The Social Isolation of Native Americans: The Crow Nation

The possibility of immersing oneself in a unique culture within the United States, and learning about the Indian Health Service system and the determinants of a population’s health, is an unparalleled experience. The Crow Nation extended an invitation to come to the reservation, learn their history, and explore what they had to offer. Within these visits, a new relationship with the Apsáalooke, known as Crow, was initiated.

Following support from the school of nursing, the first planning visit was conducted by faculty in August 2021. After this visit, it was evident that this immersion experience would engage students in learning about Crow culture. In June 2022, fieldwork was conducted to understand life on the reservation, focusing on the Crow Peoples’ experience of living on the reservation. Extensive fieldnotes were recorded by this faculty member and students in attendance. During the analysis of the field notes, an unexpected theme of being idle appeared, and indicators of social isolation emerged. Although this research study also considered student input related to the immersion experience, the focus of this article is discussion about the social isolation aspect of our findings, as it relates to the Crow People living on the reservation in Montana.

Background

Social Isolation
Social isolation, or experiencing infrequent social contact, is gaining recognition in the United States as a public health concern (Holt-Lundstad, 2020). Current evidence highlights the negative impact of social isolation on mortality and morbidity, especially related to cardiovascular disease and diabetes mellitus type 2 (Holt-Lundstad, 2020). While the recognition of social isolation in the United States is known, its impact on underreported populations has not been adequately studied. Cultural competency training and experiences in nursing are paramount to help providers understand how social determinants of health impact communities in the United States. Many Native Americans, similar to other Americans, experience social isolation on their reservations; the Crow Nation in Montana is no exception (Personal communication, participant #1, 2021 & participant #2, 2022). (Is there a reference for this - RY)

Geographical information provides insight into the growing social isolation of the Crow People. There are approximately 11,000 members of the Crow Tribe, with about 7,900 members currently living on the 2.2 million acres on their reservation in Montana (Governor's Office of Indian Affairs, 2022). This translates to 1 person per 278 acres. Compared to the 6.8 people per acre in Montana, this demonstrates the vastness and separation of the people. While these numbers are astounding, it is notable that a proper understanding of the actual size of the population is lacking due to underreporting and the lack of submitting census data (Personal communication, participant #3, 2022). To appreciate the geographical isolation experienced on the reservation, the current census information for the Crow Nation is presented in the Table.

Table. Census Data for the Crow Nation Reservation

Note: Data obtained from 2020 Census reporting. Adapted from "Big Horn County, MT" by the Census Reporter, 2021, https://censusreporter.org/profiles/05000US30003-big-horn-county-mt/. United States Census information is public domain.

Literature regarding social isolation is emerging and is limited in quantity. When adding the terms Indigenous People, Native Americans, Crow Indian Reservation, Apsáalooke, and Crow Indian Nation, our search resulted in one relevant article dating back to July 1957. Much of the literature in the last ten years has examined health issues. Seven articles on social isolation did not mention the Crow People but did examine Native American populations in the United States and their health disparities with social isolation (Blue Bird Jernigan et al., 2020; Davis et al., 2016; Enoch & Albaugh, 2017; Guittar, 2012; Manson & Buchwald, 2021; Marley, 2018; Tomayko et al., 2019). Four articles mentioned the focus on the Crow People; however, these authors focused on other health or environmental factors (Huyser et al., 2014; Martin et al., 2020; Real Bird et al., 2016; Old Elk, 2019; Simonds et al., 2018).

Before the arrival of Europeans in North America, the Crow was considered to be a nomadic tribe. They followed the changing seasons and migration patterns of buffalo. Buffalo were a significant source of food and clothing. The Crow People were known as a nation of warriors. Competing tribes would challenge them for land and resources; however, the Crow could defend and maintain their way of life. With westward expansion, freedom to roam and hunt was rapidly extinguished. The White man wanted to control the Crow and worked to integrate them into a White man's society. The ability to be nomadic was restricted; buffalo herds were hunted to extinction to make room for cattle ranch herds. Customs where people gathered were restricted (e.g., sweat lodge and Sundance spiritual practices). Children were forcefully pulled from their families and placed in boarding schools. They were required to learn English, dress, and act like American children. They lost the Crow language and customs.

While scant and not aimed at addressing social isolation specifically, the literature supports the idea that Native Americans are uniquely impacted by social isolation. Real Bird et al. (2016) noted in their qualitative study that many of the Crow People identified that decreasing historical practices and health were related to changes in their community's social and political structure. They highlighted a participant who noted that many Crow People are distant and do not get together as they did before. Huyser et al. (2014) and Martin et al. (2020) discussed social isolation as it relates to geographical isolation, and its association with poverty and issues with water resources, respectively.

