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Joyce Smith, Part 1
Joyce Smith

Joyce Smith was interviewed on March 11, 2005 by Karen Brewster at Joyce's home in Ouzinkie, Alaska. In this first part of a three part interview, Joyce talks about the early days of being a health aide, the facilities, equipment and training they had, dealing with emergencies, and communicating with the doctors. Due to technical difficulties, this recording starts after the conversation is already underway.

Digital Asset Information

Archive #: Oral History 2004-17-04_PT.1

Project: Community Health Aide Program Project Jukebox
Date of Interview: Mar 11, 2005
Narrator(s): Joyce Smith
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
Location of Interview:
Funding Partners:
U.S. Department of Health and Human Services, Health Resources and Services Administration, University of Alaska Health Programs
Alternate Transcripts
There is no alternate transcript for this interview.

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

Sections

Traveling to Kodiak Island doing missionary work, coming to settle in Larsen Bay in the early 1950s, and early medical care provided by public health nurses.

Giving immunizations to people in Larsen Bay starting in 1954.

How she started providing broader medical care to people, moving to Ouzinkie in 1958 with her husband for his mission work, and how she became the health aide.

Relation between western medicine and traditional healer in Larsen Bay, and beginning of her health aide work in Ouzinkie, including getting medicine and doctors visiting the village by boat.

Development of the health aide program, the training she received, and combining her health aide work with being a kindergarten teacher and helping her husband with his mission work.

Early health aides on Kodiak Island who worked without a salary and the training received.

Handling difficult situations without much medical training, and one accident in particular that she remembers from her early health aide days.

Dealing with patients and people around them during an emergency.

Where evacuated patients were treated, types of care and education she provided in the village, role of the midwife in the birth of babies, and one case in particular where she assisted with a newborn baby.

Possible difficulties that might develop during childbirth, and the benefit of the practical training and the equal treatment the doctors in Anchorage gave the health aides.

How she communicated with doctors for assistance and what she had to do when she could not reach anyone and had to respond on her own.

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

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

Transcript

(Due to technical difficulties, this recording starts after the conversation is already underway.)

KAREN:  And so how did you get from village to village?  JOYCE:  Oh, by the boat. KAREN:  By the boat.  JOYCE:  Yes.  We lived on the boat and traveled, and we had facilities so that if there were no meeting place, we -- the Native people love to -- love to get together.  We would have as many as 40 people on the boat at once.  KAREN:  Wow.  JOYCE:  But anyway, I have quite an acquaintance with Kodiak Island.  KAREN:  Yes.  JOYCE:  And then when we came permanently, they wanted us to go to a village where there wasn't any other mission, and there wasn't even an Orthodox church in Larsen Bay at the time.  KAREN:  Oh.  JOYCE:  So it was a pretty small village, but it was very remote.  And the fishermen almost exclusively had only six months' insurance because salmon and a few clams and like that were the main industry.  And so our boat had only six months' insurance also.  KAREN:  Oh.  JOYCE:  And they kept one boat in the village with year-around insurance because it's a long ways from Kodiak when you don't have plane travel.  KAREN:  Right.  JOYCE:  And so I found out what it was like to have a family of kids and no medical service and most of the time no way to get there.  Our only doctors at that time were the Public Health nurses.  Excuse me.  And they acted almost as doctors.  My daughter, from the time she was seven years old, was determined she was going to be a nurse.  And her idea of nursing was from what she saw the Public Health nurses doing.  They, likewise, saw the problems in the village with no medical service, and they also had the problem that they would start a series of immunizations and not be able to finish them.  And they only came twice a year.  So they had to start all over again.  And they got the idea that if they could train someone in the village to do the rest of the immunizations, and as far as Kodiak Island was concerned, that was the beginning of the health aide program.  KAREN:  Oh.  JOYCE:  They had -- these -- those nurses, they did anything that needed doing.  I used to think that it was terrible that nurses were so restricted when I found out how it was in the Lower 48 because I had watched these nurses do exactly what a doctor would do.  KAREN:  So they didn't have doctors come with them?  JOYCE:  No.  KAREN:  Just nurses?  JOYCE:  Just the Public Health nurses.  It was several years later before ANS sent out doctors from Anchorage once a year.  KAREN:  Wow.  So these nurses would come twice a year by boat, or how would they -- JOYCE:  Yeah, they usually came on the mail boat.  KAREN:  Oh, okay.  JOYCE:  Uh-hum.  KAREN:  And how long would they stay?  JOYCE:  As long as the mail boat was there.  KAREN:  A couple days?  JOYCE:  Maybe two or three days.  And they saw everybody in the village.  Everybody got immunizations.  I used to say the villages protected Kodiak because the village people were so immunized.

