Rita Buck was interviewed on September 13, 2005 by Karen Brewster at the Norton Sound Health Corporation, Village Health Services office in Nome, Alaska. In this interview, Rita talks about learning from Willa Ashenfelter, communicating with the doctors, the importance of building trust and respect from the community, balancing her family and job, coping with difficult cases and challenges of the job, her current job duties, and variations among the villages.
Digital Asset Information
Project: Community Health Aide Program
Date of Interview: Sep 13, 2005
Narrator(s): Rita Buck
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
After clicking play, click on a section to navigate the audio or video clip.
Some background on her life and her career as a health aide.
How she got started as a health aide and some thoughts on the attitude a health aide should have towards the work.
Some of her mentors, and the roles and responsibilities of health aides in small villages.
The new generation of health aides, what has changed for them, and the support health aides need in order to be successful.
More about why she wanted to go into medicine, her family history, and the role of health aides in their communities.
The importance of training and compassion in health aides, the difficulties of leaving family and home when seeking training, and some ways health aides in training can get support.
The work she is doing now as a village supervisor-instructor (VSI) overseeing clinics and health aides in five villages.
A story about a time when her father was seriously injured and she was the only healthcare provider available to provide first response treatment.
Changes in the equipment available to health aides, and how health aides and communities deal with tragic situations.
Dealing with emergencies, characteristics shared by successful health aides, and how her own daughter became a health aide in White Mountain.
Interacting with doctors, and the story of helping Willa Ashenfelter with the last baby she delivered as a health aide.
Other stories of labor and delivery, and how communications have improved over the years.
Advice to anyone who wants to become a health aide, and reflection on how she stuck with such a difficult job even through the tough times.
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.
KAREN: Today is September 13th, 2005. And this is Karen Brewster. And here in Nome with Rita Buck who is visiting us from White Mountain. Rita, thank you for coming in. RITA: You're welcome. It's good to be here. KAREN: This is from the Community Health Aide Jukebox. And so just to get us started a little bit, tell us a little bit about yourself, when and where you were born and kind of leading up to community health aides. RITA: Okay. All right. I was born in Golovin in 1952 in my grandma's little one-room log cabin. And when I was about two, or going on three -- three years old, my mother married Steven Agloinga, who was my stepfather, and we moved to White Mountain. And I've been there ever since. Went to grade school there and spent four years, high school in Unalakleet where I graduated in '71. Then it was in '73 of October when I -- I applied for a health aide relief, or back then they were called alternates. And Willa Ashenfelter was the health aide then. It was very exciting for me. I had a job, you know. Although it was back then, I was paid by the city which had the lease for the clinic. And I worked on weekends, but everything I learned, all the basic stuff was from Willa. And those are things that I still practice today. You know, like she taught me how to do all the vital signs, like taking blood pressure, how to take a temperature. We practiced giving shots on an orange. And it kind of came easy and they were fun for me because when my mother was a health aide before Willa, my mom used to take us with her to the school when she did her radio traffic. And those are fun and exciting times for me, too, growing up in the '60s. Not really knowing what she was doing, but just being able to go with her up into the radio room where they had that sideband radio and listening to all the other health aides as they reported their -- their patients and the doctors respond. And I said, I want to do that. So that was kind of interesting. And it wasn't until late '70s, I think, where we started getting training, coming into Nome for basic EMS training, how, you know, bandage and package people when they get sick, like if they had to go to Nome. We didn't have medevac -- we did not have medevacs back then, if people were sick enough, we would have a plane wait up on the hill and then we would take them. You know. KAREN: So you would call for a plane to come? RITA: Yeah. KAREN: There weren't regular medevacs? RITA: Yeah. We had regular mail runs every other day or whatever. The old Muns Airlines. And working as an alternate back then, I only worked on weekends and on holidays, and Willa, she was the primary then, when she was available to go to work. You know, holidays or when she had to come to training. And if we had a trainer to White Mountain to, you know, supervise, I'd come to work then. And those are fun times, too, because one of my favorite old teachers was Dan Thomas. And he was very to the point and a very good teacher. He was very direct. Strict in some ways, but that's how we learn, you know. And some things today, I still have those in the back of my mind, you know, of about what he told us.
RITA: For I don't know how many years, I worked as alternate, then I was married and had children. And the pay wasn't very good, so there was about four years that I left the health aiding business and worked for the school as a bilingual aid. And that worked out for a while, about four years. And then there was a change at Norton Sound where the primary health aides were not primary anymore, they became full time. And so they developed the part-time positions where they can get benefits. So they had an opening and I came back. And I worked as a part time health aide for a while until, I think it was '94 when Willa -- well, she became ill and had to go to Seattle. So I took her position as a full-time aide. And we made an agreement that I would take her full time until she came back and was well enough and we could switch. So I was a full time for about a year. She came back and got well and she said she liked being part time. So that's how we just kept it. And I'm so, so thankful for the older health aides, they are the ones that taught us all the basics. I'll never forget when Willa said, one time we were talking about events that happened, she said if she were to go to another village and she were sick, she would want to be treated with respect and, you know, be welcomed and, you know, have the health aide show compassion. So she said she's always tried to do that to whoever comes through the clinic door. And that was a big lesson for me to learn, to treat everyone who comes in that door as if they were a special person. You know. I guess you grow up in villages and you always have just one or two people that you don't want to see or don't want to meet on the street, and that was very good for me to learn because you know, you really do think if you are in another village somewhere or maybe in another country and you got sick, you would want to be treated with the same respect. So that's something I also try to teach to the younger health aides that if it weren't for the sick people, we wouldn't have this job. You know. And if you like doing what you're doing, you know, show it. So I think being a health aide is a very, very big job. All the villages are different. All the communities are different. The cultures and how people learn their respect of the health aides is how you carry on in the community and in your job. That makes a big difference.
