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1986-05-22 Interview with Carolyn Bacdayan, May 22, 1986 1986OH142 UKMC 45 01:24:48 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Bacdayan, Carolyn B. -- Interviews University of Kentucky. Medical Center -- History University of Kentucky. Dept. of Behavioral Science Medical Care, Cost of Poor -- Medical care University of Kentucky. Health Care Access Committee Carolyn Bacdayan; interviewee Richard C. Smoot; interviewer 1986OH142_UKMC45_Bacdayan 1:|10(2)|23(2)|42(1)|55(3)|101(11)|112(6)|123(3)|141(3)|157(3)|172(5)|190(4)|204(5)|214(4)|227(4)|239(10)|250(6)|265(2)|274(4)|284(2)|293(13)|304(3)|319(2)|330(1)|339(6)|352(1)|365(7)|375(9)|387(1)|397(6)|406(11)|449(2)|460(2)|471(5)|480(11)|489(3)|497(8)|506(5)|520(4)|528(11)|544(8)|553(9)|563(5)|592(9)|600(15)|609(13)|622(5)|631(11)|641(10)|650(8)|684(15)|701(1)|709(10)|719(8)|729(2)|741(3)|754(5)|768(3)|794(10)|817(2)|850(6)|861(5)|869(7)|878(9)|890(2)|906(3)|931(2)|938(11)|945(5)|955(5)|964(5)|973(7)|981(11)|991(11)|1006(5)|1015(6)|1028(4)|1055(10)|1075(7)|1084(12)|1094(1)|1103(8)|1111(2)|1119(6)|1130(1) audiotrans UKMCoh interview BACDAYAN: And so I grew up in that uh, community and environment. The uh--my parents had both come from the middle west and so we had a continuing interest and contact with uh, our middle west uh, roots, but uh-- SMOOT: Where in the Midwest were they from? BACDAYAN: From uh, Iowa--western Iowa--yeah. My uh--the community that we lived in was uh, outside of New Haven, it was a small, uh, rural, uh, farming community and so basically my--my friendships and--and orientation uh, were very uh, much more--more rural-- SMOOT: Um-hm. BACDAYAN: --than--than urban. My family was uh, Quaker by uh--by conviction and uh, I think that uh, many of my values and interests as I uh, continued to mature uh, stemmed from that particular orientation of um, mutual respect and toleration for all people. Uh, it certainly contributed to uh--although I'm not a sociologist, uh, my uh, interests are there. I married an anthropologist. (laughs) My father was, although an economist, really a social psychologist in his orientation and had had a strong uh--a strong interest in that area, which probably is one thing that uh, led me to the Department of Behavioral Sciences, uh, here at the University of Kentucky as a point of contact and entry into uh, my--my uh, professional life-- SMOOT: Um-hm. BACDAYAN: --here at the university. I was fortunate as--in my growing up uh, years to be able to travel widely with my parents, uh, as a part of their professional life, uh, teaching and doing research. I think that was a--a special asset. SMOOT: Did they have certain-- BACDAYAN: Um-hm. SMOOT: Did they have certain aspirations for you? BACDAYAN: That's an interesting question. I see my uh, parents, I guess as all children do, with--wi--having elements on both ends of the spectrum, being on the one hand both very traditional-- SMOOT: Um-hm. BACDAYAN: --uh, but on the other hand, uh, wa--wanting to be sure that their children taste fully of (laughs) the modern world. Um, they stinted no effort in terms of um, educational opportunities and--and self-development opportunities and travel and so forth. I think their um, horizons were fairly traditional in terms of uh, probably teaching being a very appropriate role, uh, for their daughter, which I did in fact do for a number of years. Um, I uh--both my college and--and graduate degree are in history and I--I taught both ancient and medieval, uh, history for a number of years until I got into more--more contemporary (laughs) uh, activities. SMOOT: Where did you take your B.A. and M.A? BACDAYAN: Uh, I graduated from Swarthmore for my undergraduate degree and I graduated from Yale with my master's degree. SMOOT: Who did you study with on your master's program at Yale? BACDAYAN: Well, my interest uh, at that time was American history, predominately. SMOOT: Um-hm. BACDAYAN: And uh-- SMOOT: Good faculty there. BACDAYAN: Yeah. Samuel uh, "Wave the Flag" Bemis (Smoot laugh) and uh, Bloom were there. Uh, Potter was there, um-- SMOOT: Stephen Luger? BACDAYAN: Those are the ones that I remember-- SMOOT: Stephen Luger? BACDAYAN: --yes--yes--right. SMOOT: Um-hm. BACDAYAN: Um-hm. SMOOT: Edmund S. Morgan? BACDAYAN: Yes. SMOOT: Um-hm. BACDAYAN: Good--good colonial history course with him--yeah. SMOOT: Powerful faculty. BACDAYAN: Yes, it was--that was uh, very nice. SMOOT: Um-hm. To get back, let me ask you about the community. Now, was this--was there a large community, uh, the Society of Friends, where you were growing up, uh? BACDAYAN: No, uh, that particular, uh, meeting in New Haven was actually uh, founded, uh, by my parents, along with some other in--interested individuals. My father uh, did his doctoral research in Great Britain at the um--in coal mining communities, where individuals were out of work. This was um, in 1930 to '32. He uh, went there, a--as an unemployed man, uh, stood in the dole lines. Uh, both he and my mother uh, lived in mining communities in Wales and in the north of England. And they had come out of a very traditional Norwegian, Lutheran and Methodist, uh, tradition in western Iowa, but as a result of their experiences, uh, in these very depressed mining communities in England, saw the work that the uh, Quakers were doing in terms of relief, in terms of personal rehabilitation, um, a variety of activities. And they were so very very um, touched, uh, by that particular, um, commitment. And when they, uh---my father's graduate work was at Yale--and when they returned to New Haven, uh, continued to develop uh, an interest in--in Quakerism and found uh, likeminded, uh individuals, uh, among them interestingly enough, uh, Roland Bainton, who is the great uh, authority on Luther, who was a congregational minister, but had a great proclivity for things Quaker and uh, he was at the divinity school and there were several others. Um, so they started a--a meeting, a prepare--had a preparatory meeting and then eventually, uh, it uh, came to stand on its own. SMOOT: Hmm. BACDAYAN: So that uh, had its special origins. (laughs) SMOOT: Hmm. BACDAYAN: Yeah. SMOOT: To get back to your education, why did you choose history as a major? BACDAYAN: I think that um, college uh, had always been discussed in terms of uh, its liberal arts, uh, orientation, the um--that it was a--a--a broadening and--and uh, broad based preparation for any variety of uh, life's challenges. And um, so I--I did not go to--to college with a particular vocational, um, interest or--or need. SMOOT: Um-hm. BACDAYAN: And um, so it could've--it could've been any number of things. It could've been English or it could've been history or it could have been political science I--I suppose. Uh, I was--I was not scientifically uh, talented or oriented. I think I probably did well in school--in--in high school--in history and um, being human and wanting to know that I was going to succeed at something I already knew I could do well, uh, probably premised part of my decision there. Um-- SMOOT: Did you take any-- BACDAYAN: I think--I think history is--is a--a marvelously integrative, um, field and uh, well done and with a good faculty who--who has an orientation to be sure that you deal not just with military and political, but also look at questions of historiography