KAREN:  You were going to talk a little bit about the pilot programs that started after the ‘68 --

WALTER:  Yes.  The pilot programs were successful, and it would only be limited, you know, via could be drawn from such brief experiences, but the essential point is that funds were made available and people were willing to put their shoulder to the wheel to get the program going. 

KAREN:  So those pilot programs were before ‘68, they were in ‘64, right? 

WALTER:  They were from ‘60 -- they were in ‘60 -- they began in ‘64 to ‘68. 

KAREN:  Okay. 

WALTER:  After 1968, there were three, as I recall, there were three training programs set up.  One at Nome, one at Bethel, and one at Anchorage. 
And there must have been -- no, I think that Southeast, at the beginning, were sending their health aides up to Anchorage.  So I think there were three then to begin with.  And these were administered, of course, at that time, by the Indian Health Service that had responsibility for the total program. 

About that time, under Lyndon Johnson's economic opportunity program, so-called OEO, Office of Economic Opportunity, there were -- there was another agency set up to push this community involvement, and a number of people with considerable funds were assigned to Alaska. 

Among other things, they set up a training program in Bethel to bring people in and train them for seven months because they thought it was very bad to have people come in for two weeks. 

Well, actually, the program, as it was set up, consisted of coming in at least three times, two weeks, two weeks, and three weeks, I think.  And admittedly, this was fairly brief. 

But those young fireballs, they didn't realize that it was really not possible for these folks who were chosen to be sent in were almost all married women with a lot of home responsibilities.  And it was just not feasible for them to just leave for seven months. 

Some people did, and I think that Paula Ayunerak at Alakanuk was one of these early trainees, a very capable person.  And I don't know what her experience was with in regard to the seven months, but she did continue as a health aide for many years. 

And her story is mentioned in this little book that Philip Nice wrote, the Alaska Health Aide Program:  A Tradition of Helping Ourselves, which was published in the 1890s -- I mean 19 -- 1990s. 

Anyway, these programs that were set up continued, and as mentioned before, there were 185 positions allotted across the -- which is now a state, no longer a territory, and in 157 villages. 

Now, to put this in perspective, we can look ahead and see that today, apparently, there are approximately 500 community health aide, slash, practitioners in 178 villages with a budget just under 20 million.  So we could -- well, let's mention a few other points regarding the training. 
The candidates for training were -- were selected by the village, and the people who did the training were largely physician assistants, a category of workers that are just newly come into the medical hierarchy, and nurse practitioners.  And of course, physicians, along with the nutritionists and other ancillary health workers. 

One of the challenges, of course, is to get real clinical bedside experience.  And again, I happen to, by chance or design, to be in a unique position there associated with the large training program in Anchorage. 

I was still based in the hospital as the medical director, also, quote, clinical director, so that I was able to be involved in the health aide training. 
And it was possible for me to go on to the wards and encounter patients that had interesting physical findings, many of them whom I -- patients whom I knew or their families, and -- and then to take the health aides who were new arrivals from the village into the hospital in starched white coats with stethoscopes dangling from their pockets onto the wards. 

And assume physician roles, just to interview and actually observe the physical findings, the lung sounds, the palpable organs, and all that sort of thing.  And I think that was a key part to -- of the training so that they could learn how to communicate better with the physician. 

At the same time, a manual was being written by of all people, a pharmacist, Joe Whitaker. 

In 1976, I moved over to the health aide program full time from being clinical director to being medical director of the health aide program and was full time in teaching. 

Joe Whitaker and I shared an office, and so as he was writing the manual, he could -- we could converse back and forth.  And he produced a very usable book, which seemed to serve quite well for a number of years to get started that.