Acupuncture Denver Blog

Comprehensive health, empowerment, joy, and happiness.


The Unreasonable Burden of Control and Responsibility


I read a striking article in the Washington Post today that highlights how western reproductive medicine can fail at times, especially when it comes to egg-freezing, and how shocking and heartbreaking this can be for women who’ve felt that they’ve done everything right. It emphasizes that while egg-freezing (not embryo-freezing) can be effective (I've seen it work several times!) the odds aren't always presented realistically by IVF clinics. One provocative statement that struck me was what Dr. James Grifo, one of the pioneers of oocyte-preservation, of NYU commented mentioned in terms of women feeling that they are "in control" their fertility and the ways in which that becomes a burden:  

Your whole life it's beaten into your head that you're in control and if you can't have a baby, you blame yourself. There has to be more dialogue about what women can be responsible for and what they are not responsible for.

I agree that we need to be having this conversation more. Feeling responsible for our fertility, from anxiously preventing unwanted pregnancies to procreating when our careers and lives have come together or when we’ve finally met the right partner, is a significant burden we carry as women. It represents another set of conflicting and competing expectations ("don't be fertile" followed by "quick, be fertile before it's too late" message) that  Brene Brown  explains triggers a lot of our shame as women. 

A client and I recently chatted about the idea of "circle of influence" which she explained was based on  Stephen Covey 's self-help work. I gathered that the idea was to make choices to change or improve what is within our circle of influence (that which we can change) and to stop worrying about what is outside of it (those things we cannot change). Reminds me of the serenity prayer, which must be popular for a reason…. I tend to perseverate about things that have already happened when it's completely useless and a waste of brain bandwidth. I'm now planning to read  The Seven Habits of Highly Successful People  (which yes, I've purchased already, but never read) since this makes sense to me. The circle of influence idea totally applies to the fertility journey-- we can certainly make choices that will improve our fertility, ensure that we are getting safe and high quality medical care, and optimize our health and lifestyles, but we cannot turn back time.  (Nor should we want to! Who wants to be a freshmen in high school again? Or a freshmen in college? Or even for some of us, back in our early thirties? Not me, that’s for sure).

It seems to me that even if we experience grief for what we imagine might have been, we can also gracefully move forward, even in times of deep fear and uncertainty, with faith in our own wisdom, intuition, and the support of others to get us through whatever comes. I like to think of it as informed Taoism: recognizing that you can be accountable for your choices and make the wisest choices in the moment without thinking you are driving the ship, or in charge of the universe, or powerful enough to control your own body or nature. I know, easier said than done, but that’s why it’s called practice.

 It's an honor to be part of others’ journeys that bring up so many existential questions. One of my personal and professional goals is to empower women to release the burden of being overly responsible for so much in this life.  Let's promise to help each other remember what we are responsible for and let go of the rest! We have so much to share with the world that goes beyond our biology and will change life for the women of the future. I think we can all feel a cultural shift in this direction right now: women are claiming their voices and rights in revolutionary ways. Let's hold each other up and support each other in forgiving ourselves for things that were never our fault in the first place. Fist in the air, sisters! We got this. 

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My Miscarriage Story: In Honor of Pregnancy and Infant Loss Month


It seems that the heart is bigger than the womb, by my reckoning. The womb starts out smaller than the heart at least, flat and triangular when it’s empty. I believe most people think of it as a large hollow thing, like a chamber, which will surround a baby like a bubble or a balloon. But the womb is dark and sticky and its contractions on itself are what staunch our bleeding. It’s more diminuitive than a pear or a lemon even and has much less volume. The heart is larger than the womb and more complicated.  

In Chinese medicine, the Bao Mai is the channel running between heart and womb in women. The highway between desire and manifestation, the vertical axis from grief to letting go, the internal marriage of fire and water. For women, there are the everyday losses, a waxing and waning moon, a filled and emptied out heart, an unfertilized egg exiting us like a small unimagined future. The fertilized ones also leave us barely past implantation, so that we don’t even know that a blastocyst was there, with cells gone awry at day 5 or 6 or 7 of embryonic development. The bigger losses rip our insides out and the tentacles of these reach up the bao mai to entwine themselves around our hearts, the threads of motherhood already weaving their way into our subconscious, the barely perceptible heartbeats the stuff of our dreams.

