Transforming Our Communities Through Women's Medicine

                  I continue to have an ongoing dialogue about the importance and significants of increasing the number of Native American midwives to serve as innovators and ambassadors for their tribes.  This process of reviving indigenous knowledge through midwifery, I feel, is vital to the growth and the vitality of our tribes.  Unfortunately, this perspective of providing culturally appropriate care from an indigenous perspective is still poorly understood or respected from the medical community and yes..non-native individuals.  When I discuss our health statistics and our struggles as indigenous peoples to non-natives, I am generally met with empathy, but rather our way of life and healing practices are not viewed as primary ways of healing, but are thought to be our "religion."  When I try to explain further the importance of our culture and how it plays an important role in our livelihood, and more importantly that it is not a "religion," this to is still met with confusion.  I further begin to explain the racial exploits of our history and how this has shaped how we view the medical community, the existence of hospitals, and our relationships with the modern world, suddenly they get offended.  I don't view myself as a "racial" person, but rather I have a deep understanding of how historical trauma has played a role in my indigenous identity.  I feel like these conversations are important to bridge the misunderstandings of our past and pave a healing path to our future, especially since the majority of Native American women continue to access healthcare delivery systems that do not reflect an indigenous perspective, but rather a liner hierarchy, with much importance placed on evidence based research and "proven" ways of healing.  

                  Obviously, I am an educated woman and I understand the significants and importance for evidence based research, however I don't use it as a way to elevate my status in my community, more or less it's having this knowledge and being able to effectively communicate with the "other world" is where I see its significants.  The interesting thing is, my status in my community is based on how often I participate in traditional ceremonies and my level of traditional knowledge and traditional meal preparation,  not how many degrees I hold.  This in itself is not well understood in the non-native community, because in this "other world" much importance is placed on ones economic status and ability to effectively support your views based on valid sources of "evidence." 

                   In light of these misunderstandings and by continuing to work in what it feels like two very different realms, I see the importance of Women's Medicine.  I would describe Women's Medicine by this; having a sense of community, understanding and respecting the balance between people and nature, being of good mind, seeing equal value in different tasks and ways of thinking, and understanding the mystery of life, spirituality, and our origins of life.  Naturally, this philosophy of "being" is reflected in much of our spiritual and cultural practices, at which it is why I see it to be of much importance.  Unfortunately, in relationship to our historical trauma, it seems our understanding and respect for Women's Medicine has been misplaced.  According to the CDC the five leading causes of death in Native American women are heart disease, cancer, unintentional injuries, diabetes, and stroke.  Additionally, Native American women are twice as likely to experience violent victimization by means of rape, sexual assault and physical abuse.  

                     In reference to childbearing practices, Native American women are not accessing prenatal care in the first trimester, have high rates of smoking, and are more likely to develop diabetes during pregnancy as compared to the black and white ethnic groups.  These childbearing health disparities between Native and White infants are related to higher rates of poverty, lower levels of maternal education, and limited use of prenatal care (Grossman, 2002).  At which Native American women are at risk for poor childbearing outcomes like gestational diabetes, fetal alcohol syndrome, pregnancy induced hypertension, and large infants (macrosomic). Macrosomia, or babies born weighing more the 4,000 grams or 8 lbs 13 oz, are associated with excessive maternal weight gain and diabetes related to maternal obesity.  These factors contribute to neonatal morbidity and injury like shoulder dystocia, cesarean deliveries, and maternal injuries.

                       Now that I've painted a picture for you, how do we begin to address these issues in our Native communities?  Perseverance, innovation, and understanding our history as indigenous peoples comes to mind.  Basically having an understanding that stress from social differences can have health impacts.  These internal and external stresses accelerate the pressure to adopt unhealthy behaviors and further add in the deterioration of health in Native American women.  Thankfully, the impact of historical trauma is well documented, but identifying contributing factors is only the first step of healing generations of trauma.  By developing culturally based wellness and healing models to help women identify and in corporate positive coping practices, will we be able to start to make positive changes for the future.  By encouraging Native American women to remember their healing medicine as a vital piece to healing their ancestoral trauma, will we be able to stop the cyclical transmission of intergenerational trauma.  It is here that our work as midwives we can begin to make an impact to transform our communities. 

