Those who know it best say life at the Fort Peck Indian Reservation in the extreme northeast corner of Montana is a world apart from the rest of the state.
A high rate of unemployment is one of the differences between the reservation and, say, Bozeman, according to Kenneth Smoker, health programs specialist with the Fort Peck Tribes and Indian Health Services. There’s widespread poverty that comes with unemployment, as well as isolation, Smoker said. Problems with alcohol and drugs abound. In fact, life at the reservation drew national attention three years ago after five middle school students committed suicide and 20 others attempted suicide.
But Smoker is convinced that big changes are possible at the Fort Peck Reservation, and he points to improving health care as one shift that will have a positive ripple effect in the community.
Nursing students from Montana State University are helping Smoker make that change. Twice each year, 16 junior-level students travel to the reservation to conduct well-child exams and interact with the community as part of a partnership between MSU and the Fort Peck Indian Reservation. Since the students began traveling to Fort Peck two years ago, MSU officials estimate that students have performed more than 1,300 exams.
“This partnership provides valuable services to children and families—services that might otherwise be difficult for them to obtain,” said Helen Melland, dean of the MSU College of Nursing. “At the same time, MSU students receive valuable experiences in pediatric nursing. It truly is a mutually beneficial partnership.”
“Health care needs to be changed here (on the Fort Peck Indian Reservation), and this partnership is one part of how we can do that,” Smoker said.
The Fort Peck Indian Reservation is home to two Indian nations, the Sioux and the Assiniboine. Together, the nations form the Fort Peck tribes, with roughly 13,000 members. About half live on the 2-million acre reservation.
Too often, Smoker said, health care at the reservation is reactionary rather than preventive. Instead of having a population dependent on urgent care, he envisions a system where services help prevent disease.
“It’s difficult to address needs in a preventive way, but I’d like the tribe to be actively engaged in the process of delivering care,” he said. “This will be the best way.”
—Helen Melland, dean of the MSU College of Nursing
Smoker believes health care services will be more effective if they are more accessible. Vast distances, lack of cars or enough gas money can make it difficult for rural tribe members to get to a clinic to receive health care. Even if they do make it to town, there may not be enough providers available for them to be seen that day.
To combat those problems, Smoker would like health care providers to visit patients in their own homes. But, attracting health care providers to the reservation can be a challenge. That’s where the MSU students come in.
The Fort Peck Tribes created the partnership after the tribes received a federal grant to start clinics to provide primary care to schoolchildren in three different schools on the reservation. The program, headed by Smoker, is run through the tribes’ Health Promotion Disease Prevention Program.
Smoker spoke with a faculty member from the MSU College of Nursing about a possible collaboration. Since the mission aligned with MSU’s goals, the partnership was a good fit, according to Melland.
In the fall of 2011, MSU sent its first group of students to the reservation. Since then, dozens of students—all of them non-Native—have volunteered to travel to the reservation as part of their pediatric nursing course. During each visit, two groups of eight students each spend a week on the reservation, where they perform well-child exams in three different schools and travel to homes to provide care for families and elders.
“The students put all other experiences on hold when they go to Fort Peck,” said Julie Ruff, an assistant teaching professor at MSU who teaches the pediatric nursing course and accompanies the students to Fort Peck. “It is very isolated there, and so it’s good to be able to share and process the experience with others in the class.”
Nicolas Lawlor was one of the nursing students who traveled to the Fort Peck Reservation in last March. While there, he interacted with dozens of students, examining them and quietly asking questions.
One young girl clutched a stuffed animal in her arms as she sat around a cluster of desks in an elementary classroom on the reservation. Lawlor asked the girl questions about her health, exercise habits and well-being at home and also performed physical and vision exams.
As important as the partnership is for the children and families of the reservation, it is equally beneficial for the MSU students.
“It’s hugely beneficial for us to get experience doing assessments,” said Emilie Kuster, an MSU nursing student from Sandpoint, Idaho. “It opens our eyes to all of the assistance programs that are available. There are so many resources you don’t know about (before an experience like this).”
MSU nursing student Allison Nesseth of Bozeman said the best part about the experience was spending one-on-one time with the kids. With limited opportunities to work with pediatrics while studying in Bozeman, Nesseth said she was grateful for the opportunity.
She added that some of the children that she met indicated an interest in pursuing a career in nursing themselves, which she called a great byproduct of the partnership.
“Spending time with the kids has been great,” she said. “It actually feels like you can make a difference.”
While the MSU students wete on the reservation, the tribes put on a powwow demonstration, and the students worked on beading projects and shareed tea with elders.
Melland said learning about life on the reservation firsthand is one of the most important parts of the experience.
“(The College of Nursing) educates students to realize that it’s important for nurses to understand other cultures,” Melland said. “This is one opportunity for them to do that.”
The students, who are enrolled in a pediatric nursing course during the semester in which they travel, receive clinical credit for their work. In addition, MSU and the tribes worked to ensure that the students’ costs for the experience remain low. The Area Health Education Center at MSU provides transportation funds, while the tribes provide funding for some food as well as a place for the students to stay.
Living together while on the reservation helps the nursing students process the experience and form connections, Ruff said.
The MSU College of Nursing is delighted with the results of the partnership, according to Melland.
“We are so pleased to be able to provide services to the people of Fort Peck, and we’re proud to have served so many children and families,” Melland said.
Smoker said it would have been difficult for the children to receive the same level of preventive care without the partnership between MSU and the Fort Peck Tribes.
“We appreciate all of the students who have traveled here to work with the children and families,” he said. “They’ve provided a very valuable service.”
And, Melland stressed that the estimated 1,360 well-child exams performed at Fort Peck over the last two years is just the beginning.
In fact, two of the students who traveled to Fort Peck in March returned to the reservation in July with Ruff and Martha Arguelles, another College of Nursing faculty member. There, the group provided input into the design of a new community wellness center, set up a school-based clinic, assisted with cleaning up a facility that had been flooded, and offered physical exams for student-athletes.
“This is an ongoing partnership to which we are highly committed—both for the well-being of the children and families of Fort Peck, as well as for the educational development of our nursing students,” Melland said. â–