Monday, June 18, 2012

A Navajo perspective....

       I recently had the pleasure of presenting on a panel of ethnically diverse midwives at the American College of Nurse Midwives conference on "Bringing Cultural Diversity to Midwifery."  It was a great opportunity to educate everyone on why it is important to have cultural diverse health care providers, what the barriers are that midwives of color face while trying to attain this form of education, and the importance of having women of color providing care for their own ethnic communities. I was joined by Felina Ortiz, a CNM who is a descendent of a curandera parteras, a traditional Mexican American midwife.  Tamara Littles, a CNM who is African American and Jewish. Patricia Metz, a CNM who is Hispanic from the Las Cruces area.  Lisa Jaramillo-Husted, a CNM who is Hispanic from Silver City, NM.  Amazingly, three of these women were also classmates of mine and were graduates of the University of New Mexico Nurse Midwifery Program. Despite our diverse backgrounds and cultural views, we all share common goals in advocacy and activism for our communities.
       It was actually pretty powerful to be part of a group of diverse women sitting together and talking to our colleagues about our experiences going through school and the driving forces that motivated us all to work harder to provide quality care to those in our communities.  Speaking in public is still a talent I'm working on, but also to speak on matters that strike deep in my heart are not easy topics for me to share without shedding tears.  There was also so much I wanted to share and so little time to share it.  When I tell people of how I grew up and my personal struggles they feel sorry for me, but I also remind them that I'm not alone in my struggles; nor was my upbringing any different than a lot of young Native American women in my community. I know to my parents credit, they did the best they could with what they new.  So don't just feel sorry for me, think about all the Native American women growing up in single parent homes, with alcoholism, with physical and sexual abuse being a normal part of their lives in one form or another. Then to go to a hospital and to be treated like a sub-standered citizen because your skin is brown and your clothes are hand me downs.
        What I didn't say during my presentation is that, part of what drove me to becoming a midwife was based on some negative experiences growing up.  It got me thinking, there has to be another way, and perhaps I have something to offer.  You could say I have a different perspective.  And surprise!  Current literature on addressing Health Disparities does say I do have a different perspective on health and I do have something to offer.  For those of you who haven't read a thing about what Health Disparities is...(the CDC's definition) is that it is the differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes. Basically socioeconomically disadvantaged groups and those who have experienced racial inequity in the US( i.e African Americans, Native Americans, Hispanic & Mexican Americans); are more likely to die younger, experience poor health, have higher rates of infant mortality, have higher rates of diabetes and heart disease as compared to the general public.
          It's not so much that I have a "different" perspective, but I've been on the receiving end of government policies and what people of a different culture "think" is the right way to care for me.  So I feel like I can relate to my Native American patients better.  I understand the history behind the mistrust of providers and how important family, community, and ceremony is to our health.  On the other end, I also am able to listen to the frustration from non-native providers about how difficult it is to care for Native Americans.  I hear all the time from (non-native) nurses and midwives, how they one day dream of living on the Navajo reservation and working for IHS.  Which I think is great!...BUT!  We are not a charity group that needs to be saved so you can feel like you are giving back.  Some of the experiences I've heard from "bilagana (navajo term for white)" nurses who have worked in IHS is how they don't get treated well.  There seems to be a reverse in racial mistrust and equality.  Which, they may feel like they had nothing to do with, but in the eyes of a Native American nurse, woman, working in a hospital that historically has a bad rap with the Native American community it is trying to serve, you are going to get  some dirty looks and you will automatically be treated without much regard.  All I can say to you is 1) first I commend you for taking the initiative for wanting to work in an environment that can be hostile and know it may have nothing to do with you, but rather the place you have decided to work was part of the historical trauma that has taken place on our reservations. 2) Don't assume you will automatically be taken in with welcome arms, building trust is a MUST!, which means a 2 year stint and then leaving to climb the political/professional latter is not going to do anyone any good. 3)  If you really want to help the tribe you are working with, help them help themselves.  Empower them to define their own health in their own terms, it will be more meaningful and they will more likely add hear to it more then they would to the government issue version. 4) Finally, take the time to review research material that pertains to the group you are working with.  One size does not fit all, just so your not banging your head against the wall wondering why certain practices you were trying to institute did not work. 5) A medicine man may hold more clout then the MD in the white coat.  However, if they were to work as a team..double pow and amazing healing can be had!
         With wide cultural differences there is bound to be miscommunication and misinterpretation on both ends.  An indigenous worldview is very different from the mainstream and it is one that is rarely examined as told through indigenous voices.  This I understand is do to the lack of doctoral prepared Native American researchers...and if you are Native American and reading this...don't stop going to school..get your PhD.!  We need you! (as I still wrestle with my future of getting my PhD in Health Policy)..
          So you can imagine as I was getting bombarded with questions at the end of our presentation, that I tried to stay positive in my responses, but also realistic.  One of the the questions that resonated with me and I am still thinking about it is..."how can we get more Native American midwives?"  That is the same question I ponder too.  There seems to be no one answer.  Part of me thinks that despite some of the barriers I've experienced in my up bringing and education, it has also spurred me forward to keep going...kinda like.."so you think I can't do it huh?"..we will see.  However, I know I would not be here if it wasn't for the many prayers my family said on my behalf, the amazing support of my classmates and professors, and a very strong commitment to my community.
          Yes, yes I had many meaningful and beautiful things to say during this presentation, but I wanted you to know that despite some of the negative aspects of history and how it has affected me as a person and the world view I now have.  I'm not bitter.  I'm not hateful...and most importantly I have not given up hope that we can heal from this historical trauma that we as Native Americans continue to live through each day.  My daily prayer is that I don't become less hopeful or less genuine in my intentions...and that I don't ever forget that it is not I who does the healing, everyone heals themselves in one form or another.  I mearly help remove some of the obstacles, whether it is through the medicine of talking, listening, crying, singing, holding your hand, catching your baby.....or just being a silent ball of strength and hope you needed when you thought know one was in your corner.  As I feel my ancestors are always watching out for me in my time of need.  Healing takes many forms.