5/19/2015. Welcome to the American Indian Structural Competency Series. What is structural competency?

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1 Welcome to the American Indian Structural Competency Series This webinar is being presented live on May 19, 2015, and is being recorded and archived for future viewing. You can find Frequently Asked Questions on structural competency and additional readings and resources at: What is structural competency? Structural competency is the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication non compliance, trauma, psychosis) also represent the downstream implications of a number of decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health (Metzl and Hansen, 2014). Simply put, structural competency teaches that people s rates of sickness and death are as connected to their zip code as they are to their genetic code. The Four Beats of this Structural Competency Series 1. Historical frames of oppression 2. Present day sociopolitical barriers and challenges to health 3. Activism and advocacy within the community around health 4. Clinical cases 1

Shaylynn Raphaelito and Michael Martin Structural Competence for Urban American Indians in Buffalo and New York City Webinar Guidelines You will be listening to this webinar over your computer

2 American Indian Series Presenters and Topics 1. Dr. Lori Quigley Multigenerational Trauma: Effects of the Boarding School Period 2. Katsi Cook Woman as the First Environment Bodies Telling Her/stories 3. Chief Beverly Cook Resilience from Our Roots 4. Shaylynn Raphaelito and Michael Martin Structural Competence for Urban American Indians in Buffalo and New York City Webinar Guidelines You will be listening to this webinar over your computer speakers. There is no need to call in. There is a chat box located on the lower right side of your screen for the live webinar. Please use it to communicate with the presenter or producer only. The live webinar will have a question and answer period at the end but you may type your questions Into the chat box at any time. Chat Box Partners and Sponsors The planners, moderators, and presenters for this webinar series do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in this presentation. This program is funded by a grant from the New York State Department of Health. No commercial funding has been accepted for this activity. 2

Learning Objectives 1. Identify one of the ways in which Historical Trauma is embodied by Native American women 2. Name a body system/organ targeted by PCB contamination 3.

3 Learning Objectives 1. Identify one of the ways in which Historical Trauma is embodied by Native American women 2. Name a body system/organ targeted by PCB contamination 3. Recognize the three major elements of the Centering Model of Pregnancy 4. Understand how the political, social and cultural context of the aboriginal birthing center in Canada differs from the U.S. context Evaluation Complete the evaluation here after the program: Today s Presenter Katsi Cook (Akwesasne Mohawk) is a midwife, environmentalist, and Native American rights activist who has a long history of work and research at the intersections of reproductive and environmental justice. She is Director of Woman is the First Environment Collaborative at Running Strong for American Indian Youth. 3

4 Woman as the First Environment - Bodies Telling Her/stories Embodiment is the idea that social, economic, cultural and political forces are expressed in bodies, and are mediated by biological processes 4

North American Indigenous are not a racial or ethnic minority, but are one of three sovereignties in the United States Federal State Tribal Nations Cultural Competency - can t throw the baby out with

NAGPRA - Native American Graves Protection and Repatriation Consensus Clinical Practice Guideline NALA - The Native American Languages Act 1990 PUBLIC LAW 101-477 Ecosystem of Meaning of the

narrative (Creation Story, dream & vision, Traditional Indigenous Knowledge and Wisdom TIKW) Territorial ecosystems, metaphors of body and landscape Historical Doctrine of Recovery decolonization &

5 North American Indigenous are not a racial or ethnic minority, but are one of three sovereignties in the United States Federal State Tribal Nations Cultural Competency - can t throw the baby out with the bathwater Traditional Cultural Property protected in 2 Federal Laws NEPA - National Environmental Policy Act, Enhancing the protection of tribal cultural resources and sacred places. NAGPRA - Native American Graves Protection and Repatriation Consensus Clinical Practice Guideline NALA - The Native American Languages Act 1990 PUBLIC LAW Ecosystem of Meaning of the Indigenous Woman s Body Cosmological a cosmology of the body, living a cosmologically meaningful life (Jung in Sabini 2002) Mythological restoration of sacred knowledge, ceremony, symbol systems, narrative (Creation Story, dream & vision, Traditional Indigenous Knowledge and Wisdom TIKW) Territorial ecosystems, metaphors of body and landscape Historical Doctrine of Recovery decolonization & healing vs Doctrine of Discovery Sociological kinship, identity, ritualization of youth, needs to increase cultural capital (Mother/Baby/Mother Earth) Biological epigenetics, macroepigenetics, PNI, hormonal physiology Pregnancy is a trans-generational event 5

Matrilineal in social power, kinship structure Matrifocal/matrilocal in ritual and cultural memory Matriarchial in structures of consciousness Sharing Our Voices, Sharing Our Stories, So that the

Encourage and build on community social support, increase community interaction and cohesion and diminish social isolation.