JOYCE:  So anyway, I was chosen to be the one that learned to give immunizations.  KAREN:  Now, did you volunteer or somebody picked you or how did that happen?  JOYCE:  As I recall, the nurse asked questions.  There was one person that did some medical work in the village which was Dora -- at that time, Dora -- let's see, Aaga.  She later was, after her husband died, she remarried, but she -- she would not give shots.  She didn't want to learn.  She did a lot of the emergency things just on her own.  But the nurse took me along.  She was holding clinic at one of the other village houses, which was not better than ours, and she give me instructions.  At that time there were -- you had a single syringe and just different needles.  And you had to draw the fluid out of a bottle.  And I remember I bent the needle the first time I tried it.  But anyway, I followed the instructions and gave this fellow a shot.  He says, did you give me a shot?  I didn't even feel it.  Which was a great encouragement.  KAREN:  Yeah.  That's good.  JOYCE:  So I was left with all of the names of the people that were to be immunized.  And they would come to my little kitchen, and that's that like I showed you over there.  KAREN:  Yeah.  I would like to look at those pictures again, yeah.  JOYCE:  And one time I had 14 people come all at once.  There wasn't room enough in the kitchen, which was our living room, to seat them all.  Some of them were seated on beds down through the hallway.  And I -- I had one syringe and three needles.  KAREN:  Oh.  JOYCE:  And if we had been taught about aspirating, we wouldn't have been able to do it.  KAREN:  And now, what's aspirating?  JOYCE:  To pull, draw back.  KAREN:  Oh.  JOYCE:  And there would have been the possibility of contaminating the fluids in it.  KAREN:  I was going to ask, how did you do all those people with only three needles and didn't contaminate them? JOYCE:  Okay.  I did do three, and then I washed the needles and put them on the stove in a pan and boiled them, and then do three more.  KAREN:  Oh.  JOYCE:  Very patiently they waited through the procedure, because that's the thing that happened any place they went.  KAREN:  Yeah.  JOYCE:  And gave all 14 of them their immunizations that afternoon.  KAREN:  And what were you immunizing them for?  JOYCE:  A whole variety of things.  Not always all at once, but we had typhoid on the list, for one.  KAREN:  Oh.  JOYCE:  And I don't know, the DPT, I don't remember just when we got the single dose of that.  I think we had to give some of those separately.  KAREN:  Uh-hum.  JOYCE:  But there were quite a number of things that we immunized people for.  KAREN:  Measles and those kinds of things?   JOYCE:  Didn't have measles yet.  KAREN:  Oh.  JOYCE:  Not then.  Later when I was health aide, it did.  KAREN:  Now, what year was this again, when you were in Larsen Bay?  JOYCE:  The year I started doing this was '54.  KAREN:  Okay.  JOYCE:  My baby was born in '53, and I -- I was trying to give him his first immunizations.  KAREN:  And so at this point, how many children did you have?  JOYCE:  We had the three when we went there, then Timmy was born that first year, so had four.  So went a year and I had one more.

JOYCE:  Anyway, I was -- that's the way I started.  Well, I had no training except that, but people started coming to me for different illnesses and things.  And all I could do was tell them what doctors had told me when my children or others of us had been -- actually, my husband was a great help.  He had learned to -- to do some of these things in a college biology class.  KAREN:  So your husband helped with some of the -- JOYCE:  Yes.  KAREN:  -- treatment?  
JOYCE:  He actually taught me how to do several things that I hadn't learned yet.  But -- 

KAREN:  So had you finished high school?  

