Dr. Gloria Park was interviewed on August 25, 2005 by Karen Brewster at Gloria's home in Anchorage, Alaska. This interview took place in Gloria's living room, and there is periodic noise as her husband, Orlo, is busy with things around the house. In this interview, Gloria talks about chemotherapy aides, her first village trip, communicating with the health aides by radio and telephone, the development of manuals for rural health care, and the benefits of using local people as medical providers.
Digital Asset Information
Project: Community Health Aide Program Project Jukebox
Date of Interview: Aug 25, 2005
Narrator(s): Dr. Gloria Park
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
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Coming to Alaska and working for the Civil Service.
Start of the Community Health Aide Program and choosing aides.
Radio calls to chemotherapy aides and health aides and traveling to villages.
Traveling out to villages and doing outpatient clinic work.
The 1964 Community Health Aide pilot project.
Training manual and the pilot program.
First training manual and changes in the health care system in Alaska.
Medicines available for the villages.
Training manuals for training developers, teachers, doctors and health aides.
Other physicians associated with the program and putting together the early manuals.
The beginning of the formalized Community Health Aide Program and working on the manual.
Responsibilities after she stopped traveling, the health aide program and communication.
Health aide training and relationships with the doctors.
Changes in rural health care and the Indian Health Service.
Community health aide manuals developed over the years and the work done by early sanitation aides.
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KAREN: Okay. Let's see how yours is working. You have to say something. DR. PARK: Okay. Well, I don't know whether you've got it recorded, I came up here in 1957. KAREN: Okay. DR. PARK: And graduated from medical school in 1955. Did the old-fashioned general family medicine. Well, they didn't even use that term, the general -- the old-fashioned general internship in Colorado. KAREN: Okay. Let me just interrupt with a little intro of who you are. And I'm Karen Brewster, and I'm here with Gloria Park in her home in Anchorage. It's August 25th, 2005, and this is for the Community Health Aide Project. So we have you, medical school 1955? DR. PARK: Uh-hum (affirmative). And -- KAREN: In Colorado? DR. PARK: Yeah. And a general internship in Colorado. KAREN: Okay. And where and when were you born? DR. PARK: 4/13/30 in Washington State. KAREN: Okay. Why did you decide to go to medical school? DR. PARK: Oh, decided about -- about age 10. I've tried to track it back as close as I can get it that I was interested. Some of that might be due -- I know it was due to reading the books. I can't -- I can't think of the big old -- the Mayo Clinic, founded by the Mayo brothers. And I read those two biographies. And got more and more interested. And -- and then my grandparents had chronic problems, and I helped a little bit taking care of them. So all of this kind of led to it, I think. KAREN: Was it common for women to be in medical school at that time period? DR. PARK: No. Usually medical schools had two or three in a class, and I actually ended up in a class, I think there were eight of us, which was a little more than usual. KAREN: Uh-hum. Was that difficult? DR. PARK: No, I don't -- I think we just -- I, anyway, just went to school thinking that was what I wanted to do and I didn't worry about what the reasons were. And had no problem through medical school, that I know of, that was based on male-female ratio. KAREN: Okay. So in 1955, you were in Colorado? DR. PARK: Yeah. I -- I spent one year at the University of Washington Medical School, as I transferred out of the Pullman Washington State University to medical school. And in the meantime, had met Orlo at Washington State University. So he went into a government job in Washington D.C., and I went to Seattle. And we -- we decided we had to figure out how to get together, so he transferred to Boulder, Colorado, and I transferred to the University of Colorado Medical School from Seattle. KAREN: Okay. And when were you two married? DR. PARK: '52. KAREN: And did you -- so in medical school, did you have a specialty? Or in your internship or -- I don't know exactly how it all works. DR. PARK: No, actually -- actually, at that time there were hardly any so-called specialties. It was all pretty general. And, of course, surgery and -- well, let's see. Surgery and OB and eye and ENT developed. And I can't tell you the order. Orthopedics. I think in internal medicine. Neurology. Neurosurgeon. Anyway, not near the number of specialties that there are now. KAREN: Right. DR. PARK: So --
KAREN: So then how did you end up in Alaska? DR. PARK: We just wanted to see Alaska. So when I got through with internship and -- I don't remember. Well, we decided it would probably be easier if I contracted because I had already heard of the shortage of physicians. And -- and then he would come up and find a job. So that's -- I -- I came under contract of the old -- well, Alaska Native Service. And to the old ANMC, which wasn't named that yet. KAREN: What was it, the Alaska Native Medical Center? Is that what ANMC stands for? DR. PARK: Yeah. And it wasn't -- let's see, it was just called the Alaska Native Service for several years. I've forgotten just what it was named. KAREN: Yeah. So how do you get a job with them? What was the process? DR. PARK: Well, I had contracted to come up on Civil Service on a two-year basis. And at that time, what they did, every two years, if you wanted to renew your contract or go out -- Outside, as they call it, and come back every two -- go out every two years and sign a new contract. And so I -- I did that rather than going to -- going into the Public Health Service. KAREN: So by going out and renewing your contract, you would go -- I don't -- DR. PARK: Well, they -- oh, I'm sorry. They -- they allowed us a vacation. KAREN: Oh, okay. DR. PARK: Every two years. Paid. And along with it, if you went, you also signed up for another two years on a contract. KAREN: Oh, I see. DR. PARK: So I kept doing that for years. KAREN: That sounds like a pretty good deal. DR. PARK: Yeah. And -- but that -- I just stayed Civil Service. I had good enough, you know, reasons and health care that I just stayed Civil Service instead of going into the Public Health Service Corps. KAREN: Oh, I see. Okay. So Public Health Service is made up of both corps and civil? DR. PARK: Yeah. KAREN: Oh, okay. DR. PARK: And -- KAREN: What's the difference? DR. PARK: Oh, I don't remember the pay structure, but the Public Health Service Corps usually, at -- in the early days went wherever they were assigned. And Civil Service, we came on a contract for two years, a lot of them stayed two years and left. And -- well, it also -- I can't remember whether it was two years. I don't -- I don't remember what some of the arrangements were. But initially, there was probably more Civil Service than Public Health Service. KAREN: Hmm. DR. PARK: And eventually, it -- it went the other way. KAREN: And then the corps part, they are the more -- is it a military affiliation? DR. PARK: Yeah. KAREN: They sometimes wear uniforms, right? DR. PARK: Yeah. KAREN: I don't know if they still do, but -- DR. PARK: Uniforms are very similar to the Coast Guard. And -- KAREN: So that counted as military service for them? DR. PARK: I think so. KAREN: Think so? Hmm. DR. PARK: I think so. They owed -- a lot of them owed two years of service under some of the old regulations.
