MARLA:  Okay.  So today is October 11th, 2005, and we're in the Akiachak Clinic talking today with Moses Frederick. 

I am Marla Statscewich, and Sophie Kasayulie and Louann Rank are with us.  And this is for the Akiachak Project Jukebox, and also the Community Health Aide Program. 

So thank you very much for taking the time out to do this interview and during your busy day. 

If you just wanted to start with a little bit of background information; where you were born, your family, and how you came about being a -- the health aide, then we can go from there.  

MOSES:  Okay.  My name's Moses Frederick and I been here all my life.  I was born here (indiscernible) family.  Got a wife and six kids.  And last two are twins.  

And 1978 of August 28th, when they had the job opening on health aide, I -- I applied for it and got hired.  Did my trainings in Bethel, in five sessions.  And there's four sessions, you know, to begin.  Well, five.  Five sessions in order to be a certified health aide.
  
MARLA:  Okay.  So were you -- were they -- how long were your training sessions?  

MOSES:  Average is four weeks.  

MARLA:  Four weeks.
  
MOSES:  But I think six and -- one was six weeks and the rest were four weeks.  

MARLA:  So did you start that in 1978?
  
MOSES:  '78, yeah.  

MARLA:  So you'd have to go to Bethel --

 MOSES:  Uh-hum (affirmative). 

MARLA:  -- for six weeks?  

MOSES:  Yeah.  

MARLA:  That must have been really hard to leave.

MOSES:  Not -- this was when I was single.  Yeah. 

MARLA:  Okay.  

MOSES:  (Indiscernible).  It wasn't hard.  I had fun. 

MARLA:  Okay.  Oh, good.  And what made you want to become a health aide?  

MOSES:  My older brother was -- encourage of my older doctor, he wanted me to become a doctor, and I was kind of interested in health.  And also from one of the council members, Moses Peter.  Yeah, (indiscernible) Moses Peter.  

And but I didn't want to leave home at first.  And he wanted me to go to college, and I was -- he used to tell my -- Moses Peter always tell me the monies are available for me through their Tribal Council.  But I didn't go.  
And I was hired by Councilman George Moses, who just passed on now, last year, this spring or last year.  Then maybe last year.  Yeah. 

MARLA:  And you were -- you were selected by him --

MOSES:  Uh-hum.  Yeah.  

MARLA:  -- to be the health aide, or -- 

MOSES:  Yeah.  And maybe Moses Peter, too, also.  

MARLA:  Okay.  

MOSES:  Yeah.  There were a couple of councilmen that interviewed me. 

MARLA:  So they selected you to join the program -- 

MOSES:  Uh-hum (affirmative).  

MARLA:  -- and then you started your training --

 MOSES:  Yeah.  

MARLA:  -- in 1978. 

MOSES:  Uh-hum.  

MARLA:  And you've been a health aide the whole time -- 

MOSES:  The whole time. 

MARLA:  -- in Akiachak? 

MOSES:  But every -- '86 and '96 I took a six-month break each.  And in '92, '93 I became the supervisor instructor, Bethel base in YKHC.  

MARLA:  And how often do you teach, then?  

MOSES:  Not teaching but, you know, traveling to villages, you know, visiting health aides.  And, you know, things change.  So, you know, make the issues updated, you know.  Because medic -- medic, you know, they change.  And do a supervision on us.  You know, I had six girls at that time.
  
MARLA:  And which six?  

MOSES:  So (indiscernible) -- see, I pay a visit. 

MARLA:  Okay.  

MOSES:  Yeah. 

MARLA:  I didn't know about that.  That's pretty interesting.
  
MOSES:  It's a lot of work for being a supervisor instructor.  There's a lot of needs to be documented.  So when we have, right now we have certification part that, you know, all over Alaska.  And they renew our certification every two years.  

MARLA:  Okay.  And how long does it take to renew your certification?
  
MOSES:  Clinical certification, it's -- it's clinical issues, every six years.
  
MARLA:  Okay.  

MOSES:  And then for my certification part, every two years.  

MARLA:  Okay.  

MOSES:  Yeah.  And going back to a supervisor instructor, medicine, you know, updated on medicines, any kind of forms, and PFs, patient encounter forms. 

MARLA:  And then you were just mentioning how things have changed.

 MOSES:  Uh-hum (affirmative).  

MARLA:  And so what was it like in 1978 in Akiachak being a health aide? 

MOSES:  A lot of change.  More encounter.  More illness.  

MARLA:  Now?  

MOSES:  Now.  Now.  '78, when I became a health aide, there was, like, less than 15 or 10 circulatory problems like hypertension, strokes and related to heart.  But right now, we have 54 -- around 50 people who are -- who are taking medication for circulatory problem. 

MARLA:  So you've seen a drastic increase in that? 

MOSES:  Uh-hum.  Yeah.  

MARLA:  And do you have anything that you attribute that to?  Is that something that you've seen the cause -- why there is this -- this increase?
  
MOSES:  Uh-hum (affirmative).  It's -- it's a lot of increase.  

MARLA:  Yeah.  

MOSES:  Yeah.  

MARLA:  And then what else -- 

MOSES:  I didn't get your question there.  

MARLA:  Well, I was just wondering if there was something that if you yourself have seen, you've seen this increase, if you had any idea why there was an increase?  

MOSES:  Okay.  Yeah.  It's what they call it, change of life-style.  And we interview all these people and so are getting educated from our corporate -- health corporation, and the diet and a lot of people using transportation.

 MARLA:  Like gas transportation --

 MOSES:  Uh-hum (affirmative). 

MARLA:  -- instead of walking or -- 

MOSES:  Uh-hum.  Yeah.  It's mainly from the Alaskan, our change of life-style.  Yeah.  

MARLA:  And in 1978, did you have constant contact with the doctor? 

MOSES:  Yeah.  

MARLA:  You did?  

MOSES:  Yeah.  By that (spoke in Native language.) 

LOUANN:  Radio?

 MOSES:  Radio.  But we used to have our complications, you know.  There's a lot of interference.  And whenever that doctor calls, you know, when they are on, it seems like every voice, you know, trying to get in first to talk, talk, talk with the doctor. 

SOPHIE:  Was it a ham radio?
  
MOSES:  No.  What they call it.  

MARLA:  Single sideband radio?  

