Doctors, agents, missionaries, and teachers were all part of the same outside world.

Susan’s identity gave her an unusual position.

She had the credential of an American physician.

She also knew Omaha families, relationships, and community life.

Yet even that did not guarantee trust.

Medicine itself could become a cultural argument.

Traditional healing practices remained important to many people.

Susan sometimes opposed practices she believed were medically harmful.

The disagreement could be intense.

She had to persuade rather than simply order.