KAREN: As I said, Walter Johnson told me that you were involved in this pilot project in the -- what, 1964? DR. PARK: Well, when we -- when I came up here in '57. KAREN: Uh-hum. DR. PARK: Brand new, didn't know what -- what I was getting into at all. There were only about, gee, maybe ten of us in the old hospital, ten physicians. And two dentists. And -- and it was one of those things you had to gradually develop something, and one of the -- and of course, they had radio, phone patch with the bigger villages. I don't remember having phone service anywhere. It was the old radio. And we used to take turns taking radio call. And then as phones were developed in the bigger villages, then we -- one of us, which was usually me and the outpatient department, took the phone calls from the villages. And also did the radio phone patch. And our first -- the first thing I wanted to do was find a person in each village to predominantly make the phone call so that we got more acquainted. And of course, the village wanted to do that, as well. And like you say, a lot of the original health aides, and I don't remember whether we ever -- we even used that term, but we used it pretty early on. And usually there was a midwife in the -- at least in the bigger villages. And health aide in the smaller, and a lot of them had been the old chemo health aides. And it was all voluntary to begin with. KAREN: So what are the chemo aides? DR. PARK: Oh. The chemotherapy for tuberculosis. Both active cases and preventative type. And that program was one -- run mainly by the Health Department, the State Health Department. KAREN: It wasn't the Indian Health Service? DR. PARK: No. KAREN: Okay. So -- DR. PARK: And so the chemo aides worked with the Public Health nurses. And they traveled. And like with us, there -- there wasn't enough -- there wasn't enough Public Health nurses to cover all of the villages very often. You know. Once or twice a year. And so either an ex-midwife or a -- or as the chemotherapy program began to wane, and they had -- that was when they were testing INH all over the country, Isomyosin. KAREN: I'm not remembering that. DR. PARK: It was a TB medicine. So -- KAREN: So they were testing it to see its effectiveness? DR. PARK: They had -- they had proved in the laboratory that it was, so it was being used wherever there were hot spots of -- of a lot of TB. KAREN: What exactly did the chemo aides do? Did they -- they provided TB shots or -- DR. PARK: No. Primarily were just making house visits to keep people on their treatment, encouraging them to take the pills and -- I've forgotten what the -- primarily, it was -- I can't think of the other one. Anyway -- KAREN: Were those -- were those paid positions, those chemotherapy aides? DR. PARK: I don't know. KAREN: Oh, okay. DR. PARK: I kind of think they might have been paid a little, but then a lot of them may have just been volunteer. And -- and then from that, some of them went on to be midwives, some of them did health aide, some did both.
KAREN: And so then when you started and were doing radio calls, you would -- some of the people you talked to had been those chemotherapy aides? DR. PARK: Yeah. And especially in big areas. And occasionally, let's see, I was trying to think when we used the term "health aide" to begin with. KAREN: Yeah. I've been wondering where that term came from. DR. PARK: Some used the term "medical aide," but then that was used in other ways, too. Health -- "health aide" term came along pretty fast. KAREN: Yeah. I forgot to ask -- DR. PARK: But not paid. KAREN: Yeah. It's something I should have asked Walter Johnson where the term "community health aide" came from, you know, that has now become such a common phrase. DR. PARK: Yeah. KAREN: You know, how it developed. DR. PARK: It was so common, I can't remember where it came from, either. Walt might remember that. I did dig out one of the 1976 booklets that gives a little bit of history in the front of it. I could get that out before you leave. KAREN: Sure. DR. PARK: Or I can do it now, whichever. KAREN: No. Before I leave, we'll take a look at it. DR. PARK: It's 1976, though. KAREN: Yeah. It would be interesting to see. DR. PARK: And I can't find a copy of the first one. What happened is each -- each hospital, each field hospital, and the Anchorage hospital was considered the main hospital. And -- and we developed a program and to -- to work with health aides in the village, until later on when there were funds to bring them in, to actually bring them in for two or three weeks, or whatever, for some training. And we started volunteer-type -- well, I shouldn't use the word "volunteer." Our own staff would go out and hold field trips, and we tried to get into the main villages at least twice a year. And just once a year on the smaller ones. Later on, that got a little more frequent. And since when I came, there was no one working full time in the outpatient department. KAREN: Wow. DR. PARK: So I inherited the outpatient department, which within a few days, somebody notified me that I was supposed to go upstairs and deliver a baby, because they said whoever is working in outpatient department also did do deliveries. That way they didn't -- you know, they couldn't pull people out of surgery. KAREN: Yeah. DR. PARK: And some of the specialists had not had any background, you know, went straight into a residency program. KAREN: So had you delivered a baby before? DR. PARK: Yeah. KAREN: Or that was your first one? DR. PARK: I delivered -- I delivered quite a few in internship -- KAREN: Uh-hum. DR. PARK: -- on a regular basis. So. And later on, a lot of the physicians came up here that had not. They went directly into certain specialties. KAREN: So when you -- the staff traveled out to the villages on these field trips, were you training the health aides or was it to provide medical services for people in the villages? DR. PARK: Both. And if there was no -- what I -- what I asked our physicians to do, and I did a lot of trips, and then mainly the physicians on other services sort of volunteered to go. And we developed a -- a list of supplies and all and what to take and -- and, of course, took some of the records, not much, and take especially hospitalization records of -- of that village. And it was a matter of one of the first things each physician had to do was pack their own stuff, and then we would arrange for one of the nurses to help us with that. But we used usually two foot lockers, the old-fashioned foot lockers. And -- and we'd develop our own list of stuff, take limited records because you don't want to carry around too many of that. And go out, meet the -- the chemo aide or the health aide or the midwife, they would volunteer to help us with clinic. And -- and it was a matter of follow-up on physicians -- or on patients in the clinics. That had been in the hospital. And then see anybody who was sick or had a chronic disease. And, of course, the majority of the village might well be perfectly healthy when we arrived, but we encouraged regular physicals, and we did the school physicals. And from that is the gradual development of what to take with you and what to do and -- and get somebody that's a volunteer. Usually there would be two or three people in a -- in a village who would volunteer to help us set up for the clinic. And we would hold clinic in wherever there was space. Frequently, the back room of a school, if they had more than one room. Or sometimes just a matter of curtaining off a part of the school. KAREN: Uh-hum. DR. PARK: And we would hold clinic at least one evening to get those that were busy in the daytime.
