Thursday, August 31, 2006

Left in Akiachak


Ended my day with a Medevac to Akiachak, a village just up the Kuskokwim from here. In addition to myself, there was a pilot-in-training riding along on the flight. A flight to bring a 94 year old man who had suffered a stroke back to the hospital. Upon arriving at the clinic, we were notified that additionally there was an 8 year old girl who had dislocated her left elbow. Both needed to be brought back immediately and there were not enough seats on the plane for all of us.

The pilot-in-training and I were left on the runway in Akiachak. Sweet. There is nothing quite like watching your only guaranteed ride lifting off the gravel airstrip, dust blowing in your face, and the wings wobbling in the wind. Fortunately there was another plane with extra seats on its way to Bethel. Making its fourth stop on the milk run, we were picked up arriving just a few minutes behind our original ride. Nothing like hitch-hiking in rural Alaska. Speaking of which, the above map shows the villages in the region. there are no roads between any of these villages, and Bethel has a total of about 15 miles.

Hopefully the comments section is working. There seemed to be a little hitch on the last post. I am also disappointed that no one commented on my use of a Liz Phair album title and an A-Team catch phrase in the same post.

Tuesday, August 29, 2006

And this is why I married her...


Jana and Jackson joined me this past weekend. It is nice to have some company for awhile. Jackson has apparently entered middle school and is working on a major in Physics with a minor in French Lit. We went fishing on the Gweek River upstream on the Kuskokwim from Bethel. Jana caught on of the only two fish of the afternoon, a 24 inch Northen Pike. I have never even seen one before. First she supports me through medical school, now she supplies me with fresh kills to sustain her whole family. What did I do to deserve such a woman?

Saturday, August 26, 2006

Hips and makers

A slight grinding, sound then a sharp pop, resulting in perfect alignment. There are few things more satisfying than when a joint goes back into place. I can’t say I have a lot of experience, but I have reduced a few dislocated shoulders, and of course there was the time that I got to put Chuck’s knee back into place on the Ultimate field (I still get the willys thinking about it…).

Yesterday we flew to Kipnuk in the early hours of the morning to pick up a patient who had driven off the end of the airstrip on his 4 wheeler at around 2 a.m. His trajectory somehow directed him to land on his right leg, dislocating his right hip. After we had assessed him thoroughly, flown him back to Bethel, and shot enough x-rays to insure that nothing had been fractured, it was time to put things back into place.

Normally with shoulders, some mild sedation and pain control is all that is necessary before putting things back into place. With a hip, the muscles are so huge that spasms can make it nearly impossible to put it back into place manually. We wound up taking our patient to the O.R. and putting him under general anesthesia (totally asleep) before pulling the joint back into place. Instant relief of pain, and that leg that was pointing a completely improper direction, once again in proper alignment. Beautiful. I love it when a plan comes together.

Monday, August 21, 2006

Berries

I hope that by inferring to the “56 odd villages” that I didn’t imply the villages themselves were truly odd. That is not to say that some of them are a little different than the others, but all have their beauties and idosyncracies.

I have been doing a lot of berry picking lately. The two main varieties are blueberries and salmonberries. The blueberry you should know. Out here it is a little smaller than the grocery store variety, but has a much greater flavor and less pulp. Delicious. The salmonberry is something like a raspberry, but salmon in color, and in my opinion lacking the flavor or tartness of the other multilobulated berries. That being said, people love them out here. They are picked and collected in 5 gallon buckets to insure quantity sufficient for the winter. Blueberries are everywhere. Salmonberries are a little more rare, although this is supposed to be a good year for them. There are signs all over town with salmonberries for sale for $250 per 5 gallons. I went into the wrong business.



Needless to say, I didn’t collect any salmonberries, but I do currently have about 2 gallons of blueberries in my freezer. The possibilities are endless. I became a little pathologic on my collection, as many of us who fish or gamble know, it is hard to stop when things are going good. I’ve never seen so many berries in my life, and it was very difficult to stop picking, despite my over abundance. Tomorrow I am supposed to go drift netting for salmon. We’ll see how my addiction carries over to that.

I almost forgot to mention...the berries are made in to jams, preserves, and akutuq - eskimo ice cream. Akutug is usually a mixture of berries and seal oil, reindeer fat, Crisco, or some other fat, and sugar. I have tried it. I can't say I like it. Perhaps it was just because of the salmonberries. Lots of sugar cures almost anything.

MedEvac

One of the most fascinating things about practicing medicine up here is the transportation system and the process for determining who needs a higher level of care. There are some 56 odd villages in the Yukon Kuskoqwim catchment area, of which very few are big enough to justify a provider (mid-level, PA, NP or physician). What the state of Alaska and the Federal government have done is to create a new type of health care provider called a Community Health Aide. This is usually an individual (mostly local women) from the village who undergo several months of fairly intensive training along the lines of an EMT or paramedic. Their scope of practice, however, is quite broad compared to an EMT, and is performed under the leadership of a physician assigned to their village. When a patient comes in to clinic, the CHA consults a large book of algorithms instructing them each step of the way for common complaints such as abdominal pain, shortness of breath, poisonings, etc. They have specific examinations and treatment procedures. Then at some point during the day the do “Radio Call,” during which they present all of the patients to the assigned doc to make sure the right steps have been followed. This can lead to either approval of treatment, requested follow up, or transport from the village to Bethel for more in depth investigation.

The transport is my favorite part. I have been fortunate enough to travel to the villages of Kipnuk, Shageluk, Kasigluk, and Chevak with the Air medic crew. This has given me a bird’s eye view of the Y-K Delta and a chance to take part in the front line of health care. We fly in a Cessna Cargo Van, a big fat bellied plane which can take off and land on a dime. Most of the villages of this part of Alaska have run ways that are narrow and short enough to scare off all but the most adventurous of pilots. Pictures will follow when I get the cord next weekend.

Tuesday, August 15, 2006

Welcome to Mumtrekhlogamute

Mud. I wish I had a better descriptive word for my arrival in Bethel, but 'mud' just about sums it up. It has been raining here for the past week, and what was once a hard packed sandy road system is now goo. Thank God for 4-wheel drive and my xtra tuffs.



I am at the beginning of a six week rotation here at the Yukon Kuskokwim Health Corporation hospital in the 7th largest town in Alaska (pop: 6400). The Corporation (ominous sounding , isn't it?) serves a region the size of Oregon and it is one giant swamp filled with mosquitos out here.

Otherwise, it seems reasonably nice. We are on the bank of the Kuskokwim river, and assuming the weather lets up I am excited to be here, and may have a contact to do some fishing in my free time. Put on your parkas, and join me for the next few weeks, as I finally have the time to write again.