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Dr. William James, Part 1
Bill James

Dr. William "Bill" James was interviewed on February 1, 2006 by Karen Brewster at his home in Fairbanks, Alaska. In this first part of a three part interview, Bill talks about he talks about the development of his medical career, working at the Indian Health Service hospital in Tanana, Alaska, his work with and admiration for the talents of the health aides, and his appreciation of Native culture and life in rural Alaska. He also talks about early communication systems between the health aides and the doctors and changes he has seen in medical care and health conditions in Alaska.

Digital Asset Information

Archive #: Oral History 2004-17-26_PT.1

Project: Community Health Aide Program Project Jukebox
Date of Interview: Feb 1, 2006
Narrator(s): Dr. William James
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
There is no slideshow for this person.

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Sections

A little background on his education and his early years in Alaska with the Public Health Service.

The end of his time at sea and his assignment to the Tanana Hospital.

His preparation and orientation for the assignment to Tanana and how things have changed in medical education over the years.

The evolution of his career as he quit the Public Health Service for other things and eventually returned to it.

Changes in how medical care was provided in Alaska, and what life was like in Tanana with a young family.

His lifestyle in Tanana and his memories of the origins of the Community Health Aide Program.

Early communication between the villages and the frequency of doctor's visits to the villages.

Click play, then use Sections or Transcript to navigate the interview.

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

Transcript

KAREN: Okay. Today is February 1st, 2006, and this is Karen Brewster, I'm here with Bill James at his home in Fairbanks, for the Community Health Aide Oral History Project. And let me just do a little sound check on both pieces of equipment here. All right. Thank you very much for agreeing to participate, and we finally caught up with each other after months of back and forth. So if you could just start out a little bit, tell us about yourself, your background, how you got into medicine, how you came to Alaska. DR. JAMES: Well, I went to Ohio State University for undergraduate and graduate school, graduated from Ohio State Medical School. Then I interned at Denver General Hospital. And at that time, all doctors were drafted as soon as they got through with their internship. There was a resident there who had been in the Indian Health Service in Alaska, and talked a lot about his experience, showed me slides and pictures of Alaska. I had always had a romantic sort of ideal of what Alaska was like, and I thought joining the Indian Health Service and serving my two years would be more fun that joining -- getting drafted in the Army. So I applied, got accepted, and came to Alaska in July of 1959 with the intention of staying for two years. When I first got to Anchorage, they were very proud of the fact that the Anchorage Hospital had been open for three or four years then, and they were very proud of the fact that they had a bed for every TB patient in Alaska that needed a bed. They needed a doctor on St. George Island in the Pribilofs, and I told them I would go. So I was sent immediately to St. George Island. And I was there until the middle of December of 1959, then came back to Anchorage. And Dr. Bud Shuff was the first eye, ear, nose, and throat doctor at the Native Center. He had just arrived and he needed an assistant, so I worked with him until the following June of 1960. And they needed someone to go on the Bering Sea patrol, and the Indian -- or the Public Health Service provided medical care for the Coast Guard, and the Coast Guard had this Bering Sea patrol. So I went to Seattle in June of '60 and got on the North Wind. KAREN: That was a ship? DR. JAMES: That was the ice breaker. And it was supposed to be a tour until October. And we went up into the Bering Sea, we stopped at -- I guess the primary reason for the cruise was to just show a U.S. presence in the Bering Sea. And on the way, we stopped at Ketchikan and Juneau, Tatitlek, Kodiak, and several villages on the chain. And then went into the Bering Sea. And at the time, the Russians and the Japanese were fishing extensively in the Bering Sea. It was while we still had the three-mile limit. KAREN: Right. DR. JAMES: So we saw a lot of the Russian trawlers. KAREN: Now, were you providing medical -- DR. JAMES: And I was providing medical care, I was the ship's doctor. KAREN:  So you were providing medical care to the crew, not to people in the villages?  DR. JAMES:  Primarily to the crew, but we stopped in villages along the way, and we would have a day clinic in Yakutat and at Tatitlek -- at Tatitlek. And then Dutch Harbor, we stopped there.  And Atka.  And we just had a one-day clinic.  We had two helicopters aboard and we had a boat, kind of a landing craft boat on board.  We would either go in by helicopter or by boat into the villages.  And then just spent time.  We went to Little Diomede.  Went to the Pribilofs, and then most of the villages from Nome, Elim -- I'm thinking of what are the names of the villages.  KAREN:  Wales?  DR. JAMES:  Went to Wales.  Koyuk.  We went up to Wainwright.  Point Lay.  KAREN:  Did you go as far as Barrow, or -- DR. JAMES:  And we went as far as Barrow, but they had a hospital there.  KAREN:  Yeah.  DR. JAMES:  But we went -- went ashore.  But most of the time we were just out in the ocean.  Just going back and forth.  And so I wasn't very busy unless we were going in to have a clinic.  We went to Unalakleet, Gambell, Savoonga.  KAREN:  Were people still on King Island at that time?  DR. JAMES:  I don't know.  We didn't stop at King Island.  It was summertime and I think that even when there were people on King Island that they usually went into Nome for the summer.

