Volunteering with Mercy Ships

Volunteering with Mercy Ships

Prior to finding out about Mercy Ships, Christel A. Echu, RN, admits that if you asked her if she wanted to volunteer for any organization and not get paid, she would have said, “No.”

But when a friend who was an authority in the church she attended in Cameroon, Africa, she changed her mind. “I decided to volunteer with Mercy Ships because I was interested in being a part of the great work they were doing for the people of my country, and I wanted to help in any way that I could,” Echu says.

Mercy Ships Bring Hope and Healing

Mercy Ships is a non-profit Christian organization, she says, that sails across West and Central Africa with the mission and vision to provide hope and healing to patients who are poor and/or forgotten in countries there.

When Echu began volunteering with Mercy Ships, she had just graduated from nursing school. First, she worked as a volunteer translator when the ship, the Africa Mercy, was docked in the port of Cameron. She volunteered as a translator for 10 months.

Mercy Ships bring hope and healing

Mercy Ships bring hope and healing

By then, Echo says, she was hooked. She ended up continuing to volunteer for another two years. “I transitioned from that [working as a translator] to working as a volunteer screening nurse until the end of my commitment,” she says. “Screening nurses, we see all the patients before they are seen by the rest of the hospital. We screen, assess, and ensure patients are healthy enough for surgery.”

She says that they pre-screened more than 6,000 patients in a day when they were in Guinea Conakry. “That was the longest shift I have ever had,” she says.

One of the aspects that Echu loved about Mercy Ships is that she got to work with nurses from all over the world: including the Netherlands, Canada, Australia, the United States, and others.

“I loved working with patients and with my team. We also worked alongside our wonderful translators, which was a blessing because they helped to facilitate communication between the patients and nurses,” she recalls. “I think I enjoyed the fact that we could learn from each other to provide the best care to the patients we served. I enjoyed seeing the joy the patients felt whenever we announced to them that they were getting surgery. “The dance of joy” was a thing in the screening tent and I enjoyed seeing the patients come back to show us their “new self” without the tumor or the deformity. Moments like that, reminded me why I decided to volunteer in the first place and kept me going on difficult days.”

Biggest Challenges

There were tough days. Echu says that one of her biggest challenges while working with Mercy Ships was being away from her family, home, and community. But another difficult part was when she had to say “No” to people they couldn’t help.

“This is a part of my job that we don`t talk much about. The ship has specific surgeries they do when they sail in a nation. However, there are patients who present with conditions that are not within Mercy Ships scope of practice and that`s when we get to do ‘no’ conversations. Screening nurses initiate that conversation before the chaplaincy team on the ship takes over,” she says. “That was the most challenging thing about my job—having those ‘no’ conversations was never an easy thing to do. Most of the patients we see come with the hope of being helped, but when we have to say no to them, it almost feels like that hope crumbles before their very eyes.”

Greatest Reward

She also, though, had many rewards—the greatest of which was forming relationships with the ship’s community.  “The relationships I built during that time, [ones] that become an integral part of my life. The community is really special. Now, I have friends all over the world,” says Echu, who now lives in Minnesota. “I do not have family here in the United States, but I know friends with whom I worked with on the ship, [and they] are my family while I am here.”

Echu says she will never forget “the amazing patients I got to work with and their families and the joy they always had on their faces even without having much.”

If you’re a nurse thinking about volunteering with Mercy Ships, she says, “Do it! Go and see for yourself. Have an open mind and be ready to learn and receive as well,” she says. “Most volunteers go on the ship with the mindset of giving and serving which is good, but also go with the mindset of receiving. Receiving could be anything—like being welcome in the house of a local, or being encouraged by a patient who doesn`t have much, but they still have a big smile on their faces. It’s an experience that would change your life completely for good.”

Melanoma in People of Color: What’s the Risk—and Will Sunscreen Help? A Black Dermatologist Explains

Melanoma in People of Color: What’s the Risk—and Will Sunscreen Help? A Black Dermatologist Explains

Melanoma is a potentially deadly form of skin cancer that effects people of every racial and ethnic group. The risk factor most closely linked to developing melanoma is exposure to ultraviolet, or UV, rays from the sun. In fact, sunburns have been associated with doubling one’s risk of melanoma.

