KAREN:  So how do you train them if you don't get up and stand up in front of the room and lecture?  Give me an example.
 
LINDA:  Yeah.  Well, I'll -- yeah.  I guess we just get to talk about history. 
When I first came to the program, the students had about 80 percent to 90 percent of the time was in the classroom with about maybe 10 percent seeing patients.
 
And what I observed was these were individuals with second language trying to listen to a lecture and take notes in a second language.  Well, those of us in one language, we know that when we try to read our notes back and study from them, that that's very difficult.  So I started to look at what it was that they were writing and how that might help them. 

What I found as a teacher is that I really believed that their job is the hardest, if not -- it's just an incredible job that these folks do.  You know.  24 hours a day, 7 days a week, providing health care to family members and community members with all of the plusses and minuses that that creates in dynamics in relationships. 

But the most important thing is that the health aide, when they come to training, has to have an environment and an opportunity to learn the information and to feel good about being able to go home and do it.  They need to feel comfortable, competent, empowered, whatever the words you want to use for that. 

And often in the early years, I met individuals who had sixth, eighth grade education, and not always a positive educational experience. 

Where education for many of us has sort of been almost thought competitive.  If you have your arm up first, you then own the answer to that question.  If you, you know, get good grades, or if you -- you know, it's -- it's -- and I don't believe that. 

To me, learning is -- and it's very Yup'ik in the values that I have found over time that are there is that it's -- it should be cooperative, it should really -- it's not about one individual being better than anyone else.  It's really about everyone doing well, because these 6 to 8 to 12 individuals that are in the class, each of them are going home to give quality health care to the village folks. 

And so a number of things that I started in the early years is the training at that time, it was 70 percent to pass or fail a session, and I was concerned about that because that meant that, you know, you wouldn't want a pilot with an A in takeoff and a D in landing.  You know.  You want people to have really competent skills. 

So I believe watching and observing the students that if we, as instructors, could be very clear with very measurable, not only content but skills that we were looking for, the clearer we could be, that there was no question in my mind that these individuals could learn it. 

And so it didn't get -- it wasn't a graded affair, it became pass-fail, but we raised the point of deciding if someone could move on to 80 percent. 
And then it didn't mean an individual failed if they didn't get 80 percent, it meant remediation.  It meant, okay, what -- and it wasn't 80 percent averaged, it was 80 percent on written and clinical skills separately.  So that if someone wasn't able to master a skill, is, let's analyze that.  What piece are they missing. 

So, for example, if someone's taking blood pressure and they are not giving you the same value as you're hearing, you have a double-headed stethoscope and you're listening at the same time, if someone has two different values, why is it? 

Is it because -- and it could be a variety of things.  It can be that they have a hearing loss themselves and maybe it's never been detected until now.  Maybe it's they need glasses and they can't read the dial and you need to.  So it's not about the person, whether they tried.
 
One element is on a blood pressure dial, the numbers read up, but the pointer comes down.  And so it reads 60, 80, 100, 120, 140.  So as the needle comes down and it's between 100 and 120, well, that line is actually 110.  But you've just seen 120 so the health aide was reading the next line down as 130. 

KAREN:  Right. 

LINDA:  Okay.  And so it was just a measure of taking more time to understand the dial. 

That analysis of what piece is missing, no assumption, no assumption that -- that they are -- I know one health aide had come from an educational process where if she was slower, she was called stupid.  You know.  And there's no such thing.  It simply means that as the instructor, it's our job to figure out what is the piece missing.  And not to move forward.