KAREN: So are there some communities that have conflict with their health aides in terms of respect? RITA: I think so. Back then when I first became a health aide when I used to come in for training, they would put us up in Nanuq apartments, and there was some health aides that would come and all they would do is, you know, every night they would go downtown and come home intoxicated, and it was so disrespectful. And it just seemed, you know, when you come in for training under Norton Sound, or under your corporation's time and money, you should, you know, treat it as so, as business for your -- for your corporation. And I just -- I didn't think that was very respectful on their part. KAREN: Uh-hum. RITA: And I think that's one thing I learned from Willa and Irene, some of the older health aides that came into Nome with training. And they did real good at training, passed all their CMEs, and it's the same way in our community. If you have, like, a city council, if you have a mayor who is respectful, you know, not a drunk staggering through town, people are going to respect you. And it's the same way with health aides. And every community I think is different. KAREN: It seems like it would be much harder to do your job as a health aide if you did not have the respect of your -- and trust of your community. RITA: Uh-hum. Yeah. It was a trust that you have to build. And the biggest part, too, of that or important thing is that you're related to almost all the people in the village. And if they know you as being a person that they can believe and trust, then they will come and see you. So that's one thing I really appreciate working with the elder health aides. Not all of them were that way but most of them were. And those two ladies, they are my -- my mentors. I was very thankful for Willa. She taught me all the basic things, and she said that when she learned, she learned all this from my mother. And in thinking back, my mother learned all that stuff from her mother, Lucy. Lucy was the first midwife who -- when the nurses came summertime on the big boat, they would give TB medicine. So they asked -- and Lucy did a lot of volunteer work. Then when she got tired of doing that or wanted to stop doing it, they asked my mom to do it and she did. And a lot of it was volunteer, they didn't get paid. I remember for a short time they were getting paid from ANB. I'm not sure if it's the ANB that is here in Nome. KAREN: What is ANB? RITA: Alaska Native Brotherhood. KAREN: Okay. That's what I thought. RITA: Yeah. And they saw patients out of their home or in-home visits. And I remember my mom getting a check in the mail for 92 something dollars and she was really happy. She said we got our check today. And she would go to the store to cash it so she could give the other half to Willa. And you know, that's 40 something dollars. That was a lot of money back then. And I think they liked what they were doing. And just the pride of knowing, you know, how they -- they didn't realize all the stuff that they were doing was not recognized, not getting paid, and they were doing what they knew best. Having compassion and caring and just knowing that they were related to most of the people.
KAREN: You're of a generation, you're sort of in between, that you have had the opportunity to work with the older generation of health aides -- RITA: Uh-hum (affirmative). KAREN: -- and now you're becoming the next generation of health aides to this new young group. RITA: Yeah. KAREN: And what do you see in this -- the next generation coming up? RITA: There's a lot of new technology. Computers, Telemedicine, and they are all very good for work. I really appreciate the Telemedicine program. You know how it was hard to describe skin problems over the phone to the doctor. Back then when they had the standby radio. I have a story about my mom. She was telling the doctor over the phone that this person had stomach flu or something, she was describing the baby's stool and it was the color of cornflakes. And the doctor asked her, why do you describe it like food? And she said, well, there's no other color of that color, you know, so that was how they describe it. But today, we can use the Telemedicine and the doctor can see it right away. And it -- I think it prevents a lot of flying-ins to Nome, by seeing the picture. Because there's so many skin problems nowadays that are hard to describe. And you can look better at the ears. The new health aides now, the new generation, they are -- they are smart. They can all use a computer. And there's -- I think there's more advantages to going to school, they can learn more. Just all the stuff they are learning in school. And I know there are a lot of young ladies out there that could probably go to PA school and do it very well. But a lot of them just don't have the know-how to get the money or the scholarships. And this new generation, they are really smart. And I think it's partly the schools, too, are having computers and teaching them how to use them. KAREN: What about issues of the turnover in the job? Is that -- is that a problem? RITA: Yeah. Turnover in some villages is really a big problem. You know, they put a lot of money into training. And I think it's a lack of support from the community, possibly from their families. I think White Mountain is one of the villages where they have the longest standing health aide without much turnover. KAREN: Uh-hum. RITA: And I honestly believe it was the support of the family and the community. And I can honestly say the White Mountain City Council that has the IHS lease for the clinic, I'm very thankful that they've always been supportive. If there was a problem at the clinic, like with the building or anything they needed, you know, to help with the patient care, they would gladly provide it. We had telephones, if the phone kept breaking down, they would fix them. We've had, like, the four-wheeler or snow machine, too, to, you know, haul patients back and forth or to meet the airplane, they always kept them running and in good condition. They always believe the health aide when we said we need this or that for something, for patient care. And I think that partly is from the health aide, too, you know, their moral standards.