Sunscreen can block UV rays and therefore reduce the risk of sunburns, which ultimately may reduce the risk of developing melanoma. Thus, the promotion of sunscreen as an effective melanoma prevention strategy is a reasonable public health message.

But while this may be true for light-skinned people, such as individuals of European descent, this is not the case for darker-skinned people, such as individuals of African or Asian descent.

The public health messages promoted by many clinicians and public health groups regarding sunscreen recommendations for dark-skinned people is not supported by the available evidence. Media messaging exacerbates the problem with headline after headline warning that Black people can also develop melanoma and that Black people are not immune.

To be sure, they can get melanoma, but the risk is very low. In the same way, men can develop breast cancer, however, we do not promote mammography as a strategy to fight breast cancer in men.

This message is important to me as a Black board-certified dermatologist and health services researcher at Dell Medical School at the University of Texas at Austin, where I am director of the pigmented lesion clinic. In this capacity I take care of patients at high risk for melanoma.

Melanoma in Black people is not associated with UV exposure

In the U.S., melanoma is 30 times more common among white people than Black people.

In Black people, melanoma usually develops in parts of the body that are not exposed to the sun, such as the palms of the hands and soles of the feet. These cancers are called “acral melanomas,” and sunscreen will do nothing to reduce the risk of these cancers.

When was the last time you had a sunburn on the palms or soles? Even among white people, there is no relationship between sun exposure and the risk of acral melanomas. Famously, Bob Marley died from an acral melanoma on his big toe, but sunscreen would not have helped.

Last year my research group conducted a systematic review in which we analyzed all of the published medical literature related to UV exposure and melanoma in people of color. This includes those of African, Asian, Pacific Islander, Indigenous and Hispanic descent. Of the 13 studies that met our criteria for inclusion, 11 showed no association between UV exposure and melanoma.

Among the two studies that showed an association, one study showed a positive association between melanoma and UV exposure in Black men. But that same study also examined UV exposure and melanoma in other groups, including Black women, white men and women and Hispanic men and women. In these other groups the researchers found no association between UV exposure and melanoma. This is a surprising result, given that white people are the group in which the association between UV exposure and melanoma has been consistently demonstrated, calling into question the validity of the study results.

The other study showing an association between UV and melanoma was among Hispanic men in Chile based on latitude within the country. A major caveat to this study is that the city with the highest number of melanomas is also home to a large population of Chileans of Croatian descent, who would not be considered people of color.

Unfortunately, none of these studies measured melanin concentrations of individuals, so it is not possible to know whether theoretically lighter-skinned people of color may be at risk for UV-associated melanoma. However, even in light-skinned East Asian individuals, there is no evidence that UV exposure is linked to melanoma.

The bottom line is that the link between UV exposure and melanoma in people of color has been studied many times over and has yielded little to no evidence of a connection. The Conversation

Racial disparities in melanoma outcomes are not related to UV exposure

Many dermatologists often point out that Black patients tend to show up to the doctor with later-stage melanoma, which is true. However, this is an issue of access and awareness and has nothing to do with sunscreen application or protection from the sun. Black people should be aware of growths on their skin and seek medical attention if they have any changing, bleeding, painful or otherwise concerning spots, particularly on the hands and feet.

However, the notion that regular application of daily sunscreen will reduce an already extremely rare occurrence is nonsensical.

UV radiation does affect dark skin and can cause DNA damage; however, the damage is seven to eight times lower than the damage done to white skin, given the natural sun-protective effect of increased melanin in darker skin.

To be clear, using regular sunscreen may help with reducing other effects of the sun’s rays such as sunburns, wrinkling, photoaging and freckling, which are all positive. But for the average Black person, sunscreen is unlikely to reduce their low risk of melanoma any further.

