Hawaii

As our first Alaskan winter begins to melt away we felt it was the perfect time to get out of Bethel for a bit.  I found a conference through the University of California San Francisco on a Primary Care Update for 2013 in Maui, April 7th through the 12th.  In addition to the great topics offered by the conference, lectures adjourned everyday at 11:00am!  To sweeten the deal my mom was willing and able to come to Bethel and watch the kids for us so Mark and I could go just the two of us. 
We left Bethel Saturday morning and arrived in Maui that night.  We wanted to spend a good deal of our free time just laying on the beach or by the pool, but we also wanted to see some of the sites.

Conference registration didn't start till 3:00pm Sunday afternoon with two lectures later that night, so Mark and I decided our first day would be a beach day.  I was foolish enough to think I could go an hour or so without sunsceeen, and Mark was foolish enough to think the hair on his arms and legs would protect him.  In the end, after about an hour and a half we were both fried to a crisp.  So much so, that the next day when we picked up our rental (a convertable Camaro) we couldn't stand for the top to be down as the sun made our skin feel like it was going to melt completely off!  Needless-to-say, when people saw our beefy red burns and then found out we were visiting from Alaska, they had a sudden look of understanding (and pity) pass across their faces.  We spent the next 3 days hiding from the sun like vampires. 

Drive up to Halaekala, just below
the cloud line

A few moments later and we were
above the clouds

Crater of Haleakala Volcano

One of our car rental days we drove to the West side of Haleakala National Park.  This side of the park features the summit of Haleakala Volcano at over 10,000 feet above sea level.  The last time any lava flowed from this volcano was in 1790.  Very beautiful, but much dryer than we expected to see on a lush Hawaiian island.  We wandered on the trails around the crater for a couple of hours before making the curvy drive back to the hotel.
As our skin still felt very sensitive, we decided to rent the car one more day and drive the famous Highway to Hana and visit the East side of Haleakala park.  The East side of Haleakala park is just a few miles past Hana.  There is no road through the park to  connect the West and East sides.  To get to the East side you have to make the drive all the way around the island.  Many people only make it part way before turing back before their car sickness gets the best of them.

Highway to Hana

The drive was amazing; everything we had heard about it and more.  Although only about 50 miles long, it takes nearly 3 hours to drive as the speed limit rarely goes about 20 mph.  The road features some 620 curves and close to 60 bridges, the majority of which are a single lane.  At some points, the curve is so sharp and the road only one lane that signs are placed directing people to blow their car horns as they drive around so oncoming traffic can hear you.  This side of the island is what tropical is all about!  Waterfalls and flowers, bright green trees and plants everywhere!   
Our second to last day we decided to venture back out into the sun.  Equipped this time with broad spectrum, waterproof sunscreen of 70spf.  We applied, reapplied and reapplied some more.  Still we managed to get charred!  (Although, not quite as bad as day 1) 
From our hotel, it was easy and common to spot humpback whales out in the water.  Usually it was just their spray you saw, but more than once we saw the whales break the water.  Green turtles also frequented the shore line of the hotel.
We had a great trip!  But perhaps the event that we have told and retold to friends is this:

On one of our first nights in Maui, we walked to a little ABC store next to the hotel to pick up some beer and snacks to keep in our room.  (Resort alcohol is SO expensive.)  As we stood at the register checking out, the lady asked if we needed anything else, "some barbed wire perhaps?"  Without missing a beat Mark pipes up and says, "No thanks, just some handcuffs."  My face turns redder than my sunburn and the check out lady gives that embarrassed awkward laugh, the one that says "did I just hear what I think I heard?"  As we are walking back to the hotel, I ask Mark what on earth possessed him to say he wanted handcuffs to a complete stranger?!  He replied that she had started it with asking if we wanted any barbed wire.  Aghast I looked at my husband (who thought he was pretty slick with his quick response) and informed him, "Honey, she asked if we wanted any bottled water!  NOT BARBED WIRE!!"

