Shenanigans

I'm chugging along up here. One year older.

Since my last post, I've experienced a couple of winter storms.  The first was 2 days before Thanksgiving and shut down the clinic due to high winds and blowing snow.  Though I lost power often, it came back quickly each time, meaning I was warm and happy in my apartment, watching the snow whip by.  The second storm was less severe, I chose to stay in doors though my neighbors ventured out on a walk to check it out.  The pattern seems to be it gets really cold (like below zero) for a couple of days, then it warms up and storms. 

The wind was intense!

The sub-zero temperatures are intense.  It's interesting how I now feel a distinct difference between 32° F (0° C) and 0° F (-18° C).  I have come up with an appropriate outfit for the really cold days and I'm managing to stay warm.  I'll probably start wearing snow pants on wetter days, though currently, I choose to allow my knees to be vulnerable to the cold to save a few minutes of dressing.  The other day the temperature was in the low 30's and I was sweating (for real) in my winter ensemble.  So I leave the scarf and hat off on those days now.

My winter getup, about to leave work.

My face shield blew away the other day.  I had too many things in my hands as I was walking home from work.  I didn't realize a bag was missing until I got to my apartment, so I went on a quest to find it.  I managed to recover my work ID badge, scarf, hat and a fork (from my lunch).  But the bag, lunch tupperware and face shield are no more.  Blown away.  Keep in mind it's dark most of the time now, so there isn't much opportunity to search in daylight.  Currently, the sun rises ~12:30pm and sets before 3pm.  No bright sun.

An incredible care package received in record time!

I've learned a bit more about the mail system here.  There is USPS (the post office), then there is UPS and other private shipping companies.  Both are iffy.  The biggest issue with the post office in Kotzebue is staffing.  When people are on leave or sick, the place literally shuts down.  It was closed for a full week before Thanksgiving, then opened with limited hours for another week.  What that means is you don't get your mail.  Even if something was sent weeks before, it sits until someone sorts the mail, which no-one was doing for a while.  They also put a hold on all packages for a while, so everything was piling up in Anchorage somewhere.  I didn't know a post office could do that.  It's a government agency, one might think they would provide relief staff in these circumstances.  But no.

The private shipping companies receive mail through a different airline carrier.  Though the packages get shipped up here, they don't necessarily get delivered in a timely manner.  The local delivery people drive a white, unmarked van.  They often show up on a Saturday.  But not every Saturday.  I've heard you can go directly to the airport to get your packages.  But you have to know they're there, and tracking ends once a shipment reaches Anchorage.  So how's a girl to know??

Then there are the packages that are sent to my street address but end up at the post office.  I have a PO Box there.  Though if the PO Box number isn't written on the package, the package sits in the orphan bin.  One might think they would make an effort to match your name with your PO Box, but no.  Instead, they will announce a list of names of people that have this variety of package on the radio and Facebook.  But they won't reach out directly to the person, too much effort.  Sometimes I wonder...

I also found out today that we're on a cargo hold.  That mostly affects large shipments, so things like food for restaurants, furniture orders and vehicles.  I guess Kotzebue is out of eggs and will be for at least 3 more days.  I personally have eggs that I hand carried on the plane from Anchorage.  But you can't buy them at the store or order them at a restaurant (including the hospital).  Kinda crazy.  And so much worse for the villages.

Who would think Kotzebue would ever be given that title??

Speaking of villages, I'll be back in Point Hope in early January for a week.  Please cross your fingers and toes that the weather is good while I'm there- I don't want to get stuck again.  The wind is worse in Point Hope since it's right on the coast and the open sea.  It's a bit warmer than Kotzebue (still below freezing) but the wind chill is intense.  And it's often not safe to fly with the wind.  I keep trying to remind myself that I'm going there to help the people and they deserve that.  But I also really want to be back in my own bed as scheduled.  There's no way to know until it happens, so we'll see.

Typical view from my apartment window these days

Otherwise, I've just been working and enjoying the view from my apartment.  These days, there are a lot of snow machines that whiz across the ice.  Also dog sled teams, they are fun to watch.  Those dogs are so resilient.  They live outside and are all business.  Video is from October (before the snow) of some dog sled training.

I've been a on few walks on the weekend.  I haven't see the foxes but I guess there are a couple up the hill, I've seen their tracks in the snow.  And one moose, I've seen her droppings.  No recent bear sightings (probably hybernating??) though my neighbor is procuring a gun to carry with us when we hike just in case.  We're planning a longer walk out to the tip of Kotzebue, it'll take all day and you don't want to get caught unaware!

