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Dr. William James, Part 2
Bill James

This is the continuation of an interview with Dr. William "Bill" James on February 1, 2006 by Karen Brewster at his home in Fairbanks, Alaska. In this second part of a three part interview, Bill talks about working as a physician in rural Alaska and working with community health aides to provide medical care to the villages, communication between doctors and health aides, how conditions in the villages have changed, and the differences between rural and urban health care in Alaska. He also talks about patient confidentiality, the use of traditional medicine, and dealing with emergencies. Finally, he provides his thoughts on the success of the Community Health Aide Program and the important role health aides play in their communities.

Digital Asset Information

Archive #: Oral History 2004-17-26_PT.2

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
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Sections

How communications and record keeping have changed and improved.

Changes in the types of illnesses found in Alaskan villages.

Health Aides' level of training and how he felt it affected their work.

The differences between the general medical community and his experiences as a doctor in rural Alaska.

A comparison of the level and type of medical care available at village clinics and different hospitals.

Patient confidentiality and the improvements in health care that came about when Native corporations took over from the Public Health Service.

Traditional medicine and the aspects/strengths of Native culture he has grown to know through his career and personal life in rural Alaska.

His evaluation of the health aide program and the role health aides play in their communities.

His feelings about the future of the health aide program and also about Alaskan villages.

An exciting story about an emergency operation in the field.

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

Transcript

DR. JAMES:  Then we had health aides and clinic and good communication, either by satellite or both phones.  Made much better health care in the villages.  There was an experiment about '74 or '75 where they had TV in Fort Yukon and Tanana and Fairbanks, Huslia, maybe one or two other villages.  So that it was the beginning of telecommunication, Telemedicine.  It was on an experimental basis so that several of the health aides could present patients by TV, send electrocardiograms -- KAREN:  Wow.  DR. JAMES:  -- and so forth, to Fairbanks so we could actually see the patient. KAREN:  Uh-hum.  DR. JAMES:  And that was only in -- that was only for a year or so and the funding was an experimental thing.  KAREN:  And how did it work?  DR. JAMES:  And we tried to get back more.  It was some improvement over just talking to the health aides.  It seemed to be very time consuming for the added benefit.  KAREN:  Yeah, I was wondering if it saved patient transport at all?  DR. JAMES:  I don't know if it did or not.  KAREN:  But it's interesting that I didn't realize that there was experimentation with telemedicine that early, in the mid '70s.  DR. JAMES:  Uh-hum.  KAREN:  And then -- DR. JAMES:  At that time, it was also in -- as part of it was starting electronic records so that we had -- they were on microfiche at the time, it wasn't realtime, but we had problem list, immunization status, and TB status on microfiche.  And they were supposed to be updated every three months, but in fact, the information went to New Mexico somehow, and they would update the microfiche and send it back.  But it was -- it was not very timely.  It had a lot of good information in them.

KAREN:  You mentioned TB, which made me think about -- so when you came to Alaska and started practicing medicine, was TB still -- DR. JAMES:  TB was very common.  The Native Hospital in Anchorage had a men's TB floor and a women's TB floor and a kids' TB floor.  KAREN:  Wow.  DR. JAMES:  It was very common.  It wasn't rampant like when Dr. Johnson started trying to control TB.  But it was still common.  And another thing, things that were really common then were -- was TB, chronic ear infections in kids, and a thing called phlyctenular keratoconjunctivitis, PKC, which is eye inflammation. KAREN:  Is that like pink eye?  DR. JAMES:  No, it's a lot more than pink eye.  But in a lot of the -- scar the cornea.  KAREN:  Oh. DR. JAMES:  Dr. Fritz was in private practice at eye, ear, nose, and throat in Anchorage, and he told us that if you see a kid with PKC and you look in his ears and they are okay, well, then, the kid's got TB.  Was sort of a -- some sort of a reaction to a chronic infection.  It was thought to be the cause of it.  KAREN:  So have you seen changes in the diseases and things that -- DR. JAMES:  Oh, yeah.  KAREN:  -- that were common?  I mean, like now, TB's not common. DR. JAMES:  No.  We had kids dying of measles.  A lot of chicken pox, measles, so forth.  Meningitis.  And the immunizations have made a tremendous amount of difference.   Diarrhea in kids, kids dying of dehydration with diarrhea.  There was safe water, sanitation, immunizations, then the TB control.  The state used to have an X-ray crew that would just go through the village, X-ray everyone, and follow up that way.  They had a TB doctor.  KAREN:  A lot of people went out for TB treatment.  I don't know, what was the treatment for TB?  DR. JAMES:  Well, when they were going Outside, there wasn't much treatment except rest, surgery.  But by the time I came up in 1959, they had antibiotics for TB, and they were not sending people Outside anymore because of -- they had built the Anchorage Hospital. KAREN:  Okay. DR. JAMES:  It was primarily built for a TB hospital.  But INH and streptomycin, PAS.  KAREN:  Those are the antibiotics?  DR. JAMES:  Uh-hum.

