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Joyce Smith, Part 2
Joyce Smith

This is the continuation of an interview with Joyce Smith on March 11, 2005 by Karen Brewster at Joyce's home in Ouzinkie, Alaska. In this second part of a three part interview, Joyce talks about providing medical care out of her home versus in a health clinic, the role of her faith in her health aide work, and the importance of maintaining confidentiality. She shares her memories of the 1964 Alaska Earthquake and the effect of the resulting tidal wave that hit Kodiak Island, and also discusses balancing raising a family with working as a health aide, and changes in the communities and the delivery of medical care, such as with telemedicine and management by Native health corporations.

Digital Asset Information

Archive #: Oral History 2004-17-04_PT.2

Project: Community Health Aide Program
Date of Interview: Mar 11, 2005
Narrator(s): Joyce Smith
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
Location of Interview:
Funding Partners:
U.S. Department of Health and Human Services, Health Resources and Services Administration, University of Alaska Health Programs
Alternate Transcripts
There is no alternate transcript for this interview.
There is no slideshow for this person.

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Using her home as the clinic.

The importance of maintaining confidentiality and the burden that can place upon a health aide.

The role of prayer and faith in her health aide work.

Relationship between the community and the health aide, and issues relating to maintaining confidentiality.

Her memories of the 1964 earthquake and tidal wave that hit Kodiak Island.

Continuation of her memories of the 1964 earthquake and tidal wave that hit Kodiak Island.

Continuation of her memories of the 1964 earthquake and tidal wave that hit Kodiak Island.

Continuation of her memories of the 1964 earthquake and tidal wave that hit Kodiak Island.

How she balanced working as a health aide, teaching kindergarten from her home and raising her own family.

Social changes and their effects on the communities and people of Kodiak Island.

Changes she has seen in the administration of the health aide program and visits from doctors.

The development of telemedicine and the benefit of having a doctor able to see what you were talking about.

Helping people as a medical provider, mixing health aide work with summer Christian camp work, and the change from running a clinic from her home to having a separate building.

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KAREN:  So what kind of facilities did you have?  You said people would just come to your house for treatment.  

JOYCE:  Right around the table here mostly. 

KAREN:  Uh-hum.  

JOYCE:  Until the clinic was in operation.  What -- what I did here, which people appreciated, there was so little confidentiality.  Like when a doctor would come from Anchorage and they used to hold the clinics in the old school building.  There would be nothing but a sheet up between that and the waiting people. 

KAREN:  Uh-hum. 

JOYCE:  And you could hear everything, practically see through the sheet.  When I had a clinic here, the room off -- off from the kitchen here I had for a clinic.  And I had the medical cabinets and I had the exam table and the things like that, and in the living room for a waiting space and the bathroom over here, and the door closed, and there was -- it was kind -- it was confidentiality.  And people liked it.  It was the best that we had ever had in the village for -- as it was a private room and a place for people, and they kept the medical -- takes a lot of medical equipment to operate clinic, both for bandages and emergency things.  And the supply of different medications, and I had room for that in our basement storeroom.  So I had a lot of -- lot of people come here.

KAREN:  I was wondering about confidentiality.  I was going to ask you about that and how --

 JOYCE:  It's very -- very, very important.  I think the biggest problem I had with that was the fact that people would talk about a case, or maybe members of the family would disclose things, and often they were wrong.  
And I couldn't -- I couldn't even point out where they were wrong because in order to do so, I would have to actually tell the real situation.  They could talk, but I couldn't.  But I considered that very important not to -- not to disclose things.  Mostly not even to my husband, and he was often involved with helping me with things.  He could have been a good doctor.  He -- very observant of details, and able to take blood pressure and things like that, too.  But you go to a home and for medical call, and sometimes you would discover all kinds of things that are going on in that home.  And sometimes I couldn't tell anybody what I had seen there or what I had heard or been told. 

KAREN:  Yeah.  

JOYCE:  And sometimes it becomes a big burden not to be able to unwind, not be able to -- to have to carry it all yourself.  For a while, we had a public -- we had a mental health worker who came around and she usually stayed here.  And I found that I could talk some of those things to her, knowing it would never go any further.  But it can be quite a burden to carry.  Some things I didn't even want to share with my husband because it might change his feelings towards -- towards people.  And so --  

KAREN:  So how did you deal with that burden, then?  How --

JOYCE:  Well, most -- mostly it was only if I could talk to some other professional that was not involved, but like I say, for a time, we had a mental health worker that was coming in that I could talk with her, just -- just unburden myself with all that I was carrying.  But a lot of time there was nothing I could do.  