If sunscreen were important in the prevention of melanoma in dark-skinned patients, then why have we never heard of an epidemic of melanoma in sub-Saharan Africa, a region with intense sun, a lot of Black people and little sunscreen?

In certain subpopulations of Black people, such as those with disorders causing sun sensitivity, or patients with albinism – a condition in which people produce little or no melanin – or those with suppressed immune systems, sunscreen use may reduce risk of melanoma. But if you don’t fall into one of these categories, any meaningful risk reduction from the application of sunscreen is unlikely.

One-size-fits-all public health messaging misses the mark

Many dermatology and skin cancer-focused organizations – a few of which I belong to – promote the public health message of sunscreen use to reduce melanoma risk among Black patients. However, this message is not supported by evidence. There exists no study that demonstrates sunscreen reduces skin cancer risk in Black people. Period.

This issue of regular sunscreen use in Black people was made even more pressing after the release of two recent studies on sunscreen absorption in the Journal of the American Medical Association. This study showed that significant amounts of certain chemical sunscreen ingredients can get in the blood when used at maximal conditions, with unknown impacts on human health.

To me, the most shocking part of the studies were that most of the participants were Black, the group least likely to derive any meaningful associated health benefits from sunscreen, while being exposed to potentially harmful levels of chemicals.

As dermatologists and public health advocates, we can improve how we educate patients and the public about melanoma prevention without promoting public health messages that are grounded in fear and lack evidence. Black people should be informed that they are at risk of developing melanoma, but that risk is low.

Any dark-skinned person who develops a new, changing or symptomatic mole should see a doctor, particularly if the mole is on the palms or soles. We don’t know what the risk factors are for melanoma in Black or dark-skinned people, but they certainly are not UV rays.

This is an updated version of a piece that was published on May 14, 2019.

Study: Black Adults’ High Cardiovascular Disease Risk not Due to Race

Study: Black Adults’ High Cardiovascular Disease Risk not Due to Race

Findings from a new Northwestern Medicine study rebut the idea that Black individuals’ higher risk of cardiovascular disease is because of biological differences.

“The key take-home message is that racial differences in cardiovascular disease are not due to race itself, which is a social concept that is not related to biology.”

Black adults are at significantly higher risk (1.6-2.4 times) for cardiovascular disease than white adults. The new study found these large differences can be explained by differences in social determinants of health (like education or neighborhood-level poverty), clinical factors (like blood pressure) and lifestyle behaviors (like dietary quality).

“The key take-home message is that racial differences in cardiovascular disease are not due to race itself, which is a social concept that is not related to biology,” said corresponding author Dr. Nilay Shah, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “Rather, these differences in cardiovascular disease can be explained by differences in social and clinical factors. Clinicians should be evaluating the social determinants that may be influencing the health of their patients.

“The data from this study starts to identify what contributes to the higher burden of heart disease experienced by Black adults, and how much each factor matters.”

The study was published May 24 in Circulation, the flagship journal of the American Heart Association.

A breakdown of the findings

Black women had a 2.4-times higher risk for cardiovascular disease compared with white women. The study found that clinical factors, neighborhood-level factors and socioeconomic factors explained the largest components of the higher risk experienced by Black women.

Black men had a 1.6-times higher risk for cardiovascular disease compared with white men. The study found that clinical factors, socioeconomic factors and lifestyle behaviors explained the largest components of the higher risk experienced by Black men.

“The findings of significantly higher risk in non-Hispanic Black adults compared with non-Hispanic white adults is not surprising—this is well-known,” said senior author Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Feinberg and a Northwestern Medicine physician. “But it was surprising that the risk for cardiovascular disease was the same once social and clinical factors were considered over time. This finding is really important to rebut that there is an unexplained or genetic reason that Black individuals have higher risk.”

The study’s findings are important because they show that disparities in heart disease experienced by Black adults could be reduced by improving preventive care of heart disease risk factors and addressing social determinants, Shah said. The data provide a guide to identify strategies that may be particularly effective at reducing the persistent differences and disparities in heart disease that exist in the U.S.

