Flight back to Kotzebue, are we coming back??

9am flight back to Kotzebue.  30 minutes to enjoy the scenery at 6,500ft.  After dropping our bags at the hotel we walked to the dental clinic to debrief with the other dentists, DHAT's and the clinic director Kirk.  We also met a doc who just arrived from Arizona and was on the way out to Selawik for another week.  And, we talked to Monica, Gloria's initial contact for this adventure.

Lots of freight coming in on our flight including 6 pizzas!

Our final view of Selawik.

Aboard the Cessna Caravan 208B

Coming into Kotzebue.  The large green-roofed building
is the hospital. On the top, the airport runway.

We celebrated our success by eating out in the hotel restaurant. After dinner, we headed out over the ice-covered channel to watch people ice fish, learned the ice on the Chukchi Sea is still 4 feet thick.  They were jigging little Pacific Tomcod for fun.  The big Sheefish are further out in the channel, most people wait till summer to head out to catch them.  We did talk to one of the fishermen.  Friendly guy.  He owns a local shipping company, flies everything in and out of Kotzebue.  Busy with freight and mail for Kotzebue as well as the military and mining industry.  He also told us that his uncle, John Baker, won the Iditarod Sled Dog Race in 2011.  The first native Alaskan to win the race in 45 years. He retired a couple of years ago selling his 152 dogs!

So, we committed to returning in July for another 2-week rotation in Selawik.  The people, both colleagues and patients, are great.  The dentistry is challenging but it does keep our skills sharp.  It is a good gig.  Summer will be a whole new experience.  The ice will be gone but the '747' mosquitoes will be the next challenge.  We work indoors so that helps.  Alaska will cool us down from a hot California summer.  And, maybe some Sheefish fishing!

4th and last clinic day in Selawik

Our team!  Shelby and Hannah between Gloria and me.

Another good day.  The staff has been great getting patients in to see us.  We stayed busy all day from 9-6,  No real surprises.  Routine extractions, fillings and cleanings.  When Gloria did ask a couple of kids if they brush their teeth every day and they respond no, she asks them why not.  They will say they don't want to, and leave it at that.  If asked if they drink soda every day, they nod yes, and when we tell them not to, they look at us, like, 'right'.

So, a little tour of Selawik.  Temperatures in the 30's now, the ice and snow are melting.  Spring is swampy, summer is buggy, fall comes early and winter is long, hard and dark. 

The medical/dental clinic

Another 'vehicle' waiting for the spring thaw

At the airport

One of the three rivers that bisect Selawik

Another sewer system view

One of the many boardwalks that stitch the community together

We fly back to Kotzebue tomorrow for debriefing and home on Saturday.

Springtime in Selawik!

 A good day today.  Both Gloria and I were very busy, with a total of 14 patients plus the mountains of paperwork.  Extractions, fillings and cleanings.  We got our second assistant this afternoon.  Shelby.  Great to have another assistant to maximize our patient flow.  Tomorrow is already booked to finish out our clinical week.

One of the two operatories

Sterilization

Our sewer has held up.  Toilet works, after skipping showers last night, we're going for it tonight.  Kinda, maybe getting back to normal.  After work, actually, at 9pm, we went for another village walk.  Beautiful sunshine, no wind, and it warmed up 20 degrees!  Above freezing now, very pleasant.  Fun to talk to all the people out and about since it is warmer.

Yep, the 'honey pot'.

Finaly, I have mentioned the 'administration' in my blog.  His name is Augustus L. Kirkland, Kirk for short.  We learned he is also a pastor in a local church.  The Living Word Water of Life Church.  He is one busy guy.  

Kirk is Samuel L. Jackson's lost, little brother!

First clinic day but the sewer is frozen!

 Busy, busy clinic today for both Gloria and me.  Many needs, one can only chip away and hope to reduce pain and infection.  The challenges we see are similar to what we have seen in the past in developing countries.  But, outside of the US, we do the work, clean up and move on to the next patient.  Here, working for the Department of Indian Affairs, our paperwork has paperwork.  Gloria and I are much better at the dentistry then we are with paperwork!

