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As Pacific Northwest University's new Regional Assistant Dean of Fairbanks arrived on the health sciences university’s campus in Yakima, Washington, her eyes widened in awe. It had been more than six years since she had last seen the building that would change the course of her life, and more than a decade since her first visit to PNWU.
Her heart raced with excitement as her eyes explored the rapidly-expanding health sciences campus around her. This was her campus — the same place where she earned her doctorate, met her husband and decided to take a chance on a new adventure — and a lot had changed.
Back in the spring of 2007, her heart raced in a similar fashion as she turned onto University Parkway, scheduled to interview for a slot in the new medical school’s inaugural class. As she got closer, and as the details of this new osteopathic medical school — PNWU — became more clear, her pounding heart was driven by different motivating factors.
What Have I Gotten Myself Into!?
When Dr. Hanley first arrived in Yakima for her medical school application interview more than a decade ago, she did so with high hopes and boundless dreams. She had long considered a career in medicine, and when she heard about a blossoming non-profit medical school just over the mountains from her childhood home, which emphasized a holistic approach to medicine and supported a mission of serving those in need throughout the Northwest, it sounded perfect. But when she arrived, she couldn’t help but wonder: was it all too good to be true?
The PNWU campus consisted of a big, mostly-vacant dirt field and a half-finished building, complete with loose ends of house wrap flapping softly in the warm valley breeze. To this day, she recalls walking toward the front doors of Butler-Haney Hall thinking: ‘What have I gotten myself into!?
As soon as she entered the still-developing space of the soon-to-be College of Osteopathic Medicine, however, everything changed.
She timidly entered a room that was listed as the location of her interview, where she was greeted by the smiling face of Dr. Robert Sutton, one of the fledgling university’s founders, and a thirty-plus-year veteran in the world of medical education. Dr. Sutton had been born and raised in the nearby rural town of Cashmere, Washington, surrounded by the eastern foothills of the Cascade Mountain Range.
In other words: for the kind-eyed man that shook her hand, PNWU’s mission of bringing doctors to rural and underserved communities throughout the Northwest was more than just a mission statement — it was a life’s work.
"Anybody can say that they have a mission,” explained Dr. Hanley, “but at PNWU, I could tell from the moment I walked in the doors that they were going to walk the walk. It was just this tiny little building — there wasn’t a lot to it — but there was such a passion. I hope that is something that people always feel when they come here; that intangible sense of: I don’t have a choice, I have to come here.
Eleven years later, Dr. Hanley’s decision to trust the assertions of Dr. Sutton have resulted in a Doctorate of Osteopathic Medicine Degree, a husband (fellow PNWU Class of 2012 member Dr. Owen Hanley), two healthy children, a successful pediatrics practice, a home in Alaska, and her latest accomplishment on a long list of impressive feats— a role as PNWU’s Regional Assistant Dean of Fairbanks.
Those outstanding achievements and the remarkable stories behind them, however, were not always a part of her life plan.
First Impressions of The Last Frontier
Raised in the sprawling urban metropolis of Seattle, Dr. Hanley grew up, as she describes it, thinking that everyone recycled everything and rode Vespas to work. Living in Portland after college didn’t do much to shift those misconceptions. After familiarizing herself more with PNWU’s mission of serving rural and underserved communities, she decided to pursue her third-year clinical rotations somewhere unfamiliar — a place where snow machines were the preferred method of transportation, and bears often took care of the “recycling” — Fairbanks, Alaska.
It wasn’t long long before the glaring contrasts of life in Fairbanks came crashing in. In fact, they did so — almost literally — just moments after she first crossed the Alaskan-state line.
Having decided to drive up to Fairbanks with her then-boyfriend, Owen, for their third-year rotations, Anne spent much of her time on the notorious Alcan Highway wax poeticizing to him about the wild world they were adventuring into. Owen, a Fairbanks native, laughed as she audibly envisioned frigid temperatures and untamed mountain passes. Having grown up in Fairbanks, he had plenty of experience with just about all of her imaginative musings, including hair-raising encounters with the Alaskan wildlife she kept wishing to see out the window of their Subaru.
Thankfully those experiences had prepared him to act appropriately when her wish came true.
Anne was disappointed that they’d yet to see a moose on their drive, and she didn’t hide her frustrations. “I thought they were supposed to be everywhere,” she said sarcastically from the passengers seat as they crossed into Alaska. Just then, as if responding to her wry remark, a massive moose came charging toward her passenger-side door from the thick forest that lined the shoulder of the highway.
