WONDERFUL, EXCITING WEEK AND WORK IN POINT LAY

I fell into bed Friday night exhausted, but happy, having returned from a successful five day nursing trip to Point Lay.  I’d put in 14 hour days while there, wanting to see all of the 36 children who were due for immunizations and also do well child checks and developmental screening on all those three and under.  Seeing clients in the evening, making calls to parents after dinner to arrange appointments, charting--handwriting details about each encounter and making notes about need for follow up with referrals I’d made, kept me working late with the good company of serial cups of hot tea.  I didn’t feel that I could afford to start each new day with the previous one’s work left unfinished so soldiered on past my fatigue and was grateful when I had finished and filed the last child’s chart each night.

The sun shone brightly on my first day there.  On the ride from the airport to the clinic and looking out the windows once there, it was glorious and one could see for miles and miles.  I slept on a mattress in the dental room and was pleased to see that the angle of my bed coordinated perfectly with the broad beam of sunlight shining through the window still in full strength at 10:30 pm when I found my way there.  So it seems as though I fell into a welcomed sleep on a sunny beach.  This experience wasn’t to be repeated on subsequent nights however as the weather turned cloudy and rainy for the rest of my time there.   

I love going to the villages.  I’m assigned to both Kaktovik, the farthest east village on the North Slope and now to Point Lay the farthest west village that Public Health Nursing out of Barrow serves, traveling to each three to four times a year.  Other nurses, Bertrand and Michelle, travel to Wainwright, Atqasuk and Nuiqsut and Jennifer, our newest public health nurse who helps administer the Healthy Lifestyles Grant in conjunction with the North Slope Borough School District, travels to all five at least once a year for several days.  It takes just over an hour to fly the 152 miles to Point Lay, a village of approximately 260 people on the Chukchi Sea where one feels transported back in time.  There are no roads out of or into any of the villages, except for an ice road in the winter from Prudhoe Bay to Nuiqsut.  There are no paved roads, sidewalks or traffic lights and few street or stop signs.  Barrow, the largest village is well lit at night with street lights while the smaller villages have less.  Some of the villages do have something that towns and cities to the south don’t have--polar bear patrols that chase away hungry Nanook who wander some of the villages’ streets, looking for fresh whale meat that hasn’t been cut up and stored in underground ice cellars yet after a successful hunt.       

I learned while in Point Lay that it is the only village on the North Slope that isn’t incorporated, so is still considered by the Federal government, a tribal community.  A tribal council meets to make decisions in the best interest of the residents there.  The other villages have elected mayors that are at the head of their governments. Point Lay has moved twice over the years.  Its original site was on a barrier island off shore but over the years eventual flooding prompted its move inland.  The new site along a river on the tundra became unfeasible because of encroaching wetlands.  I believe that it was at this point that most families left for other villages.  Some returned to its permanent site now, which is called Kali, meaning mound, built on a rise that prevents both flooding from the sea or land.  One can see the barrier island that rims the Kasugaluk Lagoon and the expanse of water between both points of land that used to be connected.  A woman there shared that the village watched as a conex and a front loader at the end of one of the points were submerged under water and disappeared this year before a barge could make its way from the south to rescue them from their watery descents.

Tom, a man who lives in Minto, 125 miles outside of Fairbanks, has been a community health aide for the past 14 years.  He itinerates to Point Lay often, usually working 5 weeks on and 4 off, but was doing 10 weeks this tour.  I took time between some of my appointments to ask him about his work and was able to shadow him during one of his appointments.  People of all ages came in with conditions ranging from fever, seizure disorder, atrial fibrillation, asthma, a broken clavicle, a deep cut in a woman’s hand made with an ulu while cutting up an ugruk (bearded seal), a man with a piece of metal that had been driven through the tip of a finger and had emerged close to the knuckle above his fingernail and an abscess that needed to be drained.  Three infants were born in the past nine months with congenital heart conditions, so he monitors them in the village in between their trips to the Alaska Children’s Heart Center in Anchorage. He also coordinates travel arrangements for the pregnant women in the village for their prenatal and postpartum appointments at Alaska Native Medical Center in Anchorage.  He was especially relieved that a woman who is six months pregnant had agreed to her first prenatal appointment in Anchorage soon. 

He and health aides in all of the villages are the day to day medical providers there, delivering babies when needed, performing code procedures on residents having heart attacks and doing numerous other interventions, some at all hours of the night.  Residents with health conditions that can’t wait until morning call the local fire department that sends responders in an ambulance.  An EMT calls the health aide with details and then the patient is brought to the ER for treatment.  Health aides have been trained by doctors and physician’s assistants in Anchorage and Barrow to act in many different sorts of situations.  They also have a manual that takes them step by step from assessment to intervention and when needed, an on-call doctor at the hospital in Barrow is called.  Medivacs, when weather allows, are routine in serious cases, although planes are not stationed in the villages and must come from Barrow, Fairbanks or Anchorage prolonging the time until the patient is seen by a physician. Tom shared that his work is often harrowing and that he feels as though each life is in his hands.  There is a morgue attached to the clinic for those who don’t survive.