KAREN: So what made you decide to apply for that alternate job that first time? Why did you want to do health aide work? RITA: When I was -- I just remembered not too long ago when I graduated from the 8th grade, they used to have the graduates do a little speech. And I had a real short piece of paper. There was -- there were just two of us that graduated from the 8th grade and this girl was from the Children's Home. But my friend reminded me, Rita, I remember your 8th grade graduation speech, it was real short and all you said was you wanted to finish school and go become a nurse and come back to White Mountain and work. And I think that was a dream I always had when I was little, you know, I wanted to help people. And when that opening came for a health aide, I said, now's my chance, you know. Maybe I can go from there. KAREN: Now, with your mom having done health aide work before, did she teach you things? RITA: Yeah, she taught me a lot. She taught me a lot of things, too, that we learned the same, and I know Willa got this from my mom, and my mom always used to tell me to believe people when they tell you something. You know. If somebody tells you they are sick, don't just look at them because you think they are different or you know, every village has people who are high in standing and some who are not, and you have to believe everybody, treat them all equal. And I didn't get a chance to work with her as a health aide, but being with her in the radio room and watching her treat people, I knew she really cared. I mean, that's the biggest thing, I think, being a health care provider is letting people know you care. Sometimes all you have to do is listen. There's a lot of people who come to clinic who just want to talk. There's really nothing wrong with them, but being a good listener is very important. KAREN: When did your mom pass away? RITA: She died in November of '87. And I grew up with my mother and my stepfather, and for a long time I was ashamed of it, but we've become more aware of domestic violence and all the stuff that can really make people sick, and we grew up with domestic violence. My parents were both alcoholics, and I think that's where my mother's downfall was. She did real good in training but the community didn't want, you know, a health aide who was still drinking. And I know she did try to quit a couple times, but it was my stepfather who was not a very good support system. And all that stresses over a marriage during alcoholism, I think it was part of stress that killed her. KAREN: If -- in the way people talk about it, you never would have known. RITA: Uh-hum. Yeah. KAREN: Because it sounds like she was an important influence with the health aide community. RITA: Uh-hum (affirmative). She was a very proud and happy woman. I remember when she used to go to Golovin to cover for Irene, she always dressed respectfully, they were poor and everything but she always had nice clothes. She used to have these white shoes, and white nurse shoes, and she would put them on and walk to the clinic or whatever. And she really, you know, not only tried to do her job the best she could, but she dressed the part. She was really proud of that. KAREN: Do you think there are pressures on health aides sort of being role models in the community, and is that sometimes too much for people? RITA: I don't think in some communities they probably don't even think about that. But it really -- it was important for me. I don't know if it's because of growing up in White Mountain or going to a high school at Covenant High. Covenant high was a private Christian school. KAREN: Where? RITA: Unalakleet. KAREN: Unalakleet. RITA: It closed in '84, I think. I really wanted my kids to go to high school there and graduate from it, but it closed because of lack of funding. And I think it's just based on every community, different communities. But my parents were really strict, too, although we grew up with a lot of domestic violence and alcoholism, they were very strict. Which I'm very glad for. Looking back, I don't think I would want to choose any other parents, even though all the hard times we went through. They provided for us all the important things. KAREN: Uh-hum.