We may only have a ghostly gray-white image from an ultrasound, printed on shiny photo paper, our name and date on it the only evidence of motherhood.  These were hard for me to see once, when my happy patients brought them in for me over and over, sometimes in envelopes and once proudly displayed in a frame. I came across my ultrasound picture just the other day. December 21, 2005. 9 weeks and 5 days gestation, measuring 2.3 centimeters. Measuring off by a couple of weeks at least. Heartbeat detected but no doubt too slow, indicating a doomed attempt at circulation, indicating a likely chromosomal misalignment, maybe trisomy 16, which is most common, maybe 21. Even though the nurse neglected to tell me that the baby was too small for my dates and likely had a sluggish heart rate, she didn’t.

But my heart knew what my womb didn’t. The fetal demise probably happened around the end of the 9th week, but I would carry that baby until 12 weeks. But I dreamed of pushing a baby carriage into a driveway a few nights before the bleeding started. I dreamed that I gave a baby to two women who pushed it onward without me, I dreamed of knowing the baby was going to be safe. My dog, Milo was with me and acting up on his leash as usual. We left the baby with the women and we walked on.

When mild cramps started at 12 weeks, I thought they were normal at first. I felt them all day at the office and asked my doula client if they were normal. They built as I sat through my friend’s mom’s reading at the Tattered Cover bookstore that night. I was looking at a Mary Ellen Mark photography book when they became too intense to ignore, when the pain started to steal my breath bit by bit. I told Greg we needed to go. I remember being on Josephine street, driving by the Botanic Gardens, my feet up on the dashboard as Greg drove us home. I remember calling my old friend Diane in San Francisco when we got home. She had had a miscarriage and said she also didn’t bleed right away either. Maybe I was just cramping and it would be OK.  I remember calling my sister Becky, the OBGYN, to see what I should do. I drank water, like they always say, and took a bath.

At some point around 11 PM I walked through the threshold that lies between worry and resignation and knew I was losing this baby. In moments like this, I fold inward. I could barely look at Greg by then and could only repeat “why is this happening to me” over and over, as if there was an explanation. As if understanding it would make it better. I later integrated this gradual loss of control in my body as a valuable practicing for death. Something was happening inside my body that was beyond my control. Something precious was slipping away and I couldn’t stop it. To stop this small death in life would be like stopping a tidal wave with a teaspoon.

             In immediate need of animal comfort, I knelt on my old zabuton-turned-dog bed and rested my forehead on Milo’s forehead, girl to dog, like when I was a lonely kid in a big house where there was always at least one equally lonely dog to soothe me. My crazy, poorly trained bird and possible pitbull mix, the one who had accompanied me to six houses in seven years, who had a feral streak that blossomed in the marshes of Georgia where he took down raccoons and rabbits and even what we believe was either a small gator or a badger once. Who fought to the death with whatever that loud hissing animal was until his throat was riddled with puncture wounds and filled with a grapefruit sized pool of blood. Milo, who slept in my bed and under the covers, until Greg came on the scene and kicked him out. Shiny, black short-haired Milo, long-legged beauty with the spotted belly of a dalmation. One of a kind and impossible to walk. Leash aggressive and happiest in the mountains, a dog who almost drowned himself chasing a pelican out to sea. A dog who stayed upright on all fours in a canoe in the surf of little tybee island when Greg and I both went overboard. A dog who was my first baby really, when I should have been old enough to be a good parent, but made crazy choices for the both of us.

As I lay down against Milo’s body, something deep inside me popped like a soggy cork and I knew my water had broken. When I stood up, the blood and fluid that gushed out of me drained my face of its color. Greg fell to his knees, grabbed my ankles, and let out a guttural howl I had never heard from him before. I was frozen in that spot and didn’t dare move my head, saying, “I don’t want to see it, I don’t want to see it.” He wiped up the floor and gave me a thick black dishtowel to soak up the blood that was coming in waves with each contraction.

When I called my OBGYB sister, she said we’d have to go to the ER since I was so far along. We drove the few blocks to St. Joe’s hospital and passed the sign for the L&D entrance, circling around to the emergency room parking lot. As we got to the back of the hospital, I had the dreaded thought that maybe I had bad eggs, even though I was barely 36. In my fertility acupuncture practice, I’d seen other women younger than me with fertility issues and recurrent losses. I didn’t want to be one of them. I had conceived on my first try. I had even put an exclamation point in the relevant section on my pregnancy intake form a few weeks before. I believe it was the part that asked, “how many pregnancies have you had?” and I wrote, “one- pregnant on my first try!” like I was somehow above average even in this regard.