DR. JAMES:  And when we were in Nome, the first atomic submarine could go from east to west under the ice pack, came to Nome.  And Nome has no harbor so they used us for the harbor.  They attached, you know, they hooked up to the ice breaker. KAREN:  So your ship was anchored off shore and they -- DR. JAMES:  Yeah.  KAREN:  -- anchored next to you?  DR. JAMES:  And they anchored or tied on to us.  KAREN:  And was that a Russian submarine?  DR. JAMES:  No, it was an American.  I don't remember the name for sure.  I think it was the Sea Dragon maybe or something.  KAREN:  That's kind of interesting.  That was 1960?  DR. JAMES:  So we toured the -- this was in the summer of '60.  KAREN:  And what were the conditions like?  I mean, is it rough seas or -- you must not get seasick. DR. JAMES:  No, not -- it wasn't bad.  And we were supposed to go back, be back in Seattle in October.  And on the way back from the Bering Sea, we stopped at Adak, and then at Kodiak again, got orders to take several oceanographers back up into the Arctic Ocean.  So we turned around and went back up north and we would just make a zigzag pattern in the Arctic Ocean taking water samples.  And we went -- we got east of the Canadian border and it started to freeze up, and we thought for a while we may not get out.  But we got back to Seattle in December, and then I went to Tanana.  So that was in December of '60 when I went to Tanana.  KAREN:  And so that, working for the Bering Sea patrol, that was -- you were employed by the Coast Guard then?  DR. JAMES:  Well, I was still -- KAREN:  You were still employed -- DR. JAMES:  I was still a physician in the Public Health Service, but the Public Health Service provides medical care to the post office -- to the Coast Guard.  KAREN:  Hmm.  I never knew that. DR. JAMES:  Uh-hum. KAREN:  They still do?  DR. JAMES:  I think so.  KAREN:  Okay.  And so then how did you end up in Tanana?  DR. JAMES:  Well, there was a vacancy there.  And I wanted to get out of the Bush and so I asked to be assigned there and I was.  It was a two-doctor station.  And the -- one of the doctors that summer had gone to Dillingham, I believe, so there was just one doctor there for about six months until I got there.  And the doctor had a very young family.  I was still single.  So I started making field trips to the villages that January.  And I would charter a 180 and go to Ruby for a day, Galena for a day, Koyukuk for a day, Nulato for a day, and then -- what's the village past Nulato?   KAREN:  Kaltag?  DR. JAMES:  Kaltag for a day.  And then fly back on Saturday.  There were no health aides in the villages so there were no -- there was very poor communication between the villages and Tanana.  There was no phone -- in fact, in the hospital, we had no phone in the hospital.  Once a day -- once a week we would go out to the Wien station at the airport and have a call, Anchorage, and I would talk to the medical director, and head cook would talk with the cook, and the nurse would talk with the director of nurses, and so forth.  There was a scheduled time that we talked to the people in Anchorage.  So that was the only phone communication we had.  We had a sideband radio that sometimes we could talk to some of the villages and sometimes we couldn't.  Another week I would go to Galena and then Huslia, Hughes, Allakaket.   Another week I would go over to Fort Yukon and went -- I tried to go to Fort Yukon every month.  It was a big -- biggest village.  And I would go to Fort Yukon and then go to, say, Arctic Village and Venetie the next day.  Next time go to Circle and another village, kind of alternate.  KAREN:  And your region also included Anaktuvuk, right?  DR. JAMES:  And we also, Anaktuvuk Pass was in our service unit at the time.