Hannah, our assistant is great, but we all realize she can't chairside assist, do sterilization plus all the paperwork that is required for government reimbursement.  They are flying in another assistant tomorrow from Kotzebue to do the 'admin' work.

Now, some comments on the meals!  Breakfast for the medical-side employees was caribou liver and pancakes.  They offered all I could eat but I demurred.  For lunch, our maintenance man cooked up Spam soup.  Another variation I hadn't thought of.  I did have a bowl, not bad really.  I fear, though, that the 'non-Spam' meat in the soup was leftover liver.......

Frozen sewer?  A story and a picture.  As Gloria and I walked around town after clinic yesterday, we saw what looked like AC ductwork going from house to house, the village is laced with it.  We thought, how odd to heat that way.  When we asked, we were told that this is their sewage system!  Again, due to permafrost, it, like the houses on stilts are above ground.  They are insulated and they don't depend on 'flow'.  The answer?  Suction.  They have huge suction pumps to draw the sewage.  Problems arise if it is too cold for the pumps to work.  Hence no suction and no flushing toilets!

So, without any more graphic descriptions, with all the toilets in the medical/dental clinic not flushing we finally ended up with one bucket to use.  What we used to call a 'honey pot'.  Not ideal for around 10 of us working at the clinic.  Fortunately by 6pm today, the suction was sucking again and we could flush.  Oh my.

Bush flight to Selawik and caribou for dinner!

                                

An 8:30am flight to Selawik.  5 seater plane, more room for cargo than humans!  Uneventful 30-minute flight over the frozen tundra.  We were greeted at the gravel airstrip by snowmobiles, quads and cargo sleds!  It is a bit of a walk to town over a bridge, or, since everything is still frozen, over the river!  So we walked over the river, a snowmobile trailing a dog sled took our suitcases and supplies to the clinic.

A large, modern medical/dental clinic, fully staffed on the medical side, dental has been closed due to covid.  We spent the morning organizing and cleaning the two-chair dental suite and saw our first patient at 2pm.  I relieved him of two infected molars, he was grateful for the care, I was pleased to start doing what we came up here to do!  Two more patients followed.  A good start.

Hannah, our assistant is calling a long list of locals who have indicated an interest in dental care hoping to fill our next three days.

Now, the dinner menu.  Actually, Gloria made Thai curry in the kitchen tonight.  But, after dinner we decided to walk around town.  Just outside the clinic an older gentleman invited us in to the community center for caribou!  He went on to explain that someone just died so they were having a potluck.  So, we went in and found the bar-b-qued caribou ribs, a few other parts, yet to be cooked, and the casket!  Caribou is chewy.

Raw caribou in front, Gloria in the middle, casket in the back

The Kotzebue 10K, well 14K

We've been told about the 8 mile walk around Kotzebue by the dental staff, so today was the day.  You start by the hospital and it ends at the airport.  Much of the walk is in caribou country, (when caribou are around and hunters aren't).  Not much to see, frozen tundra and snow, but good exercise.  Turns out to be just over 9 miles door to door.  4 hours.

On the loop was Cemetary Hill.  Winter burial is a challenge due to permafrost.

I mentioned the numberous abandoned snowmachines, quads, cars, truck, etc.
 all over town.  Same applies to airplanes! Probably 6-8 abandoned planes
beside the runway.

Last night was a real treat.  Stephanie, one of the DHAT's (dental mid-level provider) invited us over to her house for dinner.  Stephanie is from Texas but she married a native Alaskan, Raymond.  Retired military who now teaches cultural awareness to the high school students at Kotzebue High.  Specifically, he is teaching them the Inuit language and also takes them on 250-mile snowmachine campouts in the winter!  They learn how to hunt, survive and thrive in -30 degree weather.

