In a strongly worded letter to the United States Commissioner of Indian Affairs in 1914, Dr. Susan LaFlesche Picotte, the first American Indian woman to become a Doctor of Medicine, wrote: "I call attention to two problems that are of vital interest to my people, which your Department can and ought to remedy. One is the liquor traffic which is carried on very extensively and openly among them; the other, the Health Condition prevailing among them, due to changes in their mode of living."

As a physician and intermediary between her reservation and the U.S. Government, she advocated federal action on issues essential to the health and survival of the Omaha Indians of Nebraska.

Susan LaFlesche was born in 1865 and grew up at a time when the traditional ways of Indian life on the Great Plains rapidly were disappearing. Her father, Joseph LaFlesche, known as Iron Eye, was the last recognized chief of the Omahas. The son of a French fur trader and an Indian mother, he knew both the Indian and white worlds. He believed that the future of the Omahas depended on their adapting to the ways of the white society that was engulfing them. Iron Eye introduced the Omahas to some of these new ways, and he fostered in his children both a pride in their heritage and a hunger for knowledge. Susan's older sister, Suzette, became a journalist and international spokeswoman for Indian rights; a step-brother, Francis, became a distinguished ethnographer with the Smithsonian Institution. Susan's own interest in medicine was awakened in childhood, as she witnessed the toll that disease was taking on the Omaha people.

At age 13, after attending school on the reservation, Susan was sent to a boarding school in New Jersey. She continued her studies at the Hampton Normal and Agricultural Institute in Virginia. Established after the Civil War to educate newly emancipated slaves, the Institute had expanded its mission to include Indians. Hampton was committed to coeducation and higher education for women, and the faculty encouraged Susan's interest in medicine. She was graduated in May 1886 as salutatorian and was awarded a gold medal for academic achievement.

The Hampton Institute physician, Dr. Martha Waldron, was an alumna of the Woman's Medical College of Pennsylvania, one of the first institutions in the United States to train women doctors. Dr. Waldron and others recommended Susan for admission to the college, and with the support of a government grant and a scholarship, she began a program of intense study and clinical work.

After graduating in 1889 at the top of her class of 36 women, she interned at Philadelphia's Woman's Hospital. Later that year, she returned to the Nebraska reservation as government-appointed physician to the Omaha Indian School. Her practice soon expanded to include the entire population of 1,200. "There was another physician," she told a Hampton audience in 1892. "But I found that I had most of his practice in three months' time, for I understood their language and they felt I was one of them, so I had the advantage. After he left, I had all the tribe on my hands."

LaFlesche traveled all over the 450-square-mile reservation, visiting patients on widely scattered farms. She saw that many of the health problems stemmed from changes in their way of life. When the U.S. Government banned buffalo hunting in 1876, the Omaha lost their main source of fresh meat. Without wild game, they often resorted to eating meat that was diseased. In the frame houses that replaced their tepees and earth lodges, they kept the windows and doors closed, preventing the circulation of fresh air. Water had to be carried from springs and wells, making frequent bathing difficult.

She found that practicing medicine among the Indians presented particular challenges. Epidemics of cholera, measles, influenza, dysentery, and conjunctivitis were commonplace, due in part to the use of communal drinking cups. Tuberculosis also was prevalent. Teaching basic practices of public health became one of her main objectives; her other great desire was to establish a hospital on the reservation.

Working long hours, paying house calls on horseback or with a horse-drawn buggy, even through the bitter Nebraska winters, the young doctor damaged her own health. In 1893, exhausted and suffering from chronic earaches and pain in her head, she resigned her post. She was only 28. Within two years, she married a Sioux man named Henry Picotte, bore a child, and moved to the town of Bancroft. There, although still suffering long bouts of illness, she resumed her medical practice, treating both Indian and white patients. At night she kept a lantern burning in her window, so anyone needing help could find her.

The death of her husband in 1905 from alcoholism left her with two young sons and an ailing mother in her care. She moved again and devoted even more of her energies to the welfare of the Omahas. As their representative, she made several trips to Washington, D.C., where she successfully lobbied for the Omaha's right to manage property and a ban on alcohol in new townships on the reservation. She also led church activities and was the first Indian ever appointed a medical missionary by the Presbyterian Board of Home Missions.

Susan LaFlesche Picotte did not limit her work to the reservation. She was an active member of the both the state and county medical associations, chair of the health committee of the Nebraska Federation of Women's Clubs, and a lobbyist for state health laws. Through her efforts, disposable cups and drinking fountains replaced the communal cup. She campaigned against alcohol and lectured widely on tuberculosis prevention and the role of flies in spreading disease.

Her efforts were increasingly directed toward the establishment of a hospital. Her dream came true in 1913 with the opening of the Walthill Hospital. Located on the Omaha reservation, it served both Indians and the local white population.

Dr. Picotte did not have long to enjoy the advantages of the hospital she had worked so hard to create. In 1914, her chronic ear pain was diagnosed as "decay of the bone" (possibly bone cancer), and she underwent two unsuccessful operations. She died on 18 September 1915 at the age of 49. The institution she founded was renamed the Dr. Susan Picotte Memorial Hospital and continued to serve as a medical facility until after World War II. The building, which still bears her name, is now listed in the U.S. National Register of Historic Places.