A little about myself and how I got where I am

I've had some questions lately wondering a few things about me and my relationship with midwifery and schooling.  I thought I might answer them here since I'm sure for every person that asks a question, many more are thinking them.  My main purpose of starting this blog was to help prospective students (and eventually students) to understand what the lived experience of the midwifery education program is like, but I never really did give myself a backgrounder!

My first thought of midwifery was when I was 19, and newly pregnant with my first daughter.  I even called Ryerson and had their MEP information package sent to me, but after longingly reaading through it, I put it down and forgot about it.  I was sure that I would never be able to do it, for a number of reasons.  Mostly because we were poor.  But also because of a secret that I sometimes try to keep hidden (although I'm not really sure why) - due to a tumultuous and emotional adolesence, I dropped out of high school at 17 and never went back.  Seriously, who could possibly get into an amazing program like that with no high school diploma? 

Then, my daughter was born.  Struggling to heal from a very difficult birth (emotionally), I confided to my doula that I was interested in supporting birth.  Mostly, to try and help women to avoid unwanted c-section, since that was so close to home for me.  Luckily, she just happens to be a doula trainer, so I attended one of her trainings and also eventually started running a c-section/VBAC support group online and through in person meetings.  Ever since my daughter was born, I've been very passionate about VBACs, and I found myself attending quite a few.  Many of these which were attended by OBs (ok not just VBACs) frustrated me to no ends.  Why can a woman not ask to sit in a different position?  To have a few more hours time when the baby is doing well?  Why does she not deserve a better connection with her care provider, more respect, more information? 

Well, of course she deserves it.  She just doesn't have a midwife!  Absolutely, many OB/nurse attended births I went to were lovely, and women were well informed and choices were made together - but overwhelmingly, most were not.  And as the doula, with no real rights in the birthing room, there was little I could do about it aside from help her to feel better about it.  It was through this process that I revisited the idea of being a midwife.  I had probably been to 10 or 15 births by the time I started working on the prerequisites for the program:
- Gr 12 University level english
- Gr 12 University level social science
- Gr 12 University level chemistry or biology

I also got my high school equivalency. And I passed everything with flying colours.  This really helped me to develop my writing and understanding skills.  I was part way through getting these courses when I gave birth to my son.  This was rather monumental for me, because I was aware of the potential for my motivations to completely change depending on how his birth turned out.  I was so, so devoted to VBAC (homebirth, actually).  And I didn't know if I would still be as committed to birth if I got the "birth of my dreams".  Or whether it would be too difficult for me to revisit if I didn't.  So I left myself open to suggestion.  Thankfully, once the acute memory of the pain of feeling him coming out, the overwhelming sense that I needed to continue on this mission came over me.  I started going back to births much sooner than I expected after he wass born (8 months maybe) and LOVED it.  FAR more than I had before I had Robin - - - because my demons were gone.  I can't restate this enough - birth professionals who have their own personal birth baggage from their own births are really at risk of carrying this around with them to other women.  Lucky for me (and the women I was working with) this baggage got carried away when I got the "birth of my dreams" and I knew I was ready. 

I applied to the MEP at Ryerson in Toronto when my second was 12 months old  (and I, only 24).  The waiting process was excruciating.  I'm a great writer, and I wasn't worried about the letter I wrote, but the time after the interviews was back breaking.  And then I got the heart breaking news that I was wait listed.  I took it completely as a failure, and I signed up for 5 courses at Athabasca University (online) that I knew would qualify as transfer credits, so that next year my load would be lighter.  Well, no sooner had they arrived in the mail when I got the call that I was accepted!!!!  What a wonderful feeling! 

 Managing the program itself, with two small children and a one-way 2.5 hour commute (yup, 5 hours a day) is a challenge, but I am by no means the only one doing it.  Although I sent many of those Athabasca courses back, I did one through that summer, and am doing another three currently, during this summer approaching second year.  This has been tremendously helpful in reducing my commute down to only three days a week (except for first semester).  I'm one of the rare few who doesn't have a university degree already (and even rarer that never finished high school), so taking these courses helped to lighten the very heavy courseload for those who didn't come in with a ton of transfer credits. 

