The Plain Truth

THE PLAIN TRUTH

            I have thought many times about what I would say in this last blog.  As that my journey as a midwifery student has ended, but my journey as a new Certified Nurse Midwife has just begun.  The job search has not been an easy task.  As that, our national certification exam, NM license, and other professional necessities to practice as a CNM has taken time and money to attain. With that said... up to this point I've avoided talking about the specifics of my daily life while in school, only because I wanted you my invisible readers to get a sense of my personal thoughts on each life altering event I encountered.  What I hoped to capture in my blog was how each interaction effects us all on a personal level and that the person we see on the surface is not all that they are.  Each woman has her own story. We all have an undercurrent of emotions and thoughts that we let few people see and I felt privileged to have been allowed into the sacred circle of trust of each woman I cared for while in school.  This is what I value and find most fulfilling about being a midwife.

            With that said, I now find it necessary to discuss my life as a midwifery student.  Like many women who have families and who have decided to take the plunge to follow their dreams, I to took this plunge....and lived to tell about it.... For me to go on this journey, I said many prayers and had many silent moments of reverence while on the 1 hr and 30 min drive to Albuquerque for class.  Yes, that is right, I did not live in the city where my classes took place.  Some programs can get away with mostly on-line classes for students who live a distance like myself, but this was not one of those programs.  Granted some classes were on-line, but I'd advise those of you considering programs of the on-line nature...Student interaction in a classroom settings is vital and necessary for this kind of work.  The way our classes were set up at UNM, we had block schedules, meaning 3 weeks of class from 8 am to 5pm..then 6 weeks of clinical at a site..then class again. So basically I would drive down daily for classes and back again the same day.  My mornings started at 4:30am and ended around 11pm.  Upon returning home, I had some time with my family, but most of my evenings were spent at our dinner table reading or writing up papers for class.  Because I was determined to make things less stressful for my husband, I continued to work as a labor and delivery nurse on the weekends and during school breaks.  Even at work, when things were slow, I would use the time to study.  Still the extra money I was making as a nurse was not enough to support our family.  I took it upon myself to apply to as many scholarships as I could.  I called this my part-time job.  When I had my exit interview with Julie, my wonderful and amazing professor, she said out of all her students I had received the most scholarships she has ever seen...still this was not enough...  I also received graduate school loans and my husband had a full-time job. Because I was very enthusiastic about the work I was going to be doing, I took time out of my busy schedule to do out reach to talk to young Native American students at a local school in Albuquerque about traditional Navajo birth practices and to students coming to UNM for a visit.  For my friends who didn't hear from me during this time..this is why.  I was not avoiding you, I was just crazy busy.  Most of the time after a busy day at the clinic, hospital or class, I was a senseless blob on the couch..or wanted to be.         

Chinle, Arizona

         You are probably wondering with all the financial support I got..where did it all go?  Well, as that I was not home all the time I had to set up dependable after school care for my kids, at which I spent 9 thousand dollars on this for one year.   I also had to have my appendicts surgically removed and I spent a lot of money on gas traveling to and from school.  I am thankful that I had wonderful and amazing friends who let me crash at their homes in Albuquerque during clinical and block classes, because I don't know how I would have done it without them.  UNM is one of the best midwifery schools in the nation and one of the reasons why is that it focuses on training midwifery students to provide care in rural settings.  Which means, 2 out of the 3 clinical sites had to be out of the city.  As a student in this program, that means we had to find places to live at each clinical site and pay out of our own pockets for housing, food and gas. Just to give you an idea where we could be sent for this on site training, here is a list of some of the places...Los Alamos, Las Cruces, Belen, Socorro, Shiprock, Gallup..NM.  Texas, Arizona (Fort Defiance, Chinle, Tuba City)....and out east at a birth center.

