Audrey Booth transcript

Karen Thomas: Today is September 19, 1977. My name is Karen Thomas with the southern oral history program and I’m interviewing Mrs. Audrey Booth, former dean of the school of nursing at UNC Chapel Hill and also in charge of the AHEC program for the school of nursing. Mrs. Booth when and where were you born?


Audrey Booth: I was born in Nebraska in 1924 and I lived in a rural area on a farm for my first 16 years I guess.


Karen Thomas: Did those experiences growing up in a rural community make you want to get involved in rural reform later on?


Audrey Booth: Probably not. I probably didn’t look at it that way. What it probably did for me was to create enough confidence because of the things that I learned to do at a very early age. My father really thought we ought to be quite independent and taught us lots of things about being independent and taking responsibility because of the way we lived and the country, we were all contributing and I think that probably had a great deal to do with it. I have an appreciation for the rural situation and I must say, I didn’t feel particularly isolated at that time, but I didn’t know anything else. So when you say how do you feel when you go into the—you know, sort of the hinder lands of North Carolina, not very different.


Karen Thomas: Right.


Audrey Booth: Yeah.


Karen Thomas: How did you become interested in nursing as a profession?


Audrey Booth: Well, my family lived on this farm and this was during the time of the great depression and unfortunately the great drought and the great dust bowl and all of those things happened in the Midwest in the late twenties and early thirties and by about 1940, my family decided that they couldn’t send my brother and me to college is we stayed there in that non-productive farm situation. So, my father found another tact to take on his own career. He became—went into agribusiness. He already knew the business of farming but providing seeds and all that kind of thing.


Audrey Booth: So, we moved to a small town that had a college in it, so that he knew that we could be afforded the education if we wanted it, and when I went to college it was during World War II and it was on the trimester system and I just zipped through in three years, and so here I was at twenty--did I want to teach school? No, no I didn’t, and there were other things that were sort of trying to facilitate the war effort and we had officer training at this little—pre-officer training at this little college and we got a little caught up in that and I decided well I had majored in English, but I minored in science.


Audrey Booth: We had a very good faculty counselor who knew of excellent nursing and medical programs and she referred and influenced a lot of us to go into medicine and nursing and I went to Case Western Reserve in Cleveland, which is one of the two schools at that time that had graduate basic education. In other words, in nursing you go to school and get your degree, your undergraduate degree, then you go and get your nursing degree. But, you’re farther along in terms of your sciences and everything. So, I did that and that afforded me a very racing start because there weren’t many people who had Master’s degrees at that time.


Karen Thomas: Sure.


Audrey Booth: And after, well let’s see you don’t need my whole curriculum vita here. I did go back to Nebraska from there and there was a terrible—the polio epidemics were so bad at that time. Throughout the time of my education in Cleveland, I had more experience in it than I should have. I went back to Omaha and there was a raging polio epidemic going on there and I meant to just stay a few weeks of vacation and go back to Cleveland and continue to work there and I went to go work in a children’s hospital to make a long story short and I stayed there three years. It was filled with polio patients, but because of my advanced degree I was overestimated as to my ability.


Audrey Booth: I was still twenty-three years old and got promoted kind of fast, so I was looking for another kind of adventure that I suppose that most people at twenty-three, especially when they feel overburdened in the situation they are in look for, and I went to Hawaii and worked there for three years, which is excellent from all aspects, and at that point I was realizing that the educational degree that I had—the Masters degree was a basic Masters and nobody appreciated that and I was beginning to feel kind of guilty about it like I needed to go back to graduate school and get the more conventional educational preparation that goes along with that.


Audrey Booth: So, I knew that there was to be a graduate program here. There weren’t very many graduate programs; in fact there were very few graduate programs in nursing at that time especially in the south, and the southern regional education board was trying to promote schools in the south. This school of nursing which was—first students came here in 1950 I guess and graduated in 54 I think—5 maybe, 5, was the first baccalaureate program in North Carolina, and I knew that they planned also to start a graduate program. So, I was very interested in pediatrics and there was a position here at the university, what we now call the university hospitals, which is North Carolina Memorial, and I secured a position as pediatric nursing supervisor. In fact, this interview is a bit reminiscent of one that I did for a book that I’ll show you when we finish, that the department of pediatrics put out about history.


Karen Thomas: Yes.


Audrey Booth: Perhaps you’ve seen that


Karen Thomas: Yes, I just interviewed Floyd Denny yesterday so…

Audrey Booth: Yeah, well I spent a lot of time with Floyd Denny and others in thinking about that particular book. So, I took that job and established my residency in North Carolina, thinking I’d stay here long enough to go to school and fulfill whatever requirements for the scholarship that I got from the southern region education board and then I would go elsewhere. Go back to Honolulu probably


Karen Thomas: Mhmm.


Audrey Booth: because I was having offers from there. But, I liked it here so much, its just such a great state and I’m thinking how recreationally, the way I was thinking then. The mountains and the beach and there were just so many things that were wonderful to do that were never very—were never a part of my life in the Midwest that I was quite enthralled with it. So, I didn’t leave.


Karen Thomas: Was it much of an adjustment culturally to come here?


Audrey Booth: Well, I had made a rather big adjustment. Well, first of all, I had made a big adjustment going from the country to the city of Cleveland; dirty, cold, and huge. Then I made a big adjustment going to Hawaii, a multiracial, wonderful place, which I was definitely in a minority of Caucasians of course at that time, unfortunately, and I think its been changed since. At that time there might have been 20% of people in the hospital I worked in that were Caucasian, but we were all the leaders—well, named leaders and most of the others then were the Japanese, Chinese, and so fourth.


Karen Thomas: Right.


Audrey Booth: So, you know, I was kind of used to cultural changes.


Karen Thomas: Right.


Audrey Booth: And I don’t know that I had a big problem with adjustment here. I was very interested in it and I continue to be very interested in southern riders, which we have a great group of right here in Durham.


Karen Thomas: Mhmm.


Audrey Booth: So, maybe I’ve just gotten so—lived here 42 years now that I don’t look back on it. I do remember a visit that my parents made and my father commented on how my speech had changed.


Karen Thomas: Mhmm.


Audrey Booth: That was only after two years. But people who live here and who are native North Carolinians, which of course there aren’t too many in this town, don’t feel that my speech is very typical of the south.


Karen Thomas: Having come to UNC in the mid fifties can you say when community medicine started to be a focus at UNC in the health programs here?