KAREN: Do you remember your first trip out to the village? DR. PARK: No. I think it was probably the Iliamna area, but I wouldn't guarantee that. KAREN: One of your first experiences, do you remember when you first went to the village and what you thought about all that? DR. PARK: Well, it was just something I thought I had to do. And it was interesting, of course, to meet the villagers and meet whatever aide you'd been talking to over the phone. KAREN: Do you remember how long it was between when you started in Anchorage and when you had to go out and do a village trip? DR. PARK: I think -- I think it was probably 1959 because for a year or two, I was the only one in the outpatient clinic locally. And I don't remember -- I'm pretty sure. I think it was probably '59. KAREN: So what did you do -- you said you ran the outpatient clinic. What was that all about? DR. PARK: Just a general outpatient department. One position. And across the hallway was one dentist. And then we soon had two dentists. So they got the ball -- they got work. And I don't remember what year it was that I got a full-time second physician. And so initially, you just did whatever needed to be done. KAREN: Yeah, I was going to say, what kind of patients and cases did you end up seeing? DR. PARK: Anything. With -- see, there was no -- I don't think I had an -- let's see. There was one internist on duty. You know, for the whole hospital. Two surgeons. The first year there was no pediatrician. Might have been two years. But there were a couple private pediatricians helping us. John Tower. Do you -- KAREN: No. DR. PARK: And Helen Whaley. You've probably heard that name. KAREN: That sounds familiar. DR. PARK: And they saw patients whether we -- on call for us, whether we paid them or not. So that was a volunteer basis, too. And even when they started paying them, that wasn't a very big fee. KAREN: So did people come in from all around Alaska? DR. PARK: Yeah. They didn't travel in as much as they do now. They did an awful lot of they ordered their -- whatever they wanted to order for delivery to a village, you did an awful lot of that on phone or radio. And didn't -- didn't travel back and forth near as much. KAREN: Do you feel like the training you received in medical school in your internship prepared you -- DR. PARK: No. KAREN: -- for that work? No? DR. PARK: I'd just as soon that I'd do anything that needed to be done. And there were a few things that were surprising. KAREN: Like what? DR. PARK: Well, I mean, you just -- you just did it. And you'd go into a village -- you know, you wouldn't go into a village when a lot of people were sick. It was unusual unless there was some kind of URI or flu going around at the time. But usually it was a matter of immediately realizing that anybody with a chronic disease should be seen every trip. Kept them from having to get back and forth to the hospital. And it was awhile before we had the funds and the money to actually pay for bringing them in -- KAREN: Right. DR. PARK: -- if they needed to come in. And that started fairly early on, the early '60s. In fact, it might have been a little bit sooner than that, that if we -- that we could authorize with our travel office to pay for someone to come in. But at that time, sometimes when a child had got sick, quite sick, and had to come in on an emergency basis, they would just hand them to the first Bush pilot that came by. And they would bring them by. And sometimes they didn't even -- they had forgotten to get their name. So we -- we occasionally had a baby or a little kid who couldn't give a name. And it might be a couple days before someone would call in and say, how's Johnny? You know, that -- it was pretty -- pretty grass roots type thing. And -- and we soon had authority to pay transportation. And then we finally got authority to also pay for the -- one of the parents to come in. And -- but once in awhile, even then, we would get little kids in because the parents were busy with several others at home, and they -- or there would be only one parent. So you just -- you just got so you did whatever had to be done. KAREN: Do you remember what one of those surprises in the hospital where you -- you're faced with something and you didn't -- weren't prepared for it? DR. PARK: Well, usually, here in town we had enough staff that we could call somebody. It might be someone else with the same kind of training, which was basic general medicine. But we did have at least one surgeon around, you know, that they weren't covering for each other. And we had two surgeons in about the second year I was here. And we had one internist. So we had people we could call on locally. But for the most part, I saw whatever came in the door. And decided what -- what was to be done or -- or call on what few specialists we did have. And then when we -- and we also used a few of the private specialties, like the pediatricians. KAREN: Right.
KAREN: So can you talk about what this pilot project that Walter Johnson mentioned, what that was and how that worked? DR. PARK: This -- KAREN: The 1964 pilot project for the health aides, before it was an official program. DR. PARK: Not quite sure what he meant. Let's see. Well, two of us sat down -- well, I may -- may remember. KAREN: There was a doctor in Kotzebue, some -- you, there may have been somebody -- DR. PARK: Yeah. In Bethel. KAREN: Yeah. DR. PARK: So. I had forgotten what years Walt was out in Bethel. KAREN: I can't remember. DR. PARK: Anyway, I had another physician voluntarily, and we worked together on developing a training aid for people to -- to train aides. We developed a -- oh, I don't know, a small -- a small manual that was ideas on what -- what to try to do for training health aides. But it was -- and we were encouraging, or the area office was encouraging, well, this type of thing, you know, medical aide training. And I'm trying to think what -- I don't know whether it had a name. If it did, I -- no, I think -- I think the original little manuals were just medical aide training. And -- Hmm. KAREN: Do you remember what motivated you to start developing that training program? DR. PARK: Because of the villages we were trying to cover. And down the Aleutian Chain and the Iliamna area, McGrath area. Kodiak area. And it seemed like each year it kind of grew. KAREN: Yeah. It sounds like that's one of -- what the area that the Anchorage hospital covered. DR. PARK: Roughly that. KAREN: It's a big area. DR. PARK: Let's see. I knew -- we went into places like Tatitlek, near Cordova. So there was -- it was a big area. And -- and two of us helped develop an actual manual for anybody to use in any of the villages to help with the training. And then each service unit developed its own training program. KAREN: So the service units were at Bethel? DR. PARK: And Kanakanak. And, well, Barrow. Kotzebue. I'm trying to think of the different ones. Do you have a -- do you have a list of the old service units, or -- KAREN: No. DR. PARK: Okay. KAREN: Kanakanak is now the Dillingham? DR. PARK: Uh-hum (affirmative). Well, let's see. It was where there were any field hospitals located. KAREN: Bethel, Kanakanak, Barrow, Kotzebue, Nome? DR. PARK: No. Nome had a private physician and -- and that was part of the hospital. So we didn't send patients, or we didn't send physicians in there. KAREN: Tanana. DR. PARK: Tanana, yeah. KAREN: What about Southeast? Juneau? Sitka? DR. PARK: Well, yeah, the Mount Edgecumbe service unit. Initially, well, there was the -- the sizeable hospital there at Mount Edgecumbe. And that was considered -- what did they call it -- had an area office, and you had -- and they had two sub-area offices. One was Anchorage and one was Mount Edgecumbe. And so they took care of the -- the villages in that area. KAREN: Is Fort Yukon, did that have a hospital? DR. PARK: Well, they had a couple beds they could use if they had to. It was kind of -- they didn't have much. And then they would transfer into Fairbanks, and eventually into Tanana out of Fort Yukon. KAREN: Okay.
