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First Native Hospital, Built By Nation's First Native Doctor, To Again Care For Nebraskans
The ask was simple.
Will you donate $132 to honor your fellow physician, Dr. Susan La Flesche Picotte? The Nebraska Medical Association put the word out to its members in 2021.
Who's that? Nebraska doctors asked. After they learned her story, $600,000 in donations poured in.
In 1889 — 132 years before the ask — La Flesche made American history when she became the first Native American to earn a medical degree. Born in a tipi in 1865 on the Omaha reservation in northeast Nebraska, she graduated from a Pennsylvania college, became a doctor, but turned down prestigious offers to stay on the East Coast.
Instead, she took the train home and became the reservation's first medical doctor, driving a horse-pulled buggy across the vast, 1,300-square-mile reservation and treating more than 1,200 Native and non-Native patients.
In 1913, she raised the money to build a hospital in Walthill. Dr. Susan's hospital was the first ever built on a Native reservation.
More than a century later, that still-standing historic building is being restored into the Dr. Susan La Flesche Picotte Center. It's a space dedicated to sharing La Flesche's singular story. It's also, once again, a place where the tribe's members and nonmembers alike can get medical care in Nebraska's poorest county, where 18% of residents live below the poverty line.
The restored hospital will be celebrated Saturday at a private dedication event. The public then can visit it at an open house on June 22. The project's leaders, a combination of tribe members, doctors, community members and La Flesche's descendants, hope to have medical care up and running by the end of summer.
"She paved the way for a lot of people to have the confidence within themselves to accomplish the things that they thought they couldn't do," said Liz Lovejoy Brown, executive director of the Picotte Center. "She accomplished all this because she persevered."
Lovejoy Brown calls the famed Native doctor "the definition of Omaha" because, she said, the word Omaha means "against the current."
As a child, La Flesche watched as a white doctor refused to treat a sick Native American woman.
The experience shaped her, starting her on the path to becoming a doctor.
The daughter of Joseph La Flesche, the last recognized chief of the Omaha tribe, Susan La Flesche and her siblings were encouraged to pursue an education. Her sister, Susette "Bright Eyes" La Flesche, was well-known for acting as Ponca Chief Standing Bear's interpreter during his 1879 civil court case in Omaha.
Susan La Flesche left Nebraska to attend college as an undergraduate in Virginia, at what is now Hampton University — a historically Black college that also accepted Native students.
She returned home to work as a teacher. It was then that she fully realized her reservation's desperate need for medical care, Lovejoy Brown said.
In 1886, La Flesche went back east, enrolling at the Women's Medical College of Pennsylvania.
By 1889, she graduated at the top of her class.
"What she did all happened at the height of the Victorian era, when the bar for white women was about a quarter of an inch off the ground … and for Native American women, there was no bar at all, because they were invisible," said Joe Starita, a retired University of Nebraska-Lincoln professor and author of an award-winning book, "A Warrior for the People," that chronicles the life of La Flesche.
"For somebody to emerge out of that context and get into a medical college and graduate as valedictorian," Starita said, "the odds of that happening were 100,000 to 1."
When she graduated, La Flesche's East Coast friends begged her to stay, Starita said.
"She didn't listen to any of it," he said. "She got on the next train back to Omaha, where her father met her in a buckboard (wagon) and drove her back to the Omaha reservation, where she spent the rest of her life taking care of her beloved Omaha people."
The U.S. Had 104,000 licensed physicians by 1890, Starita said. Only 4.4% were women. And only one was Native — La Flesche.
Returning home to the Omaha reservation, 24-year-old La Flesche was suddenly responsible for 1,244 patients scattered across 1,300 square miles.
Day after day, she awoke by 5 a.M., hitched her two horses to a buggy and followed vague directions to get to patients spread across the reservation. In the winter and snow, she'd throw on a buffalo robe and scarf. It was often dark by the time she got home.
"Went to bed hungry, too tired to eat," she'd write repeatedly in her journals.
After years of doing this, La Flesche believed there had to be a more efficient way to see patients.
She needed a hospital.
La Flesche rallied her East Coast connections, the Quaker donors and Presbyterian women's groups who'd helped fund her education. She raised $9,000.