Just before slamming into them, the gigantic bull shifted its course, turning and running alongside their car as Owen’s knuckles turned white around the steering wheel. Anne estimates that they were traveling at over 30 miles per hour as the mammoth animal galloped effortlessly alongside them. It was so close that she could hear its hooves trotting on the pavement and see the vessels in its bulbous eye. She thought it was awesome. This was the wild Alaska she’d heard so much about. When the moose finally veered back off into the woods, however, Owen pulled over and took a deep breath, aware of the catastrophe they had so narrowly avoided.
Anne recalls him looking over at her, his eyes still wide, and saying: "That wasn’t awesome. We could have died.”
At that moment, the enormity of her new reality became clear. She wasn’t in Seattle, or Portland, or Yakima, or anywhere like any of the places she had ever been before. She was in Alaska.
A little over five-hours later they arrived in Fairbanks, and the real adventure began.
"I think Owen was really nervous that I wasn’t going to like it,” said Anne, looking back on those early days. “It’s one of those places where you either love it or hate it the moment you arrive. Thankfully, the minute I arrived, I knew it was home.”
“It’s 40 Degrees Below Zero For Everybody”
Anne and Owen were among the first PNWU medical students to arrive in Fairbanks, and the new territory that awaited them was dotted with challenges. Thankfully they had Dr. Todd Capistrant — the very man Anne is now stepping in for as Fairbanks' Regional Assistant Dean — to guide them down the uncharted trails ahead.
“Dr. Capistrant is a force,” explained Anne. “He could make decisions in a split second, and when he decided what was going to happen, that was it. That was really good at the nascency of the rotations in Fairbanks, because he kept driving things forward. Every wall that came up, he just pounded it back down. He’s the reason Fairbanks has medical students.”
As a medical student, Anne began adjusting to — and embracing — life in Fairbanks.
“When you take a step back and look at it, it does seem like a wild experience,” she said, “but when you’re in it? It’s just daily life.”
In Fairbanks, she discovered a tightly-knit community; one that fit perfectly with the type of care she hoped to deliver.
“If it’s 40 degrees below zero, it’s 40 degrees below zero for everybody,” said Dr. Hanley. “If your car doesn’t start, you have to go find your neighbor and get help. If the driveway is iced over and you can’t get to the grocery store, you ask your neighbor for an extra cup of milk to feed your kids. You can’t call Uber to come pick you up. There aren’t those amenities like there are in so many other communities, and that allows you to get to know people really well. That’s the stuff that matters. You depend on your neighbors.”
Those close bonds provide her with opportunities to interact regularly with the patients and families she sees in clinic, which in turn creates an inherent bond between patient and physician.
Her patients’ mom will check her out at the grocery store; she hires their fathers when they need work done on their house. Those genuine connections have been invaluable assets in allowing her to bring the holistic approach she cherishes to life in ways that may not have been possible had she decided to practice anywhere else.
“Our shared experiences are constant reminders of our shared humanity,” she explained. "When you live in a city, or anywhere where there are lots of distractions, you can tend to lose track of the things that really matter. You can’t lose track of those things in a place like Fairbanks.”
While there are undeniable benefits to the seemingly-constant environmental struggles Dr. Hanley endures alongside her patients, those perspective-altering experiences also come with significant challenges.
Caring for The Great Land
There’s an ongoing joke in Alaska that rarely elicits a laugh from the proud Texans who visit the state. The outline of the Lone Star State — famous for being a place where “everything is bigger” — is regularly seen on t-shirts, dwarfed by the outline of Alaska around it. In other words
— Texas is big, but Alaska is bigger.
While the joke serves as a bragging point for Alaskans, the reality of it is overwhelming for Fairbanks practitioners like Dr. Hanley, who provides care for all of interior Alaska, resulting in a catchment area roughly the size of Texas. So, while many of her patients come from the densely-populated Fairbanks area, she also sees many patients who have had to travel vast distances to find the help they need.
