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Beverly Hugo, Part 2
Beverly Hugo

This is the continuation of an interview with Beverly Hugo on March 15, 2005 by Karen Brewster at the Bertha Moses Patient Hostel in Fairbanks, Alaska when Beverly was visiting from her home in Barrow, Alaska. In this second part of a three part interview, Beverly talks about providing health care for Alaska Native people, becoming a physician's assistant, health aide training, and challenges of rural health care and being a community health aide.

Digital Asset Information

Archive #: Oral History 2004-17-05_PT.2

Project: Community Health Aide Program Project Jukebox
Date of Interview: Mar 15, 2005
Narrator(s): Beverly Hugo
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
Location of Interview:
Funding Partners:
U.S. Department of Health and Human Services, Health Resources and Services Administration, University of Alaska Health Programs
Alternate Transcripts
There is no alternate transcript for this interview.
Slideshow
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Sections

Health care for Alaskan Natives.

Meeting Dr. Peter Marshall and deciding to become a Physician's Assistant.

Continuing education to become a Physician's Assistant.

Trying to set up a Community Health Aide Program (CHAP) training center in Barrow.

Why the Barrow CHAP training center didn't open.

A disconnection between the health care providers and villages on the North Slope.

Why she stayed with the CHAP program for so long.

Other challenging projects.

Being the only health aide in a village and the jobs she had to do.

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After clicking play, click a section of the transcript to navigate the audio or video clip.

Transcript

KAREN:  You were just talking about TCC and care coming to Fairbanks.  How does it work that Anaktuvuk, which is part of the North Slope Borough, gets medical care here in Fairbanks with TCC?   BEVERLY:  Well, I guess when they did the divvying up of the villages and Anaktuvuk Pass was closer to Tanana than to Barrow.  And then there was regular flights that were Anaktuvuk to Tanana.  And there was only chartered flights from Anaktuvuk Pass to Barrow.  So those -- those people that made that decision, you know, it was cheaper, cost effective, to go Tanana for Anaktuvuk Pass folks, although they are Iñupiaq, they went to Tanana for their care.  And Indian Health Service, you know, is pretty much -- if you're Alaskan Native, they just kind of lump us all together.  So it just was cost effective then for Indian Health Service to serve Anaktuvuk, as well, out of Tanana.  And it just carried over when they moved to Fairbanks that they were -- it was a paternalistic decision, you know, then, through the Indian Health Service, and although they are a part of the North Slope Borough, but with ANCSA, you know, it says that they are mandated to provide health care.  It don't say whether you're Iñupiaq or Indian or Athabaskan or Iñuit, it just says Alaska Native Health Services, and that's where it has fallen in.  And I think it's too -- you know, it's the best thing.  Yeah.  We're able to get good care here in -- Anaktuvuk folks going here to Fairbanks for care.  I've always felt that we provided very good care, along with the doctors here.  I got to know the doctors pretty well, you know.  The ER doc, Dr. Marshall.  Peter Marshall.  He was wonderful.  You know, he was there in FMH for five years, and I got to know him.  And he's the one that found me.  I probably would be still health aiding had I not been found by Dr. Marshall.  He was the ER doc and --

