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INTERVIEW BY ANNA MARIE MURPHY After graduating from Boston College's School of Nursing, Kelvie Pleas '01, of Seattle, headed north for the summer to remote Bethel, Alaska (population: 5,471, mostly Yup'ik Eskimo). There she worked in a small hospital run by a tribal consortium. The hospital services an area of approximately 50,000 square miles, flying in patients from 56 villages on the Yukon-Kuskokwim River Delta. "When you discharge patients," says Pleas, "you need to make travel arrangements." To get to Bethel, you have to go by boat or airplane. There's no other way. The Kuskokwim region is called the "Bush of Alaska," but it's really just swampland. There are no trees, only swampy grass and dirt roads. The houses--mostly shacks--are on stilts because of the way the ground freezes and thaws. The horizon stretches out forever and ever. Bethel Hospital, where I worked, looks like six yellow submarines connected and on stilts. It's a 50-bed facility. I worked half as a clinical nursing assistant and half as a temporary registered nurse--giving meds, IVs, doing wound care, respiratory care. There's only one floor, and it's for infants to elderly, so I got the whole human cycle up there. In the summer, most of the people are at fish camp, catching their fish for the winter. The villagers live off seal and fish. One day we were serving lunch in the hospital and some patients asked, "What is that stuff?" It was chicken. They had never seen chicken before. The natives talk in Yup'ik, and many don't speak English. Yup'ik is a very hard language to learn, because much of it is not written. I did feel like an outsider. Most of the people who work in the hospital are white, and I kind of felt like we were invading, even though the board of directors and the people that run the hospital are native. The hospital is completely different from any in the lower states. For one thing, visitors are allowed to wander around. Since everyone seems to be related to everyone else in some form, people just come in and look at the board where we write the names of patients, to see if a relative is in. And at least one relative always is. They go into the room and say, "Hi, I'm your cousin (or whatever), and I just came to make sure you're okay." The hospital is a hangout. People sell crafts and fish and ivory in the waiting room. I've heard that in the winter the hospital's more packed, partly because of the colder temperatures, but also because the villagers can use the river as a freeway for their snowmobiles. Everyone socializes more in the winter. Bethel is a pretty good hospital, but it's not equipped with everything you need in the case of an acute emergency. So a decision often has to be made about whether a patient can stay or has to be flown out to Anchorage. You don't want to send many patients, because, although Bethel's not very big, it's big to a lot of people coming from the tiny little villages. To them it's overwhelming. To send them from their families, their tribes, is a big decision for a new nursing school graduate to make, and it is a responsibility that the hospital places on you. I was asked to stay on this year, but I think it would be better to get a year of experience in an acute care hospital before going back. I want to be more confident in my decision-making skills. My goal is to become a nurse practitioner, so I can work by myself and prescribe meds. What I want to do is traveling nursing, meaning that from BetheI I would go for two weeks or so from village to village. You have to have a little experience before the hospital will send you out in charge, but that's my next goal. That's what I want to do. Photo: Bethel, Alaska. Photo by William Sanford Top of page
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