JOYCE:  Yes.  

KAREN:  You went through high school?  

JOYCE:  Yes.  

KAREN:  Before you were married and started in -- 

JOYCE:  Oh, yes.  I didn't have college education, but I -- like I say, I studied with my husband.  Every night.  To keep him awake.  He was working full time and going to school full time.  And in the middle of the night we did our studying.  And if I hadn't have helped him that way, he couldn't have stayed awake.  So anyway, the health aide program developed when we began having doctors come.  Let's see.  I was four years at Larsen Bay, we had lived there six years, but I was four years with them.  They started the health aide program.  Here in Ouzinkie, they closed the children's home and sent the children into Kodiak.  And the house mother here was a registered nurse.  And she had taken care of things for people here in the village quite a bit.  And they asked her what are -- they asked the Public Health nurse what are we going to do when she's gone.  She said, well, Joyce Smith's coming from Larsen Bay, she can take care of things.  So I was assigned to Ouzinkie before I even got here.  

KAREN:  And the woman who was the nurse before, what was her name again?  

JOYCE:  Mary Setzekorn.  S-E-T-Z-E-K-O-R-N.  So I began doing the immunizations and things here, and then about that time the doctor -- suddenly the doctors are around.  And they were very helpful in teaching us a lot of things.  We worked with them when they had clinic.  And they just -- they taught us a lot of things right along the way.  So it was a long time before we got any medicines to keep on hand.  We -- in fact, I didn't even have a stethoscope or a blood pressure cuff.  And the doctor told me where I could order one cheaply.  So I got that, and that was one of the things my husband knew how to do, he taught me.  

KAREN:  So you came to Ouzinkie in, what, '62?  

JOYCE:  In '58.  

KAREN:  Oh, '58.  Okay.  And you came here because your husband was coming here for the mission?  

JOYCE:  Uh-hum (affirmative).  

KAREN:  Is that why you moved from Larsen Bay?  

JOYCE:  See, the mission had quite a program.  I don't know how they did it.  There were three women in charge here, they had as many as 12, 15 children to take care of.  But they still had programs for village, different -- off and on there was a kindergarten, as often as they could manage with other things.  And they had a Boy Scout troop and various things going on here.  
And they -- when they moved them into Kodiak, the mission owned this building and they wanted to continue here.  And we were having troubles at Larsen Bay.  That little shack just kept developing mold.  My oldest daughter had the asthma tendency, we could not keep a room free from mold.  

KAREN:  Yeah.  

JOYCE:  And anyway, there's this good sized house and they asked us to move here.  So we did.  

KAREN:  Okay.  

JOYCE:  And this was the base for the boat, was a place to keep it here.  And my husband, we were usually gone in the summertime.  We also helped start a Christian camping program that's still in progress.  And he used the boat in connection with that because first it was on Long Island and then on Woody Island out from Kodiak.  So even going around with my husband on the boat, I often had opportunities to do medical things.  And just call on me.

KAREN:  So those four years in Larsen Bay, you were mostly doing immunizations and then people would come to you?  

JOYCE:  Uh-hum.  Uh-hum.  

KAREN:  Because you were there?  

JOYCE:  Because I was there and they figured that I could do it.  

KAREN:  Were there also any traditional healers or midwives in the village?  

JOYCE:  There was in Larsen Bay, Dora.  

KAREN:  Oh, she was the traditional healer?
  
JOYCE:  Uh-hum (affirmative).  

KAREN:  Okay.  But even though they had her, they still would start coming to you?  

JOYCE:  Uh-hum (affirmative).  

KAREN:  Do you know why?  