DR. JAMES:  The first time I went to Anaktuvuk Pass was in March, I think, of '61.  And somehow we got a -- got word that there was a flu epidemic going on in Anaktuvuk Pass, and they wanted a doctor to come up, so I chartered the plane and went to Anaktuvuk.  And at the time, most everyone lived in sod houses.  Then just went from house to house checking people.  At that time, we carried an awful lot of medicine supplies with us because there was nothing in the village.  We had two big metal cases we filled with medicines and bandages and so forth.  And then we also had the highway system.  KAREN:  Oh, you did?  DR. JAMES:  Yeah.  KAREN:  Oh.  I didn't know that was part of your service area.  DR. JAMES:  Uh-hum.  And so I came to Fairbanks, rented a car, and we drive down, go to Dot Lake, Tanacross, Northway, Tok.  And Mentasta was in our service unit then.  KAREN:  Wow.  And what about the other side, down to Cantwell also?  DR. JAMES:  No.  I never -- I don't know if that was in the Anchorage service unit or if -- just didn't go there because there weren't enough people.  I don't know.  KAREN:  Yeah.  And you had Nenana, Healy, that side wasn't included?   DR. JAMES:  Nenana.  We went to Nenana. KAREN:  Oh, Nenana was in there?  DR. JAMES:  Uh-hum.  But not -- KAREN:  Past there?  DR. JAMES:  -- not there.  We didn't go past Nenana.  KAREN:  It was a big service unit.  DR. JAMES:  It was.  And so most of my time for the first six months was travelling to the villages.  And when we started, we had no medical records, there were no medical records in the villages.  In fact, we didn't even know what villages were occupied.  And I remember the director of nurses and the other doctor and I were standing in the hallway looking at a big map of Alaska, wondering if we should go to Venetie or Allakaket, and so forth.  And the janitor came up and who was a Native guy from Tanana, he told us which villages had people in them and how the planes flew and so forth and how to get there.   KAREN:  Yeah, you'd think that -- I find it surprising that the Public Health Service wouldn't have kind of prepared you guys.  You weren't the first doctors there. DR. JAMES:  No, there had been doctors there for a while.  KAREN:  Right.  And that there wasn't sort of -- DR. JAMES:  But there was some sort of a lapse between the -- the doctor who had been there before, Dr. Hadley who was there when I got there.  So he had no orientation to us.  KAREN:  Did the Public Health Service provide you any sorts of orientation?  I mean, nowadays cross-cultural orientation is pretty popular. DR. JAMES:  Our orientation in Anchorage consisted of learning how to pull teeth, how to put in temporary fillings, and how to do refractions.  KAREN:  Which is eye?  DR. JAMES:  So I spent several meetings with Dr. Sheldon who was a private opthalmologist in town who taught us to do refractions.  KAREN:  So refractions is checking people's vision?  DR. JAMES:  Prescribing glasses.  KAREN:  And your particular medical training, did you have a specialty?  DR. JAMES:  No.  I was straight out of internship.  KAREN:  So you're back -- DR. JAMES:  Most of -- most of the doctors at that time would take what they called a rotating internship.  So you would have -- I think I had four months of surgery and four months of internal medicine and two months of OB/GYN and two months of pediatrics.  KAREN:  So do you feel like you were prepared for -- DR. JAMES:  No.  No.  I felt very confident.  It was -- felt pretty confident that -- the longer I was there, the more I knew that I didn't know.  The more -- you know, when you get out of your internship in those days, you thought you were -- a lot of people would go straight into practice without a residency training.  KAREN:  And nowadays people do residencies to get sort of specialized trainings?  DR. JAMES:  And now everyone takes a -- if they are going to practice medicine takes a residency.  If they want to be in family medicine, they take a family practice residency for two or three years after their internship.  And now internships are sort of incorporated into the -- into the residency, so you may have a three year residency in pediatrics and the first year is sort of considered an internship, and the next two years would be your residency but it's all pediatrics and nothing else.  KAREN:  Okay.

