Roy Huhndorf was interviewed on August 23, 2005 by Karen Brewster at his home in Anchorage, Alaska. In this interview, Roy talks about managing the Community Health Aide Program, the transition from the Indian Health Service to regional health corporations, disputes between agencies, the strengths and weaknesses of the program, and what the job meant to him personally.
Digital Asset Information
Project: Community Health Aide Program
Date of Interview: Aug 23, 2005
Narrator(s): Roy Huhndorf
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
After clicking play, click on a section to navigate the audio or video clip.
His personal background and early involvement with the Community Health Aide Program (CHAP).
The training and education of community health aides to provide primary care in their communities.
The training and education of community health aides to provide primary care in their communities.
The role of the Community Health Aide Program as a model for similar programs around the world, and the governmental support the program received.
His experiences working in the administration of the Community Health Aide Program.
His memories of some individuals who contributed significantly to the Community Health Aide Program.
Cultural concerns that arose in the implementation of the program, and who was in control of policy making decisions.
The appearance of regional Native corporations, and the development of his own career.
How health aides were selected and educated, and the role of traditional health care providers.
The hardships faced by early health aides, how the program has changed, and strengths of the community health aide program.
Weaknesses in the community health aide program, education, training, and skills of health aides, and the overall success of the program.
The evolution of the Community Health Aide Program and the various administrative entities helping in its development.
His reasons for the career path he chose, the challenges he faced as administrator of the Community Health Aide Program, and some more information on sources of funding for the program and which communities benefited.
The construction of clinic buildings, how early health aides communicated with doctors in other communities, and some comments on important nurses from early on.
What working with the health aide program meant to him personally and his career development, and how as an administrator he dealt with conflicts between organizations.
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KAREN: And then an introduction, which is I'm Karen Brewster, and here in Anchorage with Roy Huhndorf. It's August 23rd, 2005. And this is for the Community Health Aide Project Jukebox series. So thank you for being -- willing to participate in this. I appreciate it. Just to get us started, tell us a little bit about yourself and what your involvement with the Community Health Aide Program has been. ROY: Fine. I'm happy to do this. This is a -- Community Health Aide Program has always been one of my -- the favorite chapters in my life. I was born and raised until I was 15 years old at Nulato, Alaska. Born in 1940. And then moved to Anchorage in 1955, which has been my home since. In 1970 -- wait a minute. Excuse me. In 1972, I had the good fortune to become involved with the Community Health Aide Program. I was hired at the time to replace the administrator who was leaving, and I interviewed for the job and applied for it and -- and was given the appointment. The program was under the auspices of the Indian Health Service at the time. Indian Health Service was divided into -- had an area office and then had -- had service units, which really had hospitals at the center spread out to cover the geographic area of Alaska. And the area office administered the general policy for the service in Alaska, and the statewide programs. The Community Health Aide Program was a statewide program. It was funded and operated by Indian Health at that time. It was an innovation of Indian Health Service, going back to the mid late '60s. And interestingly, federal agencies are not known for their innovations. This was one of their innovations. The health providers for Alaska decided that it was important to involve the recipients of the service in the delivery of the service. And that was the central idea in starting the Community Health Aide Program. And it had long been known that there were natural providers of health services in rural Alaska that predated the Indian Health Service, Native people for many centuries, actually, probably thousands of years, had some sort of health provider in each village. And as modern medicine progressed in the 1900s and people began to become familiar with the -- with the -- with the things that were available in modern medicine. These health workers began to take on, on their own, a more sophisticated administrations of medicine. KAREN: Did the -- ROY: And so it was a natural for the service, they saw these providers working, and decided that they might benefit greatly from additional training and some organized supervision, some high level supervision, medical supervision.
ROY: And so the idea of training what we would call, I suppose, paraprofessionals in the villages became a reality about 1967 or '68. Maybe even a little earlier. You'll have to check the records on that. KAREN: I think '68 is the official date. ROY: Yeah. And the program was organized to bring selected health workers from the villages into Anchorage and to the service unit hospitals for specialized training in the delivery of primary health care. The program kind of grew through experience. It was modified and adjusted as we went along, and of course, having come in 1972, the program had already been in operation for some four years. But there was still a lot to do. There were more innovations to put into operation. We had learned from our mistakes, I guess, in the past, and now we were -- we were tuning up the program and fine tuning the training. There was a staff of nurses, essentially, that were the training staff, supervised by a medical director. They were all very collegial and worked as a team, though. Very competent team. They -- the nurse trainers traveled throughout the villages and -- and performed training seminars, very well structured ones in each of the villages to augment the training that health aides would get when they were brought into Anchorage. As I recall, there was, like, two or three weeks at a time an aide would come to Anchorage and -- and undergo intensive training, and then would receive supplemental augmentative training as -- as they progressed and matured.
