Suction --- GROSS ALERT - feel free to skip

So I had a handful of kids today that needed their ears suctioned out due to wet, goopy, slimy, smelly drainage. Problem... I don't have have suction. So after I had to let all these kids leave... I am forced to go on a mission. After asking a few people. It's finally decided that I take the portable suction that's in my clinic (and hardly ever used) and use it. So currently, my assistant is trying to track down more tips so I can suck goobers out of all my kids ears and not have to make them come see the ENT when they come to town.

Car insurance

It's been a 2 day process due to time differences but I've changed my insurance to cover me here in Bethel.
I had to go with a national carrier so we'll see how that goes. But I'm licensed here, my car is registered here and now my insurance is finally switched.

Time and Temp

9:15 am @ 39 degrees F with a high of 57 degrees F (keep in mind the sun's only been up for an hour)
Sunrise: 8:16 am
Sunset: 9:07 pm

"I'm from the village" ...

I had a patient and their parent in here the other day and  I was talking to them about what we were going to do during the testing session. The parent looks at me and smiles, then says, "I'm from the village, you're going to have to speak slower or we won't understand you. We have a slower way of life."

I love this because 1) the parent is right, way of life up here is slower than most other places I've lived and even slower in the villages. My frenetic energy when I go on a cleaning tear (as my Work-Mom can attest to) is something that would be an absolute spectacle up here. and 2) the parent spoke up and told me what I needed to do to help them communicate with them.  - This should never be a source of embarrassment for anyone. Communication makes us human and creatures who love. It's the currency of life. Even in times of complete poverty or depression, the communicate your idea is essential to survive. And communication is a give and take. You can't just give a message, you have to receive it as well.

A little background on my voice:

•  At home-  my voice is a 'typical level and I sometimes swallow the ends of my words, and talk into cabinets/fridges/from the other room."  Essentially, I'm human. I do this even though I have people in my family with hearing loss- I make mistakes, I think we all do. That being said, I do try to raise my voice or talk over my shoulder. I also know that there's a very good chance I'll have to repeat or rephrase what I'm saying. I'm ALWAYS aware of situations that are difficult and try to make changes to how I'm talking before necessary. Communication is a 2 ways street. It's hard for me to know exactly WHAT a person does or does not hear in any given situation. At the same time, I've never met anyone who LIKES to have voices raised at them unnecessarily and everyone's ability to hear is different. So as much as I may try to speak clearly and loud enough, it's also the listeners responsibility to let me know if I can do something different to make things easier for them.  --So this parent was communicating beautifully--

• At work- my voice is slower, louder (not shouting but definitely projecting at times), and I enunciate. Essentially, I play it by ear, but I'm always trying to make adjustments in my voice to make it easier for someone to understand. I still have people tell me to speak up or get softer because I'm 'shouting' to them. -I'd rather have someone correct me than not be able to understand a darn thing I'm saying but pretend.

BTW, one of my humble opinions is that Enunciation is key to communication with anyone, especially with a hearing loss or when there are language barriers. That's exactly what was going on here. There was a language barrier. Many people who live in the villages grew up learning a Native Tongue, like Yup'ik. I had two teenagers last week who were just starting to learn English. And, yes, these are teenagers living in the US in this day and age. It's part of keeping a culture alive, it's being able to speak to your elders without complete assimilation into American teenage culture (lack of assimilation is NOT a bad thing in my mind).

Gave Blood!!!

Bethel had an annual Blood Drive today. ... YES, you heard that correctly, the ANNUAL blood drive (I live in such a small place that they only get a drive that often).

There's the Blood Bank of Alaska that travels to villages all over and does a drive. Good news is that they were full and not even able to take walk-ins by 3/4 through the first day. I wish they'd been able to stay open longer, there's always a need. I also wish the hospital had some sort of blood bank here but maybe someday, right?

Winterized

My car now has a tail... in the front. Mine is actually zip-tied to the front grill, but it's there.

