Bethel Survival Guide

April 2015 Edition

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.

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.

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.

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

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

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.

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.

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.

Rotation Preparations

Contacts

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

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.

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

Arrival

Recommendations Before Your Trip

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: http://www.ykhc.org/library/Pediatric%20Orientation%20Manual%20Binder.pdf

Packing

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.

Food

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.

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.

Clothes

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.

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.

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.

Lockout: Find extra temporary set of house keys in “Haggerty” mailbox in ER doc office on the wall

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”

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.

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.

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.

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.

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.

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).

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.

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.

Taxis

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.

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.)

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:

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.

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.

6. Hospital tour, usually provided by Diane,

7. eRAD access when visit radiology.

8. Call ANMC at *97 to ask for technology to get passwords to their Powerchart/Outreach program as above

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

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

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.

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 doc office by rooms 159 and 162 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 some variation)

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.

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 or 7 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 or other gear.

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

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.

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.

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.

1. Fill out the form, but leave the date blank.

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.

3. On the day you want to ride along call the Lifemed house in Bethel 543-5036. They will confirm they have received your Observer form 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.

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.

Groceries

Swanson’s: across the street from the hospital recently went out of business. The movie theater is still in operation.

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.

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.

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.

Stores

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.

Raven Fabrics: lots of fabric choices along with some basic sewing supplies. Used to offer classes, but have been short staffed recently.

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.

Other Places

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/

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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!

Restaurants

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

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!

Alba’s: coffee shop in the same plaza as the Subway, across from the AC.

Subway: the only chain restaurant in Bethel. Pricier than its lower 48 sister stores, but with basically the same offerings. Across from the AC.

Coffee shop: in the YKHC admin building, across from the hospital. Housed in the safety store, which is also fun to explore.

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.

Ptarmigan Restaurant: in Tundra Ridge. They attempt Mexican food but also have the typical Bethel choices of burgers and pizza.

Brother’s Pizza: in Yute terminal at the airport.

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.

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.

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.

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.

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.

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.