Disorientation

So here I am in Bethel. Initial observations: it is dreary (see photo above, view outside of my house), there is good internet access (in comparison to Kenya's sad sad dial up situation), the Cranberry Cottage (my home here) is as nice and quaint as the name implies (see photo below) and equipt with a chef-worthy stove as well as a flat screen tv that would make Ben proud.

But boy is it dreary. And wet. When I stepped out of the plane onto the runway last night I nearly was blown away by gale force winds and sideways whipping rain drops. This is the start of the wet season, so it is not a great shock to have constant rain and wind, though apparently it was a very wet summer as well, which has caused the ground to be a mucky, mushy mess. I brought some old hiking boots to walk around in which very likely might not cut it. This is the land of sturdy, knee-high, rubbery boots. I might invest. It may cost a small fortune.

Which brings me to my next observation: the transport of people and goods to this area is fascinating. The plane from Anchorage to Bethel was actually the same size as the one from Seattle to Anchorage, though only about 1/3 full. Apparently there are similar jets that have only half the seat capacity with the front half of the plane carved out for large cargo transporting (cars, machinery). And people coming to Bethel really know how to pack. Suitcases are very passe. Most of the luggage coming off the line into the 1 room airport (with signs in both English and Yu'pik, the native language here) were large, sturdy (that's a theme) crates or chests (I hear ice chests are the luggage of choice for real fishermen in these parts - better to bring the salmon back). My green victorinox suitcase was surely in the minority.

I braved the weather again to catch a taxi outside of the airport. I hear that Bethel is the only place where there are more taxis than people. Not that there are many of either. But I jumped into a taxi and quickly figured out that they are communal as two other folks piled in next to me. The drive to my place was about 2 minutes. I'm hoping to be able to walk a little around here, but the weather and ground conditions are daunting, even to this rain-seasoned Seattleite.

Today and tomorrow is new employee orientation. The most interesting part has been learning about the structure of the medical system (village health aides, subregional clinics, regional medical center (aka the hospital here), and statewide services). The YK hospital and medical system serves 58 native tribes in an area that is the size of the state of Oregon. Part of the work as a doc here is receiving radio medial traffic (RMT) from the health aides (usually high school educated folks with some very basic medical training) in the villages. They are the eyes and ears of most of the region, and our job is to decide if/when/how a patient is to be transported here for more care. The transport options are medevac emergently, put the patient on a scheduled flight to Bethel (there are a few from each village daily), or help the health aide treat the patient in the village without transporting. RMT promises to be a unique and challenging part of the work here.

Aside from RMT, my clinical work here will be mostly inpatient wards (which I think includes adults and ob but I'm not sure) for the first half, and then ER shifts for the latter half. Friday I'll be shadowing another FP hospitalist on the wards to learn the ropes. Seems like there are a lot of ropes to learn. Luckily my housemate, a pediatrician from Oklahoma who is here for a 3 month locums job, has clued me in to a few essential things (like where to get food, how to get to the hospital...). She was watching the tv show Northern Exposure last night when I arrived. I assumed that the show is on constant loop on television but, in fact, it was a DVD she brought. I caught a bit of one episode and have a completely new-found appreciation for it. Jewish doctor comes to the tundra? That's me!