美国国家公共电台 NPR In Rural Alaska, A Young Doctor Walks To His Patient's Bedside

 

MARY LOUISE KELLY, HOST:

And we turn now to Alaska, where providing health care means overcoming a lot of hurdles¹ - fickle² weather that can leave patients stranded³, for one, and complicated geography. Many Alaskan villages have no roads connecting them with hospitals or with specialists, so people depend on local clinics and devoted⁴ primary care doctors. As part of her series Our Land, NPR's Melissa Block followed a young doctor on his weekly visit to a tiny village in Southeast Alaska.

MELISSA BLOCK, BYLINE⁵: Adam McMahan calls his regular visit to Klukwan the highlight of his week. Along with checking patients' cholesterol⁶ or blood sugar, he's just as likely to ask...

ADAM MCMAHAN: Hey, what type of puppy did you get?

LANI HOTCH: A yellow lab.

MCMAHAN: Aw.

BLOCK: Or to a fisherman...

MCMAHAN: Hey, did you find a deckhand?

HENRY CHATONEY: No. I'm going to lease out my permit.

BLOCK: This is the kind of intimate, full-spectrum family medicine the 34-year-old doctor loves.

MCMAHAN: And how often are you sneaking⁷ a potato?

EVERETT SIMONS: I eat a half a potato.

MCMAHAN: OK. OK.

BLOCK: Klukwan is a speck⁸ of a town alongside the Chilkat River, with snowy mountains looming⁹ in the distance. A few hundred people live in and around Klukwan. And over the past three years, since he finished his medical residency, Dr. McMahan has come to know them really well.

MCMAHAN: And I know that Everett, he's amazing potato farmer. I know that Henry is full of adventures and has fished Bristol Bay for longer than I've been alive. And yeah, you get to know your patients as human.

BLOCK: The Klukwan clinic is open on Tuesdays and Thursdays. It's part of the Southeast Alaska Regional Health Consortium, or SEARHC. The staff drive up from the bigger town of Haines 22 miles away. The clinic has two exam rooms, a dental suite¹⁰, a small lab for basic diagnostics.

MCMAHAN: A lot of it is doing the best we can in the moment with limited resources. I can't send you down the street to go see a cardiologist. I can't get a CT done in 10 minutes.

BLOCK: On the day we visit, Dr. McMahan is seeing mostly elderly patients, including one, an Alaska native elder from the Tlingit tribe, who's bedridden after a stroke. So with stethoscope looped around his neck, the doctor walks down the road to pay her a house call.

MCMAHAN: Hello.

EVELYN HOTCH: Hello.

BLOCK: And the first thing Evelyn Hotch does is offer us a snack.

E. HOTCH: You came to Indian house, and this is what Indians like to eat.

BLOCK: Some dried red seaweed.

E. HOTCH: Everybody take one.

MCMAHAN: What's the Tlingit word for seaweed, for red seaweed?

E. HOTCH: (Speaking Tlingit).

BLOCK: It's only after Dr. McMahan has shared Evelyn's seaweed and asked about her grandchildren that he turns to the medical stuff.

MCMAHAN: I'm going to press on your belly¹¹, OK?

E. HOTCH: OK.

BLOCK: The goal with regular primary care like this is to keep people out of the E.R. But in such a small, remote town, what happens in an emergency? Well, there's a volunteer ambulance squad¹² that'll drive up from Haines. That's about a half hour away. But Haines doesn't have a hospital, so critically ill or injured patients might need to be medevaced by Coast Guard helicopter from Haines to Juneau.

MCMAHAN: The vibratory effect of that, when your heart rate's beating fast and you've got a really sick patient, hearing the helicopter, hearing the blades is such a relief.

BLOCK: And even then, they might still need to be flown by air ambulance to bigger hospitals in Anchorage or Seattle hundreds of miles away.

MCMAHAN: The Rubik's Cube of resource coordination¹³ and transport is probably one of our biggest challenges.

BLOCK: In part because of these complicated logistics, Alaska has some of the highest health care costs in the country. For people who don't have health insurance, Dr. McMahan says...

MCMAHAN: It's often cause for catastrophe¹⁴ financially.

BLOCK: Have you thought a lot about what would happen if the Affordable¹⁵ Care Act were repealed¹⁶, replaced?

MCMAHAN: I think if the Medicaid expansion is undercut, people will go without care. They're not going to be able to afford it.

BLOCK: That expansion of Medicaid in Alaska means Dr. McMahan is able to see patients now who had gone years without access to primary care. More than 32,000 Alaskans have gained coverage¹⁷ with the Medicaid expansion. So the current political debate in Congress over health care, even though it's taking place thousands of miles away from Dr. McMahan's clinic, it hits home.

