Photo: Harry A. Webb

Defying the odds, Susan La Flesche Picotte became America’s first Indigenous woman physician and practiced during a historically destabilizing time. As a young girl, Susan La Flesche had comforted a very ill Omaha woman as they waited all night for a white doctor who never came. The next morning the woman died. Out of that experience Susan dreamed of one day becoming a doctor who could minister to her people honorably.

Born on June 17, 1865, in a buckskin tepee during a buffalo hunt, Susan arrived in turbulent times―the civil war had just ended and the stripping of Indigenous lands persisted. Both her parents, Mary Gale and Joseph La Flesche, were the offspring of Native American women and white men. Joseph, the last recognized Omaha chief, had seen hundreds of Euro-American immigrants (often desperate themselves) foul the water, use up the wood, and over-trap. Most egregious of all was the wanton slaughter of buffalo. This sport by white men spelled ruin for Indigenous people who relied on bison for food, clothing, shelter, and spiritual sustenance. With this onslaught, Joseph came to believe Omaha survival depended on assimilation―he endorsed wood-frame houses and cultivation of land; he practiced Christianity and sent his four daughters to white schools.

The Omaha reservation’s missionary school had provided Susan a relatively poor education and at age 14 she headed east to continue her schooling. Over the next ten years she attended several institutions, culminating in her earning a medical degree from the Woman’s Medical College of Pennsylvania.

Through church acquaintances, Susan had met the Protestant women of the Connecticut Indian Association who took an interest in her and funded her medical education. The Association elevated her as a symbol of what could be accomplished by supporting Indians in Christian schools. Although Susan remained unassuming her whole life, her capabilities and perceptions far-outshone most of the women with whom she interacted. She spoke four languages―English, French, Omaha, and Otoe. Curious and adaptable, she felt comfortable wearing hats and gloves in the latest fashion or wearing her mother’s traditional beaded moccasins and hand-sewn clothes. She delighted in art museums and orchestral concerts as well as riding her horse across Nebraska’s wind-swept plains. Most impressively, she graduated valedictorian of her medical school class. In 1890, there were 104,805 physicians in the U.S.―only 4.4 percent were women and only one of those a Native American.

After a four-month internship at the Woman’s Hospital, Susan returned home to actualize her dream. The Omaha Agency hired her as boarding school physician to care for the young residents. But after word got out, adults began seeking her services and the non-native reservation doctor departed shortly thereafter. At 24 years old, Susan’s practice suddenly surged to 1,200 Omahas living across an area of 1,300 square miles with various ailments including tuberculosis, influenza, dysentery, fever, and childbirth complications. She traversed the undeveloped terrain on foot, by buckskin horse, or in a horse-drawn buggy. During the winter season the number and severity of illnesses increased, advanced by brutal blizzards and sub-zero temperatures. Susan pushed herself from sunrise to late at night, month after month.

Four years into this punishing routine, a convergence of events led her to resign. Initially she injured herself falling from her buggy. Then she suffered with a mysterious condition causing severe pain in her ears and neck (plaguing her the rest of her life). Finally her mother became quite ill and Susan moved in to care for her.

Luckily, the following year heralded better times. Susan met and married Henry Picotte, a Yankton Sioux who had been a Wild West circus showman. They moved to a comfortable house in Bancroft where she set up her medical office, kept a lantern lit throughout the night, and once again began making home visits. Happily married, she gave birth to two sons Caryl and Pierre. Although the boys thrived, Susan’s painful affliction sometimes returned and incapacitated her for weeks. During one such bout a visitor recalled Susan telling her.

Indians are mystical, they are not understood by those who are inclined to be practical.

The Omahas’ traditions and mystical beliefs―their honoring of land and animals as sacred, their concept of time as cyclical, and their history of holding tribal lands in common―were all undermined by the dominating Euro-American-Protestant values. During Susan’s life, the Omaha reservation (“domestic dependent nation”) consisted of approximately 300,000 acres adjacent to the Missouri River―their hunting and ancestral grounds having already been treatied down from an original five million acres.

Then in 1882, Congress passed the Omaha Allotment Act dividing the reservation into individual land plots of 160 acres per family. This was purportedly to encourage Omahas to adapt to private ownership and farming. Yet, even those trying to farm remained dependent on the government who retained control via a 25 year trust. An added clause allowed unassigned land to be sold to non-Omahas, which the government encouraged for tax purposes.

This same allotment scheme was enacted nationwide by the Dawes Act of 1887―Henry Laurens Dawes argued that time had come for Indians to choose between

extermination or civilization.

This hate-filled invective by a U.S. senator further sanctioned dehumanizing Native Americans into a caste of others and gave them much to fear. Having long since lost their freedom as Original People of the North American continent, by 1887 they had been quarantined into approximately 138 million acres. Then within just 13 years of the Dawes Act, their total acres were reduced again by half. The defrauding lubricants of whiskey, dollars, and English language contracts ravaged a people already on the edge―many signing their land away with x’s.

As a physician Susan saw up close the despair that set in over loss of land and former lives. She witnessed the ravages of poverty, alcoholism, and poor health. Having walked the formidable middle between the two cultures and with her passion to help, Susan acted as physician, Christian temperance crusader, and English interpreter. She campaigned vigilantly to slow the spread of tuberculosis: telling people to stop using communal drinking cups, put up screens against flies, not consume diseased food (fresh meat no longer being accessible), and get plenty of fresh air and sunshine. She launched a fierce anti-alcohol crusade, working with the Omaha Tribal Council to pressure government Indian agents to enact stricter laws against bootleggers and punish drunkenness. Susan’s fervor for temperance and Christianity, coupled with her promotion of Western medicine, riled some tribal members against her. Yet, she worked tirelessly translating documents and writing petitions on behalf of individuals requesting funds from the Indian Bureau.