KAREN:  In terms of your work with the health aides, do you feel like they had sufficient training to able -- to provide what you needed?  DR. JAMES:  Well, they didn't have enough.  You know, you consider the doctor spends how many years trying to learn enough to practice medicine, and you're asking these people to practice medicine in the villages with a couple weeks or at most a couple months worth of training. And it was sure much, much better than it was before.  And some of the -- some of the health aides were just really tremendous, and others were not as good.  But some of the health aides, one of them, we used to joke, if she had been born in Chicago, she would be dean of the medical center at Northwestern or something like this.  But I remember this one, I won't name her, Public Health nurse came through for a woman's clinic, did breast exams and pap smears and so forth, and this health aide decided, well, gee, we ought to have a men's clinic.  So she brought them in and checked their blood pressure and did rectals on them, picked up one or two cases of prostate cancer.  KAREN:  Wow.  DR. JAMES:  And a case or two of diabetes.  But a lot of them had a lot of common sense.  I remember one health -- some of them didn't have confidence in themselves, so if someone was fairly ill, they would want to send them to town right away.  And we'd have patients pop off the plane and walk into the clinic and wouldn't be very sick.  But I remember this one health aide, she told me one time, Dr. James, I don't know what's wrong with him but he is bad sick.  I said, well, send him in.  And he sure was bad sick.  But she had -- her knowledge of medicine wasn't enough to know what was wrong with him but she sure knew he was sick and needed help.  KAREN:  Well, that example sounds to me a little bit like there was a need to build a relationship and trust between you as the doctor and the health aide to know that, okay, that health aide knows what they are talking about and I'm going to believe them and send them in.  And so is that right?  DR. JAMES:  That's for sure.  KAREN:  And it seems like a unique working situation in that regard.  DR. JAMES:  It is just like all doctors are not made equal, all health aides were not made equal.

