Missionaries arrived with religious instruction.

Government physicians came and went.

Promises were made from outside the community and then broken.

Under those conditions, skepticism toward another professional system connected to the federal government was rational.

Susan’s position was unusual because she stood both inside and outside that system.

She had been trained in Philadelphia.

She held a medical degree recognized by American institutions.

She worked for the government.

Yet she was also Omaha.

She knew that a diagnosis delivered in English by a stranger could sound very different from advice delivered by someone who understood a family’s relationships and history.