MOSES:  Yeah.  Yeah.  

MARLA:  And so I know from other --

 MOSES:  But -- but I heard from Elsie, they used to go to -- to the school, and used to every before, you know, (indiscernible) try and talk with the outpatient. 

MARLA:  And that was Elsie?  

MOSES:  Wassillie.  Yeah.  

MARLA:  Wassillie.  Okay.  And then who was the -- 

MOSES:  And in '78, they used to have that radio in the clinic, in that old clinic.

 MARLA:  So there was a clinic here when you started in '78?
  
MOSES:  Uh-hum.  Yeah.  

MARLA:  Okay.  And I've heard from other health aides that there was a radio call where they would go from village to village to village? 

MOSES:  Uh-hum (affirmative).  

MARLA:  Was that the way it was in -- when you started?
  
MOSES:  Yeah.  Up we met with doctor, and we called the -- each village had their own call signs. 

MARLA:  Right.  

MOSES:  Yeah.  And sometimes you go by (indiscernible) order and then sometimes it starts from the above. 

MARLA:  Okay.  And who was the doctor that you spoke to most?  Or someone who stands out in your mind? 

MOSES:  I would say George Brown.  (Spoke in Native language.)  Right now I can't remember.  

MARLA:  That's okay. 

MOSES:  Yeah.

MARLA:  Were there anybody who -- any people who influenced you, who encouraged you or who you looked up to during your training or becoming a health aide?  Other health aides or --

 MOSES:  No.  No.  No.
  
MARLA:  Okay.  And what are some of your most memorable experiences about being a health aide?
  
MOSES:  In trainings, there was mostly like older ladies.  And they used to always, you know -- there was a health aide housing for guys and the ladies, but when they are overpacked with ladies, you know, some ladies stayed in the -- in the other -- you know, with guys.  Because hardly any guys were health aides at that time.  And -- 

MARLA:  What was that like?
  
MOSES:  This was -- I always think of this one, I got those older ladies, you know, they used to call me boy.  And when they tell me to do something, like get -- get, you know, water, you know, they used to call me boy.  Hey, boy, do you want to do something, get -- get this one.  But I used to get -- (spoke in Native language) -- I didn't want -- I didn't want to get, you know, called boy.  Because I thought I was a man at that time. 

MARLA:  And what was that like being one of the few men at the time?  
MOSES:  I wasn't really, you know, think of that as -- as -- as a guy.  I was really -- I wasn't offended, being a guy.  

MARLA:  Yeah. 

MOSES:  Yeah.  And now the guys are and it's growing all over.  Yeah. 

MARLA:  Yeah.  And then what was -- do you have a memory of one of your -- the first time you gave birth or the first time -- can you tell me about that story?  What that was like?
  
MOSES:  You know, there have been in the clinic -- we had a school training on, you know, how to check pregnant ladies and emergency delivery.  And we were mostly training on complications.  And I used to -- when for when -- when there was a (indiscernible), one of the ladies had a (indiscernible) and I was nervous because I was thinking about the compli -- the complications.  

But after that, I had seven deliveries here in the village. 

MARLA:  So that's great.  

MOSES:  If the person doesn't think of the complications, but, you know, they, like, have faith, it will go good. 

MARLA:  Yeah. 

MOSES:  Yeah. 

MARLA:  As long as you don't worry about it.  
MOSES:  Yeah.  But I had two ladies, you know, who had a problem, bleeding couldn't stop.  Because placenta was stick to the uterus.  Sticking.  And Dr. Kruzie, he -- he was also one of the one that -- he direct me how to do everything. 

MARLA:  Dr.?  

MOSES:  Dr. Don Kruzie.  

MARLA:  Don. 

MOSES:  Yeah.  Good doctor.  And he -- he instructed me, and just massage that -- the uterus and slowly pull it. 

MARLA:  So he instructed you over the phone?  

MOSES:  Yeah.  Over the phone.  

MARLA:  Okay.  

MOSES:  Over the phone.  Yeah.  Because I just -- we had the phone at home.  

MARLA:  Okay.  

MOSES:  This was '84.  

MARLA:  So you delivered her at home?  

MOSES:  Uh-hum.  Yeah.  Uh-hum.  I think that's Stella.  

MARLA:  Yeah, I'll pause it for a second.  

MOSES:  So we could finish that -- that conversation. 

MARLA:  Yes.  

MOSES:  They make a policy on, you know, pregnant ladies, like they could go down, you know, one -- like in the first six weeks before their due date, they go one month early.  

And if they don't follow the policy and just, like, stay at home, they won't send out the medevac.  Got to be delivered in the other ones.  But if there's any complications, any left or any things, they will -- they will take her.  

MARLA:  So -- 

MOSES:  So it's part of encouraging, you know, to be in Bethel in 36 weeks.

MARLA:  And so where do they stay if they go to Bethel?  

MOSES:  Pre-maternal.  

LOUANN:  There's a pre-maternal home, but I never really knew -- 

MOSES:  Last week I heard it's overloaded now.  So it's getting -- the upper room is getting smaller, too.  

(Inaudible statement.)

 MARLA:  So with the pre-maternal home, did that then make your deliveries a lot less?  

MOSES:  Uh-hum.  Yeah.  

MARLA:  And most people -- 

MOSES:  The health aide started to, you know, like, if they do -- 

MARLA:  Prenatal? 

MOSES:  -- prenatal exam, you give them encouragement and let them know that about the policy.  

MARLA:  And that there is that option?  

MOSES:  Number.  Yeah.  

MARLA:  Got ya.  Got ya.

MARLA:  And then what's -- what do you think is the hardest part about being a health aide? 

MOSES:  Hardest part.  Being on call.  Yeah. 

MARLA:  24 hours, 7 days a week, or? 

MOSES:  I'm not going to say 24 hours, 7 days a week.  You know, nowadays there's four or five health aides.  Bigger village have more health aides than smaller village.  

MARLA:  And in 1978 when you started, how many?  

MOSES:  Two.  

MARLA:  Just you and?  

MOSES:  Elsie.  

MARLA:  And Elsie.  

MOSES:  Yeah.  

MARLA:  You then were really on call much more. 

MOSES:  Uh-hum (affirmative).  

MARLA:  And did people come to your home or did they come to the clinic?
  
MOSES:  Come to the clinic. 

