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

A Walk of Miracles

On January 21st I will depart Kansas City, MO by bus and ride for two days to reach San Miguel de Allende, Mexico in the state of Guanujuato.  Once there I will join my 8 American companions who make of the "Sisters of the Morningstar".  Our peculiar little all female group of sojourners will travel to San Miguel to participate in San Miguel Walk, a total of nine days of walking across the Sierra Madres.  I will walk with the group for three to five of those nine days.  Our small group will meld into a group of about 10,000 Mexicans who make this walk annually.  I will arrive later and leave earlier than the others in my group because of my school/work schedule.  I have participated in this walk three times before, but this time will be different.  The other times I went for the walk, this time I go for the destination.  The final destination of this pilgrimage is a Catholic church in San Juan de los Lagos, in the neighboring state of Jalisco.  When I reach this church (I'll be driven the remainder of the way after walking for three to five days) I will do what thousands of other pilgrims do when they reach it- petition La Virgin for a miracle.  There are special rooms in the back of the cathedral- walls lined with requests for miracles.  Some of the requests are accompanied by letters of gratitude (brought at some later date) for the received miracles.  For example, you might see a photo of a bedridden child, and a second photo taken a couple of years later of the same child running and playing.

I plan to bring my request for a miracle, Uzazzi Village, to La Virgin.  She is well known for granting miracles and I figure she might just as well grant mine.  After leaving my petition, I will return to San Miguel and board a bus for the two day ride back home or if finances permit, I will walk two additional days and then board a plane home.  When I return from my walk of miracles, I want to begin the Community Conversations on Maternal Infant Health.  From these Community Conversations I hope to find volunteers and donors to fuel the work.

In order to raise funds to cover the costs of starting the 501c3 that will become Uzazzi Village I am offering to carry prayer requests in exchange for your donation.  Your prayer request will be transcribed on paper, made into a small scroll, which I will carry in an amulet around my neck for the duration of the walk.  All prayer scrolls will be left at the alter upon my arrival in San Juan de los Lagos.  No donation is too small or too large, and all donations can request a prayer scroll.  Unfortunately, they will not be tax-deductible until the 501c3 is established.  None of your donations will go toward my expenses to do the Walk of Miracles, as I plan to cover all those expenses myself.  Thank you to all those who are a part of this vision taking shape. 

For more information, or to make a donation go to the website: http://www.uzazzivillage.webs.com/

Community Visioning Survey

It's Ready!

Here are links to the Community Vision for Maternal Infant Health document
AND
a link to the survey so we can get your feedback on the vision
AND
you can schedule a Community Conversation


Community Vision
https://docs.google.com/open?id=0BxG6TJv-guhPNjIxNmFjZGYtMjQ4ZC00NTZhLWI3MDktODhiYjk2Y2M4MTQ1
http://bit.ly/t7vEJw


Survey
https://docs.google.com/spreadsheet/viewform?formkey=dEVIcEZCTkZId2gzRS1rWElWVVlBeXc6MQ
http://bit.ly/vMD5lW


Please read the vision, and then take the survey.  We look forward to getting your feedback.

Uzazi Village is Concieved

The Community Visioning was a great success.  Here is the document created after the meeting that summerizes the vision. 

Uzazi Village- A Community Vision of Maternal Infant Health

December 9, 2011 a community meeting was held at the Kansas City, MO Health Department. The purpose of this meeting was to gather a group of community stakeholders to come together to create a vision of what maternal infant health in our community SHOULD look like. Here is snapshot of the vision that was created specific to zip codes within the African-American community of KCMO:

Current Conditions	Goals	Strategies	Action Plans
infant mortality rates above national average FIMR mom profile highest low breastfeeding rates high rates of prematurity high rates of cesareans and inductions high rates of preterm delivery low birth weight delayed or insufficient prenatal care smoking rates increasing high rates of obesity/ social determinants of health put residents of certain zip codes at high risk of poor health indicators	Infant mortality and morbidity rates at or below national average infant deaths not concentrated in the urban core increased rates of initiation, duration, and exclusive lactation among Black urban mothers infants born at term with adequate weights decreased cesareans, and inductions improved access to prenatal care improved maternal health prior to pregnancy work with others to improve life overall in the urban core	culturally appropriate care models midwifery model of care mother friendly care models baby friendly care models collaborative planning and working with all stakeholders home visiting models of care community-based solutions health care delivery models sustainable without government funding woman-centric care models affordable accessible care that preserves dignity and respects those it serve	create a series of “community conversations” to discuss the vision invite others to share in the vision through donations of time, money, or goods identify leadership and create a 501c3 to enact the vision begin to work with existing organizations and community stakeholders to transition the vision to reality make a positive difference in the lives of women and infants and their families in the urban core by improving health outcomes

Uzazi Village- A Culturally Relevant and Respectful Model of Maternal Infant Health for the Urban Core

What is Uzazi Village?

