Adventurous PA Embraces "Bush Medicine" in Alaska

Nicholas Genes, MD, PhD


Medscape Med Students. 2006;8(2) 

An experienced physician assistant recently moved to the land of the Yupik Eskimo, in southwestern Alaska. Under the pen name "The Tundra PA," she writes about her experiences living and practicing medicine in this unique environment on her blog, "Tundra Medicine Dreams."

Dr. Genes: How did you come to choose life in the bush? It's such a drastic shift from anything you'd done before. And your relationship with the Yupik sounds understandably complicated — on the one hand, you're impressed with their hospitality and their stoicism; on the other hand, you seem occasionally frustrated with their habits (such as the permissive mother whose child bit you. What has surprised you the most about this culture? What (if anything) have you needed to do, mentally or emotionally (or physically), to adapt and get along?

Tundra PA: The culture here, the "flavor of life," if you will, is so very different from the lower 48. In many ways it is very like living in a Third World country, right here in the US of A. Non-Natives are definitely the minority; our ways of thinking and speaking, our perceptions of time, our attitudes about what is important and how things should be done are often at odds with Yupik culture. The biggest adjustment for me, and for most Westerners (ie, those raised in Western culture/civilization — lower 48 US states, Europe, etc), has to do with pace. The metronome of life ticks at a rate of about 120 for East Coasters (130 for New Yorkers!), perhaps 80 for Californians, and something like 40 for Yupik Eskimos. When you ask a Yupik a question, you better be prepared to wait 10 to 20 seconds for an answer, maybe longer. They think slowly, consider carefully, and answer slowly. Words are not wasted. The worst mistake Westerners make is to interpret that slowness as lack of intelligence; far from it. The most common Yupik criticism of us is that we talk too much and don't listen enough. There is a reason, they say, that we have 2 ears and only 1 mouth: We should listen twice as much as we talk.

Conveying to the world the beauty of these people and their culture is, I think, the real "reason" that I came here. I thought I came to practice medicine, but that was just the vehicle to get me here. I love the medicine, and the work that I do, but it is only a part of a much bigger picture. That is probably why only a portion of my blog is about medicine. The practice of medicine here is so deeply informed by the culture in which we do it. I could not describe the medicine without a whole lot of background about the culture.

The Tundra PA hosts Grand Rounds

September 19, 2006

Dr. Genes: Looking over your archives, some of your posts read like travel literature - such as your fascinating description of the annual ice break-up. Other posts, like on "huffing" or iq'mik tobacco, have citations and could find their way into a medical journal. Some are an appealing mix of both cultural profile and medical information (like that vivid post on mosquito bites). You once mentioned that you were a writer, and you're clearly bringing some experience to your craft.

Tundra PA: Writing is something I have always enjoyed, but done very sporadically. I always wanted to be a writer professionally, but never seemed able to figure out how to do it. I won a short-story writing contest as a teenager, which fueled that ambition, but writing fiction never seemed to come easily to me. I just did not seem to have a story to tell. My best efforts occurred during times in my life when I was involved in events that had significant emotional intensity — events that gave me something to write about. I discovered that the process of writing about them deepened my understanding, both of the events and of myself. Writing could take me to deeper layers of knowledge and perception that were unavailable to me if I did not do the work of translating the experience into words. And the words had to be written, not spoken. The spoken word only skims the surface for me. When I write, I go to a much deeper place. I often spend long periods of time there, thinking and sorting, to find just the right words. Many of my posts have taken me hours to create.

My second love, after writing, is photography. I seem to have a "natural eye" for it; I won my first photography contest when I was 8 years old, with my ancient Brownie camera. It was a photo of a dog sitting on a driftwood log on a beach. My dad, who is a gifted amateur photographer, explained to me afterwards why — from a structural point of view — it was a good photograph. I just knew that I liked it. In college, if I could have chosen my ideal career, it would have been to be a travel writer and photographer, as I also love traveling, seeing new places, experiencing cultures different from my own. Growing up in the backwaters of the Deep South, I had no clue how to accomplish that. So, it comes as no surprise to me that many of my posts read like travel literature.

Dr. Genes: Is there a book in your future? I imagine many of your blog entries could find their way into a book without much effort at all.

Tundra PA: When I moved to Alaska, I realized that I had finally found the source material that I wanted to write about: The place, the people, the way of life here have given me the story I want to tell. For the last 3 years or so, I have been evolving in my mind the rough outlines of a novel about a young(ish) woman who comes here to work as a PA, moves to a village, becomes a dog musher, and has challenging, fulfilling, sometimes harrowing experiences with the people and the climate. What I have not managed very well is finding the time to actually do the writing. I started the blog as a tool to hone my writing skills and to provide more discipline about writing. It is doing both, I think.

Dr. Genes: You write anonymously, and yet you work in such a unique environment that I wonder whether a Web-savvy clinician in Anchorage or in your hospital could figure out your identity. I know this is a big issue for bloggers with big practices in litigious areas, but is it as much of a concern for you?

Tundra PA: The question of anonymity is an interesting one, and something I fluctuate about. Before I started blogging, I corresponded with several bloggers about their experience of blogging, and how important they felt anonymity was. Ultimately I chose to do the blog anonymously, mostly because I was not sure how my employer would feel about it, or how "high-profile" I might become as a result of it. I discussed it with my clinical director at the beginning, because I did not want her to be somehow blindsided by it. After the first month (May 2006), my employer recognized the recruitment potential of the blog, and requested permission to link to my blog on their recruitment site. They felt it was the most positive and yet accurate portrayal of life here that they had seen. People interested in working here are now strongly encouraged to read the entire blog before deciding whether they really want to sign on. Most everyone at the hospital knows about the blog and that I am the one writing it. A Web-savvy clinician from somewhere else could probably figure out who I am by name if they wanted to. At this point it wouldn't matter.

Dr. Genes: It's hard to imagine a better introduction to practicing medicine in Alaska than Tundra Medicine Dreams. This week, the Tundra PA applies her narrative prowess to hosting Grand Rounds, the collection of the best in online medical writing (the link to Grand Rounds goes "live" on Tuesday, September 19, 2006). Make a trek over to her site, and see if the Tundra haunts your dreams as well.


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