Bethel Survival Guide

WELCOME TO BETHEL!

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

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.