6 Matrilineal in social power, kinship structure Matrifocal/matrilocal in ritual and cultural memory Matriarchial in structures of consciousness Sharing Our Voices, Sharing Our Stories, So that the Generations Continue Nurture initiatives that empower women, especially within the context of reproductive health and childbearing. Encourage and build on community social support, increase community interaction and cohesion and diminish social isolation. Increase the capacity for tribal members to develop community-led and culture-based initiatives. Increase the knowledge of community members and public health staff in communications concepts regarding age appropriate human sexuality. Provide trustworthy cultural resources to help guide the integration of conscientious cultural knowledge. 6

7 Akwesasne Mohawk adolescents who had been breast fed had significantly higher PCB levels than those who had not been breastfed (Schell et al., 2003b), a difference that persisted into their young adulthood. In a Mohawk Young Adult Well Being Study, Schell and Gallo (2010) of the University at Albany found that Mohawk adolescents average PCB levels were between the 90th and 95th percentiles of the U.S. reference sample. 7

Levels of the sum of 14 PCB congeners found in 50% or more of the sample were more than twice the average for the

Environmental Health Literacy www.niehs.nih.

information, services and skills needed to make informed health decisions and actions.

8 Levels of the sum of 14 PCB congeners found in 50% or more of the sample were more than twice the average for the U.S. as described by the CDC (Gallo et al., 2011). This is evidence of the persistence of some PCB congeners. Environmental Health Literacy Definition: The degree to which individuals have the capacity to obtain, process, and understand health information, services and skills needed to make informed health decisions and actions. Piloting innovative ways of delivering EH messages through group prenatal visits It s extremely difficult to change people s behavior. Instead, change the environment in which people make decisions - HBR, p. 62 May

9 We promote excellence in reproductive health care for Inuit, First Nations, and Métis women. We advocate for the restoration of midwifery education, the provision of midwifery services, and choice of birthplace for all Aboriginal communities consistent with the U.N. Declaration on the Rights of Indigenous Peoples. As active members of the Canadian Association of Midwives, we represent the professional development and practice needs of Aboriginal midwives to the responsible health authorities in Canada and the global community. 9

This book informs the reader of the impact of early sexual

self-help skills, counseling and psychotherapy techniques.

doctors, nurses, midwives, doulas, and others.

10 This book informs the reader of the impact of early sexual abuse on children, adults, and on all aspects of childbearing. The second section teaches skills in communication, self-help skills, counseling and psychotherapy techniques. The third covers clinical challenges and solutions for doctors, nurses, midwives, doulas, and others. Case histories throughout the book clarify and apply the content. We will reawaken the strength of all female life to bring forward the love and medicine from the mother earth we dance upon because we remember the coming faces. HONESTE Maize, Corn 10

11 Oherokon Under the Husk REACH the Decision Makers 11

12 Provider outreach to increase discussion of these topics Develop integrated EH/RH messages for preconception care and pregnant women beyond alcohol and tobacco smoke exposures 12

13 References Under the Rattlesnake: Cherokee Health and Resilency (Lefler,Ed. 2009) Jenny James, The Sacred Feminine in Cherokee Culture Bodies Don t Just Tell Stories, They Tell Histories : Embodiment of Historical Trauma among American Indians and Alaska Natives (Walters et al 2011) Tracking Biocultural Pathways to Health Disparities: The Value of Biomarkers. (Worthman & Costello 2009). NAHO Cultural Safety Fact Sheet. df Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality. Metzl, J and Hansen, H. Social Science and Medicine. Vol. 103, pp Feb doi: /j.socscimed Evaluation Whether or not you are applying for continuing education credit, we would appreciate it if you would take a few minutes to fill out the evaluation. We really value your feedback and are using it in developing the rest of this series. You can fill out the evaluation here: THANK YOU! 13

Reproducing Reproduction From Mythology to Living World

Reproducing Reproduction From Mythology to Living World Tekatsitsiakwa Katsi Cook (Mohawk) Aboriginal Midwife First Environment Collaborative www.indianyouth.org Promising Practices, Projects and Processes