The Villages of Southwest Alaska

A gray, cold, windy Saturday and I think perhaps it would be a good time for a geography lesson. Most maps of Alaska show only a few of the villages of the southwest quarter of the state. I've mentioned several of them in previous posts, and I thought you might like to see where they are. I love maps anyway; my dad taught me how to read one when I was pretty young, and I've always enjoyed pouring over them.

When I first came to Bethel in 1998, I was fascinated by the village names. Some of them are quite lyrical and fun to pronounce; kwig-a-LING-guk sounds like a bird call to me. AK-i-ak sounds like laughter. And e-MUNG-UK sounds like throat clearing. Yupik is a very gutteral language, with many sounds deep in the throat, so it makes sense.

The entire region between the Yukon River and the Kuskokwim River is referred to as the Y-K Delta. There are 58 villages in this region, home to about 20,000 people. The great majority are Yupik Eskimo. The smallest villages--Nunam Iqua, Oscarville, Pitka's Point, Lime Village, Stony River--have less than 50 people. The largest village, Hooper Bay, has about 1200 people. Most villages are in the mid-range, with populations of 400 to 600.

Each village has a health clinic staffed by community health aides with very limited services available. Health aides can draw blood to send in to the hospital for processing; the only lab tests they can do in the clinic are urine pregnancy tests, rapid strep tests, dip stick test of clean catch urine, and finger-stick glucose. There is no imaging (x-rays) available, and only a limited formulary of medications which health aides can dispense on a provider's order.

There is an intermediate level of care available in the Delta which I have not previously discussed. The hospital operates four larger Sub-Regional Clinics in the villages of Aniak, St. Mary's, Emmonak, and Toksook Bay, with a fifth planned for Hooper Bay in the next few years. These clinics are staffed by two mid-level providers (physician assistant or nurse practitioner), in addition to community health aides. They have x-ray machines capable of doing chests and extremities; these are initially read by the PA or NP, and then transmitted electronically to Bethel for reading by a radiologist. They have small labs capable of doing automated blood tests (ISTAT chemistries, CBCs). And they have a larger pharmacy than village clinics, with more medications available; health aides can only dispense this expanded formulary when the PA or NP is in the clinic. The goal is to also have a full time dentist in each Sub-Regional Clinic (SRC), though that hasn't happened yet. Each SRC does include a fully equipped dental operatory. The Physical Therapy Dept. at the hospital sends one of our four physical therapists on field trips regularly to the SRCs, which helps provide service to patients who cannot travel easily. It is generally easier and cheaper for patients to travel to the closest SRC than to come to Bethel.

When I first came to Bethel, there was only one SRC, at Aniak. The other three have been built in the last few years. There has been discussion in the past of having physicians at the SRCs and mid-levels at all the village clinics. I expect that will eventually happen, and I hope it does. At this point, staffing is such a challenge for us that it is not even a goal that is in sight. The SRCs have not been consistently fully staffed with PAs and NPs in the last two years; and the hospital has never had a full, permanent medical staff in my eight years of experience here. It is hard to find medical and nursing staff that want to come here, and even harder to find ones that want to stay longer than two years. The life here certainly doesn't suit everyone. I feel incredibly lucky to have found my way here, because it does suit me. If there are any hardy and intrepid souls out there who think it might suit you too, let me know. We are always looking for a few good folks who are ready for the adventure of their lives up here at the edge of the planet.