JOYCE:  Well, she dealt just with emergencies, serious things.  And she was busy with too many other things.  She went out fishing with her husband and that sort of thing.  After the doctors started coming, we learned a great deal more.  Finally, ANS said that they just could purchase medications at wholesale from the hospital up there.  And so the village had some kind of fund-raiser, raised some money, appointed me the drug official at Ouzinkie, and tried to select the major medications that -- that we really needed.  
And it wasn't very long after that when ANS decided that if the health aides were going to do a good job, they had to have enough medications available.  None of the villages could afford to keep -- to buy that much, even at wholesale prices.  So they began supplying us with medications.  

KAREN:  And ANS is?  

JOYCE:  Alaska Native Service Hospital.  That was just what they called it in the villages.  

KAREN:  Right.  And that was out of Anchorage?  

JOYCE:  Uh-hum (affirmative).  So -- 

KAREN:  When did the doctors start coming around?  Do you remember when?  

JOYCE:  I don't remember exactly.  

KAREN:  It was after you were in Ouzinkie?  

JOYCE:  Hum?  

KAREN:  You were already in Ouzinkie when they started coming?  

JOYCE:  I think so.  I remember the health boat came once while we were there.  And I went over and observed what they did.  
They carried the doctor and the dentist on board, but they were headed up north, clear up to -- as far as Barrow they would go.  And they weren't much interested in Kodiak Island, if they -- they just would stop if they -- if it was convenient, but -- 

KAREN:  What was the name of that ship?  

JOYCE:  One was the Health and the other -- what was it.  I'll think of it.  

KAREN:  Was it the North Star?  

JOYCE:  Hum?  

KAREN:  The North Star?  

JOYCE:  No, it wasn't the North Star. 

KAREN:  Okay.  

JOYCE:  I don't remember the North Star ever coming in.  I've heard of it, though.  

KAREN:  Yeah.  Because I know that one went up north.  

JOYCE:  Well, this -- these went up north, too.  One or the other every year.  
I know that Mary Setzekorn had worked with that program that she had been Public Health nurse around the island.  And she traveled on that -- that boat.  And I learned a great deal about the island and its people from her.

KAREN:  Now, so when the doctors started coming regularly.  

JOYCE:  First it was one a year, and then they -- so they were coming twice a year. And it -- they went, you know, back to Anchorage and told about this program that was developing with the village aides, as they called them.  
And the Native Service Hospital decided to take it on as a -- as a project.  And they developed the program for training.  Maybe a four-week course, and then send me back to -- they had to have -- you would have to have so many hours of actual service before you would get to have another session of training.  I was actually one of the last to get training. 

KAREN:  Oh.  

JOYCE:  Because I was doing so many other things.  I wanted to have training in the summer, and that wasn't when they offered their training courses mostly.  But I was -- we had a program of activities here.  I was teaching kindergarten every morning, and I was operating the health service.  

KAREN:  Wow.  

JOYCE:  All of it unpaid. 

KAREN:  I was going to ask, did you get paid?  

JOYCE:  No, I didn't get paid for any of it.  It was -- it was -- let's see.  I had been here.  In 1968 was when they first paid health aides.  

KAREN:  Wow.  

JOYCE:  And I had served here 10 years in Ouzinkie without any salary whatsoever.  And we kept learning more things and wanting to know more.  I had never imagined I would be so -- get so involved in it, be so intensely interested in it.  When I was younger, some of my high school classmates took nurses training, and I was not well enough.  I wasn't strong enough for all that's required in nurses training.  But this program, I was doing everything.  It wasn't like nursing in a hospital, it was going into people's homes and -- and having people come here.  And dealing with all kinds of things.  It could be anything.  And a lot of it was preventative, but a lot of it was emergency things.  And I was thrilled with it, to tell you the truth.  I was just really excited, couldn't wait to get training.  I wanted to learn to do suturing, for one thing.  And felt it was really needed.  

KAREN:  And so why did you like it so much? 

JOYCE:  I don't know.  It was just a way of helping people.  And I liked the whole thing -- first of all, when the doctors came, they would give the instructions, they would give people their medicines, and they would not -- most of them wouldn't even use them until they came and asked me what's it for, how am I supposed to do this.  I was explaining everything to people.  Being an interpreter for the doctors.  And it wasn't that people didn't speak English, they did, but they didn't understand the doctor's terminology.  

