Note: This story is part of the project: "Indigenous Impacts: How Native American communities are responding to COVID-19." We invite you to view the entire project here.


On a mid-spring Sunday in 1837, the steamboat St. Peters churned along the Missouri River to Fort Clark, a trading outpost in modern-day Mercer County, North Dakota.

For its upriver trip, it was weighed down with supplies, plus passengers and crew. Some of them had smallpox. Like any other trading good, the virus made its way upriver, off the ship and onto the plains.

At first, it crept quietly. Less than one month later, inklings of disaster rippled back to Fort Clark. Francis Chardon, the fort’s superintendent, recorded that a member of the Mandan tribe had died of smallpox. In a brief journal entry, he mentioned it was a “smokey” day, and one of the warmest of the year. For a while, the disease existed at the margins of Chardin’s writing.

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A view of the open landscape at Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle
A view of the open landscape at Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle

But page by page, Chardon’s journal grows more painfully descriptive, as the Native population near the outpost unravels. Deaths began soaring; Natives suspected settlers had visited the disease upon them. While some Natives called for violence, others chose suicide. One of the most difficult passages describes a Mandan man, caught in the throes of grief, killing his ailing wife before killing himself. Within months, the local Native villages had collapsed.

“It has destroyed seven-eighths of the Mandans and one-half of the Rees Nations, (and) the Rees that are encamped With the Gros Ventres have just Caught it,” Chardon wrote in late September. “No doubt but the one-half of them will die also.”

What happened at Fort Clark would be just a corner of a devastating epidemic. Thousands of Native Americans died; the North Dakota State Historical Society notes that, of the roughly 2,000 Mandans in Knife River villages, only 138 were alive in October.

An outpost building sits atop a bluff at Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle
An outpost building sits atop a bluff at Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle

The episode marks just one early chapter in Native American public health history — a story that’s been marred for centuries by poor health outcomes that have outpaced the rest of the country. Native Americans have played quiet roles throughout American medical history, though rarely as healthy survivors. In the late 1990s, lung tissue from a mass grave of Natives in Alaska helped provide insight into the Spanish Flu. A Centers for Disease Control study found that Native populations died of the 2009 swine flu at a rate four times higher than the rest of the country, likely due to ongoing gaps in health outcomes and relative poverty.

Jacque Gray, an associate director at the University of North Dakota’s Center for Rural Health, is a Choctaw and Cherokee descendant. She traces that early history of Native health through centuries of colonization and neglect. The Indian Health Service is so underfunded, she said, that it’s a common joke among Natives not to need certain specialty care by June — because the money to fund it will be dried up until the end of the fiscal year.

Gray mentions the case of the Seattle Indian Health Board, which requested medical supplies for local care earlier this year as it battled COVID. It was delivered body bags instead, in what was widely reported as both a mistake by local authorities and a dark metaphor for Native Americans’ place in U.S. health care.

Hardwoods and prairie color the landscape view south of Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle
Hardwoods and prairie color the landscape view south of Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle

"So many times we're addressed as if we can't make our own decisions,” Gray said. "You get to the basics of going forward: part of that is rebuilding some trust."

That frustration would probably sound familiar to Marcella LeBeau, a member of the Cheyenne River Sioux Tribe who served in the U.S. Army Nurse Corps in World War II. In an interview from her Eagle Butte, South Dakota home, the 100-year-old career nurse described how tribal health is often the quiet echo of colonial history — an era that’s only barely passed.

"I want to go way back, way, way back, to the Fort Laramie Treaty of 1868. At that point, my great-grandfather was one who put his mark on that document,” she said. The treaty penned Native people on a reservation, curtailed their ability to hunt and provide and — in a roundabout but very real way — changed their bodies, too, as shifting diets led to greater prevalence of ailments like diabetes, which leave modern-day tribal members more susceptible to the dangers of the COVID epidemic.

The northeast view from a bluff over the river bottom near Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle
The northeast view from a bluff over the river bottom near Fork Clark State Historic Site in Mercer County, N.D. Photo by Craig Bihrle

For Native people, that history is now the backdrop for the ongoing coronavirus crisis, which is expected to be far worse for them than for the rest of the country. A May bulletin from the American Medical Association pointed out that, on top of the universal risks of the coronavirus crisis, “the added burdens of chronic disease and persistent underfunding of American Indian health systems have put the nation’s indigenous population at higher risk of poor outcomes from the disease.”

That history is also the backdrop for a legal battle unfolding in South Dakota, with the federal government and Cheyenne River Sioux at odds over Native checkpoints outside their reservation — meant to help deter the spread of the virus.

An interpretive sign at Fork Clark State Historic Site in Mercer County, N.D., which notes the 1837 smallpox epidemic. Photo by Craig Bihrle
An interpretive sign at Fork Clark State Historic Site in Mercer County, N.D., which notes the 1837 smallpox epidemic. Photo by Craig Bihrle

LeBeau looks back over centuries of Native history and sees the same kinds of traumas that haunt soldiers returning from war. The conversation, for her, isn’t just framed up around disease — it’s just part of a much greater, more difficult thing.

“Ever since the doctrine of discovery, the foreigners came in here thinking that all this land was open and free. So they came in. They pushed the Natives back, back, beginning with the Trail of Tears, and coming this way onto our area, the Black Hills, and then along some time came the boarding schools,” LeBeau said. "For myself, I went to a boarding school (for) several years. All that trauma that we experienced has left a lasting impact on our people, on our reservation.”

Read the entire Indigenous Impacts stories and essays.