“Things change when Indian people get inside federal policy-making organizations, and it’s exciting to see that happen,” says Captain Pelagie “Mike” Snesrud, RN.
Snesrud, a Certified Public Health Nurse and career officer in the U.S. Public Health Service Commissioned Corps, is literally in a position to know. In January 2002 she was appointed to a key policy-making position at the Centers for Disease Control and Prevention (CDC) in Atlanta: She is the Senior Tribal Liaison for Policy and Evaluation in the Office of the Associate Director for Minority Health.
In this capacity, Snesrud--whose tribal affiliation is Dakota from the Shakopee Mdewakanton Sioux Tribe--serves as the office’s primary point of contact for leadership and coordination of the CDC’s activities supporting American Indian and Alaska Native health initiatives. She is responsible for helping to develop and facilitate CDC projects, programs and policies that benefit and improve the health status of Native American communities nationwide.
As her title implies, a key part of Snesrud’s role is acting as a liaison between the federal government agency and the nation’s 569 federally recognized Indian tribes, which are sovereign nations that have a government-to-government relationship with the United States. With her more than 24 years of experience working with Indian health programs and her distinguished record of effective leadership working with tribal elders, tribal governments, and local, state, regional and national public health programs and agencies, it is easy to see why the CDC sought her out for this important post.
Mike Snesrud’s nursing career over the past 30 years has been remarkable and determined, showing a singular drive and ambition to serve the Indian community, be a role model to other Indian nurses, and balance this work with her equally important responsibilities as a wife and mother of four children. A closer look at her professional path clearly shows it is no accident that she has arrived at her destination as a national leader in Indian health today.
Snesrud grew up in Shakopee, Minn., on land indigenous to the Mdewakanton people. In 1974, after graduating from Winona State University with a BSN degree, she embarked on her career as a public health nurse. She worked for the City of Bloomington (Minn.) Health Department for four years. From the beginning, the young nurse’s goal was to work with American Indian people after she had obtained sufficient experience in the field.
Moving to Kansas with her husband, a teacher, in 1978, Mike obtained a position at the Douglas County Health Department. Within six months, however, she faced her first big professional disappointment: She was dismayed to find that the agency’s level of commitment to minority health did not measure up to her experience in Minnesota, a leader in the nation’s public health system. Although Douglas County was rich in resources, she recalls, many of its minority residents did not have adequate health care available to them.
Frustrated by this situation, Snesrud transferred to Lawrence Memorial Hospital in Lawrence, Kan., to work on the surgical floor. In this acute-care setting, where patients only came to her when they were very sick and left shortly after surgery, she realized the limitations of hospital nursing and that public health nursing was indeed her true calling. “We didn’t get to see the whole picture,” she explains, “and I learned that I preferred to interact with patients in their own environment, where they were in control.”
A major turning point came in 1980, after Snesrud had given birth to her fourth child. She was recruited to work at the Haskell Indian Junior College (now known as Haskell Indian Nations University) Ambulatory Care Clinic in Lawrence. It was here that she first began her service to Native people and saw firsthand the importance of having Native health professionals providing care as well as administrating programs. In addition to accepting her new position at the college, Mike decided to keep working about 30 hours per week at the hospital--partly to provide more income for her growing family and partly to help enhance the communication between the two organizations.
Simultaneously, she was asked to serve as a clinical instructor with nursing students in the new RN Program that had been established at Haskell. The Native nursing students needed a hospital rotation and it made sense to have Snesrud, who was already known and trusted by the hospital staff, assist in forging a closer relationship with the Haskell nursing program staff and students. Many of the American Indian surgical patients treated at Lawrence Memorial were also clients of the college’s clinic, and Mike saw this as an opportunity to bridge a partnership between the two health care facilities.
Drawing on her strong administrative and leadership skills, she played an important advisory role in the expansion of the college’s nursing program. As a clinical instructor at Haskell, she was able to regularly bring a troop of nursing students to the hospital on a weekly basis.
Unfortunately, a lack of institutional support prevented the nursing program from flourishing. In two years it folded altogether, which was a huge disappointment to Mike, other Native nurses and the college. During this period, however, the health director for the Fond du Lac Band of Lake Superior Chippewa in Minnesota began to call her every six weeks in hopes of recruiting her to head his public health nursing program. His goal was to hire a Native nurse from Minnesota who had a strong commitment to improving the health of Indian people. So in 1982, Snesrud accepted the position and moved back to her roots in Minnesota, where she stayed to nurture her public health career and raise her family for the next 20 years.
When Mike first arrived at the Fond du Lac reservation, the Human Services Division was in its infancy stage, with a staff of only eight health and social services personnel. But by the time she left in 2002 to accept her appointment at the CDC, it had become one of the premier tribal health programs in the nation and a shining example of how health care staff can collaborate successfully with tribal governments.
