KAREN:  Where you talked about how the health aides were selected by their village, but what about the doctors?  Were all the doctors required to work with health aides or were you volunteered or chosen or what? 

WALTER:  Well, we're aware that people have come all over the world to look at the health -- the Alaska health aide system.  And we realize that as -- that there's a problem, especially in the developing world and in the urban centers, of people getting direct physician care.  And some of us believe that if they -- you know, four of the six billion people in the world are going to get very much medical care, the primary part of that's going to be through somebody that's like the barefoot doctor or the health aide. 

But there's been -- well, the system does exist, and of course, in China, it's been quite successful.  And -- and it's been tried in Mexico.  There was one who wrote a book about where there is no doctor.  But -- and I did some work and involved in projects in Africa, in Tunisia, where we used auxiliary workers in connection with the tuberculosis control.  But my observations has been that the physicians in general in the world are not accustomed to interacting with a health aide.  The reason it worked in Alaska is sort of fortuitous, I think, because physicians chose to come and work or they were assigned as they entered the PHS, either to -- in lieu of military service a number of years ago, or by choice now, they were -- they found themselves working in a -- again, in a position where the role was quite clearly defined. 

If you were assigned to Bethel, you -- you -- back in the radio days, you -- you did the radio call, which means that you sat down for an hour or so and you talked on the radio and went by every village, whether they had traffic or not, and interacted.  And so the role was there and they fell into it and were willing to do it.  And then after they did it awhile and made field trips and became acquainted with the health aides, they learned from experience which ones they could rely on more comfortably than others and -- and you had a physician that was -- was interacting with a health aide because he found himself in that role. 

I don't know of any medical schools that -- where this is a part of their, you know, formal medical training.  So I -- that's why it apparently worked in Alaska. 

KAREN:  Well, yeah, I was wondering, too, as if, you know, not -- as you say, not everybody would have the skill set or the desire to work under those conditions.  So were all the doctors required, or it was I fell into this and I like it, I'm going to keep doing this, versus I fell into this, I'm uncomfortable, I'm going to stop? 

WALTER:  No.  It was -- it was required.  And actually, it would result in their leaving a position, I guess, if -- if it were not fulfilled. 

I might mention here a little book that Philip Nice wrote and published in -- actually, it was copywrited as recent as 1998.  Philip Nice was associate -- was a pathologist professor at -- at the University of New England.  He came up to Alaska toward his retirement to volunteer first, and then later worked in Bethel and later than that in the Washington, Alaska, Montana medical school program associated with the University of Washington. 

But he developed a real interest in the health aides.  So he wrote this book entitled the health -- the Alaska Health Aide Program:  A Tradition of Helping Ourselves.  I loaned him a good bit of material and worked with him on that.  And the book covers the period from the '68 to the roughly '90, 1968 to 1990.  And of course, the time is not -- since then hasn't been covered.  There is some good little vignettes in here by the health aides themselves about their role. 

Now, I have a -- I did a chronology, which I gave to Phil, in about -- the date I have on it here is in 1992, which involves my recollection and a review of the health aide files up until that time, which I will -- would like to share with people.  Now, it had been my hope that it would have been published directly in this manual, but Phil had cancer toward the end and was ill and he moved Outside and our -- our contact was -- was not very good. 

A lot of the little -- some of these things are mentioned in the single column, highlight columns on the left, but it -- it's intermixed with other things there. 
So I -- I'm going to give Karen Brewster a copy of this chronology of the Community Health Aide Program.  Actually, it says, from 1820 to 1991, but it's essentially all from -- from 50 -- from the 1950s to 1990s. 

Now, there are other people, and there are a number of documents and reports that have come out, like The Health Aide in Crisis that was published by the academic review committee, and some -- the CHAP directors a number of years ago that gives an excellent summary.  And Linda Curda came to Anchorage -- was at Bethel working in the health aide program, but originally at the hospital, I think, as a midwife, she came to an academic review committee for the first time in 1980 or '81 and has been in the middle of the program since and still is. 

So she probably has the great evidence repository of papers and I think memory of the program in the last 20 years.