Farewell

This will be the final post for the LaborPayne Epistles.  Please follow me to my new blog, "Urban Village Midwife (urbanvillagemidwife.blogspot.com)" where I will be writing about my adventures over the next year as I complete midwifery school and start a clinic and birth center.  http://urbanvillagemidwife.blogspot.com/

Winter Update

Well, its been three weeks since the 'pilgrimage' and readers should have an update as to what has taken place.  I did go to Mexico, but I did not participate in the walk with my friends.  Instead I spent an entire week writing a grant.  I finished writing it, but I did not submit it.  I plan to submit it in a second round in August.  It has been a very strange odyssey.  I returned home to hacked email and stolen luggage (all of it!).

However in the weeks I have been home, I have started to lay the groundwork for Uzazi Village, made partnerships in the community to support the grant, and assembled a board for the new nonprofit.  I have started a new teaching job (going very well), started the midwife program at KU (loving it!) and applied for a position on a gubernatorial board, and a position as a state-wide breastfeeding promotion coordinator.  I also have a book and article deadlines looming.   I have also identified several other smaller local grants to apply for and continue to work on the national conference slated for my city next year.  I sit for the lactation consultant exam in July, and the certified nursing educator credential in April.  Whew.

I have also never been more satisfied with the direction my life is going.  Folks are appearing out of the woodwork seemingly to help with the work.  I feel a deep sense of peace and commitment to the work I am doing.  All the pieces seem to be coming together. Your continued well wishes and offers of assistance continue to be welcome.

Leonora of the Desert

     This trip has not been at all what I thought it would be.  I have not participated in the pilgrimage at all, but made the somewhat difficult decision to stay back at my friend's home and complete the grant writing I started.  It has been an eventful few days.  On the morning I arrived in San Miguel I knew that Michele, my hostess would be waiting for me.  Despite the fact that my bus was an hour and a half late and that I was the only passenger left on it- I knew she would be there, waiting for me.  I was so glad to be on that bus to greet her.  At each stop, I wondered would I get my connecting bus?  Would I be stopped at the border?  Would I be able to ask for information if I needed it?  Would I get the help I might need. I learned later that my friends had  forced to pay bribes at the border to get their visas.  I need not have worried.  The Mexican people have been very gracious with my limited Spanish (which I have been forced to use).  As the bus pulled into the station at San Miguel, the first thing I spotted was my friends head.  She is about six feet tall and towers head and shoulders above the Mexicans (so do I, and I'm only 5'7").  Peace flooded my soul.  I had come to the end of my long journey.  I was dropped off at the home of a generous sponsor who allowed me the use of one of the bedrooms in her villa in town.  She was out of town, but gracious to offer her home to American pilgrims.  San Miguel is full of American and other International expatriots who settle in cozy townships like San Miguel to live out their retired lives.  It is not unusual at all to see tall white-haired Americans journeying to and fro on the narrow cobblestone pavements.

        Once I settled into my spacious quarters, I took a long overdue shower, changed clothes, and settled down to attend a lecture via the internet.  Once that was done, it was time for breakfast.  Fortunately for me, here in Mexico, 12:00 is still considered breakfast time.  I walked a few short blocks to the town square and found my favorite restaurant, El Correo.  I settled in and in my broken Spanish ordered my favorite dish, Migas, Mexicana.  That is, scrambled eggs prepared Mexican style with tomatoes, onions, and chilis, with fried tortilla strips cooked into them, served alongside a side of refried beans.  This really is my favorite Mexican breakfast.  I thought I might get tortillas on the side, but instead was served a large crusty roll with butter and pineapple jam. I washed the entire thing down with agua de mineral con limon.  I felt incredibly spoiled. Next I roamed around the town square, half expecting to find my companions who had all arrived several days before me and were staying in different homes.  Not seeing any familiar faces, I did my souvenir shopping and visited an internet cafe to check email.  Afterwards, I returned to the villa where I was staying and found it overrun with people setting up for a luncheon.  It appeared that even in her absence, my hostess had arranged for a fundraising luncheon to raise money for a local cause.  I thought it funny that her house would be full of strangers and visitors, her household running as if she was there to run it.  About fifty people were expected so there were folks everywhere cooking food and setting up tables.  I dodged the traffic and the animals (so many animals!) and sequestered myself in my room.  The hostess has a small menagerie of exotic birds, cats, dogs, and two marmosets (monkeys) that chit chatted at me when I accidentally came upon them grooming one another on top of a bookshelf.  I missed the entire event-even though it took place in the courtyard right outside my patio door.  I closed my curtains and fell into a deep sleep, and when I woke up all the guests were gone, and all the same people were taking the tables down and cleaning the kitchen.  It was near time to meet up with my traveling companions, as we had a prescheduled meeting.

