Sunday, June 18, 2006

A Village on the Yukon

Note to readers:

For reasons I cannot fathom, Blogger will not upload my photos. I have many beautiful images that would illustrate this post, and I would love to share them with you. The file sizes are less than 500 kb, and each attempt to load them claims to be successful, but no photos appear. If I ever figure the problem out, I will come back and add them here, but for now the writing will have to stand alone. I am hugely disappointed by this technical failure...


Pilot Station, Alaska, is a small Yupik Eskimo village on the Yukon River, about 200 miles due north of Bethel. The population numbers a little over 500 people. The village is nestled in the cleavage between two large bluffs, a small valley that slopes gently to the river’s edge.

The village consists of about a hundred homes (mostly pre-fab HUD houses and a few log cabins); a small general store selling groceries, some clothing, gasoline, tools and hardware; a Tribal Council building, large enough to hold most of the people for village meetings; a lovely new school (K-12); a lovely new clinic; two churches, one Catholic and one Russian Orthodox; and a barn that houses the village’s road grader and dump truck.

There are no commercial enterprises other than the village store—no restaurants, no businesses. The only paying jobs in the village are at the clinic, the school, the store, or with the Tribal Council, taking care of roads and landfill. The clinic employs nine people: five health aides, a behavioral health counselor, two clerks, and a janitor. The school employs perhaps as many as 30 people (I’m guessing here, and that’s a generous estimate). The principle and all of the teachers are Outsiders who come here for a few years and leave; the local people are employed as teacher’s aides, secretary, and janitor. The store employs about five people. The Tribal Council employs perhaps a half dozen people. Overall, less than 20% of the people have a job. The rest depend completely on the traditional lifestyle of subsistence: fishing, hunting, gathering, living completely off the land. The Native people of the Yukon-Kuskokwim Delta have one of the lowest per-capita incomes in the entire United States; and they are, on the whole, among the happiest people with the richest lives that I’ve ever known.

I have been the primary care provider for Pilot Station for the last seven years. I am responsible for managing their chronic illnesses, their medications, and their specialty referrals. I spend an hour or so on the phone with the health aides every day, discussing the patients they have seen in the village clinic, and deciding on plans of care for each one. When that plan includes coming in to Bethel, the health aide and I must decide whether transportation can be by commercial flight, available twice a day; by charter, usually available within two hours; or by medevac, usually within an hour. If the patient’s destination is not the ED, then he or she will be seen by me in clinic if at all possible.

Once or twice a year the hospital sends me to Pilot Station for a week to see patients in the village clinic. This is absolutely the best part of my job; I love village trips.

The health aides know several weeks ahead of time when I am coming. They start making a list of patients I need to see while I am here; especially elders who have difficulty traveling, home-bound patients, people with no Medicaid and no way to pay for travel. Additionally, the hospital wants me to see as many as possible of the babies under one year of age, the pregnant women, the patients with diabetes and/or hypertension. One of my own goals is to do as many Pap smears as possible. There are currently 84 women in the village who are due for Paps.

The new clinic is quite spiffy and modern. It was built about two years ago, and is a huge improvement over the old one. It has hot and cold running water, flush toilets, and (oh, luxury!) a shower. There is an itinerant sleeping room with two comfortable bunk beds, a microwave, a sink, and a tiny refrigerator. There is a large waiting room with cable TV, an office, four exam rooms with working exam tables complete with stirrups, a counseling room, a dental operatory (rarely used), a lab/pharmacy room, two bathrooms and a storage room. Everything is still shiny-new, and very clean. The clinic is very well supplied with most things any clinic would need. There truly is no hardship in working here, compared to the old days of honey buckets and dipped water.

When I make a village trip, I like to go a day or so early, to have time to settle in a bit, and walk around the village visiting with people. It helps to spread the word that I am here, which gets patients coming in to see me earlier in the trip. And it is just nice to have a little relaxed time in the village before starting very busy clinic days.

For this trip I have a companion, one of the new physicians on staff, Diane. She will soon be making trips to her own villages, and this is her training trip on how to do it. She is quite as excited as I am about coming to the village.