Raymond has stories!  His best, though, was on a good day of hunting he bagged 3 caribou, 3 wolves, a wolverine and a moose.  Why so many animals?  Well, they had to fill their freezers for the year AND they, at that time had 58 huskies they were training for 'mushing'.  What a guy!

Also, their son, Spencer is a world-class Greco-Roman wrestler!  In fact, yesterday he won the Nationals for his class.   He is in the Army who pays him to play and sends him all over the world to compete.  He barely missed a spot on the Olympic team but should be competitive until the 2028 Olympics in Los Angeles.  Two links below.  First, his news conference yesterday, then a very neat background on living in the Alaskan tundra in preparation for his career in wrestling.  Check them out!

https://www.youtube.com/watch?v=hC4BC1tyUXs

https://www.youtube.com/watch?v=GqvN5HivuOo

BTW, we met Raymond on our hike today.  He was running, training for his next marathon.  He is amazing!

We left Stephanie and Raymond's house at 11pm, the sun still not set.

A grim postscript to the restaurant that burned down a few weeks ago. They evacuated our hotel at 3am, many of the windows shattered from the heat, note the scorch marks that remain.  After the fire was put out the owner was missing.  Due to the below zero temperatures, the water used to fight the fire turned to ice and they were unable to search the ruins.  They had to bring in cadaver dogs to locate the remains of the owner, they then removed the ice and wreckage to recover his body.  

Tomorrow we fly to Selawik.  Hoping for adequate bandwidth to post.  If you don't hear from me, we didn't.

A Parade!?

After a relaxing 4 mile stroll through Kotzebue in, still, rather frigid temperatures, we relaxed in the hotel room until we heard police sirens.  Surprised, since little that exciting happens in Kotzebue, we looked out the window and saw the Homecoming queen in the back of a pickup doing the 'queen's wave'.  Following her were the rest of the senior class of Kotzebue High in their graduation regalia!  Fun to see.

Other interesting sites in town.

We are now used to seeing half-buried snowmachines, quads, cars
trucks, etc.  Not sure if they are really used anymore.  Just sitting in front yards.

No problem wearing a mask outdoors, it keeps you warm.  All flights
come and go out of this airport.  Alaska Airlines, Bering Air, that takes you
to the villages and a couple of bush flying companies that take out
hunters and fishermen, they typically land on gravel roads, glaciers,etc.

If you look closely, there are four boats here.  Waiting for the thaw.

Paperwork is finished, we're ready to work!

Final day of paperwork.  Our week of integration into the medical staff of Maniilaq Hospital is complete!  We also got our blood work back and I discovered that I was not vaccinated for or had mumps!  

Today, we worked with the dental software and packed needed equipment and supplies for our Monday flight out to the village of Selawik.  Learning more about the Selawik clinic, it has not seen a dentist since Covid hit over a year ago.  So, they aren't sure what it will look like and what it has or doesn't have as far as supplies.  We fly out Monday morning, unpack and set up in the afternoon, then see patients Tuesday, Wednesday, Thursday, then fly back to Kotzebue Friday.  We leave for home on Saturday.

Additionally, we are discovering, that the administration is anticipating that this will be 'our clinic'.  We are to set it up as we wish and return during the rest of the year to see patients.  In other words, The McKelvey Clinic.  Hmm.  

So, in the meantime, it remains cold!  Still in the teens, not quite as windy this afternoon so the wind chill is only -1.  But, snow flurries all day.  Our hotel is about a half a mile from the hospital so the walk in the morning is a good wake-me-up.

Finally, below is our 'dinner table' in the hotel room.  Burritos tonight.  We made sandwiches for lunch today but splurged on a $6.00 order of french fries in the hospital cafeteria.  Life in Kotzebue.

-7 degrees windchill and the whales have arrived!

 A brief note today.  We spent all day in front of the computer completing 20 sections on healthstream.com.  An online hospital competency platform that covers everything from HIPAA to bloodborne pathogens to disaster protocols to what you are supposed to do with an active shooter in the hospital.  Then, after each block, there was a competency exam.  But, we completed them all and we are now ready to fine-tune our skills with the dental software tomorrow.  

