This is my last day for this time in the Polar North. I've spent the last two weeks seeing patients in two villages. They are a study in contrasts, which perhaps shows how isolation plus geography changes human behavior.
Point Hope is a whaling village of 800 people on the northwest coast of Alaska on the Arctic Ocean. It is thoroughly isolated with almost constant winds and cool temperatures. The town is uncluttered compared to most Eskimo villages. No rusting vehicles lying about. The ground consists of many layers of swept gravel making it about as hard to negotiate in places as sand on a beach. Little wonder the elders need a 2 block ride to their clinic appointments in the snowless season. I am intrigued by a house made out of an airplane. There's one sizeable grocery store and no neon anywhere.
The beach is a half mile from town which makes it feel forbidding as I finally leave the clinic to take in my surroundings my third night there. I see floating ice everywhere as I look up and down the beach. The midnight sun makes the light shine brilliantly off the icy sculptures. The water appears bluer than Kotzebue's brackish hue. An abandoned bike and a large pile of rusting 4 inch pipes litter the inland portion of the beach. I find part of a seal skeleton to take home. It feels spooky to me to be here alone. I've been warned about polar bears but I'm not about to carry a firearm, which is the only reasonable means of protection, whether you're one or ten. I think I have more reason to be concerned about human predators anyway.
The clinic is busy any time the door is not locked except from 2 AM to 9 AM. People here have learned to be dependent on the community health aides to fix all their bumps and bruises and worse. Many are accustomed to treating their aches and pains with narcotics. The changing flow of medical personnel makes narcotic abuse easier than some other places in the US. The health aides fax the request to the hospital in Kotzebue and whoever is managing the "radio room" where all the village consultations and refills come through decides based on very little information whether the med is refilled. The doctor who is supposed to oversee the clinic went to Iraq, returned, but not to Alaska yet, so this clinic is orphaned, rudderless, and it shows.
I see middle-aged people and older with lots of degenerative arthritis from hauling around seal carasses and whale blubber and no physical therapist to teach them better ways to use their bodies. So I listen, examine, and try to treat them humanely, knowing that I'm feeding a few people's addictions in order to help a few more get through the day more comfortably. It's the same dilemma many primary care providers face in the lower 48 except there's no pain nor rehabilitation specialist or
The oldest man in the village visits me for prescription refills and regales me with stories about the village. It was moved in the 1960's 2 miles inland because of erosion. The original houses consisted of wood and peat mostly underground - very fuel efficient in this coldest of places. HUD then built houses on stilts - modern ones- in the relocated village and things began to change. Satellite TV and then internet came even as some subsistence activities like whaling were retained. Fuel bills skyrocketed.
The Native dividend money, food stamps, and other subsidies mean that young people don't have to work. Like the young everywhere, they want to be modern like the rest of the world, and the old subsistence ways don't appeal to them. The influx of marijuana in the 60's hasn't helped people's motivation either. People of all ages smoke it regularly, and it's not considered morally wrong nor a health hazard by most.
The clinic building has been heated for years by the excess heat generated by the diesel generator which provides the electricity to the town. The exThe furnace and water heating system is finally getting fixed. The contractor who's finally fixing the furnace and hot that young people didn't have to work so they started making more trouble. The parents don't provide structure for the children as that has not been historically part of the indiginous culture.water system, gave me a key the Whaler's Inn where he stays so I could steal a hot shower. I worry I won't make it out of town due to inclement weather and the bush planes don't fly on Friday the 4th of July. The chaos and unhappy feeling in the clinic make me want to escape on time. As I prepare to meet the plane, a mother stops me in the waiting room for a quick assessment of her child's facial rash and the aide asks for help to suture a child's face. I make my escape despite the last minute requests.
I came back to Kotzebue tired out. After a three day break I flew to Ambler, an inland village at the junction of the Ambler and Kobuk Rivers near the Baird Mountains in Kobuk National Park. We flew over the Kobuk Sand Dunes, which are striking after seeing spruce-covered tundra dotted with meltwater ponds and lakes for miles. The great thing about the bush planes is that they fly low so you can see the topography well. The planes fly 800 feet above ground going east and 2500 feet going west, which theoretically prevents mid-air collisions. Some of the pilots have the disturbing habit of looking down for many minutes at a time doing paperwork while on autopilot. They assume that everyone in the air is complying with the Alaska flight rules that are updated every 6 months. This is not defensive flying!
Ambler Clinic is run by an older health aide named Emily. She is a quiet, peaceful Native woman who exudes confidence and kindness. Although she manages any medical problem that presents itself most weeks of the year, she takes advantage of my presence during the week to check on a child's breath sounds or to evaluate a high fever.
from Kotzebue who is responsible for the village had given me a list of all the people who needed immediate followup for their medical problems. Many came in to visit me with a wide variety of problems.
Emily explained that people here do not disturb her in the middle of the night and only ask for the things they truly need. She attributes this to the fact that many still "live subsistence." I wonder if it's also because she's set clear limits on what is acceptable interface with the clinic.
I see the oldest villager who has a critically elevated potassium level. He doesn't have one physical complaint. He does express frustration and anger about the doctors who don't listen and treat the Native people "like dogs. Since the advent of ATV's, the status of dogs has really plummeted so he is perceiving a mighty disparagement here.
I do not get one request for narcotics even though I am seeing many older people with the same severe arhtitis and chronic pain problems as the people in Point Hope.
People are fishing on the river but many of the boats are grounded (as well as ATV's thankfully) because the town is out of gas. It's also had an electrical outage so all the vaccinations are spoiled. No one tells me whether more have been ordered, and I don't like to pointedly ask the question as I don't want to imply blame if nothing's been done.
Evenings I chart the day's medical notes in the kitchen looking up sometimes to see tree swollows, mountains, and clouds through the big picture window. In my bedroom as I drift off to sleep, I hear balls bouncing and childen laughing as they celebrate freedom from school, their biorhythms confused by the lovely summer light.
Tonight, Sunday the 13th is my last night in Kotzebue. As I wander Front Street on the ocean, I met a tribal doctor, a woman of about 62 whom I had seen as a patient in the hospital clinic. She chatted telling me about her parents who were reindeer hunters in the 1940's in a small village in the region. When the reindeer stopped coming, they had to move to Kotzebue. She pointed to the foam along the shore, much like that which forms along the Mississippi in spring, and said that it was a sign that the Beluga whales are passing by farther out to sea, and the foam was created by the blow hole.
I stopped along the way to say good-bye to my friend Wendell Stalker, who plays a mean guitar, carves ivory from fossilized mastedon and walrus, and fishes in front of his house on the ocean. He gave me my first sheefish, a favorite of the locals. Pointing to a nearby net which catches fish while the fisherpeople sleep and play, he said, "I get to have more fun with my rod and hook!" He is a truly joyful soul.
I will miss this place. My plan is to return in January, the season of darkness and cold. One our Physician Assistants was sitting in the doorway as I passed his apartment tonight and I asked him about the 5 years he spent at the South Pole. He said it is colder here in winter! The difference lies in the humid air here versus the dryness of the Pole. The tribal doctor promises to make me seal skin mittens and a beaver hat and it looks like I will need them.
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