ROY: At the time, as I recall, we had nearly 200 what we called primary health aides, and maybe half that many alternates that were trained. Maybe -- maybe more than that. Maybe -- an equal number of alternate health aides that were not as well trained, but could stand in when the primary was not able to perform. And the system consisted of a book of standing orders, what to do in case of emergencies, a radio that they could talk to the service unit hospital with, and -- and get more complicated, complex instructions as -- as necessary. They could decide -- the health aide was sort of the eyes and ears of the physician and they would, together, decide whether the person needed to be evacuated or -- and so forth. The health aides could administer first aid. They could administer some pretty sophisticated stabilization, you know, things. They did some preventative health, performed well-baby clinics, they gave immunizations. So they really provided for, I would say, the great bulk of the primary health care delivered at the village level. So here was a brand new program coming, bursting onto the scene, the first of its kind really in the world, and it was intended to provide first line medical care to sparsely populated, large geographic areas. And so it kind of became a model. In later years, I understand, and even while I was there, people would visit from Australia and from Canada and from Russia and China and elsewhere where there were scattered populations that required or needed a health system, a health delivery system.
ROY: So the program became quite a model. It was noticed by the Office of Economic Opportunity, which was a new agency created by the Johnson administration to provide for special initiatives in enlisting young people, particularly in the famous slogan that John Kennedy used, ask not what your country can do for you, but rather what you can do for your country. So OEO had a number of agencies, you know, I'm not sure which ones they were, but Peace Corps, and there was another operation nationally, and they became involved in -- in effective programs that -- like that. And the health aide program caught their eye. And so they funded -- they made a funding effort in Alaska to augment the Indian Health Service effort. And under that funding, the out -- came the Yukon Kuskokwim Health Corporation and the Norton Sound Health Corporation, which started, I believe, about 1968 or so, just about the time the health aide program was getting off the ground. KAREN: Wow. I didn't know those were so old. ROY: Yeah. And they augmented Indian Health Service's effort with their budgets and began taking up the training, collaborating with Indian Health doctors, hiring their own doctors based out of Nome and out of Bethel. And became a great accelerator to -- to the furtherance of the program. There were often disputes, and I remember some of those disputes. Three organizations really working together are bound to have -- have disputes, but they were there and they argued over or, you know, the quality and quantity of -- of services, and in the end, it all worked out for the best. And there was this, you know, private esprit de corps organization saying, you know, our health aides are better trained than yours, and they are higher -- they are more capable of delivering more sophisticated services. And you know, whether that was true or not, I don't know. KAREN: So some -- ROY: But it was a good thing, but it was competition. KAREN: So some of the health aides worked for the Health Service and some worked for the corporations? ROY: For the corporations. Yeah. Uh-hum. And later on, as the health corporation model began to take hold, each of the 12 regional areas organized their own health corporation. And now you have a system of at least 12 health corporations that administer to their health aides, most of them have hired their health aides in their region, and -- and work with the Indian Health Service in the continued training and -- and utilization of the aides, aide system. KAREN: Yeah. I didn't know if the Indian Health Service is still involved with it now or if it's all now health corporations? ROY: Well, most of that money is Indian Health Service money that has been contracted. You're right. Indian Health Service does not really now exist as an operating entity in Alaska. All of it -- all of its services have been contracted out to the Native corporations. KAREN: Okay. ROY: Including the old area office, which is the statewide hospital now. And it's called the -- the Tribe -- with's the -- I'm trying to look for it now. KAREN: The Tribal Consortium? ROY: The Tribal Consortium that runs it now. KAREN: Something like that. ROY: Right. KAREN: Which is Alaska Native Hospital -- ROY: Yeah. KAREN: -- is what it used to be. ROY: The Alaska Native Tribal Health Consortium. That's it. Yeah. And it runs the hospital. It's a -- it's a -- it's composed of the 12 regional health corporations. They all have a representative, and together they supervise the statewide hospital. The other hospitals are run and supervised by the health corporations of their areas. KAREN: Yeah. Right. I know in Bethel it's YKHC. ROY: Yeah. And here in Anchorage, the Cook Inlet -- the Cook Inlet's Health Corporation, Southcentral -- Southcentral Health Corporation, Southcentral Foundation, rather, runs the primary health care system for the hospital at Anchorage here. It's really attached to the hospital -- KAREN: Okay. ROY: -- but they have charged of all of the primary health care, which is -- KAREN: Like a clinic typesetting? ROY: -- the clinics, the preventative health care, the screenings, the lab work -- KAREN: Okay. ROY: -- and things like that. And the hospital involving beds and patients are really run by the hospital itself. KAREN: Yeah. That's similar to -- ROY: Uh-hum (affirmative). KAREN: -- Fairbanks where TCC has the Chief Andrew Isaac's Clinic that's attached to the hospital, and the hospital isn't run by the health corporations, it's run by a private entity. ROY: Oh, I see. Yeah. KAREN: The Fairbanks Memorial Hospital. But TCC -- ROY: TCC is really the health corporation for the area. KAREN: Yeah. ROY: Yeah. KAREN: And they have their own clinic there -- ROY: Right. KAREN: -- attached to it. ROY: Right.
