Jennifer Van Syckle  0:00  
Thank you for joining us for this episode of Talking Health in the 406, where we're one community under the Big Sky. I'm your host, Jennifer Van Syckle, longtime health care worker turned health educator. For this episode, we're going to listen back into our conversation with Amy Stiffarm. Amy is Aaniiih woman who grew up near Harlem Montana. And she's got a great story. So let's continue to listen in

you are at healthy mothers healthy babies, you went, you mentioned you got a PhD?

Amy Stiffarm  0:37  
Yeah. So after I got my master's,  there wasn't really a lot of folks being like, Hey, we're hiring for someone who knows a lot about Native American breastfeeding, you know, like, there wasn't, that didn't happen. And so I, I did a few different kind of public health ish jobs. And I ended up working a little bit for a research and evaluation firm that worked with tribal communities. And it was kind of like maternal child health focused, but not really, you know, around specifically breastfeeding or birthing and that kind of stuff. It was just like, federal initiatives, kind of like that. And I kind of started feeling like, yeah, I would want to, I would want to lead research projects are, you know, I knew then that I didn't have the right initials behind my name, I was like a research assistant. So I was kind of doing the, you know, taking notes on meetings and that kind of stuff. But I also had a lot of input and help when they were talking about working in tribal communities, as far as like, Well, don't ask that, or, you know, don't word it that way. And got to also help us a lot of the Institutional Review Board. So like, when you do research, like kind of like these ethics standards and whatnot, that a lot of either reservations, or Indian Health Services for their service areas, have in place to put in extra protections for tribal communities participating in research. So I got to learn a lot about that and help with those applications. And, but I, I still, I like was kind of feeling like I wanted to go and get a PhD, but the one at U of M, like you had to move there and are in I remember, I did a couple times, like look at what rent could be or how much student housing was, how much child care was. And I'm like, No, not doing that. And I also thought about, like how much work it was for me in those classes to be learning about, like the general population, and then kind of on the side doing the extra work of finding information about the, like, Native American rates and how this impacts tribal communities, whatever topic it was. And I felt like I have two kids now, like, I'm not doing that like I would, it would have to be like a, I thought it would be like an interdisciplinary PhD. That would be like part Native American studies, part public health, and I just felt like, I don't want to do that. That's a lot of work. And so I you know, I thought about it, but didn't really wasn't really actively pursuing it. Until the University of North Dakota announced their first this brand new program, an indigenous health Ph. D. program. And it was going to be all virtual, it was going to you were going to all the classes would be after work. So it'd be in the evenings. And they were looking for applicants. And so I was like, wow, or, you know, like, this is like what I wished for, right as far as like it being lists, like Native American studies and public health, you know, combined, like, it felt like they did the hard work that I was gonna have to do for myself. And they felt like if, I mean, I kind of say this a lot, but it did really feel like the stars aligned, of like, wow, like, it didn't feel like oh, I want to do that. It felt like I have to do this. So I applied. And then when I got in, it was COVID we were we were coming on on COVID. And I had to make that decision. Like, am I going to do this with my two kids and I was a single mom. My youngest at that time was three and knowing the classes were in the evenings and the COVID completely, you know, took away a lot of like, that support system of like how will pick up each other's kids and hang out at our house and then you'll hang out at your house the other night, you know, it was always Oh, well, we were around so and so. Oh, and they had COVID Or else people were sick with COVID so it just wasn't what I thought it was gonna be when I first signed up for the program, but I decided to do it. And the first time I had to take my kids to, we didn't know it was still going to happen with with COVID. School hadn't started yet for them. But they had been out of school since like March. And it was July. And we hadn't. I hadn't been home yet since like Christmas, probably home being Fort Belknap. And I was like, What am I going to do, like I, my seminar was not going to be on the evenings, it was like three or four days of all day, Zoom meetings. And I'm like, I can't have my two kids here during this, like, this is going to be hard. So I was kind of feeling like, maybe I shouldn't do it. And my parents, my mom, and she's like, my sister, I call on my sister, Melinda, we're like, send them over, like, send them over. We'll, we'll take them. And it was scary. Because, you know, my parents, I didn't want to get them sick. And we didn't know, you know, any of there were still a lot of unknowns. But that was another time where I, we were driving through Glacier to meet them in Cut Bank. And, you know, we pulled off, we weren't going into towns, and so we pulled off to have like a little snack and whatnot. And, you know, I remember just like praying that, like, Please let this be worth it. Like, please let this be worth like sending my kids here and putting these peoplel at risk. And, you know, just thinking of it. And I was really sad. Like, as first time I hadn't been around my girls since COVID happiness with them every single day. And it was really hard for me. And I kind of kind of felt like a big sacrifice. And it was like at that time, and yet it ended up being very much worth it. And from the very first seminar, you know, sitting down in that in that Zoom Room. And it wasn't we all and there were non Indigenous students there too. But they worked with tribal communities. And so we all sat, you know, we're talking about what, you know, what brought us here. And none of us had to go into that disparity, we didn't have to talk about the disparities, we didn't have to talk about or explain the history of like, why things are the way they are, we already knew it. And so we got, we immediately started in talking about like solutions and things we wanted to do and things we wanted to see change. And so that right, like I knew I was in the right place. And I didn't have to like a lot of people, like you were saying earlier, introduce themselves with their ceremonial names. A lot of people, you know, talked about their families and would introduce themselves, like how I would normally introduce myself. And so it just felt like from the very beginning, I've been in a lot of situations and some classes, even at SKC, sometimes where it felt like I had to leave like who I really was at the door and come in and put my like Western education hat on and sit down and learn this stuff, and then go out and being and then at the bow on the weekend or something, you know, but this was the first time I really truly felt like, I could be my whole self and that my experience as an indigenous person was like needed, it wasn't like, you need this degree to help indigenous people. It was like, the world needs this degree so that indigenous knowledge can help with the health in the state of like the world. But you know, of course, tribal communities too. And so it was really empowering. And I didn't know what I wanted to study, I was still interested in maternal child health. But when I had my second baby, I really struggled with postpartum depression, and anxiety. And I kinda was still dealing with a lot of that shame and guilt because I had two kids, I wasn't doing the same type of advocacy work that I had done before. So I really had this guilt and the shame of like, Well, who am I, you know, who am I to study? Want to study? Maternal Child Health, like Indian moms and babies, like I didn't even I didn't even have a good experience, you know, with my pregnancy and postpartum like, I didn't even like it. So who am I to study this? You know, I kind of felt like it wasn't my place and like, I didn't deserve to or something and but there was, you know, gotta start thinking about your dissertation. You got to start thinking about what topic area you're gonna do. And I kind of had this moment where I like, I just kind of felt like this like immense grief or something. It was like, like It hurt, like physically hurt me.