“It is important to note that clinical risk factors, lifestyle and depression are not independent of socioeconomic status and neighborhood segregation,” Khan said. “Future research needs to go upstream to target social determinants of cardiovascular health. Our study lays groundwork to help inform community-engaged interventions that ensure equal opportunities for all people to have access to high-quality foods, environments and health care.”

The study evaluated data from about 5,100 Black and white adults who participated in the CARDIA (Coronary Artery Risk Development in Young Adults) Study at four locations in the U.S. (Chicago; Minneapolis, Minn.; Oakland, Calif.; and Birmingham, Ala.). The participants enrolled around 1985 and have been followed for over 30 years. The scientists evaluated the information participants provided starting from the time of their enrollment to determine the role of social and clinical factors in the differences in cardiovascular disease experienced by Black compared with white adults over the course of 30 years of follow-up.

Other Northwestern co-authors include Norrina Allen, Dr. Donald Lloyd-Jones, Mercedes Carnethon, Kiarri Kershaw, Lucia Petito and Hongyan Ning.

Funding for the study was provided by the National Heart, Lung, and Blood Institute (NHLBI) (grant K23HL157766); the National Institutes of Health (grants P30AG059988 and P30DK092939); and the American Heart Association (grant 19TPA34890060). The CARDIA study is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (grants HHSN268201800005I and HHSN268201800007I), Northwestern University (grant HHSN268201800003I), University of Minnesota (grant HHSN268201800006I) and Kaiser Foundation Research Institute (grant HHSN268201800004I).

For Hispanic Californians, Drop in Life Expectancy Was 3 Times Greater than Whites in Pandemic

For Hispanic Californians, Drop in Life Expectancy Was 3 Times Greater than Whites in Pandemic

The life expectancy of Californians decreased by about three years as a result of the COVID-19 pandemic, according to a study by UCLA researchers and colleagues published in the Journal of the American Medical Association.

The research further shows that life expectancy for Hispanic, Asian and Black Californians decreased more than for white Californians and that the gap in life expectancy between those living in the highest- and lowest-income census tracts increased, from a difference of about 11.5 years before the pandemic to more than 15 years in 2021.

“Our findings are another troubling sign of how the pandemic’s impact was not felt evenly across all communities,” said study co-author Till von Wachter, a UCLA professor of economics and director of the California Policy Lab’s UCLA site. “Policymakers can use these findings to craft a more equitable response now, and also to inform how we plan for future public health crises.”

In their analysis of 1.9 million deaths in California between 2015 and 2021, the multi-campus research team calculated that life expectancy for Californians fell from 81.40 years in 2019 to 79.20 years in 2020, and down to 78.37 years in 2021. This study demonstrates that the reduction in life expectancy continued from 2020 into 2021, despite the availability of vaccines for much of 2021.

Life expectancy is not the average life span of individuals in a society but a hypothetical measure based solely on the mortality rates observed in a given year. It estimates how long a cohort of newborns could expect to live if it experienced the mortality rates of that specific year throughout their entire lifetimes. In the current study, life expectancy captures how much life was lost collectively within a population during the pandemic years, and it illustrates the dramatic differences in the pandemic’s impact across communities of different socioeconomic status.

Hispanic populations in California lost 5.7 years of life expectancy between 2019 and 2021, while Black populations lost 3.8 years, Asian populations lost 3.0 years and white populations lost 1.9 years, according to the study. During this time, income also became more tightly correlated with life expectancy than it had been previously.

“We’ve had indications that the pandemic affected economically disadvantaged people more strongly, but we never really had numbers on actual life expectancy loss across the income spectrum,” said lead author Hannes Schwandt, an assistant professor at Northwestern University’s School of Education and Social Policy. “I am shocked by how big the differences were and the degree of inequality that they reflected.”

The study is based on an analysis of restricted death data obtained from the California Comprehensive Death Files maintained by the California Department of Health.

“In California, Hispanic individuals have historically lived longer than white individuals, but the pandemic upended that, as the life expectancy for Hispanic Californians decreased by about six years, three times as high as the decline for white Californians,” said co-author Jonathan Kowarski, a research fellow at the California Policy Lab and a doctoral student in economics at UCLA.

