On a recent visit to a tribal health clinic in northern Minnesota I was greeted with a big smile and a friendly, “hi, how are ya doin’?” Artwork by a local American Indian artist hung on the walls of the small waiting area along with health posters displaying images of American Indian people. A nurse was busy at her computer checking on a client’s status. Charts lay ready on the desk for review before clients arrived for their visits.

I marvel at how this clinic has grown. It started with a public health nurse recognizing that American Indian people living outside the boundaries of the three surrounding reservations were unable to access health care that was culturally sensitive. Finding transportation to attend a clinic on one of the reservations was always a scramble.

The public health nurse obtained a grant from the state health department to set up a nurse-run clinic in a small, one-room office. Staff created fliers and posters and sent them out to reservation offices, schools, Head Start sites, county agencies, and the hospital and clinic located on the reservation. At meetings on the reservation and throughout the county, the nurse promoted the clinic and encouraged referrals. Tribal and local newspapers published stories about the new clinic.

People started trickling into the clinic. It was not long before it became apparent that an on-site nurse practitioner was needed to treat the ear infections, strep throats, and other health issues of the growing client base. A nurse practitioner began seeing patients two days a week. Women’s health clinics were added, and a podiatrist was recruited to see individuals with diabetes.

When a new family center was built nearby, the Public Health Nurse Clinic was invited to move in with other county agencies. For a while clinic space was shared with several other agencies; however the American Indian clients began to feel out of place. The large waiting area and lack of privacy was uncomfortable. Clinic attendance began to decline.

Clinic staff seized upon an opportunity to move within the building. Private waiting areas and exam rooms were available again. Clients started coming back to the clinic. More than 350 people attended an open house of the new clinic space. Having tribal leaders and health professionals attend the event raised community awareness and increased referrals to the clinic from other agencies. The number of clients served doubled from the same six-month period the year before. Approximately ten clients are seen each half-day the clinic is open.

When I asked a nurse if any clients stood out for her, she recalled a 43 year-old gentleman with a traumatic brain injury who was homeless and depressed. With a big smile she reports that he is doing well and now owns his own home. She also related the story of a mother with four children between the ages of four and nine years. All of the children needed physicals. The children were scheduled for the same day and time. “We pretty much just held clinic that day for this family. It was a hectic clinic; we had toys to keep the children busy. The mother appreciated being able to have all of her children seen at the same time.”

Other successes have occurred with clinic staff members. An American Indian licensed practical nurse was inspired to continue her education to obtain her registered nurse license. A tribal public health nurse, who does diabetic teaching, is hoping to expand her practice at the clinic to include more teaching to prevent diabetes in American Indians.

This all started with a public health nurse realizing the needs of American Indian people living off their reservation and identifying the barriers they had in accessing health care. She identified and pursued the means to meet the needs of the people in a way that would be culturally acceptable.