Weaving New Threads

            Well it’s been about two months since I’ve last posted anything.  I don’t know about you, but there has been a lot going on.  In my personal life and in my professional one.  However, the point of this post is not to discuss either in to much detail rather to shed some light on a few current issues.  Much to my dismay, I’m still commuting to Albuquerque weekly and sometimes more, for work.  For those of you reading this blog who are not familiar with New Mexico, it is generally a very rural state.  Most of the employment opportunities for certified Nurse Midwives is in Albuquerque, the opportunity for us to branch out to work in the rural parts of the state are limited. As it stands, Los Alamos does not have a Nurse Midwife at its hospital, Espanola Presbyterian hospital does not have a Nurse Midwife at its hospital.  Santa Fe does have 3 three nurse midwives working with two practices to provide full-scope midwifery care to the community, however this relationship is still at the beginning stages and currently they are not at a place to where they can expand their nurse midwifery care services.  The Santa Fe Indian hospital does not offer Nurse-Midwifery care and the women who receive care at this setting will have to transfer their care to a surrounding practice at 30wks. 

            To further compound this issue, when the possibility to work as a full-scope nurse midwife close to home did present it’s self to me, the details of a work agreement is what had me saying “no.”  My question to you is, how many nurse midwives sign contracts that have non-compete clauses and line items stating that if they left the practice they could not work within a certain millage of the practice for a number of months, after leaving.  To me, this is what limits providers from opening practices and setting up healthcare delivery clinics in rural settings. 

            From the business end, I am told that the clinics are protecting their investment and on the side of providing care to women in rural NM; they are actually monopolizing the care of women.  Ok, now I’m going to give you my Native perspective on this way of thinking and doing things.  As a Native American, the thought of signing my rights away from working in an area that has historically been our stomping grounds is offensive.  By monopolizing who can care for women in rural settings by requiring providers to sign these contract agreements, is only compounding the issue of access to care rather then addressing it.  This western way of thinking that business is business is what got us into this mess to begin with.

            You can imagine that the homebirth midwifery community is booming in this area, because there are not enough OB’s or Nurse Midwives to care for this community of women in hospital settings.  I don’t think that the shift from hospital to home birth is a bad thing, but rather another option presenting itself.  However, my point is, women have to have access to birth services and right now that is a major issue. Based on the 2010 census for Rio Arriba County, the approximate population is 44,000, 31% of that population is younger then 19.  16% identified themselves as being Native American, 71.3% Hispanic, and 12.8% white non-Hispanic.  19.7% of the 44,000 are living below the poverty level. 

            According to the 2009 PRAMS report, NM ranks last in the country for recommended levels of prenatal care, which means women are not accessing prenatal care early enough and are receiving less then 5 prenatal visits during their pregnancy.  Why does this matter? This contributes to low birth weight and preterm birth weight babies being born in New Mexico.  So what were the identified barriers to prenatal care, 1) Could not get an appointment; 2) Did not have enough money or insurance; 3) Did not have a Medicaid card.

            Obviously, there is need here for birth services and women’s health.  However, what I’m finding is that there are many barriers for midwives who are interested and invested in setting up alternative healthcare delivery system.  For one even though the concept of birth centers is not new, how and who regulates them is.  As it stands the current birth centers here in NM are running into problems with insurance reimbursement.  Insurance companies reimburse hospitals and practices for the provider who provided the birth serves and they also get reimbursed for the facility that these birth services take place.   Some insurance companies are not reimbursing the birth centers for the facility that they are providing birth services in.  This lack of reimbursement from insurance companies actually makes it harder for birth centers to provide services. 

