Breathing In and Out: Another Era of Care

Photo Sarah Whiting

Smoke of burning cedar,

Honey and peony blossoms

On a strawberry full moon…

March 16, 2020. I locked the door to my bodywork clinic near downtown Minneapolis. I was known in my community as an integrative health massage therapist and birth doula who had worked in war zones as a researcher with the United Nations — yet I was reeling.

I viscerally felt the arrival of a crisis that would change everything about health care, and my own practice as a health care worker. I wondered how long my savings would last. I ached over what isolation might do to us, and to our children.

How would our lungs recover from this virus? How would we react to closed gyms, churches, and shopping malls — spaces that, for better or worse, filled the gaps in our barebones mental health system?

Blooming lilacs on the breeze

Mullein and thyme,

Yet we still can’t breathe…

May 30, 2020. We protested for the life of George Floyd, and I watched and smelled the fires on Lake Street in my neighborhood. California was burning too. I sensed that all of health care had to be trauma-informed now. I felt an ancestral call for change and a new era of medicine.

I started medical school with a plan to combine Western and Indigenous healing into an integrative, public health practice, and join the less than 3 percent of U.S. doctors who are Black women. I began a year-long journey of hosting an interracial collective of healers and birth workers called the Oshun Center for Intercultural Healing, based on studies that show cross-racial relationship building is more effective at reducing racism than implicit bias training.

To inform our work, I reviewed hundreds of articles from the last 30 years of research on racial health inequities and anti-racist health care, with a focus on the Black maternal health crisis.

A slow burn of sweetgrass and sage

Peach leaves and palm oil

Questions, like seeds, emerging from soil…

I have always known that health care in the U.S. is unusual. We have fewer midwives, more expensive doctors, and still worse patient outcomes than most Western industrialized countries. When I discovered the Flexner Report, I realized that U.S. health care today is also vastly different than it was 100 years ago, when holistic providers were more common. In the early twentieth century, a few transformative decisions created a new era of American health care.

In 1910, the newly founded American Medical Association commissioned a nationwide review of medical schools. They hired Abraham Flexner, an education specialist trained at Johns Hopkins University. Flexner’s report designed medical education standards that stimulated massive funding from foundations and wealthy donors like Andrew Carnegie — but only to the schools that Flexner gave the highest ratings.

Flexner’s report transformed the nature of medical schools in the U.S. by privileging large academic centers like Johns Hopkins over smaller, rural, and Midwestern schools. His standards amplified the European style of medicine, and the scientific method and biomedical model that became the gold standard in American medicine.

Of 155 medical schools across the nation, all but 63 closed, lacking the funding to implement curriculum upgrades to meet the new standards. This changed the landscape of holistic healing, since many of the schools that closed also practiced styles of healing outside of the biomedical model, such as folk psychiatry, homeopathy, chiropractic, and osteopathy — practices that originated from traditional Indigenous healing methods and Native American bodywork.

Doctors no longer apprenticed for barter with mentors; instead, they paid to attend universities and pass complex licensure exams.

There was also a chilling racial effect. Flexner wrote that African American physicians should be trained in “hygiene rather than surgery,” and serve as “sanitarians” whose purpose was “protecting whites” from diseases.

As a direct result of the Flexner Report, five of the country’s seven Black medical schools closed. A 2020 study estimated that if all Black medical schools had remained open, the U.S. could have up to 35,000 more Black doctors today. This would nearly double the current figures — from 5 percent of U.S. doctors to nearly 9 percent.

A smear campaign against midwives also arose. Discussed openly in the Journal of the American Medical Association as “The Midwife Problem,” physicians claimed that “great danger lies in the possibility of attempting to educate the midwife. If she becomes a fixed element in our social and economic system … we may never be able to get rid of her.” Midwives at this time were mostly Black, brown-skinned, or immigrants.

In 1921, the Sheppard-Towner Maternity and Infancy Protection Act offered funding to states to reduce high infant mortality rates. Because of rumors that “dirty midwives” were causing infant deaths (later, poverty was found as the cause), Sheppard-Towner introduced a process of registering and training midwives. Some midwives were illiterate and excluded from continuing to practice. Until as recently as 2019, states such as Alabama criminalized the entire practice of midwifery. This loss of hundreds of thousands of midwives forever changed the scope of the midwifery profession, which today is nearly 90 percent white and requires extensive biomedical training.

