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Gambell, Sat Jan 13, 2007

It’s 9 o’clock Saturday morning and I am certain I am the only person awake in this village – it is pitch black out and the only lights I can see are 1) the office in the clinic where I am working, 2) the airport strobe lights (a very good sign) and 3) the lights in front of the school.

The Flight from Nome to Gambell was cancelled yesterday due to poor visibility, so no mail, no satellite phone, AND no leave! We were supposed to return to Nome to restock and wash clothing. I am out of food (having planned very well, I might add, to make it through he first week - Sharon is down to her last pair of Hot Pockets.) We are also out of anesthetic (supplied by the clinic – I was not permitted to bring my own) so doing more dental work would be a challenge. The fact that we ran out of Novocain is, I suppose, a tribute to how much work we did this week.

There are only 40 last names in the village of about 700 people – the “phone directory” is exactly two photocopied pages. Yesterday I met Leo Apangalook Sr, 68 years old, who has never left the village. He has ten children ("5 girls, 5 boys, 70 grandchildren and great grandchildren"). I met him in the middle of the "field," the undeveloped center of the town where the "Hondas" and snowmachines drive. (I learned the proper etiquette for shaking hands up here - if it is below zero, leave your gloves on, above zero, take your gloves off - and never one person “glove on” and the other “glove off”. Leo was admiring my new Timberland Parka, remarking how nice it was. It was the first thing he said after we exchanged names). He asked if I was the new teacher in the school. I could see how he might make that assumption – I met several of the teachers yesterday and they are all whites with the exception of the Native Studies teacher (who is Yup’ik, of course…).

I visited the school yesterday to use the gym - there are 3 Cross Country ski machines in the weight room. I found this interesting in that there is 8 feet of snow outside, but have yet to see a single person using skis. The ski machines seemed untouched.

I took a “Honda” ride out to the shore where the hunters depart – it was exceedingly cold – like “if-you-don’t-put-those-mittens-on-right-now-young-man-you-are-going-to-regret-it-for-the-rest-of-your-life” cold.  Took some video from the back of a speeding “Honda” (if you ever get the chance to see it,  forgive the expletives. I could not feel anything but pain in my hands but I wanted to record it for someone to see.) Also saw what my guide told me was a “Snowbird, very good, very rare” – honestly I do not know whether he meant how the bird tastes when undercooked or they are merely very hard to find. (I saw an extremely curious sight while watching the bird, a small yellow, brown and white Chickadee-looking thing. A short white man with a bulky SLR camera and a big honking lens leapt out to photograph the tiny creature. The village is very small, he does not belong here, my guide never saw him before, there were no flights today, there are no roads – I know “birders” are resourceful and Gambell is known for rare species, but this is going waaay overboard.)

Double big news in Gambell today!! There was a baby born in the clinic, just two doors down from my operatory, AND a huge walrus bull was killed on the ice – both around 4 pm. One weighed in at 5 lbs 11oz and the other at just over 700 lbs. Can’t remember which was which….

The stars are out until about 10:30 in the morning, and I periodically step outside to watch the Big Dipper twirl around Polaris, the North Star. This is a minor thrill to me – with 19 hours of darkness I can watch the heavens through 270 degrees of rotation. The down side is that the cloud cover and weather changes from minute to minute, so the star gazing is unpredictable. I can say that my interest in the night sky is a source of fascination to the Yup’iks, who marvel at my unusual habits and hobbies (using the exercise bike in the clinic, watching the stars, waking up at 5 am, etc). 

Nome Sunday Jan 14, 2007

A single flight made it in to Gambell yesterday and we were on it. I am back in Nome doing laundry and restocking – I lost about ten pounds in my week in Gambell, but after eating constantly for the past 12 hours, I have my strength back.

Did you hear about the Tsunami warning in northern Alaska? Me neither, at least not until yesterday morning when I learned that the entire village of Gambell was supposed to be prepared to evacuate to higher ground. The staff decided that I didn’t need to know.

“A powerful earthquake slammed the North Pacific region on Friday night and stirred fears that a tsunami could sweep east across the sea and strike in parts of Alaska.,” said the official report. –“An 8.2 earthquake struck east of the Kuril Islands in Russia. The quake hit at 7:23 p.m. Alaska time.

