Martina Lauterbach was interviewed on November 9, 2005 by Karen Brewster at Martina's office at the Alaska Native Tribal Health Consortium in Anchorage, Alaska. In this interview, Martina talks about how she became a health aide, particularly memorable cases she had, what being a health aide meant to her, and how her career has developed.
Digital Asset Information
Project: Community Health Aide Program Project Jukebox
Date of Interview: Nov 9, 2005
Narrator(s): Martina Lauterbach
Interviewer(s): Karen Brewster
Transcriber: Carol McCue
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A history of her education and involvement in the Community Health Aide Program, including some information on the pay and training of health aides.
What she studied at training sessions and what it was like being a health aide in Emmonak.
The kinds of illnesses and emergencies she dealt with as a health aide
Being a health aide in a small community, treating family members, and issues of privacy.
Her medical career after being a health aide.
Delivering babies, and cultural factors that influenced patients and care providers in the village.
The frequency of visits from outside health practitioners, and a few examples of difficult cases she dealt with successfully.
Use of traditional medicine, treatment of tuberculosis in the early days, and a story about Dr. Walter Johnson.
The locations and histories of the communities of Kwiguk and Emmonak, and what inspired her to go into medicine.
Advice for young people who might be considering a career as a health aide, and reflections on what she learned as a health aide.
Patient confidentiality and diagnosis when all they had was radio communication.
Working through difficult situations, working as a young health aide with no training, and starting a family while working and helping her husband through school.
Hygiene in Emmonak through time, and how improved health care and public education have changed the rate of illness in rural Alaska.
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After clicking play, click a section of the transcript to navigate the audio or video clip.
KAREN: -- introduction, that this is Karen Brewster and today is November 9th, 2005, and I'm here in Anchorage with Martina Lauterbach -- is that how you say it? MARTINA: Uh-hum (affirmative). KAREN: Okay. -- for the Community Health Aides Project Jukebox. And we're here in the offices. Why don't you tell me the offices here. MARTINA: Department of Community Health Services. KAREN: And it's for the Tribal Health Consortium? Is that what you're part of? MARTINA: Yes, Alaska Native Tribal Health Consortium. KAREN: Well, great. Well, thank you for being interested in this project and willing to be interviewed. MARTINA: Uh-hum (affirmative). KAREN: Why don't you start by telling me a little bit about you and when and where you were born, where you're from, a little bit about your background. MARTINA: Okay. My name's Martina Lauterbach. My maiden name is Redfox. I was born in Kwiguk, Alaska, which is like two miles from Emmonak, upriver from Emmonak. And I've lived in Emmonak, or I lived in Emmonak most of my life until I left for high school and college. And I went to Chemawa, Oregon, for high school. Graduated in '69 from high school, and went home. And I had plans on, you know, going into LPN, you know, training after I graduated from high school, but that was not possible, so I got into being a health aide when the Emmonak Village Council asked if I was interested. And that's how I got into that, into being a health aide in my village for three years, from 1969 to 1972. And I went to the Bachelor of Science Nursing Program at Alaska Methodist University, now Alaska Pacific University. And that's, I guess, my history. KAREN: And when did you go to the nursing program? That was after you were a health aide? MARTINA: After I was a health aide. I was a health aide for three years, from '69 to '72. And then I went to the nursing program from '72 to 1976. KAREN: Okay. And so were you the first health aide in Emmonak? MARTINA: No, I wasn't. There was several, you know, before myself. And I guess you know about Axel and Pearlie Johnson. KAREN: I've heard of them. MARTINA: Yes. They were the health -- medical aides, I guess they used to call them. I'm not sure exactly. But I think they were called medical aides at the time. And then after them, there was Ursula Kizofnikof that used to be a health aide before myself. And then there was two other that I can remember. Russell Lamonte and Ambrose Shirley were the two that I worked with when I started as a health aide. KAREN: Uh-hum. Yeah, because the Health Aide Program officially started in 1968. MARTINA: Uh-hum (affirmative). KAREN: So that's why I was wondering. But it looks like maybe a lot of them worked before they got paid? MARTINA: Yes. Axel and Pearlie, I think, were never paid, and Ursula might not have been paid also. I mean, if she got paid, it might have been from the village. KAREN: Yeah. MARTINA: And it was not very much. KAREN: No. MARTINA: Russell and Ambrose Shirley, when I came on, you know, were getting a little bit of money. KAREN: Yeah. MARTINA: And the -- I think it was the village that was paying us at the time and we were getting -- well, I was getting, like, 150 a month. KAREN: Oh, my gosh. MARTINA: And that was for -- until I went into, you know, training, then my pay did go up a little bit. And then by the time I was done working as a health aide, I was getting, like, 500 a month, I think, from Alaska Village. No -- Alaska Village Council -- no, what is it? KAREN: AVCP. MARTINA: AVCP, Association of Village Council Presidents in Bethel. KAREN: So -- MARTINA: Yes. KAREN: -- Yukon-Kuskokwim Health Corporation didn't exist yet? MARTINA: No. I think it started probably about the time that I started working as a health aide. Because I wasn't even aware there was a YKHC, you know, at the time. KAREN: Yeah. MARTINA: And I think I -- who did I hear it from. Robert Wainwright was -- you know, I think I heard it from him. KAREN: -- yeah. MARTINA: And then there was Phillip Nice that, you know, came, my -- probably in '72, somewhere in that area, you know, he came into the village and, you know, he mentioned, you know, the YKHC. And that's when we were training. You know, we had like -- our first phase of training was, like, two weeks in Bethel. And then we went to our second phase of health aide training, and it was here in Anchorage. And that would be, like, for three weeks. And then the third phase of training was in Bethel for two weeks. And then our last training, Phase 4, was here in Anchorage for three weeks. And that was enough then. And I think they have -- I'm not sure what their program is right now. KAREN: Uh-hum. Now, was that training you did all at the beginning or you did -- that was throughout a year or? MARTINA: Yeah, that was in the beginning. That was, I think, in two years of me working as a health aide is when I got all my trainings. KAREN: Uh-hum.
