This is a continuation of the interview with Barbara Johnson on May 27, 2006 by Karen Brewster in Yakutat, Alaska. The interview took place at the Blue Heron Inn Bed and Breakfast, where Karen was staying, because it was quieter than Barbara's house. In this second part of a two part interview, Barbara talks about treating patients, changes in communication technology and the use of telemedicine, changes from federal to Native management of healthcare, and the Health Aide Association and certification process. She also talks about the use of traditional medicine, the emotional impacts of the job, and health aides needing to be creative problem solvers.
Digital Asset Information
Project: Community Health Aide Program
Date of Interview: May 27, 2006
Narrator(s): Barbara Johnson
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
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Use of medications in the clinic, and doctors ordering prescriptions for patients.
Using telemedicine to treat patients, changes in communication with doctors about patients, and the effect of these changes on patient care.
Health aide certification requirements and procedures, and serving on the statewide health aide certification board.
The formation and purpose of the statewide health aide association, and its recent disappearance.
Early days of health aide program management.
Differences between health aide program management by the Indian Health Service and the Native controlled Southeast Alaska Regional Health Consortium.
The role of traditional medicine in healing, and the influence of her grandmother on her life and career choice.
Hard moments faced as a health aide, using a specific baby delivery as an example.
Needing to be creative and flexible when handling new types of cases.
Caring for the survivors of a major boat accident off the coast from Yakutat and having to talk with the families of the victims.
Times when she wanted to quit being a health aide and why she stayed with the job.
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KAREN: The one thing I did want to ask you about, you were talking about getting prescriptions from the doctor. BARBARA: Uh-hum. KAREN: That you had to -- you couldn't order them, you had to have the doctor order them. So how did that work? Did you have to wait for the prescription to be mailed to Angoon or here, or you had -- BARBARA: No. KAREN: -- them in stock or what? BARBARA: What I was talking about was what we had in stock. We had to -- each -- each -- once a month we used to have to order our medications from SEARHC in Sitka, the pharmacy there. And that has to be okayed by the doctor that we would be able to administer all those medications. So he signs that off. You know. And we -- we do our monthly orders. And also that we get our supplies from there, too, for the clinic. And then there's two different ways the community, when they are on certain kind of medications, like, you know, Atenolol or stuff like that, we -- we don't have in our -- on our medicine order, you know, but we do have it in the clinic because the PA is able to give that. But some of the people that are on medications like that, they get that -- it's sent to them individually. KAREN: Individually. I see. Okay. BARBARA: They don't have to go to the clinic to get it, it gets sent to them individually. KAREN: So there were things you had on hand, but if you wanted to administer them, you still have to get the permission from the doctor? BARBARA: Oh, yeah. Oh, yeah. Well, we would have things like morphine, you know, if someone gets hurt, we would not be able to give that unless we had the doctor's orders. He would say, yeah, you can give a certain amount or Tylenol 3, you know, you can give one or two tablets, you know. And we -- we are not able to do that without the doctor's permission. KAREN: I see. Okay. BARBARA: And we would have a sign-out sheet, too, that we would have to go by. KAREN: To keep track of them. BARBARA: Uh-hum.
KAREN: Does SEARHC have telemedicine? BARBARA: Yes. KAREN: So have you used some of that? BARBARA: Oh, yes, we have. We have. KAREN: So you've seen it go from radio all the way to telemedicine, huh? BARBARA: Uh-hum. Uh-hum. Yeah. KAREN: Can you talk about that change? BARBARA: Well, yes. It's a big, big change, you know. We had to go out to training so we could do our -- our -- that telemedicine, you know. And we have used it for a few things, you know, like ear, bad ear infection or someone has a perforated ear, take a picture of that and send it through telemedicine to the doctor. And he'll tell us, you know, what to do and whether this patient needs to come in or you know. It -- it would work that way on different -- you know, different things that we send to him through the telemedicine. And then we wait for his answer. He sends us back, you know, answers through the telemedicine. So that's pretty good. I haven't used it as much as they are using it now. You know. Because I am not that good with computers. KAREN: How do you think it's changed the health care now? BARBARA: Well, I think it's good, you know, because we don't have to wait, you know, for a long time to get orders from the doctor or -- or to be able to show the doctor what we're talking about. You know. Instead of trying to describe it over the phone, we can actually show him, you know, the eardrum or a bad rash or, you know, anything like that, we could actually show him through the telemedicine. And it's -- it's so much better that way, you know. That's from what I see. KAREN: Yeah. BARBARA: So. KAREN: That's good. BARBARA: Uh-hum. But we still -- good, old telephone, you know. KAREN: Yeah. It's hard to believe you used to do it without the good, old telephone. BARBARA: I know. I know. Yes. I know one time we had to use a satellite phone because the phones were out, and I think someone -- we had someone in the clinic with heart problems, you know, that we had to talk to the doctor about, and we had to go outside to use the phone. You know, that kind of reminded me of the older days. KAREN: It sounds like you were lucky you had that satellite phone. BARBARA: Uh-hum. We have it through the EMS here. KAREN: Oh, okay. BARBARA: You know, they have it. So if anything should happen where we can't phone, then we use that one.