Audrey Booth: Mhmm. Oh, well, I don’t remember community medicine being very much of a focus until Doctor Smith came. There may have been other—well yes, there were others; T. Frank Williams and yes there were that group very much so and that must of been in the sixties. The Smith I was speaking about was probably late sixties, but he had predecessors.


Karen Thomas: Right, but at that point, when you first came to UNC he nursing program didn’t send people out into the communities…


Audrey Booth: Oh yes, oh no, they definitely did.


Karen Thomas: Okay.


Audrey Booth: I was going to say, almost as much as they do now.


Karen Thomas: So, I get the feeling that public health and nursing had a lot more foundation in these kinds of programs before AHEC…


Audrey Booth: Well, when you talk about community medicine I was assuming you were talking about medicine physicians…


Karen Thomas: Right


Audrey Booth: And, you know, I don’t think they were doing it very much.


Karen Thomas: Right.


Audrey Booth:  To the best of my knowledge, but yes, nursing of course this was a very small hospital and most of the experience—clinical experience of nurses—most of it was in hospitals. Now it’s in many, many settings in the community, but this hospital was not big enough. This was a big class, big university, wasn’t big enough to provide all of the experience that our students needed just in terms of numbers.


Karen Thomas: Mhmm.


Audrey Booth: Particularly for public health—community health and we sent students to other counties for that. We sent students to Smithville for experience in a small rural hospital. They probably went to areas in Durham. Later, when I was associate dean in the school of nursing, part of my job in addition to my AHEC job was student contracts for placement of students for their various undergraduate and graduate experiences. So, I’m much more aware of it after I came back to the school in 1973. I haven’t told you where I went before that but--


Karen Thomas: Right

Audrey Booth: After 73 I’m much more aware of clinical placements around, but I do remember in the early years that this was such a small hospital that—with a class of 40 or 50 that it wasn’t enough space for them.


Karen Thomas: Right. Before the interview, you had mentioned being involved in the regional medical program--


Audrey Booth: Mhhm.


Karen Thomas: Can you maybe talk about some of the programs that you were involved in that might be seen as predecessors?


Audrey Booth: Oh, sure. Well, he had placed me as pediatric supervisor here and then I went into other middle management of other areas in the hospital. Through that time, I had a clinical appointment in the school of nursing, as did many of us who were the first middle management line in the hospital and in about 1968 the North Carolina Regional Medical Program began to hire staff and they were hiring—well, their programs more to the point than the staff. Their programs were of course focused on heart, cancer, and stroke those three great killers at that time and president Lyndon Johnson I believe was a heart patient and I cant remember who all of the others were, but it was influenced by the very personal experiences of our major leadership in the country at that time, and those were largely continuing education programs and I think I would say that nursing in general was much more likely because they were employees and not self employed to be sent or become participants in continuing education than were the practicing physicians less likely to go.


Audrey Booth: We began to plan educational programs. I can think particularly cardiac. That was the time that the intensive care units were just getting going to begin to do some team planning if you’re going to have—teach all members of the team to do whatever it is that is going to diminish the morbidity and cardiac disease. We had a cancer registry, one of the first that was started. There were lots of multidisciplinary programs in rehabilitation of the stroke patient for physical therapists, for nurses, and physicians, and there probably were others that I’m not recalling. These were not university based. They were project based. Projects could be written describing some educational program that they wanted to have done and of course they probably—we wanted to politically we wanted to spread them across the state. Politically, we want to involve the medical schools but there was just Duke, UNC, and Wake Forest at that time. So, the stroke program was in Wake Forest and probably cardiac was at Duke. I don’t remember. Things were dished around a little bit.


Audrey Booth: It began to be very concerned about quantity and quality of health care workers and this was at the time that the nurse practitioner program concept was emerging as well as the physicians assistant program over at Duke. I had been in the state nurses association so that I was pretty well known around the state, I’d been the president of the North Carolina league for nursing at that time. So, nursing leadership promoted me I guess I would say. They wanted a nurse in the position in RMP that would really be sure that nurses were given the proper attention, and the projects that they had, representation in the planning and so fourth, and I became that person and of course one of the things that I’m very aware of is that we had our own newsletters, PR promotion and everything, which made me better known in the state in that instance.


Audrey Booth: One of the things that physicians and some physicians and some nurses in the state really wanted was to further the concept of nurse practitioner or advanced practice for nurses and it was just barely being talked about. We, here at Carolina, and I say we now because I was associated with it before and I had an appointment on the school of nursing faculty. All of us did in RMP. We had a foot in some—one of the universities. One of the three, we could choose and it was a practical thing that our employee personnel practices came through that employment. If I’d been at Duke I’d been on their plan and so on. So, I continued to be here and folks here in both medicine and nursing were very eager, the dean of the school, Dr. Lucy Connant, to start a nursing practitioner program in the school of nursing here, as was Glen Wilson who—I mean Glen Pickard, Larry Kitchen, who was the AHEC director down at Tarboro and was until not long ago and others. We began—and there was a physician at Duke who was very interested in this from the standpoint of nursing and his name is escaping me at the moment.


Karen Thomas: Was it (inaudible)


Audrey Booth: No, he was a physician’s assistant there. This was his pediatrician. Anyway, we began to develop through committee a curriculum for teaching public health nurses or other nurses concepts having to do with physical assessment, particularly children. Again, to afford this kind of care in rural areas where people weren’t particularly educated prepared to do it. We did a curriculum, it was kind of a short course, and it wasn’t to be at the graduate level. Oh dear God no, we got to do a quick course, more of a continuing education course and of course begin to develop that, got a lot of acceptance because of the people that were brought into it--


Karen Thomas: Right.


Audrey Booth: By being involved in its preparation. Then we began to take it further than just that pediatric group and in order to do this we needed to of course have some legal sanctioning because this was considered practice of medicine. So, I think I’m saying that there were a number of skills taught if I could just back up a minute and generalize. There are a number of skills that came out that were far beyond the physical presence capability of physicians. In cardiac care units, if the physician is the only one that can put in a catheter or the only one that can punch a vein, or the only one that can (inaudible) equipment, we aren’t going to be able to take care of very many of them. So, came the cardiac care nurse, coronary care nurse.

Audrey Booth: So, a lot of advanced techniques were being put forward. Now, this was okay with everybody although this did not make great reasonable sense. As long as in the hospital, never mind the doctor wasn’t in the hospital, as long as in the hospital it seemed ok, but when you begin to do it other places far separated from the imaginary supervision of that physician then people began to worry about it. So, we had to begin thinking about, well, what kind of legal sanctioning, how will we change the practice act so this will be ok. At federal levels, I think they were realizing at this time that this was sort of a short range band aid to do things project by project and I think the thing was also that the major medical schools weren’t in on this. They weren’t the dispenser of the funds. They weren’t the center of it. They could put in for a project, but they might not get their project funded anymore than some hospital over here that didn’t have the resources and other things to make it come to pass.