In 1913, the Presbyterian Memorial Hospital opened on the north end of Walthill. La Flesche walked to work from her home three blocks away.
"This is the first hospital that was built on any reservation," Lovejoy Brown said. "This was before women were eligible to vote, and before Native Americans were considered human beings."
The hospital could fit 40 patients. La Flesche operated on patients in the room with the best natural light. An east-facing screened porch included hooks for hammocks, so tuberculosis patients could relax in the fresh air. The third floor included three rooms where nurses lived.
La Flesche spent her days delivering babies and treating the elderly. In her free time, she founded the first library for children on the reservation and taught Sunday school. She promoted proper hygiene to help prevent the spread of disease, like screens on windows to keep flies out. She traveled to Washington, D.C., to testify before Congress about the harms of whiskey peddlers selling alcohol on the reservation.
"Starting this hospital was one of 50 items that you could put on her greatest-hits list," Starita said. "She was just so utterly unique in so many different ways."
La Flesche worked for two years in the Walthill hospital she built.
She died at the age of 50 in 1915.
"She definitely was before her time and did things well before people even were aware of the possibilities of what could be," Lovejoy Brown said. "She carried such a strong legacy just for the time she was here. We want to try to carry out the legacy that she had."
Lovejoy Brown first learned of La Flesche's legacy from her mother.
"Ever since I was a little girl, I was like, 'I'm going to be just like her,'" Lovejoy Brown said.
Raised in Omaha, Lovejoy Brown learned the Omaha Nation's culture through her grandfather. Just like La Flesche, she wanted to get her education and move to the reservation to help in any way she could. Eight years ago, she did just that.
After getting hired to oversee the renovated hospital, Lovejoy Brown realized the building's original dedication and her own birthday were on the same day. Then she realized the dedication of the renovated hospital falls close to La Flesche's birthday.
It felt like everything was aligning, Lovejoy Brown said. It felt like she ended up exactly where she needed to be.
After La Flesche's death, the hospital stayed operational until 1944, when it became an elder care facility. It was then a private residence, an upholstery shop, a bakery, a thrift store, a law firm and a farm aid office.
The nonprofit behind the hospital renovation eventually bought the building. Then, eight years ago, the Nebraska Commission on Indian Affairs formed a committee to look into what it would take to restore it. The effort brought together La Flesche's descendants, big-city doctors and architects and Native and non-Native residents of Walthill and the rural northeast Nebraska reservation.
In total, the committee raised more than $6 million to make the restoration happen, including money from the various family foundations, the U.S. Department of Agriculture and the National Park Service.
"It's a Native American story, but it's also a physician story," said Dr. Britt Thedinger, past president of the Nebraska Medical Association and member of the renovation committee. "It's a wide swath of people … enthusiastic about the story. Hopefully it also gives the tribe … and the community a sense of pride in their history."
Once the center is up and running, it will include social spaces, such as an artists' space for people to work on beadwork, sewing and embroidery. There will be a business incubator for new entrepreneurs looking to launch a business. There will be a gift shop that sells Dr. Susan merch and an office for Boys & Girls Club representatives.
An old patient room will be arranged to look like it would have 100 years ago, to give visitors a view of the original hospital. Exhibits will take visitors through La Flesche's story, displaying her medical bag and tools as well as family artifacts such as moccasins and tribal regalia.
Most importantly, Lovejoy Brown said, the first floor will include a range of health care services. The Munroe-Meyer Institute, a University of Nebraska Medical Center department that provides health care for people with disabilities, will staff an office in the restored hospital. The building will offer an urgent care clinic, counseling services and behavioral health care.
To get specialized care or behavioral health diagnoses currently requires a drive to Omaha or Sioux City, Lovejoy Brown said.
In Thurston County, the need for easier access is critical, Lovejoy Brown said. The reservation continues to see a spate of youth suicides, often happening in clusters. Too many children are going undiagnosed with autism and ADHD, she said, and babies continue to be born with fetal alcohol effects.