A wave measured around 1 foot rolled onto the shores of Shemya, near the western tip of the Aleutians, about 9:30 p.m., according to the Alaska Tsunami Warning Center. The tsunami warning, which is the highest level of tsunami alert, kept residents on edge from Attu to Sand Point, an island off the coast of the Alaska Peninsula. Such a notice means that all residents of the affected area who are near beaches or low-lying regions should immediately move inland or to higher ground away from harbors and inlets.”

Apparently nothing happened in the village of Gambell, but people were prepared to move to higher ground and I, for one, am glad that I didn’t worry about it at the time. I bought a pair of dolls for my daughters here in Nome – they are made of reindeer skin, rabbit and beaver fur and are dressed in traditional outfits. The shop keeper told me they were made by a woman named “Lilly” living in Nome’s “retirement home.” With nothing better to do I walked to the “home” and knocked on her door. I introduced myself and she could not have been more gracious. Lilly is an Inupiaq from St. Mary’s, Alaska. She kindly dressed in her own traditional skirt and permitted me to take several photos with the dolls, then showed me many of her latest creations.

Gold was discovered in Nome in 1898. Then, as now, Nome was not accessible by road – back then the only way to reach Nome was by ship or dog sled. Very few prospectors struck it rich and most could not tolerate the relentless winter. When the first ships arrived in mid May, the shores would be packed with people desperate to flee the town, having spent the last 7 months locked in ice, cut off from civilization.

Dogs outnumbered people in the town in the early twentieth century. All Nome households owned a team of dogs to haul their sled over the icy terrain. When a diphtheria epidemic struck the town in 1925, Dr. Curtis Welch, the only doctor for hundreds of miles, radioed Seward that he was in desperate need of antiserum. A team of dogs traveled the 1150 miles in the dead of winter to deliver the medication, saving countless lives. That sled trip became legendary and was covered every step of the way in the press in the “Lower 48.” It was the basis for the Steven Spielberg animated movie “Balto” and was also the inspiration for the annual Iditarod Sled Race. The race, which started in 1973, takes from 8 - 12. Each musher team makes use of from 12 – 16 dogs. The finish line is on Front Street in “downtown” Nome – watch for the finish of this year’s race March 11th -16th…

Last night I caught a glimpse of the Aurora Borealis, otherwise known as the Northern Lights. It was just a briefest view – a few seconds – but it was a breathtaking sight. The colors were green, dark blue and maybe a halo of red. I got one poor photo, but photographs don’t do it justice. The Northern Lights are caused when the sun throws off ionized particles which are captured by the Earth’s magnetic field. As the charged particles impact the atmosphere, they give off photons (light energy) resulting in the display.

Speaking of photos, I am taking a flight this afternoon to try and get some aerial shots. Each of my flights to and from Gambell has been in the dark so I’ve had no chance take pictures.

Nome/Gambell Monday Jan 15

Flying on Bering Air to Gambell is very casual. It is more like taking a bus than a plane No tickets, no security or ID check. Oh, and it is totally OK to bring your guns with you on the plane. You read that correctly – you can carry guns on the plane. They don’t even ask if they are loaded. But whatever you do, don’t try to sneak into the village – that is strictly forbidden. (Something else caught my attention on the flight. A pleasant woman's voice assured us that "should it become necessary, extreme exposure survival gear is located in the right wing storage locker.”)

The medical and dental staff flies weekly between the 15 village clinics. In 1986 a dentist and dental assistant were killed when the plane crashed en route from Nome to Teller. The weather up here can change in a flash and apparently that day it went from bad to worse.

I am heading back to Gambell this morning after a day in Nome where I stocked up on food, washed my clothes and did some shopping. While in Nome I had dinner at the home of the dental director for Norton Sound Health Corporation (NSHC). Dr. Kelso has been working in this area since graduating from dental school 21 years ago and now he runs the 15 village clinics all around the western part of Alaska. I asked him why he chose to work in Alaska. Without missing a beat, he answered "So I can kill large mammals." He hunts whenever possible, and doesn't go anywhere without a couple of loaded guns. I asked him why he keeps loaded guns in his car and he answered again without hesitation. "In case I see something that needs a bullet in it - like a fox or coyote." He has at least 50 sets of moose and elk antlers in his garage stacked from floor to ceiling. Dr. Kelso served an outstanding Musk Ox stew for supper. His 8 year old son had killed the 800 pound beast last fall.