KAREN: What kind of things did they train you in, do you remember? MARTINA: It was more, you know, doing screening types, and then we also did a little bit of dental, but we didn't do -- you know, I guess we just -- you know, they just taught us, you know, what to look for. As far as, you know, dental, what needed to be taken care of right away, I'm sure. So. And then when we were here, it was a little bit of anatomy during our Phase 2. And more -- you know, a little bit more first aid type things or, you know, what we were taught. So. And history taking, of course, you know, for people, you know, that came in to see the health aide or call the health aide or phone the health aide in the village. And you know, those days, we were on 7 days a week, 24 hours a day. I mean, you know, we didn't have any leave time or any type of leave, either sick or, you know, annual when I was health aide. That was not, you know, put into our time. KAREN: And did you have an alternate or it was just more -- MARTINA: Yes, I had, after -- when I first started out, I guess I was working with the two health aides, Russell and Ambrose, and then they were guys, of course, until they went out hunting. And who was left back in the village? So -- and after one of them left, I had -- I kind of became the primary after the two guys left. And I had several. There would be, like, only two of us in the village. You know, there would be myself and the primary. I mean, primary and the second -- KAREN: Alternates? MARTINA: Alternate health aide. And, you know, just was kind of like the village would pick, you know, who their -- you know, I guess they would tell us who it was. So we were both pretty much on call. We weren't -- you know, we couldn't -- if I was gone to maybe escort a patient to Bethel, a baby or, you know, a sick patient, then I would, you know, return quickly. You know, I would go on a charter with the patient and then get them to the hospital, and then return, you know, that same -- same day. KAREN: Yeah. MARTINA: So. And -- yeah, that was, you know, the whole time I was a health aide, it was like that. KAREN: And how did you handle that kind of a schedule? MARTINA: It was pretty hard. I didn't have any time for anything else. You know, we, of course, we had some slow times, but you know, it was more -- it was more going to the homes at the time, too. We didn't -- you know, they didn't come to the clinic. KAREN: You had -- you had a clinic? MARTINA: We had to go to the -- yeah, we had -- I had a little room, BIA schoolhouse in Emmonak. And you know, in that room we had, you know, a refrigerator, we had the -- we used the school's radio that we used to use, you know, for reporting patients and stuff. And of course, you know, everybody heard. And everybody channeled their radios. Anyways, that's how, you know, we did our patients. Most of the time we went to their homes and did the screening at their home. And then during the radio, what we called the radio traffic, we had a certain, you know, time that the doctor would, you know, call our -- I can't remember what our number was. KAREN: You remember the call number? MARTINA: KIK something. And then, you know, if the weather was nice or sometimes, you know, we had problems with the radio traffic because of the problems, you know, you couldn't hear or they couldn't hear you, we couldn't hear them, you know, type of thing. So -- KAREN: How many people were living in Emmonak at the time, about? MARTINA: Probably about 500. It was one of the bigger villages, you know. KAREN: Yeah. MARTINA: And I was the health aide. So -- KAREN: It seems like, yeah, for one person to be responsible for that many people -- MARTINA: Uh-hum (affirmative). KAREN: -- that seems like a lot to do. MARTINA: Uh-hum (affirmative). There was two of us, but you know, we both worked, you know, because -- pretty busy.
KAREN: Back to the radio traffic, what did you do if you couldn't reach the doctor? MARTINA: I guess waited until, you know -- we had some standing orders, you know, for emergencies. You know. Then. And so you know we would use our judgment, you know, what to do, you know, with the patient. And you know, after working and seeing a lot of diseases and stuff, you know, you kind of, you know, learned how to recognize, you know, what could be wrong with the patient. And we had a lot of respiratory. And ear infections and, you know, if you saw maybe a sore throat, you know, you would kind of figure out, you know, what you could do. Because we didn't do throat cultures at the time, too. KAREN: Oh. MARTINA: Yeah. I mean, you know, it was like if you had pusy tonsils, then, you know, you would automatically give penicillin. KAREN: That was one of my questions is what kind of equipment and medicines and things, what did you have available to you to treat people? MARTINA: Well, we had, you know, the basic. We had a stethoscope. We had an otoscope to look in the ear. Stethoscope was, you know, for listening to the heart and lungs. We had a hemoglobometer, which was, you know, you stick a finger and then, you know, check their hemoglobins that way. You know, it was battery operated. KAREN: Like it pricks the finger? MARTINA: Yeah, prick the finger and get -- you had a little slide that, you know, you had to mix before you put in the meter, and we got hemoglobin that way. And then we had dipsticks for urine. KAREN: Uh-hum. MARTINA: And then, you know, we had only a couple of types of antibiotics at the time. You know, there wasn't much. We had triple sulfa, penicillin, maybe ampicillin, erythromycin, and then we had a lot of ear drops, you know. Cortisporin for, you know, ear infections. What else did we have. You know, it was, you know, limited. You know, medication. And then if the patients got prescribed medications from Bethel, then we would -- if before they run out and stuff we would make sure that, you know, they didn't run out and order, you know, the medications from Bethel. And they would, you know, come into the -- or they were addressed to the clinic and we would keep them in the clinic until the patient needed more of their medicine. This would be for, like, blood pressure, or a lot of it was I think mostly blood pressure because we didn't have diabetes then. You know. KAREN: Yeah. So what, that makes me think about nowadays diabetes and cancer are very prevalent. MARTINA: Uh-hum (affirmative). KAREN: And what was it like back then? What sort of things were you dealing with mostly? MARTINA: Like I said earlier, there's a lot of respiratory, ear infections, fevers, you know, children with seizures, you know, from -- I guess most of it was from febrile or fever. And you know, emergency-type things, if we had emergencies, then we took care of that. And just one, you know, example was like in the fall time, there was, you know, people, men that went out hunting, moose hunting. And this one person, you know, got accidentally shot in the groin, or in the groin, and the day was, you know, pretty blistery. And they had a dog team, they didn't have a snow machine. And they were using dog teams. And it took them hours from where they were hunting and the closest village was Emmonak, so they, you know, of course, then they came there. And by the time the person got there, you know, with the other people that went out hunting with him, you know, when he got there, he was pretty shocky and didn't have a blood pressure, or if he did, it was very, very, very low. And they did a tourniquet but it wasn't, you know, like a real tourniquet, you know, type thing to stop the bleeding. And of course, you know, he did not make it, unfortunately. And you know, had -- we were going to get a plane, you know, to take him after talking to the doctors in Bethel. And we did CPR on this guy for about an hour and, you know, he didn't, you know, make it. And those were the type of emergencies, you know, that I dealt with. I mean, there wasn't many, but that was one of the ones that I can really remember. KAREN: Sticks in your mind. MARTINA: Sticks in my mind. And then there was another, you know, pediatric patient that I had that had pneumonia. And he was, you know, getting the antibiotics two times a day but -- you know, the IM penicillin, and his hemoglobin was very, very low. And the weather was bad and couldn't get out, and so, you know, he didn't make it either. That was -- those are kind of hard on me because I was still young at the time. You know, when I was a health aide. KAREN: So how do you deal with those kinds of things, or how did you deal with those kinds of things? MARTINA: I guess, you know, I had some pretty good people, you know, in the village that, you know, supported and, you know, the families that didn't blame me for, you know, having, you know, their -- one of their family members die. And so that -- I think that helped. And it was hard, but I honestly can't remember how I dealt with it. And --