KAREN: We were talking before about delivering babies. That one that you mentioned that was premature. BARBARA: Uh-hum. KAREN: Was that the first baby you delivered, or -- BARBARA: Yeah. KAREN: Oh. BARBARA: Yeah, that was -- that was the first one I -- I helped with. But I'm not sure, let's see. The first one I delivered, I'm not sure, I can't even remember that, but I've delivered so many, you know. And I think that it's the most wonderful thing, you know, to be able to do that and have the child be okay. You know. Well, it was wonderful, you know, to see that happen. It's one of the good parts of our job. KAREN: Yeah. BARBARA: To do that. You know. I also, not too long ago, we had started the health aides being certified by the state, and I was on the certification board that certifies the health aides throughout the whole state of Alaska. And that's every two years, we have to go through that. So it's -- it's a lot better, too, because they can -- we can do like the Medicaid program, we can see the Medicaid -- patients that are on Medicaid, and the clinic can get paid for that. KAREN: So if you weren't certified through the state, you couldn't do that? BARBARA: No, we can't do that. Huh-uh. You have to be certified through the state certification program. KAREN: Is that certification just for Southeast, or is it for the -- BARBARA: No, it's for the whole state. Yeah, for the whole state. And we would meet like every -- every, like, four times a year, and go through all the applications. And you have to have, you know, like 48 hours of education and stuff like that, you know, the certification program. You'd have to have all those things done before you could be okayed for it. So it'd have to go through quite a few applications, you know, to okay it. And I think it's going pretty good. You know. KAREN: So the board sits and reviews the applications from health aides around the state? BARBARA: Uh-hum. Yeah. Yeah. KAREN: And decides whether to certify them or not? BARBARA: Yeah. And the health consortium from Anchorage, that's who the board's under. KAREN: Oh, okay. BARBARA: You know. They are the ones that we have to answer to. KAREN: And you're still doing that? BARBARA: No. After I retired, I had to let that go, too. I liked it. It was pretty good, you know, seeing all that done and seeing all the health aides that were certified. But there's two kinds of certification, one is that, that one, and one is when the health aide has to redo her preceptorship, you know. It's every six years for that. It's more -- it's more of a requirements than the other, the every two years one. Yeah. KAREN: The every two years one is if you want to do that, to get like an extra certain -- level? BARBARA: Well, they have to do that, you know, in order to keep working. KAREN: The every two years one? BARBARA: Uh-hum. Yeah. KAREN: Okay. BARBARA: Well, you know, it -- I think they are still talking about that, but it's the way it's been going is you have to have that in order to keep your job. You know. KAREN: So that certification board meets and says, okay, you've got two more years? BARBARA: Uh-hum. Uh-hum. They always notify the patient. I mean, the health aide if -- you know, if their term is coming up for recertification, they will send them a letter. KAREN: Okay. BARBARA: And then -- KAREN: And they have to keep their -- it's like keeping your grades up? BARBARA: Uh-hum. Yep. Exactly. It is.
BARBARA: We also had a Health Aide Association, too, before. It's kind of -- it's kind of in a slump right now because, I don't know, maybe it has to do with our older health aides, you know, being able to keep things going like the Health Aide Association. I don't know why, we just haven't been able to keep it going, you know, because that was where we used to go through the problem that we have, you know, we'd meet together when we have our Health Aide Forum, they'd let us have a day just for meeting, you know, and we'd go through the stuff that we'd like to see in our training. You know, after we go through the whole training course with -- with CHAP, you know, as far as the job, when you -- when you're a practitioner, then you have to have further education, that's when you go to the Health Aide Forum and they'll have certain things, you know, to further, you know, their training. KAREN: Special classes? BARBARA: Uh-hum. Special classes that they'd like to see, you know, like -- like the hepatitis or the -- even with narcotics, you know, with all of this drug business going, you know, we see a lot more of that in our communities, and we want to know how to deal with it and how to recognize what's going on. You know. KAREN: Yeah. BARBARA: Those kinds of things we would have. So we would -- we would meet. But just this last year, we haven't been able to keep it up. KAREN: That's too bad. BARBARA: Uh-hum. KAREN: But so yeah, that association is a statewide thing? BARBARA: It was supposed to be, yeah, but we just didn't make it, to keep it going.
