Remote health care in the Aleutians: treating patients in this rural area has its problems.

• Author: Finlay, Robert

On the Aleutian Chain, as anywhere else, there are needs and expectations for modern medical care. While Alaska Natives have Community Health Aide Program clinics to see to routine services, non-Natives also have their needs. In Unalaska, there are two clinics: Iliuliuk Family and Health Services Inc., which employs about 24 full-time and caters to Natives and non-Natives, and the Ounalaska Wellness Center, which caters to the Native population. While there is no hospital, Iliuliuk Family and Health Services does provide some emergency care.

Patients with chronic illness need medical management, babies are born and need well care, workplace and home injuries occur, school children need immunizations, old or terminally ill people choose to be at home to die yet need assistance with hospice issues. Medical administrative details must be provided, workers need pre-employment clearances, children going to summer camp in California present their forms for camp physicals, Alaska Department of Transportation commercial driver exams are required, Occupational Safety & Health Administration respirator clearances are requested, stress-related and mental health issues need to be addressed. In short, all aspects of family practice care, emergency room issues and occupational medicine are needed. Occasionally patients also are referred to physician assistants or itinerant doctors by the CHAP clinics for additional diagnostic or definitive care issues.

For seasonal variety, fold in 4,000 or more fishery processors from a dozen or more countries; land a dozen warm-season international cruise ships making port call; divert a mid-ocean supertanker seeking the nearest medical facility to the city with a crewman suffering intense abdominal pain; bring in Coast Guard patrol ships regularly for shore leave, injured crew care and fuel; dock enormous container ships weekly to load and unload cargo; anchor foreign ship "trampers" crewed from Korea, Russia, Japan and China with a crew member having fevers and pneumonia (and think about SARS at least); stage incoming workers from offshore processing facilities and factories on smaller islands with no medical care to await medevacs that then cannot be launched and need holding care; entertain barge crews and tug deckhands from Seattle; dock the National Oceanic and Atmospheric Administration research ship Miller Freeman for crew changes and R&R, and more. The need for medical care increases in two separate and identifiable yearly cycles, during which the population is nearly tripled. For medical practitioners this "United Nations" mixture of patient population can often pose minor difficulty in obtaining translation services, although a good supply of bilingual clinic employees cover Spanish, Tagalog and Vietnamese. Local fish processors are usually able to supply Korean, Japanese and Chinese interpreters, however many medical words do not seem to...