Position of privilege

Story by Diana Campbell, photos by Diana Campbell and Greg Lincoln/The Delta Discovery

Teresa Flores, '03
Teresa Flores, ’03

The gray fall evening settles quietly on Bethel as surely as an overnight frost.

Yet cabs, the nearest thing to public transportation in Bethel, rush up and down Chief Eddie Hoffman Highway. Across town at the Bethel City Council Chambers, city council candidates debate, among other matters, if the city should build an indoor swimming pool.

Inside the Yupiit Piciryarait Cultural Center, home to the Bethel Public Library, a museum and multipurpose rooms, Teresa Flores, ’03, studies her small group of would-be cake decorators. It is their final class, and she has instructed the five students to create a themed cake.

Some of the bakers stare at their bare cakes, hoping for inspiration. Flores walks among them, offering encouragement.

“I think the answer is more icing,” she says, laughing. “Having a bad day? More frosting!”

Flores, 33, is a cake decorating and sewing instructor in her free time. During work hours the UAF alumna is a physician assistant at the Yukon-Kuskokwim Delta Regional Hospital.

The 50-bed hospital is operated by the Yukon-Kuskokwim Health Corp. and is one of Bethel’s major employers. Bethel is in Southwest Alaska, at the mouth of the Kuskokwim River, and is accessible only by air, river, snowmachine or four-wheeler. Situated on the tundra, the town of just over 6,000 is a hub for 56 smaller communities. The air has a distinct grittiness to it, maybe from Bethel’s 16 miles of dirt roads, or from the Kuskokwim’s relentless churning up of river dust.

Balancing act

Like Flores, several of her cake students work for YKHC in demanding medical-professional jobs.

But this night is all about creativity. Flores checks each person’s progress, pausing to take photos of undersea worlds, an American flag, and a triple-decker, heart-shaped, red velvet cake.

The evening is also a chance to socialize. Jonica Thomas and Flores work together, but now they discover they live near each other. Thomas has always been interested in baking, and Flores tells her she has a marble slab she uses for pastries and confections.

“I think we’re going to be best neighbors!” Thomas says.

Flores is not afraid to deal with tough issues. One of her duties is as a sexual assault forensic examiner for the YKHC, meaning she is called on to conduct official interviews, provide medical examinations, collect evidence, and offer treatment and referrals for further care to rape and molestation victims. Her co-workers at YKHC say she has the right temperament for such a job.

“She listens,” says Melinda Norwood, a nurse in the Bethel hospital’s emergency room. “She asks for clarification. She shows empathy as well as compassion.”

It’s a privilege to do so, Flores says.

“I remind them they are still human,” she says. “If I remind them of that, then I’ve done so much.”

Flores admits she doesn’t really like the job, because of the reason she has to do it. But she balances that with the knowledge she is caring for someone going through a difficult time. She often will continue treatment with those people at the clinic where she is a PA.

“On one hand it’s really hard to see that part of humanity,” Flores says. “On the other hand, at least I know what I’m doing there can help somebody who’s gone through this, to help them know they can have a life again.”

Choices

Teresa and her mother, Martha
Teresa and her mother, Martha
As a young girl in Mountain Village, Flores never thought she’d work in health care because her mother, Martha Flores, was busy as a community health practitioner there.

Unfortunately for Teresa, her mother was good in her work. Martha’s supervisors encouraged her to become a physician assistant. That meant she had to leave her family and go to Seattle for the two-year training. The training and the job kept her away from home, and the 12-year old Flores resented it.

“I always said after that I would never work in health care,” Teresa says. “I was really angry at times. She was always working.”

She admits now she understands the difficult choices her mother had to make. Martha became one of just a few Yup’ik PAs working for YKHC. Maria Beans, the family’s matriarch — and Mountain Village’s magistrate at one time — instilled in her family a work ethic that they do their best and always finish a task.

Grandma Beans’ standards also meant there was no question that Teresa would go to college.

After high school, Flores decided she’d become a kindergarten teacher, and she enrolled at UAF. Besides her grandmother’s belief in education, Flores knew she needed to be able to support a family when the time came. An education would help her provide for them.

“UAF seemed to have more community,” she says. “Fairbanks seemed a lot homier, close-knit.” She settled into campus life by joining the sorority Tri Sigma, volunteering at the Women’s Center and taking the required education classes.

“I was always doing something,” she remembers. She also was a resident advisor and read books on tape for UAF’s Disability Services, among other tasks in her student jobs.

Plans never end the way they are envisioned. UAF’s School of Education, while keeping its state accreditation, temporarily lost its national accreditation. When Flores sought her advisor to find out what that meant for her education degree, she discovered the woman was no longer at UAF.

Flores then turned to UAF’s Rural Student Services and came up with another plan.

“I had taken psychology classes for fun,” Flores says. “So I ended up getting a BS in psychology.”

The change also steered her thinking about what to do with her life. The YKHC would hire her to work during every school break she had, even if it were only for a week.

The opportunities placed her in many different types of jobs with the health care organization. She worked in the specialty, outpatient and behavioral-health departments.

YKHC also offered a scholarship loan program that allowed her education loan to become a scholarship if Flores worked for the organization for two years after graduation.

“I’ve always wanted to help people,” she says. “At the hospital I found I could really help people one-on-one.”

Change of place

"Having a bad day? More frosting!"
“Having a bad day? More frosting!”
Flores graduated from UAF in May 2003 and by that June headed to Washington state to become a PA. She worked as much as she could to save up money in preparation.

“I bought my round-trip ticket, got on the plane, went to my new home,” she recalls. “I bought bread, peanut butter and jelly, and the required school books. After all that, I had $15 left in my pocket.”

