11.18.10: A peek into how far we've come in health care and how far we have to go.
I must have been the only person in America who hadn’t seen Mad Men. That is, until last weekend when rain and lack of motivation found me lying on the couch with my laptop and a pile of Season One DVDs. No surprise that it’s just like everybody’s been telling me - phenomenal. I’m totally hooked - the characters, those clothes, the furniture and that hair. It’s love.
Mad Men is an anthropologic peek at how life really was for women not that long ago. It may seem like ancient history to some of you who are pregnant now, but it really wasn’t all that long ago. The first season, set in 1960, was the year Jennifer Grey (Dirty Dancing, Dancing with the Stars), Julianne Moore, Valerie Bertinelli, and I were born. We grew up with the revolution that spawned The Women’s Movement and helped create the evolution of women’s health. Go ahead and thank your mother, older sisters and aunts for making a trip to the doctor’s office or hospital a compassionate, respectful affair. Mad Men is doing a great job showing how far we’ve come.
That scene when Peggy visits the gynecologist to get birth control pills made me cringe. The doctor smokes and chides Peggy because she's seeking contraception, but she is unmarried. He gooses her with the speculum and says, "As doctors, we like to think putting a woman in this kind of situation isn’t going to turn her into some kind of strumpet. I’ll warn you now; I’ll take you off this medicine if you abuse it. It’s for your own good, really…even in these modern times, easy women don’t find husbands. …Don’t think you have to go out and be the town pump just to get your money’s worth." He wraps it up by tossing in a few degrading remarks about Peggy’s coworker, a patient he apparently sleeps with.
Yes, this really is how women were treated in the 50’s and 60’s. My mom told me she hated going to the doctor for prenatal visits and her hospital births more than labor itself because the doctors and nurses treated her disrespectfully, like an ignorant, ill-behaved child instead of a woman having a baby. It wasn’t uncommon to be shamed, criticized, bossed around and threatened. We’ve come a long way, baby.
Patients rave about the care they receive from their labor nurses. They’re treated like princesses; every need met, every whim catered to. There’s a reason for that. It’s called customer service. Labor and delivery is a gateway department for hospitals. If a woman has a great experience there, she’ll return when her child has an emergency or her mother needs surgery. She’ll use their pediatricians, send her husband to their urologist and recommend their rheumatologist to her friend. Health care is a market-driven commodity and labor units are income generators. Don’t get me wrong, your nurse does, sincerely, care about you. That’s why she’s in the business. Still, making the customer happy is part of her job.
This policy of compassionate and high-quality care is not universal though, not even in the United States. Many women, especially in low-income areas, experience indifference and even hostility from their caregivers. In many countries, poor treatment is normal and the revolution towards respectful woman-centered care isn’t even on the horizon.
I’ve written about simple changes made in developing countries that are transforming women’s attitudes about accessing birth centers instead of delivering at home, alone. Before CARE became involved in rural Peru, women could expect no privacy, no dignity, not even to be called by her own name or spoken to in her own language. If she was poor (and most are), she learned to expect disdain as her standard of care. CARE asked patients what they wanted and all they wanted was respect, a name and kindness.
I spoke with Jackie Danicki, Head of Communications for Innovations for Maternal, Newborn & Child Health, a project of Concern Worldwide (another non-profit global humanitarian organization) about how they’re tackling this challenge. Danicki told me Concern sponsored a competition specifically targeting previously "unheard voices" who hadn’t traditionally been consulted on this process, for example, women who might need healthcare. Through crowd sourcing, they asked for inspiring, innovative ideas to bridge gaps in the health delivery system. Check out this video about the Concern Innovation competition’s winning ideas.
While some competitors came up with flashy new ideas, the winning entries were about improving quality from healthcare workers; simple stuff like having them be accountable, wear name tags and treat patients kindly. Jackie told of a woman who walked for miles to get vaccinations for her newborn. When she finally arrived, a healthcare worker slapped her for not bringing her other children in too. No wonder poor women are scared to seek healthcare.
Why would a healthcare worker do that? Because she’s overworked, underpaid and tossed into desperate situations where she doesn’t know what to do. She’s exhausted, scared and oppressed too. She hasn’t been trained or supported to provide good care. She doesn’t have any supplies, resources or respite. That’ll make any caregiver edgy. Once you support the caregiver, they support their patients. American nurses usually provide high-quality care because our hospitals pay us, train us and make it a priority. We still have a ways to go because many nurses and patients in America still feel mistreated and unsupported, but look how far we’ve come, ladies. We’re not that Mad anymore.
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