Nolita Madros was interviewed on October 26, 2005 by Marla Statscewich at the health clinic in Anaktuvuk Pass, Alaska. At the time of this interview, Nolita was the only health aide for the village so she was very busy. At one point, she had to stop the interview while she attended to some patients. In this interview, Nolita talks about why she became a health aide and the training she received, being a health aide in Huslia and Ruby, Alaska, working as an itinerant health aide, and settling in Anaktuvuk Pass. She also talks about what a health aide does, changes she has seen in health care practices and technology, the benefits of telemedicine, and dealing with issues of confidentiality and job stress. Finally, she reflects on her career as a health aide.
Digital Asset Information
Project: Community Health Aide Program Project Jukebox
Date of Interview: Oct 26, 2005
Narrator(s): Nolita Madros
Interviewer(s): Marla Statscewich
Transcriber: Carol McCue
After clicking play, click on a section to navigate the audio or video clip.
Background about her family and growing up.
Her transition into a career as a health aide and her first training, and the importance of babysitters.
Her early experiences as a health aide and where the work took her.
What it was like working as an itinerant community health aide and what it was like working for different health corporations.
Being a community coordinator instructor and how she ended up settling down in Anaktuvuk Pass.
The newly remodeled clinic in Anaktuvuk Pass and how much she appreciates the ambulance service there.
Some of the details of her job, such as how much vacation time she gets, who she works with, which parts she enjoys, and where the money and services come from.
How she maintains her qualifications as a health aide, especially how she works with other health providers like doctors and nurse practitioners.
Some of the changes she has seen over the course of her career, especially in the realm of technology.
The benefits of telemedicine, and dealing with emergency situations and transportation of patients.
Dealing with issues of confidentiality in a small village, and the emotional stress of treating friends and loved ones in emergency situations.
She compares her experience to that of health aides who came before her, like her mother.
Closing reflections on her work as a health aide, and on her career and education plans.
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After clicking play, click a section of the transcript to navigate the audio or video clip.
MARLA: Okay. My name is Marla Statscewich, it is October 26, 2005. And I'm in Anaktuvuk Pass at the clinic here with Nolita Madros. And I just want to thank you very much for agreeing to do this interview. If you just wanted to maybe start with a little background information, where you were born, your family, and then we can go from there. NOLITA: I'm the daughter of the late George Madros, Sr., and Anna Madros, who was also a former health aide. And I grew up in Kaltag, Alaska. And I've been a health aide in several villages throughout Alaska. I'm the last of 10 children. MARLA: Wow. NOLITA: And I have one son. MARLA: Okay. And so you grew up mostly in Kaltag? NOLITA: Yes. MARLA: Okay. And then your -- your mom was the health aide there for how long? NOLITA: I think 25, 26 years. MARLA: So what was that like growing up in a house where your mom was a health aide? Did she have patients come to the house or? NOLITA: When -- when I was very, very young, I remember they -- they used to come in and get checked and they had their little pharmacy white box with the little padlock, it was all wood, and all the -- it was like the bottom half of a refrigerator and all the drugs used to fit in there. I know. A wooden box. Later it moved to a different building. But it was okay, I guess, oh, there was nights she would be out all night with emergencies. And then as I got older, some nights I'd have to go with her. Which is, oh, why is it my turn, why couldn't Georgianna go. Georgianna was my older sister. But we used to take turns. MARLA: So did you go with her because you were helping her? NOLITA: No. No. Because it was dark and cold and because sometimes it was rainy and she was the only one on call that -- that particular week or whatever, and she didn't like to walk around in the dark by herself. MARLA: Oh, okay. NOLITA: So. And sometimes my dad used to go with her, too, so. MARLA: Okay. And so was she a role model for you in becoming a health aide or how did you become a health aide? NOLITA: How did I become a health aide? Well, health care was always a part of my family because I -- I grew up with it, my mom being a health aide. But when I got out of high school, I went into the Job Corps and did the whole carpentry thing, and I worked as a carpenter probably 8, 9 years. And that was good. My dad was a carpenter so there was a time there I worked with him. And then I had my son and I couldn't go out on crew anymore. So and I lived in Huslia at the time. And I looked around, there was only very few jobs in the village that was full time. And one of the jobs was being the health aide and CHR in Huslia. So I was first a CHR and then later became a health aide. MARLA: And can you explain what a CHR is? NOLITA: At that time I went out to the elders and made sure that they were taking their meds, and just did like little daily checks on them, like once a week, twice a week, make sure they were okay. Give them enough wood, made sure they had enough food. And if there was a problem going on, I'd come back and talk to the health aide there. At that time, that was Roseanne Burroughs. MARLA: Okay. NOLITA: So. And after about a year and a half of doing that, it just kind of -- I learned everything I needed to know to be a CHR and I just wanted to know more. So there was a position open but it was in a different village, it was in Ruby, so I went ahead and signed up for that. And I did, transferred from being a CHR to a CHP. And it's been a learning experience since then. MARLA: So what --
MARLA: So what was -- what was the transition from being a CHR to a CHP? NOLITA: Well, the CHR was mostly letting the CHP know what was going on with the patient, versus when you're a CHA, you actually get to help the patient with their medical problems. MARLA: Okay. And so just so we can clarify, CHR stands for? NOLITA: Community Health Representative. MARLA: And CHP stands for? NOLITA: Community Health Practitioner. MARLA: And CHA is? NOLITA: Community Health Aide. MARLA: Health aide. Okay. So transferring over to Ruby meant you had to go get more training to become a CHP or -- NOLITA: Oh, yeah. When I transferred, it just meant that my whole door for medical information opened up. I had to go to sessions, and then, of course, you had the training period to take care of people. MARLA: And what kind of training? What was the training like? NOLITA: The first one I went to, I transferred in June and I went to my first session, Session 1. Back then there was three sessions, 1, 2, and 3. I was like the last part of that program with the three sessions. Right now we have five sessions. So -- so I went to Sitka. Or, no, Seward. I went to Seward first. And that was pretty interesting. Because I got to meet six other -- five other health aides that was from all over the state of Alaska, and we started our -- our training. MARLA: So when was