Saturday, 20 October 2012

Healing begins at home. Idle No More

I don't have time tonight to edit this properly. But, here is my presentation at the 22nd Annual Breastfeeding Conference. Toronto, ON 2012

I have the PowerPoint. Just let me know if interested.

This is about language - the power of language today which both hurts and hinders. And empowers. When one can speak the language of the medical and scientific literature, you can better explain stark realities in terms they can understand.

Sago, everyone.

Thank you to the organising committee for inviting me to give this presentation. I am honoured to be speaking with such distinguished scholars and breastfeeding advocates. I am also grateful to be speaking to a captive audience – you can’t run and hide much while I am speaking, unlike my family.

Let me say at the start, I am explaining realities from the other side of the fence. I was raised on this side, down in Windsor, knowing of my heritage, but not knowing the depth of my history.

On my community of Six Nations, the first question we hear from people we meet is, “Where are you from? And, who is your family?” Allow me to introduce myself:

My grandfather was born on Six Nations. He was a Mohawk speaker in the home. At the appropriate age, he was sent to Residential School. Discussing his experience in the Mush Hole, he didn’t mention to us physical or sexual abuse, but there are many other forms of abuse. Head trauma, not attended to by any medical practitioner left him with memory loss, a change in personality, and, as per the government wish to take the Indian out of the child, lost his language and culture. He and my grandmother, a non-native, produced 4 children. They were both heavy drinkers, pregnant or not. I believe my mom is the only child of their relationship who has not been in jail. I also believe they all suffer from FASD. They were raised in separate non-native homes. My mom doesn’t know where she was for the first 6 months of life. We all know about the importance of bonding in infancy. She didn’t get that. She was put into a permanent foster home when she was 6 months old, and left when she was 18. My mom didn’t know she was Mohawk until that time when CAS gave her a brief copy of her family history.
My dad is French Canadian, one of 13 children. He was a homebirth and he was breastfed. I say that is why at his age of 82, he only has high blood pressure issues. He was the stabilizing force in our home while we grew up.
My parents married, produced 3 children – myself and 2 older brothers. They divorced after 25 years and remarried each other 7 years ago. It’s not as romantic as it sounds. My mom’s mental illness, which I attribute to FASD and lack of bonding in infancy, led to many issues in their marriage, our childhood, and our adulthood. If my brothers and I didn’t work so hard to break the cycle, it could have had effects on our children as well.

I graduated with a joint degree from Trent University in Native Studies and History. A year later I became a very content stay at home mom for the next 10 years.

I have been studying and working on Six Nations for 9 years now. Cordelia was 7 months old when I started back to school. She weaned after she turned 3. I started schooling at the Birthing Centre to become an Aboriginal Midwife, graduating 5 years ago. I spent the following years as the Community Breastfeeding Coordinator, and studying for the IBCLC exam, passing it last year. As far as my networking has been able to find, I may be the only band member IBCLC working on their own community in Ontario. It does make a difference to how women listen to me. I am asked for advice on reserves an hour or 2 away because they don’t have anyone in their community with the knowledge or skill that I have or the health care providers women will trust.

I have been very blessed by support from the Director of Health and front line staff, because breastfeeding is strongly encouraged and supported. While I am still working with departments to follow the WHO Code and to get BFI ready, they are eager to send clients my way for prenatal breastfeeding classes because they and their clients believe it to be important, not just their families but our Community as a whole. When notified of the WHO Code for our Breastfeeding Day last year, one department took it to heart so much, I was asked if their very large basket of baby goods was permitted to include teething toys. Mentioning the WHO Code as a base for the event made a difference then, and I’m sure it’s continuing to make a difference in their offices today.
Here is part of a talk from Ruby Miller, Director of Health at our Breastfeeding Day this year. After listing the risks of formula feeding to mom and baby, she said this:

The Creator intended for babies to be breastfed, to be nurtured at their moms’ hearts for as long as mom and baby feel the need. Nothing man-made could ever have more advantage to our children’s health.

