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, parent...you 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.


Blessings!
           

      

Bringing Cultural Diversity to Midwifery

Life in the Day of a Native American Midwife

"Every Day is a Good Day"

               As I sit here and write this blog, I find myself thinking about my purpose and wonder how it will all come together.  Please don't mistake this for doubt, but rather honesty.  You see, I have a big dream, at which I work daily to make a reality.  This deep purpose to use indigenous spiritual beliefs to help find solutions to contemporary problems....I think Wilma Mankiller said it best.." the creator provided us with ceremonies to remind us of our place in the universe and our responsibilities as human beings." It is with this view of the world that I see a way for our native people to thrive again.  However, I understand I have a long journey ahead of me, for this is not a task easily attained in a couple of years time, rather a lifetime goal.  For those who do not know me, I'm not a one task kinda gal, nor do I feel approaching this one task at a time will do either.  

                 Just to give you a little insight on what I've been up to I'm happy to say that I've teamed up with Longhouse Media to start making a film about Native American Midwives and the importance of tradition, culture and ceremony in pregnancy and birth.  It will be a documentary that will hopefully be shown on PBS and National Geographic.  No this is not a film that will give away all our ceremonial secrets, rather I hope it will emphasize our unique world view on birth and how important it is to Native American women to birth in a cultural way.  This idea steams from my own experience as a student midwife and the questions I received from my family about my chosen profession.  As much as I love Ina May's work, before entering school, I've never read a thing about her, nor did I view our profession as a "hippie" thing.  However, this was how it was viewed by my family.  It wasn't until I met my dear friend Ursula, that I realized that we had a deep cultural history in midwifery.  You can imagine my surprise, because me..a native woman did not even know this?  I can only blame this on the strong emphasis on the many health policy changes and the emergence of hospitals on our reservations that have taken  Native American midwives out of the picture.  I'm not sure whether it was purposeful and I will not lead you down that path, but hopefully your curiosity will cause you to read about this event.                

           This is actually a very large project and will take 3 years to make.  We are still at the planning phase, but hopefully a website will eventually be set up to view updates on it.  I feel blessed to have met up with Longhouse Media and that they are just as excited as I am about making this movie with me.  Movie making is way left field out of my realm, but I look forward to the story telling and learning about what other tribes are doing to keep birth sacred in a cultural sense.

Longhouse Media

www.longhousemedia.org/

            Additionally, I am also working with some pretty amazing midwives from Espanola to start a birth center.  That also is in the planning phase, we are still working on becoming a non-profit organization and gathering information to make it a sustainable practice in the community.  We happily have hired a project manager to help coordinate all our ideas and talents to make forward progress.  My piece in all this is still gathering cultural and traditional birth knowledge in the surrounding pueblos so that we can provide culturally appropriate care.  This however has proven to be a challenge, as that some tribes have made a decision to not write down their language and that it will only be passed down verbally.  It is also a challenge because it seems few elders remember what those traditional birth practices were before hospitals became part of the picture. 

               These projects are on going, but exciting too.  I love talking to elders about tribal knowledge and cultural practices.  As if these two projects were not enough, my Espanola midwife colleagues and I have agreed to present at a the New Mexico Public Health Association and University of New Mexico Health Disparities Joint Conference.  Basically " Birthing Options in New Mexico: Addressing health disparities through innovative models of midwifery care."  This presentation is not a 2 man presentation, we are teaming up with Women United, Nightingale Midwifery, and Taos Birth Center.  I'm all about collaboration and team work.  I'm also part of a panel of midwives who will be presenting at the ACNM conference in Long Beach, CA to talk about "Bringing Cultural Diversity to Midwifery."

                  I am happy to say that my small stabs at educating the greater public about midwifery and the importance of culturally diversifying midwifery, has not gone un-noticed.  There can now be two more Native American Midwives added to NM.  I am proud to see them stepping up to the task at hand and know that I am not alone in the work that needs to be done.  

