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'''April 2015 Edition'''
<big>'''WELCOME TO BETHEL!'''</big>


''Created by Patti Clay, Peds resident 2015, adapted for Family Medicine by Rima Butler 3/2015, Updated by Marcia Haggerty April 2015 w contact details.''
[[file:Rainbowmush.jpg|right]]'''The Paris of the Kuskokwim!'''


While Bethel is not a large town, it can be a bit tricky to navigate your first time out here since most info is spread through word of mouth and there are certainly not many Yelp reviews to depend upon. As a basic review, Bethel is a town of approximately 7,400 people in western Alaska, located on the Yukon Kuskokwim Delta. The Yukon Kuskokwim Health Corporation (YKHC) serves approximately 28,000 people spread across an area roughly the size of Oregon. There are no roads connecting the 56 villages in this area, and transportation is by small plane, boat, 4-wheeler or snow machine.
''Created by Patti Clay, Peds resident 2015, adapted for Family Medicine by Rima Butler 3/2015, updated by Marcia Haggerty April 2015, updated by Lye-Ching Wong Feb 2023''


This guide includes information on your house, places in town and what to expect at work. It is not exhaustive, but it does contain enough information to help prepare you for your time in Bethel before you arrive, and to get your bearings around town once you arrive.
While Bethel is not a large town, it can be a bit tricky to navigate your first time out here since most info is spread through word of mouth and there are certainly not many Yelp reviews to depend upon. As a basic review, Bethel is a town of approximately 6,400 people (based on 2017 Census review) in western Alaska, located on the Yukon Kuskokwim Delta. The Yukon Kuskokwim Health Corporation (YKHC) serves approximately 28,000 people spread across an area roughly the size of Oregon. There are no roads connecting the 56 villages in this area, and transportation is by small plane, boat, 4-wheeler or snow machine.
==Basic Info==
'''Address''': 223B Akiak (also known as 223B city sub for the cab drivers/delivery people)
'''House phone''': 543-2830
'''Internet''': Akiak_House. Password: Bethel 2014


'''Mail''': Mailing Address: General Delivery, Bethel, AK 99559
This guide includes information on your house, places in town and what to expect at work. It is not exhaustive, but it does contain enough information to help prepare you for your time in Bethel before you arrive, and to get your bearings around town once you arrive. This guide is applicable for both pediatric and family medicine residents, but pay attention to small details where our clinical duties and resources differ.


'''Peds Residency PO Box''': Talk to them if you would like to have mail sent to the box to confirm they are okay with sharing: PO Box: 1630, Bethel, AK 99559
==IMPORTANT INFORMATION==
===House Address===
223 Akiak Apt B
<br/>Bethel, AK 99559


'''House keys/Computer/Pager/Phone''': Confirm with the resident finishing up/coming after you where these are left. I recommend leaving them with Diane to pass on when she picks the next resident up or in “Club Doc” with a message to Diane about where to find them.
===Mailing Address===
The post office is on the highway on the left as you come in to town before the hospital. The window is open 11 to 5:30 Monday through Friday and 12 to 2 Saturday for packages.  The lobby and P.O. Box access is open 7 a.m. to 7 p.m. M-F and 7 a.m. to 2 p.m. Saturday.  


'''Phone''': AT&T and Verizon don’t work. GCI is the only thing that works out here. Parin bought a prepaid phone (for Fam Med resident) that we have been passing along. Its number is 545-8360. It will send a message when the plan is about to expire. You can pay for the next month at the GCI store in the AC. Turn to the left when you enter the store and you will see the sign.  
====SCH Pediatric Residents:====
Your Name
<br/>P.O. Box 1630
<br/>Bethel, AK 99559


'''Pager''': Computer Pager for “AFP Resident”.  To page you from Anchorage, someone would need to call our operator at 907-543-6300 to have them text page you through the computer icon.
====Family Medicine Residents:====
==Rotation Preparations==
Your name
<br/>"General Delivery"
<br/>Bethel, AK 99559


===Contacts===
*Go to the post office between 11am and 5pm weekdays with a photo ID to get your mail
'''Marcia Haggerty, MD''': YK Family Medicine Hospitalist/Physician Liaison to Family Medicine Resident rotations
marcia_haggerty@ykhc.org email works best,  907-543-6300 and ask the operator to page Dr. Haggerty. Cell: 907-545-1386


'''Diane Wasuli-Dock''': Dian_wasuli-dock2@ykhc.org. work: 543-6439
OR


Diane will be setting up your flights and rotation schedule and will likely be the person picking you up at the airport so it is important to coordinate with her.  Residents usually come in Sunday evening or Monday morning. On occasion if you arrive Sunday evening we might give you instructions for the cab system and directions to the house.
*Ask your peds colleagues if they mind sharing


Please let us know if you have a significant other or children that will be staying with you at anytime so that we can get family housing for you if there are kids.  Diane would arrange “site visit” flights for your family from a budget different than what we use to fly you out. 


You should receive a Hireright request (approx 1 month before arrival) that JCAHO requires as a background check even though you have had them at other sites and we need that to be filled out to get you set up in our system.  Susan Charles in HR will also sent out a student/resident INFO sheet for you to fill out to get you into our system
===Phone===
==Arrival==
Unless you have GCI or AT&T, you will have to rely on an alternative phone while in Bethel. Forward your number or leave a voice mail message before you leave so your contacts know how to reach you! GCI, AT&T, and sometimes Verizon are the only carriers that work in Bethel.  GCI also works in the villages when you go on village trips, but not Verizon or AT&T.


===Recommendations Before Your Trip===
'''SCH Pediatric Residents''': 907-545-3234. You are provided with an iphone. Limited data, unlimited calling and text. (Hook up to wifi if you are browsing or you will be charged overage!)
Figure out whether or not to forward your mail. You have to go to the post office during the weekday to pick up your mail (i.e. during lunch).  Use the general delivery address as above.  Hours change but currently 11am to 5pm.
Let the current Bethel resident know you are coming and find out where they are leaving the keys/computer/pager.
Make a shopping trip to stock up on food and save money. You are allowed three checked bags up to 50 pounds each on the flight within the state of Alaska.  Ice is illegal to bring on planes, so frozen vegetables work better for a cooler. 
Diane should be picking you up from the airport if you have arranged that with her ahead of time by emailing diane_wasuli-dock2@ykhc.org


Dr McClure wants you to have this Peds orientation link before you arrive in case you have time to start reading it:
'''Family Medicine Residents:''' The number is 907-744-6181. It is pre-paid by the residency so you don’t have to go to GCI anymore. Attendings and Lifemed will use this phone as a contact, so when you give it out please remind them that this will ALWAYS be the family practice resident phone number. Verizon and AT&T service are spotty in the hospital and will kill your battery, so this phone should serve as your work contact. Passcode is 8888. Do not leave it charging all day/night.
http://www.ykhc.org/library/Pediatric%20Orientation%20Manual%20Binder.pdf


==Packing==
===Medical Staff Coordinator===
Thi-Anna Hunter: Thi-anna_Hunter@ykhc.org. Work: 543-6439. Cell: 690-2593


Packing for 6 weeks can be tricky, especially when traveling to Bethel. You are headed to a very isolated part of the country, and while there are stores and Amazon can ship to you (if you are very patient-2 weeks standard mail), it is good to come prepared.  You will find a system that works for you, but here are some thoughts based on our experience thus far.
===Medical Staff Trainers===
===Food===
Abigail Morgan: Sarah_morgan@ykhc.org. Work: 543-6914
You should bring a lot of food, because it is super expensive out there. I brought out a cooler full of food and then a plastic tote full of food. If you want booze, bring it.  Boxed wine works well! I would also recommend bringing with you things like soap and shampoo (all toiletries) because for whatever reason, they are REALLY expensive out there. You get 3 free bags.  
Susan Richard: Susan_richard@ykhc.org. Work: 543-6218
 
'''SCH Pediatric Residents''': Abigail is the contact person for taxi vouchers and meal tickets. (Amanda Soliai will continue to be your contact for flights, etc).
 
