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Stella Krumrey
Stella Krumrey

Stella Krumrey was interviewed on March 10, 2005 by Karen Brewster in Kodiak, Alaska. Stella is from the village of Old Harbor, Alaska, but was interviewed at the Kodiak Area Native Association offices in Kodiak City while waiting for the weather to clear for flying. She was traveling to Ouzinkie to help the health clinic there establish a manager position, similar to her job in Old Harbor. In the interview, Stella talks about the importance of family and community support for health aides, the joys and hardships of being a health aide, the difficulties of being from the community you work in, the training she received, and why she enjoys health care work.

Digital Asset Information

Archive #: Oral History 2004-17-03

Project: Community Health Aide Program Project Jukebox
Date of Interview: Mar 10, 2005
Narrator(s): Stella Krumrey
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

Personal history of when and where she was born, her childhood and educational background, and how she became a health aide.

How she was recruited to be a health aide and the type of training she received.

The health aide being the eyes and ears for the doctors and communicating with doctors in Anchorage and Kodiak.

Training, certification, and continuing education credits required to be a health aide.

The old and new clinic buildings and facilities, and visits to the village from doctors and dentists.

The relationship between traditional and western medicine and healers and the community health aides.

How important the community health aide is to the village, and some of the difficulties of the job.

The work schedule of health aides and shifting her job from health aide to clinic manager.

What she likes about doing health aide work, and how the community comes together to help during a crisis or emergency.

Changes in the health care system and the equipment used in rural clinics, especially the advancement of telemedicine.

The joys and hardships of health aide work.

What she has learned and how her life has changed because of her work as a health aide.

How being a health aide gave her confidence in being able to do things, and advice for younger people wanting to become health aides.

Differences in health aide program management and changes in the quality and availability of medical services.

Her parents, important health issues today on Kodiak Island, and how the Kodiak Area Native Association (KANA) is involved with health education.

The importance of having family support when you are a health aide, why she stayed with the job, and health aides as role models in their community.

Her appreciation for having the clinic manager job and how she thinks it is unique to Kodiak Island.

Types of medical cases seen, sending difficult cases to the doctor, and how her level of training helped her.

Advanced medical training, such as physician assistant's school.

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

Transcript

KAREN: Today is March 10th, 2005, and this is Karen Brewster, and here with Stella Krumrey. STELLA: Krumrey. KAREN: And we're here in Kodiak, although you are from Old Harbor? STELLA: Yes. KAREN: Okay. And this is for the community health aides project. And Stella, thank you for agreeing to participate. STELLA: Oh, you're welcome. KAREN: So I'll just start with when you were born and where. STELLA: I was born in Old Harbor in November of -- November 10th, 1947. KAREN: Uh-hum. STELLA: And I -- I grew up in Old Harbor. Actually, I'm sorry, I was born in Old Harbor, I was raised in Kaguyak. It's a village between Old Harbor and Ahkiok. It was wiped away by the tidal wave in -- after the earthquake in 1964. KAREN: Oh. STELLA: So then I moved permanently to Old Harbor after that happened. KAREN: So you were there in '64 with the -- STELLA: In Old Harbor. Actually, you know, we moved back and forth because Old -- Kaguyak didn't have a school for us to go to school. KAREN: Oh. STELLA: So my parents moved us every winter after I became of age to go to school. KAREN: Uh-hum. STELLA: Probably when I was about eight, though, eight years old. KAREN: And how many in your family -- STELLA: There's -- there's four of us in the family. It's two girls and two boys. KAREN: That seems like a small family -- STELLA: Uh-hum. KAREN: -- for around here. STELLA: Yeah. KAREN: So what sort of an educational background do you have? STELLA: I went to school, grade school, in Old Harbor, and I didn't get -- I took my GED in -- and took a couple of years of community college here during the time -- after I became a health aide -- KAREN: Uh-hum. STELLA: -- I took one year off and went -- year and a half off. Uh-hum. KAREN: Okay. And so, now, when did you become a health aide? STELLA: 1980. March of 1980. KAREN: And what got you involved in becoming a health aide? STELLA: I was a community health representative before I became a health -- health aide. That's a CHR. KAREN: Uh-hum. And could you explain what that is. STELLA: It's -- basically, I worked with the people that needed help filling out paperwork or -- and I was kind of like a liaison between the court system and, you know, the people that needed to have some sort of a counseling. So-- KAREN: Uh-hum. STELLA: Yeah. Those kinds of things. KAREN: Uh-hum.

