CHRONOLOGY OF THE ALASKA COMMUNITY HEALTH AIDE PROGRAM

Written by Walter Johnson, M.D., 1/14/92.

:: 1820 -- Manager of the Russian-American Company instructed to set up a hospital and pharmacy to teach Creoles and to give care in Russian-America.

:: 1940's -- Public Health Nurses employed by the Territorial Department of Health, instruct village midwives.

:: 1954 -- Report on Health in Alaska by Surgeon General Thomas Parran suggests use of village health workers.

:: 1954 -- Sanitation Aides selected, trained and employed by the Alaska Territorial Department of Health in villages in the Bethel area under the leadership of Amos J. Alter. Course development by Larry Parker who had written manuals for the U.S. Army. This program existed from 1954 to 1965, limited mostly to the Bethel area.

:: 1954 -- Villagers are trained and employed as "Chemotherapy Aides" to assist in isoniazid prophylaxis studies in 27 villages in the Bethel area directed by Dr. George Comstock and Mary Lou Heminghouse-Hansen, supported by Arctic Health Research Center, United States Public Health Service, Anchorage. Later, the chemotherapy aides supervised tuberculosis treatment with isoniazid and para-amino salicylic acid of tuberculosis patients awaiting beds in the hospital or on post-hospital treatment. Dr. A.B. Colyar was Director of the Arctic Health Research Center. Nurses employed by the Center trained and supervised the chemotherapy aides, including many village visits.

:: 1955 -- U.S. Public Health Service assumes responsibility for health care of Alaska Natives from the Bureau of Indian Affairs (BIA), July 1, 1955.

:: 1956 -- Letter to Dr. Theodore Hynson, Health Director of the Alaska Native Health Service headquartered in Juneau from Dr. Walter Johnson, staff physician at Bethel ANS Hospital proposing training of village medical aides.

:: 1956 -- Over 1,500 Alaska Natives hospitalized for tuberculosis in Alaska and Washington state. Several hundred "ambulatory" tuberculosis patients, pre and post hospitalization, receiving isoniazid and para-aminosalicylic acid in the villages under supervision of the village chemotherapy aides.

:: 1957 -- Chemotherapy medical aides in 27 Bethel regional villages give one year of isoniazid to the persons who received placebos in the earlier isoniazid prophylaxis trials.

:: 1964 -- The question of training and employing village medical aides was a major subject of discussion at the 1964 Service Unit Directors Conference held in Anchorage. A large number of federal and state workers representing many of the health professions participated. A recommendation was made, though not unanimous, to seek funds from the U.S. Congress to train and employ village medical aides. Pilot projects to do so in a limited way with existing resources was endorsed.

:: 1964 -- Pilot training of one or two weeks for volunteer or village-paid medical aides initiated by: Dr. Thomas Harrison at Kotzebue, Dr. Jay Keefer at Bethel, Dr. James Justice at Mt. Edgecumbe. Results of these projects used to bolster appeal by Alaska Native Health Service (ANHS) to U.S. Congress for funds.

:: 1969 -- Office of Economic Opportunity (OEO) provides funds and staff to augment training and support at Bethel and Nome. Local training programs are established at these two sites.

:: 1970 -- Yukon-Kuskokwim Health Corporation (YKHC) offers seven months of "Class B" health aide training to eight students at Bethel under the direction of Dr. William De'ak. Problems with this training reported by Dr. Robert Wainwright at a Community Health Aide Evaluation Committee meeting in Anchorage, included: aides entered with inadequate basic education, session was too long, and eight were too many students in the class.

:: 1971 -- Alaska Native Claims Settlement Act (ANCSA) passes U.S. Congress, December, 1971. The non-profit regional health corporations at Bethel and Nome established by OEO received added impetus. The other ten regions designated in ANCSA establish corporations in following years. Responsibility for supervision and pay of Community Health Aide's (CHA) moves from Alaska Native Health Service to existing and newly forming regional health corporations.

:: 1972 -- Three major training centers are being recognized and funded from federal sources: Anchorage, Bethel and Nome.

:: 1973 -- Alaska public health nurses' role in training and evaluation of CHA's work in villages is being formalized in the annual contract transferring ANHS funds to the state for public health nursing services to Alaska Natives.

:: 1973 -- Informal meetings by representatives from the three CHA training centers, Alaska Public Health Nursing and others interested in CHA training and support became formalized with the adoption of the group name: "The Planning and Advisory Committee for Health Aide Programs in Alaska" (PAC-HA-PA). This occurred at a meeting on the fifth floor of the Alaska Native Medical Center which was opened by Roy Huhndorf, Chief of the Community Health Aide Program (CHAP), chaired pro-tem by Dr. Russell Huffman, and Jeanette Norton, R.N., acting recorder. Represented at this meeting on the morning of September 10, 1973 were five from Norton Sound Health Corporation (NSHC), four from YKHC, three from CHAP - Anchorage, Kaarina Abel from ANHS, and Airlee Bruce, Alaska Public Health Nursing. The minutes of this meeting were in the "problem oriented" format which was then being introduced to record patient encounters. The criteria recommended for selecting the CHA are still in use almost two decades later. (Note: the last meeting of PAC-HA-PA was in Anchorage, October 4-5, 1979.)

