This is the continuation of an interview with Marge Adams on May 28, 2006 by Karen Brewster at Marge's home in Yakutat, Alaska. In this second part of a three part interview, Marge talks about attending physician's assistant training in New Mexico, opening a clinic in Anchorage for the Cook Inlet Native Association, managing the community health representative and health aide program, and being health aide coordinator for Cook Inlet Native Association and for Southeast Alaska Regional Health Consortium (SEARHC) in Sitka, Alaska.
Digital Asset Information
Project: Community Health Aide Program
Date of Interview: May 28, 2006
Narrator(s): Marge Adams
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
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Conflict on the job that led to her quitting her health aide position.
Attending a physician assistant training program in New Mexico.
Some of her experiences at physician assistant school.
Working with a doctor during physician assistant training that she thought did not know what she was doing.
Difficulties she had using the differential diagnosis method of treating patients.
Quitting physician assistant school and the emotional effect this had on her.
Opening a clinic in Anchorage for the Cook Inlet Native Association.
Problems she faced when trying to open the Cook Inlet Native Association clinic.
Treating children at the clinic, and differences in the care provided by health aides, doctors and physician assistants.
The Community Health Representative program and taking over management of it.
Management duties for the Community Health Representative (CHR) and Community Health Aide programs.
What she did as the health aide coordinator for Cook Inlet Native Association.
The pride she has in successful diagnoses and treatment of patients.
Getting the job as health aide coordinator for the Southeast Alaska Regional Health Consortium (SEARHC).
Formation of the Southeast Alaska Regional Health Consortium (SEARHC), and deciding on how it would be structured.
Criticism of the current Southeast Alaska Regional Health Consortium (SEARHC) board structure, decision making and quality of healthcare services provided.
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After clicking play, click a section of the transcript to navigate the audio or video clip.
MARGE: That was a real indication of what she felt and what she thought about emergencies 'cause you know the man was dead. And all she had to get was a urine sample. And she did not do it. KAREN: No. MARGE: And she is a P.A. now, she's not a health aide. She is a P.A. and she is our supervisor because she is a P.A. No, she was afraid of emergencies, she didn't want to do that. Which is too bad. She wouldn't take night calls. KAREN: Wow. MARGE: She would not take night calls. And the mayor let her go ahead and do that. I finally got mad and said: “Why? She is our supervisor, why? Because she is not not Native, she is white, she is supposed to be smarter than us?” And I says: “You know how many years of training we've had, it's probably a lot more than she's had.” And I know it's the wrong thing to say but I was already so upset with him. Basically telling us we were too dumb to do what she could do, which was next to nothing, same thing we were already doing. And when she was leaving that one time going to Colorado for emergency training, she says: “I hope you guys don't mind.” I said: “What?” She says: “Well, I'll be gone for about a month. I'm going to training.” I says: “You just got back!” And I finally said: “No, I don't mind. If we could get your pay, since we're doing the work.” You know. “It doesn't make any difference. We can't hold the emergencies for you. So, we have to do it. And we've been doing it for years.” And she got embarrassed but, you know, that's where I was at. I don't know what she had going with the mayor but she got to have whatever she wanted. When he was taking away our salary, half of our salary, we couldn't afford that. You know, we might as well forget it and find another job where we can get full pay. So, I told Larry, I said: “Forget it. I'm not gonna work for half time, not after all these years I've put into this place.” I said: “You've done everything to us already. You've taken away our annual leave, our sick leave. If we get sick we don't get paid. And I know Indian Health Service is paying for that but I also know that you're taking the money and using it elsewhere.” He just got embarrassed over the whole thing 'cause he knew what I was talking about. I knew what I was talking about. KAREN: So, did you end up quitting? MARGE: Yeah. That was in '77. We quit. That was the end of that.
