Tag Archives: women

A Lesson in Cultural Sensitivity: Assumptions

Last week, my team and I learned a valuable lesson in cultural sensitivity. Having traveled as much as I have and having been in many situations where I have been privy to privileged information, I considered myself to be well versed in culturally sensitivity. However, as I have learned countless times in essentially every aspect of life, there is always space for improvement and a seemingly endless stream of lessons to be learned.

Focus Group

 As I am currently in India studying a highly sensitive topic, in planning my research, I attempted to make every effort to ensure that my data collection was appropriate and inoffensive. I have spent years rearching this facinating culture but despite my research on these topics, I still had a lot to learn being on the ground interacting with women. Before leaving, I felt like I was constantly debriefing my team members on what to expect with Indian culture. We set up focus groups with Community Health Workers (CHWs) to refine our questions, piloted the final result, and asked our questions with well-educated Telugu translators. I knew that the women in villages would be too embarrassed to discuss their menstruation habits with men, so I arranged to conduct interviews with the only female translator that was available. The other members of my team, both male, interviewed CHWs and, unfortunately, had to take a male translator.

 

Hut in a Village

 This is where we made our first mistake–the assumption that because the CHWs interact with both male doctors and men about sensitive health information, that they would feel comfortable talking about the menstrual health habits of women in their villages with a male American medical student. However, the questions asked were still too sensitive and the situations in which they were asked brought embarrassment to the CHWs. On our first day, at the suggestion of our male translator, the male portion of our team interviewed the CHWs outside their home. The translator had a very loud and projecting voice and he spoke so loudly that I had to send my translator out from where I was interviewing to ask him to speak quietly. The next day, we realized that these questions needed to be asked in a private environment and, with the intense heat (110 F +), again at the suggestion of the male translator, this team decided to interview the CHWs in a private, air conditioned car. In making this decision, no one considered how this would appear to the villagers, and we neglected to think of having a female chaperone.    

In both of these situations, our team attracted attention to our project. As we are discussing such a sensitive and taboo topic, much of the attention that we drew was negative. In a society that is unfortunately dominated by males, the husbands of our interviewees interrogated their wives and became angry at us for asking their wives such sensitive questions. In retrospect, I see how someone might be offended if a group of men took another man’s wife into a private vehicle and asked whether she or the women in her village wore underwear… Sometimes it takes this sort incident to shift the lens and change perspective.

Some of the questions themselves that we asked were offensive. For example, we were interested in finding out about the villager’s and CHW’s general knowledge of menstruation. We quickly found that no one knew anything about the physiological process of menstruation and that this lack of knowledge made them feel uncomfortable. One question in particular, asking about the origin of menstrual blood, was extremely offensive. Even a seemly innocuous question—a question about which religion our interviewee followed–was met with extreme discomfort. Unfortunately, this question was misunderstood by the villagers, who thought that we were asking about their caste.

Unfortunately, we did not know that any of this was going on for our first two days of interviewing–we were at the mercy of our translators. We had made yet another assumption that our translators would translate the full responses, including the discomfort and the scolding that apparently went on in some of the interviews. We only learned of the trouble we caused when it was large enough to inhibit the study’s progress. One evening at dinner, we were told that the CHWs were calling each other and saying that we should not be allowed into their villages, as we were asking “bad questions”. We also were told that the husbands were particularly angry that we were asking their wives such sensitive information, and that if we proceeded with the study as is, we could be met with violence in some villages. I think that this lack of communication was due to the fact that our translators, who were also our hosts, felt obligated to proceed with our faulty and insensitive study, as they did not want to offend us. Having worked closely with people in this part of India for the last two and a half years, including one of our translators, I regretfully should have anticipated this issue and should have spoke with our translators more about giving us “bad news”.
 

Esther and BeBe (CHW)

 After learning this unfortunate and surprising news, we were all understandably upset. After all, we came to India in attempts to help alleviate some suffering, not to cause further discomfort and suffering. I felt (and am) responsible for the discomfort caused and couldn’t help but think that I could be responsible for episodes of domestic abuse, which is horrifyingly all too common in the villages. I retreated to my room, where, between several episodes of crying out of frustration and guilt, I began to brainstorm ways to salvage the study. After several Skype calls with friends and mentors, I was able to organize my thoughts and come up with a plan. In the period of about 16 hours (including about four and a half hours of sleep), I shifted the focus of the study, pulled the males (and with them, an important aspect of the study, as I do not have time to do in-depth interviews with all 25 CHWs on my own), and built in the mentorship and knowledge of key persons into the study, getting every question approved by multiple wise and influential women. 