KAREN: So who was the other person who helped you develop that training manual? You said there was two of you. DR. PARK: Dave Dixon. And I have no idea at the moment -- it was spelled D-I-X-O-N, I think. KAREN: Okay. DR. PARK: And we would meet, we met several times, either his house or mine, and go over some of the -- we would draft up something for the -- for the trips. Not specifically what one trip would do, but what -- if they developed a training program, what they would do in the training. KAREN: Okay. DR. PARK: I don't know. I might have another -- an old copy of one of those, but I'd have to dig for it. KAREN: Right. Now, he was a doctor also? DR. PARK: Yes. KAREN: Okay. DR. PARK: A general. You know, all -- anybody that worked in the outpatient department was a general. But it wasn't long until there was a big pediatric clinic. As soon as there was a pediatrician to hold separate clinics. Because the population was young and -- and needed it. KAREN: Do you have any memories of specific health aides or villages that you developed a close relationship with? DR. PARK: I think we ended up with about 35. Do you want -- KAREN: Villages? DR. PARK: -- to know what some of the first villages were? KAREN: Yeah. DR. PARK: Well, Nondalton, Iliamna. Let's see, what's the name of those little towns out there. I haven't tried to think of this for a long time. KAREN: I think I said who were the first ones to benefit from -- DR. PARK: Pedro Bay. KAREN: -- from your training there? DR. PARK: And -- and then the Kodiak villages, we did some teaching and all the health aides, but they also dealt with the physicians in Kodiak quite a bit. And they were private. But we both got involved, usually, on a -- on acute emergent aid. And then things just grew. McGrath and -- I can't think of the village up north of McGrath. It's been so long since I tried to label them all. KAREN: I just -- DR. PARK: Well, and the Aleutian Chain, of course, were places like Unalaska and Atka, King Cove, Belkofski. False -- False Pass. KAREN: So this training program and manual was designed? DR. PARK: To help with training the aides. KAREN: So who was -- who was the audience? Who was supposed to use this manual? The doctors or the aides? DR. PARK: Doctors. And we worked where we had Public Health nurses, State Health nurses, we worked with them closely. But they were scattered and few between, too. KAREN: The Public Health Service, are those State -- that was a State program or a Federal program? DR. PARK: The Public Health nurse is the State. KAREN: Okay. It's confusing because I think of the Public Health Service. DR. PARK: Yeah. KAREN: INS was Federal. DR. PARK: Uh-hum (affirmative). And then we -- but we did a lot of work with the Public Health nurses. And traveling Public Health nurses preexisted any of the -- of our travel. There were a few people making clinics once a year here and there, but it was so sporadic. Milo Fritz, have you heard of him? KAREN: Huh-uh (negative). DR. PARK: Was ENT. And he was one of the first ones. And he died not too long ago. I don't know -- well, his wife traveled with him a lot, but I don't know how she's doing. Joe Shelton was a local ophthalmologist that voluntarily made trips.
KAREN: So how did that work using the manual? Was that successful, your first training manual? DR. PARK: Yeah. We used it in our service unit, you know, for bringing in and doing training. The Bethel service unit developed their own manual, using our manual to some degree. And Tanana did, Barrow did. But depending on who was there and -- and more familiar with the area, I don't know how much they relied on -- on ours or just wrote their own. So -- KAREN: Do you remember some of the content, what kinds of things were in that manual? I mean, in a general sense. DR. PARK: In -- from the teaching standpoint? KAREN: Right. DR. PARK: Well, rather -- rather basic trying to teach the aides when to recognize what was an emergency. And -- and what to do with common things, which they already had some, you know, on-the-job training, but of course, a lot was on TB and respiratory problems. And then, of course, how to handle minor injuries and when to -- when something was at the point that it should be referred in and taken care of, all kinds of injuries. So there's quite a bit on respiratory problems and injuries. And then at the time, the most common ear, nose, and throat problem was draining -- draining ears and how to treat them, as well as how to recognize when the infection had gone on into a mastoid infection. And other things, how to follow prenatal patients and watch for problems. KAREN: And, say, back in the late '50s, early '60s, medical care was way different than it is now. DR. PARK: Oh, yeah. So. And health care was so scattered, you know, and so few that you did what you could. Then yelled help if you had a problem. KAREN: I was going to say, how did you handle treating some things? I mean, was there sufficient medicines or equipment or whatever to treat the cases in the rural Alaska? DR. PARK: Well, one of the -- well, one of the first things we developed was a standing orders for the health aide, or what they should go by. And especially if they couldn't reach us by phone or radio. And each trip, we started out leaving a small supply of medicines. We were carrying quite a bit of stuff in the -- the old foot lockers. And, of course, you had to guess at what you'd need, but towards the end of your trip, you could leave quite a bit here and there for the health aides and teach them what they were and what they were for. And had a list of what they could order from the pharmacy. And then we had the standing orders from the health aide of what to do if -- if she had to. She or he. We had both. KAREN: What's a standing order? DR. PARK: Well, like with a throat at that time that looked like a strep infection, rather than just the usual upper respiratory cold, you know, with pusy areas in the throat and that type of thing, and when to use penicillin. KAREN: So it was -- DR. PARK: Nowadays they wait until there's a culture, and there was no way to do that. KAREN: So a standing order is like -- DR. PARK: If -- KAREN: -- if they see all these symptoms and make this diagnosis, you're giving them permission to go ahead and prescribe -- DR. PARK: Yes. KAREN: -- this medicine, they don't have to call you as a doctor? DR. PARK: Well, preferably -- preferably call in. But initially, communications was poor. KAREN: Right. DR. PARK: And if -- and there was only one physician on duty at night. In fact, when I arrived, we were just on call at night, but rapidly we decided that somebody should stay at the hospital. And because there were just too many things going on. And the hospital at that time was at least, I don't know, at least 200, if not pushing 250 in the hospital, which is almost a -- that's a -- that's a full-time job, if there's -- there were physicians, of course, taking care of different groups. But there were incidental things going on all the time. And if someone came in with -- with a broken leg, they might also have the runny ear, have TB, be pregnant. So there were a lot of general things going on. KAREN: So that 200, 250, that's beds? DR. PARK: Yeah. KAREN: Okay. DR. PARK: I don't remember what the maximum was. But I think we packed in a little more than that sometime. And you might have 50, 60 kids for TB treatment. And you know what illnesses 50 or 60 kids can have in addition to TB. And minor injuries. And we did -- we did, like I say, initially tried to take call from home and ended up just staying at the hospital. And it rotated the assignment. And worked the next day, too, if we didn't have enough backup. KAREN: Right. How did you manage those kind of hours? DR. PARK: Well, it could wear you out. And I had two little kids, and shortly after we arrived had a couple more. So -- so -- but Orlo helped a lot. KAREN: Yeah. I think that would be a challenge. DR. PARK: Yeah. It was. And then a time or two when whoever was on call and at the hospital would call for help and backup, and if I -- if he wasn't home and I didn't have a baby-sitter, I couldn't go in on backup, but I'd try and call someone that could go in and help a little bit. So -- but a time or two, I gathered up the kids and went in to see what I could do on an emergency basis. KAREN: I wonder, did that cause a problem with other staff members and when you said I don't have a baby-sitter, I can't come? DR. PARK: Well, I'd try and help them find somebody else. KAREN: Okay. DR. PARK: But there again, you're kind of -- everybody kind of got used to the fact that at night, you're it. And like I say, we did a little backup from the private physicians in town, orthopedics and -- and a surgeon, if -- if necessary. We -- we only had two surgeons. And -- and they are not always in town. If they made any kind of trips, and they -- KAREN: Right. DR. PARK: -- made trips out to the major hospitals. Didn't go to the villages, of course. KAREN: It sounds like you were lucky to have a husband who was supportive. DR. PARK: Oh, yeah. So. And of course, when I made field trips, he had the kids, so -- KAREN: How many kids total did you have? DR. PARK: Four. KAREN: Four kids.