and uh--which of course, at--when you start out to be a major you don't even know that such a thing exists, um, and who has an interest in uh--in the social history--um, I wish I could remember the name of the chairman of the history department when I was at Swarthmore, Um, I think it was Mary Robertson, who was very much a social historian. And uh, I think that was uh, a very broadening perspective. SMOOT: It's jumping ahead of the game just a bit, but-- BACDAYAN: Yeah. SMOOT: --you have found history has served you well in the work that you have done since? That type of thought process that you develop, uh, doing historical work. BACDAYAN: I think--I think one would have to say yes. I think that uh, first of all, it provided me with a number of wonderful years of--of uh, teaching experience and association with--with people. But I think always it um, forces one to step back and--and try to have some perspective on events, even--even in--as small a--a microcosmos as--as a university. There--there is always a historical perspective about why things have happened or have been shaped, uh, in the way--the way they are. SMOOT: Let me ask you about your teaching. BACDAYAN: Um-hm. SMOOT: You went to teach where? BACDAYAN: I went, um--from Yale I went to teach in the Philippines. Um, I--I went to graduate school right out of my undergraduate years. SMOOT: Um-hm. BACDAYAN: And I found myself, um, wondering if I was--as I wrote paper after paper and spent hour after hour in the library--if I was ever going to be able to do anything practical in my life at all. And so I decided that I should take uh, a couple of years out and teach, or--or better put, test myself and uh--and have some of that breather space that some others are wiser to take after they have graduated from college, (laughs) before they go--go sailing in for--for more of the same. I um, was not particularly choosey about where I taught, I just wanted--I wanted the time to test myself and I wanted it to be uh, broadening and of interest. So I sought out uh, possibilities in a number of areas of the world, uh, the African Crossroads Program and uh, England and so forth. And unbeknownst to me, some uh, friends who had contacts with uh, an Episcopal church school system, um, put my name in a hopper and I received unsolicited a cablegram, uh, saying that uh, there was a position in an international school in the Philippines, uh, that a letter followed, uh, but kind of hold tight. (both laugh) And um, so subsequently a letter did arrive from the head master who indicated that uh, I had come very highly recommended from people whom he--he knew and respected and uh, that they had a position. Uh, and the terms were that uh, they'd pay my round trip airfare and um, a small monthly stipend of uh--I think it was about twenty-five dollars-- and with all my room and board needs met. And of course I would have to be a house mother and I would teach whatever they wanted me to teach, but for starters it would include ancient history, modern European history, American history, sixth grade English, um, and uh, knowing- -knowing that I was trying to test myself (both laugh) and be--never having really taught or knowing what--what degree of preparation all of that required, I thought it sounded like a great idea. (both laugh) SMOOT: So they presented you with quite a challenge, didn't they? BACDAYAN: That's right. And uh, so I did go and in the--in the course of that year, I uh, met my husband, who was a teacher at this school. Having um--he having um, grown in an area that the Episcopal church, um, had a mission to and after he had graduated from the uh, University of Philippines, had uh gone back to--to uh, give some service, uh, to the uh--the church uh, school system there. So we were uh--we were married at the end of that year and uh, subsequently came back here for him to pursue graduate study, uh-- SMOOT: Now, here meaning Connecticut? BACDAYAN: To--no, to the United States. We went uh, for a year to Hartford, Connecticut where he took a master's in education, uh, at Trinity College, which is an Episcopal Church school with some anticipation that uh, we would go back uh, for him to--to un--undertake an administrative career in the school system there. In the course of that year, he became acquainted with um, a Zulu anthropologist, who was teaching at the Hartford Seminary Foundation and having grown in a tribal area, which uh, anthropologists occasional trek through and ask uh, probing questions and so forth, uh, he realized that he had uh, both a very special um, interest and--and insight, uh, uh, uh--a native insight--into many of these things. And so we proceeded at that point, then to um--for him to undertake graduate study in anthropology, which uh, started out at--then the following year at the University of Pittsburgh and subsequently we moved to Cornell, where he finished up his doctorate and which is where I um, taught in the senior high school system. SMOOT: Okay. BACDAYAN: A great place on earth. (both laugh) Wonderful--yeah. SMOOT: After that, what did you do? BACDAYAN: Probably um, as a--as a part of uh, those years at Cornell, which were from 1962 to '67, um, two of those years were his field research years. And he had a London-Cornell fellowship and we returned to his area, to his uh, home area in the Philippines and uh, by this time we had a s--a small son and I was also expecting our second child. And I went and lived--uh, stayed in his home village in Banga 'An with his family. Uh, we lived independently, but uh, I had all the support uh, of--of his family being in that area. And uh--while he went to study a neighboring tribe, uh, the Kalingas, uh, and to look at their uh, uh, primitive legal system and its um, development, uh, under conditions of acculturation once uh--once the Americans had penetrated the area in the early 1900s. Um, so we were there for two years, uh while he carried out that research. He would be gone for three weeks, four weeks at a time and would come back. And during that time, uh, probably--uh, there were many, many things for me to do, aside from--from looking after two small children, uh, in this--in this uh, wonderfully primitive village. Um, I became involved in um, a pilot project for family planning. At that--the Philippines as a whole is 85 percent Catholic and very, very traditional. But the tribal areas, which have not been touched by either the Spaniards or the Catholic Church, were the areas that the American Protestant churches chose to proselytize when the area opened. And uh, there uh, in 1964 or '65, the Lambeth Conference of the Episcopal Church, um, indicated a--an--interest and support for the concept of family planning. And so within--within hours I guess, the word went out (laughs) and around the world, that uh, Episcopal uh, missions and churches and so forth should uh--should look into this. Well, the--the uh, Episcopal clergy and church workers, in that uh, area, being sort of encapsulated in--in this larger Philippine, uh, Catholic, anti-family planning epoch, really didn't have very much information. I didn't either for that matter, but you know, perceived as a--as a progressive uh, westerner, they assumed that uh, I must know something. Uh, (both laugh) so they--together there was a small mission uh, hospital, about an hours' hike from where we