March 2009 Stint in Kotzebue, Alaska
Dear Friends,
I am a fish out of water - which may explain why I felt bad when I pulled my first sheefish out of a hole in the Chukchi sea ice last week, watching as it flailed about gasping for air for 20 minutes. My fishing companion and instructor, Chuck Luck, said "absolutely not" when I asked if I could throw all 15 pounds back down the hole.
The strangeness of my surroundings gets me to thinking about what's acceptable and what's not. How propriety evolves according to the needs and desires of people living in a specific place with its own unique cultural history.
As I flew from Anchorage to the Inupiat village of Kotzebue on March 1, I sat next to the a 12 year old boy who is an avid hunter. Mostly Arctic hares so far. But he's pretty sure his uncle will take him inland to find wolves - to thin them out as there's too many of them this year. For the record, Eskimos don't hunt wolves but wolves do eat their beloved caribou so I thought he might be telling me the truth.
He thought they could kill 40 wolves, maybe more. He's never gotten a caribou but soon enough he thought he would. I found myself encouraging him, thinking about other interests a young teen can have up here - mood-altering substances, sex, tobacco, and racing around on a snow machine without a helmet.
The truth is there's not much to do up here for children or teens. If a kid doesn't like to wrestle or play basketball, he or she is out of luck. There aren't any organized activities at the boys and girls club because it's hard to find people who have the time to volunteer who don't have some sort of criminal record. Kids don't take lessons up here. There's no baseball diamonds. Not even an ice-skating rink even though our lagoon could be made skating ready. Cross-country skiing? Nope. No bowling alleys. No swimming pool. And you can forget dance lessons. There is a small park near the cemetery equipped for the under 10 set.
So children learn to hunt early in life. During a sports physical last week, I found myself asking a 9 year old if he locked up his shot gun when he was done with it. His dad told me that once it's deployed there aren't any more bullets left. That's how much I don't know about guns.
Hunting up here is a cultural affirmation. Maybe even a kind of therapy, an appropriate way to release the destructive emotions like pent up anger. Better to kill to feed your family than violate your family. Better to pass on this cultural competency to the young. A suitable violence.
And fur attire only makes sense in this cold place. Wolf or wolverine ruff is best for keeping one's breath from condensing on the glasses and mustaches. Many of the women are able seamstresses making hats from seal skin or everyday leather and using beaver or fox fur for the earflaps and to warm the forehead. Animal rights activists would be laughed out of this place.
Eskimos were hunter-gatherers until the late 1800s when white traders introduced items like rifles, tobacco and alcohol. The simple but brutal life off the land gradually became a mix of cash/carry and subsistence.
Now there are those that do some "subsistence" and those that don't. This word, subsistence, seems like a euphenism that some anthropologist made up in order to show respect for people who have until recently lived off the land. These "simple" people have a stoic core, a propensity for doing - not analyzing - that made it possible to survive in this hostile environment.
The material life didn't pass the Eskimos by any more than it has any other people who've had the option to indulge themselves. But now they must hold jobs in order to buy gas for their "snowgos", having abandoned their dog teams for the ease and power of zipping along on a machine fit with skis. Electricity, piped in water, and sewers are costly. Mushing is now a sport for the few people who have the desire,time, and money to do it. Hard to believe the inhabitants of Kotzebue illuminated their homes with seal oil and and then kerosene until as recently as the 1960's.
As I was leaving the small village of Shungnak a few weeks ago, the health aide who had driven me on her snowgo to the airstrip reminisced about life before bills. She wished she could go back to the old days. Much simpler then. Everyone knew what they were supposed to do. Now that she works full time as a health aide, she doesn't have the time and energy for hunting. As we looked out to the distant mountains, she told me their names -" Beautiful Lady" with her sculpted breast and abdomen and "Old Man Mountain" with his rugged face.
Mostly it's the elders who crave the caribou flank, muktuk (whale skin with its blubber), seal ribs, and muskrats. I met the director of the hospital's program to provide wild animal meat to those who can no longer hunt. He explained that the younger still hardy men are paid to go out to make the kill. Given the 10 dollar a gallon gas, this is a necessary compensation.
I struck up a conversation with a woman I met at the Nullagvik Hotel where I live this time. She told me about caring for her mom with Alzheimer's. The doctor had told her at the Alaskan Native Hospital 600 miles away in Anchorage that her mom was going fast - maybe 1 or 2 weeks to live. She brought her home and made all the old time foods - chewed her caribou meat for her, made her the soup she loved from childhood. Triumphantly she said, "Mom made it 2 more months!"
The first Inupiat word I learned on the job was nuvuk - snot. There does seem to be a preoccupation with nasal discharge up here. When I work in radiotraffic advising the village health aides about children with plugged up noses, I try to delicately inquire about congestion relief. There are mothers and grandmothers who suck the snot out with their mouths and those that don't, preferring the blue bulb that is dispensed at the hospital on discharge of mom and babe.
As a white medical professional I have recently learned a hard lesson: I am not Native, therefore the statements I make about unhealthy health habits can be misconstrued. I received an overhead page a little after 6 the other evening. My medical director had a letter in hand from a patient I had seen that day. He reported that I had said that Natives are drunks.
