Transcript

SPEAKER_03
0:04

Hey
Denise,
how
are
you?
Good
evening,
Ginger.
Well
meeting
on
the
evening
for
months.
Oh,
we
are.
And
you
know
what?
It's
a
city.
It
is
cold,
and
we
have
no
heat
in
our
house
tomorrow.

SPEAKER_02
0:18

Well,
you
have
no
heat
in
your
house,
and
we
have
no
heat
outside.
We
just
are
finishing
a
blizzard
with
many
inches
of
snow.
So
I
hope
you
stay
warm,
Ginger.
We're
gonna
have
to,
you
know,
talk
fast
so
that
you
stay
warm
tonight.

SPEAKER_03
0:31

I
know,
I
know,
I
agree.
And
and
maybe
we
bring
some
of
that
sunshine
to
the
Midwest
here
soon.
Uh,
we're
really
excited
today
because
our
listeners
know
that
you
and
our
guest
were
bringing
on
uh
were
in
Haiti
recently,
but
before
we
go
there,
I'm
gonna
highlight
some
new
news
that
maybe
you
and
our
guests
don't
know
about.
We're
gonna
find
out.
There
is
a
very
famous
organization
called
Partners
in
Health.
They've
been
around
a
very
long
time,
and
many
folks
might
know
that
Dr.
Paul
Farmer
and
some
of
his
colleagues
started
this
even
before,
I
think
before
he
went
to
med
school.
And
one
of
the
first
places
he
visited
was
Haiti,
which
we're
going
to
talk
about.
But
here
is
the
new
news
The
newest
release
of
Time
magazine's
women
of
the
year
includes
a
nurse
midwife
from
Sierra
Leone.
This
was
just
released
in
the
last
week,
and
her
name,
I
won't
pronounce
it
correctly,
so
my
apologies,
uh,
isata
Dumbuya,
Director
of
Nursing
and
Midwifery
for
Partners
in
Health,
Sierra
Leone,
Reproductive
Maternal
Neonatal
Child
and
Adolescent
Health
Program.
Fantastic.
Started
a
maternal
center
of
excellence,
which
opened
a
couple
days
ago.
Wow.
Project
they've
been
working
on
for,
I
think,
over
a
year
to
get
to
this
achievement
of
opening
their
doors.
And
um
it's
it's
pretty
incredible.
She's
actually
British
trained
and
worked
in
the
UK
25
years
before
she
returned
to
her
country
of
origin
in
Sierra
Leone.
Uh,
remarkable
story
that
I
will
put
on
um
our
Buzz
Sprout
website.
But
my
question
to
you
that
I
learned,
and
I
watched
this
90-minute
video.
Have
you
ever
seen
the
documentary
Bending
the
Ark?
No,
that's
gonna
have
to
go
on
my
list,
I
think.
It
is
because
it
is
the
origin
story
of
Dr.
Farmer's
work
and
his
colleagues
and
how
they
framed
the
problem
that
they
found
in
Haiti
and
then
developed
it
in,
I
think,
four
countries
around
the
globe
to
improve
health
for
communities.
And
it's
a
remarkable
political
focus
uh
on
health
care
for
all,
but
it
also
addresses
equity
and
medication
management
to
prevent
death.
I
was
I
was
blown
away
with
watching
it.
It
has
many,
many
awards
from
the
Sundance
Film
Festival
and
more,
but
wow.

SPEAKER_02
3:29

I
wrote
it
down,
Ginger.
So
thank
you
for
sharing
that.
That's
that
will
be
very
fun
to
listen
to.
Um,
I
think
Betsy
and
I
both
know
Paul
Farmer.
We
know
him
personally.
We've
met
him
and
um
he
has
so
much,
he
has
done
so
much
amazing
work.
Um
and
we
certainly
I
I
certainly
always
have
at
least
one
of
his
books
on
my
audiobook
or
my
shelf
that
I
love
to
kind
of
refer
to,
um,
especially
just
going
back
to
Haiti.
Recently,
I
I
was
just
listening
to
his
Haiti
after
the
earthquake,
um,
because
I
hadn't
spent
a
lot
of
time
there
after
the
earthquake.
It
had
been
quite
a
while.
So
thank
you
for
sharing
that.
Yeah,
I
I
was
really
the
midwife
of
the
year.

SPEAKER_03
4:10

Yeah,
I
I
really
thought
about
what
I
could
find
that's
new
news
that
that
you
and
Dr.
Wickstrom
would
be
fascinated
by
and
how
a
midwife
really
created
this
uh
through
her
passion,
this
project
with
the
help
of
of
that
team.
And
it's
reality.
I
mean,
Sarah
Leone
is
one
of
the
worst
uh
maternal
infant
uh
morbidity
and
mortality
rates
in
the
world.
It's
amazing.
So
there
you
go,
Denise.
Who
are
we
who
are
we
welcoming
today?

SPEAKER_02
4:40

Well,
this
this
does
give
me
the
chance
now
to
welcome
our
guest.
Um,
there's
so
many
things
that
I
could
say
about
Dr.
Elizabeth
Wickstrom,
who
we
um
are
allowed
to
call
Betsy
most
of
the
time,
right?

SPEAKER_00
4:52

Um
because
otherwise
I'd
think
you're
a
telemarketer
if
you
call
me
Elizabeth.

SPEAKER_02
4:57

Correct,
correct.
Um
how
many
I
don't
even
know
where
to
start.
We
met
a
long
time
ago
when
she
served
as
one
of
our
collaborative
practice
um
providers
at
St.
Luke's
in
Kansas
City.
Um
and
Ginger
knows
we'll
tell
you
more
about
that
probably.
But
I
I've
spent
the
majority
of
my
years
working
with
um
Dr.
Wickstrom
going
to
Haiti,
working
at
Maison
de
Naissance,
uh
essentially
a
freestanding
birth
center
in
the
rice
fields
of
Larnage,
Haiti,
um,
far
from
you
know,
big
cities
and
far
from
any
resources.
And
I
I
I
think
I
could
say
in
a
few
words,
um,
which
would
never
describe
all
of
her,
um,
but
that
she's
is
she's
fierce,
she's
a
warrior,
she
has
the
heart
of
a
midwife,
she's
generous,
and
um
and
she's
uh
just
incredibly
intelligent
and
and
giving
on
so
many
levels
as
a
as
a
physician,
as
the
heart
of
a
midwife.
She
really
is
uh
has
holds
midwifery
in
her
dear
heart
for
women
and
birthing
people
as
well
as
for
midwives
that
she
works
with.
Um
and
she's
a
fantastic
mother
as
well.
And
um
I've
I
hear
lots
of
stories
about
her
as
a
partner
as
well.
Um
so
I've
got
to
hear
a
lot
more
of
those
recently
on
as
we
traveled
to
Haiti.
So,
Ginger,
what
else
can
you
add
to
share?

