SPONSORED: Even when they’re hundreds of miles from the nearest hospital, rural Alaskans are served by a complex health care delivery system, and the Community Health Aide Program stands on the front lines.

If you’ve spent any significant amount of time in rural Alaska, you know the important role played by community health aides. On any given day, community health aides handle a wide range of medical issues and concerns, from treating common illnesses to assessing emergencies. They use telemedicine for additional assistance and diagnoses, and when necessary, they refer patients to regional hubs or cities for higher levels of care.

“Your care is as close to home as possible,” said Alaska Native Tribal Health Consortium CEO Roald Helgesen, describing the philosophy behind the health aide program.

Since it was established by presidential authorization in 1968, the Community Health Aide Program has developed and grown into a long-term solution for village care provided by local people who offer medical services in their own communities. What started out as a volunteer program that often operated out of private homes and school classrooms is now a professional position that comes with culturally relevant medical training, certification, and dedicated clinic space. The successful program, which receives statewide service and support from ANTHC, has since spun off into new disciplines and begun to inspire similar programs Outside.

Local care, better dental health

In the 2000s, after more than 30 years of success with medical health aides (sometimes abbreviated as CHAPs) in rural communities, Tribal health care leaders and providers started to wonder: Why not expand to dental care?

“CHAPs do have a little bit of training to do some dental work, so it wasn’t such a stretch to think we could add health aids that specialized in dentistry,” said Dr. Mary Williard, director of ANTHC’s Department of Oral Health Promotion. And so in 2005 the Alaska Dental Therapy Educational Program for Dental Health Aide Therapists (DHATs for short) was born.

Today, Willard said, there are about three dozen certified DHATs practicing in mostly remote communities. They provide care to 81 villages and more than 50,000 Alaska Native people. ANTHC partners with Iḷisaġvik College to offer a two-year training program.

The outcome has been measurable, said Williard, who cited a 2017 study of the program’s impact on oral health in the Yukon-Kuskokwim Delta.

“The paper demonstrated the villages in the region with the most DHAT days of coverage had fewer abstractions than (those with) no coverage, with more prevention services,” she said. Researchers found a reduction in the number of kids referred to surgery under general anesthesia for their early childhood cavities in communities with DHATs.

Like CHAPs, dental health aides tend to stand as role models in their communities. Williard shared a story of kids who were playing alongside a road in Emmonak. One child was peering into another’s mouth. When asked what they were doing, they said, “We’re playing ‘Bonnie’” -- that is, Emmonak Dental Health Aide Therapist Bonnie Johnson.

“That is powerful when they come back home and work in the field,” Williard said.

Meeting behavioral health needs close to home

Behavioral health, such as depression and substance abuse, has long been an area of concern for Alaskans, especially in rural communities where access to mental health services is limited. It’s a need that since 2009 has been filled in some communities by another CHAP spin-off: the Behavioral Health Aide Program.

Behavioral health aides provide support, information and links to resources for members of their communities who experience problems related to mental health and substance use. They often respond to community behavioral health concerns by hosting prevention activities and participating in or organizing local events like Choose Respect walks, but they also help people who are in crisis. Care provided by BHAs can range from supporting someone who’s grieving a breakup or the loss of a loved one to working with clients who have co-occurring disorders, like substance abuse and mental health problems.

“BHAs know their communities and their community members; they know when someone is not doing well,” said Dr. Xiomara Owens, ANTHC’s director of behavioral health aide training. “By recognizing them sooner, BHAs can do an early intervention screening and see if they need additional help.”

All of the health aide roles are challenging -- ANTHC now offers a Healthy Healers course to help improve providers’ own wellness and resilience -- but the behavioral health job can be particularly tough. It can be a challenge to get people in the door, because there is a lot of stigma related to behavioral health, and in small rural communities, BHAs likely grew up with the individuals and families they’re trying to help. Burnout happens. But often, behavioral health aides are motivated by their personal experience, according to Owens.

“Some are in recovery themselves from substance abuse or mental health concerns,” she said. “They want to give back by helping others.”

‘I love being a good example for my children’

In recent years, Tribes from around the United States have begun looking to Alaska’s community health aide programs to see how culturally relevant care is delivered to remote and rural communities. In 2016, the Indian Health Service consulted with the National Indian Health Board to study the Community Health Aide Program, including the dental and behavioral health sections, and last year IHS formed an advisory group to work on expanding the program to the Lower 48.

“It's become infectious,” Helgesen said. “It's really exciting.”

Ask any CHAP, DHAT or BHA and they’ll tell you it’s not an easy job. They’re often working with their own families and friends, which can be a challenge. On any given day, at least one health aide is on call overnight. They need strong support systems for themselves and their families -- like having childcare at a moment’s notice.

But despite -- or maybe because of -- the challenges, many health aides have found their calling through the program. Amanda Oldman is one of them.

“I had a strong will in my heart to become a health aide after I turned 18,” said Oldman, an itinerant health aide from Hughes. “I applied for the position soon after I graduated high school.”

Oldman was inspired by her late grandmother, Sophie Beatus. She was a community health aide, too.

“The benefits of helping people is a good feeling,” Oldman said. “I love being a good example for my children.”

This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization working to meet the physical, behavioral, and environmental health needs of more than 175,000 Alaska Native and American Indian people living in Alaska so that they can fulfill the vision of being the healthiest people in the world.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.