KAREN: And so you started -- how did you do this, becoming a health aide with no training? That's amazing. RITA: I know. It's -- sometimes I think about that and I -- just basic patient care, I think. Letting people know you care about them. Like if someone is hurting, you know, you want to fix the hurt. It might not be a physical pain, sometimes it's emotional or -- and I think my mother was a very good listener. She used to sit with a lot of women when they had problems. You know, as a health aide back then, we didn't have a clinic, but you'd meet people in the store or on the road, coming from church, and just being a good listener. I think that's a big part of being a caregiver. And I think that's what my mom used to do. And becoming a health aide back then and having no training, that's a good question, hard to think about, but it was all the basic stuff, you know. KAREN: Yeah, you said you learned the basics from Willa and everything. RITA: Uh-hum (affirmative). KAREN: But how long was it before -- RITA: Before training came along? KAREN: -- before you got to go out and get real training? RITA: Yeah. '73 was when I first started, and it wasn't until I think Norton Sound was incorporated in 1975. And I went to session -- I think my first session was in '76. I went to Session 1. And I became certified in -- did I say '75? KAREN: You said Norton Sound was incorporated in '75. RITA: Uh-hum (affirmative). KAREN: So you think you started training in '76. RITA: Yeah. '76, '76, '77, '78. There were CMEs I think. I might have my dates wrong. Anyway, I became certified in '87, so it was '83 when I first went to my first Session 1. And it wasn't until that time that they had this -- Norton Sound developed part time. Back then when we were alternates, there was no training. KAREN: Really? RITA: We just -- we just did what the health aides did, the primary health aides did. KAREN: Yeah, because the primaries got training. RITA: Yeah. KAREN: But the alternates didn't. I didn't realize that. RITA: Huh-uh (negative). KAREN: Because back when you first started it was Public Health Service that you worked for, right? RITA: Right. Uh-hum. And the only training we ever got were, like, when the health -- the trainers went to the village and we would do IVs on each other and, you know, practice with the traction splint, backboarding. And it wasn't until the '80s that we had EMS training and they started with Session 1, Session 2. And back then it was only through Session 3. And I graduated or I completed certification '87. KAREN: So those Session 1, 2, and 3, it was here in Nome? RITA: Yeah. KAREN: How long was each session? RITA: Each session was four weeks long. So in '83 when I came for Session 1, my youngest daughter was an infant and I left her with my mom. Well, I came to training. And it was really hard back then. Even now today, I think these health aides are leaving their town, their home villages, leaving their babies, all their kids, and coming to training. And usually there's not enough money to go home, like on a weekend, so four weeks away from home was -- was a big deal. KAREN: Yeah, I've wondered. RITA: Uh-hum (affirmative). KAREN: How was that for you? RITA: For me, I had a support -- the support from my parents, and my husband was working, he took care of the older kids, but my mom had the baby. So just the support from our families is what helped along. KAREN: Because it is amazing that it's mainly -- it's mostly been women who have done this, right? RITA: Yeah. Uh-hum. KAREN: That would leave their families and children to do that. RITA: Yeah. KAREN: That takes an incredible person, I think. RITA: Uh-hum. Yeah. And these husbands have to cook, clean, you know, whatever. And I know they are capable of doing it, but seemed like back then there was a little more support than there is today. KAREN: There was more support? RITA: I think so, yeah. Nowadays there's more jobs, I think more men are working so it's hard to find good baby-sitters. And that's where a lot of the problems seem -- I think seem to come up when they come in for training. But Norton Sound is now developing a -- they will have a trainee come in, if they are breast feeding an infant up to a year old, they can bring their baby with them, and a sitter, and they can house them. Which is very nice. KAREN: Yeah. RITA: I wish they had that back then. KAREN: Yeah, that's nice. RITA: Uh-hum (affirmative).
KAREN: So now, what are you -- are you still a health aide or your position has changed within the system? RITA: I'm still a certified health practitioner, and I work in the clinic two days out of the month. And my main job is the village supervisor instructor. And I have five villages that I supervise. I have a big village which is Shishmaref, they have five full-time health aides, two CTCs. KAREN: What's CTC? RITA: A clinic travel clerk. They are the ones that answer the phone, make appointments. We have an appointment book system. And they are just a -- like a secretary. I have Shishmaref and I have Brevig Mission. Brevig Mission has three part times and a CTC, and they have a PA. Shishmaref has a PA. The PA in Brevig Mission has Brevig, Wales, and Teller. Then I have Elim, which is another big village. They have three part-time health aides and an opening for one. And a CTC. And they have a PA living there and she covers Elim, Golovin, White Mountain. And then I have Koyuk, they have three part-time health aides. They just got a new clinic. And they have a PA, the PA lives in Unalakleet. He has Unalakleet, Shaktoolik and Koyuk. And then I also have Shaktoolik, it's a smaller village. So the VSIs, there's four of us, we all -- all the villages are divided. KAREN: And what do you do as a VSI? RITA: We go to the village and observe the health aides as they work. We evaluate their patient encounter forms. Make sure they are following the CHAM. Because the health aides do not have licenses, you know, we are working under a doctor's license. Make sure they are following the CHAM, following medical standing orders. And we do some training like doing backboard, you know, if there's time, make sure they all know how to use the oxygen tanks. All their equipment, like the Zoll, AED, and we check some other things like the medicine control drug logs, make sure they are -- there's no discrepancies. And just the overall run of the clinic. There's Clena (phonetic) involved, you know, Clena is the lab, you know, like the doing HemoCues and finger sticks for hemoglobin, urine checks, glucose checks, all the equipment needs to be -- make sure that their maintenance is running, stuff like that. There is a lot that we have to do. Observe the health aides, how they work with patients. Patient encounter, evaluation. And we also, if there's a health aide there that is going through training, we maintain their -- I follow through with their skills. When they complete a training, we have to do post session learning needs. The health aide trainers will send them home with a list of things that they observe them in training that they might needed help on doing more. So we finish up their post session learning needs and make sure that they pass that session. Then they are ready for the next session. It's a lot of paperwork. KAREN: And how long have you been doing that job? RITA: Must be going on five years. It's challenging and interesting. I love going to all the other villages. Every village is different and the communities are different. Every community has good people. And all the clinics, they do things all different, but all their things that they do work for them. And so sometimes if there's something that is working there, I might incorporate in another clinic. Okay. This is how someone doing it, you might want to see how it works for you, you know. So it's very interesting and I like it.