The Indian Health Service was set up in the 1960s to provide care for Native Americans. In some areas of high concentration of Natives (such as up here in Western Alaska), privately held Native-run corporations (such as NSHC) have been set up to manage the delivery of care. The NSHC receives a large monthly payment from the U.S. Government to provide Native American health care. If they provide the care more economically than the Indian Health Service, the corporation shows a profit. By hiring their own staff doctors and auxiliary health care providers (rather than having to pay "per service" to private practitioners), the corporation has shown a profit every month for the past ten years. The hospitals and clinics are state of the art and now provide care to non-Natives on a "fee for service" basis. Not all Native health care corporations are run as well as the NSHC - some are managed very poorly, with the administrators skimming a large fraction of the monthly payments. When the quality of care falls below the expectations of the IHS, the government terminates the agreement and resumes management of care.

In a previous entry I mentioned the importance of dogs in Alaska. There are lots of dogs in Gambell as well, but I have not seen any hitched to sleds; mostly they are guard dogs, living out doors to announce the approaching Polar bear. There is one rather outstanding dog in the village but no one else seems to think so but me.  He is a Chihuahua named Cuddles but he runs with the big dogs and shows no evidence of being cold or one tenth the size of his canine colleagues.   

I flew to Shishmaref yesterday to get some photos from the air during the short daylight hours. Shishmaref is a tiny island north of the Seward Peninsula on the Arctic Circle. It is being battered by the elements, rapidly eroding away, to the point that there is a serious thought being given to relocating the entire village of Nupiaqs - all 600 residents - from the island to a new village on the mainland.

I was fortunate enough to sit as copilot on the 45 minute flight – the pilot was originally from Alton, IL and is a big Cardinal fan. I was slightly concerned that he seemed more interested in hearing my tales of the World Series than the actual flight though "white out" conditions, but the trip was very enjoyable and I got some decent photos of the sunset peeking between mountain peaks.

Gambell, Tuesday January 16, 2007

It is noon. According to the National Oceanic and Atmospheric Administration  (NOAA), the sun came up 15 minutes ago, but the sky is still battleship grey (or slate grey or gunmetal grey – take your pick). With a little imagination (ok, a lot of imagination) I can sort of detect a slightly less grey area where the sun should be, but that is only because I’ve already spent more than a week here in the village and I know where to look.

The darkness is profound in both the depth and the duration– the only consolation is that I like astronomy and this means I can study the sky with my binoculars in the morning between patients. Two minutes of daylight are added each day until mid June when the sun rises about 4 am and does not go down until midnight. And even when the sun is “down,” the sky remains light, a sort of dusky twilight. In the summer, Gambell averages 75 degrees, and the town sees visitors from around the world in search of rare birds. There is a lodge in the village where “birders” can stay, but private homes are also made available. I am told that “Gambellers” (that is my word for the people who live in the village – they do not like that, or “Gambellites” either) sleep more in the winter than they do in the summer. That must be true because they can’t sleep any more… My assistant Derrick woke at noon today, ate breakfast then went back to bed until dinner time.

Ok, readers, raise your hand if you have ever heard of Iqmik (that is i-q-m-i-k)? Me neither, until yesterday. It is a chewing tobacco made by mixing the ash of mushroom which grows on hardwood trees (in the Alaskan interior) and chewing tobacco. This combination, which has been used by Yup’iks since the mid 18th century, is a popular stimulant originally used by hunters to stay awake while manning a seal breathing hole (hunters chop a hole in the ice for seals to use as breathe holes – when an unsuspecting snoot appears in the hole, the hunter jabs with his harpoon. Or nowadays blasts away with a shotgun.  In the past it was not uncommon for a hunter to man a hole for 12 hours straight waiting for that breathless seal.)