KAREN: I was wondering, you know, how being from a small community and being a health aide, if that's hard, you know everybody. MARTINA: It was hard at times because, you know, you're familiar, you know, you were dealing with your family members. KAREN: Right. MARTINA: Relatives. And I think -- you know, they were pretty good to me. You know, I can't say anything, you know, that -- I guess, you know, just took care of them. And, you know, that was my thing, you know, if I took care of them and, you know, there were -- that's all I can do. I can't -- I mean, you know, I was there all the time. You know, if there was some type of illness and they called on me, I had to be there. I mean, you know, it was -- and that's all I did. KAREN: I'm somebody who don't think I could be a medical practitioner. I don't have the -- I think I'd pass out if I saw certain things, so I'm always amazed about how people handle those situations and how they get through them. MARTINA: Uh-hum (affirmative). KAREN: And how that's possible. MARTINA: Yeah, I guess, you know, you have to have, you know -- you have to be compassionate. And, you know, empathetic. And I was -- I think I was that, you know -- you know, from the time I got into taking -- you know, doing medical stuff. KAREN: Now, you said you had wanted to go to nursing school, so why did you want to go into medical things, do you know? MARTINA: I'm not sure. I mean, just -- it was kind of like I honestly don't know because I was in high school when I decided that I wanted to go into, you know, nursing, or, you know, some. And it stuck with me. I mean, it did. And I guess me going into nursing after being a health aide, you know, that had been my dream, so you know, I pursued it, you know, after three years of being a health aide. And I think I probably -- it could have been that, you know, I was going through a burnout, you know, type when I, you know, left the village to go into the nursing program. Because I was in a lot of things like, you know, things that were happening, and I was -- I guess, you know, I kind of felt like I'm the only person taking care of a village and, you know, I had another person, but, you know, just I was starting to feel overwhelmed, I guess. KAREN: And you were how old when you -- you said you were young when you were a health aide, so you were how old? MARTINA: Well, I started -- I was 20 when I started. And, I mean, I wasn't that young, but I was still -- KAREN: Well, that's young. MARTINA: Yeah. From being a village person, I think, you know, that was young. KAREN: Yeah. Do you feel that the training that you got as a health aide prepared you for the things that you had to deal with? MARTINA: Yes. Uh-hum. You know, we had some, I guess, for emergencies or, you know, what not to do type of things and, you know, at the end, I think it was like I was trained in one of the trainings that, you know, you should try and get the people to come to the clinic rather than you always going to their, you know, homes and stuff, but that was hard. I mean, you know, if we had a child that had real, you know, high fever or something, you know, just didn't feel that they should be going outside and in the cold, especially. And older people. You know, I could go to them. And I think I kind of spoiled the people in the village that way. But you know, it was my choice. And, you know, I did -- the ones that weren't too ill or, you know, I felt that weren't too ill and stuff, then I encouraged them to, you know, come to the clinic and let them know this is the hours that I have the clinic open. And you need to be there at a certain time because, you know, radio traffic was at a certain time, so you know, I could get them reported to the doctor in Bethel. KAREN: And if they came to the clinic, were you able to have some privacy with the patients? MARTINA: Yeah. We had -- KAREN: I know sometimes -- MARTINA: Yeah, we had -- you know, the office, or, you know, the little clinic that I had, it was even smaller than this room here. KAREN: Yeah. MARTINA: It had a door, so you know, you could -- and there was no windows from the hallway. You know. So that was good. KAREN: Yeah. Because I know from talking to some other people in some of the communities, you know, it was just a curtain in the back of the school. MARTINA: Oh. Yeah. No, I was -- you know, when I started, I had, you know, a little office, and had, you know, cabinets where I could keep their medicine. It had a sink. So this was pretty -- I think it wasn't like, you know, some of the, you know, other villages that had -- didn't have the stuff. KAREN: Right. When did Emmonak get a clinic on all on its own, so that it wasn't part of the school, do you remember? MARTINA: I was already gone when -- I mean, I had already graduated from nursing school and left and I can't remember exactly, might have been in the '70s sometime. Late '70s, early '80s. KAREN: Okay. MARTINA: I can't remember exactly. KAREN: Yeah. So quite awhile after you had -- MARTINA: Yeah. And they got the Regional Clinic just a couple years ago. So that's a brand new clinic that they have right now. KAREN: Oh, good. MARTINA: Yeah. It's the Axel and Pearlie Johnson Clinic they called. KAREN: Nice. MARTINA: They dedicated it to them. So.
KAREN: So now, after you went and finished nursing school here in Anchorage, let's just sort of finish out how you got from 1976 to now and what you did. What did you do? MARTINA: Well, when I first started, it used to be the Alaska Native Medical Center, which is the Indian Health Service. KAREN: Uh-hum. That one downtown? MARTINA: Downtown. Yes. When I started in 1978, November of 1978. And I started working on their surgical floor at that hospital. And was there for, like, two and a half years on the floor working different shifts. And I had -- I was just starting a family then. And decided to apply for a clinic job. So I went to pediatric clinic, and that was like a day job, 8:00 to 5:00, or 8:00 to 4:30, you know, job. And that was in 1981. And worked in that clinic for -- until 1984. And then I figured, well, I need to get more experience in, you know, inpatient pediatrics, so I went into -- I applied for a Level 2 position for infant pediatrics. And worked there from 1984 to 1988. And, you know, got more experience in pediatrics then. And then in 1988, I applied for a research position, and that wasn't with Indian Health Service, that was contract with UCLA at the time. And worked on the Hemophilus Influenza Type B vaccine study. And did that for two years. I actually got licensed. The -- you know. And then after the two years, stayed in the state, I worked for the Center for disease control. And worked on the infant hepatitis study with Dr. McMann. And did that for a couple more years. And then there was an opening for community health nurse at ANM -- you know, for IHS then. Immunization program. So I applied for that, I got that job. And did immunization -- trying to get the immunization rates up in Alaska. And did that, and in that program, they decided, well, you know, they were going to do home immunizations. And so I was doing, you know, home immunizations for pediatrics. KAREN: That was here in Anchorage? MARTINA: That was here in Anchorage. And then while I was there, they decided that they were going to start the high risk, you know, program for moms and infants. And so I did that and did community health high risk program with a nurse midwife that you know was working at ANMC then. And I did that until 1996. Let's see. I'm trying to figure out the years. Oh, I did that, yeah, until 1996. And then I did community -- no, yeah, field health, case managing for pediatrics, and this would be, like, for certain parts of Alaska. And we, you know, would get referrals in from Bethel, Dillingham, Barrow, and, you know, for pediatric patients. And we would work on getting them in for appointments and, you know, try and get their appointments all taken care of by them here, you know, different types of appointments that they might need. So I did that until November of '03. And then I got this job. And this is kind of like it's a research type of position and doing traditional food monitoring studies. And we did in Barrow, and then now we're doing the Yukon-Kuskokwim Health Corporation area villages and the Aleutian Pribilof Island Association villages. Doing the traditional food monitoring study. KAREN: And what is that study? MARTINA: It studies for contaminants, heavy metals, pesticides. And we're also doing some, you know, nutrients, stuff in the traditional foods that the pregnant moms eat. And, you know, we get -- what we do is we recruit for pregnant moms when they come in for their first prenatal visit to YKHC or here in Anchorage for the API villages. And then when they -- we get their blood, you know, the time that they are being seen, and so that, you know, blood is checked for the, you know, contaminants. And when the baby is born, then we get the cord blood, and then we check to see if there was any hemo transfer to the baby from, you know, those -- any of those contaminants. So that's pretty interesting. KAREN: Yeah. That sounds neat. MARTINA: Uh-hum (affirmative). KAREN: So yeah, you're looking at anything to do with the health benefits of eating a traditional diet? MARTINA: Yes. Uh-hum. KAREN: And trying to encourage that with people? MARTINA: Yes, we are. And then, you know, there's, you know, not much. You know, there's some contaminants, you know, in the traditional foods, but it's not, you know, to where it's dangerous. I mean, you know, like they were talking about at the one time the mercury in the fish and stuff. We don't -- you know, there's a little bit, but, you know, it's not where they have to restrict, and, you know, you don't have a number, a certain number of, you know, fish that you, you know -- I guess some, you know, places like out of state and stuff you -- you know, the stuff are more contaminated -- KAREN: Yeah. MARTINA: -- in the Big Lakes than, you know, up here. KAREN: It sounds like a very worthwhile research. MARTINA: Yes. And, you know, I've learned a lot from, you know, this. KAREN: It sounds -- you've come a long way from a 20-year-old health aide to doing all this research. MARTINA: Uh-hum. Yes, I have. And I'm proud of it. KAREN: Good. MARTINA: I was -- I was the first one from my village to go to college and graduate from college. KAREN: That's great. MARTINA: So. Yeah. KAREN: That's really good.
