HEALTH COACH - A young doctor tends to his patients in rural Alaska: Shots

HEALTH COACH - 
 A young doctor tends to his patients in rural Alaska: Shots  









Dr. Adam McMahan practiced medicine in rural Alaska for three years. This is the kind of intimate, full-spectrum family medicine that the 34-year-old doctor loves.



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 Dr. Adam McMahan practiced medicine in the rural areas of Alaska for three years. This is the kind of intimate, full-spectrum family medicine that the 34-year-old doctor loves. 



Elissa Nadworny / NPR





 In rural areas of Alaska, providing health care means overcoming many obstacles. 
 
 Crazy time that can leave patients stuck, for one. 
 
 Also: complicated geography. Many villages in Alaska do not have roads that connect them with hospitals or specialists, so people depend on local clinics and a cadre of primary care physicians. 
 
 I followed a young family doctor, Dr. Adam McMahan, during his regular weekly visit to the clinic of the village of Klukwan. 
 
 This is a reason for a town located next to the Chilkat River in southeastern Alaska, framed by snowy mountains that stand far off. 
 








The village of Klukwan is populated mainly by the Alaska Natives of the Tlingit tribe and has fewer than 100 residents. It lies along the Chilkat River in southeastern Alaska.



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 The village of Klukwan is populated mainly by the Alaska Indians of the Tlingit tribe and has fewer than 100 residents. It lies along the Chilkat River in southeastern Alaska. 



Elissa Nadworny / NPR





 The staff of the clinic leads to Klukwan twice a week from the largest city of Haines, 22 miles to the south. 




 Our Earth is a project of the special correspondent Melissa Block. She spends the next few months traveling the country, capturing how people 's identity is shaped by their lives. Help her decide where to go and who to spend time by filling out this form. 










 On our way, McMahan points out the clouds of dust that blow on the sand bars along the river: "Probably today we will see some with a lung problem because of Sand that comes out of the river. "
 
 Klukwan is populated mainly by the Native Alaskans of the Tlingit tribe, less than 100 people altogether, with a few hundred people in the surrounding area. 
 
 During the three years he practiced medicine in Klukwan, McMahan came to know his patients well, and it becomes clear as he begins the consultations of the day. 
 
 With the patient Lani Hotch, with the examination of her cholesterol and blood sugar levels, McMahan remembers that she has a new dog. "What type of puppy did you get?" He asked him. (A yellow Lab.) 
 
 With the fisherman Henry Chatoney, he asks: "Hey, did you find a mattress?" 
 
 And knowing that Everett Simons grows large potatoes and was put on a diet low in starch for his diabetes, the jealous doctor: "How often do you sneak a potato ? "
 


 





The Klukwan Clinic is open on Tuesdays and Thursdays and includes two examination rooms, a dental suite and a small laboratory for basic diagnosis. This is part of the Southeast Alaska Regional Health Consortium, or SEARHC.



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 This is the kind of intimate, full-spectrum family medicine that the 34-year-old doctor loves. 




 
 "I know that Everett is an amazing producer of potatoes," he says. "I know that Henry is full of adventures and fished Bristol Bay for longer than I am alive." You know your patients as a human. 
 
 McMahan can trace his inspiration to become a doctor back to A striking series of black and white photographs that he saw in a magazine when he was a teenager. His grandfather was a pediatrician and had a 1948 issue of  Life magazine  on a shelf in his office. The photographic essay by W. Eugene Smith, "Country Doctor," shows a medical specialist who tends to his patients in rural Colorado: make calls at home, make broken ribs, sew wounds. 
 
 "These stills were really captivating," says McMahan. "I was watching those other days and they are no different from what we are doing now in Alaska." 


 





Everett Simons and Lani Hotch are chatting in the waiting room of the health clinic.



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The Klukwan clinic is open on Tuesdays and Thursdays. This is part of the Southeast Alaska Regional Health Consortium, or SEARHC.

The clinic has two examination rooms, a dental suite and a small laboratory for basic diagnosis.

"Many things are doing the best at the moment with limited resources," says McMahan. "I can not send you on the street to see a cardiologist. I can not get a CT [scan] done in 10 minutes."

On the day of our visit, McMahan sees mostly elderly patients, including one, a Tlingit elder named Evelyn Hotch, who is confined to his bed after a stroke.

So, with a stethoscope buckled around his neck, McMahan goes down the road to pay him a phone call.

Once we are inside his house, the first thing that is Evelyn Hotch is to offer us a snack: dried red algae. "You came to an Indian house," she says, "and that is what the Indians like to eat"

This is only after McMahan shared his seaweed and asked Grandchildren whose photos cover just about every inch of her walls as she turns to her medical problems, asking her for the pain and her supplies she needs. "We'll see you next week, okay?" He said as he went out.










McMahan calls home an elderly Tlingit called Evelyn Hotch, who is in bed after a stroke.



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McMahan calls home an elder Tlingit named Evelyn Hotch, who is winged after a stroke.




Elissa Nadworny / NPR








Objective with regular primary care like this is to keep people out of the emergency room. But in a city as small and remote, what happens in case of emergency? There is a volunteer ambulance team going from Haines, about half an hour away.

Haines does not have a hospital, however, seriously ill or injured patients may need to be evicted by a Haines Coast Guard helicopter in Juneau.

"The vibratory effect of this, when your heartbeat is beating fast and you have a really sick patient, hearing the helicopter, hearing the blades, is such a relief "Said McMahan.

Once a patient arrives in Juneau, he may still need to be transported by air ambulance to larger hospitals in Anchorage or Seattle, hundreds of kilometers away .

"The Rubik Cube of resource and transport coordination is probably one of our biggest challenges," says McMahan.

Partly due to this complicated logistics, Alaska has some of the highest health care costs in the country.

For people who do not have health insurance, "it is often a disaster, financially," says McMahan.








McMahan and medical student Jesse Han go to the clinic after a home visit.



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But, he added, since Alaska expanded its Medicaid program in September 2015 under the Affordable Care Act, it is able to treat patients now who had spent years without Access to primary care.

More than 32,000 Alaskans have earned medical coverage through the expansion of Medicaid.

McMahan worried about what might happen to his patients if the ACA is repealed and replaced by Congress: "I think that if the expansion of Medicaid is undermined, the People will go without attention, "he said. "They will not be able to afford it."

Even though the current healthcare debate is taking place thousands of miles away from his clinic, he knocks at home.

"It is unbelievable that politics affects everyday life when it comes to getting some basic, basic care," he says .

For now, however, Dr. McMahan is turning to his immediate concerns: he has more patients to see and more stories to hear. The series " Our Earth " is produced by Elissa Nadworny.

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