STELLA: How I got into the health aide program, we had a health aide, a sole -- you know, one health aide that was -- lived in Old Harbor, Jenny Lee Erickson, and she had an alternate health aide that quit her job, and they were looking for someone. So I was asked to -- to try -- to try out to see -- you know, for a while I thought about it. I said I don't know if I could do this because I just know because as a CHR, I was called on to help with some emergencies -- KAREN: Uh-hum. STELLA: -- with -- with the health aide. But I decided I would try it, and that's when I, you know, said I would. KAREN: Uh-hum. STELLA: And I -- I have been since. KAREN: Uh-hum. And you said they asked you to. STELLA: Yeah. The people -- KAREN: Who is "they"? STELLA: The Tribal -- Sven -- when Sven Haakensen was our Tribal president, I think, and he came to me and asked me if I would, you know, be willing to become, because they were looking for a health aide and nobody really wanted to. KAREN: Uh-hum. Yeah, that's one of the interesting things is how people get recruited. STELLA: Yeah. KAREN: You know. And why did they choose you? STELLA: Because I think I was there and I was, you know, available in the village. KAREN: Uh-hum. And so had you ever -- before you became a CHR, had you ever done anything with health things? STELLA: No. I never was the health aide. I worked at the school -- for the school district as a teacher's aide. KAREN: Uh-hum. STELLA: And I -- a house parent. KAREN: Uh-hum. So once -- STELLA: So I was -- I was always working with, you know, kids. KAREN: Right. So once you became the health aide, then, what kind of training did you receive? STELLA: I -- I went to the CHAP program up in Anchorage, they sent me there. I had -- I went to -- I can't think, was it three sessions at the time? I can't remember. Three or four sessions. But when I -- when I became a health aide, I -- I kind of was trained by the former health aide in Old Harbor -- KAREN: Uh-hum. STELLA: -- before I went up for my training sessions. KAREN: So explain more about those training sessions in Anchorage. STELLA: Yeah. You -- I -- when they send us up there, we spend a month at a time. KAREN: Uh-hum. STELLA: To -- to our sessions. KAREN: And is it classroom training or -- STELLA: Yes, classroom. And then we -- it was on -- hands on, where -- you know, where you went to the hospital and followed a doctor or then whoever to -- KAREN: Uh-hum. STELLA: -- to see and how -- how it was done. KAREN: Uh-hum. And, now, is that required training for all health aides before you start the job? STELLA: Yes. It's -- not before you start the job, though, it's a -- you know, you have all the -- you can become a health aide and be -- and the health aide that's there is your trainer. KAREN: Uh-hum. STELLA: They give you so many -- you know, so many weeks, whatever, to decide if you want to become one. KAREN: And then you say yes and then they send -- STELLA: Uh-hum. KAREN: -- you to Anchorage? STELLA: Yes. KAREN: And so do you go back -- the training in Anchorage is just one -- one month, or it -- STELLA: It's -- KAREN: -- you go multiple times? STELLA: -- multiple. It's -- it's -- during my time, it -- it was three sessions. I finished mine in two -- actually, 1980, and I was certified in 1982, so it took me two years to finish my sessions. After the three sessions, you go to your preceptorship for two weeks, and that's in -- I did mine here in Kodiak for two weeks. KAREN: Okay. And so each of those three sessions, do they have a focus? STELLA: Yes. They have -- it's -- it's divided into three sections, and I just don't remember what -- you know, the first, I know the first one was, like, basics, with teaching you how to do paperwork, like filling out your PEF's, doing the vital signs -- KAREN: Uh-hum. STELLA: -- and doing examinations on a -- on a -- on a patient. KAREN: Uh-hum. STELLA: So it was always three different sessions, you know, with different topics. KAREN: Uh-hum.

KAREN: So the health aide, explain a little bit about what the job is and what you end up doing. STELLA: It's -- basically what the health aide does is we see patients and report it to the doctor. You know, we are kind of like eyes and ears for the doctor that we report to. KAREN: Uh-hum. And the doctor that you reported to was where? STELLA: When I first started? KAREN: Uh-hum. STELLA: Was all the way up in Anchorage. KAREN: Oh. STELLA: It was through a radio, so it was those -- those years when we still didn't have telephones in the villages, so I had to use the two-way single sideband radio to talk. And it was mostly like you have to have somebody relay for you because the -- the reception was not good, you know, or you couldn't -- it was -- KAREN: Yeah, I was going to say, you could get from here to Anchorage by two-way radio? STELLA: Yes, for some it -- we always did. It was just -- I never could understand it, but yep, it was. KAREN: Hum. And so when did it switch to a doctor being here in Kodiak? Or is -- is that -- you said first it was in Anchorage, and then -- STELLA: Oh, our -- yeah, we had -- it was Public Health Service up in Anchorage. KAREN: Uh-hum. STELLA: Again, we worked for, and KANA, when had they formed, took over, I think it was 1975, '76, somewheres around -- I can't remember what year, but that's when we started the doctors from here we would talk to. And -- and then we, you know, got the telephones during that time, so we had to use telephones. KAREN: Do you remember when the first telephone -- STELLA: The first one we had, we had only one telephone in the whole village and it was in our Tribe -- our City Council building, and we had to use that phone. KAREN: Uh-hum. STELLA: And then it was back in -- it had to have been '80s because I became a health aide in '80, and I was still using the radio. So it was probably a couple years after I became a health aide -- KAREN: Uh-hum. STELLA: -- is when we had.

KAREN: I didn't finish talking about your training. You said once you became a health aide, then you continued to get training? STELLA: Yes. You have to. You had -- you were required to, so many CME's that you had to get every -- every two years. KAREN: Those are continuing ed credits? STELLA: Continuing, yes. Uh-hum. KAREN: Do you know what "CME" stands for? STELLA: Continuing medical education. KAREN: Oh, okay. STELLA: Uh-hum. KAREN: And where would you go to get those? STELLA: Anchorage is where I went to get mine. KAREN: Uh-hum. And -- STELLA: And some -- you know, and here in Kodiak, one, if they offered something here. KAREN: What's an example of some kind of a course you'd take to go for CME credits? STELLA: Emergency kind of things like, you know, how to take care of people, those kinds of things. And we always had, like, for pediatrics for children or for giat -- gia -- how you say, for older people. KAREN: Uh-hum. STELLA: Those -- just whatever they think that we needed. KAREN: Uh-hum. And that's to keep your certification active? STELLA: Certification, yes. Uh-hum. KAREN: And what happens if your certification -- if you don't get those credits and it runs out? STELLA: Well, you lose your certification. You have to, you know, go and start over again, or try to get all those credits in. KAREN: Uh-hum. And is there some sort of an exam for being certified? STELLA: Yes. You do a -- uh-huh, you get a testing after. KAREN: Uh-hum. STELLA: You do a -- well, they -- what we did is we had a pre-test and a post-test. They wanted to know how far along we were to be able to, you know, take the -- take the class. KAREN: Uh-hum. STELLA: Like a math class, English class, and all those other stuff that -- that you would have to know before you went to sessions. KAREN: Oh, so you would have to know all that beforehand? STELLA: Uh-hum. KAREN: Oh. Okay. Again, I was wondering if -- if there are health aides who don't pass the certification but who continue to be health aides without the certifi -- can you continue to be a health aide and be employed without that certification? STELLA: No. No. You have to be certified. KAREN: And even from the beginning it was like that, in the beginning of the program? STELLA: Yes. KAREN: Yeah. STELLA: Uh-hum. Yes. We have to keep up our certification to be -- to be able to be employed. Uh-hum. KAREN: Okay.

