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Walter Johnson, M.D.

H2004-17-06,
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WalterJohnson grew up in Nebraska, came to Alaska in 1942, lived in Wiseman, attended the University of Alaska Fairbanks, went to medical school at the University of Nebraska, and practiced medicine in Bethel and Anchorage. In the interview, he talks about establishing the Community Health Aide Program, training health aides, integrating health aides into the western health care system, communication systems used, curriculum development, the program as a model for rural health care, and what he sees for the future. The interview took place at his kitchen table on a warm summer day with a view of Kachemak Bay. After the interview, Walter led a tour of his apple and cherry orchard and vegetable and flower gardens.

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Walter Johnson, M.D. talks with Karen Brewster on July 8, 2005 at his home in Homer, Alaska about...

1) His personal and educational background, and coming to Alaska.
birthdate\ birthplace\ Nebraska\ Alaska -- coming to\ University of Nebraska\ bicycle trip\ Seattle\ student -- University of Alaska Fairbanks\ students -- number of\ Army\ World War II\ Ladd Field -- hospital\ Wiseman\ Brooks Range\ English, Bill\ store\ Road Commission\ job -- heavy equipment operator\ medical training\ University of Nebraska Medical School\ Alaska -- return to practice\ hospital -- Bethel\ Jackson, Dr. Harriet\ doctors -- number of\ field trips\ Kuskokwim River\ Yukon River\ villages -- lack of doctor\ Yukon health boat\ tuberculosis -- treatment of\ village -- contact\ BIA teacher -- contact with\ diseases -- village\ disease -- pneumonia\ disease -- ear\ teacher training -- Bethel\ shot -- penicillin\ becoming a doctor -- motivation\ pre-med student -- University of Alaska Fairbanks\ Brafladt, Richard\ Nome\ courses -- limited\ majors\ anthropology\ biology\ medicine -- interest in\ military service -- hospital laboratory\ Wiseman -- year round\ summer -- length of\ school -- late start\ remote care\ medical treatment -- limited\ money -- lack of\ medical resources -- lack of|

2) His inspiration for recommending development of a community health aide program.
Bethel\ villages -- visiting\ Lower Yukon\ Emmonak\ Alakanuk\ village stay -- length of\ local person -- help from\ school -- lack of\ Guy, Betty\ Kwethluk\ Johnson, Pearlie and Axel\ medical care -- local people\ local people -- training\ Wiseman\ Mrs. English\ Inupiaq\ local people -- observation skills\ field trip -- return from\ Alaska Native Service -- headquarters\ Juneau\ local training -- proposal\ Hynson, Dr. Ted\ medical community -- acceptance\ US Public Health Service\ Alaska Native Health Service\ training -- residency\ military service\ Boston\ training -- internal medicine\ Anchorage\ job -- chief of medicine|

3) Meeting of the Indian Health Service area directors in Anchorage as a key event in the evolution of the health aide program's development.
health aide program -- history of\ Indian Health Service\ meeting\ Anchorage\ area service unit directors\ physicians\ service units -- responsibilities for\ community -- involvement of\ letter -- area director\ Wherrit, Dr. Holman\ local people -- training\ public health nurses\ nurses -- itinerant\ villages -- medical problems\ medical care -- health aide\ training -- level of\ Hope, John\ Bruce, Arlie\ public health nursing program -- director\ budget -- lack of\ service unit directors -- develop own program\ villages -- training\ training -- report\ Justice, James\ Sitka\ Keefer, Jay\ Bethel\ Park, Gloria\ Anchorage\ Harrison, Tom\ Kotzebue\ Alaska Medicine -- publication\ Johnson, Dr. Emery\ United States Congress\ budget -- approval\ health aide program -- beginning of\ health aides -- name origin\ medical aides|

4) Pilot programs that were established to test the idea of having community health aides, the early training programs, and how things have changed.
pilot programs\ funds -- availability\ training centers\ Nome\ Bethel\ Anchorage\ Indian Health Service\ Johnson, President Lyndon\ Office of Economic Opportunity\ training program\ training -- length of\ health aides -- women\ training -- difficulties\ Ayunerak, Paula\ Alakanuk\ book -- The Alaska Health Aide Program, A Tradition of Helping Ourselves \ Nice, Dr. Philip\ health aides -- number of\ villages -- number of\ positions -- changes in\ health aides -- selection\ trainers -- physician's assistants\ trainers -- nurse practitioners\ trainers -- physicians\ trainers -- nutritionists\ training -- challenges\ experience -- clinical\ job -- medical (clinical) director\ Anchorage\ health aide -- training\ patients -- contact with\ communication\ manual\ Whitaker, Dr. Joseph\ health aide program -- medical director\ teaching|

5) Other aspects of training health aides, and key people involved in the development of the health aide program.
health aide -- training\ training -- funding\ University of Alaska\ Kellogg Foundation\ Kennedy, Rosaire\ Robert Wood Johnson Foundation\ grants\ health aide -- curriculum\ College of Rural Education\ Reeves, Winnie\ Kotzebue\ health aide -- trainer\ health aide -- training\ training -- expansion of\ Community Health Practitioner -- degree\ health aide program -- administration\ Anchorage\ Huhndorf, Roy\ CIRI Native Corporation\ [Sosoff], Jim\ Burgess, Rob\ Community Health Aide Manual -- revision\ Curda, Linda\ Bethel\ Academic Review Committee\ mentors|

