Get My Job: Spotlight on Midwifery

In this Nexus series, Get My Job, we interview alumni and faculty from one of the University’s 200 undergraduate and graduate professional programs. The latest installment features Midwifery Institute graduate Jen Heller.

There are rural jobs. And then there are rural jobs. As Class of 2016 graduate Jen Heller will explain, she lives and works in one of the most remote places in the United States—Unalaska, Alaska.

The alumna shares the excitement and challenges of being a midwife on the Aleutian Islands, how Jefferson gave her the confidence to excel at her job, advice for prospective students and more.

How did the University’s midwifery program best prepare you to enter the field?
One of the best things about the Midwifery Institute is the undaunted attitude of the staff. Midwives tend to be problem-solvers and a distance education program can require a great deal of problem-solving. Dr. Dana Perlman worked with me when I asked to be at an unconventional primary care clinical site at Iliuliuk Family and Health Services (IFHS), a community health center in Unalaska, Alaska. Unalaska is a remote island in the Aleutian Islands, 800 air miles from Anchorage.

I was still taking classes, of course, and needed to connect online. (This was before the pandemic forced us all to fine-tune remote work.) The poor internet connectivity on the island prevented me from using the Midwifery Institute’s usual proctoring program. Dr. Perlman reached out to Jefferson’s physician assistant program, determined that its proctoring program would work with restricted internet access, and we benefited from interdepartmental collaboration so that I could take my exams. I had an amazing clinical rotation that broadened my experience while I continued to attend classes and complete my didactic work. I didn’t know it then, but this clinical rotation shaped my life today.

What was your career path to land in your current position?
For my first two years, I worked at a freestanding birth center with two other midwives in Anchorage. It’s a wonderful clinic that offers fantastic care for families. We supported birth at the birth center and local hospitals. I grew in midwifery skills and made connections within the Anchorage women’s health-care community.

After two years, I decided that the heavy on-call schedule required wasn’t the best for me and my family and I took a position at a family medicine residency program. However, I couldn’t practice as a Certified Nurse-Midwife (CNM) at their clinic, so I only stayed for a short period.

At the same time, my husband, a family medicine physician, was being recruited to work at IFHS where I had done my clinical rotation four years earlier in Unalaska.

They were primarily looking for a full-time family medicine provider and wanted to hire a CNM as well. They asked if I could include some administration as part of my responsibilities. We took them up on the offer and moved to Unalaska in fall 2019 for the adventure of a lifetime.

IFHS serves a year-round population of about 4,500 people in Unalaska, which is located on an island of the same name. It’s the traditional home of the Unangax people, who have lived here for 9,000 years. Today, Unalaska supports the Port of Dutch Harbor, the largest fishing port in the United States. In addition, it’s an ice-free deep-water port on the route between Asia and North America, so it stays busy with international cargo shipping.

The weather is notoriously bad. Nicknames for the Aleutian Islands include “Birthplace of the Wind” and “Where the Sea Breaks Its Back.” It’s both a breathtakingly beautiful and awe-inspiringly difficult place to live.

The community is diverse as the fishing industry attracts people from around the globe. Over the years, some of them have brought their families and now live here permanently. In addition to the 4,500 year-round residents, another 4,000-6,000 seasonal workers come for fishing seasons. (They’re not considered migrant laborers due to the agricultural definition of migrant labor.)

It’s a fascinating place to work. There’s no hospital in Unalaska (it was bombed during WWII and never rebuilt), so IFHS provides emergency and primary care to the year-round community and seasonal workers. It’s a three-hour flight to the nearest hospital—when the weather allows and if we have a plane on the island. That adds a layer of complexity to clinical decision-making.

I was hired to work part-time, splitting my time between clinical care and managing the clinic’s quality improvement program. My clinical duties are straightforward and rewarding. I provide primary and prenatal care for women on the island. As with many remote communities in Alaska, we have no birth services on the island and women go to their planned birthing location at 36 weeks.

However, my administrative duties have required even more flexibility. I started in 2019 running the quality improvement program, which includes risk management, safety, infection control, emergency management and employee health. This past winter, IFHS’s CEO and director of operations (DoO) left. I took on the duties of the DoO and stepped in as interim CEO until we found a replacement.

That was a steep learning curve. I now have successfully navigated a Health Resources and Services Administration on-site visit and a Joint Commission survey and have learned much about grant management. All of this was highly unexpected and super interesting.

My midwifery training enabled me to take it one step/one day/one challenge at a time and keep problem-solving my way through those transitions. As with labor and birth, it’s not an option to step away from the situation. I simply keep working through each new puzzle to support the staff and provide care. The Midwifery Institute emphasizes excellence and encourages students to explore their passions, which gave me the courage to take an unconventional path in midwifery.

What are your favorite parts of your job?
I work with a committed, hard-working and diverse team. In addition to the four permanent providers, a paramedic, two nurses and a handful of EMT/MAs, we work with regularly scheduled family medicine residents and a steady stream of locum providers from different backgrounds.

Although it’s almost cliché, the patients are wonderful. I’m humbled by how hard working they are, with such varied and fascinating life journeys. I really value bringing the midwifery philosophy to my patient care.

Finally, the position comes with 12 weeks of time off. That was a huge plus to the job, and it fits our lifestyle. We work hard on the island and don’t have many of the conveniences of modern life. In addition, it’s expensive and difficult to come and go from the island. Between the weather, active volcanoes, a notoriously challenging runway and only one commercial airline, flights are often canceled and you can spend days waiting for a flight on either end. Short trips aren’t a viable option, so the time-off package convinced me and my husband to accept the positions.

What’s the most challenging aspect of your job?
The remoteness. Issues that wouldn’t be a huge effort in other settings become one here due to transportation challenges. For example, a referral for diagnostic imaging means a $1,000 plane ride plus two days minimum. And a medivac transport costs approximately $100,000. However, providers need to balance that with the worst-case scenario risks for patients without ready access to higher-level care.

My self-doubt also is a challenge to overcome. Imposter syndrome is real! I work with a team of primary and emergency medicine providers with a huge scope of practice and experience. They do many things in clinical practice that I’m not trained for, and it helps to remind myself that I also have skills and training that they don’t.

What advice do you have for students considering this profession, in particular, those interested in working in rural areas?
Rural work is challenging and fun. I highly recommend it. You have to be comfortable working independently and know your resources. It’s important to consult with specialists who know the limitations of your situation. I preface calls to other providers with a brief explanation of where I am and, if they aren’t familiar with remote Alaska, I’m clear about what resources we have and what it will take to get to Anchorage or any higher level of care.

Healthy boundaries are essential for long-term survival. We’re always “on.” We’re each other’s backup.

You will see your patients in the grocery store and library.

You will be asked to do many things not in your job description. This happens no matter where you work, but in rural areas, often there just is no one else to do it. Figuring out what you can and cannot do is essential; allowing it to change over time also is important.

We have one long-term provider who recently expressed feeling burnt out—the call load and stress of caring for friends and neighbors had worn her down. We worked with her to minimize the draining parts of her work and keep the parts that “fill her bucket.”

Your support system also is essential. It can be lonely being a provider in a small town. Fostering relationships where you can relax and unwind helps to process the tough aspects of the job.

Anything else to add about your time at Jefferson?
The students and staff at the Midwifery Institute come from many different places and backgrounds, and they brought rich and fascinating perspectives to my schoolwork. During my time there, the faculty opened my mind to the many paths that midwives can successfully pursue. I don’t think I would have had the confidence to step up to my responsibilities if I didn’t have the example of the faculty and other students.