ON BEHALF OF TP NIH AND THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES AND INDIAN HEALTH
SERVICES I WOULD LIKE TO INVITE
EVERYONE FOR JOINING US WITH THE
RIVETING PANEL DISCUSSION,
HEALTH AND REPRODUCTIVE EQUITY
FOR ALL, TO DOULA OR NOT TO
DOULA.
THIS PANEL DISCUSSION LAUNCHES
THE EDI SERIES WHICH WILL
FEATURE ANNUAL WEBINARS FOCUSING
ON CHALLENGES FACING NATIVE
AMERICAN COMMUNITIES IN MATERNAL
AND CHILD HEALTH.
THE PURPOSE IS TO BRING
AWARENESS TO NATIVE AMERICAN
BIRTHING PEOPLE, CLINICAL
PROFESSIONALS IN TERMS OF CHILD
MORBIDITY.
HERE AT NIH, THE EUNICE KENNEDY
SHRIVER INSTITUTE OF HUMAN
DEVELOPMENT DEFINES MATERNAL
MORBIDITY ARE ANY SHORT-TERM OR
LONG-TERM PROBLEMS FROM BEING
PREGNANT AND GIVING BIRTH.
MATERNAL MORTALITY IS THE DEATH
OF A WOMAN FROM COMPLICATIONS OF
CHILDBIRTH THAT OCCUR WITHIN SIX
WEEKS AFTER THE PREGNANCY EARNS.
WE WILL DEFINE IT AS SIX WEEKS
TO ONE YEAR AFTER PREGNANCY
ENDS.
I WOULD LIKE TO INTRODUCE OUR
DISTINGUISHED PANELISTS WHO ARE
LEADING THIS PANEL ON THIS
SERIOUS HUMAN HEALTH CRISIS THAT
AFFECTS FUTURE GENERATIONS.
THE ORDER OF THE AGENDA TODAY
WILL CARRY ON THE DISCUSSION
ABOUT THEIR PROFESSION, THE
IMPORTANT WORK THAT THEY DO AND
WILL ENGAGE IN QUESTION AND
ANSWERS AT THREE DIFFERENT
POINTS THROUGHOUT THIS
PRESENTATION WITHIN THIS PANEL
DISCUSSION.
SO NEXT PLEASE JOIN ME IN
WELCOMING A TRAIL BLAZING
ENTREPRENEUR, ADVOCATE AND THE
FOUNDING EXECUTIVE DIRECTOR OF
HUMMINGBIRD INDIGENOUS FAMILY
SERVICES, DIRECTOR CAMIE
GOLDHAMMER.
THANK YOU FOR COMING.
NEXT JOIN ME IN WELCOMING A
PHYSICIAN SCIENTIST SPECIALIZING
IN OBSTETRICS AND GYNECOLOGICAL
CARE FOR ADOLESCENTS AND
BIRTHING PEOPLE THROUGH ALL
THEIR LIFE STAGES, DR. REIESHA
GRAHAM.
THANK YOU BOTH FOR JOINING US
TODAY.
BEFORE WE BEGIN WITH THE
QUESTIONS FOR TODAY, I WOULD
LIKE TO ASK EACH OF OUR
PANELISTS TO TELL US MORE ABOUT
YOURSELVES AND YOUR PROFESSION.
WE'LL START WITH DIRECTOR
GOLDHAMMER.
PLEASE TELL US ALL MORE ABOUT
WHAT YOU DO AND HOW YOUR COMPANY
GOT STARTED.
>> YES.
THANK YOU SO MUCH, CLARISSA, FOR
HAVING ME.
[ SPEAKING NATIVE LANGUAGE ]
CAMIE GOLDHAMMER.
SO GOOD MORNING, RELATIVES, GOOD
DAY RELATIVES FOR THOSE OF YOU
ON THE EAST COAST.
MY NAME IS A CAMIE GOLDHAMMER.
I AM A DAKOTA WOMAN, I USE
SHE/HER PRONOUNS.
MY TRIBE IS SISSETON-WAHPETON
OYATE.
I'M GLAD TO LIVE IN THE HOME OF
THE DUWAMISH PEOPLE IN SEATTLE.
I'M A FULL SPECTRUM DOULA AND
LACTATION CONSULTANT.
I AM -- I HAVE SPENT NEARLY 20
YEARS WORKING IN MATERNAL CHILD
HEALTH IN THE NATIVE COMMUNITY
WITH THE LAST 15 OR SO DEVOTED
TO THE RECLAMATION AND
REMATRIATION OF OUR BIRTH AND
BREAST FEEDING PRACTICES.
I'M VERY HAPPY TO BE HERE ON DAY
TWO OF INDIGENOUS MEDICINE WEEK
IN ADDITION TO INDIGENOUS
PEOPLE'S DAY.
HUMMINGBIRD INDIGENOUS FAMILY
SERVICES, THE NONPROFIT I RUN IN
SEATTLE, WE SUPPORT NATIVE MOMS
AND THEIR FAMILIES.
WI BELIEVE THE BEST THING FOR A
NATIVE BABY IS TO LOVE AND TAKE
CARE OF THEIR NATIVE MOTHER AND
LIFE GIVER AND WE HAVE COMMITTED
TO DO THAT AND WE DO THAT
THROUGH SEVERAL PROGRAMS,
INCLUDING HOME VISITING, A
GUARANTEED BASIC INCOME PROGRAM
WHICH GIVES NATIVE MOMS $1250 NO
STRINGS ATTACHED CASH ONCE A
MONTH THROUGH THREE YEARS.
WE ARE DOULAS.
ALL OF THE PROGRAMS STAND ON THE
FOUNDATION OF THE DOULA PROGRAM.
I HAVE BEEN A DOULA FOR ALMOST
15 YEARS, STILL ATTEND BIRTHS.
JUST HAD A TALK LAST NIGHT ABOUT
HOW I'M GOING TO BE ON CALL THIS
WEEKEND FOR BIRTHS BECAUSE ALL
OF OUR DOULAS ARE DOING AMAZING
THINGS.
I'M SURE OTHERS MIGHT BE
FAMILIAR WITH BABY BOOMS, BUT WE
HAVE A LOT OF BIRTHS HAPPENING
RIGHT NOW.
WE ARE REALLY LUCKY TO BE
TRUSTED BY THE LOCAL URBAN
NATIVE AMERICAN COMMUNITY.
WE SERVE NATIVE HAWAIIAN AND
PACIFIC ISLANDER MOMS AND THEIR
FAMILIES, TOO.
I'M GRATEFUL FOR THIS
OPPORTUNITY AND TIME TO BE WITH
YOU ALL TO TALK MORE ABOUT WHAT
WE DO AS DOULAS.
>> THANK YOU SO MUCH.
AND DR. GRAHAM, PLEASE DO TELL
US MORE ABOUT YOUR PROFESSION
AND WHY YOU STARTED SPECIFICALLY
HAVING AN INTEREST IN THIS TYPE
OF MEDICINE, THIS PARTICULAR
SPECIALIZATION.
>> GOOD MORNING.
THANK YOU SO MUCH FOR HAVING ME.
I AM DR. REIESHA GRAHAM.
I HAVE BOTH AN M.D. AND PH.D.
AND I AM A BOARD CERTIFIED
OB/GYN HERE WORKING IN MY HOME
STATE OF DELAWARE WHERE I AM
PART OF THE NANAKOKE TRIBE HERE
IN DELAWARE.
GROWING UP, YOU KNOW, BEING A
TRIBAL WOMAN, WE PUT AN EMPHASIS
ON THE WOMEN OF OUR COMMUNITY,
THE LIFE GIVERS IN OUR
COMMUNITY.
AND CARING FOR THEM HAS JUST
BEEN A HUGE PART OF MY LIFE
GROWING UP.
AND SO IT ONLY SEEMED NATURAL TO
BECOME AN
OBSTETRICIAN/GYNECOLOGIST TO
CONTINUE TO CARE FOR WOMEN ALL
STAGES OF THEIR LIVES IN MY
PROFESSIONAL REALM AS WELL.
SO I DO FULL SCOPE OB/GYN.
I ALSO AM TRAINED IN LACTATION
AS WELL.
I SERVE MOST OF OUR LACTATION
NEEDS FROM A PRACTICE
STANDPOINT.
WE ALSO PARTNER WITH LACTATION
CONSULTANTS WITH OUR PRACTICE,
IN OUR HOSPITAL SYSTEM.
I'M HAPPY TO BE THAT RESOURCE
FOR OUR PATIENTS.
FOCUSING ON PATIENT CENTERED
CARE FOR OUR PATIENTS BECAUSE
THAT MEANS THE MOST TO THEM.
>> EXCELLENT.
I CAN'T HELP BUT NOTICE THE
CROSSOVER AND SIMILARITIES
BETWEEN THE WORK YOU DO, HOW IT
LAYERS INTO ONE ANOTHER.
DIRECTOR GOLDHAMMER, CAN YOU
EXPLAIN MORE ABOUT WHAT A
LACTATION COUNSELOR OR LACTATION
CONSULTANT IS AND WHAT THEY DO
AND EXPLAIN MORE ABOUT WHAT
DOULA SERVICES ENTAIL?
>> I WOULD BE HAPPY TO.
SO THE BEST WAY THAT I DESCRIBE
A DOULA IS SPECIFICALLY AN
INDIGENOUS DOULA, WE GET ASKED
THAT A LOT, WHAT MAKES YOU
DIFFERENT THAN OTHER DOULAS.
THE SIMPLEST WAY I PUT IT IS WE
FULFILL THAT TRADITIONAL ROLE OF
AN AUNTIE.
WHEN WE LOOK AT COMMUNITIES
PRECONTACT OR PRECOLONIZATION
AND MAKE GUESSES AND LOOK AT
ANTHROPOLOGICAL STUDIES AND WHAT
LIFE WAS LIKE FOR BIRTHING
PEOPLE PRIOR TO CONTACT WHAT WE
KNOW IS THEY WERE CARED FOR BY
THE COMMUNITY.
AND THEY DIDN'T NECESSARILY HAVE
DOULAS OR LACTATION CONSULTANTS
OR COUNSELORS, BUT THEY HAD
AUNTIES AND THEY HAD MOMS AND
THEY HAD GRANDMAS AND THEY HAD A
FORCE OF PEOPLE WHO HAD CULTURAL
KNOWLEDGE OF HOW TO SUPPORT
PEOPLE AFTER OR DURING THE PERE
NATAL PERIOD.
AS DOULAS, THAT IS WHAT WE ARE
DOING.
WE ARE FULL SPECTRUM DOULAS,
WHICH MEANS WE SUPPORT PEOPLE
REGARDLESS OF THE OUTCOME OF
THEIR PREGNANCIES.
WE SUPPORT PEOPLE EXERCISING
THEIR RIGHT TO TERMINATE THEIR
PREGNANCIES, EXPERIENCING OTHER
TYPES OF PREGNANCY LOSS.
BUT THE OVERWHELMING FAMILIES
WHO COME TO US ARE HOPING TO
PARENT AND PLANNING TO PARENT
THEIR CHILDREN.
WE KNOW A FEW THINGS ABOUT
PREGNANCY AND CHILDBIRTH SO WE
CAN GIVE THAT ADDITIONAL
KNOWLEDGE, HELP TRANSLATE SOME
OF THE INFORMATION THEY LEARN AT
MEDICAL APPOINTMENTS, THINGS
LIKE THAT.
BE SOMEONE TO PROVIDE
INFORMATION SO THEY CAN BE
EMPOWERED TO MAKE A DECISION
BASED ON WHAT IS BEST FOR THEIR
FAMILY.
WE KNOW THE BIRTH COMMUNITY SO
WE ABSOLUTELY WILL SAY DON'T GO
TO THAT HOSPITAL.
DON'T USE THAT DOCTOR.
OR THIS IS A MIDWIFE WE TRUST OR
A PROVIDER THAT WILL TREAT OUR
FAMILIES WELL.
THOSE KINDS OF THINGS.
POSTPARTUM WE ARE THERE.
WE GENERALLY WILL BE THERE
BECAUSE MOST OF OUR FAMILIES
DELIVER IN HOSPITAL SO THEY ARE
COMING HOME 24 TO 48 HOURS AFTER
THEY HAVE THEIR BABY.
AND WE ARE THERE, HAVE THEIR
HOUSE WARMED UP, PICKED UP, A
GOOD TRADITIONAL MEAL OF
WHATEVER, WHETHER THAT IS
BUFFALO OR SALMON OR WHATEVER.
WE DO A LOT OF RESEARCH IN WHAT
MAKES MOST SENSE FOR THE FAMILY.
AND WE JUST HELP THEM REALLY
TAKE CARE OF THEIR BABIES AND
ANSWER ANY QUESTIONS AND BE OF A
SUPPORT FOR THEM.