In our community, we are privileged to have an International Board Certified Lactation Consultant, on call to help moms and families with breastfeeding education and proper breastfeeding support. Generations of our people have not breastfed and vital breastfeeding education, passed from our grandmothers, has been lost.

Let’s bring it back.

Let’s make this day the start of a community-wide commitment to bring back the normalcy of breastfeeding in our community. Together, we will promote the significant benefits of breastfeeding to everyone. Mothers, fathers, grandparents...let us all remember these benefits of breastfeeding not just for the baby or the mom, but to our families, and to our community as a whole.

Being a Registered Nurse, I know that our Best Practises for infant feeding begins with skin-to-skin to contact immediately after birth, baby-led breastfeeding, and having babies within mom’s reach so they can be fed when babies show signs of hunger.
I congratulate the moms who have breastfed their children. They will see how their health and the health of their children is stronger, not just in their infancy, but in the childhood and adulthood, as well.

As Pat Martens would say, this is an upstream approach to breastfeeding in our community. Buy-in from the big boss is always a good thing. The dissemination will take more time, but I’m determined, or just plain stubborn enough, to make that happen.

Other First Nations communities are not as fortunate. While speaking at the annual Best Start Conference in March about how to work and serve people on a reserve, or with Aboriginals who are clients, I was shocked and disheartened that women from fly-in communities asked me basic questions about breastfeeding. I was asked, “If breastfeeding hurts, how can I make the pain stop?” and “What is a tongue tie?” and “How can you tell if baby is getting enough breastmilk?” I wonder if they would have approached a non-native as freely as they approached, and shared a meal, with me.

For us in this conference, we realize how multi-faceted these answers are. I felt useless in answering. For example, for the “How can you tell if baby is getting enough breastmilk,” question, my answers started with: How old is baby? How many wet/dirty diapers? How is the weight loss/gain? Is mom in pain? Were there drugs used in her birth? My answers were vacant stares. The one woman thought I could help her client fully, right then and there – give her the knowledge she needed to return to her community and fix her right up.

We all know that can’t happen. I was astonished at the lack of breastfeeding knowledge these women had, especially working with healthy babies programme. These wonderful women attended that Best Start Conference to bring knowledge home. I know they went home knowing more research about breastfeeding teaching or why it’s healthy, but not the how-to’s. As an example, can you teach me to play a French horn, without teaching me first what an “A” should sound like, or how to vibrate my lips together properly in the mouth piece in order to make that A?

The women from the fly-in communities are caring, loving, and receptive to knowledge. They know their grandmothers were breastfed, maybe some were even breastfed themselves. But because of the residential schools, and the 60’s Scoop, it wasn’t just children that were taken out of their homes. Knowledge was also stolen from these children, knowledge about pregnancy, birth, breastfeeding, and parenting.
I understand that there are some in Canadian society who take the stance that what happened to Aboriginals in the past, has no, or should have no, bearing on the present day. If you read comments after Canadian media articles regarding any First Nations’ issue, you will always read things like this, and I quote:

It's time to end the reservations completely. They've outlived any usefulness they ever had.

When you squish all the poverty, dysfunction, depression and limited opportunities you can into such a small geographic area, of course people turn to substance abuse as an escape
The parents of these youth have to start... parenting.

The problem isn't substance abuse; it's a lack of parenting. If I came home drunk or high on drugs when I was a youth, my parents would have take swift, corrective action. They wouldn't have turned to the government to solve the problem.

Lock the gas away, control the community, insure that drugs are not coming into the community and report the people who are bringing them in, community elders and youth know who they are. See that the kids go to and stay in school. Put some of the government $$ towards scholarships etc, towards the youth in terms of educational programs. Help build their confidence. Assimilate maybe?

Trans-generational trauma sounds like a convenient cop-out to avoid taking responsibility.

Other cultures managed to overcome such stigmas in much less time. some by immigrating, others through pulling themselves out of despair.