         Before applying to this program, I had to also make sure my support system (my husband and kids) had a support system.  I sat down and visited with my husbands parents.  I told them about my plan to become a midwife and how much we were going to need their support while I was in school.  Parents being parents, they were cautious and asked repeatedly if this was the right time for me to return to school.  At the time, I don't think they understood my deep desire and need to do this, but thankfully in the end, they where there for us in every way possible.  From cooking dinner, to picking up our kids from school when my husband had to stay and work.  I will forever be thankful for all the sacrifices everyone made so that I could become a midwife.

Blessing of the Hands and Pinning Ceremony

          I am telling you this because in order for me become a midwife, I needed to have a good support system in place and the financial means to pay for childcare, gas, food, and travel while in school.  These things are vital to the success of anyone considering becoming a midwife.  When I first applied to this program, the four things they asked me during my interview were 1) how do you coup with stress, 2) do you have a good support system, 3) are you planning to work during school (if so..STRONGLY advised not to)...yeah I didn't listen to this advice... 4)..lastly are you willing to travel.  Thinking back to that first interview with my future faculty, I can honestly say..... I didn't know what I was in for.  I just knew I was going to do what ever it takes to make it work.  

        I now understand why more women have not chosen this type of work for themselves and also why there are so few Native American midwives.  It is grueling work with sometimes impossible expectations...and that was just my training.  I hope you know, while reading about my travels and experiences and my sacrifices..that those of us who have chosen to take on this impossible task of being the hands to help bring life into this world, we do it because we were called to it...

        As that support is vital to all midwives health and well-being, I wanted this blog to be a sounding block and hopefully my way of telling midwifery students and especially native american women considering midwifery, that you are not alone.  Whether you are in the throws of block or clinical, or wondering how you are going to get childcare for your kids while having to live miles away from them for training...you will get through this, if you believe in the spiritual world (as I do) our ancestors are always looking out for you...and if you find yourself on this path and wondering if you belong on it, you wouldn't be here if you weren't mean't to be here.  Lastly..trust yourself and your instincts, they never steer you wrong.

        Many blessings to everyone!  Remembering the beautiful Navajo journey song Ursula sang for us at our blessing of the hands after she blessed us with cedar and corn pollen to send us on our way.  I may start another blog...but we will see what the future has in store.

          

                      Happy..Happy..Happy!!!  

Little House of Miracles

     Thanks to my friend Miss Whitny Doyle, who happens to write for the New Mexico Alibi, for keeping us all informed of the changes being made in our state due to the financial cuts to medicaid and medicare.  She recently reported that the "state's only residential substance abuse treatment clinic for pregnant women, Casita de Milagros, will be closing on July 1, 2011. This clinic provides prenatal care and treatment to pregnant women who use drugs and alcohol."  Well, I don't know about you, but this is a serious disservice to the women of New Mexico.  Not only did this clinic treat women with substance abuse during pregnancy, but they partnered with Reflejos Familiares and Vision to help them get basic living necessities and taught them how to create a safe living environment for their new family.  Thankfully, these additional services will still be offered as an outpatient service, but Casita de Milagros will no longer be used for inpatient treatment. 
      While the topic of drug and alcohol dependence during pregnancy draws out major moral judgement by others, it is still area in women's health that needs to be addressed.  While some may say they don't believe in "Addiction" and that people can quite if they really "feel" like it, may not know the real meaning of addiction.  So let me define it for you...Addiction is defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin and other drugs) which crosses the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain. So basically, drug and alcohol addiction isn't just a bad habit one can stop on their own.
       My guess is who ever voted on removing medicaid funding for this service did not do their homework. I consider myself a novice researcher, but I was able to look at several different websites for information about pregnancy and substance abuse.  According to the National Survey on Drug use, 4.5% of pregnant women aged between 15 and 44 years old, used illicit drugs in the past month between 2008-2009.  While this might not seem like a large number for some, but I think because of the moral stigma associated with drug and alcohol use during pregnancy, it is under reported by mothers in fear of back lashing from the health care community.  The interesting thing I found while reviewing websites like CDC, IHS, New Mexico Department of Health, and 2009 National Survey on Drug Use & Health, was that alcohol and tobacco use was highly reported and illicit drug use was not reported enough.  Furthermore, the website by HRSA, Women's Health USA 2010, alcohol and illicit drug use were not identified on the maternal health status report. Which means to me that, by it not being identified as a women's health indicator, a goal can not be set to address it.
        My point being after reading and reviewing all this information is, perhaps if we as women and representatives of our community make issues like this worthy of notice rather then having members of the "research" community report on low-birth weight babies, preterm births, and all the issues that can also result from drug use make headlines, only then will places like Casita de Milagros be standing to meet our needs.  I think it is important to address preterm births and low-birth weight babies, but these are outcomes of 9 months of prenatal care where we could have made an impact on these health indicators in our state.  So while "they" meaning those in charge of making cuts like this to health care programs, who think they may be saving money, really they only increasing the cost it will take to care for the outcomes of their decisions.  I'd be interested to see how this will have an impact on New Mexico in the next 5 years...

