Without Reservation

Captain Pelagie “Mike” Snesrud, RN, is a Lakota Sioux Indian and a commissioned officer as a public health nurse for 27 years, and in January 2002, she was appointed to a key policy-making position at the Centers for Disease Control and Prevention is Atlanta. She is the Senior Tribal Liaison for Policy and Evaluation in the Office of the Associate Director for Minority Health.

Essentially, she is charge of the CDC’s health promotion and disease prevention efforts specifically for members of Indian tribal communities. As her title implies, a large part of her role is acting as a liaison between the federal government agency and the nation’s 569 federally recognized Indian tribes, which are self-governed sovereign nations that have a government-to-government relationship with the United States.

Her 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 model to other Indian nurses, and be a wife and mother to four children. She has successfully “done it all” and an examination of her professional path demonstrates it is no accident that she has arrived to her destination as a national leader in Indian health today.

She graduated from Winona State University in Minnesota in 1974 with a BSN, then worked as a public health nurse for the Bloomington Health Department for four years. Her goal was to work with American Indian people after she had obtained sufficient experience in the field, and she set out to acquire the experience she felt she needed.

In 1978, she transferred to Kansas with her husband, a teacher, and worked for the Douglas County Health Department. Within six months, she faced her first big professional disappointment. She said she was dismayed at the facility’s level of competency, which did not measure up to her experience in Minnesota, a leader in the nation’s public health. She said that although Douglas County was very rich, large numbers of minorities did not have adequate healthcare available to them, and the situation became too frustrating for her to continue nursing there.

She then transferred to Lawrence Memorial Hospital and worked on the surgical floor. Here she learned she did not want to be a surgical nurse long-term, and her resolve to become a public health nurse returned. Patients came to her only when they were very sick and left shortly after surgery. “We didn’t get to see the whole picture, and I learned I preferred to interact with clients in their environment where they were in control,” Mike said.

After having her fourth child in 1980, she was recruited by Haskell Indian Junior College in Lawrence, Kansas, which served a significant percentage of American Indians. Many of her hospital Indian patients were also treated at the college’s clinic, and she saw an opportunity to forge a closer relationship between the two institutions. She decided to keep working about 30 hours per week at the hospital, while accepting her new appointment at the college, partly to provide more income for her growing family and partly to help enhance the communication between the two groups. Mike played an important advisory role in the expansion of the college’s nursing program and in 1981, its LPN program turned into a two-year RN 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, there was a lack of institutional support for the nursing program to flourish and in two years, the program folded altogether, which was a huge disappointment to Mike and the college. During this period, however, the health director at Fond du Lac Reservation in Minnesota began to call her every six weeks to recruit her to head his public health program. His goal was to recruit a Native nurse from Minnesota because he thought such a person would have a greater commitment to the Indian people. So in 1982, Mike 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 she arrived, the program was in its infancy stage with only eight health and social services personnel. When she left, there were 48 staff under her; 75 percent were Native people from the community. Their maternal-child health program saw 98 percent of pregnant mothers in the community. The child check-up program provided a minimum of six home visits during the child’s first year, which improved immunization rates from 30 percent to more than 90 percent. They developed a car-seat program in which every child received a car seat. The Fond du Lac Human Services division became one of the premier programs in the nation, and its tribal human service became an example in how health staff could collaborate with tribal counsel to satisfy health needs.

In 1993, she became the first president of the National Alaskan American Indian Nurses Association (NAAINA).  Between 1995 and 1997, she was chair of the Indian National Council of Nurses Administration, which included 300 nurse administrators throughout Indian country. She is also the project officer of the American Indian Higher Education Consortium, the mouthpiece of the 35 tribal colleges in the nation. They play an important role in recruiting local community members to pursue further education.
At last year’s NAAINA national summit, Mike called her CDC appointment “an amazing opportunity” for an American Indian professional nurse. “Things change when Indian people get inside federal policy-making organizations, and it’s exciting to see that happen,” she said. “It’s a great opportunity to be inside the CDC and see the programs that are developing, and be an advocate who says ‘What about tribes?’ and build a circle of players that can come together to help Indian people.”

Q: When you arrived at Fond du Lac in 1982, how was the atmosphere?
A: There was distrust with the nursing and medical staff among the Natives. Many community people came to check on them and reported them to the county, which sometimes took away their children and disrupted their family life. We had to earn the trust of the tribal counsel. Likewise, we didn’t have a hospital, so native clients 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.

Q: How were you able to make improvements at Fond du Lac?
A: I helped develop cultural sensitivity with our health care team—the home health aides, the community health representative, the nursing and physician staff. Many who were not Indian came with a different understanding of where the Indian community was coming from. Some of the elderly’s concept of health and illness was very different from the physicians’. Many did not go for healthcare until it was an emergency. Clients wouldn’t follow their plan of care and there was no follow-up. Health staff learned to do follow-up, to provide transportation, to help get financial assistance.

