KAREN: Today is May 31st, 2006.  This is Karen Brewster here in Juneau with Jessie Jim, who is visiting from Angoon, and this is for the Community Health Aide Project.  Thank you for coming in a day earlier.

Tell me a little bit about yourself, and your background, and when and where you were born? JESSIE: I was born in Angoon. Born and raised in Angoon.  I went to Mt. Edgecumbe high school, used to send us off to boarding school. And, graduated from there.  I stayed home for a year after I graduated. 

Then, I went to PN (Practical Nurse) training in Mt. Edgecumbe.  Became a LPN (Licensed Practical Nurse).  And, worked in the hospital in Mt. Edgecumbe for a year. And got married there, and my first husband died when he was pretty young from stomach cancer.  After he passed away then I moved back to Angoon.  I mostly lived in Angoon. KAREN: May I ask you when you were born? JESSIE: August 15, 1939.   KAREN: When did you graduate from Mt. Edgecumbe? JESSIE: 1958. KAREN: And your LPN (Licensed Practical Nurse) / PN (Practical Nurse) training, was that for a year? JESSIE: Yes, I believe it was in 1960… '59 or '60, something like that, I can't remember. KAREN: What was your maiden name? JESSIE: Gamble. KAREN: Jessie Gamble… who were your parents? JESSIE: John and Nadja Gamble.   KAREN: Did you have brothers and sisters? JESSIE: Yes.  I have one brother and six sisters. KAREN: Where did you fall in the line? JESSIE: Probably in the middle, just about the middle.

KAREN: Why did you decide to become a nurse? JESSIE: My girlfriend talked me into it.  She said let's go and take this training. After you graduate, you wonder what you're going to do after that.  And, she talked me into it, then she backs out, there I was.  They used to have a nurse PN (Practical Nurse) training in Mt. Edgecumbe, and not very far from where the high school is. KAREN: So it was a separate program from the high school? JESSIE: Yes.  Because while I was taking the PN (Practical Nurse) training my younger sisters were in high school in Mt. Edgecumbe.  KAREN: That's nice to be close to each other.  After your training you said you worked in the hospital as a floor nurse? JESSIE: Yes, as a LPN in the hospital. KAREN: What is the difference between a LPN (Licensed Practical Nurse) and RN (Registered Nurse)? JESSIE: More schooling. LPN's go for one year and RN's go for three years. I think that's what -- and they do more the higher up there. KAREN: So when you went back to Angoon that was after your husband died? JESSIE: After my first husband passed away. KAREN: What was his name? JESSIE: Frank Lane, he was from Point Hope. KAREN: You moved back to Angoon in what year? JESSIE:  1962, or 3, because I remarried in ‘64. KAREN: And his name? JESSIE: Charlie James, Jr. KAREN: How did you become the health aide? JESSIE: Barbara Johnson talked me into it.  They needed one in Angoon.  She  needed help, I believe.  They were going to hire one more.  And she asked me if I could.   And at the time I thought well a little extra money wouldn't hurt.  And, it was just a little extra money. KAREN: So you actually got paid? JESSIE: Yes, like a hundred and something a month. KAREN: Do you remember what year that was when you started? JESSIE: I believe it was like September of '69. KAREN: So, who did you work for? JESSIE: It was like a government thing.  I know we used to get our checks from the government.  And none of the taxes were taken off.  I don't know how that worked.  We didn't have to worry about paying our taxes. KAREN: Was it the Indian Health Service? JESSIE: It probably was. KAREN: Because SEARHC (Southeast Alaska Regional Health Consortium) wasn't in existence yet. JESSIE: No.

KAREN: You had a nursing training, so you already knew a little bit of something before? JESSIE: A little bit. It is a lot different then -- working in the hospital is a lot different than being out in the field working as a health aide.  KAREN: How so? JESSIE: In the hospital, you have your orders there.  You get in there and your orders are there on what you have to do, and you do them.  In the field as a health aide, you have a lot of decisions you have to make on your own.  I think working in the hospital is better.  