'''Family Practice Residents''': Abigial is the contact person for taxi vouchers and meal tickets.
<br/>May Engler Marilyn_Engler@ykhc.org, arranges travel and family visits. 543-6725 Mien Chyi, MD Mien_Chyi@ykhc.org is the contact person for schedule.
 
===Resident Site Coordinators:===  
'''SCH Pediatric Residents''': Lye-Ching Wong, MD Lye-Ching_Wong@ykhc.org
 
'''Family Medicine Residents''': Megan Young, DO Megan_Young@ykhc.org
 
===Housing issues===
Leif Albertson and Jenni Dobson, who live next door in the yellow house, own the home. Any house concerns should be directed to Leif or Jenni for immediate attention, especially any concerns regarding heat or water.
<br/>'''Leif's and Jenni's cell phone numbers are posted on the bathroom door and refrigerator in the resident housing and are also listed as a contact in the Bethel Pediatric Resident Phone.
'''Leif's email:''' leifalbertson@gmail.com


The grocery stores in Bethel are very well stocked, but you will be paying a Delta premium, with a gallon of milk at about $8 and flour at $10-15. If it is heavy, or has to stay cold, it is expensive. We typically make a Costco run in Anchorage prior to heading to Bethel and transport food in a bin and our bags.  Also know that Bethel is “damp,” which means that you can have alcohol, but you cannot buy it here. So, if you would like some wine with your dinner, make sure to bring it because once you are here, there are no buying options.
===House keys/Computer/Pager/Technology===
===Clothes===
Confirm with the resident finishing up/coming after you where these are left.


The dress code is very casual, and is more functional than fashionable. You either have snow and ice or mud and dust, so don’t bring your super nice things. Boots are essential. You need warm ones for winter, when it can be -40, and you need waterproof ones to combat the mud and wet tundra. Breakup is normally early May on the Delta. Work attire is not formal, and a pair of khaki pants and a casual shirt work. The hospital has scrubs for inpatient/ED, but if you have a favorite pair or two bring those, as lime green is not a good color on everyone.
'''Keys:''' There should be two sets of keys – one set for each of the two people living at the resident house. Thi-Anna Hunter will have a spare.


For the cold months, make sure to pack appropriately. If you have any interest in medevacs, riding a snow machine or exploring outside, you will need a very warm jacket, snow pants, gloves, hat and possibly a face mask. There are two AKFMR snow suits hanging in the entry way for taller residents and a pair of bibs for those on the shorter side. There are people willing to lend you the warm jackets and down pants, but if you have warm stuff and it fits in your bags, you should bring it. The boardwalks and roads can also be very icy, so a pair of microspikes to go over your boots is helpful.
'''Computer:''' A laptop will be provided for you while you are here.  
==The House==


We live at 223B Akiak, referred to as 223B City Sub when calling a cab. Leif Albertson and Jenni Dobson, who live next store in the yellow house (225B), own the home. Any house concerns should be directed to Leif for immediate attention, especially any concerns regarding heat or water. Leif’s cell number is 545-5510 and home number 543-2819. His email is leifalbertson@gmail.com. We share the house with the Pediatrics residents and so we typically live with one other person.  
'''Paging:''' Paging is now done through Tiger Text. For SCH residents, you can sign into your account using your ykhc email through the app on the peds resident phone.


'''Lockout''': Find extra temporary set of house keys  in “Haggerty” mailbox in ER doc office on the wall
'''Technology:''' 543-6070 Use this for technology issues at work or for internet at home (543-6525)


'''Vehicle issues''': We don’t do vehicle maintenance at the hospital anymore and the maintenance dept told our current resident to contact an auto shop and have them bill YKHC. The two auto shops I am aware of are Ed’s 543-4445 by the post office and Nicholson’s at the cross street of the “hwy past the 3-way stop at “mainstreet”
==Recommendations Before Your Trip==


We are fortunate to have city water and do not rely on water delivery like most of Bethel. There are winter precautions for the house to help prevent the pipes from freezing, and these are listed on the fridge, which include keeping the Toyo stove set at 68 degrees. It is convection heating so to keep the pipes in the bathroom and your bedroom warm keep the doors open.  
Figure out whether or not to forward your mail and set it up.


There is a bigger room that is carpeted and a smaller room that is wood floor and a third room which is set up as storage. There are a variety of sheets, pillows, blankets and towels in the house. These items may not be pretty, but they are functional and so you do not have to bring your own. The kitchen is well stocked with dishes, utensils and cooking supplies. Slippers to walk around in are a good idea. There is internet at the house, but you are not supposed to stream anything.  
Please let Thi-Anna know if you have a significant other or children that will be staying with you at anytime so that we can get family housing for you if there are kids.


Laundry: I would check with the resident who was there before you if there is any detergent there, and consider bringing some with you from Anchorage. Detergent is pretty expensive in Bethel.
'''Family Medicine Residents''': You should receive a Hireright request (approx 1 month before arrival) that JCAHO requires as a background check even though you have had them at other sites and we need that to be filled out to get you set up in our system. Chelsea Kinegak in HR will also send out a student/resident INFO sheet for you to fill out to get you into our system.


'''Cleaning Supplies''': There are cleaning supplies in the house.  Please leave the place at least as clean, or cleaner, than you found it, and replace cleaning supplies if needed. There is a vacuum in the house.
Make a shopping trip to stock up on food and save money. You are allowed three checked bags/bins up to 50 pounds each for free on the flight including carry-on and small carry-on (backpack). See below for more info on this.


'''Water''': The water in Bethel sometimes has a yellow-tinge to it.  You will probably want to filter your water for drinking.  There is a Brita filter in the kitchen.  Bring your own filters when you come.  You can get filters at AC and other stores, but you don’t want to pay Bethel prices for water filters!  Ask the current resident when it was last changed.
'''SCH Pediatric Residents:''' There are several bins in the resident house in Anchorage that you can use.


'''Garbage''': There is no garbage service in Bethel. There are dumpsters all over town (you will drive by one on the left just before pulling into the drive).
===Packing===
Packing for 6 weeks – 8 weeks can be tricky, especially when traveling to Bethel. You are headed to a very isolated part of the country, and while there are stores and Amazon can ship to you (if you are very patient--2 weeks standard mail), it is good to come prepared. You will find a system that works for you, but here are some thoughts based on our experience thus far.


Please leave it as clean or cleaner than you found it and resupply any paper or cleaning products that run out while you are there.
You get 3 free 50 pound bags on AK airlines traveling in-state. Sometimes, one bag is asked to be flown on standby and will make it into Bethel in 1-2 days.
===Before You Leave===
* Wash your bed sheets and towels.
* Clean the house.
* Fill the truck with gas and oil if it needs it.
* Be sure your Cerner (computer record) inbox is empty
* Put in a forwarding address for your mail back to Anchorage.
* Return your ID badge and computer to Diane
* Return any scrubs you borrowed
* Contact the next resident and let them know where you will leave the keys to the apt and the vehicle.
==Transportation==
We have a truck! For those of us who lived here in the era before the truck, we know this is a luxury. We now share a very beat up pick-up truck with the Peds residents. It is nice to have, since relying on taxis is a pain. Just keep in mind that gas is pricey (recently $6.75 /gallon), but luckily there are only 22 miles of road, so you don’t use that much gas.  The least expensive gas station is the one on Standard Oil Road. Please be courteous to the resident following you and leave it at least half full…especially in the winter when it should ALWAYS be at least half full.


On your orientation day, you will have to give YKHC your driver’s license to be photocopied.  The office to go to is on the third floor of the YKHC admin building across the street from the hospital.  When you exit the elevator/stairs, turn down the  hallway to the right and go to the end of the hall and take a left into the last office – Risk Management. They may also have a form to fill out. 
===Food===
===Taxis===
There is a normal size refrigerator/freezer to keep frozen/refrigerated goods for the weeks while you are in Bethel if you want to bring perishable items in a cooler/tote for the plane trip.
Lots of companies, they are pretty much all the same. The fare within the center of town is always $5 but if you go to Tundra Ridge, the airport or Kasayulie it is $7. YKHC had been giving us taxi vouchers, but this may be discontinued since we now have the truck. You call, give your address, they come pick you up. When you give the home address, it is 223 City Sub. Be warned that they may pick up other people along the way, and thus a 5 minute trip may turn into a much longer adventure.
'''Quyana Cab''': 543-5454
'''Alaska Cab''': 543-2111
===Getting to work===
You can see the hospital from our back window and there are a few ways to get there in the morning. 1. You can make a right on Akiak, pass the College and head out to the Highway and then walk along the Highway to the hospital. 2. You can go left on Akiak, then make a left on Napakiak and go to the end where you will find a bridge over the water pipes and then you are almost at the hospital. 3. Across the tundra simply walk behind our house, over the pipes, and walk across the tundra. There used to be an elevated boardwalk leading from the Cultural Center to the hospital, but it has been closed. The walk across the tundra takes you right under this old boardwalk. As long as you have mud boots or Yac Traks on, depending on the season, the tundra is much more beautiful than the other options.


