Interdependence and Healing Justice: A Holistic Perspective (2013)

Title (as given to the record by the creator): Interdependence and Healing Justice: A Holistic Perspective
Date(s) of creation: June 13, 2013
Creator / author / publisher: Geleni Fontaine
Location: Philadelphia, PA, US
Source: Geleni Fontaine
Reference #: PTHC-Keynote-2013
Links: [ Geleni’s web site ]

Interdependence and Healing Justice: A Holistic Perspective

Keynote Speech by Geleni Fontaine
Philly Trans Health Conference
Thursday 6/13/13

Good morning and welcome to everyone!  My name is Geleni Fontaine.  It’s with tremendous joy, humility, and deepest gratitude that I speak to all of you here today. I have the best view in the house.  How amazing to look out at you all. You’re all beautiful!  I want to offer huge thanks to the organizers, planning committee, and national working groups that have created this amazing conference, in all the ways that it sustains and continues to grow.  Also the partners and sponsors, panelists and facilitators, and everyone here.  I wouldn’t be able to be here and do the work that I do without the grace, love, and support of my spouse, Lissette Cheng and the amazing family of my co-collective members at Third Root Community Health Center.  Sending special love and a hug to Jacoby Ballard for his work as co-founder there and returning facilitator here.  Loving gratitude to Cicely for suggesting me as a speaker.  Deep thanks to the folks doing ASL interpretation today. Lastly, I’m so grateful to Jacsen Callahan for the logistical work that physically got me here to speak today.  I’m deeply appreciative!

When I was asked to be the Thursday keynote I was really floored, and my first question was – why me?!  I was told that there was a lot of interest in having a holistic healer speak, which was really exciting for me to hear because I’ve felt a lack of holistic focus here beyond a couple of panels and presenters, and it’s great to consider the ways that might change in the future.

So it makes sense to define some terms here.  When I talk about allopathic medicine today I’m referring to what’s thought of as conventional western medicine (developed in the past few hundred years) which diagnoses disease and treats or suppresses symptoms of disease primarily through the use of pharmacological drugs and surgery.  The term was created in the 19th century by homeopathists and literally means “other than disease” because of it’s focus on treating symptoms.  

By contrast Holistic medicine, which includes traditional health practices from around the world (some of which have been developed over thousands of years) focuses on the individual in all their aspects: emotional, physical, spiritual, historical, cultural, and all orientations when treating their complaint – disease.  The methods used vary hugely from modalities like acupuncture, herbal medicine, chiropractic, meditation and yoga, qigong, and much more.  A provider might give you a treatment, create a series of exercises for you, counsel you.  The provider might be a teacher in a class.

It’s my belief that the lines between allopathic and holistic care aren’t always that thick, and that since we obviously need both as a community it benefits us to think about how to increase access to both.

Today I’ll be talking about both my work as a holistic healthcare provider and the ways that these traditions can support our communities, as well as barriers to care and examples of how people and groups cope with them, and my own experience seeking healthcare as a fat, queer, genderqueer, working class Latina/o transperson living with illness and chronic pain.  I’ll tell stories, so please bear with me – stories are their own healing.  

I’m not a techie person.  There’s no cool video or visual presentation.  I’m my only special effect today.  But I am going to ask you all to join me in a gentle activity – nothing too taxing I hope, but a chance to center, be present, and offer ourselves love as we start this conference.  I’ve thought about ways to make this activity accessible for different bodies and needs and will offer ways to approach it, but feel free to change anything that doesn’t work for you and know that there’s no wrong way to participate if you put your intention and presence into it .  And it’ll hopefully feel good, so don’t be scared!

Led the group in a self-massage activity. How do you feel?

Now I’ll talk about myself for a bit. I grew up in Brooklyn, New York mostly in the same building I live in today.  My father was the chief of the repair crew at the Cumberland Sugar Packing plant by the Brooklyn Navy Yard and my mom worked at home.  They emigrated to the US from Cuba in 1960, the year they were married, and left all their family behind them.  My grandmother, my mother’s mother, was able to follow a few years later and lived with us when I was very small.  She was a healer.  They were rural people, guajiros from the east of the island.  My mother and father’s families had adjoining land where the Rodriguez farm met the Fontaine ranch and my parents knew each other growing up.  The story goes that one day my father’s father was attacked and robbed by men with machetes.  He had a bad wound to his head and lost consciousness.  The town doctor examined him and told his sons to take him home to die.  Instead they took him by oxcart to my grandmother who tended him with herbs, stitched him with sewing thread, and laid hands on him.  She cared for him until he was ready to go home.  And when I was a child she lived with us, picked her own herbs in Prospect Park and took care of me when I was sick.  Holistic healing was in my life before I was born, but it took me awhile to make it the work of my life.