Audrey Booth: So, I wasn’t in on all these. I lived it, but I wasn’t so aware of the policy discussions that were probably taking place in Washington relating to it, but the medical schools were really going to change the legislation so that that funding would come to medical schools rather than the project based.


Karen Thomas: Right.


Audrey Booth: So you see, I had to have five years of experience doing essentially the kind of things that AHEC does.


Karen Thomas: Right.


Audrey Booth: It was the four runner.


Karen Thomas: Right.


Audrey Booth: And since my base was here at this university when we became aware that—knowing it was going to come here and nursing would have their person, I came back and became that person.


Karen Thomas: it sounds like AHEC addressed some organizational needs that had been kind of absent in the regional medical program.


Audrey Booth: Well, the organizational needs were that the medical schools weren’t the center of the AHEC, of the regional medical program.


Karen Thomas: Right.


Audrey Booth: They had representatives. The deans were all on all the committees and all but the money didn’t flow to them. The money flowed to this board.


Karen Thomas: Right.


Audrey Booth: Yeah, I would definitely organizational entities.


Karen Thomas: I’ve read many places that in the late sixties many health professional organizations and of course later the Carnegie report sensed that there was a crisis in health manpower and you kind of eluded to that a little bit earlier. Why do you think it was at that point in time that this great concern arose over the quality and quantity with health manpower?


Audrey Booth: Well, you probably being engaged in this activity know about the—whatever that study was of the health of the people of the state of North Carolina who failed the draft exams and great…


Karen Thomas: Are you talking about the Poe commission?


Audrey Booth: I don’t remember the name of the—it was in the forties. It was probably post World War II.


Karen Thomas: Yes.


Audrey Booth: And at that time we know we didn’t—that’s why we have a bacheloret in nursing here. That was one of the first steps. I think at that point we realized—maybe we didn’t know we had the shortage of health manpower. That we learned how bad the health of our people was and as we began to address it they prepared people out there to do that.


Karen Thomas: So, it really went back as far as World War II then.


Audrey Booth: Well, I would say so. Just after World War II if you think that—or whatever year this medical school got going. That was after World War II.


Karen Thomas: Oh sure.


Audrey Booth: And the nursing school and pharmacy was here because it was an early pharmacy school. Dental was around that time possibly we digress.


Karen Thomas: Well, it seems though that some people even during the late forties and fifties said that—well, we don’t really need more doctors and some even said that as we improve technology that we will actually need fewer people in hospitals.


Audrey Booth: Yeah, but then they never went any pace east of Raleigh.


Karen Thomas: Right (laughs). Okay, I guess.


Audrey Booth: I mean they were not family practice oriented.


Karen Thomas: I guess what I’m saying is that there had been concerns for a long time. I certainly agree, but it seems that things really came to a head in the late sixties and I’m trying to figure out why was it that point in time that things started happening,


Audrey Booth: Well, for one of the things the technology of the coronary care units. Oh you know, as I say, I haven’t thought much about this in ten years, so I may not think of all the things, but coronary care units were certainly—the technology and the way that handicaps of strokes were treated—the fact that we did not—when we began to take on those additional duties before that time but the things that were done in hospitals were as far as nursing was concerned were much simpler. There wasn’t a lot of high tech equipment. It was cure and comfort to be sure, but it wasn’t to the—so, at that point it became very apparent that the manpower shortage was beginning to show up. There are a lot more medications coming to the forefront that were being utilized and administered in highly technical ways.


Karen Thomas: So, it was the need for specialized knowledge because of these new technologies that was partly…


Audrey Booth: I think so and I think for nursing, my observation is, which I just reinforced this week by spending a couple of days in the hospital with somebody—there were two classifications of people that worked in hospitals. Nurses primarily were there all the time and physicians in and out. You sent out for your drugs, you had people that scrubbed and people that fed, but you didn’t have inhalation therapists, you didn’t have all the intricate laboratory technique kinds of things—many of them, which are done on units. When all of them came into being the people that did them were the people that were there.


Karen Thomas: Right.


Audrey Booth: The nurse is there. She does that. Until the nursing responsibility just got so big that we began to do some subdivision tasks, or a physician, or a particularly technically oriented physician—yeah, would train their own people to come along and do that. That’s where the physician’s assistant program also emerged.


Karen Thomas: When did you first hear about AHEC and what were your first impressions of the program?


Audrey Booth: Well, I first heard about it in 1972 when it was getting started here and they were talking to our board. The North Carolina Medical Program Board had medical school dean etcetera on it and we knew from our own national meetings what other funding was coming along and we had meetings with the AHEC group or I remember with Glen Wilson and John Pain a year or 6 moths before I came back here to work with AHEC. So, that must have been in 72 what was developing.


Karen Thomas: Since there were so many of these other programs proliferating, did it seem like AHEC was going to be different or did it seem pretty experimental or...


Audrey Booth: Oh, I think it seemed quite different to me from the standpoint that this was going to be the hub, but that there were going to be the regional AHECs. I mean we went immediately to Tarboro and Wilmington and what was the other one? The first…Charlotte? Was that it? I can hardly remember it, yeah, and that we were working out there. It wasn’t that people came here.


Karen Thomas: Right.


Audrey Booth: We had a hub out there. My job was to be the nursing consultant to the nurse to help employ that nurse, to help write the job description, to help decide how—in keeping with what those people wanted to decide what tasks they might be looking to have done and then to help recruit.


Karen Thomas: Right.

Audrey Booth: And help interview in some instances and when we got a person in place in Wilmington and Tarboro, then I was working with each of them individually and we would meet together quite often to talk about our plans because it soon became evident that we—what the state board of health and the coronary care nurses—if you do a program one place very often they want it to be available in another one, that they would all have programs together and as AHEC spread through the other six regions of the state and our nursing group got larger, we did a lot of program development together that we then just took around to each of the AHECS.


Karen Thomas: Right


Audrey Booth: There were a lot of things we did for public health. Some of them in concert with the school of public health, some of them we did through the continuing education department here at the school of nursing, developed the program, and then went from AHEC. I was actually a booking agent at that point.


Karen Thomas: Mhmm.