KAREN: You mentioned the first telephone, and that it was in another building. It made me think -- STELLA: Actually, it was not in another building, it was the same building, it's a different room. KAREN: Oh, okay. STELLA: Uh-hum. KAREN: Because I was going to ask you, so what were the facility -- the clinic kind of facilities you started in and how has that changed? STELLA: We had a building that was connected to the Tribal and the City office at one time, the first building that I work in, and so we just had, like, a one -- the waiting room and exam room and the bathroom. So there was only, what, three rooms -- KAREN: Uh-hum. STELLA: -- that we had. And then we -- they built this new clinic that -- well, this clinic that I'm working in right now was built in 1980 -- probably 1987. And we just moved in, like, 1990 -- KAREN: Hmm. STELLA: -- to the -- to this building. So we have -- it's a bigger place. We have two exam rooms, we have a waiting room, a receptionist room, and we have a dental room. We have two bathrooms and a storage room, so --  KAREN: Uh-hum. And does -- did KANA build that? STELLA: No. The City of Old Harbor built it. KAREN: Oh, I see. So you guys just -- STELLA: The Public Health -- the Public Health -- no, not the Public Health. PHS is what you -- KAREN: Yeah, Public Health Service. STELLA: Rents that space -- KAREN: Oh, okay. STELLA: -- from the city. KAREN: Oh, okay. STELLA: Uh-hum. KAREN: What was I just going to ask. Oh, about the -- you mentioned communicating with the doctors. How often did doctors come -- did -- did doctors come and make a visit to Old Harbor? STELLA: Yes, they did. When I was -- before I started working, they always came, you know, they are, like, once a year. KAREN: Uh-hum. STELLA: They came. Then they made it to twice a year that they came, until KANA was formed, then we started having visits like four times a year. KAREN: So that's what it is now, is about -- STELLA: Actually, it's -- yeah, pretty much four times a year now. KAREN: Uh-hum. And then you also said now they have dental -- STELLA: Uh-hum. KAREN: -- dentists that come? STELLA: Yeah. Twice a year. KAREN: And that -- that's a new thing? STELLA: No, no, that's been -- gosh, how many years now that KANA has been doing that? I don't remember. But it's been twice a year for the past 10 years maybe. KAREN: Uh-hum. STELLA: Maybe more. We have a dentist that come and then the hygienist that come, so it's two different groups. KAREN: Oh, I see. STELLA: The dentist will come and the hygienist twice a year. KAREN: Uh-hum. STELLA: So it's four visits for the dentists. KAREN: Uh-hum.

KAREN: I know that in Kodiak, there's been a long, strong history of traditional healing and medicines. STELLA: Uh-hum. KAREN: Can you talk a little bit about the connection of that and the health aide program. STELLA: Actually, there isn't really a -- growing up, you know, we had traditional healers. KAREN: Uh-hum. STELLA: I -- we didn't have health aides. Where I grew up in Kaguyak, we didn't have any health aides at all. So we had just a traditional healer -- KAREN: Uh-hum. STELLA: -- that used to take care of us. And she used a lot of herbs, you know, from out the ground, wherever she could find -- KAREN: Uh-hum. STELLA: -- is what she used. I remember growing up, her taking care of me. KAREN: Uh-hum. STELLA: When I was sick with fever or sore throat or, you know, stomachache, things like that. KAREN: Uh-hum. And -- STELLA: Cuts and sores. KAREN: Was she also a midwife? STELLA: Yes. Uh-hum. She was, but then people -- where I grew up, there was a little village, so people would come to Old Harbor to midwives that were really trained as midwives, just the midwives. KAREN: Uh-hum. STELLA: So that's why they went to Old Harbor to deliver. Like my mom, for instance, went to Old Harbor to have me. KAREN: Uh-hum. And who -- who was the -- what was the name of the healer you were just talking about who helped you when you were a kid? STELLA: Oh, Julie. We called her Julianna but her name was Julianna Ashouwak. KAREN: How do you spell Ashouwak? STELLA: A-S-H-O-U-W-A-K. KAREN: Okay. STELLA: And she died in early 80s, I think, or sometime. KAREN: Uh-hum. And with that -- STELLA: Or her 70s. KAREN: -- with that history of people using traditional healers and midwives, and then this new system of Western medicine coming in, have people -- were people accepting of this new system and going to community health aides, or was that a difficult transition? STELLA: No, because during the time we had traditional healers, we had teachers that came in and also would, like, give, you know, immunizations or shots or things that -- that -- and if someone got hurt or broke -- I mean, they always went to the teacher. So that was -- I don't think it was a difficult transition. KAREN: Uh-hum. STELLA: Because they already had some -- someone that knew what they were doing. KAREN: Uh-hum. STELLA: Old Harbor didn't really have a healer, a traditional healer. KAREN: Uh-hum. STELLA: So people from Old Harbor would come to Kaguyak to see Julianna. Uh-hum. I remember those times. KAREN: Yeah. STELLA: Uh-hum. People with -- that used to have -- say, that had heart problems would come and see her or high -- high -- it must have been like high blood pressure, probably. I'm not sure. KAREN: Uh-hum. STELLA: But I was never really, you know, around her or watched her do things, but I knew that she -- KAREN: Uh-hum. STELLA: I know that she took care of me when I had fever -- KAREN: Right. STELLA: -- and when I had sore throat, and gave me some -- some things to drink that I don't even know what was in it, really. KAREN: Right. Now, are there still traditional healers and midwives practicing in villages? STELLA: No. KAREN: No? It's all community health aides? STELLA: It's all community health aides now. Uh-hum. Growing up knowing, you know, we had -- Old Harbor had quite a few midwives. KAREN: Uh-hum. STELLA: In fact, I had one of my -- one of my -- my second child was born in Old Harbor with a -- by a midwife. KAREN: Uh-hum. STELLA: She was. Uh-hum. KAREN: And who was -- who was that? STELLA: Actually, there was two of them, and they are both gone now. KAREN: Yeah. STELLA: Irene Shugak and Irene Kapchon, one of my midwifes. Along with your -- with their assistants, they had other, you know, people -- other women that were practicing, so, you know, they let them come and watch. KAREN: Uh-hum. STELLA: And so we had -- up until Lucy Shugak moved out, we had, you know, midwives, but after -- after she moved, we -- nobody is practicing anymore. KAREN: Nobody's taking up that -- STELLA: No. Huh-uh.