Iqmik is highly alkaline and this might explain the exceeding high rates of decay for the older population (I have no data on this, but it fits the picture I am seeing every hour on the hour.) Derrick, the Siberian Yup’ik dental assistant I am working with this week, chews Iqmik during breaks “for energy” and, apparently, to stain his teeth so he blends in with the other natives.

More than half of all Alaskans use tobacco in some form (according to the Alaskan Lung Association). Up here it has to be closer to 85%. It is a bit disheartening to give an extraction patient instructions not to smoke or drink carbonated beverages (the clinic instructions say “fizzy drinks”) for 24 hours, and then step outside to see that patient with a cigarette in one hand and a Coke in the other. Six of the 8 health care providers smoke (although they have been counseled by Norton Sound Health Corp and to “not do so in front of our patients” ).

((DENTAL NOTES BUT THIS IS INTERESTING: I have yet to see an adult who has more than 20 teeth – I think so far 16 is tops. As I review the charts of all of the patients I have seen (more than a hundred), I can see that there is rampant “baby bottle caries” (decay of the anterior primary teeth from being put to bed with a bottle). This usually requires a trip to Nome to remove the baby teeth under general anesthesia OR being strapped to the papoose board to remove them here in the clinic (the deciding factor being whether the family has Medicaid coverage). Then there is a 6 year period of low decay rate (similar in the decay rate I see in St. Louis). Because the teeth are so crowded by age 10 (due to the removal of those baby teeth), extraction of the first premolars is required to allow the eruption of the remaining permanent teeth. Then, around age 12 (in boys) to 14 (in girls) the decay rate skyrockets due to extreme consumption of soda and candy. If a patient can make it to 18 or 19 with only 6 cavities or so, there is a very good chance that they can have a healthy dentition. Any more than that and the decay spreads like wildfire and decimates the entire dentition, resulting in that toothless appearance of most adults.))

I continue to ask every patient I see under the age of twenty what they would do if they could do anything at all – where they would like to travel or what they would like to do when they are “grown up.” The universal answer is still “I don’t know.” Only one patient has given me a specific answer (the boy who said he wanted to “see trees”) – some have said “get a job” (but no specifics). One 11 year old girl yesterday said she “wants to drive up and down the village,” which is certainly something she sees each and every day of her life but probably not particularly rewarding. About half of the kids have been to Nome (many of them only for the dental care which could not be delivered here), and a handful to Anchorage. They all know Elvis Presley (music we play in the clinic) but none know Bono (or U2). Johnny Cash is popular but not Toby Keith. Beatles recognized more than Stones.

My patients are remarkably non-communicative. They might come in with a toothache, but cannot (or will not) describe the symptoms. None can ever tell me when the last time they saw a dentist (although there is one here at least every 6 months and I one case anyway, it was three months ago). No one ever asks me “when will the numbness go away” or “when can I eat” and no one ever wants to look at the work I’ve just done, even on front teeth. The question every single patient asks me (and the only phrase uttered by a few….)  -  “Can I go now?”

Gambell Wednesday January 17, 2007

It is 9 am and the first three patients have not shown up for their appointments. We call the ones with phones to implore them to come in but 1) they are still sleeping, (expressing no remorse whatsoever) or 2) their child is still sleeping and they don’t want to wake him or her. It is my guess that we have seen most of the people who want to be seen this go around - about 15% of the village. 

According to the U.S. Dept of Interior Geological Survey, the hill to the east of the village is called Sevuokuk Mountain, but no one here knows that. They call it “the mountain” or “the hill.” The contour map says it is 614 feet tall – the natives know that that is the place to go when 1) there is a tsunami and 2) you have to bury a dead body. They also know that is where the wicked wind comes from and a place you definitely do not want to go when the temperature dips below zero. Of course that is exactly what I did yesterday on my lunch hour –took a “snowmachine” up the mountain. Somehow a tiny sliver of my neck was exposed and got frostbite. I would have covered it up with one hand if I didn’t have to use both to hold on so tightly.