MARGE: After that I got a call from Stan Hadley in Anchorage and told me that I was one of the five picked out of Alaska to go to the PA training. And I thought: “Oh, how neat.” And then he calls me back later and he says: “Marge,” he says, “there is five of you going down, could you do me a favor?” And I said: “If I can.” And he said: “Could you kind of keep an eye on those girls going down there. They've never been out of the state before.” I said: “Welcome aboard, I haven't been either.” I said: “But this sounds fascinating. Sure I'll keep an eye out.” KAREN: So, were you the oldest one is that why he asked you to do that? MARGE: Uh-huh (negative). KAREN: No? MARGE: I don't know. I don't know. KAREN: So, where did you go for PA school? MARGE: Gallop -- KAREN: New Mexico? MARGE: Gallop, New Mexico. We worked under Allied Health and the University of -- I was gonna say Alaska, University of New Mexico. KAREN: So, tell me about that program. How long where you there? MARGE: I was there a year. And all the stuff we had as health aides, I knew all that stuff already. And I know one time it was all on what this doctor gave us all week on babies. And so every Friday you get a test. And we did the test. And, oh god, at the end of the day on Friday, I was so embarrassed. She asked me to stay behind. She wanted to talk to me. And of course everybody was looking at me. And it ended up that, yeah, I was the oldest one. Yeah, everybody else was a lot younger. And I thought: “Oh, my god, I failed the test.” And of course everybody is looking at me as they're walking out the door. And that made me more embarrassed, thinking I had failed. And they knew that I had failed. And Dr. Birenhoff, she called me up to her desk, and she says: “I wanted to talk to you about your test.” I said: “Oh, no Doctor,” I said: “I didn't fail did I?” And she said: “Oh, no.” And I looked at my paper. It had 100% on it. I was so shocked I couldn't answer her. What she wanted to do was tell me that -- you know, I was passed 45 already, all the others were just kids. And she says: “You know, I wanted to tell you that ordinarily by the time you hit 40 you start losing your brain cells. And I know you worked as a health aide. But I'm also here to tell you that your brain cells are doing A-0k.” Oh, man all the different feelings I went through before she told me that though. God it was bad, it was terrible. Yeah, that was something else. I didn't think I was gonna live that down. And it's no use, I never did say anything to the rest of the girls or the rest of them.
MARGE: But yeah, we used to go over to Albuquerque some times. And we tried to do an autopsy and for whatever reason we never did get to do one at the University. They kept -- I think we went over about two or three different times and we never did get to do the autopsy. But never did see one so -- KAREN: In PA school you do a lot of hands on work with patients or it's all classroom stuff? MARGE: It's all classroom stuff for the first year. The second year, then, is the hands on. Although they had us working in the hospital at maybe -- they put us six weeks in different departments. I went into X-ray department and then I -- that one doctor, the main instructor, for some reason she didn't like me at all. And my boys brought me home for Mother's Day. They brought me here. I couldn't believe it. We left Seattle and I was sitting by the window and I was watching out and all of a sudden I saw our mountains. And instantly tears came to my eyes like -- I thought: Gee, I didn't even know I was homesick.” But you know, I'd been there since August and I finally was getting to go home for -- well home, it was in Anchorage 'cause the boys had their construction (company) up there then, so they brought me home for Mother's Day. And then I was late going back. Not my fault, it's the plane, you know, just making connections, right? And man, she read me the riot act. She dressed me up one side and down the other. And she was always doing that.
MARGE: When she put me with a doctor -- that woman had no business being a doctor, she didn't know anything, she just got out of school. And she looked at me one day and she said: “Why are you following me around, I can't help you.” I said: “I know Judy Cook is your friend and she's decided that I should follow you around.” She said:“ I'm gonna have to talk to her.” Evidently, she didn't because I had to follow her around. And one day they brought in a patient, Navajo. And they told me his story. That he had come in just to get the cast taken off his leg. No big deal. And while he was sitting there waiting to get his cast taken off his legs, or maybe they took it off already. Well, he went into convulsions. So, they rushed him up to the hospital. And when they told me that, you know, didn't faze me at all. I know what that's all about. And that doctor went and -- and I can't tell her anything. You know, she is the one supposed to be teaching me, but I can't say anything to her. And she was supposed to do - what do they call that - when they put that needle in your back? KAREN: Oh, a spinal? MARGE: A spinal test. Yeah, she was supposed to be doing that. And I had to hold the patient down and the patient would go: “Hhhh.” (expression of pain) Just every time she put -- KAREN: From the pain? MARGE: Sure, and he was a big man. But that's painful. So soon as -- I tried to hold him down. I couldn't hold him down, he was a big man. And I watched her for a while and I knew what she was doing wrong, but I couldn't tell her. And she