So, there's the long story short (or not so short)!  Voila, Melissa, the former-doula-soonish-to-be-midwife.  I'm sure the story will get MUCH more interesting when placement starts in January.  I'm so scared!

HIV and Voudou in Haiti

Okay, this post is completely unrelated to midwifery and my personal life, but rather another essay that I recently wrote.  Even though its unrelated directly to midwifery, anyone interested in differing cultures might appreciate some of the info in here for general knowledge.  I wrote this essay for my Human Sexualities course - which, after a slow and somewhat boring start, has turned into a really interesting learning experience about  not only different sexualities but also different cultures.  I'm happy to be able to say I was able to take an anthropology course that doubled as one of my social science electives!  Although the course load is a little heavy (3 8-10 page essays, two "quizzes", and an exam) its worth it for the info that can very often be applied to midwifery. 

So, without further ado: HIV and Voudou in Haiti, by Melissa J Nowell
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Long before its ravaging earthquake that brought global attention hit it, Haiti was the focus of a health crisis. AIDS is a continuing epidemic in Haiti, and its prevalence has become so high that it now represents 67% of all reported cases in the Caribbean  (Martel and Mueller 2007:107).  In 2009, approximately 7,100 AIDS-related deaths were reported in Haiti, and currently 1.9% of the total population is infected with HIV (AVERT.org 2010:1).  Although these are rough estimates which are debated by locals and the international community abroad (Treichler 1999:103, 113), these numbers represent a significant risk to the population.  Haiti presents many unique challenges to the international efforts at reducing the prevalence of AIDS.  Its adherence to both Catholicism and voudou practices present a framework of beliefs that is often contradictory to the prevention of HIV, and the intense stigmatization that those suffering AIDS face presents barriers to the reception of effective health care.  In this paper, I will discuss the role that voudou has played in the AIDS crisis in Haiti, and discuss both the failures and successes in overcoming the many barriers to AIDS prevention and care that this group of people faces.

AIDS in Haiti

Much like AIDS in other Third World countries, in Haiti, HIV is spread primarily through heterosexual transmission (Martel and Mueller 2007:107). Multiple partner sexual relationships are also common (Devieux et al. 2004:110).  Education about HIV is not standardized in Haiti, and access to communication through various media outlets is limited (Martel and Mueller 2007:107).  Perhaps partially as a result of this, there are many misconceptions in Haiti about the validity and stigma in regards to the AIDS crisis.  Denial that AIDS presents a problem to Haiti is common.  Prostitutes and community leaders alike are often under the distinct impression that AIDS is an American conspiracy, and/or that it doesn’t actually exist (Treichler 1999:103; Fitzgerald and Simon 2001:302).  Some have even gone so far as to call it “le Syndrome Imaginaire pour Decourager les Amoureux”, or the Imaginary Syndrome to Discourage Lovers (Fitzgerald and Simon 2001:302).  Accompanying this denial is an intense stigmatization of those who do suffer from AIDS-related illnesses.  Because of many prevalent beliefs about the perpetuation of disease in Haiti, those who suffer AIDS are often “shunned by the community” and “denied their status as humans”; forced to suffer a vicious cycle of deterioration, neglect, and resulting further deterioration (Fitzgerald and Simon 2001:303).  Further, because of both stigmatization about STDs and suspicions about colonialist motives in regards to efforts from the medical community, many of the hospital-based education initiatives that have been attempted have been met with “denial, passivity, and rumors” (Devieux et al. 2004:111).  Fitzgerald and Simon (2001) summarize the AIDS problem in Haiti by asking,

“How does a community fight a disease whose existence it denies, whose victims it shuns, when the community is seemingly powerless to fight the disease on its own but mistrustful of any outside help?” (p.305)

This situation has posed many problems for both the prevention and the widespread understanding of AIDS.  Much of these barriers are due to cultural differences between those attempting to educate the masses, and the framework of understanding that the masses hold about disease and the world around them.

