WILDERNESS MEDICINE
Arctic Emergency Medicine: Navigating the Intersection of Climate and Health in Rural Alaska By Lorenzo Albala, MD, on behalf of the SAEM Wilderness Medicine Interest Group
SAEM PULSE | MAY-JUNE 2023
“We might be able to charter a plane from Big, he might be willing to land and pick her up.”
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You wouldn’t expect to hear this in the back room of an emergency department (ED). After spending some time in Kotzebue, however, something like this wouldn’t seem out of place at all. Kotzebue is located on Alaska’s western coast, about 33 miles north of the arctic circle. The population of a few thousand Inupiat is served by a small hospital with a 6-bed emergency department. When I first arrived, I couldn’t help but wonder — can you really practice “wilderness” medicine in a place that people call home? The short answer is yes. I believe that working in Kotzebue’s ED highlights
“can you really practice “wilderness” medicine in a place that people call home?” the scope of wilderness medicine. I had to rethink my (recently minted) way of practicing emergency medicine: no in-house specialty support, no MRI, no ICU, a 90-minute flight time to the closest tertiary center. There is no shortage of bread-and-butter cases such as necrotizing marine zoonotic infections, hypothermia, or frostbite. Some days, it feels like a cultural immersion: an elder may describe his symptoms with a peppering of Inupiaq words. These words soon become
wonderfully familiar, you chat about muktuk (whale blubber) and seal oil, and you wonder “am I really still in America?” I move to my next patient, a middleaged woman living at camp, her lifestyle defined by subsistence hunting and fishing. With a grimace, she describes how she now needs to be careful snowmachining into town, because although it’s the middle of January, there are still holes in the river ice. I recently read an article shared by Harvard Kennedy School’s Arctic Initiative,