For people less willing to walk through the mud, snow, ice or wind, you can always call a cab or negotiate with your roommate to use the truck.
The grocery stores in Bethel are very well stocked, but you will be paying a Delta premium, with a gallon of milk at about $8 and flour at $10-15. If it is heavy, or has to stay cold, it is expensive.
==Self Guided Orientation - The first Day!==
(Diane may assist in getting you started)


1. Go to HR on the second floor of the admin building across the street from the hospital. (Go down the right hallway and the office will be a glass paneled door on your left.)
Ice is illegal to bring on planes, so the prior recommendations have been to use frozen vegetables to keep items cool.
* Do the AMO (Annual Mandatory Orientation) in the computer kiosk in HR
* Get fingerprinted in HR
* Have someone in HR bring you to technology in the same building.  


2. IT  - Obtain your passwords for:
For fresh fruits and vegetables while you are in Bethel, the major store carries its fair share, but Full Circle Farm (www.fullcircle.com) does deliver to the area. You can open an account and stop delivery while you are away from Bethel.
*network access
*Powerchart
*email (might be the same as network access)
*AFHCAN telemed password
*other passwords you will get elsewhere include imaging eRad from the radiology dept and the ANMC Cerner computer charting by calling 907-563-2662, asking for technology and having them set you up with your password – if they say they don’t have your SARF, have Diane resend it)


3. Go to the legal dept on the third floor (opposite end from Technology) and give your driver’s license to have photocopied for insurance.
If you want booze, bring it. Boxed wine works well. There are no liquor stores in Bethel.  
4. Go across the street to the hospital side
* In West Wing (enter through the doors on your left as you ascend the wheelchair ramp) find employee health (past the WIC window) to have them update your immunization record from the record sent from your residency.
* If you are due for a Tdap or flu shot, etc they will give it to you for free.
* If you are due for a PPD (or CXR since a pos ppd) they will offer that for free as well.


5. Get a badge in maintenance (ask Diane to escort you since you need someone with a badge to get you in the hallway to maintenance). Make sure the badge says ”MD” or “DO” and “Resident Physician” somewhere.
Consider bringing things like soap and shampoo (all toiletries). These items are especially pricey in Bethel.
6. Hospital tour, usually provided by Diane,


7. eRAD access when visit radiology.
Check in with the previous resident to see if there are any communal supplies needed or if there is food left behind


8. Call ANMC at *97 to ask for technology to get passwords to their Powerchart/Outreach program as above
===Clothes===
'''Dress code''': Dress code is very casual, and is more functional than fashionable. You either have snow and ice or mud and dust, so don’t bring your super nice things. In the winter it gets as low as -40 ambient (-70 windchill), in the summer as warm as 70 degrees. Spring and Fall are muddy and rainy. Breakup is normally early May on the Delta.


'''EMR''': We have a “new” Cerner system that we call RAVEN and you should be receiving a half day orientation on it within your first few days that we will set up. 
'''Work''':
==Work==
Medicine in the Delta is very different than it is in Anchorage. The majority of the villages have clinics with health aides, and some of the larger villages have subregional clinics with health aides and mid level providers. The geographic isolation, and challenges in transporting patients across a vast area, plays a role in every patient interaction. At first this will be challenging, as you get a feel for the location of the villages and what can be managed in the village clinics, subregional clinics and YKHC.
===[[Medical staff meetings]]:===
'''High Risk OB rounds'''
Fridays 8 a.m. to 9 a.m. - West Wing Conference Room – Near Diane’s’s office in the West Wing to the left as you walk up the wheelchair ramp. As you enter the doors, go left and then turn right and go in one of the first doors on the right with a table and a few chairs.
===Schedule===
Your schedule will be ready a few days before your rotation begins.  Diane will send it to you.


'''The schedule KEY'''
Work attire is not formal.


'''WK''': Inpatient wards “Kusko” with patients from approx 28 villages including peds, adult, OB, and radio medical traffic (hours 8 a.m. to 6 p.m.) meet in the doc office by rooms 159 and 162 on the inpatient ward.
The hospital has scrubs for inpatient/ED, but if you have a favorite pair or two bring those as supply is limited.  


'''WY''': Inpatient wards “Yukon”...same as Kusko except approx 28 other villages of patients
In clinic, most wear business casual erring on the casual side.  


'''NF''': 6 p.m. to 8 a.m. night float meets at 6 p.m. in the doc office by rooms 159 and 162 on inpatient. Same responsibilities as WY and WK
People often wear rain/snow boots for commute and change to shoes in office.  


'''ER''': in the ER, check the times carefully to know if it is a p.m. or a.m. shift (often 8 a.m. to 8 p.m., 8 p.m. to 8 a.m., or some variation)
'''General:'''


'''Peds''': email whichever provider is listed to find out what time they want you to show up in the little doc office behind the peds nursing station - usually between 8 a.m. and 9 a.m.
Swim suit and goggles if you plan to do laps in pool or play water polo.


'''Village''': email the provider listed to make sure they get a flight for you when they go on the trip. Occasionally we do not have any village trips in the summer due to the patients being away at fishcamp, but we will try very hard to get you on a trip during your stay here.
Running shoes (bring some that have not been outside for gym equipment, separate “dirty pair” for road running as it can be muddy and dusty).


'''Clinic''': email the provider listed to see what time their clinic starts and which clinic they are in...they usually start at 9 a.m. and go until 5 or 7 p.m.
Backpack to fill with warm gear for medevacs


If a medevac comes up while you are in the ER or on wards, most preceptors are enthusiastic to let you go, so feel free to ask. You must be ready to get in a cab and go the first time to the hangar without going home for raingear or other gear.
'''General Winter:'''
* Warm boots: popular options include Sorrels, Baffins, and bunny boots
* Wool socks
* Warm parka
* Fleece
* Snow pants
* Warm gloves or mittens
* Neck gaiter
* Warm Hat
* Face mask
* Yak tracks, microspikes, or ice cleats for ice


You should get an average of two days off per week even if they have you working weekends, so check your schedule to make sure you have that.  
'''General Fall/Spring/Summer:'''
===Hospital Essentials===
* Tall rainboots (your hike across the tundra may have you in some deep water!)
There are scrubs in the men’s locker room in the OB section of the hospital.  Just knock before you go in.  Please return them at the end of the rotation—this is much appreciated by Dr. Bowerman, who orders them.  He prefers that none are taken from the hospital and left in the bin before you leave the hospital at the end of each shift.
* Rain coat
* Fleece


'''Meal Vouchers''': Diane Wasuli-Dock of the Medical Staff Office on west wing of the hospital will give you two meal cards for each night shift you are working. The rest of your food is on your own. The tickets are for dinner and breakfast before and after your shift.  The cafeteria has limited hours.
'''Family Medicine''': There are two AKFMR snow suits hanging in the entry way for taller residents and a pair of bibs for those on the shorter side.
==Village Visits==
The trip to a subregional clinic is a great opportunity to experience medicine in the true village setting, and to mingle with the PAs, NPs and health aides that make the entire system function. At the majority of these clinics, you are provided with a place to sleep and there is a sleeping bag at the house for village visits (occasionally it is a cot in the clinic)
Bring enough food for yourself for the trip, typically 2-4 days, but also a little extra in case you get weathered in. You might consider bringing fresh fruit for the clinic staff as a thank you gift since it is hard to get in the villages.  If you have the time, try to explore the town a bit, including the grocery store, to get a sense of what it costs to eat well in a village.
===Medevacs===
You will likely have the opportunity to go on medevacs while you are in Bethel. Lifemed is the company that manages the medevacs from the villages into Bethel. The process to ride along is a bit convoluted, but here are the steps:


When you arrive (or by email prior to arrival) Diane will give you the Lifemed Observer form.  
==HOUSE==
===Directions to the house===
There are taxis at the airport that can take you to your house. Tell them you need to go to "223B City Sub." The taxi should know how to get there. The cost is $8 and you may be riding with other people commuter style. From the airport – take the main road out of the airport. Take Chief Eddie Hoffman “Highway,” past the hospital parking lot, just past the courthouse and make a left onto Akiak. You are in a light blue building. The arctic entryway is shared between 2 houses. Enter the building where it says “A” and enter the second door on the right to apartment B. There is one family medicine resident and one pediatric resident living in the house at most times.  Cab company phone numbers are 543-2111 or 543-2169 or 543 5454.


