Healthcare needs are great in South Dakota's Reservation communities. Diabetes and heart disease are prevalent, and emergency room waiting areas are often jam-packed.
While people get injured, fall ill, and grow older everywhere, part of the challenge in rural areas is getting qualified medical professionals to the patients who need them.
South Dakota boasts one of the lowest unemployment rates in the U.S. and one area where jobs are plentiful is rural healthcare.
"There is a disparity in the amount of providers that we're able to get in rural America. It just so happens that every Reservation is rural," said Cheyenne River Sioux Tribe Vice Chairman Wayne Ducheneaux.
For new graduates, the prospect of moving to an isolated, tight-knit community can be daunting.
"When they come here, I think it's incumbent on us to make sure they feel a part of the community. And that's one of the things we need to work on," said Ducheneaux.
"It's not the easiest job. It's not easy living on a Reservation. You don't have the conveniences of going to the mall or going to a really nice grocery store," said USD Junior Clayton Reinhard.
"You do have to decide if you want to live here. That does make a big difference," said Gaylene Pretty Bird, an administrator at Eagle Butte's Medicine Wheel Village.
It's about finding the right fit, which can be a difficult job for rural health administrators. At assisted living facilities like Medicine Wheel Village, background tests and drug screening are part of the application process.
"As far as employees, there was a lot come out, but those who actually showed up for the interviews or come back, or still had working numbers, because we kept their applications as ongoing, we've had trouble finding them," said Ramona Simon, manager at Medicine Wheel Village.
"We do have a very thorough interview and everything is brought out, you know, and we do ask those questions. Because we want to know, 'Are you …do you have the compassion and the heart to be here?'" said Pretty Bird.
Clayton Reinhard is studying nursing on an Indian Health Service scholarship. That means he's obligated to work in a Reservation community after he graduates.
Reinhard says he's ready for the challenge, "You don't have all the equipment in those smaller hospitals like they do here at Sanford, so you have to know how to do a lot more stuff with less equipment. For instance, they generally don't deliver babies on Reservations, but you don't always have the time to make it to a new hospital, so you still have to be equipped to do all that."
In addition to doing more with less, there are cultural factors to consider when working in a Reservation health system.
"What their needs are, what traditional remedies they like to use, and you need to know how to incorporate them into their practice if they choose those," said Reinhard.
And despite being an enrolled member in the Lower Brule Sioux Tribe, Reinhard has found that race remains an issue for some, "I've already experienced it, like Native Americans at the health facility I worked at, they didn't want me to work with them because I was white. Little did they know I was Native American."
But for those who decide to take the rural or Reservation health path, the rewards can be great.
"We've had people move in here and they love it here. They love to hunt, fish, some have bought ranches. They have cattle, have horses now. You know, they've really engrained themselves into this community," said Simon.
"You know I've worked in many other jobs and this one - what sets it aside - is I feel like I'm giving back. Because a lot of elders taught me a lot of wisdom and knowledge and my culture and my language - our own language. And I feel that in return, this is how I give back," said Pretty Bird.
The Cheyenne River Sioux Tribe plans to expand Medicine Wheel Village from an assisted living to include nursing home services next year. Simon tells KSFY News that they are always looking for qualified, caring people to join their staff.
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