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Jennifer's Writing
Bob's Writing
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Writing:
| Bob and Jennifer are both nationally published writers.
Another facet of OTG Adventures Inc. activities is providing support
for the writing and publishing efforts of its principal officers. Their
work while traveling includes not only tour research for future OTG
Adventures Inc. guided tours, but writing. Their writing includes
articles for medical magazines, as well as writing of adventure
travelogues, novels, newspaper articles, web pages, press releases, and
brochures. This is part of their work for OTG Adventures Inc.
As any serious writer can attest, for
every published article there is a stack of rejection slips to keep them
humble.
A historical novel
in progress by president of OTG Adventures Inc., Jennifer Morris,
requires research into her "Mayflower" ancestry, and a fall 2004 trip to
England, Ireland, Wales, and Scotland helped to gather background
information. She is writing a historical novel about the early Women pioneers who
helped to build America. Stay tuned here for excerpts of that novel.
OTG Adventures Inc. is seeking a literary agent. Please contact at
otgadventures@hughes.net
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The following story (pre-edited version) appeared in Alaska
Business Monthly Magazine in October 2003
Recipe for remote healthcare
Physician-Assistants in the Aleutians
Robert Finlay PA-C
First, mix up an almost daily batch of wind-whipped precipitation, in
the form of snow, sleet, rain or fog, and frost the volcanic mountains
like lines of Bundt cakes perched precariously at the north edge of the
pacific tectonic plate. Next, warm the plate by sliding it 3" a year
under the North American plate, and heat up the busiest geological
activity on earth. Then carefully and artistically, arrange these
islands in a graceful 1100-mile arc extending from the 400 mile curve of
the Alaska Peninsula into the middle of the richest fishing grounds on
earth. Scoop out a natural frost-free deep harbor protected by a mile
long spit and sprinkle 2500 full-time residents over two islands in this
location. Employ these hard working Alaskans in government, municipal,
marketing, retail, management, wholesale, industrial, transportation,
shipping, supply, hospitality, food service, police, fire service,
education, healthcare, and religion, and include their families too.
Have them providing a year-round community-wide support structure for
the world's largest fishing industry.
Gradually rebuild, re-grade, widen, pave and improve an old WWII US
Army-Airforce gravel landing strip into a 3900' runway that just so
happens to be the shortest runway in the world with regularly scheduled
commercial jet service. Oh, just to add more spice, make that daytime
operations only, between sunrise and "civil twilight" as posted by the
FAA, while folding in winds that are considered hurricane-strength
elsewhere. Winds capable of knocking down stacked four-ton forty-foot
long metal shipping containers.
Here violent winds, earthquakes and volcanoes are the norm. These
islands reach toward the desolate Kamchatka peninsula in Russia. This is
where the Bering Sea is separated from the Pacific. The deep, cold water
of the 8000 meter (24,000 feet) Aleutian-trench at the margin of the
north Pacific brings nutrients upwelling to the relatively shallow (less
than 600' deep) Bering Sea, producing the abundance of fish and crab. To
these waters come the Humpback, the Orca, Sea Lions, Sea Otters, and
uncountable flocks of sea birds too.
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This is the island complex of Unalaska and the Port of Dutch Harbor, two
separate zip codes sharing a patch of earth whose picture could be in
the dictionary next to "remote."
Here nevertheless, as anywhere else, there are needs and expectations
for modern medical care. While native Alaskans have CHAP clinics to see
to routine services, non-natives also have their needs. Patients with
chronic illness need medical management, babies are born and need well
care, workplace and home injuries occur, school children need
immunizations, old or terminally ill people choose to be at home to die
yet need assistance with hospice issues. Medical administrative details
must be provided, workers need pre-employment clearances, children going
to summer camp in California present their forms for camp physicals, DOT
commercial driver exams are required, OSHA respirator clearances are
requested, stress related and mental health issues need to be addressed.
In short, all aspects of family practice care, emergency room issues and
occupational medicine are needed. Occasionally patients are also
referred to Physician Assistants or itinerant doctors by the CHAP
clinics, for additional diagnostic or definitive care issues.
