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 third part of a three part interview, Joyce talks about being a non-Native health aide in a mostly Native community, differences between her early days as a health aide and current practices, providing quality care to patients, and the joys and hardships of caring for people. She also talks about the history of her house which had belonged to the American Baptist Mission and was used as her clinic, her thoughts about the success of the health aide program, the challenges of dealing with alcohol issues in the village, and why she enjoyed being a health aide.
Digital Asset Information
Project: Community Health Aide Program
Date of Interview: Mar 11, 2005
Narrator(s): Joyce Smith
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
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Her experience as a non-Native health aide and being accepted and cared for by the community of Ouzinkie.
The pros and cons of being a health aide who is originally from the village versus being an outsider.
The type of personality needed to be a health aide, and her praise for Old Harbor health aide, Stella Krumrey.
Advice to young people who want to become health aides and the need to be dedicated to the work in the long-term.
The self-sufficiency and independence of early health aides compared with the restrictions placed on the care provided by current health aides.
The hardship of losing patients and the joys of having people recover.
Knowing your limitations as a health aide and trying to get the patient out for better care, and changes in the availability of equipment from the early days to modern clinics.
Having the clinic in her home, the history of the house, and the relationship between the Mission and the clinic.
The importance of having gatherings of health aides to share their experiences, and her thoughts on the success of the health aide program in rural Alaska.
Continuation of her evaluation of the success of the health aide program and how it has become an international model for rural health care.
What she gained personally from being a health aide, and some observations about the current health aide program and schedules compared with when she was a health aide.
Dealing with alcohol issues, the role of health aide as an educator, and her satisfaction with having done health aide work.
Her coming to Kodiak with her husband, Norman, the challenges of raising a family while also doing health aide work, and her love of learning.
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KAREN: One of the questions I had was about who your mentors might have been along the way. JOYCE: Well, it's hard to think of names. But I know there was some at the hospital that were very great teachers. KAREN: Uh-hum. And they were doctors or other health aides or nurses? JOYCE: As far as mentors, we were pretty much all on the same -- same level. The early ones. We were all learning together. I'm sorry, I can't think of names. KAREN: That's okay. JOYCE: I had one Native nurse teacher at my first session of health aide, and I was the oddball, I was the one non-Native in the group, and she really put me to the test. She just tried me out on everything. But it turned out that she was, like, the one who give me my final evaluation. And she said that I -- she felt that the village of Ouzinkie was very fortunate to have me because she said I had such obvious love for the people. And I thought that was the most -- one of the greatest things that was said because I found that I did have a tremendous love for Native people. And I noticed the response. I would go with the doctors on rounds. This elderly Eskimo ladies who couldn't even speak English, they would reach out and grab my hand. There were several of us and there were several of us that were Native, and they would reach out to me and just hold on to me, and just like I was a lifeline for them. And I noticed that, there was such a good response from very Native peoples. And here I was the strange one, you know. It was a little hard going there because everybody wondered how does it happen. Well, your husband must be Native. I was the one that could do the job and was asked to do it. That's all. And -- KAREN: Yeah, I was wondering what those pressures might have been. Because most of the health aides are Native. JOYCE: Uh-hum. Well, I was impressed into service in Larsen Bay, I was impressed into service here. And there was no -- people seemed to figure I was the one for it and that was it. KAREN: So you felt you were well treated by the community here? JOYCE: Yes. Very much so. They certainly have been wonderful to me in my older years. They had a senior dinner shortly after Norman died, and one of the elderly women said, you're not going to move away, are you? And I said, no, this is my home. Oh, we're glad. Things like that make it all worthwhile, you know. KAREN: You said your husband died 8 years ago? JOYCE: Uh-hum (affirmative). KAREN: All right. It's nice to be in a community that cares and supports you like that. JOYCE: People send over meals sometimes and just nice things. But they've -- they just say they are glad I'm here. KAREN: That's good. JOYCE: And I'm not doing all the things I used to -- I used to do so many things and I'm not doing them now, and they still want me here. KAREN: That's good. JOYCE: It's -- it's good.
