Wendy Red Star: Tell me about your career path into nursing: how it all started, and why you decided to become a nurse. 

Molly Malone: I originally didn't want to go into nursing, because in high school, I was a candy striper in a hospital and it was terrifying for me. So I initially ruled out nursing, but I wanted to go to college and I didn't really want my parents to pay for it because both my twin and I were going. I applied for the Walter Reed Army Nursing Scholarship, which was set up to recruit more nurses to go to Vietnam. I ended up getting the scholarship, and I did two years at Colorado State University in Fort Collins, and then two years at Walter Reed Army Hospital. I went to Hawaii for three months to take an OB/GYN specialist course for the army, then I was reassigned to Maddigan in Tacoma Washington for a little over a year. I still owed the army 13 months, and there was a 13-month tour in Korea, so they sent me there. 

WRS: Was that your decision? Did you want to go there? 

MM: No. I just got sent there out of the blue one day. They gave me orders to go to Korea. 

WRS: What was your experience like in Korea? 

MM: I really liked experiencing Korean culture. And of course, that's when I adopted your older sister. I worked in labor and delivery. When my tour was over, your sister did not have a passport yet, so I got a job at Westinghouse Electric, that was helping construct a nuclear power plant on the East coast of Korea. They had a lot of expatriates -- a lot of American, British, and Australian civilians -- so they wanted an English speaking nurse onsite. I was in Korea for just under two years. 

WRS: And then when you flew back to the states, what did you do? 

MM: I had a job at a local hospital in Denver, a huge medical center. I worked in labor and delivery, but I was more like a community counselor in an outpatient clinic. It was very stressful to work in a big hospital, especially with a baby, and I think that the culture shock made it extra stressful.

I only stayed for a few months. I decided I wanted to work on an Indian reservation.

WRS: Why? How did that idea come to you? 

MM: Granny was always fascinated with Native American and Western history. She spoke about different tribes to us when we were kids, and took us to museums and we saw Native American artifacts, so it always interested me. Also, it’s a federal job: if you work with an Indian tribe, you work for the federal government. So my military time would completely connect so that my retirement and everything would just automatically add up from what I did with the military. 

WRS: What reservations did you apply to?  

MM: I applied to Navajo reservations, Rosebud or Pine Ridge, and to Crow. They called me up one after the other, and Crow, I think, offered me a little more money. So I went there, but I never had heard of the Crow tribe at all. 

I really liked the Indian reservation after being in Korea. Crow Culture was a lot different from American culture. 

WRS: Did you apply specifically to be a public health nurse? 

MM: I applied to work in a three-bed, small hospital. And at that time I did everything. I did medical work, the emergency room labor and delivery as well as pediatrics and care for newborns. I think it's typical for a rural hospital. It’s not really specialized, the nurses pretty much handle everything.

WRS: When did you transition into public health nursing? 

MM: I was pregnant with you, and one of the public health nurses took a leave of absence to go get her master's degree. What helped me get the job was my experience in Korea, because I was working with another culture. I made a lot of home visits when I was in Korea and I made a lot of independent assessments of patients. That helped me get my foot in the door. 

WRS: As a public health nurse, do you feel like you got to know the community better? 

MM: When you take on a patient, you take on the whole family as your client. For example, if you work with a grandmother, you go into the home and also find out about everyone that lived with her. We also ran local child clinics and followed pregnant women. So we knew the families really well; who lived in one household, who was related, and how the dynamics worked between this or that family.

It was really interesting. If there were little things going on in the community, you would coordinate your visits to accommodate those. You knew what was happening in the community and you'd see people preparing for it and talking about it in their households. It was fun to get to see someone beading for an upcoming pow wow or fair, or to see them making their clothes for handgame tournaments and talking about what team they’re on. 

WRS: What does a public health nurse do on the Crow reservation? 

MM: When I first started, our major goal was preventative health. We had child clinics and made sure pregnant women got access to care. 

