Indigenous Mothers Matter: Rethinking Maternal Health in Tribal Communities

In this episode, we speak with Wendell Honanie Jr. of the Hopi Tribe about the importance of maternal health in Indigenous communities and the unique challenges facing Native mothers today. Drawing from his experience and community perspective, Wendell shares insights into how cultural traditions, family support systems, and Tribal leadership play a role in supporting healthy pregnancies and births within the Hopi community.

The conversation explores the broader landscape of maternal health across Tribal Nations, including barriers to care, the impact of historical and systemic inequities, and the ongoing work to strengthen culturally grounded healthcare for Native families. Wendell reflects on the importance of honoring traditional knowledge while building stronger health systems that support mothers, babies, and future generations.

Join us for a thoughtful discussion on community resilience, the power of culture in healing, and the path toward better maternal health outcomes for Indigenous families.

Transcript

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We could not place a child within a home if that home did not have XYZ for the child, even though they were direct relative, or that was the last relative they could be placed with. So we had to reassign them to another home that had those accommodations. Now, if we took the system away and just looked at the way communities lived. As far as tribal communities, it's very common to have grandma, grandpa, mom, dad, or just Mom, no dad and like three kids all within the same home. The home was not of disturbance, and it was functional, and they were able to get their resources. But if the rules state that this is what the system says, then it kind of prove a little bit of disconnect. Welcome to perinatal and reproductive perspectives. This is a podcast where we empower birthing individuals, partners and health professionals with evidence based insights, holistic strategies and relatable stories. Hosted by a healthcare expert, this podcast fosters understanding equity and growth in perinatal and reproductive health. Here's your host, Becky Morrison gleed, welcome everyone to another episode of perinatal and reproductive perspectives. We are very lucky to have Wendell honani, Jr, who is an independent operational consultant who focuses on tribal public health and infrastructure. Welcome to the show. Oh, thank you, Becky. It's really fun. This is actually my first podcast I've ever done. I've mostly done lectures and different like public speaking engagements. So to be media, you're kind of, you're actually fulfilling my my goal. Because I was like, one day I'm like, Oh, I'd love to do podcasts, like, just to, I don't know, chill, be on it, or even create it myself, because there's so many issues that I'd love to discuss in relation to tribal specific so I'm just gonna say thank you for income giving a voice to tribal nations. It's funny because you say that, and I would have never known, because I was sitting in one of your lectures in the very back, and I was just thinking, I've got to get him on the show. He's just speaking so eloquently about maternal health, and it was really compelling. Some of the information you were sharing tell our audience a little bit more about who you are, where you are, what you do. Yeah, so I'm if I go tribal, I mean, I'm originally from Hopi, so I'm from Northern Arizona, which is Hopi is a tribal community that is about an hour and a half northeast of Flagstaff. It's very rural, where the tribe that lives on the mesa tops as well as has a lot of remote access, I like to say, so to speak. But we're culturally very rich, though, so we do have our own system as far as religion, culture and the whole nine yard. My only issue with all that is it's always so hard to acclimate that to anyone that's not from Hopi, because everything is so multi dimensional and so religious focused, and what we call just Hopi, and it's hard to explain sometimes, but everyone seems to be so curious at some point, so I try my best to explain it as much as I can. And then, as far as with on the professional side, working as an operational independent consultant. So operations is my jam. I learned that over the last so many years, like understanding all of the logistics ins and outs of business when it comes to either agency or small programs, and looking at the framework, as well as putting that into action and trying to manifest the best outcome and services for obviously, I specialize in tribal because there's so many gaps and needs there. But I also have worked in other different communities of color. I've worked with tribal communities all across the state of Arizona, as well as nationally, and then just landing eventually at my at my former role, which was at the inter tribal council of Arizona, working in maternal health innovation. And somehow all that just stuck where I practiced so many things under public health and maternal health seemed to be that last stop which I'm still intersected in in some projects or another. So it's coming even to a bigger full circle, and I want to take a deep dive today into your experience in the maternal health and what we could do better as providers, and what light we can shed on what folks are experiencing. But before we do. I don't want to gloss over where you are on top of the May says, Can you paint a picture for the audience? Because a lot of our audience may not have been to Northeastern Arizona, yeah. So I like to do little visual visualization activities. So I always encourage. Like, All right, let's just close the eyes and first, like, just envision what you think Arizona is and let that go. Like this. 100% let that go. Most people, when they're visualizing, they think like Phoenix, Arizona, like cactus, desert, all