We also got a thumbs up to travel to Selawik on Monday.  Weather looks good, (for now), our dental assistant has been chosen, the clinic should be usable and there is a place to sleep.  Will be nice to start seeing patients!

Now, my title......after a balmy 30 degrees the last few days, it started to snow yesterday and the wind really picked up today.  High of 20 but with the wind, the wind chill registered -7!  We could really feel it walking between the hotel and the hospital.  Jeans, ski jacket, neck wrap and wool hat didn't cut it.  It was COLD.

Whales?  Another factor to consider which patients (and employees) show up for care or employment.  Whales are starting to migrate in, which means people need time off to hunt!  For many in the villages, it is their main food source for the year.  Can't miss that opportunity, a toothache can wait.......

Yes, there are cars, trucks and loaders in Kotzebue but you see 
a lot of snowmobiles (called snowmachines up here), quads, and 
Polaris RZR's.  No helmets, no speed limits, no age requirements.
Just going from point A to point B.

Savaqatigiiksugut

 Yep, Savaqatigiiksugut, We Are Working Together.  This is the mission of the Maniilaq Association.  Today was an all-day employee orientation.  As mentioned in the preview yesterday, we talked about everything an employee needs to know about working for Maniilaq.  All attending were ready for full-time employment, except us.  But you can't wear the employee tag unless you check all the boxes,

Tomorrow is becoming proficient in the dental software, Dentrix, which we used in our practice, so just catching up with that.  Our travel to Silawik is still on track.  They are dealing with a water issue in the village, so we are waiting for the latest update.

Some of you are asking where and what we are eating.  First, we were told that there are only four restaurants in Kotzebue, did I mention that the 5th burned down in the last month or so?  We have tried two with two more to go.  Our latest find is Little Louie's.  For breakfast, their signature dish is the "Train Wreck" which is layers of toast, hash browns, sauteed onions, bell peppers, eggs, cheese, bacon, sausage, and ham topped with country gravy!  (Glad the hospital is only a block away)

Breakfast and lunch are on our own and we have eaten in the room the last two nights.  Gloria made cornbread in the microwave!  Turned out great.  A new perspective on 'home cooking'.

Meeting the docs

Day 2 of onboarding. More meetings and a full tour of the 17 bed, 88,000 sq. ft. hospital. They are considering our employment as permanent! They are grouping Gloria and me with others who have moved here and are ready to start full-time. So, we are learning a lot about the hospital and its software including full access to our patient's medical history.  

We continued talking to the two full-time dentists today and I was also in the operatory as they saw patients. Rebekah and Zazz (short for something!). Both great gals and excellent dentists. We also met Stephanie a DHAT, Dental Health Aid Therapist. She is similar to, say, a nurse practitioner in medicine. Two years of training in New Zealand. She can do simple fillings, extractions and cleanings with additional emphasis on prevention and education. Another excellent provider. 

 So, with that update, a few more pictures from the community of Kotzebue.

I have no idea what this sign says or what it is for.  I googled it, nada.

As mentioned, no roads into Kotzebue, EVERYTHING comes in by plane.
Note in the top picture, Pampers, toilet paper, bottled water, etc.
Bottom picture is more freight.  Pumps, ice maker (?), a motorcycle, etc.

A map of the 12 clinics.  Note where Kotzebue is.  Gloria and I are going to Selawik 
next week.  We were told we may fly out there on Friday to check out equipment
and supplies, return for the weekend then back on Monday.  We'll see.

Tomorrow, another full day of employee training including cultural sensitivity, an introduction to Kronos, their workforce management software and discussions on infection prevention and HIPAA.  Oh my.

Onboarding at the Maniilaq Health Center

This the view from our hotel room.  The Chukchi Sea.  It is only navigatable 4 months out the year.