Here is the link to the article: http://alibi.com/news/37375/The-Miracle-of-Treatment.html

Vision

      It still feels unreal to me that I am finished with school and now have exponential free time to ponder where this path will lead me next.  Let me tell you, I've given serious thought to returning to school for my Family Nurse Practitioner degree, but I've sense fallen into a state of relaxation and stillness that the thought of returning to a stressful state is not something I want to dive into right now.  I'm not saying I will never return to school, because getting my Family Nurse Practitioner degree is very appealing and will be very helpful in the future.  However, it seems right now I am regaining a sense of equilibrium with my family.  I actually have time to reflect on the past two years and how I've grown as an individual.  I feel, for once in my life I know what kind of mother I want to be and what direction I want our family to grow in.  I finally feel like I've found my voice.  This for me is something I've struggled with, because I've been the woman who has accepted other peoples opinions of me and taken them to heart.  I've allowed my fear of other people's ideas of me to keep me from achieving my goals and being the woman I know I am.  I've basically not been true to myself and have allowed people to put my inner light in a box.  

        I truly feel like anything is possible if you trust in your own abilities to achieve them.  I can say that my reasons for becoming a Midwife remain and if anything my desire to serve women in my community has strengthened.  I feel like this poem really reflects how I felt when I decided to return to school.   

and the time came

when the risk it took to remain

in a tightly closed bud
became infinitely more painful

than the risk it took to blossom.”

- Anais Nin

      It is very easy to rationalize with yourself as to why you should not grow in a certain direction and you will probably have people in your life who will agree with you that to take a certain path would be risky and detrimental to all who love you, but are they really looking out for you?  Everyones personal goals are different and most of the time those people who are warning you not to take this major step in your life have themselves chosen not to take their own path of growth.  

       The path that I now find myself on is navigating the varies employment options.  Because of the location of our home and the type of environment we want our children to grow up in, I am faced with the creating a place for me to work.  Surprisingly, this actually is exciting.  Being a midwife comes with many obstacles, but it also comes with many opportunities to be creative.  This just happens to be an area I flourish in.  Like many artists,   I am imagining my work of art on my canvas before I've even started to paint, but my ideas will soon take shape.  This is only the beginning......

Blessing of the Hands

  

   "On this day, I dedicate both my heart and my hands to service..."

     What a way to end this journey and to begin our life's work as Certified Nurse Midwives.  Some of us will be traveling to our new destinations and others will be enjoying a few days of rest with our families.  It has been a tough two years of countless papers, exams, and training for our new professions.  Thankfully, we've had each other to lean on while balancing our many roles.  Thus far, we've been blessed to have had this time to learn from each other and to have our paths cross.