KAREN: Were there ever times during your years of working as a health aide where you wanted to quit, you were just done with it? JOYCE: No. Not really ever wanted to quit. Towards the end of my time, I had some friction with some of the leaders who actually ended up being found to be incompetent. But almost jealousy over my realm of knowledge, and he was. KAREN: But you got -- JOYCE: He was -- it was difficult. It was shortly before I retired. I was plenty old enough to retire. But that's the only time I really, that I ever had any -- any problem. But -- KAREN: Do you think that there's a benefit to being the health aide and not being related to the people in the community? JOYCE: Very much so. There were times when I was so glad that I wasn't related to anyone in the village because I heard other health aides of the terrible problems they had with family instigated complaints and various things that I didn't have to deal with at all. It was much easier. I -- I knew the village, I was part of it, but I wasn't related to anybody that could -- family, some of those family things, and these were various health aides that I heard of that had problems like that. KAREN: Well, also, I think, some of it, the hard -- how hard it would be as the health aide to have medical issues with family members. JOYCE: Uh-hum. Very hard. KAREN: Death and dying and those things that -- and how you deal with that. JOYCE: One session, there were two health aides that were late getting back. One of them was called to an accident, and one, they turned the patient over, discovered it was her own brother, terribly mutilated in an accident. The other one, I was trying to think, she had an uncle or something that had died and had had to go through all of the rituals they go through, and some are religious about it. But very close. Very close to their lives, these problems.
KAREN: Have you thought about what kind of person makes a good health aide, someone who -- who sticks with it? JOYCE: Somebody like Stella. Good humored, imperturbable, shall we say, and just a tremendous amount of knowledge and experience. Never -- she never flaunts it or anything. She's -- I can see that she could fit beautifully to the needs of her community. KAREN: And you said before that you've known Stella since she was a child? JOYCE: Yeah. My first recollection of Stella, we were visiting the village of Kaguyak, which doesn't even have a dock, didn't even have a -- store didn't have a -- they had had a church and that was all it did have. And my daughter Robin and Stella playing together on the beach. Somebody gave Robin a half a smoked salmon. And anyway, the two little girls played together and they -- I kind of followed Stella all the way from there, Old Harbor and her work. She worked with the head start program and she did a good job with that, and then she became a health aide and -- KAREN: How would you -- how do you respond to if Stella were to say, well, Joyce was my mentor, my inspiration? JOYCE: Well, I don't know exactly how, but I -- it pleases me very much. Because I'm just proud of her.
KAREN: From all your so many years, do you have any advice you might give to the newer generation of people wanting to become health aides, or to encourage to become health aides? JOYCE: Well, I would say first of all, if you're going to go into it, go into it long term. Don't think of it as a job for a year or two. A good health aide is someone who will dedicate their life to -- to the work that she's doing. It isn't a -- it isn't just a take a job for a year or two. The whole attitude has to do with your -- your feeling towards people and your feeling that you can do a job that is not going to end quickly. Making house calls is, to me, a primary part because when you get people in their homes, you see what the real problems and needs are. And sometimes it's far beyond what you'd ever hear in the clinic. And be on call. KAREN: You think it -- well, you talked before about how it's changed, how the health aide worker seems to have changed. JOYCE: Well, it's -- it's more restricted. And for me, that would be very -- was very difficult even when they began to do that. Because I guess I had operated more or less independently always with knowledge of what I'd been taught and what I had learned, but not even that I should have been asked to do everything that I have been trained and knew how to do. And I think some of us, of the early group, were very independent that way. We had to be in order to do the job. But it's hard to have someone come in who doesn't even understand the situation and say, no, you can't do that, you're just a health aide, you can't do this and this and this, which you have been doing for 30 years or so. And I think that was the kind of problem that might arise. Nowadays, they have -- maybe it's because they are more limited, they don't feel that they are so essential as we felt we were.