Under Snesrud’s leadership, the public health nursing program grew to encompass a staff of 48; 75% of them are Indian people, many from the Fond du Lac community. One of its most successful initiatives was a maternal-child health program that provided care to 98% of the community’s pregnant women. It included a check-up program that provided a minimum of six home visits during a child’s first year. As a result of these visits, children’s immunization rates improved from 30% to more than 90%.
The 1990s brought many more opportunities for Mike Snesrud to demonstrate her exceptional leadership skills in highly visible executive positions. In 1993, she became the first president of the newly formed National Alaska Native American Indian Nurses Association (NANAINA). Between 1995 and 1997, she was chair of the Indian Health Service’s National Council of Nurse Administrators (NCONA), which represents nurse administrators from IHS, tribal and urban Indian health programs. From 1996 to 2001, she represented tribal public health nurses on the National Council of Nurses (NCON). Currently, Snesrud is the project officer of a CDC cooperative agreement with the American Indian Higher Education Consortium (AIHEC), a professional association representing 34 tribal colleges in the U.S. and Canada.
Speaking at NANAINA’s eighth annual national summit last year in Oklahoma City, Mike called her CDC appointment “an amazing opportunity for an American Indian public health nurse”--an opportunity to serve as a powerful voice that can speak up for the needs of Indian tribes at the highest level of federal health policy making and program development.
“The CDC is a huge bureaucracy with very specialized Centers, Institutes and Offices, and it can be very hard for tribal leaders to relate to,” she says. “That’s why it’s so essential to have someone inside the CDC who can be an advocate who says ‘what about tribes?’ and can build a circle of players that will come together to help Indian people.”
A Conversation with CAPT. Pelagie “Mike” Snesrud, RN
Minority Nurse: When you first arrived at the Fond du Lac reservation in 1982 [to become director of public health nursing for the Fond du Lac Band of Lake Superior Chippewa], what were the biggest challenges you faced?
Mike Snesrud: There was a lack of trust between the Native people in the community and the medical and nursing staff. In the past, county workers did home visits and reported back that they thought the Indian children were not being cared for properly. As a result, sometimes children were taken away and family life was disrupted. Families consequently were extremely hesitant to allow nursing staff to come into their homes and their community. We had to earn the trust of the community and the tribal council. There was not an Indian hospital on the reservation, so Native patients were referred to one of four non-Indian hospitals. There was a lot of prejudice and resentment on both sides because of historically bad relationships and this needed to be addressed to ensure Native people received the quality care they deserved.
MN: How were you able to make improvements at Fond du Lac?
MS: I helped develop cultural sensitivity and competency in our health care team---the home health aides, the community health representative, the nursing and physician staffs. Many of the providers who were non-Indian did not have a good understanding of where the Indian community was coming from [culturally]. Some of the elders’ concepts of health and illness were very different from the physicians’. Many did not come in for health care until it was an emergency. Patients wouldn’t follow their plan of care and there was no follow-up. So the health staff had to be taught to do much more than the usual: arranging transportation, helping people to assess various programs for assistance, following up to ensure that the patient heard the right information, and allowing Indian people to own their health and well-being by making their own choices.
MN: Tell us about your own Indian background.
MS: I am affiliated with the Dakota Sioux Tribe on my grandmother’s side and the Ho-Chunk Tribe on my grandfather’s side. I grew up in Shakopee, Minnesota, which was named that because of Chief Shakapay and the Dakota Sioux people who were present in the area for years. During the 1950s and ‘60s, the reservation nation wasn’t well developed and Indian people just were not treated very well. One thing that really stands out in my mind is the prejudice that was directed at me and other Native people as I was growing up. As long as we were quiet and invisible, that was fine. But when we spoke up, there was animosity and conflict.
MN: What inspired you to become a nurse?
MS: I had an older sister who was an RN and I looked up to her as my role model. She practiced nursing for more than 40 years and often provided me with real professional expertise and visible nursing leadership that gave me high standards to work towards. I was about five years old when I attended her graduation from the Mayo Clinic, and I knew then that I wanted to get involved in health care somehow. My sister became a head nurse at the Shakopee Community Hospital and I began candy striping under her when I was about 11. During high school I became a nurse’s aide. I saw that nurses often were the ones who spent time with the patients and had the ability to impact them more intensely than physicians, so I opted to become a nurse.
MN: What are some of the challenges for Indian nurses in the 21st century?
MS: Recruiting American Indians and Alaska Natives into the nursing profession and then recruiting Native nurses into tribal [health care] positions. Even though tribes and the IHS have many nursing positions open, it is extremely difficult to compete with other public and private hospitals and agencies that can offer higher salaries, sign-on bonuses and quick hires.
MN: How would you describe Indian nurses?
MS: My feeling is that most Native nurses are the cream of the crop because they have had to go through many personal and professional challenges to get to where they are today. Almost 90% of Native nurses are the main breadwinners for the family. That means they juggle the scheduling of a career and raising their children. Many are single mothers who survived a lot of hurdles to get through nursing school.