Uzazi is Swahili for birth. Uzazi Village will be a community-based perinatal care model created by community men and women for community women and infants (and their families) who are at higher risk for poor perinatal outcomes. We seek to create a model of care that is affordable, accessible, sustainable, high in quality, is culturally appropriate, and respectful of traditional/ancestral knowing, that promotes a high level of wellbeing and improves overall potential for the individual and the community to live in harmony in order to pursue its full purpose for being.

What does this model of care look like?

Maternal-infant health                   Family health                       Community health

-Peer to peer learning models    -family care/pediatric care       -high risk zip codes

-home visits with 'peridoulas'    -male leadership roles                - on bus lines

-midwifery care                  -assumed male involvement            -vibrant communities

                                       

  -lactation supportive          -same provider throughout             -providers live here

-bartering system for pay     -school nurse expanded role        -linked to other resources

-house calls by midwives   - parish nurse expanded role         -community supported

-same provider throughout   -group centered care              - decreased medicaid reliance

-personal ownership of health    -wellness focused care          - we did it ourselves

-partner with clients, listen       -clients define family            -community gardens

Does this sound like a conversation you would like to join?

This document will be dispersed far and wide throughout our community with a survey attached to invite feedback.  In addition, we will begin next month attending assembled groups to share the vision for the purpose of finding 'our people'.  Those individuals looking for just such a project to work with will hear about us through our "Community Conversations" series.  They will help to write this story.

Another interesting development this week: I invited a national insurance company to join me in crafting an application for a federal grant seeking innovation in healthcare service delivery to Medicaid populations.  They said yes!  We will be submitting a proposal for pregnancy doulas (or what I call 'Peridoulas' ) to follow pregnant medicaid clients from the start of pregnancy to up to a year following pregnancy.  I fully expected this insurance company would read my email and hit the delete button.  Imagine my surprise to get a call the very next day from the Vice President of Research and Innovation out of Long Beach California!  So add to my to do list, crafting a winning grant proposal that is due at the end of January.  Even though I accepted two adjunct teaching positions for the spring semester, I am considering turning down one of them so I can concentrate on grant writing (and book writing, and workshop writing, and article writing...not to mention starting CNM school).  This should teach me to be careful what I ask the universe for...

A Meeting of Minds

Next Friday, December 9th, a very important meeting will take place: 'A Community Visioning'.  This meeting, hosted by yours truly, is an invitation to all 'Community Stakeholders' to come and discuss a plan for creating community-based maternity care; what it would look like, and what it would take to make it happen.  I have been planning this meeting all year long.  I don't want 2012 to come without a plan of action in hand.  All year long now, I have been looking at the vision board in my bedroom next to my bed.  It is the first thing I see when I wake up every morning.  A large poster board covered in sticky notes and timelines foretelling a seemingly impossible dream; an urban prenatal clinic, birth center, and midwifery school.  All quite heady stuff for a former teen welfare mom. How do I galvanize the considerable resources of this community to make it happen?  Well, it will start with this meeting.  I have sent out my clever and attractive EVITE invitations.   I have enlisted a top notch talented facilitator.  I have a state-of-the-art, large meeting room.  I have my mother's cinnamon rolls and fresh fruit for feeding the participants. And I have an agenda.

In many ways I have been waiting 20 years to host this meeting.  I have agonized over the invitation list for months.  I understand that whomever is meant to be there, will be there.  I also understand that this is the first step in taking my dream PUBLIC.  Oh sure, lots of people have heard me talk about my plans to do this or that, but this is the first time in 20 years that I have invited anyone else into that conversation. Its like leaving your five year old at kindergarten for the first time- it finally hits you that someone else will have influence on the way your little one thinks and behaves.  In taking my dream public, there are risks.  On the other hand, alone I can only accomplish so much.  Already, I have been flooded with offers for space for housing the project.  I will be out next week, looking around Troost Ave. for the perfect store front.

