Dr. Lee Schmidt was interviewed on June 2, 2006 by Karen Brewster at his home in Sitka, Alaska. In this interview, Lee talks about being a doctor in rural Alaska, experiences traveling to villages, and changes in Alaska's rural health care. He also talks about his appreciation of health aides, his administrative duties as chief of the Community Health Services Program, and differences between the Indian Health Service and the Southeast Alaska Regional Health Consortium (SEARHC) as health care managers.
Digital Asset Information
Project: Community Health Aide Program
Date of Interview: Jun 2, 2006
Narrator(s): Dr. Lee Schmidt
Interviewer(s): Karen Brewster
After clicking play, click on a section to navigate the audio or video clip.
1) His career background.
2) Coming to Alaska and serving as a physician in Bethel in the early 1960s.
3) How he became interested in the Community Health Aide Program, and discusses the type of training that would be beneficial to the health aides.
4) The role of health aides, and communicating by radio with them in the villages.
5) Medications prior to the Community Health Aide program, and the challenges of radio communication between the physician and health aide.
6) Health aides collaborating with physicians to develop a common understanding of medical terms and descriptions of symptoms.
7) The relationship between the health aide and the physician, and traveling to villages in the Bethel region.
8) Preparing medical supplies for travel to the villages, and understanding the socio-cultural life of the villages.
9) Being the first physician to visit Lime Village, and doing the tasks of dentistry, prenatal care, eye care, and pediatrics.
10) The importance of health aides to the village, patients, and physicians, and the many public health services the physicians performed.
11) Physicians and public health nurses he has worked with.
12) His wife traveling with him to villages, and the positive experiences of being a physician for the village communities.
13) Why he became a physician, his job as Chief of Community Health Services at Mt. Edgecumbe Hospital in Sitka, and changes he has seen within the Community Health Aide Program.
14) Positive and negative effects of changes in the Community Health Aide Program.
15) Expansion of the Community Health Services Program in Sitka, the development of local health councils, and the transfer of health programs from the Indian Health Service to the Southeast Alaska Regional Health Consortium (SEARHC).
16) The National Indian Self Determination Act, the emergence of tribal corporations in overseeing public health services, and transferring management of health programs from the Indian Health Service to tribal corporations.
17) The funding and organizational differences between the Indian Health Service and tribal corporations, and how the role of health aides and the use of their services have changed.
18) His employment with the Indian Health Service and the Southeast Alaska Regional Health Consortium, and his perspective on the issues of confidentiality in medical care.
19) Cultural training for physicians and health aides, and the importance of understanding the cultural norms of a community.
20) Administrative duties managing the Community Health Services Department, assessing, prioritizing and funding community health care needs, and the importance of good communication.
21) The administrative and decision-making process for providing health services, and the role of the Southeast Alaska Regional Health Consortium (SEARHC).
22) His role in improving organizational appreciation for health aides, including establishing a better salary schedule, recognizing specialization, and creating employee incentives for advancement.
23) The success of health aides for rural health care delivery, what he sees for the future, and what working with health aides has meant to him personally.
Click play, then use Sections or Transcript to navigate the interview.
After clicking play, click a section of the transcript to navigate the audio or video clip.