KAREN:  And now where did you say you grew up? DR. JAMES:  I grew up in Ohio.  KAREN:  And what made you decide you wanted to go into medicine?  DR. JAMES:  My dad was a veterinarian and I knew I didn't want to be a veterinarian.  And I was just sort of always told I was going to be a doctor some day.  You know, it was just a family expectation.  And I enjoyed science and math and so forth in school.  KAREN:  Do you have siblings?  DR. JAMES:  Yeah, I have a brother and two sisters.  KAREN:  Where do you fall in the age?  DR. JAMES:  I was the oldest.  KAREN:  The oldest.  What kinds of things have they gone on to do?  DR. JAMES:  Well, my two sisters, one was a social worker.  Another one, the other one more just a housewife.  And my brother's a judge back in Ohio.  KAREN:  Varied.  It's just sort of interesting how people end up doing what they are doing. DR. JAMES:  Uh-hum.  KAREN:  And the family influences in childhood.  So in Tanana, I've heard other people talk about radio call. DR. JAMES:  Uh-hum.  KAREN:  And this they would talk to the villages on the radio. DR. JAMES:  We had a radio.  KAREN:  There weren't health aides, though, so who were you talking to?   DR. JAMES:  It would depend from village to village.  There were sometimes a store keeper, sometimes a missionary.  Seemed like there were several missionaries' wives were nurses.  The Episcopal Church had quite a few missionaries around.  There was a -- one in Hughes, one in Allakaket, there was a missionary nurse in Venetie, there were priests in Nulato and Ruby, Kaltag.  And sometimes a radio was in the -- in the store in town. KAREN:  Uh-hum. DR. JAMES:  And they would -- maybe a store owner or someone would answer the phone.  KAREN:  And what were you doing in these radio calls?  What kind of communication was going on?  DR. JAMES:  Well, we were just talking to someone there about the general condition or any special patients they thought should come to Fairbanks -- come to Tanana for advice and so forth.  Public Health nurse, there was a Public Health nurse stationed in Tanana who covered the downriver villages, and very often she'd be out in the village and talk to us.  But it was hard to -- some days we wouldn't get through to anyone.  Some days there was good communication.  KAREN:  And how do you practice medicine via radio?  DR. JAMES:  Well, not very well.  Later on, the second time -- I left the Public Health Service in 1962.  I was in Tanana.  And they were putting pressure on me to leave.  And I was told that I had to move on to bigger and better things.  At the time they had what they called the medical officer in charge.  So I was a medical officer in charge of Tanana.  And they said that for career advancement and so on, you should go to a bigger place, more doctors, and so forth.  So most of the doctors stayed just two years, and I was in my third or fourth year then.  And I thoroughly enjoyed being in Tanana.  And they had a lot of doctors who would go in for two years because of the draft, and once they served their two years, they would get out.  So I was somewhat of a rarity in that I stayed longer than two years, and so I had more experience, and they thought I should go somewhere else. And I was offered either Kotzebue or Bethel or Window Rock, Arizona, I think.  And I decided that I really wanted to stay in Tanana.  And then they were putting pressure on me to leave, or where did I want to go next year, and the Yukon 700, which is now the Yukon 800 boat race.  KAREN:  The boat race, yeah.  DR. JAMES:  Used to go from Circle -- from Circle, go down to Tanana, and then come into town on the Tanana River.  And they would refuel in Tanana.  And so we were -- we stayed up very late one night, it was 2:00 or 3:00 in the morning, it was in June, the days were long, and I had just gone to bed, and I got a call from the nurse, Dr. James, there's been a -- very calm, she said, Dr. James, there's been a plane crash, would you mind coming over.  So some of the people from Fairbanks, quite a few people from Fairbanks, they were interested in the race and would come out to Tanana and watch them go by.  And it happened that one of the -- two of the people in the plane crash was Dr. Dunlap who practiced here in town, his wife and his nurse.  So they flagged him down in Nenana.  And his wife was fine, but his nurse had compression fracture of her spine.  So Dr. Dunlap came down to Tanana.   And he and Dr. Lundquist had just started the Tanana Clinic.  KAREN:  Here in Fairbanks?  DR. JAMES:  Yeah.  And they were interested in getting more doctors.  He came down, got his wife, went home, and then came back down, stayed a day or two there with me.  And talked to me about coming into Fairbanks to practice in the Tanana Clinic.  And finally about October, when they kept pressuring me to go somewhere else the next year, I resigned my commission and came in, I think I was the fourth doctor at the Tanana Clinic then.  KAREN:  And that was in what year?  DR. JAMES:  That was in '63.  '62, I guess.  '62.  I practiced from '62 to '63, and decided that I felt incompetent in town for some reason, and thought I should take a residency.  And there was a real cold winter and we had two little kids, and we only had one car.  My wife just loved Tanana, but didn't like Fairbanks, and I didn't like the private practice and everything involved, and so we decided to go Outside.  We went to Idaho for a year.  A little town in Idaho.  And we were there about six weeks and decided we wanted to come back to Fairbanks.  I decided to take a residency, so I took my pediatric residency, so we were gone for three years, from '63 until '66.  KAREN:  And that pediatric residency was in Idaho?  DR. JAMES:  No, it was in Ohio.  I went back to Ohio.  Did my residency, then came back, was a pediatrician at the Tanana Clinic in July of '66.  And then I was there from '66 until '73.  In the meantime, they opened up a Native clinic, the first Native clinic in Fairbanks, and it was over in the bowling alley building.  KAREN:  I didn't know that. DR. JAMES:  And I started going over there as a pediatric consultant, a morning a week, then I was going two mornings a week.  And I enjoyed that more than private practice, so in '73, I joined the Public Health Service again.  At the Native clinic, by that time, it was in the hospital.  KAREN:  And that's now Chief Andrew Isaac clinic?  DR. JAMES:  Yeah.  KAREN:  I think that's the same -- DR. JAMES:  Yeah.  It was just called -- it was still part of the Public Health Service.  And then in the mid '80s, the Tanana Chiefs took over the clinic.

