Heart Burn

          I have to say, I've had one of the most interesting weeks.  Yet, again I am amazed at the magnitude of how social circumstances can manifest as "heart burn."  It seems that women today continue to be afflicted by their circumstances while maintaining some sort of balance in their lives.  While looking at the bigger issue, it is no wonder one of the major causes of death for women is cardiac related.  Do we really take our emotional issues to heart?  Or is it socially acceptable to place an outward appearance of strength and stability, when really you are doing your best to just get out of bed every morning? At which, emotional instability begins to manifest itself in other physical forms. It seems that women's health issues need to be addressed from a feminist perspective, which would explore and incorporate a woman's health from within the context of how women live their lives, collectively and individually within a patriarchal society.  This perspective incorporates social, environmental, and economic aspects of women's health, which is vital to understanding how women are able to achieve health and well-being (Womens Gynecological Health, 2006).

          With that said, I wanted to shed some light on some of the issues that women are facing today.  I think for those of us who are health care providers or working within health care, these women are usually the ones that continue to come in to be seen for varies health issues during pregnancy or for other gynecological crises.  When taking a closer look at their background you may find that they have an extensive social history ranging anywhere from depression, anxiety, abuse, homelessness, and the list goes on and on....Some of these women may have partners that are in and out of their lives, but they continue to bare the burden of raising their families alone and with little resources.  So again, are we really treating "heart burn" or is it a physical manifestation of their circumstances?  Apparently, 60% of patients coming into primary care have clinically significant mental health issues. Furthermore, while researching barriers to prenatal care among the Native American population in New Mexico I was somewhat surprised to find that among the top five reasons Native American women may not seek out prenatal care or there is a lack of prenatal care, are belief systems, family dysfunction and low socioeconomic status.  Findings that supported these reasons were that there was association with lack of transportation and childcare, traditional belief systems and family dynamics. 
          Obviously these issues are so complex that a 15 minute visit with your physician, midwife, or nurse-practitioner will most likely not fix the problem.  So what will?  Unfortunately, I do not have that answer for you.  I think it is important to keep a running dialogue among health care providers so that there is an awareness of the issues that our Native American communities are facing.  I realize seeing at least 20 patients on a daily bases with varies complex health issues can numb your senses as to what is going on in the home setting for these women, but some level of understanding and sensitivity needs to be maintained.  Because, when you see these women, you are not just treating heart burn.