SPEAKER_03
6:25

I
I
don't
want
to
take
up
too
much
time,
but
I
do
want
to
share
with
our
listeners
that
I'm
gonna
I'm
gonna
call
her
Betsy
from
this
point
forward.
Um
was
one
of
the
original
consultants
with
the
first
uh
midwife
practice
that
started
in
Greater
Kansas
City.
Um,
oh
my
gosh,
I
just
lost
the
dates,
Betsy.
Uh
I
I
want
to
say
2019,
but
I
could
be
wrong.
Um
96.
No,
I
had
to
be
a
1990.
No,
no,
no.

SPEAKER_00
6:53

You
were
my
provider
for
Elena,
who
was
born
in
1996.

SPEAKER_03
6:57

Yeah,
that's
yeah,
I'm
like,
no,
that's
not
right.
Oh,
anyway.
Uh
it's
it's
it's
exciting
to
me
to
have
Betsy
here
because
as
one
of
the
maternal
fetal
medicine
physicians
in
a
practice
of
four
or
five,
she
was
our
medical
consultant.
She
was
the
one
we
met
with
to
talk
about
patient
records
and
to
talk
about
collaborative
care
and
management
plans,
and
was
just,
as
Denise
said,
a
fierce
advocate,
not
only,
not
only
for
um
for
midwives,
but
for
families,
and
for
listening
to
what
would
meet
the
family's
needs
within
safe
care
in
the
hospital
setting.
And
so
today
we
hope
we're
going
to
talk
a
little
bit
about
collaboration,
not
only
global
issues,
which
both
Denise
and
Betsy
bring,
but
but
what
is
what
does
collaboration
look
like
to
her?
I
know
she
um
has
vast
experience
with
all
types
of
CPMs
and
CNMs,
and
so
I
think
that's
important
as
we
think
about
what
the
future
of
the
maternal
child
healthcare
team
might
look
like.
So,
Betsy,
we
would
love
for
you
to
share
with
us
uh
your
journey
into
the
midwifery
world
and
um
your
origin
story.

SPEAKER_00
8:16

Well,
I
think
probably
something
that
influenced
me
heavily
is
that
my
mother
was
a
registered
nurse.
Now,
she
did
she
did
geriatric
care.
So
she
was
kind
of
on
the
way
out
as
opposed
to
on
the
way
in.
Um,
but
I
was
raised
to
respect
nurses
and
to
understand
that
they
had
a
lot
to
teach
me.
And
then
through
residency,
I
met
with
midwives,
I
met
with
advanced
practice
nurses,
and
my
goal
is
to
learn
something
new
every
day.
Doesn't
matter
to
me
who
teaches
it
to
me,
but
if
you're
open
to
that,
you
will
always
grow
and
you
will
always
learn.
And
so
I've
had
such
a
variety
of
mentors
and
teachers
of
all
stripes.
And
then
I
went
to
fellowship
and
at
Northwestern
in
Chicago,
it
is
the
midwives
that
teach
the
med
students
about
normal
birth.
Yes.
We
as
fellows
got
to
teach
about
the
abnormal
stuff.
Um,
but
really
they
were
they
were
molded
by
this
midwifery
concept
that
birth
is
a
process
and
most
of
the
time
it
goes
just
fine.
Is
it
great
to
have
that
safety
net
at
this
tertiary
center
hospital?
Sure.
But
for
the
most
part,
you
leave
them
alone
and
they
come
out.
And
I
learned
a
tremendous
amount
about
patients
from
my
midwife
colleagues.
And
then
um
I
came
on
out
to
the
real
world
and
at
St.
Luke's,
our
um
our
practice
manager
was
an
advanced
practice
nurse
and
also
someone
I've
known
forever
and
ever.
She's
been
to
Haiti
as
well,
hasn't
everyone.
And
um
so
seeing
how
important
advanced
practice
nursing
is
to
expanding
what
we
can
do
as
physicians,
being
able
to
see
more
patients
and
being
able
to
give
that
special
touch,
you
know,
the
high
touch,
low
tech
model
of
care
is
definitely
something
I
see
a
lot
in
my
advanced
practice
colleagues.
A
specifically
special
one
to
me
was
one
of
your
midwife
colleagues.
Um,
and
as
I
mentioned,
you
guys
were
my
care
providers
for
my
second
birth,
and
it
was
phenomenal.
It
was
a
great,
great
delivery.
I
had
the
best
time.
And
um,
and
you
know,
when
you
push
out
a
nine-pound
baby
unmedicated,
and
you
could
say
it
was
a
good
time
to
do
something.
And
my
labor
nurse
ended
up
being
one
of
our
advanced
practice
nurses
in
the
office.
Yeah,
so
it's
just
this
confluence
of
how
all
of
this
comes
together
that
built
me
into
the
midwifiest
maternal
fetal
medicine
specialist
you're
ever.
I
don't
actually
wear
birkin
stocks,
it's
a
different
kind
of
sandals,
but
I'm
always
in
sandals.
That's
a
fact.
Um,
and
so
when
I
went
into
my
own
practice,
it
was
still
part
of
St.
Luke's,
um,
but
I
was
mostly
at
another
community
hospital.
I
brought
my
midwife
with
me.
And
what
she
did
was
she
ran
the
entire
gestational
diabetes
program.
And
that
was
phenomenal
for
me
because
it
really
allowed
me
to
expand
out
into
so
many
other
things
that
I
could
see
because
it's
a
huge
chunk
of
our
practice.
But
it
bogs
you
down
if
it's
all
you're
doing.
So
having
that
strong
right
arm,
I
don't
think
of
my
advanced
practice
midwives
or
practice
nurses
and
midwives
as
a
physician
extender
as
much
as
I
do
my
strong
right
arm,
and
what
on
earth
would
I
do
without
them?
Um,
and
so
then
when
I
really
did
have
a
solo
practice,
it
was
me
and
me
and
my
midwife,
and
we
had
this
beautiful
little
camelot
of
a
practice
with
my
two
favorite
sonographers,
my
favorite
midwife
that
that
I
worked
with.
And
so
I
have
just
seen
how
much
that
means
to
our
patients
to
have
someone
who
has
the
time
and
has
the
experience
and
has
the
personality
to
do
a
lot
of
teaching.
Yeah,
because
so
much
of
what
we
do
in
obstetric
care
is
all
about
how
do
you
eat
and
how
do
you
move
your
body.
And
so,
you
know,
as
a
telemedicine
specialist
for
a
hospital
in
the
middle
of
Missouri,
um,
I
spent
a
lot
of
time
talking
about
how
to
eat
and
how
to
move
your
body,
and
I'm
sure
missing
my
midwife
for
doing
all
of
that.
Um
but
it's
still
it's
great
fun.
And
and
I
have
been
so
blessed
to
work
with
a
variety
of
people,
and
I
got
one
other
thing
because
one
day
my
CPM
friend
who
does
home
birth
all
over
Missouri,
but
a
lot
for
the
Amish
community,
who
they
really
just
don't
come
into
the
hospital.
So
if
they're
gonna
have
skilled
care,
it's
gonna
be
at
their
house.
And
what
she
had
noticed
was
that
the
transition
from
a
home
birth
to
a
hospital
birth
is
so
often
fraught,
and
it
just
doesn't
need
to
be.
If
we
on
the
receiving
end
can
have
respect
for
that,
what
that
person
is
doing,
right,
and
if
they
can
prepare
their
patient
in
a
way
that
they
know
what
to
expect
from
us,
they've
got
the
basic
labs
and
at
least
one
ultrasound
at
some
time
ever.
Um,
that's
what
I
need
to
be
able
to
care
for
the
patient.
So
that
transition,
um,
that
successful
transition
is
something
that
I
worked
on
a
lot
with
this
person
who
also
came
with
us
to
Haiti.
So
now
we've
come
full
circle
to
last
month
when
Denise
and
Betsy
went
to
Haiti.

