BETHEL — Jill Seaman just wrapped up another summer in the Alaska Bush, a concentrated four-month stint of emergency room night shifts and baby deliveries in a region where hundreds of families still lack running water.
Call it the easy part of her year.
Now she's off to Africa, her other home, a place where a treatment she helped to refine has saved thousands from a deadly parasitic infection. There, she's a war-zone doctor whose work receives international attention.
For decades, Seaman, 64, has split her time between two of the most remote and challenging spots on the planet: the Southwestern Alaska hub of Bethel and South Sudan, a country being ripped apart anew by civil war.
In Bethel, she shares a small place on Brown Slough with friends who also live part-time in the Bush. It's a cozy house built on a tight budget with smooth-sanded plywood floors and a low counter just right for the petite Seaman to knead bread.
In the African village of Old Fangak, she eats lots of rice and popcorn, keeps her solar-powered computer and printer in a mud hut and sleeps outside in a camping tent.
Some special doctors devote a few years to helping those most in need — impoverished people far from big hospitals, in places where infectious diseases can destroy whole communities if help doesn't arrive.
For Seaman, who came of age in the 1960s, this devotion is her life. To her, the most important element of quality medicine is fundamental — it's access.
"If there's a place that has a problem with access for whatever reason, whether it's cultural or financial, than that place needs some more help," Seaman said one recent evening in Bethel. "I am very lucky I have two places like that."
In Alaska, she works for the Yukon-Kuskokwim Health Corp., an Alaska Native organization that runs the hospital in Bethel and clinics in villages, an elders home and a medevac service. The region's challenges are immense, with high rates of infectious disease and cancer, suicide and death from injuries.
Still, Seaman is able to work out of YKHC's soon-to-be renovated hospital with a stocked pharmacy and sterile operating rooms, registered nurses and telemedicine links to villages. She sees how trained health aides have improved lives in Alaska villages — a model that holds promise in Africa.
There in Africa, when she doesn't have the right drug for a patient or when her clinic is overrun, the depth of the need rips into her core.
In Old Fangak, she hangs IVs filled with life-saving medicine from trees, works out of a clinic built with the help of an Alaska-based group, and holds office hours outdoors.
Bethel residents as well as those in Anchorage have long supported her Sudan work.
Now, a new philanthropic group intends to send half of what it raises over the next three years her way.
"She's a local hero and I think we are all kind of looking for local heroes, really authentic people who are doing good work with their skills," said Katie Basile, one of the organizers of YK Delta Women in Philanthropy. "And that's Jill."
Basile, a Bethel-raised photographer and videographer, spent a month in 2015 documenting Seaman's work in South Sudan, more than 7,000 miles from Bethel.
"Every afternoon when it's like 105 degrees, Jill sits outside and takes patients for hours. Sometimes right into the evening. And that's when evening clinic starts," Basile told a group of about 40 women who gathered earlier this month in Bethel for the launch of the YK women's group.
Conditions in Old Fangak are gradually improving. There are now wells and latrines, though a recent project to empty them cost $100,000, only for them to fill back up within months. Plumpy'Nut, a French-made peanut paste, has rapidly fattened up starving children but it is expensive too.
When someone needs a blood transfusion, Seaman may donate her own for the procedure. A sick child doesn't require much of it.
Locals work alongside her. She told a Bethel group about one man who was illiterate but skilled in providing injections to the sick. She has sent one promising young man to school in Nairobi with the hope he eventually can take over the project as a doctor, Basile said.
Seaman works through a variety of nonprofits, benefactors and funding arms. She spent years with Doctors Without Borders, or Medecins Sans Frontieres, as it is known in most of the world.
She now operates through the newly renamed South Sudan Medical Relief project. She started that group along with friend and nurse practitioner Sjoukje de Wit, who now mainly runs a sheep farm in Holland.
A separate Alaska Sudan Medical Project, started by Dr. Jack Hickel, a medical missionary and son of the late Gov. Wally Hickel, built a clinic for her and does other work in the region to support good health.
"He thought we needed a place to put patients," Seaman said. "Now we have a floor we can actually wash."
That group now wants to drill six more wells in the area. It is holding this year's Wine to Water benefit for South Sudan on Sept. 29 at the Hotel Captain Cook in Anchorage.
Patients in the Yukon-Kuskokwim Delta often take small planes or travel by river to get to the hospital in Bethel.
In South Sudan, some go by boat to reach her hub village, also on a meandering river. Most walk, some for days or weeks. If they are too ill, family members carry them. They carry their own food too.
