Name: David Ray Baines, MD
Clinic: ILIULIUK Family & Health Services (a designated frontier extended stay clinic)
Years a Rural FP: Twenty-six
HPSA-designated Community? Yes
To see Dr. Baines, his staff and clinic on the Discovery Channel, go to:
http://dsc.discovery.com/videos/deadliest-catch-real-dutch-health-clinic-part-1.html
and
http://dsc.discovery.com/videos/deadliest-catch-real-dutch-health-clinic-part-2.html
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Profile of a Rural FP: David Ray Baines, MD
I grew up in a remote American Indian (Tsimshian Tribe) village in SE Alaska. There were only 700 people in our village which could be only accessed by air or water. When I graduated from high school I wanted to join the Marines. It was a family tradition to go into the Marines or Navy. In 1973 they were not hiring as they were demobilizing from Viet Nam. I got a job in the tribal saw mill and was in a serious accident. The main compressor that ran the mill blew up and I was blasted 63 feet and landed on a dock. If I missed the dock I would have certainly perished. It took 3 hours to get me to the hospital in Ketchikan and the next day I was flown to Seattle. After my first surgeries I went to stay with my mom in Arizona. I quickly got bored so started going to the community college she was going to part time. I had no idea what to major in as we were not encouraged to go to college or seek professional careers. I only took a few classes at first as I was in a wheel chair but then there were lots of us in wheel chairs then. I eventually took a career test and it said I should be a truck driver, but then 7 of the next 9 were all in medicine. I took this as a sign and then transferred to Arizona State University as a pre-med. I planned on going back to my reservation.
After the first semester I got a full ride academic scholarship and eventually got into medical school at the Mayo Clinic. I did a rotation on my reservation during medical school and it quickly became clear I would have a difficult time being accepted as a professional, although they were very proud of me. I was very disappointed but eventually got to work with many other Alaska Native/American Indian patients.
Community
Unalaska is a village of 4,000 but swells to 10,000 when fishing season is on. Originally an Aleut village it was taken over by the military during WW II and bombed twice by the Japanese. Now its claim to fame is the Discovery Channel's series, "Deadliest Catch." The Aleut name for the land is Alashka, hence Alaska and Ounalashka mean land away from the land as we are on the first big island off the mainland of Alaska and at the beginning of the Aleutian Island chain which stretches across the International Date Line. It is 800 miles southwest of Anchorage and 1,140 miles west of Seattle. We are closer to Russia and Japan than to Seattle, and we are west of Hawaii. We are the largest sea food processing port in North America.
Unalaska is a village of 4,000 but swells to 10,000 when fishing season is on. Originally an Aleut village it was taken over by the military during WW II and bombed twice by the Japanese. Now its claim to fame is the Discovery Channel's series, "Deadliest Catch." The Aleut name for the land is Alashka, hence Alaska and Ounalashka mean land away from the land as we are on the first big island off the mainland of Alaska and at the beginning of the Aleutian Island chain which stretches across the International Date Line. It is 800 miles southwest of Anchorage and 1,140 miles west of Seattle. We are closer to Russia and Japan than to Seattle, and we are west of Hawaii. We are the largest sea food processing port in North America.
Clinic/Practice
ILIULIUK Family & Health Services is a community health center. It was formed in 1971 by a joint effort between the United Methodist Church and Alaska Children's Services. It became a federally funded community health center in 2002. We provide full spectrum primary care & urgent/emergency care. We are not a hospital, but since we are so far from one and often get weathered in (we can go days with out any planes in or out), we sometimes have to keep critically ill or injured patients for several days. We also have integrated dental, physical therapy and mental health services. We are 800 miles or at least a three-hour flight from the nearest hospital in Anchorage. There are many days, especially during the winter, when we cannot get patients out of here. The US Coast Guard is often a valuable partner to us.
ILIULIUK Family & Health Services is a community health center. It was formed in 1971 by a joint effort between the United Methodist Church and Alaska Children's Services. It became a federally funded community health center in 2002. We provide full spectrum primary care & urgent/emergency care. We are not a hospital, but since we are so far from one and often get weathered in (we can go days with out any planes in or out), we sometimes have to keep critically ill or injured patients for several days. We also have integrated dental, physical therapy and mental health services. We are 800 miles or at least a three-hour flight from the nearest hospital in Anchorage. There are many days, especially during the winter, when we cannot get patients out of here. The US Coast Guard is often a valuable partner to us.