We also did a lot of prevention work with communicable illnesses. When I first arrived, there were a few cases of tuberculosis and we followed those cases; we followed sexually transmitted cases and hepatitis cases to catch them early and to do further education. 

WRS: Can you talk about tuberculosis? Because that was hugely devastating to the Crow community. Can you talk about the trauma of the experience of tuberculosis in the community, too, as you encountered patients with that? 

MM: When I first started, I had a caseload of patients that were either active or that had to be monitored in case they became active again. In newly active patients, you had to jump on that, and find out who their contacts were, and get them tested and make sure that the original case was isolated and treated. 

Those cases were very difficult because, number one, these patients were very scared; and number two, they remembered when tuberculosis patients were being sent away to a sanatorium. There were confidentiality issues. They didn't want the whole community to know that they had it and they could be very defensive about trying to tell you who they might have exposed. 

WRS: What sort of big communicable diseases does the Crow tribe have to deal with? 

MM:  In that time period, we had sporadic outbreaks of hepatitis A. There were also sexually transmitted diseases like gonorrhea, syphilis, chlamydia, HPV, and some cases of HIV/AIDS. We also had a couple of measles cases. These were the common cases we had. 

With Hepatitis A, it can be spread by sharing certain kinds of food. If a person on the basketball team has it, then we'd have to hurry up and try to immunize the rest of the team so they wouldn't get it. Any close contact with the player and it would be spread among the basketball team as they all would drink out of the same water jug or Gatorade jug or something. 

WRS: Well, what happened to the white students that were going to school with the students? 

MM: There was a public health nurse in Hardin and she usually would handle the white students. 

WRS: What was your experience like over time? 

MM: Towards the end of my career, I knew at least three to four generations in a family.

I saw the methamphetamine problem when it arrived on the Crow reservation. There were problems with alcohol on the reservation, from fetal alcohol syndrome to motor vehicle accidents and domestic violence. We did a lot of education on fetal alcohol syndrome, because, in the early 80s, people hadn't really identified it yet. Before the mid-80s and end of the 80s, this was a national problem, not specific to Native culture. 

WRS: It's so interesting to get to know a family of four generations. 

MM: It was sometimes a little frustrating because you could see how things are passed from generation to generation, like some of the child neglect issues. I saw the neglected children of your age grow up and neglect their children, doing the exact same thing. 

WRS: How could that cycle be broken or had you ever seen that cycle be broken? 

MM: One of the biggest helpful things was the start of a college on the reservation. Having a community college was a motivator to get through high school. Or if you can get a GED, and still go to that college, it just opened up a whole new world for many, many people signing on to education. It provided an opportunity to go to college with a lot of their own Native teachers. 

This gave some students enough confidence to go to other colleges and get scholarships elsewhere. This passed on through generations, and it helped their children get more education when they grew up. 

WRS: This is so interesting.

MM: And also, when I first went to Crow Hospital, there were only two or three Crow Indian nurses working out there, the rest of the staff was non-Crow or from another tribe. But when I left, at least 75 percent were Crow Indians or from other tribes, and there weren’t as many non-Native staff. 

WRS: That’s incredible. Were you given any advice on how to work with the community? 

MM: Not in any formal class at orientation, but the Crows that worked along with you would say, ‘this person is very traditional,’ or ‘this is how you need to approach them,’ or ‘just copy how they interact.’ 

There was also the process of hearing critiques of you, like, they were afraid to talk to you because you don't really listen to what they say. You had to listen to them tell their story, then ask questions, and help plan to improve the problem that they came to you with. 

WRS: When you first started, what was some of the most surprising stuff about the community that you can remember, or that you had to get used to?

MM: One of the biggest things I had to get used to was that everybody knows everything about everyone.  Especially if you work in health care, you have to be very careful about not letting out anybody's information.  

