After spending 33 years caring for the health needs of her fellow Native Americans as a nurse with the Indian Health Service, Frances Stout, R.N., had earned a well-deserved rest. She could have taken some time for herself, started a hobby, or perhaps traveled a bit. Instead, in her 70s, Stout now serves as Chair of the Board of the Tohono O’odham Nursing Care Authority (TONCA), which under her leadership governs the groundbreaking and innovative Archie Hendricks, Sr. Skilled Nursing Facility on the Tohono O’odham Reservation in Arizona.
Reflecting on her years of dedication to others, Stout says, “My grandmother said, ‘We are here to serve…that is why we are put on this earth.’ As long as I am physically and mentally able, I will do so. I am very grateful for this privilege.” In 2009, the Robert Wood Johnson Foundation honored Stout with the prestigious Community Health Leader Award for her work on behalf of the senior citizens in her region.
The Navajo in Arizona
Stout was born at the Ganado Mission on the Navaho Reservation in Ganado, Arizona. Founded in 1910 by the Presbyterian Church, the Mission became the largest Native American mission in the United States. A school for Navajo children opened in 1911 shortly after the Mission’s founding, and Stout’s family history is rooted in the institution. The Ganado Mission became a driving force behind educational and medical advancements for the Navajo people.
Part of its advancements included the twelve-bed Sage Memorial Hospital, the first non-governmentally funded hospital on a Native American reservation in the United States. Sage Memorial opened a School of Nursing in 1930, the first and only accredited nursing training school for Native American women in the United States. At the time of its founding, attitudes persisted among many Anglo-Americans that Native American people were not mentally capable of succeeding in an academic environment.
The Sage Memorial School of Nursing’s founder, Dr. Clarence Salsbury, was a personal acquaintance of Stout’s. “I was told a thousand times that Indians were just not temperamentally suited to be nurses,” writes Dr. Salsbury in his memoirs. “Lots of people said that girls with red skin would never be able to handle the academic subjects, could not master the surgical techniques, and most emphatically [because of their cultural attitudes towards death] would never touch a dead body.” Stout is evidence to the contrary; her cultural beliefs and customs did not impede her nursing practice—rather, she incorporates them into her work.
The school was very successful, graduating many Native American students from all over the United States as well as foreign students from as far away as China and Japan. The school closed in 1951 due to a combination of factors, including changes in administration, difficulties meeting increasingly rigorous accreditation standards, and a change in emphasis towards educating nurses in colleges or universities rather than hospital diploma programs. However, the significance of the Sage Memorial Hospital School of Nursing cannot be underestimated. With the pioneering success of the school and its graduates, it challenged the negative attitudes towards the capabilities of Native American people. In addition, the school’s Native American nurse graduates were at least partially responsible for an increased acceptance among Native people of the benefits of modern, “white” medicine and technology.
Finding her calling
“There is a lot of information out there, you can never know it all,” Stout’s grandmother would say. She encouraged her granddaughter to pursue wider dreams than those readily available on the reservation. After graduating from Ganado Mission High School in 1953, Stout decided to pursue a career in nursing. “When I chose to be a nurse, way back when, there were only three careers available for women—nurse, teacher, and secretary, so I decided nurse. It has been extremely rewarding,” Stout says. “There isn’t another career that allows a woman to use her ability to comfort or care for another person the way that nursing does.” By the time she was ready to enroll in nursing school, the Sage Memorial Hospital School of Nursing was closed, so Stout headed to Dallas, Texas, where she attended and graduated from the Methodist Hospital School of Nursing. Stout continued her education, earning a public health certificate at Western Reserve University (now known as Case Western Reserve University) in Cleveland, Ohio. From there, Stout found her calling in the Indian Health Service. She worked all over Arizona, from Flagstaff to Sells, where she finally retired—at least, she “officially” retired. Her busy schedule says otherwise. “My whole family was involved with public service,” Stout told the Navajo Times in 2009. “I was raised that you serve as long as you are able.”