DR. JAMES:  Congress passed the Indian Self-Determination Act, which gave Native tribes or organizations the right to contract with the government to provide any services that the government was doing.  So the Tanana Chiefs contracted to provide the health care.  And named the clinic the Chief Andrew Isaac clinic.  KAREN:  That's interesting.  I didn't know about the Indian Self-Determination Act.  I always thought it had to do with the Native Claims Settlement Act.  DR. JAMES:  With what?  KAREN:  With the Native Claims Settlement Act.  I -- that's why -- DR. JAMES:  No.  KAREN:  I'd never heard of the Native Self-Determination Act.  That's interesting.  DR. JAMES:  So a lot of the BIA work was contracted by the Native groups.  And the health care.  A lot of the social service type things.  KAREN:  So what is it about private practice that you didn't like?  DR. JAMES:  Oh, it's not so much that I didn't like private practice.  It was that I enjoyed the Indian Health Service more.  I enjoyed being in private practice.  It's just that I enjoyed working in the Indian Health Service more.   KAREN:  I guess so what -- what did you like about the Indian Health Service?  DR. JAMES:  I guess the people and the travel and so forth.   So I rejoined the Public Health Service in 1973, and then the day school was out in '76, we moved to Tanana, again, and we stayed there until the day before school started in '78, then we moved back.  If it hadn't been for the kids in school, we -- I probably would have stayed. But when we went to Tanana, they pushed all our kids up a grade.  And they were still behind what they were in Fairbanks.  And then when we came back, they just went back into their regular grade again.  KAREN:  So they did a couple rounds of the same grade?  DR. JAMES:  Yeah.  So like someone may have -- they just finished first, third, fifth, seventh, and ninth grade in Fairbanks.  And so they went into the third, fifth -- KAREN:  So they were extra good, they did it twice. DR. JAMES:  So they skipped a grade and they repeated a grade when they came back. KAREN:  That's funny. DR. JAMES:  But we just rented out our house, so they came back to the same school and same classmates and everything. KAREN:  That's good.  DR. JAMES:  My kids -- my daughter didn't -- my daughter was a good student and she was high school then.  She would have been in tenth grade, I guess.  And there were a couple kids that were good students in Tanana, but most of them she felt were goof-offs and weren't there to learn anything, and she was very glad to get back to high school here at Lathrop.  KAREN:  And then did your wife work, as well, in Tanana?  DR. JAMES:  No.  She took care of the kids.  That's -- you know.  KAREN:  Six kids are a full-time job. DR. JAMES:  That's a big job.  KAREN:  Yeah.  Definitely.  It's interesting that she really -- she preferred Tanana over Fairbanks.  DR. JAMES:  My first wife was from Fort Yukon.  KAREN:  Okay. DR. JAMES:  She was a Native gal.  I met her.  She worked for Wien.  And so we got married in Tanana and she knew village life.  But my other kids very much enjoyed Tanana.  KAREN:  Yeah.  I think -- I don't know about nowadays, but in some ways, the villages are really good places for kids, in some ways.  In some ways not.  That's for sure.  DR. JAMES:  I remember all my kids were good swimmers.  I remember one day this woman came running in the hospital, Dr. James, Dr. James, your kids are out in the river, they are going to drown.  And what they would do, they would go clear up a mile or two upriver and push driftwood and stuff into the river, and we had a little raft, and they will just hang on to the driftwood and float past town and swim in, the downriver end of town.  And I guess it was dangerous but I was never worried about it.  We had three little Skidoos while we were there.  And my youngest kid couldn't -- they were all pull starts, and I guess he was in second grade that winter, and couldn't start it.  And he would ride down to the store or something or ride around to a friend's house, and when it was time to come home, he would wait until someone came by and they would start it for him, and then he would drive it home.  We had a little pickup.  My boy was in ninth grade, he'd drive it all around.  And you know, 14 years old or so.