      I know the significants of this ceremony will resonate in all of us when we are faced with a difficult situation.  I hope that we can all look back on this day and remember all the blessings and words of encouragement by our mentors, professors, husbands, mothers, children and fellow classmates.  I look forward to fulfilling my pledge as a midwife and serving the women of my community.  I was especially touched to have had my wonderful and inspirational mentor Ursula Knoki-Wilson pray over us and send us off with a traditional navajo journey song.   To hear those words sung for us held all the meaning for me as to why we were brought together to pledge our hearts and hands to the service of women.   Each and everyone of us brings with her a piece of themselves to the art of midwifery and I know we will help cultivate peace in all of our associations.

  
      I can truly say this experience has forever changed me and has made me stronger as an individual.  It has also strengthened my family and my relationship with my husband.  It has brought about an inner peace that my spirit has been seeking all of these years.  A peace that I am a woman who fought hard for what she believes in and brought anyone willing to be apart of it with me.  I feel like a woman who has "walked through my past and has healed into the present."  I've learned that being with women during birth is truly a gift.  I am truly honored to be with them and to bare witness to their transformation into womanhood.  I am thankful to have had my amazing sisters be apart of my transformation through the turbulent waters of midwifery school and to have been able to be apart of their transformations as well.

      I believe this poem says it best about my amazing classmates who I have had the privilege of knowing and will continue to build a life long relationship with.  Written by Patricia Lynn Reilly...

Imagine a Woman in Love with Herself  

     Imagine a woman who believes it is right and good she is a woman.

A woman who honors her experience and tells her stories.

Who refuses to carry the sins of others within her body and life.

    Imagine a woman who trusts and respects herself.

A woman who listens to her needs and desires.

Who meets them with tenderness and grace.

   Imagine a woman who has acknowledged the past's influence on the present.

A woman who has walked through her past.

A woman who has healed into the present.

   Imagine a woman who authors her own life.

A woman who exerts, imitates, and moves on her own behalf.

Who refuses to surrender except to her truest self and wisest voice.

  Imagine a woman who names her own gods.

A woman who believes her body is enough, just as it is.

Who celebrates her body's rhythms and cycles as an exquisite resource.

   Imagine a woman who values the women in her life.

A woman who sits in circles of women.

Who is reminded of the truth about herself when she forgets.

  Imagine, we are all this woman.....

      Many blessings to my lifetime friends who have now become my family. 

 ....And to my amazing husband who remained my true friend and partner in life while I traveled this path to my truest form...

  

      

          I know our work has only begun, but I look forward to what lies ahead...............My we all walk in beauty on our own paths in life.

International Day of the Midwife 5K Walk: Why We are Walking

International Day of the Midwife 5K Walk: Why We are Walking: "We are walking because...It is International Day of the Midwife and one of the most appropriate days to highlight that over 340,000 women an..."

A Woman's Heart

     There is a constant pull on my heart between the life I lead as a woman, mother, and wife.  My duties stretched between husband and grandparents.  As I work with women in this rural setting I see that I'm not alone in this trivial divide between finding a healthy balance in the choices I make.  I realize that even though their choices may be different, we are all one in the same.  Still making our way with or without the support of those who we call family.  I don't ever remember having a conversation with my mother about the hard choices she has had to make on our behalf, nor did she ever tell me how hard it would be to make those choices for my family.  It seems as caretakers of our families and of our own minds and hearts there is a point where our future is decided for us by our circumstances or we are able to make those decisions for ourselves.  Either way, there is a pull to do what is right for our families and the decision is never easy.
     Is this what it means to be a mother? A woman?..... To always be torn between what is right for us or our families?  It seems we are not brought up to take our own voices seriously.  Do I count?  Do you hear me?  Why I am I selfish to want this?  Your more important then I am.....This is what I hear in my conversations with women.  They don't say it out loud, but it if you really listen its in her posture, her tone, her eyes, and how she asks a question or the questions she does not ask.  What a gift it is to find trust in a stranger who actually listens.  I'm not saying they aren't strong, because by all means I believe ALL women are strong, they would have to be.  To put her dreams aside to care for a dying mother,   to stay with a man who beats her so her kids will have a roof over their heads, to chose a career of helping other women even though it will take her away from her own family.   All the while being judged by other women making similar choices and perhaps their choice was different, to leave the man who beat her, choosing her family over a career, not putting her dreams aside to care for her dying mother.   I wonder why we as women must make it harder for each other by making comments full of judgement rather then understanding each decision we make is a difficult one.  Whether we show it or not.
   Each woman walks her own path making many decisions along the way. All the while wondering if it is the right one or knowing with all her being that it is the right one.  Some like the sound of their own voices and are not afraid to be heard, while others are still getting used to hearing the sounds of their own voices............I just know that my voice is all I've got to tell my truths... that is if anyone is listening.......
  