1. Fill out the form, but leave the date blank.  
===House Basics===
House is 3 bedrooms (1 is more of a storage room), one bathroom, large living area and one tiny kitchen. It is shared with a pediatric resident and a family medicine resident and occasionally members of his or her family. There is a crib that can be put together, but if there is a child coming, your clinical contact should be notified to ask to set up another place for you to live.


2. Fax the completed form (minus date) to the medevac house, 5 to dial out then 907-543-1262. Also, keep a copy with you in case it needs to be re-faxed since you are here for 6 to 8 weeks at a time.
===Water===
You have unlimited city water, so no need to worry about usage, unlike many homes in Bethel. Be aware of this when visiting other peoples’ homes. They may be conserving water, since it is delivered on a weekly to monthly schedule.
You will probably want to filter your water for drinking. There is a Brita filter in the kitchen. You can drink the water unfiltered. Currently, the house has several filters in the kitchen cupboards. Ask the current resident when it was last changed.


3. On the day you want to ride along call the Lifemed house in Bethel 543-5036.
===Laundry===
They will confirm they have received your Observer form
There is a washer and dryer in arctic entryway to the apartment. I would check with the resident who was there before you if there is any detergent there, and consider bringing some with you from Anchorage. Detergent is pretty expensive in Bethel.
If no one else has requested to ride along they will take your phone number.  
FM phone is 545-8360 or another line you are using in Bethel.  Confirm the hours that you want them to call you before hanging up.


The medevac team will call you when they get a call and you have 15-20 minutes to make it to the hangar. You must be ready to get in a cab and go the first time to the hangar without going home for raingear or other gear.  After you know where it is, you can drive out there and leave your truck there during the medevac.  They will not wait if you are not there when they are ready for takeoff since by definition, the patient waiting is in an emergency situation.
===Cleaning Supplies===
There are limited cleaning supplies in the house. Please leave the place at least as clean or cleaner than you found it, and replace cleaning supplies if needed. There is a vacuum in the house.   YKHC has also hired a cleaning company to do a deep clean on the apartment every 4 weeks at the start of the month. Please let Thi-Anna know if there are any concerns with cleanliness of the resident housing.


The most important tip is to come prepared. You may be riding in a boat, snow machine or ATV from the village airport to the clinic. You may also have to spend lots of time outside and so if it is cold, bring the gear. A headlamp is helpful.  
===Garbage===
There is no garbage service in Bethel. There are dumpsters all over town and close to the resident housing. Please place any garbage in the nearby dumpster.


Medevacs are an amazing way to see the village clinics, meet the health aides and get a feel for what emergency services look like in bush Alaska. Just remember that when you go, you are observing, not providing or suggesting medical care. If you show up prepared, ask questions and offer to carry some gear, they will likely keep calling you.
===Internet===
==Groceries==
Internet usage is limited, so please be cognizant of your downloads and streaming use. If you go over the data limit, you may have to pay a significant overuse fee (hundreds of dollars). General internet usage is ok, but please avoid downloading movies or books and streaming movies or tv.


'''Swanson’s''': across the street from the hospital recently went out of business. The movie theater is still in operation.  
===Food/Kitchen===
The kitchen has everything you need, including microwave, coffee pot, toaster, instapot, pots/pans etc. There may also be some staples, spices, and other food items left by previous residents.  


'''AC (Alaska Commercial)''':  Can walk here from the apartment: right on Akiak, left on Mission, right into the driveway before the Park & Rec building with the playground and you will walk on a path with a small lake on your right and a water pipe and cemetery on your left. The path ends at the highway and when you make a right, you will see the AC down a little ways on the left side of the road.  
==Transportation==
Taxis are your best bet if you don't want to walk. There is also a city bus Mon-Sat.


'''Meyers Farm''': in Tundra Ridge. Tim sells locally grown produce as well as imported organic produce. Open Wednesdays 1-6 and Saturdays 9-1. It is a busy spot, so get there early if you want the best selection.  It’s a $7 cab fare each direction and unless you have a phone who knows how you’ll get back.  
===Taxis===
Lots of companies, they are pretty much all the same. The fare within the center of town is $5 to $8 but if you go to Tundra Ridge, the airport or Kasayulie it is $15. You can ask Abigail Morgan for cab vouchers. You call, give your address, they come pick you up. When you give the home address, it is 223B City Sub. Be warned that they may pick up other people along the way, and thus a 5-minute trip may turn into a much longer adventure. You are centrally located within a 10-15 minute walk to the hospital and grocery store.


There are several “Quick stop” type stores including Sammy’s market and the Swansons Quick stop. Corinas is down by the small boat harbor and carries case lot/costco size products.
Taxi drivers do not expect to get tipped in Bethel. There is a flat fee of $5-15 per person if you have to pay out of your pocket. If you do take a taxi in town, you may occasionally have to make several other stops to pick-up/drop off other passengers.


==Stores==
'''Kusko Cab''': 543-2169
<br/>'''Alaska Cab''': 543-2111


'''Art store at the Cultural Center''': all handmade art, including carvings, photographs and ceramics.


'''Lucy’s Cache''': Out at the airport, above the Yute terminal. Has Native jewelry, cards and gifts. Also has fur sewing supplies, just in case you need that, too.
==Work ==
===Getting to work===
You can see the hospital from our back window and there are a few ways to get there in the morning.  


'''Raven Fabrics''': lots of fabric choices along with some basic sewing supplies. Used to offer classes, but have been short staffed recently.
#You can go left on Akiak, then make a left on Napakiak and go to the end where you will find a bridge over the water pipes and then you are almost at the hospital.
#Across the tundra simply walk behind our house, over the pipes, and walk across the tundra. There used to be an elevated boardwalk leading from the Cultural Center to the hospital, but it has been closed for years. The walk across the tundra takes you right under this old boardwalk. As long as you have mud boots or Yac Traks on, depending on the season, the tundra is much more beautiful than the other options.
#You can make a right on Akiak, pass the College and head out to the Highway and then walk along the Highway to the hospital.
''For people less willing to walk through the mud, snow, ice or wind, you can always call a cab.''


'''Video Rentals''': Library #20 for free. Video World, next to AC, for one night rentals with a good selection of movies.  There is no rhyme or reason to how they file their videos so expect to spend a long time finding a specific video.  AC also rents for the same cost as Video World.  AC has athree non-new release movies for thee days for there dollars on Tuesday(?).  Also the new videos show up on Tuesday. 
===Orientation===
==Other Places==
Be prepared for a one-day orientation including getting your badge from HR and doing some online modules. After your first day of orientation, you will be given an introduction to our electronic computer system. Please find a way to keep track of all of your log ins and passwords, and then spend 1-2 days shadowing providers. Pediatrics and family medicine residents usually start clinical duties day 3 of arrival.
'''Post office''': on the highway, past YKHC. Can access PO boxes from 10 a.m. - 7 p.m. M-F, though the pick up desk closes at 5:30 p.m. Can usually access boxes 10 a.m. - 12 p.m. Saturday, and pick up packages, but this is not always the case.