Q: Tell us about your Indian background.
A: I am affiliated with the Lakota Sioux Tribe on my grandmother’s side and the Hochunk tribe on my grandfather’s side. I grew up in Shakopee, Minnesota, and our band is named after Chief Shakopee. Our small reservation nation wasn’t well developed. 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 insignificant, that was fine. But when we spoke up, there was conflict.

Q: What inspired you to become a nurse?
A: I had an older sister who was an RN. She was my role model and she’s been practicing until about two years ago, well into her 60s. 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 healthcare somehow. My sister became a head nurse at the Shakopee Community Hospital and I began candy striping under her until I was about thirteen. During high school I became a nurse’s aide. I saw that nurses had the ability to impact patients more intensely than physicians, so I opted to become a nurse.

 

Q: What are some of the challenges for Indian nurses?
A: It’s a major issue to recruit American Indian and Alaskan nurses into tribal positions because of the nursing shortage. Many Native nurses are recruited by other agencies that can offer better salaries and hire them quicker.

 

Q: How would you describe Indian nurses?
A: My feeling is that most Native nurses are the cream of the crop because they had to go through many personal and professional challenges to get to the point where they’re at.  Almost 90 percent of Native nurses are the main breadwinners for the family. That means they juggle the scheduling of a career and their children. Many are single mothers who passed a lot of hurdles to get through nursing school.

Q: Why do you think Native nurses are usually the main breadwinners?
A: Maybe it’s the caliber of the women. The kind of person who aspires to be a nurse is a strong, caring person. They have juggled their lives to serve their community, to make an impact, to be a mother and member of their family. They do it all.

Q: What was it like for you to be a nurse, wife, and mother of four children?
A: I’ve been the main breadwinner in my family. I’ve also been happily married for 32 years. My husband is a teacher, and teaching doesn’t pay well. Because of my high commitment to my family and community, I do what needs to be done. I work the amount of hours necessary to be successful in both those realms.

Q: Tell us about your children.
A: I have twin daughters, 28 years old. Tara graduated from the University of Minnesota as a nurse practitioner and is now at the Mayo Clinic. Heather has a degree in business and is at Merryl Lynch. Matthew is 26 years old and is playing professional hockey with the Manchester Monarchs, the Los Angeles Kings minor team. Jeremiah is 23 and he’s a junior at the University of Wisconsin completing a degree in personal and corporate health.

Q: How did you ultimately move to the CDC?
A: I was ready to expand what I was doing. Different people had been tantalizing me to work on the national level. I was not considering a move until my children essentially finished college so that they were secure with their desires.

Q: What are you doing at the CDC?
A: I am a public health analyst with American Indian and Alaskan Natives. When I came on board, my role was expanded with the additional title of senior tribal liaison for policy and evaluation. One of my roles is to take a draft policy written by an internal tribal consultation workgroup and take it into Indian country to ask elected tribal leaders what they thought about it so that they could give specific guidance and recommendation.

Q: Can you describe your meetings with the tribal leaders?
A: We did a regional consultation series through November 2002. We had 11 regional consultation meetings and send invitations to all the 569 tribal chairmen to attend. We had a good showing. We’re now reviewing the transcripts, but those recommendations from the tribes will constitute the CDC’s tribal consultation policy.

Q: What are some of the basic issues among Indians?
A: We need to develop a Native public health workforce with experience and training to deal with the unique issues in their area. We not only need Native nurses, but we also need Native epidemiologists, statisticians, environmentalists, and scientists. We’re also working to enhance the cultural competency of the CDC staff. Although the CDC has some of the best and brightest health professionals, many are not aware of the uniqueness of the 569 tribes and the important role that the tribal council plays in carrying out the health programs on their reservations.

Q: What are some of the common health problems among Indian tribes?
A: For hundreds of years Native people have not accessed quality healthcare. They are very entrenched in poverty, have a lack of resources, and barriers to accessing them. They have chronic diseases and infections. They’re not used to using car seats and wearing seatbelts. They also mix alcohol with driving.

Q: What advice to have for other Indian nurses?
A: Stay connected with the community people and then be willing to extend yourself and go to a totally different environment. Government agencies, like the CDC, the National Institutes of Health, the Food and Drug Administration need Native people working intricately within their agencies to remind them about the sovereignty of tribes and the important role that tribal councils play.

Q: Anything else you’d like to add?
A: It’s an exciting opportunity to be considered part of such an astute group of health professionals at the CDC. Working with the tribes is a big challenge, but I’m learning from the success stories that have occurred with other minorities and how we can translate those successes to the tribes.