KAREN: I wanted to ask you about the medicines. What kind of medicines did you have available at that time? DR. PARK: To be stocked in the villages? KAREN: Uh-hum. DR. PARK: Basically penicillin and sulfa was for an antibiotic, for example. And we would usually leave and teach them about nitroglycerine pills, you know, the old-fashioned, having a heart attack, you put one under your tongue. KAREN: Oh. Did it work? DR. PARK: Help -- probably did. You know. And, of course -- and, of course, they had the basic TB drugs they knew how to use. INH and PAS. That's the other one I couldn't think of. So it was kind of limited. And we did leave things like cough syrups. And I guess I mentioned the sulfa and the penicillin was the major antibiotics in those days. KAREN: So this idea of having somebody in the village to work with you, how did that come about? DR. PARK: Mainly because it was nice to be able to talk to the same person. KAREN: Okay. DR. PARK: And you'd get an idea on the phone who understood what was going on and -- and things to do. KAREN: Okay. DR. PARK: And working with them so that it was -- and of course, help with the clinics when we did get out to the village. And it just seemed to be one thing that you had to have was a contact in each village. KAREN: How did that work with you on the radio with the person, the health aide in your village, and them telling you, this is the symptoms of a -- how were you able to know what was going on? DR. PARK: You -- you tried to do it over the phone. And -- KAREN: And was that hard? Easy? DR. PARK: Well, that's where we definitely needed to get more training in for the health aides, so that they could report what they were seeing better. And I -- for example, one time I -- from what the health aide was telling me, I -- I thought that the patient was going to need to be flown in on a stretcher. And then when I said we'd -- we would have to arrange travel and bring them in, she said, oh, he's up and around. So obviously, you get off on -- on a wrong tangent sometimes. And I -- I thought -- I thought it would be a stretcher patient. And I don't remember the details of that now, but I -- I did think we needed to get into a training program. And -- and, of course, the obstetricians, the more -- whoever were doing some deliveries could handle a little of that. They -- they were involved in that training. Kind of from -- from the time we had obstetricians. Initially, we had none. So -- Yeah. The -- the early on teaching, some of it was for the teachers themselves in the villages that got so involved, and if there was no one else like a health aide or -- or similar to a health aide, they automatically were -- patients would go to them. I mean, the villagers would go to them for treatment.
DR. PARK: So this particular manual was developed in 1944 for the teachers to use. And -- and they also, this area anyway, was Bethel. And kept a few supplies in the big villages for the teachers to use. KAREN: It's a Medical Manual For Teachers prepared by Fred -- DR. PARK: Fred Langsam. KAREN: Langsam. DR. PARK: L-A-N-G-S-A-M. KAREN: Government physician, Bethel, Alaska, August 1944. Yeah. I was wondering if the teachers received any medical training because they were relied upon. DR. PARK: Yeah. Most -- most of them, you know, just whatever they had learned offhand. And this, as far as I know, was the first -- well, I take that back. I think there were previous, but very informal-type guides sometimes left in the village. This is the first one that looked formal at all. And you can notice how -- how old it looks. KAREN: Very yellow. And typed. DR. PARK: So -- and then we were speaking a little while ago about the first one that we worked on. This was 1964, trying to pull together some of the -- the training that was needed in the villages. And also have something more up to date to use by -- by this time the volunteer health aides, instead of relying on the teachers. And most of the teachers were very happy to get out of the medical care of the village. And this is one of the -- one that I was mentioning to you. This is what two or three of us, it was supposed to be a committee assignment, and it ended up being about two of us. And we just called it the training program, medical aide. In fact, the term was used, medical aide. KAREN: Alaska Medical Aide Training Program. DR. PARK: Yeah. KAREN: Compendium. DR. PARK: We decided to have a different wording for it. KAREN: Submitted by the Community Health Aide Committee, January 1964. DR. PARK: Yeah. As far as I know, that's the first, actually -- at least in the Anchorage area. But it was aimed more at people that were going to develop then local health aide manuals. KAREN: Okay. So this tells -- let's see. DR. PARK: And then in about 10 years, we went from this one, I don't know, 25 pages, to the ninth -- to this one that I -- that I could dig out the other day when you called. Are you familiar with this one? KAREN: You mentioned it and I -- I tried to find it in our library, and I -- I asked about getting a copy, if they could find it in one of the other libraries or something. So I haven't actually gotten it yet, but Guidelines For Primary Health Care in Rural Alaska, 1976. Is this the Rob Bridges one? DR. PARK: I don't know. KAREN: Oh, no, Joseph Whitaker. DR. PARK: Yeah. He was a pharmacist that spearheaded that program, or was spearheading it. KAREN: That's pretty thick. That's about 2 inches thick. DR. PARK: This does give you quite a bit on who was working in which areas and like Walt Johnson as clinical director. I could loan you this for a while, if you'd like. KAREN: Sure. Here now, I was just saying, there's a new training manual. DR. PARK: Uh-hum (affirmative). KAREN: It's four volumes. DR. PARK: I wouldn't be surprised. This was the first time that -- that a program really got formalized. And other than -- and prior to this, each -- each service unit might have their own little booklets that weren't any bigger than this one. KAREN: That first, that '64 one. DR. PARK: And a loose-leaf notebook that had maybe 25, 30 pages in it. KAREN: So this -- this big yellow one, this Guidelines For Primary Health Care, how was that meant to be utilized? Was it -- DR. PARK: By the -- by the health aides. KAREN: So it was supposed to be in the clinic to help their -- DR. PARK: So there was a formalized health aide training by then. Actually, it was a training manual. And -- KAREN: Okay. So when they came to Anchorage for training, this was, like, their textbook? DR. PARK: Yeah. KAREN: Okay. MR. PARK: And let's see, who else. Do any of these names look familiar to you, as far as -- KAREN: The Airlie Bruce, Walter Johnson, Janet Morton, John Rich, Loretta Throop. Lillian Walker, Community Health Aide, Holy Cross, I interviewed her yesterday. DR. PARK: Is that right. KAREN: And Genevieve Westwick -- no. Lillian and Walter are the only familiar names. DR. PARK: And then -- KAREN: These are the acknowledgements of the people that worked on the manual. DR. PARK: People that worked on the manual itself. KAREN: Uh-hum. Those are the names. DR. PARK: Let's see. I haven't tried to remember what -- some of them are specialists. A lot of them are general. Tom Bender still work at the Native Hospital? KAREN: I have no idea. DR. PARK: Anyway, there might be others that -- Howard Bonar was one in charge of the -- keeping the radios working. KAREN: Oh? DR. PARK: And that was in the days where you had to say "over and out" and all, you know, and take your turns. You couldn't interrupt anybody. KAREN: Right. DR. PARK: You just took the message, talked back when it was your turn. KAREN: So did he go out to the villages and maintain the radios out there? DR. PARK: He did a little, but he was primarily in Anchorage keeping the main radios up. And I don't know how many radios we -- we had two or three in the hospital. And -- KAREN: That's funny. I never thought about radio maintenance in the villages and who would have kept those going. DR. PARK: Yeah. And he did travel. I've forgotten what -- what all his job was. Yeah. He would all -- he would -- he does this volunteer work with the local senior center, if it's somebody you'd want to try to talk to sometime.