were, that had a physician. And uh, the physician and the local minister, who was uh, progressive and open-minded, and I, uh, proceeded to put together a uh, a pilot project that would uh, be something that could be critiqued and so forth, uh, for the rest of the mission areas. And we did uh, a lot of uh, traveling to remote areas. We found that we had really to meet with the old people because the young people weren't really able to do anything unless the elders said it was all right to think about these things. Um, we did uh, household surveys, uh, to establish um, what kinds of--of mortality, uh, people were experiencing and why they--why they thought they needed to have or to try to have twelve to fifteen children. And it turned out that the average number of children per family was eight--average number of births. Average number of living was three, average number of um, dead children was five, and so it really quickly became clear that um, nobody was really interested in limiting their families, because so many children died-- SMOOT: Hmm. BACDAYAN: --that if you didn't just keep having them you were not going to have heirs, you were not going to have helpers, you were not going to have uh, what's considered culturally to be the most valuable asset that you have. And so our program broadened very quickly to uh, look at nutritional, uh, to say, well, that's true, uh, but you know, spacing is going to make your children stronger and then if you also look at what you're feeding them and so forth, uh, that you will have greater likelihood of survivors and heirs and so forth. Was--that was a very, very interesting experience for me. And then I--earlier I told you I--I wasn't scientifically endowed, but again being--being a westerner, uh, the school teachers in the local schools perceived me as--as knowing everything about technology and--and (laughs) uh, scientific method and so forth. So I--I did put together, um, again, a series of uh, weekly workshops for them on how to teach science, uh in a situation where you had absolutely no equipment and their--their feeling was, we're so poor, we have nothing, we can't teach science. But I did find uh, a book uh, that UNESCO put together after World War II for war torn countries in Europe, which was how to teach science without--in--in devastated situations. Um, and of course so much of it is--is uh, observational and--and putting together, um, um--well, just developing strategies for observing what's--what's around you. Uh, but they also had a great deal of equipment in terms of bottle caps and things to collect specimens in and so forth. We had a lot of fun and that was--that was very rewarding for me. I really--really enjoyed that. Um, and I think it was a very special time for our children who saw--who saw birth and death and funerals and um, the whole--the whole gamut of uh, life's uh, trials right--right there at their fingertips. And I have often wondered how or if that particular experience and--and a later one that we had uh, going back with them, really will affect their own sort of adult attitudes and child rearing practices and um, so forth. Um, then after uh--after Cornell--well, we came back from that particular um field--field trip and uh, my husband wrote his dissertation and then uh, the year after that we came to Kentucky in 1967. SMOOT: Why did you come to Kentucky? BACDAYAN: Uh, well, he--my husband uh, got a job here uh, with the anthropology department. A um--the chairman of the anthropology department here at that time was an individual who had come from Cornell and whom my husband had assisted as a graduate assistant. SMOOT: Um-hm--okay. BACDAYAN: And um, so among--among--at that time, interestingly enough, there were still lots of options, um, but uh--unlike the job market now that's really--really uh, narrowed down. Kentucky had at that time both uh--in the anthropology department is very uh, strong interest in applied anthropology which was Cornell's forte and of course the individual that came here uh, had that--had that interest. Uh, secondly, they were uh, just starting to think about a Ph.D. program here and the individual again, um, the chairman, uh, was very interested in modeling it on the program at Cornell and uh, I think--I think my husband had a--a very strong and good feeling about the less structured approach that Cornell took to its degree, that uh, he was interested in--in contributing uh, to uh, developing for a Ph.D. program here, And thirdly, there was a very--at that time uh, the Patterson School, it was actually the Patterson School, it was a separate entity--had as its director uh, um, a man by the name of Butz, who had a very very strong uh, southeast Asia interest and there was, at that time, an apparent uh, thrust towards developing a--an interdisciplinary southeast Asia program here. So all of those things together, uh, sounded like--like a good mix. Things--things did not proceed with the Patterson School or with--with that program thrust and so that uh--that kind of faded. But that's why we chose Kentucky. SMOOT: What were your first impressions of Kentucky? BACDAYAN: I think one of the things that uh, sticks out strongly in my mind as a--as an outlander coming here was that our--our neighbors were very quick to tell us that Lexington had been a very nice community uh, until I.B.M. and--and President Oswald came, (Smoot laughs) We heard that many, many times and of course we were a part of the--the people being recruited, but that didn't seem to phase them, And um, so it was- -it was very clear to us that there was uh, an established, um, local uh, population that um, was feeling a little--a little pressure, uh, from the changes that were--were being visited on it. Uh, the ot--the other interesting thing is that um, probably the very first question that people always asked us was, what church do you go to? That had never, ever happened, uh, in any of the other places that we had lived and--and--and they were many and diverse and both here and abroad. And uh, so that was an interesting um, perspective that uh--I think um, I would have to say, first of all, we--we have really enjoyed, uh, Lexington. It has been a very nice place to raise our children. Uh, that was really uh--of course another one of those considerations that every--gets factored in when you're choosing where to--where to take a job. And we have enjoyed the uh, many opportunities we've had here. I think, I would have to say that as our children have grown and we have looked more and more at the community from their perspective, that it is still an exceptionally homogenous community and that um, in terms of the life and vitality, uh, that comes to a place with a more cosmopolitan um, population, um, and probably especially for children growing, who--who need to see that diversity--all children who would benefit from that diversity, but also, you know, especially perhaps our own children, who were a part of that diversity. Um, I think--I think the homogeneity is a little--can be a little suffocating. SMOOT: Um-hm. BACDAYAN: And um-- SMOOT: What did you tell them, by the way, which church you went to? (laughs) BACDAYAN: Oh! Well, they always--we--we told--I--we told them that we were Quakers and um, that usually rocked them back on their heels because-- SMOOT: Um-hm. BACDAYAN: --many--many individuals