KAREN:  Could you talk to other health aides in the other villages?  

JOYCE:  No.  No.  No opportunity to do it, really.  I did, when we got the clinic radio, I -- we had more communication, but of course, we couldn't talk confidentially with things on the radio. 
KAREN:  Right.  

JOYCE:  But Ahkiok and Old Harbor usually could not reach Kodiak.  There's mountains in between, and -- but they could reach here.  We're all on an island.  And I often relayed medical things for Old Harbor or -- or Ahkiok.  And that was interesting.  Just to be able to take a message of a need and -- and -- and be able to communicate it directly to the clinic and hospital in Kodiak.  

KAREN:  It's interesting that all that was by radio.  You were talking to the doctors by radio that everybody else could listen to.  

JOYCE:  Not --

 KAREN:  No?  

JOYCE:  Not -- the frequencies were not -- they were special -- special frequencies.  

KAREN:  Okay.  So that helped protect? 

JOYCE:  Uh-hum.  

KAREN:  To some -- okay.  I thought it was all on open channel.  
JOYCE:  No.  This wasn't open radio.  This was on special channels that we were given for medical purposes.  

KAREN:  Okay.

KAREN:  How do you think your faith has played a role in the work that you've done? 

JOYCE:  I one -- was one of those accidents, afterwards an observer, a village man said, were you praying?  I said, yes.  But, you know, sometimes it -- my faith has, I think, had a lot to do with it, but sometimes when I get through with something, I wonder, how could I manage that?  You know, maybe if, say, three cases all at once are like that, how could I do it?  And I realized that it was -- I had help beyond myself.  It just -- I think any medical person probably finds that in an emergency, things come to them that they wouldn't have even remembered that they knew.  But I think a person's faith has a lot to do with it.  
And I found, while I -- I was not then an ordained minister or anything, but I found that often the things people came to me about were superficial compared with the burden they were carrying some other way.  
And I think I didn't -- I even still do a lot of counseling.  It's not officially religious, yet without my faith, I couldn't do it.  So that's very important. 

KAREN:  Yeah.  And I was wondering with that -- about, you know, that burden, you couldn't talk to other people and --

 JOYCE:  Oh, yes.  In prayer.  

KAREN:  -- if you feel your faith helped in that?  

JOYCE:  That's very much so.  But also, for help and direction and each situation that you didn't think you knew what to do, and yet I did.  And I think I very much give credit to God for that.

KAREN:  That is sort of related to the confidentiality.  Did you notice being a health aide, how that affected your relationships with people in the community in interacting and -- did it -- did you feel isolated from people, because -- or did it help bond you to people?  

JOYCE:  I think when they realized that they were safe with me that I think it caused bonding.  Because they certainly knew that I did not communicate.  
I had one situation where when we had one telephone in the village, it was located at the store, and I had to deal with a problem.  I had a lot of problem with doctors who wanted you to give so many details.  And I knew that people had their radios tuned to listen to private conversations.  And it was very difficult because I had to -- had to get the information to a doctor in order to be able to handle it.  And somebody got very angry about it.  Well, they had no business to be listening on a -- on that kind of a frequency.  That's why I didn't like it at all with that public telephone because it -- it wasn't confidential.  And I couldn't get it across to doctors that I couldn't give the details.  Because of confidentiality.  

KAREN:  Yeah.  

JOYCE:  I think that's the only time I've ever really had any problem that way.  And it was -- the doctors demanded details that I did not want to give when I knew that people that had radios tuned to it.  I don't think they can do that with the present, you know, telephones that we have.
KAREN:  Yeah.  

JOYCE:  If it was a radio-operated telephone, it wasn't a regular telephone service.  
KAREN:  So when did the -- when did you get regular telephone service here?  

JOYCE:  I can't remember.  Funny, some dates I remember, and some things I just came into them and it became part of things, but I didn't recall dates exactly.  

KAREN:  You had already been a health aide for ten years?  Five years?  I mean, you know --

 JOYCE:  Oh, much, much longer than that before it ever happened.