Audrey Booth: We have a program here or Greensboro has a program and we try and get it throughout the system and that meant literature, follow-up, evaluation, and it was known as something we funded. As we got more skilled in our statewide working together and assessing needs we also got money from other grants.


Karen Thomas: Right.


Audrey Booth: To do programs. To do educational activities. I want to go back to a nurse practitioner eventually, but don’t need to at this moment.


Karen Thomas: Okay.


Audrey Booth: To me, that’s one of the greatest things that AHEC—regional program, medical program, and AHEC helped me contribute to.


Karen Thomas: Having done a little research on some of the different groups that were involved in the creation of AHEC, you know, there were the different medical societies and nursing societies and the different professional groups of—there’s the state legislature, there’s the university administration, there’s all these different groups that had to come on board with each other I guess. Was there a great deal of opposition at first to the idea of AHEC and if so how was that overcome? Or was it pretty much an easy solve in the beginning?


Audrey Booth: I can’t think of any opposition. I think everybody—of course sometimes you see it very optimistically when you’re looking from the inside.


Karen Thomas: Sure.


Audrey Booth: But I think people saw it as a great salvation of things that they wanted. Whether that great enthusiasm lasted 5 years, ten years, you know, as it got leavened a bit by reality of we can do this or we cant do that, whether it was as enthusiastically supported, but I think so. I feel that it was very highly regarded in the state and I know we were highly regarded in the nation. We were amongst the top in terms of whatever their rating system was.


Karen Thomas: Sure.


Audrey Booth: And I think the fact that Glen was a very astute politician, Bill Friday was a great ally. You know, even Dean Berryhill really was one of the early pioneers and he did things that made this then come into being. Probably Ike Taylor, who was the dean at the time that AHEC started—well no, I’m not sure that he was. I worked with him in RMP and he was a great supporter of the nurse practitioner program. The deans in the medical school and their influence kind of run together in my mind because it was…


Karen Thomas: Well, certainly the end result was that AHEC was a very well thought of program and was quite successful. I guess that in the beginning I’ve gotten the sense that there are a lot of people especially on the local level that were weary especially of federal program, that there was fear some one might come in and tell them what to do and force change.


Audrey Booth: That it would go the way of other federal programs. I’m sure that’s true and it may be. I have saw more suspicion between here is Carolina the mother ship in getting it all? And what about Duke? You know, and how are we going to cut up the pie so that Duke—and that was always a tough job. They got Fayetteville but they didn’t really have Fayetteville. Fayetteville wanted us. That’s a crude way to express it, but I think there was a lot of anxiety in the beginning. Having just had the regional medical program at least where you know, you could, how you were going to get cut in to the program—and of course that was such a small program to what AHEC had. AHEC didn’t begin hugely, but in very few years it surpassed that.


Audrey Booth: Then I think East Carolina became very nervous about whether or not they would be getting a fair share and of course at that time there was a great dal of political unrest about East Carolina getting a medical school. I think that the nurse practitioner school got a lot of its support early on because people thought about that as a way to get rural health care needs addressed without pouring so much of the state’s money into yet another medical school. We’re a pretty small state to have four medical schools. Now, maybe you can say well population now and all of the urbanization that’s different, but lets talk about 1960.


Karen Thomas: Right.


Audrey Booth: It was small and rural, but that was a great political issue.


Karen Thomas: Well, you said you wanted to talk about the importance of the nurse practitioner program and that seems like a great lead in.


Audrey Booth: Right.


Karen Thomas: What kind of role did that program play in AHEC?


Audrey Booth: Well, I was telling you from the regional medical program that there were a number of kinds of committees that had people really buying into developing nurse practitioners and at the same time we had others working on the physician’s assistant program that was at Duke and we did a lot of things. We cooperated in a lot of ways because we knew that neither of them were going to succeed alone. They both had to succeed and we had a lot of help from the institute of government here with helping craft the laws that might provide for legalizing their practice and this was about 1971, and about that time the board of nursing, which is the regulatory board for nursing in the state for all nurses licensing and educational programs approval. I got appointed to the board of nursing because I’d been doing all of these things with the committees for nurse practitioners and we knew we were going to have to do something about the legal thing.


Karen Thomas: Right.


Audrey Booth: So, it took about eight years. Six or eight years I guess of finally working with board of medical examiners and we had all kinds of advisory committees with nurses in medicine trying to be helpful to warm up the potential legislation that we needed. There was lots of lobbying. The nurses association were into it very heavily.


Karen Thomas: So, were you part of that lobbying effort yourself?


Audrey Booth: Yes.


Karen Thomas: Who all did you go to talk to?


Audrey Booth: Well, mainly I talked with the physicians on the board of medical examiners and the nurses association too because they were interested in a much more independent practice. Then, from my position I was seeing as a reality that we could accomplish and we’ve ended up in having an approval to practice associated with specific physician. To a lot of the nursing group, I didn’t disagree with them. I felt that nurses were educationally prepared and every other way to do the kind of independent practice that we were talking about, but I knew it would never fly and so, to me it seemed politically important that we get something. If the medical society didn’t agree to it we would have had a very difficult time getting it through legislature.


Audrey Booth: Well, that’s a very long story. AHEC was very influential in this way because we had medical school personnel and we don’t need to name them, who were supportive working with it, we had the transportation of the airplanes, we had instant communication with Bill Friday’s office. It was communication, transportation, and a lot of political cloud that got it done and eventually that went on to encompass nurse midwives. Obstetricians very heavily opposed that. Of course we were going to have a midwifery school here, but we had no basis for clinical practice because the medical school used all that was available in our clinical facilities here.


Audrey Booth: At one point, we had an AHEC program in Shelby, North Carolina. We had nurse practitioners, we had midwives that we flew out there to establish a practice. We were going to set up a basis clinical practice and fly our students out for it. Well, it was just too much. Too (inaudible) we never did it.


Karen Thomas: Right. So, you did start a nurse midwife program. Was there still concern at this time that a lot of babies were born in North Carolina outside hospitals and without an attending physician?


Audrey Booth: Yeah. Well, (laughs) as much concern for they didn’t have any prenatal care. No, we did not actually start a midwifery program. We got approval to practice for midwives, but we did not prepare them in this state.


Karen Thomas: Right.


Audrey Booth: We had some midwives on our faculty with the idea that we would start a program, but w couldn’t get enough access to clinical sites midwifery.


Karen Thomas: You had said that there was an attempt at starting a nurse midwife program, but it failed because you couldn’t get access to clinical sites. I was wondering if there were other specific health problems that the AHEC nursing program tried to create solutions to? Or, maybe what were seen as the greatest health problems that AHEC and the nursing program could address at that time?