Tragically, the lethal combination of tuberculosis and alcoholism touched Susan personally as she watched her husband and other relatives succumb. Now in addition to scores of patients, she assumed sole responsibility for the care of her two sons and her ailing mother. Overcoming daunting bureaucratic hurdles, she obtained proceeds from her husband’s land allowing her to invest in a modern-convenience home. Her mother, who had previously lived in a traditional way and never spoke English, had broken her hip and Susan lodged her in the new home where she lived until she died. With both her husband and mother gone, Susan ached with loneliness and following another attack of her disorder, she lost hearing in one ear.

Courtesy of the Nebraska State Historical Society Photograph Collections

In Spring 1909, Susan was confined to bed but later that year when a contagion of diphtheria threatened the reservation she rallied to meet it. Also, the 25 year trust period on the Omaha allotments had expired and the government threatened to extend it. Although still quite sick, Susan joined the Omaha delegation to Washington D.C. Susan told the officials that if government deemed her people incompetent, they had themselves to blame. She spoke to the debasement imbedded in the government’s paternalistic approach where Indian

lands are leased for him, his rents are collected for him, his bills are paid for him if the department approves them; his money is doled out to him like a pension; when he desires to purchase a horse or blanket or wheelbarrow or stove, he submits his desires to the superintendent, who writes for authority to the Indian office in Washington. . . .

In 1910, the government ended up issuing 230 fee patents to those meeting their criteria for ownership. Unfortunately, with the ongoing socio-economic despair on the reservation, within just a few years 90% of those lands had been lost.

As Susan watched the vitality being sapped from her people, her own health became increasingly precarious. With her two sons enrolled in the Nebraska Military Academy, she poured her remaining energies into fund-raising for a hospital. Through numerous donations (without using a single tax dollar), her hospital building was completed in January 1913, where Susan performed surgeries and treated patients. One of its distinctive features was the fully screened porch running the length of the building’s east side―a nod to Susan’s insistence on fresh air.

Unfortunately she had only a couple years to practice in her new hospital before unrelenting pain drove her to undergo two surgeries to remove malignant bone fragments from her face. In midsummer she returned home where her son Pierre and her niece Margie vigilantly attended her. After hearing that the Nobel prize winner Marie Curie had promoted radium as a potential cancer cure, Susan’s family contacted Curie who sent a lead-lined box containing a radium pellet. The agency doctor attempted to place it in Susan’s ear but the pellet slipped deep into the canal and it took hours to retrieve―intensifying Susan’s agony. As she drifted in and out of consciousness, her family praised her remarkable accomplishments and lauded her for the heart she had brought to her people. Ever reverential, Susan replied.

I cannot see how any credit is due me. I am only thankful that I have been called and permitted to serve. I feel blessed for that privilege.

On September 18, 1915, Susan passed away at age 50―having learned to navigate the currents of both Anglo and Omaha, she offered profound and lasting contributions during her short and rigorous life. Built on a reservation long before Native American health care was critically regarded, she left her legacy hospital that provided modern medical care to the Omaha for 30 years after her death.





Primary Sources:

Starita, Joe, A Warrior of the People, How Susan La Flesche Overcame Racial and Gender Inequality to Become America’s First Indian Doctor, St. Martin’s Griffin, 2016.

Tong, Benson, Susan La Flesche Picotte, M.D., Omaha Indian Leader and Reformer, University of Oklahoma Press, 1999.

Secondary Sources:

Erdrich, Louise, Tracks, a Novel, Harper Perennial, 1989.

La Flesche Picotte, Susan, Letter from Dr. Susan La Flesche Picotte to the Commissioner of Indian Affairs April 29, 1914, Concerning Liquor Traffic on the Reservation and the Health Condition of the Omaha, Nebraska State Historical Society, 1914.

Lepore, Jill, These Truths a History of the United States, W.W. Norton & Company, 2018.

Lesiak, Christine M. and ReCorn, Princella P., Directors, Medicine Woman, Documentary Film, Narrated by Joy Harjo, 2016.

Wilkerson, Isabel, Caste, The Origins of Our Discontents, Random House, 2020.



  1. Sadie says:

    wow, that was a history lesson on the Omaha, as with all indigenous tribes and nations their story is heartbreaking. Susan was so strong and determined, the fact she continued on despite’s her own health issues is inspiring. thank you for this beautiful story

  2. Amy R says:

    Such a wonderful story of an amazing woman!

  3. Lisa Kagan says:

    Your descriptive writing clearly is effective. The heart of your writing opens up ones soul. The reader is overcome with fine details which allows the reader to become completely absorbed with the character. Thank you for providing the historical journeys

  4. Sindi Schwartz says:

    Thank you Justine for sharing profound experiences with us your readers .
    I pass your stories on to my Granddaughters so that they can realize a path of strength and future .
    Sindi Schwartz
    December 24 , 2020
    Almost Christmas !

  5. Brent Thomson says:

    Thank you Justine for bringing another story of a remarkable woman who’s contribution gave comfort to others in a harsh time. Your eloquent writing and historical research give a broader picture of times before.

  6. so inspiring yet so very sad. breaks my heart to face the truth of our cruelity.

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