MARLA:  Yeah.  

MOSES:  Yeah.  

MARLA:  That's good.  

MOSES:  Yeah.  

MARLA:  And then were there ever times that you wanted to quit, you wanted to stop being a health aide, and if so -- 

MOSES:  No.  I never -- 

MARLA:  No?  

MOSES:  -- I never think about quitting.  The only thing, you know, I mentioned about six-month break in '86 and '96.  When I feel like doing -- don't want doing it no more.  

MARLA:  Yeah.  

MOSES:  It's do something -- do something different.  That's why I took those six-month break.  

MARLA:  And then what made you come back? 

MOSES:  I wanted to work.  Yeah.  But '96, start generally, you know, they call me and they wanted me to be a lead health aide because they took over the program from YKHC under 630 contract.
  
MARLA:  And that was in what year?  

MOSES:  '96.
  
MARLA:  '96.  Okay. 

MOSES:  Yes. 

MARLA:  And so now you have other health aides working under you?  Is that what being a lead health aide is?
  
MOSES:  I won't say that. 

MARLA:  No?  

MOSES:  I won't say that.  I just mostly got to like -- more like supervision, too.  And encouragement. 

MARLA:  Okay.  

MOSES:  So I -- I hate to see -- I'm not trying to overpower them more, trying to be a really boss person.  

MARLA:  Right. 

MOSES:  But equally.  That's why we have the on-call schedule.  Take turns.  

MARLA:  Okay.  And what is that like?  How many hours on or days on?
  
MOSES:  Like yesterday I was on call from 9:00 a.m. to 9:00 a.m. this morning.  24 hours.  

MARLA:  Okay.  

MOSES:  And then after that, you know, somebody took the on-call from that.  Well, we start the on-call, see, after four o'clock, after hours when the clinic close.  

MARLA:  Okay.  And how do people in the village know who's on call?  

MOSES:  There's the schedule.  Post it.  You know, somebody could come, if anybody wants to take it, there's a folder and with the on-call calendar.  

MARLA:  Okay.  

MOSES:  And some people just, you know, call -- call our home and ask who's on call.  

MARLA:  Okay.  

MOSES:  Yeah.  

SOPHIE:  And do you have a cell phone?  

MOSES:  It's never connected.  But we have the cellular, cellular phone. 

MARLA:  Okay.  

MOSES:  But they have to work on it, the antenna.  

MARLA:  Okay.  And then getting back to communicating with the doctor in Bethel, I just wanted to know, before when you had the single-sided radio, you said there was some trouble that you had when you couldn't contact them?  

MOSES:  Uh-hum (affirmative). 

MARLA:  What did you do in those sort of situations?  

MOSES:  In our -- our (indiscernible) goes back to Bethel, and we -- if -- if they need urgent care, usually the -- you know, they go down.  But if they want to wait for next day, you know, they wait for medications.  Yeah.

 MARLA:  So if there is -- 

MOSES:  And we've got limited standing orders.  We can treat -- we can't treat lung problems, circulatory problems, but if there's a life-threatening thing, they appreciate raising -- use our use our (indiscernible) and we can always treat the patient, but I never come across it, you know, with a situation because of nowadays like ease of communications. 

MARLA:  Yeah.  And then you could medevac people out. 

MOSES:  Uh-hum.  Yeah.
  
MARLA:  And in 1978, no problem medevacing people out?  Or if you needed to send somebody, you would just put them in a boat or a plane or?  

MOSES:  Boat, plane.  Yeah.  

MARLA:  Yeah.  And then what was -- you had mentioned that Elsie was the health aide before you.  Do you know how long she had been a health aide or how long she had been working?  

MOSES:  I don't know.  But I think -- I think she became a health aide like in the early '70s.  

MARLA:  Okay.  

MOSES:  Around there.  

SOPHIE:  No, '60s.  

MOSES:  No, '60s.  I think she was in that first training in Anchorage, '68 or '69.  

MARLA:  Okay.  

MOSES:  Yeah.  

MARLA:  Okay.  And she -- well, I'll -- maybe I'll ask her.  I'll get talk to her. 

MOSES:  Yeah.  

MARLA:  But I just sort of wondered what the health -- what the health system was like before, you know, in the '60s. 

MOSES:  Uh-hum.  

MARLA:  Just to have a history of what the health system -- what was going on in Akiachak, you know, in the '50s and the '60s.  Do you know any of that history? 

MOSES:  No.  

MARLA:  No. 

MOSES:  No.  The only thing I heard about was like also this morning, they mentioned like that diptheria.  (Spoke in Native language.)  The first time I heard the word tongluk (ph).  Diptheria.  

MARLA:  Diptheria. 

MOSES:  The outbreak, yeah. 

MARLA:  When was that?  

SOPHIE:  '52.  

MOSES:  Yeah.  Around there. 


MARLA:  And then I imagine that equipment has changed in the last 27 years.  What sort of advances have you seen in the clinic?  

MOSES:  Lots.  

MARLA:  Yeah.  

MOSES:  Yeah.  

MARLA:  Like what?  

MOSES:  Make things easier, you know, for health aides.  Like SP-2, it's to check the -- how much the patient is up -- 

(Knock at the door.) 

MOSES:  That must be RMT. 

MARLA:  So we're back on.  So you're talking about some of the advances in equipment. 

MOSES:  Oh, yeah.  Yeah.  Going back to, like SP-2, to check the oxygen. 

MARLA:  Oh, okay.  

MOSES:  It's the electronic -- you check the heart rate and how much they are breathing of their own oxygen.  

MARLA:  Okay.  

MOSES:  So that, with the patient, you know, when we assess, it make it more easier.  

MARLA:  Okay. 

MOSES:  Like if they are in respiratory distress.  

MARLA:  Then you can find out why?  

MOSES:  Uh-hum.  Yeah.  

MARLA:  And do you have oxygen, as well?  

MOSES:  Uh-hum (affirmative).  We've got oxygen.  And through our EMT procedure, their oxygen is low, you know, we put them to the -- to the oxygen.  And do oral NT.  

MARLA:  Okay. 

MOSES:  But you've got to really watch it even for people with SP and COPD. 

MARLA:  What's does that stand for?
  
MOSES:  Chronic pulmonary disease.
  
MARLA:  Okay. 

MOSES:  Really bad lungs, you know, with history of infections.  