We left Bethel yesterday morning on a Cessna Caravan operated by Hageland Air, the commercial charter company that makes scheduled daily flights to Pilot Station. Taking a small plane to the villages is more like the old (pre 9/11) days of air travel. There is no security screening; no one minds that I have a Swiss Army knife or a Bic lighter in my pocket. The Caravan is a single engine nine-seater (plus two pilots) that holds a fair amount of luggage. The flight up was reasonably smooth, and took about 50 minutes. The view of the tundra from the plane during the warm season shows what a sponge the land is; an endless spread of lakes, ponds, rivulets, and streams. What land there is, is pretty marshy. From the plane we saw several colonies of tundra swans, congregating on the larger ponds by the dozens.

The last few minutes of the flight were a bit turbulent, and my stomach was glad for a smooth touchdown at the airstrip above Pilot. We were met by the Hageland agent, who has one of the very few trucks in the village; he loaded all our gear, and the two of us, in the back of the truck and drove us down the hill to the clinic. The health aide on call for the weekend was there as planned to let us in and give us a key to the clinic.

Transportation around the village in the summer is either on foot or by four-wheeler. The clinic owns a four-wheeler, but the health aides have to buy the gas themselves ($4.75/gallon) if they want to use it, so it mostly sits around unused. I am happy to buy the gas for it; buzzing up and down the hills of the village is great fun, and Diane and I had a ball yesterday touring the place. We stopped and visited a few friends that I have known quite a while now. One friend, Agnes, was totally delighted to see us; she hadn’t heard that I was making a village trip. She hopped on her own four-wheeler with her three-year-old son Devin, and we went to visit her mom and sister.

Mom is eighty-something, a tiny little woman who was so happy to see me, she kept stroking my arm and patting my knee in disbelief that I was actually sitting on her couch. Her nearly toothless smile was ear-to-ear for the short visit. She is the mother of seven daughters and five sons; three unmarried daughters live with her, and most of the rest live in Pilot. She speaks only Yupik, so the daughters had to translate for me as she got out her medicine box and told me about her pills, then showed me her arm where it still aches occasionally since she had a Colle’s fracture a few years ago.

After the short visit we climbed back on the four-wheelers and Agnes took us down to her smokehouse, where her husband Andrew is tending the fire. Salmon are running strong on the Yukon, and the men are out drift-net fishing every day. The women “cut fish”, which means they fillet the big salmon, and then cut the fillets into long narrow strips (half inch wide by about three feet long, depending on the size of the fillet), or make “blankets” by leaving the fillet intact and making cross-wise cuts an inch apart which go down to, but not through, the skin. These are dipped in a brining solution and then hung on a covered drying rack for several days, where no rain and a good breeze will shrink and harden the surface of the meat. Then the strips and blankets go into the smokehouse, where they are hung directly over an oil-drum woodstove fired up with green cottonwood to make a really smoky fire. The fish smokes for two weeks, and the fire must be kept going constantly the entire time. It is a labor-intensive process, but the tasty product will be the staple of the family’s diet for the next year.

Some people also dry and smoke the salmon’s head (as opposed to fermenting it into “stinkhead”, as I described in an earlier post). Next door to Agnes and Andrew’s smokehouse, Bernice and her two grown daughters are cutting strips and brining them. Her younger daughter, Linda, is just learning how to butterfly the salmon head for drying. Bernice smacks her lips and says yummm, she loves the eyes the best. They are nice and crunchy when they are dried. Both daughters look at me and laugh. Linda wrinkles her nose and says, “Yeah, and she can have them all, too.”

From the smokehouses along the slough, we decided to drive up to the air strip and look for wild rhubarb. Agnes was “greedy to get some” and Diane and I were glad to help her gather it. The airstrip is up on the taller bluff and has a beautiful view of the Yukon River. The area around it has nice trees and tall grasses, and the rhubarb grows all over the place. It is early in the season for it yet, so we didn’t find too much, but Agnes was quite happy with what we did find. She will peel the stalks and eat it raw, or make rhubarb agutuk, or bake it in pies. The leaves can be boiled and eaten like spinach, or soaked in dill pickle juice and eaten raw.

