Village Trips

From Guide to YKHC Medical Practices

Always let the village clinic know when you will be coming. The village clinics have a varying number of Community Health Aides and exam rooms. You will want to know how much clinic space will be available to you.

Upon your return, you will need to complete a Village Trip Report


  • You can email the scheduling manager (Mien Chyi) and ask when the best time for you to travel to a village. You can also pre-schedule your village trips. Expect to make quarterly village trips.
  • Village trips are usually 4 days, departing on Monday morning and returning on Thursday evening. You can leave Sunday evening if you would like, which would give you the opportunity to start seeing patients first thing Monday morning. It is entirely possible that there will be a weather delay and you will not leave when scheduled. You will usually have administrative time on the Friday of your travel week.
  • Sub-Regional Clinic trips are usually 3 days with a half day of administration time on Friday.
  • Review the Village Travel Calendar in Outlook to make sure there are no other providers (Dental or CHAP Itinerants) in the village the dates you wish to travel.


  • For non-SRC village trips, email the Outpatient Nurse Manager your travel dates and he/she will arrange for a nurse to travel with you.
  • You will not need a nurse for SRC trips because a Community Health Aide (CHA) will be screening for you.


One Month Prior

  • Ask your Case Manager for lists of patients including:
    • Prenatal patients
    • Chronic Peds patients
    • Elders (over age 60)
    • Patients needing women’s wellness visits
  • Call the clinic and notify the Office Assistant (OA) and CHAs you plan to travel.
  • If you travel during the summer months, inquire if the clinic has “summer hours”.
  • Ask about running water in the clinic and if it is potable.
  • Ask how many beds are available. The clinics have bunk beds with twin mattresses.

One Week Prior

  • Complete the medication request form for pharmacy
    • Pharmacy prepares the pre-filled Village Trip Provider Medication Kit, which you will bring as checked baggage.
    • The link for placing your provider kit order is on the YKHC intranet page under 'Clinical support.' The bottom link in that list is 'Monthly and Emergency Village + SRC Drug Orders.' That’s the one you want to choose. A new list of links will open and the provider medication kit request is the third link from the bottom
    • Please let the Pharmacy Director know if you have any questions or trouble placing orders. Also, if you place an order for a kit and you don’t hear from someone from the pharmacy within 2 days, please give them a call so They can make sure your request was received and make arrangements for you to pick up/drop off your kit.
    • Let pharmacy know if you will need to bring controlled substances with you; these will be locked in the pharmacy safe in the clinic.
  • Familiarize yourself with the Village Clinic and SRC formularies.
  • Consider reviewing elder charts in advance and make a list of labs you want drawn.
  • Contact the CHAs in the village a few days before you leave to see what supplies they may need and try to plan to bring those supplies.
  • Ask the CHA if they need any immunizations. You will need to contact the Immunization Department to prepare and package Varicella and Zoster vaccines. They can also package any other immunizations that the clinic needs, and they will bring the vaccines to the airport for you.
  • You may also want to ask the CHAs what types of procedures they have patients scheduled for (e.g., toenail removal, long acting birth control insertion, etc.) so you can prepare those supplies as well.
  • Consider contacting school administrators about doing some education at the school while in the village. The Office of Environmental Health and Injury Prevention (second floor of CHSB) has some materials you can bring with you. They have handouts on Sex Education, Helmet use, Drugs, Starting Menses, etc.
  • Confirm that someone will be able to pick you up from the airport, and get the phone number of that person.

One Day Prior

  • Contact the pharmacy and confirm medications are prepared for the trip.
  • Pick up and sign for controlled substances one business day prior to your trip (pick up Friday before a Monday morning departure).
  • Pack up any supplies you want to bring.
  • Call the CHA to confirm plan for patients to see (prenatal, chronic peds, women’s health, elders, immunizations, cancer, any special patients, etc...)

Day of Trip

  • Go to pharmacy and pick up extra supplies
  • Call the airport to make sure plane is on time and flying.
  • Consider contacting the clinic when the plane is ready to take off so they can plan for your arrival.


