Today may have been our most productive day since coming to Cass Lake. Ben Dropkin and Jidi visited the Indian health advocacy specialist at Sanford Hospital (staying for half-a-day each), while Ayo and Margaret shadowed providers at Cass Lake Indian Health Clinic. Sanford is a gorgeous hospital with 118 beds located in Bemidji, particularly in contrast with the local socioeconomic situation as we know it. Vikki Howard is the advocacy specialist, and she couldn’t have been more warm and generous in taking the two of us around the hospital and showing us the different departments, introducing us to providers and patients, and explaining to us the local state of health care as well as various aspects of Native American culture, language, and history. For example, it is believed by many Indian patients, particularly the elderly ones, that we are constantly surrounded by spirits, both good and evil; the good ones, which include deceased family members and friends, must be welcomed, while the evil ones need to be warded off with much effort. Similarly, it is believe that traditional medicine, such as different types of plants, need to be worshipped and communicated with in order for them to be effective; as Vicky said, “We need to build a relationship with the medicine, before it works for us.” The entire session with Vikki offered an insightful perspective on health care from the nurse and social worker’s side, as well as a fascinating and honest introduction to the Ojibwe culture.

Post-shadowing, the four of us grabbed a quick bite with the one and only Shawn O’Leary and his dad at a casino restaurant (where Ayo had a stack of BBQ ribs to warm up for his actual dinner at a Chinese buffet 2 hours later). Afterwards, we got working on the real reason why we were at the casino: to run a blood pressure screening for the casino patrons and (covertly) perform motivational speeches. After much confusion in the beginning with the security guard as far as who we were and why we were there, we got a table set-up in the back for the casino employees, and a table upfront across from the main entrance to catch the patrons as soon as they enter. We worked from 6~8pm, and screened more than 50 people of all ages (that can legally enter the casino). We even (almost) got a couple of people to quit smoking for good (no guarantees, but we did our best.) I suppose it wasn’t a surprise that just about everyone smoked, some even while pregnant or with young children at home. Interestingly, folks who had hypertension were much more reluctant to participate, while those who know that they have healthy BP were much more eager to join us. I suppose it is human nature to want to ignore problems that you know full-well exist and try to pretend that they are not there by not partaking in activities that blatantly remind you that, yes, you indeed have those problems and that they carry serious consequences.

Alright, enough blogging for one night. It is 10:28pm as I type this sentence, and we need to be up at 6am for a presentation for middle schoolers on measures one can take to eat more healthily (clearly a major lifestyle challenge for many if not most local residents that we’ve encountered.) Good night!


Happy Pi Day!!! – from Bois Forte

Today Tony and Mildred went to the Vermillion Clinic, which is a small clinic about one mile away from the Fortune Bay Hotel and Casino. We shadowed Dr. Charles Helleloid and had the opportunity to see some dental procedures. This facility only has two exam rooms, one of them only used for simple surgical procedures. The staff can also draw blood, but they have to take the samples to Nett Lake in order to analyze them.

Here in Vermillion, we were able to interact and learn from Ojibwe patients that belonged to every age group: children, young adults, adults and elders. It was an excellent experience to be able to observe what a whole day runs like. As stated before, we also saw a couple of dental procedures. Both of them involved anesthesia administration. This was actually pretty interesting, for we got to review the anatomy we learned on winter term (yes, superior and inferior alveolar nerves, long buccal nerve and the mental).

<The Vermillion Clinic>

We had lunch offered by the site, delicious food, which was prepared not only for them, but specifically for the Vermillion elders.

After visiting the clinic with Dr. Helleloid, we went outside to a beautiful 60°F weather. Behind the clinic was the frozen Lake Vermillion with its 365 islands. During the winter, the ice can be 3-4 feet thick, enough for trucks to drive on. Shawn O’Leary’s uncle, Bernard drives 20 miles on conventional roads to get the mail. With the frozen lake, he can take a short cut and drive 6 miles.

<Lake Vermillion>

            After taking a few photos of the lake, we walked a few feet from the clinic towards the Vermillion fitness center where Bernard works at. The facility, built in 2006, includes a gym, a basketball court, a sauna, zumba dance classes, and a recreational center for youths. The facility is free for all native Band members. For $30 a month, 24 hour access to the facility can be obtained. In addition, the Vermillion fitness center awards a pair of Nike running shoes specialized for Native Americans for every 52 miles walked. Bernard has a won a few pairs already.

