KAREN:  You had mentioned before that, you know, you had confidence in the local people and their skills, and you believed in them and their abilities to do this type of work and, you know, were out there promoting the creation of the rural health care system.  What kind of opposition and support did you get for that position? 

WALTER:  Well, interestingly enough, we -- the health aide program, to my knowledge, never experienced any serious opposition from the organized medical community.  There was some feeling of being threatened among the Public Health nurses at the beginning, but this was not widespread. 

And I'll have -- I want to recognize one person, particularly, the deputy director of the Public Health Service in Alaska, Airlie Bruce, who has retired and moved Outside, was always very supportive, as were most of the Public Health nurses.  The Alaska Medical Association were -- never voiced formal opposition.  One of the reasons may have been that a number of us worked very closely with the local practitioners, including the -- the more influential ones, the Alaska Native Medical Center in Alaska had a number of consultants that almost all of the major fields from the community who came in weekly and saw patients with us who were always on call to consult and give advice. 

And for myself, I had lived in Alaska before I went out to medical school, I lived in the village, and I think had some credibility.  And I was involved in developing a library, not just for the Public Health doctors, but for all Alaska under grant.  And so I think we reacted with the -- with the medical community on a -- on a one-to-one basis by that.  There were a number of physicians who were opposed to government medicine on principle, and there were several who were quite vocal in criticizing the -- the -- especially the Alaska Native Health Service under the BIA, and later the Indian Health Service, more -- more on principle of -- political principle of being opposed to government bureaucracy in general. 

But I will not open too far the question of the dental aides, which currently is in the -- on the radar screen and apparently has -- has received a lot of opposition.  Not -- not only from the Alaska Dental Association, but from the national organization of dentists to the use of dental aides. 

When you look at that, I think one of the -- some of the reasons might be that the things that the health aide would -- were doing were a little bit different in the medical field.  They were reporting on the -- the findings, doing a history and physical, which is normally a doctor's work, and actually administering medicines, but never without this connection.  They either looked at the manual or they talked to the doctor, and if there was anything very involved, it always -- the doctor was involved specifically in that case. 

With a dental assistant, if you're going to have somebody out there examining a patient without the benefit of X-ray, with -- and filling a cavity without the benefit of initial X-ray, I don't know whether they would have that capacity as it's designed.  And extracting teeth, the dentist isn't there and he's not really involved, so what you have is somebody who is attempting to do the dentist's work, who is, in fact, unlicensed and limited in training.  And, you know, it does work in some parts of the world, and it would have limitations, but it -- and it seems to touch a hot button that is not true with the medical practitioners.