KAREN: Back to sort of the health aiding side of things, since that's kind of what we're supposed to talk about -- MARTINA: Right. KAREN: Do you remember delivering a baby? MARTINA: Yes. KAREN: Your first one? MARTINA: There was two of them I delivered. There was a -- you know, one that I -- the first one I helped deliver because we had to -- the -- like a traditional midwife that, you know, helped, you know, with that delivery. And that went well, you know. And then the second one that I helped deliver was the -- the Public Health nurse was in the village, you know, at the time. So, you know, her and I, you know, both, you know, both delivered the baby. KAREN: So you never delivered -- MARTINA: I never had to deliver by myself, thank goodness, because I would not -- I mean, I'm sure I would have been able to because, you know, when -- at our trainings and stuff, you know, we would watch deliveries, you know, in the hospitals, Bethel and here. KAREN: So did you like being a health aide? MARTINA: I enjoyed being a health aide. I learned a lot being a health aide. And I respect the health aides today because of that. And you know, just knowing, you know, a lot of work that they do. And you know, they are the first contact that the village people have for their health. So, I mean, you know, they are to be respected. So -- KAREN: And then -- you sort of talked about it a little bit but why you chose to not continue as a health aide. MARTINA: I guess, you know, I wanted to -- you know, I had to pursue, you know, what my dream or, you know, what I wanted to do, and so that's why. And, you know, like I said earlier, it probably could have been kind of a burnout, you know, thing for me to be a health aide because that was a lot of work. KAREN: Yeah. MARTINA: And you didn't have really a social life. I mean, you did with the village people, but I mean, you know, even though you were -- I mean, you could be visiting somewhere and then they would be looking for you. And we didn't have phones or CBs, you know, at the time, so people, if they needed a health aide, they would come knocking on your door or, you know, find you somewhere. So -- KAREN: And at the time you were single, you didn't have children or you weren't married? MARTINA: No, I was single. Uh-hum. KAREN: Okay. MARTINA: I met my husband while I was in nursing school. KAREN: Oh, okay. It's interesting, too, you mention -- you said something about, you know, the men who were the health aides that you worked with at the beginning and they would go out hunting and you had to take care of the village. MARTINA: Uh-hum (affirmative). KAREN: It seems like there are more women who have been health aides than men. MARTINA: I think it's probably because, you know, the men had to go out hunting. I mean, they had to because that was, you know -- we had subsistence living at the time. You know, we didn't have any beef and chicken and that kind of stuff in the stores at the time. You know, when I was -- KAREN: Right. MARTINA: -- growing up in the village and stuff. And so the men had to go out hunting. I mean, that was, you know, something they had to do. KAREN: Right. MARTINA: And I'm sure that's probably why, you know, we have a lot of women, you know, as health aides. KAREN: Yeah. I hadn't thought of that before. It's -- I'm glad you pointed that out. MARTINA: Uh-hum (affirmative). And you know, it was hard for men because, you know, it was like all your -- you know, they had to go hunting, like in the fall, you know, for seals or moose, and then wintertime they would have to go out hunting for, you know, rabbits or other winter, you know, subsistence. And then they also had to get wood for the firewood -- you know, for heating the house. KAREN: Right. MARTINA: Because we didn't have -- well, a lot of times, you know, we didn't have the oil stove. I mean, there's some people that had it but, you know, you have to pay for that, too. So men had to go out and get fur like meat or, you know, wolf, or wolverine, and sell those to, you know, get money to buy. KAREN: Right. MARTINA: Our oil for the stove. KAREN: So did the doctors come out to the village at all? MARTINA: Yeah. They did, oh, how often, maybe a couple of times a year. And they would be there in the village for maybe three to four days. And then the Public Health nurse came out about every three months. And the Public Health nurses that, when I was a health aide at the time, used to come from Anchorage. KAREN: Oh. MARTINA: They didn't have the Public Health nurses in Bethel. They now -- they now do have Public Health nurses in each service unit. KAREN: And so how did that work when the doctor came to the village? MARTINA: We would be -- you know, they -- they did have a nurse that came with them, a travel -- you know, like a doctor or nurse came, you know, from Bethel. And then before they came, they had a list of, you know, people that they, you know, would have to see for some reason or another. And then I would let these people know. And try and make appointments. It didn't work. So you know, they kind of showed up when they, you know, showed up because we didn't -- they -- time wasn't important, you know, those days. KAREN: Right. MARTINA: And I'm not sure, you know, how it is right now. I'm sure a lot of times it's still not the important thing for them. Yeah. KAREN: It's a different schedule -- MARTINA: Yeah. KAREN: -- out in the villages, for sure. MARTINA: In the villages, yeah. Because it's pretty slow. There's a lot of people that just don't work, even now. Because it's hard to find jobs. If you don't have a job in the city office, you know, pretty much don't have a job, I guess. I don't know.
