SMALL WINDOWS OF TIME BETWEEN BLIZZARDS

This time of year, blizzards are common on the North Slope of Alaska—it’s just a part of life that one takes into consideration when making plans.   

Kaktovik is a relatively small village (approximately 300 people) on Barter Island, east of Barrow and not too far from northern Canada.  It’s a beautiful spot, treeless, but with nice views of the Brooks Range to the south and the mountains of Canada to the east.  I’ve been assigned to travel there three times a year, bringing public health services to the residents.  I did TB testing on all of the school children in the village in September and am scheduled to return in February to do height, weight, BMI, vision, hearing and blood pressure screening along with catching up with children’s immunizations and well child checks.  My third trip was going to be in May, offering some sort of community education as well as continuing to give immunizations and do well child checks. 

I’d been concerned that children’s flu vaccines hadn’t been available to take on my September trip and that waiting to vaccinate the village until February might not be effective in helping to prevent some cases.  I felt fortunate that our new coordinator agreed to my trading my May trip for one in November, so went the week before last, Monday through Friday. 

Along with bringing flu vaccine, I was accompanied by our new public health nurse, Jennifer, who is in charge of an obesity grant.  She’s been assigned to travel to all of the villages and gather the height, weight and BMI’s on all 1,600 of the schools’ students and make presentations about reducing risk factors for obesity and its’ accompanying chronic conditions like diabetes, heart and vascular diseases.  Jennifer has been a public health nurse for 20 years and has worked in quite a few areas of Alaska.  Her father was a big game hunter who flew all over the state.  Many of her earliest memories have to do with sitting behind him in his airplane.  She most recently worked as a public health nurse in Seward and says that she’s extremely happy to be here on the North Slope where here job requires her to do quite a bit of flying.

Another benefit of the timing of the trip was that two of our nursing students from Gustavus Adolphus College in Minnesota would be able to experience public health nursing practiced in a village as well as put on presentations at the school about the detrimental effects of pop including tooth decay, obesity, diabetes, and bone loss.  Laura and Madeline had been shadowing me on appointments in the clinic and I was happy that they’d be able to visit Kaktovik and was grateful for the program that they’d be presenting. 

The blizzard abated long enough for us to make the trip from Barrow, landing briefly in Nuiqsut to exchange freight and passengers, and then on to Deadhorse at Prudhoe Bay. I got out of the plane in Nuiqsut to stretch my legs and because other passengers boarded there, found the open seat at the rear of the plane, with much lower temperatures.  A man up front said that he didn't think that I had enough meat on my bones to keep me warm, so came back and sent me to where he was sitting up front.  When the pilot boarded he said that our walking could have caused the plane to tripod onto its nose as he'd already taken off the anchor that helped to stabilize and balance the plane.  The photo below shows when it is in place while on the ground.

Flying never gets old for me and every trip seems as interesting and as exciting as the first.  In the picture below, you can see one of the trucks I could see from the plane that looks as though it’s heading down the Dalton Highway to Fairbanks.

We were detained for several hours in Deadhorse until conditions there made it safe to take off.  There was three quarters of a mile visibility for quite a while and finally the mile required opened up and we were off.  One must be ready to leave in a moment’s notice as the pilot walks through the small terminal saying, “I’m leaving for Barter Island.  Whoever’s coming, follow me”.  If you’ve taken off your winter gear and opened your lunch, it’s a very hasty redressing and reloading your backpack and out the door.  We reached Kaktovik just between a day of 70 mph winds and the next one that would find us listening to the force of 58 mph ones with gusts up to 70. 

Strong winds are a factor in the ice being blown in close to shore and we could see from the air that there was a good solid-looking expanse that had moved in.  We were told that all of the polar bears had gone…the males were out on the ice hunting seal and the females had moved inland or onto the ice to hibernate in snow packs where they would give birth to their young in the coming winter months. 

It’s very cold, difficult to see, walk or to breathe in the high winds so when we set out the following morning for the school, my taking our group left instead of right caused some momentary concern.  I’d been disoriented, so when things began to look unfamiliar, I suggested that we retrace our steps, go in the opposite direction and was extremely grateful that before long the school appeared.  Fortunately for me, Jennifer, Laura and Madeline were mesmerized by the whole experience and didn’t seem upset, although we all were extremely glad to get in and out of the cold. 

I’d met Amanda, the school secretary and Marie, an assistant, as well as Todd, the principle of the pre-K through 12^th grade school on previous trips and had emailed them about our coming, hoping that both Jennifer’s and Laura and Madeline’s projects would be approved and that they’d have access to the children during one or two days of our visit.  I couldn’t have overestimated their warm welcome and willingness as well as the children’s response to our being at the school.  Many of the younger ones hugged each of us in the hall ways and participated happily in especially Laura and Madeline’s fun presentation.  They’d brought a giant sized monkey with an accompanying tooth brush, a power point presentation for the older students and toothbrush, floss and toothpaste kits for everyone.

After seeing that things at the school were underway, I returned to the clinic for my well child checks and immunization visits.  Several people brought their children in and others said that they didn’t want to bring them out in the strong winds but agreed to a home visit.  It’s an honor to enter their homes, feeling very welcomed.  One senses strong, warm family ties, that elders have a meaningful influence on younger family member’s lives and that children bring much joy to their parents, grandparents, aunts and uncles.