In addition to Schwandt, Von Wachter and Kowarski, study authors include Janet Currie of Princeton University, and Steve Woolf and Derek Chapman of Virginia Commonwealth University.

Health is Wealth… So Manage It Wisely!

Health is Wealth… So Manage It Wisely!

All my life I have rarely been sick, in fact there have only been two times that I can recall. So, about three months ago  when I started feeling bad, it was out of the ordinary.  I did not have any obvious symptoms, such as nausea, vomiting, headache, runny nose etc.  I just had a lack of energy and no appetite.  During this time it made me realize that “I would rather have great health, more than any material thing”; not that I do not like nice things or places.  As children, many of us dreamed of growing up and having lots of money, big houses, cars and anything else that money could buy. We were only focused on the “material” things.  There were never any thoughts about our physical or mental health. Health is wealth.

I would rather have excellent health, than all of the money in the world.  If you are sick and cannot get around, what good is having money and things, if you cannot enjoy it? Some people may say that they would use their money to hire the best doctors, but that is no guarantee that you will have good health.  I often think of our patients that we are taking care of in the hospitals and clinics, they are relying on us to give them the best possible care to make them feel better. During this time, they become dependent on the healthcare staff and this may be hard for many that are used to having control of their own lives.  Before you make an assumption that the patient is “difficult” or “hostile”, remember that these are people that were working, taking care of themselves and families and making their own decisions.  We need to include them in all aspects of their care, instead of dictating what will be done.  Although we may have our daily assignment planned, discuss with the patient the Plan of Care and let them have some input on the order of some things, to give them that feeling of control.  We still have to stay on task, but we need to make them feel like adults and not like children being told what to do.  Some people may think that this will interrupt your normal day, but imagine if it were you laying in that bed, how would you want to feel?

I have decided that I am going to enjoy life, spend more time taking care of myself and creating experiences with my daughter. I have been privileged to accomplish a lot of things in my life: writing my first children’s book, starting a home-based travel business, building my photography portfolio, traveling domestically and internationally; all while being a mom and nurse.  We spend a lot of time taking care of others; but we must start taking care of ourselves; otherwise we will not be here for others.

So, the fatigue and loss of appetite that I was having was due to  my Vitamin D level being critically low. I am currently working remotely, so eight hours of my day is spent inside on the computer.  When I get off work, I wait until the sun goes down to go on my evening walk; therefore I was getting minimal to no sun. I am happy that this is a condition that can be easily corrected by diet, taking nutritional supplements and spending a few minutes sunbathing (in moderation).  The benefits of sunlight is that Vitamin D is produced when your skin is exposed to the sun and it is one of  the many vitamins our bodies need to stay healthy, relieve stress and increase energy.

I realized that work will be there; so I have made it a point to sit outside on my breaks and lunch. I am glad to say that I am feeling a lot better now. Never take your health for granted.  You only have one life and you need to make sure to maintain your health.  Take care of yourself, mind, body and spirit. The six best doctors in the world: sunlight, exercise, rest, diet, self-confidence and friends.  Maintain them in all stages of life and enjoy a healthy life.   Remember Health is Wealth!!

 

Nurse-Midwives Train Doulas to Reduce Black Maternal Health Risks

Nurse-Midwives Train Doulas to Reduce Black Maternal Health Risks

Nurse-midwives and educators from three prominent research universities have teamed up to improve pregnancy outcomes in Black communities by providing specialized training for doulas, persons who support birthing mothers and families through the entire process of childbirth.

The Alliance of Black Doulas for Black Mamas is led by Vanderbilt University School of Nursing Associate Professor Stephanie DeVane-Johnson, PhD, CNM, FACNM, Duke University School of Nursing Assistant Clinical Professor Jacquelyn McMillian-Bohler, PhD, CNM—both graduates of Vanderbilt’s nationally-recognized Nurse-Midwifery program—and University of North Carolina School of Medicine Assistant Professor Venus Standard, MSN, CNM, FACNM. The project leaders are Black, certified nurse-midwives with a combined 60+ years of midwifery experience.