KAREN: So when the doctors came, did you -- did they -- were they specialty doctors or were they regular doctors? MARTINA: They were just regular doctors. They didn't have -- you know, the time I was a health aide, they didn't have pediatricians or anything like that, it was just general, or what they call general medical, family medicine doctors, I'm sure. KAREN: Uh-hum. MARTINA: And that came out to the hospitals like Bethel, Dillingham. KAREN: And then what did the Public Health nurses do? MARTINA: They did immunizations, and if there was, you know, some chronic things that they had to follow up on, like TB, if there was -- you know, if there was TB, you know, making sure that these were taken care of. And some women's health, stuff like pap smears and that. KAREN: So the health aides, you weren't able to do immunizations and those other kinds of tests? MARTINA: No. I was -- I don't know if I should say -- I was taught by a Public Health nurse on giving immunizations, which was good. You know. I helped her, you know, do immunizations. And we were scheduling well baby appointments also at the time, you know, when the Public Health nurse came. So she would do physicals and give immunizations. KAREN: Yeah. MARTINA: You know, pediatric patients. KAREN: It doesn't seem like immunization's too complicated. It's interesting why the health aides weren't trained to do that. MARTINA: Well, you know, the -- I think the -- we were taught, you know, how to give immunizations or, you know, give IM, you know, shots and stuff like that, but the vaccines are pretty -- some of them are kind of -- you have to have certain temperatures -- KAREN: Oh, okay. MARTINA: -- for them in the refrigerator. And there was no way of controlling, you know, the refrigerator temperatures or some -- even some of the villages didn't know how -- probably didn't have refrigerators. KAREN: Right. So you couldn't store it, you'd have to be -- MARTINA: You'd have to -- KAREN: Nurse comes in and gives it. MARTINA: Right. KAREN: Okay. MARTINA: And, you know, you could keep your -- and you know, they do expire, the vaccines and stuff, and if they sent them out to the villages, they could freeze, you know, like sometimes the airplane or, you know, when the planes came into the village, you know, there would be boxes left and it could -- KAREN: Right. MARTINA: -- you know, not come to the clinic right away. KAREN: Right. MARTINA: Like, you know, it's supposed to. So -- and the Public Health nurses had them, you know, controlled, you know, when they came out to the villages. KAREN: Yeah. Okay. MARTINA: Yeah. KAREN: We had talked before about a couple of those emergencies where those patients didn't make it. MARTINA: Uh-hum (affirmative). KAREN: Can you think of some examples where because of what you did, you saved somebody? MARTINA: I'm trying to think. I'm sure. I mean, there's a lot of -- KAREN: You have a memory of a particularly successful case that ever made you feel good about being a health aide? MARTINA: Oh, gosh. I mean -- KAREN: I don't want to focus just on the bad ones, that's what I mean. MARTINA: Right. Yeah. I'm trying to think of. I'm sure there were several, but I can't, you know, right now even think of, you know. I mean, I had a lot of success, I think, you know, just -- KAREN: Any times that you surprised yourself at what you were able to do? MARTINA: Many times, but you know, just things that had to be done. You know, if we had to -- maybe cuts or -- well, hepatitis, I guess, is one that I can think of that I took care of pretty well. It was Hepatitis A. And you know, the person was taken care of. I know how to, you know, deal with what I needed to do because I learned, you know, from one of my trainings, you know, on Hepatitis A. Because it was, you know, Hepatitis A, you know, you'd see several times. And I guess, you know, I kind of knew how to take care of that. So that was one of the things that I guess I'm proud of, you know, having known, you know, what to do. And you know, not getting it spread, you know, when a person had the Hepatitis A in the family. So I guess that would be one of the good things. KAREN: That's good. That's good. Yeah. No, you learned to recognize something very contagious and keep it from getting worse in the village. MARTINA: Yeah. And then typhoid, too, I had one typhoid. KAREN: Oh. MARTINA: In a pediatric patient that, you know, I did -- took care of correctly also. I mean, you know, the pediatric patient did come into Anchorage for that, too, and it was contained. KAREN: Good. MARTINA: Pretty well. Yeah. KAREN: Typhoid doesn't seem like something particularly common in Alaska. MARTINA: No. And I can't remember how this -- I think there was one person that was a carrier, if I can remember. KAREN: And how you managed to recognize it. MARTINA: It was, you know, high temperatures and couldn't get it, you know, taken care of, even with -- I can't honestly remember. But it was -- you know, the baby couldn't -- you know, wasn't getting well. KAREN: Uh-hum. MARTINA: After several days of antibiotics, I think. And we thought maybe it was an infection, you know, at the time. And when we sent her into Bethel, you know, they did the blood work and stuff and found out that she had typhoid. KAREN: Oh. And she survived? MARTINA: She survived. And she now lives in Anchorage. And I can't -- I think she's married. So. Yeah.
KAREN: I'm just looking at some of my questions here to see what we've talked about and haven't talked about. One thing I was thinking about is the -- if you've -- say something about how the community of Emmonak responded to having the Health Aide Program set up and how much it -- you know, was it traditional medicine going on before there were health aides, or would -- MARTINA: I think they've always used traditional medicine, I mean, even though there was health aides. And I think they still do nowadays. And you know, they took it very well, you know, for having health aides. I mean, it was some -- you know, somebody that they respected. And you know, somebody that took care of them, you know, if they were needing medical help. And I mean, they still use traditional medicine. KAREN: Did you ever incorporate any traditional medicine when you were a health aide? MARTINA: No. I never did. I mean, you know, there's some herbs and that kind of stuff that, you know, I encouraged, you know, for them to use, but I didn't really know too much, I guess. Because I wasn't in the village very much when I was -- I, I guess, because you know, I went to Oregon for high school and I was gone for four winters, you know. KAREN: Right. But it's interesting to note the combination of traditional. MARTINA: Uh-hum (affirmative). KAREN: So was there a traditional healer in town that people -- MARTINA: Not when I was growing up. KAREN: When you were a health aide, were there? MARTINA: No. Those were way older. I might have been an infant when they had one, you know, in the village, but you know, they were gone by the time I was grown up. KAREN: Can you think of some of those herbs that you encouraged people to use? MARTINA: Just Caiggluk, I guess you've heard of that, I'm sure. KAREN: Yeah. MARTINA: And then, you know, like for boils and stuff, they'd use the tobacco leaves. KAREN: Oh? MARTINA: You know, to draw out the -- you know, I guess the infection. KAREN: Uh-hum. MARTINA: I think that was pretty much. KAREN: Is Caiggluk stinkweed in English, do you know? MARTINA: I think so. We have to -- Caiggluk, it's from a certain type of tree or bush. And you know, you boil that. No, it's not even a bush. It's more like a plant, you know. KAREN: Uh-hum. MARTINA: And green. And, you know, you boil those or -- KAREN: You take the leaves? MARTINA: Take the leaves and boil. And drink that. And they used that a lot for colds. KAREN: Yeah. MARTINA: Sore throats. And even for sores, you know, if they have open sores and that kind of stuff. KAREN: What, they would make a -- MARTINA: Yeah. KAREN: Like a -- MARTINA: Like a leaf. Yeah. KAREN: Yeah, I think it might be stinkweed. Big leaf that's kind of -- I don't know how to describe it. MARTINA: Yeah. KAREN: Since we're not on video, I don't know how to do it. I had something else I was just going to -- oh, I was going to ask you about tuberculosis. Were you having to deal with a lot of tuberculosis still? MARTINA: No. Not that time period. Tuberculosis around my village or in my village was, like, from 1954 to '58 maybe. Yeah. And then, you know, it was a lot of the TB patients went to the, you know, hospitals, like here in Anchorage and Mt. Edgecumbe. And some went to Seattle -- KAREN: Right. MARTINA: -- you know, for their TB. KAREN: So that's what Pearlie and Axel were doing with TB? MARTINA: Yeah. They would be the ones to ask -- or not Axel but Pearlie. KAREN: Pearlie, yeah. MARTINA: Pearlie would be the one to ask about the TB because she would know. KAREN: She was the one at that time period. MARTINA: Yeah, she was -- yeah, at that time period, yeah. KAREN: Yeah. Because Walter Johnson has talked a lot about TB in the Delta region and treatment and all that. MARTINA: I remember Walter Johnson, when I was little, I was maybe about five years old, he used to come to -- he came to Kwiguk for -- as a doctor at the time. And those doctors, you know, those older doctors and stuff, they were everything pretty much, dental, and they pull out teeth and stuff like that. And he was -- he pulled one of my tooth out. I remember. And just kind of like when I was in nursing school or I had -- yeah, I think I was in nursing school when I ran into him at the Alaska Native Medical Center, he was in the emergency room, and I think he was doing health aides, teaching health aides at the time. And he recognized me, you know. And I was, you know, an adult at the time. I was kind of surprised. He remembers a lot of people. I mean, you know, he's really -- he's got a good memory for faces and names. KAREN: Yeah. And I know that Axel and Pearlie were very important to him. MARTINA: Yeah. KAREN: He spent a lot of time up in Emmonak.
