On the one hand, Dr. Gray offered, much of what he experiences day-to-day is no different than what he might encounter in Denver, where AMRDI is headquartered, or any other major Lower-48 population center. Much of his time is spent attending to people with common medical conditions found throughout the U.S., such as pneumonia or skin and soft tissue infections. He also notes that the Alaska Native Medical Center in Anchorage is a state-of-the-art facility that provides a the full spectrum of care to Alaska Natives – from emergency care to the myriad specialties and sub-specialties that constitute modern medicine.
On the other hand, the Alaska medical care landscape is of course unique, and health care professionals encounter a diversity of patient populations, from both extremely rural and urban locales, as well as illnesses, including a long-standing battle in the state with tuberculosis. Limited access to running water or plumbing in some communities contributes to higher rates of skin and gastrointestinal infections and transmission of respiratory infections in Alaska.
Dr. Gray is nevertheless optimistic about the future of medicine in rural Alaska, broadly speaking, based largely on three factors:
First, speaking very generally, Dr. Gray lauded a system that efficiently funnels patients from rural clinics to more robust facilities, as the need is determined, assuring quality healthcare and minimizing costs.
Second, in the smallest communities without medical professionals there is system of community health aid practitioners (CHA/Ps) that are local community members trained in patient assessment, treatment of simple illnesses and appropriate referral when needed. They cover the immediate needs of over 170 Alaska Native villages and constitute a cornerstone of the wider referral system organized by the Alaska Native Tribal Health Consortium. Discrepancies in local funding and support, and thus access to CHA/Ps and other medical professionals, can create differences in care across the state, however.
Finally, telemedicine has created opportunities for patients and doctors in Alaska. Doctors and patients can avoid unnecessary travel, including in unreliable and severe weather. Patients can receive consultation and informed feedback from specialists with minimal loss of time from work and to travel.
Telemedicine services, frequently using Vidyo software is becoming more available throughout Alaska village clinics. In some rural clinics there is also hardware including remote stethoscopes and otoscopes – permitting physicians in Anchorage, for example, to conduct more thorough diagnostics and patient assessments from Anchorage.
Challenges remain, including the coordination of busy patients, CHAP/S, and doctors for consultations, as well as coordinating adequate regular supply of medicines to rural locales. Alaska’s healthcare challenges remain large partly due to its low population density spread over remote communities, and uniquely high rates of certain infections such as tuberculosis. Our conversation with Dr. Gray provides an encouraging perspective, however, but also underscores the need for regular and unrestricted access to robust health services in remote locations, led in Alaska by the unique role of the Alaska Native Tribal Health Consortium in particular.