unknown
14:13

Yeah.

SPEAKER_00
14:13

There
we
go.
That
was
my
job.
Thank
you.
Yeah.

SPEAKER_03
14:16

Well,
I
think
I
think
we
should
throw
in
here
too,
Denise.
I
know
that
where
you
work,
the
hospital
you
work
at
really
worked
hard
on
this
smooth
transition
concept
from
out
of
hospital
into
the
hospital
setting.
That's
not
easy.
That's
not
easy.

SPEAKER_02
14:32

It
did
it
took
a
lot
of,
it
took
some
years.
Um,
it
it
took
years
of
really
kind
of
working
with
all
the
parties
that
were
invested,
all
the
stakeholders,
which
were
all
the
people
sending
patients
and
moms
in,
the
midwives
that
agreed
to
be
um
the
recipients
of
those
patients
when
they
came
in,
just
to
transition
midwifery
care
to
midwifery
care
out
of
the
hospital
to
in
the
hospital.
And
then
really
just
to
convince
our
OB
and
maternal
fetal
medicine
colleagues
that
it
was
a
good
thing
to
do,
and
it
was
uh
it
was
a
respectful
thing
to
do,
and
it
was
a
safe
thing
to
do.
And
I
remember
the
discussions
and
maybe
they
bordered
on
arguments,
and
um,
but
at
the
end
of
the
day,
uh
it
came
down
to
what
are
the
statistics
of
when
people
are
coming
in
and
who
are
the
best
providers
that
could
take
care
of
them
unless
they
had
a
need
that
was
outside
the
scope
of
Midwickery,
and
then
we
would
tr
safely
and
carefully
trans
and
transition
them.
So
it's
a
fantastically
like
satisfying
and
great
process
that
we
have,
yes,
at
the
current
hospital.
And
it's
it
is
hands
down
the
best
for
everyone.
That's
great.
Thank
you.

SPEAKER_00
15:44

Well,
and
I
think
that
families
that
are
prepared
for
a
home
birth
that
have
to
make
that
shift,
I
think
there's
a
certain
amount
of
grief
there.
Sure.
And
I
think
you
need
to
be
prepared
to
walk
alongside
them
in
that
grief
and
show
respect
for
them
and
their
original
plan
and
show
respect
for
the
things.
I
mean,
sometimes
women
are
planning
a
home
birth
because
they've
had
a
terrible
experience
with
the
medical
community
and
they're
traumatized.
So
if
we
can
come
at
this
from
trauma-informed
care
from
that
perspective,
we're
gonna
be
a
lot
better
providers
for
these
folks.
And
if
we
can
set
aside
our
medical
hat
and
put
on
our
human
being
hats,
there
you
go,
and
say,
what
would
make
this
a
better
experience
for
you?
Yeah.

SPEAKER_02
16:35

One
of
the
yeah,
one
of
the
first
things
I
say
when
they
come
in
usually
is
like,
I
know
this
isn't
where
you
planned
on
being,
but
we're
happy
that
you're
here.
And,
you
know,
let
us
know
how
we
can
make
your
stay
better.
And
then
inviting
the
person,
you
know,
that
was
taking
care
of
them
to
come
and
still
have
a
role
in
whatever
the
birth
process
will
be,
you
know,
as
a
support,
you
know,
provider
or
whatever.
And
yeah,
it's
it's
really
it's
actually
very
fantastic.
Everybody
wins,
everybody
wins.
It's
like
the
Descabez,
Betsy,
the
win-win.
Right,
double
win.
That
we
use
um
for
Maison
de
naissance,
which
is,
you
know,
everybody
wins
if
you
take
care
of
people.
The
mom
wins,
the
baby
wins.

SPEAKER_00
17:17

And
in
this
case,
you
know,
moms,
babies,
providers
of
all
kinds
of
communities,
you
know,
that
mom
goes
back
to
her
community
and
talks
about
this
amazing
amazing
experience
she
had
with
an
in-hospital
birth
with
a
midwife,
and
that
her
original
provider
was
still
encouraged.
I
won't
say
allowed,
was
still
encouraged
to
be
with
her
so
she
doesn't
feel
abandoned.

SPEAKER_03
17:42

Right.
Or
that
she
did
something
wrong.
Right.
Right.
Well,
this
is
a
perfect
segue
into
how
both
of
you
took
your
highly
educated
career
positions
into
one
of
the
most
under-resourced
countries
in
the
globe
and
created
a
safe
birthing
environment
that
is
still
sustained,
Betsy.
How
many
years?

SPEAKER_00
18:05

Um,
we
started
in
2004.
So
22
years
coming
up
this
October.
Yeah.

SPEAKER_03
18:11

Can
you
share
a
little
bit
about
how
you
decided
this
was
important?