MARLA:  And so you have -- are all your medical records now in the computer, they are all digital, or do you have still have your records to know if somebody has chronic problems, or are they all still written in paper?
  
MOSES:  They are written in the chart, you know.  Even -- we call it the electronic patients, even they have like mild hypertensions, they document with the outpatient form.  They also have it at -- the Bethel medical works have it. 

MARLA:  Okay. 

MOSES:  And if we talk -- if we do the medical traffic, talking with the doctor about the patient, they look into the -- into the computer.  They can look into the records.  

MARLA:  Oh, that's pretty great.  

MOSES:  Uh-hum (affirmative).  

MARLA:  How recent has that been? 

MOSES:  Maybe late '80s.

 MARLA:  Okay. 

MOSES:  Or early -- maybe late '80s, yeah, or '90s.  Early '90s, yeah.  
And pretty soon they going to hook up our telemedicine.  And it's across there, it's set up already, but they are working on the wire things.
  
MARLA:  And so what will that mean?  Setting up a telemedicine. 

MOSES:  If that's set up, you know, the provider who is doing ER can talk to the doctor, will be sitting across there right there. 

MARLA:  You'll be able to see each other?  

MOSES:  Yeah.  Yeah.  And if we have a couple doing the communication, you know, they don't understand it, we'll show how the patient is doing.  So they can see.

 SOPHIE:  (Indiscernible) they see that.

MOSES:  Yeah.  If we -- so we show the patient how -- how it is. 

MARLA:  Wow.  

MOSES:  It's across there. 

LOUANN:  You can show the injury, too.  

MOSES:  Yeah.  It's at the same time.  That's what I'm trying to say.
  
MARLA:  So it's a two-way video conference?  

MOSES:  Uh-hum.  Yeah.  

MARLA:  Wow.  That will be great. 

MOSES:  Uh-hum.  

MARLA:  Are there other things that you can -- that you would like to have in the clinic, things that you would like to have that would improve it even more?  

MOSES:  X-ray.  

MARLA:  X-ray?  

MOSES:  Yeah.  

MARLA:  Yeah.  

MOSES:  Because that seem like every -- not everything, but like every injuries, like they have the symptoms of a fracture, when muscle occurs, you know, that they will have pain.  

Some patients, when we send them out, you know, even with splints, they have negative X-ray, but we always, you know, every severe injury we got to treat them as fractures if they are really hurting. 

MARLA:  Right.  And if you had an X-ray -- 

MOSES:  As if we had the X-ray.  

MARLA:  -- then you wouldn't have to send them out.  

MOSES:  Yeah.  

MARLA:  I see. 

MARLA: One of the things that Louann was mentioning was just something that was happening in -- that was in the '80s, it was a lot of meningitis in the area?  

MOSES:  Yeah.  

MARLA:  And I was wondering if that was -- if that was something that you had to treat or -- 

MOSES:  Since my 27 years of work, we had bacterial meningitis that make the baby -- he's 25 right now.  I think he's in Anchorage.  And with the foster -- or he might be in some kind of nursing home right now.  Yeah.  

MARLA:  So that was something that was affecting the whole area, though --

 MOSES:  Uh-hum (affirmative).  

MARLA:  -- at that time.  Is that correct?  

MOSES:  And more than 10 viral meningitis cases we had. 

MARLA:  Wow.  

MOSES:  And anybody with seizure or a high fever, we treat them, like, in the village as meningitis.  Yeah.  Because we have that -- some kind of a miracle medicine, (indiscernible) it treats a lot of patients who have meningitis.  

MARLA:  Is it like -- 

MOSES:  Prevent, you know, from make serious.  

MARLA:  Is it like an antibiotic or?  

MOSES:  It's an antibiotic.  

MARLA:  It's really powerful?  

MOSES:  Uh-hum.  Yeah.  Seems like we had 10 viral meningitis.  
But as soon as the immunization program started in about the mid '80s or late '80s, health aides started doing immunizations, in August we heard YK area, there was one case of meningitis.  So -- 

MARLA:  Big improvement. 

MOSES:  Big improvement.  

LOUANN:  So this was a vaccine --

 MOSES:  Uh-hum (affirmative).  

LOUANN:  -- that was suddenly found to work?  

MOSES:  Yeah.  

LOUANN:  Before that, they didn't have a vaccine?  

MOSES:  No.  

MARLA:  Hmm.  

MOSES:  And now there's a new vaccine called varicella, you know, for chicken pox, but we can't use it in the village because it's so new. 

MARLA:  Okay.  

MOSES:  They got to go down to -- for the -- for the shot.  

MARLA:  And you immunize, do you do immunizations for the whole village?  

MOSES:  Uh-hum (affirmative).  But we got to get, you know, training, about two weeks, two weeks training, just concentrating on the immunizations. 

MARLA:  Okay.  And so are you always going for training, then?  Every -- every year or every six months or every six years or -- 

MOSES:  Not -- not really.  Like there's advanced trainings in, like, a week or two weeks.  The last training I went was in Anchorage, so for two weeks in July of 2003 for cancer course.  

MARLA:  Okay.  

MOSES:  And I have my -- not preceptorship but clinical update because our certification expires every six years.  

MARLA:  Okay.  

MOSES:  So I'll have it next week here in the clinic with the instructor.  Seeing patients with the instructor.  

MARLA:  And the instructor is coming from Bethel? 

MOSES:  Uh-hum.  Yeah.  

MARLA:  Okay.  And how long will the instructor stay? 

MOSES:  One week. 

MARLA:  One week. 

MOSES:  Or like after 15 patients, limited to 15 patients in the order for recert.

MARLA:  And do you have a doctor that comes out to Akiachak now or in the past, a traveling doctor or?
  
MOSES:  The last visit was two years ago.  There isn't any -- also Bethel and Akiachak, there's short staff.  

MARLA:  Okay.  

MOSES:  Mainly, you know, they were coming for call patients, or people who are taking medications and do follow-ups.  

MARLA:  But the fact that you're so close to Bethel -- 

MOSES:  Uh-hum.  

MARLA:  -- maybe the doctor doesn't come as often because more people go to Bethel. 

MOSES:  Uh-hum.  And that's not an occasion for them not coming.  The case that there isn't there hardly coming is because of the staffing.  