The trouble that we faced happened because we made assumptions. We made the assumption that menstruation was less taboo of a subject, the assumption that the CHWs would be comfortable talking with men about menstruation, and the assumption that our translators would translate our interviewees discomfort and inform us if our study was not well received. As painful and frustrating as this experience was, myself and my team learned important lessons in global health and cultural sensitivity that we will take with us on future endeavors. 

  

Post Interview

  

 Currently, the newly designed study is going smoothly. The women leave the interviews smiling and many wait for all the interviews to complete to take pictures with me or walk me to my vehicle with their children. The CHWs are happy and comfortable, generously offering their home and electricity so that I can have both comfortable and private interviews. So far, my findings are interesting and my mind keeps rolling with new study ideas and possible interventions. In fact, one important finding is that many of the women in the villages suffer from painful menses and cite this as a primary reason for missing work or school. Today, I was able to present information on normal menstruation as well as an intervention for painful menstruation to 22 CHWs at the quarterly CHW training. 

In closing, I learned a valuable lesson in cultural sensitivity and in making assumptions. However difficult, this experience will undoubtedly shape my approach to future work abroad. Luckily, I was able to salvage and reshape the study and look forward to sharing the results in the coming months.

Chalagamari VIllage

New Beginnings (the journey ends)

20130416-104147.jpgMy journey in Asia has ended and I have returned to the United States where I am currently visiting my parents in beautiful Sedona, Arizona (of the countless countries and places I have visited, Sedona continues to be one of the most beautiful and special places that I have ever been. I feel so blessed to have grown up here). In total, I traveled out of the country for six months and 10 days although I could have gone on indefinitely had money and time allowed. What an amazing trip! I spent roughly a month in Nepal, three and a half months in Southern India, one month and a half in Cambodia, ten days in Thailand, and five days in Singapore. I have finally caught up on sleep and have recovered from my long and sleepless flight from Singapore, to Tokyo, to Los Angeles, to Phoenix, followed by a two hour drive north, to Sedona.

In Singapore, people were surprised that I traveled so long—especially when they found out that I did so alone. “Wow!” they would say, “did you have any moments of amazing insight?” “Shouldn’t you have those everyday?” was my reply. And I did. And I still do. But I will say it is so much easier to be “gifted” this wisdom and intense appreciation for life while traveling.

So, of course I had many eye opening experiences on my travels. Far too many to count and probably far too many to even remember! But, they were all meaningful and all served to help me stretch and grow as a person.

Now, what are these insights you might ask?

Firstly, my work in India (especially) showed me something that I already knew—that I need to spend my life working for the improvement of health and happiness in others, particularly women. We women are such incredible creatures and while the world has made enormous strides in helping to better our lives, we still have a long way to go and I would like to be part of this push. Thus, spending so much time with women in need made my conviction that I need to be a doctor even stronger because, as a doctor, I can combine all my passions and, in doing so, do so much more to improve the lives of others.

13919_10200340754134414_1825709756_nSecondly, the world is a strange and beautiful place—and my traveling days are far from over. I had so many beautiful experiences and exchanges that I cannot even begin to capture in words. However, I will try: Eating corn after a long motorbike ride on the side of a dusty dirt road in rural Cambodia while attempting to converse with the seventeen year old girl tending the shop. A little boy using me as his pillow on a bus ride while his grandmother gave me apologetic glances. Stumbling on places of such intense natural beauty that my atheistic mind declares—“Alas! God must exist!” The realization that there is just so much more to discover…

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A morning prayer

Thirdly, the sentiment that I literally constantly felt flowing through my veins of—“How lucky am I?” On my entire trip, I had next to no bad luck or unpleasant experiences. Even when it appeared that disaster struck (the loss of a rented motorbike) redemption followed (it miraculously was returned). I am incredibly lucky to have the opportunities and experiences, good and bad, that I have had and I absolutely love my life. I am incredibly grateful to be alive.

The next portal?

The next portal?

Lastly, the journey didn’t end when I stepped foot on American soil. I feel as though my life is a (nearly) blank canvas that I can fill and consciously create whichever way I choose. I am so lucky to have the opportunity to create the life that I want for myself and plan on taking full advantage of this rare freedom. I will continue to live honestly, continue to grow and expand… I have so much life and learning ahead of me—it will be exciting to see where it all takes me.

Note: I have been asked by several people if the end of my trip means the end of my blog. In case you haven’t noticed, I love writing so the answer is probably not. Anyways, I have at least two more posts about my trip that will come out at some point in the future so look out for those. Also, thank you all for your continued support!

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Blaming the Victim

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The river in Kampot

A terrible thing happened last week near Kampot, Cambodia: the body of young French woman was found in the river. Her body showed signs of sexual assault. Terrified (for I too am a single girl traveling and was in Kampot just a few days ago) and curious about the atrocity, I spoke with others to find out more.

