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I read with interest the commentary by Madisyn Parker titled, “Addressing Alaska’s Obstetric Healthcare Desert,” and as I am a physician who specializes in obstetric care and lives and works in Alaska, I wanted to share some thoughts based on my personal experience.
The dictionary defines a “desert” as an area without water or life. I used to live in Arizona, and much of the state looks like a desert to the casual observer. But to those with a keen eye, the Arizona desert is actually teeming with life.
Geographically, Alaska is the largest state in the United States. According to government data, Alaska has some 162 communities organized as cities or municipalities. In addition, there are at least 229 federally recognized Alaska Native villages. Health care is not easy for anyone in Alaska, especially mothers and children. But despite Alaska’s vast distances, sparse population, and great challenges, I do not consider Alaska a birthing or childcare desert. Like the desert in Arizona, maternal and child health in Alaska is teeming with life.
Nearly every Alaskan village, no matter how small or remote, has at least one medical assistant who plays a vital role in monitoring the health of pregnant women and young children. Many villages and remote communities also have nurse practitioners and physician assistants. Once a patient is found to be pregnant, she receives important guidance on nutrition and a healthy lifestyle, is prescribed common medications such as prenatal vitamins and iron, and works with the medical team to receive prenatal care. Great efforts are made to ensure that children receive routine medical checkups, dental care, and standard immunizations.
The state has large health systems that direct patients to larger, more complex hospitals and medical facilities. For example, the Yukon-Kuskokwim Delta region is 75,000 square miles and is home to more than 23,000 people in 58 rural communities that are not connected by roads. Bethel, the region’s service and transportation hub, has a hospital and clinic staffed by highly qualified medical personnel who visit the villages to provide medical care to the people. Across the state, there are several large communities that serve as hubs for smaller, more remote villages. These hubs refer patients to Anchorage for medical needs.
Technology also plays a key role in health care in Alaska. Patients can receive medical care and education over the internet and phone, which we use to monitor conditions like diabetes and high blood pressure during pregnancy. In addition, thousands of dedicated health care workers, including obstetrician-gynecologists, family medicine physicians, certified midwives, nurse practitioners, physician assistants, nurse practitioners, and more specialized physicians like pediatric cardiologists, travel across Alaska to see patients through outreach clinics, improving health care for pregnant women and children in rural and remote areas.
Alaska has the largest and most complex air transportation system in the United States. Medical evacuations and patient transports occur daily throughout Alaska. Patients are transported from remote villages to regional hubs, Anchorage, and even to highly specialized hospitals in Seattle and Portland. These medical evacuation teams are skilled and will risk their lives to transport patients throughout Alaska if necessary.
Some areas have arrangements in place for pregnant women to stay near hospitals during the later stages of pregnancy. Patients who live in the YK Delta can stay in Bethel or travel to Anchorage. Patients in Southeast Alaska may stay in Sitka or Juneau or come to Anchorage. Patients in the north may stay in Fairbanks. Alaska Medicaid and most private insurance companies will help you arrange transportation from your home village or area to a more substantial medical facility. Most local medical corporations also provide financial assistance for patients who need to stay in a larger area for pregnancy or birth. In Anchorage, patients can stay in local hotels, Ronald McDonald Houses, Hickel Houses, or other locations as needed. When patients give birth in Anchorage, they receive assistance in returning home with their baby, and follow-up is arranged to check on the health of the mother and newborn. This includes breastfeeding assistance for mothers who choose to breastfeed their babies.
Overall, considering the unique challenges faced by patients and their families, Alaska is a wonderful place to live in. The challenges of providing quality health care to pregnant women and children are many, but thanks to the dedication and hard work of many outstanding medical professionals and dedicated organizations across the state, Alaska ranks among the best in the nation for health care outcomes.
Dr. Debra Damron He is an Anchorage-based physician who specializes in obstetric care.
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