um, either had not heard of the Society of Friends, uh, or didn't know that there was a group--and still don't know that there's a group, uh, a meeting in town. SMOOT: Um-hm. BACDAYAN: And uh, it--it's sort of a conversation stopper, I would have to say. (both laugh) SMOOT: Yeah, you usually figure somebody to be a Baptist or a Methodist-- BACDAYAN: Right--that's right. SMOOT: --in this area, although there are certainly lots of other-- BACDAYAN: Oh, there--there-- SMOOT: --denominations represented. BACDAYAN: --oh, there certainly are, yeah--yeah. SMOOT: Probably better--we better clarify that-- BACDAYAN: Right. SMOOT: --for whoever (laughs) hears that you mentioned it. Um-- BACDAYAN: Right. SMOOT: What--what started your association with this Medical Center? BACDAYAN: Well, it's an interesting um--I suppose being in the right place at the right time. This--the uh--in 1971--no, let's--let's step back a bit here--by 1970, uh, we had been away from the Philippines, um, since 1966. It doesn't seem like a very long time, but we--we realized that our children were, uh--who were very young when we left, our son was um, five and our daughter was not two yet, um, that they were asking questions about their family there and we felt that we really wanted, uh, to have an opportunity to uh, refresh their--their uh, identification and their--their uh, knowledge area. And uh, since my hus--husband hadn't been here very long it certainly was not time for a sabbatical yet, so we decided that um, we would take a years' leave of absence and just go. And being an anthropologist one has somewhat the privilege of--of uh, (both laugh) of uh, working in almost any kind of environment and there were certainly many things to follow up on, uh, both in terms of uh, his--his uh, law study there as well as um, ethnographic research on his own people that he hadn't done when we were previously there. But uh--and once we're there it's basically a subsistence existence, so that--we didn't see that as a problem, what we needed was boat money, And um, so I began to ask around, uh, about possible employment opportunities just to uh, earn enough--enough boat money. Uh, by this time the teaching--they were not taking applications in the school system, they had a glut of teachers. Uh, I had been uh, very much involved in--in setting up and then coordinating um, five preschools in the inner city for children who could not afford to go to private kindergartens or preschools and uh, for whom Head Start uh, did not have enough accommodations. Head Start had only two hundred and thirty slots or--or something in that neighborhood. And yet there were probably at least a thousand children who qualified, uh, particular age span, under a certain income level. So uh, I had spent pretty much from 1967 to 1970 uh, operating these preschools in the inner city, but that was a--a volunteer effort. And--simultaneous with that, I had uh, joined the League of Women Voters and that was a very, um--that's a wonderful organization to join in any town because you immediately get to uh--get to study, uh, the local political scene. And I had made a friend, uh, in the league, uh, whom I bumped into and um--in reviewing what was up with our families and what our interests were, I said, by the way, I'm--I'm looking for boat money. And she said, "Well, I--my goodness, you know, the department that I work for at UK is uh, looking for a uh, research assistant--or an editorial assistant, and uh, why don't you come in and uh, talk to the--this person." And so I rang up and made an appointment and uh, I went to meet with Bob Straus. And very very quickly, uh, we shared a number of things in our--in our background and, you know, he coming from New Haven and um, having--having grown up there and uh, having gone to Yale and actually uh, his--his particular kinds of interests, uh, had uh, very strongly overlapped with my fathers and there were many colleagues in--in common and so--and so we had a very--a very uh, congenial and-- and uh, good conversation, uh, and basically that was the point at which I entered the UK system because I was hired to uh, help him edit uh, his materials on Stoney, who was the uh, alcoholic whom he had followed over a number of years, and he just had mountains and mountains of uh, all this wonderful correspondence which needed um, analysis and uh, it needed to be put into a--a framework--a framework for analysis. And I was launched on that, first--first to digest all the uh, (both laugh) all the correspondence and then to uh, uh, work with him. SMOOT: What were your impressions-- BACDAYAN: On that, and uh--and-- SMOOT: --of Dr. Straus? BACDAYAN: Of Dr. Straus--wonderful, uh, warm person. My first impressions I'm not really sure. I can't--I can't remember. I was delighted to have the uh--the position. I think--I think the impression and the attachment and the respect, um, and the depth grow as you work with him because he--he's very methodical, uh, patient, thorough, accepting (laughs) and you--you--you learn those things and you--you appreciate them, uh, in his style of work because after one had worked alone for a week or two weeks on something, then I would turn it in to him and I never got anything back with a note on it or even with his um, editing on it. We always got together and we went line by line, section by section. Um, I mean there was nothing that was done on a--on a sort of remote control basis. Uh, and it's a wonderful kind of working relationship to have. And uh, so you learn--you learn so much more, um, doing it that way than uh, just by getting the conventional kind of feedback that uh--that an employee would get on that. Um, so that was--that was uh, 1970 to '71. And then we did in fact take, uh, that year off and went on the boat, (laughs) took three weeks from San Francisco to Manila. And um--but he indicated that he hoped that I would come back to work for the department when we returned, which uh, I was delighted to do. And uh, he--he--he'd done a little homework (laughs) while I was gone, but we--we picked right up uh, where I-- where I left off, uh, and continued to work on--on that manuscript. SMOOT: In the capacity as a research assistant? BACDAYAN: Correct. SMOOT: Okay. BACDAYAN: Yeah. Then, as a part, uh--well, there were--there were other things happening in the department--one of the things that I think he found, uh, was that the hospital, in particular, would come to the department, uh, with a variety of problems. And because of the name behavioral sciences, uh, they were really looking for some--some very applied, practical kind of uh, advice or interpretation on--on a situation. And I think that, uh, on a great number of these problems, they were--they were clearly good problems for the hospital to be concerned about, but they were not problems which had the potential for developing a--a um, long-term uh, research or--or professional line of interest for the full-time faculty members who are in the department. But clearly, he um, wanted appropriately to be responsive and of service to the broader institution and so in a sense, I became a service arm for the department to um, other elements of the Medical Center. And in that capacity then I did many, many studies, um, both for the hospital and uh, for the dean, uh, of the College of Medicine and uh, on other