that? NOLITA: September of '92. MARLA: Okay. And so the -- what was the first training? What did you learn at the first training? NOLITA: How to do blood pressures, how to do measure -- you know, basic stuff. You know, blood pressure, vitals, emergency skills, we had to have that. And we did some suturing. Some IV stuff. But just basically how to check -- check the patient. MARLA: Okay. NOLITA: So. MARLA: And how long was that session? NOLITA: Four weeks. MARLA: Okay. Wow. That's pretty long, huh? NOLITA: I don't know. Four weeks is a long time to be away from your family, but it really helps your job when you learn. MARLA: Yeah. NOLITA: So. MARLA: Yeah. And then why in Seward? NOLITA: It was one of the training centers. There's training centers in Nome, Bethel, at that time Seward, Sitka, and later there was one in Fairbanks for a while. So. MARLA: Okay. And so how long did you stay in Ruby? NOLITA: I stayed there until '98. MARLA: Oh. So six years. And during that time, did you continue to get the rest of the trainings? NOLITA: Yes, I did. MARLA: Okay. And what were the -- what were they like? NOLITA: Well, the Session 2 just basically brought you back up to speed to Session 1, and then it gave you more experience in how to do different kind of exams and stuff. MARLA: Okay. And did you know people in Ruby before you moved there? NOLITA: Yeah. I had friends there. MARLA: Okay. NOLITA: Friends. Friends from school. MARLA: Was it hard to be a health aide or a CHP in a village that wasn't your own? Or wasn't the one you -- you were raised in? NOLITA: Well, no, but you know, as -- I always look at things in two ways. One door closes, another one opens. It's just like a new adventure. And so once my CHR door closed, my CHA door opened, at first it was hard because I had a two-year-old son and I was a single parent, I had to find a dependable, reliable baby-sitter, and that -- that didn't take very long. I got someone that, you know, would take my son and at a moment's notice or -- and she had a lot of kids, her and her husband. And they would always know when something was going on, even before I knew. So one of the kids, one of the older kids, the teenagers, would come pick up Adrian, and would say this person got hurt on a snow machine, blah-de-blah, and I'm bringing Adrian to mom and dad. And you can pick him up -- and if it was late at night, I'd just pick him up the next day. So. MARLA: That's pretty great. NOLITA: So -- and on the very bottom line with baby-sitters is you've got to -- that is your lifeline to your job. So you treat your baby-sitter the best. They -- there's no other person in the world that you could trust to watch your child. MARLA: Yeah. NOLITA: And they did a great job. MARLA: That's great. NOLITA: Linda and Butch did a great job. And with their kids, too. MARLA: And what's their last name? NOLITA: Captain. MARLA: Captain. NOLITA: Yeah.
MARLA: And so did you work with someone else in Ruby? NOLITA: Yes. Edna Peters. MARLA: So she was your -- NOLITA: She was kind of like my mentor. She helped me train, showed me how to do different things, how to -- how to, you know, suture and different types of things with suture, how to do IVs. You know, she would help me along. She would show me a couple of times and then she'd make me do it the next time. So that was pretty cool. MARLA: So were there any particular experiences that stand out from like your first kind of emergency that you had to deal with or anything that kind of stands out in your head from either of those two villages? NOLITA: No, not really -- well, in Ruby, I got there on, like, Tuesday. Well, Edna left on Thursday. And I had, like, oh, one day CHA experience, and then I was on call. Which was okay, but she told me, you have to follow the manual. And this -- this is the manual we use now, but back then we had another one, it was a white one, a white manual. A CHA manual. And she said just follow the procedures and talk to the doctor on call. It's like, oh, okay. And I can't even remember who I sutured, but my first real emergency, somebody tripped, it was summertime, somebody tripped and fell and cut their arm. And I knew it needed suturing, and it's like I'm on the phone with the doctor, Dr. James, and he goes, well how long have you been a health aide? And I said, well, three hours. So, and he was really nice. He knew that I didn't know how to do it, and so he kind of step by step walked me through how to use the CHAM, and how to do the sutures, and I was, like, okay. That was cool. MARLA: So was it -- it must have been pretty scary? NOLITA: Well -- well, before bleeding, once you can -- once you can control the bleed, it's just the mess that looks scary. MARLA: Yeah. NOLITA: So. MARLA: So not the suturing part? NOLITA: Oh, no. No. Not to a sewer. MARLA: That's great. So after Ruby, what did you do? NOLITA: I went home and was the health aide over in Kaltag for about a year and a half, maybe two years. So. And that was kind of interesting, but I don't know, it's a little harder to work at home. I got used to going home and not having to do anything. Then all of a sudden I'm working there and now work consumes you. My son was a little bit older, which was good, but I -- I think going home was someplace I'd go to rest. I didn't really want to go there and work. MARLA: And so does that mean then you'd have people coming knocking on your door or you're on call 24 hours and so -- NOLITA: Pretty much, yeah. Pretty much, yeah. Even now when I go home, people stop in at my house and say, well, I really need help, you really need to go to the health aide at the clinic. You know, I can't give you any advice. But you know, you need to depend on the people that are responsible for your health care. MARLA: Right. NOLITA: So sometimes it was pretty hard to. Of course, you know, at the same time, major casualties, I would help. MARLA: Yeah. NOLITA: I'm always available for that. MARLA: So you stayed in Kaltag for a few years, and then -- NOLITA: About '99, I decided, oh, I'll try itineranting. So I went to the North Slope, up to the North Slope. Which was interesting. Because I went in November and it -- the sun had already gone down, and it was not -- not going to come up for a couple more months. MARLA: Right. NOLITA: But no, during the day, they say it's pitch black, but it's not. You still see -- you get brightness like from 10:00 to 2:00, then it gets dark. So it's not really -- you just don't see the sun for a couple months. MARLA: Right. NOLITA: And it took couple weeks to get used to that. MARLA: So where were you being -- when you were doing itinerant work? NOLITA: My first village on the North Slope was Nuiqsut. MARLA: Okay. NOLITA: And I got there the week that he had overbooked the clinic, I think. We already had two itinerants in clinic, we had the doctor and his nurse, we had dental and their staff, so we were pretty booked. I was so waiting for them all to leave on Friday. MARLA: So being an itinerant means what? NOLITA: You're CHA-ing, you're CHAP, and you go from village to village to provide health care coverage. MARLA: And how long are you in each village? NOLITA: It kind of depends. It kind of depends on when you're talking to your -- the office, or no, the CHAP office, how long they need you in the village. Some places they only need you for a week, week and a half, other places they just need you for more than three or four weeks.
