ANCHORAGE, ALASKA — Located along the Kuskokwim River, situated about 310 miles west of the nearest city, Chuathbaluk is a small, quiet Alaskan village of about 95 people.

Like many of Alaska’s over 200 native villages, Chuathbaluk has no road system and can only be accessed by air or travel between the villages on the river. The people of Chuathbaluk live off the land around them, hunting, fishing, and helping each other.

They are also no strangers to tragedy. “The first people who lived in this area succumbed to influenza,” Patricia Yaska, the village’s Tribal Response Program Coordinator, told Direct Relief.

Pandemics past

Between 1918 and 1919, during what would later become known as a first and second wave of the disease, Alaska’s death rate more than doubled due to influenza deaths. It has been reported that besides Samoa, more people died of the Spanish Flu in Alaska, per capita, than anywhere else in the world.

Indigenous people accounted for the vast majority of those deaths. Entire villages were decimated, leaving behind only small graveyards in their wake.

“From the history, I learned that epidemics don’t discriminate, and they travel fast, and take a long time to leave the area,” Yaska said.

But when it comes to Covid-19, rural Alaska is working hard to prevent history from repeating itself.

Alaskan villages were among the first to institute lockdown measures, in many ways cutting themselves off from the already limited access they had to the outside world in hopes of preventing the disease from seeping in.

“When we think about how our regions and communities are responding to Covid-19… They have that memory,” said Andrea Gusty, President and CEO of The Kuskokwim Corporation, which represents 12 Alaskan Native villages.

“We have several villages in our region that don’t exist anymore because of the impacts of the flu and tuberculosis. Our region was hit particularly hard because our villages just don’t have the immune system built to fight these things.”

The memory of the devastation these epidemics caused, passed down from elders to current generations, is guiding the village response today.

Together, apart

“Many of our villages have combined their knowledge and their stories to, in effect, shut down their villages and protect their residents,” Gusty said. “We’ve been helping with the coordination of some of these efforts so one village understands what another village is doing.”

What that looks like for now is eliminating passenger traffic whenever possible. “Stony River is a perfect example,” Gusty said. “It’s a small village of 40 to 50 people and they made the decision early on to not let anyone in or out of the village.”

Of course, this kind of isolation presents many challenges, particularly because these villages have always relied on each other for survival.

Now, they also have reduced access to health care options to consider.

While many villages have clinics, they are rarely staffed. Before Covid-19, if village members suffered from an injury or illness, Gusty said there was an 800 number they could call. They would then get on a flight and go to one of the regional clinics, or be flown to Anchorage if the issue was serious enough.

But the main village air carrier filed for bankruptcy shortly after the villages started closing to passenger traffic, just days after the state issued a mandate against most intrastate travel in an attempt to slow the spread of Covid-19.

“There are a number of air carriers trying to fill that gap, but right now the only way to get them out for treatment is by medivac,” Gusty said.

What was meant to serve as a way to protect the villages may have inadvertently cut off one of the best options for getting people out and to the treatment they may need if Covid-19 does begin to spread throughout these rural communities.

Risks and challenges

Dr. Robert Onders is the Medical Director of Community and Health Systems and Improvement at the Alaska Native Tribal Health Consortium.

“I think of the villages that are geographically isolated in Alaska as being incredibly strong. It’s their inter-connectedness that makes them strong,” Onders said. “But that inter-connectedness also presents challenges in a pandemic.”

He pointed to the multi-generational and community housing that typically exists in a village setting as being a benefit under normal circumstances, but a risk of rapid disease spread in times such as this.

Then there are the ways people typically work together within a village to survive. “I’ve been on calls with rural communities about how they can continue their ways of life. Some things, like whaling, are just impossible to do without multiple households,” Onders said.

There are also sewer and water challenges to consider. “And there’s a history of trauma that has resulted in a disproportional disease burden,” Onders explained. “That makes rural Alaskans a little more susceptible to the disease spread related to Covid.”

Halting the spread

For all these reasons, Onders believes it’s imperative to allocate additional resources in protecting these communities, above and beyond what’s being done for the general population. “We can’t provide the same level of effort as we do in Anchorage. We have to make extra efforts to protect these villages.”

According to him, that means more testing, more supplies, and more assistance being provided so that intra-village travel can continue to be eliminated as much as possible. ANTHC is working hard to coordinate these efforts with the nearly 30 village health corporations serving on the ground.

So far, it seems to be working: Just one case was identified in the village hub of Bethel nearly a month ago.

Since then, Covid-19 does not appear to have continued spreading throughout these remote regions.

Seeking safety

That’s comforting news to Ron Harrelson, an electrician at Alaska Native Medical Center in Anchorage. He and his wife, Lynnette, a labor and delivery nurse, made the difficult decision to send their six-year-old daughter, Tommi, out to stay with relatives in the village of Shaktoolik over a month ago, before the mandate on intrastate travel went into effect.

“We felt like it’d be a little more normal for her, and with us both working at the hospital, we wouldn’t be exposing her to any more risks,” Harrelson said.

In Shaktoolik, Tommi is able to play with her cousins and live what, thus far, feels like a pretty typical village life to her. It’s a familiar experience: Tommi has spent weeks at a time in the villages where her mother and father grew up throughout her life.

“It’s harder, knowing we can’t really get her back now that the passenger planes have shut down,” Harrelson says. “Not having a definite timeline is difficult. But we’re just looking at the blessing of it. She gets time with her grandparents and family. And she’s having fun. There’s always light.”