Most people are telling me that you should go out an hour before you're ready to go and plug it in.Essentially letting your car idle while you're inside for 1 hr.

I was told by the mechanic that it was best if you plug it in at night when you get home. Then when you're ready to leave in the morning you unplug, put the key in and go- no worries about going outside ridiculously early in the cold and in your PJs to start the car. Apparently, what you end up spending in extra electric is far less that what you'd end up spending on extra fuel while idling for an extra hr a day (remember, gas is currently $6 a gallon, it only changes once or twice a year though).

The only thing left to do for the car there is get my fluids replaced. (Was going to get it all done at once, but it just didn't happen)

Water... cont.

I know I've mentioned in the past how some people have water tanks and some have city-water.

I've recently been told that some actually prefer to be on tank-water because the city-water comes out red/brown tinged due to rust in the lines... yuck.

I can see Winter...

Conclusion that there's really 2 seasons here in Bethel. Winter and Summer.

I've not yet experienced Winter (but of course I'll fill you in when I get to that point), but I can tell you that It's going to be COLD. Boots are rated to -30 at a minimum. Car's are Winterized to deal with the same. Wool is a staple up here as are: BOGS, Smartwool, Columbia, Patagonia, North Face and fur. ...

Now before anyone goes at PETA on me... Animal skins are fur are used here. There is subsistence fishing, hunting and gathering. Subsistence Living is living living off the land and what you can grow, hunt and gather yourself. Native Alaskans do quite a bit of subsistence living. They hunt moose and other game. They fish for their yearly meals and they gather berries during the summer and fall. Now everything gets frozen and saved for later. Moose can be sent out to be made into particular cuts like steak and also to have summer sausage or have the meat ground for burgers. The skin and furs of these animals are used to make clothing: coats, mittens, hats, boots. Very little, if anything, is tossed after kills.This is their livelihood and not done 'just for sport' or for fashion.

To me, the weather we've had all Summer is actually more of a Fall. It was shorts-like weather for 1 day that I can recall. The rest of the time it's been at least long sleeves or pants and sometimes both. This week for instance, some locals are wearing short sleeves and some are wearing fleece coats over many other layers.

I've yet to pull out a coat other than my raincoat (which is quite lightweight) but I have been wearing long-sleeve fleece almost everyday.  (BTW- if anyone knows a good place to get good quality fleece zip-ups for a decent price, I'd appreciate the heads up). Maybe I'll be OK this Winter after all.

Car Winterization

So it's not super cold yet, BUT, looking ahead, I just scheduled my car for it's Winterization. Appt: 9/15th.

I will get it serviced to get new lube, oil and filter then 2 heaters (Block and Oil Pan), so long as my car can handle it. Everything will be rated to kick over in -30 degrees.

Rain Water

I learned last night that rainwater here is not the acid rain nastiness that I'm used to. I don't know that i would go so far as to say it's potable since the environment is picking it up from somewhere else outside, but it is gentle enough that if you wash your hair in rainwater, your hair is nice and soft.

My assistant has a couple barrels/huge Rubbermaid containers out to catch it as back-up water for when they need more than they have trucked in.

It's nice living in a place where the rainwater won't give you an instant need for a decontamination bath.

Flu Shot

I just walked into the hall to consult on a patient and the employee health Flu Shot Cart was in my hallway. I raised my hand to signal I wanted a shot while still talking about the patient and she told me to bare shoulder and write my name and birthday. Before I was done consulting, my shot was done.
Surreal and great time-management.

Darkness invades

It's still a reasonable time at night when the sun goes down (it's setting in the 9s) but what's hard to get used to is that it's still dark when i should be waking up and twilight-ish when I drive to work.

Someone told me we lose 6 minutes a day of daylight. not sure how true/untrue that is but it sounds about right.