AS LACTATION COUNSELORS OR
LACTATION CONSULTANTS, I'M A
CONSULTANT, MY STAFF ARE
LACTATION COUNSELORS, WE ARE
PROVIDING SUPPORT TO OUR
FAMILIES TO MEET THEIR BREAST
FEEDING GOALS.
WE HAVE 100% BREAST FEEDING
INITIATION RATE SO 100% OF OUR
FAMILIES WANT TO BREAST FEED.
AS MANY OF YOU PROBABLY KNOW
ABOUT 60% OF PEOPLE DON'T
IMMEDIATE THEIR BREASTFEEDING
GOALS IN THE UNITED STATES.
WHEN WE BREAK THAT DOWN BY
COMMUNITIES OF COLORS,
SPECIFICALLY BLACK AND
INDIGENOUS COMMUNITIES WE SEE
EVEN MORE PEOPLE NOT MEETING
THEIR GOALS.
AND SO A LOT OF WHAT WE DO IS
PROVIDE SUPPORT, ANSWER FEEDING
QUESTIONS, ANSWER THOSE CALLS AT
2:00 A.M., WORRIES ABOUT NOT
MAKING ENOUGH MILK, ALL OF THOSE
KINDS OF THINGS.
AND WHAT THE DOULAS, WHEN IT
REACHES THE DOULAS SCOPE OR
THEIR KNOWLEDGE BASE THAT IS
WHEN THEY REACH OUT TO ME AND
THAT IS THE MAJORITY OF MY HOME
VISITS DOING THE MORE COMPLEX
LACTATION CHALLENGES.
>> IT IS AMAZING THAT WITH THIS
TYPE OF IMPORTANT WORK THAT IT
IS NOT COVERED BY EVERY FORM OF
INSURANCE.
THERE ARE SOME LAWS AND STATES
THAT ALLOW FOR THE COVERAGE OF
DOULA SERVICES AND WE'LL BE
DISCUSSING A LITTLE MORE ABOUT
THAT.
I THINK IT IS ALSO IMPORTANT
THAT WE LEVEL SET AND LET THE
AUDIENCE KNOW YOU WILL BE ABLE
TO ASK QUESTIONS AND BOTH
PANELISTS WILL ANSWER YOUR
QUESTIONS.
THERE WILL BE THREE POINTS IN
THIS PANEL DISCUSSION TO ANSWER
THE QUESTIONS YOU HAVE.
FEEL FREE TO PUT QUESTIONS IN
THE Q&A BECAUSE THEY WILL BE
ANSWERED.
ADDITIONALLY, I WANT TO MAKE
SURE EVERYONE UNDERSTANDS THE
DIFFERENT STAGES OF REPRODUCTIVE
PROCESS.
DR. GRAHAM, CAN YOU PROVIDE A
LITTLE INFORMATION WHAT IS
POSTPARTUM, WHAT IS PRENATAL
PERIOD AND GIVE THEM PERSPECTIVE
ON THAT?
>> YES.
SO AS AN OB/GYN, MY CARE OF
WOMEN IN GENERAL BUT BIRTHING
WOMEN OR ASSIGNED WOMEN FEMALE
AT BIRTH PATIENTS, IT
ENCOMPASSES THE VERY BEGINNING.
WHEN WE ARE FIRST ENCOUNTERING
OUR MOON AND COMING ON TO OUR
CYCLE AND JOURNEY THROUGHOUT
WOMANHOOD WELL BEFORE WE BECOME
CONSIDERING FAMILY HAVING.
SO A LOT OF PEOPLE THINK OF
OB/GYNs IS JUST WHERE YOU GO
WHEN IT IS TIME TO HAVE
CHILDREN.
BUT THERE ARE A LOT OF
VARIATIONS IN OUR GENETICS AND
OUR DNA, IN OUR CYCLES AND
THINGS WE ARE THERE TO HELP FOR.
WITH RESPECT TO BIRTHING
PERSONS, I THINK ALL OB/GYNs, IT
IS OUR HOPE AND GOAL THAT WE CAN
BUILD THOSE RELATIONSHIPS BEFORE
THEY BECOME PREGNANT AND HAVE
PRENATAL VISITS OR PRECONCEPTION
VISITS TO GET TO KNOW THAT
FAMILY, TO GET TO KNOW AND
OPTIMIZE THEIR MEDICAL HEALTH IN
PREPARATION FOR PREGNANCY,
MAKING SURE THEY ARE INITIATING
PRENATAL VITAMINS WELL BEFORE
THEY NEED IT, BEFORE THEY BECOME
PREGNANT AND GET THEM
ESTABLISHED IN THE CARE NETWORK
AND SYSTEM AND ATTACHED TO ALL
THE RESOURCES THAT ARE AVAILABLE
WELL BEFORE THEY FIND OUT THEY
ARE PREGNANT.
THAT IS OUR IDEAL GOAL.
I KNOW THAT IS NOT THE MOST
REALISTIC.
SO PATIENTS COME TO US AT VERY
DIFFERENT POINTS OF THEIR
JOURNEYS AND CERTAINLY THERE ARE
A LOT OF DIFFERENT HEALTH CRISES
IN AMERICA LIMITING PATIENTS'
ACCESS TO CARE NATIONWIDE.
UNFORTUNATELY, EVEN THOUGH
PATIENTS WOULD PREFER TO START
THAT INTERACTION, AT THE FIRST
PREGNANCY TEST OR WELL BEFORE
THAT THERE ARE BARRIERS FOR THEM
BEING ABLE TO DO SO.
SOMETIMES APPOINTMENTS ARE JUST
NOT AVAILABLE DUE TO A LIMITED
NUMBER OF, YOU KNOW, BIRTH
WORKERS, PROVIDERS, PHYSICIANS
IN THEIR COMMUNITIES.
SO WE TRY TO GET THEM IN AND SEE
THEM AS SOON AS WE CAN.
YOU THEN CARE FOR THAT PATIENT
THROUGHOUT THEIR PREGNANCY.
PRENATAL VISITS IN THE BEGINNING
ARE USUALLY MONTHLY AND AS YOU
TRANSITION THROUGH THE DIFFERENT
TRIMESTERS OF PREGNANCY THEY
BECOME MORE FREQUENT TOWARDS THE
END, YOU ARE SEEING THEM EVERY
TWO WEEKS OR WEEKLY, SOMETIMES
TWICE WEEKLY IF THEY HAVE OTHER
MEDICAL CO-MORBIDITIES OR
CONDITIONS YOU ARE CONCURRENTLY
MANAGING.
THE POSTPARTUM PERIOD IS
TRADITIONALLY DETERMINED TO BE
THE SIX WEEKS FOLLOWING
PREGNANCY.
HISTORICALLY WE'VE ONLY SEEN
PATIENTS AT THAT SIX-WEEK VISIT,
BUT I THINK SCIENCE AND DATA AND
HEALTH OUTCOMES HAVE SHOWN THAT
IS JUST NOT EFFICIENT.
PATIENTS ARE EXTREMELY
VULNERABLE IN THOSE FIRST FEW
DAYS TO WEEKS.
AND SO THE AMERICAN COLLEGE OF
OB/GYN IS PUSHING FORWARD TO
HAVE AT LEAST ONE TO TWO WEEK
VISIT WITH ALL WOMEN, REGARDLESS
OF THEIR HEALTH STATUS.
JUST TO CHECK IN, TO BE THERE
FOR THEM, TO HELP THEM NAVIGATE
THE CHANGES IN THEIR BODY,
PHYSIOLOGICALLY AND CHALLENGES
FOR THAT PATIENT.
UNFORTUNATELY, A LOT OF THE
SYMPTOMS OF COMPLICATIONS OF
PREGNANCY, LIKE PRECLAMSIA,
THINGS THAT ARE KILLING OUR
PATIENTS AT RECORD RATES ARE
VERY SUBTLE.
SOMETIMES THAT PATIENT BEING IN
THE THROES OF MOTHERHOOD AND
FOCUSING ON CARING FOR HER BABY,
THE SIGNS ARE NOT RECOGNIZED BY
THE PATIENT, SOMETIMES NOT EVEN
BY THE FAMILY.
IF YOU HAVE BEEN ABLE TO
ESTABLISH A RELATIONSHIP WITH
THAT PATIENT, THEN YOU KNOW WHEN
THINGS ARE DIFFERENT FOR THAT
PATIENT.
I THINK THAT IS WHAT DOULA
SUPPORT SERVICES AND MIDWIFERY
CARE ARE SO IMPORTANT BECAUSE
THEY CAN ACTUALLY BE THE EYES
AND EARS ON THAT PATIENT TO
BUILD THOSE RELATIONSHIPS AND BE
PHYSICALLY PRESENT AND ADVOCATE
FOR THAT PATIENT ESPECIALLY WHEN
THEY DON'T EVEN KNOW THEY NEED
TO.
EVEN IF THEY ARE HAVING SYMPTOMS
THEY DON'T RECOGNIZE AS BEING
CONCERNING.
BUT TRULY TRADITIONALLY, THE
BIRTHING TIME PERIOD REALLY
EXTENDS FAR BEYOND THAT SIX
WEEKS.
WE THINK ABOUT LACTATION AND
SPECIFICALLY THE WORLD HEALTH
ORGANIZATION SUPPORTS LACTATION
UP TO YEAR TWO OF LIFE.
AND SO WE CAN'T JUST FORGET
ABOUT THESE PATIENTS AND TURN
OUR BACK ON THEM AT THE SIX-WEEK
VISIT.
THEY ARE HAVING NUANCED
DIFFERENCES IN THEIR HEALTH UP
TO ONE TO TWO YEARS AFTER CHILD
BEARING.
>> I THINK THAT IS A REALLY
STRONG POINT AND I WANTED TO
PRESENT A QUESTION TO DIRECTOR
GOLDHAMMER BECAUSE SHE'S IN THE
COMMUNITY AND LIKE YOU
MENTIONED, DOULA SERVICES ARE
ABLE TO BE THERE AND BE PRESENT
WHERE IT IS NOT FEASIBLE FOR THE
CLINICAL PROFESSIONAL TO
CONTINUE ON WITH CARE.
THAT CARE HAS SHOWN TO HAVE
INCREASED POSITIVE OUTCOMES AND
REDUCED THE NEGATIVE
CO-MORBIDITIES AND MORTALITY
RATES.
SO MY QUESTION STEMS FROM IN
2019 THE WORLD HEALTH
ORGANIZATION IN COLLABORATION
WITH THE UNITED NATIONS
POPULATIONS DIVISION, UNICEF
PUBLISHED A REPORT CALLED TRENDS
IN 2000 TO 2017.
EVEN THOUGH THERE WAS A
WORLDWIDE DECREASE OF MATERNAL
MORTALITY RATE, THE UNITED
STATES WAS ONE OF TWO THAT
REPORTED AN INCREASE OF
PROPORTION OF PREGNANCIES THAT
RESULT IN DEATH OF THE BIRTHING
PERSON.
IN A DATA BRIEF PUBLISHED BY
COMMONWEALTH.ORG IN DECEMBER
2020 REPORTED RACE AND ETHNICITY
WAS TIED TO THE DIFFERENT CAUSES
OF DEATH AND THE PAPER STATED
THAT BLACK WOMEN AND NATIVE
AMERICAN WOMEN AND BIRTHING
PEOPLE HAVE A MARKEDLY HIGHER
MATERNAL MORTALITY RATE THAN
WOMEN OF ANY OTHER RACES.
I JUST WANTED TO ASK YOU,
DIRECTOR GOLDHAMMER, WHAT ARE
YOUR THOUGHTS ON THAT FROM YOUR
PERSPECTIVE?
WHAT DO YOU THINK IS THE
CONTRIBUTING FACTOR TO THIS HIGH
NUMBER?
>> YEAH.
THANK YOU FOR THAT QUESTION.
I THINK IT'S -- THERE ARE SO
MANY DIFFERENT THINGS.
I SAID THIS IN OUR PRETALK THAT
I ALWAYS JUST WANT TO
ACKNOWLEDGE MY PRIVILEGE AS
SOMEONE WHO IS NOT ACTUALLY
RESPONSIBLE FOR SOMEONE'S LIFE
AS A PROVIDER IS.
I RECOGNIZE IT IS EASY FOR ME AS
SOMEONE OUT OF A HOSPITAL TO SAY
ALL THE THINGS THAT ARE GOING
WRONG.
WITH THAT BEING SAID, I HAVE
SERVED THOUSANDS OF PREGNANT AND
PARENTS FAMILIES AND I HAVE A
LOT OF EXPERIENCE -- AND ALL OF
THEM HAVE BE NATIVE.
100% OF THE PEOPLE I SERVE ARE
NATIVE OVER MY CAREER.
WHILE THERE'S MANY THINGS THAT
MIGHT BE CONTRIBUTING TO IT AND
I WILL ADDRESS THOSE, I THINK
WHAT I THINK IS REALLY IMPORTANT
TO ACKNOWLEDGE WHAT IS NOT
CONTRIBUTING TO IT IS NATIVE
PEOPLE IN OUR COMMUNITY AND OUR
BODIES.
