Concerns for living in the Arctic Circle - Advice Needed!
January 3, 2013 5:28 PM   Subscribe

I need advice about the possibility living in Northern Alaska, Kotzebue/Nome/north of the 65th parallel. I have about a million logistical questions, a little disorganized, including questions about mental health problems, medications, getting specialist care. If you needed medical care on a regular basis several hundred miles away, how did you arrange that? Lots of other questions about living in the arctic! Help!

I'm looking at a job interview! Hooray! I am so unemployed! Whee! A whole lot of questions follow... obviously these are all contingent on actually getting offered a job.

While I'm from the Pacific Northwest, I've never been up to Alaska. Particularly never Kotzebue/Nome. I hear people describing the arctic circle as "beautiful", but the towns as also "grimly dreary". The job offers great pay (though I know cost of living is very high), great benefits, loan repayment, and a whole lot of vacation time, continuing education benefits, etc.

The job would be in a small tribal health association, doing women's health (obstetrics/gynecology, presumably pretty low volume). If anyone has been a health care provider in northern Alaska, I would absolutely love to hear your experiences.

My main concern; I have bipolar disorder, diagnosed several years ago after a manic/mixed episode. I've been on medication since then, and am currently on a couple of daily meds. I can't miss days; missing one day, I feel funny, missing two days I feel godawful. I need my medication supply to be regular like clockwork, and a lot of things discuss occasional breaks in shipping/flying due to weather.
I can't stop my meds for a month or have a break in-between while figuring things out. Ditto for my birth control (it's for things other than just contraception). Any way to arrange anything in advance? Would I need to get stuff shipped through Medco?

I've been stable for a long time, with some minor depressive episodes; but I stayed in school, did well, got my bachelor's with honors, got my Master's degree in an incredibly stressful field, didn't have to take any breaks.

I talked to my psychiatrist - asked if this position would be a bad idea. he said "not necessarily", presuming I got a therapy light, exercised every day, didn't drink, and monitored any symptoms doggedly. This is all very do-able, and things I work on anyway. And I know and accept that any place I move to would be, frankly, lonely for potentially a long while before making friends, and that adjustment is going to be something to work on actively.

My major concern is, how to get setup with a psychiatrist or other doctor/NP who will prescribe my psych pills? in advance? it seems like the state of Alaska is much more amenable to telemedicine also (given the extremely low population density). How did you get your medications while living up in the far north? How hard/easy is it to have a doctor in, say, Anchorage? I'm concerned that I might be working for the only game in town, if I were to get this job. If you needed to see a doctor that wasn't available in a very small area, and the nearest one was an hour by plane, how did you figure that out/arrange it?

Another set of probably dumb questions; I'd like to get a dog, but - owning a dog while living in the arctic, in an apartment? This is another dumb question, but, am I going to be able to take the dog for a walk, assuming I can suck it up and also take myself for a walk?

Pros: I think I'm up for another adventure in my life here; the position itself offers great pay/benefits as mentioned. Being able to be financially secure and debt-free before age 35 (I currently have 6-figure student loans). Living in a beautiful place. I'm interested in learning to hunt/fish. Have enough disposable income to order books I want to read, or art supplies I want to have? Subsidized housing. They say a lot of people don't own cars, I find that a real bonus.

Cons: Arctic winters. Small, extremely isolated town on the other end of the world. Higher probability of being terminally single for another few years. I'm from a rural area (my first conversation with the HR director somehow wound up on the topic of rifle ranges), but have grown accustomed to my current urban lifestyle - going to a coffeeshop, eating out wherever (there are a few restaurants in this town), going to an art museum now and again, roommates, etc. Unlikely to be able to garden. Living in an apartment.

I know that going anywhere (I'm looking for jobs all over the country), to adjust, I need to really invest and throw myself all-in to the community/area I move to (no half-assing if I'm living somewhere for 3 or 4 years), so I've been reading a lot about all the different places I'm applying to, in order to get psyched about each of the places, but I just want to investigate if the logistics of my own health care would work out.

