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”.

——

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

Lindsey Brown McCormick’s, PhD, LPCC-S, PMH-C, CLC light bulb moment

[Photo by Andrea Piacquadio]
We consider ourselves life-long learners here at Healthy Children Project. Sometimes learning occurs gradually, and sometimes there are the ‘light bulb’ moments.

We put a call out to our followers to share “Aha!” moments with us. Maybe it was a myth busted during the Lactation Counselor Training Course (LCTC) or maybe it happened during a visit with a dyad.

We also called for stories about your babies’ and children’s ‘light bulb’ moments. When have you seen your little ones’ faces light up in discovery and understanding?

The call for stories is still open! Please send your reflections to info@ourmilkyway.org with “Light Bulb” in the subject line.

Lindsey Brown McCormick, PhD, LPCC-S, PMH-C, CLC is the owner of Women Thrive Counseling & Consulting LLC. This is her light bulb moment. 

——

Dr. McCormick
Used with permission

I did not go into the field of mental health counseling with the goal or intention of working with mothers/birthing people and babies. It was never on my radar as something that clinicians even specialized in. The birth of my daughter changed everything for me. 

I’ve been working in the field of trauma and traumatic stress since 2010. My spouse and I welcomed our daughter, currently our only child, into the world November 2021. I was induced and labored for 22 hours before I was whisked away into the operating room for an emergency cesarean. Though everything was seemingly normal on the surface, between the complications faced in labor and the OR, internally I was far from okay. The spiral of postpartum anxiety had entered the chat. 

It was after we came home, in the stillness of the village that lived so far away, crying on my couch with a cluster feeding newborn, I realized two things: 1) I didn’t know anything about perinatal mental health, and 2) I didn’t know where I could even go to learn. 

In the following weeks, my spouse would arrive home from work and I would dump everything that I had discovered that day onto him. I was so energized, so eager to learn, and I was jumping into the deep end of this new clinical niche. I enrolled in a perinatal mental health training program. Upon completing that, I enrolled in the Certified Lactation Counselor training course. Bridging these disciplines, as a practitioner, just made sense to me. There can be a significant amount of mental health problems that arise from attempting to body feed: anxiety, trauma, and grief, to name a few. And, as an attachment theory and parenting nerd, I absorbed research on skin-to-skin care like a sponge. 

As I’ve continued to specialize in this field, I greatly appreciate the value of blending perinatal mental healthcare and lactation care, the healing benefits of skin-to-skin care after a traumatic birthing experience, and the neuroscience of matrescence and infant (0-3) development. It’s provided me opportunities to learn more about the relationship between my daughter and me. It’s positively influenced my parenting style. It’s positively influenced my approach as a counselor and an educator. There are FEW psychotherapists who have lactation credentials out there, and I feel honored to be one of them. 

 

Where are they now? Catching up with Lucy Ellen Towbin, LCSW

Towbin admires her grandchild in this recent photo.

Many of Lucy Ellen Towbin’s, LCSW endeavors are defined by nourishment. By the time she was two, Towbin was producing art and as she has continued to make multimedia art into her 70s, she nourishes her Self. As the eldest of four children, Towbin helped provide for her
younger siblings in their childhood. In her 30s, as a new mother,  she nourished her children.  As a social worker and lactation care provider, she supported other dyads in their infant feeding efforts. Later, Towbin started a business (which has since been sold) that offers clean, dehydrated parrot pellets, so that she and other parrot-owners could escape reliance on industry-produced pet food which usually contains additives and food coloring that parrots are particularly sensitive to.

During the first wave of the COVID-19 pandemic, Towbin retired from the
Arkansas Health Department, and while she no longer holds her IBCLC
credential, she continues to assist new mothers informally. Towbin now
practices as a part-time therapist for a psychotherapy clinic in
Arkansas.

The last time Towbin graced Our Milky Way was back in 2017 when we
featured the breastfeeding art contest she facilitated through the
Arkansas Breastfeeding Coalition.

We’re pleased to have chatted with Towbin as part of our Where are they
now? series. Responses have been edited for brevity.

