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It's not uncommon for the electrical power to fail where she works-a particularly disruptive problem for a program that relies on interactive television classes or Web-based courses. Logistics also are complex with the students and faculty who have to travel 800 miles a week for classroom and clinical experiences.

Despite the challenges of coordinating this Northern Arizona University program, Crow's team is successfully training American Indians to become nurses in hospitals and community agencies that serve reservation populations. These nurses are pioneering the delicate task of merging Western medical practices with indigenous traditions that have been used for hundreds of years.

The program is designed to allow students to stay on their reservations for much of the class work. This allows American Indian communities to feel more connected to the students and the Western concepts the students are learning.

"Reservation-based programs allow the family and student to experience the educational process together," said Crow, who is Cherokee. "It's not such a disconnect. As students begin to change, the community and family see the behavioral changes in a more gradual way.

"If someone goes away for school, there is more cultural conflict and dissonance. An individual may come back and the family may have difficulty with the changes and say the student no longer walks like us, talks like us and questions whether or not the student is one of us anymore."

Although the students complete much of the training on a reservation, senior students are expected to spend the last seven to 10 weeks at large metropolitan hospitals away from the reservation.

To help students bridge the gap between their reservation cultures and Western practices, instructors teach students how to translate and interpret Western health care information in ways that traditional American Indians will understand.

Students are encouraged to embrace their indigenous values as a technique that eases the translation process.

For example, Crow said that in most nursing programs, students are expected to answer questions, speak up in class and be assertive. Yet American Indians are traditionally not as demonstrative. Rather than forcing students to change, Crow's program advises students to be assertive in ways that feel natural.

"They may do something in a quiet manner so that it wasn't even recognized," she said, "or they may share their health care opinions in a story form."

The story, for example, could illustrate the benefits of using antibiotics rather than herbs to treat a condition.

So far, about 25 students have completed the program since it began in 1995. Crow is confident that these students are receiving a brand of nursing education that would be difficult to find in standard programs.

"This program celebrates diversity in a way that allows people groups to come together to promote unity in the diversity rather than separation," she said. "One does not need to negate the other."

Heather Stringer