What other things am I not thinking of here? Help!
posted by circle_b to Grab Bag (12 answers total) 12 users marked this as a favorite
From what I've been told by a friend who lived several years in Alaska (and, actually, loved it), it has quite a strong drinking culture, stronger than what you'll see in many (most?) parts of the continental U.S. He has a lot of stories involving drunk drunkenness and other associated shenanigans.

This may or may not be an issue for you, as a person who cannot drink.
posted by vivid postcard at 5:56 PM on January 3, 2013

Do you think there is a reasonable chance that you can find the interesting things about this new assignment in a more civilized part of the planet?

Hell, I am in Vermont, and find it stiflingly empty and I'm only a three hour drive from Boston or Montreal.

Rural is hard. Inside all the time is hard. Dark is realllly hard. Cold is hard. Single is lonely and your standards drop in direct proportion to the mating opportunities presented.

Nothing wrong with hard, of course. We aren't promised easy in life. But you are willingly selecting inauspicious circumstances during a promising period in your life. If this is only about money, you are buying a lot of grief to go with your financial progress. It may be that you are compensated with adventure, beauty, introspection, etc. that you can't easily get in the occupied parts of the planet, but those things can be gotten everywhere if you look in one form or another.

People live in community. When community is sparse, living is difficult. Good for you that you have the spirit to help folks in remote places, but in your interest, please consider that we have folks down here who need help, too, and where your 'ministry' would not involve self-sacrifice to the same degree.
posted by FauxScot at 5:58 PM on January 3, 2013 [2 favorites]

How dependent are you on friends, social contact, and a support system in keeping your depression at bay? You sound like you are facing a choice to live in an extremely isolating social environment with both limited opportunities for social contact and a limited number of people who will be socially active, seeking friendships, welcome newcomers, etc.
posted by foxy_hedgehog at 6:30 PM on January 3, 2013

Ok so I'm currently at the 48th Parallel, not the 65th, and I'm hoping someone more qualified comes along soon. But I can speak to some of your issues since I live in the "second coldest city in the US" (in fact, it is nine degrees warmer in Nome than my city right now).

First, you are talking about a 3 hour 53 minute day at its worst (winter solstice). That is pretty fucking awful, to be honest. Not sure where you are now in the Pac NW, but assuming you're at or near where I am, that's going from 8.5 hrs to just shy of 4 hours: 50% less daylight over the course of the winter months. It goes back up of course (and the summer solstice in Alaska, I can tell you from experience, is amazing) but still. Consider that you would nearly always be going to work in darkness and leaving in darkness for months at a time.

Second, food prices in Alaska are insanely, incredibly bad. The city where I live now has food costs consistently 100 to 400% higher than the food mecca where I'm from (thus a grocery bill that ranges from $40 to $75 and still there are some things I simply can't get without special ordering), and frankly I think inner Alaska will be much much worse. As a tourist, I remember being appalled. Yes, produce grows well in the short Alaska summer (do they have a community garden where you'd be going?) but that really doesn't mitigate the costs very much.

Third, native Alaska communities deal with an astronomically high rate of sexual assault and rape. You may not be able to assume that you'll see a low volume of patients and you may find the situations you deal with tragic and difficult to deal with.

Fourth, again I really hope someone more qualified comes along soon but I can speak to the health issues just a tiny bit. I live in a town with a med school and a major hospital but frankly it's amazing how often people have to go down to Fargo or even to the Mayo to get treatment (in your case, sub in nearest 'big' population area and/or Anchorage). Some treatments simply aren't possible where I am, and again I imagine rural Alaska is worse. It's a major concern.

As for a dog, I can't speak to the apartment part but yeah you can definitely walk a dog even in the worst of the winter weather. They make little booties for dogs' feet when it gets really cold (below -10F or so) and the walk may be short, but my co-workers walk their dogs every single day, -40F or +40F, blizzard or sunshine. Huskies, among other breeds, are well adapted to the Alaska weather, though how one would cope with an apartment I couldn't begin to tell you. Actually, having a dog is widely considered a good thing here because it does force you to get outside and that is a positive way to cope with the weather.

