Tillie is everything they said she would be. Soft and comforting, she creates a safe place for those who need it. She doesn’t force herself on folks but is always available for a hug.
Tillie is a female buffalo hide that hangs on the wall of the Four Directions Clinic in Kyle, on the Pine Ridge Reservation in South Dakota. The clinic is the first Indian Health Service facility of its kind offering not only reproductive health services but also a full range of services for victims of sexual assault.
The clinic’s buffalo hide was nicknamed “Tillie” by the staff in honor of Tillie Black Bear, Sicangu Lakota of the Rosebud tribe, a longtime advocate for battered women both nationally and in the Plains region. According to Terry Friend, former midwife at Four Directions Clinic, Black Bear was a groundbreaking grassroots advocate for battered and assaulted women in Indian country. Black Bear passed on in 2014.
In many ways, the Four Directions Clinic symbolizes Black Bear’s grassroots mission to place the needs of victims first. The buffalo hide, Black Bear’s namesake, carries this spirit forward.
Everyone wants to touch Tillie, including the little girl who insisted on petting the buffalo hide before providing details of her sexual assault.
“Tillie gives a sense of strength to our patients,” Friend reported.
The clinic, available 24 hours a day, seven days a week, opened in January 2014. Although the staff was aware of the high rates of sexual assault for Native women (according to Department of Justice data, 1 in 3 Native women have been raped), they were unprepared for the high number of children who sought services during the first year of operation.
“We have evaluated 60 kids since we opened,” Friend reported last summer.
Consequently, staff has had to seek additional training to better address the needs of children.
“Our main goal at the Clinic is to break down barriers for victims and increase access to care,” according to Friend, who has since moved on to a posting at the IHS headquarters in Rockville, Maryland.
In the past, victims on Pine Ridge reporting sexual assault were faced with numerous obstacles, including traveling to different locations in order to provide evidence to law enforcement and long waits in busy emergency rooms for exams by physicians.
Guided by their experiences serving the community and information from victims’ advocates, Friend and her staff carefully designed the clinic to respond to the unique needs of local clients. “We try to be very sensitive to victims fears and needs,” Friend said.
When victims come to the Four Directions Clinic to report sexual assault, they can access numerous services in one place, including forensic examinations conducted by a Sexual Assault Nurse Examiner (SANE). A SANE nurse is a registered nurse who has received special training to provide comprehensive care to sexual assault victims. SANE nurses can also conduct forensic examinations and provide expert testimony in court if assault cases go to trial. Forensic collection equipment is all located at the clinic so clients don’t have to go elsewhere.
In the past, victims would have to travel to an IHS hospital and wait in the emergency room in order to be examined by a physician, and only physicians at IHS facilities were allowed to conduct sexual assault exams or give evidence in court. According to Friend, most sexual assault victims are not physically injured and may not require physicians’ services. Many have been fed alcohol or drugs that disarmed them.
“Many of our victims said that the excitement of the emergency room was a deterrent in seeking help,” Friend said.
In contrast the clinic is a quiet space that also provides reproductive services such as prenatal, routine gynecological care, family planning as well as HIV services. The Clinic is designed to protect victim’s identities; clients in the waiting room could be at the Clinic for a variety of reasons. On the other side of the locked door leading from the waiting room, however, is a separate hallway that leads to forensic examination rooms. There is also a private entrance for clients who request it.
“We wanted to create a clean, welcoming, safe and supportive environment,” Friend said.
Numerous Lakota shields hang on walls throughout the clinic. “We offer the shields as symbols of protection for our clients,” according to Friend.
The Clinic also has space for law enforcement to conduct forensic interviews if clients wish to report an assault as well as conference rooms and spaces for family and friends to wait while evidence is collected. Forensic interviews are recorded so that victims don’t have to undergo the stress of repeating details the assault.
There is also a shower where victims can clean up after examinations and change into clean clothing provided by the Clinic.
“We would like people to leave here feeling better than when they arrived,” Friend said.
“All of our staff, including midwives, nurses and receptionist has had Sexual Assault Response Training (SART),” according to Friend. Victims also receive referrals for mainstream counseling or traditional healing.
One of the most unique aspects of the Four Directions Clinic, however, is its funding. Although initially funded by a four-year grant, the Kyle Center, IHS has committed to assume ongoing funding after the grant expires.
“All the tribal leaders who visit our clinic ask the same question,” Friend said. “They want to know how they can get such a clinic in their communities.”