 

Towbin poses with Ruth Lawrence roughly a decade ago.

How did you become interested in maternal child health? 

The first job I had at the Department of Health was as the refugee health program coordinator. We worked with mostly refugees from Southeast Asia.  I was really interested in and intrigued  by the difference in how
they were taking care of their children. They slept with their babies, which I’m sure plenty of people in the U.S. still did quietly, but back then, no one was talking about it.
During a panel discussion we once held, a speaker from Laos shared
that his six children born in Laos were breastfed, and the five children
born in the States were bottle-fed. This is when I really became
interested in the cultural aspects that affect infant feeding, and I started
to try to figure out what was going on.

Is there a current trend, project or organization that excites you?

I’m really not that up-to-date about trends in lactation, but what does
excite me are the portable pumps that working moms can wear. A close
friend of my daughter’s is a nurse practitioner and she showed me her
pump that she wears under her white jacket as she walks around seeing
patients. It makes almost no noise and it’s amazing because you don’t
even know that it’s under there. That would’ve been so incredible for me
to have as a working breastfeeding mom.

When I was working outside of the home, it was really difficult; even La
Leche League wasn’t very supportive of working moms at the time. With
my first child, I had a manual pump and my own office, but the pump was
miserable.  It hurt and wasn’t that effective. With my second child, I
stayed home longer with him and then he wouldn’t take a bottle, so I
didn’t do that much pumping. When I went back to work, my mother took
care of him and she lived close to where I was working, so I would nurse
him before work, and then drive back and forth to her house to feed him
about every two hours. It was a lot of back and forth.

What is the most significant change you’ve noticed within maternal child
health?

I have a very small sample size to talk about significant changes. All I
know is from my daughter and her friends. I’ve noticed that there seems
to be less unmedicated births happening in the hospital. I know there are
still a lot of people choosing home birth. But of those having babies in
the hospital, I haven’t heard about anyone doing what I did and having
mine in the hospital, but with no pain medicine or IV or anything.   I was
lucky to find the physicians that I did who went along with my wishes.  I
would expect there would be more supportive physicians now and instead, I don’t hear about any. I do want to reiterate that my observations are based on just a small group.

What is your best piece of advice for the next generation of lactation
care providers?

The most helpful lesson combines my training as both a therapist and
lactation consultant. New mothers need so much emotional support.
They don’t need people to take care of the baby. Bringing food and running errands for them is helpful. But I think what gets overlooked is
how much they need to be told that they’re going to make it, that they will
survive this early period of no sleep, and not knowing if they are doing a
good job. They need reassurance that this difficult time is normal and
they need to be told they will get through this.

My best piece of advice for the next generation is to take a holistic
approach, don’t just emphasize the physical exam. Equally important is
how much sleep the mother is getting,  what she is eating, if she is
getting exercise, if she has family and friends supporting her, if she has a
plan for if she’s going to be working outside of the home. It’s important to
equip new moms with coping strategies like easy breathing exercises or
something when she is feeling stressed that are doable in short time
frames and at home.

Where do you envision yourself in the next decade?

Asking someone my age where I see myself in the next ten years is
basically just hoping I’m still healthy and active! I do all the right things
and have good genes, so I’m on the pathway to that, but you never
know. Appreciate good health and youthful energy if you still have it.

Field of lactation gains child psychologist

The field of lactation just gained another amazing care provider. Kenya Malcolm, PhD, CLC is a child psychologist, consultant, and trainer in Rochester, New York. Dr. Malcolm’s work focuses on programs and interventions in early childhood in mental health settings, preschools and pediatric offices. Among her many responsibilities, Dr. Malcolm is the HealthySteps program coordinator at a large pediatric practice.

Dr. Malcolm says, “The research is pretty clear that working with caregivers early to support children is the best way to promote optimal family and child health. So, that’s what I do!”

In fun, Dr. Malcolm is not only passionate about mental health, but she’s a self-described stationery nerd.

