Friday, October 28, 2011

Trust and Research in Indian Country

      I don't know what it is about today, but the topic of research seems to keep re-emerging in discussion topics.   As a full blooded Navajo woman, this topic presses my buttons on so many levels.  Which is why I feel the need to discuss it.  Aside from the personal and historical relationship I have with "research," I also have a professional relationship with "research."......I just needed to clarify that with you before hand, because its not a straight road from here.....
       While writing a literature review about barriers to health in Native American women, I found a lot of research data to be outdated by at least 10 to 15 years.  Which made my review difficult, because what I was reading didn't really reflect what was going on today.  For college students interested in reading research about what is going on in Indian Country, you will run into this. So where is all the current research?  It's no secret that there is a "common feeling among many tribal people that research has harmed American Indians and Alaskan Native people."..This is not just a feeling too..

Historic Distrust

  • Termination of government - to - government relationships with many tribes (1950's & 1960's)
  • Relocation to urban areas (1950's-1960's)
  • Sterilization without knowledge or permission (through 1970's)

Current Issues
  • Misuse of blood samples taken from tribal members by ASU (tribe told it would be used for a study on the genetics of diabetes..however blood samples were used for studies on schizophrenia, inbreeding, and possible migration patterns of the tribe's ancestors from Asia to America..(2004).
    The history of research in Indian country has not been a positive one....Now here is the kicker.....Why is research even important? With the many health disparities afflicting our tribes, how do we even begin to identify and address these issues, because many healthcare providers and community programs rely on research to justify their work.  If we stick to "all research does harm,"  how are the tribes going to justify community programs that support families and if the research is not current how are the healthcare providers going to know how to guide their practice when providing care in Native American communities?
     At the many conferences I attend, I am always hearing about how we need to shape our care to meet the needs of the population we are caring for...Research??..Anyone..The question then becomes, who does the research, how is the research used, and can we read and understand what the research means?  I can tell you will not find vary many Native Americans doing research...PhD's..etc..I'm not being an educated snob here by saying that, but seriously, you want to be at the tables where decisions are being made that affect your tribe, get educated.  Use it to your advantage...consider it another language...use it so you don't get taken advantage of...
      On that point, tribes are now developing or have developed regulatory policies and institutional structures to regulate research.  Which is a positive thing, because as soverign nations, we should be able to regulate research on our reservations.  Institutional Review Boards, Community Advisory Boards are all types of research committees who decide what type of research is ethical, safe, and will benefit the tribe..and a few other things, but I will let you look those up yourself...Now before you start reading the word "U.S. government formed" and decide to "doubt" the efficacy of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research..remember this is a group of scholars and policy-makers who basically wrote the "Belmont Report" (look it up!)..a set of ethics codes that guides the responsible conduct of research.  Basically..Respect for persons, beneficence, and justice.  It was drafted in 1979.  Federal Law mandates that all research conducted or funded by federal departments and agencies must follow the Protection of Human Subjects, meaning research involving human subjects must be approved and continuously monitored by (IRB's)..yes IHS has one. The down side to the IRB's I just stated, are that it is founded by Universities and community members at large. However, thanks to the Indian Self-Determination and Education Assistance Act of 1975 and Self-Governance, American Indian and Alaskan Native communities have the legal bases for regulating research as it relates to health and social issues.
              Basically, we have the means to develop our own research communities that support how research studies should be conducted.  Enforcing these laws is up to the tribe, but the National Congress of American Indian (NCAI) Policy Research Center (PRC) maintains a data base of tribal complaints that allows tribes to share information about "unethical" researcher conduct with other tribes. (Sahota,  Research Regulation in American Indian/Alaska Native Communities: Policy and Practice Considerations )