BEVERLY: I remember my baby girl, she was seven months old, born June 21 of '79.  Anyway, my husband had been working on fox pelts inside the house.  You know, we had a 24-by-24 house, and two bedroom, and I mean, unlike our first dwelling of 12-by-16 multipurpose, we had a nice two-bedroom house and a lot of room.  So my husband was working on fox pelts.  You know how you auk them, you know, you start cutting through the mouth and you just kind of slip off the fox pelt off the -- without making no cuts, you know.  Just through the mouth.  Auk.  We call it auk, (Native word).  Yeah.  Anyway, we were doing that, and then our little baby girl, she -- you know, I guess she was allergic to that -- we found out later she was allergic to dogs, cats, and she couldn't have any raw furs.  Poor Eskimo girl had to have tanned fur, you know.   Anyway, we found out that she was allergic to the -- the -- KAREN:  The fur. BEVERLY:  -- the fur or the dander or something of raw furs.  Because we were drying them, you know how we have these little drying racks on fox pelts, we were drying them in the house, and she was severely -- she started off with this patch on her arm.  It was weird, you know, they called it a herald patch.  It started coming out through there.  It got thickened and crusted and start to ooze.  And -- and then I tried to tell the doctors, you know, to be objective with your own family is a little bit harder.  You know, I found that I didn't want to be -- I was always so cautious to be objective with your own -- own family, you know.  That's the part about you'll have family no matter what, you know, as you're a health aide, you know, and I didn't want to be overly -- and I would try to report to the doctor that, well, she started off with this patch on her shoulder, and now it seems to be spreading, you know.  Anyway, it just kept getting worse.  And I did try to tell the doctor, but the doctor just wasn't, you know, seeing it.  And anyway, I -- well, I told him that, well, it's just spreading, you know.  I don't think I'll -- I'm going to bring her in.  Because I think, you know, your number one defense is your skin.  You know.  For -- for immunity or immunity is -- your skin needs to be intact and -- but her skin was starting to get all these lesions all over.  Just spreading.  And -- and then I brought her in.  I did wait, you know.  We did try some antibiotics and antibiotic ointment and -- but it just wasn't, you know, taking -- taking care of it, so I brought the baby in.  And then the doctor said, how come I didn't tell him it was so bad?  Well, I did try.  You know.  We ended up in the hospital there for two weeks, in isolation.  She had severe eczema with secondary strep and staph infection, and we were just isolated and only I could -- and the nurses, you know, would.  And she had to have IV.  Anyway, I was in there waiting, I stayed with her.  I breast fed my babies, so I always -- you know, that's one sure way of getting your meals in your room paid for if you're a breast feeding mom, they have to.  That's one of the beni's of being a breast -- breast-feeding mom is they will feed you well and they will give you a nice place to stay.  Anyway, I stayed with my daughter in the room.  And anyway, I was just reading while she was resting, I think, and this doctor came in, and I never met Dr. Marshall before and I didn't know what he looked like.  We just know each other by voice, you know.  Anyway, this doctor -- I mean, this person came to my daughter's room.  You need -- here I'm sitting on the couch, you know.  Little cot, you know, little chair.  And he just goes right past me and he says he's looking for Mrs. Hugo.  And I was trying to make myself look -- I'm Mrs. Hugo.  And then he says, you're young, you know.  He kind of scared me because I did not -- I never met him or thought I never met him, you know.  Anyway, he says, you're young.  And then I said, who might you be?  You know.  And he says, he's Dr. Marshall.  He's the patient -- he said he's always receiving my patients in the emergency room.  And he said, you're young.  And I said, yeah.  I'm young, yeah.  What about -- I mean, what is -- he said -- and he told me that all of the -- I always help him out so much when I write down all the past medical, or whatever I knew of -- of the individual, I would write down that might be pertinent and helpful and -- to the doctor.  Because often a lot of our elders don't speak Iñupiaq. KAREN:  Don't speak English. BEVERLY:  Yeah, I mean don't speak English.  Yeah, thank you, Karen.  And so I would -- you know, I'm able to speak in our language and I've never had any problems getting it across to a doctor or a provider that whatever they will share with me.  So anyway, that time the doctor found out that I was young.  And he said -- and that's when he introduced me to a PA.  He provided me material about PAs, you know, what they do.  And he said I already do the work of a PA.  And then I said, what's a PA, you know.  And he said, well, they are physician's assistants, you know.  And he said, it's a natural thing for me to just go into if I want to do more.