DR. PARK: Do you want any more names of people? KAREN: Whatever comes to mind. DR. PARK: Okay. Don Dippe' is an ophthalmologist in town who was with the Public Health Service for years, who could tell you a lot about the development of the eye program. And -- and it is different. That was another thing that I had to do initially was learn how to do a very brief refraction of eyes for glasses. And like somebody said one time, you know, we were kind of balking at trying to do -- fit eyes. We had a lot of things to do without trying to make glasses. And I asked somebody one time, I said, with -- I said, with what little training we've got, we're apt to make mistakes. And he says, if you can make them see better at all, they are not going to worry about mistakes. So along with our other supplies, we carried a refraction kit of lenses. And sometimes it was almost a matter of reading glasses, show them a few lenses and see which ones they liked best. So that was part of our program. Let's see. Who else is in here. Robert Fortuine has done a lot of work. KAREN: Yeah, I know the name. DR. PARK: Have you interviewed him? KAREN: Huh-uh (negative). I know his books. DR. PARK: And Bob Fraser, but he's -- he's not real well, so I don't know, although he might -- might be available. He worked with the TB program for many, many years. Lives here in town. Retired. And then, like I say, the one on the committee that got -- got to doing most of the dictation had to be the chief of the committee, which was a pharmacist. Keene -- what did we say? KAREN: Whitaker. DR. PARK: Whitaker. Excuse me. Okay. Ron Perkins is a sanitation engineer, and of course, we rapidly got involved with water and sewage and sanitation in the villages. And had traveling sanitarians, but they were like us, they couldn't have somebody out all the time if there were only a one or two-man office. And -- but he -- he was involved with writing a lot of the programs for their -- for their sanitation aides. And -- and it wasn't long before we had both a health aide and a sanitation aide. And when -- at that time the teachers were getting aides, and the Public Health nurses were helping to find medical aides at the time. And dental aides. And Dave Templin's been very involved with those kind of programs, too. He still works, makes a few clinics for the Native Hospital. KAREN: So this book that -- the health aides come to Anchorage and for their training and they would use this book. Did a copy of it go back -- DR. PARK: Yeah. KAREN: -- to the village with them so they had it as a reference? DR. PARK: Uh-hum (affirmative). KAREN: Okay. What kind of response did you get from the health aides? Did they like this book, or -- DR. PARK: The -- they -- a lot of them felt overwhelmed at first. You know, they didn't have the background even to really read it that well, some of them. But they -- they wanted something. And initially, they wanted a few medicines and a few bandages and, you know, very abbreviated kits. And then as they got some training and all, they needed a manual. And there was a manual, I think -- well, anything between this program and this program was -- KAREN: '61 it says. DR. PARK: -- wasn't in a good format. And of course, this was -- this one was way back. KAREN: That '44. Yeah. DR. PARK: And then that was to help some of the teachers of the training program.
KAREN: So when the program was then formalized in 1968, what was your involvement at that point? DR. PARK: In '68? We had -- we had pretty good -- pretty well had traveling clinics going pretty well at that time. Prior to that, it was more sporadic. And -- and we were gradually growing from a handful of villages to a dozen to 20 to 30. KAREN: And so did you continue to work with health aides? DR. PARK: Yeah. And I've forgotten when -- when I made the last field trip. Probably I finally had enough help in outpatient that I had someone that -- well, what I did before we had enough help in outpatient to do this, we borrowed any of the -- what we call GMOs from the different wards and specialties. And they were working as general medical officers -- they used that term with the Public Health Service -- on the internal medicine ward, on the pediatric ward, in surgery. And as they had time to do it, then we sent them on trips to some of the villages, and assigned some areas to them for as long as they were here. And some of them came for two years, some renewed their PHS and stayed. And the Public Health Service would usually let them stay, rather than send them somewhere else, if they wanted to. And -- and I tried to assign villages to -- to them, to cover and do the general stuff, but they didn't also work in the outpatient clinic where I was working until I had at least two physicians that I could assign a few villages to each one. And as I assigned villages to other general positions, then I backed off from making as many trips. And being gone for, you know, a couple months at a time. Or -- well, six weeks is the biggest, I think, that I made. And I rapidly decided this had to be -- to be divided up. KAREN: So -- DR. PARK: So -- so I was more involved then in helping with developing manuals. And we'd get volunteer physicians on other -- other wards to make some of the trips. And they appreciated, too, having certain villages that were sort of theirs. It was kind of like being a general practitioner for -- KAREN: Right. DR. PARK: -- for half a dozen villages. KAREN: Right. So about when do you think was the time where you transitioned out of those field trips? DR. PARK: Personally? KAREN: Yeah, you personally. DR. PARK: Oh, about -- probably by the '80s. KAREN: Okay. So you did it for a long time. DR. PARK: Yeah. And started out, you know, just going. KAREN: So you said up to six weeks. So tell me the schedule of the field trip. DR. PARK: Yeah. Actually, I was trying to think. Six weeks was intermittent over the certain period of time. I was trying to think, the longest actual trip, if you didn't get weathered in, was about two weeks at the most. KAREN: And that would be for one village or -- DR. PARK: No, say all the villages on the Aleutian Chain at one time. And go from village to village. And I actually had one physician marooned because of weather for almost two weeks one time. KAREN: Oh, wow. DR. PARK: The most I -- I didn't usually miss a -- I didn't get marooned more than two or three days at a time. KAREN: You had enough supplies with you? DR. PARK: Personal supplies? KAREN: Yeah. DR. PARK: Or medical or -- KAREN: No, personal. What happened when you got stranded? DR. PARK: You just made do. You know. So -- KAREN: All right. So did you enjoy doing those field trips? DR. PARK: Oh, yeah. Get more contact, you know, with the villages, and it was kind of like being a family -- instead of, you know, the first -- the terms of a family physician. And it was the old do whatever you could type thing. But it -- it was interesting. It was kind of like being a small-town doctor on -- on flying here and there. KAREN: So did you miss it once you stopped doing that traveling? DR. PARK: I did. Yeah. But I became more involved in the administration and working in clinic half time. KAREN: Do you -- DR. PARK: Of course, during this time, I was -- I don't know, I think I -- let's see, 1980. I think I was still making trips up close to 19 -- it might have been a little before that. KAREN: So it sounds like you've seen a lot of the state and met a lot of people. DR. PARK: Oh, yeah. Yeah. And each clinic, well, you know, it was like being a family physician for a small group. It was almost -- and of course, almost everybody in the village was related. So it was -- it was a -- it was a good training experience. KAREN: And when did you retire? DR. PARK: In '85. That's why I'm thinking that maybe that '80 was -- might have been closer to '75.
