But why drive the Taco Bell truck from the airport to the Cultural Center when you can air lift it by helicopter?  After the dramatic truck landing, we were prompted to all charge across the muddy road for our free tacos like starving children.  All in all, it was a lot of fun.  I'm probably going to end up on national television shoving a Doritos Taco Bell taco into my mouth.  At the very least I made Anchorage news.  But for those of you who know me well, seeing me shove delicious food into my mouth should be no surprise.     

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 ;-)