                My point in all of this is, as a healthcare professional I see the need for research, as a Navajo woman, we have to tread lightly in this area.  Rebuilding trust, mutual respect, and letting tribes be FULL partners in the research is vital.  Assuming that all research is untrustworthy and not taking an educated look at it, so that you can make your own decision as to whether or not it is best practice for allowing yourself to be volunerable.  As someone who has chosen to get an education, so that I may use that information to make changes for our tribes, it is extremely frustrating to encounter those who still avoid possible healthy practices to go by the wayside because government is attatched to it, rather then learning how to read research for themselves.  It's even more frustrating to continuesly hear the overabundence of complaints of how government makes these decisions for us.  Get out of your box and do something about it...Put yourself in a place to be heard, be on the committies that make these decisions.  I'm not saying be a politician, rather be an educated advocate.  Which is why there needs to be more Natives going to college and beyond. You have something to offer!
         Yet..Again..another reason why I love midwifery!

NCAI Policy Research Center link:

Wednesday, October 26, 2011

Our Life Ways

     Recently, I had the pleasure of giving a presentation at the University of New Mexico on integrating traditional healing practices into modern medicine.  I was even more elated to learn that I would be sitting on a panel with Dr. Lori Arviso Alvord, M.D., the first female Navajo surgeon, as well as author of  "The Scalpel and the Silver Bear."  I also had the pleasure of meeting additional panelists Dr. Eliseo "Cheo" Torres, who has written two books on Curanderismo " Mexican Folk Healing."  To say the least, we were a very interesting group of panelists.  I think it is rather an amazing thing when healers from varies cultures can come together to share their traditional knowledge, as well as discuss how it can be integrated into modern medicine.  Why is this amazing?....If you've ever met a medicine man/woman, you will quickly learn that they are very busy people.  I'm not calling myself a traditional healer by any means, for that title takes years of apprenticeships and spiritual calling.  However, to have "scholarly" individuals like ourselves interested in learning and sharing traditional knowledge, as well as integrating it, that is short of a miracle.  I honestly felt truly honored to even be considered "knowledgable" on the level of these other two panelists....and yes I did have Dr. Alvord autograph my copy of her book. I would have had Dr. Torres sign a copy of his book for me as well, but I wasn't aware of his accomplishments before hand, otherwise I would have brought his book with me too!
        Aside from being excited about presenting at this academic star studded event, it really allowed me to take an in-depth look at our Navajo teachings and what they really mean.  I named the title of my presentation "Our Life Ways, " because that is really what they are.  A set of values, teachings, stories, and basic necessities to live.  What struck me the most about these teachings were that they were very basic and made a lot of sense.  I didn't find them in a self help book that showed me how to reach enlightenment, but rather bits and pieces of oral history I had remembered throughout my life.  I also had the pleasure of spending some time in Chinle, AZ, where I got to ask two medicine women about our Life Ways and what they mean.  It has been quite an education and something that has really made me think about everything I do and what knowledge I will pass on to my children.  Most importantly, I had to ask myself ..was I following our "Life Ways?"...and how was I going to integrate this knowledge into my care?
         I think it's important to first acknowledge that Native Americans think differently and to remember that how we experience the world is through our traditional knowledge and teachings.  Part of socially supporting our needs is to first give voice to our Life Ways and accept that it is who we are.  Rather then trying to get us to fit into a medical model of care that is completely detached from our Life Ways efforts need to be made to use that knowledge to reach the positive health outcomes we are all striving for.  Also, to be mindful that our teachings and healing practices have their own timeline.  You can't necessarily take a pill and feel better tomorrow, nor can you learn all there is to know about health in a 20 minute office visit.  
       Here are a few basic Navajo values that I will share with you and I pray that they make you think a little deeper at what you are saying and who you are caring for.

Think and speak in a positive way
Our thoughts and language have the power to shape reality and control events.

Importance of relationships
Awareness & respect for interconnected systems in the universe

All living beings have a natural lifespan, and the cycle of birth, growth, maturation, and decline is essential to the worlds harmony.

  Like I said, these are basic teachings, but filled with so much meaning.  Don't get lost in the science, but rather respect and live by the meaning......
Here is a wonderful article that expresses what I mean by speaking and thinking in a positive way..
Setting up Realistic Expectations

                               Who We Are- Dine

Tuesday, October 18, 2011

Strategic Planning

      "Change is disturbing when it is done to us, but exhilarating when it is done by us!"