'''UAF Kuskokwim Campus''': the majority of the regular classes are very expensive but they also offer a lot of short term classes through their cooperative extension program such as Judo, step aerobics, fur mitten sewing, pickling and guitar lessons. http://www.bethel.uaf.edu/
===Working in Bethel===
Medicine in the Delta is very different than it is in Anchorage. The majority of the villages have clinics with health aides, and some of the larger villages have sub regional clinics with health aides and mid level providers. The geographic isolation, and challenges in transporting patients across a vast area, play a role in every patient interaction. At first this will be challenging. You will eventually get a feel for the location of the villages and what can be managed in the village clinics vs sub regional clinics vs YKHC vs ANMC/Prov.


'''Cultural Center''': large, multipurpose building housing the library, meeting rooms and gift shop. This is where the Saturday Market and the majority of events are held. Also houses the Yup’ik Museum.  
===Schedule===
'''Pediatric Residents:''' You should be given your schedule several months before you start. Your schedule can be found on the Google calendar that Amanda has set up. Try to let your site coordinator or Amanda know if you have schedule requests at least 3 months prior to your start to try to facilitate these. You will likely work with a different provider each day and have two weeks of inpatient with a couple flex shifts. During inpatient, you will get to manage Radio Medical Traffic (RMT). Your second and third years you will take a village trip with a provider where you will do Well Child Checks for Chronic Peds patients. When you pull up your schedule for the day on the computer you will be likely listed as “L1B.” These are filler schedules for locums (hence the “L”).  


'''Library''': inside the Cultural Center. You can get a library card and they have a small collection of books, movies, and a very good collection of books on Alaska. There is a small group of women who knit on Saturdays starting at around 1 p.m. in the “Alaska” room. A book club meets on Thursday evenings at 6. Story Hour – Wed from 11 a.m. - 12 p.m. @ Kuskokwim Consortium Library (great computer for kids, children’s videos and books).
'''Family Medicine Residents''': The schedule will be ready a few days before your rotation begins. Mien Chyi, MD will send it to you. See “KEY” below for understanding your schedule:


'''Lion’s Club building''': Across the street from the Cultural Center. Lots of events held here from Bethel Friends of Canines pancake breakfasts to rummage sales benefitting the Winter Home.
===The Family Medicine Schedule KEY===
'''WK''': Inpatient wards “Kusko” with patients from approx 28 villages including peds, adult, OB, and radio medical traffic (hours 8 a.m. to 6 p.m.) meet in the family medicine doc office on the inpatient ward.


'''Chester’s Dance Studio''': Chester trains many of the heath aides, but he is also an amazing dance instructor. He offers tango, salsa, swing and cha cha classes. His studio is at 199 Alex Hately or at the Elder’s home. His number if 545-4699, which you can call for an updated schedule. He donates the proceeds to the Tundra Women’s Coalition.  
'''WY''': Inpatient wards “Yukon”...same as Kusko except approx 28 other villages of patients


'''VFW post''': right down the street from the house on Akiak. There is Bingo here Monday to Saturday evenings, as well as NRA funded steak dinners.
'''NF''': 6 p.m. to 8 a.m. night float meets at 6 p.m. in the family medicine doc office on inpatient. Same responsibilities as WY and WK


'''Banks''': There is a Wells Fargo Bank in the building with Video World next to the AC grocery store and an Alaska USA in the AC store. There is an Alaska USA ATM in the entrance to the hospital. There is also a First National Bank of Alaska on the riverfront.
'''ER''': in the ER, check the times carefully to know if it is a p.m. or a.m. shift (often 8 a.m. to 8 p.m., 8 p.m. to 8 a.m., or 10am-10pm or noon to midnight, etc)


'''YKHC Employee Wellness Center''': a small gym located in the YKHC admin building, across from the hospital. You sign up for it at HR, also in the admin building, on the second floor. $25/month.
'''Peds''': email whichever provider is listed to find out what time they want you to show up at the inpatient peds office - sign out is usually at 8 a.m.


'''Yukon-Kuskokwim Fitness Center''': New pool and fitness center. Offers classes and open gym access. Open Tuesday to Sundays. Fees range from $8 per visit to $60 monthly. There is also a Flex and Fit package that allows 10 class sessions in 8 weeks. You will have to ask about this as they don’t volunteer the info. Classes currently include Zumba, Spin, Cardio, Water polo.  
'''Village''': email the provider listed to make sure they get a flight for you when they go on the trip. Occasionally we do not have any village trips in the summer due to the patients being away at fishcamp, but we will try very hard to get you on a trip during your stay here.


'''Yukon Delta National Wildlife Refuge''': Interesting displays of stuffed wildlife in the area with info about the animals and refuge. Good place to get info on bird watching, berry picking, fishing, etc. Movies on Saturday.  
'''Clinic''': email the provider listed to see what time their clinic starts and which clinic they are in...they usually start at 9 a.m. and go until 5 p.m.


'''Walks''': In the summertime, up the road from Larson subdivision, there is a path that goes out on the right side behind a gate that says no trespassing.  WE take that to mean motorized vehicles, not us…  Also, part way to Kasayuli Subdivision there is a path on the left after the big curve around to the right that has a nice path that goes out to the airport.  Both are good for cranberries and blueberries as well as beautiful views.
If a medevac comes up while you are in the ER or on wards, most preceptors are enthusiastic to let you go, so feel free to ask. You must be ready to get in a cab and go the first time to the hangar without going home for raingear, N95, or other gear.  Please already have the medevac form filled out and on days that you would like to be considered to go, you must communicate with the medevac team ahead of time at 543-5036 to ask if you can be the ride-along when a medevac comes up as there are other people that also do this.


You can also walk down by the river…reached by walking across the street from the hospital and behind the admin building along a dirt road and turning left when you get to the river…Or ask someone where Pinky’s park is in City sub for some boardwalks across the tundra but within the circle of town.
You should get an average of two days off per week even if they have you working weekends, so check your schedule to make sure you have that.


In the wintertime, be very cautious about skiing or hiking on the trails.  Snow machines travel very fast and their ability to see you can be very limited, esp. in the long hours of darkness.  One of the docs here got run over by a sno-go and ended up with a compound tib/fib fx.  Beware!
==Hospital Essentials==
==Restaurants==
===Scrubs===
'''Mud Hut''': on the highway between the hospital and the post office. Burgers, fries, daily specials. They also have a new drive through espresso window, the first drive through in town
[[file:YKDRH.jpg|right]]
There are scrubs in the men’s and women's locker rooms on the 3rd floor of the hospital outside the OB ward. Please return them at the end of the rotation.


'''Dimitris''': on 4th Ave., near the AC. They offer typical Bethel food such as pizza and burgers, but also offer gyros, chicken lemon rice soup and a few other unique options. Plus, people love them on Yelp!
===Meal Vouchers===
The policy on this fluctuates substantially. Residents will receive meal vouchers from Abigail Morgan. The cafeteria has limited hours so stock up before night shifts or bring your own food.


'''Alba’s''': coffee shop in the same plaza as the Subway, across from the AC.
===Medical staff meetings:===
'''Grand Rounds''': Tuesdays at 8 a.m. in the outpatient clinic King Conference Room. Pediatrics will miss these due to didactics.


'''Subway''': the only chain restaurant in Bethel. Pricier than its lower 48 sister stores, but with basically the same offerings. Across from the AC.
'''C&C (care and collaboration) conferences''': 2nd and 4th Thursdays at 8 am in Raspberry conference room. You are encouraged to attend as there are usually interesting cases presented that provide good clinical orientation. We highly encourage residents to present cases of their own as well!