  • If you are traveling to a Sub-Regional clinic, you will not need to bring any extra supplies or medications with you. You can use medications and supplies from the SRC stock.
  • If you are traveling to a village clinic, you will need to bring supplies. Please let your charge nurse know your travel dates in advance and he/she can get your supply box ready for you. The supply box will be checked as a piece of luggage.
  • Prepare supplies for the CHAs, procedures if necessary, etc.

Personal Supplies

  • Sleeping bag or blanket/sheet (a fitted sheet provides a nice covering for the plastic mattress)
  • Pillow
  • Sleeping pad/travel cot - in case there are no beds available
  • Towel
  • Shower shoes/flip flops
  • Personal toiletries
  • Medications
  • Indoor shoes
  • Stethoscope
  • Computer and charger
  • Phone and charger
  • Books/movies the help pass the time in the evening. There is no cable TV.
  • Dishes and/or silverware

Other Supplies/Packing

  • Food
  • The village stores often do not have fresh fruits and vegetables; there is usually much pre-packaged food, and often just regular pop, no diet pop
  • Food suggestions
    • Instant Oatmeal
    • Frozen Dinners
    • Sandwich Supplies
    • Canned Soups
    • Pre-packed bag of salad and dressing
    • Home-made soup in containers
  • Most clinics will have a small fridge and microwave, and some have hotplates.
  • Luggage
    • People have traveled with totes, waterproof duffels, and suitcases. Whatever you find works best for you. Avoid just stuffing your bedding in a garbage bag. Those large North Face or Patagonia duffel bags are durable and work very well.
  • If you are able, consider bringing fresh fruit for the clinic staff. You could also bake something to bring for them. If you are a coffee drinker, please either bring your own coffee or bring some to share at the clinic. They are very appreciative of any goodies that they receive!


Village Stores

  • When in the village, please go see the village store so you can get a better understanding of what our population lives through on a regular basis. It will help you better educate your patients on diet and exercise knowing what is usually available and the cost.

Village Water

  • Some villages do not have running water; ask the clinic about the water supply. YK recommends boiling non-potable water for 2 minutes before drinking.
  • There is usually bottled water for purchase in the village stores.
  • Bedbugs
    • These are unfortunately a fact on the YK Delta, so please check beds when you arrive.


  • If you are traveling in the winter, dress as if the plane is going to crash. Flights can be cold. You need to travel with snow pants / heavy coat / winter / boots / hat / gloves / scarf / balaclava, etc. Avoid cotton directly on your skin.
  • You will travel by snow machine or four-wheeler for home visits, and will need to be warm.
  • Earplugs or headphones are a good idea if you are sensitive to loud noises.
  • Casual clothes are acceptable in village clinic, but use discretion.


  • Please, make sure your CHAs know when you are planning on arriving.
  • Get the phone number for the CHA who is on call so that you can get in touch with someone if needed.
  • Remember to ask the CHA how you will get from the airport to the clinic. Often the airline ticket agent can drive you. Sometimes the school may have a vehicle that can give you a ride. Sometimes you may need to ask someone at the airport. Have cash on hand. For example, in Marshall, the airport is over two miles away from the clinic and everyone who has a vehicle charges $5 one way for a ride to or from the airport.


  • Work with the CHA and Office Assistant to develop a schedule. The nurse traveling with you will screen your patients.
  • Do not see intoxicated patients in the clinic. They are too disruptive and too unpredictable.
  • At the end of each day, try to finish that day’s paperwork and document the number of specific visits:
    • Women’s health
    • Elders
    • Prenatal
    • Acute care
    • Referrals
  • Contact the school principal in advance of your visit and find out if they would like you to talk about whatever they deem appropriate.
  • Dental education is very important in the villages. If you want to give a healthy presentation and talk about tooth brushing, you can get toothbrushes, toothpaste, a big Teeth and Big Toothbrush from dental for teaching if the dentist has not been out for a while.
  • Try to get to the school for hot lunch (usually costs around $5) then hang out with the kids and teachers.
  • Try to do something social, e.g., go to Bingo or a community function.
  • Go to the Tribal Council and talk with the administrators. Plan some talking points.