"We have all the issues that you have in the inner city … unemployment, alcoholism, housing issues … but we're in a rural setting," said Nancy Gillis, a member of the restoration board. "And, we're in a fishbowl. People see something happening on the reservation from the outside, and it's immediately tagged as, 'Oh, those Indians.'"
What was once La Flesche's operating room will soon be transformed into a reading space for children. This room will represent the second hill of the four hills of Native life that Lovejoy Brown's grandfather used to describe to her — a hill for infants, another for children, a hill for adults and, finally, one for elders.
"When you're at the very top of the (last) hill, and you look back and you see the other three hills, you see your children and your children's children all going through life," Lovejoy Brown said. "The top of that last hill, it's a sense of accomplishment. You left some sort of legacy."
La Flesche's own final hill is clear.
"With Dr. Susan, she has left a huge legacy, not just for her family, not just for our tribe, but for all minorities everywhere," Lovejoy Brown said. "So many people are following her path still, even after she has made it to the spirit world."
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This story was originally published by Flatwater Free Press and distributed through a partnership with The Associated Press.
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Eliminate Obstacles To Delivering Patient Care
The healthcare environment is complicated, with many operational barriers that significantly impact patient care experiences, clinician productivity, and population health. Issues such as staff shortages, compliance problems with medical devices, and poor patient meal-delivery services are some of the behind-the-scenes challenges faced by healthcare facilities.
Disparate systems lead to disconnected experiences. Healthcare providers often scramble through multiple apps to access information, and patients experience inefficiencies when requesting services. While technology integration in healthcare, particularly electronic health records (EHRs), has revolutionized patient data management, operational efficiency remains a concern for many healthcare providers. A report by McKinsey1 states that 42% of a nurse's current shift involves activities that could be simplified through technology. Much time is spent manually updating and filling out clinical documentation, which can be automated.
Despite 60% of health systems employing over 50 unique software solutions for healthcare operations, many of these investments lack seamless integration with the most crucial technology—the patient record.
Without enterprise-wide interoperability between the patient record and other systems, several issues can arise:
What if there was a way to address each of these operational challenges by providing a unified portal experience to seamlessly integrate diverse systems?
ServiceNow offers a healthcare service management solution that eliminates silos, improves efficiency for care teams and patients alike, and facilitates the flow of information for increased accuracy. With easy access to complete data, providers are less likely to make errors when communicating treatment plans, and patients are less likely to experience delays.
Implementing this type of operational efficiency does not require a complete replacement of your EHR or system solution. ServiceNow technology is designed to enhance, not replace, your current IT investments.
Today's patients are also consumers, and their experience as consumers has realigned their expectations for healthcare. They want quick access to answers and information without navigating multiple systems and reentering the same information in a confusing array of forms. Clinicians and facilities need better, more consistent ways to access patient information, communicate proactively, and keep patients up to date.
Fragmented architecture can fuel poor patient experiences and negatively impact satisfaction with healthcare services. Patients can be misinformed about their treatment plans and experience unexpected delays and inefficiencies. For healthcare organizations, improving the patient experience means more than just doing the right thing for people who need care. In the U.S., patient satisfaction scores are an increasingly important factor in some reimbursement paradigms. The good news is that overcoming the technical hurdles that compromise patient experience and consolidating siloed data sources can lead to more efficient processes, lower costs, and a higher quality of care.
1McKinsey & Company, Reimagining the nursing workload: Finding time to close the workforce gap, May 26, 2023
Global Oncology Trials: The Role Of Academic Medical Centers In Expanding Access To Cancer Care
The International Agency for Research on Cancer forecasts over 35 million new cancer cases in 2050 globally. The growing burden of cancer reflects the urgent need for global collaboration by academic medical centers to drive innovation and improve access to cancer care. International collaborations by AMCs have the potential to expedite research on new treatment options, improve access to care and enhance their global presence.
While the success of screening programs has reduced the incidence of advanced-stage disease for certain cancer types in high income countries, there remains the need to evaluate treatments for early-stage disease necessitating global collaboration. Large sample sizes are critical to detect potential benefits of new treatments or similar efficacy of less toxic regimes, while diverse samples from global populations can enhance identification of molecular markers to better define patient cohorts based on tumor biology and genomics. Broad applicability of collaborative research findings will facilitate the uptake of improvements in cancer treatment into standard practice internationally.