Typical day
There really is no typical day which is what makes it so fun and interesting. Each day is unique. Some days I mostly see appointments and do primary care, and some days I do more urgent and emergency care. We have a very ethnically diverse population. Over half are foreign-born so that is often a challenge. Learning to be culturally competent in many cultures is challenging. On my days with appointments, we do full spectrum primary care including managing diverse diseases in an ethnically diverse population, doing physicals, doing procedures (colposcopy, ultrasounds, lesion removal, vasectomies) and teaching students and residents. Each year, twelve to eighteen students and residents come out to work with us. Showing them how broad of a spectrum of care we can provide is a lot of fun. Urgent care is a lot of colds, aches and pains. Emergency care can be everything from sprains and crush injuries to having a limb ripped off, constipation to acute abdomen, and of course many other problems. I've had to bag a septic intubated patient on pressor agents in a Coast Guard helicopter during Class 4 hurricane force winds to meet a medevac plane an hour from here. I also have had to divert a medevac to Seattle due to an erupting volcano. We do house calls and run clinics on big catcher processor boats, do house calls on home bound patients and teach in the junior high and high school health classes. We get to see some of the guys on the Discovery Channel's "Deadliest Catch" series, and some of us have been on the show.
There really is no typical day which is what makes it so fun and interesting. Each day is unique. Some days I mostly see appointments and do primary care, and some days I do more urgent and emergency care. We have a very ethnically diverse population. Over half are foreign-born so that is often a challenge. Learning to be culturally competent in many cultures is challenging. On my days with appointments, we do full spectrum primary care including managing diverse diseases in an ethnically diverse population, doing physicals, doing procedures (colposcopy, ultrasounds, lesion removal, vasectomies) and teaching students and residents. Each year, twelve to eighteen students and residents come out to work with us. Showing them how broad of a spectrum of care we can provide is a lot of fun. Urgent care is a lot of colds, aches and pains. Emergency care can be everything from sprains and crush injuries to having a limb ripped off, constipation to acute abdomen, and of course many other problems. I've had to bag a septic intubated patient on pressor agents in a Coast Guard helicopter during Class 4 hurricane force winds to meet a medevac plane an hour from here. I also have had to divert a medevac to Seattle due to an erupting volcano. We do house calls and run clinics on big catcher processor boats, do house calls on home bound patients and teach in the junior high and high school health classes. We get to see some of the guys on the Discovery Channel's "Deadliest Catch" series, and some of us have been on the show.
Challenges
Being on call so much is the biggest challenge. It gets harder as I get older. They can only support three to five providers here, so we are on call a lot. Not much we can do to change that. We do get locums occasionally when some of us are on vacation.
Being on call so much is the biggest challenge. It gets harder as I get older. They can only support three to five providers here, so we are on call a lot. Not much we can do to change that. We do get locums occasionally when some of us are on vacation.
Rewards
Being a part of a community that has a real sense of "community", seeing so many patients that we have helped a lot every time I go out of my house, and knowing I made a difference in so many people's lives is very rewarding.
Being a part of a community that has a real sense of "community", seeing so many patients that we have helped a lot every time I go out of my house, and knowing I made a difference in so many people's lives is very rewarding.
Advice
For me, practicing rural medicine is not just an art or science. It is a sport. Not that it is not serious! But it is so much fun and we get paid to do it. I think all medical students and family medicine residents need to do a rural/frontier rotation to see what it is like to practice where you really have to use your clinical skills rather than depend on technology. Being a part of a community and having a sense of community is a wonderful experience and it is like becoming a part of my patients' families. One of the great things about living in a rural/frontier place is you learn to become a part of your environment. We live off the land and sea and harvest berries, fish, crab, moose, caribou, etc. Young people with a sense of adventure, a strong desire to serve their community, and who want to live an exciting life are good candidates for rural practices. Students with rural backgrounds do better adapting to the slower pace of life we have.
For me, practicing rural medicine is not just an art or science. It is a sport. Not that it is not serious! But it is so much fun and we get paid to do it. I think all medical students and family medicine residents need to do a rural/frontier rotation to see what it is like to practice where you really have to use your clinical skills rather than depend on technology. Being a part of a community and having a sense of community is a wonderful experience and it is like becoming a part of my patients' families. One of the great things about living in a rural/frontier place is you learn to become a part of your environment. We live off the land and sea and harvest berries, fish, crab, moose, caribou, etc. Young people with a sense of adventure, a strong desire to serve their community, and who want to live an exciting life are good candidates for rural practices. Students with rural backgrounds do better adapting to the slower pace of life we have.
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