KAREN: It's different from being a health aide? RITA: Yeah. Sometimes I do miss that, though. There are two days out of the month that I am a health aide. And I try to pick days in White Mountain where I know there is a shortage. Like White Mountain has all three part-time health aides, so one health aide will work from Monday to Thursday, 8:00 to 5:00. And then the next health aide, she will work from Tuesday to Friday from 8:00 to 5:00. Then there's a part time that works every day five hours from 8:00 to -- or 9:00 to 4:00 -- 9:00 to 3:00. So there's a -- there might be a day here and there when there's a shortage, so I'll try to pick those days and work. But I do miss it sometimes. And all the health aides are EMT. They've all been trained in EMS. And that's another thing that we have to do in our villages, make sure that their trainings are up, they don't expire. Every two years our EMS expires, and then Norton Sound has a program here where they have ongoing training. So that's something we have to keep up with all the different health aides in all the villages. And we have to keep those up, too, ourselves, as VSIs. KAREN: So when you were a health aide, when you were part time, even alternate or part time, did you have to deal with this sort of 24/7 on call, anytime-type schedule? RITA: Yeah. It was -- it was like you had to be available for people to find you. I'm so in awe of Willa and Irene, these older health aides, back before Norton Sound became incorporated, they were on call like 25/8, you know. They couldn't leave town. They -- I remember when Willa would finally get time to leave White Mountain, she would be so happy. And she would leave White Mountain to come to Nome to see friends or relatives or go on a boat ride to Golovin to go fishing. And so they would call us to work and you know, I know those are valuable times for them just to get away. Just get out of the village. Because you never know when someone's going to call, middle of the night. And back then when they got emergencies, too, you know, it was always seemed like it was always during dinner. I remember my mom cooking dinner and then someone coming, running to the house saying, oh, someone got hurt, and she would have to get up and leave. So it was either my dad or myself who would have to take over cooking. And Willa did that quite a bit, too. And her husband was a good cook. KAREN: And what about with your family, did that happen to you that you get called away in the middle of something? RITA: Yeah. KAREN: Or in the middle of the night? RITA: Yeah. Yeah. There was a couple times we had babies delivered over there and are emergencies. They would be like two o'clock in the morning sometimes. It would be middle of the day when you're gone, you miss dinner. So someone has to take care of it. I remember in June of '86, it was my dad who was helping some village guys work on our city generator. It was a big building with two -- three beams down the middle. It must have been like the 20-by-24 building. They were moving it and my dad just volunteered to help. So he went under the building and was trying to move the jack, and the whole building fell on him. And it was -- it was, you know, when you come through emergencies like that, your mind just goes, okay, this is what I have to do, and I have to do it. It was my dad and I wasn't thinking. You know. Some people would just go blank if it's someone you're related to. But knowing that someone was hurt and I had to do it, I was the only caregiver there, we didn't have medevacs back then, we put him on the backboard, they finally got him out from under the building and put him on the backboard, and all these guys helped carry him to the clinic. And there was a plane up on the hill, so they waited and we brought him out to the plane, came to Nome. And they were all so impressed that they got the X-rays and everything. He had multiple pelvic fractures. And Dr. O'Neill overheard me call him "dad." And she said, Rita, is that your dad? And I said, yeah. She said, oh, she said, I wouldn't be doing that if I were you. Because they couldn't get his IVs in the hospital, and the guy who was trying to get the IV, the nurse knew I was a health aide, he said, Rita, maybe you can get it. I said, okay. I was going to try. You know. That was the only thing I could do. But then Dr. O'Neill heard me call him "dad," she said, I don't think I would do that if I were you. You know, I didn't know back then. But you just have to do what you have to do. And he ended up going to Anchorage the very same way we put him on the backboard at White Mountain, they couldn't turn him over. And in a way, Dr. O'Neill told us that he was going to die. That was her fifth person ever she saw with multiple pelvic fractures and they all died. But my dad survived. But they even showed us the slides, the X-ray. I was impressed. KAREN: That must make you feel good that you helped save him. RITA: Uh-hum. Yeah. You know, there's just some times there's nothing you can do but just be there and just try to do your best. Nowadays they have better equipment and they have medevacs and it did take a while to get here, but you know back then, it was just you have to do what you have to do.
