AYESHA RASCOE, HOST:
Dr. Mary Fariba Afsari is a practicing OB-GYN in Portland, Oregon. In 2022, she felt like the health care system was broken and started to dream about reinventing how she did her job. So she walked into Camping World and bought an RV.
MARY FARIBA AFSARI: (Reading) My friends and family, all more business-savvy than I am, had many questions to which I did not have answers. A clinic like the one I envisioned did not really exist. Who is going to want to see their gynecologist inside of an RV? My mother didn't understand who would drive the 31-foot clinic. I'm going to drive it, I answered her question over the phone. You know how to drive an RV? She was incredulous.
RASCOE: Afsari's new book recounts this professional journey, and also her search for answers about her family's past in Iran. It's called "Labor: One Woman's Work." She joins us now from Portland. Welcome.
AFSARI: Hi, Ayesha.
RASCOE: Let's start with the RV. Twenty years into your medical career, and you decided - I don't want to say to blow it all up, but to do something totally different. What did you feel like you could do out of an RV that you couldn't do in a hospital or a traditional doctor's office?
AFSARI: What I wanted to do was create a space where I felt we could take ourselves - those of us who are practicing specialists in obstetrics and gynecology - literally drive ourselves to a community that needed practitioners, pop open and see folks the way that we see them in our offices. And I thought, well, I think the only way to do this is inside of an RV. I realized I needed running water and a toilet and space for people to check in and have exams in the back and feel safe.
RASCOE: You call the mobile clinic a joyful F-U to the medical system. What do you mean by that? And is that particularly about the overturning of Roe v. Wade?
AFSARI: I think it starts much earlier than that. And when I say that, I'm not trying to be pejorative to folks that work in the medical system. I come from a family of physicians, and I have watched how the medical system has transformed itself from being a profession based on service to becoming a profession that's really focused on bottom line. So when I say it's a joyful F-U, what I mean is that I want to bring the joy back into providing this care that I came into the profession to do.
RASCOE: You spent your early childhood in the U.S. and Iran. And in kindergarten, you're back living in California, and your parents told you they were renaming you and your brother. What happened?
AFSARI: Yeah. I mean, I think it's a common story for kids of immigrants. We were named with traditional Persian names. My birth name is Fariba, and that was the name that I was called for the first few years of my life. In California in the late 1970s and early '80s, every single day on the news, we were hearing about the Iran hostage crisis. And I think in order to protect us from what we might face just from our names alone, our parents decided to name us some of the most common names in the United States, and so I was named Mary.
And what happened later is I learned that my grandmother's name had actually been Mehri. All of a sudden, and this wasn't until I was late into my 20s and 30s, that I learned that I actually had a grandmother in Iran who unfortunately died at a very young age. But I became connected to her, and she actually created a little bit of an obsession in me.
RASCOE: As you said, your grandmother died young. And tell us what you learned about her death, but also what that journey meant to you - why it meant so much to you to find out what actually happened.
AFSARI: Yeah. I mean, it was so interesting for me 'cause I was about 10 years into my career as an OB-GYN. And I chose OB-GYN because I want to provide care for mothers. I went into it for a love of taking care of those patients and for a love of the profession. And it seeped into my consciousness somehow that my grandmother had died during a pregnancy. And now I was an OB-GYN, and I didn't understand what she had died from. I was an expert potentially in what had killed her, and yet I didn't know what that was. And so I started asking family members, and nobody really had a great answer for how she had died. And so I tried to figure it out myself, and that sent me on this journey.
RASCOE: You do take readers inside the delivery room with you, in the operating room, in some really harrowing situations. And it's very jarring and, you know, scary. That's what it felt like to me.
AFSARI: When I tell people I'm an OB-GYN, there's usually a great deal of excitement. I'm usually met with a lot of joy. Like, wow, you bring babies into the world, and that is just amazing. And people have an idea of what the work looks like. And they're not completely wrong because most of the time things go well, and we are welcoming new life and families. It is a celebration. But when things don't go well, they can get very, very hairy and intense. And the life of young women - mothers - and the babies are at stake, and this is a minute-to-minute decision-making situation. So when I tell those stories, the point was to bring people behind the curtain with me because it is so essential for us to understand why obstetric care and why access to care is so critical.
RASCOE: You know, you talk about - you were on a road trip and out of cell coverage when the Supreme Court overturned Roe v. Wade, ending the constitutional right to an abortion. How did that decision change your work or your perspective on your work?
AFSARI: I happen to be in Oregon, and so we're in a state where we're able to continue to provide standard of care - how we were trained - in order to ensure that people get appropriate care at the appropriate time. But right next door in Idaho, that is not the case. And that is how, since the Dobbs decision, it has seeped into our lives. So the receiving, not just of potential, you know, women who need lifesaving care and are having difficulty accessing it in their states. I mean, that's, like, a logistical issue. But the distress of our colleagues in those states who are not able to provide the actual care that we were trained to provide is the hardest part to witness. The fact that my colleagues are being criminalized in other states simply for trying to provide lifesaving care feels like a nightmare.
RASCOE: The book is called "Labor," and I have to ask you - how do you view the laboring process? Because it is joyful. I was very happy to go into the hospital and have my three. But it was also scary as heck. So how do you think about labor?
AFSARI: I mean, I was pregnant with my second daughter, and we were getting close to my due date. And I remember looking down at my giant belly and feeling this life moving inside of me, and I couldn't believe that it had to come out of me somehow. I just - I didn't want that to have to happen. But I also knew there was no alternative. Like, she had to be born, right? And there was no easy way.
There is actually no easy way for a baby to be born. Like, whether it's, you know, out the canal or through an incision in the belly, like, they all come with risk. They all come with bleeding and pain and a lot of fear and anxiety. And, yes, the outcome is often quite joyful. But the way that I think of labor is it is a complete minute-to-minute unknown. And there's something very exciting about that, and there's something also quite nerve-racking about it. I mean, it is a constant process that we are addressing in our country today because we have a high morbidity and mortality rate even in this country today.
RASCOE: That was Mary Fariba Afsari. Her book is "Labor: One Woman's Work." It's out this week. Thank you so much for joining us.
AFSARI: Thank you, Ayesha.
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