What do you do when no-one thinks they're responsible for themselves?
It's difficult to be partners with people who won't work.

I bring these comments (copy and pasted directly from media sites) into this talk because this is how some, hopefully only a loud-mouthed minority of, Canadians think. Some people with these opinions work not only on reserves, but in health care positions which have them work with First Nations people, through Friendship or Health Access Centres, hospital settings, or home visits. I have seen with my eyes, and heard with my ears comments like the ones I’ve mentioned said to my clients, or said to me (because I don’t look Mohawk).
I am not a spokesperson for my community. While researching for this presentation, I have been in contact with people on reserves coast to coast to coast and coast, if you include the Great Lakes. They have allowed me to share their wisdom with you. They all agreed on one vital point: The Residential School system is the turning point; the turning point of disconnectedness, of dysfunctional families, of a lot of addictions, and the loss of traditional parenting knowledge, including breastfeeding.

Why am I Poor: First Nations Child Poverty in Ontario, Best Start Resources 2012 SLIDES

In areas of the north, there is often a lack of local child mental health services
To deal with serious issues such as FASD, depression, autism, and behavioural problems...waiting list of 18 months to get a child diagnosed, after which, there was no local service provider available to work with the child and the family. The only alternative was to take the child outside of the community for critical services.
(Why Am I Poor?)
The majority of protection workers are straight out of university and are armed with the best intentions. They go into a First Nations home and see overcrowding for example, or that there may not be a lot of food in the home, and the worker immediately sees neglect. The worker is evaluating the situation from their own perspective and not from that of the family or culture. (WAIP)

Almost 30% of water in First Nations was potentially harmful.

22 % on reserve households lived in inadequate housing and were in core-housing need, compared 2.5% of Non-Aboriginal households.

Off-reserve, 21% of Aboriginal households had problems affording housing and were in core-housing need, compared to 14% of NAH (CMIHC, 2009)

Living in poverty over extended periods is linked to an increased risk of behaviour problems, depression, emotional problems and family dysfunction (AFN, 2006)

Education: Report from BC by Canadian Teachers Federation confirms that not only do Aboriginal students experience racism in schools, Aboriginal teachers experience it as well (St. Denis, 2010)

Food insecurity: 33% of Aboriginal households in Canada experienced food insecurity compared to 9% of NAH.

In areas of the north, there is often a lack of local child mental health services

To deal with serious issues such as FASD, depression, autism, and behavioural problems...waiting list of 18 months to get a child diagnosed, after which, there was no local service provider available to work with the child and the family. The only alternative was to take the child outside of the community for critical services.

Underpinning the approaches that are effective in working with First Nations families is the need to stabilize the family, strengthen the family unit and avoid focussing on the needs of the child separately from the needs of the family.

The First Nations approach is to consider the perspective of the family, not of the individuals in the family and to identify what the family needs to help them succeed. There needs to be recognition that there is a long history and current realities behind the immediate family problems and that it will take time and support for the family to change.

SLIDES on Social Determinants of Health
WHO
ANNEX A. RIO POLITICAL DECLARATION ON SOCIAL DETERMINANTS OF HEALTH
Rio Political Declaration on Social Determinants of Health RIO DE JANEIRO, BRAZIL, 21 OCTOBER 2011
6. Health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health. These include early years’ experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health. We are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies. Positioning human health and well-being as one of the key features of what constitutes a successful, inclusive and fair society in the 21st century is consistent with our commitment to human rights at national and international levels.
7. Good health requires a universal, comprehensive, equitable, effective, responsive and accessible quality health system. But it is also dependent on the involvement of and dialogue with other sectors and actors, as their performance has significant health impacts. Collaboration in coordinated and intersectoral policy actions has proven to be effective. Health in All Policies, together with intersectoral cooperation and action, is one promising approach to enhance accountability in other sectors for health, as well as the promotion of health equity and more inclusive and productive societies. As collective goals, good health and well-being for all should be given high priority at local, national, regional and international levels.
8. We recognize that we need to do more to accelerate progress in addressing the unequal distribution of health resources as well as conditions damaging to health at all levels. Based on the experiences shared at this Conference, we express our political will to make health equity a national, regional and global goal and to address current challenges, such as eradicating hunger and poverty, ensuring food and nutritional security, access to safe drinking water and sanitation, employment and decent work and social protection, protecting environments and delivering equitable economic growth, through resolute action on social determinants of health across all sectors and at all levels. We also acknowledge that by addressing social determinants we can contribute to the achievement of the Millennium Development Goals.