occasions uh, I spent a--a year or two (laughs) on special project assistance to the chancellor and so forth. Um, and I think--I think that was good for the department, uh to be able to offer that service; it certainly was a tremendous education for me, yeah. [Pause in recording.] SMOOT: You mentioned that you worked for the--the deans and the chancellor, now, was this uh--this would be Dr. Bosomworth that you had been working for? BACDAYAN: Correct, Um-hm. SMOOT: Okay. BACDAYAN: Um-hm. SMOOT: And which deans? BACDAYAN: Uh, Clawson. SMOOT: Okay. Kay Clawson. BACDAYAN: Kay Clawson, correct. SMOOT: Tell me a little bit about the work that you did with them. BACDAYAN: Probably um--I myself have even (laughs) forgotten the sequence of these things. On--one of the major uh, tasks was to uh, coordinate the institutional self-study for the last uh, L.C.M.E. uh, accreditation, uh, that the College of Medicine had. And that is an eighteen month to two year process with numerous uh, self-study committees uh, set up to look at every--every uh, dimension of--of operation. Uh, Dr. Heller was the uh, principal, uh--was the director of that process and I, uh, was uh--I worked directly, uh, for him. That was also a very good working relationship because Lynn was uh, very supportive and um, open to suggestion. Uh, I was--I was privileged to have that kind of uh, supportive person to both encourage me and to work with. But that gave me, um--I loved that because I, um, became familiar with virtually every--every department whether clinical or basic science. All of the people who were on the committees--it was a, um--although a College of Medicine uh, self-study, there were representatives from the university who sat on all the committees and um, it ranged um, all the way from uh, getting--getting together the materials that uh, people needed, uh, helping to do s--a statistical analyses of departmental operations. Uh, in many cases it meant writing a draft committee report that people could--could shoot at and say, no--no we absolutely didn't uh, mean to say that. Um, plus uh-- coordinating, getting all-- SMOOT: Um-hm. BACDAYAN: --all the--all the people to the right places at the right time and making sure that all of the, uh, volumes and volumes of uh, material in preparation for that were ready and then, of course, the- -the uh--managing the site visit itself. Um, in early 1980, probably- -or maybe in '79, uh, Dr. Bosomworth undertook a, um--extensive educational program for the entire Medical Center. Uh, he called it Preparing uh, Academic Health Centers--or Issues Facing Academic Health Centers in the 1980s, and this uh, was three prong; clinical, research and educational issues, there were uh, committees established uh, in each of those areas. Uh, Dr. Straus headed up the uh, education uh, committee for that. Uh, Dr. Cowen headed up the clinical dimension and uh, Roger Lampson headed up the uh, research committee. That uh--that was truly a full year's work, uh, with people identifying what those issues were and trying to put uh, UK in context of where we were nationally with respect to those issues. Um, I think probably, uh, aside from the self-education that went on in all of those, that one of the most significant pieces of information that was developed for that was an analysis done by Howard Bost of the intent of the original legislation for the Medical Center with respect to indigent care. Because uh, at that very time, uh, the hospital was facing virtual bankruptcy and uh, we had not come to grips with the problem of--of how to render all the care that everyone expected us to render and which traditionally had become our responsibility, uh, and which traditionally no one else had chosen to pick up because it didn't pay very well. And Howard put together um, a good historical assessment of--of the um, governors' commissions and the original legislation and the original charter and the planning documents which made it very clear that uh, this Medical Center would provide care incidentally to meeting its principal missions of education and research, that it would be a by-product of those missions. And that of course, some of the people who would receive care, uh, would be those who could not afford any other kind of care and therefore we would be a part of a statewide system which would try to address the problems of uh, indigent health care. And of course certainly the programs, the educational programs, that we would undertake would try to orient people towards the primary care kinds of uh, needs that existed. Um, through uh, whatever mechanisms, the--Governor Chandler's enthusiasm for uh, the role that the Medical Center would play in serving, you know, Eastern Kentucky constituents and so forth and--and other providers' uh, uh, reluctance to--to either become identified with indigent care or--or to, you know, uh, undertake the losses that that would mean for their operation. I don't know, but it became very clear that um, there had not been, uh, this intent in the formal documentation-- SMOOT: Um-hm. BACDAYAN: --of the mission of the Medical Center. SMOOT: Do you have a copy of that uh, documentation? BACDAYAN: Yes--yes, I do. SMOOT: May I see it. BACDAYAN: Yes, I--I'll get it for you. SMOOT: Let me ask you about this question of bankruptcy with the hospital-- BACDAYAN: Um-hm. SMOOT: --or near bankruptcy-- BACDAYAN: Um-hm. SMOOT: --I-- BACDAYAN: Right. SMOOT: --should clarify that. Was that due primarily to the problem of indigent care or was that a part--was that a part of the cause for this danger of bankruptcy? Was there something else perhaps? Was the management of the Medical Center's university hospital-- BACDAYAN: Um-hm, um-hm. SMOOT: --questionable at certain points or was, was there--were there other problems, in effect? BACDAYAN: Well, I think--I think that the--the principal contributor was, uh, an out of control, uh, (laughs) indigent care problem. SMOOT: Um-hm. BACDAYAN: And um, the reimbursement, uh, for all hospitals, including us, uh, had been cost based, uh, and so in--industry wide there had not been, until really just recently, uh, the--the kind of close scrutiny, uh, of--where efficiencies and economies and so forth really could or should be introduced. And um, I think the one thing that the uh, prospective payment system under Medicare has um, shown everybody, uh, and basically that is that we'll give you a set amount to take care of patient X, see what you can do within those parameters. Um, maybe you don't need to do all of those tests, maybe one instead of three. Uh, more--more strategically timed or more thoroughly evaluated or what have you would be sufficient. Um, so that um--that particular reimbursement uh, change in the Medicare program, uh, I think, although it--it terrified virtually everybody, uh who'd been used to operating under a different modality, uh, probably came at a very good time because it meant that um, everybody had to take a very hard look at how they were going to make do, uh, with the very, very constrained payment. And uh, although not all third party payers have--have gone in the prospective payment mode, they have all threatened that they're going to. Uh, Medicaid and--and Blue Cross and--and other third party payers are saying, uh, you know, that's the way to go. So that everybody, uh, has been very busy getting