It was dark and empty in the ER lobby. There were lots of potted plants and empty tables and just a couple of other people there since it was past midnight. We waited in silence until the admin brought me to the ante-room where she took my blood pressure and remarked how calm I seemed for what was going on. It’s times like these that my mother’s main admonition to me growing up, which was “be stable, be stable” and my protestant stoicism served me, at least on the outside.

I don’t think I said much back to the intake lady and waited several more minutes, the dish towel getting heavier and heavier as I continued to bleed. Finally, after at least 45 minutes, they decided to bring me back and made me sit in a wheelchair to take me down the hallway to the examination rooms. We were left in a room and I curled into child’s pose on my knees as the contractions overwhelmed me on the white cot. When a nurse came in, Greg said, “she was 12 weeks pregnant.” The nurse replied, without even a hint of empathy, “well, is she 12 weeks pregnant or was she 12 weeks pregnant.” I go into a black hole of forgetting here and know I was curled up and not looking at her but I think I said, I’m having a miscarriage. I was still a serious Vajrayana Buddhist practitioner at the time and the teachings kicked in, for better or worse, as I prayed that the karma of all sentient beings ripen upon me through this suffering. The logic of it goes something like this: since I’m enduring such intense suffering right now, I may as well bear the burden of all sentient beings’ bad karma while I’m at it, so at least I’ll come out of this with some merit.

When the ER doctor finally came in, he opened with, “are you doing Lamaze classes? My wife I did the Lamaze classes.” I was taken so off guard by this that I started to say, “ I was thinking of doing the Bradley method classes” but just trailed off.  I really had to pee at one point and went down the hall to the bathroom around the corner. Plum-sized clots were dropping out of me into the toilet by now. It didn’t feel right to potentially flush a fetus down the toilet, so I let the nurses at the counter know as I went back into my exam room. A few minutes later, I heard them joking about who on that shift would have to fish out the contents of the toilet bowl.

Wheeled to another room where there was a transvaginal ultrasound machine, we were able to confirm that the pregnancy was no longer viable. The ER doctor actually drew a uterus and cervix on the sheet of the cot by way of explanation, letting me know that when the cervix opens too early and the fetus comes out, that the baby can’t live. I thought to myself, “No shit, Sherlock,” and “FYI, I know my female anatomy, douche bag.” I’m pretty sure the poor guy suffered from Asberger’s.

When Dr. Warner, the Kaiser OBGYN, finally came in, she was the first person who seemed to realize what was happening. She looked me in the eyes and took my hand. I finally had permission to cry. Just before she examined me, I had the feeling that people describe as part of labor: the overwhelming need to defecate. I went to the bathroom, this time with a yellow colander-like basket to catch any tissue, and pushed. When I came back, she examined me and said that indeed the tissue was coming out and she used a hemostat to extract it the rest of the way.  It felt like she had sharp things way up inside my uterus at one point and I wondered if I was having an unmedicated D&C, which is how it felt. I was too spent to argue about having the tissue karyotyped knew Kaiser wouldn’t want to pay for any testing since this was my first miscarriage. A robotic nurse, whose kids’ photos were added to the ID badge on her lanyard gave me some handouts on choices about where the fetal tissue would go if we didn’t wish to have it buried. I think we signed off that it should go into a group cremation. I’m not really sure. She also gave me some handouts on loss and told me to take Advil when I got home.  I was still being racked by intense contractions and I said I didn’t even have Advil, so they gave me a few Vicodin, two of which barely took the edge off.