     Brittany Simplicio

     Brittany is Navajo and Zuni Pueblo, who grew up in Shiprock, NM.  Like myself she is very dedicated to her work as a Native American student and midwife. Her interest in midwifery was sparked by a fellow midwife who noticed her calm nature with women in labor while she was a student nurse, she also credits her grandmother for being a strong and intelligent role model to look up to, as well as a pediatric nurse. Her desire to make an impact in her community was further intensified when she saw how health care was being delivered to the community and families on the reservation.  Time constraints, decreasing funding, lack of long term providers, and the distrust of the health care system streaming from the historical tribulations of our elders that did and still contribute to the fractionalized health care system today.  

          I am happy to say that she is almost at the end of her 1st year of nurse midwifery school and will soon be catching babies in the fall.  An important thing to understand here, is that she is also the family caretaker and has continued to mentor students while being in midwifery school.  She is currently completing her women's health rotation in Shiprock, NM. Meaning, she is commuting from Albuquerque weekly for this experience to work in her own community.

Nichele Salazar

            Nichele Jicarilla apache from Dulce, NM.  She attributes her interest in midwifery to first always having a passion for obstetrics and women's health.  Growing up on the reservation, she has witnessed how important women are to her community.  She has encountered many single mothers who would go to the clinic for care and only be judged for the life style they lead, rather then be encouraged to be caretakers of their own health.  Nichele was just recently accepted in the Nurse Midwifery Program at UNM and will be starting her journey in May.  She is a mother, wife, and works as a nurse at Lovelace hospital.  She received her Bachelors of Nursing from Georgetown University in Washington D.C. 

             

              Both of these women are an example of what I talk about in my blogs.  Despite their struggles they have managed to rise above it and strive to make an impact on there communities.  I hope they will also inspire other Native American women to become midwives and take the knowledge they learn back to their communities.  This is why midwifery needs more women from culturally diverse backgrounds, they have very strong desires to not just stay in the cities to work, but to bring it back to their rural communities.  They offer a perspective in Native American women's health care that is lacking now.  They understand first hand what the women on the reservations are dealing with on a daily bases and may have experienced a lifestyle that few have experienced in our profession. Most importantly, they bring hope to a community of women in their Native communities that, despite their struggles, you can still rise above it and give back.  Your life is what you make it and defeat is only when you stop striving towards something better.  

               So you see, my dream may be big and a long journey, but I'm in good company.  Once NM had only 2 Navajo midwives, now will have 4 Native American midwives.  Seeing these two women and what some may call mentoring, but I call friendship, has also given me even more hope.  And incase your wondering about my other duties...yes..being a mother, wife, and midwife commuting to Albuquerque for work several times a week does comprise much of my time.  However, participating in these other activities feeds my spirit and remind me every day that I have the greatest job in the world and I'm always in good company.  Yes..I sleep like the dead when I can, but often sleep is a necessity for my creativity.  At which with my work schedule lately, I've been lacking.  Which is why my blog has been somewhat neglected lately.  

       

                                           "Every Day is a Good Day"

 options in NM: addressing health disparities through innovative models of midwifery carew 

 Public Health Association and University of New Mexico National Health Disparities

2012 Joint Conference               

Rape in Indian Country

Rape in Indian Country     

            “More than 1 in 3 of American Indian/Alaska Native American (34.1%) will be raped sometime during their life (CDC & DOJ, NVWS 2000)”

         

            I recently attended a community presentation on Sexual Assault in Indian country at Nambe Pueblo, NM.  I wasn’t surprised by the statistics, which in itself is appalling, because it means that sexual assault has become such a common practice that I, a Native woman is not surprised by the high numbers of Sexual Assault that occurs on our reservations.   What was surprising to me was the lack of community representation at this presentation.  Which made me wonder…..What is it going to take for a community to react to a horrible act of violence.  How important are our daughters, aunts, grandmothers….. or just women in general?  Have we as Native people become so used to facing heartache daily that we expect and accept it, rather then rally to find ways to fix it? 