Voudou in Haiti

Voudou is a way of living that is woven into most aspects of life for Haitians, whether they declare themselves Catholic or not.  In Brown and Beck’s (2009) description of its “purple” worldview, voudou is classed within a group of worldviews that follows traditions of “superstition, allegiance, obedience, and kinship” (p.7).  Under this framework, belief in supernatural occurrences such as curses, spirits, and other things magical are characteristic and very common (Brown and Beck 2009:7).  Voudou is often poorly understood by the global community and foreigners within Haiti.  Yet, its principles and many of its fundamental beliefs exist within most aspects of life in Haiti – including even Haitian Catholics.  Many have adapted a belief system that has incorporated aspects of both Catholicism and voudou, which they conclude are compatible with one another – which has unfortunately only further stacked the odds against prevention and treatment of HIV/AIDS in Haiti (Martel and Mueller 2007:107).  And yet, because voudou is incorporated into so much of the fabric of Haitian society (Devieux et al. 2004:110), problematic beliefs and practices about AIDS continue to persist.

 The Relationship Between Voudou and AIDS

                Voudou practitioners hold a variety of beliefs and superstitions about AIDS, most of which have proven to be quite challenging to those attempting to prevent AIDS and alleviate the suffering of those diagnosed with it.  Because of its superstitious nature, traditional cures and diagnoses by voudou doctors, priests, or leaders follow a different system of logic than in Western thought.  Most believe that the onset and development of AIDS has supernatural or magical roots, which may manifest in a variety of imaginative scenarios: as a punishment from the Gods, a curse from another individual (Martel and Mueller 2007:107), or as a result of a person’s soul being stolen from them (Fitzgerald and Simon 2001:303).  Each of these beliefs transmits the potential that the sufferer brought the disease upon themselves by malicious acts.  Because these beliefs do not take responsibility for the technical aspects of transmission, they often stand in the way of education efforts to help with the very fundaments of the problem – the spread of a viral infection through sexual intercourse.

In regards to curing AIDS, another host of problematic beliefs emerge. Many Haitian voudou followers believe that sex with a young virgin can protect them from, or cure them of AIDS – and the younger the virgin, the more effective the cure (Brown and Beck 2009:8).  Many also believe that protection from AIDS can be obtained through various charms or protection spells (Fitzgerald and Simon 2001:302). These beliefs and values, coupled with the Catholic custom to refuse condoms and birth control (Martel and Mueller 2007:107), breed a dangerous mix for those at risk of HIV.

The social and physiological consequences of these stigmas towards AIDS are great.  Those who suffer from AIDS are often presumed to have brought it upon themselves and are gradually ostracized from family and friends, neglected, and shamed, sometimes causing the premature advancement of their illness and untimely death (Fitzgerald and Simon 2001:303). Those who believe that they have protection from AIDS may continue high-risk behaviour under the false impression that they are protected by charms or spells - increasing both their own risk of contracting the virus, as well as the risk of their sexual partner(s) (Fitzgerald and Simon 2001:302).

Voudou and the Medical Community

                Many efforts have been made to enhance communication between the health care community and voudou leaders.  Unfortunately, much of the health care that is delivered has not addressed the “tremendous social stigma and isolation” that people with AIDS face in Haiti (Fitzgerald and Simon 2001:302).  Because many of the approaches have been through generic, international, hospital-based means that taught the “facts” about AIDS , the unique worldview that voudou practitioners hold has not often been taken into account (Fitzgerald and Simon 2001:302).  As a result, many people in Haiti (particularly voudou practitioners) have become suspicious of the motives behind medical community’s efforts, with those who follow Catholic beliefs suspecting a “family planning conspiracy,” and voudou followers fearing a “murderous trap”  (Fitzgerald and Simon 2001:304). Some voudou doctors have also become weary that the promotion of AIDS prevention and treatment is an attempt to steal their “patients” (Fitzgerald and Simon 2001:303). Unfortunately, many of the attempts to meet with voudou leaders directly led to suspicions of conspiracy or attack (well warranted given the colonial history in Haiti), and very little feedback or true exchange between voudou leaders and members of the medical community resulted from it (Fitzgerald and Simon 2001:301-309).