Merry Christmas and Happy New Year!

Connection

I've been thinking a lot about feeling and being connected lately.  Selfishly, but also for the people that live in Kotzebue full-time.
One of the first things I wanted figured out when I arrived here was a WiFi connection.  My mobile carrier is Verizon, and there's no service.  AT&T has a tower, but alas, that's not my company.  So my phone roams all day long, sucking data and still not having a reliable or consistent connection.  At the hospital, there is WiFi and I can use WiFi calling though Verizon.  Works pretty well, I'm able to call and receive calls.  But as soon as I leave work, I'm back in the same boat.
So I researched WiFi options for my apartment.  There seem to be 2 options in town, one is through a cable company, the other is through satellite.  For unlimited data, satellite is the way to go.  BUT, the signal is hit or miss and could be out for weeks.  So cable is what most people use.  The problem with cable is it's a data plan system, so you choose how many GB you want and what speed.  The fastest speed option is up to 10 Mbps.  From what I've been told by tech savvy people, 10 Mbps is still pretty slow.  And the "up to" part is key, as it's often slower than that.

I went to sign up for cable internet only to find out they were out of WiFi routers through Jan 2020.  I could get hooked up through a modem, but I would only have a hard connection through an ethernet cable, no WiFi.  That wouldn't work for me.  So I asked my neighbors if we could share WiFi.  They agreed, and everything was great for a weekend.  But before we knew it, they were out of data and asked me to stop using their WiFi.  Luckily, one of the nurses had an extra router, I got my own cable hooked up, and voila, I now have WiFi.  I have to monitor my usage to make sure I don't run out of data.  And when it's slow, it's slow.  That's just the way it is.
Though I enjoy streaming shows and movies, my real motivation for having WiFi is to be able to call family and friends.  Though I could stay at the hospital and chat, being at home on my couch gives me a better feeling.  More relaxed, less rushed.  Unfortunately, there's often an echo or voices cut out.  But not always.  So I'll keep calling, keep texting.  Hope I don't get cut off.
Then there are the native people here.  They are called Inupiat.  Culturally, they are a subsistence tribe, meaning they live off the land.  Many natives still enjoy hunting and fishing, making clothing out of the skins from their hunt and building with their hands.  That doesn't mean they don't enjoy the luxuries of modern life.  Most people I've met have a cell phone, drive vehicles and live in proper structures.  But they also have camps out of town where they go, off the beaten path and away from modern conveniences.  Maybe I'll be invited to go to a camp one day, I'd like that.

A dog sled out for a run over the frozen lagoon. 
If you look close, you can see modern windmills beyond the hill in the distance.

Everyone speaks English though they also have their native language, Inupiaq.  Like with other native people groups, their culture and language were threatened and discouraged after the Europeans came.  Thankfully, thoughts have shifted and there are more efforts to preserve and celebrate their culture now.  For example, our hospital has a long term care wing for the elderly, and they serve local cuisine (caribou, muktuk= whale blubber, seal oil, etc) once a month for their residents to enjoy.  My patients often use Inupiaq words mixed into their English sentences.  They'll say "I have a lot of nuvak", which means mucus/phlegm.  I'm trying to catch on.

Muktuk- whale skin and blubber.  Usually eaten raw, though can also be eaten frozen or cooked.

I was able to take a weekend trip to Anchorage over Veteran's Day weekend.  Along with some shopping to replenish my food pantry, I made an appointment with a dentist (thankfully they were open on Veteran's Day) and checked out the city.  It was refreshing to get away, see the beautiful mountains, check out the zoo and museum.  Go see a movie.  Overall, it was an enjoyable trip.

The amazing mountains behind the fun eat-in theater I enjoyed in Anchorage

As soon as I got back, I repacked and headed to my first village- Point Hope.  To read a bit about the village: https://en.wikipedia.org/wiki/Point_Hope,_Alaska.