BODILY FUNCTIONS: “Fast Runner,” a Cannes Film Festival winner from 2003, relates the tale of a murder in an Inuit village in northern Canada. The movie was filmed in the native language (with subtitles) and shows vividly the subsistence lifestyle still practiced today (Gambell is a bit advanced beyond that – no dogsleds, no igloos). But one aspect which persists to this day is the belching. In the film, the men belch loudly and without regret or apology. I didn’t understand what significance it had to the story, but it didn’t detract so it was easy to overlook. Now that I am living here among Eskimos, I now know that it is a normal aspect of their behavior. I am no longer surprised when I hear a loud “brrraaaap” echoing down the hall or coming from a mother patiently waiting while I complete treatment on her child. My assistants think nothing of burping so loud it rattles the window.

((THIS SPECIFICALLY ADDED FOR MY 10 YEAR OLD SON – not for the squeamish – sled dogs are fed a diet of leftovers and miscellaneous animal parts. This can include parts of sled dogs that no longer pull their weight on the trail. But the sled dogs’ favorite delicacy is human feces. That’s correct, human poop is the preferred taste treat sensation for Siberian huskies and Alaskan Malamutes.))

My last patient of the night was a 58 year old man named Wade Okhtokiyuk who, like so many other adults, says he has never left the island. That is not technically correct as he is once rowed/sailed a “skin boat” (walrus skin covered wooden boat) to Russia. In 1999 he sailed there to help distant relatives move to the U.S.  Most of the natives here are Siberian Yup’iks and only became official U.S. citizens when Alaska became a state in 1959. His 36 mile voyage took 38 hours. On the way back his boat got caught in a “terrible storm,” (and if he says it was bad, it must have been hellaceous) and the Coast Guard had to rescue him. Two people drowned in the storm, the mayor of Gambell and his son.

I had moose this evening for dinner – that is moose, not mousse – very tasty, not gamy at all, but not quite as good as the Musk Ox stew I had this weekend. I also enjoyed the reindeer salami I bought in Nome. (Did you know that Reindeer and Caribou are the same animal? Reindeer are raised in a farm and Caribou are wild.) I have yet to try walrus, whale or seal, but not for lack of trying. The natives are not particularly generous when it comes to their traditional foods, and I cannot get an answer why. I have offered to buy it or trade my own food for a taste and so far, no one has come through.

There is a television in the hallway of the clinic. It is sometimes used to entertain the children of adult patients, but when “The Price is Right” is on (10am) the hallway becomes crowded with natives who seemed thrilled with Bob Barker. It is by far the most popular show on television here. Think about this… The Eskimos have never seen most of the products showcased on the program – hair spray, cleaning supplies, appliances. What enjoyment are they getting guessing the prices that these items sell for? I am imagining that it would be like St. Louisans guessing the prices for goods used on the Jetsons. Many of the Eskimos have never seen a car in person – what must they think seeing the price of a car at $26,450? That is five times their average annual income.

The wind has picked up a bit. I’m guessing about 30 mph. It is whipping between the wooden frame houses (some of which honestly would be better described as “shanties”). I can’t believe wind like this doesn’t blow houses like that off the face of the Earth. I am watching the weather very closely. If it seems like there will a chance of being delayed getting out of here this weekend, I am leaving sooner rather than later.

Gambell Thursday Jan 18, 2007

Imagine taking a really long train trip – the constant rumble of the wheels on the tracks, on and on and on. Add to that some semi-rhythmic rocking, a periodic shudder and the sound of a jet airplane taking off in the next car. Now imagine that for 24 hours straight, but add to the mix that icy fingers are reaching under the doors and around the window trying to get to you and the view out that window is nothing but horizontal streaks of white. And imagine that the bar and dining cars are closed. That is what it feels like being stuck inside this trailer during the current blizzard which might subside in another 11 hours.

We are packed up to go home today. We have seen everyone that wants to be seen (note that I said “wants” to be seen – there are hundreds who could benefit from what we can offer, but they have other things to do. It was suggested that I hang around in Nome and see patients there for free for another couple of days. I am somewhat “under whelmed” with that opportunity.)