An elegantly dressed older man had come into walk-in clinic for his narcotic refill. Because a policy for prescribing controlled substances has been recently created so as to dramatically reduce the use, abuse, and sale of prescription drugs at our Bush hospital and clinics, I am allowed as a temporary medical provider to give no more than a 5 day supply of medication. This gentleman had received a 2 week supply with 5 refills of 2 very potent narcotics in January -prescribed by a temp internist who is now back in Seattle.
I took meticulous notes outlining the history of his chronic pain syndrome and response to medications. I asked him about past or current substance use, and he gave me a detailed history of his alcohol use starting at age 11 when his father handed him two beers. He emphasized his sporatic use as an adult. I talked with him casually about the relationship between substance abuse and reduced pain threshold and the genetic vulnerability including ethnicity to alcoholism. We talked of many things, and I never detected a note of hostility. I explained the new narcotic policy and gave him a five day supply of his meds until he could see a permanent provider here next week for a larger supply.
Someone might say his accusation is an example of reverse racism. If I had been an Eskimo doctor (there are none here), he wouldn't have made the complaint. But my sense is this isn't about racism, reverse or otherwise. It's about pain. Individual and collectively as a culture.
White people have had a long history of misbehavior up here, starting with suppressing the local language, music and dance and continuing through much of the twentieth century with shipping Native children to the lower 48 to become "civilized", under the pretension of providing them a better education. It was shocking for Native teens to go from a private bedroom with TV (after it came in) back home to a cramped sod house shared by as many as 10 or 12 people with no electricity. Store bought food was a luxury here that could be a few days away or more if the weather prohibited travel. The teachers down south were less likely to wrap one's hand or denigrate the child who had a harder time sitting in his or her seat.
I have often wished I had a little more pigment in my skin where there aren't any freckles. I think it would have comforted all the people of color I've seen over the years. People seem to gravitate to people who are more like themselves. Trust is kindled more quickly. I've always been a contrarian in this respect - a little bored with people like me and intrigued by otherness.
Growing up in suburban Chicago in the 1950's, the only dark-skinned person I saw in my neighborhood was the occasional woman who came by bus from the city to clean peoples' homes. I have a very clear memory of driving with my family past a city pool filled to the brim with African-American kids. My dad made a disparaging remark to the effect that the water was not safe for swimming because of the Schvartzes - a Yiddish term that has thankfully fallen out of use. I knew that day there was something impure about what Dad said.
My high school in Indianapolis integrated in 1967. Kids with names like Darn were bused in from downtown. I remember how isolated those kids were. I saw the teachers' repulsion. The middle class Blacks - there were 3 girls I remember well - did ok, although I'm sure they experienced their fair share of discrimination. Even I was on the receiving end of a few teachers' discriminatory remarks and behavior. But it was still a heck of a lot better to be Jewish than African-American.
Three mornings a week the medical, psychological, social, and nursing staffs meet to discuss problem cases in the hospital, community, or villages. Rushing into these 8 AM meetings, I strip off my pants and jacket as I go. It's the only staff meeting I've ever attended that regularly includes a weather report. The explosion of Mount Redoubt 100 miles from Anchorage has thrown a monkey wrench into the best laid plans, including the likelihood of flying home as people complete their stints here.
Local weather in the farflung villages we service is most important as it determines whether seriously ill or injured people will be "weathered in" the village without professional medical care or can be safely flown into our Bush hospital. The responsibility for medical care when the weather is foul falls squarely on the village health aides. I asked the aides in Shungnak the worst time they could remember having to care for patients who couldn't be flown out of town. It was 15 years ago when a man was shot by the Alaskan State trooper in the abdomen, and a woman miscarried and bled for 3 days. The two village aides took turns caring for the two patients over 72 hours until the medevak plane could safely fly from Kotzebue to get them.
Local weather in the farflung villages we service is most important as it determines whether seriously ill or injured people will be "weathered in" the village without professional medical care or can be safely flown into our Bush hospital. The responsibility for medical care when the weather is foul falls squarely on the village health aides. I asked the aides in Shungnak the worst time they could remember having to care for patients who couldn't be flown out of town. It was 15 years ago when a man was shot by the Alaskan State trooper in the abdomen, and a woman miscarried and bled for 3 days. The two village aides took turns caring for the two patients over 72 hours until the medevak plane could safely fly from Kotzebue to get them.
After the morning rounds a Code Review is done if a cardiopulmonary resuscitation occurred in the preceding week. Last week two 18 years olds hit a truck while they were riding on a snowmachine at 70 MPH at 3rd and Lagoon in the center of Kotzebue. The ambulance brought them in where resuscitation was performed for at least an hour on the driver. He died but the code was judged to have been done efficiently and well, with just the right number of people doing the right things at the right time. His heart was on the right side of his chest. The doctor who led the code admitted they probably went on too long but it made the family feel better. There were some comments about how it was difficult working around both families of these two young men due to some logistical problems with the layout and design of the ER. The second man was taken by medevac to Anchorage with multiple grave injuries.
I can't help but wish they had a Code Preview. What can be done to stop all the injuries and deaths from accidents in this part of the world? But that would require a deep culturally- considered conversation.
