The class examines the medevac team’s incubator, used for emergency births in the village.

Article by Chester Mark, Senior Basic Training Instructor

Bethel, Alaska – March, 2014 — A class of 10 Community Health Aides recently completed their Session 3 training in Bethel. Community Health Aides provide a large range of health care services. They give immunizations, perform Well Child and WIC exams, respond to emergencies and care for all sick and injured patients in the village. Health Aides stabilize trauma patients and begin life-saving treatment, such as giving intravenous fluids and performing CPR. They prepare patients for transport to Bethel or Anchorage by the medevac team when necessary.

The Session 3 students shared some of their experiences and the rewards and challenges of being a Health Aide. Mae Heatherington of Lower Kalskag says, “I enjoy working with people to improve their health and wellbeing. We are an important stepping stone for the patient to get better health care and advocate for their needs.” Mary Petluska-Alexie, a Health Aide in Eek for almost two years, states, “I really like seeing patients and doing things like drawing blood and starting IVs.” When asked what is most rewarding about her work, Mary replies, “helping patients get better and helping them in any way possible, even after hours.”

YKHC is one of three Alaska-wide centers for training Community Health Aides. The Health Aides come to the Bethel or a Training Center in Anchorage or Nome for Sessions 1, 2, 3 or 4. Session 3 (S3) training focuses on specialized topics, such as pre-natal care, labor and delivery, male and female reproductive problems, and well child care. S3 students are required to spend one night in the hospital’s Labor and Delivery unit to learn how to take care of women and babies before and after delivery. If a delivery in the hospital takes place, they participate in the birth and help care for the mother and the newborn. This experience helps prepare them for a possible emergency delivery in the village.

Although Health Aides have delivered babies in villages, this situation is less than ideal. If a baby or mother has medical problems during or after delivery, the Health Aide and the clinic may not be equipped or trained to deal with such emergencies. Mae continues, “One time I had a woman early in her pregnancy that was having lots of contractions. I watched her vital signs and contractions closely. My RMT provider told me to give her terbutaline (to slow or stop the contractions). I gave her two shots already but she was still contracting. I was praying and praying, and hoping that she would not go into labor (or have a miscarriage). I was really scared. Finally, after the third dose, the contractions stopped. I was so relieved!”

Besides caring for prenatal patients, other emergencies are also stressful. Jamie Jenkins of Napakiak recalls working alone and getting a call about a very ill patient. “He went into shock and almost collapsed on the exam table. It was scary! I had to start an IV. There was a lot of pressure on me, and I had to make sure I was not going to miss the IV.” Giving intravenous fluids is one of many important life-saving skills that Health Aides learn and do. They review IV skills and other emergency trauma skills in each and every session.

Most health aides have the desire to help people in their villages, but the job can be stressful for these dedicated individuals and their families. Carmen Murat of Aniak says, “One time I had a diabetic patient who had a blood sugar of 28 (normal is 70 and above). There was no PA in the clinic. I was able to give her a shot and save her life! I like helping others and having a positive impact on someone’s life,” but at the same time, “my job takes up my free time with family and friends, especially when I am on-call for emergencies.”

Jessica Lee says, “I love working here at the Aniak SRC. I love helping people, sick or not. The most scary part is the emergency on-call phone. My heart jumps when it rings because we never know what kind of emergency it can be. After losing my brother, I didn’t think I would come back and work in the health field. But I did and I’m a Session III Health Aide now! I want to continue my career to become a CHP.”

Post-Traumatic Stress

Another Health Aide in the class recounts how she responded one night to a call and found a young woman unconscious with blue lips, a sign that she was not breathing. She began CPR after the patient would not wake up or respond. When the patient coughed, she turned the patient onto her side to remove secretions from her mouth. She also tried the AED, an electrical device that monitors the patient’s heart and shocks it when needed.

After an hour and a half of trying to revive the patient, the physician on the speaker phone told the Health Aide to stop CPR. But the Health Aide couldn’t stop. Her adrenaline was running full speed, and she continued CPR. Finally, she stopped when the physician told her the patient was not going to make it.