MARLA:  Because they are short staffed?  

MOSES:  Yeah.  

MARLA:  Hmm.  

MOSES:  And right now you know who's all around there is Dr. -- the doctor moved to (spoke in Native language) where they are doing deliveries.  For OB.  OB department.  Yeah.  

MARLA:  Okay.  And pediatric. 

MOSES:  Dr. Evan Hodges.  

MARLA:  So what does that mean, not having a village doctor?  

MOSES:  Nothing.  I mean --  

MARLA:  It doesn't make your job harder?
  
MOSES:  No.  It doesn't.  

MARLA:  Okay.  

MOSES:  And we mentioned about the -- from -- from our Kusko department, one provider, you know, called couple those, and Ellen Prindley called (indiscernible). 

MARLA:  Okay.  So there's one -- that's your RMT. 

MOSES:  Uh-hum (affirmative). 

MARLA:  There's one provider to all three villages.
  
MOSES:  RMT?  I thought that was my last one.  

MARLA:  Okay.  Hold on. 

(Off record.)

MARLA:  So we're back on after you had two RMTs, radio medical traffic.  
And we -- we sort of had discussion while we were off of about -- I was -- about the clinic and when it was built.  And if you can give me some details about -- about that, that would be great.  

MOSES:  I don't have that much knowledge about this whole building, but what you just mentioned, but yeah, the community built it.  

MARLA:  The community built it?  

MOSES:  Yeah.  

MARLA:  So everyone got to -- 

MOSES:  But I don't know, when the street moved in '94.  More room.  

MARLA:  Yeah.  

MOSES:  But that happened earlier.  It made it good, you know.  But there's complications.  Like the water source system.  The leveling because -- (indiscernible.)

LOUANN:  What did the clinic look like before this building, the space you had?  How big is that?  

MOSES:  Small.  It used to -- you know, when we had that -- before we had that FM system, it used to be in a pad.  And we used to see -- there used to be extra health aides and two exam rooms.  And non -- you know, we used to say nonstop, you know, patients, patients, patients.  

And that was part of -- you know, I didn't like it.  And used to stay like after 4:00.  Usually four o'clock is our after hours.  And after that, we used to see only medical patients or emergencies.  

But before we moved in here, and we used to work in that old clinic, we used to be in the clinic and finish the patients.  And even they are not that sick.  But since that appointment system created, I guess this was in '97, '98, it's new.  It's not that old.  It's much better.  

MARLA:  So now people make appointments and come? 

MOSES:  Uh-hum (affirmative).  And our -- our last appointment is three o'clock.  

MARLA:  Okay.  

MOSES:  And it's much easier.  Like talking about radio medical traffic, you know, Dr. -- doctor who (indiscernible) -- the reason we do the radio medical traffic is because we have limited standing orders.  You know, we couldn't treat the sinus.  There were recurring ear infections.  Circulatory problems like blood pressures, high blood pressures.  That's why we do RMT.  And if we think about medications after three o'clock, we could call them, you know, to give the medicines to the patients.  

MARLA:  And do you have a full medical -- do you have full medical supplies here for -- and pharmacy supplies, as well or?  

MOSES:  Uh-hum.  Yeah.  But the one that we don't have, like (indiscernible) -- other medications that can -- that doesn't have, you know, they send by hand carry.  

And you know, if you do talk with the provider, do the RMT in the morning, it will get here, like, in the late afternoon.  But if we talk to them in the afternoon, it will be, like, tomorrow morning or in the afternoon. 

MARLA:  Okay.  

MOSES:  So it -- they call it hand carry.  Yeah.  Make it more easier.
  
In the past, you know, when they used to send somebody, take -- it used to take forever.  

MARLA:  That's no good when someone's sick.  

MOSES:  Yeah.  But like when we talk, when we talk with the doctor, like if they are getting worse, two-hour -- like if we see the outpatient getting worse, you know, just send them out.  Or let them -- let them know through our (indiscernible).  So it depends on the condition they do the medevac.  It's more easier than in the past.  

LOUANN:  If you have to medevac, does YK send a plane or?  

MOSES:  Uh-hum.  Yeah.  They send out the -- 

LOUANN:  So fast, half an hour.

MOSES:  Yeah.  

LOUANN:  You know, I stayed in -- 

MOSES:  The Aeromed, yeah, I think you guys read about the Aeromed.  Yeah.  But if that isn't available, also they could send out the -- 

LOUANN:  Another airline?  

MOSES:  Yeah. 


MARLA:  And then when you started was Public -- was Public Health Service running the Community Health Aide Program at the time? 

MOSES:  No.  It -- it was run by, when I was started it was run by YKHC.  

MARLA:  Okay.  

MOSES:  It was -- the program was formed by, I think by YKHC board members.  

MARLA:  Okay.  

MOSES:  That's what I heard.  Yeah.  

MARLA:  Okay.  And still is now, is still being run by -- 

MOSES:  But I think the idea -- in the early years, what they used to call those, before they used to call it a health aides or practitioners.
  
MARLA:  Well, there was a Public Health nurses who used to go to the villages. 

MOSES:  It's some kind of volunteer.  

MARLA:  Yeah.  

MOSES:  By -- by the Public Health Service, I think they got idea from the doctor, about the forming as health aides.  Yeah.  

MARLA:  Uh-hum.  

MOSES:  And I read it somewhere, too.  

MARLA:  Yeah.  

MOSES:  And YKHC board members, I think they create the CHAP program.
  
MARLA:  Okay.  And is YKHC still running the program and still involved in --

 MOSES:  Uh-hum.  Yeah.  It's growing.  It's growing.  

MARLA:  Okay.  

MOSES:  Everything -- not everything, but it's up -- everything is updated medicalwise, even our CHAM book.  

Even we have the drug reference, the Village Drug Reference, and we do the outpatient education with the drug reference, you know, about the side effects, when to stop and -- and continue.  

Like they will -- they will -- drugs will -- some will have side effects, some are good, some are bad.  So we do the -- when we give out the medications, we do the patient education from our Village Drug Reference. 

MARLA:  Okay.  

MOSES:  Uh-hum (affirmative).  

LOUANN:  You were mentioning -- 

MOSES:  It's everything now, it's easier than in the past.  Yeah.  

MARLA:  Before you ask that question, I'm going to just flip the tape. 