KAREN:  What -- do you have a sense what the general medical community's feelings were about the Health Aide Program?  I mean, you said that, you know, your situation at Tanana when you wanted to bring people in, there was opposition.  DR. JAMES:  There was opposition from the Anchorage Public Health Service.  As far as like the dental thing that's going on now where the Dental Association is fighting the -- KAREN:  Right.  DR. JAMES:  -- the dental providers in the villages.  There was nothing like that.  Nothing at all like that -- KAREN:  Okay. DR. JAMES:  -- with the health aides.  The physicians in private practice were cooperative and realized that something like that was necessary.  KAREN:  Yeah, and I was wondering when the new docs would come into the hospital, were they willing to work with health aides?  Because that may have been something they weren't used to.  DR. JAMES:  You mean the new ones in the Public Health Service?  KAREN:  Yeah, the new ones in the Public Health Service, or you know, when you were here in Fairbanks and, you know, they -- I was thinking the training that doctors received in medical school may not have -- DR. JAMES:  Well, I think that -- I don't remember any doctor that belittled the health aides.  KAREN:  Oh, okay. DR. JAMES:  Especially after they made a trip to a village.  The doctor is just out of his training and then you send him to Arctic Village with a limited -- no X-rays, no blood tests, so forth, they realized right away what the situation was.  And I never heard a thought that any doctor belittled the health aides because once they had been in the village and seen what it was like, then they realized the circumstances that the health aides were working under.   KAREN:  Were there any ever -- you gave an example before of a good example that came from with the health aide that said bad sick, and it was a good thing that they sent them in, and hopefully you were able to help that sick person.  DR. JAMES:  Uh-hum.  KAREN:  But were there other situations where things didn't always come out so positively in the end?   DR. JAMES:  Well, I think the main thing was that sometimes the health aides -- you know, the health aides are on 24 hours a day, 7 days a week.  At first there was just one health aide in every village.  And I'm sure that some of the patients that they sent in was to kind of get a rest for themselves, which was okay with us.  That some of the patients could be very demanding and we realized what the health aides were putting up with the village, they were on call all the time.  KAREN:  Yeah.  Yeah.  I don't know how they could do that.  DR. JAMES:  So it's hard to be available all the time.  When I joined the Public Health Service here, there was another doctor here.  And I joined July 1st.  About September, he said he was going to go work on the Slope.  So that whole year I was here alone.  KAREN:  Wow.  DR. JAMES:  In Fairbanks.  And then there were three doctors at Tanana, and when I went out in '76, all three of them left.  So I was in Tanana for a year alone.  And so being on call all the time, day after day after day is -- it wears on you.  KAREN:  Yeah.  How do you deal with that?  DR. JAMES:  And I know that it's the same way with the health aides.  KAREN:  So how did you deal with that, whether it was Fairbanks or Tanana, being the only doctor?  DR. JAMES:  Well, in Tanana, I lived right next to the hospital.  And if I was going -- say if I wanted to go skiing for a couple hours, I'd just tell the nurse, I'm going skiing and I'll be gone for a couple hours.  I started water skiing on the Yukon River.  I first went out there, no one had ever seen water skis before.  KAREN:  Yeah.  DR. JAMES:  So when I went back in '76, I took a pair of water skis and we went by boat to Tanana. KAREN:  You didn't water ski all the way down, did you?   DR. JAMES:  No, but we water skied a lot. KAREN:  Wow.  DR. JAMES:  And I had this one woman who was just starting into labor, and I told the nurse I was going to go water skiing.  And that if the woman really started into labor, she was to come out on the front steps and wave a sheet and I'd come right in.  And I hadn't water skied, you know, we hadn't been out for half an hour, and out she came just waving it like crazy, and went right inside in my bathing suit, and delivered her right then.  KAREN:  And were there middle of the night emergency calls?  DR. JAMES:  Oh, yeah.  KAREN:  Yeah.  DR. JAMES:  Not too much because you know, local, there are only 300 people there. KAREN:  Right.  DR. JAMES:  In Tanana.  So the things that we would get in would come in by plane. And we knew usually ahead of time that they were coming and knew what to expect.  So you'd have emergencies, be up pretty much all night.  But I would sometimes occasionally, when I'd been up all night, make rounds in the hospital in the morning and say, well, let's cancel clinic.  In the clinics -- the outpatient clinic was pretty much just for the people in Tanana.  So I'd just go home and take a long nap.  If someone came in that really needed me, they called me over.  Otherwise, the nurses would take care of it.

KAREN:  I was wondering, too, you know, about the kind of equipment you had.  Like you said, you know, if you went out to the village, there was no X-ray machine, and how you provided medical care and with what kind of equipment.  DR. JAMES:  Well, just you had a stethoscope and you'd listen to their lungs, and if you thought they had pneumonia, you'd treat it.  You wouldn't need an X-ray to confirm it.  If they -- it was something that they needed X-rays and so forth, we would bring them back to the -- bring them back to the hospital.  KAREN:  Do you think there was a difference in medical care when there was a hospital in Tanana versus now when everybody has to come to Fairbanks?  DR. JAMES:  I think it's much better now.  Partly because it got so that the only people come -- the people coming to the hospital would be the downriver people.  That would come to Tanana.  People in Fort Yukon and Venetie and so on, they would have to come through Fairbanks to get to Tanana.  And they resisted it.  The people on the highway, Northway and Tanacross, so forth, they had to come to Fairbanks, and then go to Tanana.  So having the hospital in Tanana was a benefit only for the people in Tanana.  The people in Galena had to get on a plane and it was only a little, say, an extra hour to get to Fairbanks -- KAREN:  Right. DR. JAMES:  -- than it was to get to Tanana.  And certainly the medical care in Fairbanks was much great -- better.  They had specialists available when you need them.  You have all the equipment, Cat scans, MRIs, and so on.  You have experts to read the X-rays.  And so people get much better care coming to Fairbanks than they did going to Tanana Hospital.  You'd have two -- one or two doctors there and don't have the equipment.  Now, back in the '60s, you know, Fairbanks didn't have a Cat machine. KAREN:  Right.  DR. JAMES:  A Cat scan.  They didn't have ultrasounds and MRIs and so forth.  And there was no trained obstetrician when I came to Fairbanks.  KAREN:  Wow.  DR. JAMES:  The family docs just did all their OBs.  KAREN:  Right.  DR. JAMES:  But the care has become more specialized and especially with the new equipment.  So in 1960, they could probably get just about as good of care in Tanana as they could in Fairbanks.  We would send emergencies to Fairbanks or to Anchorage, but we did some surgery, we would do appendectomies and do deliveries and do C-sections, ectopic pregnancies, and so forth, in Tanana.  And on occasion, we would send people to Anchorage for more difficult things.  KAREN:  It's interesting that even with all the specialization in medical care, the Health Aide Program is still working.  DR. JAMES:  Uh-hum.  The entry into -- into the medical system.  And they can handle a lot of them.  And what they can't handle, they send on.  And what we couldn't handle in the clinic, we would send on, too.  KAREN:  Right.