MARLA: And where was the main CHAP office that you were talking to? NOLITA: Barrow. MARLA: Okay. NOLITA: In Barrow. MARLA: And so that's North Slope Borough -- NOLITA: Yes. MARLA: -- is managing? Have you also worked for TCC? NOLITA: Yeah. When I worked in Kaltag, Huslia, and Ruby, I worked for TCC. MARLA: What's the big difference between -- or is there a difference? NOLITA: Outside the pay? MARLA: Yeah. Pay is different? NOLITA: The pay is different because the cost of living on the North Slope Borough is a lot higher than the cost of living in TCC. MARLA: Okay. NOLITA: But it's really not too much different. MARLA: So you have to do the same trainings and -- and the health care is essentially the same, and you have the equipment that you need? NOLITA: Yeah. MARLA: Both -- both places, or both -- NOLITA: Both areas, yeah. MARLA: Yeah. I just wondered if there was, because there's so many different -- different chapters, that I wondered if there was -- NOLITA: Well, like, if you walk around the clinic here, you'll see how big it is. The size of the Anaktuvuk clinic would be the size of a subregion clinic in TCC. Subregion meaning there's like -- like -- like, for instance, the Galena subregion, this would be about the size of the Galena subregion clinic. And then you'd have other clinics outside that depend on you for help, like Kaltag, Nulato, Ruby, Galena, Huslia, they are all the clinics outside the subregion. MARLA: So if they need to, they would come to Galena. NOLITA: Yeah. MARLA: For additional care or -- NOLITA: Or help. Yeah. MARLA: This is a really big clinic. There's at least three -- three exam rooms? NOLITA: Yeah. MARLA: And the itinerant apartments in the back, is that where you would stay? NOLITA: Yeah. MARLA: When you were travelling around? And is it sort of this -- so you'd be in the clinic? NOLITA: Yeah. I wouldn't have to leave the clinic. MARLA: So you're really on call 24. NOLITA: Yeah. MARLA: Hard to get a break, then. NOLITA: Yeah. But the -- there's other people that come in that are itinerants, as well, so they take call. MARLA: So that first week in Nuiqsut, was there anything that stands out in your mind besides it being really crowded? NOLITA: Nuiqsut, let's see, we worked a longer hour. I mean, North Slope Borough works 10 and a half, TCC works 6. So it was longer hours for me. But it was more interesting. MARLA: Why? NOLITA: Well, every new place you go, you have a -- you kind of see different medical problems that you don't normally see if you're just one place all the time. So it was more of a learning experience because you get to learn more about different kind of illnesses or procedures that may be going on or, you know, or if someone had a certain procedure, you get to know all the kind of labs that you have to draw weekly, monthly, blah-de-blah. So it was -- it's more of a learning experience to be an itinerant than -- some people think it's a pain in the butt.
MARLA: And so you -- so can you tell me about some of the other villages that you worked in, as well, as an itinerant? NOLITA: I worked in Point Lay, I went out to Point Hope for a week. Worked in Point Lay, Wainwright, Ataqsuk, and of course, I lived in Kaktovik for, like, four years, so. MARLA: So when you were living in Kaktovik, were you -- were you still itinerant at that time, or were you the community health aide? NOLITA: No. I was the community coordinator instructor for North Slope Borough on the east side -- east side villages, which -- which would be Kaktovik, Nuiqsut, and Anaktuvuk. MARLA: So what did that mean, you were coordinating -- NOLITA: I kind of came to all the villages with the village CI visits, make sure everything was in order, make sure everybody's training was up to date. Kept track of how many education hours they have, and did a basic, you know, checklist, there are PCCs that check off, make sure they covered all the spots, you know, on the exam and stuff. MARLA: And then what about I would imagine if you're in one spot for a long time you would know -- you would know the people's medical history as soon as they walk in. What's it like when you come to a village and you don't know, you're kind of working with a clean slate? NOLITA: Well, in most of my patients, if I'm just going into the village, I -- I at least want to see the charts before I go to the patient. And then once I get into the patient, you know, being with them, I just flip through the chart to see, you know, what's current, what needs to be done, what's happened in the past, you know, you have to do a chart review for every patient. MARLA: Yeah. And how many people are we talking about when -- in the villages? NOLITA: Some people do six appointments a day, some health aides do six appointments a day, but like in cold season, I try to do two patients an hour. MARLA: Wow. That's a lot. NOLITA: And two patients an hour is a lot, but there's been times where I shouldn't have, but I -- you know, my appointments, I max three people an hour because larger communities, less health aides, you spend less time. MARLA: Right. Yeah. You have to get people healthy. NOLITA: Yeah. Yeah. So definitely, anything over an hour, I -- I -- none of my appointments last over an hour unless it's critical care. MARLA: Okay. And so how long were you an itinerant? NOLITA: Gosh, from '99 until -- well, '99 for a couple of years, then I was in Kaktovik, and I was an itinerant last year when I came here. MARLA: Okay. So you were an itinerant when you came to Anaktuvuk Pass, and then you decided to stay, or -- NOLITA: Yeah. MARLA: And what made you want to stay? NOLITA: I've -- I came here before and I was CI for this area, and it's just a beautiful place. And the scenery, and if I need to go downriver, downriver is to Kaltag, to my home, I could jump on the morning Warbelow's and be there by four o'clock in the afternoon. So I could be home same day, whereas if I live on the North Slope, per se, further north, I'd have to overnight in Fairbanks. MARLA: Right. Because there's no -- no direct flight -- NOLITA: Yeah. So. MARLA: -- to -- NOLITA: It's easier for me to get home from here -- MARLA: Okay. NOLITA: -- if I have to. But basically, I just like the community and I like the people. And they have pretty much welcomed me into the village. So. MARLA: That's great. Yeah. I was wondering because I wondered if there was sort of a cultural difference because you're Athabascan and this is an Eskimo village, so I wonder if you had any -- NOLITA: Discrimination issues? MARLA: Yeah. Yeah. NOLITA: No, not really. They -- they pretty much welcome most everybody into the village. It's very -- the people here are very nice. And I like it. MARLA: And do you have any language, have you ever had any language problems? Are there elders who only speak Iñupiat and -- NOLITA: If I need help in interpreting, I always get the CHR Alice Ahgook. She's a good speaker, fluent. She can interpret for me. MARLA: Okay. Have you had many -- many instances like that, or most everyone -- NOLITA: Most everybody can explain in English very well. MARLA: Yeah. NOLITA: You know, most of the elders are both English and Iñupiat speaking. So. MARLA: Yeah. NOLITA: That's good. That helps.