KAREN: When -- the community used to be -- I can't say the name. MARTINA: Kwiguk. KAREN: Kwiguk? MARTINA: There's two -- there's Kwiguk, which was mostly like a summer, you know, because it had a cannery. KAREN: Oh, okay. MARTINA: The Post Office was in Kwiguk. The AC store where Axel and Pearlie, you know, ran it was -- it was Northern Commercial at that time. Was in Kwiguk. And very few people lived there. And the school was in Emmonak. So, you know, people that wintered in Kwiguk used to have to come to Emmonak for school. And Kwiguk, you know, caved in. There's no more. It's all gone. You know. And you know, like from the current -- KAREN: From the river? The erosion? MARTINA: Yeah. River current. Yeah. Erosion. Yeah. KAREN: Wow. So that's why everybody moved to Emmonak? MARTINA: Uh-hum. Yeah. And so the Post Office was moved to Emmonak and stores were moved to Emmonak. KAREN: Do you remember about what year that might have been? MARTINA: I can't -- well, the BIA schools came in '58, '59. So it was around that time, I think. KAREN: So yeah, when you were a health aide, it was all Emmonak by that point? MARTINA: Yeah. Yeah. KAREN: Okay. MARTINA: There might have been one person living in Kwiguk. KAREN: So when you were a health aide, you'd always -- you were single and many of the women who were health aides, you know, they had kids that they were taking care of and all that. So I often ask about the support they got and how -- in balancing that. But with you being single, you still had the need for some family support, I'm sure. How did that work? MARTINA: Oh, it was -- I was living with my parents at the time. And I had six brothers that I -- under one roof. So it was pretty crowded. But you know, they supported me in a lot of ways. I didn't have to cook, I didn't have to bake bread, you know, like the other married health aides had to do, you know, when they were -- they had to go home, cook supper, bake bread. And you know, I didn't have to do that, so I -- my family support was pretty good. KAREN: And they were encouraging and supportive of you going on to nursing school? MARTINA: Not really. My, you know, parents didn't want me to leave, but I was an adult, so -- KAREN: Yeah. MARTINA: They supported me in going to high school, you know, high school and stuff, but they didn't really want me to go on further. I mean, in those days, you know, you stay home, get married, have kids, and that. KAREN: Yeah. What do you think inspired you to do what you did? MARTINA: Well, I guess I was determined that I was going to go further, you know. I wanted to -- that was my dream. And so when the time came, you know, I did it. I mean, applied for grants and got that and started, you know, going to nursing school. KAREN: Uh-hum. Can you think of anybody in your life as a mentor or particularly important teachers that have been important along the way? MARTINA: I guess there was a teacher, my 8th grade teacher, he kind of said that -- you know, told me that you know, you're smart. You can do it. And you know, I guess, you know, at the time he told me that, I was being kind of lazy, not doing what I needed to do in -- as an eighth grader. But I think that kind of said, well, he says you're smart, you know, you can do it. And you know, when I was in high school, I was, you know, pretty -- I was on the honor roll the whole time I was in high school. So that -- so he would be the, you know, person that, you know, kind of opened my eyes to what I could do. KAREN: Do you remember his name? MARTINA: Robert Henry. I think he -- he might be -- he died. Yeah. And he even wrote that when I went to high school, he wrote that in my -- I guess they have to send notes -- KAREN: Right. MARTINA: -- you know, to the high school and stuff, and he put that in his notes, she can do it. KAREN: Oh.
KAREN: What kind of advice would you have now for somebody who might want to be a health aide, a young person? MARTINA: A young person, go for it. And you know, if you want to go on, I mean, you should. I mean, I encourage everybody to go to college right -- you know, nowadays, because you know, if you're going to be in the village, you know, then I would encourage, you know, somebody that wants to be in the medical field to go into being a health aide because they are -- it's not as hard as -- or it's hard, still, but it's not like, you know, when I was a health aide, because you know, they have, you know, paid time off and you know, they have several health aides, you know, in the villages now. They just don't have, like, two people for people -- a village of 500. And they have the itinerant -- itinerant community health practitioners now, too. KAREN: What's that? MARTINA: They travel. KAREN: Oh. MARTINA: I mean, you know, like if they need a cover in the village, these itinerants will go to different villages. My aunt is one of those. And she does, you know, travelling, covering for people that need health aides in the village. KAREN: Oh. If somebody needs to go on vacation and their alternate is not available. MARTINA: Right. Then, you know, this person is, you know, called to go, you know, to that village. KAREN: Well, that's good. MARTINA: Uh-hum (affirmative). KAREN: And is she based out of Bethel? I mean, is it a Y -- what is it -- MARTINA: She can be based -- well, she was living here for a while, and, you know, she would fly from here. But Bethel would be the one to contact her to let her know that, you know, this village needs to be covered. You know. Can you -- or would you, you know, be able to cover for them. KAREN: That seems like that's a new -- fairly new idea. MARTINA: They've had this for a couple years or longer. KAREN: It seems like a really good idea. MARTINA: And they have several of them. I think a lot of them are probably based out of the villages, you know, from their villages, but they -- you know, Bethel is the office. I'm not sure who it would be in Bethel that would, you know, be their supervisor. KAREN: Right. But also it seems like a good way to be a health aide but get some relief from the pressures of the constant. MARTINA: Right. KAREN: Because you could go someplace and then you get a break and then you go someplace else. MARTINA: Uh-hum (affirmative). KAREN: Yeah. I don't know how you handle that 24 hours a day, 7 days a week schedule of the health aide in the old days. MARTINA: It was tiring. It was. I mean, you know, even if I wanted to go camping, I couldn't go camping. Because, you know, if I wanted to, you know, go for a boat ride, you know, or just to go a few miles, I mean, I had to make sure that the other health -- you know, the other health aide that was working with me, you know, would be available. And maybe she had plans, I don't know. I mean, so it was really hard. But I -- you know, I'm glad I experienced it. KAREN: Well, that's one of my other questions is how do you think being a health aide influenced your life? MARTINA: Taught me how to be patient. And you know, work hard at my job, you know, right now. And independence, you know, taught you independence. Making decisions. So, I mean, taught you a lot of things. KAREN: Yeah. Your making decisions made me think about you needed to trust yourself -- MARTINA: Uh-hum (affirmative). KAREN: -- to know what I see here and the symptoms and the diagnosis and what to do, that I'm -- I'm doing the right thing. MARTINA: Uh-hum (affirmative). KAREN: And it sounds kind of scary. MARTINA: Yeah, it is, but you know, I could have been wrong. And you know, I still was wrong, you know, sometimes, but at least you know the patient got taken care of. I mean, went to Bethel, and if they needed to go from Bethel to here, you know, Anchorage. And got taken care of.