SPEAKER_00
18:18

This
is
one
of
those
things
where
you
just
get
knocked
over
the
head
with
stuff
and
you
just
have
to
go
with
it.
Um,
I
first
went
to
Haiti
as
one
of
many
instructors,
Haitian
and
American,
for
a
conference
that
was
going
on
in
Port-au-Prince.
And
as
part
of
that
conference,
we
ended
up
also
teaching
at
the
university
hospital,
teaching
the
residents.
And
then
they're
giving
us
a
tour,
and
as
a
result
of
that
tour,
it
dawned
on
me
how
little
access
to
prenatal
care
there
is
in
Haiti
and
how
that
impacts
their
outcomes.
I
knew
walking
into
it
that
according
to
World
Health
Organization,
they're
like
down
on
the
bottom.
I
got
that,
but
I
didn't
really
have
any
idea
why
until
I
talked
to
these
residents.
And
I
said,
why
is
it
these
women
are
having
eclamptic
seizures
and
you're
not
delivering
them
with
pre-eclampsia?
They
don't
come.
And
they
didn't
really
even
understand
why
they
didn't
come.
That
came
clear
later
when
reading
a
sociologic
study
that
my
neonatal
friend,
who
was
the
one
who
wrote
me
into
going
there
in
the
first
place,
um,
Dr.
Schaefer,
he
found
this
sociologic
study
where
a
sociologist
had
walked
through
village
to
village
around
Haiti,
interviewing
people
who
had
lost
someone
in
childbirth
to
understand
why
that
happened.
Literally
everyone
she
met
knew
somebody
who
died
in
childbirth.
That's
why,
that's
how
often
it
happens.
And
she
described
lack
of
education,
not
understanding
how
important
it
is
or
what
the
warning
signs
are
or
when
you
should
go.
Um,
lack
of
access,
which
could
be
many,
many
places
charge
money
to
go
and
potentially
more
money
than
these
people
have
that
are
making
a
dollar
a
week.
Yeah.
Um
or
even
if
you
could
go
if
you
had
the
money
to
pay,
if
it's
the
nighttime,
good
luck
getting
a
tap
tap
or
a
moto
to
take
you.
Nobody
drives
around
the
hinterlands
of
Haiti
after
dark.
It
just
doesn't
happen.

SPEAKER_04
20:32

Yeah.

SPEAKER_00
20:33

Um,
and
then
also
the
quality
of
the
care
once
you
get
there.
And
boy,
did
I
see
that
as
a
huge
problem,
um,
especially
within
the
general
hospital
system
supported
by
the
Ministry
of
Health.
Um
midwifery
care
is
woman-centered.
That's
why
the
word
means
with
woman.
That's
what
it
means.
And
this,
the
midwifery
model
from
the
professional
midwife's
from
the
midwife
school
was
very
much
stand
at
the
nurses
station
with
your
starched
white
cap
and
wait
for
a
doctor's
order.
But
you're
not
actually
caring
for
the
patient.
Right.
And
I
that
was
so
foreign
to
me.

SPEAKER_02
21:16

But
anyway,
mind-blowing.

SPEAKER_00
21:18

Back
to
back
to
this
was
March
of
2003,
and
we're
like
going
all
over
and
give
it
our
little
dog
and
pony
show.
And
I'm
realizing,
yeah,
I'm
gonna
have
to
do
something
about
this.
I'm
gonna
have
to
do
something
about
this.
So
Stan
and
I
went
back
six
months
later,
and
we're
touring
all
around,
and
we
went
to
Paul
Farmer's
place.
God
bless
his
soul.
He
passed
away
in
2022.
But
even
his
place
still
didn't
overcome
all
of
those
barriers.
Now,
one
of
his
phrases
is
preferential
care
for
the
poor,
giving
first
world
care
in
they
said
third
world
nations
at
the
time,
which
we
don't
say
anymore.
Resourced
nations.
But
the
point
is,
give
people
the
care
you
would
want
to
have.
That's
right.
And
that
was
definitely
the
framework
that
we
walked
into.
What
are
we
going
to
build?
What
is
that
going
to
look
like?
Was
beginning
with
that
idea
was
that
if
we're
going
to
give
care,
we
want
that
to
be
care
we
would
want.
We
want
it
to
be
compassionate.
We
want
it
to
be
expert.
We
want
our
people
to
be
well
equipped
and
well
trained.

SPEAKER_04
22:26

Yeah.

SPEAKER_00
22:27

So
what
do
you
do
if
you
think
you're
going
to
build
something?
We
got
this
group
of
college
students.
And
as
their
project
for
their
Globe
Med
Club,
they
walked
around
the
neighborhood
and
did
surveys
and
found
out
about
people's
health
already,
their
baseline
health,
obstetric
care,
and
gynecologic
health,
and
what
their
family
setting
was
like,
etc.
And
then
they
asked
them
if
we're
going
to
build
something,
what
does
that
need
to
look
like?
What
do
you
need?
So
although
I
had
in
the
back
of
my
mind,
my
dream
clinic,
what
I
thought
this
should
look
like,
we
didn't
pull
the
trigger
on
anything
until
we
got
that
information
and
learned
what
was
going
to
be
important
to
the
people
that
we
aim
to
serve.
We're
there
to
serve
them.
We're
not
there
to
tell
them
what
to
do.
That's
just
in
me.
You
know,
it's
just
not
in
me.
So
I
think
that
the
combination
of
pull-farmer
attitude,
um,
surveys
by
college
students,
and
then
just
the
heart
of
this
person
and
me,
just
saying,
We're
here
to
serve
and
we
want
the
best
for
these
people.

SPEAKER_04
23:47

Yeah.

SPEAKER_00
23:48

And
that's
how
Maison
de
Naissance
was
born.
That's
remarkable.

SPEAKER_02
23:53

Yes,
and
that
is
why
Betsy
is
called
the
mother
of
Maison
de
Naissance.

SPEAKER_00
23:57

I
am,
it's
my
official
title.
It
is
my
third
child.

SPEAKER_03
24:02

Oh.
So,
Denise,
like
what
drew
you?
I
I
know
the
answer,
but
what
what
do
you
want
to
share
about
what
drew
you
to
be
instrumental
in
the
beginning
of
this?

SPEAKER_02
24:14

You
know,
I
think
as
um,
you
know,
I
I
I
describe
it
as
um,
you
know,
being
invited
to
come
help
like
set
up
the
birth
center.
Um
and
I
I
was
I
wasn't
told
the
initial
plan,
which
I
think
was
the
plan
all
along
by
Dr.
Schaeffer.
Um,
an
invitation,
oh,
come
and
set
up
the
birth
center,
you
know,
you
speak
French
and
you
can
help
us
interview
the
nurse
midwives
that
we're
gonna
hire
and
um
and
all
that.
And
then
come
to
find
out,
I
think
he
had
other
intentions
of
um,
you
know,
I
think
he
when
I
got
back
to
Kansas
City,
he's
like,
okay,
let's
have,
you
know,
let's
meet
for
coffee.
And
I'm
like,
okay,
sure.
We'll
debrief
about
the
trip.
But
it
was
actually
turned
into
an
invitation
to
to
come
on
as
um
one
of
the
first
medical
directors.
So
working
with
the
nurse
midwives
in
Haiti
as
a
nurse,
being
a
nurse
midwife
who
spoke
French
at
least.
I
didn't
speak
Haitian
Creole,
but
the
midwives
themselves
were
all
um
French
speakers.
So
that's
where
um
working
along
with
Dr.
Schaefer
and
Dr.
Wickstrom
became,
you
know,
an
everyday
thing
for
a
while.
Yeah
for
several
years.

