Bush Doctors Trade Off Creature Comforts for Medical School

It’s not a fancy Fifth Avenue practice, but then that’s not what Dr. Daryl Graves had in mind when he signed on for four years in the bush in exchange for medical school.

Unlike Dr. Joel Fleischman of CBS-TV’s hit show “Northern Exposure,” Graves is enjoying his stint in the Last Frontier.

He doesn’t whine about the lack of a good deli, the latest films or Big Apple glitz in this southwestern Alaska village of 290 people.

He looks downright cheerful as he jumps from the twin-engine plane onto a gravel runway where orange traffic cones draw the line between airstrip and tundra. In this outback village, Graves treats Yup’ik Eskimos for fox bites, snowmobile injuries and “fish finger” infections.

Graves is 4,700 miles and a time warp away from medical school at Georgetown University. When the National Public Health Service Corps paid his $100,000 tuition, he agreed to a four-year tour in the Far North.

“It was advertised as an adventure to see a different area of the United States,” Graves said.

Call it truth in advertising.

If you’re a doctor in the Yukon-Kuskokwim Delta region, you become accustomed to temperatures of 70 degrees below zero, dinners of moose meat and caribou and anxious moments in a tundra whiteout.

The tribulations of TV’s Dr. Fleischman as he works to pay back tuition to Columbia University Medical School are quirky but not authentic, said Graves, 35, originally from White Plains, N.Y.

The show doesn’t reflect the medical and social problems of Eskimos trying to hold onto an ancient culture, he said.

New York City native Dr. Gina Buono and her pediatrician husband, Dave Sherman, each signed up with the Indian Health Service for two years to pay back $50,000 in tuition loans.

“It was either a cushy job in Mystic, Conn., or it was Bethel, Alaska--76,000 square miles of flat, treeless tundra,” Buono said. “I could have made $125,000 in Florida, but who wants to live in thousands of miles of flat, treeless hot places?

“They got mosquitoes there, we got mosquitoes here--and there’s a lot of fishing.”

Graves, Buono and Sherman are among 14 doctors working for the Indian Health Service at Bethel Hospital, the medical hub for 19,000 Yup’ik Eskimos in a region larger than New England.

Established in 1955, the IHS has 156 doctors serving Alaska Natives at nine medical centers around the state.

For some, $25,000 worth of medical school loans are paid for each year of employment. Doctors also sign on as National Public Health Service obligees--the federal government pays full medical school tuition in exchange for a number of post-residency years.

In addition, Bethel doctors are paid an average salary of $65,000, including housing differentials.

Physicians fly to village health clinics at least twice a year.

In Lower Kalskag, Graves waved hello to Eskimos chugging through dirt streets on four-wheel, all-terrain vehicles. The doctor is black, a rarity in the bush, especially to Eskimo children who ask to feel his hair.

Graves examined patients at a plywood building outfitted with two examination rooms, a hot plate, refrigerator and small bed in the rear. A citizens band radio is used to let villagers know the doctor is “in.”

Doris Kameroff, 12, held out her left hand. She had caught a finger on a fish tooth while eating salmon heads. Her hand was swollen and her elbow and shoulder joints hurt.

“It was a little poke,” Doris said. “Now, it aches when I move it.”

“Fish finger,” or cellulitis, is a bacterial infection usually contracted from scraping hands on the teeth or the bones of fish. It’s a common ailment in Eskimo villages when salmon run in summer.

“Everything is kind of seasonal,” the doctor said. “In the fall when salmon berries bloom, I treat backaches and knee pains from walking on the tundra. It’s like walking on sponge.”

Pneumonia, diabetes, heart disease, ear infections, meningitis, hepatitis A and B, botulism and occasional fox bites and dog maulings are common problems in the Y-K Delta. At Bethel Hospital, physicians help deliver 500 babies to Yup’ik Eskimo women every year.

Patients who require a doctor’s checkup must make the trip to Bethel, a dusty settlement of 4,700 people where sewer pipes run above ground because the earth stays too frozen to dig. Travel is mostly by airplane and boat May through September. In winter, residents drive on the frozen Kuskokwim River.

When temperatures dip to an average 40 below and automobile tires freeze into a flattened half-circle, doctors ski, walk or take a snowmobile to the hospital.

“I always know I’m in trouble when I wake up to a radio saying, ‘Extreme temperature warning. Any exposed skin will freeze in less than a minute,’ ” said Dr. Giulia Tortora, 29, of Long Island, N.Y. “When it gets up to zero, it’s almost balmy.”

Buono dressed in a rubber suit last winter to cross roads coated with glassy ice. Falling flat, she managed to get across on her belly doing a frog-like slither, only to fall into an iced basin.

After a half-hour of struggle, an Eskimo man pulled up on a snowmobile. He told Buono he and friends had been watching from up the road for about 20 minutes and thought she may need assistance.

“It was very undignified for a grown-up,” she said.

Yup’ik Eskimos are a culture in transition, but they hold fast to a history of subsistence hunting and fishing. After a long day at the clinic, Graves joined three Eskimos to driftnet for salmon in the Kuskokwim.

The doctor helped haul in more than a dozen fish, some 3 feet long, in an expedition that lasted until 5 a.m. The sun set at midnight, turning the river pink. It rose again about 4 a.m.

Between castings, the fishermen roasted a snack over a beach campfire--charred Spam rolled in Wonder Bread never tasted so good.

One fisherman, John Kameroff, shoved off for another round of fishing. He tossed a .357-caliber handgun to a 12-year-old Eskimo boy left onshore with Graves. Black bears could be dangerous.

“Don’t miss,” Kameroff said to the boy. “It only has three shells.”

Graves was unfazed. He turned a chunk of blistering Spam over the flames.

“This is the stuff you come out to Alaska to do,” he said.