LINDA:  From that offshoot developed a course in human anatomy, physiology, and medical language.  And put together a textbook for that.
 
KAREN:  Yeah, it makes sense that if you have something explained, the meaning, you're going to remember it better than just memorizing a list. 

LINDA:  Right.  And you can understand it. 

And you know, really what you should do is look at any medical word from the end of the word.  Not the beginning.  For example, itis.  If you see I-T-I-S on the end of a word, you know it's an inflammation process of the some part of the body.  You may not know that, you know, it's -- arthro is joint, you don't know which joint but you know it's a joint somewhere, so arthritis.  It just unlocks the word for you. 

Ectomy, E-C-T-O-M-Y, on the end of any word means to cut out.  Appendectomy.  Tonsillectomy.  Mastectomy.  It's -- once you get that.  You know. 

So it was -- it's -- again, it's just ownership.  It's understanding and ownership and feeling like, oh, I -- I got it.  It's not so difficult, it's not so foreign. 

And then developing -- as I said, one of my hats in Bethel was to help look at nursing and bringing nursing to Bethel.  And so we worked closely as a team of us at the hospital, Marianne Schaeffer and myself, along with the earlier years looking at working with a program out of Utah, and then finally with the UAA School of Nursing, we were able to bring the LPN, the licensed practical nursing program, to Bethel.  And then next the RN program.  And that has been just very rewarding. 

My -- my belief is that, you know, we have to stop this rotation of Lower 48 folks to the state, especially rural communities, and so we need locally trained individuals and just as health aides, certainly nursing and physicians and lab techs and so forth. 

And then with that, develop, expanded the medical terminology to look at anatomy and physiology and medical language as an integrated approach. 

Because, for example, while you're learning the liver and what the liver does, if you learn that the word root for that is hepato, all of a sudden you can unlock hepatitis and hepatomegaly and you can just look at the word and go, oh, it's the liver.  It doesn't -- it has no meaning other than to be a word that means liver. 

So that -- that has been an element over the last few years has been nursing the medical, trying to interest people in health careers and medical careers. 

KAREN:  Have you guys been successful? 

LINDA:  Yes.  And we've really worked at the high school and did a -- several years did courses there with college credit, which were very rewarding. 

And I actually would love to be doing that again, but my life took a -- a detour two years ago when I moved here into Anchorage to work on the Community Health Aide Practitioner Manual full time. 

And I have just to sort of back up a minute.  The program itself, as I've mentioned, is the health corporations who employ the health aides, within each health corporation there is an administrative team leader whether it's called a CHAP Director, Community Health Aide Program Director, Village Health Services, they have different titles, but they are basically the administrative team for the Health Aide Program. 

That group is the -- comes together and it's the Community Health Aide Program Directors Association, and Steve Gage, and serves as the current chairperson of that group.  And that group has some standing subcommittees under that. 

One is the academic and review committee, which is responsible for curriculum and training activities, whether that be training center or a field based.  A review -- it's called RAC, Review and Approval Committee of the training centers that actually -- again, we have a unique program, so we have to hand grow our own things.  Just like you have accreditation of medical schools, we have a committee that's a very, very tight organization to approve the training programs. 

And then the third standing committee of the CHAP Directors is the Community Health Aide Practitioner Manual; and at the time, Village Medicine Reference, which has been a complementary book of the program. 

That committee was formed in the year 2000 and charged with first just looking at where we were at in terms of materials. 

We did a survey to look at the -- I mentioned the 1987 book was published, and in 1998 a new edition was put out.  And the '98 edition went through a very different process than the earlier CHAM.  And the 2000, when the committee was formed through the CHAP Directors, the charge was to look at the 1998 CHAM and whether it was meeting the needs of the health aides. 

And so a survey was done of health aides, trainers, field and physicians, and through the survey, we identified a number of concerns and problem areas and things that needed to be improved upon.  And so the committee started into that. 

And we hired part-time writers, and over the last three and a half, almost four years, we have been revising, and actually, it's become, instead of a vision, a new edition of the Community Health Aide Manual. 

We have tried to return it to the approach and simplicity of the White manual, the '87 manual, but also expand and provide a simpler and more comprehensive approach to using the CHAM. 

And an example of that is in the old books, when you entered into it, it really only identified the role of the health aide in an emergency or acute care.  And those are the only two entry points you had into the book.  But as I mentioned earlier, the practice of being a health aide is much broader than that. 

KAREN:  Yeah. 

LINDA:  And so they really need an entry point into the book that allows them to triage a patient almost from the beginning.  So the current entry point to the book is emergency, they get turfed right off. 

If there's a sick child younger than 8, those are the -- and 8 was cutoff because of CPR standards, but we're really looking at the infant, 2 and under, 3 and under, and what you're concerned about is those very sick children that can go bad so quickly. 

KAREN:  Right. 

LINDA:  And you -- again, distance, you want to be treating them right away. 

When you see patients in acute care, you often need to see them for recheck, to see if they are improving, the eardrum, et cetera, do a new lab test for someone who had, say, a urinary tract infection.  And so we've created a re-check visit that allows you to turf right to that area, which is a much shorter history and focused visit.
 
The other is that maybe the person's returning from staying in the hospital, or going into a regional clinic.  And you actually weren't the last person to see them.  And you need to follow-up on it, but how do you do that and where do you begin. 

And then the two other areas we've talked about is chronic care visits and preventative.  And so those are actually listed and direct pages.  So you don't have to -- just as I mentioned the health aide in Atmauthluak years ago, what brought you to clinic today.  It really should help you to take the right road, then, to get to the care that the patient needs.