MARLA: So you guys just moved into this clinic about a month ago. Can you talk about that? NOLITA: It was a chore. MARLA: Where were you in the meantime? NOLITA: We stayed over on the -- on the north side of the village in one of the housing units. And we -- we turned that into a temporary clinic. MARLA: Okay. NOLITA: For about a year. 11 months. They were supposed to be done and completed in six months, but no project is ever completed on time, so. MARLA: So what were they doing to this clinic? NOLITA: We kept the shell of the building and they took out -- they removed all the asbestos in the building and remodeled. MARLA: Okay. And it took 11 months? NOLITA: Yeah. MARLA: And where -- and so the clinic moved to a house? NOLITA: Yeah. MARLA: Was it your house? NOLITA: No. At first it wasn't, it was an open house, but through the course of the year, they negotiated with the TMHA and was able to secure that that would be my home, my rental, once we got out of there. MARLA: What's TMHA? NOLITA: The housing authority. MARLA: Okay. NOLITA: I don't know how to say the Eskimo name. MARLA: Okay. So -- so you ended up living in the clinic or the clinic was living in your home? NOLITA: Yeah. I was there -- I stayed there probably since January and hoping they'd move out. MARLA: So that meant that everybody would come to report for work at your house? NOLITA: Yeah. MARLA: And -- and patients would -- you saw patients there, as well? NOLITA: Uh-hum. The medical records room, which was one bedroom; the emergency room, which was the larger of the bedrooms; and then the other room was just a lab/exam room. So it's a three-bedroom house. MARLA: Okay. NOLITA: And the front was just the front office. MARLA: And then what about all, like I look around here and there's all -- you know, there's the exam table or exam bed and all -- all the equipment, did you have that in your house, as well? NOLITA: Yeah. We didn't have any -- any furniture at all. MARLA: Wow. NOLITA: We had one exam table, the ER gurney, and all the stuff in the emergency room now was in the -- in the bigger of the bedrooms, the emergency room. And we have two exams, and we just took all the stuff from one exam, all the rest went in storage. MARLA: And so you're really close right now to the airport. What was it like when you were over there to get people to the airport? How did you do that? NOLITA: Well, for an emergency situation -- MARLA: Yeah. NOLITA: -- they went on the ambulance. We have an ambulance service here. So. MARLA: Oh, that's great. Can you talk a little bit about the ambulance service? That's pretty unusual, isn't it? NOLITA: Yeah, it is. It is. But all the North Slope Borough villages have the ambulance, fire department and ambulance service. MARLA: And so they are all trained EMT's, as well? NOLITA: Yeah. MARLA: Oh, great. NOLITA: They get regular training through the fire department in Barrow. MARLA: Okay. And are they mostly local people? NOLITA: Yes. MARLA: Oh, that's great. So -- NOLITA: I don't know too much about the fire department, but I really and truly appreciate all the guys on the fire crew because they make my job easier. MARLA: Because why? NOLITA: When I work other places in Alaska, I usually have to go get the patient. When I work here in Anaktuvuk, they bring the emergencies to me. MARLA: Wow, that's great. NOLITA: And that makes a world of difference. MARLA: How -- what does it mean to go get the patient? NOLITA: I've had to do that before. Well, you have to go, like home visits, and like if it was an emergency situation, you'd have to gather volunteers to bring your patient from the house to the clinic. And most places when -- early on you had to find your own vehicle or hope someone loaned you a vehicle to bring the patient and stuff like that. MARLA: And so when it's getting volunteers, is that just sort of carry people back on a gurney or -- NOLITA: Oh, yeah. MARLA: Wow. NOLITA: Lifting. MARLA: Wow. That's pretty heavy work. NOLITA: I know. But even -- all the volunteers, I appreciate them all. MARLA: Yeah. NOLITA: Anyway, it makes my job easier.
MARLA: And who -- and who works here now? NOLITA: Eric Yardey works here, he's the maintenance custodian. Alice Ahgook is the CHR. And Harry is the senior van driver. Harry Hugo. And myself. MARLA: Okay. So there's just -- NOLITA: Four of us. MARLA: Wow. So who -- when -- when you take off, who takes over for you? NOLITA: Oh, I was just off recently like last week, and they flew in an itinerant, Ron Murphy, from Ruby. MARLA: Oh, okay. So that's part of the itinerant's job, as well, is to go where -- NOLITA: When they need. MARLA: When the health aide needs to take some time off? NOLITA: Take a break. Yeah. MARLA: How often do you get a chance to take a break? NOLITA: I think I was on call two months straight, 24/7. MARLA: Wow. Wow. NOLITA: So. MARLA: Don't get much sleep then. NOLITA: Well, no. No. Well, sometimes I get good rest, but other nights, you know, it depends on colds or accidents and stuff like that. I don't get as much rest. MARLA: Right. And what -- what -- let's see. Sorry. What -- like what are some -- do you ever have to give, to deliver babies? NOLITA: Yeah. I think I've delivered like 8 or 9 babies in my whole career. MARLA: Do you remember is there one that stands out in your mind? NOLITA: No, not really. They were -- well, no, not really. They were all pretty -- pretty much run of the mill, I guess. MARLA: So do most people deliver in the village or -- NOLITA: No. We try to get them out by 38 weeks. MARLA: Okay. NOLITA: Sooner if they are having problems. MARLA: Okay. NOLITA: So. Up to a month sooner. MARLA: And is that something that you like about the job, or -- NOLITA: Delivering babies? MARLA: Yeah. NOLITA: No, not particularly. I'd rather have somebody else that -- like an obstetrician deliver the babies. It's not really -- I'll do it if I have to. Don't get me wrong. But it's not the job of choice in this career. MARLA: Yeah. NOLITA: I'd rather suture. MARLA: What's your favorite part of being a health aide? NOLITA: Suturing. MARLA: Yeah. NOLITA: I like suturing and I like lab. MARLA: You like suturing because you like to sew? NOLITA: No. Because, well, I think it's just a little bit more -- well, depending on the laceration or what I'm suturing, you know, I guess maybe because I do like to sew. MARLA: Yeah. NOLITA: And I like to do that because it's interesting to -- to see what tubes you have to draw for what tests the doctor wants you to draw for. MARLA: Can you explain what you have to do in labs? I don't know anything about it. NOLITA: In labs. There's -- well, there's a lot of different kind of labs. There's drawing blood labs, there's finger sticks for like glucose, urine labs, sending out urine cultures. There's a lot of different kind of labs. MARLA: And is that some -- is that pretty common -- NOLITA: Yeah. MARLA: -- that a health aide would do labs? NOLITA: Yeah. MARLA: And do you know about your mom's time? NOLITA: Yeah, they did labs, as well. MARLA: They did labs, as well. Okay. NOLITA: We have a big job. And back when she was a health aide, it was a little bit -- I think it was a little bit tougher job then only because, well, they didn't have the technology that we have now. They had to do the radio phone thing and there was sometimes maybe in villages they got a plane once a week, so if there was something really going on bad, they had to deal with it then and there. You know. Whereas if there's something going on critical right now, our ambulance will be here perceptible the doctor's request, like within two hours. MARLA: And where do they come from? NOLITA: Fairbanks. MARLA: And who do you guys use specifically? NOLITA: We use specifically Warbelow's Air Ambulance. I believe they carry the contract for TCC. MARLA: Okay. NOLITA: So. But like in -- when we delivered a baby, when was it, in May, we delivered a baby in May, she was a preemie baby, so we had to -- we called Warbelow's initially, but then Warbelow's called Guardian on top of that because Guardian has the incubator for the baby. MARLA: So it depends really on what the medical situation is? NOLITA: Yeah. Yeah. MARLA: Got you. And you said that TCC has the contract for Warbelow's, but you guys are still under North Slope Borough? NOLITA: Yes. MARLA: How does that work? NOLITA: Well, actually, I don't really kind of know how. We can't get our services out of Barrow because there's not a direct flight off of Barrow daily. So the closest major hospital area is Fairbanks, and so we get most of our coverage with the doctors, the dental, the counseling, with Chief Andrew Isaac or TCC. MARLA: Oh. That's pretty interesting. NOLITA: I know. MARLA: It's sort of a strange overlap. NOLITA: Yeah, it -- MARLA: Not too many other villages like that, I imagine. NOLITA: No. Point Hope was that way, but they pretty much turned over the health care system over to Maniilaq in Kotzebue because they were getting all their services from Kotzebue, which is Maniilaq. MARLA: Yeah. Because it's so close. NOLITA: Yeah. MARLA: Going all the way to Barrow would be pretty -- and I don't think there's any direct flight from Point Hope to Barrow, either. NOLITA: There is, but I think it's more cost effective to go to -- from Point Hope to go to Kotzebue. MARLA: Right. And also probably faster. NOLITA: Yeah.
