Wednesday, January 8, 1913 was a cold day in northeastern Nebraska. Despite the chill, a group of residents, local dignitaries, and religious leaders had gathered on a rise overlooking the town of Walthill. They were there to celebrate the opening of a hospital—the first hospital in rural Thurston County and the only one in the nation built on an Indian reservation without federal funds.

Amid the throng stood the woman solely responsible for raising the more than $9,000 (about $270,000 today) required to construct it. Susan La Flesche Picotte of the Omaha Tribe was a diminutive woman with dark brown hair that she kept secured in a bun. At a time when women weren’t allowed to vote and Native Americans weren’t yet recognized as citizens, Picotte had become the first Native American to earn a medical degree, having graduated from the Woman’s Medical College of Pennsylvania in Philadelphia in 1889. She finished first in her class. And now, at age 47, Picotte was realizing her longtime dream of opening a local hospital to treat not only her fellow Omaha people but anyone who needed care.

“Even right here in the community, people just didn’t know anything about her,” says Nancy Gillis, a Walthill resident of Cherokee and Choctaw heritage who serves on the board of the Dr. Susan La Flesche Picotte Center, a nonprofit working to restore the building as a community resource. “I spoke at a Walthill High School reunion and gave a presentation on what we were doing at the hospital, and I had people who had graduated in the ’50s and ’60s who said, ‘Gee, I never knew what that building was.’ They never knew anything about her at all.”

But, says Gillis, that has been changing. Recently, awareness of Picotte has grown. In 2016, she was featured in a PBS documentary film about Native American women in medicine. That same year, University of Nebraska journalism professor Joe Starita published a comprehensive biography, A Warrior of the People (St. Martin’s Press). Starita, who has written three books about Native American history, was fascinated by Picotte’s extraordinary character and how she was able to achieve so much at a time when the barriers to advancement for Native American women were overwhelming.

“People need to know about this woman,” he says. “You line up every value and character trait that Americans hold dear—love of family, love of country, honor, courage, integrity, humanitarian impulses, whatever it is—she checks every box and she accomplished it all at a time when the odds of pulling it off were 1,000 to 1. The number of obstacles she had to overcome. ... It’s a terrifically inspiring story.”

Picotte was born on June 17, 1865 in the Nebraska Territory, likely during her people’s annual summer buffalo hunt. When she was still a young girl, she witnessed an incident that would influence the rest of her life, according to Starita. She had gone to the bedside of a sick, elderly woman, who was waiting for the white doctor from what is now the federal Bureau of Indian Affairs to visit. Four separate times, a messenger went to fetch him. But he never came. The woman died at dawn. It was an experience that haunted Picotte. “It was only an Indian,” she would later recall, “and it [did] not matter.” The doctor, apparently, preferred “hunting for prairie chickens,” to “visiting poor, suffering humanity.”

“That was the trigger to set her life on the trajectory that it went on,” says Starita. It also convinced her that the Omaha needed a doctor of their own.

Picotte’s father, Joseph La Flesche, was born to a French fur trader father and Native mother and served as the last recognized chief of the Omaha Tribe. He believed that if the Omaha were to survive, they would need to adapt to white culture and attend white-run schools. He sent each of his four daughters to the religious schools on the reservation. All would become successful in their respective fields, along with a half-brother, Francis, an accomplished author and pioneering ethnologist who worked for the Smithsonian Institution’s Bureau of American Ethnology.

At age 14, Susan (the youngest daughter) and her sister Marguerite traveled to New Jersey to attend the Elizabeth Institute for Young Ladies. It would be Picotte’s first exposure to the cosmopolitan East Coast lifestyle she learned to navigate so well. In 1884, she entered Virginia’s Hampton Normal and Agricultural Institute, a school established to educate freedpeople and their descendants and, later, Native Americans. (Booker T. Washington had attended a decade prior.) Picotte thrived at the school, graduating second in her class. “We who are educated have to be pioneers of Indian civilization,” she told the crowd during her Hampton graduation speech. “The white people have reached a high standard of civilization, but how many years has it taken them? We are only beginning; so do not try to put us down, but help us to climb higher. Give us a chance.”

It was the Connecticut Indian Association that provided a chance for Picotte. Ethnologist Alice Fletcher, who had spent time with the Omaha people and had become a La Flesche family friend, worked with other members of the group to raise the funds necessary to send Picotte to medical school in Philadelphia. At the time, women doctors were held in low esteem by their male counterparts, who derogatorily called them “doctoring ladies.” Some even hypothesized that the academic rigors of medical school could make them infertile. But Picotte persevered and graduated first in her class of 36.

Somehow, she also found time to marry—a Yankton Sioux tribal member and former circus sideshow performer named Henry Picotte—and raise two boys, whom she occasionally brought along on her house calls.

In the late 1980s, the hospital, which had been most recently used as a private residence, came up for sale. Around the same time, Keith Mahaney, a local farmer who was born in the hospital in 1948, first learned about Picotte’s achievements. “I was born in the building, grew up in the area, and had no idea about the historic significance behind it,” he says. “It was like some well-kept secret, whether you were Native or white. It had lost its significance, but it was a story that really needed to be told.”

The fledgling group had few funds, and the hospital continued to deteriorate. By 2018, the structure was in such bad shape that the National Trust designated it as one of the 11 Most Endangered Historic Places in America. “It was deteriorating fast,” says architect Gary Bowen, who serves on the nonprofit’s board. “Had we not started something, it probably would not be there today.”

Dan Worth of BVH Architecture conducted the building assessment and created the master plan, and the center hired his firm (where Bowen was formerly a principal) to design and oversee the restoration. The first necessity was to replace the badly leaking roof. Then, working from photographs of the original structure, contractors removed the 1940s asbestos cement shingle wall cladding and restored and repainted the original wood siding, trim, and window frames. Even the hooks for the hammocks on the building’s porch remain. Now, says Worth, “the exterior looks remarkably identical to the original hospital.”

Restoration of the building’s interior is ongoing and should be completed by late 2023. Many architectural details will be preserved, including mechanical transoms above the tall wooden doors, push-button light switches, and a dumbwaiter that once transported meals from the basement kitchen to patient rooms a floor above. Part of the building will house a museum relating the story of Picotte. In addition to artifacts from the hospital’s early days, her leather medical bag and textbooks (with her comments in the margins) will be on display.

Like many reservation communities, the town of Walthill, with a population of 695, has its challenges. Thurston County is among the poorest in the state, and access to health care is limited. The plan is that the Dr. Susan La Flesche Picotte Center will become a community resource, housing behavioral and mental health counseling services, a small medical clinic, an artist co-op, youth programming, community gardens, and more. “It was meant to be a place of healing, and we’re looking at all aspects of healing,” says Gillis.

Supporters also hope the building—and Picotte’s renewed legacy—serves as a source of inspiration for Nebraska’s original peoples.