that. It's like, yeah, no, let's let that go. So if I took you to what I call home, and which is what most of us at Hope USA, is like, oh, that's home. We're just going home. It's like our heartbeat, that's where we're from. Just close your eyes and envision a landscape that has multiple Mesa tops, and it is still arid. It is still a desert description, but it's a different kind of desert. And the thing about the land is it's very unique in energy. So we always like to say that's where our home is, because that's where we were led to reside permanently. So there's a sense of energy to the ground that is very spiritual and holistic to some people as they've come out there. But we live in villages, so we also envision like these, well, probably you'd say smaller communities and homes that are attached to one another. And as you go into these different villages, like there's an ecosystem, an ecosystem of community, meaning that you have aunties, uncles, relatives, clan members, like they're all living within these villages. But then the villages also extend to each other. So we have some villages that are on the mesa tops, actually, that are still people still live there. We have a home up there. And once you get up top, it's you see down, but then you also see up. And then you see the further landscape, which is the mountains, which is San Francisco Peaks in the distance. You can see, if it's nighttime, you just see the stars fresh at night. You see the twinkling of the lights of other homes that are on the mesa tops or at the below. But then you also just kind of notice a silence at the same time, like there's a silence of resonance and the silence of humble beginnings and humble endings and just the journey in between. And as you're there, you can also smell the food. I will say, that's another thing about where I come from, is food is a staple. And at some point you'll hear families or just others, like, come eat, come in, come sit down. It's like, all right, sure, I'll come in and sit down and and there's just an undertone energy of love. But visually, you just imagine probably an arid landscape with giant boulders, Mesa tops, a little bit of wind. And that's home. That's all I can describe it as. And I think for anyone that probably has traveled to other places, internationally, it's looks a little bit probably like the Middle East in terms of some of those deserts, the way they're defined in pictures similar to that. But yeah, the land just goes on for time, and you see the horizon, which is earth and, yeah, just the energy. That's the best way I can describe mom. It's a feeling more than it is an image I love that. Now we'll talk more about the love, the food, the feeling home. Thank you for painting that picture. Let's move into your experience in maternal health. Tell us a little bit more about your role, what you saw, what you did. Yeah. So my role in maternal health, it was a very interesting role. I didn't initially plan to to resume maternal health, and it ended up taking that route. And it started more or less because the agency that I used to work for was an agency that was focused more on sustainability, building, capacity development, training and education, and my background in public health literally brought that. I'm like, Okay, I've designed curriculums. I've designed presentations. Let me bring this to the forefront, and as I did, going into my operational stance, like there before I give a good presentation, or before I go into curriculum, I need to know what the needs are. I need to understand what the current climate is within maternal health, and now we're working with tribes. So I need to understand what is a tribal maternal health landscape? What does that look like? Specifically? Now, the agency I used to work for was located in Phoenix, Arizona, so it's, it's it's easy to just drive into Phoenix. You know, there's hospitals everywhere, there's birthing centers everywhere, and it's pretty much easy to get maternal health care anywhere you go within the urban setting. But now, as I focus in the maternal side for tribal one of the initiatives I took up was, before we initiate training, what does the community say? So, kind of looking at some general community needs assessments of sorts, and visiting some of the communities that are across the state of Arizona, as well as several listening circles round tables, and just collecting a lot of social data, is what I was doing. And I was looking at that as feedback more than I was like actual writing things down and putting it together, because I was also mixing a little bit of element of tribal culture in. There. And for anyone who hasn't worked with tribes, one of the things that I always tend to share with others is, if you're going to work with a tribe, yes, do it, by all means, they probably are interested in working, but it comes down to the approach with that first engagement. So most of the time when you meet someone for the first time, agency to agency, you bring in your clipboards. You're bringing in all of your different tools. Like, I'm going to write all this down. So it's like, All right, let's not do that. We're just going to visit. Obviously. Ask first, like, Hey, do you mind if I come up? I'd love to support and leave the clipboard through everything. And it was just listening sessions explaining what I what my role is, as far as with that agency and my big vision, as far as what I love to bring and just listen to what the communities have to say, or what these individuals at these different roundtables or lectures had to say. And it was less threatening, but the amount of information that was opening up was magnificent, because we started hearing a lot of different things from one the main thing is just access to care. Access to care in terms of, there is no OB, there is no hospital, there is a clinic with one provider, maybe