We arrived late at night knowing that we were expected at St. Francis early the next morning. Quickly getting settled, we peeled off our clothes from the day of work that we had both completed before leaving on the 6-hour drive to the mission. It had seemed inexcusable not to go to help at Rosebud, especially since it was so close to home and also considering that I was to be able to practice as an NP there.
I had volunteered with Remote Area Medical (RAM) before. That time, I was in Appalachia working as a nurse. I spent three days in Morehead, Kentucky working with some admirable people that I’ve ever met on that mission. Having been on some chaotic missions, I was completely dumbfounded by the organization of a RAM mission. RAM provides medical, dental, and vision, even grinding their own lenses for new glasses on site, free of charge. It’s a pretty extraordinary machine, watching this temporary health mission at work.
So when I got the opportunity to travel to South Dakota to work on the Rosebud Reservation with my friend and pediatric nurse, Elise, I jumped at the chance.
On our first day on mission, we left early, but not the usual 5AM RAM days, as we were told that people simply would not show up that early. Grateful for the early morning, we meandered over the hills of the reservation, home to the Sicangu Lakota Oyate, or Burnt Thigh Nation. We drove from the casino/hotel that sat on the southern border of the reservation, to the small town of Mission, then over past the sunflower fields, and down to St. Francis.
As a sovereign nation, the Rosebud Reservation was established in 1889 when The Great Sioux Nation was partitioned. Colonized nations around the world have suffered insults to their culture, and Rosebud is no exception. Poor infrastructure, lack of jobs, and attempts at destruction of traditional cultures by colonizing governments and churches have left communities vulnerable to diseases of poverty, addiction, and the fracturing of traditional family structures.
There have been many indignities forced upon this community historically and even to the present day. As recent as 2016, the only emergency room on Rosebud at the Indian Health Services Hospital was closed due to poor performance for 7 months, forcing people with life-threatening conditions to travel another 50 miles to the nearest hospital.
It would seem that medical help would be welcome, but trust, once broken is not so easily won back. From all accounts, it took RAM three or four years to get this mission approved through tribal council and the tribal elders. Once permission was granted, the mission was arranged to take place at the Jesuit Mission at St. Francis. The Mission currently runs seven programs for the people including a dental clinic which is critical to the health of the community as there is only one dentist for 20,000 people.
As we drove up to St. Francis, we quickly located volunteer registration and headed over to the dental/medical area. When we arrived, we were quickly met by a tiny force of nature, Mary Ann, who instructed us to set up in triage. I soon discovered that RAM had learned the day before that I wouldn’t be able to practice as an NP in St. Francis. The reason for this, it seemed, was that while we were on the Rosebud Reservation, the St. Francis Mission where RAM’s mission was set up was on church-property and thus subject to the state laws of South Dakota. Like many other states, South Dakota has no compact license for providers and no temporary licensure for volunteers (except for dentists).
So, along with Elise and Mary Ann, I spent the first part of the morning packing up speculums for pap exams and breaking down the mini-clinic that had been set up for me. This was a little sad to me for a few reasons. I was the only primary care provider in all of the United States who had volunteered to help. I couldn’t help but be a little disappointed about this, but when I heard there were women in desperate need of women’s health, and here I was with the skill but not with the legal ability to practice, it was tough. Beyond this, I was pretty sure that if we had been able to set up a tent, literally across the street on tribal land, I would’ve been able to practice, but we had not been given permission to set up on the reservation; therefore, it was out of the question.
But this is where experience helps. I thought back to Dr. Castillo in Guatemala who had to negotiate for eight years with the local government and Mayan community before he was able to buy the hospital that he had worked so hard to establish. Communities that have historically been disenfranchised are more than a little wary of people coming in offering their help and suffice it to say, this distrust has been heartily earned in spades throughout the world.
So, I decided to put my disappointment aside, shut up, and learn. And that is exactly what I did.
As tough as conditions are on a reservation with a median family income of $18,673 per year, I’ve rarely met a group of individuals so welcoming. We were fed well and invited to functions to learn about the community. The mission even opened the tribal museum for the volunteers. The museum was full of fascinating artifacts — “winter counts” dating back nearly 200 years on buffalo hide detailing a highlight (or lowlight) of each year, stunning beadwork and clothing, Crazy Horse’s flute, and they even had Johnny Cash’s guitar from his 1968 performance at the St Francis gymnasium with the airline tag still on it.
We learned a lot about the challenges of being Native, and I know that we didn’t even scratch the surface. We were told about the devastating disappearances of Native women that go underreported and uninvestigated. We saw families who laughed and loved their children. We watched grandparents doing their level best to raise their grandchildren. People were working hard to keep their rich culture alive. We even helped rescue a dog — he was quickly named Patches in a discussion with some locals and RAM volunteers. The minute Patches knew that he had a home, he went to sleep next to the feet of the young woman taking him home.
On our last morning in Rosebud, we were standing in the hotel lobby waiting to check out before the mission and a man said to us, “Are you ladies up at St. Francis with the group?”
When we said yes, he proceeded to thank us and tell us that his family had been in for care. As it turns out, Frank is a shuttle driver and a tribal archeologist.
He proceeded to tell us about the museum and how Johnny Cash came to his grandmother’s house when he performed in the late 1960s at Rosebud.
He then began to discuss the tribal artifacts in the museum. The artifacts were gifted to the mission’s first priest, Father Beuchel, who came to the area around the turn of the century. He said that Father Beuchel was loved by the tribe but the subsequent priests took many of the artifacts without permission and they are in the Vatican vaults. This would seem to be tribal property and not only would taking artifact be illegal, it’s would certainly be a violation of tribal trust.
He said there was a “winter count” from the early 1800s (or earlier) that showed a buffalo giving birth to a human child. He said that he hasn’t seen it since the early 1980s, so it also is likely at the Vatican.
He proceeded to tell us about the descriptive Lakota language and how the Lakota word for water was based on the sound water makes rushing through a pipe as their people were said to come from a cave with running water.
Then, he shared with us that the Lakota, Dakota, and Nakota, the people of the Great Sioux Nation, once had land that had gone all of the way from the Ohio River Valley, to North Texas, and up to Canada. He explained that the tribe wasn’t nomadic because being a nomad implies that you don’t have a home. He said that the Lakota people were migratory. They followed the seasons and the animals, but they had a home and this home was much larger than the current-day reservations in the Dakotas, Montana, and Minnesota.
When I went back to the St. Francis Mission that day, they reopened the museum. If something is missing, it’s in my nature to hunt for it. As I understood, the museum rotates its artifacts out annually, but I was going to try to find the winter count with the buffalo that gave birth to the human child. Lo and behold, I found not one, but two winter counts depicting the event. It made me wonder if he really hadn’t seen it or just wanted us to look for it. I am unsure if those were the winter counts that he was referring to, but I was excited and just a little bummed that I had no way to tell him.
Before we had left the hotel and Frank that morning, he thanked us and hoped we’d return.
In marginalized communities, change happens, but only at its own pace and rhythm, and as an outsider, you have to learn to trust that this is for a reason. When entering a community, it’s important to bring whatever skills you can, but then, you need to stop and recognize what they need. In this case, I strongly feel that the building of trust was the most important part of this mission. Some may look at this mission as a failure because I couldn’t practice, but to me, whether we’re invited back or not, I was proud to be a part of what I hope is the beginning of something positive for the community. Either way, this was a mission that I will never forget.