 KAREN:  Really?  

JOYCE:  Because I --

 KAREN:  If you can remember how old one of your children was, that's always a -- that's a good way to place dates.  

JOYCE:  I probably could do it if I looked on my telephone, if I had a telephone bill handy.  

KAREN:  Yeah.  No, I'm thinking like '80s, you know, how long have you had to do this radio phone kind of communication at the store?  

JOYCE:  It seems like it was in the '80s.  

KAREN:  Okay.  

JOYCE:  I wish I could remember but I'm sorry, I can't.  

KAREN:  Well, so -- 

JOYCE:  I know I had 20 or 30 years with -- without.  

KAREN:  Okay.  

JOYCE:  Like. 

KAREN:  So yeah.  That's -- that's kind of what I meant.  A long time you did it at the village -- at the store, using their phone?  

JOYCE:  They didn't even have that for years.  They had -- they had the cannery radio.  

KAREN:  What's that?  

JOYCE:  The canneries had their shortwave radios, and they were the only thing if you -- well, like at the time of the tidal wave, we had CB.  The cannery radio was out because the -- it required the generator on the dock, which was destroyed in the tidal waves.  

KAREN:  So there were canneries here in Ouzinkie?  

JOYCE:  We did here in the past.  

KAREN:  Oh.  So -- 

JOYCE:  Oh, one of them was destroyed in the tidal wave.  And then there was another one, and there was a fire and it was destroyed.  So they didn't rebuild because they had another cannery at Port Bailey and another one in Kodiak.  So we lost out.

KAREN:  But you remember the tidal wave?  

JOYCE:  Definitely. 

KAREN:  Can you talk about that?  

JOYCE:  Hum?  

KAREN:  Can you talk a little bit about that?
JOYCE:  Well, it was -- it was a pretty fearful time because there was no communication.  We -- we had -- we used to be able to get the Anchorage radio stations, and I couldn't get any radio station.  And in fact, the only -- only thing we could -- that we had was our CB.  We had our little generator that Norman started up, and so we were able to operate our CB radio.  And that was all there was until the -- one of the men renovated a boat radio, which was actually illegal just because it was outdated, and he set it up at the school and the school had a generator.  But the regular generator for the village was gone.  There was no electricity, there was no -- no radio, no -- we had actually the only communication for a while here.  And it was the uncertainty of it.  We didn't realize how -- how tremendous or how widespread it was.  We thought it was just in the Kodiak area.  And it was awhile before we discovered all the damage, and especially earthquake damage in -- in Anchorage.  I was very happy to see that -- that my high school daughter was home.  See, we had to send our children away to high school to Kodiak.  There was no -- there were no village high schools in the years that my children were growing up.  
And Norman had gone in with the boat and brought Robin home on -- on Friday for Good Friday, and -- and she was here.  It started in the afternoon on -- well, the earthquake part of it, and we were just -- we had to leave the house.  It was just so intense.  And we had to -- there were a young couple that were using one of our bedrooms upstairs, she was pregnant, and her husband worked with the Fish and Game and he was clear over at Karluk.  
And, well, this tremendous earthquake started.  And we finally decided we better get out of the house.  It was very difficult just to get out through the porch back door.  And then we thought about there was another, Karen, she was upstairs, and just about that time she appeared.  She had come down those stairs.  She was so concerned about her little dog that I think it gave her for -- she didn't think about her own fears because she said it was just coming down those stairs, and then down the front steps, which is the way she'd come.  Just everything was going sideways.  She just almost couldn't make it.

JOYCE:  Once the tidal wave started, we had a whole bunch of people in our house because we were -- we were one of the high places.  At that time the school and all the section up this way was nothing but woods.  So we were one of the high spots right here and across the bay.  A lot of people stayed in other people's houses that night.  And our cannery was destroyed.  There was a bridge that was destroyed.  Several homes.  The whole waterfront was -- was changed.  Our boat was at anchor.  We had a permanent mooring.  It was the farthest one out in the bay.  And when our nine-year-old son -- the youngest one was crying, that was normal enough, but the other one, the boy was kind of in shock.  He really was.  In fact, in later years we discovered that it was -- it affected him psychologically.  In just recent years he's had some problems and it's dated back to the fears he had about that.  

KAREN:  And he was how old?  