On our way down from the airstrip we passed the Orthodox priest, Father Gregory, and his wife Janet, out for a stroll and stopped to greet them. She invited us to a brunch at their home following Sunday service to honor fathers on Father’s Day. We were delighted to accept.

Saturday night was a bit rainy, and by Sunday morning there was a new hatch of mosquitoes that were everywhere. They are not bad if you’re moving quickly, but if you stand still for even a moment they are all over you. Fortunately, Diane and I both brought bug shirts and Backwoods Off.

We arrived at Father Gregory’s house right on time. Janet was busily making mountains of French toast for the hungry roomful of people gathered there. I went around the room, shaking hands with each person, and introducing Diane. I was pleased to find that I knew almost all the names without prompting; I’m terrible with names (but never forget a face) and I’ve worked hard over the years to keep names and faces of people from Pilot Station filed together in the often leaky sieve of my brain. Slowly, I’m getting it. Now I’m also trying to add family connections to my internal database of each person. What I really want is a wall map, where I can graph the entire village and visually see the connections.

The brunch spread was lovely. When it was ready, Father Gregory and his assistant priest lead the large (30+) group in prayers, blessing the fathers, grandfathers, stepfathers, godfathers, and fathers-to-be. The blessing lasted a good five minutes; Orthodox are known for praying quite thoroughly.

There was much talk over brunch of fishing and fish camps. When the salmon are running, most families leave their village (or Bethel) and move to their inherited spot on the river known as fish camp. They will live at camp for two to three weeks, until all the fish they need is finished smoking and ready for storage. To have a drying rack and smokehouse in the village, like Agnes and Andrew, is unusual; there is not enough room for everyone to do that. Most families have camps on the river that are passed down for generations. Some are accessible by four-wheeler, but most require a boat.

The camps have no electricity or running water. Most have rudimentary cabins, a covered drying rack and a smokehouse. Some have a steambath, which is really a luxury. The fish are headed and gutted right at the river’s edge, where they can be easily washed and the guts disposed of in the river. The cutting table for filleting and making strips and blankets is right next to the drying racks and smokehouse. It is a family affair, and even the older children will help by carrying water and feeding small fires set around the area to cut down on mosquitoes.

Just upriver from Pilot Station is a cluster of several fish camps. I know the families who own them, and Diane and I were invited to come up after the brunch to visit. Several people at the brunch were going by boat and offered us a ride. I’d have been quite happy if the boat ride had taken an hour or so, as I have never been out on the Yukon in a boat. But it only took a few minutes to get there.

Yesterday was a very good fishing day, and there were lots of fish hanging and still being cut. One drying rack had over 200 fish hanging. It was a beautiful sight. An old woman and her daughter, Martha, had done the cutting in two days; they were up most of the night last night cutting fish. The old woman was tired, and her arthritic hands were hurting from holding the heavy fillets and keeping a tight grip on the ulu (Eskimo knife), which becomes very slippery when covered in fish blood. Diane and I sat next to the drying rack and chatted with them for a while. Martha has had some health problems lately, and I had referred her in for an MRI and a visit with the neurologist. She just got home from Anchorage two days ago and wanted to bring me up to date on the trip. I was very glad to hear that the studies had been normal.

Diane and I caught a ride back to the village and returned to our home base at the clinic. We look forward to relaxing in a relatively mosquito-free space for the evening. Janet or Agnes may call us to come take a steam bath tonight, and I will be happy to accept. Tomorrow promises to be a busy clinic day.

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2 Comments:

Blogger Al said...

Very nice description of life in the bush. I look forward to seeing plenty of pictures.

Tuesday, June 20, 2006 6:21:00 PM  
Blogger Wil said...

Whener you have a problem with Blogger, first check the status of the servers by reading the Status Blog (http://status.blogger.com/).

Don't forget to place the cursor a couple of spaces into the edit window before attempting to upload photos. Don't know why it makes a difference, just that it does.

Great entries, btw. I really feel for you viz a viz the mosquitoes. After almost a solid month of rain here, they are very thick and voracious. Miserable gits...

Friday, June 23, 2006 3:38:00 PM  

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