Some of the first healing work I did was as a volunteer crisis counselor on a suicide hotline.  I learned that bearing witness and simply being present for someone in pain could make a huge difference, and that a caring and trained volunteer didn’t have to be an elite professional in order to make it possible.  

A few years later I decided that I really wanted to go into nursing.  I was a high school drop-out from an alcoholic family I was struggling to escape.  I found my way into a GED program, passed the exam with a top score, and began training at the Long Island College Hospital School of Nursing.  I didn’t have an easy time in the program.  The hierarchy of the school and hospital setting (including the compulsory gender, sexuality and body normativity, and de-valuing of low income folks and people of color – particularly the undocumented immigrants I was often asked to translate for) ground me down.  The exhaustion of people around me was palpable, and the pressure from teachers and supervisors was continuous.  Once, so distracted by a supervisor rushing me while i was setting up an IV, I accidentally thrust a large bore needle all the way through my thumb and didn’t realize until I saw all the blood on my lab coat.  Despite bleeding through several bandages, I was encouraged to put on a latex glove and “keep going”, so I did.  And I finished the program even though I had started to realize that doing the work I most wanted to do – being a resource to the people that mattered most to me in a way that was mutually empowering and reflected my values – would be an uphill battle.

When I graduated I knew I didn’t want to work in the hospital system and found a job at a large community healthcare center in Washington Heights, a neighborhood in upper Manhattan that’s still mostly Dominican and includes lots of low income and working class folks.  I was hired with another nurse with 10 years experience who would be my supervisor.  One week after starting they fired her for sleeping on the job (and possibly for a chemical dependence problem.)  They asked me to stay on as a brand new nurse, with no other nurses or mentors, at my original salary. I was very new and eager to process myself. I triaged up to 50 people a day, supervised 5 medical assistants (all more experienced than me) and became the clinic’s HIV counselor.  I also developed a huge fibroid tumor that caused hemorrhaging and led quickly to anemia.  I had surgery but was so ill afterward that I had to quit my job, give up my apartment, and move in with my mother who cared for me.  It took me years to consider the relationship between the exhaustion and isolation of my work and my illness.  Acupuncture and Chinese herbs helped me heal and regain strength.

When I was strong enough I began work at the Center for Anti-Violence Education, coordinating programs and creating violence-prevention curricula for youth, LGBT communities, people of color, disabled people, and other communities bearing the brunt of institutional violence.  Certainly another level of healing work!  I was also a self-defense and karate teacher, pushing my body on a regular basis.  When the Center lost funding after September 11th and laid everyone off in 2004 I decided to go back to healing work and study acupuncture.

I graduated from the East Asian Medicine Program of the Swedish Institute in 2008 with a Bachelors in Professional Studies and a Masters in the Science of Acupuncture.  I went into a level of debt I will not likely ever get out of, and practiced illegally for two years before being able to afford to take the exams and jump through the hoops that would allow me to be licensed in New York State.  But I haven’t a single regret about doing it.

Now a little about acupuncture: Most of us know that acupuncture is a therapeutic technique used to restore balance, health and well-being.  The technique involves the insertion of fine needles into energetic points on the body.  Through the use of very fine needles (cat whisker-thin) the sensation may be of pressure, tingling, or heaviness in the area being needled.  The needles release energetic and physical blockages along internal channels of the body (called meridians.)  They also bring life energy (called Qi) into the body to help restore balance to mind, body, and spirit.  In these ways acupuncture treatments are able to address acute and chronic illness, pain, and emotional distress.

I chose my program purposely – I wanted to study with Jeffrey Yuen, a brilliant Daoist priest and healer who’s worked a great deal to bring Classical Chinese Medicine to the US.   Here’s some background into acupuncture: Most acupuncture practiced in the west falls under the umbrella of what is called Traditional Chinese Medicine (TCM.)   TCM was developed in China during the Cultural Revolution as an amalgam of many different traditions created over thousands of years, stripped down to basic formulas, and codified in a way that allowed for faster training of acupuncturists and a medicine that was more easily accessible to a huge population.  Unfortunately many traditions, particularly those that involve a sophisticated use of many different meridians systems beyond the twelve primary ones TCM accesses, were left behind.

