First day

Dear Friends,

I sit quietly in the hospital's maternity unit - using the computer here as I have no means of communicating from my general issue apartment. No one is delivering a baby in this Arctic town of 3600 so I am grateful not to be an intrusive presence.

I read about Polar Eskimos before I came - mostly about Greenlanders- but some of the information applies to the Alaskan Inupiat here I think. The two days spent in Anchorage at the Art Museum and Native Heritage Museums set some nice groundwork I hope for all I will encounter here. The ingenious adaptations to the cold and a subsistence existence were well depicted in the museums. Grass was used to make socks. Seal intestines were used for coats and to make windows as they are waterproof and translucent. Sunglasses made of driftwood (no trees up here) reduced snow blindness and helped to see far - the eye openings like slits - the way we squint our eyes to see far. Snot was used to start fires - along with moss. Concentrated urine was a great way to soften skins - a strong base - that made the eyes burn. And always, great respect for the animals they killed - the sea otter was especially revered - the organs alligned much like a human's - believed to have a human spirit - so they were never eaten. Every part of the animal killed was utilized. A naturally ecological people - to waste wasn't a good option in such an unforgiving environment.

As I waited for my flight from Anchorage to Kotzebue, the gate filled with people who greeted each other - sharing stories of their week away - to Seattle - or somewhere else usually in "the lower 48". I could see the professional white people grouping together and the smaller goggles of native people - a young couple - so serious - with their tiny infant. I sat next to a woman and her two small squirrely children - she would gently reprimand them for their normal rambunctiousness - maybe more for my sake than theirs. Very blond little girls - looked like little Minnesota children except they were growing up in a mostly native Alaskan village. Mom is a Registered Nurse at the hospital where she takes care of patients with every kind of problem - and Dad is a firefighter - both grew up in Fairbanks - saving money here these past 6 years - and eventually to go home and buy a house. Too expensive to buy one here. She laments how few permanent staff there are in the hospital. It's really a good place to be but people come, work, and go. Then she asks me about myself and I have to tell her I am doing exactly what she was just lamenting. She tells me that the Fourth of July is the big holiday so good I'll be here - there's a 5 minute parade.

As we land I can see leads (openings like rivers) in the ice , tidal mud flats, and the waters of the Bering Strait - Russia on one side, Alaska on the other. When we debarked, one of the passengers commented that it looked from her side of the plane like we wouldn't be able to land because of the fog. Evidently we made it just in time. Sometimes the plane goes to Nome or back to Anchorage to wait out the bad weather - and this is springtime!

The medical director's wife and a woman who heads up psychological services picked me up - tipsy but not too tipsy for driving she reassures me! - and takes me the 6 blocks to my apartment. I thought the town was "dry" I say and she says - actually it's "moist" which means you can't buy it but can bring it in.

The apartment has a barracks look about it - peeling brown paint - second floor - my roommate is a nurse midwife who is ready to get back to Oregon but she has two more weeks here. Her kids are grown and like me, she has a husband at home looking forward to her return. She's been working around Alaska in various native villages for the last 5 years mostly from what I can gather for money. No one will pay her as much in the lower 48. She alludes to the difficulty of having different roommates. I think she worries I will be wasteful as everything you buy here costs a lot - milk is 9 dollars a gallon. Gas is 5.50. So I try to clean up after myself and give her space. And use just the minimum of toilet tissue and dish soap. Fortunately she keeps the TV on low volume. That's my sore spot!

I look out my bedroom window facing south and see a stack of antlers leaning against a shed, 3 snow machines, pallets scattered about and in the distance Kotzebue Sound and the foothills of the Brookings range.(Where Into the Wild the movie took place.)

At ten PM - sun sets at 1:30 AM - I take a stroll around - starting on the ocean side. It's about 30 degrees out with a bit of a wind.There's still snow along the water's edge in places but mostly there is gravel. Nets lie haphazardly about. A truly amazing number of items in every stage of degradation litter the surfaces around the homes and indefineable other spaces. I feel like I could be walking at times in an art installation at the Walker except things just don't quite hang together well enough. I think I pass a gas station - a couple of pumps. Gas prices aren't posted anywhere in Alaska - too discouraging. All the pipeline oil is sent out of state. The roofs are corregated metal or plastic and the homes very plain. No window and door trim. Very functional. With the winds off the sound (the town is at the tip of a peninsula), this is probably an adapation made of necessity.

It's Saturday night and the main visible activity is young people riding around on 4 wheel ATV's - some looking to be no more than 12 years old - and no one wearing a helmet or seat belts. I look about carefully as I walk thinking about the odds of being hit by a child driving a vehicle 25 miles an hour. Like the suburbs, there's no sidewalks here. Then my thoughts move to the kind of trauma I am likely to see at the hospital given what I'm seeing on the little roads - mostly unpaved. Visions of cleaning road rash, suturing lacerations, using the Glasgow Coma scale - all of the stuff I'm not very good at doing - and really wishing they'd pass a helmet and seat belt law for drivers of ATV's. Fomenting for change, and I've only been here 4 hours.

Today I found lunch at the cafeteria - almost desserted except for a Somalian pharmacist from Minneapolis and the hospital's regulation specialist. She grew up near Anchorage and has lived and worked for several native corporations. She is the first person to tell me things that will help me understand how to take care of patients in 2008. My immersion in the Native Alaska predating statehood was clearly not going to be enough, and I have worried about making mistakes. She said the village people are like lemmings falling off a cliff. The suicide rate is horrendous, and the people don't take it seriously - nihilism? A 22 year old hung himself on a tree in town the night before last. He comes from one of the nearby smaller villages. There is no social or genetic history for arising early each day to go to work, to live within a schedule. The older order of subsistence living is no longer relevant. People used to hunt and fish during certain times and seasons and then spend weeks sleeping, relaxing, eating. Or starving. Hunting often occurred over days or weeks - a huge energy expenditure followed by rest. People still hunt and fish but starvation is never a threat. They own the land and the native corporation provides.

She tells me about the anger the Natives feel toward the white health professionals. Sometimes the patients are verbally abusive to the staff. The doctors don't know about certain cultural expectations. For example, when an adolescent has a baby, her mother or another elder will come to the office visit and will expect the medical provider to talk to the elder, not the baby's mother. If the doctor directs the questions to the young mother and she answers, she will be beaten when she gets home.

At the end of our conversation, she worries that she has discouraged me, and I reassure her that in fact I am very grateful for the information. Wouldn't it be good to have this information written and conveyed to the staff that come and go? She thinks perhaps that there is a way in which writing it down could be detrimental. Acknowledging the problems would perhaps accentuate them? Politically incorrect with the tribal leadership? Reduce expectations for positive behavior? I don't know.

Tomorrow I start work. I am looking forward to it. Take good care my friends and enjoy summer.