MCMAHAN: It's amazing how politics impact my day-to-day life when it comes to just getting somebody basic care.

BLOCK: For now, though, he turns to his immediate¹⁸ concerns. He's got more patients to see.

MCMAHAN: We'll be with you soon. I've got one patient in front of you, and then...

UNIDENTIFIED MAN: All right.

MCMAHAN: ...We'll get you right in, OK?

BLOCK: And more stories to hear in Klukwan, Alaska. Melissa Block, NPR News.

1 hurdles   

n.障碍( hurdle的名词复数 )；跳栏；（供人或马跳跃的）栏架；跨栏赛

参考例句：

• In starting a new company, many hurdles must be crossed. 刚开办一个公司时，必须克服许多障碍。 来自《简明英汉词典》
• There are several hurdles to be got over in this project. 在这项工程中有一些困难要克服。 来自辞典例句

2 fickle   

adj.(爱情或友谊上)易变的，不坚定的

参考例句：

• Fluctuating prices usually base on a fickle public's demand.物价的波动往往是由于群众需求的不稳定而引起的。
• The weather is so fickle in summer.夏日的天气如此多变。

3 stranded   

a.搁浅的，进退两难的

参考例句：

• He was stranded in a strange city without money. 他流落在一个陌生的城市里， 身无分文，一筹莫展。
• I was stranded in the strange town without money or friends. 我困在那陌生的城市，既没有钱，又没有朋友。

4 devoted   

adj.忠诚的，忠实的，热心的，献身于...的

参考例句：

• He devoted his life to the educational cause of the motherland.他为祖国的教育事业贡献了一生。
• We devoted a lengthy and full discussion to this topic.我们对这个题目进行了长时间的充分讨论。

5 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

6 cholesterol   

n.（U）胆固醇

参考例句：

• There is cholesterol in the cell of body.人体细胞里有胆固醇。
• They are determining the serum-protein and cholesterol levels.他们正在测定血清蛋白和胆固醇的浓度。

7 sneaking   

a.秘密的，不公开的

参考例句：

• She had always had a sneaking affection for him. 以前她一直暗暗倾心于他。
• She ducked the interviewers by sneaking out the back door. 她从后门偷偷溜走，躲开采访者。

8 speck   

n.微粒，小污点，小斑点

参考例句：

• I have not a speck of interest in it.我对它没有任何兴趣。
• The sky is clear and bright without a speck of cloud.天空晴朗，一星星云彩也没有。

9 looming   

n.上现蜃景（光通过低层大气发生异常折射形成的一种海市蜃楼）v.隐约出现，阴森地逼近( loom的现在分词 )；隐约出现，阴森地逼近

参考例句：

• The foothills were looming ahead through the haze. 丘陵地带透过薄雾朦胧地出现在眼前。 来自《简明英汉词典》
• Then they looked up. Looming above them was Mount Proteome. 接着他们往上看，在其上隐约看到的是蛋白质组山。 来自英汉非文学 - 生命科学 - 回顾与展望

10 suite   

n.一套(家具)；套房；随从人员

参考例句：

• She has a suite of rooms in the hotel.她在那家旅馆有一套房间。
• That is a nice suite of furniture.那套家具很不错。

11 belly   

n.肚子，腹部；(像肚子一样)鼓起的部分，膛

参考例句：

• The boss has a large belly.老板大腹便便。
• His eyes are bigger than his belly.他眼馋肚饱。

12 squad   

n.班，小队，小团体；vt.把…编成班或小组

参考例句：

• The squad leader ordered the men to mark time.班长命令战士们原地踏步。
• A squad is the smallest unit in an army.班是军队的最小构成单位。

13 coordination   

n.协调，协作

参考例句：

• Gymnastics is a sport that requires a considerable level of coordination.体操是一项需要高协调性的运动。
• The perfect coordination of the dancers and singers added a rhythmic charm to the performance.舞蹈演员和歌手们配合得很好，使演出更具魅力。

14 catastrophe   

n.大灾难，大祸

参考例句：

• I owe it to you that I survived the catastrophe.亏得你我才大难不死。
• This is a catastrophe beyond human control.这是一场人类无法控制的灾难。

15 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

16 repealed   

撤销，废除( repeal的过去式和过去分词 )

参考例句：

• The Labour Party repealed the Act. 工党废除了那项法令。
• The legislature repealed the unpopular Rent Act. 立法机关废除了不得人心的租借法案。

17 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

18 immediate   

adj.立即的；直接的，最接近的；紧靠的

参考例句：

• His immediate neighbours felt it their duty to call.他的近邻认为他们有责任去拜访。
• We declared ourselves for the immediate convocation of the meeting.我们主张立即召开这个会议。