Building Trust at the Pine Ridge Indian Reservation

— Submitted by Carol Sullivan, PhD; photos by Devin Gamundoy, DO

At the Pine Ridge Indian Reservation in South Dakota, a medical team set up a health fair and visited various sites on the reservation, offering free medical services to the nearby Lakota. The health fair was staffed by thirteen RVUCOM second-year medical students, three physicians, one administrative assistant, and two volunteers. This annual event was organized by Camille Z. Bentley, DO, MPH, FACOFP, Chair for the Department of Tracks and Special Programs and Director of Global Medicine Track and Global Externships. It was staged at Porcupine School and offered screenings, labs, and educational services for all ages.

In addition, there were health presentations for students in sixth, seventh, and eighth grades. In one presentation, RVU students handed out felt-backed pictures of various human organs—heart, liver, stomach, intestines, and gall bladder. Mike Klepadlo, OMS III, wore an illustrative vest that showed the location for each of these organs. As students affixed each organ to the vest, they called out answers about its function. In small groups, they used stethoscopes to listen to heartbeats and abdominal sounds, checked each other’s reflexes, and explored other medical tools.

Despite the services offered, turnout was relatively low. The Pine Ridge Indian Reservation has historically dealt with issues where the health of its people is concerned. Mistrust of outsiders (which includes healthcare providers) is inherent due to many generations of mistreatment. “It makes perfect sense that [the health fair] would have a lower turnout because we epitomize the issues people in Pine Ridge already have with health care professionals,” said Nicholas Chapman, OMS III. “It is hard to build trust in a culture without demonstrating that you will be a lasting presence in the community. Hopefully, we’re building something for future trips.”

Nevertheless, students had the opportunity to work with patients and offer valuable medical care. A.J. Olson, OMS III, who had attended the health fair last year as a first-year student, relished how much knowledge he had gained since then. This time, he assessed a patient from “head-to-toe” and felt comfortable in advising her about stress levels and emotional wellness. He counseled her to set small health goals, such as walking more often, eating more fruits and vegetables, and cutting back on intake of Coca-Cola. He also taught her breathing techniques to relieve stress. During the visit, the patient opened up more as she sensed that the health fair could offer more than just a simple screening. SD Olson credited his successful patient encounter to advice from Dr. Bentley: “Take a step back and listen. There is opportunity to hone your listening and observation skills, learn if and why the patient is scared, let the patient feel heard, and make a plan that fits the patient’s lifestyle.”

Amanda Andersen, OMS III, examined a female patient, took her health history, checked her blood sugar, and—after consulting with Phil Sullivan, MD, emergency medicine specialist—used OMM to treat her back pain. The patient later explained how the screening and consult had been extremely valuable, in part because she could not take leave from work in order to see a physician during normal clinic hours.

Conner Roggy, OMS III, met with a 52-year-old man whose father had died of a heart attack at age 74 and whose mother had hypertension. SD Roggy discussed the value of exercise for those at risk of heart attacks. He also explained about the frequency and types of immunizations, as well as the benefits and risks of other health screenings such as colonoscopies and EKGs.

Seeking to understand health care delivery on the reservation, RVU students visited Pine Ridge Hospital, which is part of the Indian Health Service. The 45-bed hospital serves a Lakota population of more than 17,000 and is the largest in the Great Plains Area. The 16-physician staff sees medical, obstetrical, pediatric, and surgical patients. One physician explained to the students about how he must break through a wall of patient mistrust again and again: “Patients don’t care about your ‘standard of care’ and they don’t care that you care about their aftercare.”

A community cooperative, Thunder Valley Cooperative , is offering systematic positive change, powered by the residents themselves. The organization is building better housing, developing the community, and creating a more reliable health care system by encouraging residents to participate more actively. Sharing a meal and conversation are leading to effective participation and decision-making from residents rather than outsiders.

Moving forward, Dr. Bentley said the RVU students and volunteers will focus more on health education, cultural exchange, and historical exposure. “As much as I am open to other cultures, being competent is understanding our own biases, then acting appropriately,” she said. “This learning process goes on forever.”