KAREN: Now, I wonder how in your time, you had to do things and you were taking some big risks. JOYCE: We never thought of it as risks, we just thought of it as something that needed to be done. I think it's -- it's the big issue of danger of being sued nowadays that has come into the picture. And I think it would make a lot of difference to me if I were a health aide right now, because organizations like KANA are -- of course, would be sued right along with them, and that's why they are much more restrictive and that. We health aides were doing everything that a PA does anyway. And I -- I'm happy that Jerrilyn (phonetic) here has been accepted into the PA program. KAREN: Oh, she's a health aide from here who is going on? JOYCE: Yes. She wanted to very much, and I just read in the KANA paper that she was one of six from Alaska that was accepted. KAREN: Did you ever have an interest in going on for more training? JOYCE: Never had an opportunity. We were just kept busy right where we were. I don't think I was so much interested in a title like that because I was already doing all that. KAREN: Right. JOYCE: And it is different for them, though. And I'm wondering if -- if there aren't even now situations where they have to act on their knowledge and experience and not wait to be told. I'm sure there must be in many of the remote areas. It must still -- must still have that issue to deal with. To me, it was part of the job. But, of course, not having communication, not having -- not having telephones, not having even the clinic radio in the early days. We had to memorize everything in the training periods. We had to learn what the dosages were for certain medications that are indication. We learned a lot about medicines. Very good pharmacists that gave us wonderful knowledge of -- of medications and their use connected with particular illnesses and problems. We had to memorize what the dosages for a child this age and what -- what all the indications were for the medicines. I don't know if they do that now, but we -- we did because we had to know those things for ourselves. KAREN: Right. Yeah, I know for someone my generation, we're used to all the modern conveniences, you know. It's -- it inspires awe to imagine life like that and the things you did in the -- how hard it may have been. JOYCE: But I believe that's part of the reason that we were -- we stayed on and we -- because we -- we felt we were important, that we were necessary. And I think some of them now feel like, oh, they are just an instrument, wait until somebody calls me and tells me exactly what to do. And more like a robot.
KAREN: We had talked before about your memories of successes and how you had really helped some people. I don't know exactly how to ask this. There are times when things didn't work out and there was some great sadness or harsh -- hard feelings from your end that you could have done more. I don't know exactly how to ask it. I think you know what I mean. JOYCE: I think the only ones I had like that were times when I was away from the village. I know one man had a heart attack and died while I was gone. But my supervisor told me to go. Because it was a family situation, she says, you belong with your family. And she was in the village at the moment, but I did feel badly that I wasn't here to, you know, to do what I could. I think it was -- it took a very personal responsibility for whatever were the results. A great deal of satisfaction when people recovered from, even survived with your emergency medical dealings. KAREN: Do you remember the first time after -- I mean, before you talked about the first immunizations, but when you were doing more of the health care providing, do you remember your first case or your first emergency, what that was like, how you handled that? JOYCE: No, I really don't. I guess that was back too far. This is back almost 50 years. That's -- I remember the -- like giving the first immunization, I remember the groups of people coming to my little shack for things like that.
KAREN: Were there ever moments where you were scared when you were doing this work? JOYCE: There were times when I realized that I took more than what I had, and times when they -- the important thing was to get an evacuation, get the person sent to better facilities. I very well recognized when things were beyond my power, and the concerns then were to get them to a better source of help. And that always -- that's going to happen with anybody anywhere. KAREN: Right. JOYCE: Because there are situations that you can't deal with outside of a hospital or -- or with the particular skills and equipment that a doctor or a hospital has. KAREN: Uh-hum. JOYCE: And we were limited. For example, I never had X-ray equipment here. They did in Port Lions because there was a doctor there. But some of those things I knew I couldn't do because I had no -- no equipment to do them. And when I think of how limited we were in the kinds of things we had to work with for so many years, it took time before we got even the minimal of what was now in the clinics. You knew your limitations on those things is one thing I -- I certainly was able to recognize when I wasn't able to handle something and tried to get the person to a better source of help. KAREN: Did -- did the clinic here have different equipment than other ones? Or did everybody have the same? I mean, you mentioned Port Lions having a doctor. JOYCE: Port Lions had more equipment than most of the other clinics had at that time. For example, they -- they could do a EKG, things like that, when -- which we couldn't do because we didn't have the equipment. KAREN: Yeah. And why were they better set up than the other villages? JOYCE: Just because there was a doctor here -- a doctor, a resident doctor there. KAREN: And why was there a resident doctor at Port Lions? JOYCE: Because he had been an itinerant doctor and liked it there and decided to settle there. KAREN: Okay. JOYCE: As simple as that. But that was the -- the difference. We could learn to use equipment, but if we didn't have it, we were limited. And that was certainly true from the earliest days when I had to buy my own stethoscope and my own blood pressure cuff. One of the things that the -- some of the kindlier doctors would just happen to leave a bit of their equipment behind when they -- when they'd go back to Anchorage. I don't think there were ever any questions about it, but sometimes I got some of the things I needed because a doctor just failed to take with him what he had brought. All of what he had brought. That isn't everything, by any means. KAREN: Yeah. JOYCE: But it was a big help because they saw that we were handicapped by not having those things.