KAREN:  Another thing I'm interested in knowing about are the issues of confidentiality.  You know, in today's medical world, that's strongly emphasized.  DR. JAMES:  Uh-hum.  KAREN:  I don't know how it was in the past in the villages.  DR. JAMES:  You tried to do as much as you could, but everyone in the village knew what was going on, and we started having radio call and try to say, 37-year-old woman with -- rather than saying Mary Jones or something like that.  So we tried.  And then when we got on the phone system, the health aides were so much in the habit of saying, 37-year-old woman, I said, well, what's her name.  Well, you know, they didn't want to say.  I said, we're on the phone, no one's going to hear.  So that they could say the name since we knew a lot of the people.  It was better to know who. KAREN:  Right.  DR. JAMES:  Rather than just some vague 37-year-old woman.  KAREN:  Right.  Well, it just seems a little unusual, too, is that you stayed around so you had the continuity with patients. DR. JAMES:  Uh-hum.  KAREN:  That not necessarily all doctors would have had.  DR. JAMES:  That was -- that was very good.  And I took care of four generations of people, you know.  So you know, from '59, and even when I was at Tanana Clinic, before they had a clinic, a Native clinic, they were contract to do the Native care and the Tanana Clinic did the Native care.  KAREN:  Okay. DR. JAMES:  So I still saw a lot of Native kids is how -- when I was a pediatrician in Tanana Clinic.  And then I was consultant at the Native clinic there.  KAREN:  And then when you went to what's now the Chief Andrew Isaac clinic, were you -- did you continue to focus on pediatrics?  DR. JAMES:  No.  Because I was the only one there.  KAREN:  Oh, okay. DR. JAMES:  No.  It was family practice.  KAREN:  And then did you retire from there?  You stayed there until you retired?  DR. JAMES:  Yeah.  I started in '73 and then I retired in '03, so except for the two and a half years I was in Tanana, I was 30 years at the clinic.  Dr. Elterman started at Barrow and then went to Tanana, and then when they closed the clinic -- the hospital in Tanana, he came to town.  So he has a long experience, too.  KAREN:  Elterman?  DR. JAMES:  Elterman, Floyd Elterman.  And he's still at the clinic.  KAREN:  Okay.  Great.  DR. JAMES:  And Donna Galbreath is there -- KAREN:  I think -- DR. JAMES:  -- for about 12 years.  KAREN:  I think I just saw her -- an article.  She is Native?  DR. JAMES:  She got married and moved to Anchorage.  KAREN:  And she's Native?  DR. JAMES:  Yeah.  KAREN:  Okay.  I saw an article in the council newsletter or something, something about her -- DR. JAMES:  Uh-hum.  KAREN:  -- moving on.  And I hadn't heard of her. DR. JAMES:  So it was me and Floyd and Donna, we had a long time, a lot of experience and so forth.  Now it's sort of I left and Donna left and Floyd's going to retire.  The one that's been there the next longest is going to retire.  So it will be in probably every two years, get someone new again.  KAREN:  Yeah.  DR. JAMES:  But the stability of a staff is just remarkable.  KAREN:  Right.  Do you have any observations on the differences of Public Health Service providing Native medical care versus Native organization, Tanana Chiefs providing that?  DR. JAMES:  Uh-hum.  I was very happy to see the Native corporation of Tanana Chiefs take over for several reasons.  When we were Public Health Service, people were either Civil Service or commissioned officer.  And say we needed a nurse.  And we knew a nurse that wanted the job.  She wasn't on the Civil Service list, we couldn't hire her.  But we needed a head nurse once.  And there was -- so we got the Civil Service list.  And the one on the top of the list was in South Carolina or somewhere.  And she wanted the job and we had to give it to her.  And she came up, and she was an older woman, with very elderly parents who were still back in the South somewhere.  And she was here a year, and she was worried about her parents, she was depressed, she was -- it was just terrible.  She was absolutely worthless.  And she left after about a year.  When Tanana Chiefs came along and we needed a nurse, and we knew a nurse that wanted the job that would be competent, well, then, we could go ahead and hire her.  And not just nurses.  KAREN:  Right.  DR. JAMES:  Anyone else.  When you go into the clinic, a lot of the staff at the clinic is Native.  And it wasn't that way before because they had to be Civil Service and so forth.  So the rules of the Federal government were...  And if we decided to do something different and it was okay with the health board, we would go ahead and do it.  But you know.  It's -- the control is local and it turned out to be much, much better.  KAREN:  Okay. DR. JAMES:  But before it was sort of the Washington deciding what the Natives needed.  And now it's sort of what the Natives feel they need.

