It's that time of year again

my apartment was slightly flooded this morning when i left for work. I took a trip down to the river last night and took some pictures. but i actually had to wear my bogs to get down my stairs. Really the water was only up to the top of my foot but Danskos are not all that waterproof so I didn't take the risk. I'll try to post some pictures soon.

NY Times article on Bethel and YKHC (click here)

All credits to NY Times and Author, Kirk Johnson

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May 28, 2013

Health Care Is Spread Thin on Alaskan Frontier

By KIRK JOHNSON

BETHEL, Alaska — Americans in some rural places fret at how far away big-city medical help might be in an emergency, or at the long drives they are forced to make for prenatal care, or stitches, or chemotherapy.

Dr. Ellen Hodges only wishes it could be so easy.

She oversees health care for a population of 28,000, mostly Alaska Natives, here in the state’s far west end, spread out over an area the size of Oregon that has almost no roads. People can travel by boat or snow machine at certain times of the year, but not right now: the Kuskokwim River, which wends through Bethel to the Bering Sea, is choked with unstable melting ice in late May, magnifying the isolation that defines everything in what may be America’s emptiest corner.

“If you have a road, you’re not remote,” Dr. Hodges said.

The complex machinery of health care is being reimagined everywhere in the nation through the combined prism of new regulations and shifting economics, even here on the continent’s frosted fringe.

The grandly named Yukon-Kuskokwim Health Corporation, for example, where Dr. Hodges is chief of staff, is scrambling this spring to install a new electronic medical records system. That is a hallmark of the federal health care overhaul, compounded out here by the fact that computers run by generators in far-flung villages are subject to brownouts and fuel shortages.

Cost controls are also the way of the medical frontier no matter where you look. In other places, such constraints may be driven by insurance companies; here, by sequester-driven budget cuts to the federal Indian Health Service. The agency is the 50-bed hospital’s main support in treating the tribes and villagers who have lived for thousands of years in the boggy crescent of lowlands where the Yukon and Kuskokwim Rivers carve their paths to the sea.

The 56 tribes in the region voted in the mid-1990s to bundle their health care money from the federal government to finance the hospital. Grants supplement the work.

But the one thing that shapes every care decision, from the routine to the catastrophic, is the map. Triage in medical decisions, logistics and money is all filtered through an equation of time and distance on a vast and mostly untracked land.

Is air transport justified for medical reasons? Too slow to make a difference? Too dangerous in bad weather to attempt? What should a health worker on the ground — in most villages a local resident trained by the hospital — be told to do, or not do?

“There are judgment calls that you never have to make in the lower 48,” said Dr. David Bielak, 31, a family medicine practitioner who started coming here last fall in temporary stints from his home near San Jose, Calif.

And many of those decisions, often based on telephone descriptions from a villager, can be weighty. None of the more than four dozen communities served by the hospital have a doctor in residence.

“It’s the middle of the night, and you get a call from a clinic way up in the middle of nowhere where something very, very strange has happened,” Dr. Bielak said. “A lot of it is dark: a lot of alcoholism, suicidal ideation, a lot of abuse.”

A lack of running water and sewer systems in many villages in turn compounds the struggle to make, or keep, people well in a place long marked by poverty and isolation.

Take a glimpse, for example, into Alexandria Tikiun’s world: At age 25, with four children at home to care for, she is a community health aide, the closest thing to an M.D. in her village, Atmautluak, population about 400.

The aide system itself is uniquely Alaskan. It was developed in the 1950s, during an outbreak of tuberculosis, when the first health aides were trained to dispense medicine. Now, in sessions here at the hospital, Ms. Tikiun and 150 other aides, mostly women, learn medical skills that include trauma response, pregnancy testing and vaccination, all based on a book that they call their bible, which walks them through a kind of algorithm of step-by-step questions leading to treatment protocols.

On tougher cases, Ms. Tikiun consults by telephone with a doctor in Bethel. For medical checkups, she can use a telemedicine machine that allows, say, a child’s ear-exam results to be sent electronically from the village clinic to a specialist in Anchorage or elsewhere. X-rays are read by radiologists in Ohio.

But life in the Alaskan bush, with all its attendant risks and mayhem, is never far away. Ms. Tikiun said she once spent two hours on the floor of a pickup truck, ministering to an accident victim with multiple fractures and lacerations as her driver raced down the frozen Kuskokwim River ice road, bound for Bethel’s nine-bed emergency room.

The added stress of the work, said another village aide, Randall Gamball, is social. In a tiny village, every patient is without exception also an acquaintance or a relative.

“It’s really tough to work on someone you know,” Mr. Gamball said.