KAREN: So people have been -- do you feel people have been supportive of the community health aide -- STELLA: Yes. KAREN: -- program? STELLA: Uh-hum. Yes. And they are really -- I mean, I don't think they could live without a health aide anymore. I mean, you know, growing up, cuts and stuff that we had, you know, we kind of took care of, our parents took care of, or, you know, just -- now it's the health aide, you know, they come for any little thing, and they come to the health aide. KAREN: So it's a big responsibility? STELLA: It's a responsibility. And people really are, what you call, to the health aides are. Like I say, you can't live -- live without them or -- it's -- it's changed. KAREN: Uh-hum. STELLA: Yeah, people are -- used to, you know, kind of take care of themselves for little things, will come to the clinic, have the health aide see them. KAREN: Uh-hum. Well, it sounds like in the more traditional times that the healer or the midwife had a lot of status, you know, because -- STELLA: Uh-hum. KAREN: And I was thinking that they -- the traditional healers and midwives were people who were highly respected in their -- STELLA: Yes. KAREN: -- in their communities. STELLA: In the communities. Yes, they were. KAREN: And has the community health aide transitioned into a similar role of respect? STELLA: Uh-hum. Yes. Our -- they have been. Or are still are respected. KAREN: I can imagine that it's a difficult job. STELLA: It could -- yeah, it is at times. It is when we have -- you know, especially when we have tragedies or something that happens that involves the whole village or, you know, because you know everybody and, you know, in your home. KAREN: Uh-hum. STELLA: Yeah. KAREN: So how do you deal with that? STELLA: Oh, I myself, I prayed a lot. You know. And I have people that -- that are supportive. KAREN: Uh-hum. STELLA: People that come. KAREN: That's good. STELLA: Uh-hum.

KAREN: Talk a little bit more about just the job of being a health aide and, you know, you're on call 24 hours a day? STELLA: 24 hours a day, 7 days a week, and you can't, you know -- the only time you get -- when I was a health aide, as a sole health aide, the only time I really got to rest is when I left Old Harbor, and seen a move -- or come to Kodiak. KAREN: Uh-hum. STELLA: That's when I got my -- my rest or my relief, and didn't have to worry about being on -- you know, somebody calling. KAREN: Uh-hum. STELLA: Yeah. KAREN: Uh-hum. I admire that, people like you who can do that kind of work. I can imagine it would be very hard. STELLA: Yeah, it was. It -- it has changed. I mean, it's not as -- you're not as pressured as much as, you know, the one -- the former health aides because we have people that are trained to be EMT's now. KAREN: Uh-hum. STELLA: And so they take call. And we have them -- we call them VRT, Village Response Team. So we have, you know, a lot -- we have help that -- that know what to do in an emergency. KAREN: Uh-hum. STELLA: So we don't feel like we're alone anymore. KAREN: Oh, that's good. So when that was -- when it first started, you were just one health aide? STELLA: I was, yes, for all -- for many years. I worked mostly by myself without anybody that knew how to -- you know, I -- you know, if there was an emergency, bystanders would come and help -- KAREN: Uh-hum. STELLA: -- but they -- they weren't trained in CPR or first aid or anything like that, but you'd have to kind of tell them what to do. But now we have our EMS -- EMT's, and they know how to handle things. KAREN: Uh-hum. STELLA: So it makes it really much easier for health aides. KAREN: Uh-hum. And this morning, you and Rebecca were talking about the -- the way the hours work. You're now no longer -- you said -- STELLA: I know. For many years. KAREN: -- you were the only health aide on call for 24 hours every day. STELLA: Until -- yes. And probably eight years ago, I -- my job description changed, so I'm a clinic manager. So I am just doing mostly paperworks, paperwork in the clinic, and making appointments, doing -- you know, like I'll do blood pressures or I'll refill -- call for refills for medications. KAREN: Uh-hum. STELLA: And I go visit elders. And I work with the doctor -- doctor when they come up, set up appointments, and I do the paperwork, the monthly reports and all that stuff. So that's my job description now. KAREN: Uh-hum. STELLA: So I don't have to be on call 24 hours a day, 7 days a week, and I don't have to see the emergencies, but -- KAREN: But they still have you there -- STELLA: Uh-hum. KAREN: -- with your experience and knowledge? STELLA: Yes. And our health aides are -- you know, they work six hours a day and they get a week off every two weeks, so -- which I never had, never had when I was working by myself. KAREN: And so how many health aides are there now in Old Harbor? STELLA: I have -- we have two. KAREN: Two. STELLA: Uh-hum. KAREN: So they alternate. STELLA: Uh-hum. Yeah. KAREN: That's good.

KAREN: So how did you -- when you were the only health aide, how did you ever, you know, get out of town? STELLA: We would have to get somebody to cover the clinic. KAREN: Yeah. Okay. STELLA: Uh-hum. KAREN: From another village? STELLA: Yes. KAREN: Kodiak? STELLA: Uh-hum. Yeah. You know, it was like I had alternate health aides, but they never -- never really finished or never stayed on -- KAREN: Uh-hum. STELLA: -- during the time I was the health aide. So I worked with many other health aides that tried to become health aides, but didn't make -- you know, didn't finish or didn't -- you know, just couldn't handle it. KAREN: Uh-hum. Yeah. It seems like it takes a certain personality. STELLA: Yeah. It does. And I like working with people, and I care for people, especially older kids -- older people and little ones. KAREN: Uh-hum. STELLA: So, like, that's what keeps me in my job. KAREN: Well, that was my next question is what is it that has made you like being a health aide? STELLA: Well, I -- I like helping people. Especially -- I know that people need help, you know, certain things, and -- and I am always willing to help any way I can. And it's just not -- it's just -- it's just not a health aide job. For a long time I was -- you know, I took care of people that came in to visit Old Harbor, and I was, you know, the only one to prob -- to pick them up or bring them around, show them around, do things. KAREN: Uh-hum. STELLA: It was just -- and, like, I was, you know -- when people were sad or something they had to talk about, you know, they come to the clinic or come to talk to me. KAREN: Uh-hum. STELLA: That just -- KAREN: So as part -- part of your training, did you get some training in counseling? STELLA: Yes, I did. I did -- I'm not sure what they do anymore because I've been out of this for a long time. KAREN: Uh-hum. STELLA: I -- you know, we had training in counseling or behavior health kind of things, mental health. KAREN: Uh-hum. And then what happens if, as you say, some things, they involve the whole village, it's an emergency crisis, does the health aide provide support to the rest of the community, or is there some other sort of counseling that's provided? STELLA: Yeah, we have -- yeah, we have -- now, we have like this community health, you know, it's just called behavior health now. So -- and we have a suicide prevention person. KAREN: Uh-hum. STELLA: And we have an Indian welfare child person, so those people are there to help. KAREN: Uh-hum. STELLA: So -- and when we have any emergencies of sort, we all pull together and -- KAREN: Uh-hum. STELLA: -- work together. KAREN: And then -- but I was also thinking, is there also some sort of, what's it called, like post-crisis counseling? STELLA: Uh-hum. Yes. KANA offers that to us. KAREN: Okay. STELLA: They will come in for debriefing and stuff. KAREN: Yeah. STELLA: Uh-hum. KAREN: Well, that's good. STELLA: We have -- also, we have a VRT, Village Response Team, and we're pretty much -- everybody knows each other, and we have -- when we have any crisis, you know, we will get together and try to figure out what to do. KAREN: Uh-hum. Now, how many people live in Old Harbor? STELLA: Right now there's about 250.

