NAME: Beth Copley
DATE OF EXPERIENCE: 3/31/99-4/27/99
LOCATION OF EXPERIENCE: Bethel, Alaska, USA

WHAT DID YOU DO? Clinical experience. Worked throughout the hospital and outpatient clinics.

FINANCIAL AID: Aid received from COTWS program covered my costs. Housing was donated by a family in Bethel. I paid for my own travel. Food was provided at the hospital.

COMMENTS ON HOUSING, TRANSPORTATION, MONEY, FOOD, LANGUAGE: Housing is very difficult in Bethel. Not until the last minute was my housing secured. Transportation within Bethel wasn't too difficult. I mostly walked or paid for a taxi - which was reasonable.

TIPS YOU WOULD LIKE TO PASS ON: I would highly recommend this experience, but the student has to be persistent in looking for housing.

WOULD YOU RECOMMEND THIS PROGRAM TO A UW STUDENT? Yes, it was an excellent learning opportunity. My mentors were open to teaching and the region is full of interesting social and cultural aspects.

STRENGTHS OF THE PROGRAM: Excellent mentors and freedom of experiences.

WEAKNESSES OF THIS PROGRAM: Remote and isolating.

SUMMARY OF EXPERIENCE: I had nurtured a fascination about the Alaska bush ever since one of my good friends spoke of her experiences in some place named Bethel. There are no trees and the "streets" are frozen dirt most of the year until they start to melt into a sticky mud, then one must travel along planks placed down along the way. The homes are hoisted about the ground to prevent them from sinking as the warmth of the building would melt the soggy soil-less surface. Ironically, the Yukon-Kuskokwim Delta of southwest Alaska is considered a desert. Water has to be delivered by truck to homes individually. Pipes above the ground would be constantly freezing and six feet under marsh is permafrost. The community's waste is hauled out to an open "slew." Every spring as the rivers are "breaking" up the slew overflows into the marsh creating a environmental nightmare. To the average resident of the lower 48 it's a frozen barren desolate place. However to the 21,000 Yup'ik and Chup'ik Eskimos and Athabascan Indians who occupy this 75,000 square mile region it is a bountiful and sacred land.

Bethel, with a population of 5,000, is the largest and most ethnically diverse of the entire region. The 48 villages in the Yukon-Kuskokwim Delta region are 90% native. These geographically remote pockets of society still speak their own language exclusively, practice a subsistence lifestyle, and maintain many rituals and traditions. Work in this area of America is definitely a cross-cultural experience.

The Yukon-Kuskokwim Health Corporation was traditionally under the jurisdiction of the Indian Health Service. Since the formation of Tribal Unity in 1995, the corporation is owned and operated by a board of native individuals. The YKHC is thriving. The system includes community clinics, sub-regional clinics, a regional hospital (in Bethel), dental services, mental health services, substance abuse counseling and treatment, health promotion and disease prevention programs, and environmental health services. Bethel is the hub of all health care in the region. The 20 bed hospital in Bethel also housed the dental clinics and three primary care clinics, a pediatric clinic for chronically ill kids, emergency department, obstetrics and a small surgical site. These services provide for most of the communities basic health needs. Anyone requiring specialized needs such as surgery, critical care, high risk obstetrics, would be "medivaced" to Anchorage…weather permitting!

My work in Bethel was varied and expansive. Laura Whitman ARNP, a UW graduate, was my primary preceptor. She arranged a variety of experiences for me during my month in Alaska. I managed to arrange many of my own experiences as well. The first few days of my time were spent in one of the primary care clinics. The schedule was packed with patients with a variety of health care needs. Most of the clients had traveled from their village for these visits. There was a break around noon to do "radio traffic." The name was a left over from the days when communication with the villages was conducted by radio. Now each primary care team telephoned each of the villages in their region. Over the phone the "village health aide" would describe the complaints of anyone who was ill in the village. Village health aides were residents of the village who expressed an interest in health care. They were trained in Bethel and over time could treat common illnesses according to strict guidelines. The decision for treatment or for transport to Bethel for evaluation was made by the practitioner according to the description of the village health aide. The system worked together with an effort to provide a link for every individual to health care services. The village health aides would also keep records of the health maintenance needs of the community: vaccinations, well women and child checks, etc.

I spent several days working with a PA in the inpatient department. I performed history and physicals, admitted patients, did rounds and presented "my" patients in grand rounds.

In the evenings and weekends, I often worked in the emergency department. My background as an RN was in emergency services, so I felt comfortable in this setting. The physicians were welcome preceptors. I evaluated injuries sustained from snowmobile accidents, pediatric complaints and frostbite. I had the opportunity to follow patients from their presentation at the emergency department through inpatient and then in clinic for follow up appointments. I went with an EMT on a small plane to transport a patient who had been involved in a snowmobile accident.

After about 10 days in Bethel, I had the opportunity to travel to Aniak, a three hour's flight from Bethel. YKHC had recently established a sub-regional clinic in Aniak run by two PA's. From there I went even further into the bush to conduct a village clinic with one PA. We performed all the well women and well child visits for the village of Crooked Creek. The word circulated in no time that a women had arrived to conduct the well women's clinic. Women from adolescents to the elderly arrived to participate. In two days, I performed 14 pap smears and well women checks. It was an awesome opportunity.

Back in Bethel, I spent two days with the opthamology students solidifying fundoscopic exams. I spent several days with a PNP in the chronic pediatric clinic. In the evenings and in between clinic visits, I followed a Nurse Midwife and was present at two births. Overall, I clocked 179 hours of clinical in 27 days.

The experience in Bethel was extremely valuable both clinically and personally. I had the freedom to learn in a supportive and clinically excellent environment. The providers in this area were incredibly resourceful and compassionate. I was exposed to the complex and wonderful culture of the people in this region of remote Alaska. I believe when one truly sits at the feet of another group and listens, you walk away a changed person. Thanks to the COTWS, I was allowed this amazing opportunity.