As Native American Heritage Month ends, we wanted to pause and update you on some work we are doing in the Northern Plains. In October 2023 we started working with the Rocky Mountain Tribal Leaders Council to conduct a feasibility study of a Tribal Maternal Mortality Review Committee (MMRC). Our goal was to understand the functions of this committee and how it could be used to elevate the wellness of American Indian people living in Montana, Wyoming, and beyond.
It has been nearly two months since we started. Dr. Dewey Ertz (Cheyenne River Sioux) has led much of this work, adding wisdom to our conversations about Maternal Mortality Review Committees while encouraging us to think about deeper issues like genocide, colonization, grief, losses, and meaning. The text below is an excerpt of our discussions. Dewey reminds us of the lingering impacts of colonization, genocide, and cultural destruction while giving us insight into how to heal from traumas and loss.
We stopped and listened... and changed our direction. We realized that we must address grief and loss before we do anything else. - Dr. Dewey Ertz
History, Columbus, Genocide, Colonization
What are your thoughts about history, genocide, and where we are at today working on this feasibility study?
People have resided in North America for at least 23,000 years and likely longer. Several cultures were established in North America during this time. A second phase experienced by Native people living in North America is usually dated to the discovery of North America by Columbus. This phase was characterized by various events of genocide especially because of pandemics, other forms of cultural destruction, premature death, and the introduction of new technology as part of colonialization. The period of genocide is usually dated from the time of Columbus through the massacre at Wounded Knee (South Dakota) in 1890. Some scholars have estimated that the death toll was approximately 93 percent for American Indian/Alaskan Natives during this timeframe.
What is genocide?
“Genocide” as defined here follows the work of Gregory H. Stanton who is known for his work as a professor at Mary Washington University and for his association with the International Association of Genocide Scholars formed in 2006. Dr. Stanton is the author of the “Ten Stages of Genocide” which he authored in 1996 as the “Eight Stages of Genocide”. The ten stages are as follows:
Classification
Symbolization
Discrimination
Dehumanization
Organization
Polarization
Preparation
Persecution
Extermination
Denial
How does genocide relate to our work on this feasibility study?
The relationship between genocide and Tribal Maternal Mortality Review Committee Services begins with recognizing that these services address preventable deaths of mothers and infants. These committees process and utilize specific steps to reach this determination. Members of the human species are socialized to identify with the society of their origin.
Genocide is prevented by integrating different societies of people to adapt to differences between them and form unified acceptance to work and live together despite their differences. Genocide is encouraged when these processes fail, and one group projects responsibility for this failure on another. The final stage of genocide is denial.
Resilience and Adaptation
We talk a lot about resilience and adaptation; what are some examples?
Colonization and genocide resulted in resilience and adaptation, including new lifestyles, such as the introduction of the horse as the beast of burden in some areas rather than the dog. Other lifestyle changes occurred in Native populations that resulted in new survival skills. Various hostilities occurred between Native people and both the United States government and other immigrants from European and/or other cultures.
Managing Grief
How do those left behind grieve and find meaning from these losses?
The best-known author regarding grief and death was Elizabeth Kubler-Ross, who wrote On Death and Dying in 1969. She observed that patients she worked with displayed common experiences and/or stages, which prompted her to write these observations for others to learn from. The stages were not prescriptions but rather general processes that may occur sequentially or in different order. Individuals may also repeat the steps or stages. Five areas were labeled as:
Denial (shock and disbelief that the loss has occurred)
Anger (that someone we love is no longer here)
Bargaining (all the what-ifs and regrets)
Depression (sadness from the loss)
Acceptance (acknowledging the reality of the loss)
Finding Meaning
David Kessler wrote a follow-up book after Elizabeth Kubler-Ross’ death called Finding Meaning. This book expanded the original five stages to a sixth process, finding meaning in loss. The tasks identified include having the grief witnessed by others, which often involves sharing with one or more people. Death is identified as shaping grief and mourning. Types or circumstances of loss include suicide, complicated relationships, child loss, miscarriage and infant loss, and mental illnesses or addiction. An ability to tell the story of the loss is developed as part of this meaning.
Change also takes place in the meaning of mourning and understanding the loss differently. A need is identified in this process for the person to make a conscious decision that they are alive and to continue living in a desired way.
Developing meaning is a human goal that may vary widely based on cultural beliefs and practices. Many different methods can be applied to this depending on cultural norms and/or beliefs. Various therapists have received training in these concepts and can assist people from different cultures in utilizing these methods.
Literature
You read a ton of literature; what seems to be most relevant to this work?
The published literature regarding adverse reactions to Maternal Mortality is limited. A Systematic Review of Trauma Interventions in Native Communities by Gameon and Skewes relates many forms of trauma exposure with suffering. The review also points to gaps in health services.
Native communities suffer from interpersonal, childhood, and historical trauma experiences.
Few trauma interventions have been tested in Native communities.
A systematic review of the literature yielded only 15 studies representing 10 interventions.
Culturally appropriate, evidenced-based interventions are needed in Native communities. This is what is most relevant to Tribal Maternal Mortality, and it is what future work in Tribal communities must focus on.
Meaning of Feasibility Study Becomes Clear
As our understanding of Tribal Maternal Mortality deepened, it became clear that we had to address grief. The feasibility study now includes these two questions:
What are some culturally appropriate approaches to address grieving, loss, trauma, and other adverse outcomes?
How do we ensure that maternal and infant mortality are appropriately identified to allow for the resolution of losses and those left behind?