KAREN: We were talking about, you said some of the changes in the health care system was one of my questions, and also the -- the changes in the equipment, in the technologies, when you -- since when you started as a health aide and -- STELLA: To now? KAREN: To now. STELLA: Yeah, we had just basic -- well, you know, we had our stethoscope and otoscope tool. That's what we used mostly. Uh-hum. KAREN: The otoscope's for the ear? STELLA: For the ears and, you know, looking with a little light. KAREN: Uh-hum. STELLA: Those kinds. We really didn't have any equipment. KAREN: Uh-hum. STELLA: Now that we have our Telemedicine, we can do -- like, we have an EKG on there and we have a -- where you can take pictures of ears or rash and put it in Telemedicine and just send it right through. So -- KAREN: Hmm. So how does that Telemedicine work? What kind of a setup is it? STELLA: It's like a TV set. It's set up right there. You just -- it has an otoscope where you can look into the ear and take pictures and that goes right through the Telemedicine to here. KAREN: To Kodiak? STELLA: To KANA. Or, I think -- I don't know if it's connected to Anchorage. I'm not sure. But the doctor can look at it right here, pull it up and look and see. KAREN: Uh-hum. So do you call the doctor and say, okay -- STELLA: Uh-hum. KAREN: -- there's something coming in? STELLA: Yes. Uh-hum. KAREN: All right. What -- what difference do you think that's made in providing health care? STELLA: I think -- I think it's -- you know, it is so hard as a health aide to try to describe some of the things that you see. To -- to be able to take a picture and show it to them is much -- I think it makes it much easier for -- you know, for the health aides to try to tell the doctor what -- what's going on. KAREN: Uh-hum. STELLA: Like if we have a cut in the toe, is our -- just like yesterday we had a guy who had stubbed his toe, and, you know, that would be hard to describe, so we took a picture of that and sent it right in, and the doctor saw it and he said the patient needs to come in. So those kinds of things makes it much easier. KAREN: Good. STELLA: Uh-hum. KAREN: And do you know when that telemedicine started being used? STELLA: Let's see. Ours was like in 1997, I think it came to our village. We were the first ones on Kodiak Island to get one. KAREN: Hmm. STELLA: In Old Harbor. KAREN: What other sort of changes in equipment or technology have you seen that you can think of? STELLA: Little things like -- like HemoCue where you can check your hemoglobin, you can check it right there, see what it is. Before we had a little slide like -- it's hard to explain but, you know, we have things that are much easier to use now. KAREN: Good.

KAREN: Can you remember back to the first times as a -- starting as a health aide, like your first emergency and what that was like and how you handled that? STELLA: Oh. My first? Oh, goodness. Those were my -- my first -- when I first started, I think I suffered when I opened it because seems like every -- you know, I -- we didn't have telephones, but when somebody knocked on my door, that's when I knew there was something, you know. Especially at nighttime. Yeah. Those were kind of heart racing kind of things like, oh, what's going -- what am I going to get into right now or what is -- what's the situation going to be like. KAREN: Uh-hum. Have you ever helped deliver a baby? STELLA: Uh-hum. I delivered a couple of them by myself because of the weather. You know. As you can see, it's like today. You know. We couldn't get any planes in or the Coast Guard wouldn't even fly. So --  KAREN: Uh-hum. STELLA: Ended up delivering. Luckily, it was a normal kind of delivery; otherwise, oh, it was -- for me, it was scary because I never -- I didn't know how the baby would be born or what would happen to mom. But luckily, we had a telephone right there and, you know, talking through -- the doctor talked me through things, what to do and all that. I was working through the telephone. KAREN: Okay. So do you remember what year that was? STELLA: Yeah. 19 -- probably '84. KAREN: Oh. Can you think of something that -- you know, that -- a great medical success that you had, that you could talk about that you're proud of having done and been a part of? STELLA: Yes. I -- oh, there's a few. One I can remember is a young boy who had had an appendix, and, you know, and a young man that had a -- I can't remember what he was. But anyway, I can remember the boy that had symptoms of -- you know, he had some pains in the right side of his -- of his abdomen. KAREN: Uh-hum. STELLA: And just describing them and doing the medical examination and reporting it to the doctor, and, you know, he would ask me -- you know, sometimes the doctors will ask you, what do you think it is. Well, I think it sounds like it's -- he's got appendix. And so -- and when we -- when I sent him in and got -- you know, the doctor called back, he said, yep, he had appendix, and I was kind of feeling like, oh, I did something that -- it was -- KAREN: You did something good. STELLA: Uh-hum. And I guess there was lots of others, things that I did. I was kind of a -- felt good about. KAREN: Uh-hum. Do you have another -- STELLA: Like -- oh, and like for a little baby, you know, those are the -- those are the ones that are really worrisome, I think, for health aides are little babies because they don't tell you what's bothering them or what -- you know. Because I can remember one time when I had just probably a two, three-month baby that I had to send into town for -- ended up with meningitis. KAREN: Oh. STELLA: And those -- and I'm glad that, you know, give them the right information, and the doctor wanted him in right away. KAREN: And so the baby was okay? STELLA: Uh-hum. The baby was okay. Yeah. KAREN: That's good. Well, I'm sure it must work the other way, also, that -- STELLA: Yeah. When things don't happen right, yeah, when things are not -- yeah. Those are the hardest ones, the hardest ones that you can -- for -- for me, and I suppose for other health aides, too, because you don't forget about it for a while. I mean, to this day, you know, when I think about it, I can see it right there, right in front of me, you know, I can see what -- what it looked like and what -- KAREN: Uh-hum. STELLA: Like earlier I was telling you about this little boy that had gotten run over, and -- and, you know, it was not a good -- not a good sight. KAREN: Yeah. STELLA: And I had suicides that I had to take care of that were not -- you know, not a good sight to see. KAREN: Right. And well, and that little boy that you were talking about before, he was run over by a truck, and he -- he came to the clinic already beyond -- STELLA: Yeah. He was already -- he was beyond -- he got -- I guess this dump -- not a dump truck, but our big truck, I mean, the city truck had backed up and he didn't know that the little boy was behind him and he ran over him and hit him and he had ran over him right on the head. So the head was kind of, you know, smushed in, in the back. KAREN: You know, I don't know if you're comfortable talking about this, but, you know, one -- in that case, there was nothing -- STELLA: There was nothing. KAREN: -- you could do. STELLA: No. KAREN: But are there times when, you know, you try and try, and -- STELLA: You try, yes. To try. KAREN: Uh-hum. STELLA: The one incident I can remember is a four-wheeler accident when this young -- when this woman was in an accident, and then down, tried, you know, to do CPR. And they -- I had -- I had some help then, and so we -- we tried and tried until the doctor said there's nothing much you can do. And we also had an incident where a young boy had -- was sniffing gas, and that was 12 years old, and we couldn't get him back. Those kinds of things that are really -- you know, it just makes you really sad. And I -- I suppose there are enough times I always told myself, I'm quitting, I'm not going to be a health aide anymore, I don't want to go through this again. KAREN: But you stuck with it? STELLA: Yep, I stuck with it. Uh-hum. And I've always, you know, prayed about my job and things and just -- KAREN: I was going to say, on those hard days, what brought you back? STELLA: Yeah. Oh, what brought me back was, I guess, you know, being a health aide and people really rely on you and trust you is what it is. People -- you know, people respect you. KAREN: Uh-hum. STELLA: Because I -- after all the years that I've been a health aide, I have a lot of respect from people. And, you know, they trust me.