And it was, it kind of helped me see that, like, the kind of shame and guilt that I felt about my experience that I would never wish that on anybody that I would not, you know, if I knew one of my friends were struggling, like, I would not say, oh, well, you don't deserve to be working with moms and babies, you know, like you, you didn't like you had a bad experience. So, you know, it just really helped me see that this was not what, nobody wished this on me, nobody thinks that this is how I should feel that it's, it's me feeling this way. And that I have a privilege and an opportunity to try to study this and learn more, and try to change things so that, you know, it's not going to, I might not benefit from this anymore, but maybe like my girls, will, maybe I can change the system, so that it'll be different for them when they become pregnant, and they become moms. And so that was kind of my moment of like, alright, I'll do it. I kind of fought myself for a long time. And honestly, as soon as I started saying, yes, different things happened, where I ended up being on a panel for Healthy Mothers, healthy babies. And one of my friends, we, you know, we used to run together, like actually physically run. And she had a baby after I did. And she talks are talking about how she was struggling with mental health issues, like postpartum and she was being open about it on Facebook. And I was like, what? And I so I had messaged her and I said, Hey, you know, I, I struggled with that, too. I you know, you're, you know, I, that happened to me too. And, you know, thanks for saying that, you know, thanks for being open. And then so she knew that about me. And I always felt like I needed to keep it a secret, though. Like, I didn't like talk about it very much like my friends and family knew. But I like that shame and guilt. Like, that's a very real thing. And so before I started the program, there was like this event happening where someone was coming, and they were going to do like a writing workshop. And you could share your story. And, you know, it was supposed to be like this like, cathartic, like healing thing. And I told her, I would go and I stood her up, I messaged her, and I was like, I can't do it. Like, I'm not, I'm not ready to share my story. Like, I just can't do it. And she said, I understand. And then, like, she didn't give up on me. And after I was in school and stuff, it was like one of the first stars wasn't very far into it. Yeah, it was like November of my first year. And she messaged me, and she said, Are you ready to share your story? She's like, we're, you know, they want Indigenous women to come and talk on this panel about their experience. And at that point, I had been reading, similar like, kind of what happened with the with the breastfeeding and lactation stuff, like all of these different studies about well, not all of these, like there's a whole bunch, but trying to look for scientific literature about mental health during pregnancy and postpartum for Native women. And there was hardly anything out there. And what there was a gross amount of literature that focused on substance use, and nothing was talking about the root causes. There were like, it was known that, like birth trauma, and a trauma history was a risk factor. But nothing was talking about, like historical trauma, and how that would affect native women. And the few studies out there were had very, like had way higher rates of incidence, and it wasn't even looking at all mental health, it was mostly postpartum depression. And so I was like, mad at the literature at what I was seeing. And so when she had asked me, I felt like, no, no, I am not ready to tell my story. But someone's gotta talk about this. Someone's gotta you know, if we're going to talk about like our experience as Indigenous women, like, someone has to point to colonialism as a big reason why? Why, you know, we have these high rates. So I told her I would, and I ended up being on a panel, the Healthy Mothers healthy babies perinatal mental health conference after that panel. That's when they was a few months later when they asked me if I wanted to help on that project where they're working with tribal communities. So saying yes to perinatal mental health, studying that like saying yes to the conference, like it just kind of started opening more and more doors. And it's because there's so much work needed in this field. Like there's so much work to do. We're really behind And, and, and it's just I feel really I know that my education has really set me up. And it's a privilege to be able to do this work. And so I try not to waste these these opportunities. And a lot of times I wanted to say no and like, try to find somebody else. But a lot of times it kind of came back to well, I guess it is you, you better better be ready. So that was that was kind of when I first started at doing stuff with hmhb. And then as a furthered on in my education, focusing more and more on perinatal mental health. That first project that I helped with that ended up being a part of my dissertation work. And then I got hired on to do training. And so I developed a cultural Safety Toolkit that was also part of my dissertation work. So they really supported me while I was in school, and I moved here in December of last year, and so they were with me, you know, the last six to eight months of my program was me finishing out my dissertation. And we say, like, Man, I'm so glad I was here and with like my co workers and have their support, because it was really important in finishing my dissertation.