SPEAKER_03
25:25

Well,
I
think
what's
also
important
to
share
is
the
overlap
that
that
both
of
these
physicians,
a
maternal
fetal
medicine
and
a
neonatologist,
were
consultants
for
our
midwife
practice
in
Kansas
City.
So
it
is
pretty
unique,
Betsy,
that
midwives
admit
and
discharge
the
couplet,
the
mom
and
the
baby.
And
um
Stan
always
believed
in
in
our
skills.
And,
you
know,
the
neonatal
nurse
practitioners
were
available
for
us.
If
we
needed
a
consult
on
the
newborn,
it
was
a
little
sticky
for
a
while
with
the
pediatricians
not
being
very
happy
about
that
hospital
privilege.
But
in
the
end,
you
know,
for
about
nine
years,
10
years,
it
was
a
beautiful
um
ability
for
us
to
provide
continuity
of
care.
And
Stan
went
on
to
work
with
Jennifer
Stevens,
who
some
of
our
listeners
might
know,
uh,
creating
the
Good
Birth
Network,
which
is
trying
to
help
what,
Denise,
accredit
global
birth
centers.

SPEAKER_02
26:26

Right.
Um,
I
think
just
an
organization
to
help
um
set
up,
you
know,
standards
and
um
to
just
a
baseline
um
of
of
safety
um
for
each
that
each
birth
center
should
aspire
to.

SPEAKER_03
26:41

Yeah.
So
a
lot
has
grown
out
of
the
the
origin
story
here,
Betsy.

SPEAKER_00
26:48

Yes.
Well
when
we
talk
about
collaborative
care,
I
really
think
that
the
first
step,
and
as
you
said,
Stan
recognized
this
in
the
midwife
group,
the
first
step
is
recognizing
each
other's
scope
of
practice,
yeah,
strengths
and
talents.
And
we
worked
very
hard
with
our
staff
at
Maison
de
naissance
to
help
them
sort
of
grow
into
their
entire
scope
of
practice.
Yeah.
And
that's
an
ongoing
thing.
What
we
were
there
for
in
February
was
to
go
for
some
uh
professional
development
and
continuing
to
raise
the
standards
and
expand
their
skills
up
to
their
scope
of
practice.
We
never
expect
them
to
learn
to
do
C-sections.
This
is
some
might
run
burling
home.
This
is
not
a
hospital,
yeah.
Even
though
it's
funny
because
the
neighborhood
calls
it
L'Hotal
Lanage,
the
hospital
in
Larnage.
It's
very
funny.
And
it
you
remember
when
we
were
at
the
airport,
Denise,
when
the
guy
asked
us
where
we
were
going
to
teach,
and
I
said
L'Hetal
Lanage,
he
said,
Oh,
my
kid
was
born
there.

SPEAKER_02
27:52

Right,
right.
Yes.
Wow.
Known
for
that.
But
I
do
think
that
is
a
really
good
point,
Betsy,
because
I
on
this
trip
I
saw
um,
you
know,
the
there's
a
lot
of
different
providers
than
when
I
left,
um,
you
know,
uh
18
years
ago,
or
I'm
not
really
sure
I'd
lost
track
of
time.
But
there
there's
a
lot
of
different
um
provider
education
levels
right
now.
And
really
the
goal
stays
the
same
of
training
and
to
train
to
provide
safe
care
and
really
to
even
challenge
um,
and
this
is
something,
Ginger,
I
think,
I
think
we've
seen
is
to
challenge
people
to
be
comfortable
in
the
skills
that
are
they
are
learning
in
an
out
of
hospital
setting,
yeah
um,
to
be
comfortable
and
confident,
not
overreaching
your
scope
of
practice,
but
really
practicing
to
your
full
scope
of
practice,
because
at
the
end
of
the
day,
there's
only
a
certain
number
of
people
that
can
do
that.
And
um,
you
know,
making
sure
that
it's
efficient
and
respectful
care
at
the
same
time.
So
we
we
learned,
you
know,
a
lot
in
this
trip,
which
I
think
we
had
lost
track
of.
You
know,
Haiti
has
so
many
natural
disasters,
so
it
shifted
a
lot
of
how
this
the
staff
shifted
the
w
um
the
number
of
people
that
were
working
and
the
type
of
education
that
they
had
received.
So
it
it
certainly
like
um
we
saw
how
we
could
help
them
this
time
just
work
more
efficiently,
um,
not
duplicating
each
other's
work,
not
sitting
around
and
you
know,
waiting,
but
also
to
see
women
quickly
and
to
utilize
more
of
the
skills
that
they
have
within
themselves.

SPEAKER_03
29:37

Can
you
share
a
little
bit
about
the
outcomes
over?
I
know
you,
I
know
you
have
them,
Betsy.
Uh
how
how
are
the
moms
and
babies
doing?

SPEAKER_00
29:47

Um,
so
it's
uh
it's
sort
of
a
matter
of
pride,
but
it's
also
a
little
intimidating,
I
think,
to
the
staff
that
we
have
literally
no
maternal
deaths
in
Maison
de
naissance.
Now,
does
that
mean
nobody
has
received
care
there,
been
referred
to
the
hospital,
then
eventually
passed
away?
Yes,
a
small
number
of
people
have,
but
zero
actually
at
MN.
That's
good,
it's
great,
it's
fantastic,
but
it
also
puts
a
huge
amount
of
pressure
if
they
have
a
patient
that's
starting
to
develop
even
mild
complications.
Yeah,
the
instinct
is
to
want
to
transfer,
transfer,
transfer.
And
so
one
of
the
things
we're
working
on
at
this
trip,
and
then
we're
gonna
be
continuing.
I
I
got
a
deal
with
our
leave
leave
midwife
that
every
fourth
Friday
afternoon
we're
gonna
do
some
ongoing
professional
development.
And
one
of
the
things
I
want
to
um
really
address
is
some
of
the
reasons
I
see
people
being
transferred.

SPEAKER_04
30:53

Yeah.

SPEAKER_00
30:53

Let's
talk
about
who
how
we
could
safely
manage
that
in-house
and
avoid
a
transfer
if
we
can,
because
the
moms
literally
cry
if
they
have
to
be
transferred.
Not
only
is
it
not
a
welcoming
environment,
it's
not
all
that
clean.
And
they
charge
money.
I
mean,
we
we
so
it's
funny.
So
for
years
I
fought
and
fought
and
fought
that
we
weren't
gonna
ever
charge
anybody
anything.
So
in
the
villages,
they
have
these
health
committees,
and
the
health
committees
came
to
our
management
and
said,
Why
do
you
insult
us
like
this?
Why
don't
you
let
us
pay
for
our
care?
Whoa.
Uh,
sorry.
I
was,
you
know,
I
was
being
maternalistic
and
deciding
they
shouldn't
pay.
Yeah.
But
it
was
actually
offensive.
So
we
have
a
sliding
scale
fee
for
you
could
pay
nothing
if
you
don't
have
it.
You
can
pay
a
little
if
you've
got
it.
And
they
actually,
through
patient
fees,
raise
about
10%
of
their
operating
operating
expenses.
My
gosh.
So
there
you
go.