I don’t remember the car ride home. I don’t remember showering. I don’t remember much besides feeling emptied out, hollow, like a shell of the hopeful person I had been the day before.  Like I had been sucker punched from the inside out. Like I didn’t want to face waking up again that empty. Like it had maybe all been a dream. I sometimes wish I had made Greg look at that baby, just to know it was real. I do have the ultrasound photos, but I wish one of us could have witnessed this being in all its dimensions. I was afraid I’d be haunted by its tiny hands, or skull, or eye sockets. I’ve had clients who have thoroughly examined their fetal tissue during miscarriages and others who have held stillborn babies for hours, photographing them and documenting their existence. Naming them and giving their grief a shape to latch onto. I, however, rapidly began a process of shutting down, of a letting go just this side of total denial. I didn’t speak of him or her as a baby ever again. I spoke of a pregnancy, but no fetus. Just like the mild opiates could numb my physical pain, I would use semantics to wrap up this loss in layers of wordy deception. There was never a baby, just a pregnancy. What I didn’t see couldn’t haunt me.

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Low Ovarian Reserve: Fertility Success Story


Jane and her team at Acupuncture Denver are AMAZING.  In November 2013, I was diagnosed with Low Ovarian Reserve.  I had two Reproductive Endocrinologists tell me there was little hope for conceiving another child without donor eggs.  My husband and I were devastated, stressed and did not know in which direction to turn.  I met with another woman who had struggled with infertility, and she recommended for me to read  The Infertility Cure .  I was so moved by the book and its' contents that I sought out Jane Gregorie, since she practiced the methods I read about in the book.  

In February 2014, after meeting with Jane just once, I knew I needed to start my journey at Acupuncture Denver.  She was so positive about our situation and had a very calming and reassuring demeanor that made me feel comfortable and human again.  Jane helped me to feel like I wasn't alone and that there was hope left for me AND my eggs :).  I followed Jane's diet and supplement protocols, I also began taking DHEA under the supervision of Dr. Albrect, I saw Jane 1x per week for Acupuncture.  The Acupuncture sessions were very relaxing and allowed me a safe and accepting place to vent candidly my feelings with the ups and downs of infertility; this is something that I valued greatly.  After about 6 months, I became pregnant...naturally.  I now have another beautiful baby boy, born April 7th, 2015.  

I feel truly blessed to have found Jane, and not only because she helped me to conceive, but because she made an impossible situation seem possible, she helped me to understand and accept that it was OK if we had to look at other alternatives for conception, but most of all, because she became my friend during a time when I felt so alone.  I would recommend Jane's clinic to anyone struggling with infertility...I am a true believer in the power of Acupuncture and Chinese Medicine.
 

-T.H. 

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Mally Shaw, New ABORM Fellow!


Mally Shaw, who has been an associate acupuncturist at Acupuncture Denver since November 2013, recently sat for the American Board of Oriental Reproductive Medicine exam in Vancouver and passed with flying colors! I am so proud of her and thrilled that now all of us at Acupuncture Denver are Fellows of the ABORM.


This distinction really sets us apart from other clinics and practitioners in the area. I was ABORM certified in 2008, the first year the testing was offered and Merry was certified in 2010. We are really thrilled that Mally has now joined the ranks of the ABORM group! The ABORM certification is a rigorous process that requires many hours of advanced training in reproductive medicine and infertility before a candidate can sit for the exam. All fellows are required to be in practice for a certain number of years, complete approved advanced coursework in both Western and Eastern reproductive medicine, and to sit for a very difficult examination.  By choosing a practitioner who is ABORM certified, you can rest assured that we have an in-depth working knowledge of biomedical reproductive endocrinology, Traditional Chinese Medicine and infertility, as well as being up-to-date on best practices in terms of acupuncture, herbs, dietary therapy and other adjunct treatments we use in holistic fertility enhancement.


Mally and I were both very fortunate to also attend the first annual Integrative Fertility Symposium in Vancouver shortly after she sat for the exam. Along with connecting to many of my long-time colleagues in the field, I was able to attend a rich array of classes with leaders in the field of integrative fertility. There was a lot of focus on autoimmune issues, PCOS, recurrent pregnancy loss and integrating TCM with IVF and other Western medical treatments. The dialogue between reproductive endocrinologists, urologists and TCM practitioners was invaluable and shows how far we have come in the past decade or so in terms of integrating our care (Western Reproductive Medicine with TCM) in order to provide our patients with the best of both worlds.  I’m so grateful to be part of the cutting-edge in terms of integrated care and also very proud that all of us at Acupuncture Denver hold ourselves to such high standards for advanced training, certification and clinical excellence. Congratulations, Mally! I’m so proud of you! 
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The Essence of Motherhood: May We Honor All Women on Mother's Day


"The essence of motherhood is not restricted to women who have given birth; it is a principle inherent in both women and men. It is an attitude of the mind. It is love -- and that love is the very breath of life. No one would say, 'I will breathe only when I am with my family and friends; I won't breathe in front of my enemies.' Similarly, for those in whom motherhood has awakened, love and compassion for everyone are as much a part of their being as breathing.” 
~ Mata Amritanandamayi known throughout the world as Ammachi, or Beloved Mother ~
 
I have recently been inspired to consider the true meaning of what it means to be a mother.