After Gloria took a sunset picture at 10:30 last night, a good night's rest, and a pickup by Kirk our supervisor at 9am.  He was late due to longer rounds at the hospital and noted that when spring breaks and fall descends attempted suicides go up in the Eskimo villages.  They are still not sure why.  Interesting, though.  

 He also spoke of the impact alcohol has on the native population, (horrible) and what the two new marijuana dispensaries joining the one liquor store will do to the community.  Challenging health care issues are ratcheting up by the day.  

We spent the morning at HR.  Pages of forms to fill out and federal-level fingerprinting kept us busy most of the morning.  A great staff of young, mostly native employees.

The afternoon consisted of fit testing for our N-95 masks, reviewing covid-protocols, new tetanus shots and a 7 vial blood draw.  They are very thorough at this hospital!  After all of that, we finally get to the see the dental clinic!  8 operatories.  It has been 'covid-tized' so lots of sheets of plastic hanging from the ceilings and air purifiers.  As in the lower 48, we are on the 'back nine' of covid so they have relaxed some protocols from 2020.

Fit-testing the N95 mask

We also met the dentists that work in the clinic.  Ladies, one who is moving to Chicago this week, another who moved last week leaving two.  All very friendly and welcoming.  They are glad to get help with the almost overwhelming dental needs of the local population as well as the 11(!) village clinics scattered around the tundra.

Tomorrow, a full tour of the hospital and training on the dental and medical software we will be using.

Bonus Photo.  Reindeer stew.  Why not?

Masks on Planes

Routine transit from California to Alaska. But, when we arrived at row 24 on the SEA to ANC leg, the gentleman in the window seat was sitting there without a mask!  Before sitting down, Gloria asked him to put on his mask, which he reluctantly did.  We're thinking this may be an uncomfortable three-hour flight, or if he takes his mask off again, an empty seat once they kick him off the plane!  But, in conversation, turns out he is a nice guy, works in the oil industry; he crews on ships that service the offshore rigs in Alaska.  Postscript, he never wore his seatbelt......

Speaking of Anchorage airport.  Huge fuel stop for 747 cargo liners to and from Asia, we must have seen 15 take off or land while we were waiting for our flight.

                                                      Springtime, the ice is beginning to break up                                                                                    

Kirk, our contact, met us at the Kotzebue airport.  First up, Covid test!  They have been very aggressive in their testing and vaccinations in this part of Alaska.  The younger generation will go the Anchorage for the weekend, get infected, then return and infect their whole village,  Kirk said one flight had 12 who were infected!  They quarantined them in Kotzebue before letting them return to their village.

Kirk gave us a quick tour of the town, we are in the 'melt' now so lots of potholes full of slush and people discover that the potholes can be knee-deep.  Kirk squared us away at the hotel and left to continue helping pull people's cars out.  Lesson: carefully drive the gravel side streets in town.

Tomorrow, Kirks picks us up at 8:30am and takes us to the hospital to start our orientation.

How did we get here?

 Good question.  Well, it all started almost a year ago.  Gloria was at a National Ski Patrol clinic and met a fellow patroller who is a dentist.  In conversation, Gloria discovered that she routinely went to Kotzebue Alaska as a locum to do dentistry.  So, after a 10-month Department of Indian Affairs paperwork journey with numerous staff changes in Kotzebue and Covid, just for good measure, we finally got a thumbs up to fly up to this part of the world just north of the Arctic Circle.

Dentistry is pretty similar to what Gloria and I have been doing in service and mission work over the years.  Differences?  It's colder, no scuba diving but the Fed's pay us.  Tradeoff.  We fly out of Sacramento Saturday, April 24 with a layover in Anchorage arriving Sunday afternoon on the one daily flight Alaska Airlines flies into Kotzebue.

That's Russia to the left of Kotzebue

So, typically for these blogs, I tried to post daily.  We do know that the first two days are orientation in Kotzebue, then a bush flight out to a small, remote clinic for our assignment.  I hope to post again Sunday night.