Much has happened since we first wrote our Self-Help Clinic article last summer E.W. July, 1971. At that time, under Carol Downer's direction, we had been meeting for about four months evolving a concept that would have far reaching effects. Since early spring, first working within women's liberation cell groups, then expanding to community women's church groups, Y.W.C.A. groups, and then taking the concept across the country, we are pleased to announce that over 2,000 women (including a group in London, England begun by a Connecticut Self-Help sister), have been introduced to self-examination and the Self-Help Clinic concept. Little did we realize that first night when we all agreed to confront our physical hang-ups in a physical way, that we were all to share real sisterhood in a very meaningful way. Our grandmothers and great-grandmothers knew well the meaning of sisterhood. Mothers, daughters and aunts would meet together to share their womanly experience and be ready to help one another through their physical crises. Since grandmother's time, we have lost the closeness of sisters' experiences and helpful hands. This, along with being denied access to modern knowledge, has left us without knowledgeable good preventative health care. The Self-Help concept of self-examination is based on this reintroduction of sisterly sharing of experiences and knowledge in a commonsense, honest manner. Collective knowledge used within close sisterly groups that we call The Self-Help Clinic, have already had positive results as valuable preventative health care measures.
The Self-Help Clinic consists of 3 meetings; usually an evening a week for three weeks. These meetings deal primarily with learning self-examination with the help of all the sisters in the group. This is a very meaningful sharing experience for all, since we learn what is normal by having the opportunity to examine many women, under well-conditions. Occasionally we will have a sister who has a more serious problem and having caught it within self-examination, is encouraged to seek professional help. The Self-Help Clinic provides the opportunities for women to confront the many myths, misconceptions, and misinformation that we have been fed our entire lives. Being able to examine ourselves in a group situation gives us the first real concrete opportunity to compare the "text book" with reality. This is also the time when we learn to recognize cervical cap changes (in color, tone and other signs) in one another. Each woman during the first session has learned to insert her own speculum for the self-examination procedure and keep this speculum for continuous use. We also learn to give bi-manual (two hands) pelvic examinations by the 3rd evening. Looking at diagrams of our pelvic organs and being able to touch them and know their structure manually, gives us a far greater understanding of our bodies. We also spend the sessions reading and discussing a variety of written material, much of it brought in by the members of the group. We use the Birth Control Handbook as a major source for discussion and reference.
One major learning skill we have readily available is being able to recognize what is "normal". Since the meeting are primarily for women who want to learn about their own bodies, we have the perfect opportunity to see many, many normally healthy women. Contrary to clinics' and physicians' experiences (they have been trained and continue to work with patients suffering with some kinds of symptoms of illness), we are in the most fortunate position to learn to recognize what is a well-woman. By being able to recognize what is well and normal, we are better skilled to recognize that which is abnormal. It is interesting to note that Dr. Donald Ostergard of Harbor General Hospital in Torrance, Calif. * has been medical director for a similar program providing "book" and clinical training for women with similar non-medical backgrounds. His findings show that non-medical personnel with a high percentage of accuracy, can recognize deviations from normal. For example; Vulvar lesions, 89%, breast lesions, 85%, vaginal well muscle breakdown, 90% plus, uterine and surrounding structural abnormalities, 90%, antiflexed (elbowed backward) uterus, 90% plus. These are very high percentages of accuracy. Dr. Ostergard explains that his family planning patients are generally well patients who have come into the clinic for birth control information. His training program for the women paramedics stress normal breast and pelvic examinations. When a deviation from normal is found, the patient is referred to the physician. It is not important that the trainee recognize the exact nature of the abnormality. Dr. Ostergard's findings agree with our Self-Help Clinics' similar opportunities for well-women examinations: Women with varying non-medical backgrounds with sufficient training opportunities for examining well-women, can effectively recognize abnormal conditions.
How much better off we are, being able to recognize the unusual and to confidently make arrangements to get professional help; compared to remaining in ignorance until our problems have progressed to the point of seriousness and possible permanent damage. The Self-Help Clinic concept also helps us learn to take better overall care of our bodies. We stress breast examination and strongly encourage yearly Pap smears for cancer detection. We have found that, just like a sore throat, when we recognize an early infection or inflammation, some kind of personal care which includes lots of rest for our body, often connects the problem.