Under Jeffrey Yuen I learned the broader traditions of Classical Chinese Medicine (CCM.)  CCM contains, undiluted, many traditions that were stripped from practice during China’s Cultural Revolution.  These traditions incorporate many more channels than TCM and encompass an array of holistic healing that helps individuals find their own path to wellness, particularly for those dealing with chronic illness, autoimmune issues, and emotional pain.  They help me as a practitioner to treat on a deeper mind / body / spirit level.  Being trained in both CCM and TCM allows me to bring a lot of versatility into my treatments.

Today half of my practice is at home in my living room where I treat primarily women, queer and trans folk, people of color, and many friends from fat and body justice communities in NYC.  In a typical week I treat people with asthma, anxiety, depression, digestive illnesses, PMS, autoimmune disorders, musculoskeletal injury, hypertension, allergy, thyroid imbalance, fibroids and endometriosis, infertility, physical and emotional pain, and lots more.  At home I treat individuals alone or couples together (friends, family, etc.) using a sliding scale fee of $15 – $45 per session, plus $10 for first timers.

The other half of my practice is at Third Root Community Health Center.  Third Root is a worker-owned, collective, holistic healthcare center in Brooklyn.  Our collective is comprised of all our providers – acupunks, herbalists, yoga teachers, and massage therapists, currently 11 of us.  We’re a diverse group in age, race, ethnicity, gender and gender identity, and sexual orientation.  We have one employee – a part-time admin manager and many volunteers who receive some services in exchange for their work.  We have a rotating directorship – I’m one of the current co-directors.  This year we’ve also entered into a relationship with a fiscal sponsor allowing us to fundraise for some of our work.  Our services include yoga classes and workshops, acupuncture, massage, eastern and western herbal medicine, and an herbal education program which trains students to become community herbalists. Collective members can access each other’s services for free.  This is an investment is our individual and group health.  We offer workshops with topics ranging from partner yoga to boundary setting with healthcare providers.  

We have a sliding scale fee for all services, and for those whose income is below the bottom end, we have community health scholarships that cover care.  All collective members are paid equally on a monthly basis, with directors receiving a flat salary.  We’re invested in creating a welcoming and empowering space for queer and trans people, people of color communities, working class and low income folks, people with disabilities, and all people marginalized by the medical industrial complex as well as the elite spa environments of NYC.  Our collective keeps the issues of these communities alive by having trainings on topics like disability justice and fat justice.

We have our challenges.  Educating ourselves to be allies against particular oppressions we may not actually face individually is a process.  Only some of our space is accessible to wheelchair and scooter users.  We still struggle to make a living wage, though we get closer to it as time goes on.  It can be a different kind of challenge to gauge one’s capacity when there’s no boss.  But it’s all worth it to work in such an empowered way, and to be valued for the healing work do.  Practice models like ours are part of what I think can transform both holistic and allopathic systems of healthcare for the better.

I joined Third Root two years ago and feel that it’s been some of the best work of my life with a group of people who challenge and inspire me, and a model of working that actualizes regard and love for the people being served as well as the people providing the care – and so often those are the same communities.  Part of the grace of this work is recognizing that.

I want to take a step back and answer an unspoken question: What does this have to do with trans health specifically?  I’ve been struck by how often when I hear about trans health as a topic in different media, studies, reports, etc., what’s being referred to is gender confirming surgery, hormone therapy, and the means to access and adapt to them.  While these are pertinent needs for some of us, they aren’t for us all, and even when they are our lives inevitably encompass health needs far beyond them.  My trans patients certainly come to me post-surgery for wound healing and detoxing from anesthesia, as well as balancing the changes that come with hormone shifts.  But much more often trans folks are coming to me with anxiety, depression, emotional trauma, migraines, and physical pain.

We all know that trans people experience a high rate of personal and systemic oppression, but this becomes much more prevalent when discussing those of us with layered, intersecting identities.  The effects of this oppression manifest in conditions ranging from hypertension, addiction, and eating disorders to chronic pain and autoimmune dysfunction.  The primary way that holistic traditions can support the health and wellbeing of trans communities is that they inherently recognize the individual within the context of their whole life and being, including all their intersecting identities, allowing the practitioner to address issues on multiple fronts.  I don’t treat hypertension, addiction, and eating disorders – I treat people dealing with them.  This means getting a full medical, social, and emotional history; paying attention to the way the patient talks about the illness, including how they cope with it now; completing a physical exam of affected bodily areas, including pulse and tongue diagnosis; developing a treatment plan; giving the treatment; and developing a follow-up plan in the first visit.  This is the standard in acupuncture assessment, evaluation, and treatment.  What that means for me is that I’m a primary care and general practitioner in the sense that patients bring everything to me, often before they bring it to others (including serious infection, sprains and fractures, and concussions – all things that allopathic medicine is better suited to treat) and I refer them out as needed – though many can’t access the allopathic care they know will put them in serious debt when they don’t have health insurance, and many don’t – in which case I do the best I can for them without major institutional support, reaching out to community members as a resource.

