The airport in Bethel, Alaska, population 6,080, consists of one room with a concrete floor and a single baggage carousel. Rather than suitcases and duffles, though, it spins forth cardboard boxes scribbled with names and large plastic containers held together with duct-tape. I watched as one sturdy woman wrestled a Rubbermaid bin filled with tampons onto her luggage cart.
Alaska may have an overabundance of wildlife, natural beauty, and stick-to-itiveness, but it sorely lacks basic infrastructure. In small towns like Bethel, gasoline costs $6 to $8 a gallon, and there are few roads available to get consumer goods out of urban centers and into the shops that dot the grassy steppe. At the Swanson’s grocery store in town, a can of Folger’s coffee runs $18.55, a gallon of apple cider goes for over $20, and a box of Bisquick for $12. Locals have few options other than to make the occasional journey to Anchorage, where they grab up basics and check their stockpiles as luggage.
Plenty of people from the “lower 48” have moved to Bethel for its rugged charm and unparalleled salmon fishing. But many others, the hyper-educated in particular, find the quirks of remote Alaskan life too daunting. Much of rural Alaska, like much of the rest of the rural U.S., faces a severe shortage of doctors and dentists.
“The situation in Alaska is unique because the population is so sparse, but it’s not that much different than the rest of frontier America,” said Jay Butler, director of community health services for the Alaska Native Tribal Health Consortium in Anchorage. “I grew up in North Carolina, and I see [that] the small towns that used to have hospitals; many of those towns don’t have hospitals anymore.”
There are about 6,000 federally designated areas with a shortage of primary care doctors in the U.S., and 4,000 with a shortage of dentists. Rural areas have about 68 primary care doctors per 100,000 people, compared with 84 in urban centers. Put another way, about a fifth of Americans live in rural areas, but barely a tenth of physicians practice there.
A few stopgap measures have aimed to fix the problem, at least temporarily. The National Health Service Corps offers scholarships to students who train as primary care doctors, as long as they agree to serve for a year in a designated shortage area. The Affordable Care Act also created new grants for programs that train doctors who will work in rural locations. Kansas, which has five counties with no doctors at all, recently opened a medical school geared entirely toward rural medicine.
Still, it will take thousands more dentists and doctors to alleviate the current shortfalls. Alaska alone needs to add 60 new physicians each year.
The day I left Bethel, a suicidal man ran at two police officers with a baseball bat, hoping the officers would shoot him dead. One officer fired at the man’s chest, puncturing a lung. He had to be airlifted to a medical center in Anchorage, an hour’s flight away.
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