KAREN: So what kind of equipment was there for you to work with when you first started? RITA: We had blood pressure cuffs and I remember first getting training with the, you know, the hair splints for broken legs. We didn't have computer then, we didn't have Zoll. KAREN: What's Zoll? RITA: The Zoll is -- have you ever heard of the AEDs that they have on the planes that you get pads or someone has a heart attack, you can turn it on and. KAREN: Revive them? RITA: Yeah. We have those now. The equipment, just the health aide bag with a blood pressure cuff and thermometer. We had the traction hair splints, backboard, that's about it. But today we have Telemedicine, we have Zoll, AED, we have a trauma room, which is very, very good to have. It's a big difference. But back then, you know, just for some reason I never thought of that the comparison, didn't have much. KAREN: Did you feel like you had enough to cope with the medical cases that came in or were there times where somebody came in and you just -- you had -- you couldn't do anything? RITA: Yeah. We had one where this little kid was hit on the head with a monkey wrench or something and the brains were sticking out. What can you do? It was horrible. But just have to be there. There's nothing. KAREN: How do you cope with that? RITA: There were times when after something like that, we would get together in the clinic and cry on each other's shoulders if we had to, or say, oh, if we could have done this or that, maybe it would -- you know, the patient would have survived, or what could we have done to make things better. And that was our way of debriefing ourselves. I think getting together and crying and we would clean up. And if there was anything very tragic, sometimes Norton Sound would send a debriefing team over. I think they did that to people in Savoonga where there was a massive drowning, whole families were in the boat and they drowned. So they sent a team over there. I think which is -- which they really need. And some villages cope with a deaths and it's really important to get debriefing, to talk about what happened. KAREN: Yeah, that's what I was thinking about before, too, it's different -- I know it's different in each village. Some had a lot of tragedies. RITA: Uh-hum (affirmative). KAREN: And trauma, and others, some it comes in spurts, and how a health aide -- a health aide, I think, would sort of be in the center of it all. RITA: Uh-hum (affirmative). KAREN: And have something to -- RITA: They are related to people, too. It was really important to get them to talk about it right after. And not, you know, put it away and not talk about it. So it was helpful for us to get together like that.
KAREN: Have you had to deal with sort of some scary emergency cases? RITA: Yeah, over the years, there have been some. But I always think we were very fortunate. We do have -- like, there was one person that had a -- you know, every trauma is different. Some things you can cope with, like if someone is an elder and they have COPD and you know they are going to stop breathing. KAREN: What's COPD? RITA: Chronic obstructive pulmonary disease. And you know, we are waiting for medevac and this patient isn't breathing, you have to breathe for them. You just do it, you know, or use a big double mask. And then there's another one where someone just collapses and stops breathing. And you get down and do CPR and get the oxygen and this person doesn't survive, it's very traumatic. I think that was the worst one for me where the patient died. And other emergencies that usually come to Nome and then go to Anchorage and then they come back home. And what is really good when they come back, they come and say thank you, you know, because we did our best. KAREN: Uh-hum. RITA: But for those ones that died, it's -- it's hard. But getting together later and talking about it is -- it really helps. KAREN: What about some success stories? Something great that all came out happy in the end. RITA: Yeah. KAREN: We don't want to talk about just the bad ones. RITA: Yeah. Let's see. Yeah, there has been several. Someone -- someone was going boating and his flywheel on the motor, he didn't have it covered, the flywheel flew off and hit his leg, and you know, just got torn. And we had to package that and get him ready to come to Nome. Anyway, when they go back, they say thank you. It's -- I think when people are hurt and they see what we are doing that they know we are doing our best. And we take care of broken bones and stuff and just splint them, they always say, oh, you know, you just have to do what you have to do, and they always say that people learn, well, that was easy, you know, you could have -- you can make like if you're out in the country and you use break their legs, you use a piece of willow or a stick and make a splint, it's just all basic stuff. You know. And people always -- almost revere you, you know. You know how they do that. KAREN: Yeah. RITA: Just basic. KAREN: Yeah, but some of it is, you say basic but also some of it is who you are as a person. RITA: Uh-hum (affirmative). And how you respond. KAREN: And how you respond. RITA: Yeah. Or how quickly you can fix something. KAREN: If you have the right personality to be able to handle the situation. RITA: Yeah. KAREN: I don't know, what are those characteristics? What does somebody need to be able to do health aide work? RITA: There are a lot of health aides out there I know who it's almost like they are naturally born to be a health aide. There's a lot of young, smart health aides, too, they just -- it just seems like they already know, you know, they go to a training and they say, wow, that was a lot of fun, and we learned how to do this and that, and it was like I already know how to do that, you know. It's just -- I just feel like some of them are naturally born leaders, or maybe there's something that they learned from their parents how to fix something. You know. That you use things that are available. And... KAREN: Do you feel like you were naturally born to be a health aide? RITA: I think so. Yeah. When I graduated from high school, I wanted to go to nursing school but I didn't know how to find the money, the resources to go. I really wanted to go to nursing school. And when the opportunity came to be a health aide, you know, I -- I had to take it. And I think the main thing is just caring for people. You have to care for people and be a good listener and just want to help people. KAREN: Have you contemplated going to PA school? RITA: I did back then. Well, when they first mentioned PA school, my -- I think my youngest daughter was, like, 13 maybe. And I thought about it, but I'm such a home body, I can't picture myself leaving White Mountain. But I know my daughter wants to go to PA school and I'm encouraging her to go. You know. I know there's always still a chance to go. KAREN: So your daughter has become a health aide? RITA: Uh-hum (affirmative). My daughter is a health aide. She's a certified health practitioner. And she works with Willa's daughter. Willa's daughter is also a health aide, Carol. And they are doing very well. They are the main ones over there at the clinic. And I know if she goes to PA school, she will do very well. This younger generation, they are very smart. And I -- I think she's just waiting just a couple -- maybe another year, she will be ready to go. KAREN: And how does that make you feel to have your daughter becoming a health aide? RITA: When she first wanted to apply, I said, well, yeah, that would be good. You know. Because you're in the village and people sometimes think about families, you know. I didn't have any part in hiring her or getting her -- well, she did it on her own and the city council okayed for her to become a health aide. And I just supported her. I said, good for you, you know, do your best. And she was a young girl then just out of high school. And you know, when new kids come along, they kind of want to make their own rules, and I said, you just have to remember to be patient with people and treat them with respect. Elders and people who come to you, believe them when they say they are sick and treat them fairly. So I felt very good for her to come to work. She's doing real good.