6) Health aides he remembers working with through the years.
health aide -- relationship/ doctors -- relationship/ Anderson (Tobuk), Hannah\ Fairbanks\ Koyukuk\ Cook, Alma\ Hydaburg\ health corporation -- SEARHC\ Wolff, Trudy\ Johnson, Barbara\ Alaska Native Sisterhood\ Smith, Joyce -- Ouzinkie\ Jensen, Marge -- Pedro Bay\ Nicolai, Wassillie\ Tutiakoff, Phil -- Unalaska\ Ashenfelter, Willa -- White Mountain\ Robert Wood Johnson Foundation -- director\ President Kennedy -- physician\ cases -- discussion about\ diagnosis -- difficult\ Curtis, Esther\ Kotzebue\ Honeycutt, Irma\ Keets, Della\ traditional medicine\ Ambrose, Rose\ Huslia|

7) Mixing of western medicine and traditional healers.
medicine -- western\ medicine -- traditional\ medical practices -- mixing\ traditional healers\ physical exam\ Kotzebue\ traditional medicine -- organ manipulation\ health aides -- use of\ conflict -- lack of\ traditional medicine -- failure\ disease -- boil\ patient -- Nelson Island\ Bethel Hospital\ boil -- treatment of\ bird feathers\ septicemia\ circulation -- effect on\ shock\ patient -- death\ traditional medicine -- benefits of|

8) Relationship between health aides and doctors, and a particular case of local ingenuity in treatment of medical problems.
health aides -- friendships with\ Emmonak\ Johnson, Jake\ Johnson, Pearlie and Axel\ clinic -- naming of\ babies -- delivery of\ health care -- methods\ methods -- innovative\ disease -- urinary obstruction\ radio -- lack of\ hospital -- no contact with\ school -- lack of\ Kwiguk\ St. Lawrence Island\ treatment\ catheter -- willow\ health aides -- contact with\ meeting\ Anchorage\ Charlie, Edna\ health aides -- confidence in|

9) Challenges in training health aides.
health aide -- training\ challenges\ uniformity\ repetition -- avoidance\ Robert Wood Johnson Foundation\ grant\ CHAP liaison position\ Academic Review Committee\ curriculum -- development\ University of Alaska\ training programs -- directors\ Kennedy, Rosaire\ Nome\ Reeves, Winnie\ Kotzebue\ Curda, Linda\ Bethel\ trainers -- village trips\ report -- health aides progress\ training -- schedule\ training -- content\ training -- patient encounter\ training -- treatment\ training -- clinical\ child development\ nutrition\ health maintenance\ training -- additional\ training -- role in\ teaching -- clinical\ Alaska Native Medical Center\ health aide program -- medical director\ Anchorage\ Huhndorf, Roy\ [Sosoff], Jim\ lectures\ retirement\ US Public Health Service\ job -- CHAP liaison\ University of Alaska\ Chohaney, Marilyn\ Bethel\ curriculum -- uniformity\ curriculum -- publication|

10) Use of standard English language terms in teaching and in the manual for health aides.
job -- medical director\ hospital\ health aide -- interaction with\ communication\ ward rounds\ lectures\ language\ medical terminology\ Latin\ Greek\ language -- standardization\ language -- consistency\ chest -- examination of\ breath sounds -- terms\ organs -- palpatation of\ joint -- examination\ medical -- terms used\ manual -- revisions\ language -- medical jargon\ language -- complicated\ Curda, Linda\ manual -- success of|

11) Communication with health aides in the villages.
health aides -- communication\ radio -- single side band\ radio -- school\ radio -- store\ radio -- two way broadcast\ radio -- training tool\ Alaska Native Service -- regional units\ Anchorage\ Bethel\ Lower Yukon River\ Kuskokwim River\ Tanana\ Kotzebue\ telephones -- introduction of\ telemedicine\ health aide -- training\ Lundgren, Kari\ Sitka\ telemedicine -- development of\ clinics -- changes in\ communication -- improvements in\ communication -- telephone\ diagnosis\ health aides -- selection of\ training -- period of\ health aide -- help to physician\ communication -- importance of\ diagnosis -- based on description|

12) Relationship between doctors and health aides and background information about the program.
health aide\ doctor\ health care -- rural\ health aide program -- successful model\ China\ Mexico\ Tunisia, Africa\ tuberculosis -- control of\ health aides -- clear roles\ radio -- call time\ doctor and health aide -- interaction\ training -- requirement\ Nice, Philip, Dr. -- pathologist\ University of New England\ Bethel\ University of Washington\ book -- The Alaska Health Aide Program, A Tradition of Helping Ourselves \ health aide program -- history\ CHAP -- chronology\ book -- Health Aide in Crisis \ Academic Review Committee\ Curda, Linda\ Bethel|

13) The medical community's reaction to the health aide program.
health aide program -- support for\ doctors\ public health nurses\ health aides\ health care\ medical care -- delivery of\ health aides -- confidence in\ local people -- skills of\ Indian Health Service, Alaska -- Deputy Director\ Bruce, Arlie\ Alaska Medical Association -- support from\ Alaska Native Medical Center\ Anchorage\ medicine -- government\ criticism\ dental aides -- opposition to\ Alaska Dental Association\ National Dental Association|

14) The future of the health aide program.
health aide program -- future\ health aide -- role of\ role -- changes in\ clinics -- new\ nurse practitioners\ telemedicine\ technology -- development of\ practice of medicine --changes in\ health -- responsibility for\ behavior -- healthy\ disease -- villages\ disease -- predominance of\ diabetes\ obesity\ hypertension\ exercise\ subsistence lifestyle\ healthy|

15) Management of the health aide program, and medical services Walter receives.
health care -- management\ regional health corporation\ public health service\ doctor -- medical corps\ doctor -- oral examination\ Indian Health Service -- cooperative\ Johnson, Dr. Emery\ Indian Health Service, Washington -- director\ medicine -- alternative\ computers -- efficiency of\ medical care -- Homer\ hospital\ Seldovia Tribal Council Clinic\ nurse practitioner\ medical care -- Anchorage\ Primary Care Center|