KAREN: So out of -- up until 1985, did you continue to have contact with the health aides? By then it was quite a -- DR. PARK: Quite a -- KAREN: -- formalized program? DR. PARK: Yeah, by then, it was very formalized. And yeah, well, considering. So I was more assigning other people groups and villages. You know, like one would visit the Kodiak area villages, and one the Iliamna, one the Aleutians. And then I was doing some of the early writing and helping with manuals as far as the health aide program. KAREN: So you weren't -- DR. PARK: And worked in clinic half time. KAREN: So you were no longer being the one on the telephone talking directly to the health aides. DR. PARK: Very little. KAREN: -- by then? DR. PARK: Yeah. KAREN: Okay. As a physician, what do you think about this type of a program where you have a local person delivering the medical care instead of a doctor doing it? DR. PARK: Well, you have to have somebody. And you're never going to have the population to have physicians out on -- and living there. So you've got to train aides to help. And I've -- I strongly believe, too, that the current plans for a dental aide type program is -- is warranted. You don't have enough dentists. And even way back, you know, when I was in a village and they said, oh, so and so needs a tooth pulled, I didn't have that background. So I would immediately say, if I wasn't here, who would pull the tooth? And there was someone usually in each of the bigger villages that had scrounged a few instruments when somebody came by and said, well, can you leave this or that so I can do it. And that's the way they were learning. And so I would -- I'd -- I pulled two or three on trips, but usually there was someone that knew and had done it. And they had already learned how to do it. So -- And the same way with midwives, people would step forward frequently, women whose mothers had been midwives, so to speak. Some of them didn't use that term. KAREN: Right. DR. PARK: And so there's usually someone who had delivered babies. There's usually someone who had pulled teeth. And it got so that people that were helping with eye clinics had learned a lot about what to do about glasses. And there's a little more technique there, but they had a little bit of information. And so that's where the basic programs all developed. So -- KAREN: And do you think that the program has been a success? DR. PARK: Oh, yeah. Oh, yeah. Just -- just the -- being able to talk to people in the village who had a little experience or training on the radio phone calls, and then when radios became obsolete or went by phones, so. Yeah. KAREN: What about issues of confidentiality? DR. PARK: Pardon? KAREN: Confidentiality and privacy, how was that handled? DR. PARK: Sometimes with some things, they wouldn't ask -- we wouldn't ask the patient's name. Or the -- where the health aide would say, I can't give you that. But -- especially if they were talking about venereal disease. Because anyone could listen in on the radio calls that had a radio. And -- and a lot of them did. And used them, of course, with ships and fishing season and -- and traveling. But the big old -- the old radios were pretty sizable. But there was -- unless you were pretty careful, there was hardly -- you know, there were a lot of things were not confidential. Nobody thought about it initially, I don't think. They just accepted it. KAREN: It sounds like you must have been faced with some difficult cases or circumstances. How did you find the strength and courage to do some of those things? It sounds like you weren't afraid and you just did it. DR. PARK: Well, we just sort of thought that that's what we had to do. Yeah. There wasn't anybody else to call on. But there again, it was so obvious we needed more and more in the way of training than going back to the old manual. The teachers who were reluctant to get into it, too.
KAREN: So do you feel like the health aides got sufficient training to do what was expected of them? DR. PARK: Well, not for a long time. And even now, there can be smaller villages don't always come forward with -- you know, there's a turnover of health aides. But I think, oh, by the '80s, there was a -- you could depend on -- on your quality and you had to -- you improved training where you had to improve it. And it was hard on most physicians, sometimes, you know, I can't do that, but there's nobody else. So you can do what you can do. But having the health aides train that they can put on simple splints and -- and know how to handle the antibiotics and, of course, eventually were giving shots. So it's -- it's all been very worthwhile. KAREN: Yeah. I was wondering what it's meant to you, both personally and as a physician, having interacted with the health aides and worked with them? DR. PARK: Oh, I enjoyed the program very much. KAREN: Are there any of the health aides in particular that come to mind that were especially important in the years you worked with the program? DR. PARK: Well, you mentioned one, Betty Nelson. And -- I have a hard time of thinking of names right off the top of my head. KAREN: Yeah, it's been awhile. DR. PARK: Samuelson in King Cove, but I was trying to think. I don't think I've got names here. KAREN: That's okay. Some -- some -- I sort of was wondering, too, about the relationship that developed between the physicians and the health aides. DR. PARK: Well, it -- in areas where you could assign one physician to, say, five villages, he was -- he or she was their contact when they would call in. They would meet them on the field trips, and get acquainted, and -- and some real strong friendships developed. One physician that is still here in town at the new Native Hospital, Richard Brodsky, developed very close relationships with his villages. Which primarily the Iliamna area. And then Carolyn Brown. Is that name familiar to you? KAREN: Huh-uh (negative). DR. PARK: A physician that left here, oh, quite a few years ago, I've lost track of when, and went to the New England, Vermont I think, or somewhere, was teaching in the medical school, and then they decided to come back to Alaska. Both of them were physicians. KAREN: Yeah. DR. PARK: And I think she was offered a job with the State Health Department, and when she got here, from what I heard, the money or the funding had -- was gone, in between hiring and -- so they opened their own office. And now I don't know where they -- they've gone somewhere else now, and I don't know where. So -- KAREN: I don't know if you can talk to -- DR. PARK: Mat -- excuse me. Mattie Samuelson was her first name. KAREN: Oh, Mattie Samuelson.