'''Coffee shop''': in the YKHC admin building, across from the hospital. Housed in the safety store, which is also fun to explore.
'''High Risk OB Rounds''': Fridays at 8 a.m. in the outpatient clinic King Conference Room (Family Medicine only)


'''Chopstix''': Sushi, Chinese, burgers. Used to be called VIP and has changed locations at least twice in the past two years. Current location as of 3/2015 Go right on Akiak, Go left on Chief Eddie Hoffman. At the stop sign at the Y, Stay right on Chief Eddie Hoffman (not straight for Ridgecrest). You will see it straight ahead just before the road curves to the right to the small boat harbor. Seems to be the favorite recruiting dinner site for the hospital staff. But, sushi is not terrible and they deliver.
===Village Visits===
The trip to a village is a great opportunity to experience medicine in the true village setting, and to mingle with the health aides and/or PAs and NPs that make the entire system function. At the majority of these clinics, you will be sleeping in the clinic on a mattress or cot (but sometimes on a couch or exam table). Some of the subregional clinics will have separate housing for you. There is a sleeping bag at the house for village visits. Bring enough food for yourself for the trip, typically 3-4 days, but also a little extra in case you get weathered in. You will likely have changes to your village trip due to weather, especially in the winter. You might consider bringing fresh fruit or desserts for the clinic staff as a thank you gift since it is hard to get in the villages. If you have the time, try to explore the town a bit, including the grocery store, to get a sense of what it costs to eat well in a village.  


'''Ptarmigan Restaurant''': in Tundra Ridge. They attempt Mexican food but also have the typical Bethel choices of burgers and pizza.  
===Medevacs===
You will likely have the opportunity to go on medevacs while you are in Bethel. Lifemed is the company that manages the medevacs from the villages into Bethel. The process to ride along is a bit convoluted, but here are the steps:
After arriving in Bethel, complete the Lifemed medevac ridelong form. This can be found in the ER, on inpatient, or in the clinic. This should be faxed to the local Bethel team at 543 1262.


'''Brother’s Pizza''': in Yute terminal at the airport.
Call the Lifemed team and inform them if you are interested in flying with them and your availability for the day. The medevac team will call you when they get a call and you have 15-20 minutes to make it to the hangar. You must be ready to get in a cab and go the first time to the hangar without going home for rain gear, N95, or other gear. They will not wait if you are not there when they are ready for takeoff since by definition, the patient waiting is in an emergency situation. If you are in the ED this process is much easier.


'''Sicily’s Pizza''': Right on Akiak then left on Mission (6th) to the end of the road (on your left). They use gluten free crust and use fresh veggie’s from Meyer’s farm in Bethel.
The most important tip is to come prepared. You may be riding in a boat, snow machine, or ATV from the village airport to the clinic. You may also have to spend lots of time outside and so if it is cold, bring the gear. A headlamp is helpful.


'''Coffee Shop''': At the upstairs area of the Grant Aviation building if you need a fix of your favorite hot coffee drink. The also have some pastries and baked bread there as well.  They also make pretty good sandwiches.  Wi-fi available there.
Medevacs are an amazing way to see the village clinics, meet the health aides and get a feel for what emergency services look like in bush Alaska. Just remember that when you go, you are observing, not providing or suggesting medical care. If you show up prepared, ask questions, and offer to carry some gear, they will likely keep calling you.


There are others and menus are floating around the hospital. Everywhere serves a multiethnic menu, usually Chinese and American with a third option that is variable.
*Of note, it is the policy of YKHC that residents are only allowed to ride along on a medivac with Lifemed crew in fixed wing plane. Unfortunately, due to liability reasons, residents are NOT able to ride along in a helicopter if the RCC/National Guard/Coast Guard is activated*
==Events==
'''Cama-i Dance Festival''': in mid April. This is a huge festival with lots of dancing, food and vendors.


'''Breakup''': the day the Kuskokwim River ice breaks up and starts flowing. There is a Winter Classic, which means you enter a guess for the date and time the ice will break and the winner takes home a ton of money. On the day of breakup there is also free food and live music down by the river.
===Calling in Sick===
'''SCH Pediatric Residents:''' When you are scheduled in clinic, please call your supervising physician by 8:00 am if you are not able to make it due to illness. Please also notify your site director and Kevin Krenek via TigerText (or Kevin_Krenek@ykhc.org). This will help the schedulers by giving them time to block any openings that have not been filled and reschedule those that have. Please also email Amanda to report absences.


'''Kuskokwim 300''': the big sled dog race in the Delta, in January. Starts and ends on the river. They are always looking for volunteers to help the mushers and run headquarters. There are events throughout the week, including an awards banquet at the end.
==Around Town==
see [[Bethel A to Z]]


'''Saturday market''': at the Cultural Center, monthly. There are lots of Native crafts and it is typically the place to be on those days. There is a schedule posted at the Cultural Center on the bulletin board.
==Before You Leave==
(Pediatric Residents will be given a half day of "wrap up" time on their last day to review message center, make sure all lab results have been followed up, confirm referrals have been sent, follow ups have been taken care of, etc. Please arrange all travel plans after this time.)
* Wash your bed sheets and towels.
* Clean the house.
* Be sure your Cerner (computer record) inbox is empty and you have a follow up plan for incoming labs/ messages
* Put in a forwarding address for your mail back to Anchorage.
* Family Medicine Residents:  Leave your laptop for the next resident in the resident house.  Pediatric Residents:  Return your badge after your third year and leave the computer at the resident house as arranged with the upcoming pediatric resident.
* Return any scrubs you borrowed
* Contact the next resident and let them know where you will leave the keys to the house.

Latest revision as of 01:40, 26 February 2023

WELCOME TO BETHEL!

Rainbowmush.jpg

The Paris of the Kuskokwim!

Created by Patti Clay, Peds resident 2015, adapted for Family Medicine by Rima Butler 3/2015, updated by Marcia Haggerty April 2015, updated by Lye-Ching Wong Feb 2023

While Bethel is not a large town, it can be a bit tricky to navigate your first time out here since most info is spread through word of mouth and there are certainly not many Yelp reviews to depend upon. As a basic review, Bethel is a town of approximately 6,400 people (based on 2017 Census review) in western Alaska, located on the Yukon Kuskokwim Delta. The Yukon Kuskokwim Health Corporation (YKHC) serves approximately 28,000 people spread across an area roughly the size of Oregon. There are no roads connecting the 56 villages in this area, and transportation is by small plane, boat, 4-wheeler or snow machine.

This guide includes information on your house, places in town and what to expect at work. It is not exhaustive, but it does contain enough information to help prepare you for your time in Bethel before you arrive, and to get your bearings around town once you arrive. This guide is applicable for both pediatric and family medicine residents, but pay attention to small details where our clinical duties and resources differ.

IMPORTANT INFORMATION

House Address

223 Akiak Apt B
Bethel, AK 99559

Mailing Address

The post office is on the highway on the left as you come in to town before the hospital. The window is open 11 to 5:30 Monday through Friday and 12 to 2 Saturday for packages. The lobby and P.O. Box access is open 7 a.m. to 7 p.m. M-F and 7 a.m. to 2 p.m. Saturday.

SCH Pediatric Residents:

Your Name
P.O. Box 1630
Bethel, AK 99559

Family Medicine Residents:

Your name
"General Delivery"
Bethel, AK 99559

  • Go to the post office between 11am and 5pm weekdays with a photo ID to get your mail

OR

  • Ask your peds colleagues if they mind sharing


Phone

Unless you have GCI or AT&T, you will have to rely on an alternative phone while in Bethel. Forward your number or leave a voice mail message before you leave so your contacts know how to reach you! GCI, AT&T, and sometimes Verizon are the only carriers that work in Bethel. GCI also works in the villages when you go on village trips, but not Verizon or AT&T.

SCH Pediatric Residents: 907-545-3234. You are provided with an iphone. Limited data, unlimited calling and text. (Hook up to wifi if you are browsing or you will be charged overage!)

Family Medicine Residents: The number is 907-744-6181. It is pre-paid by the residency so you don’t have to go to GCI anymore. Attendings and Lifemed will use this phone as a contact, so when you give it out please remind them that this will ALWAYS be the family practice resident phone number. Verizon and AT&T service are spotty in the hospital and will kill your battery, so this phone should serve as your work contact. Passcode is 8888. Do not leave it charging all day/night.

Medical Staff Coordinator

Thi-Anna Hunter: Thi-anna_Hunter@ykhc.org. Work: 543-6439. Cell: 690-2593

Medical Staff Trainers

Abigail Morgan: Sarah_morgan@ykhc.org. Work: 543-6914 Susan Richard: Susan_richard@ykhc.org. Work: 543-6218

SCH Pediatric Residents: Abigail is the contact person for taxi vouchers and meal tickets. (Amanda Soliai will continue to be your contact for flights, etc).