MARLA: So where has been your favorite place to work? NOLITA: Golly, every place has got my -- got a reason why I go there. So -- and anywhere on the North Slope, if I go to a village to itinerant, I know who I can borrow a sewing machine from if I have to. MARLA: What's the hardest part about the job? NOLITA: I don't know. I don't really -- I don't really think -- well, in -- right now, it's not having another health aide to -- to talk to. I mean, we have all this other people, but I don't have a health aide I can -- you know, what do you say. MARLA: Bounce ideas off of? NOLITA: Yeah. Or we can check and balance each other, you know. MARLA: And is that pretty common to have two health aides in a village? NOLITA: There used to be three health aides right in this village. And I guess the reason why they don't have three right now is North Slope wants the Health Aide Program to go to TCC. And they are in negotiations. And North Slope Borough, I'm pretty sure, they don't want to hire anybody that in a month or so has to be rehired or however long it takes, rehired by a different corporation. MARLA: Got you. So you guys are in transition right now? NOLITA: Yeah. And they did their memorandum of agreement, and I'm not sure where TCC is with reading that contract, blah, blah stuff. So we're just kind of hanging in the balance. MARLA: Yeah. And how often do you talk to the doctor? NOLITA: Daily. MARLA: Like -- NOLITA: Supposed to be daily. Our regular physician is not at Chief Andrew Isaac, he's off on vacation, so in this last month, we talk to the doctor maybe three times a week. MARLA: Okay. And mostly when you need something specific or is it just a -- NOLITA: They just routinely call after one o'clock. Sometimes I've gotten medical traffic in this last month, while Dr. Springer's gone, sometimes at 4:30. It's like, oh, we just didn't do medical traffic with you today, so we're calling to make sure everything's okay. MARLA: And they call to see if you need prescriptions filled or -- NOLITA: Or if we have questions like with a patient and they just call to see what's going on, and we tell them what's going on with the patient. They give us back medical advice, or sometimes even have us ship the person in. If it's a life-threatening emergency, I always make sure that they know, like I don't wait for medical traffic, I let them know right away that I do have an emergency going on and I don't wait until one o'clock. MARLA: Yeah. That makes sense. What kind of training do you have now? Do you have to keep going? And if so, can you explain a little bit about it. NOLITA: Well, for emergency stuff, I have to re-cert before December on my EMT-I, and I think I'll be going within the next month or so. As far as clinical care, we go -- we're supposed to go to CME stuff, but I did a diabetes course last spring which helped out, and you get -- you do your practitioners stuff every six years. And mine's good until August '09, and then you get your certifications, every two years you get certified. Or re-certified. MARLA: Okay. And does that mean going to Anchorage or Fairbanks and spending weeks there or -- NOLITA: No. Well, as far as the North Slope Borough, they hire a family nurse practitioner, our PA, to come up and work with the health aides. And do the training -- do the practitionerships out here in the village. MARLA: Okay. How often does that happen, that a PA would come out? NOLITA: Well, if I was in continuous training like if I was just starting out, after a session she would come for a week and work with me. MARLA: That's pretty cool. NOLITA: Yeah. I think so. MARLA: To be able to make sure that you understood what you learned in your training and -- NOLITA: Yeah. MARLA: -- get a little guidance if you needed it? NOLITA: Yeah. MARLA: Oh, that's cool. And does the doctor ever come out here? NOLITA: Usually he comes for a week. Although the last four times Dr. Springer came out, I wasn't in the village. I -- you know, when you put in leave, I don't know what his schedule is going to be, he doesn't know way in advance what his schedule or what village he's going to what month. He just kind of has a -- you know, an idea when he's going. And this last four times he came here, I was not even in the village. It's like, okay, like I know my sister's getting married next spring, so my little tickler clock is already, okay, first of February, I'm going to put in for leave. Because it's four months in advance. MARLA: Okay. NOLITA: The CHAP office knows four months in advance that I have leave on this specific date, and I've been alone for how many months. And they need to send somebody to cover those dates. So I always try to, you know, know what I'm going to be doing or plan my leave four or five months in advance. MARLA: Right. NOLITA: So. MARLA: And then the doctor ends up showing up, of course. NOLITA: So. MARLA: And normally when the doctor comes, what is -- what does he do? Does he see patients the whole time he's here? NOLITA: Oh, yeah. MARLA: And you see them together, or -- NOLITA: Well -- MARLA: Well, obviously. NOLITA: I know we -- I haven't been here, so with this particular doctor, but in other villages, the doctor sees the patient by theirselves. MARLA: Okay. NOLITA: So and we just kind of, when we get done, we have a little consultation, he tells us what's going on and where the follow-ups need to go, and what labs need to be drawn when.
