This story is part of our ongoing “UW Goes Global” series, in which Department of Emergency Medicine faculty, residents, and fellows share stories and insights from their time engaged in emergency medicine in low resource settings, both within the United States and abroad.
Where in the world is Kotzebue?
Kotzebue is a town of 3,000 on the Northwestern coast of Alaska, just north of the Arctic Circle and 550 miles from Anchorage. It is only accessible by air (or sea in the summer). Kotzebue is a hub for several surrounding villages in an area about the size of Pennsylvania with a total of 6,000 people.
Why Kotzebue?
I grew up in Fairbanks, which is in Interior Alaska, so coming back to Alaska feels like coming home. I’m interested in rural emergency medicine and wanted to experience working with the Alaska Native Health Consortium.
How is emergency medicine different in Kotzebue?
The biggest difference is the geography and access to specialists. Most patients have to fly from the village to see us in Kotzebue, and if they need specialist care they then must take another plane to Anchorage. We must make decisions on whether to call a medevac for patients without seeing them. We rely on Community Health Aides, who are specially trained villagers, to relay what is going on with a patient in the village.
What kind of capabilities do you have in Kotzebue?
There is a 5-bed emergency department and a small inpatient unit staffed by a hospitalist. We have women’s health and behavioral health services. We have labs, X-ray, CT scan, and ultrasound.
What did your typical day look like?
Most of the time I worked 12-hour shifts in the Kotzebue ER, where we evaluate and treat patients as well as field calls from the villages. I also got a chance to travel up to the village of Noatak and work in a primary care clinic for a few days. On my days off, I explored the tundra around town and went ice fishing.
What is your biggest takeaway from this experience?
The biggest takeaway for me was how much thought needed to be dedicated to transportation. We might hear about a patient needing medical care in the village. Without being there to physically evaluate them, we must decide whether they can stay there, take a commercial flight, or whether we need to call a medevac. This also affects our disposition decision; a patient may be appropriate to discharge from the ED, but should they travel back to their village, or should they stay locally overnight in case their condition worsens?
Would you recommend engaging in global health opportunities during residency to residency program applicants? If yes, why?
I would strongly recommend a global health experience during residency. Experiencing emergency medicine in a different environment allowed me to broaden my skillset, think critically about which resources are needed, and required me to improvise. Plus, it gave me an opportunity to care for patients from a very different background than I was accustomed to.
Will your fellowship work in retrieval and critical care transport connect to your interest in rural emergency medicine?
Transportation logistics of critically ill or injured patients is an essential part of rural emergency medicine, and we worked closely with the air medical services in Alaska. Being able to provide advanced medical care to rural areas with UW Med Flight was one of the factors that made the retrieval and critical care transport fellowship appealing to me. Similar to rural Alaska, evaluation and treatment of patients will need to be done in unusual environments and will require a different set of skills than are typically applied in the emergency department.
Mikko Sayre, MD, completed his bachelor of science degree in biochemistry at Western Washington University and his medical doctorate training at Columbia University Vagelos College of Physicians and Surgeons.
This article reflects information available at the time of publication and may not represent current knowledge, practices, or departmental personnel.