KAREN: What are some of the things you could say that you have -- you've learned, just for you personally, some of the -- from being a health aide? STELLA: Personally, I -- being a health aide, I think I've learned about, you know, how -- learning about -- about medicine, how -- how important it is to be, you know -- to, like, exercise, to eat right, to -- to take care of yourself. KAREN: Uh-hum. STELLA: Uh-hum. And you learn that smoking is not good for you. What it does to you. And alcohol and drugs and all, you know, they teach you a lot of those things. KAREN: Uh-hum. What about more how it's affected you in the way you approach life and the world? Has it affected you in any way that way? STELLA: Yes, it has. It -- you know, I'm more aware of, I guess, how people feel, or how -- I don't know how to put it. Gosh. I just lost it. Sorry. KAREN: No, that's okay. I was thinking of another way to ask it that might help you explain what you're thinking. You know, I guess it's how has it changed your outlook on life, affected your outlook on life, your experiences as a health aide? STELLA: Yes, it has, because I'm more, you know, cautious of doing things, you know. KAREN: Uh-hum. STELLA: Of doing. KAREN: Has it changed how you live your life? I guess that's a good way to -- STELLA: Yeah. How -- how I live my life. Yeah. KAREN: Yeah. STELLA: Uh-hum. KAREN: Okay. STELLA: I've learned, you know, some bad -- some foods are bad for you, so I try not to, you know, or overeat, or you know, exercise is good for you, and all those things, you know, I really didn't know before. KAREN: Uh-hum. STELLA: And I've learned from my training. And I guess in that -- in fact, I grew for myself, I -- I became more -- that I knew that I could do things. I could do something. KAREN: Yeah. That -- that's kind of what I was -- that answer was where I was going, yeah, how it's affected you. STELLA: Uh-hum. I can -- I realized that I can be something or do something. KAREN: Uh-hum. That's great. That's important. STELLA: Yeah.

KAREN: Any -- any special moment or experience from your years that you would like to share with other people that was important to you? Good or bad. STELLA: Important to me as a health aide? KAREN: Yeah, or as a person, something that -- that experiences. STELLA: Oh, that -- yeah, my experience as I wanted to become a health aide is that I -- I was able to do something that I didn't think that I could do. KAREN: Uh-hum. STELLA: That, you know, if -- if you put your mind to it, you can certainly do something. KAREN: Uh-hum. What about for the -- the next generation of the health aides, do you have any advice or lessons to pass on to them? STELLA: Yes. The health aide is -- is a job that you really need to want to be, you know, because there is where -- a person has to be wanting -- wanting to -- wanting to help or wanting -- wanting to be there. KAREN: Uh-hum. STELLA: Is that what you were asking me? KAREN: Yeah. Yeah. Sort of advice for -- yeah, the up and coming ones and -- STELLA: And it's not, you know, a really -- you know, it might be a -- you know, something, it's a good paying job, it could be, but, you know, it's just you have to realize that sometimes it's going to be a sad situation. It's not always a happy time. It's -- and people that are sick that you worry about, but then -- and the other way, you know, I would say it makes me feel good to help them. KAREN: Uh-hum. STELLA: Uh-hum. To be there. I mean, to do something, at least, to be there, to help them, or to try to -- well, I say try to help them do -- go to a different doctors or, you know, come here. KAREN: Uh-hum. In your work as a health aide, did you ever use some traditional healing or plants or anything? Did you mix that in with the Western? STELLA: No. No, I didn't think that -- that I would do that. KAREN: Do you know if other -- other health aides around Kodiak do that? STELLA: I don't know. I don't think so. KAREN: That's interesting. STELLA: No. KAREN: Do you know the mixture and the balance that -- STELLA: Although, I also gave some advice to some people that are real allergic or can't handle the medicines, I would say, why don't you just try traditional, like even for coughing, because when I was growing up, I always had onions and I guess they put sugar in it to make it like a syrup. KAREN: Hmm. For a cough? STELLA: Uh-hum. You know, little things I would give advice if they want to try, but not to say they have to do it or -- KAREN: Uh-hum.

