Wales Day 4! Last Day…Flight back

Today was a slow day, I had lots of time to sit around in the morning waiting for patients. It seems that everyone stays up very late here–usually till 1 or 2 in the morning, and then wakes up late. Kids have a hard time getting to school, and clinic mornings tend to be slow and afternoons very busy.

I got to see a baby and a mama today! I added them into my schedule since my other patients weren’t showing up. I had extra time with them, since I had completed everything for all my patients–one lesson that I learned from my last village trips! It was a much calmer exit this time around than last!!!

I even got the airport early and had time to take some pics (last time I barely made the flight–the plane was taxiing to take off and came back to get me! :)). It was super busy at the aiport today!!! 😉 I haven’t seen this much traffic in a while. Ryan Air was there, then the chopper from Diomede came in–for the first time in a week, because of the bad weather. (see video)! The principal of the Diomede school was stuck here in Wales. Then Bering Air (my flight!) came in. Before these village trips, everyone says good luck and hope you make it out! Or “weather permitting” when speaking about any travel plans, because the weather is frequently bad.

Chopper landing (there must have been some blade-bending force in the universe when this picture was taken):
Diomede Chopper

Video of the chopper and Bering Air:

Since no planes could fly in the last 2 days due to weather, there is a lot of traffic for this little village in the middle of nowhere!

So much air traffic Wales!

Sunset at the air”port”
Airport sunset

The mountain down on the right is the Cape Prince of Wales. And out to sea are Little and Big Diomede Islands–and the mainland of Russia can be seen on the horizon!
Wales Diomede aerial

The Cape of Wales is the westernmost point of the North American continent!
Wales mountain sunset aerial

mountains sunset

Wales, Alaska~ Medical Field Trip, Day #3

1/9/14:
Got up and washed my hair in the bucket! Bucket shower

There is no running water in the clinic, but there is a chance they will get running water by this summer. No homes in the village have running water. Just a few buildings, like the school, and the “Washeteria” an ablution block, where locals can pay for tokens to take a shower. Honey buckets are still used– a 5 gallon bucket for a toilet:

Honey bucket openThese days are great and rewarding, but exhausting! I feel tired and I’m glad today’s my last day for now. Even the amazing Clinic Travel Clerk (CTC) this morning said, “We are so glad you are here—you help us out so much. But I will be glad when the doctor visit is over, because you keep us all extremely busy!” :) I take that as a good thing. (?) :) I got to see lots of great patients today, mostly elders. I love, love, love seeing the elders, because they tell me stories of their past, their history and culture. Most of the time they lament the modern change. They see a huge shift in this generation that is losing so much of what they valued. I had 2 elders that couldn’t make the appointment today, so we scheduled 2 more patients in.

The highlight of my day: doing a home visit, for the oldest, sweetest lady in the village. An 84 year old Inupiat woman who still lives alone in her home. A home up on the hill, in the oldest part of the village, where the villagers used to live in sod houses. She has two entry ways, and her door opens towards the direction of the sea. The first entry way is covered in ice inside. The second is warmer. In each, all of her storage, extra possessions are stored up. Inside, clothes line criss crosses her dining room area, where she sits for tea. She is hunched over with severe arthritis, with bowed knees also from arthritis. She now stands about 4 feet tall.

Communication is difficult, and when I speak slowly, loudly and enunciate each word, she just stares at me. I’m not sure what else to say. Her caregiver, who is like a son (who takes care of her, cleans and maintains her house, and checks in on her for a few hours at least twice a day) helps me know the right English words to use. Her mother tongue is Inupiaq, and this is what she understands best. Her son states he lost his Inupiaq when he left for a time. Most of the middle aged generation lost their native tongue when they left to serve in the military, or were taken from their homes, or left for other reasons. They speak in a slow, accented English.

She is kind and patient and smiles throughout the visits. She is one of the beautiful elders left of this generation, and everyone here respects and adores her. I wish I could paint a picture of her!

Wales, Alaska ~ 2nd Medical Field Trip!!! Day 1

Another village medical trip to Wales, Alaska! Hooray for village medicine!

The flight was delayed due to weather, so we were in the air in the middle of the day, when the sun was “high” in the sky (ie it looked like sunrise/sunset the whole time. :))

Another plane ride on the Navajo!

Snowy/cloudy Nome:

Flying over snowy nome

The clouds did clear a bit to grant us views of the sun and the wilderness.

I did not recognize it from when we flew over it before. This time it was so different flying over a whitened landscape! Compare to the flight in October. I can’t believe how this place changes so drastically.