KAREN:  I know.  

JOYCE:  So that's -- I really enjoyed, I guess, the teacher in me just enjoyed carrying these -- the doctor's instructions down to where people could use them.  So I was excited about the whole thing, and wanting to learn more and more.  In the first session, they don't -- they didn't teach suturing, and I wanted to learn.  I said, can't you teach me now?  And I think they have a different set of procedures now.  

KAREN:  So what did they teach you in the first session, do you remember?  
JOYCE:  A bit of everything.  A lot of physiology.  And I remembered everything I had learned when I was in 7th and 8th grade down there.  Those things, it was very easy for me, that part of it.  And oh, all basic things, the things they knew we were doing, they -- or needed to do, they were teaching us.  It was a very well-designed program.  They were experimenting, they were working on it, but I have been very proud of what they do.  I really have.  
And it was exciting to go to training and be with people from all over Alaska, you know, the Aleut, the Eskimos, the Indians.  My partner for several sessions was an Indian from Southeastern.  And -- 

KAREN:  What was their name?  

JOYCE:  Huh?  

KAREN:  What was her or his name?  

JOYCE:  I -- right now, I can't think of the name.  

KAREN:  Okay.  

JOYCE:  She was from down in Southeastern, and she was Tlingit, I believe. 

KAREN:  Right.

KAREN:  What year did you go -- was that first training that you went to?  

JOYCE:  I'm trying to think what year it was.  Early '70s, I think.  

KAREN:  Okay.  

JOYCE:  I know there were a basic group of women who worked volunteering for years.  I think we had probably the most stable group in the state, and many of them had worked for years with no pay or anything.  
But it was Vera Inga, down at Akhiok, and I was trying to think who was at Old Harbor.  Stella could tell me before.  And Betty Nelson was at Afognak.  
And then after the tidal wave, the village moved to Port Lions.  And -- and we -- we stayed on for years.  Nowadays it seems like there's so much turnover in the health business, but -- 

KAREN:  Do you wonder why -- have you thought about why the difference?
  
JOYCE:  I don't think they are nearly as dedicated as we were.  The fact that we were willing to work without salary because we cared about what we were doing.  Also, it's -- as they told us, it wasn't -- you probably couldn't get a job anywhere else, you're hired for your village, you're not -- not something you can take and go somewhere else and do.  I think that is changing, too, because of the high standards they now have.  But I had so many experiences with serious problems before I actually had formal training.  The doctors had given me very good training in the village.  I -- I bought every medical book I could find and read up on everything that I had been taught.

JOYCE:  And I had some very exciting and challenging situations before I had actually had the formal training in Anchorage.
  
KAREN:  Can you talk about any of those?  

JOYCE:  Well, one -- one night I got -- in those days, we didn't have telephones, we just had CB radios and stuff like that for communication.  
I got word I was needed down at the store, there had been a boat accident out in the harbor.  And three men had been drinking.  They came in with a skiff and didn't slow down and ran right into the side of one of the fishing boats that was anchored there.  Well, fortunately, they weren't thrown into the water, but there were three men with varying degrees of injuries.  I didn't even know what had happened when I left the house, I just took my medical bag and I didn't begin to have the things I needed.  But here that -- it was in the store, Saturday night after the Saturday night Orthodox Church service.  People were dressed up.  I know I was on my -- down on my knees beside one of the patients and saw this big, long, black robe, and looked up and there was a priest standing there.  He said oh, hi.  But nobody -- nobody was doing anything.  There was just one young man that was ready to run errands for me.  I needed safety pins, he went and found some on the store shelf.  
I sent him up here twice after things.  And I knew I needed some old sheets for bandaging and like that.  He brought back some, but it turned out some of them had been -- one of them had been turned in for an angel costume or something.  I used it anyway.  

KAREN:  Yeah.  

