On the reservation

Charles and associate dean Sue Odom had visited the reservation earlier to set up contracts with the hospital and other health care agencies there, but they found the hospital in a state of confusion and change.

“Instead of treating patients, we did a lot of observing and assessing the culture to learn the challenges of delivering health care there,” said Charles, Ph.D., RN, CNE. “Later, I realized that our students could practice their clinical skills anywhere. We had to figure things out as we went along, and we got to really listen to people talk about their life on the reservation. That was a good experience for nursing students.”

The words the Lakota people used most often to describe their history were “cultural trauma.”

“Pine Ridge has eight times the U.S. rate of diabetes, five times the U.S. rate of cervical cancer, twice the rate of heart disease and eight times the rate of tuberculosis,” Charles said.

With an alcoholism rate estimated at 80 percent on the reservation, one in four infants is born with fetal alcohol syndrome.

“The life expectancy of a male ‘living on the rez’ is 45 years, which is the lowest life expectancy rate in the U.S. and Western Hemisphere,” Charles said.

Staying in a retreat center of the Mucasan Presbyterian Church, the Georgians toured the hospital and talked with administrative staff at Pine Ridge. They also met with members of the Indian Health Service.

The students made home visits with a public health nurse, did rotations in acute and outpatient facilities, spent the day with a school nurse or worked briefly in a free clinic. They learned more about Native American history by visiting Badlands National Park, the Black Hills, Mt. Rushmore, Wounded Knee and the Crazy Horse Memorial.

“At first, I was kind of disappointed that we didn’t get to do more hands-on nursing,” said Catherine Davis, a senior nursing student. “I was hoping for more interaction with patients who live here, but I think we’ll build those relationships in time. I know the university wants to go back. What we did was a major community assessment and talk about how that impacts health care.”

Limited resources

The reservation is big (almost 3,500 square miles), but the roads are mostly dirt.

“When it rains or snows, it’s all mud and the people call it ‘gumbo,’ ” Davis said. “There’s only one hospital and one grocery store, but there are lot of little gas station stores with high prices. Their access to health care and other resources are so limited compared to what we have in Georgia.”

Susan Wiggins, president of Clayton State’s student nurses association, remembers passing shacks or trailers without windows or doors, thinking them abandoned, only to learn later that families lived there.

“It was very windy and cold, even in May, and I don’t know how they survived the winter,” Wiggins said.

She found the people to be friendly, but reserved. “There’s a certain cadence to the way they talk. We tend to blurt out our answers, but they would pause and consider exactly what they wanted to say.”

The Clayton State students had lunch with nursing students from the reservation college and learned that the school’s curriculum incorporated Native American philosophies along with modern medicine. Most planned to practice on the reservation.

They also witnessed an 8th grade graduation ceremony that included decorating of graduates’ hair with feathers, Native American dancing and smoking of sweet grass.

The image of a little girl coming to the school nurse to have her hair combed has stayed with Wiggins.

“It was cold and she was wearing shorts, a tank top and flip flops,” she said. “It was obvious that she had gotten herself ready for school.

“Later, she came in to borrow a sweater so that she could go outside for recess. It made me appreciate how important a resource the school nurse was for children who didn’t have the best home life.”

A white nurse midwife on the reservation gave Wiggins a valuable lesson when she said “culture is never wrong.” She explained that it’s important for nurses to understand how patients see things before they work on common health care goals with them.

“I think a nurse always needs to keep that at the back of her mind. Just because someone’s culture is different doesn’t make it wrong,” Wiggins said.

Culture shock became learning experiences for the students. For example, broken-down cars in yards weren’t signs of neglect, they were a source of income. Families sold old auto parts to make some money.

“I came away with a lot of compassion for these people, and I’m very glad I went,” said Adelene Panlilio, a senior nursing student. “It was eye-opening to see how different their health care system was from ours. A nurse needs to see and understand different cultures.”