A Century of Adventure in Northern Health: The Public Health Service Commissioned Corps in Alaska, 1879-1978 (review)

In 1982 following my residency, I joined the Indian Health Service in Kotzebue, serving Inupiat communities in remote northwest Alaska. What I did not know until I read Robert Fortuine's book was that my work continued more than a century of Public Health Service (PHS) history in America's last frontier. According to Fortuine, a PHS Commissioned Officer serving seventeen of his twenty-six years with the Indian Health Service in Alaska, the Public Health Service has had a greater impact on the health of the people of Alaska than it has had on any other region in the United States.

Fortuine recounts the PHS's history beginning with the Marine Hospital Service in the region in 1879. The book successively chronicles the Revenue-Cutter Service, marine hospitals for the care of merchant seamen, quarantine and disease control, World War II and its aftermath, support to the Alaska Native health programs of the Bureau of Education and the Bureau of Indian Affairs, the Division of Indian Health (Indian Health Service), and northern health research.

Fortuine's writing is straightforward and factual about scenarios that are intriguing. For example, the story of the Revenue Cutter Bear is the stuff of adventure sagas. After the captain of the Bear was ordered to save 265 stranded whalers, the ship surgeon and several officers traveled by dogsled and, subsequently, reindeer sleigh, herding reindeer to Point Barrow in the dead of winter to provide food and winter clothing for the whalers.

Fortuine describes the 1924–25 diphtheria outbreaks in Nome, which inspired the annual Iditarod dogsled race: "Finally, a supply of 300,000 units of serum was located in Anchorage and transported by the new Alaska Railroad to Nenana, where the precious package was passed from one dog driver to the next all the way to Nome. In total, 20 mushers participated in the 674-mile sprint . . ." (p. 54). Ironically, only a few cases were actually given the new antitoxin, which had arrived after the epidemic was largely over.

Some of the most engaging history relates to the more recent evolution of the Public Health Service in Alaska. Fortuine draws on both historical records and personal experience to describe the work of mentors and contemporaries in the PHS. Dr. Erwin Stuart Rabeau, for example, was a legendary physician who began service in Kotzebue in 1946 and spent the next eleven years in the Arctic, sometimes as the only physician north of Fairbanks. Although Rabeau had only limited clinical training, he often undertook necessary surgical procedures under primitive operating-room conditions. Much of his time was spent traveling by small aircraft and dog team to surrounding villages and other remote areas. Tuberculosis (TB) was the major killer in this era, and in the 1950s, Rabeau was involved in new developments in the care of TB patients and the prevention of the disease.

Some of the progress made during the 1960s addressed the realities of contemporary village life at a time when many Alaska Native villages lacked basic water and sanitation. Critical public health programs expanded in the area of environmental health to improve basic water supplies and sewage and waste disposal systems in Alaska Native villages. During this same period, the Community Health Aide Program (CHAP) was developed where local villagers were trained to care for minor injuries and illnesses, reporting more serious cases by radio to physicians at regional hospitals. Initial efforts were so successful that an Alaska area-wide training program was funded by Congress in 1968, and the program, in various forms, continues today.

By the 1970s, a three-tiered clinical system had evolved in the Alaska Area Indian Health Service, with primary care at the village level delivered by community health aides or visiting providers. Secondary care was delivered at...