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Students visit Pine Ridge Indian Reservation

Last semester, four members of the nursing faculty at 91�ֿ� at Salem, along with 15 nursing students, headed west for learning opportunities that cannot be taught in a typical classroom.

The group traveled to the Pine Ridge Indian Reservation in southern South Dakota to interact with members of the Oglala Lakota Sioux tribe. The reservation is home to about 40,000 people, half of whom are members of the Oglala Lakota Nation. The average income for a resident of the reservation is between $2,600 and $3,500 a year, meaning that more than 97 percent of the residents live below the poverty level.

Through Indian Health Services, the 91�ֿ� Salem students spent time at Pine Ridge Hospital’s emergency department, obstetrics department, mental health unit and the medical/surgical unit. They also worked through the Kyle Health Center and Public Health Nursing.

Healthcare services are available on the reservation, yet they are sparse, and many of the Oglala Lakota members are left without access to these services. The average life expectancy there is 48 years for men and 52 years for women.

The nursing students also interacted with children and adults in public venues such as the Wounded Knee Memorial, the local grocery store and at a dinner they hosted for healthcare workers from Indian Health Services. During the dinner, a lengthy discussion took place about health, socioeconomic and psychosocial issues facing those living on the reservation.

Lorene Martin, an associate lecturer in 91�ֿ� Salem's Bachelor of Science in Nursing (B.S.N.) program, explained that this was the fourth trip to the reservation by students and staff.

“The relationship between 91�ֿ� and Pine Ridge grows each time we visit the reservation,” she says. “We have secured clinical sites within Indian Health Services at all locations on the reservation, and we also have an ongoing dialogue with the Oglala Lakota School of Nursing. One of their graduates is now in our RN to B.S.N. program.”

The trip was offered to students through a transcultural nursing course taught by Mary Lou Ferranto, Ph.D., B.S.N. program director at 91�ֿ� Salem, who has traveled with students to countries such as Haiti, Tanzania, Canada, Japan and others throughout Europe.

“The purpose of this trip was to engage students with a culture other than their own so that they may begin to gain cultural sensitivity,” Martin explains. “It is of utmost importance that nurses be culturally sensitive and strive toward cultural competence to provide holistic and culturally appropriate care. These trips leave students with a heightened awareness and appreciation of the need for cultural understanding and its application to healthcare.”

The 91�ֿ� Salem students also attended a historical presentation at the Oglala Lakota College that provided a detailed historical account of the Lakota people’s spiritual beliefs and of events leading up to the Wounded Knee massacre.

The 91�ֿ� group hosted a lunch for students in the associate degree nursing program at the Oglala Lakota School of Nursing. Students from both schools met one-on-one to discuss cultural and educational differences between the two settings.

Martin notes that during this most recent trip to the reservation, the 91�ֿ� Salem nursing faculty members were able to establish a relationship with the Pine Ridge Dormitory, a facility where school-aged children, in grades 1-12, live during the week so that they can attend school.

“This is necessary because their parents cannot travel the long distances necessary to get them to school,” she explains. “And this arrangement alleviates some of the financial struggles many parents have for caring for these children. We plan on providing after-school programming for these students on our next trip to Pine Ridge.”

In the weeks prior to the trip, nursing students and faculty collected donations of coats, hats, gloves, boots and scarves that they took to the reservation and gave to children and adults.

It takes a great deal of time to coordinate such a trip and to work out all the details – traveling, lodging, schedules, preparing students, figuring out how to transport the collected items – but all who go report that it is worth every minute.

“This trip changes us, not just as nurses, but as people,” Martin says. “It is an amazing experience. The population of Pine Ridge is steadily growing as members are beginning to return home to, once again, live within their societal values and revitalize their lost cultural norms.”

Joining Martin and Ferranto on the trip were nursing faculty members Janeen Kotsch and Ruth Ann Mullen.

A Student’s Perspective

“This trip exposed me to a side of the human race that I have never seen before,” shares Clayton Poteet, a junior in the B.S.N. program at 91�ֿ� Salem.

