Alaska Blog II- Yakutat Tingit Clinic

The sign on the outside of the airport building said, “Food, Shelter and Booze.” Before leaving to visit the Yakutat Tingit Tribe’s clinic, I told the pilots of our plane I would be gone a few hours and suggested they step inside for two of the three featured amenities.

It was a drizzly afternoon, but life in Alaska just carries on. This was July and the weather was good, during which not an hour can be spared as they get ready for winter. Twenty hours of daylight helps, but knowing winter comes soon keeps people moving.

Yakutat is has a population of about 900 right now. A few years ago it was over a thousand. Victoria Demmert, President of the Yakutat Tlingit Tribe, explained as she drove us on their only oiled road, that when the timber industry went flat, some were forced to leave.

Yakutut is considered a larger village by comparison to most in Alaska. I’m guessing they are one of the villages that are better off. I drove past a fish plant where locals are able to bring their fish for processing before the fish are flown to Seattle on Alaska Airlines, which stops regularly. Still, government jobs are the biggest source of employment.

At the clinic, I met Leslie Jones, the Director of the Clinic. She introduced me to Dr. John Bacicocco, who actually lives in Sitka, Alaska but travels as an Itinerant doctor, visiting Yakutat about one week every three months to do face-to-face patient visits. The rest of the time, health care in Yakutat is provided through two Community Health Aides, Mina Adams and Becky Nickles. Each has completed a four-part training and certification process and they essentially operate as extensions of Dr. Baccicocco.

Mina and Becky operate using a book of medical protocols called the Community Health Aide Manual. It is a brilliantly constructed instruction manual that provides diagnosis and treatment algorithms, and tells them when to call the doctor for further instructions. They have the equipment to provide Dr. Bacicocco with information he needs to treat the more serious cases. They are his hands, eyes and ears. It’s less than ideal, but when your doctor is an hour away by air, living in a village of less than a thousand, it’s the best you’re going to get and much better than most of the remote world gets.

The big news in Yakutut health care for the coming year is the extension of basic dental services in the clinic. I met 21 year old Sheena Nelson, who is finishing a two-year dental training in Anchorage. In a few months she will return to her village as a dental health therapist. She will occupy a small dental operatory inside the clinic. Like Becky and Mina, the health aides, she will work as an extension of a dentist who resides in Sitka. She is being trained to provide oral health education and prevention, fill teeth and perform basic dental repairs. Once a procedure gets to a level of sophistication requiring a dentist, her job will be to stabilize the patient until the additional treatment can be arranged, often weeks later.

Sheena Nelson talks with Secretary Leavitt about her training to become a dental health therapist.

Sheena’s story appears to be fairly typical. She was considered one of the more serious and able students at her high school in Yakatut, but wanted to stay in the area and took employment as a waitress. When the Yakatut clinic was provided a slot for a dental health therapist, she was nominated and, after a series of interviews, selected. She will now return with a job that will dramatically enhance the quality of life in Yakatut, and she has a job that will pay $18 an hour.

Understandably, this program has been enormously controversial among the dental community in Alaska and elsewhere around the country. On more than one occasion, dental professionals have come to express genuine concern about people with only two years of training filling teeth and performing other non-reversible procedures. This visit confirmed my instinct and previous expressions to the dentists. The Professionals aren’t willing to live there and this is giant step ahead from no care at all.

While I was in Central America visiting with health ministers from that region, they expressed a desperate need for this kind of help. The alternative there is a family member using a pair of needle-nosed pliers to provide relief.

After my visit at the clinic, I was treated to a delightful community gathering where villagers, both young and old performed, in colorful native regalia. The dances they perform preserve the stories of their culture and history.

Yakutat villagers dancing in native regalia.

It was a valuable insight into the importance of family and community in surviving the brutal conditions of remote Alaska. Not only do they survive, most find happiness there.

Comments

Secretary Leavitt,

thank you for visiting Tribes and HHS workers in any of these very remote locations to provide healthcare to people in need.

Posted by: | August 04, 2008 at 09:39 AM

Dear Secretary Leavitt, I cannot understand why you do not support reproductive health care for women. What do you have against birth control that prevents abortion? It seems that you do not have compassion for women that are poor and cannot afford additional children. It also seems that you are anti-women. Shame on you! Carole Wright

Posted by: Carole Wright | August 06, 2008 at 05:09 PM

Kate, the text of the proposal is here:

www.rhrealitycheck.org/emailphotos/pdf/HHS-45-CFR.pdf

Read it for yourself. It's pretty horrifying.

Mr. Leavitt, I hope you can see that this is nothing more than an attempt by religious zealots to make it easier to deny women their reproductive freedom.

I think you owe America a statement on this subject, Mr. Leavitt. This is not something we as women can afford to ignore, and so it is not something you should ignore. The office you hold compels you to make wise decisions free from superstitious bias and faulty science.

Your silence is very disturbing to us. Please issue a statement soon.

Posted by: Amanda Gannon | August 07, 2008 at 03:34 AM

Actually, many oral contraceptives are abortifacients, which are substances that induce abortion. I and a 33 year old woman, and I agree with Bush's proposal based on factual evidence, and hope that HHS does the same. As for what DK stated, Margaret Sanger had very prejudiced/racist origins - you should look up her earlier statements.

Posted by: Karen | August 07, 2008 at 11:57 AM