University of Virginia Library

Medical 'Circuit Riders'
Cover Sioux Indian Country

By Dr. Sylvester Clifford,
Speech Pathologist

March of Dimes Cleft
Palate Clinic,
University of South Dakota

The days of the circuit riders
are not quite over here in
the Dakota country. I am a
member of a team that rides
over the broad plains of South
Dakota. Unlike the circuit
judges of the old west, however,
we do not try criminals.

The culprit we are seeking
out is a common birth defect:
cleft lip or cleft palate—oral
clefts, we call them. For reasons
that are not well understood,
these defects occur
more often in South Dakota,
and especially among the
Sioux Indian tribes, than in
the country as a whole.

Smooth Teamwork

Our team is unusual in
many respects. For one thing
it embraces many disciplines.
We have an ear, nose, and
throat specialist, a pediatrician,
an orthodontist, an audiologist,
a psychologist, and
experts in speech problems.
Headed by Dr. Willis Stanage,
a Yankton pediatrician who
directs the program, the clinic
operates out of the March of
Dimes Birth Defects Center
based at the University in
Vermilion, S.D.

Recently a medical writer
who watched the team at work
commented on the smooth, relaxed
way in which this group
of very different specialists
concentrated on the problems
of their young patients. They
exchanged information and
suggestions on what treatment
would be best for a particular
patient's condition,
write careful evaluations, and
arrange to follow up on the
patient's progress during the
year.

Travel Long Distances

To a specialist in the problems
that result from difficulty
in speaking, the work of
the cleft palate clinic is particularly
rewarding. It's such
a genuine pleasure to see
these shy, withdrawn young

children blossom as their oral
defects are treated. Some
times we recommend special
appliances to cope with the
defect. For other patients,
medical and dental treatment
is sometimes combined with
plastic surgery to restore
function.

It is inspiring to watch our
team members work. Often
they travel long distances at
their own expense in order to
contribute their highly specialized
knowledge to dealing
with a child's problem.

The clinic began almost informally
as a project dreamed
up by Dr. John B. Gregg, a
maxillo-facial surgeon in
Sioux Falls, and myself. Then
four years ago the National
Foundation agreed to support
our work. March of Dimes
support came as part of the organization's
policy of making
possible services that would
otherwise not be available.

Perhaps the most remarkable
part of our work are the
clinics we hold on the Sioux
reservation. In December,
each year, we hold a session
at the Rosebud Indian Hospital
deep in the Sioux country.
People bring children from
miles away, regardless of the
weather. Winters on the Dakota
plans can be very bitter
indeed.

Getting to Know Sioux

Sometimes it takes a little
longer to get close to Sioux
patients. For one thing, the
children are often brought in
by a relative other than the
parents. When the loss of a
day's work can make a really
basic difference in how a
whole family will live for the
next month, parents can't afford
to take time off. So the
child comes with an aunt, an
uncle or a grandparent who
doesn't know the details of his
case or how he is progressing,
and we need to take a little
extra time to establish bonds
with these youngsters. Once
they sense that you're trying
to help them they open up.
They respond.

The Sioux are a proud, reserved
people. Some of them
speak only Dakotah or Dakotah
and it takes time to get
things across through an interpreter.
But when you come
back the following year and
see what progress a patient
has made, it all falls into
place. You know you are doing
something eminently
worthwhile. Just one shy
smile on the face of a solemn
young patient is more than
enough reward.