How, Where, and Why We Practice

This is a continuation of my comments to this post over at Navelgazing Midwife's place.

I am not saying that it is problematic that (new) midwives practice in communities other than their own. But ask yourself, why do they do this? Are there not any patients in their communities that need care? Is that people in their community would rather be cared for by someone with experience? Is that they feel drawn to help communities other than their own because they see that a need exists and they have the skills to fill the need? Are they coming to this community to stay, or to get their numbers? Why is there such a need in the first place? Why is that there aren't any providers/leaders from this particular community available to fill the need? I'm a midwifery student; if it's helpful to get practice in communities other than your own...how come aint nobody ever sent me to the ritziest part of town to practice for clinical? I understand going to Casa, I really do. I have always wanted to go there. But let's tell ourselves the truth. There's a reason why there is no equivalent to Casa in Beverly Hills.
It is true that if providers from other backgrounds pulled their care out of these neighborhoods, even if it were only two or three years of care in the first place, many, many people would be without care. Dr. Jen asked: "Would taking training programs out of these communities help, or make it worse? Is there anything we, as outsiders, can do to encourage leaders to rise up within a community?" and NM asked: "If we didn’t move outside our own communities, isn’t that forcing women to travel outside their own neighborhoods to obtain care?" Can I say something radical? Withdraw your care. Maybe if you did, our community would find another way. I mean, we wouldn't have a choice, would we? When doctors and nurses would not care for us in the past, we cared for our damn selves. (we built the institutions to train and provide care) When we could not go to "your" schools, we educated ourselves (again, we built the schools and educated our children), and contrary to popular belief, we did a better job at it. Ahhh, "but this is two steps backwards", you'll say. "That's segregation" you'll declare, abhorred. I agree, it is. But I'm not convinced that what we have right now is any better, especially if you're already thinking that if you don't do it, no one will. (forcing women to travel out of their communities for care...maybe instead of coming to find you, I would support my local 18 year old who wants to apprentice, or my soon-to-graduate-college neighbor for a CNM program)
NM asked: "Wouldn’t it be a much kinder and more respectful move to get off our asses and set up shop in their areas of town, acclimate to their culture and offer them the fabulous care they deserve?

My answer: NOPE. What I want is a way to give this "fabulous" care to my damn self. I want midwifery/medicine to stop being this barely attainable career path for people like me. I don't want to have to wait until you feel inclined to give me care. After I have managed to make this possible for people in my community, then YES, certainly, come join me. Let me learn from you, and you learn from me. You're more than welcome to set up shop, but it shouldn't be because the system that leads to this possibility is rigged in your favor. When most of the providers are from one background and most of patients are from another...the learning exchange doesn't feel quite equal...

Lastly, NM asked about the future of midwifery and how people can be inspired by anybody, regardless of race. I agree. However, if it were oh-so-simply about just being around the professional in question- and race didn't matter...wouldn't we have more professionals of color already? I mean, after all, we encounter a lot of professionals that don't look like us already. NM, do you know how very few of us there are? I mean really. Do you know I prayed that I would not be the only black person in my class like my friend in the class above me? After you think about it, ask yourself again if it is not enough to simply have any midwife/primary care provider in front of you. I can tell you with absolute honesty that when I was a child, seeing someone of color in a particular profession absolutely made that profession seem more feasible for me. It is the same principle at work when colleges and universities set up mentorship programs linking ethnic faculty to ethnic students - they do it because they know it makes a difference. The whole reason I have a blog in the first place is because I know this to be true. I have lived it. I gotta write this stuff down because someone wants to know if they can do this. I wanted to know...are you hearing me? I was looking for a black, nursing student blogger from my kind of neighborhood...a black CNM blogger who had done what I wanted to do...it was like I needed proof that it was possible...it's hard to imagine college if you don't know of anyone intimately that has done it....it's hard to imagine medical school/nursing school/law school if you don't know anyone who has done it with your circumstances. Let me tell you what that low-income girl sitting in front of you is probably thinking, even without trying to think it...she's thinking I'm not good enough, smart enough, to do what she's doing...you have to be really smart to do that/be that...this is for white people...she's thinking it even when she doesn't realize it because those are the words and images she gets all damn day long. Does that sound crazy? Let me give you a comparison. You know how we are so very careful to tell our daughters "you can be anything you want to be... a firefighter, president, an astronaut" and everything else? Why do we do that? Because we know that for a very long time women were conditioned to believed that these were jobs only for men - and usually they thought this because women rarely (if ever) held these positions. Well, it's the same for black people. We have to take the time to spell it out..."you can be a CNM, a neurosurgeon, presdient." Why? for the same reason that we tell our girls, because this whole time we have been led to believe...lived in a country that told us/showed us...otherwise. Now think about the impact seeing Hillary Clinton and Barack Obama run for president is having on our children. Sure, we have told our daughters thay can be president...but doesn't SEEING Hillary make it seem that much more possible? THAT is why it's so important to see professionals of color from your neighborhood in your neighborhood-because they are a walking, talking contradiction of the bullshit you've learned about yourself from day one. No longer is it just someone telling you that it's possible, you have proof.

NM would "like to believe that [we] can leap over the color/race/culture hurdle all on [our] own without someone leading [us] by the hand."

It's not a hurdle. It's my existence. There's no getting over it NM. I might be able to work something out by going around it, but that's about it. And I'll tell you, it damn sure ain't no ways easy to get around it without some help. Someone did lead me (through this racial identity process) by the hand, and I intend to lead as many as I can by the hand, too. Why? Because it is nearly impossible to do it alone. It will drive you crazy. Yes anyone can be a role model. But what happens when racism smacks me in the face? Do I really want to have to convince you that this was about race, or would I rather go into the office of someone who already "gets it" so I don't have to relive it by explaining it?

I really, truly, appreciate people who put their thoughts out for everyone to see in a blog. It's a vulnerable position, to share your opinions, questions, and thoughts. I hope we never stop. Thanks for continuing/being a part of the conversation NM, Sage, and DrJen (and everyone else)

I'm out of steam and I have my first GYN exam in the morning.