TOO OFTEN I FIND THAT WHEN IT
COMES TO MATERNAL MORTALITY,
MAINSTREAM KIND OF SOCIETY
REALLY WANTS TO BLAME IT ON
NATIVE MOMS BEING TOO FAT, TOO
UNHEALTHY, TOO ADDICTED, TOO,
TOO, TOO.
RIGHT?
AND THAT IS SIMPLY JUST NOT THE
CASE.
WE WANT TO SEE THE DISPARITIES
THAT WE DO AND IT REALLY IS
COMPLEX STRESS AND TRAUMA,
SYSTEMIC RACISM AND OPPRESSION
THAT IS CONTRIBUTING TO IT AND
HOW WE KNOW THAT IS THE 80% OF
MATERNAL DEATHS ARE PREVENTABLE.
THE FACT THEY ARE PREVENTABLE,
AS DEPRESSING AS THAT STAT MAY
BE, I'M A GLASS HALF FULL
OPTIMIST, MAN, WE CAN ONLY GO UP
FROM THERE.
AND HOW INCREDIBLE IS IT THAT WE
HAVE WITHIN OUR GRASP THE
ABILITY TO PREVENT THE DEATHS,
80% OF DEATHS, RIGHT?
THOSE ARE STATS THAT MOST
PROVIDERS WOULD LOVE TO BE ABLE
TO BE ABLE TO HAVE AN IMPACT ON.
I SIT ON THE MATERNAL REVIEW
PANEL FOR WASHINGTON STATE, HAVE
FOR SEVERAL YEARS.
WHEN WE MAKE OUR RECOMMENDATIONS
TO OUR STATE LEGISLATURE ABOUT
WHAT WE CAN DO TO PREVENT DEATH,
IT IS ADDRESSING SYSTEMIC RACISM
AND OPPRESSION, PROVIDING BASIC
NEEDS TO FAMILY.
THE FINANCIAL STRESS FOR MANY OF
OUR FAMILIES AND THE INABILITY
TO ACCESS THEIR BASIC NEEDS
REALLY CONTRIBUTES TO A LOT OF
THIS STRESS AND MENTAL HEALTH
CHALLENGES THAT NATIVE FAMILIES
ARE EXPERIENCING.
THIS IS SOMETHING WHEN I THINK
ABOUT MATERNAL MORTALITY AND
INFANT MORTALITY THAT ARE SO
CLOSELY TIED BECAUSE BLACK AND
NATIVE BABIES HAVE HIGH INFANT
MORTALITY IN OUR COUNTRY AS
WELL.
I BELIEVE IT IS NOT OUR FAULT AS
NATIVE MOMS AND FAMILIES AND
COMMUNITY.
RIGHT?
WE DIDN'T CREATE THIS PROBLEM
BUT WE CERTAINLY HAVE THE
ANSWERS.
AND IT IS REALLY IMPORTANT THAT,
I THINK, HEALTH CARE PROVIDERS,
POLICY MAKERS, FOLKS THAT ARE
PROBABLY HERE TODAY LISTENING TO
US UNDERSTAND THAT THE ANSWER IS
IN THE COMMUNITY AND WE HAVE
PRETTY INCREDIBLE OUTCOMES WHEN
WE ARE GIVEN THE FREEDOM TO LOVE
OUR COMMUNITY UNCONDITIONALLY
AND PROVIDE THEM WITH WHAT THEY
NEED.
>> I ABSOLUTELY AGREE WITHOUT A
DOUBT.
THAT BRINGS ME TO ANOTHER
QUESTION.
IN A PAPER THAT WAS PUBLISHED IN
2021, IT WAS DISCUSSING HOW
HISTORICAL TRAUMA IS CONSIDERED
TO BE A SIGNIFICANT SOCIAL
DETERMINANT OF HEALTH FOR NATIVE
AMERICAN BIRTHING PEOPLE.
PER THE PAPER IT STATED THAT
HISTORICAL TRAUMA MANIFESTED
ITSELF IN SUBSEQUENT GENERATIONS
AS CO-MORBIDITIES, SUCH AS
MENTAL HEALTH ISSUES,
DEPRESSION, SUBSTANCE USE,
INTIMATE PARTNER VIOLENCE,
DIABETES AND OTHER ADVERSITIES
THAT DAMAGE THE SOCIAL
DETERMINANTS OF HEALTH.
MY QUESTION WOULD BE TO DR.
GRAHAM.
AS WE STATED THIS IS A
COMMUNITY-BASED ISSUE, IT HAS
HAD A GLOBAL IMPACT, RIGHT?
HOW CAN CLINICAL PROFESSIONALS
AND DOULAS WORK TOGETHER TO COME
PAT THESE SOCIAL DETERMINANTS
THAT IMPACT NATIVE AMERICAN
BIRTHING PEOPLE.
>> I FULLY AGREE WITH DIRECTOR
CAMIE GOLDHAMMER.
IT IS ABOUT KNOWING YOUR
COMMUNITY, KNOWING THESE WOMEN,
GETTING TO KNOW THEM AS PEOPLE,
NOT JUST A NUMBER, NOT JUST A
PATIENT, BUT UNDERSTANDING EVERY
ASPECT OF THEIR LIVES AND
EVERYTHING THAT IS GOING INTO
MAKING THEM WHO THEY ARE.
IT IS BUILDING RELATIONSHIPS AND
TRUST, THAT YOU HAVE THE SAME
GOAL AT HAND.
THAT IS ABSOLUTELY FUNDAMENTALLY
CRITICAL FOR MAKING ANY
DIFFERENCE, RIGHT?
WE HAVE SEEN THIS HISTORICALLY
THROUGHOUT THE DECADES THROUGH
OUR HISTORICAL TRAUMA IN OUR
NATIVE COMMUNITIES.
THE UTTER LACK OF TRUST BECAUSE
HOBBLE THINGS HAVE HAPPENED TO
BIRTHING WOMEN.
WE HAVE THOUSANDS UPON THOUSANDS
OF MISSING INDIGENOUS WOMEN AND
CHILDREN ACROSS THIS NATION,
WOMEN THAT ARE INVISIBLE, THAT
ARE DISAPPEARING AT
UNPRECEDENTED RATES.
AND NO ONE IS DOING ANYTHING
ABOUT IT.
WE HAVE WOMEN THAT ARE RAPED AND
MOLESTED AND VICTIMIZED AND NO
ONE IS DOING ANYTHING ABOUT IT.
WE HAVE TAKEN SYSTEMICALLY,
SANCTIFIED BY OUR FEDERAL
GOVERNMENT TAKING FAMILIES FROM
INDIGENOUS NATIVE LANDS THAT
WERE FRUITFUL AND THEY CAN
THRIVE AND GROW AND RELOCATE
THEM TO BARREN LANDS THEY CAN'T
GROW ANYTHING ON.
SO I THINK EVEN WHEN WE LOOK
BACK AT SOME OF THE MEDICAL
CONDITIONS AT HIGHER RATES IN
OUR COMMUNITIES, BOTH
AFRICAN-AMERICAN AND NATIVE
AMERICANS, IT STEMS FROM ALL
THOSE THINGS, RIGHT?
OUR BODY'S ABILITY TO PROCESS
SALT IS DIFFERENT FUNDAMENTALLY,
PHYSIOLOGICALLY, IT IS
DIFFERENT.
IF THE FOODS WE HAVE ACCESS TO
AT A CHEAPER RATE ARE HIGH IN
SALT CONTENT, HIGH IN PROCESSED
FOODS, HIGH IN ALL OF THESE
THINGS THEN WE DO NOT THRIVE.
IF WE LOOK AT SUGAR AND
DIABETES, THOSE THINGS ARE HIGH
IN OUR COMMUNITY, BUT NOT
BECAUSE INHERENTLY WE HAVE A
PROBLEM.
IT STEMS DOWN FROM ALL OF THOSE
YEARS AND OUR CIRCUMSTANCE.
SAME FOR MENTAL HEALTH,
DEPRESSION, SUBSTANCE ABUSE.
THESE ARE ALL PRODUCTS OF THE
SYSTEMIC RACISM, THE HISTORIC
OPPRESSION AND SITUATIONS THAT
WE HAVE FOUND OURSELVES IN.
YOU KIND OF NAVIGATE THAT
FURTHER INTO A VERY COMPLEX
HEALTH CARE SYSTEM THAT MAKES IT
HARD FOR PATIENTS TO ACCESS
CARE, HARD FOR THEM TO REALLY
BUILD RELATIONSHIPS.
YOU KNOW, THEY APPROACH THE
SYSTEM THEN FROM A PLACE OF
DISTRUST, MISTRUST, OF
SKEPTICISM, OF FEAR.
AND TRADITIONALLY I THINK WE ARE
ALSO RAISED AND INGRAINED TO
KIND OF FLY BELOW THE RADAR, NOT
RUFFLE FEATHERS, NOT ASK
QUESTIONS.
RIGHT?
SO MANY OF THE PATIENTS I SEE,
MANY OF THE FAMILIES I
ENCOUNTER, MANY OF MY OWN
FAMILY, YOU KNOW, THEY WILL GO
TO THE DOCTOR'S APPOINTMENT,
THEY WILL GO TO THE VISITS AND
WILL BE QUOTE-UNQUOTE COMPLIANT
WITH CARE BUT THEY HAVE NO IDEA
WHAT HAPPENED BECAUSE THEY
WEREN'T ACTIVELY PARTICIPATING.
THEY DIDN'T UNDERSTAND WHAT
HAPPENED.
THEY DID NOT AT THE END OF THE
DAY FEEL HEARD.
I'M SURE, YOU KNOW, DIRECTOR
HUMMINGBIRD WILL SAY THE SAME
THAT HER PATIENTS COME BACK TO
HER TO SAY, HEY, WHAT HAPPENED?
IS I DON'T EVEN KNOW.
I SEE IT IN MY ASSOCIATE CIRCLES
AND MY INTERACTIONS IN MY
COMMUNITY WITH FAMILY MEMBERS,
FRIENDS, COLLEAGUES, THAT ARE
JUST LIKE, I WENT TO THE DOCTOR,
I HAD ALL THE VISITS AND I HAVE
NO IDEA WHAT HAPPENED.
I HAVE NO IDEA WHY THEY ARE
RECOMMENDING THIS TREATMENT,
THIS EARLY INDUCTION, THIS
DELIVERY, THIS CAESAREAN WHICH
IS CRITICAL TO THEIR CARE AND
THEY JUST DON'T KNOW.
IT IS NOT BECAUSE THEY ARE
UNEDUCATED.
IT IS NOT BECAUSE -- WE FAILED
TO BUILD THE RELATIONSHIPS AND
WE FAILED TO BUILD THE TRUST
THAT ALLOWS THEM TO OPEN UP TO
US AS HEALTH CARE PROFESSIONALS
TO BE ABLE TO HAVE THAT CORE
FUNDAMENTAL UNDERSTANDING.
TO HAVE THE IMPACT ON HEALTH
OUTCOMES THAT WE HOPE TO HAVE.
>> ABSOLUTELY.
ONE OF THE THINGS I WANT TO JUST
POINT IN FACT AS A MIXED RACE
PERSON WHO IS ALSO A NATIVE
WOMAN, THE WEATHERING HYPOTHESIS
DOES SUGGEST CUMULATIVE STRESS
OF RACISM, SOCIOECONOMIC
DISADVANTAGE DOES PRODUCE
WEATHERING EFFECT AND EXPLAINS
DISPARITY OUTCOMES ACROSS LIFE
SPANS.
THIS HAPPENS NOT JUST IN WOMEN
AND BIRTHING PERSONS THAT MAY
NOT HAVE GOTTEN PAST HIGH SCHOOL
EDUCATION, BUT THIS IS FOR
PROFESSIONALS, PEOPLE WHO HAVE
MARYL
M.D. AND PH.D.s, PEOPLE AT THE
PINNACLE OF THEIR FIELDS ARE
SUFFERING AT THE SAME RATES AS
THOSE WITHOUT EDUCATION OR THOSE
WITH SOCIOECONOMIC HIGHER
STANDINGS.
SO IT HAS NOTHING TO DO WITH
EDUCATION, TO BE CLEAR.
AND ALSO TO BE CLEAR, IT IS MORE
THAN JUST A HISTORICAL CONTEXT.
BECAUSE AS RECENT AS 2021, THE
FIRST PEOPLE OF CANADA ARE STILL
EXPERIENCING THEIR CHILDREN
BEING TAKEN FROM THEM.
AND THIS IS A FACT.
THIS IS DOCUMENTED IN WHITE
PAPERS.
AND SO IT'S NOT JUST AN
UNFOUNDED FEAR.
THIS IS REALISTICALLY SOMETHING
THAT STILL TAKES PLACE TODAY.