After retiring, Stout saw how older members of the Tohono O’odham Nation had to leave the reservation to find skilled nursing care. Some elders found it difficult to spend their last years in a facility without traditional foods, language, or ceremonies. TONCA identified a number of gaps and fragmentations in the services provided to the elders of the Tohono O’odham Nation, and the group, under Stout’s leadership, created an elder care consortium to address these issues, including transportation, housing, and safety matters affecting elderly Native Americans.
To address this need, Stout worked with others to create a unique institution, the Archie Hendricks, Sr. Skilled Nursing Facility, which now also includes the Tohono O’odham Hospice. This 60-bed, five-star facility provides culturally sensitive long-term care, respite care, and hospice services for the Tohono O’odham people. The facility offers a combination of the most current evidenced-based care with Tohono O’odham values, traditions, and culturally appropriate care using traditional healers. “Because we are a sovereign nation, we want to preserve our beliefs, traditions, and culture,” Stout explains. “[For example] the Activity Director at the Center wanted to use aromatherapy. The Board asked her what she had in mind, what she planned to use. She told me and then I asked her, ‘Can’t you use mesquite?’ In the morning, the women of the village are making bread and the smell of mesquite is very strong—it is a comforting smell. The elders would love to smell this at the facility along with the sage.”
One of the facility’s initiatives is The Starlight Program, which monitors residents suffering dementia and encourages their involvement in activities. Other offerings include music and aroma therapy, intergenerational activities, and Alzheimer’s outreach.
Since its opening, the Archie Hendricks, Sr. Skilled Nursing Facility has received numerous accolades, including a 2008 award from the Harvard Project on American Indian Development, a 2008 local impact award from the National Indian Health Board, a 2009 award from the Indian Health Service, a 2009 Top Small Workplaces award from The Wall Street Journal, and a five-star rating from the Centers for Medicare and Medicaid Services (CMS) federal agency.
Stout and the TONCA Board were the driving force behind the creation of the Elder Care Consortium (ECC) that coordinates four tribal entities to address the needs of the Tohono Nation’s senior citizens. ECC members include TONCA, the Indian Health Service, the tribe’s Health and Human Services Department, and the Tohono O’odham Community College. All work together to address the varied challenges that face the nation’s elders.
“Healthy aging is an important issue. Many of our people have diseases that could be prevented. We must invest more in preventative health and education, including the incorporation of traditional Native American medicine. Western medicine does not have all of the answers,” Stout explained to the Robert Wood Johnson Foundation. “Our elders suffer from a number of chronic diseases, such as diabetes and hypertension. In addition, transportation, housing, and safety are also major issues for the aging Native American population. We live very far apart, and many of the elderly live alone. How are they supposed to get to the grocery store or to the clinic when there is no transportation? It is very difficult. We have to literally create all of our own services.”
After decades of hard work, Stout continues to address such services and her people’s unique needs. In addition, she serves on another nonprofit board and is also a member of the San Xavier Health Committee. Currently, a typical day may find Nurse Stout doing a lot of reading and responding to these committees. Some days are spent driving to the nursing care facility two and a half hours away from her home. (“The scenery is beautiful and very calming, so I don’t mind the drive,” she says.) As committed to her family as she is to her profession, Stout can also be found driving her grandson to the university he attends.
While Stout has dedicated her career to caring for Native Americans, she notes, “I don’t want people to think we are so different. A nurse can respond to any culture she’s working with. Nursing gave me the ability to care for and work with anyone, no matter where they come from or who they are.”
When Nurse Stout approaches recruiting young people to the field of nursing, she emphasizes fostering dedication and commitment. For Nurse Stout, when it comes to recruiting and reaching out to young people on behalf of nursing, it’s all about fostering dedication and commitment. They should also know up front that the classes, clinicals, and careers are not easy. She believes it is critical that future nurses commit themselves to the work wholeheartedly. Then again, all they need to do is follow her example.
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