did it for over an hour. She should have given up the third time maybe and said: “Ok, I don't know how to do this.” And then go find a doctor that can do it. But she did it for over an hour before she finally went to get the doctor to do it. And I knew what she was doing wrong. She was going straight in, instead of following the nerve path. Anyway the doctor did it. And it took him only a second to do it and gave it to her. And then she did the physical and she came out and she was laughing and saying: “You know, this man has one pupil bigger than the other.” And, of course, my mind is going: “Ok.” And I thought: “The nurses don't know what that means either, ok.” So after she was through, then I get to go in and get a complete history and a physical on the man. And I did that. And she comes out and she says: “Well, what's your finding?” And I says: “Well, for one he has an ear infection.” She was deflated: “An ear infection? I thought you were gonna tell me he had one pupil bigger than the other.” I said: “Gee, you told the whole world already, why would I do that?” Then she was upset with me because I found the ear infection. But I knew that wasn't what caused the convulsion. So, I had to go back and read up on all the reasons why -- I already knew but I had to go back up and read them, all the different reasons why he would have convulsion. And they call that differential. KAREN: What's that? MARGE: Differential diagnosis. And it happens to guys that had been drinking for a long time and you take them off the booze, which he had to be because he was coming in to see the doctor to get that cast off his leg. And that's what happened to him. I knew that. You know, worked with alcoholism here for a long time. I know what that was. But I had to have differential diagnosis. So I had to go find out what are the reasons why would he have convulsions. I already knew why he had them, but I don't know what other reasons could he have. And so I had to sit down and write out and say: This man had convulsions because -- or ruling out this because, and ruling out this one because, and say it's this one because.
MARGE: And I could not do differential diagnosis. I just couldn't do it. And when they brought in a woman from the reservation and she was pregnant - she was 7 months pregnant. After the doctor had seen her I had to go in and see her. And I went down into the library to write out, you know, what was wrong with that -- She was in pain, so much pain. And that old Dr. Sloan - he was a neat guy - he stopped and he saw me and he said: “What do you think it is Marge?” And I said: “Appendicitis.” “Yes, good girl.” But I couldn't tell you why I knew it was appendicitis and I had to. I had to tell you why I knew it was appendicitis and not this and this and this. I had to rule all that stuff out and I couldn't do that. I just never got the hang of that one. For some reason I went instantly directly to what was wrong. I've always been like that. And some times I'm glad I could because -- I know there was a patient here - crazy woman - walked away from her car wreck and came home and plopped down on the couch. Then she couldn't move. And when I got her ready for the trip to the hospital, I made them put sand bags around her -- I had to have sand bags to put around her neck to keep it from moving. In any way, shape, or form it could not move. And here is -- she wouldn't have made it, she would have been paralyzed if I didn't do that and the doctor had to tell me that. I didn't know and I didn't know why I did what I did. My mind just goes instantly to what the problem is. And she dressed me, oh man. You could hear her all over the place, yelling at me because I couldn't get the differential diagnosis. I just knew what it was.
KAREN: So did you go through two years of PA school or did you leave after the first? MARGE: I had to leave after the first because of pharmacy. And you have to know exactly how much medicine you're giving in, and I couldn't do that. I needed chemistry to help me find out exactly, like babies and stuff. And I couldn't. I didn't know chemistry. I couldn't do it. Instead of that, my grades started falling because I kept thinking about: “Oh, my god. I don't know chemistry. What am I gonna do? I can't --” You know, that's all those on my mind that I didn't know chemistry and I don't know what they're talking about in class. I don't understand it. And then, when that happened then everything started falling down and I couldn't keep up. I had to back out and say: “Okay that's it. I'll have to go some place and take chemistry in order to finish this.” And I tried to but I think I was in shock over this. That there was something that I came up against that I couldn't just say: “I'm going to do it and that's that, it's done.” That's the way I've always been. And I think the only one that understood that was Dr. Johnson. Dr. Johnson saw me at the hospital afterwards and he said: “Marge, you should've come to see one of us. You should've come in and talked to us about how you felt and what was going on in your life.” But I went through kind of a depression. Of course, going through menopause too, that didn't help matters. So, I went through kind of a depression thinking that I came across something I could not do. You know, I've always been of the opinion if I decide that's what I wanna do that's what I'm gonna do, and it's gonna be done. And I finally came across something I couldn't do. And man it took me a while to snap out of it. At least, six months or so to snap out of it.