As Ammachi points out so eloquently in the above statement, there are many women (and men) who embody the essence of motherhood who have never had biological children. As someone who has worked with scores of women struggling to become mothers over the past decade, I have been struck by so many who are childless but who are already mothering in such beautiful ways in the world. 

Maybe they have committed their lives to teaching, or to changing the education system by dedicating super-human amounts of energy to making a difference in a terribly broken system. Maybe they have chosen to work in the non-profit sector or as therapists, doctors or attorneys. Their work can change the lives of thousands of people and the ripple effect of their gifts to the world is immeasurable. 

I was recently moved to tears by a patient whose love for the students she serves shone in her eyes just as if she were talking about her own children. It seems unfair that these women, who give so much to the world, could still feel less-than or inadequate in any way. They are expressing the most beautiful and selfless form of mothering without even realizing it. And we need to start recognizing that this mothering outside of the social structure of the nuclear family is just as valid as mothering a biological child. 

As an adoptive parent, I know many amazing adoptive mothers who have gone above and beyond and parented children with complex histories, struggles and traumas with unconditional love and unrelenting hope.  And even then our culture can make us feel less-than for not having “real” children or “our own” children. 

Another huge inspiration is my best friend Donna, who faced a long fertility struggle and ultimately found peace being child-free. Instead of having biological children, she gave birth to an amazing acupuncture practice in a town where Chinese Medicine was very new. She has changed the lives of countless patients over the years and helped many women struggling with infertility. She is one of the most powerful mothers I know. 

And of course there are saints and spiritual leaders like Mother Teresa, Joan of Arc, Ammachi, Venerable Khandro Rinpoche and so many more… wise women who have been able to change the world because their concept of mothering was vast and selfless. Their examples can inspire us all. And hopefully, as women gain more power and equality in the workplace, government and clergies, we will start seeing how motherhood means more than giving birth to biological children and relegating all of our mothering energy to the domestic sphere. 

Women have always, and will continue to change the world in meaningful ways because we all have the power to be mothers in the world—whether we have given birth to a baby or to an inspiration. May we all begin to recognize this divine mothering energy and power when we see it. And may those whose hearts yearn for a child be filled with the recognition that they can express the essence of motherhood in so many ways. 
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Local RESOLVE Meet-up


One week every year is National Infertility Awareness Week (NIAW)... and that's this week... April 19-25, 2015. RESOLVE: The National Infertility Association has wonderful resources on their website:  http://www.resolve.org/

This year there is one local RESOLVE support group meeting in honor of National Infertility Awareness Week. On Sunday, April 26 from 1:30pm-3:30pm in Westminster, the Meet-up group will be led by Stephanie Renee, a fertility consultant and founder of Hopeful Possibilities. She’ll speak about natural and actionable strategies to "Thriving Instead of Just Surviving" through fertility challenges. This is a free event held in conjunction with the Colorado Fertility Warriors Meet-up group. For more information, please call Stephanie at 720-507-4673 or go to http://www.meetup.com/Colorado-Infertility-Support-Group/ where you can also RSVP for the event this Sunday.

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Fertile Ground Yoga


At Acupuncture Denver, we treat the body, mind and spirit together. It’s a holistic approach that often sets us apart from other providers that specialize in infertility. We are committed to providing our patients with the highest standard of care based on an attitude of gentleness, warmth, professionalism and respect.

As part of this philosophy, we offer Fertile Ground Yoga Classes for women and couples throughout the year. The next 4-class series starts on Saturday, May 2. Each class includes meditation, group support, yoga, self-inquiry and guided relaxation to enhance your fertility and support your vitality. There is a space for you here if you are are trying to conceive naturally, going through assisted reproductive treatments, grieving a loss or considering other family-building options. The rates are $70 for the general public, $60 for Acupuncture Denver clients and $18 for a drop-in.