JOYCE:  But I had varying degrees what they call triage where you've got to decide which is most serious and that order.  One of them was determined he was -- that he wasn't hurt and he wasn't going to be taken care of.  
And he had had both a chest and a head injury, and I knew that it was dangerous, so I had to call and ask for permission to give him something to calm him down, so we could get him onto a stretcher.  We had to devise three stretchers for these three patients.  And took care of everything.  
We called the Coast Guard.  The Coast Guard has been our first line of defense, you might say, for years here.  One of my patients who died finally from his serious heart condition used to call them the White Angel of the North.  That was his designation for them.  We had quite a system, because I was having to use the CB to call back to Norman, my husband here, for the things I needed.  And send somebody, this person, back after them.  But the CB at the store was upstairs in the apartment, so I -- they -- we thought they had the shortwave radio to contact the Coast Guard.  Well, their radio was out.  So what Norman had to do from here was to call Port Lions.  Port Lions has telephones at that time.  And have them telephone the Coast Guard to send the plane over here.  That's actually what happened. 

KAREN:  Wow.  

JOYCE:  But anyway, we had three of them ready.  The Coast Guard plane only had two stretchers, they usually had to take one of ours because they -- and just two or three days after that, we had what I would call is our first health aide conference on Kodiak Island.  And the health aides came in from the different villages.  That was a big thing for us because we needed to have some exchange between us.  We were so isolated in those days.  Port Lions had a telephone, but that was the only village in the islands that did.  We were all dependent on radio.  And with the weather and everything, so we had some pretty serious things to deal with, all of us.  And it was just good to get together.  Anyway, we went out to the Coast Guard base to show us around and to show us what happened when we sent somebody in.  And the Coast Guard personnel began to talk about how very well I had their -- three accident victims and had them so very well prepared for evacuation.  Boy, that made me feel good.  I had taken first aid and -- and EMT type of courses.  Everything I could get.  So it did help with that.  But I wonder what they thought if the Coast Guard or the patient would have discovered tinsel and stuff.  

KAREN:  From the angel costume?  

JOYCE:  Yes.  Never got it back, so I guess it was okay.  

KAREN:  Yeah.


JOYCE:  And I had lots of interesting times.  You know, called for all kinds of things.  Then you get the people who think they know better than you do.  
It was a person that had a badly cut finger.  And the bleeding wouldn't stop.  Well, they finally called for me.  They were -- it was a bunch of people drinking in the household.  Usually my husband wouldn't let me go without going with me on most of these night calls.  But anyway, they had -- they were determined -- they were determined they were going to put a tourniquet on that arm.  All it took was elevating it to get the intense bleeding to stop.  And they were just determined that they had to have that tourniquet.  And I insisted that they were not having a tourniquet.  But usually the things like that, I could always deal with the patient.  It was sometimes the people surrounding them was their problem.  But except when some of them were drinking.  They all respected me.  And I really didn't feel any sense of fear in any of the situations.  Yeah.  At another time when only a four-year-old boy saw this happen, it was a plane crash up in the woods away from the airport.  And this boy tried to tell people he saw a plane going down like that.  
But it happened that one of my heart patients was out for a walk along the side of the airstrip and saw a couple of people coming.  At that time, there was no road there.  It was a rough hillside.  And one leaning on the other, he thought they were drunk at first until he saw all the blood.  And so he ran, which he never should have done the way his heart was, to get somebody to -- to call for help.  And those two, the pilot and the other man -- this was actually out of Kodiak. And I had just been to training and got a special kind of neck brace type of thing.  We were still buying some of those things and I had them buy that.  This one man, he almost -- was almost completely scalped.  I used a special kind of large bandage and bandaged his scalp back in place and tied it under his chin.  But he had to use that special type of neck brace that we had just purchased.  And the other one had leg injury and an arm -- a chest injury.  It was, anyway, several different things.  And we were trying to get the Coast Guard in.  And it was -- first the local planes were all out for hunting people.  There had been a storm and a number of people had been stuck way out in the wilderness areas waiting to get in.  So we couldn't get a local plane, but then this -- we -- we had the -- the two patients all ready and were just putting them on the back of a truck to take them to the airport when here came a Coast Guard helicopter and landed right in the road beside us.  And we were able to evacuate those two.  One of them wrote back to thank me and supplied us with another of that special type of neck support.  

