Alaska Blog V- Kwethluk and Questions I Learned There

I had flown about an hour by jet from Anchorage to Bethel, Alaska. From there, I rode in a boat for about 30 minutes to the village of Kwethluk, population 900. In the summer, boat is the only way to get there, other than using the dirt landing strip that exists at many remote villages. In the winter, the river is frozen enough that a road is plowed on the ice for cars to drive on.

At the bank of the river, Herman Evan met me. He is the 55 year-old Tribal Administrator. He grew up in Kwethluk and lived nearly 20 years in the lower 48 states, working at what he said to be low paying menial jobs in Kansas and Oklahoma. He had a family, and they are still in the lower 48 states. The way he referenced them made clear there’s an interesting story there, but it seemed too personal for the first time two people meet. I left it alone, registering the information as part of the puzzle I was working to assemble, so I could get to know Herman.

Herman is an intuitive, smart man. While he was in the lower 48 states, he observed a lot of things. One was the transformation a few Tribal nations made with the economic base that gambling and other pursuits have provided. Another observation was the power of education. Again, I don’t know the story, but somehow Herman got a Bachelors Degree. The education shows up in Herman’s vocabulary and the sophisticated thoughts he has about trying to build a community out of this tiny, desperately poor island on a river in Alaska.

“Why did you come back, Herman,” I asked?

“It’s home,” he said. “I wanted to make the place better.”

The village can afford to pay him only half-time, but he works all day. “Some people probably think I’m an oddball,” Herman said, as he described his habit of getting up before six o’clock in the morning to walk around town.

Herman Evans and Secretary Leavitt in Kwethluk, Alaska

Herman led me to a wood building they assembled from scrap lumber. I was met by members of the council. A woman, whose name I didn’t catch, but who I instantly liked, said to me, “We’ve been waiting nearly an hour for you, and my butt is sore.”

A previous meeting and traveling had put us behind.

To ease the tension she had intentionally created, I joked with her. “We did, and I am sorry. I can do better on being late, but there isn’t much I can do for that sore backside.” As we walked into the building, I continued and jokingly said, “Probably not much you’d want me to do.” A reporter from the Tundra Drums heard me and included it in his story. It was a reminder to me that you’re always on the record.

The building appeared to be the community building. It doubled as the bingo parlor. A couple of single bulb lights provided light in the place, but a fully electric bingo board hung on the back wall.

Our conversation was unusually direct. Several of the Council members had assembled. Herman diplomatically asked each one to talk.

The head of the Tribal government’s social services talked about how difficult it is to protect children from abuse in homes that are isolated. They have limited resources.

The village manager talked about the need for a sewer system. I was about to get a more graphic view of the subject later in my visit. He said, “We are citizens of the United States and residents of Alaska. We deserve to have running water and sewer that is up to par with other citizens.”

The head of law enforcement talked about how hard it is to respond to those who need help, especially in the winter when there are no roads.

The woman who had greeted me at the door said, “Important people come here, they take notes, and then leave; nothing happens to change things.” She was frustrated and spoke plainly about it.

After listening to each of the community leaders, I wanted to make sure they had proper expectations. I told them I did not come with a checkbook to solve all these problems. I had come to learn, so that when budget decisions about Alaska and Tribal health are made, my views are populated by ground truth. They seemed to appreciate my candor in the same way I had valued theirs.

If I was looking for “ground truth,” I got it as Herman and I left the community building for a walking tour of Kwethluk. Americans would be surprised to know there are citizens of the United States living in that kind of poverty. I saw a well-equipped health clinic, a new Head Start building, a Post Office and a new law enforcement building. However, everything else was consistent with the desperate poverty that engulfs that area.

As we walked among the houses, I saw a metal canister at each home that families use to pour their sewage in. Periodically, the “honey buckets” are picked up and carried to a “sewage lagoon,” which is really no lagoon at all, but more of a hole filled with human waste, sitting in the open. It was simply unbelievable.

The problem: It would cost nearly $30 million to complete a sewer system. Even if state or federal dollars were used, a community of 900 people who are desperately poor cannot support its operation and maintenance.

The day left me confronted by so many questions to think about. For example: does citizenship entitle one to have sewer and water no matter what the cost; or is there a point where people have to choose to live without these centralized services or move somewhere they are provided? What are the respective roles of the state government and federal government?

There were other less institutional questions: what is it that causes people to stay there? Why did Herman Evans come back? Herman partially answered that one for me. He said, “I am happiest when I’m doing things to make life better for people. Perhaps, I’m an oddball (one of his favorite phrases) but I think we can make this a better place to live.”

Home is where the heart is.

Comments

[There were other less institutional questions: what is it that causes people to stay there? Why did Herman Evans come back? Herman partially answered that one for me. He said, “I am happiest when I’m doing things to make life better for people. Perhaps, I’m an oddball (one of his favorite phrases) but I think we can make this a better place to live.” ]

I agree with all that has been said here. Especially the part about making life better for people....
I am speaking of Elderly people now...elderly people that are not being allowed to have a better life. Elderly people across this great nation of ours. I am hoping for a better day for our elderly. Too many have been in that black hole that exists on the back end of the court appointed guardianship system. Some are still trying to climb out, other as still there and some of our loved ones never got out. I have the audacity to hope that we can make this change a reality.

Posted by: Bonnie Jean Smith | August 11, 2008 at 08:57 PM

What this community needs is inddustry. Perhaps we could drill for oil there and build a refinery? Then the government would have to provide the sanitary necessities!

Posted by: Linda | August 12, 2008 at 08:03 AM

I garee with almost all has been said here .
There are many diificult problematics all over the world from health point of view in the direction of prevetion and survey ilnesses.
As Romanian Dr. my observations llok not only for our land , where the incidence + prevalece of: HIV , Tuberculosis , cancers , heart disease who grow up progressiv statistical. I see that even other countries are obsessiv concerned about such morbidity + mortality .
More the patholgy for elderly people are more frequant as before and I am impressed about the tendince of becoming as population less in natality activity involved .
I think as catholic MD , it is the best time to focus our together forces , in an activity conducted in the benefit of our world population in needs.

Dr. Liana Monica Deac
MD, PhD
Professor
Public Health Institut, Cluj-Napoca
Epidemiology Department
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Posted by: Dr. Liana Monica Deac | August 19, 2008 at 04:18 AM

Thank you, Secretary Leavitt, for supporting a physician's right to follow his/her conscience.

As a medical professional, I would hate to be forced from my position because I could not, in conscience, do something that I am morally opposed to. I have too much respect for my patients to do something like that.

As a patient, how could I respect my doctor if she went against her conscience in treating me?

Posted by: Patricia Schmeling, RN, BSN | August 20, 2008 at 12:29 AM