KAREN: I don't know, you started in '80. Did you have experience with Public Health Service running the program versus KANA running the program? STELLA: Uh-hum. I had -- I mean, I started when the Public Health was still running it -- KAREN: Uh-hum. STELLA: -- through, you know, through Anchorage. KAREN: Can you talk about the differences and pros and cons of one versus the other? Have you thought about that? STELLA: I think -- I think it has changed. I mean, I think we have better care now, we have more, you know, doctor visits and dental visits and we have -- you know, it's closer here to Kodiak than you would have to go all the way to Anchorage -- KAREN: Uh-hum. STELLA: -- for -- for any medical stuff. So it's closer and I think I -- I think KANA was a good thing that happened. KAREN: Oh, good. STELLA: Uh-hum. KAREN: Good. The other thing is that if you have any thoughts about, you know, the medical care in the village and sort of being professionalized as a health aide versus as when it was healers and midwives. STELLA: Yeah. KAREN: Have you thought about that and the differences? STELLA: And the differences? Yeah, it's a lot more. We have Western medication now, medicine. KAREN: Uh-hum. STELLA: Instead of traditional. And that's -- people have forgotten, or, you know, don't really use traditional anymore. It's -- it's kind of -- you know, it's -- I guess it's thought of as not -- you know, it doesn't work anymore, or I'm not sure. KAREN: Uh-hum. So do you think that the professionalizing it with health aides has been a good thing? STELLA: In a way. I think, you know, more than not. KAREN: Uh-hum. STELLA: Because there's more available, you know, things that we do. KAREN: Uh-hum. STELLA: Traditional is -- when I hear my mom or the elders talk about it, you know, I think it's better off right now than the way it was before. KAREN: Uh-hum. Okay.

KAREN: I didn't ask you before what family you're from. Is Krumrey your married name? STELLA: Yes. My married name. And so my -- my mom and -- my dad's name was Nikenti Zeder, and my mom is still alive, her name's Nina. N-I-N-A. KAREN: Zeder? STELLA: Uh-hum. KAREN: I think I've heard her name in Mary's book, maybe. STELLA: Uh-hum. Maybe. I don't remember reading her name on there. Maybe you're talking about Jenny, her sister. Her name. KAREN: The Zeder last name sounds familiar. STELLA: Yeah, Zeder, Jenny Zeder is Mary's sister. KAREN: Oh. It's just the last name. No, but I apologize, I should have asked you that at the beginning, which family you're from. STELLA: Oh, that's okay. KAREN: I guess the other thing is, you know, the -- the key health issues here in Kodiak and what those are now versus what they used -- I don't know if they are the same. You know, what are the important health issues? STELLA: We have more diabetes now that we never, ever -- like, well, you know, we didn't see it then, back then. And seems like we have more cancer -- KAREN: Uh-hum. STELLA: -- than when I -- I can remember growing up. KAREN: And is there a lot of health education that goes on? STELLA: KANA comes around. You know, they have people that travel, and we do as -- as a clinic, to educate our patients -- KAREN: Uh-hum. STELLA: -- with diet or, you know, bad -- bad choices like smoking and drinking -- KAREN: Uh-hum. STELLA: -- drugs. KAREN: So that's part of the -- STELLA: Part of the clinic, the health aide program. KAREN: Uh-hum. Like wellness -- STELLA: Yes, wellness -- KAREN: -- kind of thing? STELLA: -- kind of thing, yes. And we do have, like, walking, exercising. We have senior meals that are given, healthy -- healthy meals. KAREN: Oh. STELLA: Uh-hum. Those -- those kind of things are -- are -- you know, have come up since I've been -- KAREN: Uh-hum. STELLA: -- health aide. KAREN: And that's all part of the health aide program? STELLA: No. KAREN: No? STELLA: It's just a part of KANA's wellness program. KAREN: Hmm. STELLA: Which, you know, really ties into our -- our clinic. KAREN: Uh-hum. STELLA: As to promoting it. KAREN: So it's doing preventative -- STELLA: Uh-hum. Yes.

KAREN: Okay. I was just wondering about the family and being a health aide and the effects on family or how important your family is to helping with the job. STELLA: It's very important that your family is behind you because if not, then you won't be able to do your job the way you're supposed to. Because I, for an -- I have -- my experience was, you know, my -- when I first became a health aide, I -- I was married. Then I -- after being a health aide for probably seven years into my health aide job, I got a divorce because my former husband was not very supportive. And I had four young kids that I was -- that we were raising, so it was hard when I went to my trainings, that was the most -- the hardest because I had to leave them for a month at a time. KAREN: Uh-hum. STELLA: So I was fortunate, though, that my mom, you know, would take care of them. But a couple -- I think the last -- I had to take them with me when I went to my training. It was during the summer, so I took them with me. But those are the ones that are, you know, hard on -- hard on whoever's training is if you have a family. KAREN: Uh-hum. So you took them with you to Anchorage? STELLA: Uh-hum. KAREN: So what did you do with them? STELLA: My -- my -- I have family up there, so they helped me. They took care of the two boys -- KAREN: Uh-hum. STELLA: -- during the time I was training. KAREN: Uh-hum. STELLA: And -- KAREN: And your husband now? STELLA: And my husband now, he's very supportive. I mean, he, you know, supports me 100 percent because he always wants me to get an education. And I have a young 14-year-old daughter, and she is happy with her dad when I'm gone, so -- so I don't have any problem now. It's just in -- you need to have a good, stable family, I think, to be able to be able -- to be a health aide and take care of other people. KAREN: Uh-hum. STELLA: Because I couldn't do -- you know, when -- when I first started, it was very hard. It was -- for me. Because it was not fun to go to work and come home and -- KAREN: Uh-hum. Yeah. So what kept you doing the job? I think -- STELLA: Because I loved it and I was -- and I learned more about myself, that I can do something, you know, I can take care of myself. KAREN: Uh-hum. STELLA: And that's what I did. I took care of myself. And knowing that I have to take care of myself first before I can take care of anybody else -- KAREN: Uh-hum. STELLA: -- is what it was. KAREN: That seems like good advice for the next generation of health aides. STELLA: Yeah. KAREN: That you have to be strong in yourself. STELLA: Yeah. And I try to -- you know, I -- I try to do what I teach. I don't know how you say that. You know. As a health aide, you're -- you're a role model. KAREN: Uh-hum. STELLA: So you should be a role model by not smoking, drinking, or, you know, drugging. KAREN: Uh-hum. STELLA: That's very important. And that's how you gain the respect from people. KAREN: Uh-hum. And I'm sure there are lots of pressures the other way. STELLA: Oh, yeah. But I'm -- you know, I am one of the fortunate ones that don't, you know, want to do those things. KAREN: Right. STELLA: Yeah. And with a -- with a healthy marriage and your husband doesn't do those things, then that's -- you know, that helps a lot.