I was shocked and a little disgusted at the replies and opinions of my fellow travelers for they all blamed the victim. I don’t know if they did this out of an unconscious fear for their own safety and a thought that, “well, I’m smarter so this couldn’t happen to me” or if they actually believed their preposterous assertions.

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Sunset on the streets of Kampot

When asking about the details of the crime, I heard several different stories. One person told me that the victim was riding her bicycle, maybe in the evening or at night, when she was attacked. This man commented on how stupid the girl was to be out alone at night and how the rape and murder was “kinda her own fault.” Would I be out on the streets alone at night if I could help it? No, and I am sure that this victim wouldn’t have either (e.i. could this girl have had a flat tire that prolonged her return home into darkness?) because as solo female travelers, we have to watch out for ourselves and realize that the world, however wonderful, has its faults.

Another woman told me that the victim was cycling out to a remote beach to sunbathe nude. Someone might have seen her, alone and exposing her body to the world, and took “the invitation” to rape and kill her. “She was kind of asking for it because it’s really stupid to be naked in rural Cambodia.”

Was she really?

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Canals in rural Kampot

What happened to this poor girl is terrible, under every circumstance. No one is asking to be raped and murdered and dumped into the river. Clearly this girl’s unfortunate end was not of her own doing. It shocks me to hear “open minded” individuals, including women, suggesting that crimes like these are the victim’s fault. Yes, perhaps her sexual assault and murder could have been prevented had the circumstances been different. We will never know. The fact is that men still view women as objects for the taking–completely disregarding their beautiful existence for a few seconds of selfish pleasure.

Shouldn’t men learn self-restraint? Shouldn’t they learn to be human?

Why do we continue to blame the victim?

Note: I have received a few comments that rape isn’t just a few seconds of pleasure. I realize that in most cases it is not and personally believe that rape stems from insecurity. Please read my post titled “Rape: Women and Society in India” for more thoughts on rape.

Redefining Sex-Education

Kama Sutra Statue

Kama Sutra Statue

Unfortunately for India’s youth (a huge proportion of the world’s population), India is afraid to teach her children and adolescents about sex or anything remotely related to sex. Due to this fear, sex-education here is non-existent (even though the majority of sex-education has nothing–or next to nothing– to do with actual intercourse). Thus, the vast majority of Indian children learn nothing about their bodies and how to properly care for them, or even about the changes their bodies undergo during puberty. When India thinks about sex-education, she miss its significance and utility, and instead thinks that her children will be taught the sexual intricacies of the Kama Sutra and other perversions.

Due to the unfortunate title, “sex education,” children all over the world are missing out on learning important and necessary material. Thus, for India and other parts of the world (including the American South), sex-education should be renamed (taking sex out of the name) to something like “Health and Personal Hygiene.” And, as these classes would be of major benefit even without the mention of actual sex, sex could be taken out of the lectures in countries with both conservative thought-processes and conservative sexual practices (the South does not align). This modification would allow children access to pertinent information about their health and bodies.

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The consequences of not having proper sex-ed in the US…

The United States has a very different sexual culture than conservative India (with the average age of first having intercourse at 17, which is much later than I thought) and thus requires a different sort of sex-education class that does involve sex, especially focusing on the importance of safe sex. (Sex education classes need to be catered to the actual sexual practices and culture of each community rather than the conservative thought processes that outline how things should be.) I remember my first sex-education class at the age of twelve while attending a boarding high-school in rural Arizona (as a day student). Luckily for the students (and completely necessary for a boarding school environment), we were all required to attend a gender specific sex-education class where were learned about our bodies (which was a review for most of us, ages 12-18), were shown slides and given graphic descriptions of STIs, and told that if we had sex without a condom, we would both get pregnant and contract STIs. Unfortunately, I still carry those images and descriptions in my mind (it forever destroyed my enjoyment of cottage cheese)…but it worked! Even at the age of 12, I knew that in the future, when I had sex, I would not do so without proper protection.

While perhaps India is not quite ready for such “forward” classes, India is in dire need of something to take its place. While studying thoughts and practices regarding menstruation in India, I came across several shocking journal articles regarding knowledge and beliefs about menstruation. In one study involving girls in the state of West Bengal, India, about 30% of the girls did not know about menstruation at the time of menarche (their first period) and a very small percentage of girls (<10) knew the source of the menstrual blood. Also, a dangerously high number of girls attributed menstruation to such things as curses from God or disease. Studies like these demonstrate this dire need for “sex-education” aka personal hygiene classes where girls are given the opportunity to learn about their bodies and dispel dangerous beliefs regarding menstruation.

