Harassed and exhausted, the workers at a Western Alaska village clinic have resigned, leading the regional health agency to indefinitely close the facility because of what the agency's chief calls a "hostile environment."
The village, Nunam Iqua, has no police, no public safety officers and no state trooper post to protect medical workers called to potentially dangerous crime scenes. Imagine trying to help a stabbing victim when the attacker is still in the house. That's the prospect facing health aides in a community with no local law enforcement.
All three employees at the clinic -- including two health aides and an office assistant -- recently quit because "they're fearful of harm," said Gene Peltola, president and CEO for the Yukon-Kuskokwim Health Corp. The village, near the mouth of the Yukon River, has a population of about 200.
While officials are working to provide at least part-time health care in Nunam Iqua, no one knows when the clinic will reopen for good.
"I'm not going to put an employee in a position where they could be hurt," Peltola said.
Health aides deliver basic medical and emergency help in isolated Alaska communities where there are no doctors and hospitals are a plane ride away. It's against YKHC policy for them to walk in to unsafe crime or accident scenes, but people have complained or harassed clinic workers when they don't show up, said Gloria Abraham, a clinic office worker and former health aide for the village.
The community needs cops, she said. "Our health aides are willing to go back to work, I am too, if we do get that law enforcement."
"THEY'RE JUST TIRED"
No single encounter prompted the clinic resignations, said Lucy Martin, a YKHC health aide supervisor and instructor. "They're just tired. ... They need support," she said.
The village popped up in trooper reports in March when a woman was accused of cutting her mother's head with an ulu knife and then trying to cut her own wrist. One of the health aides was called to tend to the cut in the home, where the alleged attacker was upset and hollering at her, according to a trooper affidavit. Troopers, who arrived the next day, said the family had been drinking whiskey and that "alcohol was a major factor" in the assault.
"Most of the problems within the community are alcohol related," Peltola said. "And I think they're going to have to get some kind of control on importation of alcohol into the community, which is illegal, and the manufacture of alcohol in the community, which is also illegal."
Nunam Iqua can only be reached by plane, snowmachine or boat. For such remote villages, there's no 911 service and losing your clinic health aides means losing your first line of defense against illness, injury and death.
"Health aides are the ambulance drivers. They are the emergency room doctors. They provide immunizations ... they see patients for preventive, acute, urgent and emergent care," said Bill Schreiner, head of the community health aide program.
One of the workers who resigned, Savanna Strongheart, is a former YKHC health aide of the year, Peltola said. In a March 2008 newsletter, a doctor wrote her a public thank-you note saying Strongheart's insistence that a young patient be flown by medevac rather than on a regular flight "probably saved this child's life."
For now, the health corporation plans to send workers to offer medical care in the village only when troopers are in town, Schreiner said.
That means the clinic could be open, using transplanted workers, a week or more a month, beginning Monday, with troopers staying two weeks in the village, he said.
If new health aides are hired, they likely wouldn't be able to finish training and be ready for the job until late November or early December, Schreiner said.
"STEPS TO RECTIFY THIS"
Nunam Iqua was historically the site of summer fish camps on the south fork of the Yukon, according to the state Division of Community and Regional Affairs. Formerly Sheldon Point, residents voted to change the name of the Yup'ik village in 1999.
Efforts to hire a village police officer have been unsuccessful and the local grocery store has closed, Schreiner said.
Last week, YKHC officials, the head of the village public safety officer program for the region and troopers met with Nunam Iqua community leaders, Peltola said. "Our position is, as long as it's a hostile environment. We're not going to put (temporary workers) out there."
A tribal meeting followed this week and more meetings are in the works in an effort to reopen the clinic, said Lt. David Tracy of the Bethel trooper post.
"They're building a response list and they're taking steps to rectify this," he said.
Peltola said he's been told of threatening phone calls to the clinic. Abraham said at least one of the aides, Francine Afcan, changed her number to avoid harassing calls.
She resigned last week. The other two workers' last day on the job is today.
"I feel sad that the clinic is actually closing down, but relieved. ... Maybe this is a wake-up call to the community," Abraham said.
The tribal council president couldn't immediately be reached for comment Thursday. At last week's meeting, he said he was disappointed that the people causing many of the problems at the clinic hadn't shown up to talk about them, Schreiner said.
A woman who answered the phone at the city office declined to give her name, saying "people of Nunam don't want (the clinic) to close, but they got no choice."
In some villages, tribal council members or other civic leaders help health aides by securing injury scenes themselves, Schreiner said, but in Nunam Iqua health aides are generally on their own.
Ann Strongheart, sister-in-law to health aide Savanna Strongheart, writes a blog about rural Alaska and has rallied to collect food donations for Nunam Iqua in the past. She lived in the community for about three years before moving to Ugashik to fish, she said.
Sometimes there was local law enforcement and sometimes there wasn't, but the police presence was never consistent, she said.
"The entire village needs to step up and acknowledge that something is terribly wrong, if they do not and this continues then I fear that Nunam Iqua will wither and die as people could be forced to move to some place safer," Strongheart wrote in an e-mail.
Fewer than half of Y-K Delta villages have village public safety officers, according to troopers. Schreiner couldn't say how many additional YKHC clinics are in villages with no local law enforcement but "there are definitely others," he said.
While the clinic is closed, workers 18 miles away at a sub-regional clinic in Emmonak will field calls for help by phone, Schreiner said.
If someone suffers an injury threatening life or limb, YKHC will send a medevac to take them to Bethel just as they would when the clinic is open, Peltola said.
The plane trip takes roughly an hour each way.