Celebrating World Refugee Day

This summer, we are revisiting some of our previous publications as they relate to various celebrations. World Refugee Day was honored on June 20 this year. As such, we are resharing our 2019 piece “Initiative empowers refugee and migrant women”.

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Before Florence Ackey, MSW knew what public health was, she was inquisitive about prevention. Having lost her 12 year old cousin during her young childhood, she found herself perpetually asking “How can I make things better?”

A lifelong investigator and learner, Ackey completed two years of law school in her home country Niger followed by completion of the University of South Florida Master’s of social work. She is currently pursuing a second master’s degree and will begin her doctorate in public health in fall 2019. She recently completed the Lactation Counselor Training Course (LCTC).

Ackey serves as the State Refugee Health Coordinator for the Florida Department of Health Immunization, and Refugee Services. In this position, she connected with a woman who would inspire her to found Refugee and Migrant Women’s Initiative (RAMWI), a not for profit 501(c)(3) which serves and empowers refugee and migrant women during their resettlement.

This particular woman would come to Ackey’s office almost every day and sometimes simply sit with her. Despite a language barrier, Ackey eventually learned that the woman was lonely and depressed; she couldn’t have children, and her husband was out of work.

These circumstances caused great strife, but connecting with Ackey uplifted her spirit.

Mindful of her mental health, Ackey helped cultivate a social circle around this woman. At the same time, Ackey was driven to incorporate a practical component to the gatherings,  so she taught the women to crochet.

“We made a lot of scarves,” she remembers. “We sold them and [the woman] was able to raise enough money to pay for two months rent. It changed her confidence.”

Ultimately, their informal, weekend meetings grew too large for home meetings, so RAMWI was created. Today RAMWI, run entirely by volunteers, has served over 400 families over roughly six years.

“It’s just beautiful to see how far we’ve come,” Ackey says.

Refugee and migrant women suffer from things like trauma, discrimination and anxiety.

Ackey explains: Often the story goes that the woman arrives with her husband and children from their home country; the husband finds work and grows a social life and the children go to school and make friends. In the meantime, the woman is left alone at home, sometimes too uneasy about the unfamiliarity of their new settlement to leave the confines of her home. Even when her family returns from their daily routines, she’s further isolated because their experiences become less and less common and relatable.

In light of this phenomenon, RAMWI offers corresponding, age-appropriate workshops for mothers and children in order to bridge conversation topics.

“The mom is no longer left alone; she has something she can contribute,” Ackey explains.

RAMWI offers its social, support network and classes and workshopsin a way that allows women to integrate into their new communities while still preserving their cultural identity. For instance, RAMWI’s Annual International Fashion Show during Welcoming Week offers refugees and migrant women the opportunity to share pride in their culture through clothing.

Participants pose during the Annual International Fashion Show during Welcoming Week
Photo courtesy of RAMWI

The show usually represents about 48 countries with over 80 participants.

Monthly support groups cover topics like women’s health, grief and coping mechanism, U.S. healthcare system and resources, nutrition, safety, domestic violence, disaster preparedness, life balance and personal finances among other topics.

Ackey emphasizes that female empowerment doesn’t need to be granted externally.

“Women have the power within in them to freely give,” she begins.

She goes on to describe a visual installation she’ll present at an upcoming RAMWI session to illustrate this idea.

Ackey asks participants questions like ‘Have you helped someone without anything in return?’ or ‘Have you paid a genuine compliment to someone?’ Each time a participant answers ‘yes’, she pokes a hole with a thumbtack into a blank board. The holes initially appear to be randomly placed, but when a light shines through the back of the board, the silhouette of a decorated city appears. The installation represents the seemingly small acts of women impacting entire communities.

This month, RAMWI members will assemble 240 care packages for the homeless.

RAMWI participants at a monthly meeting
Photo courtesy of RAMWI

When it comes to infant feeding, migrant women often look to formula as a status symbol. It’s a mindset Ackey encounters often, but she says the lactation counselor training course has equipped her to become a better healthy infant feeding advocate.

Ackey has also found that hospital staff generally do not take the time to discuss and educate migrant women about breastfeeding. She predicts this is sometimes due to language barriers.

“It’s easier to give them formula and go,” she explains.

Mothers are often happy with the “gift” of formula and all of the “swag” that can come along with formula feeding.

Surely birth and infant feeding culture varies greatly among the women in RAMWI, but Ackey has found that immigrant women tend to share the common value of a strong mother -child bond which stems from their collective upbringing, she explains.

Mother and child, one of Ackey’s favorite photos
Photo courtesy of RAMWI

She shares that this “it takes a village” mentality is reflected in the way they feed their babies.

“Women take care of all the children,” says Ackey.

In some cases, women breastfeed children that are not biologically their own in the spirit of shared duties, but for survival in other circumstances.

“Women breastfeed other children especially from some African countries,” Ackey begins.

She recalls one woman who adopted a child she picked up on the road next to the dead body of his mother. Ackey makes clear this imagery isn’t representative of the entire refugee population, but it is a story that embodies how the women she works with will raise any child.

Amidst the tragedy and hardship that many of the families have faced, there’s so much beauty and hope within RAMWI.

“Hope can, and will heal the world,” its mantra.

One volunteer said:  “The thing I love the most is the environment of support and empowerment that RAMWI creates for women from all over the world…the women learn from each other…form a bond that as women is something that connects you no matter where you are from.”

