Village Life

Angoon. This village of 450 (80 % Tlingit) people is located on Admiralty Island, aka "fortress of brown bears". It's roughly 40 miles from Sitka and a 30 minute flight by float plane (because the village has no landing strip). The island is 1600 square miles. There are an estimated 1600 brown bears. This is not a joke. It has the highest density of brown bears in the US. In case you are wondering, I am the family doctor for the village and yes, I carry bear spray. Most of the time I am consulted by the nurse-practitioner who lives there year-round. But 4 times a year I spend a week there seeing the most medically complex patients I have ever seen anywhere.

Smoothest landing ever

Angoon has had it rough and brown bears seem to be the least of its problems. In 1882 it was bombed and destroyed by the US Navy. Today there are very few jobs so most people here live off the land--eating what they catch, hunt, or harvest. But they can't just eat fish, deer, and berries, so a lot of what they eat is highly processed, long shelf-life, nutrient poor, calorie rich food. I haven't been there myself but I hear the grocery store is quite expensive and as you'd expect the produce isn't very fresh.

Angoon AK from the plane

If I'm honest I'm having a hard time wrapping my head around something. Much of Southeast Alaska is as beautiful and pristine as it is resource-rich. So I cannot comprehend why there is so much pathology in Angoon. It's not hard to understand the high rates of type 2 diabetes, obesity, tobacco, and alcohol. Much of the US is like that. But the autoimmune diseases just baffle me. High rates of rheumatoid arthritis (even in young people), lupus, and a very rare one: primary biliary cirrhosis. If you're reading this and are a board-certified rheumatologist or gastroenterologist I want to be your friend.

Welcome Dr. Vega! You ready for this?

Those of you in primary care--family medicine, pediatrics, geriatrics, internal medicine--know the importance of continuity in caring for chronically ill patients. Angoon has not had much of that recently. It's no one's fault, it just has not happened. So as always happens in situations like this, the patients get the short end of the stick. It's just messed up. I'm going to summarize my week in Angoon by saying I enjoyed every patient interaction without exception and I was heart broken and inspired by the stories I encountered. After seeing and caring for all these precious people one of my elderly Tlingit patients said "don't give up on us". I literally had to leave the room so I could get it together.