As he talked about his experiences on the trip to the Pine Ridge Indian Reservation, Poteet was excited, reflective, somber, more excited and even somewhat reverent. It was a trip, he says, that changed his life.

“It is difficult to fully explain how much I learned by being part of this experience and how the people we met changed me,” he says. “When I see that so many people in our own country are living without many of the things we take for granted – fresh fruits and vegetables, safe roads, technology, medicine – it makes me feel lucky. Yet, I feel confused about how we can allow this to happen in the United States.”

Poteet was part of the transcultural nursing class taught by Ferranto last semester. He explains that the class spent a great deal of time researching the Lakota Oglala Indian Nation and the Pine Ridge Indian Reservation.

“Before the trip, we had many meetings regarding the day-to-day agenda of our trip, the kinds of experiences we would be exposed to and the conditions in which this population lived,” Poteet says. “Still, I was shocked by a lot of what we witnessed.”

He and the other nursing students spent time working in the Pine Ridge Hospital and the Kyle Health Center, which he said was fascinating and eye-opening.

Working with community nurses from the reservation, some of the 91�ֿ� Salem students traveled to the homes of some of the reservation’s residents.

“They were able to experience firsthand the types of environments these people live in,” Poteet says. “Poor. Very, very poor. Other students were able to shadow nurses in the ER, where many of the students broke down in tears after only working half of a shift. These people live under such horrific conditions that it was hard to take it all in.”

Poteet explains that because of poverty, lack of transportation or even beliefs, residents of the reservation often seek medical attention only in dire situations or much too late.

“There is little to no preventive care,” he says. “We saw many people with conditions that started as something minor but turned into serious situations simply because they couldn’t get care early on.”

Poteet shares that one of his most vivid memories of the trip occurred while the group was visiting Wounded Knee.

“We met a little girl," he says. "Her family lived only a mile away from Wounded Knee, in a small trailer with several other family members. She was 12 years old and told us that she wants to be a nurse when she is older. Her family came over to Wounded Knee when they saw our cars pull up to the memorial. They were selling jewelry to make money for food, shelter and heat. She was wearing a T-shirt, light sweatpants and sandals with no socks.

“Keep in mind: the temperature on that day was around 46 degrees, with drizzling rain and moderate winds,” he adds. “Needless to say, she needed a jacket and proper shoes with socks. She told us that she had gone to the hospital a week earlier because a horse had stepped on her foot.

“She removed her shoe and exposed a large wound that was infected,” he continues. “She needed to be seen by a physician and given antibiotics. That’s easy for us to say, knowing that we would have a hospital nearby if any of us were in that situation. But, that wasn’t such an easy thing for this family. We were able to treat the wound, apply antiseptic cream and re-wrap it in fresh bandages. Hopefully, that little girl did not lose her foot, and I hope that, one day, she will be able to become a nurse. She had such a spirit about her and a story inside worth telling. I will never forget her.”

Poteet explains that the group was often placed in very remote situations, which helped him better understand just how vulnerable the people are who live in such areas. He explains that, as they traveled from the airport near Rapid City to the reservation, they drove for miles on dirt roads without seeing any other vehicles, structures or people.

“We were driving on a dirt road for several miles – which felt like a hundred – when we realized that if anything were to go wrong with our cars, we would be stranded,” he says. “We were traveling in new SUVs, with full tanks of gas, unlike most of the other people who drive that dirt road in old, beat-up vehicles. If something were to go wrong, there is no cell phone reception, no gas stations or restaurants, and the nearest hospital was over 50 miles away.

“You start to realize while driving down that dirt road how fortunate some of us are and, by contrast, how unfortunate others are,” he says.

Poteet encourages other students to consider taking advantage of opportunities to learn outside the classroom or local clinical setting.    

“On this trip, I was able to go outside my comfort zone and learn about a population that I knew nothing about,” he says. “Many professional nursing associations stress the importance of cultural competence in nursing practice, and this trip helped us begin our journey toward cultural competency. This trip changed me and my approach to caring for my patients, and I know it changed the others who were with me. We will be better nurses because of this experience.”

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