The exterior of the Dr. Susan Center in Nebraska.

photo by: Dana Damewood

Preservation Magazine, Winter 2023

The Revival of a Nebraska Hospital Founded by a Groundbreaking Native American Woman

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.

A portrait of Dr. Susan La Flesche Picotte

photo by: History Nebraska

Susan La Flesche Picotte, circa 1905.

A Methodist Episcopal pastor opened the ceremony with a prayer, while an Omaha elder, speaking in his native tongue, closed the proceedings with his own. Then visitors filed into the one-and-a-half-story, 39-room building. They toured the hospital’s maternity ward, its operating room, two general wards that could accommodate six patients each, and five private wards. The most distinctive feature of the Craftsman Style building was its 78-foot-long screened porch, spanning the building’s entire east side. From hooks hung hammocks for patients recovering from tuberculosis, a disease brought by white settlers that had been running rampant on reservations. “Plenty of fresh air and sunshine,” Picotte would often say. “That is nature’s medicine.”

In its first two years, the Walthill hospital treated 448 patients for everything from TB to fevers to broken bones. The building continued to operate as a hospital until the mid-1940s, long after Picotte’s death in 1915 at age 50. It served several purposes thereafter: a nursing home, a bakery, and an upholstery shop, among others. With every decade, the building deteriorated a little bit more.

Memories of Picotte’s impressive accomplishments also faded over the years. Public schools in Nebraska didn’t teach about her, and even many of her own Omaha people weren’t familiar with the first Native American to practice Western medicine.

“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.”

Dr. Susan La Flesche Picotte and her family.

photo by: History Nebraska

Picotte with her mother and her two sons at home in Bancroft, Nebraska, circa 1902.

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.

Despite offers to practice medicine on the East Coast, Picotte held fast to her goal of returning to help the Omaha Tribe. Once she was home in Nebraska, however, the real challenges began. “Imagine you’re 24 years old,” says Starita. “You come back to this isolated, remote reservation and overnight you have 1,244 patients scattered across 1,350 square miles.”

According to her detailed diaries, Picotte typically worked from 7 a.m. until 10 p.m. She would often travel dozens of miles by carriage along rough dirt roads in all kinds of weather to see patients, who called her “Dr. Sue.”

Along with her medical duties, the devout Christian also taught Sunday school classes, started a library, brought food to the hungry, presided at funerals, and dispatched legal advice. She traveled to Washington to lobby for Native American land rights and worked to ban liquor sales on the reservation. She was a constant proponent of proper hygiene, convincing homeowners to install screened doors that kept out disease-carrying flies and banning the use of communal drinking cups. At the same time, her missionary zeal, fervent temperance campaigns, and preference for Western medicine were sometimes at odds with her people. “I shall always fight good and hard, even if I have to fight alone,” she wrote.

The exterior of the Dr. Susan Center in Walthill, Nebraska.

photo by: Dana Damewood

The refurbished exterior of the hospital Picotte founded in Walthill, Nebraska.

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.

Dr. Susan La Flesche Picotte's residence.

photo by: Dana Damewood

Picotte’s former residence, several blocks from the hospital.

She had also begun a fundraising campaign in hopes of fulfilling her goal of building a modern hospital on the reservation. (The closest was in Sioux City, Iowa, 27 miles away across difficult terrain.) She wrote letters to her East Coast friends and spoke at local churches and town hall meetings to drum up support. The largest donation came from the Presbyterian Board of Home Missions, which had previously employed her to proselytize on the reservation. William Steele, a prominent regional architect, designed the building, which sat on a donated 1-acre plot several blocks from Picotte’s house. (The wood-frame, two-and-half-story Victorian-era house, listed on the National Register in 2009, remains a private residence.)

But Picotte didn’t have the opportunity to practice medicine at her new hospital for long. For years, she had been suffering from exhaustion and was deaf in one ear, likely from exposure to the cold on carriage rides across the prairie. She developed what was thought to be bone cancer in her ear and face, which eventually spread.

Picotte died on September 18, 1915 and was buried beside her husband in a 3-acre cemetery in Bancroft, Nebraska, about 15 miles south of Walthill. A story in The Walthill Times paid tribute: “Hardly an Omaha Indian is living who has not been treated and helped by her, and hundreds of white people and Indians owe their lives to her treatment, care, nursing.”

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 screened-in porch at the Dr. Susan Center.

photo by: Dana Damewood

Patients could breathe in fresh air on the hospital's 78-foot-long screened porch, restored in 2021.

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.”

But first, the structure needed to be preserved. He and other locals, including several of Picotte’s descendants, formed the Dr. Susan La Flesche Picotte Center and acquired the building, with the goal of restoring it as a community center and museum.

The previous year, Judi gaiashkibos, executive director of the Lincoln-based Nebraska Commission on Indian Affairs, had organized a meeting of various stakeholders to see what could be done to restore the hospital and promote Picotte’s legacy. “She had long been one of my heroes,” says gaiashkibos, a member of Nebraska’s Ponca tribe. “She inspired my daily work. I admired her tenacity and her motto that no matter how hard it was, she would do it, even if she had to do it alone.”

To help kick off the fundraising efforts for the Dr. Susan La Flesche Picotte Center, gaiashkibos secured a $100,000 grant from the U.S. Department of Agriculture to conduct an assessment and create strategic, architectural, and engineering plans. (She also identified a donor to fund a 7-foot-tall bronze statue of Picotte on downtown Lincoln’s Centennial Mall.) Soon, other grants came in, as well as private donations, including many from doctors across the state. Last spring, the National Trust’s Telling the Full History Preservation Fund, which helps interpret and preserve historic places of importance in underrepresented communities, contributed $50,000. The money will go to the center’s Tribal Youth Voices Matter Project, which aims to engage the youth of the Omaha Tribe in restoration efforts and programming. All told, the group, with gaiashkibos’s help, has raised nearly $5 million and counting.

The unfinished interior of the Dr. Susan Center.

photo by: Dana Damewood

Transom windows and push-button light switches will be preserved in the interior restoration.

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.

Architects inside the unfinished Dr. Susan Center

photo by: Dana Damewood

Architect Dan Worth (at left), Chris Nielsen of Fauss Construction (at center), and Brandon Heide of BVH Architecture on a walk-through of the hospital building.

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.

“You need heroes,” says Starita, who established a college scholarship fund for Native American high school graduates in 2012. “You need heroes to give you hope. And you can’t be what you can’t see. If more 14-year-old girls can see and understand what she did more than 100 years ago, it gives them the inspiration and opportunity to try to model some of their lives after what she did.”

In fact, many of Picotte’s descendants have gone on to pursue careers in health care, says Pierre Merrick, a family member who serves on the center’s board. “I think she would be very proud that so many of the descendants followed in her footsteps. We have a lot of degrees in this family,” he says. “And I think she would be really proud that she’s no longer in this fight alone. Today, we are in the fight with her.”

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Joe Sugarman lives in Baltimore and is a frequent contributor to Preservation magazine.

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