 

Cama-i Dance Festival

Mother of Mukluk dance with mask
and seal gut parka

Every March Bethel is host to the Cama-i Dance Festival.  People come in from all over Alaska to attend and participate.  Cama-i (pronounced ch-a-my) translated means "warm welcome."  Many of the villages have dance teams, and Cama-i is a chance for them to show off their skills.  One village that danced hadn't had a dance team in 100 years!  Most of the dancing Cama-i weekend is native dancing, but really any kind of dancing is fair game.  The weekend started Friday evening with events scheduled till midnight.  Saturday kicked off around lunch time and again went till midnight, and Sunday too was packed with dances.  Many of the groups performed 2 or 3 times over the weekend.  My favorites were the dances that included masks.  Almost as much as I loved watching the dancers, I truly enjoyed watching the elders watch the dancing.  The front row was reserved for elders, but people could sit on the floor in front of them.  Every single elder I watched was absolutely glowing. 
We had patients all week trying to use medical conditions as excuses to come into Bethel so they could be here for Cama-i.  (Most insurances will pay for travel and lodging if medical care isn't available where they live.)  Convenient when your asthma just so happens to flare up the weekend of Cama-i. 
In addition to the dancing, people set up booths to sell their crafts.  There were ivory carvings, jewelry, dance fans, seal skin hats and gloves... all kinds of beautiful artistry. 
The festival is run entirely by volunteers and donations.  Saturday evening there was a huge native foods feast.  First served were the elders, followed by the dancers and finally everyone else.  The feast included beaver, moose, caribou and goose stews, walrus, halibut, salmon, berry akutaq (Eskimo ice cream) and several other goodies all donated and served to over 850 people! 

A friend's mother, a 94 year old elder from Nightmute, was honored this year for her lifelong support of native Yup'ik daning.  She in turn honored all of us with a dance.  
Overall it was a really nice, really crowded event.  I'm glad I got a chance to get out of the house for a few kid free hours and get some nice pictures and experience something new!

Boston

Boston

The hospital I work for requested I attend a 2 day training on a new way to deliver prenatal care.  I had my choice of traveling to Austin, Texas or Boston, Massachusetts.  Easy!  Boston here I come!  Now I couldn't make a two day trip to Boston and not take a little extra time to visit all the family and friends I have in New England.  Once my parents and sister caught wind of my up coming trip they promptly booked their own tickets.  Since Gianna could sit on my lap and I would have 3 babysitters in Boston, I decided to bring her along.  Really, what part of 18 hours on a plane with an 18 month old didn't sound like a good idea?  

Plane Entertainment

We set out from Bethel Wednesday night and arrived in Boston the next evening.  Gianna did exceedingly well!  She slept for most of the flights.  For 2 of the 3 legs we sat on the aisle.  The aisle seemed like a good idea at first.  I wouldn't have to step over anyone to get to the bathroom.  However, as my daughter stretched out, arms, legs and at times her head were in the aisle.  I couldn't sleep for fear the drink cart would wack her in the head.  (Which turned out to be a legitimate fear, as the flight attendants were everything but polite and attentive.)   Ironically, I only got up once to go to the restroom.    

Alisha and Gianna at Sam
Adams Brewery 

Mom, Alisha and Gianna

I hadn't been outside the state of Alaska in over 9 months.  That first night I had a hard time sleeping.  Cars, horns, sirens.  It was so loud!  I had a village patient once complain about having to spend the night in Bethel because there were too many cars driving past the inn she was staying at, and she couldn't sleep because of all the noise.  That first night in Boston, I knew exactly how that patient felt.
The training itself over the next two days was excellent.  I learned so much and can't wait to implement it!  But while I was training, Mom, Dad, my sister and daughter were out exploring Boston.  Judging by their pictures, they had a pretty awesome time.
Following my training we set out for Maine to visit with family we hadn't seen in too long.  

Dinner

Dad and Gianna

Mom and Gianna at the
Boston Aquarium

It was such a great trip!  I got to visit loved ones (including my best friend from college), do some shopping, eat out and drink draft beer.  Gianna and I made the long trip back to Alaska (this time in the window seat).  We spent the last day in Anchorage to stock up on groceries.  After a final beer in the Anchorage airport we headed home.

