Serving the Health Care Needs of Alaska Natives
By Larry Di Giovanni
Note: This is the final piece of a four-part series examining the Geisel School of Medicine’s long-standing work with American Indian and Alaska Native communities. Read parts one , two , and three for more.
Will Boylston, MD ’11 is one of the most well-travelled young primary care physicians in Alaska and perhaps the nation.
In late August, he flew in a 737 jet to Kotzebue, a Native Alaskan village and regional commerce hub located just above the Arctic Circle. Half of the 737-Combi plane that transported him held cargo, and the other half seated passengers. The miles on the journey are just fine for Boylston, because he loves the destinations.
“It’s fun because I get to fly into some of the most rural parts of Alaska,” says Boylston. “Part of why I enjoy it is that family medicine here is so interesting. I get to do most everything: emergency medicine and hospital medicine, orthopedics, and in some places, we do obstetrics and pediatrics.”
Boylston’s wife, Erin, is a physician with the Air Force, and they have a son, Ian, nearing his first birthday.
“Because my wife might be deployed with the military, my plan for the next one or two years involves working as a locum tenens physician in different locations for a week or two at a time,” said Boylston, an Oregon native who recently completed his family medicine residency in Anchorage.
His Geisel School of Medicine education gave Boylston the skills to provide healthcare delivery “on the go.” He is already highly experienced in providing primary care to Alaska Natives. During the second year of his residency, he spent six weeks in Bethel, one of interior Alaska’s main hubs for commerce. He also worked with patients at the Alaska Native Medical Center, one of three main Anchorage hospitals.
In his third year of residency, Boylston visited Kotzebue for a month, and also served for a month at Valdez Medical Clinic, a site frequented by Geisel family medicine clerkship students. He revisited Valdez later this summer.
“They have a pretty nice hospital up there in Kotzebue; it’s quite modern,” he says. “It’s similar to Bethel in that it serves as a regional hub. The 737s that fly in serve a large area, probably a region larger than the state of Maine. It’s a jump-off point where a lot of scheduled medevacs from smaller villages fly into Kotzebue, and if patients are sick enough, they will be flown to Anchorage.”
“We handle anything that happens – there are snow machine accidents and broken bones, cases of pneumonia, and unfortunately, there are a fair amount of suicide attempts and intoxicated patients,” says Boylston.
One life-or-death case involved a male Alaska Native teen from the village of Selawik who came to Kotzebue with renal failure, his kidneys nearly shut down. He was sent via medevac to Anchorage, where he slowly recovered. “Even when he was flown into Anchorage, they couldn’t figure out at first why his kidneys had shut down,” Boylston says. “But in research I had completed, I found that ‘huffing’ chemicals can cause renal failure.”
Boylston says he and the young patient – who was homeless at times --- developed a relationship of trust. The skill of recognizing chemical abuse involving any volatile compound, whether fuel or even compressed air cleaners for computers, is an important asset for a physician to have, he said. Boylston, like all Geisel graduates, knows the importance of providing compassionate medical care that is also culturally competent.
Their (Geisel medical students) arrival is her opportunity to provide mentoring in “the most difficult job and the most rewarding job,” which is practicing medicine in rural Alaska.
Sarah Spencer, DO, who completed her Maine Dartmouth Family Residency in early 2009, joined the Valdez Medical Clinic staff in April of that year and was responsible for bringing the first family medicine clerkships from Geisel to Valdez. She had built a good working relationship with her then-mentor, Cathleen Morrow, MD, the attending physician during her residency in Augusta, Maine, and now pre-doctoral director of Geisel’s Department of Community and Family Medicine.
Spencer enjoyed working with Valdez Medical Clinic colleagues, including fellow family medicine practitioner Kathleen Todd, MD, the staff, and family medicine clerkship students from Geisel. However, being married with two small children, she wanted a job that would involve fewer night calls and other on-call duties.
In August, Spencer once again became a pioneer – this time, bringing the first Geisel family medicine clerkship students, one by one for five weeks each, to a tribally owned clinic in the fishing village of Ninilchik, located in southern Alaska’s Kenai Peninsula. She is employed by South Peninsula Hospital in Homer, where the Dartmouth students spend one week of their rotations.