One little girl who has type 1 diabetes helped me to get her Aapa’s band-aid ready (he was getting a flu shot) as well as her three.  Her Aapa said that his shot didn’t hurt a bit, so she was sort of excited to get hers, especially after hearing that we’d be blowing bubbles and that I had some stickers for her afterwards.  I explained the shots that she’d be getting and at some point found myself calling the adorable four year old “Pumpkin”.  I discovered that this was probably the last thing I should have called her as she stood to her full four year old height and exclaimed that she was not a pumpkin…that I was a pumpkin!  She didn’t sound very happy with me and not wanting her to feel as though I’d insulted her intentionally, explained that I call my granddaughters “Pumpkin” and that it means that I like them very much.  It took much explaining by her amau (great grandmother), mother and aapa (grandfather) before she calmed down.  They began calling each other “Pumpkin” and laughing to help her to see that it wasn’t a bad thing to be called.  By the time we left, they had dubbed me anna (auntie) and we were all calling each other “Pumpkin”, even our small pumpkin.  It was an especially enjoyable home visit.

Jennifer accompanied me on two home visits later that day, wanting to see how a well child check was done in public nursing for the North Slope Borough.  We’re not part of the State of Alaska system and although we follow most of their guidelines, there are some differences.  At the first house, four adults wanted flu shots along with my doing a well child check and immunizations on a little 17 month old boy.  The family was very warm and both Jennifer and I enjoyed our time there.

Annie Tagarook, one of the employees at the clinic had dropped us off and waited outside, so was ready to take us in a warm truck to the next house.  Instead of waiting, she used the time we would be at the second house to run an errand.  Jennifer and I disembarked with the heavy immunization bag and made for the door in the high winds as Annie backed out and drove away.  After knocking on the door for what felt like some time, a woman appeared through the glass and seemed to be trying to unlock the door.  She left and returned with first a wrench and then a hammer.  We stood up against the door trying to get at least a small amount of relief from the force of the wind, both wondering if the door would ever be open.  After what felt like a very long wait, in part due to the uncertainty about whether we would survive, she pulled the door open.  She was housesitting and hadn’t learned the trick to opening the stuck door.  Below is a picture of the very windy enclave where Jennifer and I stood waiting to get in and one leaving the house after our visit. 

We put in long days and late nights holding flu clinics, keeping up with paperwork, doing chart reviews and communicating with the Barrow clinic about new developments there.  On Tuesday night after falling into bed, I could hear a man’s voice outside the door to our upstairs quarters.  An itinerating community health aid stayed in the quarters as well, but was sleeping at her sister’s house that night.  The man was asking for her, so I assumed that he was a friend looking and called out where she was.  He asked me through the door if I was a nurse.  I said that I was and then with very heavy eye lids, fell back to sleep.  Not long afterwards, Madeline knocked on my door saying that there was a man in the emergency room downstairs and that they needed a nurse.  I hesitated long enough to put my jacket on over my pajamas and bounded down the stairs to find the ER filled with the village’s Fire Department as well as two of the community health aides.  They were trying to decide if they should hang a bag of normal saline or lactated ringers for the man in bed who was uncontrollably shivering, but was otherwise, unresponsive.    

Practicing acute care nursing is outside of a public health nurse’s scope of practice and not allowed, so the most I could do was round up a heater, offer moral support and bring hot cups of coffee to the people caring for him.  Jennifer found blankets to pile on him and Madeline and Laura watched with quite a bit of interest.  After some time, the patient seemed to stabilize and the four of us returned to the quarters, knowing that we’d be getting up early the next day to begin work.  As Jennifer and I fell asleep, we talked about the evening and laughed as I explained that I didn’t understand that the man was asking me if I was a nurse because he needed one downstairs.  Some nurse, we decided, laughing again when I protested saying, “I’m the day shift!”  It really is refreshing having Jennifer on staff. 

We learned in the morning that the man had slept through the night and because of his lack of alertness and the belief that he may have had a stroke, was medevac’d to Anchorage during a brief period of time when Guardian Air, a medical transport service, was able to fly in to pick him up. 

The clinic staff, Stephanie Aishanna, Mary Sittichinli, Mary Margaret Chandler, Mary Gallagher and Annie Tagarook go out of their way to make our public health nursing visits productive and I love the synergy that develops after a very short time.  I respect the work they do immensely and have thought at times that it would be meaningful to do what they do.   On one of our home visits, the mother said that two of the health aides had delivered her baby and another one whose son sustained an injury to his head that left him unconscious, was kept alive, cared for and medevac’d out by one of the health aides when a plane could finally get through.  They really are the front line in providing medical care to their communities.

Blizzards warnings indicated that there wouldn’t be any flights leaving or arriving from Friday morning to Saturday morning, but most likely because a lot of prayers were going up and visibility was at least one mile, the plane that we would be taking landed on time.  I don’t remember ever having as much trouble getting pieces of baggage from a truck to an airplane...it was as if I was being pushed backwards by a strong, invisible hand.  Finally, the bags were loaded and with almost as much difficulty, passengers slowly walked, bent forward and made their way up the stairs and onto the plane.  We took off into the wind, made our stops with a long layover in Deadhorse and nicely landed in a calmer Barrow.  A great trip…a wonderful one in all ways.