Ice shelf:
Sea ice

Before I came here I was nervous about the changes—namely, the darkness and the cold. But I think that is part of what makes Alaska so exciting. It is constantly changing. Radically! Up in the North cap of the globe, it’s a wild environment of extremes. Extremely long days, then extremely long nights. Extreme cold. And well, not so extreme heat. The people that live up here are extreme survivors. Especially the natives!

Super rad! Especially to look out over all this iced landscape. Sunny day! This is the highest the sun gets in the sky.

high noon

snowy hills

Bering Sea (how it looked before)
Alaska Coast

More stunning views:Sea ice shelf

Flying into Tin City

Nose down

After we landed in Tin City we picked up two soldiers, so I got to sit up in the co-pilot seat again! :) With a super cool pilot that I have not flown with yet, who was born and raised in these parts of Alaska. He’s been a pilot for almost 40 years. He seemed like a totally pure Alaskan. Trapper hat, mustache and very simple, unassuming, down-to-earth way about him, smelled the classic Alaska bush smell of hard work and fish. The same smell of the hitch-hiker I picked up on the way to Homer, the same smell of many of the natives, and the raw, outdoorsy people I have met here. I like it. I grew up where people smelled of nature, and that smell was their signature cologne, and I love it and I miss it. :)

Tin City (remember this from before):Tin City Mountain

Not great visibility coming into Wales! (this is an aerial view of the same village in October)
Low visibility Got picked up by the ATVs at the Wales air”port” and brought to the clinic.

ATV to the clinic It feels great to have it feel familiar! Before I had no idea what I was doing. This time I feel a bit more in tune. There is an amazing front desk clerk working at the clinic who makes all the difference in getting things done for patients. She used to be a health aid and was trained as an administrative assistant before that, so she is amazingly trained for the job. Just like anywhere, that’s not always the case. A lot of times, because the clinic jobs are tough, higher education is rare, and people have not gone out of their locality much, there are different levels of training and skills. But no matter what the skill level or training level, they do an incredibly amazing and important job for their community! Mad props to every Community Health Aid and support staff member to what they do for their villages!

Of note, she has a LOVE tattoo on her right arm, and on her left arm, a key, that she says is not “somebody’s key to her heart”, but rather the key that represents that she holds the key to her own happiness. Brilliant lady!

When I asked her what are the keys to her success, she mentioned 1. Excellent mentors, 2.  some amazing training seminars that she got to go to, and 3. Having the right attitude. And she thinks that many of these principles could be incorporated into Health Aid training, because those modules were so important in her training.

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More conversations with the janitor. I am so happy to be back! It’s great to see Joe, the Janitor again. He was super warm and friendly, and I rejoiced to see him, because I had some burning questions about whale hunts that I knew he could answer.  (and he did). I also wondered how people used to survive in the frozen Arctic, before the advent of modern housing. He told me about the sod houses that people dug under ground in the winter. And some stayed in tents in the summer. He also told me that he has found beautiful carved artifacts and dolls in some of the old sod ruins that he has found. And he told me of how hard the life was before the modern era. Of how the hunters had to paddle out to catch the whales, harpoon it without modern bombs or guns (which he says even with bombs, the modern hunts are hard and exhausting and scary), and then tie it by the tail to the back of the Umiaq, and paddle back home. And then, drag it up on the beach. Fiercely strong!  He said some of the old guys were so strong they could lift 55 gallon drums full of fuel. After seeing how tough some of these natives are, I think I believe it. They had to be.

As if to underscore the point, I watched “The North,” an Imax documentary about the “Top of the Globe” features the extraordinary plight of the people who have long lived in harmony with the harsh elements of the Arctic.

Wales Day 4

Friday 10.4.13

Last day in the village! I went to bed late, trying to tie up all the loose ends from patients I’ve seen and make sure all the charts are completed and there is good, clear documentation. Then I was awakened by banging on my door in the middle of the night to see an infant with a fever of 103.5, turns out to be a bad ear infection. The baby also vomited all over the floor when I tried to look in her throat.  And we made a mess trying to see into her ears. Didn’t get too much sleep last night! This morning I felt grubby and in serious need of a shower! My sponge-bath freshness hasn’t lasted long!

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My sleeping quarters in the clinic. The room is full of broken equipment that they keep for spare parts!