BEVERLY: I had gone through Anchorage area CHAP, and I've gone through all that they had offered, you know.  I did Session 1, 2, and 3, and I did emergency childbirth, EMT 1, EMT 2, EMT 3.  And then I had death and dying -- grief, death, and dying, with (Elisabeth) Kubler Ross.  And just, you know, there was just not much more.  And I was wanting to learn more.  So this is when Dr. Marshall introduced me to that.  So I started to, you know, inquire and, well, I would have to leave Anaktuvuk Pass, you know, and those are some of the things that I have -- my husband and I have to weigh.  And -- and -- but I wasn't sure, you know.  I had done well in school when I was going to school here.  Right after high school, I had done quite well.  But when I got married, I moved to his village and I didn't go back to school.  So I felt like I needed to go back to school.  So I registered and entered the University of Alaska Fairbanks.  And, you know, try and see if I'm still able to, you know, keep up with the course work, and lo and behold, I found out I can, you know.  And that's when -- but I wanted to just -- I always wanted to do my Iñupiaq language degree, and that's when I started doing the course work then.  But I had interviewed April of '83 for the PA program.  And I was well into almost 127 credits from UAF for my language arts degree in the Iñupiaq language.  And -- but then when I interviewed in April for the PA program, I got accepted.  So there was 200 applicants and I was one of their top contenders.  So I went fall of '83 to University of Washington with Seattle, with my husband and my two children.  And I -- it was on a quarter system.  It was very didactic.  First nine months was didactic, human anatomy and lots of pharmacology and just -- I enjoyed it, you know.  And then I had nine months of clinical.  And I did my clinical in part of it, I think, three months of it in the Seattle Indian Health Board.  And then after that, I came back to Alaska to Fairbanks.  We drove from Seattle to here and I did the rest of my clinical clerkship at Chief Andrew Isaac, nine months.  Then I graduated March 21 of '85 from the University of Washington as a physician's assistant.  And I went back to Anaktuvuk and -- and in the -- in the meantime, I had had a -- my son Clyde, he was just a -- he was born January of '87.   And it was pretty hard to be sole provider and be a mother.  And I did that for about -- Clyde was seven months old when I -- the school district hired me to be school health service provider for the Barrow schools.  Dr. Holloway, Shirley Holloway, and Patsy Aamodt, our associate superintendent, had hired me.  I interviewed, and you know, I didn't know that I was going to get it, but you know, I longed to be home with my parents because they were getting up in their age and starting to have a lot of health problems.  And I had been living in my husband's village for 14 years and I was longing to be with my family in Barrow.  So that was an opportunity for me to be home and also contribute to our community there.  Yeah.  And that was a good move, you know.  I enjoyed taking care of all of Barrow's kids.  You see three year olds all the way to 12th grade.  I had to take care of Barrow kids there.  And I did that for, I think, seven years.  And then I went and worked in the -- they needed a CHAP director, and I interviewed for it and I got it.

BEVERLY: I worked as a CHAP director for maybe about 16 months.  And I -- we also applied for a grant.  I've always dreamed about having our Community Health Aide training center in Barrow because I felt like each regions have it, and there was money through Alaska Native Health Board that for any region that wanted to try and pursue that, to do an RFP.  And by golly, I wanted to try.  And, you know, I was -- it took a lot of planning and lots of research and -- and I had to work with -- there was a lot of collaboration from the Ilisaġvik College at that time, it had recently opened.  And Dr. Edna MacLean there at the college was, you know, somebody I know.  And she knew me, and so she helped us secure a building, Building 60, for a future Community Health Aide training center there.  And everything was all in place.  And all I needed to do was hire staff.  And I had a plan to make well-rounded health aides.  And I've always felt like the -- the component that was missing at the Anchorage area CHAP was the cultural and family systems program that -- and it's community based.  They needed to -- I felt like our health aides could use the family systems training that UAF already has, you know, through rural health.  I thought this would also help them deal with a lot of the social issues.  And -- in the cultural, you know how we have to try to maintain our cultural identity and -- and still, you know, be progressive and to walk in both worlds, you needed both.  And I always felt that the family systems and the adult roots and wings and training of trainers and the six hours of community development were what we needed for well-rounded health aides because at this time and era, there was such a need for -- there was so many social ills, you know in the Native community that they weren't transitioning well, or adapting well with change because the change from rural subsistence life-style to cash economy was like, you know, you have to have marketable skills, you have to.  And a lot of our -- and then it required our -- our youth to go on to universities, you know, or to training -- training places and there was a hard time transitioning, you know.  Because all of the Western world schools are at a different -- there's differences, you know.  So and then we have our ways, our ways of learning, our ways of teaching, that were often contrary, you know.  But we have to -- and I always tried to find ways of, you know, making learning fun and to make it mutual, and that we can learn from each other.  It shouldn't just be one-sided.  And, you know, in order to have a better and greater world, we have to work together, we have to live together, we have to find answers together, you know, for the betterment of all Alaskans, you know.  But still, to keep and maintain our cultural identity because I believe our Creator made us Iñupiaq or Athabascan or Gwich'n, or you know, there is -- he made us that, you know.  And had He made us, you know, Anglos or Taniks, you know, that's -- you know.  But I think we should be who we are.

