Eskimo Ingenuity

One of the responsibilities of my job as a health care provider in southwest Alaska is to spend some time each day on the phone talking with health aides about the patients they see in their villages. (I have written before about the unique role that health aides play in the delivery of health care in rural Alaska here and here.) This phone consultation is called Radio Medical Traffic (or RMT), so-named because it was once done over VHF radio (before the days of HIPPA).

Last week I was doing RMT with a health aide in one of the downriver villages. His name is Abe; he is a forty-something Yupik Eskimo man and one of the few male health aides. I always enjoy talking with him; he is an excellent health aide, with a good grasp of the basic essentials of medicine and a lively curiosity and desire to learn more. We usually have interesting discussions about his patients, and he always has good questions. I have encouraged him to apply to PA school, but he does not have the prerequisite college coursework, and he does not want to leave the village for two years; and he really enjoys being a health aide.

One of Abe’s patients that day was a young man with a beaver in his lungs (asthmatic bronchitis). He’d had a chest cold with a productive cough for about a week (no fever), but the day before he had started wheezing and feeling somewhat short of breath. His respiratory rate was up to 28 and his oxygen saturation was down to 94%.

Abe and I discussed getting him started on albuterol. All the village clinics have several nebulizer machines which they loan out to patients for short-term use, but Abe said that none were available that day in his clinic. He did have a good supply of albuterol metered dose inhalers in the drug cabinet, however.

“OK,” I said. “Give him an MDI with a spacer, and show him how to use it properly.” A spacer vastly improves the efficacy of an MDI, even for an experienced user; for novices, I consider them essential. A spacer is basically a plastic tube; the MDI attaches at one end, discharges its “puff” into the tube, and the user slowly inhales the puff from the other end. Some even have fancy bells and whistles, like an alarm that sounds if the user inhales too quickly.

This technique allows more of the medication to get deeper into the lungs. When the MDI is held to the lips and discharged, more medication sticks to the mucous membranes in the mouth and less gets down into the lungs. The force of the discharge hitting the back of the throat may also cause the user to cough, preventing any medication from getting into the lungs. And the user’s timing of discharge-and-inhalation is crucial. A spacer eliminates these problems.

“But,” said Abe, “we’re out of spacers. The hospital pharmacy only sends us two per month, and they’ve already gone out.”

“No problem,” I answered. “Take the cardboard core out of a toilet paper roll. Show him how to hold the MDI at one end with his hand wrapped around the junction. It’ll work just fine.”

“OK!” Abe said enthusiastically. “We can Eskimo him up!”

I could just see the grin on his face.
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A few days later I told this story to my friend Henry, who has lived here for over thirty years. He laughed and nodded.

“One of the things the Yupik people are very proud of is their ingenuity in rigging up something to solve a problem. I once saw a man carve a piston from a piece of ivory to make a snowmachine engine work. I’ve seen a washing machine motor rigged to push a boat when the outboard motor failed. They are amazingly inventive when it comes to making things work.”

I thought about Abe and the spacer problem. I knew he would take care of his patient, and find a way to get the albuterol where it needed to go.