Audrey Booth: Well, I think one of the things was a lack of rural health care. I mean, you know, that was the heart of AHEC all the way initially and that was of course the whole focus of preparation of nurse practitioners and we just didn’t educate them. We did this as a non-degree program, nine months to one year—six months to one year with clinical education. We recruited them, indigenous nurses from their region with a physician from there. They agreed to be a practicing team and then they came here for their education. Then they went back there for their clinical with their own supervising physician. That kept them in the rural areas. If we’d educated them here, there’s nothing that—they already had their acceptance in the local community lets say--


Karen Thomas: Right.

Audrey Booth: And they already knew their doctor and all of that and then of course that tied in with the governor’s rural health program and we were providing staffing for that and Bernstein began to, you probably know him…


Karen Thomas: Mhmm. I meet with him next week.


Audrey Booth: So, we began to be producing the workers from the local regions that then went into private practice, health departments, Bernstein’s rural health clinics, and then it became very apparent that this program by itself wasn’t going to be able to produce them all and we wanted very much— our legislative approval depended on having the standard curriculum, the standard everything so that we don’t certify yet another critter out here that’s going to be practicing differently when we jeopardized the whole thing. So, when they started talking about how they’d like to have nurse practitioners prepared at East Carolina, we worked with them. It was one curriculum.


Audrey Booth: (Inaudible). We had such a peace together—little credentialing system that we couldn’t risk having it fall apart by different kind of ideas for educating these people. That sounds almost negative, but if we had let different curricula—because this is all based on trust with the medical society. If they knew who developed the curriculum for the first set of people then they wanted all the rest of the people to be educated just like that. So, we made quite an effort through committees and collaboration to do that.


Audrey Booth: Ultimately, the collaboration was good because it got continuing money for educating these people and we eventually opened a program at the mountain AHEC. Of course, these were still certificate programs. We felt in the nursing schools that we needed to get—once we got the initial need met, we needed to be preparing people who had the research background additional education so that they could contribute to the body of knowledge out there and not just be performing the health care delivery, but they could be doing the research and the kinds of things that need to be done in the clinics and the migrant working areas and so forth. So, we stopped preparing diploma certificate program students. These are of course RNs who were in the certificate programs and put that program in our graduate program. At this time now, many years later, we are exporting our graduate program primary care nurse practitioner education to the mountains and the mountain AHEC has it out there right now. Having said that, that’s about all I know about it because I haven’t been in on it for a long time.


Karen Thomas: One thing that I seem to be getting from what you’ve been saying—one thing I try to ask each person that I interview is how the communication worked between the central administration in Chapel Hill and on down to each of the nine AHEC sites and then out to the local communities, and it sounds as if nursing in some ways was able to do a little bit of a better job at that than lets say maybe the medical program where there is more of a focus on clinical training in the AHEC centers, but some people have said well we didn’t get people out to the local communities quite as well. Could you maybe comment on that? Or do you not understand the question?


Audrey Booth: When you say medicine here in this university…


Karen Thomas: Yes.


Audrey Booth: Who went to the clinical training center they went to Wilmington and Greensboro and so fourth, but they didn’t go to East Overshoe.


Karen Thomas: Right.


Audrey Booth: Yeah, well I think that’s right.


Karen Thomas: Okay.


Audrey Booth: Of course nursing, we weren’t delivering care. Lets say, orthopedists, they had an orthopedic clinic in Wilmington and wherever else they went—Rocky Mountains and so fourth. Nursing wasn’t delivering care. We were delivering education much more. Now you can say, well those physicians were delivering education, but they might have had a few medical students precepting out there with them, but we were educating the deliverers of care, not one on one.


Karen Thomas: Right


Audrey Booth: of course I talked primarily about the continuing education programs that we were placing out there. We also of course, when I say place clinical students—yeah, we had nurses clinically getting experience in all these areas and undergraduate nurses and graduate students, but probably the larger program for nursing was the continuing education program. I’m not sure. I mean I don’t know how we measure large, whether it is most influenced by the highest numbers, the greatest FTE, what is large?


Karen Thomas: I’m trying to figure out where I am here…


Audrey Booth: I think it’s important to recognize that just the number of health workers to be educated, or who might profit from such education—Nursing was the most numerous. Nursing practice particularly, that even broadened it. All kinds of nurses, practical nurses, nurses’ preps, even nurses’ assistants. You know, we did a lot of programs that were for those people who are working with nurses in delivery of care. So, just numerically that was a bigger group and traditionally in this state, every hospital of course had some kind of training program. Especially when the American Hospital Association required in service education, then each hospital had us—some sort of educated thing. Our AHEC nurses began to work with them providing them program was like another subset—another cut.


Karen Thomas: Right. A few minutes ago you described yourself as in the beginning as kind of a booking agent. You said that you really coordinated these different programs that were being developed and enabled them to be spread throughout the different AHEC regions. Can you talk a little bit about how your role as the administrator changed from the early days when things really kind of in fluxed to later on when AHEC became more institutionalized?


Audrey Booth: When things were really fun in the early days, when everything was just very personal and small group and primary group. You know, its always fun to get things started and Glen Wilson was a man who was very good at that kind of thing. It was—everybody knew each other and that kind of thing. It was just easy to ick up the phone and have really close communications. So, early days was sort of defining the actions that we might take and it was just a group of three areas. It was my full-time job in the school; I wasn’t doing anything else but that. I was called the director of AHEC nursing activities. That title was frequently (inaudible). People from end to end of the state don’t want to be directed from Chapel Hill, it was an unfortunate title, but consultant is equally difficult.


Audrey Booth: Anyway, that was getting the people in place, helping define the job for nursing out there, getting the people in place, having them begin to coalesce as a group of professionals that were working together. We did as many things together as we could. When I say together I mean planning activities, planning education, planning future goals as far as the nursing program, and we grew and grew until we had one all around. Probably by that time, I don’t know, that was probably about 1977. No, it would have been six. Probably six. Then they began to be—these were—you can be sure we tried to hire the leadership nurses as much as we could. They had their own important roles in the state and they interacted with each other a great deal. They saw that they were on the board of nursing and they were officers in the state nurses association.


Audrey Booth: They were powerful. I don’t know how they are today, but I think they probably still are. So, that they were looked to for a lot of advice and action. If they were in the power positions, action came about pretty easily.


Karen Thomas: So, AHEC was able to attract a lot of the nurses who are already leaders in their professional organization?


