Up, up and away

Today was a whirlwind of acclimation. First, I got an official tour of the hospital (which despite being fairly small at about 40 beds, still seems like a maze to me). Then I was placed in the hands of one of the permanent FPs to start my ward time. The inpatient service consists of adults and uncomplicated kids (the more complicated kids go to the peds service), divided into two teams by village of origin. Two FPs are on during the day shift, and 1 FP covers the whole service for a 14 hour shift at night. In addition to caring for 1 half of the service (which seems to be at this point about 10ish patients to a side), each FP on inpatient is responsible for OB triage and laboring patients. Again, the patients are divvied up by village of origin (there are at least 50 villages).

The diagnoses are your garden variety of inpatient issues (stroke, MIs, GI bleeds, TB, cellulitis) with a spot light on infections. Infections are extremely common here and are usually more severe than in the lower 48. It is postulated that the reason for the severity of infections is close living quarters (it is very common for many family members to live in a 2 room house), poverty and lack of running water in some cases, and genetic factors contributing to increased susceptibility to complicated infections. It also doesn't help that many of the patients present later in the course of an illness given their remote locations.

Kids frequently come in with perforated ear drums oozing with pus. Pneumonia is so common in young kids that many of them have chronic lung disease from scarring. RSV and influenza (with longer and more severe seasons) wreak havoc here. Mastitis usually presents with an abscess. And, of course, the offending agent is MRSA 99% of the time. (note to self: wash hands.)

In addition to attending to the inpatients and OBs, a constant stream of radio medial traffic (RMT) flows in throughout the day. Patients are seen by a village health aide who uses a state-wide standardized manual (called a CHAM, or community health aide manual) to get a history, take an exam, and make an assessment. Then the health aides send a fax (or sometimes even takes a photo and post it on the web if the condition is picture-worthy) to the FPs (me!). I got my feet wet with a few of these calls. My very first call was, as luck would have it, mastitis (go go gadget FPIN!). I also had a kid with eczema and bacterial superinfection, a woman with gastroenteritis, and a young man with chest pain that I thought was most likely costochondritis. The heath aide for this young man said to me "he has been bringing up moose for the past few days." I interpreted that to mean he had been vomiting moose meat. Nope. Not even close. Turns out he was hauling moose meat back from a hunt. Which is likely how he strained his chest muscles. Still lots to learn.

In the middle of the chaos my fellow FP got an RMT call about an 84 year old woman with a GI bleed and a hemoglobin of 5. He decided to send the medevac for her and guess who got to ride along?

Our crew consisted of me, two paramedics, the pilot and eventually the patient and her daughter.


It was a lovely day (I know! Imagine that!), clear blue skies and sunshine. I figured if I was going to go in a small death trap above the tundra, the weather conditions were at least favorable. My mind kept wandering back to the recent NPR story about the frequency of small plane crashes in Alaska that was on the air after Ted Stevens' death.

But the view from above was worth the ride which, no offense to Dr. Olson, was much less gut-wrenching than the Aberdeen adventure last year. I felt like I was staring down at the entire globe with the rich blues, greens, and browns down below.

Our destination was called Mountain Village, which is 45 minutes to the north. The village (seen in the photo as tiny specks of houses on the hillside) is nestled into the hillside and adjacent to the Yukon river.

Our landing strip was a gravel road, and most road traffic (meaning the two vehicles we saw) was by ATV. We were greeted at the clinic by the health aide and every single generation of the patient's family. Great-grandchildren, grandchildren, children, spouse were all there looking on somberly as we assessed her and eventually took her on her way. She was surprisingly stable and is now on our inpatient service.

Not bad for a first day. Wonder what tomorrow will bring...