Let’s look at where Aboriginal Communities are today in relation to social determinants of health Native Women’s Association of Canada’s Submission to the WHO’s Commission on the Social Determinants of Health, “Social Determinants of Health and Canada’s Aboriginal Women” June 4, 2007
“The vulnerable and marginalized in Canadian society, particularly Aboriginal women, are suffering from...lack of action, continuing to endure the poorest socioeconomic and health status of all Canadians.”
“The population health approach which is predominant today in Canada and internationally, recognizes that primary health care is a limited actor in human health outcomes. The population health approach is thus compatible with native ancestral laws and spiritual beliefs, in which interconnectedness and holism as keys to healing and health are central tenets...holistic approach incorporates physical, mental, emotional and spiritual factors with her personal situation, nature and the environment, as well as her family, community and other relationships and societal settings and interactions. However, the lived experiences of Aboriginal women in the 21st century often impose disconnection on Aboriginal women, isolation and marginalization in and from their own communities; due to a number of factors the population health approach now commonly labels the social determinants of health.”

It’s been 200 years of this dysfunctional, non-traditional model which has been pushed upon our communities. If we didn’t abide by the terms, we still had to abide by the terms. I have spoken with people whose family history includes women who hid in the bush with their children to stop the Federal Agents from taking their children to residential schools.
How many of us cried the first day we brought our children to school, even with the knowledge we would be getting them back at the end of the day.
What if we didn’t know if we were ever getting them back? [As an aside, the issue of not knowing if your child is coming back is still alive and unwell for fly-in communities. But, that is not the focus of my talk.]
SLIDES
Disconnect from traditions:
Namely roles of men and women, IPV/Child Abuse
Any lower socioeconomic group of people find themselves with this issue, as well.

Why Am I Poor? First Nations and Child Poverty in Ontario. Best Start Resource Centre, 2012
In some residential schools, the death rate was as high as 75% from disease, starvation and abuse.
The children who survived often had low literacy rates and did not have parenting or life skills.
35% of First Nations adults believed that their parents’ attendance at residential schools negatively affected the parenting they received as children. Additionally, 67% of the adults surveyed believed that their grandparents’ attendance at residential schools affected their parenting skills. (Chiefs of Ontario, 2003)
Considering population size, Aboriginal children in Canada were 5 times more likely to be substantiated for neglect than non-Aboriginal children (Trocmé et al, 2005). In contrast, maltreatment of non-Aboriginal children is most often in the categories of domestic violence, physical abuse or neglect, each occurring in about a third of cases (Trocmé et al, 2006).
A study of 3 sample provinces found 10.23% of status First Nations children in out-of-home care, versus 3.31% of Métis children and 0.67% of other children (Blackstock et al., 2005).
Another study found that Aboriginal children represent 40% of the children in out-of-home care in Canada (Farris Manning & Zandstra, 2003). There are 3 times as many Aboriginal children in child welfare care today than were in residential schools at their peak (Blackstock, 2003).
The high rate of poverty today is linked to the traumas experienced by current and past generations brought about by efforts to colonize and assimilate Aboriginal people in Canada through damaging government policies...it is clear that service providers who understand the impact of these past traumas are more likely to be effective in providing culturally sensitive and appropriate services to their clients.