                These questions often cross my mind when I attend a community function like this one and out of a large pueblo population, maybe 5 to 7 people show up.  It’s part of why I attend these presentations, someone has to spread the word and share this information, I can’t just lye down and be raped again (figuratively speaking). However, that is how I see it.  I’d rather fight to the end, then give up and lye down, because then I would have allowed my spirit to be broken.  That is not what my ancestors would have done. 

            What I did learn and was new information to me was that Native American women are more likely to have experienced multiple victimizations through out their life span.  So where and how does the healing begin?  For those of us in the healthcare system, victims of rape are primarily seen in the ER.  However, these victims are usually physically and brutally in need of medical attention, sometimes requiring surgical intervention.  As this was the case when I was completing my training in Chinle, AZ.  For those who may not have needed immediate medical attention, they may report it at a well woman visit or even at their first prenatal visit.  Pregnancy as a result of a rape is also what I’ve encountered when I’ve worked with women in the clinical setting.  If they are lucky, they have family support and have made the decision to carry their babies to term and raise them, however this can also be fraught with psychological trauma for a woman.  Victims of rape also first report it through child protective services and alcohol treatment centers.  However, the reporting is delayed.

               There are many reasons why reporting rape is an issue.  From the stories I heard during our discussion of why this occurs, it seems that shame is a big reason. Women/girls are not encouraged to report it.  Most families want to sweep it under the rug, because 1) Indian country is small, everyone knows everyone; 2) the perpetrator can be someone of respectful importance ie..medicine man; 3) family member; 4) it will look badly on the family; 5) denial, this happens to everyone, don’t make it a big issue; 6) Aside from reporting it, tribes don’t have a good legal way of handling these situations.  So why report it…nothing will come of it, other then making your family and self look bad. 

             “ Less then ½ of all sexual assaults are reported by American Indian/ Alaska Native women”

            The legal ramifications for victims of rape in Indian country are just as complex.  Hallie White, an attorney who works with the Southwest Center for Law and Policy was able to explain the legal process after a report of rape has been made on the reservation.  Three legal entities have the ability to prosecute on the reservation.  The Pueblo it’s self, the Feds, and the state.  It also depends on the whether the perpetrator or victim where both from the reservation or one was of a different race, and where it occurred…ie On the tribal land or off it.   For example: 

       Perpetrator (native), Victim (native)  ON tribal Land = Tribe can prosecute or Feds can prosecute.

       Perpetrator (non-native), Victim (native) On tribal land = tribe has no jurisdiction to prosecute the non-native, so the Fed’s can or the State an

        Perpetrator (non-native), Victim (non-native) On tribal land = Only state has jurisdiction to prosecute.

              This is where it becomes complex, even though the tribe may have the jurisdiction to prosecute, they don’t always have the funds to do so.  It is the tribe’s responsibility to pay for the court hearing and for all those involved, if the perpetrator is in fact charged with rape, the tribe has to pay for them to be incarcerated. Tribes don’t always have the financial pockets to pay for this process.  In which case, it is why most rape cases get sent to the Feds, who do have the financial pockets to handle these cases.  However, they have a long-standing record of not following up on reports.  Many get left in limbo. 

             It is this very reason that a recent law called the “Tribal Law and Order Act.”   Every 3 years there is a congressional hearing where all the cases that are being investigated are discussed and the Feds have to show written documentation as to why a reported rape case was either follow-up on or why it was not.  This was done in an effort to hold the Feds accountable for their lack of follow through. Another issue with the Fed’s handling rape cases on the reservation is that the U.S. Supreme court will only take 70 cases a year, which means even if they do follow-up on the rape case, it may never get heard in court.