KAREN: So as administrator, what was your role? ROY: My role was -- was primarily to hire and -- and supervise the staff in a -- in a management sense or in a leadership sense. I was in charge of the budget and -- and all the programmatic reporting and -- and accounting that needed to be done. The -- the medical side of it actually, though, received the medical supervision from a medical doctor, and a -- and a high level nurse trainer that was in charge of the other nurse trainers. KAREN: Uh-hum. ROY: And so they -- you know, they had -- they did all the medical input, they fashioned the policies, of course, always discussing them with me. But I -- I guess it was a very -- it was a situation where everybody had to consider themselves a member of the team, and -- and the very strict authoritarian boss worker kind of a -- of a organization didn't work there. It had to be very participative, very egalitarian, in order to make it work because, you know, well-trained medical people don't like to think of themselves as being just another worker, they are a pretty skillful person or persons, and they should be treated accordingly. And they have their professionals -- professions that -- and skills that I don't know anything about, you know. I'm -- I'm just a business major and I run budgets and plans and do strategies and -- and write reports and hire people and counsel people and let them cry on my shoulder, things like that, you know what managers do. Leaders do, I guess. They say you manage assets and you lead people. At least that's what business school taught me. KAREN: That's what they taught you. ROY: But in those days, yeah, it worked really well. We all had a good relationship with each other. We all talked through our problems, worked them out. It was a very exciting time. It was a very exciting time to see that with such a small budget, and I believe it was less than 2 million at the time, we were impacting 90 percent of the primary health care delivered throughout rural Alaska -- KAREN: Wow. ROY: -- with using the residents, the indigenous people themselves to provide the services. And I thought it was, you know, wow, this was -- this was really something that -- that you could dream about but didn't often happen, you know. And here it was happening. And the aides were happy. They were doing what they liked to do. They were receiving the training. They are always a respected individual in their community. And it was always great fun to -- it gave -- it gave you a great sense of accomplishment if you were involved in the program at any level, you know, that this was all happening and you were impacting positively so many lives. Saving many, as well.
ROY: I worked there for two years. I came in May of 197 -- no, for three years, excuse me, in May of 1972, and I left in May of 1975. KAREN: And so was that when Walt Johnson was the medical director? ROY: During my tenure, Walter Johnson was the medical director for most of the time we were there. He and I had a great relationship. And before him was a young very, very competent doctor. Well, I'm not remembering his name. Anyway, his name is in the file. He preceded Dr. Johnson as the medal director. A very fine man, a very wonderful writer, compassionate fellow, both of them were. And always -- always contributing new innovative ideas to how we could do things better and working very hard and very wholeheartedly at their tasks. KAREN: What about some of the nurse trainers? Who were they? ROY: Eva Boyce, during -- was there during my tenure, an older lady, very experienced, very experienced in supervision. Eva's not with us now, she died some years ago. And there was under her, working for her, some very fine ladies. There was Barbara Johnson, there was Mary Bolan, who is still around Anchorage here. And Barbara, I think, lives in -- lives in Colorado -- lives in Arizona. What's the place high up in the mountains? KAREN: Flagstaff? ROY: Yeah. And let's see. Another person who later moved down to the chain and worked for the Aleut Corporation, Aleut Health Corporation, is dead now, but she was there, as well. A woman, a Native woman by the name of Loretta Askolkoff was there for a time. She was a Public Health nurse. There were several others, but I can't remember the names now. They came -- some of them came for a few months and then left and were -- you know, went on to do other things or got hired by the corporations. KAREN: Yeah. And how did that work? Those nurse trainers, it sounds like, were mostly non-Native -- ROY: Uh-hum (affirmative). KAREN: -- from other places, and then they were obviously working very closely with mostly Native health aides, I would think. ROY: They were. There was only one Native nurse trainer and that was -- that was Ms. Askolkoff. KAREN: Do you need to get your phone? ROY: No. I'll just leave it go. KAREN: Okay.