AND PEOPLE WERE SHIPPED TO
BOARDING SCHOOLS IN RECENT YEARS
IN A GENERATION WHEN WE ARE
ALIVE, WE WERE HERE WHEN
BOARDING SCHOOLS WERE OPEN IN
THE UNITED STATES.
UNDERSTANDING A HISTORICAL
CONTEXT HAS VALIDITY BUT
UNDERSTAND FOOD DESERTS ARE
INTENTIONAL BECAUSE YOU DON'T
FIND THEM IN WELL-TO-DO
NEIGHBORHOODS.
YOU DON'T FIND THEM IN PLACES
WHERE YOU HAVE A REDUCED NUMBER
OF NATIVE WOMEN OR WOMEN FROM
OTHER ETHNIC BACKGROUNDS.
SO SOME OF THESE THINGS CAN BE
ADDRESSED WITH THE SAME
INTENTIONALITY AS THE SYSTEMIC
PROCESSES THAT OPPRESS WOMEN OF
COLOR AND BIRTHING PEOPLE OF
COLOR OR PEOPLE IN GENERAL THAT
ARE NOT FROM THE DOMINANT
CULTURE ACROSS THE GLOBE.
WE CAN DO THINGS TO PREVENT IT.
THAT 80% PREVENTIBLE IS AN
ATTAINABLE GOAL.
SOMETHING THAT WE NEED TO
STRONGLY CONSIDER.
AT THIS POINT I WANT TO SEE IF
THERE ARE ANY QUESTIONS THAT
HAVE BEEN PRESENTED IN THE CHAT.
>> WHILE WE ARE LOOKING AT
QUESTIONS OR WAITING FOR
QUESTIONS I DO WANT TO SAY ALSO,
CLARISSA, JUST I GUESS ADD ON TO
WHAT YOU SAID AROUND INCOME AND
EDUCATION BECAUSE I THINK THAT'S
REALLY COMMON MAYBE, I'M NOT
FULLY SURE ABOUT THE FULL
AUDIENCE HERE, BUT I THINK IN
THE GENERAL POPULATION, I SAY
OUT ON THE STREETS A LOT OF
PEOPLE WOULD MUCH RATHER TALK
ABOUT THINGS LIKE POVERTY OR
LACK OF EDUCATION THAN RACE.
RIGHT?
AND THAT'S OFTEN BROUGHT UP AS
WELL, IT IS POVERTY THAT IS
CAUSING THIS.
IT IS LACK OF EDUCATION THAT IS
CAUSING THIS.
NO, IT'S NOT.
IT'S RACE.
OR RACISM.
RIGHT?
THERE IS NOTHING INHERENT ABOUT
US THAT MAKES US AT RISK.
IT IS THE WEATHERING, THE
SOCIETY WE ARE LIVING IN THAT
HAS QUITE FRANKLY BEEN BUILT FOR
US NOT TO BE HERE, RIGHT?
AND I THINK THAT IS SOMETHING
THAT IS REALLY IMPORTANT TO
ADDRESS THAT THERE IS NO
PROTECTIVE FACTORS WHEN IT COMES
TO MATERNAL MORTALITY WITH
INCOME AND EDUCATION AND SO AT
MY ORGANIZATION, WE ARE A SOCIAL
SERVICE AGENCY BUT WE SERVE
PEOPLE REGARDLESS OF THEIR
INCOME.
WE KNOW A NATIVE MOM IN
WASHINGTON STATE WHO IS A LAWYER
OR A DOCTOR, WHICH WE HAVE
SERVED, RIGHT, IS NOT ANY SAFER
THAN A HOMELESS NATIVE MOM WHO
HAS ACCESS TO VERY FEW
RESOURCES.
AND THAT IS FACT.
IT IS WHAT WE SEE AND WHAT THE
RESEARCH BACKS UP.
AGAIN, IT IS REALLY IMPORTANT
FOR FOLKS TO UNDERSTAND THAT
BECAUSE IT IS OFTEN USED AS A
WAY TO NOT TALK ABOUT RACE,
RIGHT?
>> YEAH.
>> TALK ABOUT POVERTY OR LACK OF
EDUCATION.
IT IS NOT -- IT OFFERS NO
PROTECTIONS FOR DR. GRAHAM OR I,
WHO HAVE GRADUATE DEGREES,
RIGHT?
ALL THE KNOWLEDGE, ALL THE
EXPERIENCE, RIGHT, AND WE'RE
STILL, IF WE WERE TO HAVE BABIES
TODAY IT WOULD STILL BE AT RISK
AS ANY OF OUR COUNTERPARTS,
RIGHT?
>> ABSOLUTELY.
SOME OF THE THINGS THAT HAVE
BEEN NOTED, I CAN READ IT OFF.
SOCIAL DETERMINANTS ARE CITED AS
CAUSES OF POOR PRENATAL
OUTCOMES.
AS YOU STATED AS POVERTY, LACK
OF EDUCATION AND THE
NEIGHBORHOOD LEVEL FACTORS
AFFECT THE MATERNAL OUTCOME.
I WOULD LIKE YOU BOTH TO ANSWER
TO SOME FACTORS UNIQUE TO NATIVE
AMERICAN COMMUNITIES AT THE
NEIGHBORHOOD LEVEL IN RURAL
AREAS, WHAT WE WOULD COMMONLY
CALL INDIAN COUNTRY AND URBAN
AREAS THAT NEGATIVELY IMPACT
NATIVE BIRTHING PEOPLES' ACCESS
TO QUALITY HEALTH CARE BASED ON
THEIR LOCATION?
DR. GRAHAM?
>> SO THOSE ARE TWO UNIQUE
DIFFERENT CIRCUMSTANCES, RIGHT?
AND BOTH INSTANCES SERVE
DIFFERENT CHALLENGES THAT ARE
UNIQUE.
HERE IN DELAWARE THE NANAKOKE
TRIBE I'M A PART OF, THAT I
MOVED BACK HOME TO SERVE, WE ARE
URBAN, WE HAVE INTEGRATED INTO
THE COMMUNITY.
WE STILL MAINTAIN OUR UNIQUE
TRIBAL CUSTOMS AND TRADITIONS,
BUT FOR THE MOST PART MANY
PEOPLE THROUGHOUT THE STATE CAN
WALK BY ALL OF US AND NOT KNOW
ANY OF US ARE HERE.
THAT WILLFUL BLIND IGNORANCE, IF
YOU WILL, TO AN ENTIRE EXISTENCE
OF PEOPLE THAT SERVES AS THE
FOUNDATION OF OPPRESSION.
WE DON'T SEE PEOPLE FOR WHO THEY
ARE.
THERE ARE PEOPLE WHO ARE
ADVOCATING COLOR BLINDNESS AND
EQUALITY FOR ALL AND NOT
IDENTIFYING RACE AT ALL.
I THINK THAT IS A HUGE
DISSERVICE.
WE ARE UNIQUE IN OUR CUSTOMS AND
TRADITIONS, EVEN AMONG INDIAN
COUNTRY, EACH TRIBE, SUBGROUP,
SUB FAMILIES WITHIN TRIBES WE
HAVE DIFFERENT THINGS THAT ARE
UNIQUE TO EACH OF US THAT MAKE
US ALL AMAZING.
WE HAVE TO HONOR AND RECOGNIZE
EACH AND EVERY ONE OF THOSE
FACETS.
IN ORDER TO TRULY SERVE THE
WHOLE PERSON AND TO PROVIDE
COMPREHENSIVE FULL CARE.
AND THAT IS UNIQUELY DIFFERENT
THAN ACCESS ISSUES OR OTHER
ISSUES THAT PEOPLE WHO ARE
LIVING ON RESERVATIONS OR
RESERVATION ADJACENT ENCOUNTER.
>> YOUR THOUGHTS AS WELL,
DIRECTOR GOLDHAMMER.
>> YEAH.
I THINK THERE ARE SO MANY
CHALLENGES THAT ARE BEING FACED
THROUGHOUT, YEAH, AS YOU SAID,
AS WE SAY INDIAN COUNTRY.
DEFINITELY WOULD ECHO WHAT DR.
GRAHAM SAID AROUND JUST THE
INVISIBILITY THAT WE EXPERIENCE
IN URBAN COMMUNITIES
SPECIFICALLY, RIGHT?
ABOUT 75% OF NATIVE PEOPLE LIVE
IN, YOU KNOW, OUTSIDE OF RURAL
COMMUNITIES.
OFF RESERVATION.
A LOT OF PEOPLE THAT LIVE CLOSE
TO THE RESERVATION, BUT LARGELY
IN URBAN AND SUBURBAN AREAS.
AND SO THAT INVISIBILITY PIECE
IS REALLY, REALLY BIG OF JUST
NOT BEING SEEN, NOT BEING
RECOGNIZED.
A LOT OF PEOPLE HAVE STEREOTYPES
OF WHAT THEY THINK A NATIVE
PERSON SHOULD LOOK LIKE, SHOULD
ACT LIKE SO IF SOMEONE COMES IN
WHO DOESN'T MEET THAT STEREOTYPE
THEY ARE NOT SEEN AS A NATIVE
PERSON, RIGHT, AND NOT CARED FOR
IN THAT WAY.
SOME OF THE OTHER THINGS THAT WE
SEE SPECIFICALLY, AND I CAN
SPEAK TO TRIBAL COMMUNITIES.
THE INDIAN HEALTH SERVICE IS
SEVERELY UNDERFUNDED, HAS NEVER
BEEN, YOU KNOW, OUR TREATIES
THAT GAVE US ACCESS TO HEALTH
CARE, EDUCATION, AND WHAT NOT
HAVE NEVER BEEN FULFILLED.
THE INDIAN HEALTH SERVICES IS
CONSISTENTLY UNDERFUNDED BY THE
FEDERAL GOVERNMENT, HAS NEVER
BEEN FULLY FUNDED, RIGHT?
AND WITHIN THAT, WE KNOW THAT
MATERNITY CARE IS ALSO REALLY
UNDERFUNDED WITHIN IN IHS SYSTEM
BECAUSE THERE ARE SO MANY OTHER
FIRES GOING ON, RIGHT?
SO IT IS ONE OF THE AREAS OF
PRACTICE THAT HAVE LARGELY BEEN
ABANDONED BY IHS.
SO MOST OF OUR NATIVE FAMILIES
ARE GOING TO THEIR TRIBAL CLINIC
FOR THEIR PREGNANCY TEST AND
THEY ARE SENT AWAY UNTIL AFTER
THEIR BABY COMES, YOU KNOW, IS
DELIVERED.
THEY ARE SENT TO BORDER TOWNS OR
AREAS THAT ARE THE MOST
DANGEROUS OR RACIST OR UNSAFE
PLACES FOR NATIVE PEOPLE TO BE
IN.
THERE'S A LOT OF HISTORY THERE
BETWEEN RESERVATIONS AND BORDER
TOWNS AND THAT IS WHERE WE ARE
SENDING OUR NATIVE MOMS TO BE
CARED FOR, RIGHT?
BY THE PEOPLE IN THOSE
COMMUNITIES.
AND SO THE TRAUMA THAT OUR MAMAS
ARE EXPERIENCE IS REALLY A HUGE,
I THINK A CONTRIBUTING FACTOR TO
THIS.
JUST NOT BEING ABLE TO ACCESS
HIGH QUALITY, LOVING, SAFE
MATERNITY CARE IN OUR HOME
COMMUNITIES IS -- IS A LOSS THAT
CAN MAKE ME CRY WHEN WE THINK
ABOUT IT AND WHEN WE THINK ABOUT
OUR CULTURE AND WHAT IT MEANS,
WHAT IT MEANS FOR ME AS A DAKOTA
WOMAN, I CAN'T EVEN IMAGINE WHAT
IT WOULD BE LIKE TO DELIVER A
BABY IN THE BLACK HILLS, IN OUR
TRIBAL LANDS WHERE OUR BABIES
ARE SUPPOSED TO BE BORN, RIGHT?
THAT TIES THEM TO THEIR LAND AND
STORIES AS DAKOTA PEOPLE.
WHEN WE ARE REMOVED FROM THAT OR
HAVE TO LEAVE OUR HOMELAND,
THERE IS SO MUCH THAT IS LOST,
RIGHT?
SO MUCH THAT IS LOST IN THAT.
WITHIN THE INDIAN HEALTH SERVICE
THERE USED TO BE ABOUT 13
HOSPITALS THAT DELIVERED BABIES
IN THE INDIAN HEALTH SERVICES.
HALF OF THOSE WERE IN NAVAJO
NATION.
SEVERAL HAVE CLOSED WITHIN THE
LAST FEW YEARS SO I THINK WE ARE
DOWN TO NINE OR 10.
AND THAT IS JUST, YEAH, REALLY
HIGHLY PROBLEMATIC.
WE HAVE NATIVE MOMS TRAVELING
HOURS FOR HEALTH CARE.
AND THAT HEALTH CARE THEY ARE
RECEIVING IS SUB PAR.