JOYCE:  Hum?  He was nine or ten.  And anyway, we were out in the yard and had -- you know, it was just -- there was snow on the ground.  My daughter had always kicking off her shoes as soon as she could, and she was out there barefoot.  It was a beautiful, clear day.  Just absolutely beautiful.  But there was snow on the ground.  She -- anyway, my husband realized that Timmy needed some diversion.  He said, why don't you go down and see what's happened to the boat.  Well, I thought of a tidal wave and apparently he didn't, but I knew what he was doing, so I didn't interfere.  And it just seemed like it went forever and Timmy didn't come back.  And finally, I -- I heard on the radio from the Coast Guard station, it was the Navy at that time, whatever it was, it was military, was the only thing else on the radio.  And they -- this young military fella, his voice just shaking, he says -- he says, everybody get to high ground, at least 50 feet up.  He said, there's a tidal wave coming.  This station's going off the air until further notice.  Well, that was the voice of authority in all medical emergencies.  That's what they always said.  They weren't back on the year for about two years.  Yeah.  That's when we -- when we really realized.

JOYCE:  Norman and Robin had gone down to -- to look to see what had happened to the boat because Timmy had come back and said it was milling around in the bay.  And we left it tied up to another boat at the dock.  
So Norman and Robin went running down the trail, which there wasn't a road then, and -- then I get this word that -- that there's a tidal wave coming and that they are at the lowest point in the village.  So I started running down there to call them, but they were already on their way back up.  And there was the boat out there.  And it was, as we found out later, the man who operated the boat that we were tied up to at the dock lived far across the bay.  And he was an old timer, and he knew that an earthquake like that would probably generate a tidal wave.  He had a big family, he put them all in this big fishing skiff, nine of them, and came across the bay, untied his boats from the dock with our boat still tied alongside, and headed out.  And he said he had twin engines going full forward, and he managed to -- he managed to get the Evangel on its anchor out there, and he said that's when he had the two engines going full force, and he was pushed clear away back here about at least a quarter of a mile. 

KAREN:  Wow.  

JOYCE:  Even with the engines headed forward, the force of that wave took him back there.  

KAREN:  Wow.  He's lucky that he --

 JOYCE:  The smart ones were the ones that knew if their boats were away from the dock, away from land, they were safe.  Out on the water, they were safe.  Up by land, they were in danger.  The village store keeper didn't know what was happening, she went out to see what -- what damage had happened from the earthquake.  And she got pictures of several of the young fellows of the village jumping down onto the boats.  The crab season had closed the day before, and all the boats were in, but many of the fishermen were -- had -- well, shall we say, were having a party.  I mean, they -- and they were not available.  And these young fellows who had worked on the boats decided to get those boats away from the dock, and they did.  And she got some pictures of that.  Went back to their little apartment, which was down at low level in the village, and they started some summer -- supper and discovered that they had water up to their knees and had to get right out of there.  And a bunch of them went up on the mountain.  It was on Good Friday.  And they just came back on Easter Sunday morning. And we always had an Easter sunrise service here.  At that time, we had it indoors.  And then an Easter breakfast.  And many of them were wearing the same clothes they had been wearing on Friday, they just couldn't come down off the mountain.  So they came and had Easter breakfast here and were happy for that.