KAREN: When you were a health aide and you were talking on the phone or radio with doctors, how was that interaction? How do you feel you were treated by the doctors? RITA: I think the -- I've always had good communication with the doctors. KAREN: Did you feel like they listened to you and took your advice on patients, or did they disregard you or what? RITA: Yeah. I've always felt that they've always listened to me. If I had, like if I had someone that was really sick, then I would feel very comfortable telling them this patient is really sick and I believe you need to come get them. So they would say, okay, send them in. And I always felt very good about that. And if there was something that they had question for, they would ask me a question, it would make me think, oh, okay, I think we can do this, we can take care of them here. We will try this and then call you back tomorrow. But I've always had real good response from the doctors, I think. All the doctors, you know, I think if you treat them with respect, too, and they do the same for you. KAREN: Right. RITA: It's really important when you're going through training to follow the CHAM. You know, it's the doctor's -- KAREN: The manual? RITA: It's their -- it's their standing orders that we're following. KAREN: And is the way that manual put -- is put together, is it easy to follow? RITA: You kind of have to get used to it. When the CHAM first comes out, they send it to the village with a tape, a videotape on how to use it. And I think for someone new, it might be a little difficult, but the more you use it, the more friendly it gets. And we are coming out with a new one, I think, this fall. Yeah. KAREN: And so as the village supervisor, is that part of your job is to make sure that everybody in the village is -- RITA: Yeah. KAREN: -- is trained on how to use it? RITA: Yeah. That's very important part of being a health aide, you have to follow the CHAM. And it's got pretty much everything in there. Yeah. KAREN: Have you delivered any babies? RITA: Yeah. Well, actually, I don't want to take full credit for delivering this baby, but in '77, Willa had her last child, Carol, she's a health aide now, but that was the last baby I did of her, I think. And I don't like to take all the credit because her mother was there as a midwife. And it was Christmas Day. Willa was supposed to go to Nome that day. Christmas. She begged the doctors to please let her stay home for Christmas Eve because that's when the village had the Sunday school Christmas program. She was in charge of that, and she said, I'll go to Nome next day because it was Christmas Day, but that night she started labor. And I was -- you know, I was a naive little young health aide and stuff. I -- I always remember back I wasn't scared or anything. And Willa is -- oh, she's a health aide, she's having a baby, she will help me, you know. And this little baby finally came out about 1:30 in the afternoon. It was snowing and planes couldn't come, but it happened to be Willa's daughter. And I was so glad later on, I started thinking, my goodness, you know, anything could have happened. Because you never know what a delivery is going to be like. And I was just so thankful. And I think in the back of my mind I must have been praying, but nothing happened. And Willa was okay. And I was really thankful for her mom being there. She delivered a lot of babies and she -- her hands were really soft. And when Willa would have a contraction, she would just rub her belly really soft and say, okay, you can push now. And I think she did most of the work. You know, the mother, of course. KAREN: Right. RITA: Just being there for that delivery was -- it's awesome. To watch a baby being born. And being out in the village. It was kind of scary, but at the time you just have to be there and I wasn't thinking how scary it could be. KAREN: Yeah, I was just wondering, in all those scary moments, or you know, there you are, you're faced with some kind of thing you've never seen before and you don't even know what to do, how do you find the courage to do anything? RITA: I know, it's just -- it's just something in the back of your mind, you're there, and I wish I could be somewhere else, but I'm not, I'm here, okay, let's just do the best we can. You know. If a baby is going to be born, a baby's going to be born. Just help it come out. You know. Gently hold the head so it doesn't pop out too fast and help the shoulder, make sure the cord's around the -- I mean, we learned all of this in training, so you just go step by step. But later on I was thinking, man, something could have gone wrong, you know. And just after the delivery I think I -- was when it hit me. That everything went so well. And I always believed that her mom being there and being a Christian woman, she was probably praying. So it was -- it was something that I -- I always look back and say how lucky I was to be there. Willa was doing all the work.