<The Vermillion Fitness Center>

We then talked to Bernard about life at the reserve. He noted that one of the coldest temperature recorded in American history took place in Tower, MN at -60°F in February 2nd, 1996. He remembered a time where it was so cold, that when he went to spit, it froze in mid air and cracked on the ground. He also mentioned that the Hull-Rust-Mahoning Mine, the largest open pit iron mine in the world, was nearby in Hibbing, MN, providing a quarter of all the iron ore mined in the United States during World War I and II.

Bernard also spoke about how hunting is a favorite past time of Native Americans. He helped with hunting a 2000 lb moose that was outside the Vermillion clinic in the snow. Bernard’s co-hunter readied his rifle and fired. The moose survived the shot; angrily charging towards Bernard, its head lowered, its antlers readying to impale its attackers. Bernard’s co-hunter fired again, only to discover that he was out of ammo. Bernard threw him a shell and the hunter reloaded faster than he ever had in his life, pulled the trigger, the moose fell, sliding towards them. After that encounter, Bernard and 5 other friends came to prepare and clean the moose. Bernard shared the meat with his friends and family, noting the importance of sharing in the tribal community.

Meanwhile, Sara and Mai went back to the Bois Forte clinic to shadow Dr. Ray Hawk and the maternal care nurse practitioner. Shadowing Dr. Ray Hawk is an excellent example of how rural health works. He knows every one of his patients at a personal level, and remembers the patients’ last visit as if it was yesterday. He knows their family and occupational history as if he was talking to one of his friends that he hasn’t talked to in a few months. The ailments that he sees in the clinic is not necessarily any different from what we see in New Hampshire. He even has patients who call in to say that they “dropped their pain medication in the dish water.” Which are the same exact problem that clinics have in NH as well. The only difference we’ve noticed is that the majority of patients are native, and that diabetes are more likely to be on top of the physician’s minds as they look at patients.

Sara spent the morning shadowing Jill, the maternal health nurse practitioner (NP) and Paula, the medical lab technician. Jill also goes to the Vermillion Clinic once a week to provide care at the satellite location. As the only maternal health NP in the reservation, she provides health care to a wide range of patients – from infants to post-menopausal women. One thing we have seen over and over again at the reservation clinic is that people have more than one hat. They try to cover a lot of ground with the limited amount of employees they have. They only have one lab technician that runs all the tests and if she is not in, then the nurses have to extend themselves. Or when they didn’t have a pharmacist, the physician had two hats. Even with the overload of work and responsibility, they try their best to provide the best care to their patients. The doctor-patient relationship here is truly a dynamic one.

In the afternoon, Sara and Mai met with Marybelle again to listen to a recording of Gene Goodsky telling the story of how the ancestors came to Nett Lake. We sat in Marybelle’s kitchen and listened to the recording on cassette tape. In the beginning of the recording, Gene described how geographic names such a “Mississippi” and “Chicago” came from Ojibwe words. Mississippi means “big river” and Chicago means “skunks.”

The group joined back together in the afternoon to visit the heritage museum.

At the entrance of the museum, there was a collage of Ojibwe people. We were able to identify Loretta in the mural, with whom we had dinner last night.

The museum showed us the history of the Bois Forte band, starting from how the people settled, which was the story that we heard from the recording of Gene Goodsky earlier in the day. The museum also had dioramas of teepees, and the boarding schools that the older generation of Ojibwe were sent to. Seeing the dioramas helped us have a better image of the history that we’ve been listening to throughout the trip.

<People lived in Wigwams in the past>

<Mai and Sara being studious at the boarding school exhibit while Tony daydreams>

Today is actually a very special day for us. It is March 14, 3.14…. Pi day!!! So of course, we had to go find pie. Terri told us earlier in the morning that the Village Inn in Virginia is the place to find over 20 different kinds of pie.

Which we happily devoured.