Historical Trauma and Lack of Resources
Historical trauma is unresolved trauma that persists through multiple generations, experienced by specific ethnic, racial, or cultural groups (U.S. Department of Health and Human Services, n.d.). Additionally, those affected by historical trauma often experience a higher prevalence of adverse physical and mental health conditions even several generations after the trauma (Grayshield et al., 2015; Sotero, 2006). The Crow People not only saw the dissolution of their practices due to the White man's integration, but they also experienced trauma by the government forcing their children into boarding schools and introducing smallpox. Each generation's effect from the trauma is passed along, compounding the negative consequences. Trauma impacts everyone differently and may lead to depression, low self-esteem, anger, self-destructive behavior, and emotional dysregulation (US Department of Health and Human Services, n.d.).

Compounding the historical trauma faced by the Crow People is the food desert that now exists on the reservation. There is no source of fresh fruits and vegetables on the reservation. Many federal Indian policies have undermined the Crow community food practices, making healthy lifestyles challenging to achieve (Old Elk, 2019). Adverse health consequences are directly related to historical trauma and reduce the community's resiliency. The inability to access fresh, nutritious food heightens the health disparities faced by the Crow.

Study Methods

The aim of this study was to learn the history of the Crow People and to document their lived experiences living on the reservation. Following the invitation from Crow representatives to visit the reservation and the initial exploration in August 2021, we initiated an exploratory, descriptive qualitative research study in June 2022. This study emphasized the interpretation of the participants' experiences. The Crow representatives and the researchers agreed upon this approach because it allowed the researchers to observe and grasp the emic perspective. Institutional Review Board (IRB) approval was obtained from the university, and written consent was obtained from participants. Participants were not obligated to take part in the study and could withdraw their consent at any time.

Data were collected through semi-structured interviews with open-ended questions to hear the stories of Crow participants. We also conducted observation of the environment at the Crow Nation Reservation, consisting of 2.2 million acres.

Sample
A key informant shared the experience of living on the reservation and identified tribe members who might be willing to participate. Participants were obtained from a purposive, convenience sample of guest speakers. Use of this snowballing sample methodology resulted in eight participants who self-identified as card-carrying members of the Crow Tribe.

Data Collection
Data collection was obtained through participant interviews; faculty and student observations; photographs of the reservation; and a focus group with students. Data were obtained in August-September 2021 and June 2022. During the first visit in 2021, participants shared their stories about the history of the Crow People and the events of the past two centuries that have influenced their lives. During the visit of June 2022, these findings were further clarified through classroom presentations and interviews with consenting participants.

Participants were asked open-ended questions that solicited their perspectives about living on the reservation. This faculty member (R.I) and students traveled to many locations on the reservation that provided first-hand observation of the reservation, recorded via both notes and photographs. On the last day of the immersion experience, three graduate nursing students participated in a focus group with this faculty, who sought their opinions about their experiences on the Crow reservation.

Results

Narratives of rich data from Crow People participants, observations, and student input during focus group sharing were analyzed using content analysis.

Field notes recorded during observations from traveling on the reservation were recorded by this author and students. Prior to departing the reservation, the first author conducted a focus group discussion with students to review field notes, compare observations, and clarify notes. This validated what all were seeing from an emic perspective. Notes from the focus group were transcribed and sent to the student participants for validation; these were confirmed as accurate.

The interview notes were written by the corresponding author (REI) and later transcribed for examination. Both authors participated in the review of the interview notes via multiple virtual meetings. Interview notes were examined for similarities in wording, main issues of concern and if patterns of themes could be identified. Four themes emerged, discussed below with examples.

Theme #1: Effects of Colonization
The first theme focused on the effects of colonization on the perspective of life on the reservation. Examples of the effects of colonization described by participants included: historical trauma resulting in a change to the family system; insecurity related to attempts at assimilation; poverty; lack of trust of outsiders; and being idle.

In their stories, participants shared a need to know and acknowledge this historical trauma to move forward. Participant #2 remarked that history intersects with life and the daily things that go on, and through this understanding of history, there can be a lightbulb moment to connect. Many believe that if the younger generation can recognize historical trauma and understand the impact on today's experiences, they will have a healthier life. It is essential to know, recognize, and acknowledge what was described as historical trauma to move toward recovery. One key informant shared the experience of not wanting to hear of the historical trauma again; however, she did listen to the history. She stated, "learning about the history of the Crow and experiencing a ‘light bulb turning on moment’ led to her discovery and amazement of how history intersects with life and things that go on in your life” (Participant #2).