Finally, can you realistically cope without: high speed internet (potentially--but apparently Nome has Comcast), retail stores (no Starbucks, no Target, no McDonalds, no Cabelas), friends who share your values (there will be some but likely not as many), sunshine (from Oct-April at least), and all of the other amenities of urban life? That was probably the biggest shock about moving to a rural area (and to be clear, I have both sunshine and Sbux/Target/McDonalds/Cabelas). It's a lot different as a kid, where you've got a built in set of friends and snow days are fun not fraught, than as an adult. I will tell you that being single in rural America is really, really hard: most people are already married or otherwise ineligible.

Add to your pros 'good odds of seeing the Northern Lights,' 'great outdoor culture' and 'amazing sense of community' and your cons 'difficult drinking culture' and 'lack of amenities, like indoor culture.'
posted by librarylis at 6:53 PM on January 3, 2013 [8 favorites]

It is really, really tough living in northern rural Alaska, particularly as an outsider in fairly insular communities. I know a quite a few health care workers (docs, mostly) who signed long-term contracts in places like Barrow and Bethel thinking that they'd be okay and that they could do anything for two years, and then bailed after 6 months. It is a spectacularly different kind of isolation than anywhere else in the US- you cannot just drive somewhere for the weekend. It is beyond cold and dark (it is tough for people where I live in Anchorage, and we bottom out at around 5 and a half hours of daylight), and Bush communities generally have tremendous problems with suicide, alcohol, rape and domestic violence. You should know this going in.

I would imagine that, in re: your own health issues you could probably work something out, but a lot of people in the Bush take care of many of their health and other needs in Fairbanks or Anchorage, and you should probably consider that in your budget. I would imagine that mental health providers are in even shorter supply than regular health care providers. If you are up for an Alaskan adventure but maybe not so much up for being off the road system and/or someplace tiny, we are often short health care workers in Fairbanks, Anchorage and Juneau as well, and life is a lot more manageable in a more urban setting here- and it's still beautiful.

On preview, librarlis has it about right. If you have any specific questions about the experiences of my friends, you can MeMail me; in general, they found it pretty depressing and and felt that they were largely resented by the community they resided in. Maybe with your particular specialty that might be different, but I wouldn't bet on it.
posted by charmedimsure at 7:14 PM on January 3, 2013 [1 favorite]

I live in very remote Alaska (though not the Arctic) and may be able to answer some of your questions. My town is small (~150 residents) and linked to the "real world" only by twice-weekly 1200 mile, $650 RT flights. So, in a sense much more isolated and less well-resourced than Kotz, which is a regional "hub" and has a population of more than 3,000.

Even with our tiny population, there is a relatively full-service tribal clinic in town. I actually have yet to avail myself of any of their services, but a rotating cast of specialists (dentists, public health nurse, MDs) come in on a regular basis. I took a training course at the clinic once, and we used the video-conference technology that is used for consultations and, as far as I know, all mental health care. This technology is readily available throughout Alaska, and is pretty amazing in terms of quality. Basically, we were all in a small and cozy room with comfortable chairs arrayed in front of a screen with a camera attached. Talking to the other participants in the training was almost as natural as if they were in the room. I would imagine-- though I am not sure-- that employees of the health corporation have some way to access non-corporation services through this system, for privacy reasons. It would be a perfectly reasonable question to ask, though.

In terms of meds, sometimes my community has issues with meds not coming due to cancelled flights. However, Kotz is a hub and has daily flights to/from Anchorage, so I don't imagine it would be much of an issue-- flights will get through eventually. Also, I would be surprised in the corporation did not offer a certain amount of travel benefits (a few RTs to Anchorage a year). Not sure how often you need to consult with your pdoc.

