It Takes a Village
August 25th, 2019 by Mike Teegarden

Kristin Ballot is distracted by her mother’s ID badge during the exam. Karen is also a CHAP at the clinic. Treating friends and family is common.

With the nearest hospital a plane ride away from their remote village just south of the Arctic Circle, the Iñupiaq people of Buckland, Alaska, rely on a unique health care model to meet the needs of their community.


Snow machines and four-wheelers are the main yard art in Buckland, Alaska, mixed with animal skins and antlers. Racks of drying smelt are common in the spring. Throughout a long summer day, children freely roam unpaved streets on foot and on bike.

There are no yards.

The only businesses in Buckland, population 550, are the community store and the self-serve gas station.

Villagers are friendly and curious of strangers, even those toting cameras and notepads. Part of the Iñupiaq tribe, many still adhere to the old ways of a subsistence lifestyle. They hunt seal and caribou, fish and gather wild greens in the spring, living off the land. Relying on each other is a way of life and is critical for survival.

From that same ethos has evolved a health care system where members of the community are trained to provide medical care at Buckland Clinic through the Community Health Aide Program. Those trained are called CHAPs and are on the frontline of health care, handling everything from cuts and colds to life-and-death situations for their friends, neighbors and families. The nearest doctors are at the Maniilaq Health Center in Kotzebue, separated by 90 miles of tundra and ocean, the only way to get there is by plane, when the weather allows.

Buckland isn’t alone. Approximately 550 CHAPs serve 170 communities throughout rural Alaska. The Buckland clinic is part of the Maniilaq Association system based in Kotzebue, which serves 12 federally recognized tribes in the Northwest Arctic Borough and Point Hope, serving about 8,000 people.

The Community Health Aide Program was started in the 1960s by the state of Alaska to help stop the spread of tuberculosis. It has evolved to CHAPs serving as the primary caregivers in many native villages.

“We are the eyes, ears and the voice for the patients we see,” says Charles Kirk, who has been a CHAP in Buckland for 17 years. “We’re all related to each other one way or another. We know everybody.”

Charles says being a CHAP in a small community is challenging. He often responds to emergencies where those involved are close friends or relatives. CHAPs must put aside their emotions to treat their patients. The Buckland Clinic has four CHAPs and two relief trainees.

“Sometimes it’s hard, sometimes it’s scary just ‘cuz we know the patient and we’re close to them,” Charles says.

When a patient comes into the clinic with a problem, a CHAP follows a prescribed set of diagnostic questions on a computer, working remotely with a doctor to lead to a diagnosis.

“We describe what we see, what we hear, what we feel and let the doctor know,” Charles says.

CHAPs use telemedicine tools that let them perform procedures under the guidance of a doctor in Kotzebue. They can render aid to a patient having a heart attack, if required. A doctor in Kotzebue reviews the notes and signs off on all prescriptions. Patients who need further evaluation or testing are flown to Kotzebue, an Arctic hub on the coast.

Charles became a CHAP after his wife started the process but couldn’t finish. Jobs in villages are hard to come by, and this is steady work.

Charles attended four training sessions, each three to four weeks long, in Sitka. They learned how to administer IVs and give injections.

“We had to practice on each other as live patients,” Charles says.

Students also go through emergency trauma technician training or emergency medical technician training.

“We’re skilled in emergency response, so I can give IVs and medication injections. We are taught CPR and basic life support,” he says.

Charles understands the critical role he and his fellow CHAPs play in the health of his community.

“We have no roads out,” he says. “Only way in and out is with an airplane. We are the providers for the village to help our sick people.”

Working alongside CHAPs is the Public Health Nurse Program. Traveling public health nurses such as Indigo Jicha work their way around to each village by plane for a week at a time performing well-baby checks and teaching classes on healthy relationships, risk reduction, prevention of sexually transmitted diseases and other topics. Dentists also visit the villages to provide dental care.

When the children can’t be enticed to come to the clinic, Indigo heads out to the community, walking through neighborhoods offering free toothbrushes.

“A lot of the things we do are outreach,” Indigo says. “We go to villages and provide immunization clinics. We also do a lot of outreach in the schools and some education. We do disease investigations and a little bit of everything. We kind of have a lot of hats that we wear.

“The best part of my job is probably getting to be with families and learning from each other. We get to see a lot of families as they are growing either with more kids or as the children age, and we get to work with all the parents or caregivers that are involved.”

Indigo has great respect for the CHAPs.

“The CHAP program is pretty amazing,” Indigo says. “The work that they do, I don’t know if I could handle it. They are so in tune with the community. They are a part of the community and usually family members with each other. Often, they are going from the best calls where maybe a baby is born in the clinic to the worst calls where someone they know has passed away.

“Just the way it functions is really amazing. It adds a new level to the care when you have someone that is really invested in what is going on in the community. It’s such a unique way of doing health care. I think it’s a cool model—especially when you live in places where it’s so remote and it’s hard to get to main medical centers.”

About the series: This Ruralite-produced initiative spotlights health challenges in rural communities, efforts to address them and the unsung heroes behind the work. The series receives support from the M.J. Murdock Charitable Trust, which funds projects and programs in Alaska and the Northwest. The sponsorship helps fund journalism that makes a difference. Send story ideas to gro.etilarurnull@swenhtlaeh.