Family Practice Residents: Abigial is the contact person for taxi vouchers and meal tickets.
May Engler Marilyn_Engler@ykhc.org, arranges travel and family visits. 543-6725 Mien Chyi, MD Mien_Chyi@ykhc.org is the contact person for schedule.

Resident Site Coordinators:

SCH Pediatric Residents: Lye-Ching Wong, MD Lye-Ching_Wong@ykhc.org

Family Medicine Residents: Megan Young, DO Megan_Young@ykhc.org

Housing issues

Leif Albertson and Jenni Dobson, who live next door in the yellow house, own the home. Any house concerns should be directed to Leif or Jenni for immediate attention, especially any concerns regarding heat or water.
Leif's and Jenni's cell phone numbers are posted on the bathroom door and refrigerator in the resident housing and are also listed as a contact in the Bethel Pediatric Resident Phone. Leif's email: leifalbertson@gmail.com

House keys/Computer/Pager/Technology

Confirm with the resident finishing up/coming after you where these are left.

Keys: There should be two sets of keys – one set for each of the two people living at the resident house. Thi-Anna Hunter will have a spare.

Computer: A laptop will be provided for you while you are here.

Paging: Paging is now done through Tiger Text. For SCH residents, you can sign into your account using your ykhc email through the app on the peds resident phone.

Technology: 543-6070 Use this for technology issues at work or for internet at home (543-6525)

Recommendations Before Your Trip

Figure out whether or not to forward your mail and set it up.

Please let Thi-Anna know if you have a significant other or children that will be staying with you at anytime so that we can get family housing for you if there are kids.

Family Medicine Residents: You should receive a Hireright request (approx 1 month before arrival) that JCAHO requires as a background check even though you have had them at other sites and we need that to be filled out to get you set up in our system. Chelsea Kinegak in HR will also send out a student/resident INFO sheet for you to fill out to get you into our system.

Make a shopping trip to stock up on food and save money. You are allowed three checked bags/bins up to 50 pounds each for free on the flight including carry-on and small carry-on (backpack). See below for more info on this.

SCH Pediatric Residents: There are several bins in the resident house in Anchorage that you can use.

Packing

Packing for 6 weeks – 8 weeks can be tricky, especially when traveling to Bethel. You are headed to a very isolated part of the country, and while there are stores and Amazon can ship to you (if you are very patient--2 weeks standard mail), it is good to come prepared. You will find a system that works for you, but here are some thoughts based on our experience thus far.

You get 3 free 50 pound bags on AK airlines traveling in-state. Sometimes, one bag is asked to be flown on standby and will make it into Bethel in 1-2 days.

Food

There is a normal size refrigerator/freezer to keep frozen/refrigerated goods for the weeks while you are in Bethel if you want to bring perishable items in a cooler/tote for the plane trip.

The grocery stores in Bethel are very well stocked, but you will be paying a Delta premium, with a gallon of milk at about $8 and flour at $10-15. If it is heavy, or has to stay cold, it is expensive.

Ice is illegal to bring on planes, so the prior recommendations have been to use frozen vegetables to keep items cool.

For fresh fruits and vegetables while you are in Bethel, the major store carries its fair share, but Full Circle Farm (www.fullcircle.com) does deliver to the area. You can open an account and stop delivery while you are away from Bethel.

If you want booze, bring it. Boxed wine works well. There are no liquor stores in Bethel.

Consider bringing things like soap and shampoo (all toiletries). These items are especially pricey in Bethel.

Check in with the previous resident to see if there are any communal supplies needed or if there is food left behind

Clothes

Dress code: Dress code is very casual, and is more functional than fashionable. You either have snow and ice or mud and dust, so don’t bring your super nice things. In the winter it gets as low as -40 ambient (-70 windchill), in the summer as warm as 70 degrees. Spring and Fall are muddy and rainy. Breakup is normally early May on the Delta.

Work:

Work attire is not formal.

The hospital has scrubs for inpatient/ED, but if you have a favorite pair or two bring those as supply is limited.

In clinic, most wear business casual erring on the casual side.

People often wear rain/snow boots for commute and change to shoes in office.

General:

Swim suit and goggles if you plan to do laps in pool or play water polo.

Running shoes (bring some that have not been outside for gym equipment, separate “dirty pair” for road running as it can be muddy and dusty).

Backpack to fill with warm gear for medevacs

General Winter:

  • Warm boots: popular options include Sorrels, Baffins, and bunny boots
  • Wool socks
  • Warm parka
  • Fleece
  • Snow pants
  • Warm gloves or mittens
  • Neck gaiter
  • Warm Hat
  • Face mask
  • Yak tracks, microspikes, or ice cleats for ice

General Fall/Spring/Summer:

  • Tall rainboots (your hike across the tundra may have you in some deep water!)
  • Rain coat
  • Fleece

Family Medicine: There are two AKFMR snow suits hanging in the entry way for taller residents and a pair of bibs for those on the shorter side.

HOUSE

Directions to the house

There are taxis at the airport that can take you to your house. Tell them you need to go to "223B City Sub." The taxi should know how to get there. The cost is $8 and you may be riding with other people commuter style. From the airport – take the main road out of the airport. Take Chief Eddie Hoffman “Highway,” past the hospital parking lot, just past the courthouse and make a left onto Akiak. You are in a light blue building. The arctic entryway is shared between 2 houses. Enter the building where it says “A” and enter the second door on the right to apartment B. There is one family medicine resident and one pediatric resident living in the house at most times. Cab company phone numbers are 543-2111 or 543-2169 or 543 5454.

House Basics

House is 3 bedrooms (1 is more of a storage room), one bathroom, large living area and one tiny kitchen. It is shared with a pediatric resident and a family medicine resident and occasionally members of his or her family. There is a crib that can be put together, but if there is a child coming, your clinical contact should be notified to ask to set up another place for you to live.

Water

You have unlimited city water, so no need to worry about usage, unlike many homes in Bethel. Be aware of this when visiting other peoples’ homes. They may be conserving water, since it is delivered on a weekly to monthly schedule. You will probably want to filter your water for drinking. There is a Brita filter in the kitchen. You can drink the water unfiltered. Currently, the house has several filters in the kitchen cupboards. Ask the current resident when it was last changed.

Laundry

There is a washer and dryer in arctic entryway to the apartment. I would check with the resident who was there before you if there is any detergent there, and consider bringing some with you from Anchorage. Detergent is pretty expensive in Bethel.

Cleaning Supplies

There are limited cleaning supplies in the house. Please leave the place at least as clean or cleaner than you found it, and replace cleaning supplies if needed. There is a vacuum in the house. YKHC has also hired a cleaning company to do a deep clean on the apartment every 4 weeks at the start of the month. Please let Thi-Anna know if there are any concerns with cleanliness of the resident housing.

Garbage

There is no garbage service in Bethel. There are dumpsters all over town and close to the resident housing. Please place any garbage in the nearby dumpster.

Internet

Internet usage is limited, so please be cognizant of your downloads and streaming use. If you go over the data limit, you may have to pay a significant overuse fee (hundreds of dollars). General internet usage is ok, but please avoid downloading movies or books and streaming movies or tv.

Food/Kitchen

The kitchen has everything you need, including microwave, coffee pot, toaster, instapot, pots/pans etc. There may also be some staples, spices, and other food items left by previous residents.

Transportation

Taxis are your best bet if you don't want to walk. There is also a city bus Mon-Sat.

Taxis

Lots of companies, they are pretty much all the same. The fare within the center of town is $5 to $8 but if you go to Tundra Ridge, the airport or Kasayulie it is $15. You can ask Abigail Morgan for cab vouchers. You call, give your address, they come pick you up. When you give the home address, it is 223B City Sub. Be warned that they may pick up other people along the way, and thus a 5-minute trip may turn into a much longer adventure. You are centrally located within a 10-15 minute walk to the hospital and grocery store.

Taxi drivers do not expect to get tipped in Bethel. There is a flat fee of $5-15 per person if you have to pay out of your pocket. If you do take a taxi in town, you may occasionally have to make several other stops to pick-up/drop off other passengers.