JOYCE:  And that was when we had the false alarm.  And there was a -- somehow there was a -- a rumor got started that there was another big earthquake.  And we had kids coming back for Sunday school, and parents came and just grabbed them and, there's going to be another tidal wave, it's going to be a bigger one.  And we could hear screams all over the village.  Just terrified.  And Norman got on the CB and talked to the authorities, they said there -- there couldn't be another tidal wave unless there had been another big earthquake, there hadn't been, and it was absolutely false.  
But nobody would believe if they ever -- you know, the whole group hysterical, they went up in the mountains.  And that day it snowed heavily, and they were up there.  And quite some time up there in the cold and the snow on a false rumor.  And I know one little boy that had an ear infection, by the time he came down, back down, he had both ears infected.  
At that time, I had a knock on my back door which was unusual at that time, and here was an airline pilot and a man in a military uniform.  I didn't realize at that time that the doctors at the Native Service Hospital were military because we never saw them that way.  But this one was.  And he had been sent out to go to the several villages, he had two hours to spend in the village to see anybody that needed it.  It was before we had a clinic.  This table, he -- I -- that was the first day school had resumed.  It was a week, more than a week after, after the tidal wave.  And so my son Tim was in school, and I sent him up to school with a note to please allow any children that had any illness or anybody in -- with medical need to go home and tell them because there was no way of communicating.  And I discovered that these two fellas hadn't had anything to eat, so I put some stuff on the stove and I said, take care of yourselves.  And I headed down this end of the village because I knew of pregnant women and various things, people down this way that didn't have kids in school.  So by the time I came back from informing them, the people were streaming in here.  My husband had gone down with the boat, down to Pleasant Harbor, where they -- they had had a big barn, had been washed away, but they discovered where it had washed up on a beach.  It was really all smashed, but there was a lot of good lumber.  They were going to start rebuilding.  Their house was gone.  Various things.  
So he went down and towed this thing back for them.  And by the time he came back, we had a clinic here with I don't know how many people.  And doctors had left me medicine and, oh, quite a few things that were a result of exposure being out in the wet and cold.  So I had the clinic around the table here for days for people that were -- that the doctors had given me instructions and people to give shots and people to do this and that for.  So that's one of my memories about the tidal wave.  

KAREN:  Now, any lives lost here during the tidal wave?  

JOYCE:  There were -- there was one that was on a boat coming from Kodiak, and that boat was lost off Spruce Cape, the danger spot out there.  The tide just came together.  I actually heard some of the last conversation from that on my radio, but didn't recognize the voices.  Other people did.  And the family down at Pleasant Harbor had gone up the mountain and they saw it.  That was their relative.  But it was one man from here.  And there was another one who a plane had just been in to Ouzinkie just before the earthquake and tidal wave, and they were in the air and didn't know what happened.  And they -- at that time they were landing downtown in Kodiak, right on the waterfront.  
And this man got out of the plane, he had been drinking, and he started for the boat harbor and nobody ever saw him again.  They figured -- see, the boat harbor was really destroyed down in Kodiak.  And he must have been down that way.  But those were the two that I know of.  But everybody was needing things, and anything that I had on hand, you know, things that they could use.

KAREN:  How did you balance your teaching kindergarten and your health aide and your family work?  

JOYCE:  Sometimes I wonder.  I -- for a while, I had an hour of clinic here from 8:00 to 9:00 in the morning, and then I had kindergarten until noon.  Then I had clinic again from 1:00 to 6:00, I think it was.  But then I was having kids coming in here for clubs, too, various activities, I don't know -- I don't know how I managed, really.  When my husband was here, it was fine.  But when he was away with the boat, then I had everything to handle, including my family.  I didn't have things piled on the table like they are over there now.  I had to usually have these two tables put together.  And sometimes 15 or more kids gathered around the tables.  Yeah.  But if there were medical calls, you know, during that time, I just took care of the calls.  As long as I had that room in there where I could have some privacy.  It seemed like most of the emergency things were at night.  

KAREN:  Yeah.  So you never had to leave the kindergarten class here while you went off to emergency?  

JOYCE:  Well, the kindergarten, if Norman were here, he would take over.  And if he wasn't, I'd probably have to send the children home.  They didn't -- it didn't usually happen in the mornings, that was the thing.  It was just some reason, accidents and so forth.  There would be kids to see before school, to see if they could go to school because they thought they were sick or things like that, but it seemed like all the emergencies happened after noon.  

KAREN:  That's convenient.  

JOYCE:  Yeah.  

KAREN:  And how did your husband feel about you doing this health aide work?  

JOYCE:  He was with me very much in it.  That seemed a, kind of a fulfillment of the rest of my -- my feeling of a call to a place, to have the dealing with physical problems, which also included some mental and spiritual problems.