Exploration Ambivalence

             Week 5 of my clinical rotation and I'm finally more confident in my clinical abilities.  So far I've scaled the computer charting wall, collected many passwords and am spending more time talking to my patients rather then trying to figure out the computer.  I am amazed at how much of what I've learned in school is coming together for me.  Suddenly, I can make sense of the labs, order appropriate testing, and consult with my physician colleges without the feeling of dread that they will scowl at me for asking so many questions.  I guess that is what "integration" is for?..Graduation is quickly approaching and I still can't seem to bring myself to think that far ahead.  Invitations?...reception dinner?...Thankfully, I have a couple weeks after I return home to worry about those details.

             Aside from my random thoughts and wishful thinking, I am in awe of the women I care for.  Some of them traveling 6 hrs for 1 prenatal visit, some may or may not have transportation, others dealing with family members with multiple issues, trying to get a college education and trying to maintain some sense of "healthy" for themselves.  These women are doing the best they can for themselves and their families all the time!  I find myself to be not only a healthcare provider, but a counselor, advocate, friend, and many other things.  My only limiting factor is TIME!  I'm having a hard time limiting my visit to just 10-30minutes a visit.  I've heard this complaint again and again, how do they "preverbal bean counters" expect to me to see 20 women daily with varies issues?  As my wonderful preceptor has told me recently, she has had to leave pieces of her heart behind to accommodate the increasing number of clients she "has" to see daily.  Visiting with women is one of the things I love about becoming a midwife.  I will have to think outside the box to give women the kind of care I think they should have and do it in 30 min or less.

            On a separate note, I am still working on solving the pharmacy issue.  That is..why does it take so long for medications to get filled at this particular Indian Health Services unit?  Let me remind you, apparently it takes an average of 2-3 hrs for 1 prescription to be filled. I'm not saying the service units pharmacy is lazy or taking long lunch breaks, but I would really like to know the big secret as to how many prescriptions they fill daily vs. a Wall-greens and why Wall-Greens is faster?  I know I'm not the only one who would like to know this answer.

           One of my goals for being here was to educate women in their options for care and so far I've had the luxury of time to do that.  Some women have been very forth coming in their questions about "all things female" while others have taking a quieter approach, but I fear with the lack of time we as providers have to discuss all matters of heart and health, we may be missing the meat of each visit.  I know I've learned more about a woman in 1 good visit then I would have in 10 short visits!  Each woman I encounter I learn a little more about her unique needs and I pray that I do not loose that closeness with them by trying to meet the needs of the practice I am with.