Building Bridges

Some experts have made suggestions for approaches that may be more culturally sensitive, and therefore more effective, for future efforts. In addressing those who practice voudou and similar worldviews, Brown and Beck (2009:7-8) assert that HIV/AIDS communication should focus on their understandings of the supernatural, as well as appealing to their deep sense of respect for elders and authority figures.  This translates into linking references with magic and spirit beings; honouring, respecting, and appealing to the elders and leaders of the community; and using storytelling and other familiar methods of expression, rather than the written word, to convey ideas about HIV prevention and treatment (p.7-8). Martel (2007) suggests that practices voudou practitioners traditionally use, such as the use of herbal medicines, are potential launching pads for “culturally appropriate” intervention (p.115-116).

Despite the obstacles to effective care delivery, some groups have made positive steps toward healing relations between the health care workers and the voudou leaders that are so influential upon the population. Treichler (1999:10) reports a case where voudou leaders were able to “overcome men’s traditional resistance” to condom use by describing AIDS “as the work of an evil spirit who uses sexual desire and the virus as secret weapons”, whereby condoms were seen as the means to trick the spirits out of transmitting the curse.  Yet Treichler does not discuss the enormous and often overwhelming challengeof  getting past the suspicions of the voudou leaders and gaining their trust and respect enough for them to develop their own, culturally-based and very influential beliefs like the condom-trick example.   Fitzgerald and Simon( 2001:301-309) discuss a fascinating account of their failures and successes at a rural community hospital in Haiti at length. After many poorly received attempts at making contact with voudou leaders (and the rest of the community) to “educate” them about the AIDS, their hospital workers reached out to community members for feedback.  The consensus of the locals was that hands-on involvement and care for those suffering from the final stages of AIDS would be the greatest learning tool, which was implemented with so much success that those who participated were eager to teach the rest of the community. This hands-on approach taught them about the realities of the disease, the potential for preventing transmission, and the ability to alleviate suffering.  Although the initial participants were not specifically voudou practitioners, their contribution eventually encouraged some to attend the subsequent seminars, which used a curriculum based on the narratives of people suffering from AIDS. Into this program came a building cascade of influential leaders from surrounding communities that increasingly included voudou leaders. Fitzgerald and Simon (2001:301-307) report that over 1000 individuals, primarily influential community leaders, took place in the workshops, 311 of whomo were voudou leaders. 

The most positive gains from this program, in regards to the voudou community, were the results that were seen following the training.  All of those who were interviewed post-training had returned to their communities to discuss AIDS.  Most voudou leaders reported discussing it during ceremonies, where they reported that the voudou spirits “told stories about people with AIDS during the ceremony and warned people to protect themselves from AIDS” (Fitzgerald and Simon 2001:307).  By far the greatest success was that several of them had chosen to buy condoms and distribute them to their followers, as well as referring patients with AIDS to the community hospital for treatment (Fitzgerald and Simon 2001:307).  Given the great resistance, doubt, and suspicion that existed prior to this program, the measures that these voudou leaders took is an enormous step both out of their old comfort zones and into a completely new way of thinking – or at the very least, a step into some very unknown (and previously untrusted) territory.   It is also an enormous success that this information was able to reach the voudou leaders in an effective way in the first place. This Haitian AIDS success story, however, was only successful because it was almost exclusively activated, perpetuated, run, and taught by the community leaders and their followers, rather than the hospital (Fitzgerald and Simon2001:305).  This bypassed the stigma and suspicion that was held towards the hospital and the medical community in general, and used an approach that focused on something locally important – the respect and esteem that locals held for their authority figures.  Its strategy of teaching also utilized only the community centres that were most respected and which most of the population used (listed as schools, churches, and “voodoo societies”) which furthered its respectability, as well as the proportion of the local population to feel its effects (Fitzgerald and Simon 2001:305).