ROY: What else might you want to know about the program? KAREN: Well, I was wondering the relationships between the people in terms of, you know, did the nurses and the doctors get some cross-cultural training? All of a sudden they are working with people from different cultures, different backgrounds, different types of communities, and vice versa. ROY: Uh-hum (affirmative). KAREN: And how that worked. ROY: Yeah. Well, they did, in a way, first by actual hands-on experience going out there. Secondly, by interfacing directly with the health aides when they came in. And by the way, there grew great comraderies out of that relationship. Wonderful relations, probably as Walter Johnson and Mary Bolan will tell you, still exist day, you know, years later. And also I'm an Alaska Native -- KAREN: Right. ROY: -- and my boss was an Alaska Native, Jerry Ivey, who I don't know if you've interviewed Gerald Ivey. KAREN: No, I haven't. ROY: Gerald Ivey -- this program was run out of a division of Indian Health Service called the Office of Native Affairs. Strange name, but it was -- it was up high, it was right next to the area director who, at that time, was a doctor by the name of John Lee, who is now, I think, deceased. A fine man, very open-minded man. And while many of his colleagues were clamoring for, you know, this is not a program we want around, you know, heaven forbid, might do us out of jobs as doctors, and Lee would hear none of it. And -- and he gave strong support for the program. Jerry Ivey himself was a Native person from the McGrath area. KAREN: Okay. ROY: And a fellow by the name of Bob Singyke was -- was in charge -- was in charge of another branch under him. I was in charge of one branch, the health aide program, and Mr. Singyke was in charge of the other branch, which had to do with -- with building Native health board capacities. And he worked closely with Native health boards throughout the state to make sure that they became deeply involved in policy development of delivery of health services. KAREN: So what was Gerald Ivey's role? ROY: Gerald Ivey was the director of the Office of Native Affairs, reporting directly to John Lee. KAREN: Okay. And so the CHAP program was under the Office of Native Affairs? ROY: Yes. Yes. KAREN: Okay. And where is he now? ROY: He's here. He retired. He lives in Anchorage here with his wife. And you can catch him when he's not fishing or visiting his wife's Indian family in New Mexico. KAREN: Okay. Yeah, because I haven't heard his name before. ROY: Yeah. Gerald Ivey. A fine man. A brilliant tactician, a brilliant advocate of Native people's drive to assume more of the health services delivery that we were receiving. No, he -- when he retired, he retired. He just -- just decided that he wasn't going to become involved as a consultant or stay involved in the health services at the hospital. He figured he had done his time, which was like about 25 or 30 years, so I don't blame him. KAREN: Yeah. ROY: But did a very fine job when he was there.
KAREN: So what did you do after 1975 when you left? ROY: Well, before you go there -- KAREN: Okay. ROY: -- you may want to interview Mr. Ivey and Ms. Bolan. They are still around. KAREN: Okay. ROY: And they have a lot of -- they have a lot of the -- Bolan, for example, could give you a lot of the technical slant of the training. KAREN: Well, and as a nurse -- ROY: And Ivey could tell you a lot about the policy strategies. KAREN: And then her role as a nurse trainer, that's somebody, a perspective that we haven't talked to. ROY: Yeah, she's a surgical nurse by training and a very highly trained nurse, and very competent trainer. KAREN: Okay. So did you continue to do work related to the health aide program after '75? ROY: No, unfortunately, I didn't. I was involved in -- in the local Native organization at the time pursuing a claims settlement, a land claims settlement, and this dated back to the late '60s. And during that period of time, the land claims settlement had been enacted by Congress and a corporation had been formed in Cook Inlet, as had been the case with -- in the other regions. And I was a -- a member of the board. And in 1975, there had been a period of what I call high burn kind of activity where we more or less burned out two presidents in a row and each serving two or three years, and just couldn't cope after a while -- KAREN: It was. ROY: -- with the high, high pressure -- KAREN: Yeah, it was an intense time. ROY: -- and demands. And so the board asked me if I would consider being considered for president. And so after some thought, I said I would, and they hired me as the president of Cook Inlet Region, Incorporated, and I left -- so I left the program in May of '75 and worked at CIRI as president until January of 1996. KAREN: And then you retired? ROY: Then I retired from that job, and I have since been a -- a consultant. I consult with nonprofit organizations and help them raise funds, primarily from foundations and other private sources. KAREN: Oh, great. Now we can get back to the -- ROY: But I don't do it on a full-time basis, it's more of a half-time basis. KAREN: Yeah. Well, you're retired. ROY: I'm retired and tired. KAREN: I do have some more questions on the health aide, I just kind of wanted to get the whole picture. ROY: Uh-hum (affirmative). KAREN: And you said you went to business school -- ROY: Yes. KAREN: -- for your education background? ROY: In fact, I went at night. I started at community college in 1972, then switched to the University of Alaska, taking a couple of courses a semester, University of Alaska Anchorage, and took night courses. And I finally graduated in 1984, 12 years later, with a -- a bachelors degree in business administration, emphasis finance and management. In those days, they had switched over to only one emphasis, but they said I was grandfathered, so they let me -- I had enough credits for two emphases, so they let me do that.