Rare tumor types also benefit from global collaboration to provide adequate sample sizes for identification of targeted therapies. Rapid conduct of phase III trials is needed to integrate new cancer therapies into existing treatment regimens.
Global clinical care extension by major U.S. Cancer centers can increase overall revenue through patient volumes and higher reimbursement rates, which can subsidize domestic operations while promoting their own global brand recognition.
Current Global Landscape
The 2021 Global Oncology Survey of NCI-Designated Cancer Centers identified that 91% of U.S. Cancer centers reported global oncology involvement. Leading cancer centers often follow a four-stage development path beginning with educational programs, consulting or advisory services, expanding to management services to hospitals or research centers, and finally owning overseas facilities.
Another 2022 study of worldwide hospital or satellite clinics of U.S. Cancer centers identified 53 offshore entities. Over 70% of these cancer centers rank in the top 20 cancer hospitals in the U.S. Offshore entities can facilitate care extension both virtually and in-person.
For example, Cleveland Clinic's Fatima bint Mubarak Center in Abu Dhabi offers comprehensive cancer care services while Pittsburgh-based UPMC Hillman Cancer Center has the largest overseas clinic network. New York Memorial Sloan Kettering Cancer Center offers a global telemedicine platform and operates the MSK India Center.
(adapted from V. Prasad et al 2022)
China is the most prevalent location for collaborations. The U.S. Has the highest incidence cancer rate while China has the highest cancer volume and mortality rate. Hence, clinical trial cooperation could have a significant impact. Regulatory bodies in China have made it easier to approve cancer therapies based on international data, allowing potentially simultaneous regulatory approvals of new therapies.
Memorial Sloan Kettering's collaboration with The Chinese Thoracic Oncology Group has been successful. Since established in 2018, the MSK-CTONG collaboration has worked with partners to successfully launch the first U.S.-China multicenter clinical trial in late 2020 (NCT04611776).
Cedars-Sinai Medical Center's research partnership with Korea's Seoul National University Hospital focuses on genomic profiles and the tumor microenvironment of breast cancer between native Koreans and Korean Americans to better understand the disease and enhance treatment.
In the U.S., the FDA's Oncology Center of Excellence initiated Project Orbis in 2019 to provide a framework for the concurrent submission and review of cancer treatments across several countries. Its first success story came in 2019 when two drugs were simultaneously approved for the treatment of endometrial cancer in the U.S., Canada and Australia. Such efforts facilitate learning and consistency among regulators, strengthens international ties and allows earlier access to new treatment options across multiple countries.
More than half of cancer centers involved in global oncology offer training in oncology, which can take many forms including lectures, seminars, and courses. University of California, San Francisco's Global Cancer Program provides education, research training and mentorship for trainees in several low- and middle-income countries. Its Vietnam Pediatric Hematology Oncology Fellowship program provides training to become a physician-scientist, while its grant supports cancer research training in Tanzania across multiple tiers, from short-term programs to master's and doctoral degree levels.
Other examples include MD Anderson's Cancer Center's Project Echo partnership with Africa Emerging Hospitals and the Mayo Clinic Network, which offers access to educational content for members worldwide. Cedars-Sinai's Global Healthcare Grand Rounds and Healthcare Diplomacy program invites experts to share their knowledge with an international audience. Other centers such as Stanford have established collaborative tumor board discussions.
Summary
Global oncological collaboration improves clinical research and expands applicability of results, which, when paired with streamlined regulatory frameworks, could revolutionize the pace of cancer care improvement. Clinical care extension by major cancer centers can increase revenues, subsidize domestic operations and promote global branding. The growing global collaboration among leading academic medical centers in cancer care represents promising opportunities to enhance access and promote global health equity — an especially prescient effort given the global rise in cancer incidence.
Author information:
Waqas Haque, MD, is an oncology fellow at the University of Chicago.
Isurujith Herath, MD, is an administrative fellow at Cedars-Sinai International in Los Angeles.
Heitham Hassoun, MD, is chief executive of Cedars-Sinai International.
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