Dr. Kathleen Kendall-Tackett SLIDE
In a sample of primary care of 35 patients, those who experienced childhood abuse or partner violence in adolescence or adulthood reported twice as many symptoms on a review of systems than their age-matched, non-abused counterparts. They were also more likely to abuse substances and report a wide variety of chronic pain syndromes.




SLIDE
...we do know that women experiencing past or current VAW are at increased risk for depression, PTSD and physical health consequences antenatally and postpartum…Not all women who have experienced past abuse become depressed, end up in unsupportive or abusive relationships, or have difficult relationships with their children. These hopeful signs offer us at least a glimpse of what the perinatal experiences of all abuse survivors could be like. And improving the antenatal and postpartum experiences of women with a history of violence is a goal worth pursuing.

Dr. Karleen Gribble

Breastfeeding requires frequent close physical contact between mother and child and some research has found that breastfeeding women seek greater proximity to their babies. Breastfeeding involves infant-mother skin-to-skin contact which both increases a mother's desire to be with her baby and her sensitivity to her infant. Research has found that the more that babies and mothers are kept together, the greater the impact on the mother in terms of exhibition of responsive caregiving and security of attachment in the child.
Children with a history of relational trauma may experience lifelong difficulties with feeling empathy, trusting others and developing intimate relationships as their internal model of relationships tells them, "Do not let us care too much for anyone. At all costs let us avoid any risk of allowing our hearts to be broken again...”
Therefore, mothers who wish to breastfeed their adopted child are advised to instigate caregiving strategies that will build trust and attachment.
Breastfeeding has the potential to promote the development of the child-maternal attachment relationship in vulnerable adoptive dyads...
SLIDE
However, the impact of breastfeeding as observed in cases of adoption has relevance to all breastfeeding situations and this deserves further investigation. In particular, there may be applicability of the experience of adoptive breastfeeding to other at risk dyads, such as intact families with a history of intergenerational relationship trauma.
SLIDE
The Health Effects of Childhood Abuse: Four Pathways by Which Abuse Can Influence Health. Dr. Kendall-Tackett Child Abuse & Neglect, 6/7, 715-730
Results: Childhood abuse puts people at risk of depression, PTSD, participating in harmful activities, having difficulties in relationships, and having negative and attitudes towards others. Each of these increases the likelihood of health problems, and they are highly related to each other.
Conclusions: Childhood abuse is related to health via a complex of matrix of behavioural, emotional, social and cognitive factors. Health outcomes for adults survivors are unlikely to improve until each of these factors is addressed.
To improve health outcomes for adult survivors, clinicians must consider and address each of the ways by which victimization can influence health. For example, admonitions to abstain from smoking or substance abuse are likely to be unsuccessful until the traumatic past events that are driving these harmful activities are addressed and resolved. Admonitions to exercise will not be helpful if the patient believes that nothing she does makes any difference. Telling a patient to “lose weight” is likely to fail if he has no ability to make and keep friends, and eats when he is lonely or stressed. Recognizing the complexity of the forces that lead to health, clinicians and researchers must strive for an approach that addresses all these pathways. Health outcomes are unlikely to improve if professionals in the child maltreatment field continue in the current mindset of treating mental health and physical health sequelae separately. Only by recognizing, and addressing, all of these underlying factors can we hope to improve the health of adult survivors of childhood abuse.
SLIDE
Children who are breast fed may be more resilient to the stress associated with parental divorce.
Breast feeding may be associated with a variety of exposures and family characteristics that confer
resilience against stress related to parental divorce. Montgomery, S. M., Ehlin, A., & Sacker, A. (2006). Breast feeding and resilience against psychosocial stress. Archives of Diseases of Childhood, 91, 990-994