LOUANN:  Oh, okay.

LOUANN:  You were sharing --

 MARLA:  Louann was just talking about the old clinic and the size of the old clinic, and that there was no running water there.  So -- 

LOUANN:  There was one little entry room that I remembered because staying here was always so cozy, and you become part of the community to stay here, but entry room, there was a little office in the back, very small, and a little hallway, maybe to another little room.  

MOSES:  Uh-huh. 

LOUANN:  And the bathroom had a big bowl where you could use Pine Sol to wash up because no running water.  

So that just means that people were contagious or there was a wound or bleeding, without running water, you must have really had some amazing times when you needed extra water brought in, or -- 

MOSES:  For wounds, you know, for cuts, we had the extra basin.  But one, you know.  The CHAM book had you in that, after we take care of the patient wounds.  And for bathrooms, just the basin.  And hardly -- and these two could hardly change it so you wash it with (indiscernible) or then.  

LOUANN:  When people brought river water in?  

MOSES:  Volun -- some people volunteer.  And we had the guy who, it wasn't -- it wasn't our -- our record, but like a couple hours, take our -- the furnace tank, you know, and used to be a 55 gallon tank.  So they had to check it every week.  And check on our tank if we had water, you know.  
And now YKHC sent that container, bigger container.  

LOUANN:  Because hepatitis was another problem because of using river water.  

MOSES:  Uh-hum.  Yeah.  

LOUANN:  But that's -- now that is history. 

MOSES:  It's history, but we still have the carriers.  And we do every six month.  But because that's the only thing that detect the type of cancer, they have cancer.

 LOUANN:  But your water system now, where does your water come from?  
MOSES:  The (indiscernible).  It's a -- 

LOUANN:  And where do they get their water?  

MOSES:  From underground.  It's a chlorine.  It's a chlorine -- yeah.  It's a chlorine.  

LOUANN:  That was a big project.  

MOSES:  They built the bigger, you know, for water and so -- building.  Building.  Because they were out there working at the sewer -- water and sewer system.  So they are working on that site first. 

And last week, Friday, when we have the general -- general membership meeting, they are going to try that first, like if they keep up with their bills, you know, they could connect that site.  

LOUANN:  Because 25, 30 years that I've even known that water and sanitation has been this big talk of how to get better out to the villages.  And I don't know the extent that it's been done.  

MOSES:  Uh-hum (affirmative).  

LOUANN:  But that's your health right there.  

MARLA:  Yeah.  

MOSES:  And when I first became the health -- when I first became a health aide, they didn't really do education about the sanitary.  Not much, though.  But the only thing was like hand washing.  Yeah.  

Now it's even through we do the epi's and our staff, YKHC send out the review and we could do the -- and do an education from Akiachak. 

MARLA:  When you do education class, do you have education classes in the school. 

MOSES:  Uh-hum (affirmative).  

MARLA:  Okay. 

MOSES:  Seems like every month of October, it's -- they call drug conference, yeah, and we do 15, 30 minutes patient education on drugs, cares and thing, and our counselor substance -- substance counselor, you know, help out on that, too.  

MARLA:  Hmm.

LOUANN:  Well, you were talking about the different programs that you benefit from.  Some things you've lost connection with the YK, like insurance. 

MOSES:  Uh-hum (affirmative).  

LOUANN:  YK health care, YKHC.  But then you've got more programs that you work with in Anchorage.  So you mentioned there's a CHAP program in Anchorage?  

MOSES:  Uh-hum (affirmative).  

LOUANN:  I didn't know that.  

MOSES:  There's CHAP program in Bristol Bay for that area, and then Anchorage.  

LOUANN:  Is that under Alaska Native Medical Center, then, or separate?  
MOSES:  SEP -- it's under IHS.  Yeah.  It's under IHS.  And then Bethel has the CHAP program and then up north, I think, you know, they have the CHAP.  

MARLA:  And I think also in Fairbanks, as well. 

MOSES:  I never heard from Fairbanks.  

MARLA:  No?  

MOSES:  But I think Anchorage and (indiscernible) area.  

MARLA:  Surrounding area?  

MOSES:  Yeah.  

MARLA:  Yeah.  

MOSES:  And like I mentioned to her about that, our two staffs are in Anchorage right now. 

MARLA:  And what are they doing for training? 

MOSES:  Yeah.  Workshop.  It's a workshop.  

MARLA:  Okay.  

MOSES:  Alaska state board workshop, and then emergency preparedness.  

MARLA:  And who sponsor -- who sponsors that or who is -- 

MOSES:  By Alaska Health Board.  

MARLA:  Okay. 

MOSES:  Yeah.  I got information back there.  

MARLA:  Okay.  

MOSES:  And it was a good deal.  If they complete it, they will do a refund from the -- you know, their housing, the one that they paid, and the airfare. 
MARLA:  Who will pay that?  The -- 

MOSES:  They will.  So from the guys that do the hours, the Alaska State -- I think Alaska State -- 

LOUANN:  Alaska Native Health Board?  

MOSES:  Yeah, Alaska Native Health Board, yeah.  

MARLA:  That's terrific.  

MOSES:  Uh-hum (affirmative). 

MARLA:  Do you know how often they do workshops like that? 
 
MOSES:  No.  This is the first time we had the information from them.
  
MARLA:  Okay.  

MOSES:  So when one Session 3, and now our secretary attended, they are attending it.

 MARLA:  Okay. 

LOUANN:  Good for you.  

MARLA:  And you said you have five -- you have five health aides now?
  
MOSES:  Six.  

MARLA:  Six?  

MOSES:  Six -- when it's my turn.  My turn.  Yeah.  

MARLA:  Wow, that's excellent. 

MOSES:  Six.  

MARLA:  And that -- 

MOSES:  Four -- two CSPs, one Session 4, but she will have her preceptorship, and if she passes she will become a practitioner.  

MARLA:  Yeah.  

MOSES:  And then we have a Session 3 and then two new hires.  So they are going to have their -- the first training, what do they call it?  Cooperate -- it's out of my mind right now.  It's a new hire training for health aides.  Yeah.
  
MARLA:  Okay.  Well, that's great. 

MOSES:  Uh-hum (affirmative).  

MARLA:  And I imagine with having more health aides, it gives you more time to be able to spend with your family. 

