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

Reflections from a volunteer CLC working on naval base

Many of our Our Milky Way interviewees launch into their advocacy for
healthy infant feeding after they’ve endured personal situations with their
own babies. This is not Crystal Grask’s, CLC origin story into the world
of breastfeeding though.  Now the mother of a darling little one, Grask
serves as a Red Cross volunteer lactation counselor at Naval Base Rota
in Spain, but her road to breastfeeding started before becoming a
mother.

We’re pumped to feature this interview with Grask this week on Our
Milky Way.

On discovering her passion for maternal child health…

I had really no insight into maternal child health until I found myself
interviewing for the Communications Coordinator position with the Rocky
Mountain Children’s Health Foundation and Mothers’ Milk Bank. Once I
obtained the role, I started working directly with Laraine Lockhart-
Borman, the then director of the milk bank…her staff… Donor Relations
Coordinators, Certified Lactation Educators, Doulas and more. I found
myself immersed in a totally new world and was soaking up the
knowledge like a sponge. Everyday I learned something new about
breastfeeding, donating human milk, or lactation and the impact these
things have on the mother-baby dyads and the families we served.
As I learned…I found myself becoming more and more passionate about
helping moms, babies and families have successful happy starts in life.
Through the RMCHF and MMB I learned about the the Lactation
Counselor Training Course (LCTC), learned about the importance of
breastfeeding, saw firsthand the impact donating and receiving donor
human milk had on mother-baby dyads and families, and was able to
observe and glean insight into dozens of parents’ feeding journeys
through the Foundation’s  programming and milk bank’s weekly Baby
Cafe pregnancy and postpartum moms groups.

On completing the LCTC…

… Life happened, and I was unable to take the course during my tenure
at the [RMCHF], but the passion didn’t go away. It continued to blossom. I moved to Washington State where the course wasn’t offered,
but I remained passionate and steadfast in my desires using my
previous knowledge about breastfeeding/lactation to help providers (OBs
and Pediatricians) communicate with their patients about breastfeeding. I
knew I still wanted to work in this realm, and decided that once I was
able to obtain my CLC certification, I would like to pursue a private
practice.

In 2020, the course became virtual, which allowed me to start my
training! I started in December of 2020, and soon after, we moved to
Spain with the Navy. It was there I finished my training, in June of 2021. I
loved the virtual nature of the training and found – even when I was an
ocean away – I could tune in, interact during office hours, and complete
the course with ease. I really appreciated that!

On her own breastfeeding journey…

Flash forward five years… I found myself breastfeeding my daughter,
Julieanne, and having a rough journey. We started off feeding well,
resolving minor latch issues right off the bat. However, despite having a
small but adequate supply, she struggled to gain weight. Our pediatrician
immediately suggested formula supplementation, and I struggled with
that suggestion. My husband was a huge supporter of breastfeeding,
and also felt like there wasn’t a huge need to supplement. I was able to
reach out to prior colleagues… for observations, but neither of them
could find anything truly amiss. My daughter latches well and has always
been very healthy, but didn’t gain weight well no matter how much or
what we were feeding her. We discovered she has a very high
metabolism and strong passion for eating, so I found myself feeding
round the clock, triple feeding for a few weeks, and eventually settling
into a combo-feeding routine. While it wasn’t my picture perfect image of
how our breastfeeding journey would go, I am proud to say we’re still
largely breastfeeding and she’s gained a significant amount of weight.

Photo by Taylor Marie Photography

I hope to help moms receive the support I lacked in the immediate
postpartum. With consistent help and follow-up observations, perhaps
we wouldn’t have needed to supplement. I want to be that resource for other moms, to help them feel validated, encouraged to meet their goals,
and support them no matter what their feeding choices are.

On landing her volunteer CLC position at the naval base…

One of the first things I noticed after arriving at Naval Base Rota was the
multitude of pregnant women around. We were still living in COVID
times, and I quickly learned while there was support for moms to
breastfeed from a command standpoint, there were not many staff or
programs available to support the station’s breastfeeding dyads either in
hospital or at home postpartum. I knew I could help bridge this gap.
After exploring a few different avenues, I found I was able to sign up with
the Red Cross as a volunteer CLC at the Navy Medicine Readiness and
Training Command Rota (Naval Hospital Rota) Maternal Child Infant
ward! This role gives me the unique opportunity to help moms within
hours after delivering her baby, and help these dyads and families start
their feeding journeys feeling confident and supported.

On a typical day in this role…

I come in, check in with the nurse on duty or head nurse for a rundown
of our patients to learn about their delivery(ies), their baby, their current
health situation, and how feeding has been going thus far. I also ask if
mom/family has presented them with any concerns/questions about
feeding thus far, so I can be as prepared as possible when I first meet
with a mom.
After ensuring I have all the information/resources ready, I go meet with
the mom/baby dyad/ family. While in their room, we talk about how mom
is doing, I meet their new little one, and we go over how their feeling
about feeding thus far. I often provide latch assessments, and observe
feedings while in the room as well. Sometimes, during this, we’ll be in a
more relaxed setting, and mom will ask questions about any concerns
she has for when she goes home, which I answer or refer her to her
provider or the base’s Visiting Nurse if it’s a subject outside of my scope.

