How I used community engagement to investigate premature deaths in Indian Country

Published on
June 4, 2024

It all started with a 2013 report. 

The Montana Department of Health and Human Services released data that showed Native Americans in the state died, on average, 20 years earlier than their white neighbors. 

In my years covering Indigenous communities, I’d been to several funerals for sources, written dozens of obituaries and conducted tons of interviews in which health, grief and early death were inevitably discussed.

But 10 years after the state’s report, there was little data showing whether the life expectancy gap had changed. I wanted to investigate the issue but at first, I was nervous. Health, grief and death are sensitive subjects, and I wanted to make sure I approached this project with the attention, time, dedication and care it deserved. I applied to the USC Annenberg Center for Health Journalism 2023 National Fellowship to make sure I had the financial, peer and mentor support to do this project justice.

When I was selected as a fellow, I made a plan to visit three reservations in Montana and spend meaningful time in each community. I planned to travel 325 miles from Missoula, where I’m based, to the Fort Belknap Reservation. Later, I would drive 515 miles to the Fort Peck Reservation in a remote corner of northeast Montana. And my last stop would take me 404 miles southeast to the Crow Reservation, the largest tribe in Montana.

As someone who is non-Native, I knew community engagement would be critical to my project. Native people understand their communities best, and I wanted to be thoughtful in how I reached out to individuals to involve them in the series. I applied for, and received, an engagement grant through USC. The support and mentorship the grant provided would forever change me as a reporter. 

The first setback in my reporting journey came when I visited a Native American studies class at Aaniiih Nakoda College on the Fort Belknap Reservation. I told the students about the project and asked  what they’d like to see in the news and  what advice they might have for me. It was the first week of class and the students were shy and didn’t want to talk much. I felt awkward jumping in with tough questions about health, death and grief without established rapport. After the class visit, I’d planned to hang out in a common area where I was told many students came for lunch, but the cafeteria was empty.

Later, the college president told me that a lot of students were at the school’s “Indian club.” He walked me there and introduced me to the group, and we had a wonderful discussion.The club –, where students sat in a circle, knew each other and engaged in frank, lively conversation – turned out to be the perfect environment for a discussion like this.

After returning from the trip, I worked with my engagement mentor to craft an online survey, and I learned another important lesson. Our survey asked people if they had a loved one who died too soon. At first, the survey got very few responses. But I noticed on Facebook that people commented about losing a child or teenager. So we adjusted the question to ask:  “Is your family’s average life expectancy under the age of 65?” This revision completely changed the responses. Because most people had loved ones who had died before 65,  it had almost become “normal.” The idea of losing someone “too soon” was interpreted as losing a child.

People responding to the rephrased survey wrote of a mother dying of cancer in her 40s, of uncles or brothers dying in their 50s from addiction, and of their own chronic health struggles.  As the survey gained momentum, my company, Lee Enterprises, shared it in an email newsletter to readers. This drew more than 70 responses. 

On my second reporting trip, to the Fort Peck Reservation, we met with a teenager named Jaidyn Alvstad, whose therapist had seen the survey and sent it to Jaidyn. We also met with a former tribal police officer who lost two sons in early deaths and with others who had lost loved ones young or suffered their own life-threatening medical conditions. All these people had responded to my survey.  I don’t think I ever could have reached some of them without it.

My reporting trip to the Crow Reservation was the most formative. Teena Apeles, national engagement editor at the Center for Health Journalism, accompanied me, and we planned to host two listening sessions with community members. I’ll be honest – I was really skeptical these sessions would work. In my experience reporting in Indian Country, I’ve found it can be difficult to get sources together in the same place at the same time. And part of me felt bad for asking so many people to take time out of their days to meet with us. Yet though I was hesitant, I was ready to try it.

In our first listening session, we met with LeeAnn BruisedHead, the director of Crow Tribal Health Department. She had invited her staff, tribal leadership and other tribal employees, and more than a dozen people participated in a robust, two-hour session. People challenged each other, added to each other’s points and at one point, a woman called out a tribal official, saying she wanted to see more from the tribe. I don’t think I would’ve had as much engagement if I’d been the one to invite participants. It made a big difference that LeeAnn, who has the trust of her staff and her community, asked people to come and saw the meeting as worth their time. 

At the end, we asked attendees to fill out a survey on the session. Again, I was hesitant to do this because we had already taken so much of their time. But I’m glad we asked for feedback.  People told us how much they appreciated the opportunity to convene and talk across agencies. 

So often journalism feels extractive – something I’m particularly conscious of when covering Indigenous communities. I loved this listening session because we created an environment for meaningful conversation and because it seemed we were adding value by giving people space to share their thoughts. 

Teena took photos on our trip, and not the kind of photos I’m used to. Normally, our photographers make pictures of our subjects. Teena’s photos showed me hosting the listening session and posing with sources. I posted a photo of the listening session to Facebook and immediately heard from Crow community members who had avoided my calls and emails ahead of the trip. It seemed that once people saw that LeeAnn and tribal health employees  trusted me, others in the community felt  they could,  too.

My trip with Teena changed me as a reporter. I recently went to the Blackfeet Reservation for a separate story and hosted two listening sessions and posted photos of my meetings on Facebook. I also reached out to the high school journalism teacher and made time to visit the class.  These engagement methods have made me a more thoughtful reporter and connected me with new and diverse sources. I hope that as I do more of these activities, I continue to build meaningful and lasting relationships in Indian Country. 

In the end, I published  three stories: about barriers to care on the Crow Reservation, premature deaths in the Fort Peck community, and one woman’s efforts to improve health outcomes on the Fort Belknap Reservation.

While I’m incredibly proud of the series, there are a few things I wish I’d done differently. First, I wish Teena had come on my first reporting trip rather than my last. I would have implemented some of the successful engagement techniques from the beginning. I also wish I’d narrowed the focus of my stories early on. Because I spent several days in each community, I came back with lots of full notebooks. I normally don’t struggle with writing, but this project was really tough. 

My first drafts were way too long, as I tried to tell readers about every single thing that happened on the trip and every single person I spoke to.While it felt weird to leave big details out, focusing the stories made them more powerful and digestible. I must’ve written at least five versions of each story, and I’m particularly thankful to my editor Rob Chaney, who helped me workshop each draft. 

The USC National Fellowship has been one of the greatest experiences of my career. I’m proud of the work I did and the risks I took in reporting, and I’m incredibly thankful to everyone who trusted me with their story.