Dr. Michael Carroll, Transcript Section 3

Community Health Aide Program Project Jukebox

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KAREN: So once you entered the Indian Health Service and got the job in Tanana, did you receive any specialized training for working with the health aides? How did that work?

DR. CARROLL: I started the -- working in Tanana two weeks after I finished my internship. The only specialized training I received was a one-week indoctrination in Anchorage to the Indian Health Service kind of policies and procedures.

A brief one-day educational session on how to fit eyeglasses and do eye refractions, and the -- a very brief introduction to -- to dental issues and how to pull teeth. And that was the extent of the introduction.

KAREN: So as a doctor out there, you did everything?

DR. CARROLL: As a doctor, we didn't do everything. You know, we would medevac things that were particularly com -- difficult to deal with, potentially life-threatening, but over the course of several years, you know, delivering babies, treating pneumonias, treating fairly straightforward fractures, simple surgical things like skin grafting, minor burns, occasional appendectomy, things that family practitioners oftentimes will do.

KAREN: Uh-hum. And so what was the staff at the hospital, how many doctors, nurses?

DR. CARROLL: There was three doctors. The nursing staff probably consisted of, oh, I would say probably about 15 nurses. And then some nurses aids that were usually from the Village of Tanana.

And then a maintenance staff for that, we had one person who was a laboratory X-ray technician, and then we had a pharmacist who would send out medications to the villages and dispense what we needed in the hospital and all.

There were no physicians assistants, no nurse practitioners. There were several sanitation officers, one in Galena, and I think one in Fort Yukon.

And there was a small clinic that had a nurse, not a nurse practitioner, because that concept did not exist, a regular RN, in Fort Yukon. And then -- and that was, I think, about it.

KAREN: So what is a sanitation officer?

DR. CARROLL: Oh, the sanitation officers would -- they were kind of in charge to make sure the dogs were vaccinated. They were trying to deal with issues that they could as far as water and sewers. They would do some education in the villages as far as clean water.

Most of the villages were taking their water from the river and just using it without any sort of precautions at that time. And so they were trying to help with that.

As time evolved, some of the villages actually got some central facilities where they could wash clothes, take showers, and have access to clean water. And over the years, that's continued to change and improve.

But many of the villages did not have electricity, did not have, you know, wells, and as I said, would get their water just from taking it from the Koyukuk or the Yukon or the Porcupine.

KAREN: And then in terms of the medical care, what kind of equipment was available to you?

DR. CARROLL: At Tanana, there were approximately 20 to 25 beds. Some of those were beds that were really used just for people waiting for either travel back to their villages or to have a baby.

We had a large pediatric room that probably had 8 beds in it. We had a large male room that held, I think, five beds, and a female room there was the same size of that, even two private rooms for patients that were sicker and needed a little bit more privacy in their needs.

There was a labor and delivery area, and there was a small operating room. We had a pharmacy both for the inpatient and outpatient side, we had an X-ray machine, and a small laboratory.

KAREN: So you could do blood samples and things like that?

DR. CARROLL: Yeah. Well, we had, as I said, a laboratory tech that did both the X-rays and the blood samples.

Now, remember that this was in 1970, this is before CT scans and MRIs and nuclear medicine and ultrasound devices that we have now and take for granted. So you know, you just had kind of standard X-rays.

KAREN: And -- and it was probably limited surgery facilities?

DR. CARROLL: Yeah, pretty -- I mean, the actual operating room was a nice operating room. We didn't have any anesthesiologists, and so the anesthesia would usually have to be done by one of the physicians and the other physician may be doing the procedure. And anything very complicated would get sent out, either to Ft. Wainwright in Fairbanks or to Anchorage.

KAREN: And the Native Hospital in Anchorage already was in existence?

DR. CARROLL: The Native Hospital there had been there a number of years. I'm not quite sure when, but I think it was at least World War II vintage. It was an older hospital that was the major referral hospital for the entire Indian Health Service.

In 1970, there were Indian Health Service hospitals in Kanakanak, in Bethel, in Kotzebue, in Barrow, in Sitka, and I think that's probably it.

And then they had some smaller clinic facilities in some of the areas, and then they would contract for Native health care in places like Nome, which is -- at that time, had a significant non-Native population. And Kodiak and places like that.

KAREN: Kanakanak?

DR. CARROLL: Kanakanak, that's in --

KAREN: By Dillingham?

DR. CARROLL: -- Dillingham.

KAREN: Yeah. Okay. That's what I thought.