I JUST WANT TO ADDRESS LIKE
ANOTHER ELEPHANT IN THE ROOM,
TOO, IS WE HAVE SOME JUST
REALLY, REALLY INCREDIBLE
PROVIDERS THAT SERVE RURAL
COMMUNITIES THAT ARE VERY
COMMITTED TO SERVING RURAL
COMMUNITIES AND ALSO THAT IS
WHERE WE MAY NOT HAVE THE
HIGHEST QUALITY PROVIDERS, TOO,
RIGHT?
AND WE'VE -- WITHIN INDIAN
COUNTRY WE'VE SEEN THAT.
WE SAW THAT WITH BOARDING
SCHOOLS.
THE MOST TROUBLING PRIESTS WERE
THE ONES WHO WERE SENT TO INDIAN
COUNTRY TO WORK WITH A
POPULATION THAT COULDN'T SPEAK
UP FOR THEMSELVES, THAT HAD NO
VOICE.
UNFORTUNATELY, WE SEE SOME OF
THAT WITHIN THE HEALTH CARE
SYSTEM.
I JUST WANT TO ACKNOWLEDGE, IT
IS NOT EVERYBODY.
I HAVE MET SOME OF THE MOST
INCREDIBLE PROVIDERS THAT HAVE
REALLY COMMITTED TO SERVING
NATIVE PEOPLE FROM INSIDE AND
OUTSIDE THE COMMUNITY.
AND ALSO THERE ARE A LOT OF
PROVIDERS THAT JUST AREN'T THAT
GOLD STANDARD OF CARE THAT WE
DESERVE.
THAT WE DESERVE AS NATIVE
PEOPLE.
>> EVERYONE DESERVES THE RIGHT
TO PROPER HEALTH CARE AND
ACCESS, BUT IT IS A KNOWN FACT
THAT IS NOT ALWAYS THE CASE,
EVEN THOUGH THAT IS A PRINCIPLE,
IT IS NOT A PRINCIPLE THAT IS
APPLIED.
ONE OF THE FACTORS THAT PLAYS
INTO THIS IS, YOU KNOW,
PERCEPTION BECOMES THE
INDIVIDUAL'S REALITY.
THESE IMPLICIT BIASES DO PLAY A
FACTOR IN HOW CARE IS OFFERED.
SO SOME THINGS MAY TAKE
SELF-REFLECTION AND DIFFERENT
TRAINING MODULES WITHIN MEDICAL
SCHOOLS, WITHIN BIRTHING WORKER
PRACTICES, REGULARLY INTEGRATED.
BUT IT IS GOING TO TAKE A STEP
FURTHER FOR THAT TO CONTINUE TO
BE IMPLEMENTED.
THE QUESTIONS ARE WITH THE
INADEQUATE NUMBER OF PROVIDERS
AND DWINDLING NUMBER OF
HOSPITALS AS A RESULT THESE
FACILITIES ARE AGING OUT OF THE
SYSTEM, RIGHT?
THAT IS WHY THEY ARE BEING
CLOSED AND IT IS AFFECTING
PREGNANCY OUTCOMES.
WHAT ARE YOUR THOUGHTS ON HOW
THIS IS IMPACTING INADEQUATE
PRENATAL CARE?
ONE OF THE FACTORS IS RESEARCH
SHOWS THAT IF YOU HAVE PROVIDERS
THAT FEEL THEY LOOK LIKE YOU OR
CULTURALLY AWARE OF WHAT IS
APPROPRIATE AND WHAT MAY BE
CONSIDERED INAPPROPRIATE OR RUDE
OR OFFENSIVE, YOU'RE MORE LIKELY
TO BUILD A RAPPORT WITH THOSE
PATIENTS.
AND THE FACT IS NATIVE AMERICAN
PEOPLE ARE NOT ALWAYS IN REGALIA
IN THE CONCEPT OF WHAT THEY
THINK A NATIVE PERSON LOOKS LIKE
MAY BE VERY FARFETCHED FROM THE
TRUTH.
OUR FACES ALL LOOK DIFFERENT.
YOU CAN'T JUST HAVE ONE STAMP
AND SAY THAT IS WHAT A NATIVE
PERSON IS OR LOOKS LIKE BECAUSE
EVERY INDIVIDUAL IS UNIQUE, DOWN
TO THEIR BASIC GENETIC MAKEUP.
EVERYONE IS UNIQUE.
EVEN IN THE CASE OF IDENTICAL
TWINS WHO SHARE THE SAME GENETIC
MAKEUP, THEY HAVE THEIR
DIFFERENCES.
THERE ARE 574 TRIBES THAT ARE
FEDERALLY RECOGNIZED, BUT
COUNTLESS TRIBES THAT ARE NOT
FEDERALLY RECOGNIZED.
THERE ARE TRIBES THAT ARE NOT
STATE RECOGNIZED.
THEY ARE STRUGGLING.
AT THE END OF THE DAY WE ARE ALL
NATIVE.
WHAT ARE YOUR THOUGHTS ON HOW
THAT IMPACTS INADEQUATE PRENATAL
CARE AND HOW THAT MAY IMPACT
POSTPARTUM CARE AS WELL?
>> SO THAT'S ABSOLUTELY TRUE.
THE INVISIBILITY IS HUGE.
AND THERE IS COUNTLESS RESEARCH
EVEN WITHIN DIVERSITY, EQUITY
AND INCLUSION SPACES, BUT EVEN
BEFORE THAT MEDICAL CARE
PROVIDED BY FEMALE PHYSICIANS,
PATIENTS TEND TO HAVE BETTER
OUTCOMES, THEY CONNECT BETTER
THAN MALE PHYSICIANS.
YOU CAN ARGUE, RIGHT, ABOUT THE
VALIDITY OF SOME OF THESE
STUDIES OR, YOU KNOW, OUTSIDE
POTENTIAL CO-FOUNDING FACTORS,
BUT THE DATA IS THERE.
THE ARTICLES ARE THERE.
AND THERE'S ABSOLUTELY DATA TO
SHOW THAT WHEN YOUR DOCTOR IS OF
THE SAME ETHNIC BACKGROUND, WHEN
THE DOCTOR LOOKS LIKE YOU, WHEN
YOU ARE THE SAME, YOU KNOW,
OUTCOMES ARE BETTER FOR THESE
PATIENTS.
I THINK THE HARD PART IS THAT WE
HAVE TO GET MORE DOCTORS IN
THESE SPACES, MORE BIRTH
WORKERS, MORE DOULAS, MORE MID
WIVES THAT ARE COMING FROM THESE
COMMUNITIES.
I GRADUATED FROM THE UNIVERSITY
OF VIRGINIA.
I REMEMBER BEING SO EXCITED AND
HAVING A HUGE MEDICAL CLASS OF
SEVEN HUNDRED.
THERE WERE 10 ETHNIC MINORITIES
IN THAT CLASS.
I WAS THE ONLY NATIVE.
AFTER BEING THERE FOR MY M.D.
PH.D. FOR 10 YEARS, THERE WAS
ONLY ONE OTHER NATIVE THAT CAME
THROUGH, RIGHT?
AND SO FINDING US IS HARD,
RIGHT?
BUILDING COMMUNITY AMONGST
OURSELVES AND FINDING US CAN BE
HARD.
HELPING TO CULTIVATE INTEREST IN
THE LIFE SCIENCES, INTEREST IN
MEDICINE, INTEREST IN HEALTH
CARE WORK IN THE CHILDREN OF OUR
COMMUNITIES TO HELP CREATE THE
PIPELINE TO HAVE A FUTURE OF
BIRTH WORKERS, OF HEALTH CARE
PROVIDERS, OF PHYSICIANS, OF
DOULAS, OF MIDWIVES, OF NURSES
THAT ARE COMING FROM OUR
COMMUNITIES TO SERVE OUR
COMMUNITIES IS PARAMOUNT.
THERE ARE SEVERAL DIFFERENT
ORGANIZATIONS THAT ARE TRYING TO
SERVE THOSE PIPELINES AND TO,
YOU KNOW, TO DO THAT BECAUSE IT
TAKES DECADES TO PROVIDE THESE
REPLACEMENTS.
SO WHEN 10 PHYSICIANS RETIRE,
YOU MAY BE ONLY REPLACING ONE OR
TWO.
I THINK THAT GETS BACK DOWN TO
WHAT DIRECTOR HUMMINGBIRD SAID
IS WE HAVE TO PRIORITIZE THESE
EFFORTS.
WE HAVE TO FUND THEM.
WE HAVE TO FUND THESE PROGRAMS.
WE HAVE TO BUILD THESE PIPELINES
AND INVEST IN THESE COMMUNITIES,
INVEST IN THIS WORK.
OTHERWISE IT IS NOT GOING TO
HAPPEN, RIGHT?
I THINK WE ARE BOTH
AFRICAN-AMERICANS, NATIVE
AMERICANS, INDIGENOUS PEOPLE, WE
ARE RESOURCEFUL PEOPLES.
WE ARE SURVIVORS.
WE HAVE BEEN THROUGH A LOT AND
WE KNOW HOW TO WORK IN OUR
COMMUNITIES TO THRIVE.
AND SO WE SEEK OUT
OPPORTUNITIES.
WE SEEK OUT ONE ANOTHER, RIGHT?
SO EVEN THOUGH I AM NOT FORWARD
FACING EVERY DAY AS A NATIVE
WOMAN, PATIENTS MAY ENCOUNTER ME
EVERY DAY AND NOT EVEN THINK
TWICE TO THINK THAT I COULD BE A
PART OF OUR TRIBE, OTHER NATIVE
WOMEN WHO ARE COMING TO SEE ME
KNOW EXACTLY THAT THEY ARE.
THAT IS NOT JUST UNIQUE TO ME
LIVING AND WORKING IN MY OWN
COMMUNITY AT HOME.
I WAS VERY EXCITED AS A MEDICAL
STUDENT AT THE UNIVERSITY OF
VIRGINIA WHEN WE WERE ON OUR
ROTATIONS AND GOING THROUGH -- I
WAS IN THE, YOU KNOW, GENERAL
MEDICINE CLINIC AND A LAKOTA MAN
CAME AND HE WAS ON HIS
MOTORCYCLE AND HE LOOKED LIKE A
BIKER.
EVERYBODY IN THAT CLASS HAD A
LOT OF PRECONCEIVED NOTIONS
ABOUT WHO HE WAS AND WHO HE
REPRESENTED AND HOW THE CHOICES
THAT HE WAS MAKING OR NOT MAKING
WERE RESPONSIBLE FOR THE
OUTCOMES OF HIS HEALTH.
BUT ALMOST IMMEDIATELY IN THAT
ROOM HE BEGAN TO SEE ME.
AND HE SAW ME AND HE SPOKE TO
ME.
WE EXCHANGED WORDS IN LAKOTA
LANGUAGE.
WE CONNECTED BECAUSE HE SAW WHO
I WAS AT MY CORE.
BECAUSE WE RECOGNIZE EACH OTHER.
FOR THE MOST PART, WE KNOW.
SO IT IS NOTHING DIFFERENT THAN
HAVING THE, YOU KNOW,
UNDERGROUND RAILROAD AND THOSE
CONNECTIONS AND HAVING, YOU
KNOW, THE GREEN BOOK, RIGHT, AS
WE NAVIGATED RACISM AND
OPPRESSION IN NATIVE AMERICAN
COMMUNITIES TO NAVIGATE SAFE
SPACES, SAFE PEOPLE, SAFE THE
COUNT -- SAFE TOWNS.
YOU KNOW IN YOUR COMMUNITY WHO
IS A GOOD PERSON AND WHO IS
PROVIDING GOOD QUALITY CARE,
WHICH HOSPITALS ARE SAFE.
WE ARE DOING THE SAME.
I'M PART OF AN ORGANIZATION THAT
IS CREATING LISTS OF PROVIDERS
THAT ARE SAFE.
PROVIDERS THAT RESPECT A WOMAN'S
RIGHT TO CHOOSE.
PROVIDERS WHO RESPECT THE CHOICE
TO BE A NONCHILD BEARING WOMAN.
A LOT OF OPPRESSION COMES ON THE
HEALTH CARE OF WOMEN BOTH IN THE
FORM OF FORCED CHILD BEARING,
BUT ALSO IN FORCED, YOU KNOW,
FORCING THEM TO NOT CONCEIVE.
FORCED STERILIZATION.
WE HAVE SEEN THAT IN OUR
COMMUNITIES.
I THINK CREATING THESE NETWORKS
OF SAFE PEOPLE, BUT ULTIMATELY
INVESTING, INVESTING, INVESTING
IN THESE COMMUNITIES AND THESE
PROGRAMS WE SEE WORKING, WE KNOW
ARE WORKING, THEY HAVE DATA
SHOWING THEY WORK, HELP THEM
WORK.
>> ABSOLUTELY.