Audrey Booth: Those were always my recommendations of who we tried to attract and that meant that you had to have job descriptions that gave them some personal leeway, some opportunity for them to be somewhat determining their own goals and that wasn’t always easy. One of the hardest places was Fayetteville where the AHEC director was a surgeon and you know, that’s very hard for a surgeon to realize that the nurse might plan programs, directions, and so fourth beyond their office doors, but the point was to get a highest level of position, get a salary that would attract people that could do these things, and that happened and as far as I know its still happening.


Karen Thomas: That kind of brings up the point—the example with the surgeon and the nurses not always quite seeing eye to eye, how was the communication and cooperation between the different disciplines? It sounds like there’s quite a bit between nursing and public health for instance, but do you think AHEC met its goal of being an interdisciplinary program? Or did that change…


Audrey Booth: Well, how many disciplines are we thinking about?


Karen Thomas: Well, I mean I’m talking about medicine, pharmacy, nursing and health.


Audrey Booth: Well, yes. I think it did. Its not—not everything takes a multidisciplinary approach. Every discipline had action, had input, and did things around the state. Now, whether we did them—whether we had as much interaction in doing them together—sometimes we were critical of ourselves with that, but yeah, I think it happened pretty constantly.


Karen Thomas: Can you think of some examples of particularly close cooperation with another discipline in nursing?


Audrey Booth: Well, I just had been telling you this story of nurse practitioners.


Karen Thomas: Well, certainly nurse practitioners.


Audrey Booth: To me, that is the big one.


Karen Thomas: Right, right.


Audrey Booth: Lets see, I know that there were a number of things with the state board of health. Most of my examples are probably going to be physicians and nurses. Health department directors who may or may not be physicians and others in those areas, I can think of a number there of programs that they did together. Could I think of anything with pharmacy—not very easily. There might have been some; there may have been some since. I cant—I’ll come back to it if I think of anything.


Karen Thomas: What were some of the most difficult and some of the most enjoyable aspects of your job as director of nursing for AHEC?


Audrey Booth: Well, most enjoyable was to see and feel and share with every discipline the progress that we felt we were making, especially when we went to national meetings. If we didn’t know we were good before we went, we came away feeling very good because we went to our own particular groups—you know, we did a lot of things in general session, but we also had our own disciplinary groups. Our people assumed leadership roles very quickly and it was apparent. Its always sort of—its what you would hope it would be in comparison of what they’re doing in their local regions and we were doing some great things.

Karen Thomas: How about difficult parts?


Audrey Booth: Well, I think the difficult part is to change from the small, intimate, primary care beginning group when you could talk to everybody, when there’s lots of interaction, lots of equality, till you expand and there gets to be a lot of—there’s cooperation at that early area. You expand and then there gets to be a lot of competition and of course it was the competition that was felt about and I’ve felt this a great deal because I was supposed to be providing the consultation as far as AHEC went to the nurses in all regions of the state. As our group got larger and we got involved with Duke and I’d say East Carolina, there began to be more resistance to Chapel Hill as the center of things, AHEC in general, the school of nursing in particular, and me specifically because I represented that. That was not always a joyous thing to be part of, but it was just different, it was just the growth and development of any organizational structure that goes that big.


Karen Thomas: Were there some advantages of AHEC becoming established and institutionalized?


Audrey Booth: Oh yeah, I think politically it assured our continuity. Yeah, very much so, and it hasn’t gotten so—I don’t think its gotten so standardized, but what each region is still—there’s probably a lot of individual difference, but you don’t need to get that from me, you got lots of people you can get the latest information about that.


Karen Thomas: So, the regions became more standardized you think, less (inaudible) between one and the other in how things are done?


Audrey Booth: Yes, but it didn’t erase their local options.


Karen Thomas: Right. Something I’ve asked a few other people to do is sort of compare some of the different regions that they were involved with. Not necessarily who was better or worse but what characterized or made Charlotte unique versus—there’s certainly—some of the AHECS were run by non-profit boards and were independent versus ones that were run by hospitals, some were in much poorer areas of the state. Charlotte had a lot of advantages because it wasn’t as poor.


Audrey Booth: Oh, Charlotte went on doing some of the things and all of the AHEC money and support gave them an opportunity to just—you know, they were just starting from scratch. They built buildings and integrated their in-service education program into AHEC. They just did corporate things with it in contrast to Tarboro. There used to be—I guess you’d say it was a sculpture that somebody made that represented area L AHEC and it was all this broken glass.


Karen Thomas: Oh no! (Laughs).


Audrey Booth: It was a big struggle in a very rural area and the availability of staff at all levels was kind of difficult. I don’t know what they’re like today, but they were always gung-ho to go. I mean they worked at it, but I’m just saying the sophistication of the Charlotte area that—this was just frosting on their cake. To Tarboro, this was really the beginning of community education for their health providers. Probably the one I liked working with most was mountain AHEC. I don’t know that I can make any other comparisons.


Karen Thomas: What did you like most about the mountain AHEC?


Audrey Booth: Well, they tried to bring two very disparate hospitals together, the Catholic hospital in the community and Memorial Mission. They even built that flying bridge over the street. I’m not sure that was more than a symbol but that was very graphic (laughs).


Karen Thomas: Right (laughs).


Audrey Booth: Never mind that you couldn’t heed it (laughs) and perhaps I’ve known more of the people up there. They had pretty far-thinking people that were engaged in that early on as compared to lets say, Fayetteville. That’s where the surgeon was and I just think that made it a world a difference. They were very close to this university too in terms of a lot of the people that worked up there. Tom is just back from there in fact.


Karen Thomas: yes.


Audrey Booth: And Hettie garland. I don’t know if you know Hettie. Are you going to interview people from the regions?


Karen Thomas: We would like to eventually. I’m going to speak with Bryant (inaudible) and Larry Kitchin.


Audrey Booth: (Laughs.) Mr. Smooth and squire. The country squire (laughs.)


Karen Thomas: (Laughs.) But, I think we will continue to try and talk to more people from the regions. Right now we are kind of focusing on the top administrative level people and especially as I said, since I don’t have a car I’ve been sticking right here in Chapel Hill.


Audrey Booth: yeah, sure.


Karen Thomas: There are plenty of people to talk to.