JOYCE: I was excited and thrilled when they brought the clinic furniture here when I said, oh, they will never do that, not when it's not a clinic, but they did. KAREN: They did. JOYCE: They outfitted that room. It was -- it was a pretty efficient clinic. It's a lot better than we had anywhere else anyway. And there was privacy. There was a bathroom and there was a waiting room. And it worked out fine. KAREN: And, now, this house, you said, was built in 1937, '38? JOYCE: Uh-hum (affirmative). KAREN: By the American Baptist Mission? JOYCE: Uh-hum. Uh-hum. That's one of the problems in heating it, it was never heated. It doesn't have insulation. They didn't do that in those days. The similar houses in Kodiak have all been taken apart, the whole interiors, and they have insulation and everything, but that costs as much as the original buildings did. KAREN: Yeah. Now, how did that work, that the mission organization, where was that, in the Lower 48, that main mission organization? JOYCE: Yes. But we had a supervisor and either -- either from Anchorage or Fairbanks. A Dr. William -- Evan Jones was the one I told you had the burn tumor, he was -- he worked out of Fairbanks because that's where his home was. He had been chaplain with the National Guard there. KAREN: But this being their building and your husband was here with -- with the mission, how did that work with your health aide work and the mission? Were they supportive? Were they helped or -- JOYCE: They considered what I was doing was certainly in line with the mission work. And I, again, was not a paid employee. KAREN: Right. JOYCE: I never was. Only my husband. KAREN: Right. JOYCE: I'm fortunate that when each of us turned 65, we took less than our retirement and so that the one who survived would get it because I get what he was to have as a paid missionary. I wouldn't have received anything just for myself. KAREN: Right. I was wondering if the mission helped provide supplies or equipment or things to help with your health aide work? JOYCE: Not -- not -- not with the health aide work, no. KAREN: Okay. JOYCE: But, of course, the use of the building. And when they decided to close this work, which happened way back in 1977, we -- we felt that we still had work to do here. I was doing the kindergarten and the health aide work, and Norman was -- had his -- had the church and so forth. And also, while that wouldn't have supported us, he had -- he did so many odd jobs in the community, he was -- that's what made him so successful was that he knew how to do so many different jobs. So anyway, we decided that -- we rented this place until we were able to buy it outright. So it's my home, it does belong to me.
KAREN: Back to the health aide, any other particular memorable experiences you can think of that you had? JOYCE: Well, I mentioned that it was very important that we have health aide get-togethers. I remember the very first ones. I actually had some material from some of those early things, pictures were put in the Kodiak paper and some of the early guidelines we had and so forth. And then I -- I sent them to KANA with the idea that they could copy them and send them back, and I never got them back. So I no longer have them. But that would be important right now to add to what you're doing, as it was some -- some printed material about the -- KAREN: And I wonder if anybody in KANA might know where that is. JOYCE: I don't think they valued them like I did. It was very important to me, but you know, it wasn't a big thing to the KANA staff. KAREN: It might be they are someplace in somebody's filing cabinet. JOYCE: Uh-hum. KAREN: So overall, what do you think, has the health aide system and program been a good thing for rural Alaska? JOYCE: I think it is, it has been absolutely essential. And I think it's something that they can be proud of. I just hope they don't put too many more limitations on it. Because either that or give every health aide a PA's training and let them have some more power than what they have otherwise. Because we were doing the work of PAs. KAREN: Right. JOYCE: And we had the training for it. Not officially, but they were pretty wise about the needs in rural communities and the things that we should be able to do out here where there's no doctor that perhaps they might not be permitted to do if they were in a city. And I think they've got away from that idea.