Theme #2: Revival of Culture and Spiritual Influences
The second theme revealed how the Crow People have regained their quality of life through the revival of culture and spiritual influences. Subthemes included: a preservation program at the Little Big Horn College to catalog Crow history; the revival of the Crow language; the importance of the family clan system; relearning spiritual practices; and experiencing the grieving process during the COVID-19 pandemic. In one interview, Participant #6 shared how people come to him – he asks why you are here and then uses his medicines and prayer. He shared how smudging with either cedar, sage, bear root, or sweet grass is used during prayers. He expressed how his medicine is used in conjunction with western medicine, not as a replacement. Participant #7 described efforts to preserve the history of the Crow through digitalizing photographs and audio recordings of language spoken by the forefathers and the stories they shared, noting “It was sad that the language was being lost however, people are teaching the Crow language again and learning our ways.”

Theme #3: Lack of Resources
The third theme was the lack of resources on the reservation. Examples of this included: food insecurity; food deserts; housing insecurity; employment insecurity; and lack of transportation. In one interview, Participant #4 described efforts to make fresh produce available through the community garden and food pantries in the community. People are poor and lack transportation to grocery stores, so they go hungry. This is a problem for the older generations who may be raising grandchildren. Life on the reservation has restricted the freedoms of the Crow People, yet another element that drives the social isolation experienced by the Crow People. It was noted that there is no regular bus transportation and a lack of internet service in many areas of the reservation.

Theme #4: Societal Impact on Health
The fourth theme was the societal impact on health. Examples identified included: drug and alcohol addiction related to self-medication; drug cartels; human trafficking of Native Americans; violence against women; lack of access to healthcare resources, lack of professional staff on the reservation; and mistrust of non-Native people.

People have difficulty getting to healthcare appointments. Nurses encounter distrust when they go to their homes because they are suspicious of people (Participant #5). Therefore, it is challenging to be physically present where others meet and stay connected in a world where digital communication is becoming the norm. Historically, news-sharing among the Crow Nation was carried out by the Town Cryer, designated tribe members who shared the information with the people (participant #3). This practice has been losing traction over time due to the changes in cultural traditions, influenced by a lack of transportation and technological growth. However, one participant described how groups of people went out into the communities (all 2.2 million acres) to obtain a more accurate census count. They stressed the importance to people of the census being accurate to help obtain funds from the government. Not everyone believed them, and many did not participate.

Discussion

Upon reflection between the primary researcher and students, it became evident that social isolation was a feature of all the themes that emerged. Participant responses, combined with observations and photos of the environment led us to again consider the situation on the reservation from a geographical perspective. A review of the data in the Table above demonstrated that, of the 7,900 people living on the reservation, over 55% of the Crow are not living in one of the six towns; they are scattered over the 2.2 million acres. Not living close to town, no internet, antenna TV, sparse cell phone service, and no public or private transportation further compounds a feeling of social isolation. Individuals are alone in a vast expanse of nothing but land. The lack of the ability for Crow People to gather and stay interconnected as they once did has created ripple effects that have touched all aspects of their culture and way of life.

Understanding how social isolation impacts the Crow People provides insight into how cultures overcome barriers that endanger their traditions and practices. The themes identified by the field note analysis highlight the impact of social isolation on preventing the Crow from maintaining and preserving these cultural practices. Through the interviews with the Crow People, it was evident that they have identified solutions and hope to retain practices to enrich the lives of their tribe members. The hope is to recover and recultivate Crow cultural practices to enhance the tribes' livelihood and carry knowledge to further generations.

Through the ability to reclaim their care of the land and the community, the Crow People will be able to impact the preservation of their culture and traditions to impact outcomes positively (Old Elk, 2019). During this emic study, it was apparent that the community views the loss of practices and traditions as negatively impacting health and wellness. Similarly, Real Bird et al. (2016) noted in their qualitative phenomenological study on chronic illness among Crow People that not addressing historical and current loss will hold members back from achieving better health and outcomes. They noted that upholding and respecting cultural values will create an environment where community members can express their feelings and promote resiliency, ultimately leading to better health in the community.