          
              

Reflections of Time

     Its hard to believe I am already heading into my third week of clinical's here.  I met a wonderful Navajo medicine woman who shared some traditional knowledge with me and also wrote a prayer for me to say each morning in Navajo.  Per my request of course.  This was actually one of the high lights of my week.  As well as, attending a birth at which I got to see her provide labor support and prayers for a patient.  I am still at the stage in my clinical training where I am gaining the trust of my preceptors and the nurses.  This is always an uncomfortable stage for me, as that I have to share my past experiences with them and prove to them I am competent. It is even more worrisome when they know the program I am with is well known for "good" and "competent" students.  Because, then they expect no less of me.   I know it is how it has to be, but I am the type of person who likes to feel comfortable from the get go and feel like old friends, rather then to stumble around.  However, I know the stumbling around part is in important step in my develop as well.  Gotta stumble before I can stand...right?
     Aside from some of the clinical and management skills I want to develop while I am here, I am trying to get a sense of what it means to be a Navajo woman.  I mean, I know what kind of Navajo woman I am, but what does it mean to other Navajo women?....I am asking this question because it is interesting to see the role women play in each family and compare it to the role the elder women play in each family.  There seems to be a shift in what the roles used to be to what they are now and also whether they are a "traditional" Navajo family or " non-traditional" Navajo family.  I take this to be an interesting study of my own culture and what women's roles are in it.  I have my own life to compare it to, but my up bringing was a mix of tradition and non-tradition.  Further more, my experience with Navajo women in labor is limited.  And let me tell you, the experiences I've had so far with them, is very different from the experiences I've had with other cultures.  I find this interesting, because for one I am a Navajo woman, but yet I have little knowledge of how other Navajo women cope with the pains of labor, motherhood, and their overall new roles in their family. Again....this is stuff my mother never discussed with me.  She went to the hospital one day and came home with her baby the next.  She never talked about the pain of labor or how she coped with it, nor did she tell me about how her mother birthed her.  Could this be the same experience other women have in my culture as well?
      Obviously, I am seeking a deeper meaning to what it means to be a Navajo woman today and what it meant to be a Navajo women 20 or 30 years ago.  I don't think I will get this answered in the short time I will be here, but I do look forward to spending some time with some of the elders to learn more about my cultural history.  Its during this time I wish my grandmothers were still alive to share this knowledge with me.  It is only through bits and pieces of other peoples stories am I able to put it together for myself.
    

Rural Health

     I am definitely getting a taste of rural health on my Navajo reservation.  First I would like to make it clear that each community is unique in itself and the issues that one community faces might not be the same issues the next community is facing.  However, it was very interesting to see that the research I was reading, with regards to my Native American population, does reflect what is actually going on in the clinical setting. It seems that the barriers to health care continue to be related to MUD, rural living conditions, and limited emergency services.  While I've had the pleasure of spending two whole days at the Pinon clinic in Arizona.  I was able to see what kind of services were offered to the greater community and beyond.  Mind you this is a clinic that offers multiple services like pharmacy services, public health, access to a traditional healer, pediatric care, nutrition, dental services, mental health, and women's health care services.  They have one ambulance that is also available if necessary.  The nearest tertiary center is 8 hours away in Phoenix, AZ and the nearest official emergency services is in Chinle, which is located 45 minutes east.  The road between Chinle and Pinon still is partially dirt road.  I was advised that when it rains or snows that road is not safe to drive on and you have a good chance of getting stuck in the mud.  Thankfully, my trip down this road was uneventful and safe.

       Like most Indian Health Services clinics, they try to offer all of these services in one location because they are located miles from a city.  I'm not saying Indian Health is perfect, but from what I saw here at this clinic, they are making an effort to bring health care to rural communities like Pinon.
                                        
                                             So what does this mean for pregnant women?