For seasonal variety, fold in 4000 or more fishery processors from a
dozen or more countries; land a dozen warm-season international cruise
ships making port call; divert a mid-ocean supertanker seeking the
nearest medical facility to the city with a crewman suffering intense
abdominal pain, bring in Coast Guard patrol ships regularly for shore
leave, injured crew care and fuel; dock enormous container ships weekly
to load and unload cargo; anchor foreign ship "trampers" crewed from
Korea, Russia, Japan, China with a crew-member having fevers and
pneumonia (and think about SARS at least); stage incoming workers from
offshore processing facilities and factories on smaller islands with no
medical care to await medevacs that then cannot be launched and need
holding care; entertain barge crews and tug deckhands from Seattle; dock
the NOAA research ship Miller Freeman for crew changes and R&R, and the
need for medical care increases in two separate and identifiable yearly
cycles, during which the population is nearly trebled. For medical
practitioners this "United Nations" mixture of patient population can
often pose minor difficulty in obtaining translation services, although
a good supply of bilingual clinic employees cover Spanish, Tagalog, and
Vietnamese. Local fish processors are usually able to supply Korean,
Japanese, and Chinese interpreters, however many medical words do not
seem to translate, and there is of necessity much educated guesswork.
The first so called "A" season encompasses crab season and Pollock
fishing, which coincides with the winter cold and flu season. The "B"
season starting in June encompasses cod and herring, during a warmer
less illness prone time of year. Accidents unfortunately seem to ignore
seasons.
Alaska has fewer miles of paved road than Vermont, yet on Jan. 3, 1959,
the size of our nation increased by nearly 20 percent when it was made
the 49th state. The discovery of oil in 1957 helped to ease the status
of this great land into statehood. Our once thought extravagant purchase
from Russia 90 years earlier by then Secretary of State William H.
Seward in 1867 suddenly seemed like quite a bargain.
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Serve up and enjoy with gusto, a crunchy bread, and a bold red wine,
this is the Aleutians! Almost daily are these starkly beautiful, grassy
lush yet treeless islands being built-up by volcanoes, worn-down by
wind, weather and water; they continue as a work in progress.
The same ocean bounty that brings the whales, sea lions, bears, and
birds also brings fishermen willing to brave the storms, the cold, and
the hard work, in hope of making money. Those who succeed make good
money, they are willing to take the chances that mean risking injury or
worse. Some get ill. Some get injured. Some die.
It is here that Physician Assistants husband and wife Bob Finlay and
Jennifer Morris have chosen to work for the past two winters, arriving
from their home in Colorado. What things about practicing medicine this
far from the mainland are different you may ask? The relative ease of
travel that is taken for granted elsewhere, (read that as "the lower
48",) is a daily reality to be reckoned with. Imagine if you will
working in a clinic that is not only 800 miles from a hospital, but can
only be reached by airplane or boat. To put this into perspective, it is
as if you practiced in Key West Florida, and the closest hospital, as
well as your collaborating physician was in Washington DC.
Factor on top of those given geographical tidbits the most consistently
bad weather in the world, with mid-winter nights 20 hours long; an
airport that does not operate after dark, and you have the setting of
Dutch Harbor and the Port of Unalaska. The aptly named "Bridge to the
Other Side" joins these two islands to each other, replacing the ferry
that used to connect them.
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Dutch Harbor, houses most of the industrial infrastructure of the
region. This includes the airport, air cargo handling, general port
facilities, a snug small boat harbor, ship repair facilities, fleet
supply sources, three of four major fish processing plants, diving and
salvage operators, the majority of the grocery stores, apartment
complexes, storage acreage for nets and crab traps, a museum of the
Aleutians, a visitors' center outlining the history of the war, factory
housing for seasonal employees, a part time veterinary clinic, one of
two post offices within 3 miles of each other, fuel facilities,
government docks, half of the areas restaurants, and two container
facilities.
On the Unalaska side of the bridge lie most of the residential homes,
government buildings, court, police, and healthcare facilities, two
hardware stores, the beachfront ancient Russian Orthodox church called
Holy Ascension Orthodox Cathedral, St. Christopher By the Sea
Roman-Catholic Church, the meeting hall of the local members of the
B'ahai faith, The United Methodist church, The Church of Jesus Christ of
Latter-Day Saints, and the Unalaska Christian Fellowship. Here also you
can find the other half of the restaurants. The city encompasses a
thriving economy, all ultimately based on and underwritten by fishing
and community grantsmanship.