Four weeks of the clerkship are spent with Spencer at the Ninilchik village tribe's community clinic, where she works under contract as the lone family medicine physician alongside a nurse practitioner. The village has less than 1,000 residents. Between 60 and 70 percent of her patients are Alaska Natives.
After working in Valdez for several years, Spencer started serving her Ninilchik family practice patients in November 2013. She is still cultivating her practice but believes from experience that Geisel students will be a welcome addition to the clinic. She is a Geisel clinical assistant professor of community and family medicine who “loves teaching.”
“It’s exciting to work with Geisel students again,” Spencer says. “They are excellent students, well prepared, and have a good knowledge base. They’re really curious and want to do a lot of hands-on work.”
When she mentored Geisel students in Valdez, they had to prepare for any emergency because the nearest large hospitals in Anchorage were six hours by vehicle and one hour by plane. One life-saving case involved a head trauma suffered when a patient fell from a cliff, breaking his skull. “We had to intubate the patient, stabilize him and send him by medevac to Anchorage,” Spencer says.
Another case involved a pre-term pregnancy with twins. The mother’s water had broken and the umbilical cord was prolapsed, requiring a Caesarean section. The Geisel student involved provided excellent assistance and the delivery was a success."
“We could not fly her out because she was not stable so we had to do a C-section. Normally, we don’t do pre-term deliveries in Valdez, and normally, we don’t deliver twins in Valdez,” Spencer says. “So it was a pretty high-risk case but there was no choice. Everything about working there is about being forced to perform procedures you don’t normally do because of the remoteness. There are always a lot of procedures that need to be done.”
In Ninilchik there are medical emergencies on occasion but with two hospitals within 35 miles of the clinic, such cases are infrequent, Spencer says. A significant part of her caseload involves chronic disease management including diabetes treatment, and treating laborers who overwork themselves fishing and have musculoskeletal injuries. A few times each month, she serves patients in South Peninsula Hospital’s emergency room and its family practice clinic.
“Even when he was flown into Anchorage, they couldn’t figure out at first why his kidneys had shut down. But in research I had completed, I found that ‘huffing’ chemicals can cause renal failure.” Will Boylston, MD ’11
Spencer’s husband, Rob Johnson, works for the Alaska Department of Fish and Game. They have two sons: Noah, 8, and Evan, 2. Spencer is originally from Smithfield, Maine.
Kathleen G. Todd, MD, a family medicine physician at Valdez Medical Clinic with 35 years of experience, says Geisel students help serve a large number of walk-in patients. Medical needs range from removing skin-imbedded fishhooks and orthopedic care resulting from helicopter skiing accidents, to procedures including Caesarean sections and appendectomies. The clinic is privately operated and leases space from Providence Valdez Medical Center.
“Our students have to be efficient and do what is pertinent for the day,” says Todd, who recently became a Geisel clinical assistant professor of community and family medicine. She works with two physicians and hopes the clinic can add two more.
Unlike many medical schools, she says, the Geisel School of Medicine commits to full medical training for students in third-year family medicine clerkships. She hopes to mentor three of them this academic year.
Todd has also worked with fourth-year Geisel students and Geisel-graduated residents, who have included Boylston. Their arrival is her opportunity to provide mentoring in “the most difficult job and the most rewarding job,” which is practicing medicine in rural Alaska.
Todd describes Valdez, a town of 4,000 residents, as an integrated community with a small population of Alaska Natives and American Indians.
“Medical students and residents keep you sharp,” she says. “They ask questions and you have to remember how to describe things in technical terms instead of terms used with patients. It keeps me on my toes. It is fun to see things through their eyes, like the wonder of putting on a cast for the first time. All of our Dartmouth students are spectacular, a cut above other students in the skill level they arrive with.”
About the author:
Larry Di Giovanni has written about higher education, health care and Native-American communities including K-12 education for 20 years. He lives in Athens, Ohio.