their uh, examining glasses out and um, so, I uh--I think it's a--a combination of uh--the ot--the other thing that really hurt us and it was a very short, in a sense, a sh--a very short window. Um, it's not--it's not just the free care that was being given, but it was the um, care which was being given under the Medicaid program which the state consistently, uh, cranked down. They--I don't--I can't remember the year, but they, in order to manage their budget, indicated that they would not pay for any patient who had a hospital stay over fourteen days. Well, it's true that the average length of stay for patients in this state was five days or six days or what have you and fourteen seemed most generous I'm sure to the uh, bureaucrats sitting in Frankfort. They were probably saying, now, who in the world would stay fourteen? Well, the fact of the matter was that we had a neonatal intensive care unit here, where the average length of stay was twenty-three days, where it was a thousand dollars a day, where we had some patients that were staying four months, six months, eight months, um, and where fifty percent of our babies were Medicaid. You know, the low birth weight babies, the babies born to low income families, who are low birth weight because there hasn't been proper prenatal care and so forth. So, uh, one of the--the major--major blows to solvency was this--this uh, fourteen day limit that Medicaid imposed. There are very few states that have anything more stringent than that, I think there are one or two. As a matter of fact, uh, the original limitation I think was twenty-one days and then--and then in a cranking down they moved it to fourteen. It is still at fourteen. And the problem is that we are the comprehensive tertiary care hospital for Eastern Kentucky, so the sickest patients come here. And uh, to this date, we have not been successful in trying to get the state to provide any kind of uh, waver or exemption or special consideration to the fact that uh, a very high proportion of our patients, um, are going to stay over fourteen days. SMOOT: How do they take care of that problem then? That--that is to say, how--do these pay or is that just written off? BACDAYAN: It's just written off. We--we wrote off twenty-nine million dollars in care last year, which was a combination of free care--the-- the truly indigent, uh, plus what we didn't get reimbursed for over the fourteen days, plus what's called contractual allowances, which means that both Medicaid and Medicare will come in and say, we'll pay you 80 percent of your standard charge. Well, wh-- SMOOT: Where is the other 20, right? BACDAYAN: It--right--right. And uh, until now, we as well as all other hospitals shifted some of that cost to other third party payers and said, well, if you're a Blue Cross patient then your charge is, you know, um, going to be X, which--which incorporated some of those unrecovered charges from other--from other accounts. But uh, Blue Cross isn't interested in doing that anymore because their premiums were getting so far out of sight that they weren't competitive with other insurance companies. And everybody wants a discount, all the HMOs and so forth around say, we'll give you all of our business if the hospital charges only uh, 80 percent of (laughs)-- SMOOT: Um-hm. BACDAYAN: --you know. So it's um, basically our--our alternative sources, uh, to--to shift those costs are drying up. SMOOT: Um-hm. Who was the hospital administrator when you, uh, were working, I guess wi--really with the Department of Behavioral Science? BACDAYAN: Right. Judge Calton. SMOOT: Okay. BACDAYAN: Judge Ca-- SMOOT: Tell me-- BACDAYAN: --lton. SMOOT: Tell me a little bit about him. BACDAYAN: I don't really, uh, know very much about him. He was, um, I thought a very open person who had--who had the uh, good sense to--to reach out and ask for some kinds of uh, external uh, professional appraisal-- SMOOT: Um-hm. BACDAYAN: --of uh, situations. When I--when I did do my work I--I ended up working more closely with uh, some of his, you know, associate administrators who had responsibilities for some of the departments--or for the departments, uh, that I was working in. Um, so I--I really can't say-- SMOOT: That's fine. BACDAYAN: --say very much. SMOOT: Who succeeded him? BACDAYAN: I think there was um--Mr--Mr. Butler, who is currently the hospital director, was uh, his associate-- SMOOT: Um-hm. BACDAYAN: --administrator. And I think Frank was acting director-- SMOOT: Um-hm. BACDAYAN: --uh, for a while. And then uh, Mr. Schmauss, David Schmauss, was recruited, um, as the next hospital administrator. SMOOT: Um-hm. BACDAYAN: And I'm not sure how many years he was here. I think it might have been--I think it might have been three-- SMOOT: Um-hm. BACDAYAN: --years. Uh. SMOOT: Okay, let me step back. BACDAYAN: Um-hm. SMOOT: You became an assistant professor in the college--or in--in the Department--of Behavioral Sciences. BACDAYAN: Um-hm. SMOOT: When was that? BACDAYAN: In 1976, let's see, I--I had worked in the department from '70 to '71 and then from '70--then we were away '71, '72, came back as a research associate-- SMOOT: Um-hm. BACDAYAN: --in '72 to '76. And in 1976, uh, we went to Cornell for my husband's uh, sabbatical and we were there for a year. And at that time having uh, had a practical exposure to a number of hospital uh, administrative problems or hospital operational problems, I thought that I would take the year to take as many courses as I could at the Slone School of Hospital Administration in the graduate school at Cornell. So that was--that was my activity for the year, there at Cornell, to try to fill in the gaps in the--and get a more um, systematic framework for looking at what I'd been looking at. And um, it was at that point that when I came back, uh--or before I came back--Dr. Straus uh, called and asked if I would be interested in teaching in the department. Uh, the college, I think, uh, was recognizing that medical students had an insufficient uh, introduction to, or appreciation of--of health care system organization, uh, delivery issues, uh, health economics and so forth. And I think uh, Dr. Straus, in his uh, astuteness, uh, saw that as not only an area that, you know, I had interest in and I was in the department, but it was another area that the department could be of service, uh, in the curriculum. And the freshman course--the uh, medical school freshman course--in the department had always been, um, a course that all of the department members participated in, partly to--because of the range of their skills and interests and he wanted to make sure that the students were all exposed to, you know, the psychologist and the anthropologist and the sociologist and so forth. Um, so it was a natural, uh, place to add yet another component, uh, that--that they ought to be exposed to. Uh, so that was when--when we came back then in '77, that was when uh, I was uh, awarded that appointment and began teaching, uh, in the department. Um, looking not strictly at--at health care organization and delivery issues, but trying to uh, look at how different types of health care settings and the nature of the organization and the reimbursement system affect physician behavior--their prescribing habits, how they interact with patients, how much time they spend with them, uh, what kind of follow