I'm picturing it already:
"UZAZI VILLAGE" the sign will read. (Swahili for birth) In small letters beneath it, it will read: "An Afro-centric community dedicated to maternal infant and community health". To start, there will be free pregnancy tests and resource referrals.  Childbirth classes (the good empowering kind), and breastfeeding support groups will be a staple.  Other classes will be added: parenting classes, finance management, employment preparation, etc.  I intend to invite others who are already doing these things to do them at Uzazi Village, not duplicate them. I hope other support groups will spring up; fathering support groups, infant loss support groups, perinatal mood disorder support groups.  Again, there are already folks out there doing these things, I will invite them to do an Afro-centric version at Uzazi Village.  In this way I expand the capacity of organizations who have already perfected this work (whatever it is).  Uzazi Village will be divided into Houses: Umoja (unity) House will be our think tank, leadership, and administrative council (Council of Elders), Kujichacalia (self-determination) House will house job readiness, GED completion programs and such. Ujaama (cooperative economics) House will house a business incubator for nonprofits supporting maternal infant health, and courses on entrepreneurship and nonprofit leadership.  Imani (faith) House will house faith-based initiatives and church volunteer groups and hopefully a parish nurse ministry.  Kuumba (creativity) House will maintain art programs and community gardens.  I will add clinical services as soon as I graduate from midwifery school, unless a practicing midwife or physician wants to offer clinic hours sooner.  The Ida Mae Patterson Perinatal Wellness Clinic will thus, be born. Named for my grandmother, Ida Mae, who had 24 babies, but only saw nine live to adulthood, this clinic is the crux of the vision. Clients of the Ida Mae clinic can expect home visitors known as pregnancy doulas to visit them at home and do assessments and education. Hierarchies will be flattened as care providers retrieve their clients from the vibrant and active community room (no waiting rooms) and walk them back to their serene and tastefully appointed,  mutual exchange suite (no exam rooms)  I hope the place is filled with students wanting to learn: nursing students, midwifery students, medical residents (DO, OB, family practice)  etc.  As it evolves from an education center to clinical services, I will also add birthing rooms: The Nia (purpose) House. I chose this name because of Morningstar's quote in her book of the Cherokee birth blessing, "May you live long enough to know why you were born."  I want every child born at Nia House to know their purpose, to know why they were born, to be an integral part of the community that has welcomed them.   I hope there will be tutoring, a community garden, a daycare...  I hope it expands to take up the entire block... the entire city... the entire world...  I want Uzazi Village to be a sustainable, replicable model of community-based wellness care that supports maternal infant health that radiates forth to positively impact family health, that glows outward to support community health.

Now join me in my vision.  What do you see...?

Winter Update

Much has happened since my last post.  I have left my job as a nursing instructor.  I am enrolled in a nurse-midwife program, and working on my IBLCE credential (lactation consultant).  I have attended the MANA (Midwives Alliance of North America) conference in Niagra Falls and gave my two presentations.  I have attended the local March of Dimes conference on Prematurity.  I'm just back from the Holy Land for a meeting about a nine day pilgrimage in Mexico in January.  Some committments are ending, while new ones begin.  Plans are underway for the clinic/birth center it has become my destiny to create.
What has become clear is that I must press on, despite any obstacles.  The work is greater than myself and I am only a conduit of God's will and desire.  This work has nothing to do with my own resources of lack of them.   While in Niagra Falls at MANA, I was priviledged to spend a lot of time with the midwives of color, these were amazing women from all over the United States, Canada, Mexico, and the Caribbean.   Spending time with these midwives and birth workers reminded me that I am not alone in what I am attempting to do, nor am I the first to attempt it.

I hope to resume teaching in January.  Here are a few projects I am working on for next year:

• finding an adjunct teaching position
• writing a workshop that I will start presenting next May nationally
• writing a book that I hope to publish next year
• sit for the lactation consultant exam in July
• submit an article for a peer-reviewed journal
• take the nurse educator certification exam next Spring or Summer
• begin preceptor courses  for nurse-midwife program
• begin apprenticeship with a local homebirth CPM
• work with a design student on architectural sketches for clinic
• vie for a seat on the state nursing board
• feasibility study for clinic
• host community visioning sessions
• create 501c3 for clinic
• complete training and fundraising for pilgrimage
• complete 9 day pilgrimage in Mexico
• investigate MPH program (just dreaming here)
• increase business training to include ACLS and LPN-IV course
• write for some grants
• find some partnerships to complete the Mama Love Project

All well-wishes much appreciated.