Dr. Michael Carroll, Transcript Section 11

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KAREN: Yeah. Yeah. I guess we could talk a little bit about the changes you've seen in rural health care and medical delivery.

DR. CARROLL: Well, I think back in 1970, many of the villages would get mail traffic maybe once every two weeks to -- a one plane three times a week. And the biggest villages might get a plane every day and sometimes several planes a day.

Now, all of these villages are getting airplanes every day. Most of them are getting these flights in two or three times a day. And just the fact that if somebody's sick, they could put them on the mail plane, and every day makes their access to health care without having to charter a medevac easier. So the frequency of travel is so much greater now than it was at that point in time.

Many of the people didn't have the financial resources to travel much, and so you tried to do more in the villages that would get them the screening things that they needed because some of them really hadn't, you know -- you know, going to Tanana would be a big trip for them.

KAREN: Uh-hum.

DR. CARROLL: Coming to Fairbanks would be a huge trip, and some of them have never even been to Anchorage. So, you know, the travel really was a much bigger thing.

I think now, most people in the villages, you know, travel regularly, you know, to bigger villages or to Fairbanks or Anchorage. And so there's just a lot more travel from that standpoint.

I think the -- the parents of the villagers are much more sophisticated as far as their health care needs and dealing with symptoms. And so they're not so likely to delay a particular symptom for a long period of time waiting for the once or twice a year doctor visit that would happen in the village. And so they will come into Fairbanks or to Galena or Fort Yukon and try to get is the health care at an earlier point.

You know, the ability to use the telephone is huge. I mean, instead of trying to struggle and get communications for a few moments, maybe every two weeks, you know, they can pick up the phone 24 hours a day and call.

And I think all of the villages probably have lights on the runway, so unless the weather is just impossible, you know, they can get medevacs and medical care into the village 24 hours a day, 7 days a week, without the same issues that occurred back at that time.

And if you lived in Anaktuvuk Pass and you got sick with appendicitis on Tuesday, and the mail plane came Monday, Wednesday, and Friday, and you couldn't talk on the single-sideband radio for four or five weeks, your appendicitis probably didn't get diagnosed or taken care of for days.

And now, I think we would hope that those people, you know, have it recognized sooner, they can get access to that and get help that much more quickly.

KAREN: So in your time, somebody like that with an appendicitis that couldn't get out, it would rupture and --

DR. CARROLL: Rupture. And we never had anybody die from appendicitis, but you know, a ruptured appendix takes a lot more effort to clear up and patients are usually much sicker and their wounds are much more difficult to deal with than if you have someone that you have caught early before it has a chance to rupture.

And so that's an example of how, you know, better access to care gets better care and care is shorter.

KAREN: Well, it sounds like you're lucky that nobody died from a ruptured appendicitis.

DR. CARROLL: Yeah. Yeah. Yeah. I mean, you know, there were people, as I mentioned, the gun shot wound, that clearly they had four to six hours, and had we had the ability to get to that person with a gunshot wound, you know, I'm sure we could have done interventions that would have allowed us to hopefully have saved that patient, but did not.

KAREN: Were there other situations?

DR. CARROLL: Oh, you know, there were accidents that -- you know, snow machine accidents that people wouldn't make it in. People with broken hips that may take you 12 hours to get in. You know.

And again, you remember there's no pain medicines, nothing you can give that person. So they are kind of laying there suffering.

Heart attacks probably, you know, did not get timely medevaced and would end up dying in the village before help could get there. You know, that happened a few times.

I don't remember any obstetrical disasters that ended in death during the two years that we were there. I think we were lucky, but I'm sure that could and did happen.

And as I say, you need to very much get a chance to talk with Dr. James because he's got one of the great, you know, village emergency surgery stories that I think exists in Alaskan health care lore.

KAREN: Okay. Well, I'll be sure to ask him about it. Yeah.