KAREN: So when you started doing health aide work in Angoon, SEARHC didn't exist yet, did it? BARBARA: No. No. KAREN: So who was -- BARBARA: What happened was when we first started getting paid, they paid us through the Anchorage area office. KAREN: Okay. Indian Health Service? BARBARA: Yeah. Indian Health Service. Then they realized that they would have to take out such and such and such, you know, unemployment and Social Security and all that stuff, you know, what they take out. So they turned it over to -- it's supposed to be an Indian tribal governing body, supposed to be in charge of it. So they had the grant camp ANB. Have you ever heard of that? KAREN: Alaska Native Brotherhood? BARBARA: Alaska Native Brotherhood. Yeah. They took it over and they ran it. And then after that, then SEARHC did. SEARHC came into being. KAREN: Do you remember about when SEARHC came into being? BARBARA: It was in the '70s, yeah. KAREN: So. BARBARA: Because, see, I worked for SEARHC like -- well, I think I worked for them 20 years. Maybe a little shorter than that, but I remember when they started the SEARHC program, you know.
KAREN: So have you noticed a difference between SEARHC writing the program versus Indian Health Service? BARBARA: Uh-hum. Well, there's -- there's good and there's not good. You know. It was kind of -- it was kind of strange at first because you're so -- you're so used to a certain way of doing things, you know, and then all of a sudden everything starts changing. And especially with the Indian, the tribes, they got to have more say in what was being done, you know, with the health program. They had -- they had more say in it than -- KAREN: Is it because of coming under the health corporations? BARBARA: Yeah. Yeah. And that was good. But the not too good part of it was they were not more aware of what was needed, you know, like what the health aides would -- you know, were having a hard time with, and what they needed. There -- there wasn't that much input, you know. It's like sometimes you're just banging your head against the brick wall, I guess, you know. And that was kind of hard to have to -- KAREN: So with the Indian Health Service, you felt like they listened more to the health aides? BARBARA: Well, they were set -- actually, the -- they listen more now than they did before because with Indian Health Service, everything was set. This is the way it is and this is the way it's going to be. You know. But with the tribal, now they are having -- they are having more input from the communities than they had before. You know. They were strict when it was under Indian Health Service, you know, because -- by "strict," I say you know how they handled the patients. And that was good, too, because now you go to -- if you have a headache or your head hurts or something, you go to a neurologist. If you have eye problem, you go to an opthalmologist. And yet, a patient, they go down to Sitka, I don't know if you understand what I'm trying to tell you, they go down to Sitka and they go down to see the neurologist because maybe they are having headaches all the time, but they have something wrong with them, too, and you want to talk to a doctor. But when they go down to see a neurologist, that's all they do. They don't get to talk to a doctor that -- you know, about different things. KAREN: Right. BARBARA: And they come back and they are still thinking, you know, did I get, you know, things taken care of or what. You know. KAREN: Right. BARBARA: So that's one of the things that I see is not as good as it should be. KAREN: And you're thinking it used to be better? BARBARA: Uh-hum. Yeah. Because they used to -- they used to take care of your whole body, not just one, you know. KAREN: Medicine is pretty specialized now. That's true. BARBARA: Uh-hum. Uh-hum. And some people are used to, you know, having to be able to -- to see a doctor and being able -- to be able to tell that doctor everything that's wrong with them and not just something in their heads, you know. That's just an example. KAREN: Right. BARBARA: Because -- and it really makes them feel bad sometimes. You know.