Tom was looking forward to returning to Minto on Friday evening, meeting Mary Margaret, another health aide at the airport who was flying in to take his place.  Ideally she would have arrived a day earlier and there would have been time for overlap and thorough reporting, but the small plane she was scheduled on had mechanical problems in Deadhorse, delaying her a day.  I admire the health aides and all they do for the communities where they work.  Their scope of practice is broad and they must be excellent care providers as well as communicators.  I admire their spouses and families as well who live without them for long periods of time. 

Tom sutured up the hand of the woman who had cut herself while helping to harvest the ugruk.  When I saw her earlier in the day to immunize her children she shared that a nine foot ugruk had been caught.  Women in the village were gathering to cut it up.  There was an air of excitement as it was large.  Hunters were out in their boats catching more of them as well as smaller ring seals.  A large pod of beluga whales had been spotted far off shore and had passed by the time hunters made their way to where they were seen.  A pod of gray whales was seen as well, but these aren’t hunted as they’re known to be dangerous, turning on their hunters in aggression.  The beluga whales are pure white and smaller than the bowhead, but just as good, I’m told.  Many will be swimming northeast past the village, especially in early July, so hopes are high for an abundant harvest.  Many of the clients I saw had been out hunting ducks and also gathering their eggs from the tundra for food.  It was an exciting time to be in Point Lay and the people couldn’t have been more warm and welcoming. 

I received hugs as I left and many thanks for coming to care for the children in Point Lay.  It was my joy and honor.  After expressing my gratitude for their warmth and hospitality, I thought how ironic it was that my parting words were that I would be back in September or October with the flu vaccine.  My young parents, a bush pilot from California and a nurse from Texas, both working in Barrow in the early 1950’s, had possibly saved this small village by bringing antibiotics or antiviral medication for the people as well as the sled dogs who were incapacitated with the flu.  While talking with a woman while I was there, I shared their story.  She smiled deeply and expressed her thanks for them coming and said how important it was that they know about these things. 

Below are some photos of the flight there and back and of a walk I was determined to get early in morning on my last day there.  I find myself reluctant to ask people if I can take their pictures as most are clients and patient confidentiality is of course a nursing standard.  I was invited to join a family for dinner, eating ugruk and also to the Inupiat dance practice on one night, but with seeing clients well past the times they were happening, I missed them.  These would have been some great opportunities for photos.  With some hard work on each visit, I anticipate that my due list will become smaller over time and I can take advantage of some of these unique and wonderful experiences.

INSIDE THE ERA (NOW RAVN) TERMINAL IN BARROW

FROM THE AIR BETWEEN BARROW AND POINT LAY

THE COCKPIT INSIDE OUR SMALL PLANE

COMING IN FOR A LANDING IN POINT LAY

WHALE VERTEBRA

HOMES ALONG THE BLUFF

SNOW FENCE PROTECTING THE VILLAGE FROM DRIFTS

SNOW MACHINES USED FOR HUNTING IN THE WINTER

STRIPS OF SEAL HANGING TO DRY WITH SKIN BOAT FRAME IN THE BACKGROUND

HOMES ARE BUILT ON PILINGS TO PREVENT HEATING UP PERMAFROST BENEATH

TWO OF THREE STREET SIGNS IN POINT LAY

FOUR WHEELERS FOR SUMMER HUNTING ON THE TUNDRA

A STRONG INUPIAT VALUE, EVIDENT HERE IN MANY WAYS

THE ONLY STORE IN POINT LAY

BRIGHTLY PAINTED DUMPSTERS DOUBLE AS BILLBOARDS IN THE VILLAGES

KALI SCHOOL WHERE K-3 THROUGH 12TH GRADERS RECEIVE THEIR EDUCATIONS 

POINT LAY FIRE DEPARTMENT.  ALL PERSONNEL ARE INUPIATS.
BOTH MEN AND WOMEN OF ALL AGES VOLUNTEER

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THE POINT LAY CLINIC

MY RIDE HOME TO BARROW

BACK HOME, READY TO BE PICKED UP AT THE RAVN TERMINAL.  MY BAGS ARE LIGHTER...MY WEEK'S WORTH OF FOOD AND THE IMMUNIZATIONS I BROUGHT WERE USED WHILE THERE.  THE  TOYS, BUBBLES, STICKERS, COLORING BOOKS AND CRAYONS WERE GIVEN TO HAPPY CHILDREN. 

MAP SHOWING POINT LAY IN RELATIONSHIP TO THE NORTH SLOPE OF ALASKA AND BEYOND.