Space is limited, so register here today! 

This week (April 19-25, 2015) is National Infertility Awareness Week (NIAW). It was started by “RESOLVE: The National Infertility Association, established in 1974, is a non-profit organization with the only established, nationwide network mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders.” Their website has wonderful resources: http://www.resolve.org/
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2015 National Infertility Awareness Week - April 19-25


 
This week is National Infertility Awareness Week (#NIAW). It was started by “RESOLVE: The National Infertility Association, established in 1974, is a non-profit organization with the only established, nationwide network mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders.” Their website has wonderful resources: http://www.resolve.org/ 
 
 This year’s theme is “You Are Not Alone” as 1 in 8 couples in the US experience infertility. At Acupuncture Denver, we really mean this… we don’t want you to feel alone or to be alone. We’re here for you. We offer a free infertility support group every month hosted by Jill Oulmann, a Nationally Certified Counselor (NCC) who specializes in Reproductive Mental Health. And when you’re here, please ask us about other ways you can feel supported! 
 
A great post that RESOLVE wrote is called “ Infertility Etiquette” and suggests some things to NOT say or do to a woman or couple experiencing infertility, as well as some things TO say or do. Our top 3 favorites are: 
 #1 - Don’t Tell them to Relax 
#7 - Don’t Complain About Your Pregnancy 
#11 - Let Them Know That You Care 
 
Hopefully there’s a way you can share this advice with the people in your life (perhaps a co-worker or family member or friend) so that they can better understand your experience.
 
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Testimonial: Fertility Success Times Two!


When I first went to see Jane in 2008, I was 28 and had been trying to get pregnant for four years. My husband and I were diagnosed with unexplained infertility. We tried IUI a couple of times but didn’t get much further than that before I noticed my confidence and attitude start to plummet. I decided to try healthier approach than taking Clomid and stressing over IUI.

At first I didn’t like going to acupuncture but after a couple of weeks I started to feel overwhelmingly better even though I wasn’t pregnant yet. The stress and depression I was experiencing at the time was excruciating and the sadness consumed me. Having relief from that pain was worth every penny and just a few months later I was finally pregnant. That was a good day.

After my beautiful daughter arrived I knew I shouldn’t assume the problem was fixed. If the first baby took five years the second could take just as long. And I’m not getting any younger! So after another year and a half of trying for the second baby I went back to Jane. Within three months I was pregnant again.

I also referred two of my friends to Jane and they both have babies now.

I still schedule treatments with Jane because I notice that when I go to acupuncture I handle stress better, my memory is better, I have more patience and I’m just overall more grounded. I absolutely love everything about Acupuncture Denver--  the office is clean, comfortable and the staff is consistently friendly and compassionate.  So, basically, what I’m saying is this stuff really works and I’ll never go anywhere else for acupuncture. Thank you Jane!!!

-M.P

If you want to learn more about how we can help, consider attending our upcoming "Reclaim Your Fertility" One Day mini-retreat on February 8th, 2015. You deserve to find compassion, understanding and hope on your fertility journey. We are here for you! 

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2014 Midwife Scholarship Update


Acupuncture Denver currently sponsors Selam's 4-year program at the Hamlin College of Midwives located outside of Addis Ababa, Ethiopia. Weema International was kind enough to send us another update about Selam: 

October 3, 2014

Hello Acupuncture Denver!

This September, the WEEMA team met the Hamlin midwife students for a delicious lunch in Addis Ababa.  The students had just returned from their summer break and were eager to get back to their clinical clerkships.  All were beaming with excitement and anticipation for the upcoming school year.

Selam was her usual happy, upbeat self.  She, like her fellow scholars, is already dreaming about the future as her service to her home community is now only two short years away.  We discussed the idea of becoming a “master midwife” - as a Hamlin trained midwife is extremely well educated and has much to offer.  We now envision these women as master teachers supporting the clinical work at the new district hospital as well as associated health centers.  Sharing skills and knowledge will have a ripple effect throughout the area!  High quality care for moms and babies from all health care professionals will save even more lives!

Selam thanks Acupuncture Denver from the bottom of her heart.  WEEMA, thanks you, too. 

Photo from September 2014.  Selam is the second from the right.
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