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By Mikaila Holt, RN, BSN, PHN IV, Itinerant Nurse Manager

Leaving early on a Tuesday morning from Fairbanks (located in Fairbanks North Star Borough, pop. 98,645) onboard Wright Air Service, I board a small bush plane to fly northwest to an Athabascan village with a population of 150.  The village is a federally-recognized tribe and I partner with the local tribal health clinic and Community Health Aides to provide public health nursing services.

After a 75 minute flight in a Cessna Grand Caravan, we touch down. The airport is one mile from the health clinic and two miles from the school.  Rides from the runway are a treat in this community: fuel is expensive and maintenance of vehicles is a challenge, but the school truck driver was able to pick me up on this morning and bring me to the school.  Through our community relationships and payment to the school fund, there is always someone helping me out to bring me where I need to go.

I greet teachers, students, and staff as I set up an immunization clinic for the kids.  I have brought all the necessary equipment- needles, sharps container, band aids, alcohol wipes, emergency kit, and, of course, stickers for kids. These supplies enable me to be a self-sufficient off-site clinic. 

This morning, I bring three middle schoolers and two high schoolers up-to-date on their vaccines. Access to vaccines can be a challenge in the bush communities as it can be difficult to maintain necessary vaccine cooler temperatures during transport, staff skills and knowledge in administering vaccines varies by community, and there are transportation difficulties for the parents to bring  their kids to the clinic.

I am also able to spend some time in the high school class of combined 9th-12th graders to provide reproductive health education. This is typically a difficult subject to broach with this age group, but very important as Alaska consistently has one of the highest rates of Chlamydia in the country. There’s giggles and blushing, but there’s also kids who know the answers and others who are learning.  As a nurse, I need to be comfortable addressing all aspects of public health ~ from abstinence to condom use and explaining the risks of sexually transmitted diseases.  On this day, someone says “I don’t want to have a baby, I really don’t want to have a baby.”  The conversation is frank: I translate the kids’ slang terms and teach them medical terms to increase their knowledge and understanding.

I get a ride back to the two exam room clinic from a community member and check in with the two Community Health Aides on how life is going in the village. I am especially interested in any changes that impact the health status of the community since my visit three months ago.  The health aides are excited because they are preparing for construction of a new clinic in the summer. The existing clinic is over 20 years old; there is no running water in the clinic since the pipes froze and burst years ago.  They will have to temporarily relocate the clinic across the street while the new building is constructed on the existing site.

I go over my schedule with the Community Health Aides: I will be seeing two new babies and four younger kids for well child screenings. In this community, the health aides have not attended the training session for well child screenings, so we assist with meeting this community need.  I discuss the well child screening process with the health aide and offer to observe the visit if the client agrees.  One family on the schedule is not a beneficiary and would have to travel to Fairbanks to receive this service. Then this evening a young woman has made an appointment with me but I don’t know for sure why.  PHNs will see adults for STI screenings, immunizations, reproductive health counseling, healthy lifestyle and alcohol screenings, as well as community resource referrals to assure the provision of health care when otherwise unavailable.

I’m pleasantly surprised when I see the younger children this time. Over the years, I have referred kids for developmental delays to the Infant Learning Program and the native health group primary care providers.  However, this trip is my first visit after an Early Headstart program was brought to the community by Tanana Chiefs Conference in the fall of 2014. I see improvement in speech development and children know numbers and letters they didn’t know three months ago. This is very exciting to me because the families are learning tools and skills to improve their children’s education and strengthen the interaction between the parent and child.

 In the evening, I meet with “Jenny”, who I find out is not a beneficiary and can’t utilize the clinic health aides, however she is taking care of herself by wanting to get her first STI screen.  We discuss many aspects of her life and I focus on conversations around healthy nutrition and exercise, alcohol use, pregnancy prevention, STI prevention and treatment, and immunizations.  I commend her for coming in and encourage her to make the changes she identified.

Once my last client leaves for the evening, I set up my space to spend the night in the clinic.  This evening I’m really lucky, a friend in the community has brought me moose stew for dinner. There are no restaurants in town, but I will often try to stop by the local store and pick up a snack.  For my meals, I bring food that I prepared at home.  I also bring some fresh fruit to share at the clinic as that can be a challenge to get in the villages.  I sleep on a cot provided by the clinic with a sleeping bag I brought with me.  This clinic doesn’t have running water (except for a handwashing station), but the washeteria is across the street with toilets, showers, and water to drink.

The next morning I walk across the street to the tribal office and meet with the tribal administrator to tell her about the Small Community Emergency Response Plan, a template developed by the State of Alaska Division of Homeland Security and Emergency Management. I explain to her the community can personalize the plan to improve safety if there is ever a disaster in their village, for example flooding or interpersonal violence.  I have piqued her interest and I give her the contact information for the state program partner. I will follow up with her during my next visit. 

Then, it is back to the clinic for more client visits!  In the evening, I set up a flu clinic before the tribal council meeting.  This is a great way to see community members at one time and offer flu shots in a convenient location for them; while this might be a challenge for primary care providers, this is a routine activity and I have all the supplies I need to hold mobile clinics.  I was able to get 25 people vaccinated, including a couple of people who said “I wouldn’t go out of their way to get this, but since you’re here, I have no excuses now!”  I leave the next morning with a plan to return in 3 months to follow up on the emergency plan, meet with the Behavioral Health Aide who was out on training about community mental health needs, and keep checking up on the children’s vaccination and well child screening needs.

As the Interior Region’s Itinerant Nurse Manager, I always keep my eyes open for experienced public health nurses to join our team and serve remote villages throughout Alaska. My team lives in Fairbanks and travels by small plane to these communities several times throughout the year. The Interior region is one of four Public Health Nursing regions in Alaska. Learn more about all of our opportunities at http://dhss.alaska.gov/dph/Nursing/Pages/recruitment/default.aspx. To learn more about other State of Alaska nursing opportunities, go to the online recruitment job board at Workplace Alaska.

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