January 10, 2022, 9:26 a.m. David Mitchell — When Elizabeth Roll, M.D., says her health system implemented creative measures to ensure its population gets immunized against COVID-19, she’s not talking about your typical vaccine clinic.
“We’re meeting people where they’re at, including going to their houses,” said Roll, a family physician with Bethel, Alaska-based Yukon-Kuskokwim Health Corporation, a non-profit tribal organization that cares for roughly 23,000 people spread across 58 rural villages in a region the size of Oregon.
Bethel, the largest city in western Alaska, with more than 6,000 residents, can be reached by plane or boat. The town’s 16-mile network of mostly unpaved roads doesn’t connect to the outside world, and the majority of residents don’t own cars. (Bethel has more taxis per capita than any other city in the United States.) In winter, when the average low temperature is in single digits, the hub of the Yukon-Kuskokwim Delta can also be reached by snowmobile or four-wheeler. Car owners can also reach town by ice roads built on frozen rivers.
Thus, Roll and her colleagues have taken vaccine to their patients by plane, boat, snowmobile and, yes, even car. They have traveled to villages that range in size from 25 people to more than 1,000. Vaccine clinics have been offered in schools, stores, post offices and inside automobiles.
“We send doctors and nurses to a specific location, or maybe multiple locations in the same day,” she said. “You spend two hours at a school and vaccinate anybody you can. If you’re there for a few days, then you’ll pull some lists and call all the unvaccinated people and be like, ‘Hi, it’s Dr. Roll. How are you doing? We’re here, and we really encourage you to come in and get your COVID vaccination.’ Depending on which village it is, we may get a lot of buy-in or not much.”
Roll said less than 40% of residents are vaccinated in some villages, while more than 80% have been vaccinated in other locations. Overall, she said more than half of the region’s residents have been vaccinated for COVID-19 so far.
In one village where residents were particularly reluctant to get vaccinated, Roll went door to door last summer offering COVID-19 vaccines for people and rabies shots for their pets.
“A lot of people have dogs, but we don’t have a vet in any of these villages,” she said. “In a couple of days, we gave 150 rabies shots and 20 COVID vaccines.”
Roll recently visited two villages with an itinerary that involved a plane, a four-wheeler, a snowmobile and a sled. The temperature was -17 with a -40 windchill. This time, Roll brought along something more appealing than rabies shots.
“We always try to bring oranges because a lot of these small villages don’t get a lot of fresh fruit,” she said. “It’s hard to ship things, especially in the winter. They’re lucky if they have some onions and maybe apples in their stores.”
Roll has visited roughly 40 of the region’s communities in the past year, making return trips to many.
“Some people just have lots of reasons why they don’t want to get vaccinated, but what I find is when I go back to the same village multiple times, I get a few more people interested,” Roll said. “Some people who said no in February were saying yes in May.”
It helps that Roll has built relationships with people over time. As a medical student at Southern Illinois in the 1990s, she was a big fan of “Northern Exposure,” a quirky TV show about a doctor who repaid his medical school debt by serving as a general practitioner in a small Alaska town.
“I just thought it was really cool,” said Roll, a member of the AAFP Commission on the Health of the Public and Science. “I applied to do a rotation as a fourth-year medical student with the Indian Health Service somewhere in Alaska.”
Somewhere turned out to be Bethel.
“I had a pretty amazing rotation,” she said. “We did a lot of medevacs, and I worked with several different physicians. One of my mentors was actually an internal medicine doc, Dr. Julius Krevans, who was doing full family medicine, including delivering babies. I lived in his house with his family and walked to the hospital. I didn’t have any money for food, so his wife Mary made fresh bread weekly, and I ate peanut butter and jelly sandwiches every day for lunch.”
Roll, originally from a rural community in Illinois, spent six weeks in Bethel and returned twice during her training at the University of Minnesota’s Family Medicine Residency in Duluth. After her wedding in 1999, Roll and her husband moved to Bethel with a two-year commitment for loan repayment through the Indian Health Service.
“Twenty-two-and-a-half years later, we’re still here,” she said. “It’s the people we care for and my team at YKHC that have really kept me here,” said Roll, a past president of the Alaska AFP and current chapter delegate to the AAFP Congress of Delegates. “Our patients are very welcoming. They have shared with us how to fish, how to smoke salmon. We’ve learned a lot about their culture.”
The majority of Roll’s patients are Yupik and Athabaskans. Both her children attended a Yupik bilingual school and learned to read Yupik before English.
Roll has served nearly two decades on the board of the local domestic violence shelter, and her husband has served multiple terms on the city council.
“It’s very rewarding to give back to our Yukon Kuskokwim community,” she said. “This can be a hard place to live. Our pipes freeze. It is dark in the winter. There’s a lot of sadness here at times with traumatic accidents and suicides. But we all live here and work together to support each other. There’s a lot of value in honoring and learning about the Alaska Native culture that’s here. I like the medicine in Alaska. I love the people of the Yukon Kuskokwim Delta. It can be pretty chilly, though, sliding sideways on the back of a snowmachine sled with -40 windchill carrying vaccines to the village from the runway. But it is totally worth it to give Covid vaccinations and provide these Alaskan communities the protection we need to stay safe and save lives.”