Few remain in the midwifery tradition originally brought to the U.S. from countries in Africa and elsewhere, where midwives assisted births in addition to providing health care for the entire family. They were master herbalists, counselors, spiritual healers, and community pillars for families of all backgrounds, many of whom could not afford the highly expensive care of doctors or were refused care due to Jim Crow laws and racial segregation.

A slow burn of mugwort and mint

Birchbark and rose oil

Questions, like seeds, continue emerging from soil…

White supremacy culture teaches that there is only one gold standard, one perfect way, above the rest. What could have been, had the biomedical model not been held up as the only legitimate pathway to healing? What could have been, had reading, writing, and licensing exams not been the only pathways for training?

I invite you to travel with me now into the future, into a new era of care that the ancestors call us to imagine. Here exists a tender, motherly relationship between doctors and their patients. In this era, the doctor brings their wisdom about the body, and the patient brings knowledge of her symptoms, her story, and her priorities. The doctor is a consultant, offering a menu of options, and a teacher, from the Latin word docere “to teach,” helping their patient learn and make choices. The doctor is calm, unrushed, and trusts that their patient knows best.

In this era, a variety of people are nominated by the community to become doctors and paid a living wage to study and apprentice. Informed consent is a series of conversations — not simply a paper to sign. Obstetric violence is a relic of the past. The right to bodily autonomy is an unquestioned, standard part of health care, and all providers are taught social frameworks like reproductive justice, disability justice, and healing justice.

Photo Sarah Whiting

At the start of this new era, doctors and administrators stop trying to fix all of the systems at once. Instead, they find small cracks to let the light in, one patient at a time.

Smaller health centers begin to have more autonomy. Clinics receive grant funding from health justice philanthropists to become trauma-informed and to subsidize costs for low- income patients. Extra funding allows providers to spend more time with each patient and reduces staff workloads.

Clinics begin to work in partnership with community organizations, fitness centers, churches, health coaches, schools, doulas, and day cares. Feedback forms and complaints are taken seriously by senior leadership and met with transformative justice and healing sessions.

Things change, and we start to put our wealth, quite literally, into our health. Neighbors of local clinics call private donors, make T-shirts, hold bake sales, and organize a monthly membership program.

Sunflowers and mugwort float on the warm breeze…

I can see into this new era because it has already begun. This is the blueprint for Year Two of the experimental Oshun Center for Intercultural Healing.

This summer we opened our door. We are a team of Black, Indigenous, and people of color practitioners and birth workers in the Integrative Health Wing at Family Tree Clinic in Minneapolis. We offer sliding-scale and affordable rates, access to scholarships, and trauma-informed care for people of all incomes, ancestries, genders, and types of trauma, soul, and womb wounds.

We are midwives and full-spectrum doulas, chiropractors, homeopaths, craniosacral and massage therapists. We are women, nonbinary, and LGBTQ+ kinfolk — all those who suffered under Flexner’s single gold standard. We are working in partnership with the doctors of Family Tree Clinic, referring clients, and learning from one another.

We treat each other with as much care as we offer our clients, which includes access to training, healing sessions for ourselves, and schedules that move at the speed of our mental health.

We have a lovely community of supporters. From Saint Paul and Iowa, to France, Kenya, and beyond, members of the Sweet Water Alliance surround us, a monthly membership program that supports the Oshun Center and offers training in anti-racism research and advocacy, models for health care reform, and implicit bias education.

We are reimagining care in a new era, already rising.

Sage, chamomile, ginger

Rum, mezcal, and Oshun Rising smoke and sweetness

On a strawberry full moon.

Ihotu Jennifer Ali (she/her), MPH, is a graduate of Columbia University’s School of Public Health and Macalester College, and a future Doctor of Chiropractic Medicine, graduate of Northwestern Health Sciences University. She is a community healer, organizer, writer, and advocate for reproductive justice and integrative health care for all., @ihotuali