The Saranalaya Home for the daughters of prisoners

The Saranalaya Home for the daughters of prisoners

Some of the little girls

Some of the little girls

I have had the opportunity to offer a few of these “modified sex-education” classes smartly titled “Health and Hygiene” to girls in orphanages in Coimbatore, Tamil Nadu, India (with the help and support of the Womens Center). My first class was at the Saranalayam home for the daughters of prisoners. I was originally told that I would be speaking to girls ages ten and up, however, when I arrived I was shocked to see that about half the girls were under ten and many were as young as five or six. As I had planned my presentation around the central theme of menstruation and still really wanted to give the older girls the opportunity to learn about their bodies and how to care for them, I had to quickly consider my options. Do I teach the five and six year old girls about menstruation even though they won’t understand it? Will I scare them if I do? They probably won’t ever have this opportunity again… These were the thoughts running through my head in the few minutes before my scheduled talk. After consulting the nuns in charge of the house, I restructured the presentation so that everyone learned about general hygiene including toilet hygiene, nutrition, “bad touch,” and exercise. The little girls then went downstairs and I spoke with the over ten crowd about menstruation.

hanna 012After the general talk, I noticed that the nuns were shuffling out adolescent girls that should be staying to listen to the talk, leaving me with just a few of the oldest girls. The nuns told me that these younger girls hadn’t reached menarche (though by the looks of it many would within the year) and therefore didn’t need to stay for my talk. With some passionate convincing, I was able to have a few more girls added to the talk. I told them that menstruation was natural and actually a sign of good health (and showed them a drawing of the uterus!), told them things they could try to alleviate menstrual cramps (exercise and avoiding salt and sugar), and about the proper care of their bodies both generally and while on their periods.

hanna 013Next, we had a question and answer session where a nun who helped care for the girls asked me many questions about normality–and thank god not the Foucauldian sort (she was probably in her late 30s, was educated enough to read and speak English, but had next to no knowledge about  menstruation). The girls themselves asked me a plethora of questions regarding menstruation and what was normal, about pimples and shampoo, weight loss and weight gain, how to grow taller, what to do for cracked heels and cracked lips… Everything. It was actually really fun.

I was able to reassure them that menstruation is normal and calmed many of their fears about their own bodies and cycles. I ended up leaving the printout outlining the key points of my talk with the nun. She was very thankful for the talk and ensured me that she would teach the younger girls about hygiene and their bodies as they came of age.

As my readers can see, my talk was completely innocent and nowhere did it mention or even allude to sex. And it didn’t need to. Yet there is a huge resistance to providing education like this as the public believes that it will corrupt and pollute the innocent minds of children. I have several more talks scheduled for orphan girls at different orphanages throughout Coimbatore. The idea is to give these girls lessons that their mothers would be giving them if they had mothers. However, many girls with mothers do not receive this information either because 1) many of mothers simply don’t know, and 2) many people are too shy to discuss such topics with their children. Thus, I am also scheduling talks at English medium schools to both provide wealthier school girls the opportunity to ask questions about their bodies and to show that “sex-education” doesn’t need to be about sex.

Note: This talk at Saranalayam was covered by The Hindu. Yet, you can see from the article that even the media is a little afraid to mention that my lesson contained a modified version of a sex-ed class (no mention of menstruation), but instead labels it as I did–Health and Hygiene.

Rape: Women and Society in India

“Senior Citizen Attempts to Rape Nine Year-Old Girl.” “Widow Gang-Raped in Uttar Pradesh.” “Delhi Gang-Rape Victim as Guilty as Her Rapists, Asarum Bapu Says.” “Two People, Including a Minor, Rape 15 Year-Old Girl.” “Puducherry Prescription: Separate Buses and Overcoats for (School) Girls.” “School Girl Raped and Strangled with Her Scarf on Way to School.” “Dalit Girl Raped by Upper Caste Boy.” “17 Year-Old Girl Repeatedly Raped by Her Father and Brother.”

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One of many recent front-pages highlighting rape

These are just a small handful of the headlines that I have read the last few weeks in the Indian papers. It seems like every morning about ten different rape cases (all equally horrible) appear in the paper. And these are only the cases that the press finds interesting enough to write about in the fraction of rape cases that are actually reported. One of the most horrible cases I read about (besides the Delhi gang-rape case that has received international press) was about an eighteen year-old girl who was expelled from her college for being raped. Apparently, she was “following nature’s call” (there are very few bathrooms in rural India, or in all of India for that matter) with two friends when a gang of men playing cricket noticed the girls and started coming towards them. The girl’s two  friends were able to escape, leaving the girl in a vulnerable position. The girl was captured and then raped repeatedly in a field, in plain view of male administrators from her school (who did nothing to stop it). After the rape, she was expelled from her college for “behaving in-appropriately with men.” This expulsion will prevent the girl from continuing her education at another school.