MARGE: I heard about Cook Inlet Native Association and they heard about me. That I was in town. So they came looking for me or sent me a letter saying they needed a Health Aide Coordinator and they needed somebody to help them open up their clinic. And I thought: “Sure, I can do that. I've opened enough clinics.” So, I went to work. KAREN: What year would that have been? MARGE: '78. '79. Yeah, I came back. Yeah, it was almost a year 'cause like I say 6 months or more of it I went through depression. Because whatever happened to me, it froze my arm. I couldn't move it. And just all kinds of things happened to me, and it was probably because of depression. KAREN: So, you became the Health Aide Coordinator in Anchorage? MARGE: In Anchorage I started off being a health educator. Lowest man on the totem pole. KAREN: Oh, but that's pretty important being health educator. MARGE: Well, they told me: “Well, we're gonna open up this clinic and it's been taking doctors, PAs and all different kinds of people three years to open up these two exam rooms, open up the clinic.” And I got to work and I waited around because what I was supposed to do was see patients after the doctors saw them and check their chart, check their medicines and then explain to them again why they had to take this medicine. And then I would check on them again to see -- make sure they're taking their medications. August I start getting antsy. End of July, middle of August, I thought: “What am I doing here? I feel stupid. I feel like I'm getting paid for nothing here. I'm not doing anything.” I tried to clean up the exam rooms and get everything ready for where the medicines and stuff are gonna go when the doctor gets there, if he gets there. But that wasn't my job, you know, it's just something to do. And finally I went in to see my boss. And I said: “What am I supposed to be doing? When's that doctor coming? You know, I'm here, I'm not doing anything and I feel stupid. I feel like I'm failing here. I'm getting paid for something I'm not doing.” And they said: “Well, we're waiting for the doctors to come in.” And when -- I think she was the Assistant Director, she said: “I don't know why you're getting so shook up. It's been taking the doctors and PAs and all these big heads of the hospital three years to open up this clinic and it's still not open. And you think you're gonna come here in two weeks and get it open?” And I looked at her and I said: “I should have been able to do it in the first week!” And finally they let me go ahead.
MARGE: So, I went down there, I knew what I had to have. I had wrote up my list of my medicines that I was gonna need and I went down there and the pharmacist balked. And said: “No, I couldn't.” And I said: “Why not?” He says: “You don't know how to use any of these medicines. And I looked at him and I says: “You know when you should have balked? When I was a health aide. Because I really didn't know what all the medicines were for and how to use them and what it did to people.” I said: “Now 20 years later, 20 years experience with the health aide program and a year with the PA program, I know a little bit more now. I know a lot more about what that medicine is all about. And it's not even - it's not even - it's just the health aide medicine.” Boy, I had to take my boss down there and we had a big battle royal. We had the supervisor of the hospital and the pharmacist who wasn't gonna give it to me and my boss and my self sitting in on that meeting. He looks at Barbara and he said: “I thought you were already open.” And she said: “No. The doctor hasn't shown up out there and we decided since she had so much experience with clinics and stuff that we would let her go ahead and open them up and work with the doctor down here.” And he said: “That sounds ok. What's holding it up now?” And she said: “The pharmacist won't let her have her medicines.” He said: “What?” He turned around and looked at the pharmacist, he said: “I thought we went over all of this before.” He said: “That was before a health aide came along.” He said: “Give her the medicines and let's be done with this. I don't want any more meetings over this.” So, I got my medicines and I went back and I opened up the clinic.
MARGE: I opened up the clinic and I got my patients in. My first ones I was going to do is the Headstart kids 'cause we turned it into a wellness clinic. KAREN: This clinic is in Anchorage? MARGE: In Anchorage. That's Cook Inlet Native Association. And we started off with the little Headstart kids. And I went through this big stack of charts and I went through them all. I read them and put them there and one of the last ones I went through was a little girl that had been seeing the doctor every month. I don't know seeing the doctor. Her chart was yay thick. KAREN: 6 to 8 inches of -- MARGE: Yeah, she was seeing that doctor all the time. And I put it aside and I said: “I'm not gonna see a patient that the doctor is seeing. I'm not the doctor.” And finally, I just left it there a couple of days and I looked at it one day and I thought: “If I don't see that little girl she's gonna think that there's something wrong with her. She'll want to be like everybody else.” So, I put the chart in with the rest of the kids and I went to Headstart and saw her. And it so happened that that kid, I couldn't tell what actually was wrong, but when I'd have her walk for me, she walked funny, odd ball. So I referred her to ortho. And here every time she took a step, her joint, you know, in the hip, it would come apart. But she was used to it, you know, probably was that way since she was a baby. But, you know, she's been seen by a doctor every month or however because of her heart problem. But doctors are that way, they just look at one thing, they never see anything else. So, they never saw that this kid was having other problems besides the heart problems. Doctors don't do that. They don't say: “If she's having this problem, what other problems is she having?” You know, especially little kids, they don't know. KAREN: Would you think that the health aides are better at seeing those things? MARGE: No, the PA is better. KAREN: Ah, the PA is. MARGE: Because the PA is taught to go from head to toe. And as a health aide I wouldn't have -- you know, they didn't teach us that. They didn't tell us that this is how you're gonna find different things. It was as a PA you're taught to go from head to toe, even to the feeling of the skin and the scalp and, you know, you name it. We did it.