KAREN: You had mentioned radio traffic and everybody could listen in. How did you -- how did you handle confidentiality? MARTINA: Confidentiality, nothing. It was zero. Because you know, I mean, everybody in the village or everywhere, surrounding villages and Bethel villages knew, you know, there was no confidentiality. Nothing. So that was pretty bad. I mean, you know, I think we did say, you know, we didn't -- in the beginning, I remember we used to have -- we did say names because the doctor had to put it in their medical records in Bethel. And I can't remember, I think at the end we did send in copies of the notes with the names on them, but you know, I think at the end, we -- they did say, you know, male or female or, you know, infant, child. But when I first started, I mean, you had to say the name because the doctor had to, you know, put it into their medical records in Bethel. KAREN: Yeah. MARTINA: I mean, name, birth date. Yeah. So there was no -- right now, you know, there -- they have telephones and so that's a lot better. KAREN: Yeah. So when you left in 1972, it was still radio traffic? MARTINA: It was still radio. KAREN: And did you have a radio yet in the clinic at that point or was it still the school? MARTINA: Huh-uh (negative). It was still the school. KAREN: And what about the other villages around Emmonak, did people from there come in to see you as the health aide? MARTINA: No. They had their own -- each village had their health aides. Alakanuk had their health aide, they had a couple of them. And Paula was one of them. KAREN: Right. MARTINA: And then Alma Hanson was the other in Elengak. And then Sheldon's Point had -- Julia Afkan was the health aide in Sheldon's Point, or Nunam Iqua. And Kotlik, you know, had a couple of health aides. So each, you know, like all the surrounding villages had their own health aides. KAREN: So there wasn't a need to contact each other. Could the two villages talk to each other by radio if you needed to? MARTINA: If we needed to. But it wasn't, you know, very much. KAREN: It was everybody talking to Bethel? MARTINA: Right. Everybody was. They had one doctor sitting in the -- doing radio traffic. I can't remember at that time, it was maybe ten o'clock maybe, started ten o'clock in the morning, and then I think they were done, depending on how many, you know, the health aide needed to report, you know, from the village. You know, there were -- and you had to give good descriptions over the radio in order for the doctor. See, that was another hard thing for the doctor in the -- in Bethel or anywhere was because you got this report from the health aide and giving him history, and so it wasn't easy for them also because they -- they weren't seeing the patient. And so diagnosis was, you know, also hard for them. KAREN: Yeah. Yeah. I was wondering, how did you learn how to know what to tell the doctor and how to describe it or -- MARTINA: Just what we know from the trainings. I mean, you know, they kind of taught you, you know, this is how you, you know, get histories, and you know, you needed to go from kind of like head to toe kind of thing. And that's a good thing to learn. And, you know, describe, you know, what you see. And what it sounds like. What it feels like. You know. Those sort of things that we have to -- and we learned that from trainings. So -- KAREN: Did you have a manual or a guide to follow at the time? MARTINA: I think so. It was a very thin, you know, guide. Now they have, you know, the last one that they have, they have two volumes of, you know, their health aide manual. And they are making a new one right now. KAREN: Right. Yeah, that's why I asked about it because I know now it's very, very important. MARTINA: Right. KAREN: And I didn't know if back in the early days how much of that kind of assistance a health aide had. MARTINA: Yeah. We learned, you know, for blood pressure and stuff, you know, we had a certain -- you know, like norms. And like pulse norms and that kind of stuff that we were taught. And that was another thing, you know, you asked earlier, you know, what we learned and stuff. KAREN: Right. MARTINA: And so those were the things that we, you know, looked at.
KAREN: When you were hired, did you start the job -- MARTINA: Before I -- KAREN: -- before the training? MARTINA: Before the training. And the health aides that were there are the ones that kind of showed me, you know, what to look for, what to report, and/or -- you know. So I was not trained for a good six months. KAREN: Wow. MARTINA: Yeah. And they were the ones that taught me how to give IM shots. And, you know, other stuff that I needed to learn. KAREN: And that wasn't scary or -- MARTINA: It was. I mean, you know, when I first started, it was kind of scary because you know, I was, like, didn't know, you know, anything from anything. And they would, you know, make sure that I did it right, you know, before they left me alone. And one day I was left alone all by myself and I had -- oh, my gosh, I guess I have to do it, because they both went out hunting, the guys, you know, did. So -- KAREN: Do you remember what that first patient that was that you did by yourself? MARTINA: It was a pediatric patient I had to give IM penicillin to. Yeah. But they had showed me, you know, like where I have to give it and that kind of stuff. KAREN: So it worked out all right? MARTINA: It worked out really great. It worked out well. Yeah. KAREN: That's good. MARTINA: Those little things, you know, you learn because, you know, like warming up the penicillin before you gave it because it's in the refrigerator, cold. And very, you know, thick. You know, if you've seen penicillin shots. IMs. KAREN: I probably had penicillin shot, but that -- I don't know that I remember the liquid. MARTINA: Yeah. KAREN: Because I was probably a child. MARTINA: Yeah, it's white and thick and, you know. KAREN: I was probably -- if I ever had it when I was -- when I was a child, then I don't remember. And then once -- you had mentioned, you know, meeting your husband and nursing school and then raising a family, so you were raising a family and working as a nurse here in Anchorage? MARTINA: Yes, I was. KAREN: And how many children did you have? MARTINA: I have three, they are all adults. Yeah. I was -- you know, my husband and I had to -- he was going to school at the time, I was, you know, working as a nurse. And we had our first child here. And decide to -- I work nights and he went to school during the day, so I'd go home in the morning, stay up with, you know, my baby, put her down for a nap, so I'd take a nap with her. And then my husband would be home, you know, early afternoon from his classes, so I'd go to sleep, get up, go to work. So it was pretty hard. KAREN: Yeah. MARTINA: And that went on for a couple of years. And then I had my second child, and I was working days at the time, so that worked out, you know, it worked out well. KAREN: Uh-hum. MARTINA: You know, take them to day care. And my third child, I was working days also. So it worked out well. You know. KAREN: So yeah, that the clinic and research jobs that you did allowed you more time to be with your family? MARTINA: Uh-hum (affirmative). Uh-hum. Yeah. KAREN: Yeah. MARTINA: And both my girls are graduated from college, and my oldest is a nurse also. KAREN: Oh. MARTINA: Yeah. KAREN: Great. MARTINA: She started off -- I mean, she got her biology degree first and then went into nursing. KAREN: Hmm. MARTINA: Working as a nurse now. KAREN: Here in Anchorage? MARTINA: No, in Minnesota. KAREN: Oh. MARTINA: Yeah. She's married to a guy from Minnesota, so she's, you know, living there. KAREN: You know, that's why -- you know, it's interesting to see, you know, when someone becomes a health aide, if -- if somebody before them in their family was a health aide, in some cases, you know, their mother was a health aide or midwife or something, and then how it carries through the generations, and how many of them, like you, where one of their children has gone on in the medical field. MARTINA: Uh-hum (affirmative). And you know, my great-great grandfather was a shaman. KAREN: Oh. So you had a family history. MARTINA: I had a family history of, you know, medical in my family. KAREN: Uh-hum. MARTINA: So -- And that's probably why I wanted to go into nursing so bad. Some medical field. KAREN: Yeah. MARTINA: So. KAREN: That influence there.