After she finished her studies and completed rotations at seven Washington clinical sites, she moved back to Bethel to work as a PA with YKHC to fulfill her two-year loan-to-scholarship obligation.

As her term was nearing an end, Flores saw a UW Medex Northwest teaching position job advertisement and applied.

“I got it!” she says. “I was only 29. How often do you get to teach at a university? I took the job.”

Soon she became the co-chair of UW’s maternal/child health program while teaching PA courses, but she started getting homesick.

“I really missed being in the clinic,” Flores said. “I missed patients.”

After a year of teaching, she moved back to Bethel to work as a PA in one of YKHC’s three clinics in the hospital. YKHC manages health care services for about 27,000 patients who live in the Yukon-Kuskokwim Delta, most of whom are Yup’ik or Cupik. (While many patients will end up in Bethel for treatment at the hospital or one of the clinics, the YKHC also oversees five subregional clinics and 47 village-based clinics.)

Flores works in the Kusko Clinic at the hospital, where she offers a wide spectrum of health care, from prenatal services to elder care.

It’s a Thursday in fall 2011.

YKHC’s three clinics are near the front doors of the 100,000-square-foot steel hospital. Flores’ day starts at 9 a.m. and will end about 7 p.m.

The waiting areas are lined with chairs in every available space. Most are filled with patients, some with a small rolling suitcase at their feet. People hurrying to their appointments or greeting friends and relatives stir the air into a slight breeze. The Yup’ik language dominates conversations, but the infants cry in a global language.

The cafeteria is undergoing renovations and is closed, so a cab driver delivers a phone-ordered lunch to an elderly man sitting in a wheelchair. The man, Johnny from Kipnuk, has been telling people Jesus taught him a song, and he sings it for listeners before his hamburger arrives. Apparently, Jesus knows Yup’ik well enough to compose a rousing tune.

A nurse calls for a patient, and a mother and teenager follow her into a long narrow hallway with 10 exam rooms. Flores is their provider. She wears a black-and-white floral top, black pants, three-inch heels and a stethoscope around her neck. Her hair is highlighted a bright fuchsia, earning her the nickname Luscious Raspberry by her co-workers. She has cherry-red nails, wears a heavy silver chain and sports a sterling ball in a piercing below her bottom lip.

Teresa’s health tips

  • Everything in moderation. Life is meant to be enjoyed, but not to excess. (Yes, exercise can be enjoyable!)
  • Ask your primary care provider all the questions you have, even if you think it is silly. There are no silly questions.
  • Make the most of your visits — make a list of questions and concerns to be brought up during your annual physical exam visit and bring it along. This is even more important if you take medications on a daily basis.
  • Everyone should have a physical at least once a year. Screen for diabetes, thyroid issues, and cholesterol starting at age 20, then every 5 years or so.
  • Recommendations for low-risk drinking: less than 4 drinks on occasion or 7 drinks per week for females, less than 5 drinks on occasion or 14 drinks per week for males.
  • Lastly, enjoy the little things in life. Laughter really is the best medicine, and optimism does a lot for stress reduction and lengthening your life span.

The exam room is small and meager, with an aging exam table, a desk and three chairs.

While the patient explains the situation, Flores listens carefully and asks questions. She outlines the treatment plan, explaining in simple language her reasons for the course of action.

“Does this make sense?” Flores says more than once. She urges them to do what she suggests, but leaves the decision up to them. She lets them know they may contact her with any questions, and she writes out a prescription and orders labs for the young patient before leading them out of the room.

“I have a privileged position in their lives,” Flores explains. “They allow me to help them.”

The nurses’ station in the tight hallway is also small, standing room only. The station has a set-up for telehealth communications, connecting village health aides to the clinic when they need direction in treating a patient. The clinic was once the administrative offices for YKHC, but was remodeled some time ago, which accounts for the tight quarters.

Flores takes a rare lunch break and strolls through the hospital, stopping to greet workers in the inpatient ward, the lab and X-ray department. Her final destination is the emergency department, where the workers greet her warmly. This is the place she conducts sexual assault forensic examinations.

Dr. Ky Burden, the ER doctor, praises Flores for her compassion and professionalism. She’s worked with him since he came to the hospital straight from his residency four years ago. Working in an ER department is fast-paced, and it’s nice to be among co-workers who have the same goals, he says.

“The great thing is we’re all here for the same reason,” Burden says. “It’s to help patients.”

Flores chitchats with other ER workers, but it’s her mother she has come to see. Martha is the emergency room’s PA. Teresa has to wait because her mother is with a patient.

Soon her mother appears. She is shorter than her daughter but the two look alike, with the same smile and thick curly hair. Martha is wearing scrubs. The two hug.

The older Flores was taught not to openly praise her children, so she would never publicly say how proud she is of her daughter, but she admits to satisfaction at seeing what Teresa has accomplished, and that she has chosen to be a PA.

“People tell me, ‘I saw your daughter,'” Martha says. “They tell me she’s very caring. She listens.”

Teresa often seeks her mother’s advice, and since the two work as PAs in different health fields, it helps Martha keep current with other treatment options.

“It keeps us in balance,” Martha says. “It’s good for us to be in this profession. There is still so much to learn.”

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[After this story was written, Teresa was appointed to fill an unexpected vacancy on the UAF Alumni Association Board of Directors.]

Diana Campbell, ’91, ’93, is the communications specialist at UAF’s Center for Alaska Native Health Research. She is a Gwich’in/Alutiiq author and a tribal member of the Native Village of Venetie.