In the end, the Indian tribes of North Dakota could not save their preferred candidate, Sen. Heidi Heitkamp, from a double-digit loss.

But, galvanized by anger over the state's voter ID law and aided by the intensive efforts of tribal leaders and advocacy groups, they turned out for the election in numbers unprecedented even for a presidential election, much less a midterm.

In Sioux County, where the Standing Rock Indian Reservation is, turnout was up 105 percent from the last midterm elections in 2014 and 17 percent from the 2016 presidential election, according to data from the North Dakota secretary of state's office. In Rolette County, home to the Turtle Mountain Band of Chippewa Indians, it was up 62 percent from 2014 and 33 percent from 2016. In Benson County, home to the Spirit Lake Nation, it was up 52 percent from 2014 and 10 percent from 2016.

One of the most striking results of the night, though, came far from the reservations: in a normally Republican district in the Fargo area, where Ruth Buffalo became the first Indian Democratic woman elected to the North Dakota Legislature. She did it by unseating state Rep. Randy Boehning, the primary sponsor of the very voter ID law Native Americans had feared would disenfranchise them. For all the symbolic resonance of her victory, Buffalo, a public health professional with three master's degrees, campaigned on local issues — and her win underscored how partisan divisions can be scrambled when the national hot buttons are removed from the conversation.

"Ruth ran not as necessarily a Native American woman, but as a woman in Fargo who wanted to talk about issues that were affecting her community," said Scott McNeil, executive director of the North Dakota Democratic-Nonpartisan League Party. Boehning did not respond to a request for comment. The New York Times spoke with Buffalo. The interview has been condensed.

Q: Tell me about your background and how you ended up in politics.

A: I have a Bachelor of Science in criminal justice and three master's degrees: one in management, another in business administration and one in public health.

I ran unsuccessfully in 2016 in a statewide race for insurance commissioner. I became party secretary [of the North Dakota Democratic-NPL] in April 2017. I was also appointed to the Fargo Native American Commission by the mayor in July 2017. I just kind of stayed involved in the community and continued to volunteer on different boards and commissions.

Q: You've spent much of your career in public health.

A: I worked seven years at a tribal college as a "strengthening lifestyles" director. I was a head women's basketball coach for three years. For one year, after my son was born, I was assistant men's basketball coach. And then I was offered a scholarship to study public health — master's degree classes — and also be a part of a breast cancer research team in an urban setting. Prior to those seven years, I was a substance abuse prevention coordinator for my tribe, the MHA Nation. I've always been more on the prevention side of things.

Q: You've said that you went into public health because of your own family's experience. What happened there?

A: I'm the oldest of three girls biologically. My mom also raised two of my older first cousins, who I consider sisters, and three older brothers. When I was 10, my younger sister was misdiagnosed at the local field clinic in Mandaree. She had appendicitis, and it almost ruptured and we almost lost her. Local health care providers turned her and my mom away. They would say she just had flu-like symptoms and give her Tylenol and send her home.

My mom drove her to the nearest town that has a hospital — Watford City, 27 miles away — and the ambulance rushed her to the next level of care in Williston, and they had emergency surgeons. From that experience, with my little sister being 5 at the time — it really opened my eyes. It was scary, and I wanted to figure out how we could fix that in our community to where nobody else would have to experience that.

So from that point on, I set out to become a medical doctor. I applied and got into a summer program in seventh grade: physics, chemistry, math. It was a six-week program every summer. Then I went on to study pre-med in college. I found that I could not work with cadavers my whole senior year, so I had a life-changing decision to make (laughs).

Q: What were the biggest issues you focused on in your campaign?

A: Access to health care. I knocked over 6,500 doors, and that was the most common theme I found at the doors from voters. Another issue that came up was our education system, K-12 and higher ed, and then also property taxes. People are afraid to be thrown out on the street, to lose their homes because the property taxes continue to increase.

Q: Let's talk about the voter ID law. Did that affect you at all?

A: I'm living currently off the reservation, in a district that is not located near or on present-day tribal lands. But my entire family, basically — my mom, my sisters, my aunt, cousins, uncle — they all live on the reservation.

We have friends that had the precincts that they normally would vote at shut down for budgetary reasons, which is hard to comprehend, because they're right in the middle of oil country. There used to be two precincts in Mandaree, where I'm originally from, and the more rural precinct — the precinct that is farther east of Mandaree — for some reason was closed. They had to drive all the way around the river to Killdeer, at least 45 minutes.

Q: As a Native American woman, you defeated the main sponsor of the voter ID law that many feel targeted Native Americans. How does that feel?

A: It's crazy that it happened that way because I just didn't — I guess I didn't know that, to be honest. That he was the prime author. I didn't know until the day after the election, when a current legislator pointed it out.