SPEAKER_03
31:59

That's
fantastic.

SPEAKER_00
32:00

That
was
a
good
learning
lesson.
Yeah.
Yeah.
I
learn
from
our
from
our
patients
all
the
time
as
well.

SPEAKER_03
32:08

Yeah.
What
about
well-intended
midwives?
We
we
get
these
questions
periodically,
um,
especially
from
newer
grads
who
haven't
been
out
in
the
field
very
long,
who
have
no
international
experience
at
all,
but
have
big
hearts
and
want
to
go
help.
Um,
what
what
advice
would
both
of
you
have
to
how
to
even
begin
to
think
about
making
those
kinds
of
decisions
and
organizations
that
you
might
affiliate
with?

SPEAKER_02
32:42

Well,
I
I
can
speak
first.
Like
Betsy
and
I
probably
have
both
always
gotten
the
question,
oh,
we
want
to
go
to
Haiti,
we
want
to
help
out,
um,
you
know,
you
know,
can
we
go
with
you
next
time?
Um
and
it's
been
the
longstanding
um
focus,
I
would
say,
and
goal
that
when
we
go
to
Haiti,
or
in
even
when
we
don't
go
to
Haiti,
when
we're
working
with
um
any
of
the
staff,
like
myself
in
the
first
you
know,
three,
four
years
when
I
was
working
with
them
via
Skype,
it
was
always
with
the
intention,
always
with
the
intention
that
we
um
upscale
and
support
the
work
of
the
Haitians.
So
that
we
would
hire
Haitians,
hire
train,
help
to
train
them,
train
them
in
what
they're
asking
to
be
trained,
and
then
also
uh
Betsy
will
agree
with
me,
I'm
quite
sure,
that
we
push
their
training
to
a
level
of,
you
know,
higher
training,
higher
safety,
evidence-based,
but
always
with
um
kind
of
their
permission
or
their
desire,
um,
or
their
at
least
their
agreement,
um,
and
and
really
to
make
it
that
so
that
they're
always
providing
the
care,
so
that
the
care
is
always
sustainable
by
Haitians
and
not
by
some
other
um,
you
know,
people,
other
cultures,
other
colors,
um,
other
belief
systems,
and
coming
in
and
you
know,
putting
on
the
Haitian
populations,
of
which
there's
many
different
cultural
things
amongst
themselves,
which
they
know
more
than
we
would
ever
know,
but
really
to
go
in
and
to
support
the
work
that
they're
doing
in
every
way,
shape,
or
form,
from
supplies
to,
you
know,
to
training.
Um,
even
talking
with
Miss
Lotine,
that
the
head
nurse
midwife,
I
said
to
her,
I'm
like,
please
do
what
you
can
to
support
your
midwives
that
are
here.
They're
there's
slightly
less
educated,
they're
not
all
nurse
midwives
anymore
there,
but
they're
um,
but
I
said
just
at
least
support
them
to
provide
the
care
that
they
can
because
you
are
their
example,
and
we
will
support
you
to
do
that
in
whatever
way,
shape,
or
form
you
want.
We
will
be
in
touch
via
email,
we
will
be
in
touch
for
questions
or
for
the
trainings
that
Betsy
referenced,
but
it
really
is
always
to
show
them.
And
and
it
what
I
found
very,
very
beautiful
this
time
in
a
role
that
I
wasn't
a
director,
just
going
back
to
do
the
trainings,
is
they
were
seeking
with
great
desire.
They
would
come
to
either
Betsy
or
I
for
consults,
like
give
us
information,
tell
us
what
you
would
do.
They
even
said
at
some
point,
this
is
your
patient.
I
said,
This
is
not
my
patient,
this
is
your
patient.
They
said,
No,
it's
your
patient.
I
said,
It's
not
my
patient,
I'll
be
gone
on
Friday.
And
finally
I
agreed
for
that
trip
to
I
said,
This
is
this
will
be
our
patient
then
for
now.
And
then
when
I'm
gone,
then
she
will
be
your
patient.
Um,
so
it
was
a
very
it
was
it
was
very
fun
and
and
to
work
collaboratively
with
them
because
that's
the
role
that
we
should
always
play,
I
believe.

SPEAKER_00
35:38

I
think
that's
true
as
well.
Every
time
I
have
done
any
kind
of
training
or
teaching,
the
first
thing
I
ask
six
months
before
I
go
is
all
right,
tell
me
what
you
want
to
learn.
Yeah.
And
I
swear
we've
learned
postpartum
hemorrhage
every
single
time.
But
each
time
there's
been
a
new
technique.

SPEAKER_04
35:57

Yeah.

SPEAKER_00
35:57

We
had
the
last
time
we
did
postpartum
hemorrhage,
we
had
basically
what
is
a
low
resource
Bakri.
And
this
time
we
taught
a
low
resource
Jada.
Yeah.
Yeah.
You
know,
the
idea
is
to
keep
layering
the
training,
but
it's
it
was
one
of
our
founding
principles
to
always
hire
Haitians,
always
and
improve
the
community
by
hiring
from
within
every
chance
we
get,
um,
and
listening
to
the
community.
So
I
think
that's
been
integral
to
why
we've
been
successful.
One
of
my
favorite
stories
um
before
we
even
opened
is
that
we
had
this
huge
container,
uh,
shipping
container
of
furniture
and
equipment
and
all
the
things
from
my
two
different
hospitals
that
were
that
were
redoing
their
labor
delivery
units
and
had
no
place
to
put
their
stuff.
I'm
like,
I'll
take
it,
I'll
take
it.

SPEAKER_04
36:56

Yeah.

SPEAKER_00
36:57

And
so
the
truck
is
coming
from
Port-au-Prince
and
it
is
the
raining
season.
Oh
and
what
serves
as
a
road
there
in
Little
Haiti,
like
there's
been
swallow
a
small
car,
you
know,
and
the
truck
got
buried
to
its
axles
in
mud
and
could
not
move
at
all.
The
neighborhood,
their
surrounding
villages,
came
out
and
made
a
human
chain,
unloaded
the
truck
into
like
a
quarter
mile
away
to
the
birthing
center,
carried
exam
tables
and
and
hospital
beds
and
just
hugely
heavy
things,
like
five
people
on
a
on
a
and
to
me
that
speaks
to
the
buy-in,
right?
Oh
yeah.
That
was
before
we
even
opened,
and
it
just
continues.
Yeah.