KAREN:  Did you ever have any interaction with traditional healers or midwives?  I don't know if there was still any around. DR. JAMES:  I wasn't aware of very many around for any traditional healers.  Like I think the Eskimos have -- KAREN:  Well, I think it varies from community to community and region to region.  DR. JAMES:  Uh-hum.  It was some of the -- I remember I had one patient in the hospital, had a boil, infection on his leg, and he felt he'd never get better until he got some stinkweed and put on it.  And we found some stinkweed and gave it to him to put on it.  And he got better.  So though I think he would have gotten better with antibiotics, too, which he did.  A lot of the habit, you know, when a kid has an earache, blow smoke in his ear.  And use pitch for cuts and bruises and so forth.  And things like that, that no -- I wasn't aware, maybe I was just ignorant of any traditional healing.  KAREN:  Yeah, I don't know.  I don't know if the history of it in this area, the time period.  So yeah, I was just curious.  Because there were definitely different ways to practice medicine.  And how it all integrates together is interesting.  DR. JAMES:  Uh-hum. KAREN:  I guess the other thing is, looking back on your career, how -- having interacted with health aides in the work you've done in the villages and things, how that's sort of affected you personally.  In your work.  DR. JAMES:  Well, I think more than anything, just continuity of knowing who their grandparents were and so forth is -- that's been good.  Of course, I would have gotten that, I guess, if I had been in a small town somewhere of Non-Natives.  But I think it gave me an appreciation of problems, cultural problems and so forth in the Natives, the strengths.   I saw, you know, I saw a Native culture at its best.  And not just walking down Second Avenue like a lot of Non-Natives, you know, the impression they have of Natives is walking down Second Avenue.  I've seen the strengths.  And potlatches and so forth that shows the strengths of the Native culture.  When you're -- and I think it also gives me a better appreciation of minorities in general because if you're in a village and you're the only White person in the village, that's a different feeling.  You can understand maybe how a Black in a White office or a Native in a White culture where everyone's White except them, where everyone's -- you're the only Black person in the room.  If you're -- I've had the experience of being the only White person in a room or in a village.  I think it gives you more understanding of how minorities feel.  When we moved back to Tanana, my wife was Native from Fort Yukon, she and I were out walking past the playground, overheard my one son, one of the kids in town, he said, are you a -- are you a White man or are you a Native?  And he was probably in the fourth grade then.  And he said, well, my mom's an Indian, my dad, he's a honkey.  So, you know, kids could be in both worlds, I guess.  KAREN:  Right.  DR. JAMES:  But that was kind of funny that he was a little bit ashamed that his dad was a White man.