  • The CHAs are a tremendous asset to the YK Delta, and their job is not an easy one. They have limited training, which can take many years to complete. Not all CHAs have finished their training; understand that they are doing their best.
  • The expectation is to help the CHAs any way you can.
  • Use your CHAs! They know who is sick, who should be seen on a home visit, and who may need to see provider.
  • In the villages, do not assume that CHAs will triage for you. It is not their job. If you need help, you can ask and they usually are very willing to assist. At the SRCs, the CHAs will be available to assist you.
  • If you have an interesting case or a procedure, offer to share the experience and teach the CHAs (with the patient’s permission). Some providers also set up mock emergencies for the CHAs to practice (email Leslie Herrmann for ideas).
  • The CHAs will ask you questions about their patients. They are appreciative of your visit and have reassurance when you are visiting. You can offer to do their RMT throughout the day, which will allow them to finish their day sooner and go home to their families.


  • When in a village clinic, do not order labs from the SRC lab folder.
  • Plan to draw labs in the village.
    • The village clinics do not have all the lab tubes available in Bethel or an SRC
    • Ask the CHA which tubes are available and check the expiration date
    • There is a centrifuge in each clinic
  • Labs need to be “logged” into Specimen Log In by your nurse or the CHA.
  • Labs are packaged and sent out daily, weather permitting.
  • Send your labs to Bethel daily from the village—not all labs can sit for days. Schedule all elders and fasting labs for the morning. Someone can be drawing them while you see other patients.


  • Your CHAs and office assistants can let you know who is in need of a home visit.
  • Go on home visits to see elders.
  • Plan on these visits taking an hour with travel to and from the patient’s home.
  • Families appreciate your visit and may offer you food.
  • These visits are best done at the end of the day since you may need some flexibility.


  • Plan to work days, and evenings if you want. Work with the CHA to make a master plan when you arrive, but be flexible.
  • You can control your schedule, and most providers have 30-minute appointments. The main purpose of a village trip is to take care of patients who are unable or unwilling to travel to Bethel, so many provides work into the evening.


  • If you dispense a medication you brought from the Bethel pharmacy, you will need to enter a prescription into Power Chart. Select “YKHC Clinic Dispensed Pharmacy” when placing the order. This will be a one-time order.
  • If you provide a medication from the supply you brought, and want the patient to have a recurring prescription (i.e. Lisinopril), you will need to enter an additional order. Select “YKHC Pharmacy” when you place this order.
  • If you prescribe a medication from the village clinic or SRC medication stock, you will also need to write a prescription, and select “YKHC Clinic Dispensed Pharmacy”.
    • The Control Number will need to be entered into the “notes to pharmacy”
    • The CHA can assist you if there are questions.
  • Dispensing a controlled substance from the supply that you brought also requires a prescription. If you DO NOT have EPCS, you will need to print out the prescription, sign it and bring it back to YK pharmacy.


  • Our pharmacists are a great resource. Always feel free to ask the pharmacists questions. We do have a limited formulary in villages and SRCs and you will need to have the Bethel pharmacy send out the medication if it is not available in the clinic.


  • This function is not used in the Village Clinics and SRCs.


  • To change your default printer from your Bethel based printer to the village clinic printer, find the “Add a Printer” icon on your desktop. Search for the specific village printer and select it. You will need to change the default printer when you return to Bethel.


  • Yes, babies are born in the villages.
  • All pregnant women are asked to travel to Bethel at 36 weeks gestation and wait to deliver. This date is called their Be in Bethel (BIB) date. Occasionally, for various reasons, this does not happen and you may have to deliver a baby in an emergency.
  • If you find yourself faced with an eminent delivery, call the CHA. Most likely, they have delivered a baby. Call the NW physician on call for consultation. Each village should have a baby warmer and delivery supplies in the clinic (suction, oxygen, vitamin K).
  • You should document details in a note for BOTH the mom and the baby.
  • Mom and baby may need a medevac, or they will travel to Bethel by commercial plane on the next available flight.


