Surgeon General witnesses front lines of rural health care in Alaska’s opioid epidemic

The national opioid epidemic gives no exception to rural Alaska. Later this year, the U.S. Surgeon General, Dr. Vivek Murthy, will release a report on substance abuse addiction and health. To prepare, the nation’s top medical officer is meeting with health care providers around the country on ways to prevent or treat opioid addiction. He traveled last week to Napaskiak, a town of 500, located seven miles down the Kuskokwim river from Bethel.

U.S. Surgeon General Dr. Vivek Murthy in the Napaskiak clinic with Community Health Practitioner Augusta Williams and YKHC CEO Dan Winkelman. (Photo by Anna Rose MacArthur, KYUK - Bethel)
U.S. Surgeon General Dr. Vivek Murthy in the Napaskiak clinic with Community Health Practitioner Augusta Williams and YKHC CEO Dan Winkelman. (Photo by Anna Rose MacArthur, KYUK – Bethel)

“Good to meet you,” Murthy said. “Thanks for having us here.”

Murthy stepped out of a small boat and shook hands with Napaskiak Tribal Council Member Chris Larson. Dr. Murthy is here to learn how the opioid epidemic is affecting the small Alaska village, but Larson has other issues on his mind.

“We have a water and sewer haul system, and like 40-percent of the home system is not working. And we’re having problems with sanitation,” Larson said.

Larson’s list continued. He said alcohol-related problems like public drunkenness and domestic violence have increased since Bethel opened a liquor store.

“Another issue that we’re facing today is suicide,” Larson said. “We have like 500 people, and we lose one person every year.”

He attributes the deaths to not enough jobs, cultural ties between elders and young people unraveling, and what Dr. Murthy came to learn about: drugs.

“But it’s been around for a long time, the alcohol and drug abuse,” Larson said. “I think there’s more of it today.”

“Well, let’s continue the discussion as you walk us to the clinic,” Dan Winkleman, YKHC CEO, said.

About a dozen people have followed Dr. Murthy out of the boats—an entourage from his office and from YKHC—the Yukon Kuskokwim Health Corporation. We all head to the village health clinic.

Dr. Murthy shook hands with the clinic staff, and a dental health aide showed him around the small white building.

There’re four exam rooms, a dental room, a behavioral health room, and a locked pharmacy.

The Napaskiak clinic is part of the YKHC system that provides health care to the Delta’s 58 communities. Tiffany Zulkosky is YKHC’s Vice President of Communications.

KYUK: “In this visit to Napaskiak, what is it that YKHC is trying to reveal or display to the Surgeon General’s office?”

Zulkosky: “I think sometimes it’s difficult for policy makers and federal officials to really understand the unique conditions in which we provide medical care. And so what are the front lines of health care delivery in our region and that would be in our village clinic.”

The Surgeon General came to witness these front lines and to talk with YKHC about the heroin treatment program it’s developing.

Opioids often lead to heroin once the opioid prescription runs out or gets too expensive.

“It’s a challenging program to create,” Zulkosky said. “There’s a lot of pieces from the behavioral health side as well as the clinical side.”

On the clinical side, YKHC is offering Narcan, a drug that blocks the effects of opioids and can reverse an overdose. The health corporation is also closely monitoring how many opioids it’s prescribing and for how long. On the behavioral health side, YKHC heavily relies on tele-medicine. That’s when a patient talks to a counselor through a T.V. screen.

Dr. Murthy sees this technology, combined with drugs like Narcan, holding the greatest hope for rural communities like Napakiak for accessing substance treatment.

The U.S. Surgeon General’s office will release a report later this year on treating substance abuse addiction. Surgeon General reports— such as the 1964 report on tobacco— have a history of changing government policy and health care.

Anna Rose MacArthur is a reporter at KYUK in Bethel.

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