a few providers, but they're kind of multi disciplined, so they work in all a lot of different areas, from the dietary to general MD and OB, so the quality of care, but also the the type of care was it depends on the facility and depends on the provider. So not every provider is specialized in OB work or even general maternal care to some degree. So we started noticing different gaps like that access as well. In terms of transportation, some communities had no transportation option, or didn't own a vehicle. So if they were pregnant and they had to drive an hour and a half to two hours just to receive perinatal care, it was a little bit of a gap. And then we also looked at what services were available in the community, even if they were like prevention programs or different there's a birthing class or some sort of just general education on sexual health. It was also another area that was very sparse that we saw a lot of opportunity in. I started looking at other aspects, as far as like cultural influence. We started looking at familial influences, data access, what does that look like if I wanted to start a program? And I started just asking, what is the current general data on maternal health and tribal communities within for us, it was the state of Arizona, but for others, it's within that state, if there is any, and that we ran into some very creative opportunities there in terms of data capture. Most tribes don't have their own data. Their data is stored within their own communities. Some of it is through Indian Health Service, or it's through the state of Arizona. And so we started to see some different storytelling that was very unique when it came to data. So putting all that together, it gave us a lot more leverage to start developing and designing curriculums, as well as capacity to help push more sustainability within tribal communities. So an example of this would be, right now the landscape is a lot, a huge more push for understanding doulas and the work that doulas do, and how holistic they are and they can support where providers not available, or family might be gapped. So we started embarking on that. But then the issue was, is most triumphs were under the impression like, what is what is what is a doula? What exactly is that? I don't even know. The term I don't know. So we scaled back even more as far as All right, so then, if I put this on to practice, first, maybe let's launch, what is a doula? 101, at least either a webinar. But we also just did not, not all tribes have internet access, or it's very sparse, like my community, or if we do some general lectures at either conferences or some programs within the communities like this, is what a doula does, is how it can help. But of course, comes the next question, well, how can we get one? Or where can we get one? So then we start moving. All right, let's start moving into exercise in that capacity, and find a consultant or partner that can provide that training. Let's start certifying individuals, because in the state of Arizona right now, you don't necessarily need to have the licensure. You can have the certification, but if you want insurance billing and you want insurance access, then yeah, you have to have the licensure through the state of Arizona. So we started designing a broader curriculum when it comes to not only certifying, but then, how do we now look at insurance billing? Like, do people understand how to do that? Do they understand what the requirements are for the state licensure? So ultimately, it led to this whole big curriculum like, all right, not only are we going to introduce you to doulas, we're going to train the doulas, and now we're going to try to provide further sustainability. So in the event that you're not able to get to a doctor within your community, maybe they can be there. Can be a doula there. And doulas are very we've understood that their connection to the holistic matter is really strong, especially a lot. Anything with cultural values, but then Western medical models, like, there's a champion there. How can we nurse that and try to see if this can support tribal communities in the state of Arizona? It was still a work in progress. You know, this only happened within the last, like, year and a half, and a lot of that takes time and planning. So, so yeah, that's kind of one avenue. But, you know, in in between all that included focus groups, social circles, increasing education and awareness through some of the platforms and media outlets that we've done when I was with that program, but also looking at at, you know, like lectures that you've attended to share and expand the awareness beyond tribal communities, but those that are working with tribal communities, or could be working with tribal communities and really reframing a lot of Western models of what we've been institutionalized to practice when it comes to medical services within tribal communities. And maybe there's a hybrid or berated approach that's going to allow both to become more fluid, to expand the sustainability. Yeah, I what I'm appreciating is this creative solutioning. And sounds like you went in and took this. We can call it data, or we can just call it paying attention to the gaps, and then how do you fill those creatively and also pragmatically? Because I'm thinking, you're right. Doulas have this holistic perspective, and they can be flexible. They can do sibling work, they can do postpartum work, they can do labor delivery work. They can do postpartum planning. So that's one really good example, and I'm thinking of just So practically, someone goes into labor, or they become proclaimed Dick, and they've got an hour and a half drive to the closest NICU, or emergency specialized maternal fetal center. What in the world? How do you get that person safely if they don't have a car or they're limited on their resources. Yeah, another