KAREN: I'm interested in what you were talking about, about the traditional Native healers and then the transition into the health aide. And how were health aides selected to participate in the program? ROY: As I recall, they were selected in a combination of ways, whether or not they all -- already had been practitioners; and secondly, there were discussions with the village councils about who would they most -- find most favorably -- who would be most favorably disposed to being a health aide, a deliverer of health services. By interviews, volunteers would volunteer or ask to be interviewed, and express interest, express interest. So there were a number of ways the selection could be made. But -- but a lot of deference was given to people who had already been involved in delivering health care or dental care or who had, you know, worked with -- been noted by the Public Health nurse as she went through the village to -- as a person very interested in health care. Incidentally, the State of Alaska, at the time, had a Public Health nurse program. They had a series of itinerant nurses that went throughout village Alaska, they had a -- a cadre of nurses. And they traveled virtually all the time, administering primarily preventative health measures. Immunizations, well-baby clinics, Public Health lectures, and the things that Public Health nurses do. Examinations of families, women, others in the villages as they went through. And they also became involved in the health aide program. They -- they participated in some of the training. KAREN: Oh, okay. ROY: At first, it was -- it was a hard -- it was a hard relationship. It was -- the State, you know, often didn't get along with the Indian Health Service, the Federal. State and Federal didn't -- didn't get along too well. And there were a lot of jealousies and petty ego fights over whose jurisdiction what was in, and of course, Federal people, Federal guys are pretty much preeminent. And they have complete -- they have complete authority over Alaska Natives' health. And the State had long ago conceded that, but still, village Alaska was of concern to them and they did have this public itinerant health -- Public Health nurse itinerant service, and eventually, the nurses themselves just, you know, came together with the health aides and recognized them as a resource and -- and began utilizing them and didn't pay much attention, I think, to the policy -- the policy guys down in Juneau and what they wanted to do or not do. Health care was important, they were going to deliver it. KAREN: Right. ROY: And they did, you know. So I thought it worked very well. And after a while, everybody got -- started getting along and it all worked out. I don't know if the State still has a Public Health nurse program. KAREN: Yeah. I didn't realize -- ROY: Yeah. KAREN: -- that the Public Health nurses were State. I always thought that was Federal. I thought PHS was Federal. ROY: No. No, they were -- as I understand it, they were State hired and -- and -- and they represented the State Public Health. KAREN: Hmm. That's news to me. And I don't know if they still exist. ROY: Check it out and see. KAREN: Yes. ROY: I'm almost certain that they were paid and employed by the State. But they were some tough ladies. They could travel for days and days and days and live off their backpacks and -- and do the job, you know. I had great admiration for those people. I thought they were very -- very -- very important health care deliverers. And later interfaces with the -- with the health aides. And mentors, you know. So they need some credit there, too, when you do this historical because they did get involved and they were a very productive -- a very productive element in this whole village health -- on the whole village health scene.
KAREN: So was being a health aide a job that was sought out, that people wanted? ROY: To some degree, to a great degree, if you were in health, you loved it and you stayed there and you delivered it, but it was a hard job. Being a health aide in those days meant working long hours, meant not getting paid very much at all, it meant listening to the gripes and complaints of people who felt you didn't do a good job. It meant being awakened in the middle of the night because someone was badly injured in the village. It meant that sometimes drunks would -- would harass you and wake you up and demand things that were unreasonable. And so it was not an easy life. You were on call 24 hours a day. And you had to really love the -- love the labor in order to do -- to do the job. So not an easy life. Those who were there liked it. Many -- there were several who burned out, though, that just couldn't -- couldn't reconcile their families' demands and needs and be on call 24 hours a day. KAREN: And I wonder -- ROY: And often, you know, the village politics is such that, you know, the village council's relative is making unreasonable demands, but the village council is not going to do anything because he's the president's brother or the president's relative. And so it's a hard life, you know. You don't get the help when you need it sometimes. And so I -- I listened to a lot of those complaints when I was chief of the health aide program. But they made it through it all, and the program's still alive today and doing well, just as well as it always has, I think. KAREN: Do people still come and talk to you about what's going on in the programs? ROY: Occasionally. I see some health aides that are still there and it's like, what is it that's -- it's like 30 -- over 30 years later. Yeah. Yeah. KAREN: Yeah, I was -- that was one of the things I was wondering is how the program is functioning now. Is it the same? Has it changed? And also in terms of the people who take the jobs, is it still a sought-after job or -- ROY: It pays better now. It's better organized in terms of village relations. I think these people, instead of being employed by the Village Council, now are being employed by the health corporations, so that makes a big difference. They have benefits now they didn't have then. They are still not paid very much, but they at least have some benefits and they are somewhat immune from -- from local tyranny. KAREN: I have heard some people comment that more and more the health aides are becoming non-Native people coming into the village instead of people from the community. ROY: Oh, I haven't heard that. KAREN: You haven't heard that? ROY: No. But then again, I haven't heard much about the program since -- in the recent years. KAREN: At the time you were involved, or I don't remember reflections on it, how do you assess the program's strengths and weaknesses? ROY: Well, I think the greatest strength of the program when I was there were all of the people who were involved and their great enthusiasm about this -- about this project. It was a very contagious enthusiasm that we all adopted, and I consistently say that those were some of the most -- those were some of the happiest working years of my life because of the -- the going home at night and saying, we're making a difference. We're making a real difference in the lives of these people. And I think everybody else in the program were feeling the same way about it. So the strength was really the enthusiasm of all of the people that were involved from the -- from the medical directors to the trainers to the health aides themselves to the administrators, everybody was very excited about this program. That was, to me, the greatest strength. Everybody went the extra mile.