We know that there are high rates of violence against our community – particularly against young trans women of color.  I often wonder why this violence isn’t acknowledged and addressed as a major public health issue at venues like this conference, and beyond.  It could be because it most impacts the more disenfranchised in our community.  Maybe because our lives are counted less valuable when we’re black and brown, when we’re poor, when we have immigrant status, and when we’re transfeminine.  I could add young and elderly to that list, as well as disabled, and more.  But one thing that’s absolutely clear is that our power and privilege factor in hugely in our access to respectful care and physical and emotional wellbeing.

It’s important for us to remember that our power and privilege in this world aren’t static, but as varied as all our intersecting identities, and can change for many reasons.  (As a person of color I experience some forms of racism, but carry light skin privilege as well.  On the other hand I bear the brunt of fat hatred because that’s what’s most generally apparent to the world about my body – but that shifts when I’m in different spaces, countries, conversations, and furthermore my gender itself is flavored by the fact of my fatness, having grown up working class, and having a disability, etc.)  Our gender is flavored by power and privilege, particularly when it’s shifting or emerging.  I’m often struck by how in our larger community there’s often much more space taken by white, middle class, erudite, transmasculine voices.  And in my own communities I see many of these folks moving through the world unaware of the fact that they have more privilege in some ways (not all ways) than perhaps they did before transitioning.   

That privilege can take the form of monopolizing the language used to talk about all of our lives, history and work for liberation, can narrow it so it only belongs to some of us and others don’t get heard at all.  I’m interested in supporting a trans power movement that understands it’s inherent interconnection with other liberation movements, because trans people are also poor and working class, women, queers, people of color, survivors of violence, youth, elders, immigrants, people with HIV / AIDS and other chronic illness, and people with disabilities.  We need to do conscious work as a community to have all our identities recognized and welcomed – not just allowed – at the table.  And that’s where trans health and wellbeing truly begin to be fed.

Doing this work also means cultivating healers and leaders that represent the real diversity of trans community, and holding our educational and health institutions accountable to that need.  I want to be able to refer my patients to trans nurse practitioners, doctors, midwives, and naturopaths.  Of course we need our allies to take on these roles as well, but we’re limiting our movement for trans health justice if we’re not growing those healing roles within our own community.  This goes beyond encouraging individuals to pursue these professions, and into making the paths that lead to them accessible.  We need centers of training and education to be affordable, and the institutions that develop health professions to recognize trans people and address our layered health needs – and prioritize putting trans people, particularly women and people of color, in charge.  

And when we finally get into practice, whether trans people or cisgender allies, holistic providers or allopathic, we need to have practices that are accessible economically and welcoming socially.  Allopathic providers need to rock the boat and build a better one that carries more passengers.  Some of you out there have been doing this work for a while, and I really encourage you to be open resources to each other in challenging the medical industrial complex that shuts so many of us out.  Holistic providers need to stop charging flat fees that go upwards of $90 – $130 (the standard rate for a private acupuncture session in NYC) and wondering why trans folks don’t come to you or don’t come back.  Stop pricing out your own people!

Find practice and delivery models that are sustainable for you and your community – or develop new ones like the founders of Third Root did.  Take ideas and inspiration from social justice movements like the Black Panther Party and the Young Lords, the Zapatistas, and the Occupy movement.  The old, broken healthcare systems aren’t compulsory.  There’s great possibility beyond them, and people ready to do the work with you.  One example is the community acupuncture movement – a treatment model in which people are treated together, in the same space, without barriers.  This allows for the creation of tremendous healing energy, the possibility of being treated with your friend, spouse or family member, and still offers privacy when needed.  A community-style practice allows the practitioner to charge lower, more accessible fees, and consciously breaks the isolation so many people experience when ill, or in pain and seeking healthcare.  

Over the course of this year I became a patient, not for the first time certainly, but in a way that altered my life.  The knee pain that had first emerged years ago from a martial arts injury got steadily worse over the winter of 2012, and instead of improving with the warm weather of spring and summer, just continued to worsen.  I received holistic care at Third Root, but it was hard to have it regularly.  Over time I was diagnosed with severe osteoarthritis by an orthopedist who didn’t look at me, but at my chart.  When I forced him to look at me by interrupting him, introducing myself and sticking my hand out to shake, he seemed startled and angry to see my body.  He, like almost all allopathic providers I’ve been to and some holistic providers as well, saw my body as a disease – as does mainstream society.  You would think fat people filled his waiting room, but I was the only one.  I looked out at the average-sized people in the chairs and wondered what he blamed their pain on – or maybe they were deemed innocent. This is nothing new.  Fat people are considered sick, and attacked for our sickness.  This vitriol continues while a 60 billion dollar weight loss industry courts us as consumers of weight loss interventions that fail 90% of the time – and then the system blames that failure neatly on us and tells us we have no recourse but to try again.  That doctor left the room after grudgingly giving me a prescription for physical therapy, and never once touching me.  