avenue we looked at was also the miracle of networking, like building a really strong partnership and alliance with various partners and agencies. One of those examples which a shout out to Dr Lori wood from Arizona perinatal trust. She's located in Phoenix, but we worked with her on several projects, and where we last ended off was on the horizon, looking at providing their non emergency obls training that they were training Ambulance, ambulance firefighters, police officers, individuals like that that respond to emergency birthing within some of the rural communities, and where we last left off was looking at expanding that training with them to the tribal communities. Like, who can we get as far as key stakeholders within these communities, they can have access to this training. It was free. Arizona parental trust is was going to provide that training and train all these different officers, firefighters, those that respond first to medical interventions, the general basics of how to engage in birthing practices, until they are able to get to the medical facility or to any other extensive unit that is requiring that. That's where we were on that project. I'm not sure the progress of it as of date, but it is still on the horizon, and I'm still working with Arizona perinatal trust as well, and some additional projects expanding further into tribal communities as well. So maybe we'll circle back in later in the year and give an update on that. Yes, yes, we'll have to include her website on in the show notes. We can absolutely do that. Do you know a little bit more about the organization Arizona? It is an nonprofit organization, and they focus more in the medical side of birthing I've only known the practice of what they do and experiencing that, but it's led under Dr Lori wood, and she is a magnificent resource to have when it comes to maternal health, not only the medical setting, but also in just the business and operational setting as well. In order to provide a lot of resources for different communities, they piloted their program, their obls training within tribal communities, first within the Navajo Nation, which is also here in Arizona. And the response they got from that proved to be very positive as well. So the next goal was to get it to other tribes within the state of Arizona with a high focus within like some of the smaller tribes that are very rural, ours and mine, included at Hopi, very rural, very isolated, limited resources. And just to provide that bad umbrella for them, it's so funny, though, because you say this and she may be a future guest, and we'll give her an opportunity to really share the work that she's doing. We can't. I. Love that we all sit at the same table. We don't know what everybody is doing and all of the details, but somehow we're all just holding hands and doing this work together. I think it's it's really beautiful. And we find each other somehow, like I say that, we find each other somehow we intersect at the right point and the right time. Yeah, I couldn't agree more, I really couldn't what else in terms of what you're seeing for the needs specifically for the tribal nations, and how can providers do a better job about listening and rising to the occasion? That is a very good question, because I feel like it extends beyond just the provider, I feel that it extends into actually looking at the health as well as social ecosystems of the community, because we talk specifically about tribal and a provider, there's only so much information that I feel that that provider is going to share, that the individual is going to not only comprehend, but also saturate in, especially if their social influences have a little bit of a different landscape. And when I say a little bit of a different landscape, I am thinking of some of our communities which the data is there, not to rely on data, but I'm thinking of those individuals that you know have issues with substances or alcohol, or we're working with individuals with high diabetes, which leads to pre eclampsia and all those different areas. But when we get there, we also look further at what is the quality of education, what is the access to general information that is, that is connecting to these communities? Because, yes, we do receive a lot of great information from various public health networks, Center for Disease Control, all these different areas. But one thing I've always paid attention to is, what is the what is the outcome of connection like? Are our community members really connecting to that information? And I say connection on a fluid level, because it could be the imaging. It could be maybe the words are too medical, maybe the words are trying to encompass tribal. But that's the other part. Is sometimes with some of these messages, is they're all encompassing. And the issue with all encompassing messages for over 550 federally recognized tribes, because there's still tribes that are not federally recognized, is they can tell right off the bat what tribe it's catered towards, and whether they're going to acclimate to that maybe a little bit of a different story. And I said earlier too, visually, like you know, you have tribes from all over the country that have different environments, different landscapes, symbols. And for me, exactly, if I go home to Hopi, we identify in our culture on a very unique lens. And we know when something is related to us directly, or if someone's trying to relate it to us directly, and then we connect pretty quickly. But if we don't, and it's another public health message that is catered for all Native Americans, and it's giving us pictures that maybe we've seen 30 billion times before, we're not connecting. At least, chances are that's that's very likely it's not going to connect. So when it talk comes to provider, like, okay, maybe we think a little bit, and this is assuming we