Travel

I finally got to travel to a village after we shut down routine trips due to COVID-19.  Not my assigned village (Noatak), but Kivalina which was having trouble with staffing.  I was originally told I would be the only provider, so would be on-call 24 hours a day for the week I was there.  Thankfully, a CHA (Community Health Aid) agreed to stay M-F, so I only had to do night call every other day until the weekend when it was all mine.

Kivalina is on a barrier reef, not connected to the mainland though they are building a bridge/road that will connect.  The village is eroding from harsh storms and rising water from global warming.  Eventually they will need to move the village inland though there's been some resistance from the people.  A new school is being built 5 miles inland and the road will connect the village to the school.  The hope is that people will start moving inland near the school and make the permanent relocation easier.  Meanwhile, the whole village gets evacuated periodically for weeks at a time when storms come and ravage the structures here.

My plane getting unloaded.

I landed in Kivalina by propeller plane on a Monday morning.  I was picked up by the health aid trainee and taken on an ATV to the clinic.  I brought along food for a week in a cooler and a small suitcase.  I dropped my things in a small bedroom behind the little kitchen in the clinic.  Before I knew it, I hopped back on the ATV to see an elder at her home.  I saw a few more patients back at the clinic, then was asked to hold the night phone.  The challenge at night is to decide if the patient is OK to wait until morning or has to be seen right away.  Sure enough, I had someone that I tried to keep home but she kept calling, so in she came.  She left at 11pm feeling much better and I got in bed to try and rest up for the next day.  A couple days later, a middle aged man was found dead in his home so I had to go pronounce him and call the troopers to fly in for an investigation- that was a learning experience for sure.

Whale bones.  They get some beluga whales here, not often the big bowhead whales.

And so it went.  Since this isn't my village, I didn't come with a list of patients I was hoping to see.  Instead, I saw whoever called in with a concern.  Similar to when I was in Point Hope, I also saw the health aid, administrator and the janitor as patients- they all seem to come up with health concerns when a provider comes to town.  

Waking the beach, black sand and rocks.

After clinic closed at 5pm, I tried to get out and walk around.  The beach was nice though a little difficult to walk on.  It was chilly (in the 30's), so I'd walk along with my winter coat and hood up.  There were big jellyfish and crabs washed up by the waves- who knew?

One of many jellyfish washed up on shore.

One day, I walked back through town.  I saw a group of people gathered, several kids playing in the street.  As I got closer, one of the kids asked my name.  Then he pointed and said "There's a drunk over there".  A lady was lying on the street surrounded by 2 other adults talking to her and trying to get her up.  I felt sad for her.  Also sad for the children that were watching, observing.  Alcoholism is so pervasive and destructive in this people group.  There's no alcohol available to buy in the villages so they have to be strategic to get it here.  But they manage and their daemons follow them.

It was nice to get away, nice to break up some of the monotony of life in Kotzebue.  I do hope I get to go to Noatak one day soon.  We're waiting on the tribal councils to agree to allow routine visits to villages by providers again, this was halted due to COVID-19.  Though we continue to get COVID-19 cases, symptoms are mild and it's a struggle to enforce social distancing in a culture that doesn't not embrace this concept.

I also got to take a vacation to the lower 48.  I met my family in North Carolina, then drove with my parents to Nashville before flying down to Orlando to visit my bestie and her new twins.  Then back to Houston with my parents to do some on-line CME (Continuing Medical Education) before heading back to Kotzebue.  

Back to the frozen tundra.  That lagoon was not frozen over before I left, now people are ice fishing every day.  They are catching Tom Cods.

I'm in radio room today- not my favorite assignment.  I have to field all the notes from the CHAs (community health aids) in the villages.  It can be as easy as prescribing tylenol, but sometimes it involves flying them in for evaluation in Kotzebue or planning to have them seen by a specialist.  If someone is in serious trouble, we try and pull them up on the screen and walk the CHAs through things like CPR or splinting a fracture.  I much prefer to manage patients in person but with villages, that's just not possible so we rely on the CHAs to relay information to us the best they can and try and to make the best decisions to get patients timely care.  

In the radio room "dungeon" with my Halloween mask.  This is where all the magic happens.

We sometimes have patients threatening suicide in the villages- that's a hard one.  We do have behavioral health practitioners that can get on the phone with the patient.  If the patient is not in the clinic, we utilize the VPSO (Village Public Safety Officer- volunteers in the community) to go to the home for a welfare check and sometimes physically restrain them.  I wish I could understand why suicide was so prevalent up here, why we haven't managed to make strides in preventing this terrible statistic from rising.

There's a blizzard outside at the moment, planes aren't landing so village patients are on their own.  I still wonder how I ended up here sometimes...  Looking forward to getting my cross country skis out and being all bundled up.  I saw a fox yesterday, maybe there will be other critters to discover.  Always an adventure up here!