Skagway seniors met for a social in mid-November. On the agenda was a discussion with local medical clinic directors. The elders learned about Skagway’s new pharmacy and home health program, and why the town might not need a resident doctor.
Albert Wall is Dahl Memorial Clinic’s executive director. He says one of the questions he gets asked the most is when a doctor of medicine, or MD, will join the staff.
“Why can’t we find an MD?” he said. “The reality is, most of them are specialists now. And we’re not going to be able to attract a specialist to care in Skagway, unless they’re coming here to retire, which could happen. But really, the standard of care in rural practice is the nurse practitioner or the PA.”
A PA is a physician assistant. Nurse practitioners and physician assistants are considered mid-level health care providers, more highly trained than a registered nurse but with less training than a doctor.
Brittany Cahalan is a nurse practitioner and Dahl Memorial’s medical director. She said nurse practitioners and physician assistants have their advantages.
“We can draw blood,” Cahalan said. “We can put in an IV. We can do catheters. Doctors, when they have come to fill in at certain time here, they don’t know how to do an IV. They can’t do blood draws. They can’t do catheters. So, you’re in the middle of the night, you need an IV. They don’t have those skill sets. A lot of times they need other people to be there to do those skills for them.”
Wall says his focus isn’t on attracting a doctor to the clinic, but rather continuity of care. In the past, Skagway has relied heavily on temporary providers, called locums. Locums are less cost efficient and patients can become frustrated by lack of consistent providers.
“Right now we’ve got a batch of providers that will be here for basically six months,” he said. “That’s a long period of time for Skagway. We’re getting to where we’re going to have two teams of providers, basically a winter team and a summer team.”
Wall has also been focusing on an issue important to the senior population.
“Home health is, I think, one of the biggest areas of need in Skagway that I’ve seen since I got here,” he said. “There’s a pretty high percentage of older folks in town. And if you go to a place like Juneau, the percentage is a lot lower and there’s more providers. Here, we don’t have a nursing home, and there’s very little ongoing care for a person who is struggling at home and needs some help.”
Walls said he expects to have a home health program running in January. The clinic will employ a full-time community health worker, commonly referred to as a CHEW. The position is a cross between a certified nurse assistant and a case manager. The CHEW follows a physician’s plan of care. For example, dressing a client or helping with chores. They also assess needs and provide referrals and education.
The clinic is undertaking another new endeavor. Dahl Memorial plans to open a pharmacy Dec. 13. Wall said patients should manage their expectations and be patient.
“Recognize that we have to order a whole bunch of inventory and have it on hand for you when you come in for your prescription,” Wall said. “So it will be a process.”
Wall said residents on a consistent prescription can transfer their script to the clinic pharmacy and expect to have their medication regularly in stock within the next few months. The pharmacy will also stock pet medications, a boon for a town that relies on Juneau and Whitehorse for emergency pet supplies.
The group spent much of the time problem solving ways to communicate activities and important events. John McDermott is a Dyea resident. That’s an area with unreliable cell phone service.
“Our biggest issue out there, besides the need of the home health care, is finding out what services are available,” he said. “So very often, nobody knows a damn thing. It doesn’t get out. If you don’t happen to have an internet connection, some folks don’t, or they’re not on Facebook – you’re just kind of left off, out of the loop.”
Skagway resident Judy Mallory pointed out that health conditions connected to aging can make it harder to participate in community offerings.
“Please add to that that people can’t hear and people have dementia,” she said. “Add those two things to your list of why people don’t know what’s happening next, because that is a big issue.”
Finally, Wall gave a shout out to his medical assistants, or MAs. Dahl Memorial Clinic has 5.5 medical assistants, a fact that made the seniors laugh.
“My providers are wonderful, but the backbone of our clinic are the MAs,” Wall said. “They live here, they work here, they want to be here forever. And they’re all professionals. They’re certified. And all of them do more than what a normal MA in a different setting would do.”
Wall said his medical assistants perform everything from X-rays to blood work, a testament to diverse skills in a rural community.