KAREN:  So when did you stop working at the health aide program?  BEVERLY:  They laterally transferred me to have a CHAP training center focus, so I did the grant, the RFP, and -- and did all of the course development.  I thought, you know, for a well-rounded health aide, we need family systems course, EMT 1 course, and Session 1, four weeks.  But this was all accreditation through the University of Alaska Rural Health.  You know, these are -- would be helpful in attaining an associates, you know, for those that want to be on that track, you know.  Because there's some people that, you know, they just want to go to training in four weeks and that's the end.  You know.  And that's fine.  But there's some that are -- they are maybe thinking of getting an associates or bachelor of arts or, you know, and it helps.  And these little increments of training would be, you know, an opportunity.  Not too long because one of the things as being a Native person is, you know, we have our hunting, our seasonal food gathering and hunting that goes on in our regions.  That's very important, you know, because, you know, having our Native foods is -- is -- there's nothing like having your own Native food available.  And you have to go hunt, you know, within the seasons of migration or -- and we do our food gathering, and those are very important, you know, for -- to be sustainable.  You know.  Because we just can't buy all of -- can't buy all store-bought food, you know.  Uh-hum.  Because we are finding out that all store-bought food is not very healthy, or at least processed foods, and we're finding that Native foods are healthier.  And healthier not just nutritionally, but physically we exercise, we think about what we're going to catch, and how we're going to catch them, you know.  I mean, lots of thought, lots of process.  And then how you get them, you know, or hunt them.  So...  KAREN:  So did you get the training center set up?  BEVERLY:  Yes, I did.  I got it all set up and I just needed to hire staff.  And then, you know, the North Slope region is very politically -- politics plays a big role there.  And there was a change of administration, from a new mayor, and -- and somehow this new mayor felt that having a Community Health Aide training center was -- I mean, he -- I think he thought that, you know, it couldn't be done.  And -- but I was willing to give it all I got and, I mean, go for it, you know.  We got the funding, we got 235,000 for first year, and it would continue for three years as -- as a Community Health Aide training center.  We never got to test that, you know.  So the new mayor decided to just close it down and return the money.  So I was devastated by that, you know, because I believe in our people, you know.  We have to believe in our people.  We have to have our own local indigenous people, you know, take -- you know, take part in that.  You know, in caring for ourselves and our -- our fellow Iñupiaq that is there.  But somehow, some people are -- are dependent on, you know, that other people like other nurses, non-Native nurses or non-Native doctors have answers for us, but I believe that -- you know, that's why TCC has done well is because they have invested in their own indigenous people.  And I was trying to try that up North, and it -- you know, it didn't go well.  KAREN:  That's too bad.  BEVERLY:  Yeah, it is.  That's the tragic part.  And here, our health aide program, I mean, it's in dire straits, you know.  We have hardly any local Iñupiaq staff that are working there and that are -- and the thing about our CHAP directors, you know, our CHAP program staff, there are non-Natives there, they are TDYs that are from Tennessee or from New Jersey or, you know, that are just there for a little bit.  They have no vested interest.  They are not committed as, you know -- and they are just there for a while.  And they just come and they go.  That's the sad part about the care up North is that it's just so -- you know, there's like -- it's just still going on.  They perpetuate.  KAREN:  But the people who were the health aides in the villages, are they people from the villages or are they these non-Natives you're talking about?  BEVERLY:  In the North Slope, we have -- in the other, like Nuiqsut and Wainwright and Atqasuk, Point Lay, they just have TDYs that -- temporary duty health aides, itinerant health aides.  That's one way to provide care, but it's just itinerants, you know.  KAREN:  And they are usually non-Native outsiders is what you're saying?  BEVERLY:  Non-Iñupiaq.  KAREN:  Non-Iñupiaq. BEVERLY:  Or non-Native.  And that's what they are doing up North is --