    

            It is for these very reasons that some Native American women are trying find ways to provide cultural support to victims of rape in their community. SAFE STAR is an organization that trains lay people to collect evidence and provide first responder care.  They also train tribal prosecutors to litigate sexual assault in tribal court. 

            For me, this informational session was very helpful, but I still wonder how are we going to get women to first report this act of violence and second how do we as a Native people support those who have had to endure this trauma.  Awareness is not enough.  Ending a cycle of violence over the many life spans of our ancestors is not going to happen over night, but silence is not the answer. 

“Native Women who are victims of sexual assault are more likely:

            to be sexually assaulted by a man of another race

            to be sexually assaulted by multiple perpetrators

            to be sexually assaulted in public

            to be sexually assaulted with a weapon used in the commission of the crime (38% with a weapon)

            to suffer injuries as a result of the sexual assault..i.e. 50% of all victims =44% resulted in medical care…”

San Ildefonso Women Elected to Council

             This is my home...or at least a view from my window.  San Ildefonso Pueblo is one of the eight northern pueblos, located in Northern New Mexico.  It has 800 registered members who call it home, as well.  We moved here from Albuquerque almost 6 years ago.  Our reasons for living here, where to bring up our children in a traditional way and to have a life rich in culture.  However, to our dismay, it didn't go quite like that.  However, despite our struggles and disappointments, this day has come, and surprisingly change has brought fourth the voice of women. Granted, they have always been there, but now they count.
              As a Navajo woman who has enjoyed all the benefits of growing up on a matriarchal society, pueblo life is and has been quite different.  The reality of being Navajo (with CIB 100% stamped on it) and living in Pueblo territory (reservation). What kind of rights do I have?  I can't own land, I can't vote, I can't own my house...What are my rights?..This is my reality and I'm okay with it right now.  However, for the women who grew up on this pueblo and have danced Corn Dance every August in the plaza, the right to vote or hold office has never been theirs.  However, this reality has changed for them.

             Many...and if not all tribes are now facing change in how their governments are being run.  Tradition is being challenged on many levels.  Pueblos are being divided and families are being divided by the very act of challenging tradition.  Correct me if I'm wrong here, but culturally Native American tribes are revered for adapting to new living conditions.  This was one of them.  Family structures have changed, there are now more single parent households on the reservations.  Most of these families are made up of only women.  So how are their issues going to be heard or even understood if they don't have a man to represent them on the council?  I'm not implying that these women here are meek, rather most of them are bold and perfectly capable of caring for their families, without the help of men.  Many of them have been doing it for generations.  However, that to it's effect is not the root of traditional life.  The men and women here work together for the health and wellbeing of the community.  In celebration, in death, in ceremony...I have seen the men and women here work together in a way that few communities come together today.  When I go visit my Navajo family, they always ask me..did you learn how to make that oven bread yet?  In all honesty, the famous pueblo oven bread is not a product of one person.  Rather it is the work of "several women." My point is, all this political unrest..which has lead up to this very life changing event for this community, has been the dividing this community for years...and long before we ever moved back.

              This is only the beginning.  Out of the 800 tribal members, only 200-ish voted. Which means, not everyone is on board with this new era of thinking and decision making.  These 3 women may find themselves in challenging positions, not only because they are serving on the council, but their presence is also challenging cultural and traditional roles that have been set in place for thousands of years.  I commend all of them for taking on the responsibility of their families and their community on themselves.  It is nice to here our men say... you are welcome to speak at the family meeting..we want to here what the women have to say.
             Integrity, honesty, love for community are not only female qualities, but rather qualities our grandmothers and elders have been trying to teach us all along.  We may have strayed from that, but hopefully this change will be for the better.  We will just have to wait and see.

My husband tells me...especially when I'm having difficulty being strong and I'm faced with adversity.


"Be strong like a woman...Be strong like a man.."