KAREN:  Do you have a way -- let me figure out how to ask this question, but the way I have it written is your assessment of the Health Aide Program in terms of its success and failures in delivering health care in Rural Alaska.  DR. JAMES:  Well, I think it's been a success.  It's certainly much better than it was before there was a Health Aide Program.  Part of the problem is turnover and training, keeping the training up of the new people.  It's a very demanding job to be a health aide.  In some places, they have a health aide for 20 years, so.  But sometimes the health aide turnovers are such that they don't have -- the new ones coming in haven't had enough training yet.  And they have various stages of training. And so some of the health aides are acting health aides before they really had enough training.  But it's still better than having no training at all.  KAREN:  Do you have any thoughts on what could be done to reduce that turnover?  Keep people with the job longer?  DR. JAMES:  Well, I think one of the things they've done is to have more than one health aide in a village so that you're not on call continuously.   And I don't know what health aides make now, but they were very poorly paid at the beginning.  KAREN:  It's interesting to think about why in some places or why -- it's either -- I don't know if it's the community or it's the individual person and their personality that makes somebody be a health aide for 20 years versus somebody else who does it for 6 months and changes.  DR. JAMES:  I think it's more the person.  So strong health aides, you just don't screw around with the health aide, you know.  They are very -- Rose Ambrose, Jessie Williams, what they say goes. I've been in clinics where a health aide would say, you can't see the doctor like that, you go home and clean up before you come back.  And boy, they'd go home and clean up and come back. KAREN:  Yeah.  And that's what I wonder, that as the current generation of health aides, do they have that same influence?  DR. JAMES:  Well, they may eventually, but boy, you didn't -- you didn't screw around with Rose or Jessie, you know.  They -- they were the health aides and you did what they told you to do.  And if they would -- some of them, when you were coming to town, some of them would just say Dr. James is going to be in town these couple days.  Others would make a schedule, you be here at 1:15.  If you're not here at 1:15, you can't see the doctor.  Others, you know, you go in the village and you'd be -- it wouldn't be busy at all until about an hour before the plane was going to come pick you up.  And then everyone would come in at the same time.  But it's -- I think it was the person more than the village. KAREN:  That is interesting. DR. JAMES:  Because you have to be a real strong person to be a -- a good health aide and not burn out.  KAREN:  It's amazing how some of these early health aides, you know, did it for 30 years, half the time they weren't paid, and just the commitment.  And I'm thinking about, you know, my younger generation now, I don't think people in my generation would do that.  DR. JAMES:  Maybe they will as they get older.  KAREN:  Yeah, I don't know.  But it seems -- and that's why I wonder, what -- what was it about those people that made them do that, made that possible.  DR. JAMES:  I don't know.  KAREN:  And I have asked some of them.  You know.  Because it is interesting, the differences.  DR. JAMES:  Like Jessie Williams and Rose and Bertha, they were strong health aides.  They were strong people.  I don't know, the way they grew up, having no health care, and then having health care then, they've seen how -- that it's nice to have good health care.  KAREN:  Yeah.