KAREN:  Why do you think that local Iñupiaq people aren't becoming health aides?  BEVERLY:  Well, up North, we've had coordinator instructors that, you know, they are -- they are non-Native, for one thing, and they have this paternalistic infrastructure that you have answers for them instead of the answers are within the community.  This mentality of being dependent on the health care system is -- is very -- you know, it's -- it's not healthy.  We have to take ownership, you have to have stakeholders in the community that want to change things.  And we've had this administration that's so paternalistic and they want job security, they want control, so they -- you know, they make things difficult for our local people to try to -- I mean, they have no understanding when they want to go seasonally to go fall whaling or Niġliaq - geese hunting, and they say that you can't leave now, you know, or they say, I mean, like when caribou is migrating.  I mean, we close clinic and say, we're open only for emergencies because we have to harvest our caribou, you know.  Or we have to harvest our niġliq (geese).  Or we have to harvest our whales.  And these administrators have no understanding of that subsistence way of life that they say that, oh, she's abandoned her job, you know.  Or they'll say no so many times that, you know, to get food for the winter is like, it ain't worth the paycheck from a health aide, you know.  It's not equal to that.  So a lot of -- there's just miscommunication, I think, or lack of cultural, you know, competence or lack of cultural sensitivity, I think is what they like to use.  But I think they just lack that.  And -- and then our people will not put up with that, you know.  They -- they've already been through, seemed like, hell and back from our old BIA school days.  And, you know, how they try to drive the language out of us and try to make us -- school was so punitive, you know, for speaking our Native language.  And those things, you know, you have to have healing opportunities for those.  KAREN:  It's interesting, it seems like the health aide program is touted as, you know, it's so locally based and -- BEVERLY:  Yeah.  KAREN:  -- and people from the community are involved -- BEVERLY:  Uh-hum (affirmative).  KAREN:  -- and that it would provide that ownership -- BEVERLY:  Right. KAREN:  -- that you're talking about, but it sounds like on the North Slope, that hasn't happened?  BEVERLY:  It hasn't happened.  And -- and it's that I believe the paternalistic -- I just -- you know, having answers for the community, or the administrators that they get or they lack cultural vision or how can we, you know, provide good supervision.  And then the sad thing about Barrow is they have temporary doctors there.  I think in a given year one time, we had over 200 TDY doctors, so there's lack of continuity, you know, in providers.  TCC has been fortunate to have Dr. Bill James for over 30 some years, or Dr. Elterman over 20 some years, you know.  I mean, people that have made vested interests or commitments to be there.  I mean, in Barrow, it's just come and go.  They want to pay their -- their loans from RU-OP (phonetic) or rural.  KAREN:  What was it that made you stay committed in doing health aide work for so long?  BEVERLY:  Well, my goal was -- after I became a PA, I was the first Iñupiaq PA, and my goal was to have five PAs in the North Slope.  And I thought, with five PAs in the North Slope, we may get somewhere.  Because in order to change this bureaucracy that was so -- you know, just so -- they just want to be like that.  The administrators want to just keep telling us this, this, this to Native communities, you know.  Oh, you can't do this or you can't do that, you know.  I mean, what can we do, you know?  It was kind of like -- like that, you know.  And we have to arise.  And so my goal was five PAs.  I was the first, then Rosemary Attungowrak from Nuiqsut, then Margie Smith, and then we had Leanne Mercer, she was a Public Health nurse.  And then Dennis -- we had the PHN was non-Native, and the other one was Dennis Kunkel.  He was a male nurse that was -- we had five mid-level practitioners, but as soon as -- we had three Native and we were trying to make change, you know, but Leanne was part of that old system and -- and so was Dennis, and they just didn't see it like we saw it.  You know.  We wanted self-determination and self-governance and the -- I just -- mentality just...  KAREN:  So who was running the health aide program when you worked for it?  Was that the North Slope Borough or was that -- BEVERLY:  The North Slope Borough, yeah.  And often we had registered nurses that -- you know, registered nurses are good in their -- if they are in a hospital setting and working, you know.  But I believe mid-levels like physician's assistants and nurse practitioners should oversee the health aides because their scope of work is -- is aligned, you know.  And -- and that's been the thing about the nurses is that, you know, no nurses are -- are not able to treat and diagnose, but a nurse practitioner and a PA and the health aide with the doctor are able to treat and diagnose and prescribe.  Yeah.  With -- you know.  And a registered nurse is -- you know, they can't go over -- going over their scope of work.  So I believe that's why some of the nurses that run the CHAP programs tend to hold them in captive or -- or -- I don't know, you know.  They seem to immobilize them when the natural progression would be a nurse practitioner or a PA running the CHAP, being the CHAP director is your -- you're empowering them.