The Advanced Self-Help Clinics
One of the most exciting outgrowths of the Self-Help Clinics is in the development of advanced groups who have dedicated themselves to implementation and research. These groups feel that it is time that we women do the deciding on what we want in research areas on better health care for women. A large number of these women are guiding new Self-Help Clinics, sharing their experience with newer sisters to the concept, as well as perfecting their paramedic training skills. Quality libraries with up-to-date material and references on research into women's health needs, is another area of implementation. Another advanced Self-Help Clinic has published our "Ho To Start Your Own Self-Help Clinic" booklet which is available to anyone or groups interested in starting a Self-Help Clinic. There is presently a sizeable number of advanced, very dedicated and brave women who are determined to research out the possibilities of menstrual extraction. Let us here, clear up any misconceptions involving the experimentations being done within these advanced groups. And that is, menstrual extraction is not a euphemism for abortion. When the Self-Help Clinic means abortion we refer to it as abortion. This is a most important point. Our advanced groups must not be misrepresented if they are going to continue to work effectively for all women. These dedicated women, working and learning together are providing valuable information in the skills of menstrual extraction. Most of them seem to quite comfortable extract on the first day of their flow. We are told that a policy of these groups is that at no time is a sister allowed to experience discomfort. We are also told that it is almost unnecessary to mention the need for caution and gentleness, although both are major considerations in every case. Caution and gentleness seem to be almost instinctive.
While working within one of the advanced Self-Help Clinics, Lorraine Rothman found that the device that the group was attempting to use at that time needed vast improvement. It consisted of a simple syringe specially constructed to hold vacuum by the pull-back plunger; some plastic tubing; and a specially constructed small bored flexible cannula. (Neither the tubing used in manufacturing the cannula nor the finished cannula are available through laboratory or surgical suppliers. It is specially made by a large bio-instrument manufacturer and sold for a very high price.) Lorraine decided that since the syringe fell apart so easily causing air and fluid to back up into the uterus, she would devise another that would, 1) Provide a portable and continuous vacuum without back up worry, 2) Provide a syringe that need not be specially constructed, and 3) Provide a by-pass collection bottle which is a must since menstrual flows vary from woman to woman. She also realized the need to have ready access to the specially manufactured high quality, semi-flexible cannulas. They cannot be purchased at local lab houses, standard lab catalogs, nor can they be improvised out of the hardware store or drug store supplies. Lorraine's invention, tagged "Del'-Em", presently has a patent pending in hopes of keeping it within the women's movement as well as to encourage other women to put their heads and hearts to work for the movement. The semi-rigid cannula, which is a critical component of Del'-Em, when chemically sterilized, can be inserted through the undilated cervix. The cannula will bend to conform to the uterine walls without breaking or losing its flexibility and yet is not hard enough to damage the uterine lining. In addition, the cannula bore is large enough to facilitate removal of the menses. The research in these advanced groups is conducted under the guidance of medically trained personnel within clinical settings. They learn hospital and clinically acceptable sterile techniques under careful guidance. They also have access to the specially built cannulas and use only them. The women examine each other carefully to determine whether the procedure of menstrual extraction is safe for each. In this way they learn that a select group of women are eligible for the procedure. The following conditions, which are screened very carefully, are ineligible: Retroflexed (elbowed backwards) or antiflexed (elbowed foreward) uteruses, serious infections, polyps, extensive scarring, endometriosis and double uteruses. The Advanced Self-Help Clinics have also found that there is no way for a woman, by herself, to know her exact uterine conditions. Sisterhood is Safety: Safety is Sisterhood. In addition, continued research with Del'-Em indicates that group experience, knowledge, cooperation and sisterly concern improves the kit's efficiency. It would be irresponsible, here, to give step by step written directions in menstrual extraction. Just as in learning to sail a boat, it can't be done just by reading a book. It takes a seasoned sailor along to instruct with a properly outfitted vessel. The Advanced Self-Help Clinic groups, some of whom have been experimenting with Del'-Em for almost a year, know by personal experience that if this movement is to succeed, it will-only through SISTERHOOD. Groups of sisters learning from sisters and helping other sisters to fully realize their control over their own bodies is a very meaningful and workable concept. The idea of a "kit in each woman's private bathroom" is anti-sisterhood and anti-women's liberation. By being a select item for one woman only, within the confines of her own four walls, and without the collective help and support of her sisters, everyone and especially the movement looses. The concept of Self-Help stresses Sisterhood that makes possible the benefits from collective knowledge, collective experiences, collective training and especially the sisterly concern for one another. When it is necessary to travel for more extensive experiences or information, we do. Lastly, the Self-Help concept emphasizes competent medical backup and the use of safe equipment at all times.
We are seeing, today, unbelievable gains springing from this movement of sisterhood. We also forsee that it will take continued dedication by all sisters, vast investments of time, motivation, enthusiasm, and $$ for this movement to succeed. Throwing off the oppression of centuries takes total commitment and sisterhood.
The West Coast Sisters
* "Family Planning and Cancer Screening Services as Provided by Paramedical Personnel, A Training Program", by Donald R. Ostergard, M.D., AM. Assoc. Plan. Parent. Phys., Kansas City, Mo., April 5-6, 1971.
* "Family Planning and Cancer Screening Services as Provided by Paramedical Personnel, A Training Program", by Donald R. Ostergard, M.D., AM. Assoc. Plan. Parent. Phys., Kansas City, Mo., April 5-6, 1971.