            So what is a rural midwife like myself to do?  Developing a new way to care for women in my rural setting takes time and defiantly sacrifice.  I’m feel blessed to be working with a team of motivated women who all see the writing on the wall and continue to hack away at the cement wall that years of bureaucracy, business deals, and policy have built to keep innovative thinkers from thinking outside the box.  All I can do is say my morning prayers, stay the course, and make sure my morals remain true to the beautiful birth center that is growing into a reality…Blessings.

Cultural Context of Woman

      There are special times in each woman's life when she no longer is the girl, but is asked to step up and be a woman.  I am thankful that in the cultural context of girls becoming women, we have our ceremonies to help us be molded in the image of changing woman.  Our responsibilities as care takers of our families are laid out for us in song, in prayer, with chanting, with women singing together in praise of the path we will soon have to walk.  I want to share a moment with you that I had a couple of weeks ago.  I think it is a great representation of the transference of knowledge and responsibility.

      "As I stood facing the East watching the bright orange light come over the horizon, I was thinking to myself, wow what a beautiful sunrise, I can see why the early morning is a woman's time to pray for blessings and to pray over the water.  In our teachings, life begins in the east, woman are a representation of life, and it is our blessings that bring hope, love, charity, and happiness to our families.  I stood there holding my prayer feathers on my right hand and my shawl hanging over my left shoulder.  I raised my prayer feathers four times to the East to bring blessings to the water that would soon be shared by all in that prayer meeting...."

       My mom usually brings in water for our family peyote meetings, but for this one special occasion she had asked me to bring these wonderful blessings to our family.  As a daughter and mother, I felt a great sense of knowledge and responsibility being passed to me by my mother.  I have actually had the pleasure of bringing in water for our family meeting once before, but I don't remember it quite like this. After giving blessings to the water, I then bring it into the meeting and ask for blessings from the fire place.  When my mom used to bring in water, she would sit there looking beautiful in front of the fireplace and praying...and praying.  My brothers and sisters used to joke about how long our mothers prayer was, but now that I was sitting there in front of that fire place, the responsibility was placed on me to pray for  my whole family.  It was only then that I understood why her prayers were so long, because a mothers prayer is long and said with tears.

        I keep these moments close to my heart, because I feel like our true selves come out in certain circumstances and it seems like only in these moments do we get a glimpse of what we are here to do.  As a new and young mother I remember struggling with the new role I found myself in.  I think many women whether or not they are intentional in their efforts to become mothers, struggle with their own identities.  I am a woman before I am a mother or am I a mother before I am a woman?  I don't find these roles or identities mutually exclusive, rather they are a balance of individuality that is necessary for harmony.  In Navajo philosophy, the male and female aspects of our selves are necessary for harmony which allows for health, wellness, and balance.  It is when these elements are not balanced that we experience imbalance and become not well.  

        Going back to our cultural teachings surrounding roles, it is through our clan that the intimate relationship between mother and child is reinforced through the mothers clan.  It is through the blood flow of your grandmother and mother that allows you to know your mothers love.  And it is through her love that teaches you to love yourself.  We recognize that we have many mothers, like mother earth and water woman, it is understood they are all looking out for us, but it is also our responsibility to love and respect them.  You call them "Shimá" 

       As that it this the week to recognize the work that Midwives do, I thought it would be nice to talk a little bit about women and our roles as mothers and educators.  As midwives we too are mothers and educators and we have the pleasure of having a small piece in the very private exchange of a woman becoming a mother, a man becoming a father, and a families legacy expanding.  It really is a beautiful thing.

Blessings to You!