Jennifer Van Syckle  16:22  
And interesting that I know one thing and listening to your whole story, first time you've moved away, and you're not surrounded by indigenous people,

Amy Stiffarm  16:31  
me and one of my friends were talking about that, because she moved and she lives in Seattle. And so like she calls herself like a first generation, urban Indian. And I'm like, Oh, maybe I am, too. And I'm like, Oh, wait, no, because my mom lived in Missoula, but then she moved to Fort Belknap. And I'm like, it was like, Well, I guess, but it is weird. I mean, I say weird, because I don't have another it's different. Such a different experience. Like really being an urban Indian. Like, it's, it's really different in a lot of different ways. But, you know, I like that, like Helena had a powwow. So we were there. And I like being this close to home, I knew that I was going to be moving east. Eventually, I ended up coming to Helena, partly to work at hmhb. And also because my boyfriend got a job here. And so I was like, Helena is East enough. Like that'll, that'll do. And it is like it's made sort of being a full day to get back home. It takes me you know, three and a half, four hours. And that is still a long drive. But it's very, it's a lot less daunting. And it's way more doable with my two girls. And so yeah, it feels like I'm closer to home. And it kind of feels like home to like with the the landscape and you know, the rolling hills and there's not like big ol huge mountains. You could see the plains after you get through the pass. And so I like it here. I'm glad I am glad I came here, awesome.