         I walked again to the town square, and immediately came upon them.  It was so good to see them here in San Miguel after so many months of planning and talking.  Michele joined us and took us to the home of her friend Carlos, born in Venuzuela,  but a true Internationalist.  He made us a lovely dinner of vergetarian paella (a Spanish dish of rice, vegetables, and usually seafood).  I am very shy around Internationalists, since my travel abroad has been so limited.  This may sound funny to some, who think I travel all the time, but I never traveled in childhood.  Michele and many of her San Miguel friends and many of the expatriots have grown up abroad, spent their childhoods in many exotic places, and speak multiple languages.  I feel quite provincial in their company.   Nonetheless, Carlos is a gentleman and engages us all in small talk while we feast on his lovely meal.  He doesn't dine with us, but in true Latin fashion, has a dinner appointment with friends after we leave! His dinner won't start until 9 or 10pm!  (This is why they still serve breakfast at noon around here.) His home is lovely and the walls are covered in original art and photographs.  I relaxed out on his patio with my friends and enjoyed the San Miguel sky bursting with stars

      After returning from dinner, a few of us, Morningstar included, pack our bags and leave the town to spend the night at Michele's home out in the country.  I have stayed here on a previous visit and I look forward to being there again.  I didn't know I would spend the bulk of the trip here.  But it is quiet and peaceful and the internet service has been excellent.  During the day the housekeeper and gardener are around, but at night I am all alone and have been able to get much work done.  I did come to San Miguel to walk, I and still hope that I might, but so far I have made the choice to forego the pilgrimage to complete the grant I'm working on.  Yesterday I was mildly distraught to say no to the pilgrimage but today I am ready to accept what is.  My dear friend Rebecca, helping me write the grant from 800 miles away wrote this:

I write all this to say maybe you would have been so distracted up here you would not have gotten your grant done. Maybe you just needed a quiet place to be for a few days with nothing to do except prepare for your miracle, your dream to come through. You are where you are supposed to be and doing what you are supposed to do. You will walk when you are done and that may be only a walk to get on the bus.

Embrace your time alone. It could replenish you to prepare for all that will fall upon you very soon.

I think this is true.  If some miracle should prevail, and this grant is funded, my entire life will shift.  Perhaps this was the miracle I came for and not the one I thought I was seeking at all...