My lower-48 doctor was happy to prescribe a year's supply of birth control, though YMMV for more controlled substances. Since that need is really all I access health care for at the moment, I haven't actually used our insurance yet, but it has a huge emphasis on tele-medicine, and a pretty robust pharmacy-by-mail system which I hear from fellow staff is pretty good.

The weather in Kotzebue is pretty brutal, and the days will be very short (until they're very long). Light therapy would definitely be a good idea, though a good set of winter clothing and a commitment to get outside during the daylight, every day, is just as important. If you do it, get your D levels checked and set up a plan for supplementation with your doctor.

As for drinking, yes, Alaska is a pretty alcohol-heavy place. A lot of social life revolves around alcohol. Kotzebue is not dry, and has its share of alcohol-related issues. In 2011, they started an experimental city-operated distribution center, though the jury is still out on its effectiveness. Nthing what has already been said about alcohol, domestic violence, and sexual assault.

I don't really drink, and it's not been a problem at all where I live, but I am also a huge homebody and always have been. If I had moved out actively hoping to make friends, I would probably be less happy. Being an outsider is difficult, and you will be an outsider for years if not forever. However, Kotz is a hub and will have lots of teachers, medical workers, etc. who are in the same boat, so the social atmosphere might be quite different. In terms of dating, the applicable phrase is "the odds are good, but the goods are odd." It's very possible you could find someone great, but it's equally possible that there won't be anyone suitable.

Re: dog ownership, it is certainly possible but there are difficulties. I'm pretty sure there's not a veterinarian, food will be monstrously expensive, and flying with dogs to the Bush is more difficult than flying with dogs in general (temperature, delays, etc.) However, having a companion animal might be totally worth it. Another reasonable question to ask in the interview, for sure (among other things, you'd most likely be living in corporation-owned housing, which has varying policies on pets).

Other things: Full Circle Farm (produce delivery) will deliver to Kotzebue. It's wonderful to have a consistent source of fresh produce, and you can also order things like eggs and pesto and fancy cheese through them. Food in general is crazy expensive, so it's best to do most of your shopping in town, sending dry goods through USPS and taking chilled/frozen stuff on the plane. There are freight forwarders and online shopping sites that will do this for you, but it adds to the cost and we've had mixed experiences with order accuracy / completeness.

Learning how to fish and hunt has been an amazing experience for me-- go for every opportunity you can to get out and learn. And just get out. The outdoors is your friend.

Plan to go on vacation to somewhere sunny every year, even if it sets back your financial plan a bit. I'm writing from Florida at the moment (in-laws) and man, a few weeks of sun has done wonders. It also feels like a huge treat to sit in a Starbucks or a bookstore, get a haircut, etc. etc. etc.! Get the Alaska Airlines Platinum Card, which comes with 30,000 miles. Free flight to Hawaii!

I'm actually pretty content with where we are right now, and we're planning to stay at least another year. I've learned a lot about myself and what I need to be happy, and it's strengthened my relationship with my husband. I also feel that we're making a difference in our community (and, importantly, that we are generally appreciated and welcomed).

Feel free to MeMail me if you have more questions about rural/remote Alaska life. One last thing, I blog about our adventures, and the link's in my profile if you'd like to take a look!
posted by charmcityblues at 7:52 PM on January 3, 2013 [12 favorites]

I've also lived in a rural hub village in Alaska. If you go expecting a bit of hardship and an adventure, I think you'll do fine. You'll quickly find people to spend time with if you're open to learning new things and friendly with people.

Internet in Kotz is better than we get in a lot of other areas of Alaska. Your medical coverage will provide for trips into Anchorage if needed, and prescriptions come regularly by US mail. Food costs are very high, but so is the pay, right?

Time is a different concept in the Bush - I had to take my watch off for a few months to remind myself I was on "village time" until I adapted. But I found it to be a refreshing change of pace. I'm in one of the larger cities now, and I have fond memories and many friends from my time in the Bush.

Another thing about Alaska: the entire state operates like a small town. You'll soon know people all over the state, and every time you go to the airport (which will be pretty often) you'll see someone you haven't seen in awhile. The airport's where we all catch up with each other!