  • see Death Protocol for more details
  • Expected Death YKHC Protocol
  • If someone dies when you are in the village, you will be asked to pronounce them dead. You will also document the death, and call the State Troopers/VPSO, the Medical Examiner, and North Wing physician so the paperwork process and death certificate can be started.
  • If this was an expected death, an Expected Home Death form can be filled out ahead of time and faxed to the State Troopers and the Medical Examiner, making it very simple on the day of the actual death. If this was not done, you will need to have more details for the officers
  • There are auto texts for a Home/Village Death Note and an SRC Death Note.
  • Document this visit with pertinent history exam. Notify:
    • Alaska State Troopers: 907-543-2294 in Bethel
    • Medical Examiner: 1-888- 332-3273
    • North Wing doc on call (Tiger Text or 907-543-6300).
    • Life Alaska 1-888-543-3287. Get a case reference # and include in your documentation.


  • In a Village Clinic, the CHAs are first on call. If they need your assistance, they will ask. Please be willing to work with them. Since you will be sleeping in the clinic, you will likely know when the CHA has been called in after hours.
  • In the SRC, the CHAs are first on-call, and the SRC providers are the back-up. You may be asked to go to the clinic to assist
  • Some villages have an ambulance that will bring patients directly to the clinic for you to see. Sometimes the CHA has to pick the patient up on a snow machine or four-wheeler
  • If you are the only provider at an SRC, you will be on call
  • If you choose, you may take call for the CHA. They will more than likely be willing to give up the on-call phone, especially if they are the only CHA in the village.


  • You may need to help with an emergency while in the village, day or night.
  • There are two Family Medicine physicians staffing the North Wing (NW) in-patient ward from 0800-1800. One is the Kusko Wards Doctor; the other is the Yukon Wards Doctor. From 1800-0800, there is one Family Medicine physician staffing NW. Pediatricians are on service 24 hours a day.
  • If you need help or have questions about care, call or use Tiger Connect to contact the North Wing doctor on call for your village (Kusko Wards Doctor, Yukon Wards Doctor).
  • Evaluate the patient and formulate a treatment plan. Your nurse and the CHA will help you.
  • If your patient is too sick for local management and needs hospital admission, the patient will be medevaced to Bethel or Anchorage for a higher of level of care. In these cases, you are going to need to discuss an action plan with the NW physician.
  • Bethel has an OR that is used for emergencies, but there is no ICU. There is a CT scan, but no MRI machine. Depending on which village you are in, you may be able to send the patient directly to Anchorage if immediate surgery or if intubation is needed. Discuss this with the North Wing and ED physicians to help you make that call.
  • The NW physician on call can also help you with immediate management of the patient and offer suggestions of treatment plans.
  • If a medevac is needed, the Emergency Department physician will become involved. (Medevac Activation Process). The decision to admit to Bethel or have the patient transferred directly to Anchorage will be made in collaboration with the NW and ED physicians.
  • The ED physician or NW physician will contact Life Med. You may be contacted to provide more information about the patient (condition, PMH, vitals, etc.)
  • Sometimes patients need an escort, and an escort can fly with the patient if there is room. Travel back to the village is the escort’s responsibility (except for pediatric patients).
  • If the patient will be flying directly to Anchorage from a SRC, the SRC provider will call for a direct accepting physician at the receiving hospital. For beneficiaries, the SRC provider will call ANMC, and for non-beneficiaries, the SRC provider will call the ED at Providence.
  • Initiating a medevac takes coordination. If the patient going to Anchorage, you will probably speak to the nursing house supervisor, Life Med staff, and the receiving physician.
  • Pediatric patients are usually admitted to the Family Medicine Service. A complicated pediatric patient or a Chronic Peds Patient (designated in “Alerts” in the banner bar of Power Chart), should be admitted to the Pediatric Service.


  • If you want to participate in Grand Rounds while you are on a village trip, you can attend via Zoom.


  • Finish any charts you did not complete. Review your labs in the message center and create letters to send to your patients. Send them to your Case Manager Assistant to print out and mail.
  • You will receive an email link to complete your Electronic Trip Report. Fill it out indicating when you left and when you returned to Bethel. Your per diem will be determined by the number of business hours you traveled. Submit it to your manager for review.