KAREN:  And what about the changes in our society with people being worried about being sued all the time now in the medical profession?  Is that causing differences in how health aides provide services?  BEVERLY:  It's, you know, how well -- as a coordinator instructor, and I have done that, too, I worked as a coordinator instructor, too, out in Anaktuvuk after I became a -- a PA is that they would send newly -- newly hired health aides to me, and I would work with them in the clinic there.  And they have their skills list and their -- you know, they need to be competent in doing -- taking good vital signs and just all the skills that you need to do a good vitals on, you know, health assessment.  And so that time they would send the health aides to me, I would spend -- they would spend two weeks with me, and -- and then I'd go and teach also, when they had some training in Barrow, I'd go and teach some of the health aides there.  And you know, it was -- it was good.  I enjoyed it.  And -- and I think it could have worked, but we just need -- we had some nurses in Barrow that just were, you know, so controlling or they wanted -- they wanted to run CHAP this way, and only this way.  And -- and I think that was -- the sad part about some of those nurses is that they abuse their power to where they wanted to perpetuate a dependent -- a dependent way of care, you know, or delivery.  And -- and, you know, the answers are within ourselves.  What do we want?  How do we -- how do I want to be -- receive care, you know.  It's not just one way and paternalistic and condescending often as that's just how Barrow PHS or ASNA has operated.  And they need to get beyond that, you know.  And there's -- KAREN:  But you stuck with it?  BEVERLY:  I did.  Yeah.  Uh-hum.  And -- KAREN:  What -- what kept you going to do that?  BEVERLY:  When people thank me.  When people appreciate the -- the care that I've provided.  And -- and I think, you know, to be -- and I enjoyed that, you know.  And I loved to -- if there's challenges, I love to -- you know, if there's -- I call them challenges, you know, but some people call them problems or, you know, but I like to take a stab at them, you know.  And then from my -- always, I tried to -- how can I better serve my people, you know, find ways of improving, you know.  Like when I was in Barrow, when I -- when I moved to Barrow and the schoolhouse services, I was troubled by, you know, like, the students' immunizations or the children's immunizations records were not computerized, you know.  Here we have computer technology, and they don't have it yet?  I found out that the vets, the veterinary clinic had all the dogs' immunizations in the computer, and then I said, this is not right.  We should value our children more than we value our pets, you know.  So I -- I took on the challenge of working with Chris Finkler and I told her, we need to get our immunizations of our students in the computer.  So Chris Finkler and I worked on that.  And of course, we had to get these note card records from Public Health nursing and we have to do a lot of data entry and -- because Barrow has over a thousand kids, you know.  And how am I supposed to see who needs a shot and who needs one, you know.  And I was trying to do it manually, you know.  Having a little key line circle with a due date, you know, but -- so I found that, gosh, there must be a better way to do this.  So I thought, maybe -- well, Chris, maybe it's time we put it in the computer.  So we worked on that.  I mean, it was -- you know, I worked on it whenever I had a chance, you know.  And then just kept at it.  Pretty soon we had them all in the computer.  And then I told Chris, I need for it to prompt me every month, you know.  Prompt me to let me know who is needing a shot, you know.  So it -- you know, we got it to work to where I would get a prompt, you know.  So it became a lot -- a lot easier.  And then, so what I did was I brought our immunization -- computerized immunization records and brought them over to Public Health nursing and said, heck, you can do this, too.  You know, here's -- here's what we got for Barrow kids, but this is what we need for the other school kids in -- in Anaktuvuk or in Atqasuk or Nuiqsut or Point Lay and Point Hope and Kaktovik.  We need those.  So they initiated that, you know.  And I -- and I always -- you know, we have to find ways of monitoring which immunizations are due.