I just want to note here that it’s not my intention to portray allopathic medicine in only a negative light.  I’ve had two wonderful doctors in my life who’ve been hugely supportive, as well as doctor and nurse practitioner friends doing vital work, and I’m excited by the training that happens in spaces like this to support allopathic practitioners working with trans communities – but there’s a lot out there that’s not centered on the individual, that’s profit driven and marginalizes us for the bodies we live in, and I feel the need to name it.  These attitudes are also not exclusive to allopathic medicine, and can often come from holistic healers.

The health paradigm I faced, often un-named and unchallenged, goes like this – if you hurt you must have done something to cause it, or it’s all in your head; your body is a problem, until you change it you won’t improve (as if a body were a suit of clothes); I know what’s best and if you don’t follow my regimen or return to see me you must not be ready to get better.  If you’re not getting better in any case, it’s because you’re identifying too much with your illness and not ready to let go of it in your life.  Does any of this sound familiar?  I recognized it well enough from the other side – from patients telling me things like, “I was stupid and pushed too far” or “I was bad and ate pasta” as well as the questioning: “What’s wrong with me, what am I doing wrong that I feel this way?”  All damaging messages that I could see them internalizing and actually adding to their dis-ease.

Of course our actions can impact our health greatly, but they exist alongside the combined realities of luck and circumstance, genetics, our country and place of birth, access to clean air / water / food, race and ethnicity, gender, sex, sexual orientation, income level, access to respectful and relevant healthcare, and freedom from violence.  This is why healers in our communities need to be activists – because health and illness always exist in a greater context. And as providers when we consider how “healthy habits” like diet and exercise are important we need to hold them up alongside life purpose and meaning; relationships and social support; humor and play; and building emotional resilience – things that we can help our patients cultivate by working in partnership with them, empowering us both.  

Challenge body and gender norms.  Consider the effects of fat and body hatred on people and promote an attitude of body liberation – people of all sizes can cultivate wellness.  So don’t stigmatize people for their bodies and challenge colleagues who do.  Have a holistic approach (which any of us can do) and consider the patient in front of you in all their layered aspects.  Recognize that people are the experts in their own bodies and lives, and that your expertise as a provider can be used to enter into a partnership with them, versus a top-down authoritarian relationship.

I still live with pain on a daily basis and am navigating both allopathic and holistic medicine as a patient.  I now have a disability and am unable to stand or walk very far at all.  I have physical therapy twice a week and will be returning to regular acupuncture treatments and massage with my colleagues at Third Root.  I’m privileged to have access to both holistic and allopathic support when so many don’t.

Breaking isolation and finding amazing communities of people living with pain and chronic illness, and meditation which helps me integrate the experience of change are practices that bolster me up greatly.  Remembering that I’m in charge of my choices with the support and guidance of people I trust is empowering.

And what’s making the biggest difference for me in dealing with pain and mobility limitations is regularly reminding myself that they are not a punishment, and recognizing the various ways I’m taking care of myself.  This means actively countering the same damaging internalized messages many of my patients carry with them.  So we do this work together, and that feels just right.  My teacher Jeffrey Yuen used to talk about how practitioners need to take care of their own health needs in order to help others.  Some of my classmates took this to mean that one had to be in a top state of health – including perfect diet and fitness – as if wellness were black and white, in order to be a healer.  But I believe he was talking about the need to be actively engaged in our own care, in order to give care – an interdependence of healing.

Many of us are thinking about Leslie Feinberg today, who is going into hospice care at home. Leslie wrote yesterday, ‘My goal is to survive hospice. But I set out to do so with this reminder: illnesses and deaths are not personal failings. Nor is hospice a surrender.’ As healers and people we need to support the choices of those dealing with serious illness, and recognize the empowerment that can grow, even through dire experience.

I come back to my grandmother, Louisa Pena Rodriguez, who was never depleted by offering her family care because she was able to ask for and accept it for herself.  In the end there was little separation from her healing work and her life with the people she loved – they were interwoven.  All these years later her grandchild is working a lifetime to relearn that lesson every day.  Thank you all *

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