KAREN: Did you help deliver other babies? RITA: Yeah. I was with Willa, with other babies. I think there was two others. Those also went well. It was back before they had medevacs. And I would just have to help, you know, help Willa. She did most of the work. But I was -- I always hear stories, too, of other health aides delivering in other villages where they had complication, and I just felt so lucky that we were blessed not to have any major problems. I think back in '73 or '74, when I first became a health aide, it was Labor Day weekend in May, and Willa took some time off to go camping. And there was this young girl, she must have been 13 or 14, who had no prenatal care but she went into labor, and I was the only one there. And we had one telephone in the village and it was a pay phone. I'm not sure if I used the pay phone or if I went on the standby radio and told them this girl is delivering, her bag of waters broke. And they sent a plane with a nurse. And I was scared then because I was just young and I had never seen a -- a pregnancy before or a delivery. And Willa's mom was there, she was the midwife then. And that was scary for me because you know, I didn't have any kind of training or any kind of CMEs. KAREN: Yeah. RITA: And I felt like I was mostly a bystander, just, you know, the nurse came and she said get me this, get me that. So that was different from later on when I -- after seeing the other deliveries. And there was one delivery with another health aide who was on call, she called me to go help but I wasn't feeling well, and I had to step outside to get some fresh air, and I heard the scream and went back in and the baby was born. So you know, everything's different. It's just -- I was there just mostly for moral support, I think. And it happened to be Willa's granddaughter that was born. KAREN: Did you participate in these radio traffic sessions when you became a health aide? Were they still doing that? RITA: With the standby radio? KAREN: With the radio, or by the time you were a health aide, they were using telephones? RITA: I used a stand by radio. And when I first became an alternate, Willa used to let me -- they started radio medical traffic one o'clock every day, and it was with the doctors, used to be from Kotzebue. And the Kotzebue doctor had all the villages up there and all Norton Sound villages. So White Mountain being with a W, we are at the end. And we used to wait quite a bit sometimes. So I'd sit there and she -- Willa would say, why don't you just sit here and listen, you can listen to the other health aides and how they report and you can learn from it. The doctor will ask questions and you will see what you need to prepare, what kind of questions you need to prepare for the doctor to ask. So I'd sit and listen, and I think it was the last two years before they stopped using the standby that I got to use it in White Mountain. The doctor from Nome would call and because White Mountain is on the hillside and we have trees and mountains, sometimes we didn't get very good reception. So we would have to relay to either St. Michael, Stebbins, or Gamble. KAREN: Oh. RITA: Sometimes they relayed for us so we would have to go through them, and then they would talk to the doctor and going back and forth. And that was always -- it would take much longer. But using the radio, it used to be kind of a little difficult because you have to wait for the doctor to ask questions, then you come on and ask questions, and you talk back and forth. But I just learned by listening. Mostly. And Willa taught me the call numbers and how to report to patients. Like we could have two or three. And back then, you know, before training, we didn't realize that we were reporting, like, sore throats and bad colds, things that we could have been treating ourselves, but this is before training. And we didn't know. KAREN: So eventually you started treating those things yourselves? RITA: Uh-hum. By following the medical standings orders. Yeah. KAREN: And then what about when the telephone, do you remember when they started having a telephone? RITA: Yeah, that was a big change. It was a change for the better, too. Then they started calling White Mountain, we still went alphabetical order. So they would call us before three or four o'clock. And it seemed easier. And now we still use telephones, but they also have telemedicine for pictures if we have, it's better to describe. And we also had a fax, we can fax the PAs, they can read it, and they ask us to import questions that we need, do you think this patient needs this or that. And so it's a lot easier now. KAREN: So do they sort of still have the radio traffic kind of thing? RITA: Yeah. KAREN: They still have a set time to talk to the doctor on the phone. RITA: They still start at one o'clock every day, and the villages that have a PA, they tell them to talk to their PA, so the doctor just calls the villages that doesn't have a PA. KAREN: Okay. RITA: And so they are calling us earlier now where they used to call White Mountain, you know, five o'clock, six o'clock, now they are calling us like two, three o'clock. KAREN: That's good. RITA: That way we can respond to the patients', you know, needs.
KAREN: We just have a few more minutes on this tape. RITA: Okay. KAREN: Unless I change to another tape, but I know it's getting late, so I don't know if there's other things that you wanted to talk about that's important to you about the job that I haven't asked about. RITA: I think you covered everything. I think you covered most everything. KAREN: Do you have any advice for somebody who would want to become a health aide. RITA: I would encourage anyone to become a health aide if they want to. Norton Sound is very supportive. They have the best training center in Alaska. And I had a cousin who, when she became a health aide, she was kind of scared to become a health aide because she wasn't sure how she would learn. I encouraged her just take it, you know, do good, all you have to do is care about people. You know, if you love people, really care about them and listen, you'll do good. And she became a health aide. Now she's really happy about it. I think that's the more important thing is if you love taking care of people and are a good listener, everything works all right. KAREN: And were there times when you've wanted to quit the job? RITA: Yeah. KAREN: How do you get through those tough times? RITA: Yeah, when I was working alone and there was emergencies, you know, sometimes the weather was bad and the planes can't come right away, always taking call, I think the reason I really wanted to quit was because you're on call all the time. You couldn't leave the village to go, like, on a snow machine trip or on a camping trip because you're just basically stuck there. And I don't know whether the health aides long ago did that. I have so much respect for them. KAREN: So what kept you from quitting? RITA: Wondering who else would do the job that I'm not doing it. I was worried that there wouldn't be anybody else who could help people. KAREN: So are you glad that you remained a health aide? RITA: Yeah. I think it was the best part of my whole life is being a health aide and helping people. All the training, all the people I got to meet, you know, it just -- it's incredible. KAREN: Okay. If there's anything else, we're out of tape. RITA: Okay. That's fine. KAREN: Thanks a lot. RITA: Uh-hum (affirmative).