In the Fargo-Moorhead metro area, a community of about 250,000 people spanning North Dakota and Minnesota, there is only one Native American mental healthcare provider. Her name is Whitney Fear.
A member of the Oglala Sioux Tribe, Fear grew up on the Pine Ridge Reservation in South Dakota, where she witnessed many community members struggling with mental health issues and substance use. Now a psychiatric mental health nurse practitioner at Family HealthCare in Fargo, N.D., she uses her background and Lakota identity to help treat patients of all ages as they confront traumas like homelessness, trafficking and addiction.
Fear’s story premiered April 22 in the documentary, Who Cares: A Nurse’s Fight for Equity, funded by the Robert Wood Johnson Foundation. In a conversation with Native News Online, Fear talked about her experience as a Lakota nurse, best practices when helping patients heal through trauma and the impact she hopes her documentary will have on the healthcare field.
This interview has been edited for content and clarity.
Native News Online: In your documentary, you talk about the importance of bringing cultural sensitivity into medical spaces. How does your Lakota culture and upbringing affect the way you approach your work?
Whitney Fear: I tell people, I’m not the all-knowing Lakota. Both my grandmas on both sides of my family went to boarding school. So we have left what we have left. But in Lakota culture, women are the culture bearers. It’s really important to try to carry as much forward as we can.
I really do try to keep in mind traditional Lakota values, like compassion. Lakota values are kind of naturally trauma informed. The value of compassion is that you give people the benefit of the doubt that they’re doing the best they can at any given time. If you’re patient and kind to them and love them, rather than judge them and respond to them with harshness, then they’re going to feel better.
Native News Online: What are some examples of cultural considerations nurses should keep in mind when working with Indigenous communities?
Fear: One of the top ones is keeping in mind that we haven’t had good experiences with the healthcare system and the mental healthcare system. The erasure of a lot of that history has been such a detriment against our people in regard to our health.
I would say a significant amount of mental health providers have no idea that there were literal specialty asylums built for medicine men, like the Hiawatha Indian Insane Asylum in South Dakota. Those kinds of things are recent history. They’re not something that happened 300 years ago. I think that it’s really important for people to know about that and to recognize that that is why it’s difficult for us to trust healthcare providers.
A good practice is knowing your population that you’re serving. I’m not Hindu, but I do see actually quite a few people that are former refugees from Nepal, and they’re Hindu. And because they’re my patients, I think it’s important to know things about them. So just looking some stuff up about people who are Hindu and are from Nepal, and knowing why they left their home country and what things were like in Nepal. That can really go a long way with people.
Native News Online: Substance use and addiction is an issue many of your patients face. How do you help patients struggling with substance use?
Fear: I would say for a lot of clinicians, substance use stuff can be the most challenging because it can be frustrating to understand why somebody would continue to use substances despite it harming them. It’s something I grew up around and had a lot of interaction with when I was younger. I myself had a drinking problem when I was younger. And the reason that somebody would do that is because there’s something more painful that’s waiting for them at the end of that night of drinking or at the end of that period of use.
I’m thankful I don’t have that preconceived bias towards people, just because of the way I grew up. I understand that people are doing the best that they can. I tell people all the time, “I’m not going to tell you meth is bad for you. You already know that. If you want to quit doing that one day, let me know. But we’ll talk about other stuff until then.”
I do Suboxone for medication-assisted treatment for opioid use disorders, and that’s super rewarding. I have a few people who have been on that for a few years, and this is the longest period of time they’ve ever gone without using opioids. It literally is lifesaving. A few other people I can think of had some very near-death overdoses in the past, and seeing them thrive and do so great, I think that is pretty awesome.
As a nurse, you work to address not only the immediate issues your patients face, but also the underlying factors impacting people’s health, like homelessness, poverty and access to healthcare. How do you approach these systemic issues in your work?
The majority of an impact on somebody’s health isn’t even their health at all. It’s their access to healthcare services, it’s the neighborhood they live in, it’s their access to healthy food, it’s their interactions with other people, it’s the level of inclusivity in their community. It’s so many other things that influence a person’s health even more than, for example, their family history of diabetes.
Specifically for people experiencing homelessness, there are so many issues there. If somebody doesn’t have shelter, they don’t have a place to stay. In the case of our community here, there’s only one shelter that you can stay at after you’ve been drinking and go over the legal limit.