 

The day was hectic, got off to a late start and had a staff meeting that we are supposed to attend by teleconference, and we were short one health aid, but we were trying to fit in as many patients as possible to get people seen before I left. There were also several patients with food poisoning that the other health aid was busy treating. Through the day we all felt a sense of urgency, but there are so many limiting factors (like calling to get authorization and consult Cardiology for a patient with atypical chest pain and concern for a heart attack to get to Anchorage). And calling any specialists, really. Trying to figure out how to get someone lung tests, and how to get someone a screening colonoscopy and how to find the latest imaging or other diagnostic studies/consultation reports.

I did get to meet the principal of the school who invited me to come shower at the school on my next village trip. She was so kind (and probably noticed my telltale greasy hair! :) I did several employee physicals for teachers, which for the most part are easy, but I still had some chronic care patients with lots of stuff to follow up on. I also had things like pap smears and a toenail removal that we squeezed in over the lunch break! It was a lot to fit in. But I thought the plane was coming closer to 5 pm (I was told 4:30 to 5pm, and someone called and checked, and they said 4:45 pm), well it turns out, it actually came in just after 4pm!!!!

The bush planes land, unload their small cargo quickly, reload and take off; turn-around time might be 20 minutes.

Calm chaos turned to a mad rush. Now I was totally running behind, trying to finish everything, feeling under pressure and hurriedly being told that the plane will not wait for me! I grabbed my belongings, threw the dirtied procedure equipment back into the black box, and jumped on the four-wheeler. By the time we got to the airport, the Navajo (twin engine plane) was just starting to taxi, but they turned the engines off for me and let me board! Whewsh! Close call! That’s the last time that I will have appointments past lunchtime (which I was told to do, but then the CHAs (community health aids) requested that I fit in more people, and I want to see as many people as needed). We live and learn and do the best we can! The two passengers on the plane told me a few times that I was so lucky to have gotten on the flight! The pilot was so gracious and kind!

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Happy flyer! Lucky to be on this plane… Navajo twin engine

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I got to see Russia (on the right) again! 2 for 2 is an exceedingly rare thing, apparently! You can more clearly see how Little Diomede Island sits in front of Big Diomede today (the land on the left).

I was also lucky because it was a stunningly beautiful day (again)! The pilot told me he doesn’t remember seeing a beautiful day like this in Wales in a long time! I feel so lucky! He also said, “You will enjoy it here. Don’t listen if people say it is terrible to live here–it’s really not that bad!” :)OLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERAOLYMPUS DIGITAL CAMERA

Wales Day 3

Thursday 10.3.13.

Got up and brushed my teeth in the bucket. Washed my hair (at least the visible greasy part) in a bucket, used wet wipes to wash my pits and get a quick sponge bath. Splashed my face. Not feeling very clean, but slightly fresher. Up to seize the day! Saw a bunch more patients. I got to place an IUD (intrauterine device)–the patient was so grateful, because she has run out of her birth control pills (and other pills) since flights cannot get into the village consistently due to weather, and getting medications just isn’t reliable enough out here. I saw lots of village elders, again to look at their chronic illnesses and multiple medications needs from overview perspective. There are lots of labs and meds that needed to be followed up on. There is so much to do for some of these patients, though, and I feel that I am probably still missing some things. Ack! Need more time! Hopefully I can come back to this village on a more regular basis and have continuity of care with the people I am getting to know.

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Picture of a roadside sign on the way to Council. Agnes Kelly Bostrom was a Yup’ik Eskimo who grew up in Mountain Village on the Yukon River.

The elders tell me of how things used to be. How the whole village used to work together to prepare for the Winter—from the beginning of Spring through to the end of Fall, they would hunt and gather, dry and smoke fish, prepare berries and store up food.

 

 

 

 

 

 

 

It lightly snowed all day today! There is a Siberian Yupik name for light snow, that an elderly lady taught me, but I forget. I need to write these things down!

 

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Snow! It’s weird to see snow on a beach. Growing up in the Pacific islands, I just always associated beaches with warm tropical breezes and coconut trees. This is by far the furthest north I have ever been on a beach!

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Feathers=great water repellant! I just ordered a -30 Arctic down jacket (specifically made by a company for expeditions to Antarctica).  The health aid asked me if I had a warm jacket, and I told him not yet. He said, well you should get one, because Winter is coming quickly. :)

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Windmills. They are tied down, because the winds are so strong, they get blown over.

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Wales Village

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Heavy clouds. That is Fairway Rock. Today I cannot see Little Diomede or Big Diomede.

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This reminds me of the photo essay–“To Live and Die in Wales” (http://www.alaskadispatch.com/article/part-1-live-and-die-wales-alaska)

After the snowcloud blew over, the sun tried to come out through the heavy clouds and lit the place up in golden light.

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