up they're likely to give, whether in fact patients uh, put a high premium on continuity between physicians, you know, if you're going to work in an HMO as opposed to a fee for service practice, also to look at how different types of practice settings affect the quality of care, not only just their behavior, but the quality of care they render, uh, whether group practice is better than solo practice, which is better than partnership, uh, uh--or hospital based or--or what have you. Uh, I loved that. Uh, the literature was growing, it was, uh--I would have to say that probably, um--while I am enjoying what I am doing now and uh, am constantly gaining new skills--that uh, I do miss that uh, academic uh, preparation and--and constant searching and the direct--the very very direct feedback that you get from students. SMOOT: When did you--when did you step out of that academic setting over into-- BACDAYAN: I came over here in uh, May of 1981. SMOOT: Okay, okay. In 1981--well, the early eighties in fact, but especially in the '81-82-- BACDAYAN: Um-hm. SMOOT: --recession, okay, we had a big recession hitting the county. Lots of people seemed to become indigent (laughs) all of a sudden, huh? You were working over here in-- BACDAYAN: Correct. SMOOT: --in the hospital. Uh, and it had been determined earlier, if I'm not mistaken, that uh, something had to be done about the large number of indigents flocking to the Chandler Medical Center, as opposed to any other health care facility in the state. Now, was an increased burden noticeable during this early eighties period? Or was--was the management there starting to put into effect the uh, guidelines or recommendations of the report-- BACDAYAN: Um-hm. SMOOT: --coming from Dr. Bost and others who had been involved with this re-evaluation process or this-- BACDAYAN: Um-hm. SMOOT: --clarification process? BACDAYAN: Clarification, that's a good--good term, right. There--at that time, um, there were two things happening. One, the hospital undertook uh, a master planning process, which was trying to look at--from a program perspective, and a long term uh, facilities um, perspective, what we would need to do in order to uh, be able to have state of the art uh, medicine, both--both for teaching and--and for uh, patient care. And as a part of the, uh--that master planning process, uh, it became very uh, evident that we would never be able to underwrite uh, a facility modernization, much less expansion, uh, given the proportion of indigent and Medicaid patients, uh, or contractual allowances that we uh, had, both with our Medicare and Medicaid population, as well as the other write-offs. And so, there was an attempt to identify what th--proportion of Medicaid patients we could continue to serve, but not, first of all, bankrupt ourselves and secondly, generate a little fund balance that could go towards uh, debt service for the mod--for a modernization of the uh, hospital. And those, um--those percentages, uh--the--the--the best percentage was that we should have probably no more than 10 percent Medicaid patients. At that time we were running anywhere between 25 and 30 percent of our total patient load. Uh, we knew that 10 percent was totally unrealistic and so we looked to 15, uh, as a more uh, acceptable, from--from our own conscience point of view and--and from a practical uh, standpoint. Uh, over the number of months of working with that and so forth, we realized that 20 was probably a little more realistic. Uh, and every time you up that, that means you have less potential for a fund balance and therefore anything to pay on a debt service. Uh, the--the people who came and who needed care, you--you cannot turn them away. And we did--we did refine our uh, system, our intake system to the extent that we uh, assured everybody that any patient with an emergency, who needed emergency admission or emergency care, regardless, would always be received. But, you see, up to 50 percent of our patients are in that category, all right--uh, that if the patient uh, was not considered emergency, or emergent, um, then we would do everything we could within our means to uh, schedule them, but to get uh, some kind of--uh, to get them enrolled in the Medicaid program or to--to work out some kind of uh, payment arrangement. So, you know, there--there is a certain amount of elective and a certain amount of delayable kinds of things--care that people need, uh, that um, could be appropriately dealt with that way. Uh, we--we monitored that very, very closely, um, both whether patients were meeting the emergent uh, criteria as well as how individual departments were doing. Some--some consistently exceeded their quota of 15 percent, others uh, managed to live well within it. Um, but overall, it uh, became a--a uh, target that we simply could not deal with, we--or that we simply could not uh, meet. And we, uh--I don't have the exact figures right- -right today, but we are still running in the neighborhood of 30 percent Medicaid patients. Um, in the meantime, other--some other kinds of--of strategies, as I have pointed out earlier, um, scrutinizing other kinds of economies have--have been put into effect. Um, your question was, did I see an appreciable increase, I--I don't know that, to be--to be the, um, case. We were very, very busy, uh--although it's a social--a society wide problem and there may well have been more people falling into that category, uh, we were very very busy um, maintaining our own sanity and our own solvency. Um, but Dr. Bosomworth, uh--again, growing out of this sort of master planning process and--and the, uh, realization that we would never be able to do anything here, uh, if we continued to carry that load, uh, established the Health Care Access Committee, which uh, Breton Jones was uh, appointed chairman of and there was uh, state officialdom representation and local officialdom representation and so forth. And uh, you probably have a history of that from somebody else or from some other source, but that was a--a yearlong process of--of basically holding open public hearings for people to come talk about, um, uh, where the system was--[beep]--was failing them. [Pause in recording.] BACDAYAN: I think that the uh, Health Care Access Committee then was very instrumental in getting the issue into the papers and as to--to become a--a focus of public discussion. And I think has--has uh, really achieved the um, goal of--of getting public awareness. The Kentucky Medical Association, of course has--has um, undertaken uh, a program to give uh, physician services to those who qualify and--and there's a very nice cooperative relationship which has been set up with the state to--to qualify people. Um, the inpatient--the hospitalization uh, piece of it is still hanging out a little bit. Um, the--the concept of fair share, which was coined early on in the health care access meetings where it was pointed out, often that uh, the Medical Center would really like other folks to do their fair share, um, that's-- that's a phrase that's--that's persisted and uh, the Health Care Access Committee, uh, put together a--a fair share uh, program which is based on each hospital agreeing to um, take a percentage equal to or greater than uh, the amount of charity care--the average amount of charity care given in their region. I don't know what the