Audrey Booth: Oh yeah. Well, yeah, the fact that you’re going to see those two is really interesting because Larry Kutchen was along with Glen Pickard one of the people that were really interested in family practice and nurse practitioners and of course he came from the true rural area and he had a little school of nurse practitioner over there in a mobile home, which Cindy Frand, who is the dean of the medical nursing school—you might want to talk to her—is the dean of the nursing school now who probably has a much more gathered opinion of AHEC and would express it much more sophisticatedly than I do. I’d been awfully close to it. She not only started that little nurse practitioner school out of our school it was like—but she took the course at the same time so she could also achieve the credentialing. She was active in all of this research, which would demonstrate that nurse practitioner practice is good for economically, primarily economically and quality of care. So there’s Larry over here—here’s Bryant Gallucia who was chairman of the Board of Medical Examiners, which provided us a great you know…


Karen Thomas: Didn’t hurt (laughs).


Audrey Booth: Great support (laughs) and we were all talking to each other all the time. It was like a easy group trying to figure out how to end around these restraints in terms of the practice legalization.


Karen Thomas: Are there—you already mentioned several individuals that obviously you remember very well, are there any other people that you’d like to mention or talk about? That you had close relationships with or just really stick out in your mind?


Audrey Booth: Well, yes. The nurse in Fayetteville, Barbara Joe, lets see, Barbara Joe is married since then. I’m probably not going to be able to remember either one of her names, but in the AHEC registry of things, Barbara Joe is good enough. A very—she was from our undergraduate program (inaudible) graduate program and came back here. We helped steer her to be the first AHEC nurse in Fayetteville, her home town, and she helped us get our first off campus BSN-RN program, BSN program for RNs. We did in Fayetteville and that was a very great drive at that time. I don’t know where it is now. There was so little opportunity for RNs to get their Baccalaureate nursing degree without stopping work, going back, and going some place else away from where they lived and their big families probably.


Audrey Booth: So, she worked very hard with Margery Duffy, who was my counterpart as associate dean in academic affairs in the school of nursing to get that program out. Naturally, that took an enormous amount of AHEC funding, even the transportation budget. You could imagine what it takes to get faculty down there to teach in essence—I don’t know how many hours, but like a full year at least, but it was spread over probably three years. I can hardly remember that you can get that from him if you need it, anybody else, but that was one of the very first efforts that we made to get an off campus program. When you have a school of nursing with however many undergraduates and a graduate program, to think about taking your same faculty and going down the road sixty miles and setting up another one, it takes a lot of money and we negotiated for that and I remember being so aggravated that—that it wasn’t John. I didn’t get aggravated at John. It may have been Jean Mayor, we were talking about the budget and I remember saying, “listen, we’re not setting up a used car lot here (laughs).” To get people to realize that this takes a lot of money to do it in the right way.


Audrey Booth: I think we did one in Raleigh and then there were other schools that were beginning to want to do that, so I don’t know whether its as important as it once was.


Karen Thomas: Obviously the nursing school was just very involved in the AHEC program, was that an attraction in hiring new faculty? Did a lot of people seem interested in participating in this or was it seen as something that they would have to do and have to leave home or whatever and it was kind of a difficult thing for most people?


Audrey Booth: Well, I think most of them were the latter. That’s why I say I was a broker. We needed to identify what kinds of things they needed out there. I needed to look inside. After all, this is based on a budget and in order to fulfill that budget, we had to produce the teaching that we had agreed to do.


Karen Thomas: Right.


Audrey Booth: You can’t say I’ll teach so much of this and so much of that. It’s based on need out there, so I’d go out with the local nurses and they’d tell me what they needed.

Karen Thomas: Right.


Audrey Booth: I’d come home and see what I can produce. Either within our faculty, hopefully, and there were some that liked to do it, but you know it depended on how you did it, how often it had to be, spread it out, how you transported, and if you flew and had to leave your kids then that was one thing, you didn’t have to stay several days, could we do it by TV, could we do it by package materials, all of that. Of course we and Duke continued a design department in the school of nursing that designs educational materials, so that meant a lot more work, but more funds to be able to do that work with.


Karen Thomas: You’ve mentioned some concerns that people both teaching and who were students in the nursing programs had about caring for children and families since nursing is an overwhelmingly female profession. Were there concerns that were unique to women who were participating in AHEC or do you think that the concerns were pretty much the same throughout the program?


Audrey Booth: Well, I think you are quite right. There were concerns that were unique to women. Childcare, salary was another biggie.


Karen Thomas: I’ve heard that some people say that women were considered better candidates to stay in theses rural areas because they would accept lower salaries.


Audrey Booth: That’s right. They would work after sundown and weekends and that kind of thing, yeah.


Karen Thomas: Did you have anything to add to that?


Audrey Booth: Well, it was a very savvy question that you ask and I’ve expect you’ve experienced at other places. I’m sure that people in the Med. school didn’t like to fly to this part of North Carolina and do an orthopedic clinic and you know, all of that. It takes away from time here. Those little planes are key to this program.


Karen Thomas: I’m flying on one next Wednesday.


Audrey Booth: Good, and every time I read letters to the editor in this town about closing that airport, I just think that airport has been out there for a hundred and something years and all those people built their houses around it, so shut up! (Laughs).


Karen Thomas: (Laughs.)


Audrey Booth: its very important. Many times they’ve tried to move it and it’s that old, “not in my backyard.” There’s no place that they’re going to be able to put it.


Karen Thomas: The nurse practitioner program especially really seemed to envision a new role for women as independent practitioners.


Audrey Booth: That’s right.


Karen Thomas: Was there much resistance to having women in these new or powerful positions?


Audrey Booth: Of course! There was resistance. You would imagine that you would find it in hospital administration, in medicine, the less enlightened, in nursing. There was a lot of resistance in nursing and it’s that we do not need to be certified for practice. We do these things. We’re educated to do these things. What you’re teaching us to do beyond that is really physician assistant kind of things. Well, we had a hard time discussing that and separating those threads out. Particularly when its nurses who are educated at the graduate level—


Karen Thomas: right.


Audrey Booth: Who really do have a view of advanced nursing practice and to think that those things might also be included in some other kind of certification was just disgraceful and it caused a lot of discussion in the nursing profession. Especially early on when we were trying to get the thing off the ground and we were educating the indigenous nurse from a remote place who obviously isn’t going to come to us with more than a diploma school education in nursing. Nursing in itself was so centered on the fact that we need to be educating at the graduate level, they were very critical of that. How could you send somebody out with that little education for that kind of responsibility? Well, it’s like barefoot doctors in other places. You start and then you improve on it, but you have to get some service, delivery of service into the area, but there was a great human cry in the nursing profession that nursing has had to struggle for… I believe the word on the stand-up comedy is respect, and to use the old cliché that everybody uses it started so much from servitude and hand maiden that you didn’t think a great deal; it was care from the heart and how did you need to be prepared for that anyway?