Josh and Gianna enjoying Gianna's
new favorite pass time, the iPhone

River Walk

Oscarville

One of the really nice things about working at an Indian Health Service facility is several paid holidays off, certainly more than I am used to.  The most recent paid day off was President's Day.  Usually when I have a day off that Mark and the kids don't, I just roam about the house picking things up, doing the laundry, watch a movie... nothing too exciting.  But this day off would be different!  A good friend texted me Sunday night and asked if I would be up for a hike.  I said "sure!", getting out of the house and getting some exercise sounded like a great idea.  She followed up her text with another saying "I'm thinking of going kinda far... sure you're up for it?"  Well, now that just made it sound adventerous, and that much more appealing.  "Absolutely!" I texted back. We planned to meet for lunch at a local sushi restaurant (yes, we actually have a few restaurants here that serve sushi) and then walk to the next village up, Oscarville.  Oh, and did I mention, there was a wind advisory for that day, the temp would be about -35 degrees, and we were going to be walking on the frozen river!
We met the next day for an early lunch.  Once fueled up on sushi rolls we headed for the river.  The walk up wasn't bad, the wind was at our backs, in fact we both got a little warm and had to open our jackets.  Nearly every truck that passed us stopped and asked if we would like a ride.  They all looked rather confused when we declined and kept walking.  Even 2 state troopers stopped us and asked if everything was ok.  They too offered us a ride and seemed a little concerned when we declined.  I'm pretty sure they were thinking they'd get a report later that day for 2 missing white girls who were last seen walking on the river.  It's hard to get lost though when you only have the choice of 2 directions, forward or back.

We made it to Oscarville in exactly 2 hours.  We snapped a couple of quick pictures and then turned to head home.  Once we turned the wind promtly reminded us it had been there all along.  The precieved change in temperature was amazing!  Up went my face mask, which had unfortunately froze while walking to Oscarville.  Apparently, the moisture from my breath as I exhaled really built up on my face mask and created quite a bit of ice.  The googles that had been on my head on the way up had a sheet of ice on the inside.  This made visibility difficult, but again, it's hard to get lost when you only have one way to go.  (For those of you who are thinking "but what if you wander off the road?", the road has been plowed so there is a wall of snow on both sides.  To wonder off the road you would have to climb over the bank.  It was pretty easy to tell when you were on the road and when you had wandered away.) 
As we walked, we did manage to stay pretty warm.  The wind was brutel at times, we pretty much walked the whole way back with our hoods up and our heads down.  Despite my googles, my eyelashes still managed to get ice crystals on them.  As my eyes watered the water froze and the crystals kept getting bigger and bigger till my eyelashes fell from the weight of the ice.  I'd have to pick the crystals off and then the whole process would start again. 
It took us exactly 4 hours to walk the 11 miles to Oscarville and back.  Most people thought we were nuts, and maybe we were a little bit, but we had a great time.  I think we both felt about 100 years old that night, and I had a blister the size of a quarter on my heel, but I'd still do it again!

Hectic Couple of Weeks!

These last 2 weeks have been exhausting!  The hospital I work for has undergone one of the biggest (if not the biggest) changes in its history.  We transitioned from paper charts to electronic charts.  I have worked with electronic records before, but I have never been apart of the switch from paper to computer.  For the most part, the switch was a smooth one.  The system never crashed, and patients have been fairly understanding as we muddle along reading a computer screen.  To try and aide the transition we significantly reduced the number of patients we see in one day.  With our old paper system we saw patients in 20 minute appointment slots with three overbooks allowed.  This gave us a grand total of about 16-18 patients each provider a day.  Currently with the new electronic system we see patients in 40 minute appointment slots and no overbooks.  This gives us a grand total of only 8-9 patients per provider a day!  Despite the dramatic decrease in number of patients seen each day, we have all been exhausted with learning each little crevice of this new system (and trust me, there are thousands of little crevices to learn).  Each night I go home feeling more tired than I ever felt seeing twice the number of patients I currently see.  I usually go to bed shortly after the kids go down.  When I wake up the next morning I can remember all the strange dreams I had that night!  I don't know if that means I am sleeping harder or softer. 
One of the most exciting and frustrating parts of doing everything electronic is the radio medical traffic.  I've written about RMT before.  It's where the village clinics send the Bethel based provider an account of a patient they just saw and request a plan for this patient.  What's nice about the electronic system is that when a patient comes in from a village, I can see what was already done.  Before with the paper system, the patient's village chart was separate from their Bethel chart.  Ideally, information got sent back and forth, but this was rarely the reality.  Now it's all one chart!  The frustrating part is that computers rely on electricity, and electricity is very fickle in the villages.  Our email inboxes are ever flowing with up-dates on which village is currently down and reverting back to the old paper system. 
All in all its a good change.  No more misinterpreting something because of bad handwriting.  No more searching for paper notes you know should be in the chart.  No more searching for whole charts!  With time I will hopefully get faster and feel less exhausted by the end of the day.  Who knows, maybe soon I will be able to stay up past 8:30!