Very few of the patients she sees from the state's western-coast, villages along the Yukon, or places like Utqiaġvik — the state’s Northern-most settlement — have reasonable access to a physician, a physician's assistant, or anyone like that, Anne explained. If those far-off patients get medevaced in — which is often the only way to get them to Fairbanks — they are brought to the emergency room (ER). If their problem is emergent, they’re either treated or flown to a tertiary care center, in a place like Anchorage. Unfortunately, because of the challenges associated with receiving any kind of medical care in their remote homes, patients from underserved areas of Alaska often arrive at the ER suffering from things that require a physician, but not an emergency room physician. This tends to overwhelm local emergency rooms, and saddles those patients with crushing healthcare bills.
>As a pediatrician, Dr. Hanley has witnessed the devastating impact that a lack of healthcare access can have first-hand.
“We see kids who have something as simple as eczema,” she explained. “If they had access to a physician regularly, it would be easy to control — it’s just a skin rash — but when they don’t have access to the care they need, even a simple thing like eczema can become a severe problem with really awful results.”
Those challenges offer Dr. Hanley a plethora of great opportunities from a medical practice perspective, but they’re likely not things she’d ever be doing or seeing if she lived in a place like Massachusetts, where she trained, or Seattle, where she grew up.
“You do it because you have to”
Fairbanks, like many rural communities across America, struggles mightily to provide enough primary care physicians for the community. Dr. Hanley explained that many of Fairbanks’ family physicians are forced to take care of patients who, if they were in the lower 48, would be seeing an internist.
There is very little behavioral health support, in terms of both psychiatry and therapy, and no pediatrics inpatient psychiatry within a 300 mile radius of her practice. To compound those issues, Alaska suffers from a great deal of behavioral health morbidity due to factors such as suicide, depression, Seasonal Affective Disorder, and alcoholism. In fact, the U.S. Centers for Disease Control and Prevention lists Alaska as having the second-highest suicide rate in the nation, behind only Montana.
While statistics like that present massive concerns for Dr. Hanley and her Alaskan-colleagues, she sees a lot of hope in the community-based bonds of Fairbanks, where everyone is doing everything they can to band together and work through it all.
“In many places, anything that’s anything ends up being shipped to big cities, but we can’t do that in Fairbanks,” she said. “Thankfully, PNWU doesn’t teach us to just ship things to a consultant. The university really tries to encourage independent and critical thinking, and encourages us to make community-based decisions instead of self centered decisions. You don’t say, ‘I don’t manage that very often so I’m just not going to do it.’ You do it because you have to.”
“If I hadn’t gone to PNWU I wouldn’t be in Fairbanks,” she continued. “I’d be somewhere practicing what I would now consider really boring outpatient pediatric medicine, but because of PNWU I get to be a neonatologist, a general pediatrician and a pediatric intensivist, doing procedures that nobody else with my training gets to do. My husband is practicing as an intensivist even though he doesn’t have a fellowship in ICU care. We get to practice the kind of medicine that people in other places don’t get to practice because it’s needed. That need is being met in places like Fairbanks because of PNWU.”
As she begins her role as the Regional Assistant Dean of Fairbanks, taking over the duties of Dr. Todd Capistrant — one of her most cherished mentors — she too will play a major part in bringing quality healthcare to the region. While she admits that the enormity of the role terrifies her, she is confident that she’ll succeed thanks to the people around her.
Big Shoes to Fill
“It’s going to take a village, but I’m committed to going to bat for our students for anything that they need, the same way Dr. Capistrant did for us,” said Dr. Hanley. “I don’t know that I can do everything that Dr. Capistrant did all on my own, but with the help of my husband and the other preceptors who are on board I hope that we, as a team, can hopefully make one big ‘Todd.’”
Going forward, she also hopes that her fellow colleagues and previous classmates will take advantage of opportunities to serve in similar positions. “We all owe it to the people who got us here to keep the mission going,” she said.
“It’s totally terrifying, and I’m sure I’ll make a lot of mistakes, but I know I’ll get feedback and learn from my mistakes. I know that, if I don’t know something, I’ll have the humility to admit it and say, ‘I don’t know the answer, but I’m going to find out,’ because PNWU taught me how to embrace that; that sense of being in it for our communities. And I know that Dr. Capistrant is just a phone call away to help me through it.”
“I hope this can help to strengthen the PNWU footprint in places like Fairbanks,” she continued. “I sometimes hear that students don’t want to come to places like Fairbanks. I think much of that is the fear of the unknown. I hope that we can make it such an incredible rotation that the fear of the unknown is trumped by the assurance that you will learn so much coming to a place like Fairbanks. It’s an adventure, but there’s nowhere I’d rather be.”