Reflections

              Perhaps because it is a cloudy and rainy day it is a good time for reflection.  It's been a busy summer with many projects pulling me in different directions.  I think its my restless nature that is a bit frustrated with the baby steps each of my projects are taking, but mostly likely that is the creator teaching me patience. We submitted a grant proposal to the National Geographic All Roads Seeds Grant, but have yet to hear anything about it.  The good news is that those who have not been selected for funding have already heard that they were not selected.  However, the deadline for the next round of grant proposals is nearing and I am left wondering whether we need to resubmit or not.  This film business is a whole new world for me, I recently attended a few film screenings during the Indian Market in Santa Fe, NM.  Boy, what a panorama of artistic talent!  I was happy and excited to meet the film makers, actors and producers of some of the films that were screened.  I also got to meet my producer Tracy Rector.   After many phone conversations, Facebook messages, and some computer face time, the world of computers left us and we got to meet face to face.  So glad we are both on board with this project.  She is just as excited about this as I am.
             As for the birth center, thanks to the dedicated women working on this project between meetings, things appear to be moving along nicely.  We have finally all agreed on a name.  The Breath of My Heart Birthing Place, in Tewa it is "Navi pin haa un muu " which means "you are the breath of my heart."  As that this will be a place where the baby takes it's first breath of life, I think the name is befitting!  We have also spent a lot of time on our mission and vision statement.  With many revisions and time, this is what we all finally agreed on.

Vision:  To attain greater community wellness through the growth and reclamation of birth traditions and practices in Northern New Mexico, by cultivating a nurturing an environment that welcomes all families’ cultural strengths, and Ways of Knowing.

Mission:  To bring to reality a sustainable birthing place that celebrates pregnancy and birth as a sacred rite of passage through midwifery care.  To raise awareness and promote wellness, growth, and healing in our multi-cultural communities by honoring woman as our first environment.

You can follow our progress at: http://www.bomhbirthplace.org/

             We are currently working on a logo and I am happy to say that I was selected as one of the board members.  We are in the process of adding additional board members and working on bylaws.  Basically the nuts and bolts of our birth center is being worked on right now.  I am also in the process of collected and learning about Pueblo traditional birth practices.  It will be an ongoing project for me and I hope to meet with each of the Northern and Southern Pueblos to talk about traditional birth practices.  This is a BIG task and an exciting one.  The first talking circle will be held in Tesuque Pueblo sometime this month.  I was blessed to have met with an amazing woman and elder who seems just as motivated as I am,  to see our traditional birth knowledge and language return to our communities.  I have to say, our last visit was very touching and encouraging.  After our visit I went home, burnt some cedar and prayed for more people like that to be placed in my path.
              She was a great reminder that our ancestors are always there and waiting to listen to our prayers and provide the healing knowledge to walk in a good way.  With my weekly and sometimes daily commuting to Albuquerque for work and other family matters; it is easy for it to weigh heavily on my spiritual needs and ability to connect with what is really important.  But it's people like her who help bring me back to center with what is really important. As that is what I am thankful for.
           My family and I recently participated in Corn Dance in our village and I definitely prayed for the strength, clarity and courage to move forward in a good way.  It is still a constant challenge to maintain a certain level of balance between work, family, and my spiritual needs as an individual.  As it is so easy to get caught up in the busy comings and goings of daily life.  So if anyone sees a young Native woman speeding down I-25 from Santa fe with my pow-wow music blasting in the early AM or very late PM..it could be me.  It seems lately the sunrise and the sunset have becoming my morning and evening blessings on my way to a busy life!..

My Midwife Advised....