Doulas offer emotional and informational support for pregnant persons and their families. Unlike nurse-midwives, they are not medically trained; however, their help with things like breastfeeding, acupressure, birth plans and postpartum issues can be critically needed, as can their presence as an advocate for the mother.

The three researchers are addressing the U.S.’s Black maternal health crisis. The U.S. has the highest maternal mortality rate among developed countries—and the crisis is even more pronounced for Black mothers. Centers for Disease Control and Prevention statistics reveal disparities between pregnancy complications and risks across different racial groups. Black women are approximately twice as likely to have a moderately low birthweight child and three times as likely to have a very low birthweight child than white or Hispanic women (https://www.cdc.gov/nchs/products/databriefs/db306.htm). Black women are also more likely than white or Hispanic women to die from pregnancy complications—almost 67 percent of which are preventable.

Having a trained and trusted professional who can help parents-to-be make healthy decisions and choose proper prenatal care can make a difference in maternal health and birth outcomes.

DeVane-Johnson, McMillian-Bohler and Standard worked together to write and fine-tune a plan to train and provide Black doulas to help Black families, with hopes of mitigating the high Black maternal and infant mortality rate. In 2020, the doula project was funded by a $75,000 award from UNC, the Harvey C. Felix Award to Advance Institutional Priorities and the group trained its first 20 doulas. In 2021, they received a $545,000 Duke Endowment grant, which will fund the program for three years beginning in May 2022.

Nurse-midwives Jacquelyn McMillian-Bohler, Venus Standard and Stephanie DeVane-Johnson.

Nurse-midwives Jacquelyn McMillian-Bohler, Venus Standard and Stephanie DeVane-Johnson.

The main program goals are to: decrease Black maternal mortality and morbidity; improve patient experiences; provide doulas for free to families; and help those interested in becoming doulas build critical skills and later use those skills to earn wages. The program’s goals align with the 2021 Black Maternal Health Momnibus Act, which “directs multi-agency efforts to improve maternal health, particularly among racial and ethnic minority groups, veterans, and other vulnerable populations,” states congress.gov (https://www.congress.gov/bill/117th-congress/house-bill/959).

“The training is more than about labor and birth,” said McMillian-Bohler, who teaches the mindfulness curriculum. “We also introduce the doula to general stress-reduction techniques such as mindfulness and acupressure. Although evidence suggests these techniques are helpful, they are often not accessible to the Black community.”

DeVane-Johnson works remotely as the community engagement liaison for the program, which is housed at UNC Family Medicine in Chapel Hill, but the doulas will be serving families in Durham, Wake and Orange counties in North Carolina. Devane-Johnson hopes to receive funding to expand this program to Black pregnant persons in Nashville, TN.

“The strength of the program is the expertise of the entire team and the integration of the expertise,” said Standard, who connects families with doulas from the program and is currently teaching the third cohort of Black doulas. “Although each university could independently support the doula program with its hospital system and academic affiliation, a collaboration between the three universities positively impacts the project as a whole.”

Doula training applicants attend information sessions and are screened to make sure they will be successful in the program and that they will enjoy the work.

According to McMillian-Bohler, the program’s doula/family partnerships offer racial concordance, which can increase trust and understanding.

“I think the fact that we are able to come in and talk about some of these health resources and, I hope, remove some of the stigma, opens up a whole area of health care and wellness to people who desperately need it, who maybe didn’t feel like it was for them,” McMillian-Bohler said.

The doulas recognize that birthing parents have the right and need to speak up for their own bodies and health, and help them build the confidence and ability to do so.

Doula students learn to use use birthing balls to help relieve pain and pressure during pregnancy and during birth.To receive help from a doula in the program, a person must be Black, pregnant and planning to deliver at a University of North Carolina-affiliated hospital.

“By having a culturally concordant doula, the patient has a personal advocate, educator and support person to help guide and navigate the system as a Black person, whose needs are often dismissed or ignored,” Standard explained.