BEVERLY: And when I worked in Barrow, we were -- I mean, from -- they used to have really low percentile on -- you know, that kids aren't properly immunized.  But after I took it on, we were 99.8 percentile, you know.  So, you know, immunizations are important and -- but that's one of my accomplishments that I felt was really good.  And the other one was the career CHAP ladder, Community Health Aide career ladder.  And I believe that was very, very instrumental, as health aides acquired more training, they should be paid more.  So I created the Community Health Aide career ladder that improved the pay of health aides.  And I was able to testify within the CHAP in crisis testimony when Indian Select Committee came in from Washington D.C., it was 1988 or '87, in the fall.  I was able to testify.  Senator Daniel K. Inouye, from Hawaii, and he was the chairman then, and that's when the health aides finally got a raise after they were just paid. But we had to have a career ladder, you know, how much we should pay health aides.  So it improved, you know.  I started at 5.06 an hour.  And when I left, I think I was -- after seven years of health aiding, I made about 28 bucks an hour.  KAREN:  Wow.  BEVERLY:  Yeah.  But that's, you know, with all the progressive training, CHAP 1, 2 -- Session 1, 2, and 3.  And -- and then we created the Community Health Aide practitioner, you know, so two weeks of EMT and two weeks of child and maternal health to where you can become a CHP.  And that is called Certified Community Health Aide Practitioner.  That's the highest attainable level of the health aide.  You can be a CHA 1 up to CHA 5, CHAP -- Community Health Aide Practitioner.  KAREN:  And then the PA is separate?  BEVERLY:  Is the next, yeah, if they choose, you know.  KAREN:  Right.  BEVERLY:  There's been numerous health aides that have done that.  It's just a natural course of -- of next step, you know, becoming a mid-level.  And they do really well.  We have real strong clinical, real strong clinical experience, you know.  Health aides that have done that, they have that going for them if they choose to go to PA school.  The hard part was the didactic, the book stuff, you know.  KAREN:  What about being -- how long -- you were gone a couple years?  BEVERLY:  Two years.  KAREN:  Two years.  BEVERLY:  Yes.  I was gone two years.  And -- and I think, like I said, Dr. Peter Marshall found funding for me, you know.  And I always wondered whether -- you know, I can't go, there's no -- how can I?  How can I go when there's no funding, you know.  And then Dr. Marshall said, Bev, I've gotten funding for you and another health aide from Huslia, Sonia Vent, my colleague.  Athabaskan girl.  She is younger than I was, maybe about six or seven years younger than I was.   But he found funding for us from Dr. Ivy, Gerald Ivy, he had apparently gone there.  You know, their fiscal year is -- if you don't spend -- the federal fiscal spending is you have to spend the money before September 30, and apparently there was, like, $70,000 that they hadn't spent.  And if they don't spend it, it's just going to go poof, you know.  KAREN:  Wow.  BEVERLY:  So Dr. Marshall talked to Gerald Ivy, who was now the Alaska Native Services -- Service Director in the Anchorage area office, or all of Alaska, he talked him into investing $70,000 for me and Sonia Vent to go to PA school.  KAREN:  Wow.  BEVERLY:  So we had a stipend of, you know, that $35,000 was used for -- for us to go to school without having to worry about finances, and that was the intent anyway, you know.  And I think it was money well spent.  Sonia is still -- still working as a PA and she works at the Chugiak CHAP program.  She's -- she's working there in Anchorage.  And she often goes to Kenai and Nikiski and the Chugiak (indiscernible) area.  And you know, it's because of these kind of, I mean, funding -- I mean, if they'd never done that, I probably would have never gone, you know.