I moved here over 20 years ago, and I can't imagine any place else I'd rather live.
posted by summerstorm at 10:25 PM on January 3, 2013

imho (people might dis-agreee) there is a HUGE difference between Nome and Kotzebue. I think your experience would be very different depending on where you lived.

Nome is a pretty happening little town, all things considered. There is a downtown and a road system and so there are more types of living situations you can end up in. Lots of people get some land just outside town for example. You can drive to things like hot springs so it's not as claustrophobic as a place with no roads is. There is a reasonably diverse economy for the Bush, gold mining, crab fishing, the port, local businesses, tourism etc. The Iditarod comes to town in March and that's neat and brings lots of outsiders. A lot of single people in their 20s and 30s arrive in Nome, looking for work and adventure. To be honest you probably won't remain single for very long there! Nome is probably about half locals and half non-locals.

Kotzebue is a much more typical rural town, a big village. NANA corporation is headquartered there and it has good schools etc. Most of the folks who live there that I've met are Native, grew up in the region and are married with kids. Lots of young families relatively few single people in their 20s or 30s. It hasn't got too much in the way of diverse living situations since there aren't really any roads and it's harder to get a change of scenery. If you're stuck in town year round working a 9-5 job it's probably going to start feeling very small. You can get a snowmachine or a boat tho.

Everywhere you go in the Bush people are incredibly friendly and welcoming, you will quickly meet people to do stuff with. And yeah, you're going to get a dog. A skinny little mutt dog that needs hours of exercise in sub zero temperatures and chews your mittens. They issue them to you upon arrival.
posted by fshgrl at 10:52 PM on January 3, 2013

And yeah, you're going to get a dog. A skinny little mutt dog that needs hours of exercise in sub zero temperatures and chews your mittens. They issue them to you upon arrival.
Hey, where's mine? No fair!

posted by charmcityblues at 3:36 AM on January 4, 2013

The most important question to ask yourself: is there an escape route? Will there be any sort of disaster, financial, emotional or otherwise, if you have to call it quits after a few months?

If the move requires you to commit to a long time frame, and the consequences for changing your mind are severe, you probably shouldn't go. You might find either place delightful, but there's an equal chance you'll hate them. And you just won't know beforehand.

Nome is small and isolated, with few restaurants and fewer cultural activities. What beauty there is (darn little, sorry!) is of a very stark and intimidating kind. Low mountains and scrubby trees and brush. Constant wind. There are some area hikes, but nothing I thought spectacular. (Though seeing musk oxen close up in the wild was way cool!). Abandoned, rusting mining equipment lies pretty much everywhere. Took a wrong turn off one of the only roads out of town, one other car in sight. Tried to ask directions from its occupant, but he threatened to shoot. The flight to Anchorage was my favorite part of Nome.

Currently Nome is having something of a mining boom, so it's a little wilder and more crowded than usual.

Also, I don't like to bring up race, but many non-native folks report feeling very isolated and unwelcome in communities that are predominantly native. That doesn't describe Nome, but applies more to Kotzebue.
posted by wjm at 4:56 AM on January 4, 2013

Have an ex who taught school in Kotzebue for several years and overall, enjoyed it. I visited twice and loved it, but I'm a big fan of winter weather, and find that kind of weather less depressing than six months of pouring and 40 degrees in Oregon. YMMV, obviously. My friend is also an inherently optimistic person who makes friends easily, so there's that. The other teachers and folks living there on short term contracts formed a pretty close circle of friends. There were definitely significant tensions between the Native folks and these short-term residents. I'd be happy to connect you with my friend if you'd like.
posted by purenitrous at 2:26 PM on January 4, 2013

This post that just went up might be relevant: Life in Inuvik. NWT's Canada, of course, so the medical/social issues are different, but many of the climate challenges and issues around remoteness would be the same.
posted by gingerest at 5:08 PM on January 16, 2013

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