After returning home that day, her parents questioned her about her injuries and tears. After much interrogation, she told her parents what had happened. She was immediately taken to a doctor who treated her for her injuries and confirmed the rape. She is now fighting the administration’s decision to expel her for being raped (the administration is still arguing their case, insisting  that this girl was acting inappropriately, even when others who witnessed the crime clearly identified it as rape). As this story was one of the few stories to get attention from the press, I hope that the administrators of this school are closely examined and replaced.

(In India, virginity is a prized possession. Women, even after being raped, are fearful to report the crime as they are afraid that their rape will tarnish their reputation and keep them from being married (some Indian men even divorce their wives after their wives have been raped!). Thus, this stigma, along with the inefficient and embarrassing process of reporting rape (in 2012 in Delhi, only 2 out of 600 reported rape cases we brought to trial and many more cases were given up after victims were treated with disrespect by the investigating officers), prevents many women and girls from taking justice against their attackers. And, perhaps most disgusting of all, policemen and family members often encourage the rape victim to marry her attacker, for she is seen as unfit to marry anyone else.)

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After the brutal rape and death of the Delhi gang-rape victim, the Indian public is finally taking a stand against violence against women. Everyone from politicians, men, and women are demanding change, justice, and preventative measures against rape. Unfortunately, their solutions for the “Rape-Problem” are almost as problematic as rape itself. Politicians are demanding that women cover up more than they are already covered, insisting that women don burka-like dress and school girls wear overcoats to prevent leering eyes from feasting on those few inches of exposed skin. One, India is HOT and women are already covered up more than women in most other countries (with the exception of the Middle East and winter in Siberia). Two, “solutions” like this blame women for the misfortune and atrocity of being raped. “Solutions” such as this also avoid confronting the real issue behind rape. Furthermore, with politicians propagating such madness, women will further internalized the culturally engrained notion that rape is their fault. This will then prevent the few women that do report rape from reporting the crime, allowing more rapists to get away with it, finally resulting in an increase of rape. It is ridiculous and embarrassing that elected officials and politicians (including some women!) are spouting off such madness.

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Protesters demanding death by hanging for the rapists. Credit: WSJ

While the politicians are coming up with fantastic plans to stop rape from covering up women to banning the sale of alcohol, the public is demanding stricter laws against rape including harsher punishments and swifter trials. I am in full agreement that the process of reporting and prosecuting rape should be made more agreeable to the victim (including the call for more female police officers and inspectors) and for rapists to be brought to trial within a few weeks of the incident (rather than in 10 years or not at all). However, I do not think that chemical castration or the death penalty are the solution to stopping rape.

These “solutions” miss their mark. Preventing rape has nothing to do with the way women dress or the punishments that rapists receive. Rape will continue to happen no matter what women wear and whatever the consequence as long as men continue to disrespect women. Male ego or not, women all over the world are coming up in position. We are providing for our families and working in fields that were originally reserved for men. After thousands of years of oppression and second class citizenship with ridiculous and bizarre justifications (such as women lacking reason or being deformed-and thus less than-men), women are finally beginning to live freely as they rightfully should. Perhaps this rise in progress is being met with resistance, and men feel that women are cramping their style or taking over what they feel is rightfully theirs. Perhaps this insecurity is why men feel the need to dominate women with the display of their animalistic power. While I am no expert, I am sure that men rape women for a variety of reasons, but probably all stem from insecurity.

Whatever the cause of rape, the root of the problem is not with women but with society itself. Men need to learn to love and respect women from a young age. This means that their fathers must treat women with respect, and that politicians (our leaders) need to shift the blame of rape from women to men and to the society that allows men to be brought up devoid of such values. Society must also not neglect women, but seek to raise women who are confident and believe themselves to be the equals of men. As gender inequality has deep roots in Indian culture, India’s transformation will be long and hard. I just hope that India does not require another atrocity like the death of the twenty-three year-old Delhi gang-rape victim to initiate this change.

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Protesters. Credit: The Guardian

An Introduction to Women’s Health

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I have been kept so busy that I have barely had time to update this blog! After spending a few days as a tourist in Hyderabad, I left Andhra Pradesh and have settled in Coimbatore, Tamil Nadu, where I will spend the next six weeks working at The Womens Center. This small, private hospital is remarkable. Not only does it offer lavish interiors (it’s the most pleasant hospital that I have ever been in–I stayed in a patient room for two nights and it was the nicest place that I stayed since leaving the US), it offers remarkable services at affordable prices. But enough advertisement…

While here, I will be conducting educational outreach projects. I have been busy learning about all sorts of women’s health issues, finding statistics, and trying to figure out how to present my findings to women from a culture where private parts are kept very private and sex is a very touchy subject. My first presentation will be this Friday to a group of educated women working in IT. It will be part of a longer presentation on general health given by a female colposcopist who has just returned to India after practicing for several years in the UK.