If the clinic beds are full, and they usually are, people camp all around.
"If you need hospital housing, just buy a sickle and people will cut grass and get you hospital housing," she once testified to Congress.
She used to work in another African village, a couple days on foot from where she is now. To get water from a small well in the dry season, women walked 40 minutes each way, twice a day. They scrounged for containers. There are no stores.
In the Yukon-Kuskokwim Delta, Yup'ik people suffer from what has been classified as historical trauma, from epidemics of disease brought by early traders and missionaries, the suppression of culture, the loss of children to boarding schools. Alcoholism, suicide and violence are deep-rooted problems.
In Sudan, she works among the Nuer people, who have a semi-nomadic cattle culture. Cows, raised for milk and occasional slaughter, are deeply valued and given to the girl's family when she marries, bonding families in intricate ways. The culture there has not been uprooted as it has here. But people have suffered loss, from disease, from war, from boys taken to become child soldiers.
Some people in her area of South Sudan drink a black sorghum wine that goes way back. Someone who needs help building a house might make a batch to reward helpers for throwing on layers of mud. It doesn't seem to cause big problems, Seaman said. Men who want to really drink go to a place out of town.
Seaman has such a big vision that she can barely talk about herself. She is what supporters call "humble to a fault." Even having her picture taken is excruciating for Seaman.
She grew up in Moscow in northern Idaho, a woods-loving daughter of a forester. Moscow is also a college town.
In 1980, she arrived in Bethel, drawn to it after a doctor in Ketchikan described it as a demanding work environment with an intact Alaska Native culture.
"Wow, it sounds like the most perfect place in the world," she thought.
She became the first emergency doctor in what was then a brand-new hospital, the YKHC facility that now is dated and strained as health leaders prepare for a major expansion and remodel. She served as a commissioned officer in the U.S. Public Health Service, intending to stay in the Yukon-Kuskokwim Delta for one year but ending up stretching it to six years, with a chance diversion to Ethiopia during the mid-1980s famine.
To better serve that part of the world, she left Bethel for advanced studies at the London School of Hygiene and Tropical Medicine.
Then she landed in what was then southern Sudan, a clandestine mission with Doctors Without Borders in a place isolated by a simmering civil war.
It was 1989. She was in what was then Upper Nile state and in a horrific way encountered the disease that soon dominated her world: kala azar, or visceral leishmaniasis, caused by a parasite transmitted by a tiny sand fly.
It has infected millions of people, mostly in Africa and India, and is especially virulent in the Sudans. It causes skin sores and over months can attack the immune system. Of all parasitic infections, only malaria kills more.
"I walked through villages and there would be nothing left," Seaman said. She could see sticks where cows were once tied, and ashes from fires. "They were just ghost villages."
Yet with treatment, people lived.
For years now, she's divided herself between the Y-K Delta and a part of South Sudan in the Nile Basin.
The University of Washington medical school, where she went, recognized her as a remarkable alumna in 1998 with its Humanitarian Award. Time magazine featured her as a hero of medicine; National Geographic called her a risk taker.
In 2009, she was named a MacArthur Fellow, what's often called a genius award recognizing "creativity, originality, and potential to make important contributions in the future." It came with $500,000 in no-strings-attached support from the MacArthur Foundation.
Treatment for deadly disease
Seaman advocates for research and funding to fight the world's neglected diseases, the ones that occur in places where people aren't rich enough to induce government or drug companies to act.
Like kala azar in South Sudan. One drug used against it is a heavy metal that causes vomiting and for the first week makes patients feel much, much worse.
"And we sort of think that in the 21st century, maybe we could do a little bit better. And some of the reason is because maybe 10 percent of the people die during treatment," Seaman testified in 2003 to Congress' human rights and black caucuses.
Things have improved a bit. Seaman helped to develop a treatment regimen that uses daily injections of two drugs, including an antibiotic, over 17 days, which is far better than the old 30 days of treatment with the heavy metal alone. The real answer, she says, is a better drug altogether.
Before South Sudan won independence in 2011, her village was burned and bombed, and yet she continued. Now dangers are emerging anew with civil war and mass killings with ethnic undertones.
Old Fangak and the villages around it are too poor and isolated to be of interest, Seaman said. They don't have roads or oil or anything of value to the fighters.
Early this month, she left Bethel and was headed again to Old Fangak, to serve a place and a people who otherwise would go without.