“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.

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White Earth Indian Health Service (Tuesday)

Greetings from White Earth!

Team White Earth consists of Shirley, Emma, Devin, and Francis (aka “the most baller group”).

Today, we got a tour of Indian Health Services at White Earth and shadowed some of their physicians.

We arrived in the morning to meet with Deanna Pepper, a clinical nurse specialist and a quality improvement manager for the US Public Health Services. She gave us a tour of the facility, a surprisingly comprehensive care center for Natives.

The White Earth Health Clinic is a surprisingly modern and high tech facility for such a rural area. Consisting of multiple departments such as family practice, internal medicine, pediatric, dental, optometry, radiology, mental health as well as a pharmacy, the facility provides a tightly integrated, comprehensive array of services. This variety of care is virtually unheard of for such a small, federally supported, outpatient clinic.

As we soon learned, some of the major issues faced by the clinic are the rising rates of diabetes, drug use and suicides amongst the locals. During our tour of the facility, we were recounted the tale of how a grandmother, mother, and granddaughter had all been infected with hepatitis C through the use of unclean needles. A whole family line devastated in an instant through recklessness. Another tale involved the deaths of a mother and child and the rippling effects it had throughout the community. “She was my cousin; she was my aunt; I use to stay with her when I was younger.” In such a tight knit community, where everyone is seemingly connected to one another, sudden losses can have wide spread ramifications.

In the face of rising drug use, the clinic is faced with a dilemma. Do they provide clean needles to the population in order to prevent the spread of disease at the risk of potentially promoting drug use? What will truly help the community becomes a blurry line that is difficult to transverse.

Yet the clinic is far more than just a place of care, it is also a museum. Strolling through the facility, one can’t help but notice the photography, artwork and craftsmanship that line the walls. From past prominent figures in society to celebrations at the annual POWOW festival, the walls exude memories of the past. It’s not surprising to find someone pointing out a place where they use to live or a picture of their grandfather on the walls. If you look closely enough, you may even find a house where angels lurk in the shadows.


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.

Museum tour

Our second day in Minnesota was great. After spending time with the students at the Fond du Lac school, we made our way over to the local museum to soak in a little history of the Ojibwe. Out side of the displays you could find crafts like these that some of the local artisans had made. The amount of detail and precision exhibited by the works was impressive.

Here is a tiny canoe. The same wood (Birch) and design was used to construct this miniature water craft as one would use to make its larger full scale brothers.

The Ojibwe worked hard at any thing they did, as can be seen in this picture. Depicted here is a ranger uniform, an elite branch of the army. Special physical, mental, and psychological traits are needed to be eligible for, let alone pass, ranger school. I think Johnny’s medals and ribbons say the rest. Of note is the required jump medal shown with the wings and parachute in the middle and the purple heart symbolizing wounds during service.

Like other American Indian populations, there exists a proud tradition of service men and women. Dating back to WWII many of the Ojibwe served the American government in overseas wars. A story that comes to mind from the museum tells of a proud soldier that was in the Pacific Theatre. In addition to his wounds he became ill with malaria and contracted “Jungle Rot,” painful ulcers that are infected with microorganisms, contracted after spending months and months in extremely wet unsanitary  conditions in the jungles. It was not uncommon for people to have lost appendages due to the mass erosion of tissue. This would have most commonly occurred during the monsoon seasons that many military personell suffered heavy morbidities and psychological trauma from. Many Ojibwe served in later conflicts such as the Korean and Vietnam wars. Today the tradition is still alive and thriving as military life provides a structure and family that many of the peoples of the reservations have had to grow up with out. A considerable number of the elders I encountered are vets and love talking about it…all you have to do is ask. They are proud of their contribution to America, despite all the despicable atrocities they have endured by the hands of that same government.

Birch trees can be seen all over northern Minnesota. The Ojibwe people have used it for centuries. It is still extensively used in construction, especially in fine carpentry work and is a main wood used in modern skate boards. It is one of the sturdiest woods and yet a pliable wood making it good for shaping.  The beautiful white and spotted bark is not only tough but can be stretched and is naturally water tight. There were countless water tight pieces that the Ojibwe would have used birch to make: ranging from water jugs and rice containers to canoes like the one pictured above. In addition rope and a myriad of other uses can be done with the natural and abundant birch trees. These people took every advantage possible of their resources as can be modeled by the birch tree. Paintings depicting the native peoples often have backgrounds filled with this almost mystic tree. Staring in to a forest dense with the white bark of the birch tree is mesmerizing and feels ghostly.

Presentations at Fond du Lac Ojibwe School

On Monday, we were able to relate synthetic weed, cells, muscles, college, and turtles at Fond du Lac Ojibwe School in Cloquet, MN.

Several of us worked on presentations on those topics (minus the turtles) to present to select grades of the K-12 school. The synthetic weed presentation (topic chosen by the school, not us) was done by Ben Dropkin, Devin, and Jessica to the high school students — which consisted of about 20-25 kids. We talked about its history, what it is, its harmful effects, and had a group discussion at the end. And by group discussion, I mean a discussion between Devin and one student asking a lot of questions.

Jidi and Mai then did a presentation on everything related to college: how to get into college, what to expect once in college, how to finance college, and their own respective experiences.

Afterward, we split up in smaller groups to talk about muscles and cells to the younger grades. The highlight of that part was probably watching the fifth graders entertain themselves with reflex hammers and listening to the sound of their hearts after our “official” presentations.

