The Way Forward

Yesterday, I had lunch with a former nursing student of mine.  We met at a local pizza joint and she told me all about her new position at my old hospital.  I loved our visit and am grateful that I often connect with former students who are constantly moving forward in their career trajectories.  This visit felt very deja vu' as she spoke about the highs and lows of working in a teaching hospital.  I know all too well the agonies and ecstasies of working in such a facility and tried to advise her as best I could.  The facility had recently become "Baby Friendly" (that means it is certified by a national body as having policies in place that promote breastfeeding).  But while the practice policies have changed dramatically, the underlying soul sickness of the place remains. 

My 'relationship' with this hospital spans my entire life cycle.  In fact I could say that my story is inextricably entwined with this facility.  I was born across the street from the current hospital at its predecessor, General Hospital N. 2.  Even the name speaks to its legacy of racism.  In my mother's day, Whites were cared for at General Hospital N. 1 and Blacks at N.2.  By the time I was born, both facilities had merged and it was informally simply called, General Hospital. It was within its ancient corridors that I would get my first glimpses of White people, who did not exist in my day to day life.  Little girls my size, except for their pale skin and curious twin braids trailing down their backs.    In 1976, the old General Hospital closed its doors for the last time, and a new upstart hospital, bright and shiny new was built by the city.  It was named for Harry S. Truman, the former US President, from Missouri.  My first major interaction with this new hospital was, when I went there to give birth to my first child. 

I was and am a voracious reader, and I had read everything I could get my hands on about pregnancy and childbirth.  The year was 1978.  I was fifteen- a sophomore in high school.  The natural birth movement was in full swing.  I was fascinated by my own pregnancy and began immediately to amend my orientation toward healthy behaviors. I was fascinated by books I found in the library on homebirth and natural birth.  I somehow intuitively knew that these books were onto something.  Some very deep and veracious knowledge that I had never heard spoken, but as soon as I saw it on the page, knew that it was so.   I also knew that that birth experience was out of my reach.  I knew I would get the 'typical' Truman birth.  I was however committed to a natural birth.  I knew I would not take their drugs.  When the time came, to push my baby out, after a hefty labor of Lamaze style focused breathing, the resident offered to give my 'something for pain' which I declined.  He shoved a large needle into my vagina anyway, numbing me with what I would later come to discover was a puedendal block (an early precursor to the epidural).  I remember my anger at being ignored.  I had worked very hard for my natural birth.  I had endured a Pitocin enhanced labor (that I didn't know they had given me until decades later when I read my old chart), with techniques I had taught myself.  I was left to largely labor alone and then when it was time to push, had my desires completely disregarded.  I was invisible to them.  They neither saw me nor heard me.  I was merely a revenue producing commodity.  It didn't matter in the least that I spent months teaching and preparing myself for my birth.  In the end I was given over to these people for their purposes, their agenda, their learning.  I was completely at their mercy, except there was no mercy to be found in them.  There was nothing I could do as a young Black girl to make myself visible to them. 

When I returned to Truman, some twenty years later as a brand new graduate, labor and delivery nurse, I brought that experience with me, and saw my new patients through that girl's eyes.  Nothing had changed, nothing.  The population of largely Black and Latino women were simply fodder for the mostly White and male resident's learning.  I'd sit in the nurses station and listen to the White nurses talk about 'those' people and judge them by their own imperial standards even though they knew nothing about the world the patients had come from and would quickly return to with their babes in arms.  The doctors and nurses were completely ignorant of that world.  They only passed it in a quick blur as they sped through it in their shiny cars enroute to more prosperous lands.  They learned on  our Black and Brown bodies, learning to despise the very ones they owed their learning to, and quickly went on the their 'real' jobs after residency caring for Nice White Ladies.  White ladies who would reap all the benefits of their doctors having learned to sew up a nice tidy episiotomy after fucking it up on several Black women first.

All these memories came flooding back to me as I sat and lunched with my former student, now a nurse on the very unit that had caused me such sickness of soul. My experiences on that unit, first as a birthing women, and later as a nurse are exactly the reason Uzazi Village was born.   I had been back there recently as a doula with a client during a three day long induction.  I could testify to the policy changes that had put a spit shine on the appearance of the care. The residents had been taught to say all the right things. The nurses sickly sweet.  But upon closer inspection, I could still see the unseemly underbelly of racism, intolerance, white privilege, and discrimination that ruled the culture.  The underlying assumptions were the same.  "Do what we tell you to do and don't ask too many questions.  If you do, we'll label you 'noncompliant' and punish you and your baby."  And they have so many ways to punish. 

It's easy to see that moving to evidence-based care won't change outcomes either.  This is the very essence of a white-washed tomb.  It is the underlying systemic racism that is woven into the fabric of healthcare institutions that must be cut out like the cancer that it is.  Evidence-based care is a clean white bandage over a gaping pus-filled wound that continues to seep.  Change the bandage as many times as you want- that does not fix the problem.  I am more convinced than ever that my path is true.  We must build systems of care for our own.  We will never find the health and vitality and wholeness we seek in the reflection of someone to whom we are at best, invisible, and at worst despised.