BETHEL — The vision came in 2002, but key pieces didn't begin to fall into place until 12 years later. Now the biggest construction project in Southwest Alaska is underway, a complete redo of the regional hospital and associated clinics in the Bethel hub.

On Wednesday, leaders dedicated the $300 million Paul John Calricaraq Project, named for the late cultural leader from Toksook Bay with a built-in reference to the Yup'ik word for healthy living.

The Yukon-Kuskokwim Health Corp. hospital will be remade inside and out by the time the work is done in 2021. A three-story outpatient clinic will be added to the complex, plus 54 units of employee housing.

The design of the tribally run health facility is intended to evoke both the natural world and Alaska Native heritage, such as a lobby that will function like a gathering area and feature elements of an old-style qasgiq, or men's house, said Kent Crandall, the senior project manager with Arcadis, a design and consulting firm.

The project is being developed through the U.S. Indian Health Service's joint venture construction program, which means that YKHC had to find the construction money and that the federal government would provide dollars for dramatically increased staffing once it is built, said Dan Winkelman, YKHC chief executive officer.

He first heard about the program in 2002. He said he came to realize that it offered a clearer path to a new facility than if YKHC got in a long line behind other Native-run projects for full congressional construction funding.

In early 2015, YKHC was ranked No. 1 nationally for the joint venture program. The financing is complex and includes a $165 million U.S. Department of Agriculture loan, the largest loan of its type in USDA history, officials said. Just last month, YKHC closed on the final key piece, $102.5 million in bonds through the Alaska Municipal Bond Bank Authority, Winkelman said.

"Our financing is complete and our project is a go," said Winkelman.

Various bankers and funders were at Wednesday's dedication.

Dental and optometry clinics will be on site, not across busy Chief Eddie Hoffman Highway the way they are now, he said. Vehicles will be able to let patients out at the door. Now they must walk up long ramps to reach the front doors.

"This is a one in a lifetime kind of project," said Greg Stuckey of USDA's rural development program. "This is the one that is going to be the most phenomenal projects that we're all associated with."

YKHC slid in at the right time, Stuckey said, in a budget year when USDA had leftover money to spend. Now there is a backlog of qualified projects and money is drying up, he said.

Michael Lamb, representing both the municipal bond bank and the Alaska Industrial Development and Export Authority, said the project sounded cool from the first.

But he also had this early thought: "A $300 million health care project in Bethel, not going to happen." He said he is glad he was wrong.

Winkelman said he put together teams of staff and experts to move it along through various stages, which was key.

Construction began in 2016 when piles were installed. They needed to set in place over a cold winter, which happened, Crandall said.

Construction is really just beginning, he said. Steel is in Tacoma awaiting shipment. Job opportunities for locals await in Bethel, he said.

Wednesday's celebration was timed to coincide with YKHC's annual gathering of its 58 tribes.