“I think that color coding is a great way to take notes and stay organized but I’ve been mocked for my pen collection!” she begins. When her LCTC instructor Dr. Anna Blair recommended using multiple ink colors on the Lactation Assessment & Comprehensive Intervention Tool (LAT), Dr. Malcolm says she felt validated.

She was again validated during the first few sessions of the course while learning about the benefits of breast/chest feeding not only for the baby but for lactating people.

“That’s when I knew I’d made the right decision to sign up for the course,” she reflects.

Because Dr. Malcolm is new to lactation counseling, she says that “every successful chest feeding story is my favorite right now.”

Photo by Luiza Braun

“All the moms have been so happy that they’re successful!” she explains. “I was not supported in breastfeeding my own kids when they were born and honestly, being a CLC is like an opportunity to be the superhero I wish I had 20 years ago.”

In becoming that superhero, Dr. Malcolm subscribes to reflective practice as a guiding principle in her work, and more specifically, in her leadership roles.

Dr. Malcolm remembers the words of one of the founding members of ZERO to THREE Jeree H. Pawl: “How you are is as important as what you do.”

Here’s more of what Dr. Malcolm had to say:

“Reflective supervision is a special kind of supervision that focuses on the practitioner’s own thoughts, feelings, and behaviors to support their ability to provide good care to the folks they are working with. Working with caregivers and children is tough work and usually includes navigating systems that are very siloed with rigid expectations. As humans, we often respond in ways that are just as much about ourselves as about the family in front of us. Reflective supervision is a necessary space for slowing down and looking at our actions to improve care, reduce bias and disparities, and improve the well-being of everyone involved. Reflective capacity is a skill and reflective supervision is considered a necessary component of support for people who are working with young children and families by most major organizations working toward the health of families.”

In Dr. Malcolm’s side gig with The Society for The Protection and Care of Children, participants introduce themselves with their baby pictures “as a way to hold in mine our own younger selves who continue to show up in our work.” The work focuses on training staff in Infant Mental Health (IMH) principles, Reflective Supervision, and infant/early childhood mental health conceptualization and diagnosis using the DC0-3 across New York state.

“One IMH principle is that we always hold the baby in mind,” Dr. Malcolm begins. “But it’s not just the baby in front of us. We also have to be aware of the baby whose needs are still present in our own selves. That’s why reflective spaces are so important. Our own biases and histories are present in all of our current interactions–another IMH tenant is that our early experiences matter– and we want to be mindful of how those are showing up in our work in both helpful and not so helpful ways.”

Dr. Malcolm tackles another big idea. Responding to an article on moral injury she wrote on social media, “I… think there’s a savior fantasy that many health professionals have that is sometimes traumatic to lose while in the field.” This phenomenon often rings true for lactation care providers. Dr. Malcolm advises doing the self- work it takes for true humility and reflection.

She shares this anecdote:

Source: United States Breastfeeding Committee (USBC)

“I was observing a lactation counseling visit last week and a mom came in with questions about a possible tongue tie and some nipple pain with feeding. Since the latch was poor, the LC provided some strategies for improving latch that helped to address some of the pain. Like, mom agreed that there was less pain with position changes. But mom was not actually interested in working on latch; she was focused on the possibility of the tongue tie. The LC did a great job of talking through her observations and assessment and providing next-step ideas to Mom. But the LC and I really wanted mom to want to improve her latch. It would be easy to feel like that was an unsuccessful visit because we didn’t save the day in the way we wanted. But mom left feeling heard and supported. Many of us go into human services work to be a hero (I actually used the words “being a superhero” two answers ago!! I’m tempted to change that answer now, but I’m not going to.) of our own design. Families don’t need that. They need support to be at their own best.”

You can connect with Dr. Malcolm here.

Learning self care through active practice

The same principles apply to supporting self care as the business case for breastfeeding: employees who are more satisfied and loyal and cost savings realized in the retention of experienced employees, the reduction in sick time taken, and lower health care and insurance costs.

