In 2013, we celebrated 40 years of health care tribal management and operation for the inhabitants from Bristol Bay. But the background of health care organized within Bristol Bay is much longer. Before the arrival of Russians from 1818 onwards, Bristol Bay’s main health-care provider included known as the “angalkuk” or shaman. Doctors first began to enter Bristol Bay when the canneries were opened in 1885. In 1904, Dr. Joseph Herman Romig opened an emergency medical center in Carmel. The hospital was still operating until 1913, when the Dr. Linus Hiram French relocated the hospital to Kanakanak and acquired one of two schools. In 2013, Kanakanak Hospital marked 100 years of health care for residents in Bristol Bay.