KAREN:  When did the hospital shut down in Tanana?  DR. JAMES:  Mid '80s sometime. KAREN:  So when you -- the various times you were there back and forth, what kind of housing did you have?  Did the hospital provide housing?  DR. JAMES:  Uh-hum.  Yeah.  We had -- we had half of an apartment building.  It was a three-bedroom apartment.  It was kind of crowded.  It had running water and heat and hospital maintained, so it was no problem at all.  It was right next to the -- it was right between the hospital and the school.  And the kids would never go to school until they saw the light come on in their room, and then they would rush out the door and rush over to school.  KAREN:  So when was your first experience with -- well, I was going to say with health aides, but the thing with health aides is there was the official Community Health Aide Program, but my understanding that people like Bertha Moses, for instance, were doing -- DR. JAMES:  Yeah.  KAREN:  -- were helping work before they were officially health aides. DR. JAMES:  Uh-hum.  KAREN:  So in 1960, '62, when you were in Tanana, were there people like Bertha that -- DR. JAMES:  Well, there were -- there were people like Bertha, there was a missionary in Allakaket, and there was -- I think the wife was a nurse.  And I think that's kind of how Bertha got started.  A lot of them were -- the older ones were midwives sort of.  And they would help out.  I usually took a nurse with me on the field trips, sometimes I would.  And the pilot would often back us, would help out, you know.  KAREN:  So then what led into your experiences with actually official health aides?  What kind of experiences did you have there?  DR. JAMES:  The first time we were in Tanana, I forget who it was, it could have been Bertha or someone, came to the hospital.  I guess it was in the early '60s.  And we realized there were some women in the various villages who were sort of health leaders or liaison people or -- and so like I say, I don't remember if it was Bertha or who it was.  But we asked her, would you like to learn some more.  So after she got better, we said, well, why don't you stay around for a few days and learn some things.  And so the nurses taught them to take blood pressures and to take temperatures, and I would show them the ear infections and just very off-the-cuff sort of thing.  And we thought it would be real good to have people in the village with some training.  We taught her to use a stethoscope and otoscope.  And how to treat ear infections and so forth.  And then we gave her some -- left some medicine in the village for her to use.  And we went to a medical directors meeting in Anchorage and I brought up the fact that we were planning on trying to bring each one of these women into Tanana for a week or so to try to give them some training.  And I was told in Anchorage I could not do it.  And I remember part of the reason I went to Tanana was that I didn't get along with the head of the hospital in Anchorage.  And I thought that he didn't have much good sense.  One time -- the hospital was always overcrowded and he would issue an order saying we can't have any admissions while we're so much overcrowded.  And Fridays was tonsillectomy day when I was in Anchorage.  And Dr. Shuff taught me to do tonsillectomies, so I'd do four or five tonsillectomies.  And our pediatric ward was overcrowded.  And so we did the -- I did the tonsils on four or five kids.  And then they went to the recovery room, and then after they were recovered, we took them back to the pediatric ward, and he said we couldn't admit them to the ward because the ward was overcrowded.  Well, what do you want to do with them?  You know, it was one of those things.  KAREN:  Yeah, what were you supposed to do with them?  DR. JAMES:  I don't know.  There was another ward somewhere that wasn't overcrowded, but I thought it was best to have them on the pediatric ward where the nurses were used to them. KAREN:  Right. DR. JAMES:  It wasn't that we were admitting them again, they were already there, we took them out to do the tonsils, and later in the day we were bringing them back.  KAREN:  And their beds had been taken by somebody else.  DR. JAMES:  So I didn't think he was competent and I let him know.  And then he's the same one who told me that we couldn't bring people in, there was no money for it.  And I remember telling him, well, we're going to do it, you won't know who they are because we'll admit them to the hospital and you won't know what we're doing.  And he threatened me with court-martial if I did something like that.  But then we did bring a few women in to try to get them a little bit of training.  KAREN:  So you sort of did it anyway a little bit?  DR. JAMES:  So we did it anyway.  And then when I came back in '73, the official Health Aide Program had been in force for a while, and Dr. Johnson was the head of it.  And I can't remember if there was another doctor who was sort of his assistant who then took over who ran the program then for many years afterwards.  I can't remember his name now.  KAREN:  I'm sure -- I'm sure Walter told me and I can't remember either.  DR. JAMES:  Uh-hum.  KAREN:  Lots of names go in these interviews.