ROY: The weaknesses, of course, were some of the things I mentioned earlier, the long working hours, the on-call, the low pay, the bad benefits -- no benefits. Some of the local politics that pervaded. And these were negatives. And the lack of overall money, I guess, to do even more. We wanted to do more -- the training more quickly, and, you know, bring the level -- bring the education level of the health aides up more quickly than we did. It took us a long time to do that -- to do that training. Training is continuous. I know that. Continuing education has to go on in -- in health profession, especially. And the health aides even today are coming in, I think, at least one week a year for specialized training. KAREN: Right. ROY: Even those that have been trained up, highly trained. Today, some of the health aides and the doctors will tell you they are operating at a level that is at the beginning doctors level, when a doctor first comes out of the medical school and his residency -- and into residency for a while. Some of these people are operating in a pretty -- in a pretty sophisticated way out there. Very, very skilled after all these years of experience. KAREN: Right. ROY: Plus the wisdom you get -- KAREN: Right. ROY: -- that you get with years. KAREN: Right. It's interesting you say that for some of the health aides, their education level before becoming a health aide may have been minimal. ROY: Minimal, yeah. Uh-hum. KAREN: And how they reconciled that in the training. ROY: Well, it happened. We did it. And a lot of it is common sense, you know, and a lot of it has to do with the dedication of the trainers and the ability to go back and go over and over again until, you know, we make sure that -- that the health aide has it. And -- and it was not a great problem, the lack of education was not a great problem. We had people out there that had a lot of horse sense, you know. KAREN: Yeah. ROY: They knew the practical side of health delivery. And they wouldn't be health aides if they didn't have a good sense. KAREN: Right. ROY: So -- KAREN: It's interesting that it sounds like the success of the program was a lot of hard work by a lot of dedicated people, and why the health aide program got that and it worked and there's other programs that have come and gone, whether it's in health care or in other things. ROY: Uh-hum (affirmative). Uh-hum. KAREN: And it's interesting why the health aide program has worked. ROY: That was an era when a lot of things worked. And I think a lot of the people felt a calling to do a good job. You remember the old posters that were on the wall, and you're too young to remember this, but they were on the part of the Office of Economic Opportunity, some of these posters would say if -- if you're -- if you're not part of the solution, you must be part of the problem. KAREN: Right. I know the saying. ROY: You are part of the problem. Yeah. And so people were kind of, you know, admonished and urged to do their very best and be a contributor to a better society, and as a result, a good work ethic coming out of these, all the folks involved. Everyone was young and enthusiastic, too. The '60s were really a wonderful era. Young people -- young people speaking their minds, as the song goes, you know. KAREN: Yeah. ROY: Were you -- you weren't around in the '60s. KAREN: I was around in part of the '60s. ROY: Oh, okay.
KAREN: So you were saying that as the administrator, you know, people came to you with problems or, you know, some of their personal issues or whatever. How did you solve those? ROY: We would do our best to communicate with the village leadership with the region. We would do our best to make sure that -- or try to make sure that the health aide was treated fairly. That -- we would -- Bob Singyke did a lot of that communication and worked with the health boards to get that across to the health boards. And I personally had to call some village councils from time to time, presidents, and say we have got some -- some serious problems out there. And you've got to take some different action. And it all worked out. There wasn't many times I did that. A lot of it came through -- the health boards came through the great -- at the time, the motivation of the Indian Health Service was to begin turning more and more of the policy decision-making over to Native people and contracting out to Native people, and -- and it stuck -- to its credit, the Indian Health Service stuck to those policies. And more and more, if something wasn't working, you know who to call. You know, you could just call the corporation or you could -- and it would get taken care of. Most of the time. Yeah. But, you know, to say there were a lot of problems out there would be an overstatement. There were problems, but -- but they were solvable and we did solve them, and I think through a lot of good will, things got done. It worked out. And so in all corners now, in the university, the health aides are saluted as really a very high -- a very, very highly successful program and the individuals are -- are highly regarded as outstanding members of their community, very important members of their community, and I think things are much better now. Health corporations have largely organized, re-organized out there, the whole supervision and ethic of health delivery out there. And the vision, I think, has been realized. Native people running their own health care services. KAREN: And you see a difference in how the health corporations are doing it versus when it was under Indian Health Service? ROY: Yeah. There's -- there's something of a difference, though there has been no compromise in -- in fact, in -- in the quality of care. KAREN: Does -- ROY: But perhaps a little more money is spent on administration than Indian Health did. They were more sparse in that area, spartan. Maybe too spartan, you know, in a way. KAREN: I need to check the time here. I forgot to check it. ROY: So there's lots of people to congratulate here. Indian Health Service, the Native corporations, the health aides. It all worked out, you know. It worked out beautifully, I thought. I think. KAREN: That's good.