The health aides are under a doctor's supervision, too, but at a different location than you are.  You have to call them on the phone. Back then when I started, we used to call them on a radio.  It wasn't that confidential on a radio.  KAREN: Was the radio in the clinic? JESSIE: At a store in Angoon. KAREN: Was there a clinic at the time? JESSIE: There was no clinic when I started.  But the school, I believe, let us use a small space in their building for a clinic.  I don't know what happened, but we had to move out of there.  So, we were out on our own.  Barbara (Johnson) and I said, well, we will refuse to work out of our home, which is hard to do because you don't get any rest.  And, we kind of went on a strike until they get us building for a clinic. KAREN: Did it work? JESSIE: Yes, we got a building. It was one of the THA (Tlingit-Haida Association) houses. It was a house that they transformed into a clinic for us.  And, we worked out of that for a few years before the city had one built in Angoon.  And, SEARHC (Southeast Alaska Regional Health Consortium) was -- no it was under the health council.  Paula Pancho used to come out to -- they had some grants. They'd send money to upkeep the clinic.  But, it was being leased from the city of Angoon, I believe. KAREN: Was that mid-seventies, late eighties? JESSIE: Eighties… I believe that's what the sign said, there was one in front of the clinic. KAREN: Is that the clinic they still use? JESSIE: No, more modern now. We have a new clinic, that they just moved into it. What year was that? Just about two or three years ago. Not too long after I retired anyway. KAREN: When did you retire again? JESSIE: January 7 -- KAREN: What year? JESSIE: Was it 2003? KAREN: Should I check the article.  It's in that newsletter. JESSIE: Anyway, I had been working for thirty-five years. KAREN: That's a long time, you must of liked the job? JESSIE: I guess so.  It is kind of hard to leave. You have to have a love for taking care of people.  Maybe a feeling of being needed.  A stick-to-it-ness.  But, there were many times when I felt like I wouldn't be able to make it.

But, I talked myself back into it.  It is a hard job.  I don't think any amount of money would make up for some of the things they have to go through on that job.

KAREN: Can you give an example of some of that, what you have to go through? JESSIE: It's hard for a lot of them to watch someone die in front of you. A lot of it, I know, for some of the ones that I've worked with -- I've worked with many health aides, and many doctors, and many supervisors.  

But, I know one health aide that quit because she couldn't take -- There was a little girl that they brought into the clinic where they said that she had had flu-like symptoms.  And, then they brought her in because they couldn't wake her. But, I think by the time that brought her in she was already gone. 

This one health aide, being new, she tried -- we started CPR (cardiopulmonary resuscitation), we started CPR.  And, we had a clinical director there then and we tried to do IV's -- to get that going.  Back then, they used to believe in doing CPR until you can't do it anymore.  

The helicopter came and took her, but I believe that girl was already gone.  The health aide that was doing the CPR, she went with the helicopter to keep -- But, it seemed like after that she had a hard time being -- . And then -- Things that they have to take from the people back home.  I don't know, they seem to think that health aides are miracle workers.  

And then we have to take a lot of flack from a lot of people.  You have to be able to let things slide when you work in the health profession, being at home.  Because you get called down for -- if they don't pull through, it's like you get blamed.  

Because I remember that time when the little girl, too, that passed away on us.  She was home when that happened.  When they brought her to the clinic, they had called us the day before at the clinic and asked -- The question they asked us was, what do you do for someone that has the flu, vomiting. Fever and vomiting.  And then you give them, the Patient Ed over the phone. 

And, I was the one that answered and told them what we were taught.  Tell them nothing by mouth for one or two hours.  All those. But the next -- and then I told them who was on-call if they should need them.  But they thought she had just had the flu that was going around at the time.  It ended up she had gotten -- very rare to get it but she did. Encephalitis. KAREN: Is that like inflammation of the brain? JESSIE: Yes.  And, they told us by then that even if she was near a hospital she probably would not have made it.  If she did, she would be like a living vegetable. I went down to -- in small villages you go to different places to try to support the families, console them. 

I had to listen to: “Those people in the clinic they don't know what they're doing.  They, should have seen her.” Well, that was after Barbara had left. “If Barbara were here, she would have known what to do.” Anyway, things like that, it is hard for a lot to put up with.