For Ackey, success is achieved when a woman makes a choice because she has been fully informed and she’s aware of all of her options.

Visit https://www.ramwi.org/ for more information. Connect with RAMWI on Facebook here.

Other relevant pieces

Prioritizing infant and young child feeding in emergencies during National Preparedness Month and beyond

To know is to do: retired nurse dedicates time to humanitarian aid in East Africa bringing awareness to the paradox of direness and vibrancy

A collection of stories by and about those in the AANHPI community

Caesarean Doulas: Implications for Breastfeeding at 24th Annual International Breastfeeding Conference & Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives

Breastfeeding, peace and justice

Babywearing as a public health initiative

Guiding informed decision making about tongue-tie revision

In the service industry, the customer is always right. In lactation, ‘Mother knows best’. 

Lauren Zemaitis MA, CCC-SLP, is a pediatric speech pathologist who specializes in infant, toddler and school-aged children with feeding disorders. Her son– now three years old– was diagnosed with tongue-tie by a hospital-based IBCLC when he was about one day old. 

“It is still such a vivid interaction in my mind,” Zemaitis begins. 

“We had some difficulty latching within the first 24 hours. I had some [birth] complications so I was a little groggy and the two of us were just trying to figure [breastfeeding] out,” she remembers. 

“The nurses were having trouble helping me, so an IBCLC came in and was very aggressive talking at me through the latching process. She shoved her finger into my son’s mouth while he was crying and told me he had ties and said, ‘You won’t have a good breastfeeding journey. These have to get revised before you leave the hospital,’” Zemaitis continues.

“I was just like, What?” she remembers, still affected by lingering medication. 

Throughout the rest of the day she and her son laid skin-to-skin, and he latched. 

The following morning, the lactation consultant returned. She inquired about Zemaitis’s conversation with their pediatrician the night before. 

Zemaitis explains: 

“She was very aggressive again and said, ‘I know the ped came in last night. Did you talk to him about what I said? I said we did talk with the ped and right now we don’t want to pursue a revision, he’s not even 72 hours old. She said, ‘Well I just still don’t think this going to work for you.’ I explained what I do [for a profession] and she said, ‘Oh, so you know this is going to affect his feeding skills and speech development.’ I finally said that no we’re not going to do this, that I want to see where this breastfeeding journey is going to go. She said, “Fine” and left the room.” 

From that point on, Zemaitis often doubted her ability to breastfeed her baby. 

“The specialist set me up to think I wasn’t going to be successful,” she says. 

Even so, Zemaitis and her baby went on to breastfeed for over a year. 

Their story is a great reminder that we look to lactation care providers (or any health care provider) for guidance, not dictation. Professionals are positioned to help us make informed decisions. Ultimately, parents are their children’s health authorities, and in this case and in many others, Mother knows best. 

Their story is also a powerful anecdote about hotly debated tongue-tie diagnoses and treatments. 

Zemaitis considers tongue-tie a “buzz word” among some professionals meaning it’s an overused term, and it’s being over-diagnosed. 

She points out a few concerns she has. 

“Between professionals, there’s a lot of gray area; one person might say it’s a true, very taught tongue tie that needs immediate revision and someone else may say we just need to do something else like working through the re-latching process or sucking skills,” she explains. 

She also worries that pointing out tongue ties (especially if done in the manner she’d experienced personally) might plot doubt in moms. 

“The doubt continues to get bigger and bigger in terms of their emotions around it and then when something goes wrong, or different than they thought it would, they immediately doubt themselves and their decision around tongue revisions,” she goes on.

What’s more, Zemaitis notices that many revisions are being performed around three to four months of age, at which point babies have established motor patterns. Sometimes, a revision can disrupt those patterns and has to relearn them. 

Tongue-tie revisions, which sometimes sound as benign as clipping one’s fingernails, can be simple, but they can also require a more involved surgery, cutting into muscle and requiring extensive pre and post exercise and follow up care.  Zemaitis points out that parents can be apprehensive to touch the revision site to perform this care.  

When tongue tie is suspected, she and her colleagues look for a functional deficit like limited tongue mobility and/or strength and the impact on feeding development and skills, not solely the structure of the mouth. 

They’ve found that things like suck training, repositioning at the breast, and counseling mothers to allow the baby to latch rather than trying to “control” the nipple and baby’s movement can be effective tools before referral for revision is suggested. 

Through personal experience and after completing the Lactation Counselor Training Course (LCTC), Zemaitis centers her work in good counseling. 

“I think the counseling piece is something that we all really strive to continue to do better,” she says. “The counseling piece in the training was really valuable. I learned a lot by doing the small group projects and working with other professionals from other settings; how can we all do better with the active listening piece?” 

Zemaitis has the opportunity to uplift and celebrate her clients in their natural environment when she’s doing home visits. She particularly loves working with families with premature and medically complex babies. 

She explains that one of these families biggest challenges is transitioning from hospital to home and feeling like they have to start back at square one with their infant’s care. 

Zemaitis considers some of her biggest successes when she sees babies go from being completely reliant on tube feeding to becoming oral eaters. She and her colleagues are inspired by the work the children and their parents go through to ultimately “trust food”. 

“[Parents] thank us,” she begins. “We say, it’s because of you. We are guiding you. You are making the choices for your children.”