FAIRBANKS, Alaska-The practice of healthcare in Alaska is worlds apart from the way medical services are delivered in what people in the state refer to as "the lower 48."
"If a hospital in Kansas or Texas closes, there are concerns that patients may have to travel 40 miles for medical care," says Laraine Derr, president of the Alaska State Hospital and Nursing Home Association. "In this state, thousands of people live hundreds of miles from the nearest hospital or physician."
A rugged, frontier lifestyle is as much a part of Alaska's mystique as the state's beauty and wealth of natural resources. Its nearly 650,000 residents understand that and willingly accept the trade-offs. When it comes to delivering healthcare in Alaska, the geography, climate and isolation combine to produce serious obstacles for providers.
"Travel times, weather and a shortage of medical professionals are major cost factors," says Michael Powers, administrator of 198-bed Fairbanks Memorial Hospital and its Denali Center, a 90-bed long-term-care facility.
Fairbanks Memorial is the epicenter of an intricate healthcare system that helps provide medical services to 43 native villages spread across the state's interior, an area larger than Montana.
Alaskans refer to it as "frontier health," and Derr's group believes the effort involved deserves recognition, financial support and closer attention from policymakers. Hospital leaders in Alaska and Hawaii are working with their senators and congressmen to create a "frontier health" classification at HCFA.
Such a designation could qualify many Alaska healthcare providers for special assistance, grants and higher fees from Medicare, Medicaid and other government programs. That might help them attract and retain physicians, train caregivers, improve access to healthcare in remote areas and sidestep onerous regulations.
In addition to staffing and access challenges, providers in Alaska contend with difficult medical problems. For example, the state's alcohol and substance abuse rate, as well as its domestic violence, trauma and suicide rates, are among the highest in the nation.
Maintaining a system to deliver care to remote areas requires big bucks and pinpoint planning.
In Alaska, local residents are trained to provide primary care and coordinate emergency services with distant physicians. Even the smallest villages have airstrips to transport patients to places like Fairbanks Memorial, which serves about 100,000 people scattered over 235,000 square miles of mountains, high plateau and tundra.
Fairbanks and its neighboring suburbs have a population of about 85,000. Many of the remaining 15,000 serviced by Fairbanks Memorial are native Alaskans living in the 43 Athabascan villages dotting the interior. Only eight of the villages are accessible by road, and Fairbanks Memorial is the only civilian, full-service acute-care facility within a 350-mile radius.
Between rare encounters with physicians, frontier villagers receive treatment from a network of trained community health aides, nurse practitioners and physician assistants, who provide preventive and emergency care until air transport to Fairbanks is arranged.
The healthcare system for natives in the interior of Alaska is coordinated by the Tanana Chiefs Conference, a not-for-profit tribal consortium devoted to self-governance.
Galena, population 450, is one of the bigger villages in the Yukon River health network and serves as one of the system's five subregional health centers. The Tanana Chiefs Conference operates a 4,000-square-foot clinic in Galena that employs physician assistants, a nurse practitioner, a dentist, two dental assistants and two community health workers.
"Once a month, a physician from Tanana Chiefs visits the Galena clinic," says Josephine Malemute, TCC's rural health services director. "There are no inpatient beds, but Galena has a new city-owned (air) ambulance. About four or five patients per month are (transported) from here to Fairbanks."
In smaller villages like Nulato, 52 miles west by boat along the Yukon River, access to healthcare services is even more difficult. There, three health aides staff a small community clinic.
Malemute, 41, a registered nurse, has a fiery passion for her work. The Galena native oversees the community health programs and manages a hostel near Fairbanks Memorial that is used by visiting native patients and their families.
The marvels of information and medical technology offer opportunities to greatly improve healthcare in Alaska, but the staggering cost of implementation bridles providers' enthusiasm.
"Telemedicine can help bring world-class healthcare to some of the most remote communities in the Northern Hemisphere," Powers says. "But it won't come cheap."