all have the money and we have the right talent at the table. But I look at education as well as support, going beyond the provider, because they're only a small pinhole in the whole maternal health landscape, because they're working with many clients, many patients. So I look at other things. Do we have programs under social services, such as healthy relationships, or under the prevention area, under the clinic? Is there birthing classes or general awareness about what maternal health is? And then, if we scale back even further into looking at, you know, parenting classes, what do those look like? If there are any within the community, do they intersect on on general maternal health or family planning? I feel most of the time in these messages, and I think this is the culture of how it's been in general healthcare is we're always working with the outcome, but never sometimes looking at the forefront in terms of larger ecosystems, or it's always scare tactics too, like, don't do this because you're going to get that and blah blah. It's like, all right, I'm not going to talk to you right now because you're going to give you that shame or lecture. So yeah, when it comes to providers, I feel like it goes beyond them, and I hate sometimes also relying all on the doctor, like I know that you're here, you're providing what you can. I don't want to hold you 100% reliable or liable for that message that I know that can be supported through other avenues, through the network in my community. So I guess that's where collaboration and partnership come really. Strongly into play when it comes to creating strong messaging and awareness. Yeah, the message goes beyond the provider that it's so much more complex and so many other considerations. Thank you for pointing some of those out. And if we make space for disparities, we have some pretty strong data. There's a lot of disparities between the bipoc community and, for example, white birthing individuals. What can you speak to in terms of what you see in terms of disparities of maternal health? And do you have any kind of hope that we can address some of it. I think some feedback when it comes to disparities, after all my years in public health, is more if we really wanted to get some of the root causes, I would look at probably dissecting the way the system is is designed at the beginning, just to kind of like dissect that as far as and not so much dissected. It's also looking at the origin, like, how did these systems initially start? For example, if I look at the social services system, anyone who studied social work, the starting of how that all came about was in the immigrants in New York and all the children. And the framework just kind of built from there. And then ultimately, we just somehow mirrored that same framework across the country into other different areas and communities. And I did social work for a few years when I was working one of the tribal communities, we were taking this, this western model of Social Work, and trying to incorporate it within a tribal community, and it was good. But I also found that there's so many different issues that were not the system was not aligning with how the community lived. For example, one of these options is most of our homes, they're multi generational, what people might consider poverty, as far as, oh, you have like five people living in a two bedroom home. You know that's not normal. Like we need everyone to have their own bedroom. Everyone needs to have their own vehicle, a nice fence, very Western, Hollywood, Western model there. And what I remember is sometimes within the social work area is if we could not place a child within a home, if that home did not have XYZ for the child, even though they were direct relative, or that was the last relative they could be placed with. So we had to reassign them to another home that had those accommodations. Now, if we took the system away and just looked at the way communities lived, as far as tribal communities, it's very common to have grandma, grandpa, mom, dad or just Mom, no dad and like, three kids all within the same home. They never had an issue with sleeping. Yeah, they probably had to share beds, but the home was not of disturbance, and it was functional, and it they were able to get their resources. But if the rules state that this is what the system says, then it, it kind of proved a little bit of disconnected. I look at kind of just things like that, and we come talk about disparities, that's the first thing that more or less comes to mind, is looking at all right, what is, where are we sitting with the system, and how much of it has been modified or adapted to meet the needs of tribal communities today, and how much influence do we even have over that as well? Because I sit at some tables where we have people making rules for tribes, and there are no tribes there or no tribal members. They're like, all right, you're not in my community. So that's where I get into my whole advocacy side and my whole policy side. Like, all right, don't make rules for me if I'm not in the room to speak on my behalf and help to contribute to the overall infrastructure. But that's nine out of 10. That's usually what happens when it comes to some of those disparities. And then, even if we're looking at, you know, some of the, you know, you're probably more familiar with this than I am, but just some of the medical updates when it comes to maternal health, you know, who are we really basing a lot of those different ideals off? Is it science medicine, or are we still looking at some of the more ideal Western constructs of what and how, what is healthy considered for a woman or a birthing person that is going through that journey, and in tribal communities, sometimes we look at we talked about access earlier. Some of our communities have one store, not grocery store, store. And