KAREN: The other thing, some health aides have talked about their faith as helping them through some of the difficult times. I don't know if that's something you would want to comment on. Okay. MARTINA: No. KAREN: Is there anything else that you could think of that I haven't talked about? MARTINA: I don't think so. I mean, I'm sure, you know, something will come up later. Uh-hum. Did I tell you this? KAREN: Well, one thing -- one other thing I can think of, because I think about some of the other interviews I've done and things that have -- subjects that have come up, and it varies from community to community, conditions in the village at the time in -- in terms of healthy living or -- MARTINA: Uh-hum (affirmative). KAREN: -- or things that were going on and how the health aide was impacted by that. And I've had some people talk about feeling the need to be a role model for having a healthy life-style and the pressures of that. I don't know if that's anything that you have experience with or want to talk about. MARTINA: Not really. KAREN: Okay. As I say, it varies from place to place. MARTINA: Yeah. KAREN: Time period to time period. MARTINA: Right. KAREN: That everybody's -- that's why we like talking to so many different people because everybody's had -- MARTINA: Different experiences. KAREN: Yeah. MARTINA: And different viewpoints. KAREN: Right. MARTINA: Yeah. KAREN: And different time periods and different villages -- MARTINA: Uh-hum (affirmative). KAREN: -- have gone through different phases -- MARTINA: Yeah. Uh-hum. KAREN: -- in their histories. And I don't know the history of Emmonak, so I don't know if it's something you want to talk about. MARTINA: History of Emmonak healthwise, it's pretty filthy. Because of honey buckets. We didn't have running water. We were one of the first ones to get, like, the vacuum -- KAREN: Oh, really. MARTINA: -- sewer system. KAREN: Oh. MARTINA: In Emmonak. KAREN: Cool. MARTINA: So -- but it was pretty dirty, I think. Because, you know, people just kind of dumped their wastes right outside their homes. Or you know, they -- they were taught, you know, to make -- you know, like dig holes and stuff like that. But you know, there was still a lot of people dumping right into the slough. And I think that was pretty -- that's probably why I did some, you know, Hepatitis A. And, you know, prevention, I think, would come to mind for me. You know, for my time period as being a health aide. KAREN: So did you, as a health aide, did you work on health education prevention kind of things? MARTINA: Not really, no. Huh-uh. KAREN: No. MARTINA: We didn't -- you know, I guess we weren't even -- we never even had a prevention at the time. I mean, you know, there may have been some, but you know. I was too busy taking care of, you know, the acute things, you know. Well, prevention was -- yeah, for immunization, you know, like for disease prevention I encouraged when I was out there. So I guess that would be -- you know, that's one of them. KAREN: Yeah. So you did do some of that? MARTINA: Yeah. Uh-hum. KAREN: Yeah. It sounds like. MARTINA: I liked to make sure that their kids got, you know, their immunizations. KAREN: You know. So does it seem like education -- health education and prevention has become more part of health care in Rural Alaska than it was years earlier? MARTINA: I think so. Because, you know, there's a lot of -- a lot more things, you know, out there that they put out in the villages. And even with their little, I guess they have the village TV, I'm not sure if -- I'm sure, you know, they have little announcements, you know, on their TVs -- KAREN: Right. MARTINA: -- that come out. And I think they have, you know, like prevention-type stuff. So -- And then they get, you know, a lot of pamphlets from everywhere. So -- KAREN: Have you seen whether that makes a difference, all that advertisement and flyers and things? MARTINA: I think so for the younger, you know, population, you know, preventing illnesses or -- and there's, you know, not -- Hepatitis B, you know, is kind of not there either anymore because of the vaccine, plus you know, learning how to make sure that, you know, wash their hands and that kind of stuff. So -- A lot of the diseases that used to be aren't, you know -- well, you know, some of the infectious diseases aren't there anymore. Thank goodness to vaccines. KAREN: Yeah. And now we have new ones instead. MARTINA: Right. KAREN: Well, that's all I have that -- we've pretty much covered a general overview there, unless there's some particular thing that comes to -- some memorable story that you haven't told me. MARTINA: I don't think so. I think I've told you pretty much. KAREN: So yeah, when you said I want to do this interview, we've covered what you thought you wanted to talk about? MARTINA: I think so. KAREN: Okay. Good. MARTINA: Yeah. KAREN: Yeah. I just -- MARTINA: I saw that and I said, well, you know, I'm an old health aide. You know, from that time period. You know. KAREN: What I didn't ask you, your birth date, how old you are. Did you tell me when you were born? MARTINA: Huh-uh (negative). KAREN: I can do some math, let's see, 1969, you were 20 -- MARTINA: 7/5/48 is my birthday. KAREN: Okay. I guess that means I don't have to do the math. We just like to know, you know, what generations of people we're talking to. MARTINA: Uh-hum (affirmative). Uh-hum. I was one of the youngest, you know, younger health aides when I was a health aide. And there must have been a couple of -- I think two of us that were about, you know, in that age group. The rest of them were older. KAREN: What was that like being one of the younger ones? MARTINA: I don't know. Maybe just a little more -- no. I don't know, I just -- I guess I didn't really think of -- think of that. KAREN: Okay. Well, I think we're done.