JOYCE:  Strange thing, but it seemed like so many men who would come with some -- you know, men are always getting cuts and bruises and stuff like that, but it would be something that wasn't life and death.  But then stay to talk about problems.  There were a lot of changes going on in the village.  After the -- was it 1970, with the -- all the changes when the villages began to organize, tribal council and things that they had never had before, and there were lots of problems and people who just didn't know how to govern.  They had to learn.  And sometimes they would come and after taking care of medical things, they would talk to me.  They couldn't talk to anybody.  They couldn't talk to anybody in the village about what was bothering them.  And so I was a sounding board on a lot of things.  And there were very many changes psychologically in the villages when they began to form corporations and things like that.  They didn't have the business experience.  And they had some pretty difficult things to deal with.  And not always prepared, sometimes people were not the best of leaders.  They needed to learn, but they -- they were making some mistakes.  And it was -- it was quite a -- it was a tremendous psychological change for Native people.  And from being primarily just a fishing people, who worked only really in the summer months, to year-around fishing, to having part in tribal organizations, and then government of various kinds, the big corporations that have formed and like that, it's -- it's been quite a change for them in so many ways.  Even around the island, some of the villages we visited, there was one village which was wiped out in the tidal wave, but people there were just about as isolated as they could be.  There was no school there.  Many of the women didn't know how to read.  And the men might have learned a few things from traveling around fishing, but -- this really isn't part of the health aide business, but when we would have meetings for children, all the mothers would come because they never experienced anything like that in their lives.  They hadn't even -- scissors and crayons and all those things, they never done that in school, and they loved it.  It was interesting because when we had -- I'd have meetings for children, I could almost be sure that all the mothers would be there, too.  The other thing is they would stay just as long as you could -- you would possibly have time for them.  

KAREN:  Yeah.

KAREN:  It is -- it is related to the health aides in that I was wanting to ask you about you were involved with health aide work for so long, you saw it go from Public Health Department to the tribal corporation.  

JOYCE:  Native -- Native Service it was -- was before, and then later the tribal, as they organized, it began to be.  

KAREN:  And how you've seen the changes in the people running -- being in charge of the health aides.  

JOYCE:  Uh-hum (affirmative).  It's --

 KAREN:  How that's changed.  

JOYCE:  It's been amazing to see the kids who grew up coming here for -- we had the only social activities for them in the village in those days, and they grew up really isolated.  You'd be surprised how isolated each village was.  
We tried to give them a little bit bigger view of things.  But to see them using them, the things that we taught them.  Now, they are the leaders doing things in the village.  It's -- it's very interesting to watch.  

KAREN:  How do you think that the delivery of medical services has changed?  

JOYCE:  Well, of course, it's become far more professional than it was.  I don't think the health aides have nearly the freedom that I had.  I think they are much more restricted now because the Native corporations have become very fearful of legal claims, you know, if any -- you know, like that, and they -- so they very -- be very careful that they only do the things that they are -- are allowed -- allowed to do.  In the early days, we did whatever needed to be done because there wasn't anybody else to do it.  

KAREN:  And how often do the doctors come to villages nowadays?  

JOYCE:  Well, I really don't know.  They sent out now -- they come from now from Kodiak, you see, they have the organization there.  And they come, I think, about every two months.  I -- you could ask at the clinic.  They know. 

KAREN:  Yeah.  

JOYCE:  Not being closely associated with them anymore, but I know that it's much more frequent.  

KAREN:  Yeah, that's -- they seem to come much more frequent than when you were --

 JOYCE:  Uh-hum.  Much more frequently.

KAREN:  Now, during the times when you were working, did you ever get to use that telemedicine that they use now, that video conference kind of thing?  

JOYCE:  We didn't have -- we didn't have that.  I know -- I know what you're talking about, where the doctors get in and see --

 KAREN:  Right.  

JOYCE:  -- the patient.  Like from Anchorage.  It's -- I don't think there's any of that around Kodiak Island.  It's been more from -- from Anchorage out to the Interior than it has been around here.  I know that we never had it.  

KAREN:  Right.  Yeah, I don't know what year that technology started to be used and if it was while you were still working or not, but it you haven't experienced it.  It would be interesting. I was curious, you know, if you had used it, how that felt to use that technology versus the way did you it.  

JOYCE:  I -- I often wished sometimes that we had that kind of thing because if you -- if a doctor could see your patient, it would be, you know, so much better able to prescribe, give advice, but we didn't ever have it.  In fact, we were pretty much on our own many, many times.  

KAREN:  How did you deal with that?  

JOYCE:  Hum?  

KAREN:  How do you deal with that, being on your own?  

JOYCE:  You learn everything you can.  You keep books and reference materials to look up everything you can, and then just trust that you're going to be able to make the right decision.  Use the knowledge that if you don't do something, nothing's going to be done, and it can be critical.  I don't know, I don't think they do nearly the amount of suturing that I did.  