KAREN: I was thinking, you've seen it also go from your grandmother who was a traditional doctor to this making medical care very professional with the health aides. BARBARA: Uh-hum. KAREN: Do you have any thoughts on that, on -- BARBARA: Well, when -- when -- you know, when my grandma was taking care of people, you know, she used traditional medicines, and -- and then all of a sudden there -- there wasn't -- there was just the medical, you know, medicines and stuff like that. And they didn't listen so much to -- to the Native ways of doing things after -- after a certain time. But then it's going back to it now. You know. KAREN: Interesting. BARBARA: They are -- they are now looking into Native foods, Native herbs and stuff like that, the Native used before, you know, to help them heal themself and stuff. So they are looking into that more now. KAREN: Yeah. BARBARA: Whereas before, they didn't as much. They -- like they dropped everything, you know. KAREN: Right. BARBARA: You weren't supposed to talk about it. KAREN: You said you liked being a health aide because you could help people. BARBARA: Uh-hum. KAREN: Have you thought about why you ended -- you know, you said you just sort of started doing it. BARBARA: I don't know. It's just -- KAREN: Can you tell me why you wanted to do that? BARBARA: It was just a feeling in me. You know, like -- well, you know, sometimes I could tell if something's going to happen. And this is weird, you know, because it's just intuition, I guess, I don't know. But anyway, it -- it was -- it is something inside me that, you know, would make me feel so good when I'd help someone. You know. Just made me feel really good that I was able to do that. And maybe it was from -- from my grandmother, you know, her being -- she only went through the second grade. KAREN: Yeah. BARBARA: And she was -- she could read from the Bible and she'd read books and stuff, you know, and she taught herself a lot of stuff. You know. And she knew a lot of things. And I guess I just inherited it from her. You know.
KAREN: Yeah. You also had said, you know, one of the good things was the delivering babies. BARBARA: Uh-hum. KAREN: What were some of the -- BARBARA: Bad. KAREN: -- bad, the hard parts? BARBARA: Well, one of the saddest things I had ever seen, I delivered a baby that the mom was, like, six months, I think, yeah, six or seven months, but she had also been taking drugs, marijuana, cocaine. And that baby didn't have a brain. And it was just sad. I just had to wrap the baby up and I sent the mom in, you know, with the baby wrapped up and I -- I could hear the mom crying, crying so hard. It just broke my heart. You know. In the first place, her -- she was living with this one guy and this guy's daughter called me up and she said, when are you going to work. I said, well, I usually go at 10:00, because we had it from 10:00 to 12:00 and from 1:00 to 4:00. And she said, well, could you go a little bit early because So-and-So -- I think she's in labor. You know. So I said, well, I'll meet you guys right now. I'm going right now. So bring her up. So they were waiting for me there and I took her in, and she was just a young girl, probably didn't know very much, you know. She didn't have any checkups, you know. And she took her into the exam room and she was, you know, moaning and stuff, and she said she had to go to the bathroom, so I let her go, and she came back and sat there. And I was getting ready to, you know, to deliver the baby because it sounded like it was pretty close. So she said she needed to go again. And I told her, I said, well, you know what, I'll let you go this last time, but next time, I said, I'm going to have to put a bed pan underneath you. And she was in there and her baby was coming out. And she -- she was crying and her daughter -- her -- her stepdaughter, I guess it would be, told me that she was crying in there and so I went rushing in there and the door was locked. And she said the baby's coming. I said, hold it and just come by the door. So I don't know how we managed it, I got her up on the table just in time to catch the baby. KAREN: Wow. BARBARA: But the baby didn't have a brain. It cried for a little while and that was it. It was gone. KAREN: That sounds very scary. How do you handle a situation like that? BARBARA: It's tough. You know. It's -- it's hard. You just have to pray about it and ask the Lord's help. That's what I did.