KAREN:  When you started as a health aide, were you the only health aide or was there somebody you shared the job with.  BEVERLY:  I was the only health aide in Anaktuvuk for many years.  And I -- I think we had an alternate.  You know, they kind of started -- after the CHAP career ladder was established, each community size, you know, can have two health aides or can have three health aides, and you know, depending on the size and population.  And Anaktuvuk was -- you know, we had an alternate.  KAREN:  When you first started, when you were the only one, how did you handle that?  BEVERLY:  I guess when you're young, you have lots of energy, you have lots of -- and you know, I -- and I just was -- I would prioritize or offer, you know, if they -- if I'd get a call, if I get a call through the CB, you know, or if they come over to my house and, you know, I'd offer, well, have you tried this, have you tried that, you know.  Just lots -- just like triaging, yeah.  You just spend a little time and -- and eyeball the whoever, you know.  And if they look really sick, then I'd have to see them and -- or if, you know, if they just have a slight fever, just Tylenol and bring them in tomorrow.  KAREN:  It seems like a lot of responsibility and demands on one person to be the sole provider 24 hours a day on call.  BEVERLY:  Right.  KAREN:  Seven days a week.  BEVERLY:  Uh-hum.  Yeah.  KAREN:  I was just wondering how people handled that.  BEVERLY:  Yeah, I think there's -- I mean, it just was natural for me.  I just -- I never was bothered by.  And I think, you know, always have -- well, I've always never felt alone.  I always had my faith and my prayer, and my prayers, you know, prayers availeth much, you know, if you ask for help and intervention.  And help is on the way, you know.  And -- and to this day, it's been so, you know. And help comes in -- in many ways.  And I think, you know, I had two children, they were like five years apart.  And in the community I had lots of help from my husband's family.  If there was, you know, an emergency, they would watch the children.  But you know, when I went to Seattle, my -- my -- my nice backup, my safety net, which I always called my safety net, you know, your extended family, was -- it was not there.  So we had to find other ways of finding a good neighbor and -- and starting to develop friendships.  And in Seattle, I was blessed with a very good neighbor.  Her name was Marie Nisavich (phonetic).  She was -- she was from Victoria Island in Canada.  And her husband was from Arizona, a Navajo Indian.  They were just really -- she was staying home because she had just had a baby, so it worked out well for me to where have her cover, you know, sometimes child care or I would leave them.  And like I'd start to study real early because when you have two children, I had a nine year old and a five year old.  And, you know, my quiet time was real early in the morning.  And I'd put in about two or three hours before I went to class studying.  And then what time I had, you know, 8:00 to 5:00 was when I was in the classroom, or in the University of -- University of Washington Hospital, or whatever clinical sites they had for us.  And we went far and wide.  We -- my scariest thing was getting on the ferry to go to Bremerton because I am unseaworthy.  I was so terrified.  And I remember I was just begging and wanting my husband to drive me.  We have to catch a 6:00 a.m. ferry and catch the last ferry out is like nine o'clock.  And you know, in Seattle, I thought after seven o'clock, I didn't go driving around.  There's a Green -- Green River Killer out there, you know.  At that time, it was -- KAREN:  At that time?  BEVERLY:  Yeah, at that time that was what was going on, you know.  And in Seattle, you know, I wasn't used to all these huge trees, you know, you couldn't even see.  And I missed the openness and the vastness of the Arctic, you know, where you can see for miles.  And here in Seattle, you feel so closed in, you know.  It's these huge trees, you can't even see what's next, you know.  And it rains so much, you know.  Oh, I didn't like the rain.  KAREN:  So you ended your career in medical care, I mean, you're still doing it, I'm sure, but in terms of being paid for it as a job, when did you stop doing it?  BEVERLY:  After I did the -- the schoolhouse services for 7 years, I did CHAP, I worked in CHAP for maybe 3 years.  And then -- oh, I did -- in Anaktuvuk, I think I put in 14 years as a PA, and 7 years as a health aide.  And I did that in -- in Anaktuvuk, Barrow, Schoolhouse Services, ASNA, at the hospital there.  And as a CHAP director, I -- then I was also coordinator instructor for health aides.  So during the 14 years as a PA, I did -- I did that.  KAREN:  So you stopped doing that in what, 2002 or something?   BEVERLY:  '99 maybe.  KAREN:  Okay.  BEVERLY:  Seemed like after 2001, that was when I left the ASNA.  And my parents had passed 11 months apart, and I took care of them with my family, our family.  And I was their medical provider.  And my father, in December of '97, and then my mother, November of '98.  And then my mother-in-law of April of 2001. Seemed like after that, I -- I think in October I turned in my resignation for 2001.  Around there.