Friday, August 2, 2013

Not an Object

Hello from Santa Fe! 

It's a lovely August morning; I've been largely much enjoying my metropolitan life, rife with local food and lots of biking. My parents visited for five days this past week, and that was a delight of food (restauranted and home-cooked), Goodwill & Craigslist hunting, and generally exploring the fringes. Due to my as of yet frustration and ineptitude with downtown driving, we mostly skirted the metro center. I know it sounds a little ridiculous, but you have to remember, I am accustomed to relaxing rez driving: everyone pulls out from their dirt lots, goes 20mph, swerves around the various animals in the road, and then parks in another dirt lot. It's the life. 

I also have had the privilege to become a volunteer for the up-and-coming Birth Of My Heart Birthplace, which will open soon in Española. The name comes from a phrase in Tewa ( Navi pin haa un mu), emblematizing its culturally-responsive concept. 

I am so excited to continue working on the organizational narrative; as well as helping out, it is infinitely helpful to my discernment and path. The research on different birth risks (C-section, lack of breastfeeding, PIH, SGA, etc), has also made it painfully clear how present - and linked with race & SES - disparities are in wellness in our country. Along with the Achievement Gap, we have the Health Gap. Figure in the Legal Gap of civil rights (in the wake of the shameful voting-down of the VRA), and it's a veritable chasm. Troubling but important work, indeed.
A small excerpt from the "Causes" section I've written, this one concerning Nutritional-Related Disorders in Pregnancy:

Though there are accessory catalysts to each of these conditions (some of which unknown), PIH, 
gestational diabetes, and anemia all result in some part from sociodemographic factors. As above, race is linked with SES is linked with health; women of color are disproportionately affected by the effects of poor health. For instance, anemia is linked to smoking, PIH to type II diabetes, and gestational diabetes to being overweight prior to the pregnancy. (Adebisi, 2005)
(Reem & et al, 2012) (Li & et al, 2013) (Berkowitz & et al, 1992)

I have e-mailed the Teen Parenting Center at Santa Fe High, so hopefully I will be able to work / volunteer with student-parents there. I would ideally work as a volunteer doula; as I've written before, the politics and justice and healthcare of teen parenting is something I am very passionate about.

I've additionally written The Birthing Community of Santa Fe, hoping to be able to assist / volunteer at their organization in exchange for sitting in on their prenatal classes; it'll fulfill my DONA requirement, but also be great to get more experience with the Birthing From Within approach.

As you see, at this point I have largely thrown my various hats into rings - doula, substitute teacher (with ID badge!), writer - and so am waiting for responses. I spend my days biking, reading, studying Hole's Human Anatomy & Physiology 13th ed. (I am taking A&P I & II in the fall), and rationing the fabulous Orange is the New Black.  
Though it is a little dry for summer reading, I have generally very much enjoyed my daily portion of anatomy and physiology. I have just finished chapter 15, and so this afternoon it's onto the Lymphatic System. Other than the baffling endocrine system (ENDLESS hormones!), it has generally been a sensical and interesting read. I have also, numerous times, been thankful to my AP Bio course. Though I took it six years ago (oh geez), it's refreshing and delighting to see how quickly so much of it comes back. 

Now, you can expect some angry posting on here once I arrive at Chapter 23 (Pregnancy & Birth); I look at it whenever I'm feeling especially ensconced and confused to reassure myself that I really do know quite a lot at least of certain parts. Mostly, it's a pleasant romp of fetal states and maternal health. But then I see a line talking about episiotomies being done to 'aid healing' more than a tear and the enjoyment ebbs. News report: tears heal faster (jagged edges adhere to one another much more easily, and do not rip further as easily as cuts do). The only thing that is easier is suturing them.

Anyway, that example is representative of the thing I do find sometimes problematic; the book is written so entirely from a physicians' point of view. What's the problem with that? you say. Indeed, it's a text designed for those up-and-coming in the health field. My issue is that the extreme polarization can lead to a lack of empathy and even to the objectification of the patient.