Nearly a decade ago, Healthy Children Project’s Donna Walls, RN, BSN, ICCE, IBCLC, ANLC helped establish a meditation room in the maternity care wing of the hospital she worked at. With soft lighting, comfy chairs and the option for aromatherapy and calming music, the room was well-received, or necessary as Walls would argue.

Photo by Karolina Grabowska: https://www.pexels.com/photo/woman-kneeling-on-a-yoga-mat-4498216/

Now, Walls co-teaches an overview of holistic health as part of the Allied Health program at Sinclair College in Ohio.

Walls and colleague Jeri Layer recently presented a compressed version of the course, “Learning Self Care Through Active Practice”, to Sinclair faculty.

In their course, they ask participants to consider what they do on a daily basis to maintain physical and mental health.  Participants are also asked to consider: what are their stress triggers and what are the sensations associated in those times of stress?

Typically, as a nation, we have been taught to be reactionary with our health, but Walls says that even before the COVID-19 pandemic struck, she started to notice people paying attention to mental health and self-care.

“The pandemic put a really bright light on it,” Walls says.

Walls and Layer have broken down self-care into very specific strategies and offer a variety of modalities for humans to promote emotional, mental and physical health.

Photo by Valeria Boltneva: https://www.pexels.com/photo/closeup-photo-of-white-petaled-flowers-965982/

For instance, aromatherapy can come in the form of simple awareness of the scents around us like freshly baked bread, the air after a rain, or the scent of roses. Essential oils can be used therapeutically as they have “a direct effect on the brain and trigger emotions and hormonal responses.”

The duo advise how to use essential oils along with methods of administering like steam inhalation, direct application to the skin with carrier oils, or used in diffusers like lamp rings or cotton balls for example. Oral ingestion is NOT recommended, they warn.

Tapping, or the Emotional Freedom Technique (EFT), is another modality proposed.

“Tapping is a self-help technique that involves tapping with fingertips on points of ‘energy meridians’ located around the body,” Walls explains. “It is based on the theory used for acupuncture, but without the use of needles, to stimulate energy points on the body which create a balance both emotionally and physically.”

Affirmations can be coupled with tapping.

Walls and Layer share these:

“Even though I feel this anxiety, I deeply and completely accept myself.”

“Even though I panic when I think about ______, I am strong enough to deal with this.”

“Even though I’m having pain, I can see myself relaxing and releasing this pain.”

Other self-care techniques include the Havening Technique which is a method that uses sensory input to alter thought, mood, and behavior through a process called synaptic depotentiation, mindful breathing, 4-7-8 breathing, box breathing, and three-part breathing, and mediation.

The majority of these practices are inexpensive and accessible making them good options for whenever the need arises.

Walls and Layer emphasize the importance of building the immune system as a self-care tool. Part of building a healthy gut, a major component of the immune system, is minimizing the use of antibacterials and instead, washing hands with toxin-free soaps.

Using appropriate herbs, ensuring proper micronutrients through whole foods and prioritizing sleep are all vital components in caring for ourselves holistically, the duo teach in their course.

Photo by Nathan Cowley: https://www.pexels.com/photo/woman-slicing-gourd-1153369/

Walls acknowledges that it’s often most difficult to carve out time for self-care when we need it the most.

Reminiscing about when her children were young, Walls says, “I look back on those really busy times in my life and wonder ‘How did I get through those crazy times?’ I think I learned early on how to do a lot of these self care techniques… and I am really glad because I can see the benefits as the years have gone on… I am reaping the benefits now at my age from [practicing self-care] back then.”

When we practice self-care, we’re setting examples for the next generation, too. Walls points out that her adult daughter now uses many of techniques she observed as a child with her own children and with the children she works with at an elementary school.

Walls likens this to a concept Dalai Lama is credited with: “Just as ripples spread out when a single pebble is dropped into water, the actions of individuals can have far-reaching effects.”

Photo by Felix Mittermeier: https://www.pexels.com/photo/closeup-photography-of-water-drop-355724/

Check out another Our Milky Way piece Self-care strategies for lactation care providers for more thoughts on providing sustainable care.