The flight took 1 hour on a single propellar plane.  I got to the airport 1.5 hours early, had to wait outside in the cold for 45 minutes until the terminal opened, then waited another 30 minutes before they finally took my bags and we walked right onto the plane.  No ID needed.  Full water bottle, no problem.  I went with a PA student (Ciara) and we were the only 2 passengers along with 2 pilots (we think one might have been learning), 3 empty seats and the rest of the plane full of cargo.  Like large boxes of tortilla chips.  Ciara and I figured if we crashed, we'd at least have chips to keep eat :)
We arrived at 10 am, the sun was just starting to come up over the horizon.  From above, Point Hope looks like a perfect rectangular grid.  The airport was the tarmak and a few vehicles waiting to pick up the cargo and passengers.  No building.  When we got off the plane, we collected our luggage from the lower compartment of the plane and looked for our ride.  We couldn't find anyone from the clinic, so hopped on the senior center van which took us right to our clinic.

Point Hope from the plane just before landing at 10am.

The clinic is actually quite roomy.  There are 4 medical exam rooms, 1 dental room, a couple counseling rooms, a trauma bay and a couple of sleep rooms.  The dentist and one of the counselors live in Point Hope year round (unusual for most villages).  Currently, there are 2 CHAPs (Community Health Aids) who manage the patients 24-7 when no providers are present.  They call in to the "Radio Room" in Kotzebue that's manned by a provider who advises on any medical interventions or treatments that might be necessary.  The CHAPs handle it all- anything from the common cold to major trauma, overdoses, deliveries.  Of course, anything too complex gets sent to Kotz or Anchorage via medivac.  

The clinic with our trusty ATV parked in front

The clinic was short staffed, so Ciara and I had to do our own thing during our stay.  We roomed the patients, got our own vitals, drew blood, gave vaccines.  Nothing too ground breaking, but things I haven't done in years (or ever).  There is a small pharmacy in the clinic that has basic medications in a kind of vending machine.  If I needed a med, I'd order it and the computer would tell me if it was available in the village or if it would have to be sent out from Kotzebue.  If there was a flight delay, we'd try and scramble to find a temporary supply for the patient to help manage their symptoms until the plane could land.  And if labs were collected, we also relied on planes to transport them to the lab in Kotz.  Lots of delays with this system.
It was very windy while we were there, gusts 60+ mph.  The temperatures were in the teens, but with the wind chill, it got into the negative teens- burrrrrr.  We rode an ATV around the town, but our faces and fingers got so frozen we couldn't stay out long.  Then it took a while to get our fingers feeling back to normal.  Frost bite was a fear, thankfully we didn't push the limit that far.  Though we also couldn't resist getting out and about a bit.
Point Hope is known for whaling.  The season starts in April/May and there's a big celebration in June every year- 100+ people fly in, making PH a hopping place.  There are whale bones stacked up around the town, some artistically placed.  They also use whale bones to mark their cemetary- I got to see it but didn't get a picture as we were in a rush to catch a plane.  When a whale is caught, they cut it up and distribute the pieces among the towns people.  We were told they bury the tail and wait for it to ferment.  Sign of fermentation is when the water slushes, then they dig up the tail and again, distribute to those who want it.  One of my patients said only the elders eat the tail these days.

Some artsy whale bones out in the tundra.  It was hard to take my glove off long enough to snap this pic with the wind chill!

We were supposed to leave Thursday afternoon.  But with the high winds, all flights were cancelled.  The wind continued to howl through the night, and the morning flights were also cancelled.  Luckily, the winds calmed down enough to allow a flight to come get us Friday evening.  Otherwise, who knows.  I had heard there could be weather delays.  I didn't know it would happen on my first trip up.  But I now know PH is a windy place through the winter and not to expect to arrive or depart as scheduled.  I'm scheduled to go back in January, we'll see.

One of the planes.  This one left Friday afternoon without us- it was a charter flight and they were full!

It was interesting how much different PH felt from Kotz.  Yes, it was smaller.  People were mostly nice.  But everything was slower.  The computers, the pace of the clinic.  I didn't mind being there but I found myself longing for my apartment in Kotzebue.  I wanted my bed, my TV, my WiFi.  That extra day was rough.  I got to help out the CHAPs with a midnight overdose I would have otherwise missed.  I tried the local pizza (surprisingly quite good).  And when I got back to Kotz, I was finally able to rest.
There will be more new experiences with the holidays coming up. Opportunities to get to know my collegues and neighbors better.  Explore the town, especially when I'm properly dressed and there's some daylight.  I'm trying to take one day at a time.  Not get too bogged down with the little details (hard for me).  I'm taking vitamin D.  I still really enjoy my sun-rise alarm clock.  Let's see what more Kotz has in store.

Waiting for a plane to taxi with my neighbor on one of our weekend walks.