KAREN: So you got this clinic running in Anchorage. Then what did you do? MARGE: I ended up with the clinic, health aide coordinator and then they were going to put the CHR. That was one program nobody ever knew what to do with. I know they were complaining about it down in Gallop. And saying -- the CHR is the Community Health Representatives -- are nothing more than taxi drivers down there. And here they were trying to use them for everything. KAREN: What's the community health rep? How is that different than a community health aide? MARGE: They are supposed to go into the community and -- say you're a mother with 6 kids and you're not feeling well, you're sick. Somebody has got to do something with those little kids. They got to eat, they got to -- So, the community health rep. is right there to help you get better and make sure these kids are taken care of until the father gets home or somebody gets home. KAREN: So they're kind of a liaison almost. MARGE: Yeah, but they're -- Yeah, I guess. They keep track. If you're an elderly, they keep track of all your medicines and to see if you're taking them all. They also check to see what's going on socially in your life. Your kids aren't battering you or nobody's bothering you, nobody's stealing your money, you know, as an elderly. Yeah, those are the types of things that a CHR is supposed to be doing, but nobody ever seems to know what to do with them. And, of course, they were a line item in DC, which means anytime the budget comes up they can look at it and say: “Ah, they're not doing anything so CHRs are gone.” Whereas we're not line items, we're in the hospitals' budgets, so, you know, the hospitals aren't going away so the health aides are gonna be there. But the CHR was, oh man, that was a mess. I know the one in Cook Inlet was using them for ambulance drivers. They used them for dental assistance. They just did all kinds of crazy things with those CHRs. And when I got there, oh god, me and my big mouth. They were having a meeting - staff meeting - and they're giving a report on the CHRs. And I know the boss was frowning because she knew what they were supposed to be doing and she also knew that they were a line item that they could lose that money in an instant. And so she went around the table to find out if anybody had any ideas of what they could do with the CHR program. And when it came to me, of course, leave it to me, my big mouth. I said: “I know in the villages as a health aide, it was hard for us to leave the clinic to go visit the elderly and check on their medicines. It was hard for us to see a woman with kids that was sick, if they didn't have other family members that would come in and cook for the kids, or take the kids or do whatever. You know that woman needed help with her kids.” There's all different kinds of those scenarios in the community that could be going on. And she kept looking at me and I thought -- I just said it like I saw it. And finally, she looked around the room and she is, why, glaring at everybody and she said: “See there. I knew the CHR program, there was a reason for that CHR program. It's from the villages and they're the ones that don't have the people and they don't have the jobs. They don't have, you know, whatever. I knew the people from the village are the best people to decide how the CHR should be used.” And I thought: “Oh my god.” Because the CHR coordinator was sitting there. I wanted to hide under the table. You know, especially when the boss said: “Ok, we're gonna take that program from you and put it over here.” She gave it to me and I thought: “Oh, my god. I'm in trouble.” I didn't want to cause a problem. But even from the beginning, you know, she had been there for quite a while before I was there. But I was there a month. And when the bosses left town, I was put in charge. Wow, a whole health department? Scared me 'cause you know, I didn't know too much about it. And that upset the one that had been there longer. Oh, she was upset. And I didn't blame her in lots of ways, but then after a while I started figuring out why she couldn't be in charge.
