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In the southwest corner of South Dakota, on the Nebraska border and at the southern end of the Badlands, sits the Pine Ridge Indian Reservation. It is home to the Ogalala Lakota Nation.

This fall, faculty and students from the Bachelor of Science in Nursing program at ����Թ� State Salem traveled to the reservation in what has become an almost annual excursion. The COVID-19 pandemic put a halt to the trips over the last three years, which made this return visit quite significant for members of the group.

Leading the way was Lorene Martin, program coordinator for the BSN program on the Salem Campus. She was joined by Melissa Duvall, BSN faculty member, and 11 nursing students.

The students are all enrolled in the semester-long transcultural nursing course and must complete the health and human services modules on culture before embarking on the trip. The course begins with cultural pre-immersion meetings in which the students learn about the reservation and the Lakota people and then requires them to each make a class presentation.

“The course and the trip are meant to allow students to begin the journey toward cultural humility and understanding,” Martin explained. “I find the Lakota people so kind, welcoming and warm. Every time I go, I leave with sadness when thinking about the plight of this beautiful culture and the abhorrent conditions in which they continue to exist. I also am so fulfilled to watch students begin this journey of understanding and compassion.

“These are future nurses and they must see other cultures through a lens of humility and acceptance. This the just a beginning, but watching their transition is amazing!”

����Թ� Pine Ridge

Pine Ridge is the eighth largest reservation in the U.S. and is the poorest of all. It covers 2 million square acres and has a population of about 20,000 people.  Most families live in small homes without electricity, telephone, running water or sewage systems. The annual median household income is $26,000.

The unemployment rate is 89% and the average life expectancy is the lowest in the western hemisphere (52-66 years for women; 47-58 for men).

The reservation makes up the Oglala Lakota County which ranked 59 out of 69 counties in South Dakota for overall health outcomes (2017). One in four children born on Pine Ridge is diagnosed with either fetal alcohol syndrome or fetal alcohol spectrum disorder.

Approximately 85% of Lakota families are affected by alcoholism and there is a methamphetamine drug crisis, leading to alarming rates of teen suicide (150% higher than the U.S. average), infant mortality (300% higher), tuberculosis, diabetes and death.

Travel log

This year’s trip started in Rapid City, South Dakota, with stops at the local Walmart and Dollar General. Using nearly $2,000 in gift cards (purchased with donations from Salem Campus faculty and students, as well as community members), the group purchased socks, boots, hats, gloves, clothing and personal hygiene items to be given to children at the Pine Ridge Dormitory.

The next morning, the students visited Crazy Horse Mountain to learn more about the Lakota culture and the historical significance of this region.

From there, the group drove to a hotel in Gordon, Nebraska, which is about 20 minutes from the reservation.

“There are no other available, suitable hotels on the reservation for this trip,” Martin explained. “Interestingly, the cultural immersion begins at the hotel. Students were disappointed that there were not more amenities --no pool and no nearby restaurants. The hotel is older and small, but very clean and the owners were very accommodating. Thus begins the understanding of the immersion into this extremely rural, isolated area. No Starbucks!”

The next three days were spent at Bennett County Hospital in Martin, South Dakota. The facility serves Lakota natives with its small hospital, emergency department, rural health clinic and an extended care facility.

The students rotated through each of the units and some were invited on home health visits with public health nurses.

The hospital administrator met with the students and led an in-depth discussion about the disparities and lack of access to healthcare in that part of the country, as well as challenges related to cultural traditions.

One afternoon, the group delivered the collection of donations to the Pine Ridge Dormitory, a facility housing 110 children in kindergarten through 12th grade. Because homes are spread so far across the Pine Ridge area, making daily travel to school almost impossible for most families, the children arrive at the dormitory each Sunday evening and stay until school is dismissed on Friday afternoon.

“Most of the children arrive with nothing more than the clothes on their backs, so the donations of personal items were greatly needed and appreciated,” Martin said. “We were invited to eat in the cafeteria with the children and we spent a great deal of time on the playground and talking with them. We even had a small Halloween party with pinatas, glow sticks and other games.”

Cultural immersion

During a visit to the Oglala Lakota College Historical Center, the nursing students learned more about the history of the Oglala Lakota people, including the colonization of the tribes to the reservation, the stripping of their cultural and spiritual beliefs, the killing of the buffalo and the atrocities of the Wounded Knee Massacre that occurred on Dec. 29, 1890.

The group visited the Wounded Knee Cemetery and the site of the massacre and mass burial. While there, the students engaged in conversations with several Pine Ridge residents who were selling handmade dreamcatchers and jewelry – an important source of income for them.

“As always, I find that we are warmly received wherever we go,” Martin said. “I find that the Lakota are anxious to tell their story and be heard.”

She noted that this part of the trip is always enlightening for students, but the real lessons in social and economic disparities happen during the “windshield survey” that follows.

“We drove into the heart of Pine Ridge and the students did a survey of the homes, available resources, lack of resources and such,” she said. “Then, we went to the only grocery store and they had to compare prices to where we live.”

Through her many trips to Pine Ridge, Martin has become friends with several residents and considers many of her contacts colleagues. One such woman, Patricia Hammond, is Lakota and active in a community garden initiative on the reservation. She met with the students to share her story of living and growing up on the reservation while addressing health concerns and food insecurities of her people.

Hammond led a tour through the “high-tower” gardens on her property and shared her knowledge of traditional herbs and foraged foods while also discussing her work to help build handicapped accessible gardens within the community.

Lessons learned

Martin explained that during the trip, each student must complete a self-reflecting journal entry each day and participate in a daily debriefing. Once back on campus, the students must each submit two journals and attend a focus-group debriefing session.

“The journals and debriefing sessions are aimed at increasing awareness of what they had experienced each day,” she said. “My goal is for them to begin a reflective evaluation of their cultural biases, begin to find humility in the ethnocentricity that they may not have noticed before and to be intrigued enough to further their cultural experiences and education. One thing that I try to make them understand is that cultural competence is a journey, not a destination!”

Cutline A: Students and faculty who traveled to South Dakota this year included (front, from left) Natalie Ammon, Aubrianna Mellott, Karsyn Faulk; (middle, from left) Makenzie Ashe, Ilania Schmidt, Baylee McCandless, Brielle Waugaman, Lorene Martin; and (back, from left) Alexis Rhodes, Chloe Chappell, Melissa Duvall, Paige Adkins, Katie Goodwyn.

Cutline B: Halloween at the Pine Ridge Dormitory

Cutline C: ����Թ� State students at Bennett County Hospital

Cutline D: Learning Lakota history