Section 1: Pennsylvania\ Bethel\ job -- doctor\ Public Health Service\ job -- alternative to military\ Public Health Service -- commissioned officer\ Portland, Oregon\ pediatric residency\ Sitka -- relocated to\ Mt. Edgecumbe Hospital\ medical -- career in\ medical -- administration\ medical -- public health\ public health -- interest in|
Section 2: Alaska -- coming to\ Bethel -- based in\ physicians -- number of\ community health aide program -- interest in\ patients -- number of\ public health situation -- problematic\ Indian Health Service -- Bethel Service Unit \ region -- Yukon-Kuskokwim Delta\ villages -- number of\ public health -- type of problems\ tuberculosis -- rate of\ income -- rate of\ birthrate\ water supplies -- quality\ quality -- poor\ water supply -- health problems|
Section 3: health aide program -- interest in\ health aide -- training\ training -- funding for\ physicians -- advocate of\ training -- provided by physicians\ training -- preferences with\ illness -- recognition of\ training -- physical skills\ training -- academic\ academics -- emphasis on\ academics -- disadvantages of|
Section 4: health aides -- interaction with\ health aide -- early\ health aide program -- beginning of\ health aide -- responsibilities\ health aide -- natural healers\ physicians -- interaction with\ communication -- method of\ radio -- short wave\ radio -- disadvantages of\ radio -- advantages of\ medications -- placement of\ medications -- identification of\ radio --use of\ patients -- reporting on\ medications -- limited\ medicine -- oversight of\ pharmaceutical standards -- current\ local medications -- need for\ pain -- treatment of|
Section 5: medications -- early days\ medications -- common\ Penicillan -- injectable\ illnesses -- common\ infection -- ear\ infections -- children\ injection -- psychological impact\ shot -- fear of\ clinic -- visit\ medication -- delivery method\ oral method -- disadvantages\ injections -- advantages\ medications -- naming of\ health aide -- relying on\ physicians -- distance\ vocabulary -- common\ creating understanding\ pain -- description of\ symptoms -- communication about\ communication -- radio\ description -- verbal\ radio -- challenges\ symptoms -- standard\ descriptions -- detailed\ symptoms -- meaning|
Section 6: medical vocabulary -- training in\ health aides -- patient escorts\ clinic -- experience in\ communication -- physician to health aide\ physician -- village visit\ physician visits -- number of\ public health -- negative impact\ medical cases -- types of\ care -- acute\ care -- chronic\ toenail -- ingrown\ treatment -- lack of\ toenail -- infection\ health aide -- reporting skills\ health aide -- trust\ health aide -- relationship with|
Section 7: health aide program -- early\ Indian Health Service -- Bethel Service Unit\ physicians -- regional assignment\ health aide -- relationship with\ villages -- assigned to\ villages -- names of\ physician -- enjoyment of\ travel -- enjoyment\ travel -- frequency of\ villages -- number served\ physician -- personal purpose|
Section 8: travel -- preparation of\ medical supplies -- packaging of\ medical supplies -- names of\ weather -- forecast\ pilot -- confidence in\ village -- travel to\ village -- arriving in\ village -- social event\ conditions -- social\ culture -- understanding\ physicians -- adapting to\ physician -- impact of\ village -- enjoyment of\ health aides -- appreciation of\ health aides -- women\ health aide -- job\ job -- passed through family\ health aide -- acceptance of\ health aide -- respect|
Section 9: village -- first physician\ Lime Village\ Lime Village-- description of\ village -- location of\ airplane\ travel\ village -- arrival\ dentistry -- tasks\ dentistry -- unfunded\ dentist -- communication with\ health care -- non-Native\ health care -- Native\ politician -- reaction to\ dentistry -- cancellation of\ lawmakers -- disconnection with communities\ field trip -- description of\ public health care -- types of\ dentistry\ eye care\ prenatal care\ eye care -- refraction\ glasses -- fitting\ eyesight -- fixing\ treatment -- joy of\ prenatal care -- lack of\ Bethel -- baby delivery\ pediatric care -- frequency of \ immunization -- children\ Public Health Nurse\ communication -- frequency of\ illnesses -- long term\ arthritis\ illness -- acute care|