And especially the more associated you are --  like with your dad being Crow -- sometimes that would help me because I'd be perceived as more approachable than the other nurses who were non-native and who didn't live on the reservation and didn't have any connection really other than working there. But then other times, they would rather see other nurses because they thought that might be more confidential to talk to someone who didn't have any connection. But most of the time, I think they felt more comfortable talking to me because I wasn't out there gossiping. When we did get more Crow nurses, they could still talk to me, because I wasn't related to them, whereas a Crow nurse might have been related to them. 

Every time you go to a store or a grocery store, you're going to see people. The little kids would cry when they would see me because they recognize me as a nurse giving the shots when I went to the grocery store. So that was probably one of the biggest things: just being very careful about people's confidentiality and knowing that everyone's related to each other.

WRS: If you could give advice to a new public health nurse coming to work on the Crow reservation, what advice would you want to give them that you wish that someone would have given you? 

MM: It’s important that they understand how the families are connected together, and how, they can't judge their Native American patients the same way that they might look at their non-native patients. Wherever they came from, this is a group with unique circumstances. 

It’s a little bit like being in a different country. They have their own language, their own culture, and their own ways of interacting together. They had a whole generation that was taken away and put in boarding schools, which might affect parenting. 

This community operates like a big extended family, different from a person who comes in from Denver, Colorado that grew up with just a small little nuclear family. 

Just like you wouldn't go to France and expect them to act like Americans -- you would be respectful if you wanted to connect with them and help them --  then you have to be the same way with the Crow nation. This is a different nation with a different set of circumstances. It’s not the same as growing up, for example, in a suburb in Omaha, Nebraska.

WRS: Do you think that’s part of the reason why non-Crow or non-native medical staff don't stay on the reservation that long? 

MM: Some people were fascinated and really got involved, and other people couldn't handle the isolation they felt. For example, if we got a doctor from New York, they couldn't fit in very well because they didn't have like their museums and theaters -- the state of Montana just didn't have those regardless of the Indian reservation. And I don't know, sometimes they just seemed intimidated by Native culture. 

Other people got adopted by members of the tribe and participated in some of the religious activities.

WRS: You’re currently on the Crow reservation with my dad, and the pandemic is raging.  Though you are retired, what are some of your thoughts about what's happening with the pandemic? How dangerous is something like Covid-19 for the Crow tribe or for any native reservation? 

MM: I think that right now the Crow tribe is experiencing one of the highest death rates in the nation. There are just so many factors that make the virus go through the tribe like fire.

Number one, many people can't isolate. You know, there could be several families inside one household and each one lives in a bedroom. So it's very hard for them to isolate the person who is positive. 

Two, there are usually many people in that family that may be immunocompromised or have illnesses like diabetes or obesity or things that complicate recovering from the covid virus. 

You see younger people, maybe a person in their 50s or 60s, dying more on the reservation because of underlying conditions that make it harder to get over Covid-19. 

WRS: So, your thoughts are that it’s currently a mess? 

MM: Going back to the idea of stigma. People don't want to tell people who their contacts are. They don't want to be labeled as the person who has a disease in the community and that's contagious. So a lot of times they're not telling all their contacts or they're going around the community not quarantining. 

Is it a mess? I’ve heard public health nurses are extremely busy, very distraught every time there is a death. The hospital itself is not equipped to handle anything serious at all. Those people have to go into Billings or elsewhere [off of the reservation] where they have the capability of putting seriously ill patients on a ventilator. Currently, it’s understaffed and underserved. 

Being rural, and having extended families that all live in close contact, it’s hard to tell a family member that they can't come and see you. It seems kind of disjointed, because there may be three members of one family dead, in a fairly rapid time period. But still, many people are trying to go about their normal habits and lives. 

WRS: Did you, as a public health nurse, ever talk about what to do if a pandemic happened? 

MM: Yes, during the Bush administration. We had a few pieces of training about pandemics, Specifically, they talked about the 1918 Spanish flu and how lethal pandemics are. We did have an H1N1 flu scare one year. I think people at the Billings area office were probably writing protocols about what to do during a pandemic. But it seemed like all that really filtered down to us were a couple of movies about pandemics that we watched.