resources are limited, but we also understand that we have high rates of pre eclampsia. We have high rates of diabetes. Yeah, the doctor's telling me, like, I need to be healthier in terms of nutrition and diet, but if that's the only thing that's within my ecosystem of health and nutrition. Question, it's going to be really hard for me to get that what you're telling me, and then if it's also reinforced on a social level or cultural level, and cultural meaning social culture, not religious culture or tribal culture, for example, sugar is one of those things I do know, especially when I get to my home, yeah, there's, there's a lot of sugar involved. And I try to challenge my own family, like, I don't think we need that much sugar, but it is hard to break some of those social cultures. Is like, well, this is how it's always been. Like, yeah, then, but let's try to change it now. So I challenge my family sometimes on that, but I look at kind of the infrastructure when it comes to disparities. I look at the root causes, as far as how we're functioning some of the outcomes today and reassessing or re engaging with is this the best approach? Is this what's working? Or are we continuing to see data increase? Are we going to continue to see disparities increase? And if so, how can we reassess that? So I know that's a long answer to your question, yeah, and I think others will appreciate it too, because kind of the automatic go to is maternal infant mortality, and it goes beyond that. You're talking food disparities, access to education, health care, transportation. So for someone who may just assume the biggest health disparity is outcomes of of life or death, that is not just what we're talking about. We're talking about so much more. Oh, absolutely, and we're talking about generations of the influence of colonization, which we haven't talked about at all and and it's, I don't spend too much time of it, because I feel, over the last so many years, the the the phrase of historical trauma, has kind of caught in trends, so to speak, to the point where it's, you know, everyone's kind of already heard about historical trauma. It's like, yes, we've heard about historical trauma, but how are we connecting historical trauma to the outcomes of how we manifest it, and bringing that into some of the perspective of the generations, but also maybe a timeline of how some things have influenced I know in that lecture I did at psi, we got a little bit into it, and I ran out of time before we got to the to the end, where we started looking at formulas of hybrid approaching and unifying, some of the different solutions and strategies that can bring Western models, but also tribal models into the table To increase better outcomes. Yeah, yeah. And we can actually include some of those figures, if you're open to it, into the show notes, so people can look at them and take time, and then they could ask you questions. Or, you know, we can create some type of timeline like that. Sounds really important to be able to make some meaning of that. Oh, absolutely. And the one thing I do know as well when it comes to historical trauma is there's also a recognition of community trauma, meaning, like each tribe or each region or environment, they have their own traumas. So to look at it in a blanket approach is one thing, but to look at it on a micro level is another. So for example, with us at Hopi, we've had our centuries of issues with the Spanish arriving with colonization from the Americas, and we align that with where we live in our region. But we also say we know when you get home, those that were on the East Coast saw the visitors far more sooner than we did. So their lives had to change a lot quicker than ours did here in at Hopi, here on the west side. So we they came to us later, as we like to say. But that still doesn't mean that they didn't influence us, but we were able to hold our culture a lot longer than maybe those that were on the ridges of the ocean. And same thing with looking at peer tribes that are around us, you know, what are the what are the stories there? Because they've had their own experiences. And as much as I hate to say it, but the the experience is still are very live today with some of the different issues that are occurring. So the battle with tribes and colonization is an ongoing relationship. I will say it that way. And how do you think that influences or affects maternal maternal health? Well, right off the bat, I know that we've had discussions lately about the Medicaid cuts that are coming through that affect a lot of the different rural clinics, and particularly for a state like ours, in the state of Arizona, and then we throw in tribal communities. You know, some of our tribal communities, they some do have Indian Health Service clinic within their vicinity. Now it's a clinic, not hospital, and there may or may not be OB care. There, if we're talking about maternal specifically, but if the nearest clinic does have an OB, maybe it's about 30 minutes or an hour away, but if they're 90% funded through Medicaid, and that gets cut, and the way that the formulas is manifesting is, is that they're those cuts that come through eventually there were last update I got if I'm correct, and somebody call me and tell me if I'm wrong, but they were mentioning the state would have to shoulder the costs that are going to be taken away by Medicaid that are going to go to these clinics. And then our senator, I forget his name because I was on a call with him, but he was candid in his response and saying the state of Arizona doesn't have that funding to keep that shoulder, we couldn't afford to have that. So if we're looking at over years and vision, not saying tomorrow, but clinic closures could be a huge impact, and for those that are especially in rural Arizona, they would be the first hit, which would include tribal