The Health Aide had done CPR and tried several life-saving measures for almost two hours! She was exhausted. “I couldn’t sleep for three days after that. I still have flashbacks, even now (several months later). Some nights I wake up, scared, remembering the CPR, and I can’t go back to sleep for hours. It makes me afraid to do CPR again.” During CPR review in training, the Health Aide was again having flashbacks, but she continued with the practice. “I had Critical Incident Stress Debriefing (CISD) and other counseling. They referred me to Behavioral Health also. The flashbacks are getting get less with time,” she says.

Post-traumatic Stress Disorder (PTSD) is a common experience of Health Aides. It affects the Health Aide and their loved ones. Another Health Aide said that she was getting very impatient and angry with her own family, losing sleep, and crying easily for no reason before she realized how much the PTSD was affecting her. Fortunately, the Community Health Aide Program has a full-time staff person available for Critical Incident Stress Debriefing, support, and counseling. The Behavioral Health department also assists Health Aides with recovering from PTSD.

Besides the emergencies, Health Aides see patients every day during regular clinic hours. Patients call each morning to fill in the appointment book with problems such as coughs, rashes, sprains, strains and a variety of infections. As the appointments fill up, Health Aides are already working and getting the clinic ready for the day, performing narcotic checks and quality assurance on lab supplies, checking for expired drugs, ordering supplies, and following up on patients from the previous day.

Some Health Aides may see six to seven patients a day in a busy clinic. This makes for a long day because all Health Aides are required to follow a manual that requires them to ask several detailed questions and perform a thorough physical exam. “The quality of the history and exam of a Health Aide far exceeds the standard for physicians,” says Al Shear, one of the staff’s Training Instructors. “The Health Aides are the eyes and ears for their RMT providers so they have to do a very thorough work. They are also the voice for their patients. This helps their RMT provider make the best possible choices in caring for the patient.”

 Standing Orders

Many get Standing Orders, which gives experienced Health Aides the ability to treat illnesses without reporting to a physician, physician assistant or nurse practitioner, a process known as RMT, or Radio Medical Traffic. Recently, the training center awarded Standing Orders to all 10 Session 3 Health Aides. The orders allow them to treat 75 common conditions or ailments, such as strep throat, viral illness, minor skin rashes, strains and sprains. They were extremely happy about getting their Standing Orders because it speeds up their patient care and gives them more autonomy.

The class recently had the chance to honor one of their own as Health Aide of the Month. Joe Okitkun of Kotlik celebrated this honor with his classmates, instructors and Supervising Instructors (SI). He was nominated back in October 2013 but bad weather forced the cancellation of a celebration in his village then. Anna Tinker, the SI for Kotlik, says Joe is being awarded because he “was giving immunizations at the clinic, even while he was on PTO. He works tirelessly at his clinic, and offers to float out to other villages.” Tinker added, “he is a very responsible health care provider, he communicates frequently with his supervisor, and he never complains.”

Along with Joe Okitkun are two previously-selected Health Aides of the Month in this Session 3 class. Adeline Wiseman of Chefornak and Lena Stewart of Upper Kalskag were previously selected as Health Aides of the Month. Village Operations, the YKHC department that oversees all the village clinics, created the Health Aide of the Month program to recognize Health Aides for saving lives, working under difficult circumstances, providing outstanding care, or promoting healthy living by doing well child exams and immunizations.

Any YKHC staff person working with Health Aides can make a nomination for Health Aide of the Month. The nominations are forwarded to the Health Aide’s SI. The SIs review the nominations each month and select a Health Aide of the Month. One year all 12 Health Aides of the Month were invited to the annual Tribal Gathering in Bethel, and were publicly recognized by the board for their hard work and commitment.

Health Aides are the unsung heroes of the Delta. They collectively see almost 100,000 patients a year. “If it weren’t for the Community Health Aide Program, the hospital system would be overwhelmed and patients in the villages would not be well cared for. Thank goodness for all the Health Aides—they are dedicated health providers who do outstanding work. We always remind patients, medical providers, and the community to make certain they show appreciation to their Health Aides,” says Al Shear, one of the Basic Training Instructors.