Initial Thoughts

I've been here a few weeks now- can hardly believe it.  Many of you have asked what it's like, so this is my attempt at giving you an idea.
I flew in via Anchorage.  I purposely had a several-hour layover in Anchorage so I could go to Costco and pick up some perishable and cold items.  Things like eggs, yogurt, frozen veggies, bread.  As an Alaska resident, I can check 3 bags for free (2 bags if coming from outside AK). When I got back to the airport (thanks Uber), my food box was 65 lbs.  Limit is 50 lbs, so the lady gave me the option of splitting it into 2 boxes.  After doing that, I was told I was checking in 1 item over the limit, $100.  Ugh!  Thankfully she was nice and waived the fee just this one time.  So off I went on the 1.5 hour flight to Kotzebue.

My apartment is a short walk to the hospital where I'll be working most of the time.

Typically, doctors stay in hospital housing (right behind the hospital), but there's an 18 month waiting list for those apartments, so I was put in teacher housing.  It's a bit further away, but not too shabby.  Plus, it's right on the water.  Not the ocean, on a large lagoon (I called it a lake for the longest time) where the airport runway is.  There wasn't enough space to build the runway on solid land, so they built it right over the lagoon.

The city of Kotzebue.  Population ~4000.

I have a wonderful view of the water and get to watch planes take off and land right from my living room.

View from my couch

The sound of the planes isn't terrible and has never woken me up (maybe because they don't routinely fly at night).  There are 2 commercial flights from Anchorage every day, then daily flights to each of the 11 surrounding villages.  Flights for medical emergencies also go when needed.

The Inupiat villages surrounding Kotz

The water in the lagoon froze over in the middle of last week.  One day, there were waves from the wind.  The next morning, there was a sheet of ice that has only grown thicker since then.  Just a few days ago, I saw people cutting their holes for ice fishing.  I fear they'll fall through, but hopefully they know that it only takes a few days to be strong enough (?).
I have a 3 bedroom apartment all to myself (I was expecting a 1BR).  So anyone who wants to visit the arctic, I have a place for you to stay!
I started work on October 1st.  Though it was light until close to 9pm, the sun didn't rise until 9am, so I walked to the hospital in the dark at 8am.  The temp was 30-40's, not too terrible, though nothing like the 90+ temps I was having in Houston.  So after a few days, I figured out how to dress better for the weather.  It's gotten down into the teens now, those are bitterly cold walks.  I have to give myself pep talks, "Just a few more steps, you can do it".
Thankfully, the heat works well both in my apartment and the hospital.  So as soon as I get to work, I peel off all my layers.  I wore a sweater one day and was way too hot.  So I've learned, a short-sleeved shirt with a cardigan or a long-sleeved shirt is enough for work.

I have yet to see an igloo, not sure they exist anymore??

The days have already gotten shorter in the few weeks I've been here.  Now it's dark until 10am and gets dark again before 7pm.  The days will keep shortening until there's hardly light at all in Dec/Jan.  My biggest worry about this is getting around town.  Right now, I walk and I feel relatively safe.  But when it's dark, I don't want to be wandering around, not knowing quite where I am.  I've already chosen not to go places in the evening because of this.
I've thought about getting a vehicle.  The options are a snow mobile (called snow machines here), ATV or an SUV/truck.  So far, I haven't felt I needed one.  But as the snow and ice intensifies, it might not be a bad idea.  There's no protection against the elements with the snow machine/ATV option, though they seem to be most popular around here.  I guess you just bundle up and go.  My concern is the cost and availability of maintenance for these vehicles- I've heard it's not great.  So we'll see.

The coolest ambulance I've ever seen

I have both a PO Box and a physical address.  What I've learned is for USPS (normal mail), everything goes to the PO Box.  The post office is across town, maybe a 15 minute walk, so not terribly far.  Though I don't go often, it's cold and I don't have much mail to pick up anyway.  Then on-line orders (like Amazon) use my physical address.  I got my first Amazon order last week, it was so exciting.  My neighbor texted me, told me Christmas had arrived.  We get excited about mail around here :)

Yay, packages!

I have explored town and some of the surrounding area a bit.  The first weekend, my neighbors invited me to go cranberry picking.  They are really lingonberries, but they call them cranberries here.  We walked 20 minutes or so out of town and picked for a couple hours.  No bears to see, though I heard someone spotted a grizzly with 2 cubs just the week before.  I made cranberry jam which I've been mixing in my yogurt- yum!