The hospital’s flight paramedics, meanwhile, have to be ready with unpredictable medical emergencies and a sometimes radically ferocious climate at the same time. Whiteout conditions and temperatures 40 degrees below zero are not uncommon in winter.

Mark Stevens, a paramedic originally from eastern Washington, described one particularly memorable rescue: His team — two paramedics and a pilot — landed their propeller plane on a village airstrip, but then freezing fog closed in, coating everything with thick, heavy ice.

It took three hours of frantic scraping — two crew members at the plane, the other with the patient — before they could head back.

Every flight must be a consensus, Mr. Stevens said, and any member of the three-person team can veto the plan if conditions seem unsafe. “It’s three to go, one to say no,” he said.

Doctors and nurses are also mostly from the lower 48, doing stints here of a week or a month. Sometimes, being thrown together in an isolated place has unexpected benefits. Dena Gray and Gary Holmes, both registered nurses — he’s from Alabama, she’s from Oklahoma — met at the hospital. Last month, they flew to Las Vegas and married.

Others fall in love with the patients, or the tundra, or some combination. Dr. Hodges, 38, came to Bethel on a two-year contract, vowing to leave at the first possible opportunity. That was 10 years ago.

This article has been revised to reflect the following correction:
Correction: May 28, 2013
An earlier version of this article misstated the number of tribes that voted in the mid-1990s to bundle their health care money from the federal government to finance a hospital. It was 56, not 58.

Things to look forward to...

- cheaper gas (I just got gas at a wonderful $7.06/gallon)
- internet that doesn't decide to take a nap randomly throughout the day
- Phone service that doesn't drop calls for seemingly no reason.
- a change of scenery

... and so much more

Bethel was a great experience but it is not the place for me to spend the rest of my days. Maybe in another time and place with a different set of circumstances. I will miss so many of the people and I have made some lifelong friends here so it was in no way a waste but it's time to move on.

On the heartwarming side, I've had 2 patients this week that just kept asking me "why?". For them, my answers were total BS. I understand that. It would take much too long to explain everything so the short answer is what they got. Oh well, I'm doing this for me. 

Move #... 16

That's right people, I'm getting ready for move number 16, 11 of which were just to a new city within the same state/general location. This is not my first Rodeo.

I have a new apartment. I feel like a grown-up because it's actually a rental condo. It has 2 bedrooms and 2 baths... all for lil 'ol me. Seriously though, when did I grow up?  The new place has garage parking (shared), storage, walk-in closet, kitchen pass-through, balcony. I'm excited.

My car and all my belongings will get there within 2 weeks of pick-up but hopefully it won't take that long. And I'll have a rental initially so I can still get around. I have someone coming to hang out and help unpack if everything gets there. If not, i'll get some shopping done, sight see a bit and go from there.

There will be a lot cooler settings in the background in Anchorage so I'll try to take many more pictures for you guys as time goes on. I'll be there at least another 2 years.

Back to organizing for the move... :-D

Coming together...

6/7/13:  Last day at current job
6/11/13: Pack and Load
6/13?/13: Fly to Anchorage
6/24/13: First day at new job

I am REALLY really close to having an apartment. I have a good friend going into Anchorage next week who will take pictures and, knowing me pretty well, if he thinks I'll like it and be happy there will hand over the paperwork and deposit check.

If it works out... it's a 2 bed, 2 bath (or 1 bath- there are 2 different units available), with garage parking that's pretty centrally located. balcony. the 1 bath has a walk in and regular closet. the 2 bath has a walk in closet in the master--- I don't have ANY closets right now.

Interesting Alaska headline

Bear attacks human... and loses! But Why?

Yesterday I saw an article about a brown bear that attacked a human and lost. Wait, what?!? Yes people, you read that correctly. It was also seen acting erratically attacking a pole. My first thought was rabies. Then this article popped up today.

Short story... The bear was blind. Completely on one side and partially on the other. It was killed with an empty belly after this attack. Likely hasn't been able to hunt for some time. Anyone who has had a pet that was blind knows they are more tentative in some ways, but when faced with fear they will lash out. Sometimes successfully and sometimes not. It's hard to say if the bear was going after the human because it saw it as easy prey or because it was startled and trying to protect itself.

New rule...

Be completely 'unavailable' during my lunch break. If I sit where people can find me or keep my phone so I can be called or sit in front of my email... people call, they come find me, they shoot me an email. Then I end up working through lunch and wondering why I get absolutely exhausted at 3pm. I NEED time to just sit and fill my belly, maybe read. I need to to sit and face the sun and feel rested.

Preparing for relocation

So this time, the relocation isn't nearly as far or as restrictive. This time instead of a $ limit (including my car) I have lbs limit (and my car). So JAX will be going to Anchorage with me as will all of my stuff here, and possibly the stuff that I left at M/D's in a closet.