Team Cass Lake

Monday March 12th

Tonight, we were in America – or at least what Ben Dropkin thought to be most of it. We drove through Choppowa national forests and saw two eagles and 2 white herrens.
We partook in the culture of the quintessential Midwest, as represented by the taste of Golden Light. Ultimately, we chose to go to applebee’s, expecting an outrageously large quantity of food, at an outrageously low price. This is what we found.
Our neighbors of twenty-odd students from Bemidji State University celebrated the wonderous occasion of the birthday of a colleague with the killer deal of five-dollars of burgers, wings, or pitchers. Maybe not, but that’s what we did. Now the four of us are back at the super 8 motel room, being thankful for our lives in Hanover. Room 123.
We started the day with a tour of the minoayawin clinic and had a chance to speak with health workers about the health care state of the area and the strives they have made since their establishment in the 1980’s. The program had some very innovative treatments, including brain wave synchronization therapy. We had the chance to listen to presentations by the local diabetes and lifestyle health care specialist about the prevalence of diabetes and obesity affecting the local tribe members, as well as the from the clinic managers about the epidemiology of Native Americans. It was a very productive and informative session for everyone, and we have gained new-found respect for the local health care providers for the difficulties they have to overcome on a daily-basis.
After grabbing a quick bite at Erbert’s and Gerbert’s, we headed to the Ojibwe school that teaches grades k through 12. We were given a tour of the school by a crew of high school students and their mentors, and a few us even got a chance to be interviewed by the school radio station. We spent the first part of the afternoon giving a talk on synthetic marijuana, and another on how to go about getting to college; subsequently, we divided into 4 groups, and gave fun presentations on cells and muscles to the kids from grades 5 to 8. We even got a chance to do some fun physical examination bits, listening to the heart, tapping for knee reflexes, and what not.
Meanwhile, a few students took a observatory trip to the local substance abuse center called Mash-Ka-Wisen; a treatment center owned and operated by Native Americans that uses cultural practices in the treatment of chemical dependency.

Team Cass Lake

Tuesday March 13th


We spent today at two very different clinics that serve Native Americans in the Cass Lake area.

Cass Lake IHS is the primary care facility for Indians on Leech Lake Reservation. It also runs a dental clinic, and a pharmacy. Internists, family med docs and pediatricians work in coordinated teams with nurses, pharmacists, and social worker. The want to have a mental health provider on each team, but they can’t recruit them. Right now they have a social worker who is trying to cover mental health for the whole clinic.

In addition the lack of access to mental health care, we also asked about detox facilities for alcoholics. We found out the only facilities in this part of the state is several hours away, and often full, so they have to send patients home if their withdrawal symptoms do not justify admission. They also have to come up with transportation to the detox center in many cases.

Sanford Clinic Bemidji is a private hospital 25 minutes away from Cass Lake.  Patients are referred to Sanford from both the Cass Lake and Red Lake IHS facilities.

Some students shadowed Vikki Howard, an Indian Advocate who serves as a social worker for Indians, who make up 25% of the patient population, and a cultural awareness educator. Vikki gave us a presentation about Ojibwe healing traditions.


Then we ate Mexican. It was good.

“Where the grass is green and the river is flowing” -update from Bois Forte

“Did you pass by the accident on route 53 this morning? “ That was one of the first things that we were asked this morning as we stopped by the gas station for breakfast, and when we arrived at the clinic. This was concerning the accident that we passed half-way to the reservation. News travels fast in the Bois Forte band. Everyone in the community knows each other’s news, and know one another from childhood. For example, the clinic manager Ray Hawk, gave nurse Terry her immunization when she was a baby. Now they work side by side at the Bois Forte health clinic. The Bois Forte health clinic was established around 2006 to fill a gaping hole in health care for the reservation. Until then, members of the reservation had to drive 20 miles to get to the nearest health clinic. Since opening, the clinic has expanded twice, and they just installed their x-ray machine last September.

When we arrived at the clinic, we were separated into two groups. Two of us got to shadow a doctor, a physician assistant and the diabetic educator at the Health Clinic. The clinic facilities are located in a new building. They are actually attached to the head start and elementary school, making it easier and convenient for children to make it to their regular checkups and appointments. We had the opportunity to meet several patients and get a good insight about what rural health is all about. It was very interesting to not only get the cultural experience, but also to open our perspective on what healthcare is all about.

One of the most compelling aspects about working in this small community is the fact that the clinic staff is not only there providing services to the people, but they are also family members and close friends with their daily patient population. Thus, the doctor-patient relationship and communication is built on multiple dimensions. Patients are more open to their providers, and because of this, they are able gain a better understanding of the disease processes.

The other two of us went to the human services portion of the clinic. Mai talked to Teri, the public health nurse to see the WIC (woman infant care) in action. Unfortunately, both the scheduled patients cancelled for the day. This gave us time to talk more about the WIC program and the issues attached to them. The most recent challenge seen in the program is that a few women in the program used the vouchers to buy baby formula only to return the formula for money. The nurses are now considering the possibility that domestic abuse is the reason why these women are not keeping the baby formula. Domestic abuse is an issue on the reservation that is present, but not addressed.