Pilgrimage to Mexico

While I have participated in this pilgrimage, three times before, this will be my first time to take the bus to Mexico.  Two days on a bus is an adventure prior to the adventure.  My mind is consumed with two thoughts- completing the grant I'm writing for community peer educators and seeing my San Miguel 'home' again.  In Mexico, I am called by a different name.  I become Leonora (because there is no "SH" sound in the Mexican alphabet, the Mexicans have trouble with my name, so I simply changed it to my middle name).  I can hardly wait to join up with Morningstar and the other women of Morningstar Community to make this walk through the beautiful vast landscape of the Sierra Madres of Central Mexico.  I have been training for months, walking, running, and even achieved some small weight loss (though training in Kansas for a walk in the mountains is somewhat deficient).  Mostly for the pilgrimage, what is needed is endurance.  You simply keep walking until you think you cannot take one more step, and then you take another step.  Even in the company of 10,000 Mexicans the landscape is so vast, you can feel completely alone.  It is quite a journey.  At the end of it (for me 3 days, but for the others 9 days) we will visit the holy shrine at San Juan de los Lagos and present petitions for miracles to La Virgin.  My miracle request is well rehearsed: the grant, and then the clinic.  In that order.  It will take a miracle for either to happen.  For the grant I am asking the US Gov. for 3 million dollars to impact perinatal outcomes in the urban core.  This involves an intricate three year plan to engage community health workers, insurance companies, healthcare organizations, and governmental bureaucracy, along with community stakeholders.  This is a long shot at best.  I am untested and ignorant when it comes to mobilizing something like this.  Yet, it could change my community.  Follow that up with finishing CNM school (which I only started this week by the way) and opening a clinic in the urban core.  Again, I am in no way qualified to do these things- yet they are mine to do.  I could do with a miracle or two.  Even going to Mexico is a miracle of sorts (the miracle of credit!), seeing as I've been unemployed for three months now.  I am somewhat astounded by the lengths God will go to, to make something of my life.

Guest Post

I almost never do guest posts, but I found this essay  by another homebirth woman of color thought provoking. I've obtained the permission of the writer to re-post it here for your perusal.  Whenever you see Chicago just mentally insert Kansas City- you'll get the picture.

Occupy Childbirth: Will a single-payer system work for us?

December 21, 2011 //

6

On, Saturday, October 10^th (which happens to be International Human Rights Day), the Illinois Single Payer Coalition along with the IL Chapter of a Physicians for a National Health Program and the Chicago Single Payer Action Network, sponsored a Teach-in at Occupy Chicago. The teach-in not only focused on the overall heath disparities within Chicago, but more specifically on how a single-payer health care system will (or will not) address health disparities in Chicago and throughout the nation.
Community groups and organizers were solicited to join the discussion and were encouraged to provide action steps to move the movement of a national health program forward. I was excited to attend the event as I am familiar with single-payer health care program as a whole but never really sat down to think of specific concerns and or questions as to how this type of system will affect the maternal health & medical industrial complex.
The event began with a brief but truly thorough overview by Steve Whitman, PhD, Director of the Sinai Urban Health Institute, about the history of racial segregation and access in Chicago, health disparities amongst whites and blacks, and his research over the last 28 years. As highlighted in the event announcement on the Illinois Single Payer Coalition website:

Chicago is one of the most racially segregated cities in the country, with one of the worst records on health disparities by ethnicity and economic class. Responses by major public and private institutions have been ineffective at best, and at worst actively sacrifice public health to the interests of big corporations. Wall Street’s demand for ever higher profits for health insurance and pharmaceutical companies exacerbates disparities instead of addressing them.

Chicago has some of the worst health disparities in regards to maternal and child health. With the countless advances in medicine and improvements in technology, the medical industrial complex has continued to fall short in its ability to adequately provide evidence-based, scientifically proven care to lower income and racially oppressed people. According to the research Steve presented, in 1995 many of the 15 health outcomes his work focuses on were equal when comparing blacks and whites. 15 years later, in 2005 when they re-investigated the current data, 11 of these 15 measures were worst amongst Black people; including ones specific to maternal and child health.
Three of the 15 measures used in his research, Low birth weight, infant mortality, and no-prenatal care, were specific to maternal and child health. His research concluded that after the 15 year difference, Blacks ranked highest for all three measures. The most shocking and most well articulated realization that I have ever heard about the criminality of this segregation is, when you look at all of these measures and look at the “excess death” (meaning those preventable deaths due to lack of access) he says about 3200 Black people died 2005. These excess deaths are due to no other reason than racism. If you do the math, that’s about 9 folks a day. Breaking it down even more, 3 Black babies die each week due to this racism.
According to the 2005 publication of The Birth Outcomes and Infant Mortality in Chicago report compiled by the Chicago Department of Public Health Office of Epidemiology, the following data shows how desperate Chicago (and nationally) is for attention to these disparities in birth outcomes.

