Rural life opens cabinet secretary’s eyes

By Alex DeMarban
Kwethluk, Alaska (AP) 8-08

A member of President Bush’s Cabinet walked away from a tour of a Western Alaska village with a better understanding of the problems that help leave Alaska Natives riddled with health problems.

“This is just unacceptable,” said Mike Leavitt, who heads the Department of Health and Human Services, as he stared at a festering sewage lagoon on the edge of Kwethluk, a Yup’ik village of about 750.

Frothy, olive-colored “Honeybucket Lake,” as residents call it, is where the village dumps its feces because, like dozens of rural Alaska communities, it lacks flush toilets and running water.

Diapers, toilet paper and plastic trash bags sat in the muck and ringed the muddy banks. A wide trail of trash rose up a far bank.

“When it floods, it seeps out,” mixing with floodwaters that reach town and turn dirt roads into a soupy mess, said tribal administrator Herman Evan.

He and other village leaders suggested that may be one reason children often miss school with diarrhea, fevers and other illnesses. Also, the lack of tap water makes it difficult to wash hands most villagers draw their drinking water from the Kwethluk River.

Leavitt, a lean man who peppered people with questions and folded his hands as he listened, flew to Bethel and Kwethluk in a government jet on July 23 during a three-day swing through Alaska.

He said he requested the Southwest Alaska tour to understand the unique challenges facing Bush health care and to see solutions offered by the tribal-run hospital that provides services across the Yukon-Kuskokwim Delta.

Toward the end of the day, he said the trip gave him an eye-opening view of village life that will lead to better-informed decisions as he reviews budgets totaling in the hundreds of millions of dollars.

“I have seen people living in remote, impoverished conditions all over the world, but there’s a uniqueness to what I saw here in Alaska,” he said.

He said he was impressed with the high “degree of ingenuity” and passion employed by health aides, administrators and others who are trying to fix the problems.

Throughout the day, Leavitt, HHS secretary since 2005, got an earful from health care officials and other leaders of the Y-K Delta, one of the nation’s poorest regions.

The day started with a visit to a behavioral health center in Bethel, where psychiatrists, teachers and other experts help troubled boys recover from a history of huffing gas and other inhalants.

Dan Winkelman, general counsel for the Bethel-based Yukon-Kuskokwim Health Corp., which operates the region’s lone hospital and dozens of village clinics, presented grim statistics on an overhead projector.

Native women have the highest per-capita cancer mortality rates in the nation, and Native men aren’t far behind, Winkelman said.

He and others pointed out that Natives suffer the nation’s highest per-capita rates of dental disease and are plagued by diabetes, suicide, respiratory illnesses, obesity and accidental deaths often caused by alcohol.

They offered reasons for the illnesses, such as limited access to hospitals and a lack of flush toilets and easily available drinking water. Other reasons mentioned include dust clouds that fill villages during windy summers and a changing diet with more processed foods and less wild meat. Many Natives also make poor personal choices, using drugs, drinking liquor or eating too much junk food, they said.

Health care improvements have been made in recent years. YKHC has built dozens of clinics and employs health aides in 50 communities who provide basic care. It’s also capitalizing on telemedicine, even providing patients with psychiatrists through videoconferences at the Bethel hospital.

And it recently launched a program to put dental health aides in villages. The aides are a step below dentists and can extract and fill cavities.

But the officials told Leavitt the system needed more money to hire health care professionals, study illnesses and to build facilities such as a regional nursing home in Bethel so dying elders are no longer sent 400 miles to Anchorage.

Around noon, during the skiff ride along the glassy Kuskowkim River linking Bethel to Kwethluk, Leavitt traded in shiny dress shoes for a pair of rubber boots and slipped a float coat over his blue jacket.

In the village, the scent of burning plastic wafted past visitors, perhaps the result of smoke coiling from trash mounds at the dump. Children pedaled bikes and the occasional four-wheeler sped down muddy roads that residents said become impassable when winter snow melts into spring.

A stout woman in a fleece jacket stood on a porch outside the bingo hall, saying village leaders had waited more than an hour for Leavitt and his entourage.

“My butt is sore from sitting,” she said, shaking hands with the secretary.

“There’s not much I can do about that,” he said. “There’s not much you’d like me to do about that.”

Inside the dusty hall, where mosquitoes whirred above plywood floors and colorful bingo posters adorned walls, village leaders described their village’s wide-ranging problems.

George Guy, the village corporation’s business manager, described the poverty that stems from few jobs and said the village deserves the same amenities as the rest of the country, including flush toilets and tap water.

“Maybe you can relay the message to President Bush that we live in a Third World country,” Guy said.

During the Kwethluk visit, which included a tour of the new clinic, Leavitt seemed especially taken by Evan, the tribal administrator who trouped Leavitt and his entourage through the village.

Leavitt asked Evan why he chose to live in Kwethluk.

Evan, a graying man with black hiking boots, said he was educated at a tribal college in Kansas and lived in the Lower 48 for two decades but returned to his village because he wanted to help improve life for his relatives.

The tribal government can’t afford to pay Evan full-time, so he volunteers after noon each day, trying to speed up a project that should bring running water to the village, battling river erosion and looking for money to improve roads.

Leavitt, who doesn’t expect to continue as secretary once Bush leaves office in January, cautioned that he couldn’t simply write a check to fix rural Alaska’s health care problems, though he wished he could.

But on the return skiff ride to Bethel, he said he’ll have a better idea how the department should spend its money in rural Alaska in the next two years.

“For example, I’ll ask how much can be allocated to sanitation, and I’ll think of Herman instead of just looking at numbers and I’ll say to myself, ‘This is unacceptable.”’