KAREN:  He replaced the neck brace?  

JOYCE:  Uh-hum.  Because the original one was so covered with blood, we couldn't use.  So that's the only time I ever had anybody -- most of these accidents are people are away from here, and you don't hear again, you don't hear whatever happened.  One man was in here about six o'clock one morning, and on a boat down off the dock, or was on his way, I guess on his way from Kodiak, and had some piece of machinery fall on his hand, and it was really lacerated.  I said, you need to go back to Kodiak and get this taken care of right.  No, I can't, I've got to get up to Port Williams, which is clear on beyond -- beyond Afognak Island.  I've got to go up there.  So I did what I could for him, I put it together as best I could.  We were always instructed not to suture hands because they are so vital, and if you get something wrong, it could cause a lot of trouble.  And so I did what I could for him.  He was just determined not to go to a doctor.  And I never heard.  I always wondered whatever happened about that.  He had a big piece of machinery fall on his hand, and it was -- it was in awful shape.

KAREN:  And so when you were medevacing these emergencies out, were they going to the hospital in Kodiak with doctors or they had to go all the way to Anchorage?  

JOYCE:  They -- they would go to either Kodiak or to the Coast Guard hospital, one or the other. 

KAREN:  Oh, all right.  

JOYCE:  The Coast Guard personnel made the decisions.  Maybe they would be seen first at the Coast Guard and then transferred to the Kodiak hospital.
  
KAREN:  I didn't realize that the Coast Guard had its own hospital. 

JOYCE:  Yes, it did.  They did for most all of the years I was working out.  
One of the people I sent in was -- that time I had the three, he said if I hadn't had him well bandaged and well protected, he says, the way they dumped me out of there at the Coast Guard, I could have been injured from that.  
You have to get them as well splinted and everything as you can, realizing that even a plane trip can be awfully bumpy.  

KAREN:  Yeah.  

JOYCE:  And I gave the immunizations and I saw prospective mothers and gave -- you know, gave them all the prenatal type of things.  And I went to the school and taught health classes.  And just generally was part of the -- the health situation for the whole village.  

KAREN:  Did you deliver babies?  

JOYCE:  Hum?  You know, there's a strange thing, but I never did deliver a baby.  There was a midwife here.  But I took care of babies 10 minutes after they were born, but usually it was an emergency if they were born in the village.  People tried to get to Kodiak.  

KAREN:  They did? 

JOYCE:  One time the midwife, who was quite elderly at the time, was visiting with a -- down at a home down here, and there were people from another village that are just in there that are kind of strangers, and the lady of the house excused herself, and the midwife, Irene, went -- 

KAREN:  Oh, we have to wait for the -- we have to wait for your clock to finish.
  
JOYCE:  Okay.  Now, what was I saying?  

KAREN:  The midwife and going into a home where there was some people from another village or something?  

JOYCE:  Yeah.  She was there -- she was there because the heat was off in her house and she was over there to get warm.  And the next thing they knew they heard a baby cry. And these people, I think they were from Akhiok or someplace, they didn't know, they just thought there was a baby in the house.  The husband came up here and just absolutely looked in shock.  He said, I just had a baby.  So I gathered up all my materials and got down there.  
It was the baby, absolutely naked.  There wasn't a solitary thing in that household for baby clothes.  This was the eighth child in that family.  And the mother said to me since, I didn't want that baby.  She didn't tell anybody she was going to have it.  I can't believe her husband didn't know.  But the way he acted, you'd think he -- not a thing for the baby, not a bottle, not a -- she didn't want to nurse it.  I got the bottle from somebody else and mixed up some formula and gave the baby its first -- first meal.  And found some baby clothes here because we used to keep a lot of things like that on hand for emergencies.  Took baby clothes and blankets and stuff down there.  I didn't deliver the child, I was 10 minutes later, and they took care of everything, the cord and everything.  

KAREN:  Now, so that baby, that was a Ouzinkie family?
  
JOYCE:  I don't want any names mentioned, of course.