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Dr. George Papanicolaou

My talk will be about the importance of the Pap-smear in cervical cancer prevention. India has one of the highest rates of cervical cancer and basically no prevention program, so the aim is to raise awareness around the issue. In this first talk, I will discuss the use of Pap smears in the US and the dramatic reduction in the rate of cervical cancer. For example, with screening, incidences of cervical cancer have been reduced by 75-90% depending on which journal article one reads. This figure is quite remarkable as in 2010, only 73.3% of women in the US had a Pap smear within the last three years. Also of interest is that over half of all cervical cancer cases in the US occurred in women that have never had a Pap smear, where ~25% of cases occurred in women who haven’t had a Pap smear in the last 5 years, and the remaining 25% or so of cases occurred in women who failed to follow-up properly after an abnormal Pap smear. It is estimated that if all sexually active women received Pap smears every 3 years, the incidence of cervical cancer would be reduced by 99%! So, I must find a way to present these promising statistics to women who are very fearful of both cancer and talk of sex (especially as 99% of cervical cancer cases are caused by HPV, a virus transmitted through sexual contact).

(In the US, an estimated 80-90% of sexually active women contract the virus at some point in their lives although the majority are able to clear it to undetectable levels before it becomes a problem)

In discussing these issues with the colposcopist, she told me some startling anecdotes about the female Indian patient. The body clears most abnormal growth on the cervix naturally, so in most cases patients are asked to return for another Pap smear in 6-12 months to check on the condition. However, some patients hear “abnormal,” stop listening there, and nod their heads that yes, they will come back in 6-12 months. But instead they rush to another doctor and, if they have already had their children, they demand a hysterectomy!

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Another issue with this sensitive topic is women wondering HOW they became infected with HPV in the first place. As very few women in India have had more than one sexual partner and their husbands insist that they have both been faithful and were also “pure”  at the time of marriage, this creates yet another problem. I have been thinking about how to answer the questions that I might receive on this topic with something other than  “Your husband is a liar.”

(HPV can be spread without actual intercourse but contact is necessary).

Another project that I will be working on involves visiting orphanages in the area and giving talks on feminine hygiene and sexual abuse. I just did some quick research on feminine hygiene in India and found some pretty startling results. For example, in India, only 6% (around 30 million women) use some sort of hygienic sanitary napkin during their monthly menstruation (compared to the 96% rate seen in developed countries). The remaining women use whatever they can find. Thus, women often endure embarrassment, infection and loss of workdays due to the negative social stigma and discomfort associated with monthly menstruation. Reproductive tract infections are 70% greater among women who lack access to hygienic supplies and as many as 31% of adult women in India note a drop in their productivity levels when they menstruate, resulting in missing an average of 2.2 days of work each month (click here to read more). Aside from these issues, I will also teach simple exercises to relieve menstrual cramps as well as exercises to help combat depression. These presentations will be a challenge as the customs and sexual culture are just so different from what I know (I still haven’t even figured out how people here get by without toilet paper).

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Sketch of a baby with arthrogryposis (Wikipedia)

Meanwhile, I have read about 30 journal articles and reports on different aspects of female health, evaluated sperm for male infertility tests (more observational on my end), watched mammograms and ultrasounds, watched a C-section, spent time in the NICU with preemies including one suffering from arthrogryposis, went on rounds, watched heart scans on newborns… Its been busy but I’ve learned so much and am so excited to learn more!

An update on my Widows Project:

The first widow I spoke with who was taking care of her orphaned grandson is currently making arrangements to live at the BIRDS farm where here grandson will attend the BIRDS school. On a more upsetting note, the two little boys whose parents died of AIDS and suicide, are both HIV positive. The twelve-year-old girl with tuberculosis does not have HIV. BIRDS is aware of this situation and will be doing all they can in order to get treatment for these children and support for their grandmother.

I am also still plugging along on the development of SHELTER, the non-profit sustainable women’s shelter that I am working on developing with two Indian MBAs.

(Hopefully Not) Lost in Translation

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Every act of human communication requires some form of translation. Even speaking in our own language requires translating what one person meant in his own mind into what one thinks he meant to convey. Body language as well requires translation–but perhaps body language is so engrained in our nature that it requires a bit less translation (although it can add even more confusion to the act of translating for the body often says one thing and words another).

