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The following reflective essay was written by Lorene Martin, Bachelor of Science in Nursing program director at ����Թ� State Salem and fulltime faculty member. In what has become somewhat of an annual pilgrimage, she organizes these trips to help expand her students’ view of discrepancies in our country’s healthcare system, as well as the extreme differences in social, economic and cultural opportunities among those living in the United States.

As our society becomes increasingly more diverse every day, understanding cultural differences is an important skill for success in both the career world and everyday life. This skill is especially significant for those entering the healthcare field; therefore, the question becomes: What is the best way to teach cultural understanding?

One proven effective method of learning is to immerse oneself into a culture. These annual trips are how we choose to start baccalaureate nursing students from ����Թ� at Salem on the journey of cultural competence.

Thirteen BSN students and two instructors from the Salem Campus traveled to the Pine Ridge Reservation in South Dakota from Sept. 29 through Oct. 10.  This has been an annual trip (pre- and post-COVID) over the past 15 years led by me and former faculty members. This year, I was accompanied by Melissa Duvall, also a full-time faculty at Salem.

On this year’s trip, students engaged in a variety of opportunities through which they interacted with members of the Oglala Lakota Sioux Tribe on the reservation. These opportunities included experiences in the Pine Ridge Hospital; the Bennett County Hospital; the Kyle Health Center; public health nursing across the reservation; the mobile clinic; rural health clinics; and the Pine Ridge Dormitory.

Health disparity, food and poverty are among the many inequities witnessed by the students.

While at the hospitals, students were not expected to perform clinical skills, but they did work with staff and talk with patients. The students rotated through all departments in these facilities, including the emergency department. Historically, students in the emergency room deal with adolescents and teenagers with suicidal ideation and/or suicide attempts. This year was no different.

The trip began with an overnight stay in Rapid City, South Dakota. While traveling to the reservation, the group stopped at the Crazy Horse Memorial. There, the students learned the history of the Lakota people and viewed Native American artifacts.

Over the next eight days, the students experienced full cultural immersion on the reservation. One exercise included a trip to a grocery store for price comparison. Before their trip, students received a list of food items so they could check prices in Ohio which they then took to the ONLY grocery store on the reservation to compare prices.

It was there that the true interaction with the residents of the reservation began. The students witnessed many people standing outside the store, asking for food and money. This is often an overwhelming experience for the students but allows them to begin understanding life on the reservation.

The experience with public health nursing is often the most impactful for the students because they actually entered homes on the reservation. It is not unusual for these homes to have no running water, no electricity, boards on the windows, and to be inhabited by 10 or more people. Students are often in tears after this experience.

One student reflected: “Even though I have been on this trip and have seen a lot, I had not been in a house on the reservation. I have never seen living conditions like this.”

We also visited the Pine Ridge Dormitory where children, ages 5 to 18years old, live so that they can attend school. Some students are only there Monday through Friday, while many others stay seven days a week because their families are unable to take care of them at home. These children often arrive at the dormitory with nothing, so we have provided donations of personal care items, clothing, school supplies and small toys. We have done this for several years.

This year, students spent two days in a community garden setting with Patricia Hammond, a Native American who grew up on the reservation. She talked with the students about life on the reservation and taught them about native plants and medicinal herbs, and took them foraging for these items. She also invited a Native American gentleman to the garden who played the drum and sang a prayer from the sacred Sun Dance.

Students visited the Oglala Lakota College Historical Center where they learned the story of the Wounded Knee Massacre through an audio tour of paintings and pictures. Following the presentation, students traveled to the Wounded Knee Memorial Cemetery and Massacre site.

Often, residents living near the cemetery are present to sell homemade jewelry, dreamcatchers and other items. This is their only source of income for most. As it was on past year’s trips, this experience left students emotionally raw and quite disturbed.

As the trip was nearing the end, we traveled through the Badlands on our way to Rapid City. This allowed students to witness, again, why farming on the reservation is difficult because of the poor soil that makes up a great deal of the land. Additionally, this provided the students with a much-needed opportunity for relaxation and fun!

This year, students also attended the Black Hills Pow Wow. This opportunity not only allowed students to witness the traditional dress and dance of the Lakota, but also to experience what being in the minority actually feels like.

Another student reflected : “The racism we experienced was unexplainable. Knowing what it feels like to be the minority is something we will probably never be exposed to again. We were the only white girls in the entire arena. … This has really encouraged me to be more aware when in public when it comes to people outside of my own race. I think that, often, we all find ourselves experiencing biases even when not meaning to.”

My goal for students who make this trip is for them to begin a reflective evaluation of their cultural biases;  begin to find humility in the ethnocentricity that they may not have noted 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!

Plans for next October’s trip are already underway and several of this year’s students told me that they plan to go again!

The following are just some statistics that help define the status of Pine Ridge Reservation:

• Multiple people live in small homes, often with leaking roofs, broken windows and no running water or electricity;
• Median household income is $26,000 per year;
• Poverty rate is 53.7%;
• Unemployment is 89%;
• Average life expectancy is the lowest in the Western Hemisphere: Women at 52-66 years; men at 47-58 years;
• Tuberculosis cases are 800% higher than the American rate;
• Infant mortality is 300% higher than the American rate;
• Teen suicide is 150% higher than the American average;
• Approximately 85% of Lakota families are affected by alcoholism;
• Approximately 58% of grandparents of Lakota families are raising their grandchildren;
•  Approximately 50% of adults over the age of 40 have diabetes;
• Oglala Lakota County is ranked 59 of 60 counties in South Dakota for overall health outcomes;
• One in four children born on the Pine Ridge Reservation is diagnosed with Fetal Alcohol Syndrome or Fetal Alcohol Spectrum Disorder.
• There is a drug crisis – Methamphetamines

Photo A: BSN students and faculty stopping in the Badlands of South Dakota included (front, from left) Alexis Solvey, Kaylee Burcaw, Karsyn Faulk; (middle, from left) Lorene Martin, Baylee Mohr, Cally Mason, Sunni Saconi, Makiyya Plumer; and (back, from left) Chloe Chappell, Morgan McGaffick, Annie Davidson, Caitlyn McTrusty, Katie Goodwin, Melissa Duvall and Katie Dunn.

Photo B: A member of the Lakota tribe welcomed the students as he played a drum and sang a prayer from the sacred Sun Dance.

Photo C: Experiencing a powwow

Photo D:  A fine representation of nursing students and faculty from the Salem Campus.

Photo E: An up-close experience at a powwow.