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Last frontier state offers nursing adventure

By Carole Kelly

Close encounters with stalking white wolves or prowling bears took the place of a more routine life for Clinton nurse Dixie Ishee, FNP-C, who responded last year to a call for medical personnel to serve in Alaska. When not at home in Clinton seeing patients at Baptist Medical Clinic, she served in a very expanded role of family nurse practitioner working in clinics in remote northwestern Alaskan villages.

At home in late fall, she worked at the Clinton clinic before boarding a plane December 3 for the day-and-a-half journey to Alaska to work two weeks. She worked a total of four months in Alaska in 2023.

 

Warm clothes are necessary, but space was limited as Dixie Ishee packed for her work in Alaska. Flying into northwestern Alaska is a tough day-and-a-half journey. She had an overnight stay in Anchorage before completing the trip to her station on a small plane carrying supplies. A full day's work awaited her.

Warm clothes are necessary, but space was limited as Dixie Ishee packed for her work in Alaska. Flying into northwestern Alaska is a tough day-and-a-half journey. She had an overnight stay in Anchorage before completing the trip to her station on a small plane carrying supplies. A full day’s work awaited her.

Her husband, Tony Massara, is supportive of her calling and recognizes that she likes the opportunity to take her medical skills to the 49th state.

“I like a challenge, and I’ve always liked Alaska,” says Ishee, recalling that her mother Inez White, who served as Utica librarian, had once expressed a desire to teach in Alaska.

Alaska, which became a state in January 1959, has hundreds of clinics located across its wide expanse. Ishee worked in four villages in the Northwest Arctic Borough area, population around 7,560.

“I worked in Kivilina, in Kiana, the largest village, was in Buckland much of the time, and in Noorvik,” explains Ishee. The nearest city is Nome, near the Bering Strait, which connects the Bering Sea and the Chukchi Sea and separates the United States and Russia.

Clinics are staffed by community health aides, with medical providers coming from many countries. Cell phones are used much of the time when clinic phones are down. Staff talk to each other between clinics, and, for needed assistance and direction, call the emergency room in Kotzebue, the largest community and the seat of the Northwest Arctic Borough.

“The emergency doctors are great,” says Ishee. She emphasized the impressive work and dedication of the workers certified in the Community Health Aide Program (CHAP).

With no X-ray equipment in clinics, patients with broken bones are supplied with crutches and splints and given fluids and medication. Hypothermia cases and snowmobile accidents are common occurrences; accident cases that would go to an emergency room in other areas must be treated in the clinics. The more serious illnesses and injuries are transferred as soon as possible.

“It’s no Jack London Call of the Wild world. It’s more like Dr. Quinn Medicine Woman. Being in Alaska makes me appreciate our advantages here more,” she says. “The routine calls for two flights a day to the villages, weather permitting, with emergency flights for very critical patients.”

Transporting patients from clinics to emergency rooms for treatment involves an hour-and-a-half to two-hour flight in eight- or ten-seater planes. Travel to the villages can be hindered by no roads and ten to fifteen feet of snow. Sixty-five mile-an-hour crosswinds can cause flight delays.

 

Ishee’s work weeks in 2023 saw her meeting the challenge of intense days, often treating one emergency after another. The medical personnel also have to do the lab work. Sometimes house calls are made at night, traveling by snowmobile. With the sun rising at noon and setting at 3:15 p.m., people usually sleep until 11 a.m. or 12 p.m. and go to bed after midnight when they are not working.

 

The village size determines the staff in clinics. There are three to four health aides most days, and then sometimes only the nurse practitioner and an aide will be in a clinic.
“In bad weather, we care for a patient needing further treatment in the clinic, until a flight transfer can be arranged,” says Ishee.

Performing the duty of deputy coroner is another aspect of the work.

Last frontier state offers nursing adventure
Ishee is used to wearing different career hats, as she looks back on her years as an attorney before she had the calling to enter the nursing field. She is certified as a nurse practitioner and as a nurse anesthetist.

“Working in Alaska is a labor of love and definitely an adventure,” Ishee says. There’s plenty of snow and a variety of animals, including caribou, reindeer, foxes, bears, moose, sea lions, otters, whales, bison, seals, elk, walrus, wolverines, and rufous hummingbirds.

Interesting challenges can arise with what should be a simple activity, such as taking a walk. A fur-clad woman rushed to warn Ishee of nearby wolves. The woman’s son killed four of the wolf pack, generously offering Ishee pelts, which she graciously declined.

Moose can be hostile, and Ishee was warned about the aggressiveness when she stopped to photograph a mother moose with two babies. Fortunately, there were no problems; but, checking the photo later, she discovered a bear in the background of the picture. Ishee says it was probably not the same bear that poked his nose into a tent where a woman was frying doughnuts. The woman poked the bear on the nose with a hot-oil spatula, sending it on its way.

Warm weather brings a different type of problem, Ishee reports, when mosquitoes “the size of hummingbirds” can find any exposed skin to inflict misery.

Weight limitations for flights to Alaska had Ishee packing clothes thoughtfully, along with some foods. Food prices are high, with an example of a can of Veg-all mixed vegetables costing $4.85. The work and the food supply can contribute to the loss of several pounds, she admits.

In addition to her medical work, Ishee enjoyed visiting with the health aides and meeting area citizens. Ishee found interacting with the aides and other residents a special part of her service. Most speak English, with older people speaking a mixture of English and Inupiaq.

“My clinic friends share food, such as Alaskan ice cream, a mixture of berries and seal oil, whale meat and fat. I had caribou stew and chili a lot, which was very good.” A serving of smoked salmon Ishee described as “delectable.” Also tasty are smoked smelts, small fish caught in rivers with nets in the fall for a winter food staple.

Dixie Ishee, second from right, is shown with certified health aides from left, Eunice Carter, Karen Ballot and Amy Carter. Ishee served as a family nurse practitioner in Alaska four months last year.

Dixie Ishee, second from right, is shown with certified health aides from left, Eunice Carter, Karen Ballot and Amy Carter. Ishee served as a family nurse practitioner in Alaska four months last year.

Homes and clinics are heated with oil and propane. Chemical toilets are in many homes, since some have no running water.

The clinics have running water, and some have ambulances, while others have only four-wheelers and snowmobiles to travel from village to village along snowy or dirt paths. With no roads for access, planes take care of most transportation needs.

When she left Buckland for the trip home December 17, the chill factor was minus 47 degrees.

“You have to be tough,” she says. “Coming home feels like being at the Ritz—luxury,” she says.

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