Now move these complexities into a different language and add yet another filter and layer of translation–a translator. And now add different customs that might even obscure some body language (i.e. do people smile because they are happy or because it is their custom?). From all these complexities one can easily see the difficulties of translation–especially when one must use a translator.

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Interview with translator in a tribal village

In my interviews with widows, I had to use a Telugu to English translator. While it was incredible that I could “speak” with the widows, I did run into a few problems (really more minor annoyances) with my translator. For one, he was a man and I was interviewing uneducated women who came from a culture where women are considered less than their male counterparts–and I was asking these women for some fairly personal and gender-based information. Seeing this potential barrier, I had originally arranged for a female translator, but she had an unforseen arranged marriage and was no longer available. So, I had to make due with what I had and now must factor the male translator into the equation. Doing this, I assume that the stories that these women told me were actually more horrific than the information and translations that I received.

Some other issues that I faced with the translator involved him filtering what the women had to say and giving me only what he thought I wanted to hear. While my questions were answered somewhat directly, I had posed the questions as open ended because I wanted to get the women to talk about their lives. And, from what I could not understand but judging from the length of their answers, it worked. However, from the brevity of the translations I received, I know that my translator had his filter on high. I would constantly ask, “What else did she say?” and my translator would respond:

“She is telling me about her sorrows.”

“And…”

“Next question.”

I would receive this frustrating response to my pleas for better translation (or actual translation!) several times each interview.

Another frustration besides the filter set on high was my translator responding “same thing” instead of actually translating what the woman actually said. Yes, every woman that I spoke with suffered from neglect and discrimination. But I wanted to hear their stories and hear what they had to say.

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Interview in a village school

And yet another annoyance which I think actually did affect my research was the translation of the responses to the mental health questionnaire. These questions were a little more direct. Where the first part of my interview asked open ended questions such as “What is your opinion about widowhood in your village?”, the mental health questionnaire asked questions that were meant to get responses more along the lines of “yes,” or “no,” or “sometimes.” But, as these women wanted and needed to talk and share their sorrows, their responses were not quite so direct. For example, their responses to “In the past month, how often have you been feeling sad?” would consist of a long story about what had happened in the past month rather than a response such as “seven times.” Thus, my translator would say “sometimes” or “no” and would look annoyed when I would ask him to elaborate. As each response in this section was meant to generate a number, such inaccuracies in translation do effect my research.

In regards to inaccuracies in the mental health score, towards the end of my interviews, I realized that my translator was adding a little too much of his own translation onto the responses in regards to questions about whether the widows ever thought that life was not worth living. I discovered this issue when a women gave a long and emotional response and my translator simply translated, “No. Next question.” Here, I demanded an elaboration. It turned out that this woman had twice attempted suicide but for the sake of her children did not want to harbor such thoughts. And so, in response to the question: “Have you ever felt that life was not worth living?”, my translator translated the response of a woman who had actually admitted attempting suicide more than once as “no”. Thus, my translator failed to translate the difference between wanting to feel a certain way and actually feeling a certain way.

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Interview at the BIRDS farm

From this point on, I demanded actual translations to these questions. However, for the previous eighty-five or so widows that I had questioned, I cannot fully trust the accuracy of their mental health scores. Thus, I will have to translate and factor these inaccuracies into the mental health scores. Unfortunately, the actual scores are probably actually much higher than those that I have calculated. And, as the previous post states, the average mental health score for the one hundred and eleven widows was 4.47 on a scale from 0-8.

Despite my issues with my translator, I do feel that my research is fairly accurate and am thankful that I had a translator. Unfortunately, the inaccuracies and issues due to the gender of my translator and his actual translation only make my results even more depressing.

Portraits of Indian Widows

I have completed my research and have now interviewed one-hundred-and-eleven of India’s poorest rural widows. I have entered some findings into a spreadsheet and now have some basic statistics. I interviewed women ages nineteen to eighty-nine with an average age of fifty-one. Sixty-four of these women live alone or are the sole supporters of their families (only forty-four report receiving support at all). Of these one-hundred-and-eleven women, the average age of marriage was just 14.48, with the youngest being married at just ten years and the oldest at twenty-five. The mental health scores from the mental health questionnaire, with a range of 0 to 8, averaged 4.18 (and I am not sure how accurate this number is as I always had trouble with my translator here–but I will go more into that issue in a later post).

This experience has been transformative to say the least. I have been deeply moved by these women and amazed at their strength and endurance for life at its worse. I have loved my time here and feel honored to have had so many women share their lives with me. I know that I will somehow continue this work in the future.

Below are portraits of thirty-four of the widows, including the nineteen year old and the eighty-nine year old.