MARLA: The other thing I was -- I wanted to ask you about is you've been doing this for probably 13 years, so what kind of changes have you seen in 13 years? I mean, I imagine with computers, it would make some difference. But either medical changes or changes in the equipment? NOLITA: Oh. Well, when I started, about a couple years after I started, we got a fax machine. Voila! Technology. And a few years later, we got a computer to go with the fax machine. So -- and then, of course, we have the telemed, which I think is really great. MARLA: How does that work? NOLITA: Right now, it's not working in this village, but only because we were out of the building for such a long time. In fact, I talked to the guy yesterday and he's going to see if he can schedule to come back in to re-hook it up. But when I used it, like when I was in Nome -- no, not Nome, I wouldn't say Nome, Wainwright and Nuiqsut, I'd just type my whole encounter and e-mail it to that doctor that's in charge of that area, like Dr. Gonzales in Nuiqsut, and at that time Dr. Smith did Wainwright. And so they would check their e-mail. And it took them a long time to get used to, oh, you know, we've got to check the computer for patient things. And they were kind of resistant. But I think in the long run, you know, after -- they got used to it. Because his rash, I took a picture, like, two days ago, and we did this like per your orders, and this is what it looks like today, and it's not getting any better, so we take the picture and we e-mail it, and then they -- they kind of -- if they need help, they e-mail it to ANMC, as well. MARLA: So what's that's what the telemedicine is, is -- is it just a computer system or is it cameras or -- NOLITA: It's a bunch of different things. It's cameras, the EKG, the ear thingy, you can look in the eyes. It's practically all the things around my exam room all in one thing, and you can e-mail that to the doctor on call, or to your doctor. MARLA: Wow. NOLITA: I think it's pretty cool. Where I saw it used most effectively was in Point Hope. That's like they were right on top of things, the Maniilaq and training those health aides over there and making sure they got to use it and stuff like that. MARLA: Wow. NOLITA: It's like one night, one night there was something going on and the health aide took a picture of it and sent it to the doctor over in Kotzebue, and like within a couple of minutes, he called and he let us know that there is a medevac being sent out for that particular patient, but while we're waiting, he gave us instructions of what to do. MARLA: That is cool. NOLITA: Because he saw from the picture we sent what was going on. And that -- my first experience with telemedicine and telehealth was in Point Hope and they were doing it really well. MARLA: Wow. NOLITA: So. I was impressed. MARLA: That's very cool. NOLITA: So.
MARLA: Okay. We're back on. NOLITA: Okay. MARLA: After a little break. Where Nolita had to go back to work and do -- and see several patients. And so thanks again for coming back and talking to me. I kind of was -- there's a bunch of things that I wanted to ask you based on what we were talking about earlier. When we left off, you were talking about telemedicine. NOLITA: Uh-hum. MARLA: And I just wondered if you could go into that a little bit more, like where the first time you saw it, you said -- you said the first time you used it where you really saw a benefit was in Point Hope. What other places are using it and when did they start using telemedicine? NOLITA: Point Hope. I was out there maybe four years ago. MARLA: Okay. NOLITA: No. Yeah, maybe four or five years ago I was out there. And they were using it like all the time. All their patients and stuff. But where I really -- and the provider that was using it, you know, she would be typing in all the information and stuff, but it wasn't until we had the fax -- or take picture and send it to the doctor that I really saw the benefit of the telemedicine. MARLA: Right. NOLITA: And so I thought that was really cool because we have all these telemedicine carts in all the clinics that I've -- you know, I've itineranted in, and that was really when I saw it working. MARLA: And so it's something that's common to all clinics now generally, or -- NOLITA: Yeah. Pretty much. MARLA: Cool. NOLITA: And their EMG machine is a little bit better than the one we have right here now. So my hopes is to get this one up and running so I could -- just for the EKG machine. MARLA: So the EKG machine is connected to the telemedicine machine? NOLITA: Yes. MARLA: So that means the doctor in Fairbanks can watch what's happening as it's happening? NOLITA: Pretty much, yeah. As I send it, yeah. MARLA: Wow. NOLITA: I could still fax them a copy of the -- what I get out of the machine now, our own, you know, clinic one, but I think it's a lot easier if I just send it by e-mail. MARLA: Right. NOLITA: Because then it's right there at his desk. You know. MARLA: That's awesome. NOLITA: He doesn't have to run down the hall to the secretary, grab the thing, come back, and do the interpretation, he just opens the screen and, voila, it's there. MARLA: That's great. NOLITA: And he could just let me know, e-mail me right back, let me know what's going on, if it's okay, if there's a question on it, or if I need to send them out, or whatever. So. MARLA: Okay. And then if -- if a doctor wants to send someone out, they send an order to -- to who? How does it work when someone -- once a doctor determines that they want a patient to come in? NOLITA: Well, usually they will call us back, and like if it's a medevac situation, we make the arrangements for the medevac. Or if it's just a not a medevac but a urgent medical travel, we make the arrangements with one of the local airlines to fly them in as a regular passenger, but they still have to go to the hospital. MARLA: Okay. NOLITA: Or the clinic. MARLA: Okay. Yeah. I just wondered how -- how that worked, whether the doctor called and -- or whether it was something that you guys were able to do. NOLITA: Here when we talk to, like, the doctor over at Chief, they tell us to notify the -- the Warbelow's Air Ambulance or whichever airlines, you know. When you do a medevac out of Samuel Simmonds in Barrow, they let us know that the medevac, or the Search and Rescue will be coming out for the patient, and they make the arrangements for Search and Rescue to come out. MARLA: Okay. NOLITA: So. We can't -- we can't just call up Search and Rescue and say, hey, we have a patient over here, blah-de-blah, and we need you to come get them. They won't move if the health aide calls them because they have a little different system. So. MARLA: And have you ever had to go out to the other villages when, you know, for emergencies or going out into the field, you know, away from the clinic to -- to manage or maintain emergencies? NOLITA: Yeah. MARLA: So what was that like? NOLITA: It was -- well, you know, the -- the -- and that goes back to the difference between the North Slope Borough clinics and the TCC clinics. When we worked for the TCC clinics, we usually have to go out and get the medevacs and the serious patients and bring them back to the clinic, whereas within the city limits here, we have the ambulance, they bring us our patients. So I've had both sides. MARLA: And Search and Rescue is something that's particular to North Slope Borough or was there also a Search and Rescue at TCC? I mean, so if someone's out, I'm thinking out in the mountains or out in the field and they needed to be rescued? NOLITA: Difference villages have Search and Rescue set up different ways. MARLA: Okay. NOLITA: Right now, because we're a part of the North Slope Borough villages, we have Search and Rescue out of Barrow. MARLA: Okay. NOLITA: And then they have here, locally, they have a local Search and Rescue unit, as well. MARLA: Okay. NOLITA: So.