Hospitality... in review

*** Disclaimer: These are my explanations and examples. Feel free to add your own 10 cents. ***

Southern Hospitality:  Charm with a southern drawl or twang. Lots of smiles and nicknames like "Hun", "Darlin", "Sugar", etc.  Slower pace. Offered tea or lemonade when you arrive (and there is NO such thing as unsweetened tea). You can strike up a conversation in the grocery store with a stranger and be acting like best friends by the time you're done checking out and you may never see the person again. Everybody nods to strangers on the street and in some places it's a tip of the hat. Gentlemanly ways are still taught and people are always there to lend a helping hand and regularly go out of their way to do it. Can be passive aggressive if someone wants their way and feels the need, e.g. the art of telling someone to go to hell with a smile and sometimes without the receiving individual even knowing you're telling them to go to hell. 


Mid-Western Friendliness:  There's a wholesome-ness. The Girl-Next-Door and the All-American-Boy archetypes. And again, The Art of being a Gentleman is also still taught and you can still start up a conversation in the grocery store. Just generally friendly. People are not mean really.

Pacific-Northwester Laid-back(ness): Nothing seems to stress these people out. Things are no big deal, clothes are no big deal. Things are functional and not stick-up-your butt. I'm pretty sure people still wave and nod but there just isn't much if any elitism.  (I haven't lived in this area so please take my opinion with a grain of salt above and beyond the fact that it's just my opinion)

Alaskan Accommodation: I'm still learning about the extent of the accommodating nature but from what I've seen people here definitely go out of their way. If you look stranded in a boat or in a car, no one passes you by. There's an honor system with things like locking doors to homes and cars (I still haven't quite gotten the hang of this one). Part of this is out of necessity. If it's winter, you wouldn't want to be stranded and you wouldn't want it to be a friend or family member stranded if someone could easily just pull over and ask if you need something.  Almost every patient I have asks how I like it here so far and offered suggestions for housing or entertainment or even recommended scheduling trips out of town, etc. People recommend places to get certain things and aren't much for the "figure it out on your own" rule. It's refreshing after spending time in places with  very different mentalities at one point or another.

Good News!!!

Background:
I have student loans to pay back for graduate work at a private institution. This adds up to a pretty penny, and the plan prior to relocating to Bethel, AK was that I'd slowly pay off these debts for the next 17or so years. This cuts into my paychecks fairly substantially when you look at interest and principle over the repayment period. I know many of you out there understand exactly where I'm coming from.

When I looked into the job here in AK, I found out that 1) There's no state tax in AK. 2) There's a dividend paid to AK residents every year (you have to establish residency first) and 3) working int he medical field, there was the option of getting loan forgiveness or repayment for working with the native population/working in a rural area.

Enter stage left... Loan Repayment Program (LRP) through Indian Health Services (IHS). Those who work in certain medical fields are qualified for tuition repayment if you work with the Native Alaskan or Indian populations and/or rural areas.

When I looking into the LRP, it was quite clear that all Federal and State loans taken out during the education period to obtain my degree (all of grad school) would be eligible for repayment, the question was IF my private loans were qualified as well. The application and policies said "federal, state and corporate loans". Corporate loans in my understanding were loans for a business but as it turns out, they consider private loans for school to be under this category.

Current:
I received an award letter that all of my grad school loans are qualified for the LRP. This means I get to save more money, and Pay off my school debt in 5-6 years instead of 17-20 years. Also, I'll be staying a little longer in Alaska than originally planned (unless I absolutely HATE the winters, which I'm doubting).
As I put it to my parents... I'd be an idiot to turn down free money.

My insides are all gooey at the prospect of being completely debt-free by the time I leave here. And who knows, maybe I'll love it enough to stay forever. Only time will tell.

Change on the horizon

Sunrise @ 7:40 (it's still dark when i get up... but it's still light when I head to bed then gets dark as I fall asleep)

Weather... a gray/drizzly 44 degrees (I pulled out the Under Armor today with a vest)