           I spent most of yesterday in a planning meeting discussing how we were going to build and sustain a comprehensive communty-based midwifery care & birth center.  A place that is accessible, culturally congruent and effective in nurturing family and community health.  Let me tell was an amazing experience.  Imagine 10 to 15 motivated individuals discussing a "vision" and how we are going to get there.  It was a good mix of varies cultural perspectives with past and present philosophies converging on a project that is worth the time and effort.  What I loved most about this planning meeting was everyone's ability to think "outside the box." This kind of motivation and creativity is inspiring, as well as nurturing.  It  was good to know that despite the years of "internalized colonization," that our traditional knowledge and necessity to reinforce "community" was not lost.  We spent most of the day discussing barriers to birth center visions like ours and you would be amazed at what came up in our discussions.  Here is what we came up with...

Vision Wall

Blocking Progress..

1) Inability to hold/respect multiple world views alienates healthy relationships
2) Misogyny denies the divine feminine blocking harmony and spirituality
3) Fragmentation of spirit disconnects us and blocks healing.
4) Healthcare chaos blocks effective collaboration and nurturing care.
5) Culture of violence uses intimidation to block resources, creativity, and love
6) Addiction to consumerism creates insecurity, distracting us from our authentic self, empowerment and  meeting our real needs.
7) Institutional oppression replaces and suppresses critical consciousness.

       Before you begin to think that we are radicalists, let me explain something.  Native Americans in all parts of the country have experienced hardship and organized separation from their cultural knowledge.  Does the concept "Intergenerational Trauma" ring a bell?  I'm not going to go into the history of this,  I think that it's important to read up on our history, because it will help you understand why things are the way they are on our reservations.  From my perspective..alcoholism, sexual abuse, physical abuse, child abuse, depression, suicide, and devaluing of women are all outcomes of these past traumatic events.  I bring this up now, because we see what the issues are.  We want to try to make an effort to provide a space for change and healing.  Again..I realize healing and deciding to change is an individual choice, but it is possible.
      Okay..I'm going to go all out "midwife" here, but there is substantial cultural knowledge and scientific (for those of you who need hard evidence that this does occur), that a woman's emotions during pregnancy effect the fetus.  We are all well aware that what we eat during pregnancy effects the growth in our fetus's, but so does our emotions.  In our "Navajo Way"  we are not to see or say things negative while pregnant, because this will effect our child.  Recently, while attending a conference a physician presented evidence that this does happen. I can post the article's if you like.  My point is, change happens at conception.  I've always thought that each community should have a birth center, because their presences should be a health indicator of the community.  Because, really when things went way ....left field is when birth was taken out of communities.
         Our goal is to bring birth back to communities, while encouraging harmony, healthy relationships, and reinforcing our relationship with the land (which has sustained us despite how we continue to treat it). Indigenous people used to farm this land for food, but this has also gone by the way side.  If you can pull yourself away from the TV, you might notice that more communities are starting community gardens and there are more grants supporting farming projects that encourage teaching youth traditional agricultural practices.
          I think the time for healing and for regaining some of our indigenous "life ways" are returning.  I find myself surrounded by more and more individuals who are motivated and ready to get things going.  Which is why being apart of strategic planning meetings like this one feed my spirit.  I look forward to catching my first baby in this new birth center.