DR. JAMES:  But when I came back in '73, then, we had the satellite, ETS-1 satellite, and we had an hour a day, noon to 1:00 or 1:00 until 2:00 where we had medical traffic scheduled with all the villages, and most of the villages then had a satellite.  So the trans -- or the communication then was pretty much 100 percent.  KAREN:  So yeah.  It seems like Tanana was one of the few places that had satellite.  It was sort of an experiment, from what I understand, right?  DR. JAMES:  Uh-hum.  KAREN:  And did it prove successful?   DR. JAMES:  Yeah, I think so.  KAREN:  But it didn't last.  DR. JAMES:  Well, when telephones came in. KAREN:  Oh, Okay. DR. JAMES:  When all the villages got telephones, then there was no reason for the -- there was no reason to use the satellite.  KAREN:  Okay. DR. JAMES:  But just for the traditional, we still call it -- it's time for radio traffic.  Well, it's telephone traffic then. KAREN:  When did telephones start coming in?  DR. JAMES:  Sometime between '63 and '73, I don't know.  Because they weren't there when I left in '63, but they were there when I came back in '73.  Just a minute.  I take that back.  I don't know when the -- the satellite was available when I came back in '73. KAREN:  In '73.  DR. JAMES:  I don't know when the -- when the telephones came in.   KAREN:  After -- when you went back in '73, it was satellite, it wasn't telephone?  DR. JAMES:  No, it was satellite in '73.  It was sideband radio in '63.  KAREN:  Right.  Okay.  So what was that like now having trained health aides in the villages?  DR. JAMES:  Well, it was real -- it was a great advantage because we could talk with someone who knew something.  And the health aides had been trained to -- to diagnose and treat and they would talk to us about the proper treatment, help with the diagnosis.  If they felt that the patient should come to Tanana, to the hospital, well, then, we would make arrangements to get them in.  And also when they started having clinics, at first the health aides pretty much worked out of their homes.  And so they had some supplies, and they would just have them in their home.  And then when they had actual clinic buildings, then we could have a lot more supplies and medicines for the health aides to work with.  So our field trips, we took very little about us then.  We didn't have to take all the medicines and supplies with us.  KAREN:  Did you make field trips on the same type of regular schedule or now that there were health aides, did you make a few more trips?  DR. JAMES:  Well, then, when I came back, there were more doctors.  There were two in Fairbanks and three in Tanana where -- so that was five physicians.  And where before, we were just two physicians.  So we continued making field trips, but each physician didn't have to make so many.  We divided it up so that the people in Fairbanks would take care of the Fort Yukon area, and the people in Tanana would take the downriver, Koyukuk River area.  And we just took care of Fort Yukon and Anaktuvuk Pass.  And then the people in Tanana, since there were more of them and they were less busy, took the highway, too.  KAREN:  So would it still be like a one trip -- one -- like Fort Yukon would get a doctor once a month?  DR. JAMES:  Pretty much.  KAREN:  And so every village still got a doctor on the same kind of regular schedule?  DR. JAMES:  Yeah, pretty much.  I think that we tried to get to Tok once a month, Fort Yukon once a month, and Galena once a month.  And the others four times a year was a goal.