Interview by SHARON BUSHELL
(Published: March 6, 2004)
After completing an internship in Spokane, Washington, I went to work as a general practitioner in Bethel from 1954 to 1956. Dr. Harriet Jackson, a highly motivated, well-trained colleague, had arrived several months earlier. For the first time, the vast Yukon-Kuskokwim Delta, with 12,000 people, had two doctors.
Tuberculosis and all kinds of infectious diseases were rampant. The hospital beds were usually full -- over 50 people at times -- and there were lots of patients coming to the outpatient clinic. We also spent time on the radio talking to Bureau of Indian Affairs teachers and others in the 40 villages. The nurses did a lot of care usually done by doctors, like handling uncomplicated nighttime deliveries.
On New Year's Eve, 1955, Dr. Jackson and I were doing an emergency Caesarian section on a young woman from the Yukon. Dr. Morton, the dentist, was giving drip ether anesthesia, and all was going well until a blast came from within the operating-room wall. A pipe had burst, and the steam blast quickly cut its way through the wall, fortunately not directly at us. Forrest Jones, the engineer, quickly shut it off. There is now a 49-year-old Alaskan whose arrival was announced by a jet of steam.
We soon found time to start making medical trips to some of the villages. I made a couple of visits to Kwiguk (now Emmonak) in the spring of 1955 and again in 1956. On such trips we usually stayed with the BIA teachers, but Kwiguk didn't have the usual teachers' quarters. The only school was a small building the villagers had put up using logs pulled out of the Yukon.
They had persuaded the BIA to send them a teacher, Betty Guy from Kwethluk. Axel and Pearlie Johnson, both native to the area, were running a small branch of the Northern Commercial Company. Pretty much on their own, with some help from the itinerant public health nurses, they were delivering the babies and giving some other medical care. They collected money to send to Fairbanks for sulfa pills to treat infections. I stayed with them, and we held clinic in the store.
After several days of sorting out medical problems, I set aside one afternoon to do eye refractions, especially on the kids, so they could see the blackboard. Many villagers had large and painful tooth cavities. With only one dentist -- and that one far away in Bethel -- there was no realistic hope of their getting dental care, so I told them to come back such-and-such a night for extractions.
After dinner on that night, we came back to the store. The place was jammed. We set up milk crates of various heights for seats. Luckily, I'd brought lots of Novocain. My dental assistants, young village women, changed needles and loaded syringes while I anesthetized half a dozen patients at a time. While the second group waited, the first group had their teeth pulled. All were taken care of by 3 the next morning.
Then I did something that perhaps few doctors would do. I stayed in Kwiguk an extra day so we could have a dance. That evening, we all packed into the tiny log schoolroom. There was room for only two or three people to dance at one time. Axel explained to me why they all laughed so much at some of the dances. Someone would perform a dance -- inventing as they went -- to ridicule some person who had previously insulted or hurt their feelings. Everyone would laugh, and the incident would soon be forgotten.
I was inspired by the medical work that Pearlie and Axel were doing in the village with only minimal radio contact with the doctor at Bethel and infrequent visits by a public health nurse. In March of 1956, I wrote a proposal for training local village residents as "health aides" and sent it to Dr. Hinson, the director of Alaska Native Services. He agreed with the idea but pointed out that many medical professionals would not and that it would probably take several years.
Eight years passed before anything was done. Finally, pilot studies were conducted in which volunteer health aides from various villages were brought in for several weeks of study (with) Dr. Tom Harrison at Kotzebue, Dr. Jay Keefer at Bethel, Dr. Gloria Park at Anchorage and Dr. Jim Justice at Mt. Edgecumbe. The Community Health Aide Program was funded by Congress in 1968.
Today there are over 500 community health aides serving in 178 villages across Alaska. Many villages now have modern clinic buildings equipped with telecommunications technology and use telemedicine to transmit pictures and information directly to the consulting physician.