SPEAKER_03
37:53

Well,
one
of
the
things
before
we
transition
maybe
to
some
domestic
conversations
as
a
maternal
fetal
medicine
uh
doc
is
is
it
okay
with
you
if
we
put
the
Maison
Dana
Massan's
uh
website
on
our
uh
marketing
materials,
our
bus
route
website,
and
can
people
give
donations
there
if
they
would
like
to?
Is
there
is
there
a
portal?

SPEAKER_00
38:16

A
hundred
percent.
It's
gonna
say
donate
now,
and
you
just
click
right
there.
Various
ways
to
do
it.

SPEAKER_03
38:22

What
a
question,
Ginger.
You
know,
I
I
we
have
to
we
have
to
capture
this
moment
because
I
am
so
proud
of
these
two
women
in
front
of
me
who
bring
such
energy,
passion,
um,
and
commitment
to
continuity
of
care
uh
for
so
many
years.
I
mean,
there
aren't
a
lot
of
places
that
have
replicated
this
model
that
has
been
able
to
be
sustainable.
And
I
I
mean
it's
it's
a
big
job
fiscally
as
well
as
ongoing
training.

SPEAKER_00
38:55

And
some
of
it's
just
sheer
stubbornness.
There
there
have
been
man,
there
have
been
so
many
setbacks
and
so
many
things
that
could
have
just
done
us
in,
and
we
just
refused.
Yeah,
you
know,
my
my
executive
director
would
say,
Do
you
think
we
need
to
cut
back
on
our
services?
I
said,
No,
I
will
give
more.
He's
like,
You
can't
give
more.
I
said,
I
can
give
more,
it's
gonna
be
fine.
And
we
just
kept
going.
Yeah,
because
I
just
I
don't
really
see
any
other
option.
I
don't
see
us
stopping.
Yeah,
what
would
those
people
do?

SPEAKER_02
39:29

I
know
without
getting
almost
500
deliveries
of
a
year
at
that
birth
center
alone.
Like
I
was
gonna
ask
how
many
and
it's
not
just
births,
it's
it's
HIV
services,
it's
community
health
services,
it's
vaccinations,
family
planning.
I
mean,
I
I
don't
know
what
they
would
do
either,
Betsy.
And
you
have
really
been
always
there,
and
um,
and
I
will
always
want
to
be
there
as
a
part
of
it
um
to
help
you.
But
you
know,
it's
really
important
the
repetition
of
trainings,
the
repetition
of
donations,
um,
supplies
are
always
needed.
Um,
so
human
resources
and
human
supplies,
I
mean,
for
our
humans
in
another
region
is
just
important.
Yeah.

SPEAKER_00
40:16

Yeah.
Agreed.
I
appreciate
you
asking,
Ginger.
Thank
you.

SPEAKER_03
40:19

Sure.
We
will
do
our
best
uh
to
promote
that.
So
maybe
for
the
last
part
of
our
conversation
together,
I'm
sure
you
know,
Betsy,
there's
still,
even
though
there's
an
incredible
workforce
shortage,
there
aren't
enough
physicians,
there
aren't
enough
OBs,
there
aren't
enough
MFMs,
there
aren't
enough
midwives
for
the
demand
of
women
needing
a
variety
of
healthcare
services.
And
yet
in
America,
we
still
seem
to
have
these
incredible
barriers.
I
don't
think
we
have
a
critical
mass
of
our
profession
yet.
It
takes
about
everything
I
read
delivering
18%
of
the
population
for
America
to
really
know
what
a
midwife
is,
and
we're
not
there
yet.
We're
at
about
13.
What
ideas
might
you
have?
We're
gonna
go
on
the
on
this
and
see
if
we
can
help
people's
side.
What
ideas
might
you
have
as
a
physician
to
help
the
midwives
struggling
to
convince
physicians
or
even
get
them
to
engage
in
a
conversation
about
collaborative
care
models?
And
are
there
things
you've
learned
that
maybe
could
be
helpful?

SPEAKER_00
41:27

I
think
it's
not
just
the
physicians.
I
think
it
has
to
come
from
a
government
perspective.
Okay.
The
recognition
of
maternity
care
deserts.
Yep.
And
that
so
I
was
looking
up
some
stats
before
we
came
together
here.
Um,
overall
in
the
United
States,
there
are
38
practicing
OBGYNs
for
every
100,000
women,
and
they're
mostly
in
the
cities.

SPEAKER_03
41:53

We
just
talked
about
this
on
our
last
podcast.

SPEAKER_00
41:57

Yeah,
nearly
half
of
counties
have
no
practicing
objens.
Right.
7%
of
American
living
women
live
in
a
county
with
no
OBGYN.
So,
yeah,
how
do
you
say
that
the
OBGYNs
are
going
to
be
the
only
ones
providing
care?
That
is
nonsense.
It's
not
possible.
So
recognizing
that
we
need
to
expand
our
workforce.
That
needs
to
include
family
practice
people
that
have
OB
certification,
that
needs
to
include
potentially
nurse
practitioners
at
health
departments
providing
prenatal
care,
and
then
they
refer
in
to
an
OB
provider
or
a
birthing
center.
But
we
need
to
grow
more
birthing
centers
and
we
need
to
empower
our
midwives
of
all
stripes.
There's
CNM,
CPM,
CMs,
and
in
Missouri,
right?
Yes,
we
do
have
certification
through
the
it's
N-A-R-M,
whatever
that
stands
for.

SPEAKER_04
42:55

NARM,
yeah.

SPEAKER_00
42:56

Yeah,
NARM.
And
then
there's
also
um
Missouri
Midwives
uh
association
that
can
like
you
can
look
it
up
on
their
website
and
say,
okay,
yeah,
what
mid-wifery
practices
are
there?
And
some
of
those
are
CNMs
and
some
of
those
are
CPMs,
and
they're
a
different
animal.
So
just
like
the
staff
at
Maison
de
Naissance,
Enthemersage
Faum
is
someone
who
has
a
nursing
degree
who
then
went
to
midwifery
school
and
then
did
a
residency,
a
stage,
and
then
practices.

SPEAKER_04
43:27

Okay.

SPEAKER_00
43:27

And
there's
a
second
group
of
midwives
that
are
trained
um
on
more
of
an
apprenticeship
practice
through
midwives
for
Haiti.
They're
still
midwives,
but
they
didn't
they
didn't
start
with
a
college
degree.
They
started
with
more
of
a
high
school
degree,
right,
and
then
went
through
18
months
of
training
to
learn
how
to
be
a
midwife.
There's
a
whole
different
category
of
people
called
auxiliaires
who
are
more
of
M
A's,
yeah,
and
they
did
more
on
the
job
training.
They
don't
have
necessarily
any
any.
Any
certification.
And
it
takes
that
whole
team
to
run
Maison
de
Nessance.
And
if
I
could
just
plant
that
idea
in
our
um
boards
of
registration,
our
health
boards
in
state
by
state
and
also
nationally,
understand
that
it
really
does
take
the
entire
team
to
help
spread
that
care
out
through
these
maternity
deserts.
And
that's
the
only
way
we're
gonna
start
decreasing
our
maternal
morbidity
and
mortality,
which
is
scandalously
high
for
such
a
wealthy
group.
Yes.