I THINK FUNDING IS FUNDAMENTAL
NEED.
YOU NEED RESOURCES.
WHERE THERE IS A DEARTH OF
RESOURCES YOU ARE GOING TO FIND
THERE IS GOING TO BE STRUGGLE TO
JUST GET THINGS DONE THAT IF
THEY HAD THE PROPER
INFRASTRUCTURE OR RESOURCES
COULD BE EASILY MAINTAINED.
WHAT IMPACT DO YOU FEEL,
DIRECTOR GOLDHAMMER, THAT
DISCRIMINATION IS HAVING ON
NATIVE BIRTHING PEOPLES, NATIVE
CLINICAL PROFESSIONALS, NATIVE
BIRTH WORKERS?
WHAT DOES IT REALLY LOOK LIKE?
I KNOW WE ARE SEEING IT IN THE
NUMBERS OF BEING ASTRONOMICALLY
HIGH FOR MATERNAL MORBIDITY AND
MORTALITIES, RIGHT?
BUT WHAT ARE THE IMPACTS YOU
THINK THIS IS HAVING?
>> YEAH, I MEAN, IT'S ROUGH OUT
THERE.
AS DOULAS WE SERVE AROUND 30% TO
50% OF NATIVE FAMILIES IN THE
KING COUNTY AREA.
WE ARE REACHING A LOT OF
FAMILIES.
WE ARE CONSTANTLY AMAZED AT WHAT
HAPPENS IN FRONT OF US AT
HOSPITALS TO WHERE WE HAVE TO
QUESTION WHAT HAPPENS WHEN WE
ARE NOT IN THE ROOM.
YOU KNOW?
BECAUSE AT THIS POINT WE'RE
FAIRLY WELL KNOWN PEOPLE.
MOST BIRTHING HOSPITALS KNOW
ABOUT HUMMINGBIRD.
OH, YOU HAVE A HUMMINGBIRD
DOULA, OKAY.
THAT KIND OF STUFF.
I HAVE A LOT OF CONNECTIONS IN
THE HOSPITALS, TOO.
AND I -- IT STILL SHOCKS ME, YOU
KNOW, LIKE WHAT HAPPENS TO
FAMILIES AND WHAT WE SEE.
WHETHER THAT IS COERCION,
IGNORING THEM, NOT RESPONDING TO
THEIR NEEDS, NOT ADDRESSING
PROBLEMS THAT ARE VERY CLEAR,
VERY CLEAR PROBLEMS.
BUT THE LAST NATIVE MOM THAT WE
KNOW OF WHO DIED, WHICH WAS A
BIG PART OF WHY I STARTED
HUMMINGBIRD AND STARTING OUR
DOULA ORG WAS AFTER HER LOSS WAS
A MOTHER, SHE'S PREGNANT WITH
TWINS HAD A HEART CONDITION, WAS
FULL TERM, WORKING AT A STADIUM
FOR A BASEBALL GAME AND STARTED
NOT FEELING WELL.
WENT TO THE HOSPITAL, WENT TO
THE ER AND THEY TOLD HER TO GO
HOME AND REST.
AND HER AND HER BABIES DIED.
YOU KNOW, IT WAS JUST, LIKE, HOW
THERE WAS NO OB CONSULT, HOW NO
ONE THOUGHT TO, YOU KNOW, ADMIT
HER.
LET'S REALLY DIG INTO THIS,
RIGHT?
I MEAN, THERE WERE SO MANY
THINGS GOING ON THAT WOULD
TRIGGER THIS IS A PRETTY HIGH
RISK SITUATION.
LET'S SEE WHAT WE CAN DO.
BUT IT WAS KIND OFFEN DETERMINE
THAT SHE WAS OVERWEIGHT AND THAT
IS WHY SHE WASN'T FEELING WELL
BECAUSE SHE WAS WORKING AT A
BASEBALL GAME AND THAT IS THAT.
RIGHT?
AND THEY SENT HER HOME.
SO IT IS THINGS LIKE THAT AND
THEN BEING, YOU KNOW, FOR HER,
TOO, HAVING NO ONE WHO WENT WITH
HER, NO ONE TO ADVOCATE FOR HER,
NO ONE TO SAY WE NEED A SECOND
OPINION.
WE NEED SOMEONE ELSE TO CHECK
HER OUT.
PLEASE CALL THE OB.
RIGHT?
WHATEVER IT IS.
THERE WAS NOBODY THERE WHO WAS
THINKING WHAT COULD WE DO
DIFFERENTLY, RIGHT?
HOW CAN WE HELP THIS PERSON?
AND, YEAH, AND THAT'S WHY WE
STARTED OUR DOULA PROGRAM
BECAUSE IT WAS ONE OF THOSE
THINGS THAT, LIKE, WE ARE
RECOGNIZING THAT OUR FAMILIES
ARE GOING AND INTERSECTING WITH
THESE SYSTEMS THAT JUST AREN'T
WORKING IN OUR FAVOR, RIGHT?
IS AND KIND OF WHAT DR. GRAHAM
SAID EARLY ON, OUR FAMILIES
DON'T FEEL SAFE BEING INVOLVED
IN THEIR HEALTH CARE.
I KNOW WE HAVE KIND OF ALLUDED
TO IT, BUT WE TALKED ABOUT IT
FRANKLY IN OUR PRECONFERENCE
CALL AROUND EVERY NATIVE MOM IS
AFRAID HER BABY IS GOING TO BE
TAKEN AWAY.
THAT IS AT THE FOREFRONT OF OUR
MINDS WHEN WE'RE PREGNANT, WHEN
WE HAVE BABIES AND CHILDREN.
AND THAT'S NOT AN IRRATIONAL
FEAR, RIGHT?
IT IS NOT AN IRRATIONAL FEAR
BECAUSE EVERY GENERATION BEFORE
US THAT HAS HAPPENED.
AND CONTINUES TO HAPPEN AT
DISPROPORTIONATE RATES.
AND I THINK WHEN FOLKS, AND I
SAY THIS AS A MANDATORY REPORTER
AND RECOGNIZING LIKE WHAT THAT
MEANS, BUT WHEN PEOPLE IN OUR
COMMUNITY ARE INTERACTING WITH
FOLKS THAT THEY SEE AS MANDATORY
REPORTERS OR KNOW OF THAT HOLD A
LOT OF POWER, WHICH A DOCTOR
DOES HOLD A LOT OF POWER IN A
RELATIONSHIP.
MOST NATIVE FAMILIES ARE NOT
GOING TO RUFFLE FEATHERS.
LIKE DR. GRAHAM SAID, THEY ARE
GOING TO FLY UNDER THE RADAR AND
DO AS LITTLE AS THEY CAN TO
RAISE ANY FLAGS FOR A PROVIDER
THAT MAY BE COMBATIVE OR MIGHT
DO THINGS AGAINST MEDICAL ADVICE
OR WHAT HAVE YOU.
THAT FEAR REALLY, REALLY, REALLY
IMPACTS THE DECISIONS THAT WE
MAKE AROUND OUR OWN HEALTH CARE
AND THE WAY WE INTERACT WITH THE
HEALTH CARE SYSTEM.
SO, YEAH, I THINK THOSE ARE JUST
SOME OF THE THINGS WE SEE.
THAT KIND OF IGNORING, TREATING
TERRIBLY, I CAN'T EVEN TELL YOU
THE THINGS, LITERALLY IT WOULD
GIVE PEOPLE SECONDARY TRAUMA TO
REPEAT THE STORIES OF THINGS I
HAVE SEEN PROFESSIONALS,
PROVIDERS DO TO NATIVE MOMS
DURING THEIR MOST SACRED
CEREMONY, WHICH IS HAVING A
BABY.
>> I THINK IT IS ALSO A LACK OF
UNDERSTANDING.
I'M GOING TO GO TO DR. GRAHAM
ABOUT THIS.
I THINK IT IS A LACK OF
UNDERSTANDING OF THE INTRICACIES
IN THE NATIVE CULTURE, LACK OF
UNDERSTANDING THE CULTURE, THE
NATIVE WOMAN HERSELF OR THE
NATIVE BIRTHING PERSON.
OUR TWO-SPIRIT FAMILY MEMBERS.
WITH THAT LACK OF UNDERSTANDING
AND THE STEREOTYPES THAT OCCURS,
YOU MAY BE A DRUG USER SAYING
THIS TO A PERSON THAT IT DOESN'T
HOLD TRUE FOR OR EVEN SAYING IT
TO A PERSON IT MAY HOLD TRUE
FOR, HOW IS THAT A GOOD BEDSIDE
MANNER?
HOW DO YOU APPROACH SPECIFIC
TRAINING AND HOW TO -- AND ALSO
THE OTHER THING THAT SHOULD BE A
CONCERN OR AN ISSUE -- HOLD ON,
I'M GOING TO ADJUST MY HEAD SET.
I APOLOGIZE FOR THE TECHNICAL
ISSUE.
BUT THE OTHER THING THAT SHOULD
BE NOTED IS THE MEDICAL
CONDITIONS.
WHEN THERE ARE PREEXISTING
MEDICAL CONDITIONS OR MEDICAL
CONDITIONS THAT PRESENT
THEMSELVES.
FOR EXAMPLE, THREE OF THE
LEADING CAUSES OF PREGNANCY
RELATED DEATH IN NATIVE AMERICAN
BIRTHING PEOPLES IS HEMORRHAGE,
CARDIOMYOPATHIES AND
HYPERTENSION DISORDERS.
THESE ARE ISSUES CONSISTENTLY
THAT CAUSE DEATH.
THE POINT OF FACT IS ONE THIRD
OF DEATHS, MATERNAL MORTALITY,
OCCUR DURING PREGNANCY, BUT 52%
OF DEATHS OCCUR AFTER THE DAY OF
DELIVERY.
HOW DO WE COMBAT THAT WITH A
SYSTEM, A WESTERNIZED SYSTEM, A
SYSTEM THAT STEMS FROM
COLONIZATION?
HOW DO WE COMBAT SOME OF THE
NEGATIVE IMPACT THAT HAS ON
MATERNAL MORTALITY RATES FOR
NATIVE AMERICAN PEOPLES?
OR ANY, EVEN OTHER PEOPLES
BECAUSE WE MAY NOT HAVE THAT
MUCH DATA, BUT THERE ARE
PLETHORA OF DATA FOR OTHER RACE
AND ETHNIC GROUPS THAT CERTAINLY
APPLY AS MODELS.
SO WHAT ARE YOUR THOUGHTS ON
WHERE DO WE GO FROM THERE, DR.
GRAHAM AND I WOULD LIKE TO ALSO
ANSWER THAT SAME QUESTION
DIRECTOR GOLDHAMMER.
>> YEAH.
I MEAN, I THINK -- I WOULD HAVE
TO SAY THAT I THINK OUR
TRADITIONAL HEALTH CARE SYSTEM
OF WESTERNIZED MEDICINE IS BUILT
UPON PATERNALISTIC VIEWS.
RIGHT?
IS BUILT UPON A POWER-BASED
STRUCTURE AND A HIERARCHY OF I
KNOW BETTER, I'M SMARTER, THIS
IS WHAT YOU SHOULD DO, YOU
SHOULD DO IT.
IT ALSO REFLECTS OUR VIEW OF
WOMEN AND OUR VIEW OF THEIR
WORTH, THEIR WORTH IN SOCIETY,
THEIR WORTH, ET CETERA.
NOT JUST WOMEN, BUT PEOPLE.
IF WE VALUE THE PERSON, IF WE
VIEW THEM AS WORTHY, THEN WE
TREAT THEM DIFFERENT.
WE APPROACH THEM DIFFERENT.
FUNDAMENTALLY THE CARE THEY GIVE
IS DIFFERENT.
WE SEE THAT IN EVERY WALK OF
LIFE, EVERY ASPECT OF LIFE,
INCLUDING THAT FINANCIALLY,
RIGHT?
WHAT ARE OUR COMMUNITIES
INVESTING IN?
WHAT DO OUR LEGISLATURES VALUE?
WHERE ARE THEY PUTTING THEIR
MONEY AND THEIR RESOURCES?
AND WOMEN'S HEALTH,
UNFORTUNATELY, HAS NEVER BEEN
VALUED.
WE'VE NOT BEEN VALUED AS PEOPLE.
AND THAT, I THINK, IS
FUNDAMENTALLY HAS TO CHANGE.
THAT FUNDAMENTALLY HAS TO
CHANGE.
WE HAVE TO BE IN FULL FACULTY OF
OU
OUR BODIES, FULL ABILITY TO MAKE
DECISIONS FOR OUR BODIES AND WE
HAVE TO VALUE THAT AND INVEST IN
RESOURCES REGARDING THAT.
BECAUSE THE HOSPITAL AND THE BAD
THINGS THAT SHE HAS SEEN, THAT I
HAVE SEEN, THEY STEM
FUNDAMENTALLY FROM THAT
PERSPECTIVE.
