From the bookshelf: Medical history illuminates Natives' tragedy

Posted: Thursday, October 06, 2005


  'Must We All Die?: Alaska's Enduring Struggle with Tuberculosis', by Robert Fortuine

'Must We All Die?: Alaska's Enduring Struggle with Tuberculosis', by Robert Fortuine

'Must We All Die?': Alaska's Enduring Struggle with Tuberculosis

By Robert Fortuine

Published by University of Alaska Press

304 pages


$39.95 (hard cover)

Historians used to tout the exploits of kings and generals. But recent revisions suggest that other forces have shaped our lives in profound ways. For example, modern scholars now believe that immigrant epidemics played a huge role in allowing European expatriates to displace Native Americans.

Physician and historian Robert Fortuine has broken new ground in chronicling Alaska's medical history. His 1992 book, "Chills and Fever: Health and Disease in the Early History of Alaska," was a landmark. Yet it only told the story up to the year 1900.

His new book, "'Must We All Die?'" while not exactly a sequel, picks up where the earlier volume left off. This time, he focuses on tuberculosis and the devastation it wrought on Native villages. He took the title of his book from the heartbroken question an Athabaskan father asked a visiting health team in 1946, after they told him his 9-year-old son was doomed to follow five brothers and sisters to an early grave.

Society has a short memory, and it is a shock to read that just 50 years ago the suffering and death in rural Alaska was on a staggering third-world level.

"It would, in fact, be reasonable to suggest that this tuberculosis epidemic, with all its tragic personal, social and economic consequences, was the most devastating event affecting the lives of Alaska Natives in the 20th century," he writes in his preface. "Few families in the past 100 years have not been touched by this baleful disease. Many individuals did not live to grow up, or they escaped with damaged lungs; a crippled spine, knee or hip; a scarred neck; or an irreparably impaired brain."

Fortuine calls tuberculosis the scourge of Alaska. He describes the disease and its treatment past and present, beginning with clues from archeological finds such as the frozen family near Barrow and continuing to the first years of our new century.

Ironically, tuberculosis in Alaska seemed to worsen in the late 1800s, just when the rest of the nation was reining it in. The disease peaked about the time of World War II, when western and northern Alaska showed the highest TB rates in the nation and some of the worst in the world.

Although much of the subject matter is grim, the overall tale told is one of triumph. Despite lagging pathetically behind the rest of the United States, Alaska's fledgling medical community and alarmed public fought the pernicious disease with a gritty perseverance that eventually beat back the threat.

In the 1950s, when pharmaceuticals capable of preventing or destroying the tubercular bacteria became available, the tide turned. The declining case load was dramatic, but it was not until 1968 that Alaska officially had a year with no tuberculosis deaths.

A retired public health officer now living in Wasilla, Fortuine has strong opinions. He blames the slow progress on inadequate government funding. But he acknowledges that circumstances beyond anyone's control conspired to spread contagion and limit rural medical services. In general, he emphasizes positive efforts.

He praises not only medical personnel — noting that many worked for meager pay under appalling conditions — but also the community volunteers (mostly women) and Native villagers who invested countless hours in coordination, assistance and public awareness campaigns essential to the eradication effort.

He also speaks with deep respect oaf the patients. The treatments they endured, especially in the early decades, were painful and prolonged, yet few people balked at following medical advice. He devotes a section to describing life in a sanatorium, with the boredom and cultural dislocation involved.

"'Must We All Die?'" tackles sensitive issues such as the racial divide in health care. It emphasizes from the beginning that tuberculosis was overwhelmingly a Native problem in Alaska. At times the death rates differed by as much as twenty-fold between Natives and whites.

Particularly thought-provoking is the book's epilogue, in which the author ponders the epidemic's direction and concludes that many outsiders' efforts to "civilize" remote Alaska villages may have contributed to their decimation.

Fortuine warns readers that although tuberculosis is down, it is not out. The disease lingers on the fringes of society, with troubling trends such as intermittent village outbreaks and growing resistance to antibiotics. He pleads for public vigilance (and funding) to prevent conditions that could allow for resurgence.

To document his narrative, Fortuine did a daunting amount of research. He cites obscure publications, reams of government and medical reports, and the reminiscences of people directly involved. He bolsters his text with historic black-and-white photographs, a timeline, morbidity tables, a glossary, an index and meticulous footnotes.

The resulting style can be dry and dense, and it tends to jump around in time following narrative threads. But Fortuine writes with clarity and conviction. Between the lines, he conveys the passion of a physician dedicated to reducing suffering through professional acumen.

Fortuine makes another valuable and unique contribution to Alaska's history with "'Must We All Die?.'" It is not light reading, but it contains plenty of pathos and drama. For anyone interested in medicine, rural health issues or Alaskas history, it is full of engrossing and eye-opening information.

Shana Loshbaugh is a writer and former Clarion reporter who now lives near Fairbanks.

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