MOSES:  Yeah uh-hum, yeah.  Uh-hum, yeah.  

MARLA:  What was it like when there was just the two of you?  Were you still single then or?  

MOSES:  No, I wasn't single.
  
MARLA:  How was that on your family? 

MOSES:  Well, the turnover, so far I had, like I would see about 15 coworkers.  Some, you know, quit.  

In the past 10 years, we have been trying to be 5 health aides, you know we get tired and then somebody quits.  And that makes, you know, hard the on-call system.  And this way we're being on call every other day because of one is on leave, one is on -- one is on the workshop.
  
MARLA:  Right.  

MOSES:  And health -- health aide after Session 2, they are really, you know, watching closely after session -- trainings, by sessions.  I guess the policy right now is like after Session 1, the -- they provide the instructor do the -- work with the health aide and it's -- he or she's capable, they need to do proper care, they could, you know, become -- being on call.  

MARLA:  So you need to have two -- you need to have the first two training sessions before you can go on call?  

MOSES:  Maybe after -- after Session 1 training.  But this is after, you know, working closely with the instructor.  

MARLA:  Right.  

MOSES:  Yeah.  

MARLA:  And having clinical training, as well? 

MOSES:  Uh-hum.  Yeah.  Yeah.  In the past, you know, they used to get tired and work right away.  You know.  Seeing patients even before trainings.  
And that -- after seeing patients after hours.  And in the past.  But since the program is growing and I know precautions, I would say precautions, because a couple of corporations, you know, health aides got sued.  

MARLA:  Oh, okay.  Oh, that's a shame.  

MOSES:  Yeah.  I think that opened the eyes of like the corporation, corporate members, board members.  

MARLA:  Right.  

MOSES:  Yeah.  So it's -- in the last (indiscernible) yeah, even they had the Alaska Certification Board and the CHAP group programs, more staff, so it's growing.  

MARLA:  Right.  

MOSES:  And lots of procedures, there's lots of procedures.  

MARLA:  Which has also increased over the years, I'm sure.  

MOSES:  Uh-hum.  Yeah.  

MARLA:  Yeah.  Yeah.

LOUANN:  Well, on the other side of the coin, almost, not the new modern, but you know, every spring YKHC has traditional medicine gathering. 

MOSES:  Uh-hum (affirmative).  

LOUANN:  And then Anchorage, the Alaska Native Medical Center has a traditional medicine woman on staff whose name I forget right now.  But -- 

MOSES:  Rita?  Yeah.  

LOUANN:  Yes.  

MOSES:  Blumenstein?
  
LOUANN:  Yes, Rita Blumenstein.  

MOSES:  Well, she was the -- I guess one of the old CHAPS that did that. 

LOUANN:  So you have to be careful about the medicine you practice, but are there ways that you can still bring in some of the old herbal treatments or --

 MOSES:  Yeah.  

LOUANN:  -- what you do here? 

MOSES:  No.   

MARLA:  Traditional medicine?  

MOSES:  We can't do education, you know, on the traditional medicine.  Only from our CHAM book.  

MARLA:  Okay.  And then the other question that you said that there was a high turnover, or not a high turnover, but in the 27 years you've seen 15 people come and go.  

MOSES:  Uh-hum (affirmative).  

MARLA:  Have you seen characteristics in those people who make good health aides?  Are there any characteristics or personality traits that you've seen which make a good health aide?  Do you know what I mean?  

MOSES:  No.
  
MARLA:  Like the ability to be a caregiver. 

MOSES:  Uh-hum (affirmative).
  
MARLA:  Or to have a good bedside manner or something within their personality that has made them either stay or be a great -- or made you stay or be a good health aide?  

MOSES:  Still I didn't get it.  

LOUANN:  Well, you could say out of all the 15 people who you've worked at maybe some you thought were really good at what they do and some were good people but you know somebody who was good and what was -- what made them good, in your mind?  What were they good at?  Why were they good as a health aide?  What were their strong points?
  
MOSES:  I would say the women were caring and wanted to work.  Yeah.
  
MARLA:  So women -- 

MOSES:  Another -- and you know, why they leave, because of their habit.  Like I guess you guys know what I mean by "habit," have drinking problem.
  
LOUANN:  It's hard work. 

MOSES:  And family, family problem. 

LOUANN:  Well, that's another whole -- all the emotional side of being a health aide when you take in everybody's problems. 

MOSES:  And some -- like if there was a little bit emergencies.  

MARLA:  Or trauma? 

MOSES:  Yeah.  Uh-hum.  Some, you know, couldn't take it.  Yeah. 

But YKHC CHAP program, they hired the -- one lady, a counselor, and for health aide, just concentrate on health because of the -- all the about the -- you mention about the turnovers.  

LOUANN:  Yep.  

MOSES:  Yeah.  And there's a really big incident in the village, they call this some kind of coordinator.  

LOUANN:  I don't remember anymore.  

MARLA:  So it's someone who can help the health aide to get through the trauma?  

MOSES:  Yeah.  Yeah.  

MARLA:  Right.  And so what -- 

LOUANN:  When things were really bad, sometimes they bring all the health aides, just bring in, everybody come in and talk because they can't do it.

MARLA:  And was there -- was there something that helped you get through those -- those traumas? 

MOSES:  Uh-hum (affirmative).
  
MARLA:  What was that? 

MOSES:  Lots.  

MARLA:  Like if you've seen a lot of traumas, what was it that helped you stay and get through those?  

MOSES:  Let me men -- let me mention about this one first, you know, about confidentiality.  Before we had that, the counselor, we had like a really bad incidents, and some health aides were killed in there.  And now I think this program started in '98, the counselor, health aide counselor, and she's really a good, caring person.  She stays in Aniak.  And -- 

LOUANN:  What is her name?  

MOSES:  I think -- I think you guys will get more information about the -- being a health aide.  

LOUANN:  From her?  

MOSES:  From her.  Yeah.  Jeannie Rhodes.  

And I guess you guys heard about the incident from a couple days ago about this young man?  
LOUANN:  Yeah.  Just driving in, you know. 

MOSES:  One of the health aides was there after.

 LOUANN:  And she's young.  She's fairly young, the health aide who -- 

MOSES:  She's my daughter.  

LOUANN:  That's right.  So of course she's young.  

MOSES:  Yeah, she's young.  