KAREN: How do you handle a situation like that where the people are saying those kinds of things? How did you handle it?  How did you get through that? JESSIE: Only with talking with the Lord and asking him to help me through those times.  A lot of times that is the only way I made it through. Because everything is so confidential. You can't talk to your friends. You can't talk to your family. You can talk to co-workers.  They have -- getting off the subject, I don't know.  They have this thing now they call a debriefing.  After something like that happens, which I think helps a lot, now. Where they get everyone that was involved with it together and have them talk about their role and what went on. KAREN: I've heard about those kind of debriefings when there is a big trauma, emergency kind of thing.  They do that everywhere now to help people cope and sort of counsel them through it. JESSIE: They never had that earlier. When we started, I don't know how -- I think about it, I don't know how I made it through.  Barbara (Johnson) was a lot of help.  She pushed me along. She was a lot of help. KAREN: After she left, was there a new health aide that came in? JESSIE: Yes. KAREN: So you never had to do it alone. JESSIE: Sometimes we did. To be alone in the village. They try to prevent that now because there was so much of a drop, drop-out of health aides.  Sometimes we would be in the village by ourselves, too, which is scary.  I think there is a little bit more support now with having an EMS system. KAREN: Local fire fighters or something, they get EMS (Emergency Medical Services) training? JESSIE: ETT mostly in Angoon, now. KAREN: What is ETT? JESSIE: Emergency Trauma Technician (ETT). That comes just before EMT1 (Emergency Medical Training Level 1). Some of them, they try to get into EMT1.  I think as a health aide it's required, at least EMT1.

KAREN: So when you became a health aide, what kind of training did they provide for you? JESSIE: It was called phase one, two, three, and four. It's just a little more each time, teaching you. It was so long ago I can't even -- They take you out of your home and take you either to Mt. Edgecumbe or Anchorage and teach you.  

When I started we had a little yellow book that we could turn to. Now they have all those -- you were talking about the new CHAM (Community Health Aide Manual) that they have.  Now you can turn to those.  It took me along time to get used to those things.  You could ask any of my supervisors. It's always on my evaluation to use the CHAM more.  Because when we were working, we did not have those things to turn to earlier. Once I got used to it, that was a lot of help to use the CHAM. KAREN: And that CHAM, that is the Community Health Aide Manual, how are you supposed to use it? JESSIE: It's got in there questions you need to ask the patient and different things you can tell them.  Patient Ed (education), there is a lot of Patient Ed in it. I havn't seen the new one. I just glanced at it, that's all. KAREN: But the old ones that you used, how were they set up? JESSIE: At the front page it asks questions like name, birthdate, those things, and what your complaint is.  After getting those things, they have different places in the CHAM where you can look at what you need to.  Like if it's a cough or a sore throat or a ear problem or UTI (urinary tract infection), abdominal problem. Different places in the CHAM where you can look at after interviewing from the first, then you can go to one of those. KAREN: That yellow book you had when you first started, what was in that? Do you remember? JESSIE: I can't even remember. It will tell you the basics.  Kind of like what to do in different situations. The CHAM has a lot more detail now.  Because I don't think in that little yellow book it had stuff like what to do in emergencies.  I don't remember childbirth. Stuff like that.

KAREN: What kind of equipment did they give you when you first started out? JESSIE: Blood pressure cuff, stethoscope, thermometer. Some medications. I can't believe what we used to take in that little box for medications to give. KAREN: Aspirin, what kind of medications? JESSIE: Penicillin, aspirin, Tylenol -- Well, I don't know even though if we had Tylenol then. KAREN: I don't think, back then, they even had Tylenol, did they? JESSIE: Aspirin. But I know penicillin was in there. Erythromycin. KAREN:  Erythromycin is an antibiotic, is that what that is? JESSIE: A lot of people are allergic to penicillin, so they use Erythromycin.  Now with all the modern technology, we have in our new clinic we have computers on almost everyone's desk.  I am one that has a hard time with modern technology.  With a computer, if I can just get into my email that's all I know, and how to do my timesheet on there. KAREN: Do they have telemedicine machines? JESSIE: Yes. Sometimes it doesn't work. It goes out of whack or something.  But they do now for looking in the ear or taking pictures of skin problems and stuff like that. KAREN: Do you think those kind of changes have helped or -- ? JESSIE: It has.  But, well the clinic in Angoon is a lot more now.  We have an x-ray department. Where they have mostly the PA's (Physician Assistant) doing the x-rays. And they can tell now if you have a fracture, if someone gets hurt.  Before that we used to have to guess. Well, just talking to the doctor and then seeing what he would think if it were enough of an emergency to have the patient come in. KAREN: So if it was a fracture or a broken bone, could you guys set it and put a cast on? JESSIE:  I could put a splint, a plaster splint on it and send them in.  But I think we were taught to -- Well up to the time I was there, we were never taught how to put casts on. But we do plaster splint they call them, like on a leg or an arm, where you mold it out and the one on the bottom, or sugar-tonged they call them -- KAREN: And that would hold it temporarily until they get to the hospital? JESSIE: Yes.