Lingonberries, AKA cranberries.

I've also walked a bit through the town.  There isn't a ton to see.  Lots of run down houses, a few abandoned buildings.  The hospital is the biggest and most pleasing building.  Most structures are on stilts due to permafrost- ground that stays frozen year round.  Global warming is threating these structures, as we rely on the ground staying frozen to keep our buildings up.  But it seems we're pretty safe for now.  Because of the stilts, houses/buildings sway.  When I first felt the sway in my apartment, it reminded me of being on a boat.  My neighbor said the first time she felt it, she thought it was an earthquake.  Now, I'm more used to it and I know it will pass.

Maniilaq Hospital, on stilts.

The only wildlife I've seen so far are birds and seals.  The seals are fun, their heads bob just at the surface in the Sound, sometimes they splash and play.  There are boats with guns waiting to get them, so that's not as great.  I guess seal skin makes great hats and boots.  Also something called seal oil which is used both in cooking and as a home remedy for colds.  I went on a walk over the weekend and saw moose droppings, so I know they're around.  Also caribou and bears, though I've yet to see either of them.  I suppose we won't see much in town.  And I don't wander too far out of town, not alone anyway.  So maybe I'll see them when I'm at the villages?
The places of note here in Kotzebue are the hospital, the airport, the post office, the grocery store and the cable/internet company.  There's also a shipping port on the other end of town, only active in the summer.  The grocery store is overpriced but has everything you might need in a pinch.  There are also 4 restaurants in town.  One is in the hospital (the cafeteria), one in the hotel and a couple others.  I bought soup at the cafeteria yesterday for $7, bought a side salad for the same (full salad was ~$15) at one of the restaurants.  There is pizza for $20 medium/$30 large.  Something to splurge on from time to time.

I've mostly managed my food from the things I sent up.  Besides my Anchorage Costco run, I sent up 3 bins full of non-perishable items.  I feel like I have most of what I need.  I don't have a salad or fresh fruit/veggies as often as I'd like, but I have things like raisins and dried peaches to get me by as a snack.  I've bought a weekend flight to Anchorage in a couple weeks, so I'll pick up the food things I'm missing then and replenish what I'm going through.

Then there's work.  Once again, I'm learning a new EMR (Electronic Medical Record), this one is called Cerner.  No fun and in my opinion, not a great system.  But it's what we've got, so I'm trying.  I've started seeing patients, many run-of-the-mill, some not as much.  The difference here is we see both people here in Kotz (90% native) and from the villages (100% native).  Patients from the village come by plane and are triaged by a PA/NP before they come, so we have an idea of why we're seeing them.  But it's dependent on the flight coming on time, and making sure they are done in time to get back on the plane to return home.  So if we order medication, labs and/or an x-ray, we have to try and get all that done before their flight back.  Or if they're sick enough, we keep them here.  Either in the hospital or put them in the hotel.  Or fly them down to Anchorage or elsewhere is it's really bad.  So I have to determine their severity and make decisions in a timely manner to make sure they get the medical care that they need.
Interestingly, there is a high no-show rate here.  Meaning people schedule an appointment to be seen in the clinic, but never come.  This happens even with village patients.  It's hard to know if it's because they missed the plane, or if they came just for a free trip to Kotz and didn't bother getting their medical need addressed.  There's no consequence for no-shows, so we just carry on.
I've been assigned to a village- Point Hope.  It's a relatively wealthy village due to whaling and actually is technically in a different region than Kotzebue.  However, we are paid to see their people.  I will be going there in a couple weeks from Monday-Thursday, seeing everyone I can that need to be seen.  Mostly chronic medical conditions that need to be monitored periodically or other conditions that can wait.  We're short-staffed, so even though it's my first time, I'll be going alone.  I have no idea what that will be like- I'll let you know!

That's it for now.  I'm sure there will be more revelations as I learn and experience more up here.  I feel like I'm leading a fairly boring life here so far.  Not really lonely (yet), but boring.  Just work, hunkering down in my apartment at night and doing some exploring on the weekends (while it's still light).  Time will tell.

Alaska is BIG!

P.S.  For anyone wondering, here is my address.  I love mail, especially chocolate ;)
        Katrine Bengaard
        PO Box 1427
        483B 9th Ave, Apt 9 (only need this line if NOT using USPS)
        Kotzebue, AK 99752