GAS Slide
George Albert Smith: “You cannot drive people to do things which are right, but you can love them into doing them, if your example is of such a character that they can see you mean what you say.”
Breastfeeding is the original traditional medicine. Help people to trust that. I recently met a family, who has never had a generation that has not been breastfed. Wouldn’t researchers love to study those women! In this day, in these past decades of the media and medical machine of formula marketing, there is a family that has not succumbed to it.
I asked the great-grandmother about how they breastfed in her day. (She is close to 80). She said – I just let the babies tell me when they were hungry. I kept the baby as close as possible at all times. Grandmas, and, aunties and sisters would come over to take care of the new mom so she could take care of the baby. Long term breastfeeding problems were unheard of because moms, and aunties and sisters and grandmas were there to help. Women also grew up always seeing babies at the breast. Men didn’t ask to feed the babies because it wasn’t their role. If men were meant to feed babies, they would have working breasts, too. Breastfeeding also meant babies knew where they were safe, where their centre was. They knew mom was there to take care of them first and foremost.
NEW SLIDE
“Breastfeeding had a positive impact with parenting behaviours regardless of marital status or income level. However, it appeared to be particularly important for single and lower-income mothers, continuing to have a positive effect for these groups when their children were 5 years of age, but not for married and higher-income mothers, or for the sample overall. Conversely, not breastfeeding seemed to have particularly negative consequences for the parenting behaviours of single and lower-income mothers.”
Here are a couple of other quotes, directly from the paper:
P 39,
​Breastfeeding is often difficult for new mothers, and in some communities it may be such a rare practice that mothers lack role models or the support of peers. In addition, Bolling et al. (2007) found that while reasons for stopping breastfeeding included insufficient milk, rejection of the breast and pain or discomfort in the first 2 weeks, in later months, return to work became a factor.
​Parenting programmes, for example, that focus on skills such as awareness of the needs and feelings of others, including the child, may be particularly useful, especially for those mothers without support of a partner.
40
​...parenting of lower income mothers is more vulnerable when they feel less control over their lives, targeting resources at these mothers may be particularly beneficial.
41
​Our findings indicate that both who you are and what you do are important in terms of parenting—personal characteristics such as interpersonal sensitivity and education and behaviours such as breastfeeding are significant predictors. Socio-demographics perhaps have less influence than we might expect (only education has independent significance)—the other socio-demographic factors are mediated by the processes such as social networks and post-natal depression. Given this, we can see that there is room for intervention – “what you do” and even personal characteristics are amenable to support if appropriately and sensitively offered.


SLIDE

Maternal Child Health Program
At the September 13 2004 Special Meeting of First Ministers and National Aboriginal Leaders, the Prime Minister announced additional funding for programs that promote the health status of Aboriginal people - one of these programs is the Maternal Child Health program in First Nations communities, on-reserve.
Why are Maternal Child Health Programs important, and how do they differ from other approaches?
In the past, health services in First Nations communities have focussed on treatment and crisis response. MCH takes a more proactive, preventative and strategic approach to promoting good health and preventing disease.
Early experiences are the foundation on which an individual’s life is built. In Canadian and international health systems, MCH programs have been shown to have a positive effect on the participating mother and child’s physical and mental health. In fact, effective MCH programs enhance the physical, psychological, cognitive, and social development of all family members.
Home visiting by nurses and family visitors – a key element of MCH programs – has been linked with improved parenting skills and quality of home environment, improved cognitive development of infants and young children, and the decreased incidence of unintentional injury. These visits have also improved detection and management of postpartum depression, improved rates of breast-feeding, and enhanced quality of social supports to mothers.
Cost-benefit analysis of two long-term home visiting studies, conducted by David Olds of the University of Colorado Health Sciences Center and his colleagues, indicate that the social and economic benefits of home visiting programs outweigh the costs by a ratio of more than five to one.
Interventions like MCH, that focus on improved reproductive health, prenatal and postpartum services, and early childhood development, present an opportunity to break the cycle of persistent gaps in life chances between Aboriginal and non-Aboriginal children. These kind of approaches are referred to as making strategic ‘upstream’ investments early in a child’s life.
In sum, the MCH program will be community-based, community-driven and community-involving. By building on community-specific cultural knowledge and ways of doing things, it will deliver the culturally appropriate services and supports that community members need, and that they will appreciate and accept.

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