                The AIDS crisis continues in Haiti today.  Many positive steps have been taken, but many more need to be taken.  Its 2010 earthquake and the resulting breakdown of infrastructure have taken the focus off of AIDS while the country recovers, but the 1.9% prevalence rate of AIDS in Haiti from 2009 (AVERT.org 2010:1) is not likely to have gotten better.  Culturally appropriate approaches are clearly more effective than generic information campaigns that may be successful in other places, particularly given the complexities that voudoun beliefs present to Western thought.  Most importantly, though, I feel it important that preserving these spiritual beliefs is an important aspect of culturally appropriate education, as they are a spiritual outlet that can be used to alleviate psychological and mental suffering for many.  Clearly, as Fitzgerald and Simon demonstrated, there are ways of reaching out to the public and voudou leaders and teaching them in ways that help to reduce the impact of the illness while still respecting cultural beliefs.  More research and efforts in this direction will be of great benefit not only for those in Haiti, but surely for many other international contexts as well.

References

AVERT.org
2010 Caribbean HIV & AIDS statistics. Electronic document, http://www.avert.org/caribbean.htm, accessed July 14, 2011.

Brown, B. C., and D. E. Beck
2009 How to tailor public communications about HIV/AIDS to different worldviews. Electronic document, http://richardslaughter.com.au/wp-content/uploads/2010/02/Barrett-Brown_D…-Worldviews.pdf, accessed July 12, 2011.

Devieux, J. G., R. M. Malow, M. M. Jean-Gilles, D. M. Samuels, M. M. Deschamps, M. Ascenio, L. Jean-Baptiste, and J. W. Pape
2004 Reducing Health Dispairities through Culturally Sensitive Treatment for HIV+ Adults in Haiti. The Association of Black Nursing Faculty Journal 15(6):109-115.

Fitzgerald, D. W., and T. B. Simon
2001 Telling the Stories of People with AIDS in Rural Haiti. AIDS Patient Care and STDs 15(6):301-309.

Martel, L. D., and C. W. Mueller
2007 HIV/AIDS Teaching Behaviors of Educators in Haiti. Journal of HIV/AIDS Prevention in Children and Youth 7(2):105-118.

Treichler, P. A.
1999 AIDS and HIV Infection in the Third World: A First World Chronicle. In How to have a Theory in an Epidemic: Cultural Chronicles of AIDS. Pp. 99-126. Durham, NC.: Duke University Press.

In my blogging absence...

I guess I took a bit of a period of absence from blogging!  I've been far too busy lately to jot down thoughts on here but things are definitely going very well.  The boom that Robin's birth story got was absolutely incredible - I think I got over 1000 hits in the first day it was online!  Very encouraging feedback.  I love to share that story everywhere I can, so that people can understand that it CAN be done - and it can still be empowering, even if its really, really hard!

I've been working away on three courses through this summer, but have also had the opportunity to spend a ton of time with the kiddos.  One course is completely done, one is about halfway there and the other is a third or so - so I'm pretty well on track and they're all going well! 

We have been working very hard (actually, my partner Jamie has been) on night weaning our litlte guy.  Yes, at 2.5 he is still nursing - but not through the night anymore!  Jamie has been sleeping with him each night and he adjusted to it surprisingly well.  Unfortunately, when Mommy is in the bed he doesn't think that the same rules apply.  And doubly unfortunately, Jamie leaves this Thursday for 5 days/4 nights to sell drums at the London Sunfest.  Wish me luck people!  Night-time parenting of both kids who do not sleep through the night (despite being 2 and almost 6) is not my favourite of jobs!

More to come, hopefully a lot sooner than last time!