Women Physicians Day: Dr. Susan La Flesche Picotte
February 4 is National Women Physicians Day in the USA. I may be Australian, but I couldn’t help but be inspired by the positive representation I saw around social media, and I thought it might be worth talking about one doctor who really ought to be recognised as a leader of primary care physician culture in the USA. Her story struck me as resonant with a lot of the work GPs do today; not just physical care, but helping to change patients’ lives. This is the story of Dr. Susan La Flesche Picotte.
In 1865, when Dr. Susan La Flesche Picotte was born, the experience of Native Americans was precarious. The reservation system had been in place for a little over ten years, confining Native Americans by law to reservations of allotted land - prior to establishing reservations, many Native American communities had been forcibly removed from their original territories, or locked in bloody conflicts and massacred over attempts to remove them. In 1865, the American Civil War ended, but the unnamed unofficial wars with Native American tribes continued - both as physical conflict, and as cultural warfare. The ability of a single Native American to control their life on a reservation depended on their ability to negotiate bureaucratic processes designed to prevent the empowerment of “incompetents”; one’s competence to manage one’s own affairs was determined by their ability to assimilate into “civilisation, to satisfy states that their “guardianship” was not necessary.
When Susan was a child, still living on the Omaha reservation in eastern Nebraska, she watched a sick Native American woman die because a white doctor refused to treat her. Later, she credited this experience as inspiring her drive towards medicine. As the daughter of the principal leader of the Omaha at the time, she was often exposed to her father’s conviction that assimilation was the best protection for their people; to that end, her father attempted to give her access to all the “civilising” influences that would give her cultural credence among white colonists. She attended a mission school at the reservation; essentially a boarding school which taught techniques for Native Americans to shed their cultural identities and assimilate into white colonial culture. She did well at school, leaving the reservation to study at the Elizabeth Institute for two and a half years before returning to the reservation in 1882 to teach at the mission school. Susan then studied at the Hampton Institute, a non-white college, graduating as class salutatorian and being awarded the Demorest Prize as graduating senior with the highest exam scores during the junior year. With a sparkling academic record, she applied to medical school.
Higher education for women was limited in the USA in the 1880’s, with very few medical schools accepting even white women. The Women’s Medical College of Pennsylvania accepted her application, but of course was too expensive given the working restrictions on herself and her family and the reluctance of banks to provide loans to non-white individuals of any citizenship status. Susan reached out to a friend from Hampton whom she had supported during a flare-up of inflammatory rheumatism, and this friend was able to turn her onto contacts in women’s reform organisations. As it is now, so it was then: networking is the backbone of change.
The Women’s National Indian Association sought to “civilise” Native American women by teaching and promoting cleanliness and godliness, in the belief that this would lead to positive changes in their communities. In a very delicate bit of targeted grant application writing, Susan appealed to their priorities of cleanliness, pitching her medical degree as a pathway to teach her community about hygiene. The Association considered this a noble goal, and it was not completely false that hygiene (and public health in general) would be an issue during Susan’s career; Victorian medicine was not perfectly equipped to combat the tuberculosis, influenza, cholera, dysentery, and trachoma that became the frequent subject of her house calls, especially when reservations were often the last to gain access to treatments, cures, or public health-related infrastructures.
The Association sponsored her medical school expenses, housing, books, and other supplies, making her the first person to receive financial aid for professional education in the USA. However, they did attach a condition to this funding; that she remain single while at school and for several years after graduation. This may have been partly motivated by morality concerns, but was more likely due to a value-for-money calculation; Victorian women were expected to retire to raise children when wed, after all, and a medical degree is no use to the community if it is languishing on the desk of a stay-at-home mother. This would prove not to be the case with Susan, however; she bore two sons and outlived her husband, yet we have records of her working until at least 2 years before her death. In some cases, she even took her children with her on house calls.
Susan graduated top of her class and valedictorian, finally Dr. La Flesche, in 1889. She was asked by the Conneticut Indian Association to do a speaking tour to talk about how empowering an experience it is to assimilate into white colonial culture - we know that her mother, a woman who refused to speak anything but Omaha despite also speaking English and French, would have disapproved. Although I couldn’t find her personal opinion, the Association did fund the purchase of medical instruments and books in her early years of practice in the Omaha reservation and appointed her their “medical missionary”, so it is possible that she made another calculated decision to tell people what they wanted to hear in order to bring about change in her community. She was also appointed physician to the boarding school, but because the school was more accessible to most than the official reservation clinic, she found herself becoming The community family doctor.
