Bush Medicine Evolves.

• Author: KANE, ROGER
• Position: Health care in Alaska's bush villages

In Alaska's Bush villages, there are no hospitals. Instead, village clinics offer treatment for illnesses and provide temporary relief of serious trauma.

There are no doctors, dentists or nurses. Community health aides diagnose afflictions, prescribe medications and relay messages to doctors in more urban areas via radio. Those health aides also are responsible for village-based primary health care, which includes chronic and emergency care, preventative services and disease-prevention activities. Community health aides were authorized by Congress in 1968 and are unique to Alaska.

Those health aides are the first line of defense for the ill and injured in the Bush and are the first link in a chain that connects rural Alaska with urban medical services.

Each of the hundreds of village clinics throughout the state is really a point of entry in a growing medical system. Patients whose injuries or illnesses cannot be treated by community health aides at village clinics are medevaced to regional hospitals.

These facilities provide health care for residents in all corners of the state and help fuel the economic engines of the regions they service.

Kanakanak Hospital, Dillingham

Providing medical services to 8,000 full-time residents and 25,000 summer residents of the Bristol Bay region is a cooperative effort, according to Darrel Richardson, chief operating officer of the hospital.

Because residents who technically live in Kanakanak's service area are spread out across 45,000 square miles of Western Alaska, an area the size of the state of Pennsylvania, Richardson said it is imperative that Kanakanak Hospital work closely with other hospitals in the state when developing programs and services because some residents live closer to other regional medical centers.

However, Kanakanak Hospital provides its clients with a wide range of services. The hospital is a 15-bed regional facility that also oversees 29 village clinics and two subregional clinics--one in Chignik, the other in Togiak.

When fully staffed, the hospital and clinics employ about 375 people. The clinics are maintained by a cadre of some 79 community health aides, Richardson said.

The cost of training these community health aides, spread out over four years, is about $145,000 each. This does not include health aide salaries, benefits or the cost of administrative supervision. Throughout the clinic system, there is a staffing shortage of about 10 percent at any point in time, Richardson said.

Village clinics in the region also are visited by itinerant doctors, dentists, optometrists, audiologists, drug-and-alcohol counselors and other...