A “house” in Gambell sells for $85,000. The monthly payment is around $130 – that is correct. $130 per month. No one knows the interest rate nor the terms of the loan. I have learned that if an elder has paid for half the home cost, they usually “give it to him.” This doesn’t add up to me, but I heard it more than once, so it must at least be the general understanding. And insurance is only available while the home is being financed. After that, not only is insurance not required or desirable, it is not available. The homes are all built, financed and insured by Bering Straits Housing in Nome.

Speaking of homes, it is not unusual to have 4 adults and 6 children living in a two bedroom/one bathroom house.

According to CityTownInfo.com, the unemployment rate in Gamble runs “11.5%”, but I will eat a seal skin mitten if it is not more like 50%. I ask most patients over 21 years old what they do during the day – some have said they are “getting their GED,” (HS graduation rate is around 40%), a few report their jobs (most work for the Tribal Administration Office), but most say “nothing.”

I was asked by someone in the states “don’t some of the kids aspire to be professional athletes, movie stars or performers?” Not that I have heard. When I pose the question the answer is invariably “I don’t know” or perhaps a shrug of the shoulders. (The favorite class in the past three days of asking the school age kids has been “math.”)

 I bought a hunter doll made of seal skin, ivory, whale bone and baleen from Bula Oittillian, age 59 (although she looks more like a 75 year old from the “lower 48.”). I am told Bula’s dolls are known throughout the world, selling for close to a thousand dollars in Anchorage. Her 13 year old daughter drove her to the clinic on a “Honda” to show me her work. Bula says she is teaching her daughter to sew, and her daughter nodded her head in agreement, but given the dedication and focus of the young teens here, I doubt the child will learn the craft.

DENTAL NOTES: I have taken out a surprising number of perfectly healthy teeth to make space for the other permanent teeth to erupt. The new arrangement will still be wildly out of alignment, but the patients and parents don’t seem to care. (I was told by another dentist in Alaska that “one way to cure periodontal disease was to remove every other tooth so there is no contact between them to trap food.” I have to admit it does seem to work.) The patients over 6 years of age never complain about the shots or the work, but do complain about the taste of the materials we use.

What I miss: 1) fresh produce 2) haircut 3) lively conversation 4) state of the art dental equipment (or at least something post-Richard Nixon administration) 5) healthy water to drink 6) light 7) patients who give a shit

What I won’t miss: 1)salty prepared food 2) belching of staff and patients  3) snow 4) wind 5) darkness

What I missed:1) driving a dog sled 2) eating walrus or seal 3) flying to Russia

What I will miss: 1) full canopy of stars revolving around North Star  2) chilling a drink to the perfect temperature by placing outside for 11 minutes

I had I nice conversation with Naiomi Bushoo, age 23, who has lived in Gambell “forever.” She was extremely well spoken and had an outstanding smile – would have fit in nicely in the “lower 48.” She left the village once to travel to Oregon to visit the extended family of her fiancé, and man from Savoonga. They have planned a traditional wedding which is a rather involved process up here. Once the man has told the woman’s father of his intention, he has to work for her family for a year – hunting, fishing, fixing things, moving heavy objects… Just about anything that needs to be done by a man around the house. During that year, the man’s family has to provide gifts to the woman’s family – everything from appliances and money to food and housewares. I mentioned that that seemed perhaps a little one sided – that’s a whole lot the man has to do to win her heart. The woman and her mother laughed together and said “you have no idea what it means to be married to a Yup’ik man…. The amount of work an Eskimo wife has to do would never be tolerated by a woman in your culture. Cleaning, cooking, raising the children, dressing the kills – can you see your wife preparing 300 pounds of fresh seal?” They doubled over with laughter and I joined them this time.

On a “nice” day – one where the temperature is in the positive double digits and the wind velocity is in the single digits – the hundred yard walk to the school might be described as “pleasant.” Today was not one of those days. Despite my usual three layers of clothing, the blasting frigid wind in my face turned me back less than a third of the way there. I really thought I could make it – I could see the building, all my flesh was covered – but the microscopic snow crystals somehow pierced the legs of my pants and snuck into the tops of my boots crippling me. I returned to the clinic to use the exercise bike, spectators be damned…  

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