KAREN: So what kinds of things did you do with that program once you were in charge? MARGE: Of the health aide program? KAREN: Yeah, both the health aide and the CHR. MARGE: I worked with the health aide program of course, you know, that one I knew inside out. But I also knew what the CHR was supposed to be doing. And it wasn't easy to trying to ease the CHRs into what they're supposed to be doing and what they actually were doing. It wasn't easy. I figured I'd probably lose the CHRs and maybe have to start all over again or something. Because, you know, the CHRs were ambulance drivers and they were just other odds and ends things. KAREN: So, you were able to change it so they could do what they were supposed to do? MARGE: I was going to but that person cried hard enough to the boss and she came and said -- this is a new boss now, she went crying to the new boss. I don't know, it was within a week or two the old boss left, so we got a new boss now and my new boss comes in to my office and she says: “Marge.” She says: “Could I ask you a favor?” I said: “Yeah, if I can do it.” And she said: “PJ's crying for her CHRs. She really wants them back.” I said: “I didn't ask for them. She can have them back. You know, whatever. I don't care. I've got my CHA program. I've got my dental program. I've got my hands full already as it is anyway.” But I said: “I really have my hands full.” Because the new boss came in -- the Assistant Department manager took over when the old manager left. And then they didn't IPO to get the health aide -- to get one of the people from IHS to come in and be the manager of the health department. And he was there for a while. For a few years. Maybe a year, year and a half, something like that.
KAREN: So what kind of things did you do as the coordinator for the health aide program? MARGE: I had to go out to the villages to work with the health aides and see what kind -- you know, I probably needed to start from the training program to find out what they've been trained in. Because to see them operate in the clinic, it could mean that they're not doing what they're actually trained to do. They might be afraid to start something new. But I didn't think about it soon enough that I should have gone to find out. Because I know when I was in one of the villages, somebody came in with an arm that wasn't very good and the health aide just kind of looked at it, held it and that is all she did. And I thought: “Hey. No. You had to do better than that even if it was after your first five days of training. You had to do better than that.” So, I had to take that patient and find out what was wrong. Because you know, it wasn't the patient's fault and that patient was in pain. I suppose I could have -- no, I didn't wanna embarrass her, so I just went ahead and took the patient myself. KAREN: So, what villages did you supervise? MARGE: Ninilchik, Tyonek. Those two mainly.
MARGE: Yeah, I had my hands full with that clinic. I was really proud of myself when I found that hip that was displaced. I was really proud 'cause, you know, that was doctors that were looking at that kid and didn't find that. And then I had a patient -- an elderly woman came in and her daughter brought her in and I went through the routine like I was taught in PA. And I talked to her and listened to what she had to say. And we talked about a lot of things. And then I had her, you know, go ahead and get dressed and her daughter stayed in there and helped her. Her daughter stayed all the way through. And then afterwards, I told her: “Come on in my office and we'll discuss your -- what plans we have for you.” And the daughter said: “You know, I've been taking my mother to the doctor for years and she never ever got a physical like that before and nobody ever talked to her like that before.” And I said: “Well, you know, doctors get -- you see the waiting rooms, they've got all these patients they have to go through. And really, you know, they're not doing us a service by having all those patients backed up like that. You know, because they have to do us assembly line style. And they don't get to us, they don't talk to us, they don't tell us nothing. Or they make you feel like you don't understand anyway, you know, you don't know anything, so no use telling you.” So, that was the reason, but yeah she was: “I hope you're gonna be here the next time when I bring her.” KAREN: So how long did you -- MARGE: -- have that clinic? I worked there from '78 until they closed down in '86. KAREN: '86. And then you were also the health program coordinator for that same period? MARGE: Oh, yeah. I became health assistant manager through the years but, you know, most of the time that's just writing.