Her practice as the community GP thematically resonates with the work of modern community GPs. She was responsible for over 1,000 people in her first 3.5x5 square metre office. Often working 20hr work days, she spent a significant amount of time writing letters for patients, translating bureaucratic documents, and performing other non-medical tasks to support the wellbeing of her patients. In a community where writing and receiving letters determined one’s ability to claim money owed by the Office of Indian Affairs for land, this practice supported the financial stability (and therefore wellbeing) of countless community members. She became a trusted voice, with community meetings occasionally squeezing into her tiny office. She was salaried at $500 per year by the government, with an extra $250 from the Women’s National Indian Association for her work as medical missionary - the equivalent of approximately $21,000 in today’s money. Low estimates sit average Australian GP salaries in 2019 at 10 times that much, even accounting for inflation.
Dr. La Flesche was a keen advocate for preventive medicine and social reform. She was an avid prohibitionist in a community where alcohol was often used by white colonists to take advantage of Native American land holders. She advocated for and taught school hygiene, pushed to improve food sanitation, and contributed to public health campaigns to prevent and treat tuberculosis at a time when there was no cure. A passionate educator, she believed that the key to fighting disease was education,
In the early 1900’s she was Chair of the State Health Committee of the Nebraska Federation of Women’s Clubs, served on the health board of Walthill in 1907, and was a founding member of Thurston County Medical Society in 1907. She campaigned heavily to get a hospital on the reservation; a campaign that finally bore fruit in 1913, two years prior to her death, and was later named in her honour. As the first privately funded hospital on a reservation, it was a critical part of community infrastructure, designed to prevent the endless desperate horse-and-buggy rides that sometimes got to a patient’s abode just a little too late.
Yet she still found time to build a home life for herself. Susan became Dr. Picotte in 1894, bore two sons and opened a private clinic with the support of her husband Henry, where she continued to practice despite the dictates of Victorian colonial society. After Henry’s death in 1905, Dr. Picotte struggled to claim and sell the land that was left to her and her sons, due to their legal “incompetence” as a woman and as minors. The sale of this land would enable her to invest in rental properties, granting her and her sons financial stability for years to come - once her competence to administer her own estate and that of her sons was determined. After 3 years of bombarding the Office of Indian Affairs with letter after letter, she was finally allowed to claim her own inheritance in 1907, leaving her sons’ inheritance in the hands of a distant relative who refused to sell the land. Again, she petitioned the Office, and was finally allowed to prepare a financial future. After facing this struggle all over again when a relative of her husband left a land inheritance to her sons, her increasing frustrations with the Office compounded into outrage at the land fraud committed against minors by a syndicate dedicated to swindling inheritances. She became a passionate defender of Omaha land interests, and in 1910 travelled to Washington to speak face-to-face with representatives of the Office of Indian Affairs to argue that although most adult Omaha deserved to live independently of state “guardianship”, there were still people in the community who needed guardianship, such as minors, to protect them from predatory acts.
Dr. La Flesche’s strength also revealed itself in her management of her own disabilites. In medical school, she often struggled with breathing and numbness, which must have presented a challenge to such a prominent public speaker. In 1892 she took a break from practice because she was struggling with chronic pain in her neck, head, and ears, which caused her to become bedridden for several weeks, and eventually caused her to go deaf. The next year, 1893, she resigned from the mission entirely to take care of her dying mother - then fell from a horse and suffered significant internal injuries. In 1897, she suffered a particularly debilitating flare-up, leaving her family and friends in fear of her life. Still, she rallied, eventually dying in 1915 at the age of 50 after struggling with what is now suspected to be bone cancer.
Dr. Susan La Flesche Picotte is, frankly, an inspiration - and I don’t use that word lightly. It troubles me to imagine people two-dimensionally, to elevate them above a level of complexity - yet here is the first Native American doctor, a woman, a healer, an activist, a woman with persistent health issues whose incisive intellect, compelling communication skills, and fierce compassion transformed a community in dimensions far beyond the supposed scope of her profession. Her story is one of unique struggles, in a context that is generally subsumed by national narratives, yet the impact of her life still stands.
For more info, check out:
http://www.nebraskastudies.org/1875-1899/susan-la-flesche-picotte-first-na-female-physician/
https://cfmedicine.nlm.nih.gov/physicians/biography_253.html
http://www.history.com/news/remembering-the-first-native-american-woman-doctor
https://www.legendsofamerica.com/na-susanlafleschepicotte/
https://www.jstor.org/stable/23531722?read-now=1&seq=12#metadata_info_tab_contents