KAREN: You mentioned a PA (Physician Assistant), does Angoon have a PA stationed there now all the time? JESSIE: There is a PA there now. And, I believe she's leaving on June 9th. But, we have another one, which I heard got a job here. Now I don't know what's going to happen.  But it sounds like they have one that's going to be starting, taking the other PA's place. KAREN: Is that standard SEARHC practice now, every village has a PA? JESSIE: It seems to be what they're working towards.  But, we used to have a PA come every once in awhile, but now it's good having them there the whole time. KAREN: What about when you started, how often did doctors and nurses come to town? JESSIE: I can't even remember if they even came every other month like they do now. But we'd get doctors every now and then. But right now we get them every other month. KAREN: What was that like working with the doctors? How did the relationship work? JESSIE: A lot of the doctors are -- they have to learn how to work with health aides.  But, it's worked pretty good.  We depend on the doctors. To call them, to call the shots, I'd guess you'd say. To see what we can do for the patient.

They'll guide us on what to do for the patient. Being there.  And, decide if the patient should be transported out of the village. They teach them a lot now, a lot more then we were taught.  It took a while for them to teach us to do IVs, which is a big help.  And to do suturing.

KAREN: I don't want to interrupt you.  I am waiting for you to finish your thought before I throw another question at you. Because I always have questions.  You were talking about teaching the doctors to work with health aides.  Do you feel like they listened to you and trusted you when you said this is going on with this patient or that patient? JESSIE: Hm, mm. Sometimes I feel like they expected too much of me.  There were things I felt I couldn't do there in the village that they expected me to do.  I mean, you get to know the things you can do and can't do. KAREN: Do you have an example? JESSIE: Well, let me see.  There was a -- I remember one guy that I was checking. It had to do with private parts, you know, where his scrotum skin was torn back.  And, the doctor wanted me to suture it.  

And I told him, “I can't do it.”

And he said, “You're working in the health profession, you can't feel like, you know -- ”  

I guess he thought that was because it was a private part, I didn't want to.  It's not that. That's a very sensitive area, to me, it seems like.  What if I do something wrong.  And I thought at the time, he needed to go in to have that taken care of.  

Finally, convinced him to have him go into the hospital. The next day -- it wasn't our doctor.  We have doctors assigned to the villages.  The next day I was talking to our doctor and I asked him, “How the guy was doing?” And I said, “Did it seem like something that needed to come into the hospital?”  And he said, “Yes, definitely.” I said, "I kind of thought so." 

But, it's different things like that. It's different doctors.  We only talk to the doctors that are assigned to the village.  They don't work 24 hours a day like we do. So we have to talk to the doctor that's on-call during the night or on a weekend.  KAREN: So during the day, you had the same doctor every day during the day that you could call when you had a question? JESSIE: Yes. KAREN: Did you call them whenever, okay, here's a patient and you call or was there a set time of day? How did you report on patients? JESSIE: Some said that maybe instead of calling for every patient that we saw, we should kind of write it down and set a time like maybe two or three in the afternoon when you call the doctor and then talk to him about all these patients. 

But it doesn't seem like that's going on now. With the PA's there, you don't have to call the doctor as much, it seems like. You can go to a PA and ask them, and they'll let you know if they think, "I think you should call the doctor on this." KAREN: So, you guys did decide to do that, call once a day thing? JESSIE: There for a while.  It doesn't seem like that anymore.  They call when they have to. KAREN:  What did you have to teach new doctors who came in about how to work with health aides? JESSIE: Just let them know what we can and can't do. I don't know if we ever taught them anything. Maybe we did, maybe we didn't.  To learn how listen to us more.  And kind of -- some doctors are so good about it. And some are abrupt.  Sometimes you get a feeling like "Why are you bothering me with this." Most of the doctors are pretty good about listening. 