     For women who are high risk OB patients requiring the watchful eye of perinatal services, they will still receive some of their prenatal care here, but they will be referred to a perinatal group that is in Phoenix.  For anyone who has cared for women requiring perinatal care, you know what this means.  Usually these women will be seen by a perinatal provider twice a week and once by their primary OB doctor or midwife.  What this means for women in this community and surrounding communities is that twice a week they will most likely have to go to Phoenix, an 8 hour drive, to receive this care.  This clinic does have someone drive these women to Phoenix, but still this is hard on her and her family.
If a woman is in labor or has ruptured membranes she is checked and is encouraged to  have someone drive her to Chinle's labor & delivery unit.  Because they only have 1 ambulance they use it for more serious situations.  I am starting to see why one of the most common causes of maternal and fetal death is car accidents.
     Some of more prevalent infections these women face in this area are H. Pylori, Chlamydia and Gonorrhea.  For young children, pertussis, RSV, Flu, and upper respiratory infections seem to be causing the hospital rooms to fill up. However, I think it is also a problem in other areas outside of the Navajo reservation.
      I really was not trying to paint a gloom and doom picture, because really these issues that our reservation is facing are "Real Issues."  Indian health is complex and has many issues that are still being sorted out and addressed on a community level and a national one.  I feel strongly that government funding for Indian Health Services should be increased to more than the 50% they are getting right now.    I wonder who is advocating for the health and wellbeing of my tribe on a national level.  I wonder yet..if these issues can be fixed...and how do I fit into all of this?

Chinle

     I said my fare wells to my family yesterday afternoon.  My kids all gave me individual hugs and of course I told them each to help their dad while I was gone.  I hope that I can skype here so that I can at least see their little faces on a daily bases.  My husband promises to have them all well behaved by the time I return, but I think my kids have there own ideas.  Besides, I thought they were well behaved already?  Last night I spent most of my evening putting away all my stuff and getting groceries for the next couple of weeks.  

     Today was my first official day and so far it is going well. I spent the morning filling out all the government issue paperwork.  For anyone who has worked at an Indian Health Service Unit, know what I'm talking about.  My neighbor was nice enough to let me use his wi-fi access and his washer and dryer.  Which is a major bonus!  Internet is a resource people here don't all get to use.  So I'm thankful.  The neighbor I mentioned is a pharmacist and after chatting a little with him has told me it takes about 3 hours for medications to get filled..3 hours!  I guess that is rural health for you!  

      If I could describe Chinle,  I would say it is different shades of brown with tumble weeds all curled up at some of the western fences.  Mountains to the west and Canyon De Chelly National Monument to the East.  The main road coming into Chinle, goes to the heart of the town then T's off in two different directions. The Navajo term "Chinle" translates into "A Place Where Water Emerges from Canyon's Mouth"  While driving over here I was able to take in the beautiful sites and see farm animals grazing on the side of the road.  This also means I had to be careful not to run into one.  These photos don't do this place justice, because in the evening while the sun is setting, the mountains to the East turn bright red.

     I have to say it was nice hearing my native language spoken so freely in the hallways of the hospital.  Tomorrow is a new day and I get to meet more people.  Which I am thankful for, because I am already missing my family and all the sounds of my busy house.  

Parallels

     While reading research for my Masters exam, I have found some interesting parallels between how to care for older couples in their home setting and caring for women in a clinical setting.  The study was qualitative exploration of the home care experience.  Obviously this is perhaps an odd correlation of themes, but yet should be applied to the care of all.  Those of us living in the context of" meaning well" when we help others when at times this idea of "meaning well" can have detrimental effects on the one you are trying to help. I think as human beings we have a need to feel "independent" and perfectly capable of taking care of "self."  At which the act of giving and receiving help is tricky.  Case in point: I am a terrible speller, I may joke about it, but seriously it is something that is a soft spot for me.  My wonderful and amazing professor took it upon herself to help me correct my spelling draw backs, but I was completely put out by it.  I mean it really bothered me.  I finally told her, "No thank-you, I will ask for help when I need it."  She very kindly accepted my need for independence on this one, but I also realized my need for independence affected my sense of self.  Yes, she is my professor and very knowledgeable in her right, but I didn't trust her yet to accept her help.
     I think this can be expanded to the women and families we care for in a clinical setting.  What may be going on with them medically or naturally can be something out of their control.  They first have to process and accept their situation for what ever loss of independence they may be experiencing.  This is a big deal!  For some this adjustment takes time and the bond we are seeking to make with them is highly dependent on the kind of relationship we want to have with them. The clients themselves have expectations of us, as we have of them, but how are we going to build the trusting relationship with them?  I think this article had it right when stating that first impressions are vital, but so is developing mutually acceptable relationships by really being invested in their ideas of what they value as safe and trustworthy.
     Another parallel I found interesting and important is that both spouses should be viewed as clients participating in their own overall well being.  In the end, we as providers and caretakers of our communities promote this idea, but more importantly its the relationships we gain from these interactions that is the promoter.  One of the major themes that came out of this article that struck a cord with me is this...."Women are viewed as the gatekeepers of the household and its inhabitants." I know most women would agree with this, because it is something that this article found to be vital in gaining the trust of its participants for the study.
     I am sure that the concepts I have brought to your attention are not new ones, but it is a nice reminder for me when I am working with women in the clinic, hospital, or even with friends and family.  I know trust is a big deal to me, I also know that it also has a different meaning for each and everyone of us.  I think that is why I find comfort in exploring these topics from my experiences as a student.  Our paths, our experiences are all varied and individual.  What we gain from them is also very individual.  I think the more I explore our many complex relationships with each other and ourselves the harder it is for me to define "self." Because "self" is ever evolving with each experience.    