KAREN: Did you ever have emergency situations, accidents or those types of things? BARBARA: Oh, yeah. A lot of stuff. I'll tell you something, this one -- this one fisherman called from his boat and they called me and they says this fisherman's coming in, he had a hook stuck in his face. And this was a halibut hook he had. And those things are huge, you know, like this. KAREN: Yeah. BARBARA: Yeah. And he was up there and I was looking -- I looked at him and I said, oh, my God, how am I going to do this. And so I just washed around it and I had this file. And I had him hold that and I filed -- I filed it down and all so I could cut it, you know, with the pliers. That was funny because, I mean, you have to think of different ways you can do stuff. KAREN: Yeah. BARBARA: You know. KAREN: Very creative. So then did you -- were you able to then pull out the rest of it? BARBARA: Uh-hum. Yeah. It was one of those older halibut hooks that don't have the curve, you know, real curve. KAREN: Oh. BARBARA: They have them now where they are really curved so they won't, you know, when they hit your -- KAREN: They won't go in. BARBARA: Yeah. KAREN: Oh, I see. BARBARA: But --
KAREN: Yeah, I know in some communities, health aides had to deal with plane crashes and boating accidents and all kinds of things. BARBARA: Well, we had not too long ago, I don't know if you ever heard about that boat that went down, the boat LaConte, I think it was. It wasn't the ferry but it was the LaConte. KAREN: It was a fishing boat? BARBARA: Yeah. Three guys -- KAREN: That's off of Yakutat here? BARBARA: Three guys -- three guys came in and we took care of them. There was just Karen and I were the health aides here. The PA was gone somewhere. And so we had to stay and take care of them all night, day -- they didn't have -- they weren't -- it's hard for me sometimes to think of. KAREN: Life-threatening? BARBARA: Well, what I'm trying to say is, you know, when -- when you freeze or something. KAREN: Hypothermia? BARBARA: Yeah, hypothermia. They didn't have that, you know. They all had their survival suits. But their skipper, they were telling me that the waves were so high they about reached the helicopter. KAREN: Wow. BARBARA: And they were bringing the skipper up first because his survival suit was not -- there was something wrong with it. And they got him up to the -- the plane, the helicopter, but it tipped, I guess, and the skipper went right back into the water. And they were looking for him. And then there was another guy, they were holding each other's hands. And there was another guy that the wave came and they lost him. They were trying to call, you know, call him. And they didn't know where he was at. But they hung on, those three hung on to each other, and then the skipper, they didn't know. But they -- we took care of them all night. And then, of course, the clinic didn't have food, so I just asked for one of the churches, and they didn't have -- they said, no, we don't have no food. So I had asked the community and some of the people brought some food for them. You know. So we took care of them. And then I talked to the skipper in Juneau, the owner of the boat out in Juneau, and I talked with the helicopter, you know, telling them the situation. And then they would, you know, talk to us on it. They were bringing in the skipper. And what they said on the -- on the helicopter was he's barely alive. You know. But when they got him, he wasn't alive. It was a mistake. You know. And I felt so bad because he had a girlfriend in Sitka and she was pregnant, you know, ready to have her baby. And she heard that. She heard them say that he was barely alive. And I had to talk to her and tell her that he wasn't. You know. Because we tried to do CPR and, yeah, it crackles, you know, you just hear it. You know, you know that. KAREN: Well, maybe when they pulled him out of the water he was barely alive. BARBARA: I don't know. KAREN: By the time he got here -- BARBARA: I don't think so. I think they -- you know, it's hard on a helicopter to hear. KAREN: Yeah. BARBARA: But I don't know, I think that was a mistake. You know. Because that wasn't until the next day. KAREN: Yeah. BARBARA: You know. KAREN: Yeah. BARBARA: And then the other guy, I guess they found him way, way over in Kodiak, I think. KAREN: Wow. BARBARA: And he was from Hoonah. And his brother lived -- lives right next door. KAREN: Oh. BARBARA: And when they said Hanlon, they were telling me that the guys were talking, you know, and I thought oh, Ely. And I kept thinking I've got to call Ely. And finally when I got home, I asked Ely, I said, do you know David Hanlon? And Ely said, yeah. And he hesitated for a while. He said, that's my brother. So I had to tell him. But it was all over the news and all -- you know, I think those guys wrote a -- wrote in a book about it. KAREN: Yeah. Probably. BARBARA: Hmm.
KAREN: Were there ever times that you wanted to quit being a health aide? BARBARA: Oh, yeah. Lots of times. And you know, it didn't have to do with the accidents, it had to do with the mouth. People saying things to you. You know. They blame you for someone dying. That was a hurt -- the hardest part, you know, they blame me for someone dying because they say you did this or you did that. Or you didn't do this and you didn't do that. That was the hardest part for me. You know. But the accidents, it would frighten me, you know, but it never made me feel like I wanted to quit. KAREN: But then those times when you thought about quitting, you didn't quit, so how come? BARBARA: Because I would say to myself afterwards, they are not going to make me quit. You know. No matter what happens, I'm not quitting, I'd tell myself. But I didn't tell myself that I -- that I was going to quit that often, you know. I never thought about it all the time. KAREN: It sounds like you have to be pretty tough to be a health aide? BARBARA: Oh, gosh. It has its rewards, though, you know. But it's something that you -- you need to want to do. You know. It's something that you need to have a feeling for in order to last. Because we'd have -- we'd have the nurses and a lot of these people that would come in and say boy, I wouldn't have your job for anything. You know. They always told us that. Didn't want to have your job for anything.