I guess I should say that most of the health aides now are taught about things that doctors would like to know. Instead of just blurting out, you know.  I remember sometimes I would just blurt out, but now they have different things they want you to say to them.  The age, their symptoms, their vitals. KAREN: The doctors wanted it in a very systematic, specific way instead of just -- "I have a kid with draining ears!"

KAREN: Yeah, I was wondering too that -- I would assume most of the doctors are from Outside and aren't from here, and there are cultural issues that you've had to deal with with them? JESSIE: Yes. KAREN: And teaching them about your culture so they could work together better? JESSIE: They learn from coming into the villages.  Like every other month now.  They get to know a different -- They get to know quite a bit from coming into the village every other month. KAREN: What about when you first started? JESSIE: I had a good -- Thank goodness he was a nice doctor. I remember his name even. KAREN: What was his name? JESSIE: Doctor Franks. Doctor Hood Franks.  He was a good doctor. He was a patient man. To teach us what he wanted to know. I've been through so many doctors. I said,  I've been through so many doctors, supervisors, health aides. 

Some health aides I hate to see go because they're good health aides.  They're good at their job. But the pressure of it would just get to be a little too much.  The on-call issue is, I think, a big factor in a lot of the --   The problem where they lose some of the health aides because of the on-call issue. KAREN: When you first started, you were on-call all the time, huh? JESSIE: Between Barbara (Johnson) and I, yes. We'd take a week at a time. Her and I. She'd be on-call one week and I'd be on-call the next week.  We'd trade off weeks.  And we went right on-call.  Now they at least wait until they finish session two. KAREN: Oh, of their training? JESSIE: Uh, huh. I think it's better. Work them into it. KAREN: First day on the job you could have been on-call? JESSIE:Hm, mm. It is kind of hard on our families, too.  It is a demanding job.  Before we had a clinic, we had to do a lot of house calls. I remember one time my husband getting mad at me for going out, just to take a sliver out of some guy's hand. “You shouldn't have to do that,” he said. When I first started I felt like I had to do everything people wanted me to do. KAREN: And that changed? JESSIE: Hm, mm, you have to. Now they have a radio you call. In Angoon it's 32377883237.  They'll answer the phone, “This is the emergency line. What is your emergency?” KAREN: And then they decide whether its -- JESSIE: -- an emergency enough to be seen, yes. KAREN: -- to call the health aide in. Before they just called you directly? JESSIE: Yes. Come and check this out.  Where we've had to teach people that you don't have to call for an ear ache, for a tooth ache, for a sore throat.  Teach them what to call for, anyway.  Like a baby with a high temperature is a high priority, and an elder. We do a lot of Patient Ed (education) now.

KAREN: When did that start? When you started, did you start doing that? JESSIE: No, I didn't do that much when I first started. But we were taught to do a lot of Patient Ed, which helps a lot now. But, they do like, they come and bring some of their kids in, they fell and they cut their knee or they cut their hand. “Well did you clean it out to see if, maybe you thought it might need stitching?” “Well, that's your job.” “No, our job is take care of it if it looks like it does. But you should be able to do this. Like clean it out. Take a look at it.”  But, some people that see blood, they just panic. But they're learning.  It took our people a long time to learn to make appointments to be seen. 

I remember when it first started. We were under a lot of flack, because we'd just take them as they come in. Then we started teaching them to make appointments.  Now they're not seen unless they have an appointment. KAREN: Unless it's an emergency? JESSIE: Hm, mm. Emergencies, they'll bring them in.  Usually they have an on-call person that will see them, or if there is one of the health aides.  I don't know if I should say health aides. Daphne seems to be the only health aide in Angoon. They have two new ones that are just starting and I hope they hang in there. KAREN: Has any of the new ones, or people who want to do it, have they come to talk to you for advice? JESSIE: A lot of the ones that just started used to. But, I'm not there that much anymore. I only work as needed. KAREN: So, you are not really retired? JESSIE: Everyone, you know -- I kind of get tired of it, too. “I thought you retired,” they'd say when they'd see me in the clinic. “I thought I did, too,” I'd say. Do you know how long I stayed retired? About two weeks. And then they called me, “Could you help?”  

And Daphne's a real good friend of mine. She was in a fix. She was practically pulling her hair out. The other health aide that was -- quit not too long after I retired. 

