Stebbins health aide describes responding to a village outbreak
Camille Katcheak had been working as a health aide in St. Michael for more than two years when she was asked to transfer to Stebbins at the beginning of September. Some of the health aides there were in quarantine after being exposed to COVID-19, and the clinic needed some extra hands to keep up normal operations.
Soon after she arrived, though, the handful of cases in the community multiplied into the worst outbreak the region has seen since the start of the pandemic. “I volunteered to come over for three weeks, and then three weeks turned into forever,” Katcheak said. She remains in Stebbins responding to the outbreak today.
With more than 60 cases and counting, the Stebbins outbreak has touched every aspect of life in the community, and no one has been more affected than the health aides. “We worry every day about our patients with COVID,” Katcheak said. “I wake up every day thinking about it. It’s a tough time in our village.”
Katcheak’s day starts at 9 a.m. and she spends most of the day providing urgent medical care and running tests. Every day, one health aide is assigned to exclusively run tests, and the others help as needed.
Because of the risk of infection, they’ve stopped low-urgency checkups, and test all their patients for COVID before seeing them. Every time someone comes to the clinic for medical attention, the staff have to evaluate whether treating them is worth the risk of exposure.
“We discuss amongst ourselves, does this patient need to get seen or not?” Katcheak said, “We’ve been holding off on wellness and preventative care and focusing mainly on rapid testing and urgent and emergent care.”
In larger communities, contact tracing is done by Public Health Nursing, which has dedicated employees in Anchorage and Fairbanks who spend all day following up with the potentially exposed on the phone.
But in Stebbins, that responsibility lies largely with the health aides. “The community is about 700 people, and we basically know everybody here,” Katcheak explained. “We know who lives with who, who stays where, and all that.”
That local knowledge helps the health aides figure out who might be exposed much more quickly than the contact tracers hundreds of miles away, so Katcheak spends much of her day helping Public Health Nursing identify close contacts.
And on top of all that, she also plays the role of a public educator, helping people understand why they need to stay inside even though they’ve tested negative and what they should do prevent the spread of the virus. “Some patients don’t understand isolation and quarantine, so we always have to explain to our patients about that,” she said.
All that responsibility falls on just a handful of health aides. Katcheak said Stebbins currently has four, but one is on maternity leave and another had been in Anchorage as a medical escort for about a week, so last week there were only two serving the entire village.
In addition to her normal working hours, Katcheak is on call after hours in case of a medical emergency. In some cases, health aides have in Stebbins have had to work grueling 24-hour shifts.
During the height of the outbreak, they also came in on weekends to speed up community-wide testing. Norton Sound Health Corporation sends additional staff to help with the response on a weekly basis, but most of them cycle in and out every week while the resident health aides have been struggling with the outbreak every day for months.
“We’re all super burnt out and tired,” Katcheak said, sighing. “It’s hard.”
The village’s longstanding infrastructure problems present yet another barrier. “Stebbins has been a community without running water ever since Stebbins has been Stebbins,” Katcheak said. “But we need the running water and sewer to be more healthy and clean. That’s the biggest challenge in our community right now, no running water.”
The lack of water makes hand washing in the home much more of a challenge. Going to fetch water at the washeteria is another public space that increases the risk of infection even though the washeteria has been limited to two people at a time. “Maybe if we had running water, we wouldn’t have had so many cases here,” Katcheak said.
Another issue is the lack of adequate housing. While Stebbins has some facilities for quarantine housing, it’s not nearly enough, and most patients and close contacts have to quarantine at home with their families where many live in crowded conditions.
“In one whole household, half of them tested positive and the other half tested negative,” Katcheak recounted. “And the negative patients were concerned, wanting to separate themselves from the positive patients. But we couldn’t do that because we didn’t have any other space to put them, so we treated that whole house as an isolation home.”
The result has been a huge proportion of Stebbins residents in isolation and quarantine, putting pressure on every aspect of daily life. Katcheak said NSHC’s deliveries of food and supplies to people in quarantine and isolation have made a major difference, and that she’s hugely appreciative of all the support NSHC has offered, but the work has still been exhausting.
Despite all that, though, there appears to be some light at the end of the tunnel. New cases have tapered off in recent days, and as of Monday there was only one active case in Stebbins. More people are in quarantine and may still come up positive, but Katcheak was hopeful that the worst of the outbreak is in the past.
Her advice to health aides and medical responders everywhere was to be prepared for anything and to take the virus seriously. “I love and care for my whole community, and I just want everybody to be safe, to wear a mask, and just be cautious,” she said. “It’s a serious illness and everybody needs to understand that.”
The huge challenges facing Stebbins continue to loom, but at the same time Katcheak was confident her community could make it through. “The people of Stebbins,” she said, “they’re pretty tough.”