Objectification, true, we generally think of in sexual and patriarchal terms, but in this case, the text is objectifying the patient in the form of case studies. (For a working definition of objectification, go here.) The book has little half-page sections inserted into the body of the text; they're case studies that closely correlate to the content of the chapter. The object of them is to familiarize students with a certain condition. It just reads as coldly clinical when these people are given names and symptoms in a paragraph, and then often die in the next one. 

From a utilitarian perspective, this makes perfect sense; the point of the book is to be information-rich, not a novella of people's lives, wishes, personalities. There aren't enough pages to give justice to a single life, let alone the dozens in the book's case studies. But doesn't it seem superficial, then, to include their name and then nothing else? Why not leave the case studies in hypothetical terms? I have no idea if Carl, who collapsed from an embolism and died several days after his flight, was a real man. But it seems an injustice to him, to have this clinical remembrance, much less formal than a four-line obituary. It's like the authors sought to impress upon the reader the importance of the material by implicating a life, but then shied away from addressing the patient as anything but his assemblage of relevant parts. It's an assumption, instead of the 'immortal' desires and dreams of an individual, of clinical dissection and eventual mortality. A blogger posting on Medicine and Objectification puts it well when she says: "Seeing someone as merely as a 'case' makes it very difficult to view a patient as a whole person with complex needs and desires. The result is condescension, fragmentation, and silence."

 Is there a viable alternative? I would argue absolutely. Here it is:
Okay, okay. I realize this isn't a textbook textbook; forgive me, but I'm not well-accustomed to medical texts yet. But, if you've read old Ina May's book, you'll probably understand what I'm getting at. Before the explicit chapters on anatomy and prenatal nutrition is 125 pages of birth stories told by the women themselves. They write about their pain and pleasure, joy and frustration, and almost always there's an accompanying picture. There are stillbirths; there are hospital transports; but most of all, there is an autonomy I have not seen in my anatomy and physiology textbook. How hard would it be to have the case studies written by the person depicted, or one of their loved ones? Now that would be an experience in the intensely human, as well procedural, world of medicine. 

Ina May goes further, though. She writes in her introduction: 
          It almost goes without saying that the birth stories told in Part I differ from those of most American women. Overall, the stories are too positive; there is too much talk of joy, ecstasy, and fulfillment. These stories do not describe the usual proportions of forceps, vacuum extractor, or cesarean deliveries that are representative of these interventions... Given these differences, you may wonder whether these stories, and the overall experience of the women whose births were attended by my partners and me, can have any significance for you. If the women who shared their birth stories were special beings, the answer would be no. But if it is true that the women who gave birth at The Farm are much like other U.S. women in their intrinsic physical capabilities - and I am certain this is the case - then our experinces do have something to teach. Enfolded within the stories are lessons that can empower you, too...

In other words, Ina May not only humanizes her 'patients' (and she would never use that rhetoric), but she also finds commonality with them. We too, she assures, can empower ourselves to make health (in this case, birth) choices by ourselves. She counters the 'condescension, fragmentation, and silence' with respect, community, and dialogue. What more can we ask for?

This sort of industrial objectification is everywhere: in our food, in our commodities, in our politics. Just a few days ago I saw this meme on Facebook (the x and text is my own, obvi):
Clearly, this is going for the shocking, silencing factor. Other than the gross oversimplification of Planned Parenthood and the Choice movement (that, as a Pro-Choice doula and midwife-to-be, I seriously resent), the true disgust comes from the objectification of the woman. I added "Where is this woman's face" because it drives the point home: Who is not the person here? The creators of the meme, supposedly PersonhoodUSA, are invoking the viewer's sympathy for this fetus. But in doing so, they objectify (condescend, fracture, silence - even behead!) the mother. Her autonomy, dreams, wishes? Gone. Foregone.

But before I get too glum, I think of the alternatives to polarizing discourse. For one, Michael Pollan's The Omnivore's Dilemma and every local grower everywhere are staunch arbiters of the dialogue of how our country gets its food. 

And when I see a meme like that, I think to myself.
May every child be:
* Wanted & Needed.
* Prepared for.
* Birthed with dignity.

What more can we ask for?

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