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Freedom and Choice

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The last month in India has tested my independent nature. For the past several years, I have experienced the luxury of living alone and, My!–what a luxury! I could do whatever I wanted whenever I wanted and I could eat what I liked whenever I liked (the only constraints being whether New Seasons was open or if I could find a restaurant suitable to my tastes, which happens all too frequently in Portland). I could exercise as much as I liked and however I liked. And, most importantly perhaps, I could go on long walks alone through the city or woods.

But in my experience of India?

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Some of this strain is due to my gender–for even as a westerner, I am still a woman alone in India (and rural India at that). As this trip is just a short portion of my life, I have surrendered to the customs of rural Andhra Pradesh. For the most part, I have given up my pants and I do not show my ankles. I am OK with this as I know that in a few short months, I will be prancing around in a bikini in Thailand. But at times, the constraints placed on me by my gender irk me. I am not expected to be alone or to want to be alone. I must have someone accompany me wherever I go (and if I do manage to sneak off, I am left with lectures about danger and the guilt of having made someone worry). And exercise? Practically forbidden (although I have managed to get some in). At times, part of me wishes that I were a man–able to enjoy a solo run through the fields and the other luxuries afforded by the gender. But, still happy to be a woman, I sometimes wish that I were traveling with a man, as even in cities the security opens so many possibilities…

(As a young woman who has traveled alone quite a bit, I know the need for caution and have so far managed to avoid trouble–I do have sharp elbows after all! Surprisingly, the time I felt most threatened by “the weakness of my gender” was back in Oregon, sitting by a waterfall…)

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The other struggles that I am having are experienced universally by other Type-A personalities. I cannot set my own schedule. I eat when I am called and have little to no choice about what I put into my body. I know that I have gone above and beyond my self-imposed sugar intake of 30 g/day and I know that there is nothing I can do about it. My body has started to reject rice once again (after allowing me to enjoy it for just three short weeks) but I must still eat it (rice makes up the majority of the diet here so I have resigned to my fate of eating it two or three times per day–I love it, but it hurts).

While I may feel a tad constricted, I do not feel trapped here (how could I when I love what I am doing so much?). I cannot wait until I again have the opportunity to visit this wonderful place and see my BIRDS family–this adventure has been truly spectacular. I am, however, looking forward to moving on to someplace where I can exert a little more control over my daily life. I do realize that the experience and struggle has been good for me as I cannot always have my way–it is important for me to continue to learn to let go and to let someone else take the reins for once (but I am so happy that my project affords me the little luxury of letting me be my Type-A).

This experience has also brought to mind the relation of choice to freedom and happiness. One theory suggests that choice (and the concept of freedom) actually makes us less happy and free. I guess that having no choice lets us enjoy the moment and not regret our decisions or worry about whether we should have opened Box A instead of Box B (it shifts the blame of our actions from ourselves). Perhaps. But after knowing choice and experiencing freedom and the delicious agonies they cause, is it possible to feel happy and free in their absence?

Note: Even without the luxury of total freedom of choice that I am currently experiencing after knowing its torturous pleasures, I am quite happy here (possibly because I know that I do not have to eat and endure rice endlessly).

Something about HIV

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There is just something about HIV that makes the heart stop. When it’s mentioned (especially in close context), the whole body collapses. The throat closes, the chest sinks, the stomach drops. Time freezes or at least becomes painfully slow. This is the state that I found myself in yet again this afternoon.

(I can’t imagine what patients must go through when they get their positive diagnoses.)

I will keep this story short. It involves a thirty year old woman (I will call her Lakshmi), who came to my room and brought me ORS when I was sick my first week in India. Lakshmi’s husband committed suicide five years ago after learning his HIV status and giving up on life three years later. He was an alcoholic mason who presumably frequented prostitutes in between beating his wife. After learning that he was HIV positive, he attempted to change his ways and find God, working in a church for three years. However, his attempts failed and he instead committed suicide. He left behind his wife and two HIV positive children, who are now nine and ten and studying at the BIRDS school (the mother and children are receiving treatment). I have met both children.

When I asked Lakshmi the question concerning her future, she told me what nearly every mother that I have talked to has said: That she wants to work hard so that she can give her children a good education and better lives than she had. I don’t remember if Lakshmi cried at all during our interview. But I nearly did with her response to this question. I really struggled against the tears welling up in my eyes. And it took all effort to keep my voice strong for the next question.

I could take the sad stories of her husband beating and harassing her. Of her three-year abandonment just after her daughter was born. Of her brother-in-laws harassing her daily and stealing her land. Of the time her children found her when she had taken all those pills. But when it came to the topic of her children’s futures, I broke.

Note: please read my reply for further discussion of HIV and the stigmas facing patients.