Kuskokwim 300

If there is one thing Bethel, Alaska is known for, it is the Kuskokwim 300.  The Kuskokwim 300 is the most well known, mid-distance dog sled race in the world.  It starts and finishes in Bethel on the frozen Kuskokwim River.  This year 21 teams raced for a piece of the $110,000 race purse, with first place taking $22,000.  The race trail follows an old mail route 150 miles up river to Aniak, then back to Bethel.  This year's winner, four time Iditarod Champion Jeff King, completed the race in 40 hours 30 minutes and 10 seconds.  This year's win was Jeff King's 9th Kuskokwim 300 victory; his first K-300 win was in 1991.  

Start of the Akiak Dash

Anxious to run!

Two other, shorter races, also share the weekend with the K-300.  The Bogus Creek 150 is a 150 mile race that starts about an hour and a half before the K-300 and finishes the next day.  The shortest of the 3 races, the Akiak Dash, is a 65 mile race that starts and finishes on the same day.
Everything kicked off Friday evening at 5:00pm.  The frozen Kuskokwim River was lined with more than a hundred cars and trucks.  The temperature was well below zero with the howling wind.  For the Bogus 150 and the K-300, teams start the race individually.  One of the biggest attractions of the Kuskokwim 300 kick off are the fireworks that begin shortly after the last team has left the start line.  Most of the people I talked to watched the start of the race from the warmth of their running cars.

Saturday features the finishers of the Bogus 150 and the mass start of the Akiak dash.  The temperature had greatly warmed up to just below freezing on Saturday, although still cold when you are standing on a frozen river.  
Sunday, Luke and I headed to the river after church to watch some of the finishers of the Kuskokwim 300.  We arrived minutes after Jeff King crossed the finish line.  Luke was all about loving on the tired dogs, patting each of their heads telling them "good boy".  We stayed long enough to see the second and third place teams cross the finish line before heading home.

4 time Idiatrod Champion and winner of the K-300 for the 9th time - Jeff King

The dogs get loved on by fans moments after crossing the finish line

Not even off his sled and
the media are interviewing
second place Tony Browning

Third place went to Peter Kaiser

Another great Alaskan first for the Aickens!

Kwethluk

This week I made a quick trip to the village of Kwethluk.  Kwethluk is only about a 5 minute flight east of Bethel.  In the winter, when the river is frozen, it's possible to drive or snow machine.  The weather the morning I was scheduled to leave was snowy and windy.  As a result my flight was delayed nearly 4 hours.  Once I got to the clinic, I had enough time to quickly unpack and heat up my lunch.  

Kwethluk from the plane 

The purpose of this overnight was to see home bound patients.  Kwethluk has a population of about 750 (the largest of my 3 villages), with a handful of these patients having significant mobility issues.  Since Kwethluk is so close to Bethel, especially this time of year with the ice road, most patients can easily make it into town, relatively.  Many of the patients on my list to see haven't been seen by a provider for years.  Several of these patients are on hospice care.

No plumbing in Kwethluk.  All water is either
hauled from the river or washeteria.  Homes
either have honey buckets or out houses.

At first I was nervous about seeing only patients with multiple problems, pages of medications and no one to consult with.  That fear didn't last long.  My patients and their families were some of the most pleasant people I have had the opportunity to spend time with.  It was such a unique glimpse into my patients' lives, going into their homes.  I saw some patients over coffee sitting at their kitchen table, some in their living rooms, and several in their bedrooms sitting next to them on their bed.  I had time not only to discuss how they were doing medically, but to also find out who the child in the picture on their nightstand was.

Russian Orthodox church and graveyard

One patient I saw on my first day was hosting Slaviq.  Slaviq is the Russian Orthodox Christmas.  It starts on January 7th and lasts for a whole week.  Members of the church go from home to home throughout the week.  They sing, pray, exchange gifts, and of course eat.  It would be like Christmas morning everyday for a week!  It's a big deal in this part of Alaska as the Russian Orthodox church has many members.  I have been hearing people talk about Slaviq all December and was glad to get the chance to observe the tradition.
It has been several years since any provider has been out to Kwethluk.  I hope my next trip isn't that far off.

 

Kwethluk clinic

My mode of transportation