The enemy of knowledge is not ignorance; it is the illusion of knowledge

I’ve been following this conversation started by the Grammar Girl:

“I was a guest on a podcast where kids asked two people questions to decide who was the fake and who was the real expert.

The host said that early on, the kids thought the fake was the expert every time because the actors answered every question confidently, and the experts would hedge or even sometimes say, ‘I don’t know.’

They eventually told the fakes to be less confident so the kids would have a chance of picking the expert sometimes.”

The Grammar Girl’s post was making a point specifically about ChatGPT, but the sentiment can be applied more generally, and in our case to the field of lactation and other perinatal care providers.

Some of my favorite comments on the Grammar Girl’s post include:

Never trust an expert who isn’t willing to admit that they don’t know.

Experts know that there are sometimes variables or gray areas, thus they don’t answer in terms of absolutes.

That makes me think of how an intelligent person (possibly an expert in something) is still curious and open minded enough to not always be sure of everything. 

Those who are experts, look before they leap, stop before they comment, ask for help and do their research. Saying ‘I do not know’ is a strength.

It reminds me of the quote: ‘The enemy of knowledge is not ignorance, it is the illusion of knowledge.’ 

Individuals on the perinatal care team can get stuck in a rut where humility is absent, and this can become dangerous for their patients. 

Debra Bingham of PQI, in a recent newsletter, reminds us of physiologic humility.

Bingham writes:

“Perinatal health professionals work tirelessly to provide the best care they can. Unfortunately, sometimes we get stuck performing “strong but wrong” routines. For example, we have centuries of evidence to tell us that physiologic birth practices are key to having the best outcomes. Yet, too often we do not practice what I like to call physiologic humility. Humility that the physiology of a woman’s body before, during, and after giving birth is complex and typically works well on its own. Thus, we should proceed with physiologic humility because there are so many limitations in our knowledge of the complex physiologic processes related to birth …

As perinatal health professionals it is our responsibility to do everything possible to ensure that women in our care get to experience Mother’s Day. Especially this month, may we all continue to keep that in mind and as a top priority.”

In all fields of care, cultural humility must also be maintained. As defined by the National Association of County & City Health Officials (NACCHO), cultural humility (CH) is “a lifelong process of self-reflection, used to better understand the multi-dimensional identities of clients in order to establish and maintain respectful, healthy, and productive relationships.” NACCHO’s Shifting the Care Paradigm Fact Sheet describes how lactation care providers can partner with families and their community to understand individual patients’ cultural background, experience and personal challenges, and specific goals. 

In the U.S., perinatal care is often siloed; however, this trend seems to be evolving as care becomes more collaborative. Collaboration requires all care providers to exercise a level of humility, offering their expertise while respecting and hearing out other members of the care team. Most importantly though, care team members must work together to respect their patient’s wishes and facilitate informed decision making.

“Absolute certainty leaves little room for shared decision-making,” the author of  Humility and the practice of medicine: tasting humble pie points out.

The author later concludes that “the cultivation of humility is often painful and requires a high level of self-awareness and reflective practice.”

A challenge indeed, but worth the effort. Consider “taking a bite” of “humble pie.” [Chochinov, 2010]

Centering and celebrating cultures in health: Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities

During the first week of April each year, the American Public Health Association (APHA) brings together communities to observe National Public Health Week. This year’s theme  is Centering and Celebrating Cultures in Health and highlights the importance of fostering cultural connections to health and quality of life. 

Last month, we celebrated National Nutrition Month, an annual campaign by the Academy of Nutrition and Dietetics which highlights the importance of making informed food choices across the lifespan.

Photo by Angela Roma

A beautiful example of the convergence of these two themes is work being done by the Asian Pacific Islander Breastfeeding Task Force (APIBTF) a part of  Breastfeed LA, tailoring the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities. This project augments APIBTF’s sister organization Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Continuity of Care (CoC) Blueprint Project Prenatal Toolkit for AANHPI families. The prenatal toolkit was adapted from an existing toolkit in Alameda County, and is available in English, traditional Chinese, and Vietnamese.

The initiative is supported by the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity (CDC/DNPAO). NACCHO selected seven communities to strengthen community lactation support through the implementation of the Continuity of Care in Breastfeeding Support: A Blueprint for Communities from November 2022 to July 2023. The purpose of this project is to support the implementation of CoC strategies by local-level organizations among oppressed communities with historically low rates of chest/breastfeeding. [https://www.naccho.org/programs/community-health/maternal-child-adolescent-health/breastfeeding-support#early-childhood-nutrition]

Photo by Roderick Salatan

 

The dietary resources which include an Educational Handout from Dietary Guidelines, Nutrition Resource Directory, and social media posts can be found here, available in English, Chinese and Vietnamese. The materials include a dietary guidelines hand out with two toddler-friendly recipes (with a fun suggestion to use green onion to decorate steamed eggs), three social media messages with a timeline for infant feeding, human milk recommendations, and complementary food recommendations, all commonly eaten in Asian communities. The deliverables are full of color and easy to navigate. 

Judy Li and Cindy Young presented their work during NACCHO’s The First 1,000 Days Nutrition: Improving Nutrition Security for Infants and Toddlers in Communities of Color where the Improving Infant and Young Child Nutrition during the first 1,000 days in Communities of Color summary report was introduced. 

Li, Young and their team’s work was community-informed, standing by the sentiment, “Nothing about us, without us.” The team spoke with community members about eating habits and learned that families do not eat according to the MyPlate graphic. Instead, they enjoy their meals in family-style servings from bowls. Recipes developed were tested by community members with children and tailored according to their suggestions; for example, the addition of different dipping sauces.

Participants also offered feedback stating that they appreciated the accessibility of the ingredients. 

 

Helpful links

ASAP!’s Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Social Media Toolkit 

National Public Health Week’s shareables and toolkit (available in Spanish)  

USDA’s Dietary Guidelines for Americans (2020-2025)

The Association of State Public Health Nutritionists (ASPHN) brief on Transition Feeding 

Public Health Nutrition Deserves More Attention

Undernourished and Overlooked