Section 10: health aides -- importance of\ symptoms -- assessment of\ people -- knowledge of\ health aides -- insight of\ health aide -- listen to\ patient -- visit clinic\ woman -- isolated\ woman -- sociability\ case -- successful\ travel -- duration of\ villages -- name of\ travel -- method of\ travel -- winter\ travel -- scheduling\ physicians -- tasks\ physicians -- number of\ patients -- number of\ villages -- regional coverage\ radio -- use of\ radio call -- frequency of\ physicians -- dependent on each other\ baby delivery -- number of\ work -- schedule\ hours -- long\ job -- Indian Health Service\ job -- guaranteed income\ public health services -- types of|
Section 11: physicians -- co-workers\ physicians -- names of \ Fortuine, Robert -- Service Unit director\ Brenneman, George -- physician\ Alaska Native Medical Center\ Anchorage\ Eneboe, Paul\ Trout, Gene\ Trout, Gene -- dogsled\ Scott, Rick -- dentist\ public health nurses -- role of\ public health nurses -- travel\ travel -- frequency of\ public health nurses -- time constraints\ communication\ public health nurses -- state-funded\ Boyce, Eva -- public health nurse\ Crawford, Margaret -- public health nurse|
Section 12: wife -- travel companion\ wife -- work\ work -- physical therapist\ patients -- record keeping\ experiences -- personal\ experiences -- professional\ health aides -- sharing of knowledge\ health aides -- contribution of\ public health -- guidance on\ disease -- scabies\ scabies -- symptoms\ scabies -- misunderstanding of\ scabies -- community response\ scabies -- treatment of\ care-- preventive|
Section 13: physician -- becoming\ father -- physician\ father -- advice\ advice -- treat the patient, not the disease\ father -- impressed by\ patients -- humanizing\ Bethel -- departure\ residency -- pediatric\ University of Oregon Medical School\ Sitka -- relocation to\ Mt. Edgecumbe hospital -- employment\ job -- Chief of Community Health Services\ job -- description of\ village services -- providing\ health aide program -- formalized\ health aide -- training\ Anchorage\ health aide -- funding\ health aide program -- changes\ health aides -- recognition\ health aides -- professional development\ health aides -- personal development\ health aide -- tasks\ health aide -- roles\ emergency medical providers\ pre-natal counselors\ public health preventive care\ acute care|
Section 14: health aide program -- changes in\ changes -- positive\ bureaucracy\ health care -- local control\ Indian Health Service, Service Unit\ health aide -- funding increase\ changes -- negative\ training -- amount of\ training -- overload\ health aides -- expectations\ health aide -- tasks\ job -- demanding\ health aides -- impact on\ health aides -- Southeast Alaska\ health aides -- older women\ training -- physical|
Section 15: job -- duties\ Sitka\ Community Health Services Program\ positions -- description of\ Community Health Services Program -- expansion\ employees -- number of\ services -- types of\ Indian Health Service -- funding\ program -- development\ Southeastern Alaska\ health council -- local\ health care -- local control\ health council -- emergence of\ health councils -- role of\ health aide -- selection of\ services -- selection of\ village -- politics\ mistakes -- reduced\ health aide -- reporting\ job -- health aide coordinator\ health aide -- supervision\ health aide -- coordination\ health aide -- training\ nurse practitioner\ physician assistant\ environmental health\ services -- community oriented\ health council -- communication with\ clinic -- designing\ health aides -- personal training\ health care -- management\ management -- changes in\ Indian Health Service\ Southeast Alaska Regional Health Consortium (SEARHC)\ programs -- management of\ health aide program -- management\ community health programs -- SEARHC\ SEARHC -- advantages of|
Section 16: National Indian Self Determination Act -- definition of\ tribal corporations -- emergence of\ tribal corporations -- duties\ health programs -- control of\ Southeast Alaska Regional Health Consortium (SEARHC) -- development of\ community -- advisors\ health aide program -- management of\ Lund, Ethel -- President of SEARHC\ health care -- management\ management -- transfer\ Indian Health Service\ changes -- impact of|
Section 17: Indian Health Service\ program -- federal\ organization -- bureaucratic\ Indian Health Service -- funding\ SEARHC -- flexibility\ work -- fun\ organization -- new\ organization -- creativity\ funding -- types of\ funding -- differences\ tribal corporation -- flexible funding\ tribal corporation -- billing opportunities\ tribal corporation -- wealth of\ health care -- quality of \ medical care -- differences in\ health aides -- perspective\ perspective -- historical\ work -- exciting\ health aide -- influence of\ health providers -- number of\ health care -- broad-based\ training -- improvement in\ babies -- delivery\ doctor -- consultation\ Bethel -- travel to\ pre-maternity home -- development of\ health services -- uses of\ uses -- changes in\ patients -- needing help\ travel -- weather dependent\ family -- imposition on|