IF WE DON'T VALUE THAT PERSON,
WE DON'T VALUE THEIR LIFE, THEIR
EXISTENCE, THEIR WELL BEING,
RIGHT, WE CAN'T EVER DO RIGHT BY
THEM.
WE CAN'T EVER DO RIGHT BY THEM.
AND THAT IS THE HARD PART AND
THE HARD WORK THAT HAS TO BE
DONE.
THAT CAN'T BE DONE IN A FEW
SEMINARS ON DIVERSITY AND
INCLUSION, RIGHT?
THAT HAS TO FUNDAMENTALLY CHANGE
FROM WITHIN.
AND THAT IS THE HARD PART.
WE HAVE TO VALUE PEOPLE, ONE
ANOTHER AS PEOPLE.
I MEAN, MICHAEL BLOOMBERG JUST
DONATED A TON OF MONEY, RIGHT,
MILLIONS OF DOLLARS TO JOHNS
HOPKINS TO FUND THEIR MEDICAL
SCHOOL, TO MAKE MEDICAL SCHOOL
FREE, RIGHT?
SIMULTANEOUSLY RECENTLY HE HAS
FUNDED A TON OF MONEY TO HBCUs
PARTICULARLY TO FOCUS ON
EDUCATION AND HEALTH CARE TO
QUOTE-UNQUOTE EQUAL THE PLAYING
FIELD AND TO HELP THOSE
COMMUNITIES.
I THINK WHAT IS INTRIGUING IS
THE DOLLAR AMOUNT HE PAID WAS
DIFFERENT.
IT WAS LESS IN THE BLACK
COMMUNITY.
IT WAS LESS FOR THESE HBCUs.
I CAN'T SPEAK FOR HIM AS A
PERSON OR HIS MOTIVATION BEHIND
CHOOSING THOSE DOLLAR AMOUNTS,
BUT PEOPLE IN THESE COMMUNITIES
CAN'T HELP BUT THINK IS THAT A
VALUE?
RIGHT?
WAS THAT A VALUE CHOICE FOR HIM?
AND THIS HAPPENS WITH OUR
LEGISLATURE AND THE THINGS THAT
WE ARE PURSUING, RIGHT?
WHERE DO WE FOCUS?
WHAT DO WE PUT FOCUS ON?
WE FOCUS ON WHAT WE VALUE.
WE HAVE TO VALUE WOMEN.
WE HAVE TO CARE FOR THEM SUCH
THAT WHEN THEY COME INTO OUR
OFFICE, WHEN THEY COME INTO OUR
HOSPITAL WITH A HEADACHE, WHEN
THEY COME IN WITH SHORTNESS OF
BREATH, WHEN THEY COME IN WITH
FATIGUE, WE DON'T DISMISS IT AS
OBESITY, WE DON'T DISMISS IT AS
BEING OVERWORKED, OH, THEY ARE
JUST BEING HISTRIONIC, RIGHT?
BECAUSE THAT IS WHAT IS
HAPPENING EVERY DAY.
THESE WOMEN'S CONCERNS ARE
GETTING DISMISSED.
THEY ARE NOT BEING HEARD, RIGHT?
AND SOMETIMES THAT SWELLING IS
NORMAL, BUT SOMETIMES IT CAN
KILL YOU.
SOMETIMES THAT HEADACHE IS
NOTHING AND YOU JUST NEED A
TYLENOL AND A NAP AND SOME
FLUIDS, INCREASED HYDRATION, BUT
SOMETIMES IT IS A STROKE.
RIGHT?
IT'S DEADLY.
YOU HAVE TO SEE THE PATIENT.
YOU HAVE TO EVALUATE THEM.
YOU HAVE TO PUT HANDS ON THEM.
YOU CAN'T DO THIS OVER THE
PHONE, RIGHT?
YOU CANNOT EVALUATE THE PERSON
OVER THE PHONE.
A LOT OF MY MOMS GET FRUSTRATED
WHEN THEY CALL AND I'M LIKE, ALL
RIGHT, YOU'VE GOT COME IN.
THEY SAID DR. GRAHAM, YOU ALWAYS
SAY I HAVE TO COME IN.
YOU DO.
I NEED TO LAY HANDS ON YOU, I
NEED TO SEE YOU.
THERE IS SO MUCH ABOUT THE
PHYSICAL EXAM, THE WAY YOU ARE
CARRYING YOURSELF, THE WAY YOU
LOOK AND FEEL.
BY LAYING HANDS ON THEM AND
LOOKING AT THEM AND SAYING I
DON'T KNOW WHAT IS WRONG, BUT I
KNOW SOMETHING IS WRONG.
I WANT YOU TO COME IN AND SAVE
TESTS SO I CAN FIND OUT WHAT IT
IS THAT I HAVE SAVED WOMEN'S
LIVES.
BECAUSE I HAD THE THRESHOLD OF
SUSPICION THAT SOMETHING IS
NOT -- IT IS DIFFERENT WITH THIS
PATIENT.
YOU KNOW?
SHE DOESN'T LOOK WELL.
RIGHT?
BUT WE LOSE THAT WHEN WE TRIAGE
OVER THE PHONE, WHEN WE DON'T
SIT DOWN AND TAKE A LOOK AND A
LISTEN.
WHEN WE PUT OUR TRIAGE
CAPABILITIES, RIGHT, IN THE ER,
TO NURSE PRACTITIONERS OR THE
NURSES OR TO OTHER
NONOBSTETRICIANS, RIGHT?
THOSE PEOPLE ARE AMAZING ASSETS
TO OUR HEALTH CARE SYSTEM AND
THEY EACH SERVE A VITAL ROLE, WE
DON'T KNOW WHAT WE DON'T KNOW.
THAT PERSON HAS NOT ENCOUNTERED
A POSTPARTUM CARDIOMYOPATHY
PATIENT BEFORE, THEY MAYBE DON'T
RECOGNIZE THE SYMPTOMS BEING
PRESENTED AS BEING PART OF THAT
CONSTELLATION AND SOMETHING
CONCERNING FOR THEM AND SO THEY
DON'T DIG DEEPER, RIGHT?
SO I THINK OUR COMMUNITIES, OUR
HOSPITALS, YOU KNOW, SOME OF
THEM ARE PUTTING FORTH WHAT WE
CALL OBED, OBSTETRIC EMERGENCY
DEPARTMENTS THAT ARE SPECIFIC TO
OB/GYN.
THEY ARE STAFFING THEM WITH
BOARD CERTIFIED OBSTETRICIANS OR
NURSE MIDWIVES TO BE PRESENT
24/7 TO SERVE, TO BE THERE, TO
LAY HANDS, TO SEE THOSE
PATIENTS.
SOME STATES AND SOME AREAS ARE
BETTER THAN OTHERS, BUT A LOT OF
CREATING THESE MATERNAL
MORBIDITY, MORTALITY COMMITTEES,
CONSORTIUMS TO HAVE A
COLLABORATIVE CARE MODEL TO
CREATE POLICIES AND PROCEDURES
THAT CAN HELP IDENTIFY PATIENTS.
I MEAN, THANKFULLY IN THE STATE
OF DELAWARE WE HAVE SEVERAL
DIFFERENT REPRESENTATIVES THAT
ARE IMPASSIONED ABOUT THIS AREA.
THEY ARE DOING THIS WORK.
THEY ARE INVESTING IN MANY THESE
COMMUNITIES, IN THESE PROJECTS.
YOU CREATE ACCESS, YOU CREATE
IDENTIFIABLE THINGS.
ONE OF THE THINGS OUR HOSPITAL
CURRENTLY IN DELAWARE IS DOING
IS SOMETHING AS SIMPLE AS HAVING
A BRACELET, A PINK BRACELET THAT
THE PREGNANT BIRTHING MOM GOES
HOME WITH THAT HAS JUST, I JUST
DELIVERED ON THIS DATE.
THAT WAY IF SHE IS ENCOUNTERED
IN THE NEXT SIX WEEKS, SIX
MONTHS, WHAT HAVE YOU, IF SHE IS
UNCONSCIOUS SHE CAN'T SPEAK FOR
HERSELF.
EMS, EMERGENCY SERVICES, POLICE,
FIREFIGHTERS THEY KNOW THAT THIS
WOMAN JUST GAVE BIRTH.
THEY KNOW THERE IS A CHILD.
THEY KNOW TO DIG A LITTLE
FURTHER AND THAT THIS PATIENT
PARTICULARLY IS AT HIGHER RISK
FOR CERTAIN CONDITIONS THAT
MAYBE SOMEBODY ELSE WHO HAS NOT
JUST GIVEN BIRTH IS HIGH RISK
FOR.
SOMETHING AS SIMPLE AS THAT.
WE DO IT FOR WOMEN WHO HAVE
RECENTLY HAD A PREGNANCY LOSS,
TOO.
EVEN IF THEY DIDN'T CARRY THAT
BABY HOME, THEY WENT THROUGH THE
PROCESS, THE INCREASED MEDICAL
RISK IN HEALTH CARE THINGS.
WE'VE GOT TO INVEST AND IT HAS
TO COME DOWN TO, YOU KNOW, WE
HAVE TO VALUE LIFE.
WE HAVE TO VALUE LIFEGIVERS.
>> THERE WAS A QUESTION THAT WAS
PRESENTED, HAVE THERE BEEN ANY
SUCCESS STORIES OF
NON-INDIGENOUS MEDICAL
PROFESSIONALS PARTNERING WITH
INDIGENOUS COMMUNITIES THAT
IMPROVED HEALTH OUTCOMES FOR
ANYTHING ANYTHING PEOPLE?
AND I'M GOING TO PRESENT THIS TO
BOTH DIRECTOR GOLDHAMMER AND
THEN YOU, DR. GRAHAM TO ANSWER.
I CAN SAY THAT INDIAN HEALTH
SERVICES, THE U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES, NIH,
AS WELL AS CDC HAVE BEEN
CREATING PROGRAMS AND LAUNCHING
PROGRAMS TO IMPROVE THE HEALTH
OF NATIVE BIRTHING PEOPLE ACROSS
THE NATION.
AND THE PROGRAMS PILOTING HAVE
PROVEN SUCCESSFUL.
I CAN SAY THAT ON A BROADER
SPECTRUM, YOU KNOW.
WITH HOPE FOR THINGS TO COME.
BUT RIGHT THERE IN THE WEEDS,
RIGHT THERE WITH THE PATIENTS,
WHAT IS YOUR PERSPECTIVE ON IT
DIRECTOR GOLDHAMMER AND YOUR
PERSPECTIVE DR. GRAHAM?
>> YEAH.
I THINK THERE IS PROBABLY A LOT
OF EXAMPLES OF IT.
I THINK AS NATIVE PEOPLE ARE
PRETTY USED TO WORKING WITH AND
PARTNERING WITH NON-INDIGENOUS
PROVIDERS SO WE CAN LOOK AT THIS
ON THE MICRO LEVEL, PROVIDER TO
PATIENT OR DIAD OR BRING IT UP
TO MESO OR MACRO LEVEL TO
DIFFERENT CAMPAIGNS THAT
CLARISSA IS TALKING ABOUT.
AND SOME HAVE BEEN SUCCESSFUL.
I CAN'T NAME ANYTHING LIKE SUPER
SPECIFICALLY, BUT I THINK, YES,
THERE'S A LOT OF NON-NATIVE
PEOPLE OR NON-INDIGENOUS PEOPLE
WORKING WITH AND FOR NATIVE
PEOPLE THAT ARE EXTREMELY
VALUABLE AND EXTREMELY HELPFUL.
I WILL SAY, THOUGH, THAT NONE OF
IT IS FAST ENOUGH FOR ME.
SO I, YOU KNOW, I HAVE A PROBLEM
WITH PATIENCE WHEN IT COMES TO
NATIVE MOMS' LIVES AND THEIR
BABIES' LIVES.
I THINK SOME OF THE BIGGER
THINGS THAT HAPPEN AT THE
FEDERAL LEVEL ARE A REALLY BIG
PICTURE.
LIKE DR. GRAHAM SAID, A LOT OF
THIS IS A LONG GAME ESPECIALLY
WHEN IT COMES TO WORKFORCE
ISSUES.
IT IS GOING TO TAKE A REALLY
LONG TIME.
EVEN FOR ME AS A DOULA, IF I
WANTED TO HIRE A DOULA, LET'S
SAY THIS WEEK, I WOULD LITERALLY
HAVE TO HOLD A DOULA TRAINING.
THAT IS HOW FEW NATIVE DOULAS
THERE ARE AND I LIVE IN
LITERALLY A BIRTH BUBBLE.
SEATTLE IS WHERE THE MODERN DAY
FIELD OF DOULAS WERE CREATED BY
PENNY SIMPKN AND THERE IS A LACK
OF NATIVE DOULAS HERE.
SO FOR ME THERE IS AN URGENCY IN
THIS.