 KAREN:  Oh, no, no.  We don't -- no.  We maintain confidentiality, of course.

JOYCE:  In fact, a number of times the baby arrived before anybody got there arrival.  I've taken care of innumerable newborns.  Usually I can get them to go into Kodiak because of one experience working in the -- at the hospital, I've had lots of practical experience there, and this one birth, they had a -- had a nurse midwife who did most of the deliveries at that time.  She was an expert.  
Things were going wrong.  She called for a specialist doctor.  And then the mother was bleeding just terribly.  And she said -- they said this is the reason that we prefer that you get babies into the hospital rather than do these deliveries.  Most of the time everything's fine, but when something goes wrong, it could be life and death.  

KAREN:  Right.  

JOYCE:  I saw it right there.  One thing that I enjoyed about the training at the hospital in Anchorage was not only you got practical experience along with the teaching, but I enjoyed going on rounds with the doctors.  
And you'd see some of the most critical cases and they would -- they would treat us just like fellow professionals.  And any questions we asked were answered completely in detail.  I respected the way that they -- they treated us as equals.  And I don't know what they are doing now, but they had a trailer connected, a passageway to the emergency area in the hospital.  And part of our training would be to work in that trailer.  There would be a doctor and he would have the patient file and he would send us in to do an exam, complete exam, and get a history, come back and tell him what we had found.  And he could compare it with what the files which he had and we didn't have.  And I don't know how it worked with others, but it got so that he would ask me if you had this happen in the village, he'd say, what would you do?  
I'd say, well, I'd do this and so on and I'd give this medication.  Well, go ahead and do it.  At this time, you know, the doctor would go and examine and indicate -- he'd examine the patient after we did, but he would leave it in our hands to take care of the patient.  And that was very good experience.  

KAREN:  Yeah, that hands on --

 JOYCE:  Hum? 

KAREN:  Hands-on practical training.  

JOYCE:  Very good.

KAREN:  How often did you talk to the doctors? 

JOYCE:  I had very poor communication from here.  We didn't have telephones.  Eventually we got special shortwave radio.  It's still here because it's operated with tubes and they no longer use tubes.  We couldn't get it repaired.  But we had this high antenna out here.  And with that, we could reach Kodiak or sometimes we could even reach Anchorage, but usually, when most of the emergencies occurred was at night when nobody was listening.  That was very difficult.  One serious situation, my husband was out trying to get the radio at the store and get the attention of the people there, and they were so tired of having drunk -- drunks coming around trying to get in, they wouldn't pay any attention.  And I was desperately needing some advice.  Sometimes I just had to go on the basis of what my books and my training had said, even if it meant doing things that were not really in a doctor's room.  I think every health aide, if they would be honest with you, would tell you the same thing.  There's times when you can't get anybody else to do it.  Sometimes it's with advice if you can reach a doctor, but you have to do things before it's possible to get the patient evacuated.  
I found it a very exciting thing to be involved with.  Now my daughter is a doctor and sometimes she gave me information that was beyond what I was supposed to know.  

KAREN:  Do you feel, you know, you would say those situations where sometimes you were faced with having to do more because you couldn't reach anybody.  

JOYCE:  Yes.  

KAREN:  Do you feel like you had sufficient training to be able to cover those situations?  

JOYCE:  I think so, along with the health aide manual, and other medical books that I kept on hand.  When the weather is such, you might think this is close to Kodiak, but if planes can't get in and the weather is too bad for boats to go through, Spruce Cape between here and Kodiak is one of the most dangerous spots in Alaska in a storm.  That's where tides meet, a rocky cape out there.  Sometimes you just can't get patients out.  And whatever has to be done, has to be done.  I was health aide here and health practitioner for 35 years here in Ouzinkie.  

KAREN:  So what year did you retire?  

JOYCE:  '93.  It was a couple weeks before my 76th birthday.  I retired the 1st of October, and I was 76 on the 17th of October.  

KAREN:  So you just had a birthday -- you just turned 86?  

JOYCE:  87.  

KAREN:  87.