LOUANN:  Oh, that's really hard, it's your daughter. 

MOSES:  Next day she was trying to go to Anchorage for that workshop.  And she was down, but my wife, you know, talked to her and she's fine right now.  You know, she (indiscernible). 

MARLA:  Yeah, it's really hard -- it's a really hard job to do. 

MOSES:  Yeah.  

MARLA:  And to be in the village and know. 

MOSES:  But she phoned that, that counselor, health aide counselor.  Even we do teleconference with her.  And -- and whenever there's the really bad incidences, she comes to the office and talk -- they call this debriefing.  

MARLA:  Okay.  Yeah.  

LOUANN:  And so she'll come here sometimes?  

MOSES:  Uh-hum (affirmative).  Like if she heard, counselor come and talk with them.  

MARLA:  That's good.  

LOUANN:  That's great.  

MOSES:  It's a big plus for health aides.  

MARLA:  And that was started in '98, you think?  

MOSES:  Yeah, I'd say '98, around there. 

MARLA:  That's good. 

MOSES:  Yeah.  

MARLA:  And before that it must have been very difficult. 

MOSES:  Yeah. 

MARLA:  Because you feel like you need someone -- I would feel like I would need someone to talk to about it.

MOSES:  Yeah.  

MARLA:  And I know I've heard a lot of other health aides mention that their faith really helped to get them through tough times. 

MOSES:  Uh-hum.  Yeah.  

MARLA:  That was something that, you know, their -- that enabled them to get through it and to stay with the job. 

MOSES:  Uh-hum (affirmative).  

LOUANN:  Well, it was good that your daughter could just go to the training.  That was good to get out of the town.  

MOSES:  Yeah.  And besides, she was looking forward this one, the workshop.  

MARLA:  Well, I think that was all -- 

MOSES:  And, and you want to mention about the council's -- Tribal Council took over the  (indiscernible) the programs, and then I mentioned about more -- 

LOUANN:  Benefits?  

MOSES:  Not benefit, but things, workshops, but there are benefits.  It's not -- 

LOUANN:  Those benefits, yeah.  

MOSES:  Insurance (indiscernible), we don't have that like YKHC used to have.  

But more trainings.  That's what I like about.  Because we don't need, you know -- you know, two certified or EMT-1 certified, we kind of have this continuing education numbers, you know, like 4 hours of cases, both on clinical certification and certification by (indiscernible). 


MOSES:  And I think George mentioned about with the things about the -- one of the persons about being -- becoming a PA for our -- for our clinic. 

MARLA:  Is that something you would be interested in doing, or?  

MOSES:  No.  No.  

LOUANN:  It takes a lot of work.  

MOSES:  I'm working on it for one of the staff.  Yeah.  

LOUANN:  How many credits?  How much work to become a PA?  

MARLA:  It's a lot more.  

MOSES:  First it's books.  Uh-hum.  But I already talk with one of the (spoke in Native language).

LOUANN:  Someone in the clinic now?  

MOSES:  I -- (spoke in Native language) like advisor, yeah, advisor, yeah.  Linda Curda was my advisor.  

LOUANN:  Wow.  

MOSES:  Yeah.  Keep -- you know, let me know where I am (indiscernible). 

MARLA:  Is she still your advisor or -- 

MOSES:  No.  The last thing I check was someone by the name of Emma at YKHC.  

MARLA:  Yeah.

 MOSES:  And I work on some -- I think it would be worse for -- for that -- for that (indiscernible).  

LOUANN:  You've been talking for two hours.

MARLA:  I know. 

LOUANN:  I think Linda Curda may finally be retiring almost.  She has a grandchild in Anchorage, so she's been staying there more.  But you know her husband's a judge.  

And I think another woman in our program just talked to Linda and said she had been staying in Anchorage more and more, and they wanted them there, but I don't know if Dale Curda is retired yet from the court or not.  But -- 

MOSES:  I never heard of them.  The last I saw her was when I attended.

 LOUANN:  Camai? 

MOSES:  It's some kind of statewide program, for -- 

LOUANN:  Like rural providers or --

 MOSES:  Becoming a health aide.  

LOUANN:  There's so many of them now.  

MOSES:  Yeah, and we all coordinators, you know, from CHAP program, all over Alaska, they attend that conference.  

LOUANN:  In Bethel?  

MOSES:  In Anchorage.  Yeah.  

LOUANN:  Anchorage.

MARLA:  And -- and can anybody -- can anybody in the village now, if they are 18 or older, become a health aide if they wanted to, or?
  
MOSES:  The only thing, if they -- you know, before they do the interview or hired, YKHC come here and do the -- the test.  They call this a field test.  

MARLA:  They would test the people who would be -- 

MOSES:  The applicants.  Yeah.  

MARLA:  Okay.  And everybody who is a health aide has been -- who is here now is from Akiachak?  

MOSES:  Uh-hum (affirmative).  

MARLA:  Good.  

MOSES:  Yeah.  

MARLA:  What do you think about, how has it been living and the same place as you work as a health aide?  Has it been difficult?  

MOSES:  No.  

MARLA:  Or has it -- 

MOSES:  To me, it's not.  It's good.  

MARLA:  Great.  

MOSES:  You know, being with the family and -- and now council members, like take a time out, like in September they let me take 14 days for moose hunting.  

MARLA:  Good.  

LOUANN:  Did you get one?  

MOSES:  No.  But my son did.  

LOUANN:  Good. 

MOSES:  Yeah. 

LOUANN:  You have to go up to the Yukon, there's a moratorium on moose?  

MOSES:  No.  Above -- we went above Council.  Yeah.  I think you guys heard about the Lower Kuskokwim is closed for (indiscernible).

 MARLA:  Yeah.  Well, I think that was all the questions I had.  

MOSES:  Uh-hum. 

MARLA:  To ask you.  If there's anything else you wanted to add for the record, about the -- about being a health aide or anything else.

 MOSES:  No.  

MARLA:  No?  Okay.  Do you have any more questions, Louann?  

LOUANN:  I think we've talked too much.  

MARLA:  Well, thank you very much for doing this interview.  

MOSES:  You're welcome.  

MARLA:  And especially while you were working and while you should probably be finished working.  Thank you.  

MOSES:  You're welcome.  

LOUANN:  Yeah.  Thank you.  

MOSES:  Thanks.