Espanola Valley Women's Health

Thursday, October 6, 2011

In Transition

            It seems every step I've taken in this new path, I feel a strong sense of responsibility.  Not only a responsibility to my family, but a responsibility to share my knowledge and experiences with anyone who will listen.  Anyone who knows me, gets a sense of the passion I feel for the work I do and will continue to do.  This strong sense of responsibility stems from the knowledge of knowing that there is a small percentage of Native Americans who pursue an education beyond high school and an even smaller percentage of those that pursue a graduate education.  Why is this important?  Because there are so many issues that tribes all over the world are facing and it seems we are only still trying to dig our way out of the many years of turmoil.  Those who do not understand the many years of infastructual damage that have turned our tribes inside out, really have no clue of why we live the way we live.  I hear all the time.."you natives get free health care," or "you put yourselves here", or "you chose to live this way," or "where is all that money from the casinos?"  Here is a little insight from someone who has grown up in a world where alcohol and physical abuse is the norm, where our healthcare system is struggling to meet the fast growing needs of it's people, and where there is an on going battle in tribes over who is able to receive tribal resources and who is not....and many other issues that you would be surprised to know we are still struggling with.
           Getting a higher education isn't just about getting a better job or making money, or even to show our friends back home that we have become respectable "important" individuals.  Rather, it's an opportunity to educate ourselves so that we can lead our people in a direction of healing.  I realize this may not be the case for every Native pursuing a graduate degree, but in my opinion (as that this is my blog), it should be.  I am always amazed at the work of communities who come together to bring about healing and unity.  My biggest question is "How did you do that?".."How can I do that?"  My reality is knowing that "I" can't do it.  It's has to be the priority for everyone.
           With all of this on my mind, I have to say, I'm very restless.  There is so much work to be done and it has to be done on so many levels.  Part of my restlessness with this is thinking to myself, where do I need to be to make the most impact? Grassroots, returning to school to get a PhD to generate research or getting my PhD in Health Policy and addressing these issues on a legislative/policy level?  I also think to myself..that I don't necessarily have to have a PhD to make these changes, but it would help.  Right now, I'm just trying to align myself with working in a positive working environment with motivated healthcare providers who are just as motivated as I am to providing the best care possible.  Because I'm still new and have MANY things to learn, I am being careful with who I align myself with.  Getting experience is at the top of my list for the next few years, but honestly I am one of those people who has to feel confident in those I'm working with.
             The point being....I am still very much in transition.  I'm exploring many new professional relationships, learning about who can be trusted and who can't, finding a balance between my very "loud" passion for the work I am doing and my important roles as a mother and wife.  Let's just say I'm still putting all the tools in my tool box so that I can tactfully get our issues (Native American) addressed and hopefully educate more communities on these issues. Like I said, I can't tackle these myself, but I can try my best to find innovated ways to get more people involved.  The changes I hope to see, most likely will not happen overnight or even in my lifetime, but any little bit of a change in the right direction is still encouraging.  I feel blessed that midwifery has opened my world up to think about all the factors (social/ethical/spiritual/governmental) that effect us all.
         Which brings me to the reason for starting this blog.  If you've read the "why's " in my last blog, about becoming a midwife, this one is not so much about me, but about all the amazing relationships and information I've been allowed to be apart of.  I've attached all the websites I used during school and still use professionally as a CNM.  One of things I love about midwives is, we are not just about mom's and babies, you can bet we are involved in policy, legislation, business, world health, research, and many more areas I'm still learning about.  My education and training has taught me a lot about these areas and it would be a shame for me not to share it with you.  Most of us are strong willed and committed to doing best by those we care for.  I hope this blog is informative, as well as, a glimpse of what I find so thrilling about what I do.

Tuesday, October 4, 2011

A Woman's Beauty...

 A woman's beauty is like the meandering river with many curves and secrets beyond the surface, only to be revealed one day at at time to those who dare to see beyond the shades of her eyes...

Only a fool would believe all has been revealed by witnessing the small ripples of emotion she cares to share with you...
For that is only a glimpse of her truth she has yet to reveal...

A woman's beauty can catch you off guard and make you see the world with different eyes..
Her universe is untouched with deep roots to keep her grounded,
For her beauty can not be revealed with lies...

A woman's beauty can not be bought to be put on display for all to see...
For it is fluid in form and is ever changing,
Only to be witnessed in fleeting moments when you think she has given you the key.
  A woman's beauty is all her own, individual and imperfect at times,
It's imperfection keeping you guessing,
For it is unlike anything else, but her silent blessing. 
A woman's beauty...Under the surface lies,
The secrets that keep you coming back for more...
The secrets to her individuality that lies beyond the shades of her eyes....