AMSA's 2015 Annual Convention
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February 26 - March 1, 2015 

Call of the Arctic

PSYCHIATRIC EXPLORATIONS OF KODIAK ISLAND.

The New Physician December 2000
At the beginning of my fourth year of medical school at West Virginia University, I was eager to spend a rotation doing something different—to get away and learn another style of medicine in a part of the world few people get to visit.


I found that opportunity with Dr. Donald Fidler, a professor of psychiatry at West Virginia, who has been conducting research and providing therapy to the villagers on Kodiak Island in Alaska for 11 years through the Kodiak Area Native Association. I accompanied him on one of his summer trips to complete my psychiatry rotation.


Usually, when tourists make it to the island’s “big city” of Kodiak, they think they’ve gone to the end of the earth. The city’s remote population of 10,000 and the looming mountains paint a desolate picture. But there are six little villages on the other side of those mountains that most Kodiak natives have never even seen, and that’s where we were headed.


We took a little puddle-jumper—an original Widgin, the last of which was made in 1944, flown by an Alaskan bush pilot—from Kodiak to Akhiok village. The flight under the clouds, over the mountains and through valleys caused our hearts to race, but we finally touched down on a short, dirt runway and were quickly greeted by smiling faces chasing us on all-terrain vehicles. There are no cars or trucks in the village, except a 25-year-old Jeep to help haul the big stuff around.


Akhiok is a beautiful village of 87 people, tucked far in the southwestern corner of Kodiak Island, right out on the Pacific Ocean. Most of the villagers are Alaskan natives of either Aleut or Alutiiq Indian descent, with a mixture of Russian ancestry left over from the island’s former Soviet occupation. Many have some types of Asian ancestry as well.


Given the vast cultural differences and geographic location, health-care delivery is entirely different in an Alaskan village. For example, pregnant women are flown to Kodiak one month before their due date because there are no facilities or providers in the villages to handle complications. We spent the first half of the rotation in the village itself, individually working with people in the all-purpose health clinic staffed by two wonderful health aides. However, because of psychiatry’s stigma in Alaska, the most therapeutic sessions are masked as fun events. People are far more likely to open up their hearts and let healing begin under more comfortable circumstances, such as a kayak ride, a fishing expedition or a seal hunt.


Quite a few villagers suffer from adjustment disorders, major depression and alcoholism. It’s this high prevalence of alcoholism that brought Fidler to the village in the first place. As a result of 11 years of hard work, the village was able to bring down its 85 percent rate of alcoholism to 15 percent and has formally declared itself a dry village.


Fidler focuses on other psychiatric health issues as well. The small number of people and the added lack of immigration or emigration has led to a considerable amount of incest and teenage pregnancy in the village. To combat this problem, we conducted several discussion groups with children about health, sexuality, self-esteem, mental health, parenting and general well-being.


One of our most powerful sessions was a group hike to the top of the ridge outside the village. This barrier isolates the children from the world, as they cannot wander from the village without a gun-toting adult to protect them from meeting the world’s largest bear, the Kodiak. At the summit, proud of climbing all the way up the ridge, the children made a pact that they would be proud of their heritage, support the village and remain drug and alcohol free.


With only 87 people in the village, there aren’t many general medical problems to worry about, but I did have the satisfaction of making calls on a couple of patients. One cute little 2-year-old girl had a nasty ascending cellulitis on her foot. I wanted to show off my new knowledge from my pediatrics rotation and suggested one of the trendy new bugfighters. One of the health aides just started laughing at me. They hadn’t had any supplies flown in on the mail plane lately, so the only antibiotic they had left on the shelves was amoxicillin. Of course, it worked just fine, and I learned a valuable lesson about medical decision-making.


I had a few nature lessons as well. We saw just about every form of wildlife that I’ve ever watched on the Discovery Channel: 12-foot-tall Kodiak bears, a pod of swimming orcas, seals and sea lions, gracefully soaring bald eagles, sea otters, grazing mountain goats and more salmon than you can imagine. We were even coaxed into eating the sexual organs of sea urchins. The kids took us octopus hunting a couple of times, and once we came back with an eight-foot-long specimen big enough to snack on and use the rest for halibut bait. That led to a fishing trip to bring back fresh halibut for dinner.


During the second half of the rotation, we served as counselors for the third annual Kodiak Island Spirit Camp, attended by 50 children from the island and surrounding areas. What at first seemed like a fun vacation turned into the hardest thing I have ever done in my life. A number of the kids there displayed all the criteria for a spot diagnosis of attention deficit disorder or attention deficit hyperactivity disorder. Though unconfirmed, a great number of the campers had the characteristic faces of fetal alcohol syndrome, which correlates with the island’s long history of alcohol abuse. In fact, several mothers confessed to continuous intoxication during their pregnancies.


But looking back, I find it amazing how resilient the human mind and body can be. I was lucky enough to visit during July, which at times was cool enough for coats, and it is unfathomable how the people of Akhiok can withstand the brutal climate, the isolation and the lifestyle year-round. Several dichotomous circumstances struck me. Because no fruits or vegetables, except some berries, can grow in the harsh climate, the typical diet consists of healthy seafood and junk food flown in from Kodiak. The people are completely isolated from all human contact outside the village, yet many of the cottages have access to the world through the Internet and television.


And although the village is so isolated, the villagers enjoy very little privacy. Volumes could be written on the villagers’ survival methods and coping mechanisms. I would love to study the epidemiology of the village life and how it affects the psychopathology of some of its inhabitants.


My adventure in Akhiok was one of continuous awe, and I know I learned as much practical psychiatry, sociology, anthropology and geopolitics as I ever could have in a traditional rotation at a university hospital. It turned out “something different” was the most beneficial to me.
Brian J. Caveney is in his sixth year of a combined M.D.–J.D. program at West Virginia University.