A Little Education - "The Job"

My job, or rather the organization that I work for, is pretty unique.

The Alaska Native Medical Center (ANMC) is a 150 bed, level II trauma center that provides medical services to Alaska Native and American Indians living in Alaska. This is a patient population of roughly 200,000 people. We provide acute, specialty, primary and behavioral healthcare services. Our patients live all over the state of Alaska...an area that covers 586,412 square miles.

This can make getting to the hospital for regular appointments, surgery or in an emergency kind of a challenge. Patients are medivac'd in daily for emergencies. Sometimes patients will have to take a snow machine to a neighboring village to then catch a bush plane to a larger village where there is an airport large enough to accomodate regional jets. All of the villages have health clinics, but many of them aren't staffed with doctors or PA's, only health aides with little more than high school educations. Doctors and PA's staff some of the larger clinics in places like Bethel, Barrow, Kotzebue, Dillingham, Kodiak, and Nome among others.

ANMC is jointly owned and managed by the Alaska Native Tribal Health Consortium (ANtHC) and Southcentral Foundation, tribal governments, and their regional health organizations. These parent organizations have established a Joint Operating Board to "manage" the services provided by ANMC. They receive funding from the federal government as well as from the individual Native tribes to provide "pre-paid" healthcare. If patients have insurance or medicaid, we bill it, but otherwise their care is pre-paid.

ANTHC has several divisions. Along with ANMC they have the Division of Environmental Health and Engineering (DEHE) whose function is to facilitate running water and wastewater facilities to the villages as well as institute community based injury prevention programs. Also, he Division of Community Health Services (DCHS) which manages Alaska Native health research projects, monitors industrial pollutant levels in Alaska Native mothers and infants, trains chemical dependency counselors and tracks and promotes immunization, and works to prevent Hepatitis.

I'm a physician assistant in the orthopedic department. We take first call for traumas, first-assist in surgery, run outpatient clinics, perform reductions and procedures in the clinic and ER and manage all the inpatients on the orthopedic service in the hospital. The ortho. dept. has a staff of 8 surgeons and 6 PA's located here in Anchorage. The doctors go to field clinics 3-4 days at a time in the different villages a couple times a month. Beginning in April they will be taking PA's with them. We are all really looking forward to this opportunity!
There is alot of alcohol abuse, depression, domestic violence, suicide and surprisingly homelessness in the Native population which can make for interesting injuries/traumas. Many of our patients live a subsistance lifestyle where they hunt and fish for survival. This means guns and the injuries associated with them are common. The following is a small sample of injuries that I have seen in the 8 months I've worked here:

- gunshot wounds (GSW) from cleaning loaded weapons
- finger and hands blown off from faulty explosives
- stabbings
- a BBQ skewer impaled in a patient
- harpoons (for whaling) impaled in people
- seal finger: a finger infection unique to patients in the arctic where hand or finger has been cut while cleaning seal meat and gets a unique infection.
- MANY alcohol related traumas.
- a patient trampled by a moose while intoxicated who suffered fractures
- failed suicide attempts from drug overdoses, jumping from heights and GSW's among other things.
- LOTS of frostbite and subsequent gangrene.

Some days it can be really challenging, not only with the medicine but dealing with the social issues. But alternatively it is really rewarding to be able to spend time with, and help such a unique patient population!

More to come...