               Have you ever worked in a fast food restaurant, high volume department store or hospital? More importantly have you ever worked at one of these establishments while pregnant?  I'll be honest and say that while pregnant with my last child I worked as a full-time labor and delivery nurse.  Fresh out of college and rearing to begin my career in nursing, it was during this time that I was quite surprised to find that I was pregnant with my third child.  Having experienced three miscarriages prior to this pregnancy I didn't hold out hope that this one would carry to term.  But low and behold, my son was a fighter from the start.  It was during this time that I was applying for labor and delivery positions near my home and I count my blessings that a small hospital near by took me under their wings, 6 months pregnant and all.  I had initially applied at another hospital close by, but I didn't get the job. However,  I did have the sinking feeling that my pregnancy had something to do with it. But this can never be proven, because discrimination is against the law....right?
               After starting my job, I didn't want to tell my co-workers that I was pregnant, for one I felt like it would be held against me.  Like I would be considered weak for acting tired and not working as hard as everyone else.  As I got to know everyone a little better, I revealed my little secrete.  All though I don't know who I was fooling, kinda hard to hide a 6 month old belly. What I remember of those first few months of working was that I was extremely tired after being on my feet for 12 hrs, sometimes I was to busy to take a break to eat a meal, and as soon as I came home I would lay on the couch with my feet up.  My back hurt and it usually took me a couple of days to feel rested again.  The demands of working as a nurse were sometimes out of my control.  I don't think anyone expected me to go all day without eating, that was up to me.  However, being short staffed and handling multiple tasks were not under my control. So I did what most women in my situation,  I pulled up my big girl panties and went to work.  To this day, my co-workers remember how hard I worked when I was pregnant, they say "you never complained at how tired you were, you just went all day like the rest of us."  I have to say, the woman in me was proud that I was able to work just as hard as everyone else, but I now look back and wonder why I risked the health of my baby to work so hard.
             I am sharing this story because I feel a bond with women who are pregnant and are working at fast food restaurants, high volume department stores and hospitals.  It breaks my heart every time I have to write a note to their employer asking for more frequent rest breaks, even most recently hearing that a friend of mine was not able to bring her own healthy meals to work because they were only allowed to eat food from the fast food restaurant they worked at.  I find that these places tend to be Walmart, Sonics, McDonalds, and even varies hospitals.  Some of these women are anemic because they are not getting the proper nutrients in their diet and some are underweight because they are working so hard.   Even after having their babies and now faced with returning to work breastfeeding will stop, because they don't have time to pump at work, they can't take the time to eat appropriately at work, or there is just no place to pump.
              Each of these encounters have me taking a closer look at NM labor laws and scrutinize what is in place. Furthermore,  knowing that what is in place is not good enough for pregnant women.  The midwife in me says "pregnancy is not a medical condition" but if you are pregnant and are working at a place where your pregnancy has to be treated like a medical condition to be treated humanly, perhaps something is wrong with where you are working.  Unfortunately, with jobs being scarce and businesses looking to get more bang for their buck, it feels humanity has gone out the window.  I am not sure what the answer is to this problem, I just know I am in a place to advocate for the women in my care.  I am also learning which establishments treat their pregnant workers well and which ones show no mercy.  These places need to be held accountable for the humane treatment of all their employees.

             

Where are all the Native Midwives?

        Zia Pueblo Traditional Midwife

As more individuals become aware of Native American health issues, they somehow end up exploring our  indigenous roots.  At which point they will find little historical evidence as to our pre-colonal existence.    At least in the scholarly literature sense.  I think this is a good question to ask, because it is one that I wonder about as well. Yes, our ancestors did roam the earth before columbus "discovered" the new world.  I have to laugh a little at the word "discovered" because unfortunately, this time marks the beginning of our end.  This historical event is actually not just a whisper of talk, there is empirical evidence that after the "new world" was discovered, our numbers as indigenous peoples of the Americas took a very steep downward spiral.  The cause of this event can be blamed on disease.  New visitors, brought new disease's.  I think the interesting piece in this is that before "contact" as we like to call it, indigenous peoples did in fact have our own healers.  Unfortunately, since colonial domination our healers have gone away.  Well, not entirely....our indigenous practices within the realm of healing has just gone underground.  The reason for this is "religion."  Not only did columbus bring foreign diseases, they brought their faith.  At which in their eyes I'm sure they felt that the hand of God needed to be extended into our villages so that we could be converted to their faith, however this very act is what also contributed to our demise.
          Fast forwarding to today, I had an interesting conversation with my father-in-law.  We were celebrating "All Souls Day"..which as a Navajo, this is a conflict of interest for me, but as that I live in Pueblo territory, I've had to adapt to a different set of traditional models of living.  For those of you who  have never set foot on Pueblo reservations, there is a Catholic church and a very strong inter-twinning of catholic faith and tradition in every Pueblo.  As to why these steeples of faith are even standing in  the pueblo is a whole other topic, and I will have to save that for another blog.  However, we got to talking, All souls day is a catholic event, usually the day after Oct 1.  It is also celebrated in a traditional way.  It may have been a catholic event, but the indigenous communities here were able to somehow use it as an umbrella to celebrate it in their own way.  I think this is a good example of how some indigenous communities have adapted to this new form of faith and belief.  It is also how some tribes have been able to survive.  Adapt and move forward right...