• Out the highest amounts of births in Chicago, Blacks rank #2 after Hispanics*
• % of births with no prenatal care; Blacks rank highest at 3.3%
• % of births that were premature; Blacks rank highest at 16.1%
• % of singleton babies born with low birth weight; Blacks rank highest at 13.2%
• % of infant mortality; Blacks rank highest at 14.7%
• % of neonatal mortality; Blacks rank highest at 9%
• Lastly, there were 4 maternal deaths in the year 2004 and all 4 were Black

Knowing this information and overstanding the need for immediate action to reverse 15 years (really more) of the harm imposed by the medical industrial complex, what is in store for us within a single payer health care system?
In thinking about access, race, and the current state of affairs for maternal and child health care (i.e. birth justice) I can’t help but have a few questions about how this system will support low income, mothers of color.
One of my greatest concerns about a single-payer health care system is how will this program increase mothers of color’s access to those “evidence-based” practices that I mentioned earlier?
How will this system make maternal and child health more accessible to our communities (i.e. low income, POC, limited-no access to services, birth workers, and/or midwives)?
How will it provide options to poor and marginalized women to make decisions about their pregnancy, birth and parenting without the policing of their bodies and/or reproduction?
How will policies change to support birth justice within the medical industrial complex as well be provided to our sisters in the prison industrial complex?
How will a single-payer system allow greater opportunities (including financial) for birth workers (midwives, doulas, lactation specialists, childbirth educators), healers, and practitioners of color to achieve education and/or certification (if they choose) and practice?
How will this kind of health care reform close these gaps in disparities and improve outcomes for Black women thus improving community health?
Will holistic and modestly cost public health interventions and preventative care (i.e. massage, acupuncture, yoga, etc) be accessible and covered under a single-payer system?
To add, will the midwifery model of care and out-of-hospital midwifery practices be seen as an adequate and viable option for consumers or will the “standard of care” continue to be based on profit-driven, insurance company rules and regulations and not based on evidence and research?
Will a single-payer health care system hold space for increased accurate, client-centered, public health promotion and communication around most importantly, breastfeeding, SIDS, nutrition, fathering, postpartum depression, pre-conception health, and accessing prenatal/postpartum services?
Lastly, in contrast, will Obama’s Health Reform fill in any of these gaps and concerns I have mentioned in discussing a single-payer system?

Well, I am waiting… (crickets).

The International Center for Traditional Childbearing, the Midwives Alliance of North America, and Citizens for Midwifery all have statements that include recommendations** for some kind of health reform (mostly recommendations for Obama-Biden’s Health Reform); many of which can be applied to the single-payer system as well.
I challenge the administration to really step up and address the social and economic barriers that directly affect the overall health of Black and Brown people and in addition make the birth outcomes of those disproportionally affected a continued priority.

It’s clear that what we have now is not only broken but absolutely criminal and barbaric.

*Language provided by the researchers
**Resources for your enjoyment:
International Center for Traditional Childbearing President’s “Healthy Babies are Everyone’s Business”
http://www.ictcmidwives.org/newhealthcarereform.pdf
Midwives Alliance of North America’s “Reforming Maternity Care in America: Recommendations to the Obama-Biden Transition Team on Maternity Health Care”
http://mana.org/pdfs/MANARecsToObamaHealthTeamJan09.pdf
Midwives Alliance of North America’s Working Group Recommendations
http://govinfo.library.unt.edu/chc/recommendations/orgs/midwivesalliance.pdf
Citizens for Midwifery’s “Maternity Care: A Priority for Health Care Reform.”
http://cfmidwifery.org/pdf/CfMStatementObamaTeamFINAL200901_doc.pdf
National Association of Certified Professional Midwives’ “Maternity Care and Health Care Reform: Opportunities to improve quality and access, reduce costs, and increase evidence-based practice”
http://www.nacpm.org/documents/NACPM-recommendations.pdf
Physicians for a National Health Program’s “International Health Systems.” Check out the Cuba and South Africa profile, written by me back in 2004.
http://www.pnhp.org/facts/international_health_systems.php?page=all