Being a nurse has been a calling for Mattiedna Johnson, RN, MTMA Div., of Cleveland, Ohio. In fact, it could be said that her pioneering work in health care is part of a divine agreement. The fifth child born to Arkansas sharecroppers, she tells the story of how her father, upon seeing how tiny she was at birth, begged God to spare her life. In exchange, he promised to return his daughter to God in life. As part of the bargain, Johnson’s father told her when she was just a child that she was to become a medical missionary in Africa.
Out of her determination to fulfill her father’s promise, Johnson has spent a lifetime making groundbreaking contributions to the health care field. Her work has improved both patient care procedures and the profession of nursing. She has helped form organizations for African-American nurses, been a pioneer in setting up public blood pressure screenings and conducted history-making research that helped develop a cure for scarlet fever.
These contributions have not gone unnoticed. On October 23, 1990, the Hon. Louis Stokes, one of the nation’s most prominent black Congressmen, saluted Johnson in a speech before the U.S. House of Representatives. Citing Johnson for her many accomplishments, Stokes called her “a great pioneer and a source of inspiration to our community and the nation.”
Making a Lasting Impression
Growing up in Arkansas, Johnson always knew she would one day be a nurse. As a student, she excelled in her classes. In college, she spent her weekends cleaning other people’s houses to help pay for her nursing studies.
“A Salute to a Nursing Pioneer”—The Hon. Louis Stokes on Mattiedna Johnson, RNThe following comments are excerpts from a speech made by Rep. Stokes before the U.S. House of Representatives on October 23, 1990:
Mr. Stokes: Mr. Speaker, I rise today to pay tribute to Mattiedna Johnson, RN, MA Divinity, MT, who is being honored at an upcoming “Salute to Nursing Pioneers Program.” On November 11, 1990, friends and colleagues will gather at Cory United Methodist Church in Cleveland to pay tribute to Mattiedna Johnson for her 50 years of nursing service to the community. I am pleased to salute Nurse Johnson on this special occasion and I am proud to share with my colleagues some of the highlights of her distinguished career. . .
In 1944, Nurse Johnson conducted research at the University of Minnesota Department of Plant Pathology, which resulted in the cure for scarlet fever. In 1945, she was certified by the American Red Cross and began teaching disaster nursing and basic first aid. One year later, Nurse Johnson was certified as a medical missionary and served in Liberia, West Africa, where she promoted the organization of the Liberian National Nursing Association.
Nurse Johnson moved to Cleveland in 1959, where she tutored nurses for the Ohio Board of Nurse Education and Registration, and spent much of her time as a leading American Red Cross volunteer instructor. Classes included “Mother’s Helper,” “Teenage Babysitting” and “Home Nursing.” She also developed special courses for church nurses, utilizing church basements throughout Cleveland for her classroom.
Mr. Speaker, Mattiedna Johnson has also been an outspoken and courageous advocate on behalf of black nurses. At a nurses’ convention in 1970, she called black nurses together. That meeting led to the formation of the National Black Nurses Association. She went on to organize the Cleveland Council of Black Nurses and, in 1973, with the Akron Black Nurses, she convened the first institute and conference of the National Black Nurses Association.
Although now disabled, Mattiedna has not lessened in her efforts. She is an active participant in the 21st Congressional District Caucus and the Congressional Black Caucus Health Braintrust, which I chair. In addition, she is the author of The Penicillin Project Diary Notes and is now publishing the Johnson’s Manual for Church Nurses.
Mr. Speaker, I take pride in congratulating Mattiedna Johnson. She is a great pioneer and a source of inspiration to our community and the nation.
Source: Congressional Record
In her last year of high school Johnson and another student tied for top honors in her class. Because Johnson had not been an original member of the graduating class (she skipped eighth grade), she was named salutatorian instead of valedictorian. But she was determined to prove that second place didn’t mean second best. Johnson recalls the effect her speech had on the audience attending the commencement ceremony.
“As I spoke, people stood up and listened,” she says. “They didn’t stay in their seats. When I finished my speech, they stood there and clapped for a good three minutes. Everybody was crying, although I didn’t know why. My subject was about being prepared for better things.”
In fact, her words made such an impression on those attending that even after Johnson went away to college, people in her hometown continued to remember her and her plans to be a nurse. “When I went to nursing school and came back home to visit, these people would send me a dollar and write to me,” Johnson recalls. “It was a community type of thing, a small town thing.”
Johnson graduated from Jane Terrell Memorial Hospital School of Nursing in Memphis, Tenn., in 1940. She then worked as a post-graduate nurse at Homer G. Phillips Hospital in St. Louis, Mo., where she earned her license as a registered nurse.
“This was a hospital where a woman had started a program to pull in nurses from small hospitals to replace nurses who had gone on to Fort Wachuca in Arizona in the U.S. Army [during World War II],” Johnson recalls.
