Thursday, February 6, 2014

What You Don't Know, Hurts Us

I talk to professional Caucasian people day in and day out about my proposed approach to health inequity.  I have resigned myself to being mostly misunderstood and maligned.  It is frustrating, and unfair, but I've learned to live with it.   It is so refreshing when someone actually HEARS what I am saying.  Here is the excerpt I received from an email yesterday, that I have permission to reprint for you.  I had been checking in on a group from another city that had come up to hear me speak last September.  I had given them a private session on improving breastfeeding rates in their agency after my conference session.  I was checking in to see if they had used any of my suggestions and how it was going. The writer (a Caucasian nurse) is just about to end her support group because it did not take off, but is thrilled by the response to the support group of the African-American breastfeeding peer counselor  (Monique) they had recruited.   I didn't expect this:

Both hospitals here are working on Baby Friendly, so we went from the WIC breastfeeding group + LLL to about 6 breastfeeding groups each month.  We decided to cancel mine since the attendance was lowest; appeared to me that we didn’t need the group with all the other options.
December was to be my last meeting and it fell right after Monique’s first Monday meeting.  Monique usually came to the group and, other than the two of us, the other attendee was a young, black breastfeeding mother who also happens to be a news reporter who’d heard about Monique’s group. 

Sherry, the whole tone of the room changed when the reporter mom walked in.  She and Monique engaged in a very animated, enthusiastic, boisterous conversation.  I played with the baby and observed those two….I learned SO much!!  Black women truly do talk differently with each other than they do with us white nurses!  Wow!  What an experience…it was like I was invisible and I could just listen and learn.  I know realize how much I DON’T know about helping black moms breastfeed.  I understand why I have struggled as a public health nurse working with black families.  I have so much MORE to learn!!!...  

I am grateful for the understanding that cultural congruency is a "thing".  The very thing that has been missing in breastfeeding support, the very thing that helps to feed inequities in support. It felt like a huge breakthrough to read those words.  I had just had a conversation with a local lactation consultant who turned down my request to have our lactation interns come to her hospital.  As we chit chatted some more, she mentioned that they had recently received a grant to fund the salary of a breastfeeding peer educator. I congratulated her and asked, if that peer counselor might be a woman of color.  She said, "No".  I said, "I'm sorry to hear, that." She said, "I'm sorry you're sorry" and went on to extoll the virtues of her hiring choice.  I tried to make my point that her hospital serves a clientele that is about 80% women of color, and that a peer counselor of color might have better fit the need.  She denied it, saying her peer counselor had a wonderful rapport with the clientele, and besides, no peer counselors of color applied for the job.  I told her, she should have spoken to us.  We've trained almost 15 peer counselors in the past year, most of which are women of color.  The conversation declined from there. I had put her on the defensive and there was no going back. Shortly after this phone conversation ended, I received the above email.  I responded to it, and asked permission to share her insights.  I later received this response:
I think those in my generation, those who grew up during the 60’s and observed the struggle for desegregation first hand, worry about this as on the surface, it appears to be a step backwards.  I realize now it is not a step in the wrong direction, but a move in a very RIGHT direction.  If we (white professionals) acknowledge our clients differing cultural styles, we need to look at how best to meet the client’s needs in a manner congruent with their culture, heritage, language, and social structure.  What I had overlooked was how different my culture is from the women of color in my community.  Funny thing, I was really, really good at working with the Amish culture in my years as a case manager and discharge planner.  Our pediatric pulmonologist couldn’t believe that families would agree to nebulizer treatments or home oxygen (with a concentrator).  They did because I learned their culture and built into my plan the strategies I knew they needed in order to get “English” medical technology into their homes.  It was a long process but well worth my effort.  So, if I could recognize the need to adapt my approach with this group, why did I not recognize the black and Latino families in my community might need similar adaptations?  Got to think on that one….  But at least I am more aware of available resources now!  I am looking forward to working with Mo and observing the changes in our community …..

This response is an interesting insight into the fear (and oftentimes ignorance) with which we are often approached.  How often have I counseled individuals and groups to be quiet, stand down, listen, hear, observe, but they are far too busy coming up with the next great idea...