nations, which would then move the transportation from maybe 30 minutes to an hour to maybe two hours, three hours. And if it's an emergency emergency, they would have to be flown to Phoenix if they can afford the flight. So if it's coming through Indian Health Service, of course, we have our perks there. But if it's through private they get then there comes money issues that we would have to look at. So that's kind of an ongoing battle as far as All right, so how do we, when I was working with intertribal that was one of the things like, Okay, we may not be able to control medical we may not be able to control budget cuts that come up from a federal level, but under that program, what we could control is simultaneously. If education is going to be taken away on a federal level or on a insurance level, then what can we do under that program increase that awareness, even if it is just simple education to those rural areas if they don't have access to it. And some of the simple things could be like warning signs, or if you're feeling this way, Google or call this phone number if you have a phone, because we take into consideration some of our tribes, they have burner phones. They don't have full on iPhones or anything like that. So hey, as long as you have a burner phone, you might be having a sign of postpartum depression. At least this number is there just in case. So trying to do our part to help kind of be ready for what is going to potentially could occur. So those are kind of the things that I'm thinking about when it comes to some of the rural communities and healthcare, specifically, also with our community at Hopi, we're also working through a lot of water Water Disputes, with regards to some of these private companies that are trying to engage with Little Colorado River, but also the main Colorado River, and that's another battle there, as well as looking at now we're on this frontier with with ice and the corralling of different individuals, and especially for our friends to the south, which would be to honor them nation, or in the all the o'odhams, but also the pascoagi we're sometimes concerned as far as them being that close to not only the border, but being misidentified just because of their skin tone, in regards to what is currently occurring on a national level. Yeah, you bring up so many important topics that we could go take a deep dive in. But this is such. These are tentacles of how it can have a real impact. We actually had one in Virginia. One of the clinics shut down. I believe it's in Shenandoah. It's just, it's heartbreaking. And these are real people saying, oh, oh my gosh. Like, I'm three weeks from giving birth, and I need to have this new plan, and it can be really scary. Oh, absolutely. And then also we shift in maternal mortality. What would those rates look like? Let's say, in two years, three years, like, is it increasing? Is it decreasing? And then we start looking at root causes of those deaths. As far as, was it access? Was it emergency? There's many different things that can occur when it comes from the mortality side. Yeah. Well, if we pivot away from the scarcity of food or the disparities you talked about two really lovely things, love and food. Is there anything in the perinatal period that you can speak to around love and food? So and this is just with Hopi. This isn't with other communities, but I found a common thread amongst a lot of us. You know, in native and tribal communities, food is definitely a bring together, bring together event. And I think that's universal for everybody. So if you remember, you're at work or someone, someone brings in a box of donuts, everyone's circled like, yay. But like. It is such a pivotal part of not only just tribal culture, but just us as humans. Like that culture around food, but more particularly with Hopi, because we actually have ceremony, literally, like every month, there is something going on at home, and a key staple around that for us is food. And when I say food, it is our traditional foods that we've done just since. I don't know how long you'd have to ask one of my elders how long that's gone. It's pretty much since our existence, but it was a time that we come together. We're able to eat and take part in the food, but also just the conversation. And it's a space of being together, which rolls over into family, it rolls over into the village, rolls over into cousins, kinship, and they're all in some way or another, are affiliated, not necessarily through blood, but just through relationship, and it creates another ecosystem of community. Now, in some tribal communities, they actually they don't live in villages, but they do live in communities, whether that's a large a smaller place, or if it's a scattered place, but it's still the same structure there as well. Like, there's still kinship, there's still relativity and just a relationship compared to like your your and I live in Phoenix for so many years too. It's like I never met some of my neighbor this I literally have so when I first moved to the urban setting, I found that so odd. Like, Doesn't anybody go? Do you ever go to your neighbors? Like, when's the last time you went to your neighbor's house and just talked or invited them over? Or, in Western eyes, it's like, well, we do sometimes, or we have to know them before we do. Or it's like, go to the community center or the rec hall, and then you can connect there. Everyone. This is Wendell honani from the Hopi tribe. Thank you so much for coming on tonight. If you would like to learn more about how we can help, visit our website at perinatal reproductive wellness.com, and while you are there, check out the latest edition of our book, employed motherhood. We also invite you to follow us on social media at employed motherhood. Finally, if you enjoyed listening to the show, please subscribe and rate it. Thank you. You