KAREN:  So what do you see for the future of the Health Aide Program?   DR. JAMES:  Well, I hope that they maintain it.  I hope -- you know, I don't know what the future is for the villages.  The biggest Native village in -- in the Interior is Fairbanks.  Over half the people registered in -- are from Fairbanks, they aren't from the villages.  And people are moving to town.  Every once in awhile you read in the paper that Rampart lost their school -- KAREN:  Right.  DR. JAMES:  -- because they didn't have enough students.  Some other village is trying hard to keep their school because they don't have as many -- enough kids, and so forth.  So I don't know what's going to happen to the villages, like the remote villages.  KAREN:  I've also heard that the -- DR. JAMES:  Like Allakaket and Arctic Village.  Huslia and so forth.  KAREN:  I've also heard that the Health Aide Program has kind of been looked at as a model, where you talk about the dental program and I've heard them talk about it for behavioral health also. DR. JAMES:  Uh-hum.  I look upon these trained dental people sort of like PAs.  When you have physician assistants, even like in Tok -- I guess there is a doctor in Tok now, but for a long time, there was no doctor in Tok and the physician assistant, PA, ran the health care there. KAREN:  Uh-hum. DR. JAMES:  And I kind of look upon this dental assistant like a physician's assistant.  They aren't just out there all on their own, they have a supervising doctor, a supervising dentist.  And don't see much difference from having a PA in the village or having a DA in the village. My favorite -- the dentists, it's always been easy to get a medical license in Alaska.  KAREN:  Oh, really?  DR. JAMES:  There's been no restrictions for if you have -- there's reciprocity with other states, if you have a license in Ohio.  I had a Ohio license when I came up here.  And I just applied, it was a formality, and I got an Alaska license.  KAREN:  Oh.  DR. JAMES:  I think now they look into these computerized things and whether you've had malpractice and whether you've been -- lost your privileges and so forth.  But if you have a clean record and if you have a license, you get a license in Alaska.  The dental, it's been very difficult to get a dental license in Alaska in the past.  Maybe not so much now.  But they would have their -- if you had a license in California and you came up here, they would have what they called practical, and you'd have to do a filling or make a bridge or something.  It was very subjective.  And many, many dentists failed to get a license here.  Sort of protecting their turf.  And I kind of look upon this dental assistant thing as kind of protecting their turf.  I think it's better to have some dental care than no dental care.  And if they had a dentist in Galena, well, then, maybe you don't need a dental assistant. KAREN:  Right.  DR. JAMES:  Or a dental, whatever they call them, dental technician.  KAREN:  Yeah. DR. JAMES:  But I don't think there's many dentists practicing in Unalakleet.  KAREN:  No.  DR. JAMES:  And just the most recent article I read is maybe about Bethel.  They are under the supervision of a dentist and -- KAREN:  Right.  DR. JAMES:  So I think it's a good thing.  KAREN:  Okay.

KAREN:  Are there any other particular favorite stories or memories you want to share from your years in Tanana?  Or working with health aides?  DR. JAMES:  Well, everyone knows this story, but my very first field trip, in January to Nulato, and I was new to the whole thing.  We had a Public Health nurse who covered the area, so she went on the field trip with me.  And they tried to send a nurse from the hospital out to see what village life was like.  You know, Tanana wasn't -- it was even more village than Tanana was.  KAREN:  Right.  DR. JAMES:  When I went to Nulato, it was in January.  So I had a nurse and -- a Public Health nurse with me.  Got off the plane and the plane left, and one of the patients I saw was a woman with a ruptured ectopic pregnancy.  And I told her, go home, go to bed and don't move, and we'll try to get a plane down.  Then a couple -- an hour later, her husband came down and he said she's getting worse.  So we brought her down to the clinic.  And it was cold.  We had some IVs, started an IV on her and put her in a dog sled, a sleeping bag, and IV froze on the way to the clinic.  So we had a couple more IVs.   And the radio in Nulato was broken, so there was no way we could get anyone to -- the Air Force was still in Galena, we thought we could get a helicopter or someone to come down, take us back to Tanana.  So I was running the IV and the -- one of the guys said, well, he would go to Koyukuk by dog sled to radio to Galena to come pick us up, medevac us.  So she was sort of stable.  And hours went by and nothing was happening and she was getting weaker.  So I called her husband down and the priest, there was a priest in town.   And I told him what was going on, and I thought if I operated, she might die, but if I didn't operate, I was sure she was going to die.  So they said it would be best to operate.  So they did have a clinic building there in Nulato.  And they had an old, old examining table there, must have come up by dog sled I think.  And then the room, the only light in the room was over the oil heater, the space heater.  So we got a stepladder and a 5-cell flashlight.  And I operated on her with local anesthetic.  Had a suture kit and I operated on her.  KAREN:  Wow.  DR. JAMES:  Took me a while, but we finally got her -- got her covered.  Next day about noon, a helicopter came down from Galena and they took her into Tanana.  They transfused her up.  And then took her to Anchorage.  I thought sure she was going to have infections and electrolyte imbalance and so forth.  So we took -- flew her down to Anchorage the next day.  I was -- I'll never forget, we were met at the emergency room door by this surgeon, he said Bill, what did you do?  And I told him.  He said really?  Well, what did you use for anesthesia?  I said, well, I had Xylocaine, just local. KAREN:  Right.