MARLA: And then the other thing I wanted to ask you is about issues of confidentiality, and how you deal with those in a small village. NOLITA: I have a good one for that one. I'm not allowed to disclose medical information. That pretty much, you know, someone comes up to me and ask me how is this person doing in Fairbanks in the hospital, I -- I'm not allowed to disclose medical information, you'll have to contact one of the family members and find out. And you know, that pretty much -- some of them will understand, a lot of people will understand that I can't give out information, but there are just a very few that -- that will poke at me. MARLA: Yeah. NOLITA: In the hopes of, you know, I will release something. But I -- I normally don't. I never do. MARLA: Okay. NOLITA: Because it's -- it's too fine of an area. We're just not allowed to do it. MARLA: Yeah. And you mentioned something to me when we were talking yesterday about when the clinic was in your house and that you were very aware of issues of confidentiality. NOLITA: Yes. MARLA: And what -- what was that? NOLITA: Well, my voice is a little -- I don't mean to talk loud, it just carries a lot better. So when we were over there, we have the Vanee ducts, and sometimes if the TV wasn't running in the front room, even if I was way back in the building, you could hear my voice because it carries quite easily. So -- so I have to make sure the TV was on up front so that way, it will cover whatever I'm saying in the back. And my son, he just moved over here, like about a week ago when I came home. And I didn't bring him up sooner even though they said I could, because -- well, he's a teenager, you know, and I didn't want to put myself and my patients at risk for breaches in confidentiality because you can't -- you know, teenagers, they see and they say stuff without really thinking what they are saying. MARLA: Right. NOLITA: So I didn't bring him up until the clinic was moved well away from that area. And he knows that even though he gets out of school at 3:30, he's not allowed to stop by here and loiter because I just won't -- my job is important and I like it and I won't put myself at risk for it. MARLA: Right. NOLITA: And he knows not to come here. MARLA: And you like to keep your life separate from your job? NOLITA: Exactly. Yeah. Although sometimes it -- you know, when you're really busy, kind of run together, but you know, I keep it separate. When my son is around, I keep it as separate as possible. Because kids are kids. You know. MARLA: Yeah. And I think it's something that you're trained that you learn about confidentiality, and a 15 year old might not -- NOLITA: Yeah, they don't understand. And that's the other thing, I really discourage, working in the clinic, is family members that work in the clinic having their family drop by and socialize. MARLA: Yeah. NOLITA: You know, I -- that in itself, if it happens too often, is a confidentiality breach, too, because then they -- they see who comes to the clinic. They don't really know why, but then, you know how in a small village, a little crumb can be a mountain in no time. MARLA: Right. NOLITA: And for no reason at all. MARLA: Right. NOLITA: Just because they were loitering or visiting. And so I really discourage family members from dropping by and stuff. MARLA: And hanging out? NOLITA: Yeah. MARLA: Yeah. I think that's probably a good policy. Then I also was wondering how you deal with emergency situations when you're, you know, in a village. NOLITA: What do you mean? MARLA: If you're in an emergency situation and it's someone you know or, you know, obviously, you know everyone now, you've been here for a year or so, but I just wonder how you deal with those situations? NOLITA: You just kind of have to separate it. You have to put your personal life and your personal feelings aside to do your job because the main thing right now, they are coming in by ambulance, they are coming in for an emergency, you need to be focused on what you're doing, not the fact that, oh, that's my aunt or my cousin and my son or my daughter. You know. You need to set all those feelings aside and deal with what's happening right now. Because -- and I know, it seems like it's kind of cold, but if you're more focused on what you're doing and not emotional stuff, you get the job done a little bit better and you're more, you know, level. MARLA: Did that take a long time to learn or was that -- NOLITA: To separate that out? Yeah. It has. And there are days I do something and -- or I have a bad emergency, not particularly here, but you know, because I've worked throughout the state. MARLA: Right. NOLITA: And it's like maybe a day later I finally sit down and look at what I did and it's like oh, my gosh. And then the emotion part kind of hit and I, you know, cry. And I relieve my stress by sewing, as well. MARLA: Yeah. NOLITA: So you have to do something to keep sane. And I -- I sew little projects. I've got about 15 projects right now, but, you know what, if I stay on one project too long, it just takes forever to get it done. So I've got little bits of a whole bunch going. And that just kind of, you know, relieves the tension. MARLA: Yeah. NOLITA: So. MARLA: Yeah. I was wondering how you kind of deal with those. NOLITA: The only time I really -- I really cried when I was seeing a patient was when my own son was hurt. And I was -- we were living in Ruby, and Ruby is a very hilly, live on the hillside type thing. And he was five years old, and he just got his bike like a week before for his birthday, and he was five, he got a helmet, pads, he got the works. He was going to be safe going down these little hills with his little two-wheel bike without the trainers. And one afternoon I got home from, work four o'clock, and 4:30 he's, mom, I'm going down to William. William is his friend that lives at the bottom of the hill. And I said, okay, you can go to William's. Are you taking your bike? He said, yeah, I'm taking my bike. He put on his little helmet, put on his little elbow pads and knee pads and he took off down the back side of the road to the -- to the other road and down the back side of the yard. And I didn't really pay attention because, you know, he had all his gear on and he's on his bike and he's going downhill. Well, guess what. He gets to the other end of the yard and out of sight, he takes off the helmet, the pads and everything, and he goes down the hill and he hits a big rock. And 10 minutes later I've got a 5-year-old male, bike accident, possible head injury coming in. So I go to the clinic, and it's like he came in and it's like, oh, my gosh, he had like road rash on his arms, on his legs, and on his face, and so I don't know. And he had a cut on his cheek that went all the way through. So when I talked to the doctor, he said, you have to sew either the inside, which is hard to sew, or you have to sew the outside so that -- he said the inside will heal, you know, from the skin in. So it's like he's only five and first time I'm ever going to sew him. And he's in his little papoose all wrapped up so he don't move, and I'm irrigating, cleaning out gravel, and I end up sewing his cheek like six or seven stitches. And that was the only time I cried while I was working. Because he was kind of thrashing and I was by myself, and a couple of people came in and helped me, but it was pretty emotional when I was working on my own son. MARLA: Yeah. NOLITA: And so I -- all the whole time I was crying. MARLA: And was he crying, too? NOLITA: Well, yeah, he was crying, but -- but I think he was more -- I was -- well, I was torn. I was upset because he left the house with all his safety gear on, and not 10, 20 minutes later I get him by ambulance because he had crashed, and if he had -- if he had have worn all that stuff, he would not have been as bad. Because the road rash is very hard to get out, especially the fine gravel. You have to scrub it out. There's no way to get it out. You have to take a brush and scrub. And that in itself is traumatic for anybody. MARLA: Yeah. NOLITA: So. MARLA: And then extra hard to have to do it to your own child. NOLITA: Yeah. MARLA: Wow. Yeah. I could see that being a -- NOLITA: That's probably the only time I cried while I was doing something. MARLA: Yeah. NOLITA: Otherwise, I pretty much set my emotions aside and just get the job done. MARLA: Yeah. Well, that's, I think, probably a common -- a common way of coping with it, you know, you have to kind of separate -- NOLITA: Uh-hum. MARLA: -- those, and especially emergency situations. NOLITA: Yeah. So.