THIS IS WHERE I WILL SAY DOULAS
PLAY SUCH A HUGE ROLE,
INDIGENOUS DOULAS MAKING THESE
DIFFERENCES.
YES, IT REQUIRES PEOPLE OUTSIDE
OF OUR COMMUNITY SUPPORTING US
AND I THINK THE FASTEST AND THE
BEST WAY TO SEE AN IMPACT IS BY
SUPPORTING THE COMMUNITY ITSELF
AND THOSE THAT ARE DOING THE
WORK AND THERE IS A LOT OF
AMAZING WORK HAPPENING AT THE
COMMUNITY LEVEL.
ESPECIALLY IN THE BLACK AND
NATIVE COMMUNITY.
I MEAN, IT IS SO INSPIRING, SO
BEAUTIFUL TO SEE AND THAT IS
ABSOLUTELY WHERE I THINK THE
INVESTMENTS NEED TO BE MADE.
>> I THINK THERE HAVE BEEN
THROUGHOUT HISTORY,
FUNDAMENTALLY FROM THE VERY
BEGINNING WE'VE HAD ALLIES.
WE'VE HAD ALLIES THAT HAVE
CROSSED AND PLACED THEIR OWN
SELVES, THEIR OWN LIVELIHOOD,
THEIR OWN INTERESTS, YOU KNOW,
IN HARM'S WAY TO BE EXCELLENT
ALLIES FOR US.
SO ABSOLUTELY I THINK THERE ARE
GREAT EXAMPLES OF NON-NATIVE
PARTNERS THAT HAVE COME TO OUR
AID, COME AS ALLIES IN THIS
FIGHT, RIGHT, BOTH FOR WOMEN'S
REPRODUCTIVE RIGHTS, WOMEN'S
HEALTH CARE AND, YEAH.
SO -- AND WE CAN'T DO THIS
ALONE.
THE WORK IS SO HARD.
THERE IS SO MUCH WORK TO BE
DONE.
WE CANNOT DO IT WITHOUT ALLIES.
BUT THEY HAVE TO APPROACH IT AS
ALLIES, AS PARTNERS, RIGHT?
I THINK WHEN WE START TO
APPROACH IT FROM A PATERNALISTIC
STANDPOINT OF A SAVIOR COMPLEX,
RIGHT, THEN THINGS START TO GO
SOUTH.
BUT ALL OF THE EXAMPLES THAT I
HAVE SEEN, YOU KNOW, BOTH IN
NATIVE COMMUNITIES RIGHT HERE IN
AFRICAN-AMERICAN COMMUNITIES IN
DELAWARE, ET CETERA, IS THE TRUE
PARTNERSHIP.
THE ALLIES OF PEOPLE WHO REALLY
CARE FOR THESE PATIENTS AND
REALLY WANT TO SEE THEM SUCCEED,
THRIVE, AND WANT WHAT IS BEST
FOR THEM.
>> I THINK THAT THE MAIN
THOUGHTS MOVING FORWARD
ESPECIALLY NOTHING IS DONE ON AN
ISLAND ALL BY ITSELF.
IT TAKES COLLABORATIVE EFFORT
AND COMMUNITY TO HELP PROTECT
INDIVIDUAL LIVES.
AND THOSE ARE THINGS THAT WE ARE
LOOKING FORWARD TO DOING,
PROTECTING INDIVIDUAL LIVES, AS
MANY AS POSSIBLE, AND COMMUNITY
LIVES.
AND THEN THE LIVES ACROSS THE
NATION ACROSS THE GLOBE.
NOT JUST HERE BUT ABROAD AS
WELL.
THE FACT THAT THE CHALLENGES WE
DISCUSSED TODAY HAVE CREATED
THIS SERIOUS MENTAL HEALTH
CRISIS IN THE UNITED STATES THAT
HAS A PALPABLE EFFECT ON FUTURE
GENERATIONS MAKES THIS ISSUE
EVERYONE'S CONCERN.
ALTHOUGH INFORMATION SPECIFIC TO
JUST NATIVE AMERICAN PEOPLE MAY
BE LACKING IN CERTAIN AREAS,
AGAIN, EXISTS MODELS ARE
APPLICABLE.
THE ISSUES ARE DEEPER THAN JUST
TIMING AND THE NUMBER OF DOCTOR
VISITS OR INADEQUATE CARE BOTH
IN RURAL AND URBAN AREAS FOR
UNDERSTANDING OF NATIVE AMERICAN
CULTURE AND NEGATIVE PROVIDER
EXPERIENCES, VIA DISRESPECT AND
BEING STEREOTYPED.
THE INABILITY TO TAILOR CARE TO
THE UNIQUE NEEDS OF NATIVE
BIRTHING PEOPLE TO NOT REMAIN AN
UNADDRESSED ISSUE.
AND ALLIES IN PARTNERSHIP WITH
COMMUNITIES AND COMMUNITY
PARTICIPATORY PRACTICE DOES
WORK.
SYSTEM LEVEL FACTORS CAN BE
COMBAT
COMBATTED.
THERE WAS A SUGGESTION WITH
WIDESPREAD USE OF DOULA AND
MIDWIFE SERVICES HAVE SHOWN
IMPROVEMENTS IN THE QUALITY OF
CARE IN PRENATAL OUTCOMES WHEN
PARTNERING WITH PROVIDERS.
AND THESE PARTNERSHIPS ARE
VIABLE.
THESE PARTNERSHIPS ARE HAPPENING
RIGHT THERE IN DELAWARE.
THESE PARTNERSHIPS WILL CONTINUE
TO CREATE WONDERFUL CHANGE AND
THAT IS ONE OF THE THINGS THAT
WE WANT TO DO IS HAVE THE
CHANGES THAT CAN MOVE THINGS
FORWARD AND WE ALSO CAN LOOK AT
THAT COORDINATING CARE, HOME
VISITS, TELEHEALTH, PEER SUPPORT
AND SEEK TO ELIMINATE THE RASHT
AND ETHNIC DISPARITIES ON THE
PROVIDER RELATED LEVELS, ON
SYSTEMIC LEVEL OF INAPPROPRIATE
MANAGEMENT.
WE CAN DO TARGETED CULTURAL
HUMILITY AND TRAINING
TRAUMA-INFORMED CARE, QUALITY
IMPROVEMENTS AND OTHER TYPES OF
TRAINING.
I THINK THE BIG TAKE-HOME
MESSAGE IS WE HAVE TO DO IT IN
COMMUNITY WITH ONE ANOTHER, WITH
ALLIES, WITH MEMBERS OF THE
COMMUNITY, WITH PEOPLE IN
POSITIONS OF POWER, WITH PEOPLE
WHO CAN FUND THESE IMPORTANT
INITIATIVES OR CREATE IMPORTANT
INITIATIVES WITH THE PEOPLE THEY
ARE TRYING TO CREATE THE
INITIATIVES FOR.
HAVING AN EQUAL SEAT AT THAT
TABLE, EVEN IF THEY DON'T HAVE
THE FUNDING DOLLAR, I THINK
THOSE THINGS ALONG WITH SEVERAL
OTHERS CAN BE VIABLE STEPS
FORWARD FOR OUR FUTURE.
AND NOT JUST THE FUTURE OF A FEW
OR ONE PARTICULAR POPULATION,
BUT A FUTURE FOR ALL BIRTHING
PEOPLE BECAUSE HERE IN THE
UNITED STATES IT IS AN ISSUE
ACROSS THE BOARD.
BUT IT DOES HAVE THE TWO TO
THREE TIME HIGHER IMPACT
SPECIFICALLY ON NATIVE AMERICAN
BIRTHING PEOPLE AND BLACK
BIRTHING PEOPLE.
SO THAT'S THE REASON THIS
DISCUSSION IS TAKING PLACE.
BUT I WOULD LIKE FOR YOU, DR.
GRAHAM, AND YOU DIRECTOR
GOLDHAMMER, TO GIVE SOME CLOSING
THOUGHTS.
>> I MEAN, I THINK THIS IS SUCH
A PASSION OF MINE.
YOU KNOW, AND I THINK DEFINITELY
HAVING A SEAT AT THE TABLES,
BEING IN THE ROOMS WHERE THE
DECISIONS ARE BEING MADE,
SERVING ON THE COMMUNITIES,
SERVING ON THE, YOU KNOW, IN THE
COMMUNITY, THAT IS WHERE YOU
MAKE CHANGE.
THAT IS WHERE YOU FIND ALLIES.
THAT'S WHERE YOU BUILD
RELATIONSHIPS.
TO, I THINK, TRULY HAVE BROADER
IMPACT THAN JUST INDIVIDUAL
PATIENT CARE.
AND I JUST HOPE THAT THOSE THAT
HAVE BEEN WATCHING TODAY WHO
HAVE BEEN LISTENING, YOU KNOW,
HAVE BEEN ABLE TO TAKE AWAY FROM
THIS, YOU KNOW, THE UNIQUE
CHALLENGES THAT INDIGENOUS WOMEN
FACE AND LISTEN A LITTLE HARDER.
LISTEN A LITTLE LONGER.
YOU KNOW, THINK TWICE, YOU KNOW,
ABOUT OUR OWN BIASES ON OKAY WHY
DID I JUMP TO THAT THOUGHT FOR
THAT MOM?
WHY DID I JUMP TO THAT PLAN?
IS THAT TRULY WHAT IS GOING ON
HERE?
TAKE A SECOND, YOU KNOW.
WORK HARD TO BE A PARTNER WITH
THAT MOM TO HELP THAT PERSON
FEEL COMFORTABLE IN YOUR CARE,
FEEL COMFORTABLE OPENING UP TO
YOU ABOUT POTENTIAL SYMPTOMS SHE
MAY BE HAVING OR STRUGGLES THEY
MAY BE HAVING SO THAT YOU CAN
TRULY ADDRESS THEM AND NAVIGATE
THEM.
TO MAKE IT A TRUE PARTNERSHIP.
>> I AGREE.
>> INFORMED CONSENT.
CONSENT IS PARAMOUNT.
WOMEN NEED TO HAVE AUTHORITY OF
THEIR BODIES.
AND COERCION FORCED THINGS, THAT
IS NEVER, EVEN IF IT IS FOR THE
GREATER GOOD IN YOUR MIND, THAT
IS NEVER THE WAY TO GET THERE.
>> ABSOLUTELY.
AND SO IN CLOSING WE HAVE ONE
LAST MINUTE LEFT, WE'LL CLOSE
WITH DIRECTOR GOLDHAMMER'S
STATEMENTS.
>> YEAH.
I KNOW.
THANK YOU.
I THINK JUST IN CLOSING I JUST
WANT TO SAY, LIKE, TRUST US.
I KNOW I HAVE SAID IT SEVERAL
TIMES.
WE DO HAVE THE ANSWERS.
AND AS I HEAD OVER TO THE
INDIGENOUS MEDICINE
CONVERSATION, DAY TWO OF OUR
CONFERENCE FROM HERE, THE THING
I SAID TO PARTICIPANTS YESTERDAY
ON DAY ONE OF THE CONFERENCE WAS
YOU ARE VERY PRIVILEGED AND
LUCKY TO BE IN THE PRESENCE AND
WORK IN NATIVE COMMUNITIES.
WE ARE REALLY, REALLY, REALLY
EXCEPTIONAL PEOPLE.
AND I THINK WHAT I WANT FOLKS TO
KNOW IS WE ARE WORTH INVESTING
IN.
WE ARE ABSOLUTELY WORTH
INVESTING IN AND WE CAN DO
SOMETHING ABOUT THIS CRISIS THAT
WE'RE IN.
>> THANK YOU ALL FOR COMING.
THANK YOU FOR YOUR CLOSING
REMARKS.
AND WE'D LIKE TO THANK ALL OF
THE MEMBERS OF OUR AUDIENCE AND
ALL OF OUR AD HOC COMMITTEE
MEMBERS THAT ALLOWED THIS PANEL
DISCUSSION TO TAKE PLACE AND WE
LOOK FORWARD TO MANY MORE IN
COLLABORATION WITH U.S.
DEPARTMENT OF HEALTH AND HUMAN
SERVICES AND INDIAN HEALTH
SERVICES.
SPECIAL THANKS TO EVERYONE ON
THE INDIGENOUS ENGAGEMENT
COMMITTEE AND THE OFFICE OF
EQUITY, DIVERSITY AND INCLUSION
AT NIH.
WE WOULD LIKE TO THANK YOU ALL
FOR COMING AND WE HOPE YOU ENJOY
THE REST OF YOUR DAY AND THAT
YOU HAVE LEARNED SOMETHING.
ALLYSHIP DOES WORK.
SO PLEASE JOIN US, CONTINUE TO
SUPPORT US AS WE CONTINUE TO
SUPPORT THE COMMUNITY.
HAVE A WONDERFUL REST OF THE
DAY, EVERYONE.
THANK YOU FOR COMING.
>> HAVE A GREAT DAY.
>> THANK YOU.