MN: What was it like for you to have to balance the demands of being a nurse, wife and mother of four children?
MS: My husband and I have been happily married for 32 years, marrying quite young when we were both still in college. Early on, we both agreed that we were committed to one another and to our children. We knew we needed a certain amount of resources to care for our family and it didn’t matter whether he or I got those resources. He totally supported me through nursing school and my various career choices that have helped me be successful, fully involved and free to try whatever I want to do. Public health nursing allowed me the flexibility to be very active professionally and also arrange many of my children’s activities around my work schedule, so I seldom, if ever, felt unable to get involved. Sometimes the days and workweeks got long, but when a family is the driving force and your professional role fits well with your personal values, life is fun and work is fulfilling.
MN: How did you ultimately move from your tribal health position at Fond du Lac to the CDC?
MS: My experience at Fond du Lac had given me many different opportunities and skills. I liked interacting with people at all levels and impacting policy decisions. I was ready to diversify what I had been doing. Different people had been tantalizing me to work at the national level, but I had not actually considered a move until my children were through with school and moving on with their life choices. It was the right time and the position excited and challenged me.
MN: What are some of your responsibilities at the CDC?
MS: I am a public health analyst for the Office of Minority Health/Office of the Director, and I function as a Senior Tribal Liaison for Policy and Evaluation. I help CDC Centers, Institutes and Offices (CIOs) to partner and work more effectively with tribes and Native organizations. I am a resource both within the agency and to tribes, to help connect people to work together on public health issues. One of the activities I have been engaged in is coordinating the CDC Tribal Consultation Initiative. Prior to my coming to CDC, a Tribal Consultation Work Group developed a draft consultation policy that needed input from tribal leaders. During May to November of 2002, I and other CDC staff took this policy out to 11 Regional Consultations in Indian Country to listen to tribal leaders give CDC specific guidance and recommendations about consultation and public health needs.
MN: What have your meetings with the tribal leaders accomplished so far?
MS: The tribes needed to see that CDC was willing to take the time and interest to go out into Indian Country before formulating its Tribal Consultation Policy and Plan. CDC wants to work with tribes in many different areas of public health prevention and recognizes that tribes themselves need to be fully engaged in the process. CDC’s Office of Minority Health is just completing its review of the transcripts from the meetings and is distributing summaries back to the tribes of the recommendations from the consultation held in their region. Input and recommendations from the tribes will help constitute CDC’s tribal consultation policy and ongoing activities and relationships.
MN: What are some of the most critical public health issues affecting Indian communities?
MS: CDC and other federal agencies need to assist tribes in developing and expanding a Native public health workforce with the experience and training to deal with the unique needs of their population. Native nurses, doctors, epidemiologists, statisticians, environmentalists and scientists are all needed. Tribes need to have technical assistance and resources to build their infrastructure and capacity. Most important is good data that is accurate and readily available to tribes as they build their health programs and interventions. Assistance is needed not only in getting data but also in analysis and research.
MN: What about health disparities between American Indians/Alaska Natives and the majority population? What are some of the most common health problems that need to be addressed?
MS: For hundreds of years Native people have not had access to quality health care. They are very entrenched in poverty and have a consistent lack of resources to deal with many basic issues in their communities. Much of what negatively affects Indian people today is related to preventable chronic diseases such as heart disease, cancer, diabetes, liver disease and lower respiratory disease, as well as preventable accidents and injuries. Pregnant women do not come in for early prenatal care, children and elders don’t always get the immunizations they need, and people do not wear seatbelts or ensure that their children are in car safety seats. Many Native people abuse alcohol, tobacco and other drugs and therefore do not make good choices. Rates of STDs and HIV are on the increase and there are not a lot of dollars for core public health activities.
MN: What advice do you have for other Indian nurses?
MS: Nursing is a great career choice that allows you many different opportunities that fit with your individual goals and aspirations. It’s important for you to stay connected with your community and Native people, but also be willing to extend yourself and accept challenges based on the skills and strengths you have gained. Don’t be afraid to ask for help and then, in turn, to help and mentor someone else. Be willing to accept opportunities in a totally different environment than the one in which you are used to practicing. Federal agencies like the CDC, the Centers for Medicare & Medicaid Services, the National Institutes of Health and the Food and Drug Administration need Native people working within their organizations to help them to work more effectively with tribes, increase financial and other resources going to tribes, and to help cultural competency grow and systems change. Agencies need to be reminded about the sovereignty of tribes and the important role that tribal councils play on a daily basis.
MN: Anything else you’d like to add?
MS: It’s an exciting opportunity to be part of such a dynamic and outstanding cadre of health professionals at the CDC. Working with CDC and the tribes is a huge challenge. CDC is a large federal agency made up of many very committed professionals who want to make a difference in decreasing health disparities. People often are willing to get involved when someone can assist them in talking to the right person at the right time. CDC and Indian Country have much to learn and share with one another to collectively address the public health of the nation as a whole.