Needy Texas Mothers Can Depend on NHSC Midwife for Good Health
In a corner of Texas where the poorest of the poor find shelter in windowless trailers and shacks made of corrugated siding, the motto is, "Sigue Adalante" - keep moving ahead. It is a message that has resonated through generations of immigrants flowing northward from the Mexican border in search of a better life for their families. And it is the silent prayer of an intrepid band of health care clinicians at Holy Family Birth Center (HFBC), which exists solely to deliver quality health care to the women and infants of this impoverished and high-risk population in Weslaco.
HFBC has existed since 1983 under the inspired leadership and organizational direction of Sr. Angela Murdaugh, Texas Women's Hall of Fame inductee in 2002. In any given year, more than 250 healthy babies are born here; more than 90 percent of them are born into families without health insurance.
Diana Caplan, a certified nurse-midwife (CNM), is proud to be part of the HFBC success story and also one of those who embraces the philosophy of Sigue Adalante. Caplan is a National Health Corps Clinician serving a scholarship commitment within a 4-year contract at the clinic as a volunteer. Her commitment involves living at the clinic within a community of multi-disciplined clinicians and Roman Catholic nuns and receiving a small stipend for her services, in lieu of a paycheck. It is only through the complete donation of clinician services, combined with private, Federal, and State funding, that HFBC can meet the challenge of providing vital health care access to those who live as much as 400 percent below the Federal poverty line.
Of the NHSC, Caplan notes, "They didn't have to give me a scholarship. I would have gone into public service anyway." This is evident in the career path she followed, beginning with a nursing degree at University of Maryland at Baltimore in 1997, on to her experience establishing and participating in a free standing birthing clinic in Annapolis, MD, and then in her hands-on education in natural childbirth, cultural sensitivity, and Spanish language in the Nicoya Peninsula of Costa Rica. Caplan graduated in 2000 as a CNM from the University of Colorado Health Science Center.
Beyond what Caplan characterizes as a holistic model of care for women, the underlying philosophy at HFBC also encapsulates the idea of Sigue Adalante - always moving ahead with common sense, and within the framework of what the patient wants. Traditionally, Hispanic women have preferred giving birth at the home of the midwife in a special place set aside for just that purpose. In this spirit, HFBC has created a familial atmosphere of safety and intimacy for the whole family to experience labor and childbirth on their own terms and in their own private way.
According to Caplan, bringing the family into the labor and birth process represents the gold standard in midwifery school. In the real world, however, she has learned to set aside her own standards and defer always to what the patient wants. "I have been honored by patients who ask that I alone share in their individual birth experiences," Caplan says.
Caplan has flourished in this environment that encourages autonomy of practice across the entire spectrum of health care. On any given day she may attend to her patients as clinician, doula (one who cares for the family and the household so that a new mother can focus exclusively on her infant), or respected counselor. Then, on another day, she might turn her attention to grant writing, mentoring new clinical fellows, developing standards of care, or advising a filmmaker on the details of blending traditional Hispanic midwifery with state-of-the-art medical innovations, among her other clinical duties.
As one whose first experience of Latino/Hispanic culture was within the relative isolation of Costa Rica, Caplan despairs of how the concept of Sigue Adalante has been distorted by the influence of the flip side of American culture. Among many who were once content living in a balance determined by faith, family, and hard work, moving ahead has been reinterpreted as a rush to pursue material goals. This translates into an increased violent crime rate and rising dependency on drugs. Everyday, Caplan deals with the direct result of these trends in unwed teen pregnancies, a drop in early prenatal care rates, and increased emotional distress brought on by violence and isolation from supportive family and community.
Another concern is the replacement of traditional Mexican food choices with fast food because it is cheap, quick, and easily accessible. Again Caplan sees the results of this trend in her practice in increased obesity, non-insulin dependent diabetes, and heart disease. These conditions, in turn, lead to complications during pregnancy and delivery, and higher rates of preventable disease and early mortality rates.
"More intervention isn't necessarily the best option," says Caplan. "Hospitals concentrate on the medical aspect of what is presented to them, and birth is essentially a natural process, not a medical event. We have an evidence-based, healthy, safe, unique opportunity for people who are childbearing…what I expect to see is that more people will become educated about alternative options." In saying this, Caplan emphasizes the importance of having a family doctor on hand to address medical issues and emergencies. Her role, Caplan insists, is to provide patients with the tools that will ensure good health and keep doctor visits to a minimum.
"As I reflect on my time here in the Rio Grande Valley," says Caplan, "I am continually struck by the resilience of the women. So many have said, 'Sigue Adelante'." Through compassionate dedication, Caplan has learned that, the notion of "ahead," means something totally different to each of individual. But at HFBC, where nothing is taken for granted, staying ahead means simply being in health and in balance.
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