Sara spent most of Tuesday morning with Laurie, a Community Health Representative (CHR). Laurie is one of two CHRs at the Nett Lake community health center. They do Elder home visits, deliver medications and transport patients to medical centers. There are days when she easily puts 250 miles on her car driving back and forth. There is also an Elder Nutrition Program that provides meals for the Elders. Elders want to be independent, live on their own for as long as possible before entering nursing homes. It was amazing to see how much the people at the reservation tried to help the Elders be as independent as possible. There was a strong community feeling, very different from what we are used to seeing. It wasn’t just the children taking of their own elderly parents but the whole reservation taking care of them as one big family.

Throughout the morning, the four of us got stared at whenever residents passed us on the street. In this small village, we are unfamiliar visitors. During lunch, we were approached by Brandon Benner. News that there were four Dartmouth Medical students were touring the clinics today had spread to the tribal council, and Brendan approached us to invite us to see his dancing regalia and visit the government building.

In the afternoon, Terry gave us a tour of the headstart program and the school. The school houses grades K-8, with about 12 students for every grade. All the students start learning the Ojibwe language from a young age so that the can be fluent when they grow up.

Bois Forte is possibly one of the warmest and friendliest places we have ever had the privilege of visiting. The people here are very welcoming. After our serendipitous meeting during lunch, we took Brandon’s invitation to the tribal council. Brandon took us on a tour of the Bois Forte government center, giving us a small taste of the extremely rich Native American culture. Brandon presented to us the costumes used during Native American dances, such as his war bonnet as well his plethora eagle feathers. In addition, Brandon demonstrated a wise Native American value through the use of torn eagle feathers. He explained that although one torn eagle feather may be imperfect, when combined, they become flawless—a metaphor for the importance of teamwork.

After giving us gifts of Bois Forte T-shirts and mugs, Brandon showed us photos of generations of brave Native American veterans who fought for America, from World War II to the Gulf War, including our own Shawn O’Leary’s grandfather, Thomas O’Leary. Afterwards, we went outside the Government Center, where in the back there is a memorial for the Native American veterans with the engraving “Forever Warriors”.

Bois Forte is also referred to as “Nett Lake,” and the reservation is located on the shore of the lake. We took a walk around the lake and listened to stories from Shawn O’leary’s father. We are lucky to have come during the winter while the lake is still frozen, because the Bois Forte code is that stories are not allowed to be told when the lake is thawed. At the lake we saw Spirit Island, which is a sacred island for the Bois Forte band. The golden stems of wild rice that was not harvested at the peak season was able to be seen in the distance.

In the evening, we had the opportunity to have dinner with two elders, Marybelle and Loretta. Both of them were born on Bois Forte, but moved away after high school. They both returned back to the reservation in the last 10 years. The two gave us insight on reservation life and told us more Bois Forte stories. They also described how life was for their parents who were forced into boarding schools and were banned from using the Ojibwe language. As a result, they never learned the language or many of the tradition as they were growing up. Their parents did not want to pass on knowledge that can harm them.

We still have a couple more days in this reservation, and hopefully we will get an even deeper insight on the Indian Health Services. We are looking forward to shadowing nurses in maternal services, and taking a look on what dental care in Bois Forte is all about.

From Fortune Bay Resort Casino- the Bois Forte group has arrived!!!

After a long day of Nah-gaa-chi-wa-nong clinic visit and visiting the Ojibwe school, the Boise Forte group is now in Tower, MN. This was of course, after a bit of a detour to try some mid-western Caribou coffee. We got our fill of Mint Condition, Northern Lights, and Berry White Mocha.

The Fortune Bay Casino is a bit more “homey” than the Black Bear casino that we stayed at last night.

This is the perfect situation for us, since this is where we’re going to call home for the next three days. When we got to the casino, we were starving from the long trip. The menu at the restaurant had a few unfamiliar dishes:

Yes, that is a buffalo burger made of real buffalo meat. We’ve also never heard of what a “Walleye” was. Since this is a trip for immersion and discovering new things, we decided to be adventurous and order both.

and we were quite satisfied. Buffalo tasted like a lean version of beef, and Walleye turned out to be a popular fresh-water fish eaten in North Minnesota.