This experience laid the groundwork for what would later become one of Johnson’s most significant contributions to health care.
“As post-graduate nurses, we could go to other programs,” she says. “I went to the St. Louis Isolation Hospital for a period of study. There I took care of a little baby, 18 months old, who had scarlet fever. His grandmother had given him some kerosene on sugar, which was the common treatment at the time. In those days, the disease was incurable. He died in my arms. When I put him in the morgue, I noticed they put a blood-red tag on his foot, a burnt-orange tag on the coffin and a white tag on the casket.”
Johnson returned to Homer G. Phillips Hospital where, one day, she saw in a physician’s magazine an advertisement for the Northwest Institute of Medical Technology in Minneapolis. She applied for the program and was accepted. On January 1, 1943, she took the train to Minneapolis, where her life would change in many ways.
“I stayed in the home of Dr. and Mrs. Winston,” Johnson remembers. “He was a professor at the University of Minnesota and his wife worked with the Red Cross. Knowing I was a nurse, she would talk to me.
“One day, Mrs. Winston was making some notes and she asked me what I would do [as a nurse] if Minneapolis were bombed and I saw someone injured in the street. I told her I would first see if the person were breathing and establish the breathing process, then I would check for bleeding. Mrs. Winston put that information in her notes and started a disaster nursing program for the Red Cross. Before she left to go to France [during the war], she gave me a Red Cross pin.”
In December, after a year of study, Johnson completed the medical technology program. In order to remain in Minneapolis, she rented rooms in people’s homes and returned to cleaning houses to pay for her expenses. One home where she lived was that of the family of her future husband.
Breaking the Mold
Not long after completing her medical technology courses, Johnson came across the career opportunity of a lifetime.
“In February 1944, there was a big article in the paper describing the U.S. Army Medical Corps’ Penicillin Project that was being brought to the University of Minnesota’s Department of Plant Pathology,” Johnson says. “I caught the early bus the next day and went to the university.” She was hired by the project’s director, Dr. Clyde Christianson, and worked on the research team for the next several months. She was the only African American, the only laboratory technician and the only registered nurse on the project.
Johnson’s experience from the isolation hospital in St. Louis helped her convince the project’s leaders of her potential value to the team. “When I first got to the university,” she relates, “I went up some steps and went into the agriculture building. Dr. Christianson was squatting down looking at some laboratory specimens. Some of them had burnt-orange tags. I told him that somewhere among the ones with the burnt-orange tags was a blood-red tag because somebody had died, which meant these specimens were contaminated. He stood up, looked at me and said, ‘What do you suggest?’”
British scientist Alexander Fleming had discovered penicillin in 1928, after observing that a common bread mold had the ability to kill bacteria that caused disease. He had been searching for a chemical that would combat many of the deadly diseases soldiers suffered in World War I. When World War II began, there was a renewed need for such a medicine.
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Johnson’s experiences growing up on a farm proved to have an unexpected benefit on her ability to understand and work with penicillin molds. As a child, she had been taught to churn butter and make lye soap, and she had helped her mother make apple jelly. Now, working in a makeshift laboratory in the corner of the agriculture building, she drew upon her knowledge of these natural scientific processes to develop techniques for separating the essence of molds and matching the residual liquid to a commonly used chemical substance called oxyacid. She also established isolation procedures for many disease materials that were sent to the lab.
The Penicillin Project team experimented with many molds from all over the country, growing them in a potato soup liquid. But, says Johnson, it was a mold on some cooked squash in her refrigerator at home that tested out to be the one that killed the germs.
Johnson was particularly interested in treatments for scarlet fever because of her experience with the baby who had died from the disease at the St. Louis hospital. Toward the end of the project, she conducted experiments with a tomato soup mold, testing it against specimens of saliva from an infant who had succumbed to scarlet fever. This particular penicillin mold turned out to be such an effective devourer of scarlet fever germs that Johnson nicknamed it “the terrible mice mold,” because under the microscope the mold looked like it was “running around the house tasting everything.”
After she discovered that penicillin was a viable treatment for scarlet fever, Johnson gave her results to one of the researchers with whom she worked in the lab, to take to the pharmaceutical company where he was employed. She left her final mark on the project by giving this advice: “Make the medicine up in peppermint-flavored syrup for babies and children, to be given around the clock until the fever breaks.”
Africa and Advocacy
But Mattiedna Johnson’s exceptional contributions to medicine and nursing didn’t end there. After completing her work on the Penicillin Project, Johnson embarked on a new chapter in her life. She received American Red Cross certification and began teaching disaster nursing and first aid. After the war, Johnson and her husband, a Methodist minister, spent two years in Africa, where she worked as a medical missionary in Liberia. She also taught chemistry and hygiene courses at the College of West Africa in Monrovia.