Link to News on this:
San Ildefonso Women Elected to Counsel

My Prayer At Work

            It is always a joy to walk into the hospital and see a Navajo grandmother waiting in the hallway for her family member to deliver a baby.  We both give each other a knowing node...I wave and say Ya'ah'teeh! Her face lights up.  Inside I am smiling, because yes..there is a bit of home standing in the hallway and I don't feel so out of place...Imagine that...
            You've read of my journey through school and all the many experiences I've had since starting as a new graduate midwife, and yes there is always more to learn.  However, I feel at times that I'm not well understood.  Not sure if that is a cultural thing or a new grad thing.  My lack of insecurity may come off as overly secure in my skills, but honestly and seriously I feel that in our Navajo culture we are taught to handle stressful situations through prayer and to maintain a positive attitude.  I actually pray every day to maintain a level of strength, clarity, and calmness in my decisions as a new midwife.  So what may seem like an overly secure midwife, rather then an insecure one, is really my prayer at work.  I've worked with stressful and nervous providers and that does not make everyone feel confident in their skills, rather it creates stress and nervousness in each decision.
              On another note, the Native families that I'm able to care for, man are they excited to see someone like them, taking care of their loved one.  I've heard comments like " I'm glad there is one of us in such a high position."  I don't necessarily view my position as high, however to them it might be.  This feeling of shared accomplishment, regardless of the fact that I may not be related them, they feel a sense of pride in me, as I feel a sense of pride to care for them.  This connection is powerful and worth whatever culture differences I've experienced up to this point.  These families are special gifts every time and I always look forward to working with them.  After meeting a native family, they usually ask if I'm Navajo and then they are able to place me.  If it's a Navajo family I'm caring for, I will introduce myself and my clan so they can place me.  I acknowledge not only the expecting couple, but I pay special attention to any elders in the room.
                Each couple I've encountered, Native American or not, they do seem to notice my calm nature and have commented on how it was my calm strength that seemed to help them in the throws of labor.  In the end, that is what I aim for.  Each experience shapes me as a midwife.... just as much as their experiences with me as their midwife shapes them.  For me, birth is not just a medical intervention waiting to happen, it's a spiritual experience and an opportunity for cultural renewal and a chance to connect with something bigger then ourselves.  This can not be taught.
         

Culture in a Time of iPhones

           Now that I've had the pleasure of caring for several Native American mom's, this question continues to pop up.  How do I maintain my cultural-ness surrounding pregnancy and birth, while living in a modern world?  I'm actually going to throw this question out to you.  Generally, I can counsel them on the Navajo Do's and Don'ts during pregnancy, but really and honestly..and seriously, I advise them to go talk to their mothers and grandmothers. Traditional knowledge surrounding birth should be passed down from the female patriachs in your family.  Unfortunatly, for some, even this knowledge is not accessable, as that much of our traditional birth knowledge has been lost in translation..(seriously it has). 
             Some women don't understand the importance of culture and what role it plays...well until they have children.  Then suddenly they want to know...Which is really great, because it is never to late to learn your roots and take pride in learning that knowledge for yourself.  Man, if I my Shah-mah' tsah'nih (grandmother), was still around, I would be drinking some of her coffee (the best by the way) and asking her as many questions as I could think of..... From the story of Changing Woman to asking her to show me how to weave.  These maternal feelings of wanting to learn my roots didn't sprout at birth, because like most Natives, while growing up I wanted to wear Guess Jeans and fit in like everyone else.  It wasn't until I had children that the idea of what kind of parent I wanted to be or what kind of knowledge I wanted to pass on to my children, did I think about what I didn't know and what I wanted to know.
              I imagine one day my grandchildren will be coming to me to ask about "the days back when." I imagine I will smell like bengay, be wearing my traditional squash blossom around my neck, and perhaps living in a modern day hogan.  I don't know..but really, seriously...I say my dawn prayers daily, my medicine bag is in my pocket when I go to catch babies, and my phone is on vibrate to notify me of Facebook updates.  Live the best way you can..traditional, non-traditional, both....happy.