Metcalfe, Peter, Gumboot Determination: the Story of the South East Regional Health Consortium. Softbound. 234 pages. Over 120 photographs. SEARHC Foundation. $20.00.

Providing health care to Alaska Natives has a long history, winding back down a road often obscured with dust. For many years there was almost nothing provided, then the U.S. government decided in the late 1940s to end the disgrace across the country and the Indian Health Service was ordered to increase medical care, including adding the physicians from the Public Health Service. In Alaska, the Mount Edgecumbe hospital was built in 1948 to house tuberculosis patients, the only one in the territory. The disease had been raging across Alaska since before the turn of the century, destroying whole families and villages, but there were few health workers and scanty medicines available.

Some of the clinical trials on the first effective medicines were done at the 340-bed facility, and by 1963 the census was down to around 120 patients, mostly long-term care. By the 1980s there were even fewer and the question of the future of the hospital became asked more frequently. This is when SEARHC, (South East Alaska Regional Health Consortium) became active.

This book tells the story of how the Tlingit group gradually took charge, not only of their own medical facilities, but of their own health. Today SEARHC, in addition to Mount Edgecume Hospital, has clinics throughout Southeast Alaska, many of them serving non-Natives as well. While there were and are many hard workers, the real star of these actions is Ethel Lund, a woman whose diplomatic skills could pacify the Middle East by next week.

Metcalfe has done a sterling job in most cases; interviewing numerous participants and trying his best to get both sides in conflicts such as the Ketchikan clinic withdrawal. The lay-out is excellent and the photographs fascinating. Using an oblong format enables short biographies to be set on the page with the narrative. The cover photograph of the sea pounding at an area of reefs underlines the title; the little chiton that clings determinedly to rocks no matter how the seas wash over it.

As in any account of often contentious growth, there are some omissions and playing down of some arguments. There are some issues still unresolved, primarily treating non-Natives who have insurance but live in communities with a general hospital. From their viewpoint, this threatens the existence of the hospital, particularly in Sitka. As SEARHC sees it, they need all sources of income and health insurance plays a big part.

All proceeds from sale of the book go to the SEARHC Foundation, a non-profit group that provides crutches and medications to the needy. So whether you’re prepared to praise or blame, buy several copies and help the foundation.

D. L.