In the spring of 2002, 40 years after my last contact with Emmonak, I received a call from Pearlie's son, Jake, inviting me to come to the dedication of the new clinic in her honor. In her many years of service, she had accomplished, among other things, the successful delivery of 69 babies. I stayed again with Pearlie for a week of visiting and dancing. Now the dance was held in the huge high school gym, and music was provided by young villagers playing electric instruments.
While I was in Bethel in 1956, the medical care for Alaska Natives was transferred from the BIA to the U.S. Public Health Service. I joined the regular corps of that service to go Outside for specialty training.
One interesting assignment was doing the medical survey in Somalia and Ethiopia in 1962, before the Peace Corps arrived there. I traveled through the backcountry with a local driver, checking the primitive health services left by the British and Italians and assessing health risks.
I returned to Alaska in 1964 to the 11-year-old Alaska Native Medical Center. The battle against tuberculosis was in full swing, and it became my passion as, over the next few years, the tide of battle turned. I had seen a woman step off the plane in Wiseman in August '44. Pale and weak, she had asked to be released from the Tanana Hospital so she could die at home. Effective drugs and treatments were still a few years away. Today a large birch tree grows on her grave in Wiseman.
Coming down with TB a few years later, her husband recovered with drugs and surgery, became an artist, a hospital employee and retired in Anuktuvuk. That's an example of two cases and the big change in tuberculosis treatment methods.
In the 1950s and 1960s, the Alaskan TB death rate dropped more than the New England rate had in 150 years. In 1968, Dr. Martha Wilson arranged an event at the medical center celebrating the first year since hospital beds were set aside for TB patients that no children were hospitalized with the disease anywhere in Alaska and there were no TB deaths. The complete story of TB in Alaska will be told in a book by Dr. Robert Fortuine, which will hopefully be published soon.
I was asked by the U.S. Public Health Service to be co-director, with Dr. Azouz, of a TB project in Tunisia, North Africa. Using the polar flights available in the 1970s, it was possible for us to exchange brief visits. Drugs to fight TB had been available in Tunisia for some time but had not controlled the disease as drug resistance was increasing.
With Dr. Azouz's enthusiasm, we designed a program where we trained villagers -- in this case young men, since Tunisia is an Islamic country -- to identify active cases and send specimens to the central lab to be tested for drug resistance. Within several years, TB incidence dropped dramatically and hospital beds emptied.
All my life I have been interested in bicycling. In the 1960s, a group of us in Anchorage, including my wife, Susan, Lanie Fleischer, Ron Crenshaw and John Reeves, among others, became interested in having more adequate biking trails. In '71 and '72 we obtained a permit from the city to hold a spring Bike Day parade. The first year, borough Mayor John Asplund joined us; the second year, (city) Mayor George Sullivan rode along. With police escort, we spread out and were able to stop traffic in downtown Anchorage for over an hour. Within a few years, city bike trails began to take shape.
In 1980, I retired from the USPHS and spent the next seven years with the Community Health Aide Program at the University of Alaska.
The way I see health care today, until individuals and communities take more responsibility for their own health, no increase in the amount of money given to the insurance and drug companies will make us healthier.
Our family bought a homestead in Homer in 1966 and spent summers fishing in Neptune Bay and picking raspberries. Since 1993, Homer has been my primary home along with a small place in Anchorage.
Wherever I've lived, I've planted gardens and trees. Although starting an orchard in one's 80s may seem a bit optimistic, my friend and I canned 36 quarts of applesauce last fall. Perhaps we will need a cider press next year.
Looking back over the past 80 years, I have no complaints and few regrets. The past is gone, and the future never really arrives. The only place we ever live is in the moment. And for me, those moments are rightly placed.
Sharon Bushell lives and writes in Homer. Her books, "We Alaskans" and "We Alaskans II," feature her stories about Alaska pioneers that have appeared in the Daily News. For more information, visit her Web site at www.wealaskans.com.
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