Jennifer Van Syckle  17:56  
And so for your next on the horizon, I guess what's I'm assuming keep keep at it with Healthy Mothers healthy babies, and you're looking at down the road, that's that you got your eye on for a goal or anything?

Amy Stiffarm  18:11  
Well, um, like I said, part of my dissertation work, I created this cultural Safety Toolkit. And so cultural safety is like, you know, there's cultural competency trainings, and there's a cultural sensitivity. So cultural safety is really, really came about to address like, Hey, you're not going to be competent in somebody's culture after like a two day training. And one, like, even if you do learn, like these, like you can't deduce training or culture down to skills and behaviors, like that's not it. And so it's kind of like this fallacy that you can you know, that that's even a real thing is cultural competency. But it's like, what do you do with that? And so there's like cultural sensitivity, cultural awareness, being aware and like being sensitive, being knowing that other people have different cultures. But this cultural safety really is about like addressing those power imbalances, and making sure that the individual feel safe in their clinical interact, interaction, and I first learned about it in principles of Indigenous Health, with Dr. Nicole Redvers. And it just made sense, and I wasn't planning to study it, but in some of these opportunities that came up, I presented one of my concepts my a concept map that I came up with about how an indigenous person experiences perinatal mental health. And in doing that, I kind of had the root level I made a flower and it's like the root level and the stem and the leaves as the community and then the individual being like this flower and the petals, and I got asked to present to the Montana Obstetrics and Maternal Support Leadership Committee. And so I presented that and one of my little leafs like there was the stem was like historical trauma to acknowledge like that all those things like this is still like this is still that's in our community still. But I also had a leaf, one of the leaves or collective healing to acknowledge like that traditional knowledge and that indigenous worldview of like, healing the collective and healing with people versus like, individually. And then the other leaf was cultural safety to talk about, like, how important it is to feel safe in being an indigenous person and how that can lead to trust and where someone, especially when they're experiencing mental health issues, they wouldn't feel afraid to tell somebody, what was what was happening. Like, I was like, I lied on my on my screener because I didn't want anybody, I didn't want to give anybody a reason to like, take my baby away. They were the nicest, you know, midwives nicest clinic, nobody treated me differently or anything. But that was just deep in my bones, like how I felt, I felt like I had to protect my family. So I kind of I just pointed out cultural safety. And then they invited me back, they said, Hey, can you come talk about cultural safety? And I'm like, Oh, I don't really know too much about that. Let me try to find somebody who does. And like the nearest like, trainer was in Canada. So I'm like, and it wasn't about maternal health. And I'm like, Okay, I'll do it. It was one of those of like, Okay, I'll do it. And so I did a first presentation that was like about it. And then the more I started working with people in the state, and seeing, like, how providers really wanted this, and then seeing how indigenous people were like, Man, I wish my providers knew that about me. It just kind of like I felt like really organically came about, like, this is what you're doing. So I created this toolkit. And right now I'm working on getting it pretty, because it's in boring black and white APA. I don't know No offense, APA, but I know way too much about your formatting and stuff now.

Jennifer Van Syckle  22:14  
I'm an APA person as well, thanks to my communications degree. Yes,