BUT, turns out this is considered enough of a corporate move that i'm not supposed to pack anything. They are going to fly a mover or 2 into town and they'll pack everything up. Then it turns out that instead of barging it back down to Anchorage, it's going to go in a plane via air freight. It's more expensive up front but they said they end up paying more in loss/damage claims when it goes by barge. I'm good with my stuff arriving in one piece so I'm all for it.

So my plan is to clean/purge of things that need to go, but also to organize all my paperwork and scan it to a digital format so I can then shred it and no worry about having to cart around paperwork I probably don't really need to begin with (wish me luck, not an easy task). I'm working on the cleaning part of things now. I need to take pictures of everything so they can estimate shipping costs.

I'm working on finding an apartment or possibly a roommate. Still weighing pros and cons. If anybody has friends in Anchorage who are looking for roommates, feel free to let me know.

I can't wait to start exploring more of Alaska. Maybe even learn to snowboard next winter :))).

:(

Total bummer... I got decent sleep last night (8 hrs) and the last couple days before that was at least 6 hrs yet I have big 'ol dark circles under my eyes. Not a fan of this. Also not a fan of feeling the need to cover em up with make-up. I'm really bad at being a girl and wear only the bear minimum. Most days nothing but eyeliner (blond eyelashes are a bit annoying).

Sunrise

I have no idea what time sunrise really is here yet, but I've found that if I leave my window/shade open at night the sun is up with plenty enough strength to not let my arse roll over and stay asleep in the morning.

::Edit:: Oops, i already posted about this. my bad- see... not a morning person AT ALL

As a follow-up to the move situation... I have to decide what I want to do as far as apartments go. I found a nice place with W/D but its a 2bedroom. For just me that's really not necessary, though I can work towards getting a roommate. It's about 1-200 more than what I pay now but it's about twice as big and can come with a garage. I would really prefer to have a roommate and that place but if not I have to decide if I go for something cheaper that likely doesn't have a W/D or take it and look for a roommate after I move in. Thoughts?

Change is on the Horizon... I'M MOVING AGAIN (Staying in Alaska)

I hadn't updated in a while. mostly because it's kinda the same old, same old. The river is still frozen which is a little different. I'm not sure why, but some people are still driving on it- that would terrify me right about now.

We switched to an electronic health record system at work and I've been spending lots of time trying to smooth out that transition. It's a very very slow process unfortunately. My waiting list hasn't gotten any shorter for sure.

OK... so the big change... I'm moving to Anchorage in June. Essentially,  my contract with the hospital (2 years) is up in June. So I have applied for a transfer of my LRP (Loan Repayment Plan) through IHS (Indian Health Services). I will be moving to ANMC (Alaska Native Medical Center) so I'll still be working with a native population but I will deal with all of Alaska, not just the Southwest Region. I'll be able to do some higher level testing again (more ABRs and start VNGs again) as well as some testing under sedation and cochlear implants. There's also some traveling to other cities for clinics (including Kodiak). That will be really fun. I'll get to see a few new cities and meet lots more people. PLUS- I'll be on the road system and can get in the car and drive again!!! Whoo Hoo!!

So my last day at work in Bethel is 6/7. My first day at work in Anchorage is 6/24. I'll physically move somewhere in between. Not sure on all the details but they are moving me/my belongings/my car from Bethel to Anchorage so I'll have to work on the packing and coordinate with them on pick-up. Since the river is still froze, I'm guessing I'll probably be without my stuff when I first get there. But it will all work out. Until next time...

The sun is wayyyyyy too much of a morning person

So anyone that knows me, know I am NOT a morning person. I start of hitting the snooze button at least a half a dozen times. Or I have multiple alarms. Once I'm up, I'm grumbly and and can be indifferent, if not completely combative if approached before coffee and sufficient time.

Well, I may have inadvertently figured out a way around some of this in the morning. Sunday night I went to bed on the couch, because I couldn't bring myself to finish folding laundry. Lst night I just got lazy and fell asleep reading there. But at some point today I realized I got up earlier than necessary today because the sun completely shine through my bathroom windo not my face this morning and I couldn't escape it. Super frustrating that the sun is almost full force before 7am by the way. Sigh.

I forgot how hard it is to sleep when the sun is still out after 10pm. Though, it doesn't help that the ground is still covered in snow so it's all reflecting back up.

Lighter Later

It's 9:35 and the sun is still strong. Supposedly the sun should have set 5 minutes ago but it's not asleep yet. So I'm enjoying the setting sun with my gas if wine and season 1 of Dexter.