SPEAKER_03
44:41

What
one
of
our
partners
says
a
lot,
Leslie
Rathman
owned
the
Charleston
birthplace
for
many,
many,
many
years,
maybe
16
years.
And
when
I
hear
her
talking
to
some
of
our
potential
clients,
physicians
and
hospitals
who
are
still
trying
to
figure
out
what
they
want
to
do,
one
of
her
examples
is,
you
know,
we
put
EMTs
out
in
ambulances
to
save
people
with
heart
attack
and
major
trauma
who
are
doing
an
unbelievable
amount
of
procedures
as
they're
calling
in
the
status
of
the
patient,
and
they
elevate,
you
know,
care
to
the
next
level
as
needed.
And
why
we
haven't
quite
figured
out
that
midwifery
care
can
be
stratified
in
such
a
way
with
seamless
levels
of
care
as
needed
is
just
beyond
me,
Betsy.

SPEAKER_02
45:29

Beyond
me.

SPEAKER_00
45:42

It's
the
almighty
dollar.

unknown
45:43

Yeah.

SPEAKER_00
45:44

Oh,
of
course
it
is.
Because
if
you
are
sharing
the
load,
you're
also
sharing
the
take.
Yeah.
Um,
but
uh
OBs
don't
want
to
go
out
to
outer
hinterlands
of
Missouri
and
provide
that
care.
They
don't.

SPEAKER_01
46:00

Right.

SPEAKER_00
46:01

So
any
hinterlands.
Yeah.
So
why
mess
with
the
people
that
do
want
to
do
that?
Let's
bring
them
in.

SPEAKER_02
46:09

Yeah.
I
really
do
think,
you
know,
training
rural
people,
training,
having
rural
programs
is
is,
you
know,
uh
is
one
way
of
doing
that
to
bring,
you
know,
it's
it's
taking
care
of
the
communities
in
which
people
come
from,
you
know,
and
doing
it
in
a
way
where
there's
good
education
and
good
accountability,
I
think,
is
a
win-win
for
all
the
people
that
would
be
served
by
it.
So
that's
my
that's
my
dream
is
like
having
really
good
rural
programs
that
will
take
care
of
these
uh,
you
know,
all
the
all
the
moms
and
babies
in
these
areas.

SPEAKER_03
46:48

Well,
well,
what
we
have,
I
think,
trying
to
emerge,
but
in
my
my
opinion,
the
piece
of
the
puzzle
is
still
missing.
We
have
all
of
these
femtech
companies
starting
up,
right?
Telehealth
is
like
vogue
now
in
maternity
care,
whether
it's
prenatal
support,
postpartum
support,
virtual,
you
know,
coaching
for
what
your
needs
are
through
the
pregnancy.
I
think
that's
fantastic.
I
personally
think
it
it
could
be
stronger
if
we
did
what
the
midwives
in
Scotland
and
England
do,
which
is
give
Denise
her
iPad,
send
her
out,
you
know,
three
hours
away,
go
do
the
prenatal
visits,
and
let
Denise
tell
you,
Dr.
Wickstrom,
what's
going
on
with
the
patient,
maybe
do
a
scan,
portable
ultrasound,
all
kinds
of
technology
that
could
be
used
with
human
contact.
That's
where
I
still
struggle,
Betsy,
is
yeah,
what
might
we
be
leaving
out
in
the
clues
of
risk
prevention
or
reduction?
Yeah.

SPEAKER_00
47:50

Because
though
I
love
doing
telemedicine,
my
favorite
is
if
I
actually
do
a
video
visit
in
people's
homes,
you
get
a
whole
different
view
of
them
than
if
they
got
all
gussied
up
and
came
to
the
doctor's
office.

SPEAKER_01
48:05

That's
true.

SPEAKER_00
48:06

So
I
love
video
visits
at
the
home
because
that's
where
that's
where
the
real
care
is
happening.

SPEAKER_01
48:13

It
is.

SPEAKER_00
48:14

And
when
they
come
to
the
office,
there's
a
real
nurse
that's
actually
taking
vitals
and
taking
their
history,
and
there's
a
real
sonographer
laying
hands
on
them
and
showing
me
the
images.
Um,
but
I
love
that
idea
that
you've
got
your
ultrasound
probe
that
goes
to
your
iPad
and
you've
got
your
electronic
health
record
on
your
iPad,
and
then
all
of
that,
you
know,
comes
back
to
some
central
depository
and
exactly.

SPEAKER_03
48:39

Yeah,
you
can
even
do
your
you
know,
NST
out
there.
I
mean,
all
the
technology
is
available,
but
no
one
you
the
three
of
us
should
invent
this
model.
I'm
just
saying.

SPEAKER_02
48:50

I
mean,
I
think
a
lot
of
people
are
listening
to
it
though
now.
But
I
do
think
I
the
point
of
linking
that,
you
can
have
all
the
technology,
but
you
know,
summarizing
what
what
you're
saying,
Ginger,
is
linking
that
to
then
the
humans
that
can
interpret
it,
identify
the
risks,
and
provide
some
guidance
for
care
and
then
routes
for
them
to
be
able
to
access
that
care
when
the
need
be
is
really
important.

SPEAKER_03
49:15

Um
because
I
think
the
person
who
is
the
adhesive,
I
was
gonna
say
glue,
but
I
just
watched
the
documentary,
right,
about
the
the
the
origin
story
of
the
ARC.
The
community
health
workers
and
the
doulas
existed
in
parallel
worlds
at
about
the
same
time,
but
they
were
doing
different
things.
The
community
health
worker,
correct
me
if
I'm
wrong,
were
really
out
there
moving
HIV
prevention
and
convincing
families
to
take
the
medication,
you
know,
to
be
consistent
and
give
them
immunizations,
while
the
doula
was
over
in
there
in
South
America,
sitting
in
a
room,
just
being
in
the
room,
but
but
being
there
at
a
time
of
of
labor.
And
and
yet
we
still
haven't
quite
adopted
in
my
mind
for
these
two
potential
roles
in
maternal
health
care
to
be
recognized
providers
who
can
say,
Dr.
Wickstrom,
I
saw
Denise
today.
I
really
think
you
need
to
know
about
this,
and
how
does
that
all
work
with
the
world
of
HIPAA
and
licensure
and
regulation
and
reimbursement?
It's
a
hot
mess.
And
yet
they're
very
crucial.
Because
insurance
companies
are
paying
duelists
they
are,
but
not
to
talk
to
you.