MARLA: Well, and then, another question I had for you was what -- who are some of your mentors in the health aide -- or being a health aide, in general? NOLITA: My mom was. MARLA: Yeah. NOLITA: She was a good health aide. But then there's a couple other ladies, I don't even know their names, there's a couple other nurses when I was growing up that helped, you know. And like I had to go to the hospital one time, and I went by myself because decades ago you didn't -- if there was space available on a plane to go to the hospital, you pretty much went by yourself if you were a kid, unless you were a baby, then mom or dad brought you. And they had all the old radio traffic thing with Tanana. And I ended up going to the hospital by myself one time. And there was a nurse there, I don't even remember her name, she said, when you grow up, you can be a health care provider. I said, okay, yeah, right. I was like 8 or 9, I had to sleep in a crib, that just kind of blew my image. But my mom, she has been a steady example in being a health aide. MARLA: Yeah. NOLITA: It was kind of boring when I was younger, but now that I look back at my career and look at the hardships they had when they first were health aides, you know, they -- they went through a lot, those older health aides, that I don't know if I could have done it like they did. MARLA: What do you mean? What sort of things do you remember seeing? NOLITA: Well -- well, like, you know, if I had to get a patient out right now, my patient would be out on a medevac within a couple hours. Sometimes their patients had to stay in the village two, three days before they got to the hospital. So -- and even, you know, depending on what's going on, that could be stressful. So they had to do a lot more stressful stuff. A lot of them had to do the honey bucket thing whereas I got a flush toilet. MARLA: Right. NOLITA: That's a big one. And even with simple things like hand washing, they all had to use a basin and haul the water. Some people had to haul their own water. Whereas I had the modern facility, I just turn the faucet, you know, and hope it works. Some villages didn't have electricity for a lot of years so they have to do their own, what do you call those, Coleman. MARLA: Propane -- propane or -- NOLITA: It wasn't even propane, it was kerosene or something. So see, and I just flick the light and the light comes on, hopefully. So they had a more grass roots, down to earth kind of experience whereas my facility is a lot more modern. MARLA: Yeah. And then do you remember your mother doing radio traffic? NOLITA: I know they all had medical traffic after lunch, but -- MARLA: Was there a radio in your home? NOLITA: You know what, I don't remember a radio being in my house. I know at the store they had a ham radio. MARLA: Yeah. NOLITA: So. MARLA: I wonder where she went to do her -- her radio medical traffic. NOLITA: I really don't know. MARLA: And she was contacting Tanana? NOLITA: Yeah. Tanana for a long time. MARLA: Okay. NOLITA: Tanana for a long time. Yeah. MARLA: And then she was suggesting to -- by someone else that we interview to be someone we talk to about early health aide and her experiences. NOLITA: Yeah. MARLA: But I think it's really interesting that, you know, you grew up around the whole Health Aide Program and watching your mother and, you know, being in the house when -- when patients came. NOLITA: Yeah. MARLA: Kind of prepares you for what you're doing now. NOLITA: Yeah. Back then when I watched them suture and stuff, it was like teenager, you just don't want to see that kind of thing going on. It's gross. But you know, you get used to it. MARLA: Yeah. NOLITA: Yeah. So. The thing with a bad cut is once you stop the bleeding, all you have to do is suture and clean up the mess. And it's the mess that makes you look bad, like one drop of blood in the toilet bowl can make you look like you're really bleeding because it's water and stuff. MARLA: Yeah. And head injuries, too. NOLITA: Oh, yeah. Head injuries are big bleeders. They are big gushers.
MARLA: Well, I think that that was mostly what I had to ask you. Is there anything that you want to add or anything that you would like to have on the record or advice from people who maybe are thinking about being a health aide? NOLITA: Every day is an adventure. It's not the same thing every day. And it's even more of an adventure if you're an itinerant because you get to go to other places, meet new people, and not every place has the same medical problem. You actually get a learning experience when you're travelling. So. MARLA: And then -- well, actually, one other question was have you been encouraged by other people to get further education or are you interested in pursuing a PA or becoming a PA? NOLITA: For a long time, I was like, when I grow up, I'm going to be a paramedic. And then I don't know, I kind of changed my views, but I think some day I'll go back to school. Right now, because I'm a single parent, I think I just want to concentrate on getting my son the best possible education during his school years. Because he does have a learning disability, and I think I need to concentrate on his education right now so I could set him up. And then once he's off and going, you know, I'll probably go back to school. MARLA: What does it take to be a paramedic? NOLITA: Oh, I know you have to be -- you have to go to like a 12-month training course and be sponsored by a doctor or hospital. A doctor probably. And you have to just do a lot of -- go out -- well, I guess what I want to say is I want to be a paramedic on an air ambulance so I can still do the travelling and, you know, see different things. MARLA: And meet people and -- NOLITA: Yeah. A lot of times I don't even remember people's names. I probably -- I probably won't remember your name. But if you tell me your birthday or -- I remember people's chart numbers from 15 years ago. I remember numbers a lot better than I remember names. So if I don't remember you in a year, that's why. MARLA: I won't be offended. NOLITA: Yeah. So. MARLA: Okay. NOLITA: I thought about going to PA school, but you know, PA school is okay, but I think -- I think a family nurse practitioner would be a lot better. You don't need a sponsoring doctor, and not that the doctor isn't right but, you know, working for the North Slope family nurse practitioners is the way to go because Samuel Simmonds always likes to work with the PAs, the North Slope Borough hire. They won't sponsor them. So that's why we don't have PAs. MARLA: So there's no PAs on the North Slope? NOLITA: No. MARLA: Okay. NOLITA: There might be PAs at Samuel Simmonds, but they are sponsored by the doctors there in the hospital. And we have PAs that work at Chief Andrew Isaac, but I think it's just easier. You get a lot more knowledge, you have to go through a nursing program and then do the masters to the nursing program, I think that's -- when I grow up, I'll be a family nurse practitioner. MARLA: That's pretty cool. When I grow up. Well, yeah, I just -- I wondered, too, if it's something that the program -- this they encouraged. NOLITA: They do encourage us to go on. They do. MARLA: And would they sponsor, would they help if you wanted to get further education, do you know? NOLITA: I'm not really sure. MARLA: Yeah. NOLITA: I know -- I'm not really sure about that because I haven't looked into it yet. So I don't know. MARLA: Yeah. NOLITA: But it's an interesting job. MARLA: Yeah. It seems like it. I think that there's a -- there has to be some particular personality traits to be a health aide. NOLITA: Yeah. You've got to be able to help someone and, you know, have an open mind and help them. And want to be able to help them, or try. MARLA: Yeah. NOLITA: So. MARLA: Is that one of the best parts about the job, do you think, or -- NOLITA: I think the best part of the job is actually getting to help people. MARLA: Yeah. NOLITA: So. Like I said, every day's an adventure. MARLA: Well, cool. I think that this has been a great interview. NOLITA: Oh. MARLA: And if there is anything else? NOLITA: No. MARLA: Okay. Well, thank you very much, Nolita, for taking the time out of your busy day. I know that you have long days and lots of patients to see, so thanks very much. NOLITA: Oh, thank you for wanting to interview me. MARLA: You're welcome.