In my book "River Chase" we talk about one of the Indian villages on the Bigfork River. Many families lived along the many miles of this river. One of the things most lacking for these villages was medical care and another was school for the children.
Families did their best to teach their children, but even the teacher was most times handicapped by very little schooling.
Medical care was only available a long distance from home and many died of problems easily cured by a doctor. As the tribes became more centralized, their leaders brought these two services to remote tribes.