Self-Preservation

     In my quietness and time of reflection I find many things floating through my mind.  Really, I am just thankful to have the time to reflect at all.  The semester has been a crazy busy one, some of the craziness inflicted upon self and other craziness inflicted by others.  I have made it a point to rise at dawn so that I may throw my corn mill after saying my morning prayers.  This is all part of me trying regain the inner peace and balance that has been misplaced during this past semester.  I find myself wanting to be in a state of meditation and complete peacefulness so that I may have the energy to take on what lye's ahead.  As comforting spending time with my family was, the holidays are anything but relaxing.  I have to remind myself that what is important during these crazy times is "time and memories."  Aside from the crazy holiday shopping, what will my kids remember most?  Surely, not the number of gifts they got, but that we were together trying to keep the spirit of Santa alive, because as they have grown older, they have become more suspicious.
      While on my holiday travels I found myself revisiting old hurts, which was not part of my relaxation plan, but still it was there.  Its like in its own time capsule that seems to want to open itself up for me every time I visit. How is it possible that I have grown from these events and yet for others they continue to be a cause for future burden at which they then try and rob me of my peace.  As much as I want to bring a greater peace to all that it has hurt, I know I can't.  I am greatly disappointed by this revelation.  Yes, yes those who really want change and healing will find it in their best interest to make those changes.  They can not be forced.  However, it is very hard for me to leave those who still like to stew in their own pity to move forward in my life.  Perhaps it is also why midwifery chose me and I chose it.  To have hope that change is possible is a gift in itself.  I always hold out hope that those that I love with find their way and see beyond their own pain.  It is the same hope that I hold out for all women.  Change is possible.  Perhaps some would say that this idea of doing the same thing again and again hoping for a different outcome is "insanity." And in some ways it is, but some people need that and for some the outcome is different. 
       Aside from dealing with old hurts, I am getting closer to reaching my goal...graduation, for now I am looking forward to the next leg of my journey.  I will be in Chinle, AZ working with my tribe.  I am very excited about this.  To finally be in a place where our traditional healing practices go hand in hand with western medicine.  I know something bigger than me awaits me there, but I'm trying not to get myself worked up over it.  I am doing my best to take whatever happens as it comes my way with patience. The down side to this is that I will be away from my family for two months.  I know I will miss them terrible and I hope that while we are creating memories, this one will not be a sad one for them.  I know my husband will do a bang up job of being their for all of us, I just can't let the guilt eat me alive that I will be away from my babies for that length of time.  My choices of my reality are not easy ones to make nor to live with, but I know there is a reason for them. 

    My prayer to self " to maintain and restore peace, love, kindness, humbleness, and harmony within my self and with my family"