And the PA (Physician Assistant) had to go away on training, I believe. So they asked, “Would you be able to come back? You know, as an intermittent. You wouldn't have to go on-call.” “Okay, I'll do it if I don't have to go on call”.  

But then my CHP (Community Health Practitioner) recertification ran out. Now I just work as what's called Medical Assistant. I can do IV's, EKG's (electrocardiogram), immunizations, all the vitals. I work whenever the doctor comes into town. But I can't see patients anymore. I kind of miss that. KAREN: You chose not to keep your certification current? JESSIE: I didn't choose to. It kind of just happened, I think. I believe I could, you know, but I don't have the money to -- it costs quite a bit of money to get licensed, I mean certified as a state certified CHP.  Afterwards, I was thinking, I should've kept it up. I should of did it one more year. KAREN: To keep it up, you have to keep taking classes to keep -- ? JESSIE: Yeah, to get a certain amount of Continuing Ed (education), they call it, and some clinical hour. Geez, I forget what else. I didn't keep up my -- KAREN: The cost you're talking about is to pay for the license? JESSIE: The license. KAREN: Oh, you have to pay for it? JESSIE: Yes, I hear it costs quite a bit. SEARHC (Southeast Alaska Regional Health Consortium) used to take care of that while we were working. 

KAREN: That is what I was wondering, if you are a new health aide who gets hired and you go through all that training, SEARHC will pay for all that and pay for your certification? JESSIE: In a way I kind of feel bad for them, you know, like when they hire a new health aide and they put them through all that. All that money that goes into the training.  And then when they resign.  I think they should make them sign an agreement or something saying they'll work at least two years.

JESSIE: A lot of money goes into the training, and it's a good training, too. For us old timers they finally started what they call the clinical update. Every so often we'd go to -- it's like a refresher course.  

That helped me a lot on my charting.  That was my big -- Every evaluation they'd write on there, “Need to improve on your charting.” “Okay, so have someone come and teach me or send me somewhere to learn”. I still have trouble with that. KAREN: So, when you first started, did you not -- charting is like keeping a patient's record. So when you first started -- ? JESSIE: What you do for the patient, yeah. KAREN: So when you first started did you have to do all that, keeping track of everything? JESSIE: No. To get paid at that time when I first started, all we had to fill out was like a sheet of paper and you write down how many patients you saw and for what. And that was it. KAREN: So, you didn't have to keep a chart on each patient? JESSIE: No. No. We didn't do that much charting. Charting got to be -- It was a big thing for me. I always had problem with charting because they didn't stress it to us that much when we first started. Teaching like the SOAP, they called it. KAREN: What's that? JESSIE: Subject, Objective, Assessment, Plan. Subject is what the patient tells you. What you see, what you decide to do for them, the plan. I mean, what you decide it is and what you decide to do for them. KAREN: The current situation with health aides who maybe don't stay on the job, they go through all that training then leave. Have you thought about what SEARHC (Southeast Alaska Regional Health Consortium) or places like that could do to help so the health aides stay longer? JESSIE: I think they have done some of them, like increase their pay. Each time that they go through training they get a step increase. So, the pay has gotten a lot better then it was when we were working earlier. 

And I mentioned earlier, that they at least let you go to session two before they'll put you on-call. And when they first put you on-call, they'll let another PA or health aide go on-call with you. 

And they'll be there with you to see the patient, and they'll kind of ween you I should say.  Then they'll call you -- put you on-call with the other person on-call with you only if you really need them.  So then, gradually let you go on your own. KAREN: Like mentoring or job shadowing or something, they call it. JESSIE: Hm, mm. That way it's not as scary as just plopping you there. The on-call, that's the one that's hard on most health aides.  This one that recently resigned, I believe that was the reason she resigned. She had a crazy on-call week, where she never even made it to go home hardly. So, it's too much away from her family. Had one of her children, failing at school. It's just sometimes, it's like that sometimes where you go crazy with the on-call. I remember I had one week of on-call with no call-back. That was sweet. I had no call backs. KAREN: So what does that mean, that you didn't have to go out and do any calls? Nobody called? JESSIE: No, no one called. Everything was fine that week. But there's some weeks where you're at the clinic almost every minute it seems like. Just depends. There's some horrible things that you have to deal with, too, with being on-call.