Amy Stiffarm  22:18  
my wife knew I could cite this in my sleep now. Thanks. Anyways, I'm making it pretty. And I've been giving trainings throughout the state when it's been really awesome, because it feels like it is my even doing my dissertation like this was the, this was something that I could give back, this was something that wasn't gonna sit on the shelf, and that I could use and that it seemed like would be helpful. And so, throughout, you know, I give presentations about it here and there, like kind of draft of where it was. And people be like, well, when is it coming out? When is it coming out. And so it really helped me like as a motivator of like, people want this, and this is what soon as I do this, and I can I can, I can help I can give these trainings more. So I've been really doing that a lot. Last week, I gave a presentation on mom's Project ECHO their website to a lot of providers that were like 60, some people that showed up on Zoom, and then we're going to do a follow up in November on that. So that's kind of where I'm at is, with hmhb I feel like it's a really, I feel really blessed that I'm able to do this work. Not just be in a university and studying but in a place where I can really give back to community because of my education. And so for right now, I'm really sad that I'm like licking my wounds and community because it was a really, really tough process doing my PhD like it was it was hard. And, but now it's done. And so I I'm happy that I get to work with tribal communities in my own state, all my other work before has to take I got to research and do projects with tribes, but a lot of them were out of the state. So I finally get to work with Montana. My degree is through University North Dakota, but this was something that I could do like for Montana and for the tribal communities here. So that's a big part of my work right now is helping people get trained in cultural safety and it's not the answer by any means, like this is a band aid like at the very least, providers, someone should feel safe in their interactions with a provider like this is all very low low bar. It is by no means the answer and it is it is I really see this as a bandaid. So I think next steps will come you know like in addressing these systematic issues and you know, when when I when I was struggling with my depression. And I would always like, a thought that would kind of keep me, I guess, keep me here or kind of bring me back to the present would be like, Well, what about my girls who would take care of my girls who would breastfeed my daughter, you know, if I weren't here, like who? What would happen? And so I kind of like my always, like hanging on thought was like, I have to make it through for my girls, they have to make it through so that when they're older, they're, they'll know about their risk for this. And they'll know about, like, how important it is to, like, get help when you need it. And so you're not suffering and all of this stuff. And so now I kind of feel like now my, it is about my girls too. But at a systems level, like what can I change? What kind of systems change can I help with, so that more more people don't have to suffer the way that I had to suffer through their pregnancy and postpartum period. And so that we can think of this maternal health as more more in a way of like well being, and being well, and not so much focused on focusing on all of these disparities, but so I really see a see myself right now. And like in the future, just working with tribal communities to help build this awareness about how important it is to like, utilize our values, our cultural values, and support our birthing people. And, you know, we always say that birth is ceremony and that mothers are like the backbones of our communities. And so I really think that there are ways that we can better demonstrate that and have people truly feel supported. So that's that's kind of, I think I still kind of have the same goal that I that I came out with, there's just more work to be done. Yeah,

Jennifer Van Syckle  26:49  
I like the positive messaging. There's been, there's been proof out there in the world. And then communications, that positive messaging gets farther, exactly like, you're, I think you're on the right track, positive messaging gets better results and get you farther than honing in on the negative and the disparities. Absolutely,

Amy Stiffarm  27:07  
definitely. And there's, there's research on that, too, about having a strong cultural identity and being an active participant in indigenous cultural practices, increases your resiliency, it's a protective factor for mental health issues and whatnot. So I really think, you know, we do yes, like funders need to know those, those disparity numbers so that we can get resources and whatnot. But it's important to acknowledge that we've survived the things indigenous people have been through, because of the strengths within our culture and our traditional knowledge. And so when we're thinking of solutions, and how can people help, it's really like giving creating space and creating opportunities for those strengths that are already within indigenous communities and culture. To be to be a part of that healing to guide them that healing. So that's a, that's a big a lot of with our program with the indigenous health PhD program, a big part of what we learned, and just something that I'm, I'm really excited to just a powerful message that I that I like to share with people. Fantastic.

Jennifer Van Syckle  28:27  
Any other like parting words or wisdom? Thoughts to put out? Yeah,

Amy Stiffarm  28:34  
I mean, I think that's just it. Like, there are things that happen, like find, find ways to learn, you know, learn from indigenous authors, when you're reading papers, like see, like, Did this person engage the community? Are they indigenous, there's there is an indigenous perspective missing from this paper, you know, kind of just be, you know, critique these papers and understand that, when we're always learning, reading, writing about like the negative things within a community, it is very easy to just think negatively about that community. So it's 2023. And now, we are recognizing the strengths in indigenous culture. So we're going to learn about the disparities and whatnot, make sure that we're talking about the strengths of indigenous culture not just for perinatal mental health, but for all areas of health.

Jennifer Van Syckle  29:28  
On behalf of myself, and the podcast crew behind the scenes that helped put this together, we want to extend a huge thank you to Amy stiff arm for sharing her amazing story with us, and so much education as well. If you would like any information on what you heard today, visit our website at Talkinghealthinthe406.mt.gov And until next time, take care

Transcribed by https://otter.ai