            Getting back to traditional healers, midwives included.  I mentioned earlier that they didn't necessarily all die out, but rather went underground.  Each community generally had a person who came from a long line of healers who knew which herbs to use to heal someone, but also sometimes were the very same person who helped with birth.  From what I've read from several different sources,  as our world has transitioned to newer better ways of healing (chuckle), the simple event of a hospital being resurrected on or near indigenous communities has changed our way of healing and also who we go to for healing.  I know on the Navajo reservation there was a very large campaign strongly encouraging them to go to the hospital for all their care.  This was done in light of the wave of tuberculoses and small pox that was killing everyone.  It is the same situation when it comes to birth, women were strongly encouraged to go to the hospital for prenatal care and to have their babies, rather then be attended by a traditional midwife....and deliver at home.  This was also do to the very high numbers of neonatal death and maternal death in childbirth.  However, to us..the Navajo, going to the hospital was like going to your grave.  People went there to die, why would I want to go there to be healed, when everyone just dies there.  You can see why this was a hard transition.  Also, for Navajo women, pregnancy and birth is a time of life, we are not suppose to be around anything that is to do with death.  Basically these people were telling them to go to a haunted house full of death to have there babies....ah..I don't know about you, but that makes sense!  So for many, we have Blessing Way ceremonies before going to the hospital to have our babies.  Basically to ensure a safe delivery.  No this is not what many women today would think of as a Blessing way baby shower that seems to go on these days.  No string to be tied around your wrist or ankle..no made up chanting.  A real medicine man  in a hogan, cedar, prayer..the real deal...Again adapt and move forward.
                Unfortunately with all this adapting and moving forward, we are also at a point where this traditional knowledge is being lost, basically our ability to heal ourselves is being lost.  This to me is scary.  This post colonel domination has really done a number on us. You see it in our health statistics "Health Disparities" is what the more scholarly articles like to call it.  We as indigenous people know what it is that is killing us and it is not just one thing. It is many centuries of being forced to adapt to a different way of life.
                When I talk with people and they find out that there are only 10 Native American Nurse Midwives in the United States, they are shocked. And because there are so few of us.....we don't know each other personally, we know "of" each other.  Which I think is sad too.  Well, I've been lucky enough to have met 2 other Navajo Certified Nurse Midwives here in NM.  I'm pointing this out because, traditional mainstream education for Native American's is not easy to attain.  Most Native American or indigenous women have chosen direct entry midwifery or Certified Practicing Midwifery as a means of attending births in their communities.  I'm sure this choice is based on the negative relationship Native's have with education and the extreme value "professionals" place on what is considered qualified and not qualified.  However, I would guess there are more CPM's of indigenous background for this reason.  Not that mainstream education is hard to attain, but rather they refuse to bow down to the idea that what their ancestors have done for centuries has to now be stamped qualified by "qualified professionals"..this is a crazy idea!

                 So where are they?  These Native, Indigenous, Aboriginal women who attend birth, that history has done a poor job of explaining there existence and practice. They are like a myth..I've heard of them, I've seen one.  Well, I am one!  There are 2 I've met in NM.  After talking with a wonderful couple from Santa Domingo Pueblo, they said they have 3 traditional midwives still in their community.  They are not all gone.  But, like I said they have gone underground.  Not because they will be prosecuted for the work they do, but rather more Native American women are going to the hospital to have their babies and the basic understanding and importance of tradition has gone out the window.  There is also a new trend where non-native individuals are calling themselves "healers" and trying to steal our knowledge to sell for there own.  This is why we are so secretive when it comes to sharing information.
                 As an effort to meet more Native American midwives, please leave a comment, I no longer want there to be a gap in our historical place in midwifery, it is time we begin to write our own history.
           

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!