Dr. Lindiwe Sibeko is no stranger to waiting.
During her long career serving vulnerable communities as a nutritionist and health promotion expert, she learned some valuable lessons about being patient. She still remembers how long it took to build trust with the high-risk, low-income population that was the focus of her community health work. And she gained firsthand knowledge of the bureaucratic and interpersonal challenges that can delay or complicate positive health outcomes among marginalized populations.
“You have to have patience, and you have to be authentic,” Dr. Sibeko observes of her experience working with vulnerable families. She has always gravitated toward under-served communities, in locales as diverse as Kingston, Ontario and Cape Town, South Africa.
During her years as a practicing dietitian, Sibeko frequently sought ways to address the most persistent challenges encountered by low income families. As one of CRF’s Family Research Scholars in 2015-16, she turned her attention to the “abysmal” infant mortality problem that persists in Springfield, MA.
Springfield suffers from an “unacceptable infant mortality rate, given that Massachusetts is one of the richest states in the country,” she says. “There’s a pocket of individuals suffering a persistent health inequity that is egregious and indefensible.” African American infants in Springfield are dying at rates that are greater than twice that of their white counterparts.
“The evidence says that if breastfeeding is brought into this community, it might change these infant mortality numbers. It is time to have the system as a whole take action and provide all women with accurate information on infant feeding, and to make an effort to support all women who decide to breastfeed,” according to Dr. Sibeko.
With her background in health promotion, she is eager to incorporate the latest research into a community-driven and institutionally supported plan of action. She knows, for example, that prenatal programs which encourage and support breastfeeding have a tremendous impact in improving infant health outcomes—particularly among populations with historically lower rates of breastfeeding, like the African American community.
Sibeko’s FRS research is focused on increasing breastfeeding rates of African American mothers in Springfield through the development of a community-based participatory research (CBPR) intervention.
“The African American community is a resilient one—dealing with a variety of inter-generational challenges—a community that knows how to navigate their environment, despite systemic racism. You cannot come into this environment and tell the community what to do,” she cautions. “There are African American women in the community who have breastfed successfully. We can learn a lot from these mothers by forming a partnership that encourages dialogue between providers, researchers and women who have lived experience of how to breastfeed successfully within the context of their environment.”
Sibeko believes in harnessing women’s experiential knowledge to help facilitate health behavior change. She also feels that too often families vulnerable to health disparities are viewed only from a deficit perspective, with research focused solely on lack. The danger in this limited perspective is the development of interventions that traditionally bring about minimal change, do very little to narrow the inequality gap and result in persistent health disparities. However, through a CBPR approach, assets within the community can be capitalized upon, and thereby help guide the institutional and environmental changes that need to take place in order to support important health practices like breastfeeding.
“The guiding process should focus on participation. ‘What can we do together to help bring about change? Tell us how to make this happen within the context of your lives,’” she says.
According to Dr. Sibeko, “Participants in the CBPR approach have to be able to embrace this process, be comfortable with the truth, and be patient as trust is built among all those working together. Then, we must follow through with the workable ideas people bring to the table.”
Dr. Sibeko knows from experience that these strategies will work, even if it takes time to connect with all the participants. Prior to her arrival in Massachusetts, she was employed at a community health center in Canada. There, she blended the latest research with community mobilization strategies—borrowing from other successful community health interventions to promote early prenatal care and healthy family practices among adolescents.
She explains: “Most of the families I worked with were from low-income households, female-headed and with a high number of unemployed.” The program was an overwhelming success, due to its ability to successful partner with young mothers in the development of the early prenatal care program. “The program resulted in numerous positive outcomes. The most memorable for me was improving from an undetectable breastfeeding initiation rate ... to a rate of about 80% of the mothers ,” Dr. Sibeko recalls. These were mothers who had never considered breastfeeding prior to the program. Health Canada adopted the program as a standard of care for reaching teenage mothers, developing a toolkit that was eventually used across the country.
“What I began to understand, through using approaches like community mobilization and community development—which are time-consuming processes—we could go a little bit deeper and reach the people who really needed the services in a meaningful and effective manner”.
“I always believed that part of my work was to understand the real issues that contribute to the persistence of health risks in under served communities, and to understand that solutions are more sustainable through self-determination pathways” she says. In order to effectively promote healthy behaviors, “you have to value experiential knowledge.”
“If you can find the people who ‘made it,’” she says—as in, the people who have “found a pathway to survive and thrive within a setting of social injustice or profound health inequities”—they will serve as trailblazers for other mothers. In the process, they can help bring an understanding of the “constraints and barriers that exist in making changes in their lives, and what structures or systems would make it helpful.”
Establishing rapport with providers and other governmental agencies is a crucial second step. This is necessary to start “tweaking the system” and to build capacity to aid the population that feels “disenfranchised from the healthcare system, [and] feels that there’s profound racism in their access to healthcare.”
In 2013, Sibeko brought her wealth of experience to the University of Massachusetts Amherst. She is currently an Assistant Professor of Nutrition and an Extension faculty member.
Extension faculty at UMass inhabit a unique role, according to Prof. Sibeko. Historically, “UMass Extension has a rich history of reaching out and providing education and services to stakeholders in the commonwealth,” she says. At UMass, the Center for Agriculture, Food and Environment has spearheaded Extension faculty positions, across disciplines, that are “designed to generate research scholarship that can be translated to meet stakeholder needs.”
Sibeko was drawn to UMass, she says, to “integrate research with education and outreach to address nutrition related health inequalities of low-income and racial and ethnic minority families in Massachusetts.”
And, according to Dr. Sibeko, there is one more valuable lesson about patience that she has learned: how gratifying it can be to make a difference in the fight against persistent health disparities and socioeconomic inequality—even if it takes a while to see the results. This, says Sibeko, is the key to help struggling communities. “There is an injustice in allowing health inequalities to persist. We need new strategies to help bring about change. Providing accurate information on the impact of breastfeeding on mothers and their children, and supporting all women who choose to breastfeed, is absolutely an attainable goal.”
Since 2003, CRF has offered the Family Research Scholars Program, which provides selected UMass and Five Colleges faculty with the time, technical expertise, peer mentorship, and national expert consultation to prepare a large grant proposal to support their research.