KAREN:  Well, so you eventually did learn to suture?  

JOYCE:  Oh, yes.  In the second session.  And I was ready for it.  

KAREN:  Yeah.  

JOYCE:  I had one boy, he was always banging his head on something and coming with gashes and, oh, don't give me a shot, don't give me a shot.  I very carefully used the shot to deaden the area.  And he was fine, I did the suturing, it didn't hurt at all.  He was so afraid of shots.  And I don't know how many times he had cuts on his head.  He just seemed to be prone to that kind of accidents.

KAREN:  I was wondering about talking more about some of the experiences with different cases, you know, without names, but that one you talked about with the three men sounded like one you were very proud of as a success. 

JOYCE:  Uh-hum.  

KAREN:  Other ones that you were particularly proud of as a successful, you really helped somebody?  

JOYCE:  Well, in general, I'd feel that I had done some -- what was necessary and was -- when a person wasn't able to get to other medical help, to see them survive nicely.  The funny thing was when I went to training and left my husband in charge, because I didn't have an alternate for many years, and actually KANA paid him a little something for it.  But they would come in, I had a woman tell me about how she had this bad infection on her breasts and how he took care of it, and it all healed up.  They want to show me how good it was, you know, some things my husband did.  

KAREN:  It sounds like being a health aide, then, was a 24-hour-a-day job.
JOYCE:  It was.  And when they began paying us, and I think it was something in the vicinity of $180 a month, we were expected to be on duty 30 days a month, 24 hours a day.  I remember I had to report if I was even away for a few hours on a Sunday afternoon.  

KAREN:  So how did you -- so you could never leave town.  

JOYCE:  No, not very well.  However, I had an agreement with the village I was going to be away a lot in the summertime because both the fact that the children and I would go with my husband on -- it was much more effective when it was a whole family going into villages and things like that.  
The other thing was several weeks that we were responsible for the transportation to the camp on another island, and also worked in the camps.  And so I -- it was pretty well understood that I -- I wouldn't be here in the summer months.  They couldn't really say anything.  I wasn't paid anyway, so --  

KAREN:  So what did they do when you weren't here?  

JOYCE:  The thing -- the thing that I had to do one summer was to keep coming back.  I'd come back overnight and have clinics at night here.  I'd work in the camp in the daytime, that summer my husband wasn't working in the camp, and flying back and forth.  Because my husband was the agent for the airline here in the village, and usually they didn't charge me, so I -- if there was room, I -- I would fly over in the morning early and somebody with a boat would meet me, a skiff would meet me and take me to the camp.  And then late afternoon, come back and fly over here and hold a clinic at night, several nights a week. 

KAREN:  I was just going to ask you about the clinic, and when you got -- actually got a clinic building here so you didn't have to keep having people in your house.  

JOYCE:  Uh-hum. 

KAREN:  Do you remember?  

JOYCE:  I'm sorry to say I don't.  

KAREN:  It was after you got a telephone, or before there was a telephone?  

JOYCE:  Uh-hum.  And I think we always had a telephone at the clinic. 

KAREN:  Okay.  

JOYCE:  And the clinic was down here where some of the Native offices are now, it was only a block and a half from here, so -- 

KAREN:  And so now there's a newer clinic?  

JOYCE:  No.  

KAREN:  No, it's still the same?  

JOYCE:  The new one is up -- the new one is up close to the airport, but this one was close here, so --  

KAREN:  So when you retired, the clinic here just a block away was where you were working out of?  

JOYCE:  Uh-hum.  Uh-hum.  Yes.  Yes.  

KAREN:  So it sounds like maybe in -- I'm sure I could find out, but -- 

JOYCE:  I'm sure you can, too.  

KAREN:  I was just wondering what you remembered about that --

 JOYCE:  I just -- 

KAREN:  -- how long you worked -- sort of try to figure how long you worked at home versus how long you had a clinic with better equipment.  

JOYCE:  Longer from home than with the clinic, but I worked quite a few years from the clinic, too.  

KAREN:  Okay.  And then this new clinic has been since you retired?  

JOYCE:  Uh-hum.  Uh-hum.  

KAREN:  And those are run by KANA?  

JOYCE:  Uh-hum.