Dr. Michael Carroll, Transcript Section 7

Community Health Aide Program Project Jukebox

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KAREN: How does it work, how are you able to diagnose and treat something when you can't see the patient?

DR. CARROLL: Well, you have to rely on the eyes and ears of the health aide. And the information they give you. So some health aides were very experienced, and some health aides were not very experienced.

The most experienced ones have been doing it for many years before the system existed. The ones with less experience may have been younger or people that had just come into the whole program as the village needs developed.

Some health aides had maybe 6 to 12 weeks. There was a three-part program, and I think that it consisted of several weeks, and then they would come back at a later date and get some additional training, and then by the time they had finished the third part, in 1970, they had had some training in Anchorage in a more formal structure.

But as I recall, I think the most anyone would have gotten would be between 6 and 12 weeks of -- of training. And oftentimes they were doing it with only part one of the training, which might have been a couple weeks.

KAREN: Did you feel like --

DR. CARROLL: Some never.

KAREN: Yeah. Did you feel like they got enough training to be able to communicate to you what you needed to be able to make a diagnosis?

DR. CARROLL: You always, in medicine, work with what you get. And you certainly were -- we're not going to deny trying to treat somebody, you know, based on the fact that the health aide may not have had much training or the fact that they had no training at all.

Oftentimes, if there was a question, maybe the health aide had hadn't taken the temperature or you wanted -- the temperature they had taken was last night or the morning, you'd have them go back and redo it. And most of the villages are small enough, they could run over and do it, and before you finished radio traffic, they would call back with more.

Sometimes some of the humorous things would happen as all the health aides were listening to this radio traffic at the time is while you were talking to one person and then they -- maybe one of the other people would -- would come in and say, well, we've got this same problem here with everybody with strep throats.

Or, you know, you know, you know, I think they were up -- they were here when I got sick, you know, with the potlatch or something. So it was very open, this discussion.

And it was part of the education because they were -- the really interested health aides were listening to what we were telling other health aides and trying to come up with, you know -- you know, ways to approach problems.

When you only have a handful of medications to work with, it's sometimes a little bit easier because you're not trying to sort through a formulary of a thousand drugs, you know, you only have a handful, so most infections either got treated with sulfa or penicillin.

And, you know, there was an awful lot of strep throats and an awful lot of ear infections that I'm not sure were strep throats or ear infections, but you know, they got treated along those lines.

Some health aides seemed to make the same diagnosis all the time, whereas others seemed to have the ability to come up with good assessments and plans.

The really best health aides were those that had lots of experience and they would be able to tell you whether the person was sick or not sick. And that was always the most important thing. Because if somebody was sick, you needed to bring them in on a medevac. Or if they weren't quite so sick, you'd maybe have them come in on the next mail plane. And so you had to have a reliable person.

And some of them, I can remember, would say, Dr. Carroll, I don't know what's wrong with this patient, but they look awfully sick and they need to come see the doctor. And so you'd bring them in without a diagnosis, but just on the assessment that there was something wrong, that they needed to -- you know, more assistance in dealing with.

A lot of things, the day-to-day things got taken care of really quite well by the health aides, and considering, you know, their -- their limited training, I thought they did a great job. You know, saved, you know, I think lots of lives and lots of suffering.