“My father’s hope for me when I was born was that I would become a medical missionary and go to Africa to serve,” she explains. “So this was a continuation of that promise my father made to God.”
Johnson and her husband eventually returned to the United States. Because of her husband’s many church assignments, they moved frequently. In 1959 they settled in Cleveland, where she tutored nurses for the Ohio Board of Nurse Education and Registration and worked as an American Red Cross volunteer. She also taught courses on babysitting and home nursing. But it wasn’t long before Johnson again became involved in making medical history.
“Some other nurses and I were at the church one day and we decided that Rev. Kelley [Johnson’s husband] was having too many funerals,” she says. “He was having two or three funerals a week, and we wanted to find out what was killing these people. We decided to do a 575-person blood pressure screening at Cory United Methodist Church. That was the first time that blood pressures had been taken [at a location] away from a doctor’s office. After that, blood pressure screening became widespread.”
In her later years, Johnson became an active participant in the 21st Congressional District Caucus and the Congressional Black Caucus Health Braintrust, chaired by Ohio Congressman Louis Stokes. In this capacity, Johnson began speaking out on behalf of African-American nurses. Realizing how difficult the socioeconomic situation was for black patients and health care workers, she held a meeting of black nurses at a 1970 nursing convention. That meeting led to the formation of the National Black Nurses Association in Cleveland in 1971. (The NBNA is now based in Silver Spring, Md.) Johnson later organized the Cleveland Council of Black Nurses in 1973.
In addition, Johnson’s continuing concern about the problem of high blood pressure in African-American communities led her to become actively involved in the International Society on Hypertension in Blacks (ISHIB).
“Mattiedna Johnson has been a member of the International Society on Hypertension in Blacks for the past decade,” comments C. Alicia Georges, RN, EdD, FAAN, secretary-treasurer of ISHIB and a past president of the National Black Nurses Association. “She was the recipient of our community service award for her work in blood pressure screening and education in the greater Cleveland area. Mattiedna has been a true community advocate and community educator, long before it became vogue. Her dedication to improving the health status of minority communities is exemplary.”
Mattiedna Johnson may be only one person, but her contributions to health care and the nursing field have affected the lives of many, thanks to a father’s promise to God and a nurse’s dedication to humanity.
Author’s Note: To learn more about Mattiedna Johnson and her life’s work, read her autobiography, Tots Goes to Gbarnga, available online from Barnes & Noble at www.BN.com. The book can also be purchased directly from Johnson; for more information, email her daughter, Bobby Kelley, at [email protected].
Although the average physician might disagree, some nursing leaders have expressed the opinion that nurses may be way ahead of doctors when it comes to addressing the issue of racial and ethnic health disparities. They cite, for example, the formation in 1998 of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), in which the nation’s five leading minority nursing professional organizations joined forces to aggressively advance the agenda for minority health research and policy change.
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If this is indeed the case, two recent developments provide some encouraging signs that America’s physicians are working hard to catch up. Following NCEMNA’s model, a group of four key minority medical associations—the Asian and Pacific Physicians’ Association, the Association of American Indian Physicians, the National Hispanic Medical Association and the National Medical Association (which represents African-American physicians)—have come together to establish the Alliance of Minority Medical Associations (AMMA).
The newly formed coalition’s goals include: increasing the quality of health care and access to care for minority populations; developing awareness, surveillance and treatment programs targeting major chronic diseases that impact racial/ethnic disparities in health; developing strategies to increase the minority health care workforce; and increasing minority community participation in health. One of AMMA’s first projects will be to host a National Health Leadership Summit where leaders from the public and private sectors will work on developing “measurable initiatives to eliminate health disparities.”
Meanwhile, the nation’s largest majority medical specialty organization, the American College of Physicians (ACP), has launched several new minority health initiatives, including a position paper on minority health disparities and a 5K run and walk at its annual convention to raise funds for minority health services in the San Diego area. In addition, ACP has created two patient outreach programs to educate Hispanics about diabetes and African Americans about breast, lung and prostate cancer. For information about these education programs, contact Carolyn McGuire at (202) 261-4572 or [email protected].
“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.
Setbacks and Successes
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.
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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.
“An Amazing Opportunity”
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.
Some Current Indian Health Initiatives at the CDCBreast and cervical cancer early detection
Breast and cervical cancer early detection
National Diabetes Prevention Center
Water fluoridation programs
Tobacco use prevention programs
Injury and family violence prevention
HIV/STD surveillance, prevention and education
Hepatitis investigations and prevention
Immunization promotion, tracking and evaluation
Arctic Investigations Program–Infectious Disease Prevention and Control for Alaska Natives
For more information: CDC Office of Minority Health, www.cdc.gov/omh
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.”
“Native Nurses Are the Cream of the Crop”
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.
