Winnie Mading wrote of a request from someone working in Papua New Guinea
struggling to convey to mothers the importance of colostrum in a culture
where the belief that "colostrum is bad milk" prevails and where the impact
of a lack of colostrum can immediately be seen in an increase in illness in
infants. A request for low literacy materials and help from local LCs in
finding appropriate materials was made. And Winnie quoted the person who
originally requested help as stating: "The big problem is that this is
going to go against their every being and will be really hard to show them
and have them believe, it is so ingrained into their culture..."

Anyone undertaking an endeavor such as this would do well to know:

1. The economic system, political system, history, and rules of social
engagement of the community. How do people with different social roles
treat each other and expect to be treated? Does mistrust of a dominant
culture exist due to occupation, enslavement, racism, etc. in the present
or at any point in history? What real life constraints exist in mothers'
lives due to gender concepts, laws (formalized or embedded in culture),
economics, etc.?
2. Health beliefs, practices, and systems of the community.
3. How Western medicine, healthcare, and healthcare providers are viewed by
the community.
4. Whether approaching the issue from the standpoint of a medical model
would be effective (i.e., would mothers be motivated to change what they
are doing because someone tells them that their babies would be healthier
if they did so).
5. Who the most influential members of the community are. These people will
need to be consulted and involved in the process of change.
6. Whether anyone in the community (or in a nearby community) is already
engaging in the desired behavior (e.g., breastfeeding immediately after
birth).
7. If so, how they made that change, what barriers they faced, and how they
overcame those barriers.
8. What cultural symbols (e.g., concepts, images, characters, rituals,
etc.) exist that could be paired with the new behavior to make the new
behavior more acceptable (e.g., could cultural symbols of well-being,
safety, longevity, success, community connection [whatever concepts are
valued in the culture and could reasonably [by the culture's definition of
reasonable] be related to colostrum consumption] be shown alongside images,
or with enactment, or with stories of a mother nursing right after birth?;
could a ritual be conducted that would convert colostrum as "bad milk" to
colostrum as "good milk" [e.g., expressing and discarding some colostrum so
that the "bad is now gone" and the "good is now in"?; could consuming a
particular food or herb to "make colostrum good"?], etc.).
9. Whether written materials carry any weight in the community.
10. Who the most influential members of the mother's family (however her
culture defines family and membership in it). These people will need to be
included somehow in the process of change.

I stop my list here, but it does not end here. Culturally competent
practice involves all these things and more.

Anyone undertaking working with mothers and families from a culture other
than their own (and even apparently from their own, since appearances can
be deceiving) would do well to read the book "The Spirit Catches You and
You Fall Down: A Hmong Child, Her American Doctors, and the Collision of
Two Cultures" by Anne Fadiman (1997). Take this example from the book and
then imagine applying the concepts seen in it to the "colostrum is bad"
situation:

In 1985 after an outbreak of rabies among the camp dogs in a Hmong
community, a mass dog-vaccination program failed to bring in a single dog.
Dwight Conquergood, a young ethnographer, designed a "Rabies Parade"--a
procession led by three important characters from Hmong folktales dressed
in homemade costumes. The cast, as well as the audience, were all Hmong.
The person dressed as the most influential Hmong folktale character
explained the cause of rabies through a bullhorn. The other characters
sang, banged a drum, and danced. The next morning, so many dogs were
brought in for vaccination that the emergency relief workers could hardly
keep up. Conquergood's next public health campaign was a sanitation
campaign in which "Mother Clean" (a huge, grinning figure on a bamboo
frame) and the "Garbage Troll" (covered with trash and dressed in ragged
clothes) led a procession of children and sang songs about latrine use and
refuse disposal. The second campaign was equally successful.

My point is that I don't know if a campaign based on printed materials will
be effective among that particular community of mothers in Papua New
Guinea. And I don't know what campaign would be successful. I do know that
careful consideration of what cultural symbols might be helpful, which
members of the community might be most effective in conveying the message,
what health beliefs and behaviors are held by the mothers, what barriers
they would face in making a change, etc. is appropriate. I would encourage
the healthcare providers involved to develop allies in the community, to
ask for help from cultural "informants," to review what public health
programs have been successful and unsuccessful in the past and how they
differed, etc. Always, always, we must be willing to learn *from* the
mothers and communities we hope would learn something from us.

My article, "The Cultural Art of Breastfeeding," might also yield ideas. It
can be read from the breastfeeding section of the publications page of my
website, Ammawell (http://home.attbi.com/~ammawell).

I hope something in this post is helpful.

Sincerely,

Cynthia

Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC
Ammawell
Email: [log in to unmask]
Web site: http://home.attbi.com/~ammawell

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