Section 18: Bethel\ health aides -- communication\ emergencies\ radio -- communication\ radio traffic -- use of\ radio -- challenges\ Sitka\ Indian Health Service -- career with\ job -- Chief of Community Health Services\ Indian Health Service -- retirement\ SEARHC -- employment with\ job -- SEARHC\ projects -- SEARHC\ projects -- types of\ substance abuse treatment program -- changes in\ changes -- study of\ work -- substance abuse program\ retirement\ confidentiality\ confidentiality -- philosophical perspective on\ society -- perspective on\ government\ privacy -- myth of\ confidentiality -- village\ confidentiality -- reality of\ common sense\ radio -- confidentiality on\ society -- changes in\ privacy -- definition of|
Section 19: training -- physician\ health aides -- interaction with\ training -- cultural\ cultural relevance -- need for\ SEARHC -- cultural training\ cultural norms -- understanding\ social norms -- understanding\ moiety -- Raven\ moiety -- Eagle\ moieties -- balance\ cultural sensitivity\ health aide -- moiety\ health aide -- selection\ health council -- local knowledge\ representation -- equal\ vocabulary -- shared\ doctors -- learning\ information -- sources of\ doctor -- effectiveness\ patient -- comfort level\ health aides -- clan\ health providers -- gender\ women -- role of\ women -- qualities of|
Section 20: health aide program -- administration\ job -- duties\ supervision\ communication -- importance of\ understanding -- mutual\ language -- common\ health aide -- role model\ health aide -- expectations\ community -- opinion\ health care services -- cultural relevance\ health care services -- types of\ health care -- community needs\ health care system -- prioritizing\ care -- acute\ care -- emergency\ care -- preventive\ health care -- planning\ needs -- assessment\ needs -- importance of\ funding -- distribution of\ priorities -- setting|
Section 21: health care -- needs\ needs -- assessment\ decision making -- health aides\ health aides -- role\ SEARHC -- role\ community -- power structure\ SEARHC -- board of directors -- SEARHC -- decision-making\ hospital -- control over\ hospital -- response\ job -- administrative\ needs -- decision-making\ health aides -- requests from\ health aide association -- description of\ association -- collegial\ power -- lack of\ health aide -- effectiveness\ corporation -- request to\ health councils -- role of\ SEARHC -- board members\ Tlingit and Haida Central Council\ communities -- differences\ representatives -- selection of\ health care program -- regional\ SEARHC -- effectiveness\ Indian Health Service -- differences\ health council -- emergence of\ Adams, Marge\ Yakutat Health Council\ community -- self-control\ influence\ health council -- SEARHC\ health council -- representative\ health council -- meeting with\ control -- local\ healthcare -- relevant|
Section 22: health aides -- salary\ education\ work -- length of\ specialization\ education -- continuing\ health aides -- recognition of\ job title -- change in\ responsibility -- increase\ health aides -- advocate for\ organization -- bureaucratic\ organization -- administrative\ health aide program -- changes\ Jim, Jessie -- example\ health aide -- value of\ salary -- increase\ health care services -- improvement\ developmental positions -- emergence of\ employee -- incentives\ health aide -- advanced education\ contribution -- personal\ belief -- strong|
Section 23: physician assistants\ health aide -- education\ education -- advanced\ Kake\ health aide -- advancement\ health council\ health aide -- hiring\ health aide program -- impact of\ Alaska -- challenges of\ challenges -- geographic\ challenges -- transportation\ communities -- distance between\ health aides -- benefits of\ health care -- local knowledge\ health care -- referral connection\ health aides -- respect\ community -- part of\ Bethel region -- size of\ rural health care -- success of\ health aide program -- future\ SEARHC -- future\ health aide program -- disappearance\ health aides -- over-trained\ health care -- expectations\ local provider -- loss of\ medicine -- changes in\ doctor -- personal\ doctor -- specialization\ patient -- self-care\ patient -- decision-making\ patient care -- whole person\ health aide program -- northern Alaska\ health aides -- reliance on\ health aide program -- personal impact\ gratification\ satisfaction|