Dr. Michael Carroll, Transcript Section 12

Community Health Aide Program Project Jukebox

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KAREN: One of my questions we talked about before we had the tape recorder going, so I wanted to talk a little bit about it on tape, which has to do with the issues of confidentiality.

DR. CARROLL: Uh-hum (affirmative).

KAREN: And I know that's very important in modern health care. I don't know how that was handled in the '70s when you were out in Tanana.

DR. CARROLL: Well, I'm not sure the question of confidentiality was ever raised in regards to health care traffic. I mean, we -- we tried to be concerned, you know, when we were dealing with a patient and the record keeping of that patient, that it was kept confidential.

You have to realize that if you're talking on a single-sideband radio and you've got 22 village health aides listening, waiting for their turn, that they are all hearing the same story.

Now, what we did as far as health traffic, yeah, we generally did not have any names. So the health aide would report I have an 8-year-old boy with a temperature of 102 and he has a earache on the left side. And so we would treat without the names almost always, and if at all possible.

I'm sure sometimes names would come up, and I'm sure sometimes other health aides would recognize, well, gee, I think I know who that family is. Or that person.

But -- and I think that sometimes the patients in the villages were a little bit concerned about the health aides and how much information happened to get disbursed from that standpoint.

And I would occasionally get people that would come into the clinic who would want to come in to talk about private issues that they didn't want to talk to their health aide about, but that was oftentimes because the health aide may have been a cousin or an uncle or a sister or, you know, a relative of some sort.

And they had health issues that they really did want to keep quiet, whether it was related to spouses and kids, and whatever might have occurred.

KAREN: Yeah. I was wondering -- yeah, I was wondering how that worked in the village, yeah, the health aide who is from the community and often related to many people in the community.

DR. CARROLL: And it sometimes would be an issue. And if it was a big enough issue, then we would see that person would maybe just decide to come in on their own, pay their way into Tanana and see us in the clinic, other than go to the health aide and say that they had VD or, you know, some sort of sexually transmitted -- transmissible disease.

Or, you know, maybe was worried that, you know, there was, you know, a mental illness that might -- that they didn't want to share. You know.

And -- but, you know, the health aide still dealt with an awful lot of that. And there was lots of, you know, sexually transmitted diseases that were treated in the villages over the radio, again, you know, without the names going on.

KAREN: Right.

DR. CARROLL: And I suspect without it ever being reported to the Public Health authorities.

KAREN: Right. Well, also you said in the clinics where you just have a sheet in the room?

DR. CARROLL: Uh-hum (affirmative).

KAREN: That's not very private.

DR. CARROLL: There's no -- there's no verbal privacy in some of the community centers when we would be doing it.

You know, we would have a potbellied stove over here, some benches at the back corner, and then some sheets up there with a Coleman lantern, and you know, a sheet's not goinna be very private. You felt you gave them about as much privacy as you could, and that's having -- by letting them put on a paper gown and be behind a sheet.

But, you know, the verbal ones, you know, we will oftentimes, for things like when we were doing the pap smears, we would try to set that at a certain time in the morning. You could usually get the women to come in if they knew that they had that time. And -- and do that. And they knew that there were only going to be women in the clinic then.

KAREN: Right.

DR. CARROLL: And so that was one way to handle that. Usually, you know, there would be a more general clinic that would be in the evenings.

You know, I'd always save the dental clinic and the eye clinic for the very last because those were oftentimes the most popular. People would want me to pull teeth or give them a new set of eyeglasses and so they would come in for that more than they might for other things.

KAREN: Okay.