KAREN: Yeah. Was -- you were talking about the -- the time period, and that was at the time when Native claims was being settled and -- right? ROY: Right. KAREN: It was all going on at the same time. ROY: Yes. Precisely at the same time. The lobbying for the claims settlement began in the mid '60s, early '60s, and culminated in 1971 with the passage of the Settlement Act. KAREN: So what drew you to working for -- for the health program? Why did you apply for the job? ROY: I always liked health, to begin with. I guess had my parents been a little bit more better off and had I been a little bit more capable financially, I would have become a medical doctor, probably. I -- I long -- I long thought that that would have been the case for -- I, for a long time, thought that. But yeah, couldn't, didn't. But I've always had an interest in health. I always, in high school, I scored well in biology and physics. And I always gravitated to the health section of Time Magazine when I was growing up, too, when it would appear in the house, I would look at what the health section says. I liked health, so it was no wonder I went there. I applied for the job when it came open. KAREN: What was the most challenging in the job for you? ROY: Well, people are always the most challenging. Reconciling wills are -- of the many players, was really the challenging part of the job. And I didn't suffer a lot of anguish over that. I just did it. And I haven't -- I guess I have a nature that I like to get along and work with people and I don't like fighting with people and I want to be pragmatic about this and find a way to get the thing solved. And we have a mission to do and how can we put our heads together to solve it. So it was sort of an attitude, I think, that that attitude helped me. But that was the hardest part of the job and I could see where you could burn up -- burn out pretty fast if you got too authoritarian or got too -- got too fixed in your own ways. And there were many good ideas out there, and you needed to reconcile them all and bring them together for the improvement of the program. And I think we all thought alike in those -- in those days. And so that -- it could have been a hard part of the job, I guess, but -- but it really didn't turn out for me to be a -- too hard a -- but I could see it could have been, you know. KAREN: Uh-hum. ROY: Now, the other hard part was convincing the Federal government to give enough money to the program. That was always a constant battle. Writing budget documents and having to tell health aides there would be no raise this year. We can't give you any more money. And for years, the health aide wage remained static. No -- there was no -- not even an inflationary increase, you know. KAREN: What was the wage, do you remember? ROY: It was very minimal. It was just a few hundred dollars a month. 3- or $400 a month. It wasn't much. 2- or 300 even, as I recall. Yeah. KAREN: Yeah. I mean, they were on call -- ROY: They were on call 24 hours a day, yeah. KAREN: Yeah. ROY: So it was not justified, but it was all we had, you know. And in some ways, we were relying on the -- on the neediness of the people to maintain that work force out there. They were -- they were too needy to quit the job paying the meager wage, but at the same time, they knew the village needed the help and they were the provider and people were relying on them. So in a way, it was sort of an injustice, you know, that we -- we treated those people that way for so many years. And that was a hard part for me to reconcile that. I understand Congress has limited money, you know, but we were, in some ways, we were just -- I often thought, well, why don't we just cut this thing way back and just do a few villages and -- and pay them decently and do it right. And -- but it didn't work that way. We -- instead we just didn't expand beyond what we had done. We had covered virtually all of the large villages, nearly 200 villages, and we had provided for a basic health aide -- primary health aide, and then we provided for alternates, alternate health aides to spell them off whenever they just couldn't be there. KAREN: So was there a population cutoff for the village and which qualified? ROY: Yeah. There was -- you know, we couldn't do the really tiny villages, like the ones with 25 or fewer, we just -- just couldn't get to, you know. 25 or fewer people. KAREN: Right. ROY: So that -- that was kind of a hard thing to reconcile was the lack of money and having to tell people we just -- you're working, we know you're working hard and we know you're really doing your best and you're on call 24 hours, but all we can pay you is 2- or $300 a month.
KAREN: And at the time they didn't have clinics or anything like they do now, right? What were the conditions? ROY: Very few of them did. The clinic program was just beginning. We could only build a few clinics a year. And we did that. Only a few clinics came into existence each year. Later on, the program was -- the clinic program was bolstered. And now I think it's pretty well saturated. KAREN: Right. So when you were there, do you remember which villages you built clinics in? ROY: You know, I can't tell you, but there was only a handful a year. I was not in charge of the clinic building program. That came out of Jerry Ivey's office. KAREN: Oh, okay. ROY: He worked directly with Dr. Lee on that, and the construction department of Indian Health Service. KAREN: So it was a different pot of money, too, then? ROY: Different pot of money. Yeah. Uh-hum. KAREN: All right. Well, that's good it was a different pot of money -- ROY: Yeah. KAREN: -- I guess. I was also wondering, one of the questions when I talk to health aides that I talk to them about is the communication systems and how they communicated with the doctors and all that. And I don't know, a lot of the villages, maybe there's one telephone in the whole village. ROY: Uh-hum (affirmative). KAREN: Way different than what we're used to now. And how that affected their jobs. And I don't know if that was factor on