These two islands together provide the finest year round deep-water
natural harbor in the midst of the north-Pacific fishery. All of this is
in a part of the north Pacific fittingly dubbed the cradle of the
storms. These storms however add to the challenge of emergency medevac
flights, both in making the arrangements for them, and the danger to the
flight crews and medical escorts who risk their own lives providing
services to a total stranger who needs to get to a hospital.
TOP
Frequently patients cannot be moved for several days due to weather,
which necessitates long-term critical care of severely injured or ill
persons. The added challenge of coordinating critical care in a non ICU
setting often flexes the skills of medical practitioners, who utilize
remote medical supervision to the maximum, via fax, telephone, and
emailed digital imagery. This becomes part of the routine of practicing
in an extremely remote area. Knowing the limits of the facility and
one's ability to manage care of complex patients is the other piece of
the remote care puzzle that must become routine. In the role of a
physician assistant, or for that matter any good physician, it is
critical to stay well within the boundaries of one's knowledge. Thus,
knowing when to call for help is just as important a decision as knowing
who to call is.
There are essentially 3 different ways to have someone sent out for
medical reasons. First a patient can be sent via commercially scheduled
flights with a priority slip, either with or without an escort depending
on the nature of the injury or illness. Stable patients often need
nothing other than to be seen by a specialist elsewhere for follow-up or
additional diagnostic work. Alaska Airlines and Pen-Air make every
effort to accommodate a request for priority seating, and it is
important for practitioners to never abuse the use of the "bump" slip.
Second, the Anchorage hospitals are each affiliated with exceptional
medevac flight companies, who will send a flight to pick up a patient,
accompanied by their own flight crew and nurses. These transfers are
usually for patients who need management of intravenous fluids and
medications, are unstable, and need transfer by stretcher. Last, and
often most complex, is the use of alternative transportation,
particularly at night or when the weather will not allow a medevac
flight to launch out of Anchorage. There is frequently a Grumman Goose
twin-engine airplane operated by Pen-Air at the Tom Madsen airport. The
Goose is an amphibian antique (yet quite modern appearing) flying boat,
perhaps best remembered as "The plane, boss, the plane" on television's
"Fantasy Island." This rugged and dependable airship has an added
advantage of being able to float in the event of a forced ditching due
to unforeseen problems encountered in the dangerous business of medical
evacuations in hellish weather.
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The United States Coast Guard fortunately patrols fishing grounds during
weather that claims the lives of fishermen every season. These young men
and women work long hours in stormy seas. When they put in for
well-deserved shore leave, their helicopter is based temporarily at the
airport. In a medical emergency, when no other flight options are
available, the Coast Guard may also respond to a request by medical
practitioners to transport a patient using a helicopter already on the
island, or by dispatching a crew from the base at Kodiak. Such flights
are coordinated through Seattle medical control for the U.S.C.G. Many
people owe their lives to the availability of these flying machines,
both commercial and military, and the skilled pilots willing to brave
the elements to provide emergency transport to Cold Bay or King Salmon,
500 miles away. There they are able to rendezvous with a hospital-based
life-flight at one or the other of these IFR capable airports. As with
all medevac flights, the ultimate decision lies with the pilot who is
usually not told the nature of the medical emergency, and bases his
"go/no-go" decision on the safety to crew and self.
Despite the hoops and hurdles presented daily by the nature of medical
practice in remote areas, the work is rewarding. Practitioners are not
exactly storming the gates to get to these sites. Many remote medical
practice opportunities allow interaction with native Alaskans, who
frequently have already been seen by a Community Health Aid /
Practitioner, (CHA/P) who has referred them to the next level of care.
Working alongside the Community Health Aid Program practitioners, (See
Alaska Business Monthly March 2003 Aides Work to Help Native Alaskans
Have Better Health Care ) Licensed Mid-level practitioners, both PA's
and NP's are well received and respected in the bush. It remains
possible to do good medicine, allowing time for holistic patient care,
which is something that gets harder and harder to do in the "bottom-line
orientation" of "lower 48" corporate medicine. For adventuresome
practitioners who are comfortable with their knowledge base, rural and
remote site practice is worth a try.
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