And now we have to talk about the turtles. Apparently the Ojibwe School is built in the shape of a turtle. During the student-led tour of the school, we were told that we were in the “turtle’s head” or the “turtle’s butt.” I couldn’t quite visualize this until I saw the map of the school:

And how about a 3D model?

The reason the school is in the shape of a turtle is because there is a Native American legend that tells the story of how the world was built on a turtle’s back. For those interested, here’s the story I found on the internet (source):

Many years ago the world had two parts. Animals lived in the lower part, which was completely covered in water and had no land or soil. Above was the Sky World, where the sky people lived. The Sky World had lots of soil, with beautiful mountains and valleys. One day a girl from the Sky World went for a long walk and became very tired.

“I’m so tired, I need to rest,” she said. She sat down under the spreading branches of an apple tree and quickly fell asleep. Suddenly, there was a rumbling sound like thunder and the ground began to crack. A big hole opened up next to the apple tree.

“What’s happening?” screamed the frightened girl. She tried to move but it was too late. She and the tree slid through the hole and tumbled over and over towards the watery world below.

“Help me! Help me!” screamed the girl. Luckily two swans were swimming below and saw the girl tumbling down from the sky. “Come on!” yelled one swan. “Let’s catch her before she hits the water.” “Okay!” yelled the other. The swans spread their wings together and caught the girl on their soft feather backs. “Whew! That was lucky,” said the girl. “But what do I do now? I can’t get back up to the Sky World and I can’t stay on your backs forever.”

“We’ll take you to Big Turtle,” said the swans. “He knows everything.” After hearing what happened, the Big Turtle called all the animals in the water world to a meeting. He told them an old story about soil being found deep under the water. “If we can get some of that soil, we can build an island on my back for you to live on,” said the Big Turtle.

“Sounds good to me,” said the young girl.

The Otter, Beaver and Muskrat started arguing over whom would dive for the soil. “I’ll go,” said the sleek Otter, brushing his glossy fur. “No! I’ll go,” said Beaver, slapping the water with his big flat tail. “I’m the best swimmer,” said Muskrat “I’ll go.”

“Aaaachooo!” sneezed the young girl.” Guys, guys, would just one of you go. These swan feathers are getting up my nose and making me sneeze.”

“Sorry” said the swans.

“That’s alright,” said the young Sky girl.

Then Toskwaye the little Toad popped up out of the water. “I’ll go. I can dive very deep,” she said. The other animals started laughing and pointing at Toskwaye. “You! You’re too small and ugly to help.” Cried the others, laughing.

“Be quiet!” said Big Turtle in a loud, stern voice. “Everyone is equal and everyone will have a chance to try”. The sleek Otter smoothed his glossy fur, took a deep breath and slid into the water. He was gone for a long time before he came up gasping for air. “It was too deep,” he said. “I couldn’t dive that far.”

“Now it’s my turn,” said Beaver. He slapped the water with his tail as he disappeared. After a long time he came to the surface again. “It’s too far” he gasped. “No one can dive that deep.” Muskrat tried next and failed.

“Aaaachoo!” sneezed the young girl. “This is not looking good.”

“Now it’s my turn,” said little Toskwaye the Toad. She took a deep breath and jumped into the water. She was gone a very long time and everyone thought they wouldn’t see her again.

Suddenly Otter pointed at the water, shouting, and “Look, look bubbles!” Toskwaye’s small, ugly face appeared through the water. She spat a few grains of soil onto the Big Turtle’s back, then fell back into the water – dead.

The Turtle ordered the others to rub the soil grains and spread them around on his shell. The grains grew and grew, until a large island was formed – big enough for the girl to live on. It grew into our world, as we know it today. And the descendants of the Sky girl became the Earth’s people.

Today, some people say the whole world still rests on Big Turtles back. When he gets tired and changes his position, we have earthquakes.

Toad has not been forgotten either. American native Indians call her “Mashutaha”, which means ‘Our Grandmother’. No one is allowed to harm her.

Around the entire school on can see safety posters and outreach programs to youths. The schools and reservations have really been trying to increase health awareness and mental health in the past few years. Basket ball is big stuff out at Fon Du Lac, they have a shot at going to state.

Typical DMS picture of students, faces half cut. HAHA 

Today they try to instill the values that were inherent to the Ojibwe prior to the assimilation trials and boarding schools where children lost their identities and sense of community. The ramifications that boarding schools had on these people are still very alive today: chemical dependency, suicide, violent crime, and psychological pain.A fitting representation of Native Americans in their land now engulfed by the U.S.

Arriving in Minneapolis

After leaving Hanover at midnight, departing Boston-Logan at 6AM, and having a layover in Milwaukee, we finally arrived in Minneapolis around 10AM this morning, where we met up with Shawn.

First order of business was stopping by Thea Woon’s house. We were greeted with amazing food and drink — everything from fancy cheeses to kumquats to oatmeal with an array of topping choices. Thea spoke to us about her work in somatic therapy and encouraged us medical students to act as a support network for each other so that we are not always operating on maximal sympathetic nervous system output. She had us think about things that made us happy, smile, and generally feel good.

After a relaxing meeting with Thea, we all drove to meet with Dr. Angie Erdrich (DMS ’94) and her husband, Dr. Sandeep Patel. We were greeted with signs made by their adorable kids.

Dr. Patel made us some incredible Indian food (and shared the recipe for the wild rice dish with us!):

Dr. Erdrich and Dr. Patel are both very dedicated to Native American health and had some pretty awesome stories to share. We also were able to meet some other health providers working on reservations, and at the end, a Native leader led a prayer for us. We were each able to stroke an eagle feather, which is significant to Native peoples, as eagles are a sacred symbol.