“Our hope is that by selecting doulas, who are gatekeepers into various aspects of the Black community, and by giving them tools to share with families, we create a community project that helps birthing families and doulas, said McMillian-Bohler”

The program offers doula training that is expanded to accommodate the specific needs of Black women, covering topics like reproductive justice and the “superwoman schema,” which says that many Black women care for others at their own expense, increasing stress during a pregnancy.

“The goal is to help mitigate Black maternal and infant mortality rates,” DeVane-Johnson said. “Doulas stand in the gap. Sometimes, Black women bring things up to their health care providers and are not taken seriously, or the provider does not talk at a level that the patient and family can understand. The doula is there to bridge that gap and potentially interpret information.”

DeVane-Johnson also serves as the facilitator for breastfeeding lectures. She studies the history of breastfeeding and presents lectures to doula-trainees to help them understand the hurdles faced by those they are trained to help. The doulas use this training to support Black women who want to breastfeed and connect them with lactation consultants, as research indicates that breastfeeding decreases cancer risks in mothers and improves health outcomes for babies.

“Black women have the lowest breastfeeding rate out of any race,” DeVane-Johnson said. “When variables such as socioeconomic status, education and marital status are controlled for, similar positioned white women still tend to breastfeed at higher rates.”

Doulas help solve communication issues and offer consistent labor support for those who don’t have it, something that has been shown to decrease time in labor and the need for pain medications.

“We hope to create opportunities for Black women to find their voices and be empowered to ask questions,” McMillian-Bohler said.

“Doulas are there to empower, uplift and elevate birthing families,” she continued. “If something doesn’t feel right, the doulas help them recognize that they need to speak up and keep speaking until their voice is heard.

The doulas are trained to recognize preterm, term and postpartum warning signs that may otherwise go untreated, leaving parent and baby at risk.

They train over the course of seven weekends. While on-call with patients, they assist with birthing plans, help pack bags for the hospital and even attend appointments, depending on how much support the birthing parent needs. Once trained, a doula is paired with three Black families who receive assistance for free.

DeVane-Johnson says program applicants need to be Black, have a passion for birth work and have a desire to support women in labor. In the past, applicants may not have been financially able to secure training, but thanks to the grants, training is free.

Applicants are screened to make sure they have reliable transportation, a job that’s flexible enough to allow them to leave to attend a birth and are vaccinated against COVID-19.

According to DeVane-Johnson, the most important qualification is “a passion to help support Black families in the community.”

“Being a doula often is different than what many people imagine,” said McMillian-Bohler. “They may have a romanticized notion of what the job is like. Babies come all the time, anytime, and doulas have to be able and willing to drop whatever other things they may be doing to come to a birth.”

The program benefits go beyond those received by the birthing family.

“Doulas are marketable and can hire out their services after they work with their first three families through the program,” DeVane-Johnson said. “This training will help them bring in money for their families and provide an important service.”

The program supports workforce development, DeVane-Johnson said, as the new doulas have sustainable jobs and develop entrepreneurial skills.

With many interested in training and families lining up for the service, the program is poised to make a difference in communities and in Black maternal health—and the leadership team envisions it as something that can go even further.

“Our goal with this program is to create a doula training model that can be tailored for birthing people with disabilities, those in the LGBTQ+ community, making things culturally relevant to whatever specific marginalized population that is birthing, because it’s these marginalized populations that have the worst birth outcomes,” DeVane-Johnson said.

At this time, the program has one year of data and the group looks forward to evaluating the incoming qualitative and quantitative data, something the new Duke Endowment grant will help them do over the course of the next three years.

DeVane-Johnson, McMillian-Bohler and Standard also hope to see the program expand beyond the borders of North Carolina.

“We want to disseminate this program throughout the country,” Standard said. “We want to reach out to other academic hospital-affiliated institutions and integrate this program into their maternal care systems.”

If the program receives additional funding, Standard said they plan to increase compensation to the doulas and faculty, and hire additional staff to support an expansion to help more families.

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