KAREN: So, then after 1986 what did you do? MARGE: I went and found another health deal, health place to work in. And while I was working there a sheet of paper came across my desk and SEARHC was looking for health aide coordinator. And I thought: “Wow, I get to go back home. I think. I hope.” And I had a secretary put my resume together, updated and shipped it off and I got a call. Lee Schmidt. He calls me and talks to me and I'm talking to him and I'm asking him about the budget and all other different kinds of things so I could let him know: “Hey, I know what I'm talking about. I know what's going on.” And he was impressed and he says: “Marge.” He says: “Ordinarily, I never hire over the phone, but today is an exception. You're hired.” So he hired me right then and there. And I moved to Sitka and was health aide coordinator there. KAREN: For how long? MARGE: I went down in '78. KAREN: No, you said '86. MARGE: Yeah, '78 was Gallop. '87, '87. KAREN: Okay. MARGE: '87, '88? One of those two years. '87, I guess. And when I was there, I had a hard time. They weren't into Natives, knowing what to do and how to do it. And, you know, I was a new item for them because, I'll tell you, I didn't know anything when I went to work for the Cook Inlet Native Association. I didn't know what a proposal looked like, I didn't know what it was supposed to do, I didn't know nothing. But I learned from there. And I'll have to say Cook Inlet Native Association, I wish I had kept that. But I had a big binder full of all the training programs that they sent me to help me get to be a manager, keep going up. And I did end up to be, you know, as far as I got was Assistant Health Department Manager in six years? KAREN: Wow. MARGE: So, yeah. They did well by me, I'll have to say. They did everything they could to help me move along, to keep me going up further and further. Yeah, they did a good job. But when I got to Sitka it was a different story. I was, you know, the first person they got rid of. He was suing them. And I would have backed him up, I would have backed him up. Then they got rid of another Native guy. And this Native guy they were getting rid of was the guy -- Gerry Ivey, I was there when Gerry Ivey said -- and he was head of the hospital -- Indian Health Service in Alaska. He asked Frank O.: “Do you want the job?” Which was head of Mt. Edgecumbe hospital. That's when SEARHC took it over. And I know Frank O. put his eyes down. He was probably afraid that Gerry really didn't have the power to put him head of -- you know, million things probably went through his mind when Gerry Ivey asked him. KAREN: So, Frank O. is Native? MARGE: He's a Native guy and he could have been head of Mt. Edgecumbe hospital. If he wanted to be, Gerry would have put him there. KAREN: And O. is his last name? MARGE: Middle name. Frank O. Williams. KAREN: Okay. MARGE: And he was president, I think he was the first president of Southeast -- KAREN: Of SEARHC? MARGE: No. Southeast Native Health Board. KAREN: Okay. MARGE: Yeah.
KAREN: So when did SEARHC get established? MARGE: In '75? Is that when we were putting to good use -- what was that bill that came out? Self-help, self -- KAREN: Self-determination? MARGE: Self-determination came on. That's when we started in forming SEARHC. That was in '75. KAREN: Well, I know the Native Claims Settlement Act was '72. MARGE: '72, yeah. '71 they started, but '72 was finally -- yeah, it was '75 when they had self-determination. KAREN: Oh, Indian Self-Determination Act? Something like that? Sounds familiar, okay. MARGE: Yeah, that's what we were doing when we formed SEARHC. KAREN: So you were one of the first -- MARGE: -- one of the first things they did when we were talking about SEARHC and we were, you know, we had long discussions about what it was going to do to Southeast Native Health Board. Because we realized that Southeast Native Health Board was grassroots people. And we didn't want Southeast Health Corporation to be a great big Corporation that wouldn't listen to the people. So, we went back and forth on that one and trying to decide on what was going to be best for the people. You know, maybe we think grassroots is the best, but maybe the people would rather have SEARHC. We went back and forth on it.
MARGE: Then when we decided, okay, Southeast Health Corporation. We were talking about eventually taking over. We'll take over Mt. Edgecumbe and take over the health of all of southeast. And, you know, we were gonna run with it. And then somebody got the bright idea of getting their moneys from the Health Aide Program. Their first moneys that SEARHC ever got was from the Health Aide Program. And that meant people like Trudy Wolfe, Alma Cook, Alicia Roberts, Julia - what was her last name - and other one from Kake. We were all health aides, which meant that we had to get off of that Board since we couldn't make decisions regarding our jobs. And I think, after that, SEARHC went downhill. They lost their grassroots. They lost their health aides because they were the ones that knew what the health of the community was, and was able to bring it to the table and start working on the projects that way. Eventually, it did get too big to know what was really needed in the community. You couldn't do this because you can't do it over here or, you know, there was always a reason. And it just got too lofty, I think. It's got 19 people on there? And you know, when we were on Southeast Native Health Board we stayed at quarters. Nothing but a bed in there and a closet. And we were down there to do business, we weren't down there to get fancy anything. Nowadays, that Health Board, they wanna stay in this hotel, they want a car, they want this, they want that. You know, we never thought about such things, we didn't have time, we had things to do. Now, I don't think it's worrying about what's in the community and what's needed. And I feel like they're just making rules and regulations without finding out what's going on back there and what -- you know, for every cause there's an effect. And nobody is checking in on that. So, whatever you do, you know, effects somebody, someplace. And they're not concerned about that. Yeah, that's Southeast Health Corporation. KAREN: Right.