Akiachak stretches along a bend of the Kuskokwim River about 18 miles northeast of Bethel, and the village’s new health clinic is located in the middle of town. The rattling motors of four-wheelers zipping back and forth punctuated a ribbon-cutting ceremony in early June.
Riders slowed to peer at the crowd assembled in front of the gray clinic building while speakers, including Akiachak Native Community President Fritz George and Yukon-Kuskokwim Health Corporation (YKHC) board member Moses Owens, welcomed guests and community members.
Clinic staff, tribal leaders, and visiting representatives from YKHC and other funding partners lined up along the deck at the new Akiachak Native Community Clinic to slice down on a long spool of red ribbon.
“[We’re] very happy and thankful we're getting a new clinic,” said Evangeline Phillip, a long-time health aide at the clinic. She’s been working there on and off for decades.
“My daughter is 22 years old. I quit a few times, but I came back,” Phillip said.
When asked what brought her back to work at Akiachak’s clinic, Phillip laughed and said, “Boredom.” She said that responding to emergencies and participating in training helps keep her days and nights interesting. She remembers when Akiachak’s old clinic was first built.
“I think they built it in 1995, if I remember correctly, and I was just a teenager. I thought it was pretty. Bigger than the old clinic we had. Because the old building, half was the clinic and the other side was the post office, and we were happy that that new clinic was there. And now this one's much better,” Phillip said.
The clinic employs four health aides.
“I'm happy they're with me,” Phillip said. “They're like my sisters.”
Asisalyn Jackson is one of those other health aides.
“There's a lot more space in there than we had at the old clinic,” Jackson said of the new clinic building. “Especially with the rooms, and the pharmacy, and the space we have. A lot more room. So I’m happy about that. In some cases, like with emergencies, there's multiple people, not just one. So it benefits that a lot. And this village is big, to me, we get calls, like, every day. Stuff gets busy.”
“Stuff gets really busy," added Phillip. "Like when viral stuff is going on, it gets busy every night, night and day.”
Tessi Charles also works as a health aide at the clinic. She said the new building is “much spacier.”
The lack of space in the old building, which was about a third of the size of the new clinic, made it hard to treat patients. “Sometimes we'd have to wait until somebody's done with a patient to see our patient, and then we were short on computers too,” Charles said. “It’ll be easier.”
For one thing, they won’t have to wait for a room.
“We have our own rooms!” Jackson said with delight.
“There’s the dental health aide room, the emergency room. That's the biggest thing,” Charles elaborated.
Jackson agreed. “The emergency room, that’s the biggest room,” she said.
Plus, Charles said that there’s a place for visiting providers to sleep in the new building: the bunk room. "The other clinic didn't have it and they had to, I don't know, bring their own cot,” she said.
“Yeah,” Jackson agreed. “And they had to find different buildings too for them to stay in. So having our own bunk room is a plus. Plus the laundry room, because we get patients sometimes that are bloody and we can just throw that in there.”
YKHC Board Chairman Walter Jim said that Akiachak’s new clinic is a step in a decades-long path of upgrading and replacing clinics in the more than 50 villages the corporation serves.
“Our region is growing, communities are growing,” Jim said. “We're probably one of the few regions here in Alaska that communities are growing, and that need is there for these extended clinics in newer bigger clinics in these communities. We support that.”
The new clinic is a partnership between Akiachak’s tribal government, regional tribal health provider YKHC, the federal Indian Health Service, and the nonprofit Rasmuson Foundation. The sign at the new clinic features artwork from a previous community health clinic.
At a lunch celebration at Akiachak’s school, Commander Shad Schoppert with the Indian Health Service said that the new clinic is the exact sort of project the agency tries to support through its small ambulatory clinic program.
“It's our mission,” Schoppert said. “It's a Native community, and it's a tribal project. And so the Indian Health Service, our mission is this. I mean, this is really at the heart and soul of what the Indian Health Service does is to provide health care to Alaska Native, American Indian populations around the country. So, I mean, this is kind of it. I don't know if you could get a better example.”
Akiachak’s new clinic cost about $2.5 million altogether. By rural Alaska standards, YKHC president Dan Winkelman said that's relatively cheap.
“If you look at other rural areas across Alaska, their clinics are running quite a bit higher per square foot. We're pretty happy with where we've been able to get ours,” Winkelman said. “And that's really through developing prototype models – not doing a brand new architectural and engineering drawing set for each brand new village that we do. So that has really been able to drive down costs.”
The new clinic in Akiachak follows the corporation’s midsize clinic model and is about 2,700 square feet.
“It's about three times the size of the old clinic,” Winkelman explained. “The old clinic – if you’ve ever been to Akiachak – was very run down, very old. It wasn't designed as a clinic.”
Other clinic models run between 1,700 and 3,700 square feet. Winkelman said which size clinic a community has depends on community needs and population. He also said that it takes constant maintenance to make sure people in every village can access the health care they need.
“We have 50 different villages that we're serving, and so if we're not working on four or five clinics a year, that's going to be a problem in a decade, just because the amount of maintenance and upkeep that takes,” Winkelman said. “We're doing that on all of our clinics, all the time. Especially in the summer; that's our busy season. And so we're constantly working on them. And if we're not planning for the future, that will be a problem. And that will bite us in 10 years.”
In each case, Winkelman said, it wouldn’t be possible without community partnerships.
“Literally, there's 100 different people and several large organizations that it takes to build a single clinic in each village,” Winkelman said. “Together, you know, we're able to do great things, and I'm looking forward to doing more in the future.”
In recent weeks, YKHC has broken ground for new clinics in Oscarville, Anvik, and Stony River. It’s also building a new clinic in Mertarvik and remodeling clinics in Lime Village and Kwigillingok. They’re the last clinics on the list to complete a full remodel or replacement of all the clinics the regional corporation covers.