Two of California’s most distinguished minority nurses, both of whom have devoted much of their careers to mentoring, teaching and developing training programs for students from underserved communities entering health care professions, were honored this summer by The California Wellness Foundation (TCWF) as the inaugural winners of its Champion of Health Professions Diversity Award. At an awards ceremony in Los Angeles, Linda Burnes Bolton, RN, DrPH, FAAN, and Pilar De La Cruz-Reyes, RN, MSN, each received a $25,000 grant in recognition of their pioneering achievements.
“Each of these champions has developed innovative and effective practices that promote diversity in California’s health workforce,” says Alicia Procello, TCWF program director for the Diversity in Health Professions Priority Area. “As a result of their efforts, many more health professionals are working in traditionally underserved communities, helping to decrease the well-documented disparities in health for people of color in our state.”
Both of the winners are high-ranking nurse executives who overcame significant barriers to rise to the top of their profession. Burnes Bolton, who made history as the first African American to graduate from the Arizona State School of Nursing, is vice president and chief nursing officer at Cedars-Sinai Medical Center and Research Institute in Los Angeles, where she instituted a cultural competence training program for all staff.
As a faculty member at both UCLA and the University of California, San Francisco, Burnes Bolton actively recruits and supports minority applicants for admission into the graduate nursing program and has mentored eight doctoral students from communities of color in the UC system. She also promotes equal opportunity by serving on the California Strategic Planning for Nursing Committee on Diversity and on the editorial board of Hispanic Health Care International, the journal of the National Association of Hispanic Nurses. In addition, she advised on the formation of the Asian American/Pacific Islander Nurses Association.
Pilar De La Cruz-Reyes grew up in a migrant worker family, laboring in the fields by day and studying at night. After earning her BSN and MSN degrees from California State University, Dominguez Hills, she began her career at Community Medical Centers (CMC) in Fresno as a staff nurse. Working her way up through the management ranks, she progressed from frontline manager of acute critical care to director of nursing services to executive director of the Community University and education development services. She is currently chief nurse executive at the Fresno Heart Hospital.
De La Cruz Reyes, who has personally mentored over 35 young people who sought health care careers, has initiated many programs that championed the needs of underserved communities. At CMC she established the hospital’s first Cultural Competency Task Force. In collaboration with Fresno City College, she developed the Nursing Paradigm Program, which provides training for hospital employees to enter the nursing profession. She also developed the Community Job Institute, which provides opportunities for low-income minority parents in the local community to get work experience and training at the hospital.
During its Annual Awards Banquet held last September in Harrisburg, the Pennsylvania State Nurses Association (PSNA) recognized the exceptional accomplishments of nurses working in the Commonwealth of Pennsylvania. Among those honored were minority nurses Shirley Powe Smith, who received the Human Rights Award, and Freida H. Outlaw, who was presented with the Nursing Practice Award. Shirley Powe Smith, RN, MNEd, CRNP, of Pittsburgh, is an African-American nurse who has been a long-time advocate for minority nursing students, homeless women and African-American women. Smith, who received her bachelor’s and master’s degrees from the University of Pittsburgh and is currently a doctoral student at Duquesne University, has spent her years of study working to improve the lives of others. From her research on health care needs of African-American women to creating a charter for an undergraduate African-American nursing student sorority, Smith has untiringly devoted herself to improving the lives of those around her and encouraging minorities to seek careers in health care.
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“Nursing students are the future of nursing,” says Smith. “Their education is geared toward them being the providers of competent, safe and culturally appropriate care to populations of clients in a variety of settings.”
Smith’s desire is to be a part of a health care system that reaches all segments of the population regardless of financial situation. “Homeless women are at a special risk of developing diseases,” says Smith. “Combine this with inaccessibility to health care and you have a situation that could result in increased sickness and disabilities .”
African-American nurse Freida H. Outlaw, RN, DNSc, CS, of Haverford, received the Nursing Practice Award for the difference she has made–and continues to make–in the lives of children and families in crisis. As an advanced practice psychiatric nurse specialist, Outlaw has provided mental health services to a population of women who are most at risk for depression but least likely to seek care–single, poor, urban mothers.
“It’s always been clear to me that I wanted to help people,” says Outlaw, “and although I could have gone on to be a doctor, I wanted to help people in a different way. I think it was a calling. I’ve always loved working with the underserved and needy populations.” Outlaw, who completed a postdoctoral fellowship at the University of Pennsylvania, recently accepted a position as a Research Fellow at the W.E.B. DuBois Research Institute at Harvard. There she plans to focus on educational issues, such as looking at children’s resilience and coping strategies. “We’ll be doing some research on the effect September 11 has had on children, particular regarding suicidal thoughts. We’ll be interviewing kids about their feelings about life since September 11.”