Karen Thomas: Right.


Audrey Booth: You know, into present day professionalism in nursing. It’s quite a change and when we were talking about these things in the sixties, I’m sure the discussion goes on today, but it was very high decibel back then and the people from our program who would go to national meetings of the American Nurses Association or the collegians school of nursing needs or something got a lot of guff because they were doing this here.


Karen Thomas: I guess I’m not quite clear on why there was such resistance form within the nursing profession that they feel threatened by new higher standards?


Audrey Booth: Well, no they felt it was lowering standards.


Karen Thomas: Oh too low, okay.


Audrey Booth: They felt, well we’ve been working all of these years to get first the baccalaureate program to be recognized as the basic education for nursing. We need graduate, we’re just getting into doctoral programs and you come in here and your educating diploma nurses with their certificate? It’s not (inaudible).


Karen Thomas: Right.


Audrey Booth: This is a job that you need to master as nurse to do and it’s true it would be good. We’re getting them there now, but we didn’t think if we educated them, how many masters nurses were we going to be able to recruit from Sparta?


Karen Thomas: Right.


Audrey Booth: How many Masters Nurses that came here from Raleigh, and Richmond, and Charleston that we educate here are going to go to Sparta? So, it was a question of filling that need with people who first of all were there


Karen Thomas: So, it sounds like some of the professional goals in nursing sometimes conflicted with just the sort of practical level deeds in these underserved areas.


Audrey Booth: Well true, excellent.


Karen Thomas: You mentioned cardiac care units as one specific kind of technology that really changed nursing and that AHEC tried to address them before.


Audrey Booth: Oh yeah.


Karen Thomas: Can you think of any other technological changes that were addressed through AHEC?


Audrey Booth: Oh yeah, well addressed through AHEC...I was thinking of another technological change that I participated in myself immediately before I went to the regional medical program, which gave me—although I had had an opportunity for a number of years of education it wasn’t really an advanced practice. My additional education was more in administration. I worked at Duke and the VA in the early years of hemodialysis in kidney transplant.


Karen Thomas: When?


Audrey Booth: Sixty-five. That was still very experimental and experienced for myself a lot of advanced practice. You could say physician’s assistant kind of things since we’ve never done it before, which really opened my eyes to the technological developments that nursing had to be participating in. It scared me too.


Karen Thomas: I guess I asked that question because it seems that one of the goals of AHEC was to bring new knowledge that was being generated at places like UNC Chapel Hill and make that available in continuing education in other programs to people through out the state. I just wondered what some of the most important things that you feel you were able to spread the knowledge in…


Audrey Booth: Well, the coronary care ward keeps sticking out as far as I was concerned, but because I tend to think when I think technological of…


Karen Thomas: Or just any form of knowledge…


Audrey Booth: Yeah, well I’m about to change that to the care of say infants and children. We worked together with the public health group around the state to develop workshops about care of infants in children in public health settings, which I think speak to the subject that you were referring to. It’s interesting how many of those activities that I spent so much time on are no longer a part of my ability to recall.


Karen Thomas: You said earlier that the nursing program might have put more of a focus on education as opposed to medicine, which in the process of educating doctors they were delivering care and something that I’ve run across through out these AHEC documents is that they keep saying over and over again, “we are educating medical professionals. We are not out to change the way care is delivered or...”


Audrey Booth: Of course we were out to change they way care was delivered!


Karen Thomas: Yeah, so I guess officially AHEC was emphasizing education, but certainly it seems that…


Audrey Booth: In a non-threatening way.


Karen Thomas:  Right. Do you think that this official emphasis on education was a strength? And despite in senses to the contrary, how did AHEC actually affect the delivery of care? Because it seems that it must have. Do you understand what I’m getting?


Audrey Booth: I think I do. Well, I just don’t think there’s any question to what the affect of the delivery of care was, just the fact that they were practicing in neighborhood clinics with precepting students. One of the things, I don’t think this is on your question, but one of the things that I do think nursing particularly brought about and Glen Wilson always refers to is nursing on the cutting edge was that so many of the courses that we planned were interdisciplinary. Why would we educate the nurse if the hospital administrator doesn’t see the point for doing something in a certain way or him? Sorry I can’t get into that him and her it’s mostly her, or the physicians who are going to be dealing with those kinds of cases need to be, as a part of the same education there may be break out groups, but the common core knowledge is the same whether it is the physician, or the nurse, or the PT, or whoever is going to be dealing with this particular medical ailment, or group of patients, or rehab effort. We did a lot of that and probably with teachers and counselors as well.


Karen Thomas: Did you see any new kinds of criticisms of AHEC over the years? Certainly it overcame that initial experimental period and got very well established. Later on did people seem to change the way they looked at AHEC?


Audrey Booth: Well, I could think of some examples; particularly the state health department and their nursing personnel who were responsible as consultants in the field to influence educational programs. I think they felt like we were getting all the money so we might as well do it. We should do it. We had an obligation to do it without further funding. I definitely recall that. Because we were getting the same state funds, we were all competing for the same pot of state money; the health departments or the AHEC and so on. I do remember those feelings of neglect, but from my perspective, we worked with them to—why would legislature want to set up two mechanisms of education? They set up AHEC. We should do it.


Karen Thomas: Right.


Audrey Booth: I suspect that probably initially it was much more probably public health per say may have received less attention, less funding and so fourth, and all the rural health clinics that was so much more on public health centers, but the major like the Charlotte areas and so fourth probably received more of the funding. I imagine that that was…public health is not terribly sexy.


Karen Thomas: (laughs).


Audrey Booth: But they felt quite ignored.


Karen Thomas: I think that I’ve asked most of the questions I was gong to ask, just kind of a wrap up question about what do you see as the future of AHEC? Twenty-five years later is there still a need for a program like AHEC, or has it addressed the problems it was created to solve? What do you think will happen in say the next ten years?


Audrey Booth: I don’t think I’m close enough to the health care system these days to really be able to speak to that. I don’t know what HMO is going to mean to them. It seems to me they are very institutionalized. I use that in a positive sense, I don’t know if their programs are threatening the state legislature. I do know that the cast of players has changed so dramatically with the loss of our two young leaders in John and Jean Mayor complete change in general administration. A new chancellor who probably doesn’t know AHEC from—you know, the kinds of things that I talked about are so essential to success early on...