:: 1974 -- Yukon-Kuskokwim contracts with the University of Alaska Kuskokwim Community College (KUCC) for CHA training. CHA instructors at Bethel join faculty of KUCC, John Rich, Director of the CHA training.

:: 1975 -- Norton Sound Health Corporation sponsored a meeting at Alyeska in May 1975, for the purpose of organizing a statewide CHA association. Two CHA's were invited from each health corporation. LaVonne Hendricks, R.N. P.H.N. organized the meeting and Paula Ayunerak was elected chairperson. By-laws were drawn up and adopted later. (Note: By-laws were revised on April 11, 1990.)

:: 1975 -- Alaska Federation of Natives (AFN) obtain grants from the Kellogg Foundation, and later from the Robert Wood Johnson Foundation to employ Rosaire Kennedy to evaluate the need for and assist in development of a uniform statewide CHA curriculum. Also addressed was the question of university credit, as NSHC had done earlier in approaching both Alaska Methodist University and the University of Alaska.

:: 1976 -- Guidelines for Primary Care in Alaska, a CHA manual for statewide use, was published by the U.S. Government Printing Office under ANHS auspices. The book was written by Joseph Whitaker, Health Education Training Officer, CHA Program Branch, with direction from the CHAP Manual Sub-Committee of PAC-HA-PA, and reviewed by Alaska specialists or health professionals in all fields covered. (Note: A revision was published in 1986.)

:: 1976-1984 -- Robert Wood Johnson Foundation grants supported the development and updating of the uniform statewide curriculum for CHA training with a move from AFN to the University of Alaska (UA). A position for a CHA curriculum coordinator and travel for CHA instructors from throughout the state to Academic Review Committee meetings are funded.

:: 1976? -- Village Drug Reference for use by CHA's in village clinics published by CHAP, Alaska Native Health Service. This widely accepted and much used resource was prepared by Joseph Whitaker, R. Ph., who also wrote the first statewide CHA manual. This manual is known as the Community Health Aide Manual (CHAM). The drug list had been carefully reviewed and accepted by the physicians who provided medical back-up to the CHA's. The availability of these medicines and other appropriate supplies improved the capability of the CHA's in the village setting.

:: 1976 -- University of Alaska Statewide Instructional Council recommended awarding credit for CHA curriculum as written by Rosaire Kennedy under guidance of an Academic Review Committee representing the CHA training centers, the health corporations and the health aides. The president of the University of Alaska approved this recommendation on February 6, 1976. A companion Instructor Guide was published. (Note: A revision of the Statewide CHA Curriculum was published in 1989 along with a Skills List [Chohaney and Johnson].)

:: 1976 -- Twenty additional CHA positions were approved by the U.S. Congress in the ANHS budget, increasing these from the original 185 positions in 157 villages to 205 positions in 185 villages. The health corporations, who now employ the health aides, divide and supplement some of these positions to increase the actual number of persons working as primary and alternative CHA's.

:: 1977 -- A Review and Evaluation of Health Aide Programs in Alaska was initiated by PAC-HA-PA. Dr. Wayne Myers, Director of the Alaska component of the Washington-Alaska-Montana-Idaho (WAMI) Medical Student Instructional Program at the University of Alaska Fairbanks sponsored the review. Visitation and review of the three major training programs at Anchorage, Bethel, and Nome was done by a three member team:
Dr. James R. Crook, Professor of Medical Science, WAMI
Dr. Philip O. Nice, Associate Dean, Dartmouth Medical School
Dr. Victor O. Sousa, Director, Allied Health Education, Gallup Indian Medical Center.
(Note: A second WAMI Review was done in 1983, including visits to several regional health corporations.)

:: 1984 -- State of Alaska provides money to Maniilaq Health Corporation for CHA training. In the ensuing years, these funds were extended to all health corporations. This support enhanced the efforts of the corporation CHAP directors and their staff in serving the CHA's. An example was the development of sub-regional centers by the Tanana Chiefs Conference (TCC) in the Interior.

:: 1985 -- CHAP directors of the regional health corporations organize and begin regular meetings.

:: 1986 -- Cheryl Roussain, at this time with the University of Alaska Fairbanks (UAF), obtained federal money through a Health Careers Opportunity Program grant. Seven students were admitted to a "Bridging Program" to recruit potential candidates from Community Health Aides statewide for progression into the MEDEX physician assistant educational program affiliated with the University of Washington. As of 1992, three of the seven students were back in Alaska working as physician assistants. Two of these students are planning on continuing their education as physician assistants, and another of this group is being interviewed this year for possible admission to MEDEX.

:: 1989 -- Additional funds provided by U.S. Congress to increase CHA salaries, expand capacity for training, especially the newly hired CHA's, and better fund many parts of the CHA program statewide. The document, CHAP in Crisis, prepared by Debra Caldera at the Yukon-Kuskokwim Health Corporation (YKHC) was instrumental in obtaining this additional support from the U.S. Congress which was intended to be on-going.

:: 1991-- Revision of the Alaska CHA Program Description designed and written by Amy Whitcomb and published by the Community Health Aide section of the Alaska Native Health Service, Anchorage, Alaska.

For more information about the history of the Community Health Aide Program see: The Alaska Health Aide Program: A Tradition of Helping Ourselves by Philip Nice, M.D. with Walter Johnson, M.D., 1998, distributed by the Institute for Circumpolar Health Studies.