K. Jane McClure is a pediatrician and the Chief of Staff of the Yukon-Kuskokwim Health Corporation (YKHC) in Bethel, Alaska. She has combined a busy administrative career with intense, challenging clinical work caring for Native children in western Alaska.
Located 400 miles west of Anchorage, Bethel is ?bush? because it is not on the road system. It is the hub of Yukon-Kuskokwim Delta and serves a population of twenty-five thousand Yup'ik Eskimo and Athebaskan natives. Eighty percent of the population lives in fifty villages scattered over an area the size of Washington State. In Bethel, a medical staff of over 70 physicians, midlevels, dentists, pharmacists and optometrists provide comprehensive inpatient, outpatient, obstetrical and emergency services. In the villages, Community Health Aides are integral in the delivery of care. Four villages serve as sub-regional clinics equipped with lab and teleradiology. The sub-regional clinics have midlevel staffing along with the Health Aides.
Dr. McClure moved to Bethel ten years ago. She had grown up in San Francisco and attended the University of California San Francisco School of Medicine. She did her residency at Children's Hospital Oakland. She then joined her favorite attending and another Children's Hospital graduate in a private practice in Vallejo California.
"My attention was first drawn to Alaska by my family physician husband. He had read about job opportunities in Alaska and joked that working in the bush might be a good way to die in a small airplane. But my interest was sparked." Bethel and the YK Delta seemed the most interesting possibility, as the culture is still largely intact. The region has the lowest percapita income in the country with much of the economy still subsistence lifestyle or living off the land.
The population of the region has just re-achieved the numbers that existed before the measle, influenzae and TB epidemics of the 1950?s. The result is that over half the population is teenage or less. Despite excellent immunization rates, children of the region are highly susceptible to invasive bacterial infections. In addition, the rate of RSV infection is the highest in the world. Chronic lung disease and bronchiectasis are relatively common. MRSA infections are currently epidemic. TB and botulism are ongoing and recurrent problems. Metachromatic leukodystrophy, congenital adrenal hyperplasia, osteogenesis imperfecti, Kuskokwim syndrome, achondroplasia and a variety of other chromosomal abnormalities present significant challenges. Care of these special patients is supported by specialists from the outside, several of whom have been coming for many years. For acute issues requiring services not available in Bethel, there is a close relationship with pediatricians at the Alaska Native Medical Center in Anchorage.
In the eight years since she accepted the position of Chief of Staff, Dr. McClure has been instrumental in significant growth at YKHC. "We have continuously expanded services and resources to meet the expanding needs of our patients." YKHC has transitioned from a limited Indian Health Service model to being a leader in native healthcare. "We have been central in developing and implementing local and statewide evidenced based clinical guidelines specific to the needs of our population." Hospital services expanded when administrative offices were moved and the hospital remodeled. Subregional clinics have moved services closer to the villages. A modern medevac system has been implemented that provides services locally and statewide. The Medical Staff Executive Committee has become fully empowered. A strong medical leadership team has evolved. An excellent resident and medical student rotation program has been established. "We are currently designing and implementing a same day access and continuity care system and we will soon be building a new primary care center!"
Dr. McClure continues to practice pediatrics part time by taking call regularly. "The patient's are wonderful and values of the region are still very much intact. Taking care of patients who live up to 150 miles away and must travel to Bethel by boat, snow mobile, mail plane or medevac keeps medicine in the YK Delta interesting and exciting. The rewards of working with a dedicated group of healthcare providers serving a unique Native population in a teaching environment is stimulating and gratifying."