JOYCE: But I -- overall, I think it is a tremendous program. I think it's something that Alaska and the Native Health Service can be very proud of. I have been very proud of the associates I've had in training classes from different places all over Alaska. I think they are doing a wonderful job. And it's not only that, but this program has been copied in many Third World countries. It's still being copied because the unique situations of distance and isolation in Alaska are much like those in many of the Third World countries. So we have actually been the initiators of something that has -- has been -- had worldwide significance. This is my personal feeling about the whole thing. KAREN: Do you have any idea of what inspired the people who initiated it? JOYCE: Well, it was -- first of all, it was those Public Health nurses. And they certainly knew what the distance problems were. And like I say, they were exceeding the provisions of nursing in those days. That's why my daughter thought she wanted to be a nurse was because she was shocked when she found how limited the nurses were down in the Lower 48, having seen the doctor -- the nurses perform like doctors out in the villages. But -- KAREN: I'd say it's interesting because Native people have not always been treated well and respected and thought to be competent, and then all of a sudden they were given this power. JOYCE: Well, this -- this was definitely a recognition of the abilities of Native people to -- with training, with help, to be able to carry on a program that was even -- would have been hard for the doctors to do. I think it was quite a -- quite a bit of confidence -- KAREN: Which is good. JOYCE: -- in the Native people. KAREN: About time. JOYCE: Uh-hum. It was. Every time I went to training, I'd be again proud of the other health aides I met from other places, and learn about their experiences and what they were contending with. And I thought, you've got something unique and wonderful here and it needs a lot of support.
KAREN: So what is it -- what was it for you personally about being a health aide that you liked? JOYCE: Being close to people and their needs. We had some training in counseling and things like that, but it was amazing how much counseling was involved, both medically and in other fields that could in any way be related to the health aide. At least that was my experience. KAREN: How do you feel it affected you personally in, you know, how you looked at life or how you lived your life? Do you feel it affected you in any way? JOYCE: I think it strengthened me a great deal. It always seems to strengthen a person when you reach out and see how other -- see the problems and the concerns and the strength of other people. KAREN: Well, that sort of covers my big -- all the major questions that I tried to think of in advance, with the limited background that I have, and not having known you and your personal background. So anything else that you've been sort of thinking about that you wanted to talk about that I haven't asked about? Or something you -- you remembered since I called you last week and warned you I was coming? JOYCE: Oh, I think it's good that they have developed programs where they -- where they have more than one person in a village. We really had no -- no time to ourselves, no -- no vacations, no anything to start with, just -- They have quite a program now of work -- work a couple of weeks and have a week off and things like that that we never even dreamed of. I don't know if I would have liked it. I don't like to leave my patients that much. But I guess maybe I was a bit selfish. But it's -- it is good. And they -- as Scott, the current health aide here says he's still not paid as much as the school janitors are in Kodiak. It's not considered a high paying job. We were amazed when we were paid anything. KAREN: Yeah. It's sort of like being a teacher, you do it for the love of the work. JOYCE: That's right. KAREN: It's important work. JOYCE: I felt almost guilty getting my small salary. I gave part of it to health committee for years. Worked with the health -- we formed a health committee and I worked with them. KAREN: And what did they do? JOYCE: Discussed village needs, special -- special health needs. Tried to work towards raising the levels and general health of the village. They had quite an active one here for many years. I don't think they have one now, but maybe it's not necessary with three health aides. KAREN: Have you seen a change in what the critical issue -- health issues are in the village? JOYCE: That's a question. We had to deal a lot with child neglect in the early years. I don't think there's nearly as much of that now as there used to be. I think there's a -- I think there's a higher level of understanding of health issues in -- in the homes than there used to be. They are always going to have accidents. You're always going to have some contagious diseases, although, in spite of the immunization programs. But one major issue continues, and that's alcoholism. I think any -- any place in any village, they will tell you the same thing. But I think in general, the whole level of the village is -- is higher than it was in -- in the past. I'm sure it is. I take a lot of pride in seeing the kids that I had in kindergarten and had in clubs and see them very efficiently handling a whole lot of different things.
