Marshall Trip

The foothills around Marshall

Dried beaver, a popular traditional food.

Salmon strips drying on racks. These are a main staple of the Native diet, and are delicious!

These girls live in the house pictured. They followed us around town.

Salmonberries - these are used to make "agutak" a popular Native dessert.

City office in Marshall

Marshall, Alaska

Waiting room at the health clinic - I slept on the couch during my stay.

The Yukon River

Marshall health clinic - this is where I was working.

The community park

The school in Marshall - they board the windows in the summer so that kids don't break the windows, since there is nothing to do here to keep the kids out of trouble.

Eric has arrived to take me back to Bethel! Eric and his 207 Aerial view of the village Russian Mission, another village on the Yukon River
On July 24, I had the unique opportunity to travel to the village of Marshall and provide diabetes education to patients. One of the Bethel nurse practitioners was there, and wanted a dietitian to go along with her and educate patients. Well, I think I was the one who walked away with an education. This experience made a huge impact at how I view this area (and my life).

You'd think working for the hospital I would get to travel to the villages on a regular basis, well that is not the case. My budget is not set for that, and my boss was not supportive in allowing me travel. I was shocked - how do you get to know the people you serve? Don't get me started...

Anyhow, the diabetes program is a grant with lots of money, and not enough staff. They asked me to travel to the village of Marshall for 2 days. They gave me the list of diabetic patients I needed to see, and sent me off with a box full of education materials, and diabetic supplies.

I had called the village clinic about 2 weeks before my trip and asked them to schedule the patients during my 2 day stay. Village clinics don't usually schedule patients when doctors come in because the flights are so crazy. The weather is always bad, and it you can not predict when or if you will make it to a village. So, I was pretty surprised this clinic was willing to schedule patients for me - we'll see what happens.

I flew out on Grant Aviation, another bush company. It is about a 1 hour flight to Marshall. The weather was bad, and the clouds were low. I was nervous flying with someone I did not know, but for some reason I was scheduled to fly on another airline. Oh well. I tried not to look nervous, but you could not see through the clouds, and I was praying that I would make it alive. We landed in Marshall, and the village agent, Bruce, was there to pick me up.

Bruce, like most Natives, was not very talkative - especially to a white female. I asked all sorts of questions about Marshall, and he started to open up. He told me that the "airport" - which is nothing more than a gravel runway and a shack, is 3 miles from town. He told me not to walk out of the village too far, because there are black bears - and sometimes they attack people. Good tip....

He dropped me off at the village clinic, and I paid him 2 dollars for the trip. He was much more friendly now, so I asked him to please not forget to pick me up tomorrow. My pilot is coming back tomorrow afternoon - and the way it works in the bush is if you are not at the air strip when the plane arrives, they will leave you. I did not want to get stuck!

When I walked into the clinic, things were in full swing. The nurse practitioner showed me around, and introduced me to the staff. They had a list of patients for me to see, so I just jumped in. As I waited in-between patients, I would talk with other people in the clinic. It was interesting to see their reaction to a white person. The kids were very curious - most of them had never seen light skin and blonde hair before, so they would stare at me. Adults would usually look away. They were much more shy around me. It was very obvious, so I tried to be sensitive to that.

Nothing is confidential in the village. Most people don't have phones, but everyone has a marine radio. The clinic had a radio, and when I needed to see a patient, the health aid would get on the radio and announce "Wassile, you need to come to the clinic to see the dietitian about your diabetes." It was hysterical. Wassile would respond, "Okay, I'll be there." Sure enough, the patient would arrive.

I can't believe what I learned about the Native diet. I thought I was pretty knowledgeable since I'd been out here for about a year, but I had no clue. The people here are very poor, and make due with so little, it's amazing. They must hunt and fish for survival. I learned about how food was prepared, and how it is used for medicinal purposes. Let me tell you, I've learned to really get back to basics in my approach to teaching nutrition. People here have no idea what a carbohydrate is, and I think that is pretty true for most of the world. Most of the people I saw over those 2 days were shocked that a blue eyed, blonde haired girl from the lower 48, was promoting their Native ways. Some people had a bit more knowledge about food and nutrition and would ask me about the nutritional content of things like beaver, marrow, and so on. I was stumped on some of those foods, and told them I would get back to them. Just as a side note, the USDA website has information on Alaska Native foods - I love that site and downloaded it to my PDA......

What blew me away was how people here have persevered in this type of environment. Those who have stayed active by fishing, cutting wood, and dog mushing and practiced their traditional diet were much better from a medical stand point than those who eat more store bought foods and were less active. I was not surprised at all.

Suicide is very common in these rural villages. Part of my diabetes screening is to check for depression. I met one woman who had lost her 4th child last month to suicide. It was gut wrenching to hear her stories. With the influence of TV and Internet, these teens are faced with such an identity crisis - I can't even imagine. They see how life is on the outside, but are proud of their heritage. The 2 sides collide with dire consequences. These kids have no outlet in the villages, nothing to keep them out of trouble. The elders in the villages are no longer the role models as these teens want to be like the kids they see on MTV - so they drink, and they drink until they kill themselves.... The elders in the villages outlawed alcohol years ago, but unintentional death is the 3rd leading cause of death in Western Alaska.

After my first day in the clinic, the nurse practitioner and I walked around the village. We drew a lot of attention around town, and everybody knew what we were there for. We had such a long day in the clinic, that the town store was already closed. I was disappointed because I wanted to see what the food prices were, and what was available.

That night, I slept on the couch in the waiting room. Thankfully this clinic had running water, so I could use a real toilet. Most of the village still uses honey buckets, so I felt lucky to be able to wash my hands and flush the toilet. I had brought along my own food and water. You don't want to drink the water in the village - especially where I'm not use to it. Anyway, the couch was very uncomfortable, but I was so exhausted that I fell right asleep.

The next day was just as busy as the day before. I reviewed patients' blood sugar readings, and made recommendations. I was scheduled to head out on the 4 pm flight, and by 2:30 I had not been able to get a hold of Bruce, the village agent. I was getting nervous because I wanted to get home tonight. I kept trying to radio Bruce, and finally he answered. Yes, he would get me at around 3:30. I was packing up my supplies to go home, and I heard Eric's voice over the radio. "Karen, 7-2". The health aids were impressed that my husband was a pilot. In this area, pilots are like movie stars. Seriously.... Anyway, I had never worked a radio before, and the health aids just laughed at me. They told me to change the channel to 7-2, so that I could talk to Eric. Eric was on his way to Marshall, and if he gets there before Grant, he'll take me back to Bethel. I was so excited!

Bruce picked me up at 3:30, and I said good-bye to the health aids. A few minutes later, Eric was landing in Marshall. I was so glad to see him. He unloaded the mail, and loaded up my bags. Then we blasted out of there. He had to stop in Russian Mission first to drop off some passengers. I fell asleep on the way home, and was happy to see Bethel!

I was very grateful for this experience because it really opened my eyes to life in the villages. Bethel is remote, but is nothing like the villages. I think this will really help me be a better dietitian as I continue to work here.