Environments like up here, it’s a very real threat during the wintertime that you could freeze to death if you don’t get into the shelter that night. I unfortunately have had patients that have passed away from exposure because they were staying outside, and unfortunately the elements were too much. We know if we can get somebody into housing, their likelihood of having a higher quality of life and better health increases significantly.
Another heavy topic you discuss in your documentary is human trafficking. How are you able to recognize the symptoms of trafficking, and what steps do you take in these cases?
Most human trafficking victims will get involved with the life through things like a promised romantic connection with somebody. For people experiencing homelessness, it usually involves getting put up in a hotel for a few days and getting new clothes. This person is kind of presenting themselves as a boyfriend or a friend. This is the darker truth – that it’s a process of establishing trust and emotional investment so that they’re able to leverage that emotional connection against them.
Of course, men and members of the LGBTQ community can be involved in trafficking, too. It’s just at the time when this became most pervasive, it was primarily young, Native females that were being targeted. And that was kind of the story, that they had this new boyfriend, and that’s where they’d gotten all the new clothes from, and their nails were done. And then a month or two into it, the bruises and trips to the hospital for assaults and things like that start.
I’ve heard many people who were formerly involved in trafficking speak, and how many times they wished people would have asked [if they were okay]. They were shouting in their heads, “Please ask me if I’m okay. Please ask me if I want to be here.” And they didn’t say anything.
In those situations, I tell people, go with your gut. It’s important to ask [those patients if they are okay] because that’s how those conversations get started.
Native News Online: What are some ways you’re able to build trust with patients who are facing current or past traumatic situations?
Fear: Just being there for them consistently. One lie that traffickers will spin over and over again for the people that they’re exploiting is that nobody else cares about them. The strongest combatant to that is to prove to them, there are people who do care about you. So you could say things like, “Oh, I’ve been kind of missing you, I haven’t seen you for a couple of weeks. You haven’t dropped in like you usually do. How have you been? Is everything okay?”
It’s asking them about it, not pressuring them to do anything that they’re uncomfortable with. I think that that is probably one of the harder things for healthcare providers to overcome is that if somebody says, “No, I don’t want to do a rape kit,” or, “No, I don’t want to make a police report,” just letting it go.
Of course, we want to see people who would do things like that have justice. But in this blind pursuit of justice, if you’re trying to pressure somebody into something like that, you could be forgetting about the person sitting right there who is actually the person who matters. If they don’t want to do [a rape kit or file a police report] because they’re terrified of what could happen if they do, then we’re really not seeing the forest through the trees.
You obviously work very hard to take care of other people’s mental health. What are some ways that you take care of your own emotional and mental wellbeing?
I see a therapist. That’s really important. I think that’s a conversation that we should be less afraid to have. I think for a lot of healthcare providers, they would think, “Oh, I don’t want people to think I’m unstable because I’m seeing a therapist.” I don’t see that as any different than going and having a physical once a year. You’re trying to maintain your health and you’re doing something proactive.
With the COVID pandemic, there were some really concerning rates of nurse and physician and healthcare provider suicide and substance use issues developing during that time. And I think, unfortunately, we haven’t seen the last of those numbers going up.
Peer support programs I think could be really important. If something about working with humans affects you, it’s not because you’re not Superman, Super-nurse, Super-doctor or whatever, it is because you’re a human being and it’s fully normal. There are lots of sad times, and it’s okay to be affected by them.
Native News Online: What impacts do you hope your documentary will have?
Fear: One, for Native young people to see that there’s this potential great career, and that it is possible. Because it can be really difficult to imagine that there aren’t substantial limitations on what you’re able to achieve when you’re a Native person growing up on the reservation.
Also, I hope that nursing educators and people who are in influential places in nursing see that there’s a need to do some things that are more inclusive of people of diverse backgrounds. It can be so restrictive, a lot of the admissions requirements. I think about when I was applying to LPN school, or RN school even, for my master’s degree. If I hadn’t had the opportunity to explain why I had 0.5 GPA in high school at one point, and how I was doing things differently, then I don’t think I would’ve been able to get in.
I’m really hoping that educators and people in those positions will see that there’s value beyond somebody’s GPA or ACT score. I haven’t had a patient yet say, “Did you take AP Chemistry in high school?” They care that you’re compassionate, kind, patient – that’s what they care about.