KAREN: That's kind of the end of what I had sort of prepared in advance. Other things that have -- you can think of that I've inspired in you that you might want to talk about? STELLA: No. Except that I am glad that I still -- I'm still, you know, part of the program. That I'm really thankful to KANA, my former CHAP directors, to kind of, you know, have this position for me, and I know that other health aides, you know, other regions probably don't have what we have here. KAREN: Uh-hum. STELLA: That makes it really easier for the health aides, I think, because I do a lot of paperwork, I do just supply orders, drug orders. KAREN: Uh-hum. STELLA: And, you know, answer the telephone, make appointments, those kinds of things that health aide does for themselves. KAREN: And that was going to be -- so the clinic manager position you think is unique to here? STELLA: Yes, uh-hum. I think it is. That's -- that's what I hear. Because I -- the last forum that I went to up in Anchorage, you know, other -- other places didn't really have it. KAREN: Uh-hum. STELLA: And now little clinics don't really need it because it's -- you know, they are -- I know that sometimes the clinic is so, you know, slow, that you're not seeing many -- that many patients that you can do your paperwork and all that other stuff. KAREN: Uh-hum. STELLA: But when you get kind of busy or in the bigger clinic is what you need -- when you need someone there. KAREN: And as you say, it sounds like it helps -- it's part of that support network for the health aide? STELLA: Uh-hum. Yes, it is. KAREN: And it relieves some of the pressures on them? STELLA: Uh-hum. Like I say, I do a lot of medication orders for patients. KAREN: Uh-hum. STELLA: And that, you know, just the health aide doesn't really have to do that.

KAREN: This may be a funny question, may be impossible to answer, about sort of the typical kind of cases that come up. Is there anything sort of that's the most common or typical that you end up seeing as a health aide? STELLA: Of course, sore throats. You know, for a little past three months we have been having, like, strep throats. Earaches. Cold, you know, chest colds, those kinds of things, those -- those are typical -- KAREN: Uh-hum. STELLA: -- that we see. KAREN: In your years as a health aide, something that comes to mind as the most unusual that you saw? STELLA: Most unusual that I saw. Just -- hmm. KAREN: Or was there something that was completely out of the realm of your training and you had absolutely no idea what to do or what it was or something like that? STELLA: We always have to report whatever we see, so I don't know if it's unusual for the doctors or for -- you know, it just kind of -- we see, you know, from cuts to sores to rash. KAREN: Uh-hum. STELLA: Just everything. And I don't know if that's unusual. You know, that's just -- KAREN: Well, yeah, I guess what I'm thinking is, is was your -- you found that your training was sufficient and appropriate for the kind of cases you were faced with? Or were there things that -- that came in and you're just like, I don't have the training, I don't know this, and -- STELLA: I suppose for like really bad, you know, for -- for things that we have to send in, those are the kinds of things we can't handle, like really bad infections where, you know, you can't do anything about at home. KAREN: Uh-hum. STELLA: It would have to be in the doctor or in the hospital for treatment. Those kinds of things -- KAREN: Uh-hum. STELLA: -- that we see once in awhile. KAREN: But you know to send them to the doctor? STELLA: Yeah. Uh-hum. KAREN: Okay. So do you think that the -- the three months of training and then the continuing education is sufficient for health aides? STELLA: No, it's not ever sufficient. You need to go keep track -- you know, keep training. Yes. And that's why, you know, we have our trainings that they send us to every year. KAREN: Uh-hum. STELLA: To just try to keep up with all that stuff, or they send you -- or they send you some reading materials to try to keep up with your, you know, what's ever -- whatever you need to kind of know how to handle.

KAREN: Did you ever have an interest in going further with medicine and becoming a nurse or a doctor? STELLA: I thought about it one time. I was really thinking about going to the PA school. KAREN: Uh-hum. STELLA: But then I decided we wanted to build a house, and -- and that's what's keeping up our -- keeping me at home because it's -- it's -- I have another business, besides being a health aide, we have a bed and breakfast. So -- KAREN: Oh. Okay. STELLA: And my daughter, she is just 14, so she's -- and I, you know, kind of a -- kind of a -- it's a different -- I was really young when I had my first kids, so I grew up with them. KAREN: Hmm. STELLA: And, you know, I just kind of grew up with them. And my last one here, I -- it's been a fun time for me because -- KAREN: Uh-hum. STELLA: -- I raised our older, I'm raising her, and that's -- so I wanted to stay home with her. KAREN: Okay. So where would -- if you went to PA school, physician's assistant training, where would that be? STELLA: In Washington. KAREN: And for how long? STELLA: Probably two years is what it is. KAREN: Uh-hum. Yeah. And if -- if a health aide chooses to do that kind of thing, do they pay for it themselves or would KANA pay for that advanced training? STELLA: No, I think -- I think -- I'm not sure. I think you'd have to pay for it yourself. You'd probably have to find -- KAREN: Yeah. STELLA: -- like any other, you know, schooling that you want to. KAREN: Uh-hum. Any sense of if it's common that do people often go on? STELLA: I haven't seen one from the Island, but I know of one now that wants to, you know, that's been accepted. KAREN: Uh-hum. STELLA: So I think that's -- and I'm -- there's -- I'm sure there's younger -- younger health aides are, you know, they are bright enough that they can make it there. KAREN: Uh-hum. STELLA: Yeah. KAREN: All right. STELLA: Uh-hum. KAREN: Any other things you'd like to say about your experiences as a health aide? STELLA: No. It's been just -- and, you know, I've enjoyed it. I had some bad times, I had some good times, so it's just -- you know, that's just the way it is, though. KAREN: Uh-hum. Great. Well, thank you very much for -- STELLA: I hope this helped you. KAREN: Well, I think so. If you feel good about it. STELLA: I -- I -- I do. KAREN: Okay.