KAREN: I don't know if you can talk about any changes, reflect on the changes that you've seen being involved in rural health care for so long. Pros and cons, things that have improved and things that maybe haven't. DR. PARK: Well, we -- we did the best that we could. If we saw a problem somewhere, improve on it. You know, whether it was communications or training or supplies, and, of course, pushing for clinic buildings. At one time there was no clinic buildings. We used an empty room in a schoolhouse or something. Church building. Whatever was available. And now many of these villages, if not all, have their own clinic. KAREN: Yeah. DR. PARK: And so that's been a great improvement. Plus the privacy, you know, of being -- instead of being curtained off in the end of one room. So -- but I think I wandered off your question. What was -- KAREN: What were some of the changes you've seen in -- just in generally? DR. PARK: Well, the changes are good. And if they weren't, we tried to change that. So -- and could usually manage. And working with the State Public Health nurses in our field positions, and then the health aides were getting more and more care into the villages so that they didn't have to fly in so often. Especially little kids coming in, no mama. Just been put on the airplane. So some of those kind of problems were evident right off. KAREN: Did you have any experience with the transition from Indian Health Service to the regional health corporations managing the health aides? DR. PARK: Some, by the -- by the time it got to that point, I was getting closer to retirement before the regional health office -- regional health program really got going and got in charge of their own programs. Because I was retiring by then. And people like Carolyn Brown were involved and Richard Brodsky was involved. KAREN: Okay. DR. PARK: And that was -- and my involvement was more -- it was pretty much prior to the health corporations having the manpower to get into it and the money to get into it. KAREN: Just from your observations, since -- do you have any thoughts about that change, whether it's how the health corporations are doing as compared to how the Indian Health Service operated? DR. PARK: Oh, they, as far as I can tell, have -- have been doing fine. And have been working on the old basic manuals and going -- going from there. And I can't think of any areas that aren't doing pretty good. KAREN: Okay. DR. PARK: And hopefully we left enough guidelines for them to go by. KAREN: When you look back on your years of work in this field, anything you reflect on that you might have done differently? DR. PARK: No. It was kind of starting almost from scratch. KAREN: Yeah. DR. PARK: And some of us that then stayed for several years or more helped develop the programs. KAREN: Yeah, I mean, that starting from scratch, how did you know where to begin? DR. PARK: How did we know? KAREN: Yeah. DR. PARK: Well, just by what appeared. And the patients that came in that had minor things that if there had been someone that could have helped them, wouldn't have had to come in, medically or financially. And so it depended on what landed on your doorstep in -- and was the incentive for developing the different manuals.
KAREN: Have we covered all of the -- sort of the -- looks like you have an outline there or notes or whatever. DR. PARK: I don't remember what I -- KAREN: Have we covered all the sequence of events? DR. PARK: I think so. KAREN: The sequence of events in your mind? DR. PARK: If you want any of these, I'm not sure, I've got a -- I'm not -- I'm not sure you -- well, these -- these are excerpts from the old. KAREN: Oh, the '44 manual? DR. PARK: Yeah. KAREN: Okay. DR. PARK: For the teachers. And if you want this, you can have it. I've got more. KAREN: Okay. DR. PARK: And I don't even remember at the moment why I did that. Probably for some report I was writing. And this manual on -- from Fred Langsam, different Public Health nurses were also developing guidelines for health aides. So that the teachers wouldn't have to do it. So they used this. So this was an old, old basic. Outdated, of course. KAREN: Right. DR. PARK: From even when I started. And -- but they were going by something. These are -- these are excerpts from that era, if you want it. KAREN: Okay. Sure. That's an extra one? DR. PARK: Yeah. This, I don't think you'd want necessarily, it was sort of an attempt but -- well, that page on fractures. And -- well, I know there's one that says "food," and there was frequently someone in dietary interested in helping the very basic stuff. But this was to use -- for each area to use with training. And then this was -- I was trying to think if there was an actual thinner manual prior to 1976, and I can't remember. KAREN: It might say in there. Is there a history or something? DR. PARK: But if you'd like to borrow this for a while, you're certainly welcome. KAREN: Oh, thank you. DR. PARK: Pardon? KAREN: Thank you. That would be nice. As I say, I tried to find it in the library and I don't know -- DR. PARK: Oh, that's right. I don't know whether you're going to find it or not. KAREN: And I don't know if I'm going to -- I don't know if it's going to turn up. DR. PARK: And the -- and if it's something you want with your program, and nobody does find you another one, I think I've got another copy. KAREN: No, it would more be as a reference, and maybe we, you know, could scan it in -- a little bit of it in or something. DR. PARK: Yeah. Okay. KAREN: So somebody could see what it's all about. So we could just borrow it. DR. PARK: Pardon? KAREN: I could -- I could just borrow it, would be wonderful. DR. PARK: Sure. KAREN: If you don't mind. DR. PARK: And, no. I would kind of -- historically, I would like to hang on to one of these. KAREN: No, you should -- you should keep that. DR. PARK: But you could borrow it. KAREN: No, you keep that. These excerpts will be just fine. I might write down the -- DR. PARK: Okay. I don't know what I did the excerpts for. Some report one time. KAREN: Okay. Well, so it sounds like we've covered -- DR. PARK: And I -- and I do not know whether you want this for the -- the first training type. KAREN: Okay. I would like to scan it in, scan a little bit of it in as a sample for people just to see it. DR. PARK: Okay. KAREN: And you see it's just typed pieces of paper. Nothing fancy. DR. PARK: Yeah. Anyway, you could borrow those, too, if you'd like. KAREN: Okay. DR. PARK: And -- KAREN: Is there anything else that comes to mind in reference to your work with the health aides that I haven't asked you about? DR. PARK: Well, the health aides rapidly got involved in sanitation programs, too. I don't know that we mentioned that briefly. KAREN: You mentioned it briefly. DR. PARK: But it wasn't long until -- well, like a lot of us figured the health aides were busy enough, so sanitation aides were developed out in the village. And usually men that didn't mind getting out and slogging through the -- the mud and all and help keeping the water systems going or -- And they did training within the village itself on waste disposal. That type of thing. So there are sanitation manuals out there somewhere, too. The dentists, when they got to train -- got in traveling to the villages, there are dental guidelines. And do you want -- are you going to be seeing any dentists? KAREN: I don't think we we're necessarily going to be talking to the dentists, going that direction. We have to somehow limit it. DR. PARK: Yeah. Yeah. Well, that's why originally, you stepped in and thought, well, I'm a family physician, I do whatever I've got to do. And -- and then gradually as other specialties became available, you relied on them to develop their own program. But the dentists have done a lot of traveling. And -- and I don't know why the current dentists are so upset about training dental aides. KAREN: Yeah. DR. PARK: So -- KAREN: So -- so what's your -- what are your thoughts about how the health aide program has affected health care in rural Alaska? DR. PARK: Well, I think it helped tremendously. And of course, a lot of families, somebody in the -- in big families has a pretty good idea of what ought to be done for a lot of things, but not everything. And so just getting someone to kind of tie it all together within the village, it's one of the biggest steps. KAREN: Well, that's it. Unless there's anything else you want to say in conclusion. DR. PARK: I don't know. Not unless you want names from other people involved that might still be around. KAREN: No, I think we have it. DR. PARK: Have you got enough? KAREN: Yeah. Okay.