Recultivate means to cause the growth or flourishment of something again (Merriam-Webster, 2024). The key to recovery and recultivation is recognizing the loss and reclaiming the culture. For the Crow people, this equates to bringing back customs and events. This statement was a repeated during the many interviews. Customs included: the Crow people's spiritual activities during the Sundance, the sweat lodge, the use of sage, cedar, sweet grass, and tobacco while praying, and vision quests to the mountain tops. Additionally, the Crow gather twice a year to celebrate Crow Native Days and Crow Fair Days. Clans come together to compete in rodeo activities, Powwow dance, and enjoy traditional food. These activities have earned the Crow the title of Tepee capital of the World. The Crow believe that these gatherings will decrease social isolation and renew the relationships among the people. The hope is to heal and prosper.

Implications for Education, Practice, and Research

This study has suggested implications for nurses related to enhancing cultural competency. The literature describes cultural immersion experiences and programs as an integrative learning method for obtaining cultural competency among nursing students (Brock et al., 2019; Gradellini et al., 2021; Mbango, 2023). Much of this literature speaks to the value of international, global experiences (Mbango, 2023). Both graduate students and registered nurses need the opportunity to participate in cultural immersion. Such immersions allow participants to interact with people and cultures consistently challenged by health inequity in the United States and to learn how nursing practice can lead to positive outcomes (Pool & Stauber, 2020). The American Association of Colleges of Nursing (2008) has long recognized that environments that facilitate diverse experiences best build cultural competence.

Native American communities have many diverse cultural practices that shape their health beliefs and outcomes. Students who participated in this immersion experience learned from the Crow people the need for trauma-informed care and how to integrate the spiritual needs of the Native American communities (Alexander-Ruff & Kinion, 2018; Personal communication, participant #2 & Participant #6). (Is there a reference for this - RY) While this article highlights in particular the benefit for students preparing to engage in advanced practice, practicing nurses may find information about how social isolation impacts Native Americans in their communities helpful for providing holistic, culturally competent care.

Social isolation is also another area for future research. Little is known about social isolation within the context of geographically remote populations. This study that considered experiences of the Crow living on their reservation is one example of how the study of social isolation may benefit healthcare professionals who work within these communities to better understand the health and social disparities among Native American populations living in the United States.

Limitations and Strengths

Due to the length of time of the immersion experience and the ability to reach people over a large geographical area, this study has a small sample size. Because interviews were conducted in English, those who only spoke the Crow language could not participate. This limitation affected the sample size and possibly the data. Questions asked in this study were open-ended. This enabled the Crow People to provide their stories and experiences from their perspective, without influence. However, while the topic of health came up frequently in stories, it was not the focus of the study; thus no conclusions about health or healthcare outcomes can be drawn.

Conclusion

From this exploratory, descriptive qualitative research study with the Crow People, four themes emerged identifying areas that impacted life on the reservation. Historical trauma has greatly influenced the Crow People. Many traditions and practices discouraged and dissolved from colonization have led to many health disparities. Changes to their land, nomadic way of life, food resources, and other cultural and spiritual practices have complicated their ability to return to the way of life and land their people once knew. Specifically, it became evident through our conversations that social isolation impacts the health and way of life of the Crow People. Disconnection with the land and each other added complexity to this concern among the Crow People.

Recultivating and recovering traditions and cultural practices was a solution identified among the Crow to regain their way of life and positively influence health and economic outcomes. Assuring that future generations are educated about Crow history is vital to their cultural identity. This study highlighted the need for nursing students, and even working nurses when possible, to have national and international immersion opportunities. There is a need for more research about how social isolation impacts the health outcomes of isolated and geographically remote communities.

Authors

Ruth E. Irwin, PhD, RN, CSN
Email: irwinr@duq.edu
ORCID ID: https://orcid.org/0000-0002-9648-8447

Ruth Irwin is a Clinical Associate Professor of Nursing at Duquesne University in Pittsburgh, PA. Her research is focused on the education of nursing students at the prelicensure and graduate levels. Of interest is the impact of immersion experiences on learning. Ruth has a broad background in nursing, with specific training and expertise in nursing and hospital administration, teaching at Associate, Bachelor, Master, Doctoral levels. She has also accompanied undergraduate students to immersion experiences in Rome, Italy. For the research described in this article, Ruth laid the groundwork for immersion by developing a relationship with the Crow people and establishing strong ties within the community.

Emily S. Ralston, MSN, RN, PMH-BC
Email: Emilysralston14@gmail.com
ORCID ID: https://orcid.org/0000-0003-0282-0865

Emily Ralston has worked as a mental health nurse for many years, leading her to pursue advanced education to determine how to impact those who experience trauma and violence. During her master's education, she completed a clinical rotation with the Indian Health Services on the Crow Reservation. Emily has grown as a nurse by learning through the lens of mental health, trauma, and diverse cultures.