KAREN: Working in the health field, how has that been to deal with something like the alcohol problems that it hasn't changed? JOYCE: I don't know. I don't know the answer to it. It's an Alaskan problem. KAREN: As somebody who was in that, did you feel any -- JOYCE: We have a number of people that have stopped drinking completely, and I know they can do it. But it's always the problem to keep it from being a real issue with young people because of the current acceptance of it, a sign of maturity, and so forth, whatever. But the role of a health aide is quite a bit as an educator. Scott was telling me that he was having a whole week of -- of teaching up at the schools about health issues and pregnancy, teen pregnancies, and all that sort of thing. And there's a lot of -- a lot of teaching, and a lot some that goes on outside the clinic like that. It was -- I know I had quite -- quite a lot of it. KAREN: It sounds like being a health aide is a very hard job. JOYCE: Yes, but very rewarding one. That's -- the satisfaction in feeling you're working for bettering conditions and certainly for better health. I wouldn't have missed it for anything. When I retired, I was ready to retire. And I'm glad I did when I did because at least I had a little more time with my husband, his last few years. It was good. KAREN: That was good. JOYCE: But like I say, everything, even including that, he was participating a lot more than people might have realized.
KAREN: And I do, I find it amazing that, you know, you as a young woman with newborn children packed up and -- did you come -- how did you come here, on a boat? You packed up in Washington and came on a boat? JOYCE: No. I wasn't quite that era. I -- I flew from Seattle. I came here on a boat. KAREN: From Anchorage, or -- JOYCE: No. From -- from Kodiak. KAREN: Oh, right. JOYCE: Flew to Kodiak. KAREN: Oh, right. JOYCE: Flew to Kodiak, and then overnight, got in at night, early the next morning I was early down on the beach, the skiff put us -- take us out to a boat to come to Ouzinkie. KAREN: What gave you the courage to do that? JOYCE: Well, Norman had been up here one summer before. Lots of pictures, lots of stories. And mainly, to be with him. KAREN: Uh-hum. Well, you must have had some sort of an adventurous spirit to be -- to be able to do that? JOYCE: Well, I guess -- I guess so. Certainly I've had lots of challenges and lots of -- never dreamed of all the things I've been able to do up here. Never dreamed I'd get into medical work and I absolutely absorbed in it once I was. I didn't want to come because we were involved with Christian camping, which I think is quite a challenging field. And within a year after we came up here, there was a -- we developed a camping program that's still going on around Kodiak Island. KAREN: That's wonderful. JOYCE: Yeah. KAREN: That's great. JOYCE: I think maybe the Lord laughed a bit at me. I taught kindergarten from the very first because I figured children needed to have preparation for school, and they needed to get a bigger view of life than they were getting here. They -- they weren't -- they weren't even acquainted with kids from the next villages. And Ouzinkie was one of the more advanced villages. And they just were isolated in thinking as well as other things. It was a -- it was a good start. KAREN: Uh-hum. JOYCE: But I also was involved with the health aide work right away, so it just kept developing. Doing more and more, from giving immunizations to being involved in just about everything else. And I guess I always liked to learn more, grow a bit. I still have a thirst for knowledge. I can't go to bed without reading something interesting, and finding out about anything new I can. I think the whole thing was -- was part of a bit of curiosity, enjoying learning more and -- and learning new things. There was always something that could challenge you that way. KAREN: Okay. JOYCE: It wasn't easy back in the days when my kids were -- were home. We tried to give them some lives of their own with a place full of other kids all the time. But then they had the chance to learn a lot of things that way, too. Of the five of them, four are college graduates. One has a masters degree and the other a doctorate. Kelly's the only one that didn't want to go to college. He was a -- he was a doer. And it's been all right. And he's learning a lot even yet. He does a great deal of reading and he gets involved in a lot of things. KAREN: Well, unless you have anything else, I think we'll give you a rest maybe. JOYCE: I -- I don't know. If you have got any more questions, I'll try to answer them. I'll just -- KAREN: I think that's it for now.