Miranda Petruska never imagined working in health care. At first, she had her sights set on art school, but wanted to raise her kids in her home village of Nikolai. When she moved back she said, there was really only one job available: A position as a community health aide at the Nikolai Health Clinic.

So, in 2008, she joined the network of more than 550 community health aides/practitioners working in about 170 communities around Alaska.

"Then I kind of got into it," Petruska said. "It ended up being something I really enjoyed doing."

The Community Health Aide Program, nearly 50 years old, is an innovative, uniquely Alaska solution to the various healthcare hurdles found across the Last Frontier. In rural communities around the state, health aides provide vital medical care in situations many doctors never face. It's a challenging, difficult job with life-changing rewards.

The Community Health Aide Program is a uniquely Alaskan program that helps solve various health care hurdles in rural communities. Photo courtesy of ANTHC.

"I love working in rural Alaska; I love working with villages," Petruska said. "It's so much more than just seeing people in the clinic. You really have to be a role model for your community."

To become a community health aide, students must undergo four sessions, each lasting several weeks, at one of four training centers around the state. In between sessions, students return to their home communities and practice their newfound skills. Completing the entire program generally takes around two years, instructors say. There's also a backlog: With too few instructors to handle the demand for new health aides, students must often wait to secure a spot in training.

Some people come to Alaska specifically to enroll in the Community Health Aide Program, instructors say, but the vast majority of students are lifelong Alaskans. Some hope to follow in the footsteps of older relatives or other community members. For some, the program is a way to give back to the community in which they were raised.

After growing up in Tyonek, Chrystal Moon returned more than a decade ago to take a job at the Indian Creek Health Clinic.

"I wanted to move back for my kids to experience their culture," Moon said. "I didn't know what to expect. My excitement was, 'Where else in the world are you going to be able to go out and see and treat patients without 10 years of college?' I don't think anybody could really prepare for it."

She'd always been interested in the medical field; even trained as a CNA. The CHAP training gave her the additional skills necessary to run the village clinic, and in her years of experience, she's developed the first-hand knowledge needed to handle any emergency thrown her way.

In village clinics around the state, health aides face everything from splinters and stab wounds to cases of strep throat. One day, they might see the aftermath of a snowmachine or hunting accident,  the next, it might be a family suffering from the flu. Some days, there might be no patients. Other days, there could be eight or nine.

Completing the Community Health Aide Program takes about two years. Students receive extensive training from diagnosing strep throat to providing wound care. Photo courtesy of ANTHC.

"I enjoy it: I enjoy seeing and treating and trying to help and make things better," Moon said. "We're all related, and this is all my family."

It's like that across Alaska. In many places, health aides share family ties with multiple people in the community. That can bring some major benefits: Health aides already understand the local lifestyle. Patients trust them. But those close relationships can be emotionally exhausting; like when health aides are summoned to respond to a relative's medical emergency.

"When I lived at home, definitely the most challenging part of being a health aide was working with people that you have close personal relationships with," Petruska said.

Some health aides can't handle the pressure: The program has a significant turnover rate, according to instructors and administrators. But some health aides thrive. Over 12 years on the job, Moon has learned how to handle the strain.

"When I get a call, I just do what I gotta do," Moon said. "All my feelings will come later. I try not to focus on who it is, I just try to do my job."

Calls can come in at any time of the day or night, and many health aides are on call 24/7. But for many communities, they're the last line of defense against potentially life-threatening medical emergencies.

And that's what makes health aides' work so important.

"This is something that I can handle, and who else is going to do it?" said Moon, who now works alongside another aide at the Indian Creek Health Clinic. "Who else is going to be here?"

Plus, like Petruska, she enjoys the job.  After working in Nikolai, then McGrath, last year Petruska began working as an itinerant health aide, traveling to communities throughout the North Slope Borough to provide health care when there is nobody else available. Once planning on art school, she's currently enrolled in a rural development program through the University of Alaska Fairbanks, focusing on community health and wellness. It's all worth it, she said.

"Villages need the help," Petruska said. "Even though it can be frustrating and customers can be difficult, they deserve to have health care."

This article was produced by the special content department of Alaska Dispatch News in collaboration with ANTHC. Contact the editor, Jamie Gonzales, at jgonzales@alaskadispatch.com. The ADN newsroom was not involved in its production.