Kusko Cab: 543-2169
Alaska Cab: 543-2111


Work

Getting to work

You can see the hospital from our back window and there are a few ways to get there in the morning.

  1. You can go left on Akiak, then make a left on Napakiak and go to the end where you will find a bridge over the water pipes and then you are almost at the hospital.
  2. Across the tundra simply walk behind our house, over the pipes, and walk across the tundra. There used to be an elevated boardwalk leading from the Cultural Center to the hospital, but it has been closed for years. The walk across the tundra takes you right under this old boardwalk. As long as you have mud boots or Yac Traks on, depending on the season, the tundra is much more beautiful than the other options.
  3. You can make a right on Akiak, pass the College and head out to the Highway and then walk along the Highway to the hospital.

For people less willing to walk through the mud, snow, ice or wind, you can always call a cab.

Orientation

Be prepared for a one-day orientation including getting your badge from HR and doing some online modules. After your first day of orientation, you will be given an introduction to our electronic computer system. Please find a way to keep track of all of your log ins and passwords, and then spend 1-2 days shadowing providers. Pediatrics and family medicine residents usually start clinical duties day 3 of arrival.

Working in Bethel

Medicine in the Delta is very different than it is in Anchorage. The majority of the villages have clinics with health aides, and some of the larger villages have sub regional clinics with health aides and mid level providers. The geographic isolation, and challenges in transporting patients across a vast area, play a role in every patient interaction. At first this will be challenging. You will eventually get a feel for the location of the villages and what can be managed in the village clinics vs sub regional clinics vs YKHC vs ANMC/Prov.

Schedule

Pediatric Residents: You should be given your schedule several months before you start. Your schedule can be found on the Google calendar that Amanda has set up. Try to let your site coordinator or Amanda know if you have schedule requests at least 3 months prior to your start to try to facilitate these. You will likely work with a different provider each day and have two weeks of inpatient with a couple flex shifts. During inpatient, you will get to manage Radio Medical Traffic (RMT). Your second and third years you will take a village trip with a provider where you will do Well Child Checks for Chronic Peds patients. When you pull up your schedule for the day on the computer you will be likely listed as “L1B.” These are filler schedules for locums (hence the “L”).

Family Medicine Residents: The schedule will be ready a few days before your rotation begins. Mien Chyi, MD will send it to you. See “KEY” below for understanding your schedule:

The Family Medicine Schedule KEY

WK: Inpatient wards “Kusko” with patients from approx 28 villages including peds, adult, OB, and radio medical traffic (hours 8 a.m. to 6 p.m.) meet in the family medicine doc office on the inpatient ward.

WY: Inpatient wards “Yukon”...same as Kusko except approx 28 other villages of patients

NF: 6 p.m. to 8 a.m. night float meets at 6 p.m. in the family medicine doc office on inpatient. Same responsibilities as WY and WK

ER: in the ER, check the times carefully to know if it is a p.m. or a.m. shift (often 8 a.m. to 8 p.m., 8 p.m. to 8 a.m., or 10am-10pm or noon to midnight, etc)

Peds: email whichever provider is listed to find out what time they want you to show up at the inpatient peds office - sign out is usually at 8 a.m.

Village: email the provider listed to make sure they get a flight for you when they go on the trip. Occasionally we do not have any village trips in the summer due to the patients being away at fishcamp, but we will try very hard to get you on a trip during your stay here.

Clinic: email the provider listed to see what time their clinic starts and which clinic they are in...they usually start at 9 a.m. and go until 5 p.m.

If a medevac comes up while you are in the ER or on wards, most preceptors are enthusiastic to let you go, so feel free to ask. You must be ready to get in a cab and go the first time to the hangar without going home for raingear, N95, or other gear. Please already have the medevac form filled out and on days that you would like to be considered to go, you must communicate with the medevac team ahead of time at 543-5036 to ask if you can be the ride-along when a medevac comes up as there are other people that also do this.

You should get an average of two days off per week even if they have you working weekends, so check your schedule to make sure you have that.

Hospital Essentials

Scrubs

YKDRH.jpg

There are scrubs in the men’s and women's locker rooms on the 3rd floor of the hospital outside the OB ward. Please return them at the end of the rotation.

Meal Vouchers

The policy on this fluctuates substantially. Residents will receive meal vouchers from Abigail Morgan. The cafeteria has limited hours so stock up before night shifts or bring your own food.

Medical staff meetings:

Grand Rounds: Tuesdays at 8 a.m. in the outpatient clinic King Conference Room. Pediatrics will miss these due to didactics.

C&C (care and collaboration) conferences: 2nd and 4th Thursdays at 8 am in Raspberry conference room. You are encouraged to attend as there are usually interesting cases presented that provide good clinical orientation. We highly encourage residents to present cases of their own as well!

High Risk OB Rounds: Fridays at 8 a.m. in the outpatient clinic King Conference Room (Family Medicine only)

Village Visits

The trip to a village is a great opportunity to experience medicine in the true village setting, and to mingle with the health aides and/or PAs and NPs that make the entire system function. At the majority of these clinics, you will be sleeping in the clinic on a mattress or cot (but sometimes on a couch or exam table). Some of the subregional clinics will have separate housing for you. There is a sleeping bag at the house for village visits. Bring enough food for yourself for the trip, typically 3-4 days, but also a little extra in case you get weathered in. You will likely have changes to your village trip due to weather, especially in the winter. You might consider bringing fresh fruit or desserts for the clinic staff as a thank you gift since it is hard to get in the villages. If you have the time, try to explore the town a bit, including the grocery store, to get a sense of what it costs to eat well in a village.

Medevacs

You will likely have the opportunity to go on medevacs while you are in Bethel. Lifemed is the company that manages the medevacs from the villages into Bethel. The process to ride along is a bit convoluted, but here are the steps: After arriving in Bethel, complete the Lifemed medevac ridelong form. This can be found in the ER, on inpatient, or in the clinic. This should be faxed to the local Bethel team at 543 1262.

Call the Lifemed team and inform them if you are interested in flying with them and your availability for the day. The medevac team will call you when they get a call and you have 15-20 minutes to make it to the hangar. You must be ready to get in a cab and go the first time to the hangar without going home for rain gear, N95, or other gear. They will not wait if you are not there when they are ready for takeoff since by definition, the patient waiting is in an emergency situation. If you are in the ED this process is much easier.

The most important tip is to come prepared. You may be riding in a boat, snow machine, or ATV from the village airport to the clinic. You may also have to spend lots of time outside and so if it is cold, bring the gear. A headlamp is helpful.

Medevacs are an amazing way to see the village clinics, meet the health aides and get a feel for what emergency services look like in bush Alaska. Just remember that when you go, you are observing, not providing or suggesting medical care. If you show up prepared, ask questions, and offer to carry some gear, they will likely keep calling you.

  • Of note, it is the policy of YKHC that residents are only allowed to ride along on a medivac with Lifemed crew in fixed wing plane. Unfortunately, due to liability reasons, residents are NOT able to ride along in a helicopter if the RCC/National Guard/Coast Guard is activated*

Calling in Sick

SCH Pediatric Residents: When you are scheduled in clinic, please call your supervising physician by 8:00 am if you are not able to make it due to illness. Please also notify your site director and Kevin Krenek via TigerText (or Kevin_Krenek@ykhc.org). This will help the schedulers by giving them time to block any openings that have not been filled and reschedule those that have. Please also email Amanda to report absences.

Around Town

see Bethel A to Z

Before You Leave

(Pediatric Residents will be given a half day of "wrap up" time on their last day to review message center, make sure all lab results have been followed up, confirm referrals have been sent, follow ups have been taken care of, etc. Please arrange all travel plans after this time.)

  • Wash your bed sheets and towels.
  • Clean the house.
  • Be sure your Cerner (computer record) inbox is empty and you have a follow up plan for incoming labs/ messages
  • Put in a forwarding address for your mail back to Anchorage.
  • Family Medicine Residents: Leave your laptop for the next resident in the resident house. Pediatric Residents: Return your badge after your third year and leave the computer at the resident house as arranged with the upcoming pediatric resident.
  • Return any scrubs you borrowed
  • Contact the next resident and let them know where you will leave the keys to the house.
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