definition of region is. Um, but that--that would significantly increase what all hospitals were expected to do and--and could significantly decrease what was expected of--of uh, us in this--in this region. Um, I understand that there have been uh, not a lot of hospitals who have agreed to this. I don't know the proportion, but um, there are some--some uh, systems, uh, that have not agreed. The--the proprietary systems have not agreed to do that and--and other non-profit uh, hospitals have not jumped on the bandwagon. So it's still a problem. SMOOT: Um-hm. BACDAYAN: It's still uh, a statewide problem. But we're--I think we're doing--we're doing better. Uh, I think we feel--feel good that we're- -we're both um, able to continue to give uh, a substantial amount of--of uh, free care to folks who need it. And we know we have a very special role in--in this part of the state, so we're glad to do that. But financially we're--we're looking a whole lot better too. So-- SMOOT: Let me ask you about the--your relationship uh, with the Department of Behavioral Sciences and with the hospital, to ge--uh, you've had--uh, you've had an opportunity to work with physicians in the making-- BACDAYAN: Um-hm. SMOOT: --and physicians, no doubt, since-- BACDAYAN: Um-hm. SMOOT: --you've been over here. BACDAYAN: Um-hm. SMOOT: Various levels. BACDAYAN: Um-hm. SMOOT: And one of the goals of the Department of Behavioral Sciences, at least from my understanding of it, was to create a--a greater degree of social consciousness among physicians coming out of medical school so they would have a--a broader view, a community view, uh, with responsibility-- BACDAYAN: Um-hm. SMOOT: --and understanding those responsibilities would take a greater role in the community and in uh--then their own bailiwick, whatever it may be. Uh, how successful do you think that behavioral science idea, concept has been--at least from your own-- BACDAYAN: Um-hm, um-hm. SMOOT: --experiences? BACDAYAN: Well, first of all, most of the faculty here have not been trained here at Kentucky and so they may or may not have had that component as a part of their training and of course for so many of the students, um, their role models are the fac--the clinical faculty in these other departments. So, I think that the department has undoubtedly had um, a significant influence on the students who have gone through. And I know that um, many of them have said in their clinical years, their third and fourth years, uh, "Boy, I wish I was having that kind of course now, because now I'm really dealing with patients. I didn't recognize or appreciate the significance, uh, my--my first year." That has prompted, uh, an effort to try to--to get some time in a very, very crowded and a very traditionally um, defined medical school curriculum; it's prompted the effort to get some time in the clinical years when there would be a um--whe--when there is a greater recognition of the problems of dealing with individual patients and where some of that kind of assistance, uh, in--in uh, patient management would be--would be helpful. Um, I know that Dr. Straus chaired a um, curriculum--a major curriculum revision effort, uh, in the last two years and I believe, but it would need to be verified, that that kind of adjustment in the time that the department has--or--or the--the point at which the department has an opportunity to interact, uh, has been--has been uh, introduced as a part of that curriculum change. I think that's very, very important. I think that students, um, who have--have left and gone on to uh, residencies in other places, uh, have given uh, testimonials to Dr. Straus about the significance of that in their--in their practice behavior. I think that as with all students and with all teachers and with all subjects, some like it a whole lot more than others and some are much more predisposed to add that perspective and dimension to their whole, uh, armamentarium of--of analytic skills and others really could care less, um, you know, an attitude that they reflected in class just--they just carry with them, right on through. So I--I would have a hard time uh, making a general--a general assessment. I would have to say, whether it's due to a humanities course or a behavioral science uh, course or practicum or what have you, that I am constantly amazed at the tenderness and humaneness and, uh, I would almost have to say vulnerability, uh, of many of the physicians that I have worked with. Um, in situations where I would have said, oh, they've seen thousands of these, you'd think they were--would be calloused, you know, their- -both their feelings and--and uh, attitude would be calloused, uh, toward certain situations and uh, they're not. Just--just amazing personalized, uh, sensitive interactions that I--that I have observed and um, and those are special people and for every one of those I'm sure--I'm sure there are others (laughs) who uh, are unaware of their callousness, um, and who haven't been sensitized. That isn't a very--a very, uh, straightforward assessment of the impact of a particular, you know, department's influence. Um, but I think it's important, I think--I think that uh, many schools do it in many--in many different ways, be--the--the behavioral sciences or that dimension is sometimes, uh, a part of a psychiatry department. There are colleges of medicine that have psychiatry and behavioral science departments, uh, there are colleges that have uh, medicine and humanities departments, um, and whatever it's called, it's very, very important for a--for a medical school to have that opportunity for those that are so inclined to--to get their feet wet and to--to understand what some of the resources are and to--to have supportive people say, you're absolutely right to feel that way or to--to want to hold that patient's hand, (laughs) you know. Well, I was going to say that um, the department is also a very important training ground for people in the basic science departments of anthropology, sociology and psychology on the depar--in--on the uh, main campus. Uh, so that individuals who are going to continue doing basic research in medical sociology or medical anthropology or what have you, need the opportunity to have colleagues over here or uh, faculty over here who have both the--the entree into this environment and who have um, a more continuous interaction with clinical faculty which your--your basic anthropology faculty would not have. So although anthropology gives the anthropology degree, we need this uh, department and the anthropologists' presence over here to uh, provide that training ground for--for those other departments. [End of Interview.] Carolyn Bacdayan (Associate Professor at University of Kentucky Department of Behavioral Sciences) went to the Philippines to teach at an international school, where she began working on public health and demographic issues. In this interview, Bacdayan describes coming to Lexington and becoming acquainted with the Medical Center as an editorial assistant to Bob Straus. She discusses later assignments, cost and expenditure studies she researched at the Medical Center, and how that influenced thinking about shared responsibility in the health care industry. In addition, Bacdayan discusses the impact of the behavioral sciences emphasis on the students in the Medical Center. insert here