Medical professionals for Rural Alaska: working together on the challenges of remote healthcare.

• Author: Orr, Vanessa
• Position: HEALTH & MEDICINE

Despite the fact that Alaska is the largest state in the nation, more than half of its population lives within the Anchorage metropolitan area, where they have the opportunity to access high-quality healthcare. For those who live in more remote areas, including rural communities without access to road or ferry systems, finding help for acute or chronic health conditions can often be a challenge.

To this end, a number of different providers--ranging among community health aides, nurse practitioners, physician assistants, and doctors--work together to provide the care that each community needs. Healthcare providers are also taking advantage of state-of-the-art technology to make sure that patients are receiving the best possible care through telemedicine, linking those in remote locations to the expertise of physicians and specialists in the state's larger cities.

"ft really is incredibly challenging to deliver remote healthcare; you can only get to many of these areas by slow boat or small plane, and it doesn't even require extreme weather to create a problem," explains Eric Gettis, director of practice management, SEARHC (Southeast Alaska Regional Health Consortium). "This summer, for example, it only took a few days of fog to cause real complications for providers taking care of a patient who they were trying to transport out of the village.

"We are very fortunate to have community health aides in some of the smaller communities, who are marvelous practitioners to have on staff, and to be able to partner them with midlevel providers in some of the larger villages," he adds. "We also bring out physicians to the villages on a periodic basis--maybe three or four times a year--who meet with patients, review the work of the on-site providers, and consult as needed with those providers throughout the year."

The Front Line of Care

When a person gets sick or has an accident in a remote area, the first healthcare provider that they usually come into contact with is a village-based physician assistant, nurse practitioner, and/or community health aide, trained by the Alaska Native Tribal Health System through its Community Health Aide Program. The Community Health Aide Program is designed to offset challenges such as geography, the high cost of travel and transport, inclement weather, populations too small to support physicians or midlevel providers, and issues in recruiting trained health care professionals.

"We really rely on the community health aides; they are our eyes and ears when it comes to knowing what is going on with families," explains Matt Hirschfeld, MD, PhD, medical director of Maternal Child Health Services at the Alaska Native Medical Center (ANMC) and co-chair, executive committee, the All Alaska Pediatric Partnership. "The training that they go through is very extensive; there are five different levels of community health aides, and by the time they reach the fifth...