Once my initial visit is over, I will make a follow up plan with mom if
desired, then input notes and do any supplemental research for her. At
my follow up visit (usually that day or the next) I will give her any
resources we discussed and provide answers to her questions.
In the LCTC, we focused a lot on listening to mom, hearing her story and
using that, her experience and her health history to guide our
counseling. I think I use that often to meet moms where they are and
give them the care they deserve. I also find I’m teaching the asymmetric
latch often, even to second and third time moms! I also cover hand
expression and storage guidelines often. We get a lot of questions
around pumping and building a stash of milk for returning to work,
especially for active duty moms.

I have also started seeing postpartum patients in the hospital’s OBGYN clinic.

On unique challenges…
Grask at Rota Breastfeeding Week 2023 presenting topics like skin-to-skin and hand expression 

I think there is a strong desire to help breastfeeding moms here, but
there is an apparent lack of resources, especially for postpartum moms.
The community has one Visiting Nurse who is a rockstar seeing many
moms daily, but she’s unfortunately the only one able to do so at the
moment. To help bridge this gap, I’ve gained approval to have a small
business, Asbury Breastfeeding Counseling, and am offering my
services to moms in the community in addition to my work as a
volunteer. I’m also working with the Visiting Nurse and hospital MCI
leads to host monthly breastfeeding courses at the hospital, promote the
existing pregnancy and postpartum support groups, and soon will be
offering a BYOBB (Bring Your Own Baby and Breastfeed) class at the
hospital for new moms to learn the various positions they can breastfeed
their babies in and be available to answer any questions/troubleshoot
any feeding/latch issues in person.
We also hosted Rota Breastfeeding Week helping educate the
community here on what is available for new moms and showcasing the
various lactation spaces. We also had a latch on nursing event.

On goals for next year…

 

Over the next year, I hope to reach more moms and families to help
them feed successfully… I know this community’s resources are slim. I hope to establish these classes and have imparted education to staff so
when I ultimately transition out of this station, I know I am leaving moms
with supportive providers who can help her achieve her goals.

Some favorite breastfeeding stories…

While working at the Mothers’ Milk Bank, I was able to sit in on several
Baby Cafe postpartum support groups. During a few of these groups, I
met a parenting duo and their little one. No matter what they did, this
mom struggled to make enough for her little one, but desperately wanted
to make breastfeeding work. I listened and observed them for weeks,
learning from their interactions as a couple, parents and individuals and
gleaning insights from the [lactation care provider]  helping them.
Ultimately, I believe they began to feed with donor milk and formula, but
it was their journey and the persevering passion to help their baby and
family thrive that left an impression on me.
Here in Rota, I have been lucky enough to see a few of the moms I’ve
helped in early days several months postpartum. Two such dyads come
to mind. One was a new mom, baby born a couple weeks early had had
an ample supply of milk. Due to her baby’s early arrival, the baby was
transferred to a Spanish hospital where they received formula instead of
her breast milk. I saw her about five days postpartum and her milk
supply had fully come in but the baby was fussy and struggled to latch.
We worked on several techniques, including skin-to-skin care, cross-
cradle and football holds, asymmetric latch and also discussed ways to
pump/store milk. I was worried as this mom seemed to be ready to give
up quickly, but I ran into her six months postpartum and her once small
baby was now thriving on breast milk! It was a beautiful thing to see and
she is still breastfeeding.
In January, I served the family who had the first baby of the year. The
parents were first time parents, and had no idea what to expect or how
to navigate breastfeeding now their arrival had made her debut. Mom
and I worked on recognizing feeding cues, latching, promoting skin-to-
skin care, using dad for support, and discussed various ways to pump– hand express, manual, double-electric, wearables, to help her build a
supply later on. Soon after I had my own baby, I ran into this mom at a
moms group and found breastfeeding was going well for her! Her little
one was steadily gaining weight and she felt confident in her feeding
routine and encouraged by the support she had received early on. I was
elated at this update and so happy to see them thrive.
Personally, breastfeeding hasn’t been as easy as I’d like, but when I feed
it is the most wonderful, almost indescribable feeling. One of my favorite
stories I have is from my early postpartum days. I had been hanging out
skin-to-skin with her on the couch and accidentally fallen asleep. A little
while later I awoke — to a baby suckling on my breast! I had heard and
known about a baby’s natural instinct to find the breast, but I hadn’t expected her to seek it out and find it on her own when she was so new
to the world. Now she giggles whenever she sees my breast and is
especially excited for boob food time!