your end. ROY: It was a factor, big factor. Then there were long wave radio, and some UHF stuff when you could do line of sight, but the long wave was unreliable because bad weather, you know, would interfere. It bounces off the ionosphere. And just when you were getting to the vital part of your discussion with the doctor, you got a bunch of crackling going on, you know. KAREN: Uh-hum. ROY: It was tough. Now telephone systems are much better, satellite telephone systems. KAREN: And now they are also, in some places, using that telemedicine, right? Video conferencing? ROY: Video conferencing. Exactly. KAREN: I'm sure that was a long ways from anybody's ideas when you were there. ROY: It was around as a dream, you know, but that was it. Because the health aide was viewed as the eyes and ears of the doctor, you know. KAREN: Uh-hum. ROY: The person with the feet on the ground and at the site, you know. KAREN: Yeah. Well, I find it amazing that they could communicate all the necessary information for a doctor to be able to make a diagnosis without seeing a patient. ROY: Uh-hum (affirmative). KAREN: You know, very talented and skilled people. ROY: Yeah. In many ways, their name belies their skills. They are really not health aides, they are -- they are primary health care providers -- KAREN: Right. ROY: -- they have in the village setting. They are paraprofessional. And the word health -- the name health aide belies their skills and their -- and their responsibilities and their training. KAREN: It's interesting, I haven't ever asked anybody how that name came about. Do you have any idea? ROY: Yeah. It was there when I got there. KAREN: I'd have to ask Walt maybe. ROY: Yeah, Walter might know. KAREN: I forgot to ask him that. ROY: But I would -- you interviewed Walter? KAREN: Uh-hum. ROY: I'd definitely get to Jerry Ivey and I'd get to Mary Bolan. KAREN: Okay. ROY: Mary Bolan is a -- is one of the partners in Ken -- in the practice of Kenlein, and they have an office, so you might want to call her. KAREN: Practice of Kenlein? ROY: Practice of Kenlein. K-I-E-N-L -- L-E-I-N, I think. KAREN: Okay. ROY: K-E-N-L-E-I-N or L-I-E-N. Practice of Kenlein. It's a counseling practice. KAREN: Okay. ROY: It helps -- from what she described to me, it helps people realize their own capacity to solve their problems, and apparently, it's a successful approach to -- to helping people cope. She was a professor at the University of Alaska Anchorage for a while, as well. Worked there for a while. KAREN: Okay. ROY: And she's still here, as far as I know. KAREN: Okay. ROY: But she can give you some of the technical aspects of what happened there. KAREN: Oh, and as a -- as a nurse. ROY: Yeah. KAREN: As I said, that's a perspective we haven't addressed yet in any of the interviews. ROY: Yeah. KAREN: So-- ROY: Also, I think Lavonne Hendricks is still around. KAREN: It's a familiar name. ROY: Lavonne Hendricks worked for the Norton -- or for the Norton Sound -- yeah, from the Norton Sound Health Corporation, and she was one of the lead trainers there. She's a Public Health nurse by training, as I recall. KAREN: Okay. ROY: And she's still around. I think she may live in Kotzebue, but I'm not sure about that. Ask anybody in Kotzebue, they know her, she's lived up there a long time and they would know if she was there. KAREN: Well, I also have contacts with Norton Sound Health Corporation, and I think -- ROY: Yeah, they would know where she is. KAREN: Yeah. Because I've been trying to get out to White Mountain to interview Willa Ashenfelter. ROY: Yeah. I know that name. Know the person. KAREN: Yeah. So I haven't made it there yet. That's my next trip. ROY: Yeah. Uh-hum. KAREN: And then I'm interviewing Rose Winkleman. ROY: Rose Winkleman is a health aide from my era as well. KAREN: And Lillian Walker -- ROY: Yes. KAREN: -- I'm sure you know. ROY: Yes, I do. KAREN: I'm interviewing both of them tomorrow. ROY: Yeah, they can give you a village perspective. KAREN: Yeah. And I interviewed two women out on Kodiak, Joyce Smith who was from Ouzinkie, and Stella Krumrey from Old Harbor -- ROY: Yeah. KAREN: -- is a more recent. ROY: Yeah. KAREN: But Joyce, she was a health aide before there were health aides. She was one of those. ROY: You will find that there are -- there are some real veterans here. Still there. Still working for their people. KAREN: Yeah.
ROY: So, sounds like a good project. KAREN: Yeah. Well, thank you. I guess the only other thing I was thinking is -- just, I guess, your -- you sort of already talked about it a little bit, but what being involved in the health aide program has meant to you personally and for the development of your career, both of those. ROY: Well, it has meant more to me personally as a -- as a wonderful activity that I was fortunate to be involved in. I enjoyed my -- my working life immensely then. It brought great joy to me to be able to work there and do that job. And I'm sure it advanced my career somewhat. I -- I got to know some people that later became influential in some of the things I later did in my life, I suppose, or -- But -- but no, I think the joy of working there was the main meaning to me of being -- being what I was at the time. Yeah, I do, you know, get nostalgic about that. It was a great thing. It was a great era. It was a great run. KAREN: And I guess, too, how would you -- you know, you talked about sort of the problem solving and all of the agencies working together, and how that worked and what were some of the things that, you know, have been examples of -- of problems, good things -- the good things about it and the bad things about it. ROY: Yeah. I have a hard time remembering the bad things. Sure, there were problems. We ended up talking them through. There were controversies with particularly -- particularly the Norton Sound Health and the Yukon Kuskokwim Health Corporation. And I would often be called on to -- you know, to kind of referee these things and make sure that they didn't get out of hand. (Interview ends abruptly because tape ran out.)