Demand for Sunshine center services is growing

MAT-SU — The waiting room at Sunshine Community Health Center doesn't look much different than that of any other small medical practice.

Within reach of the chairs are toys for toddlers, and books and magazines for people of all ages. The walls are decorated with posters that discourage smoking and encourage healthy lifestyles, and there's a rack of educational leaflets offering advice on specific conditions and drug company propaganda.

Walk through the medical center's main building, which once held two small apartments, and you'll notice something different about this particular clinic — the people here don't just work alongside one another, but over the top of each other as well.

One work station has paperwork organizer trays on a shelf 6 1-2 feet off the floor. Desks are back-to-back and edge-to-edge and patient files are on space-saving shelves that roll aside on tracks to reveal more patient files.

The place appears well organized, as a medical practice should, but with the exception of the floor there isn't a single horizontal space that doesn't have something on it.

"We've become experts at managing space," said Richard Ambrose, Sunshine center's development director. Ambrose's office, like nearly every office space at the center, is both small and shared. It's a 4- by 10-foot space he splits with the center's bookkeeper.

As development director, Ambrose seeks funding sources for the nonprofit, hunting for available grants from various government and private donors, and then targeting the grants with descriptions of how the center will spend the money providing health care to the Upper Susitna Valley.

This year, the hunter is targeting big game— the nonprofit has set a $3- million goal for its capital improvements drive and plans to design and build a 10,000-square-foot permanent home for Sunshine Community Health Center.

The health center is also a window into the lives of the people of the area. Located at Mile 4.4 Talkeetna Spur Road, it serves people from Talkeetna, Trapper Creek, Chase, Petersville, and Sunshine itself, named for a flag stop on the Alaska Railroad.

It's a place where billboards proudly announce lots for sale in subdivided, but mostly roadless, forest.

The area had slow, steady population growth for most of the last century. Talkeetna reported 70 residents in 1920 when the railroad was nearing completion, and 106 in 1950.

It wasn't until 1971, when the Parks Highway brought road traffic between Anchorage and Fairbanks through the neighborhood that the area saw much change. But in the mid-'90s the railroad built a new passenger depot just south of downtown Talkeetna.

By then, the railroad was carrying nearly half a million passengers each summer and things were changing a bit faster. Two new hotels were constructed, one by Cook Inlet Region Inc. on the Talkeetna Spur Road, and one by Princess Cruises and Tours about an hour-long bus ride away.

After expansions, the two hotels had 440 guest rooms between them this year.

Enough people visit Talkeetna to crowd streets even on weekdays during the summer tourist peak. An ice cream cone or hot dog can be a 30-minute wait. The people who live there are often so busy serving Outsiders they can barely take time to serve each other.

But at the heath center, four physician assistants and a staff of clerical workers and administrators serve up health programs and primary health care much like a general practice physician's office would if it were grafted onto a community clinic.

"We've struggled really hard to bring as many services as possible up here, and we've basically spent all of our time and money doing that," Ambrose said. "We haven't had the time or personnel to focus on any kind of capital drive."

Founded in 1986, the Sunshine Center began with seed money from the state of Alaska, and just one physician assistant. The result of its progress and the area's growing population is four small buildings brimming with activity.

The center provides a raft of health-care services to people in an area of 12,250 square miles, including X-rays, lab work, substance-abuse counseling, mental-health counseling, in-home health care, a public-health nurse, and specialty clinics. And the client list keeps growing.

The place is busy without much effort at marketing, the clinic's yellow pages ad is a modest one column inch, text-only listing.

Ambrose arrived eight years ago with his wife, Jessica Stevens, a physician assistant who also works as the center's medical director. Stevens wasn't available for an interview, but did pause to say hello.

"She's especially maxxed right now, but she's always been a busy person," Ambrose said. In 2000, the number of patients at the center increased by 40 percent over 1999, according to the clinic's staff.

From the outside the clinic appears to be an improvised office plaza. The buildings are situated on a gravel parking lot at the front end of a wooded lot. The duplex came with two outbuildings, each the size of a two- car garage, and they serve as the center's administrative offices, and counseling center.

The newest building is a 56- by 12-foot trailer built in Palmer by a company called Arctic Structures. It's a building of the sort that replaced the Quonset hut as Alaska's signature architecture — the structures are often used as classrooms at space- and cash-strapped schools.

That's where Ambrose works corresponding with would-be patrons, the trailer also has offices for two program directors and a one-chair dental clinic. There is enough demand for a second chair, according to Ambrose, but no place to put it at the moment.

Ambrose, the board of directors, and the staff have landed federal funds for even more programs which they haven't been able to take advantage of for lack of space.

"We're at the edge," Ambrose said, "and that's what's driving the urgency of our capital campaign."

The good news is that the clinic is at the edge of an 11-acre parcel, which it owns. The real estate equity can serve as the clinic's matching share for some grants, according to Ambrose. He also said it's not likely the clinic will ever liquidate the land for cash.

"The board has decided that this is a good place for a clinic," he said.

This is where health care is making a stand in the Upper Susitna Valley. The clinic is already networked with both Valley Hospital Association and Providence Alaska Medical Center. Doctors who practice farther south pay regular visits to the clinic, just not every day.

The population in the Sunshine center's service area is currently about 5,000 people. Industrial tourism is driving an economy that is bringing that number up, and Ambrose pointed out that population growth isn't the only effect the industry has on Sunshine center.

Last summer, a flu virus spread through a tourist coach and an entire bus load of people was diverted to the clinic. It seems like a small, almost funny event, but in an area where the nearest emergency room is a chopper flight away it was a reminder that much of Alaska's health care needs are just starting to be met.

"We're hoping that the major tour operators will help contribute, and support the social services which they are driving the need for," Ambrose said.