Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all in any true sense. Under the clouds of war, it is humanity hanging on a cross of iron.
- Dwight D. EisenhowerFriday, May 29, 2009
Thursday, May 28, 2009
these fragile bodies
After nearly a week at conferences I start to feel like my head is going to explode. I come to these conferences every year and every year I love it—getting to see friends I really only see at conferences, learning about new things, meeting new people, having the fire in my belly for the world's poor and sick stirred up a little. I remember my first year at these conferences, five years ago—nervous me in my suits, needing a job, not knowing who to talk to in the sea of strangers. Now I can hardly get where I’m trying to go for running into people I know and want to talk to, and even the people I don’t really know (or can’t remember if I know) all look weirdly familiar. Today a woman about my age walked up to me and I still can’t for the life of me remember how I know her but we concluded that we did in fact know each other from my DC days and somehow I know she’s a Christian as well so it was fun to talk.
Anyway, it is now my 6th day at conferences and I am feeling like I need to sleep and I need to cry and I definitely need to stop eating rich conference lunches and desserts and did I mention that I really need some rest?
Today I have heard a couple stories of the kind that I have heard so many times but will never get used to. Child soldiers. Child mothers. Child mothers whose bodies rip so that they leak feces and urine for years and decades to come. Obstetric fistula can happen when women are too young and their bodies too immature when they go to give birth. Anal-to-vaginal fistula can also happen as a result of violence, such as what is happening in N Uganda and North Kivu, DRC. I have blogged about this before. A doctor today told stories-- guns shoved into women's bodies and fired, rape in the most horrible ways you can imagine.
He shared a quote from a child soldier in N Uganda who had forced old women to lay down and spread their legs and then had shoved sharp sticks into their vaginas until they died. To me nothing is more chilling that children who perpetuate violence like this. It's such a clear picture of the dehumanizing nature of evil and such a reminder that our struggle is not against flesh and blood but against the powers of evil. I wanted to weep for the child as much as the poor grandmothers-- that poor child who begged his counselor (during his re-integration counseling) not to send him back to his mother in the village because she would know what he had done and how could he ever live with himself?
What is on my mind is the fragility of women's bodies-- and the aching question of why? Even in normal circumstances of pregnancy and childbirth there is so much that can go wrong, so many ways a woman's body can break and tear. Those poor pregnant girls who become leaking, stinking outcasts as a result of one bad delivery. The millions of women who die in childbirth. Why could God not have built our bodies to be more the equivalent of, I don't know, armored tanks. So that a child couldn't invade old women's fragile bodies with a stick until they died. So that a soldier with a machete couldn't rip open a woman's body in her most vulnerable place. Why this fragility and horrible vulnerability?
I think I've blogged some of these before but Nick Kristoff at the NYT has some good stuff on Catherine Hamlin's work at the fistula hospital in Ethiopia.
Tea with Mother Theresa (blog post about tea with Catherine Hamlin)
Alone and Ashamed (article about hospital)
The Illiterate Surgeon (my favorite article of all-- makes me cry every time)
There's a great book about Catherine Hamlin. And yes, she and her husband (now dead) were missionaries and committed Christians.
And a movie about women being healed from fistula that I'm dying to see: A Walk to Beautiful.
On a happier note, how is this for an “it’s a small world” moment. We were having dinner last night with J’s good friends, who he knows from
Monday, May 25, 2009
it's that spelling bee time of year
A couple hours ago J and I came back to our hotel room, flipped on the TV (having a TV around is kind of fun, I have to say), and there was the National Spelling Bee! Actually, it was a rerun of the 2008 National Spelling Bee. The 2009 bee starts tomorrow.
So it reminded me that it's that spelling bee time of year again. It's kind of funny, because the last 5 years I have been in DC during it, which brings back memories of my own national spelling bee experience in 1992, here in DC.
There's not much to say about the bee itself. I spelled out in the first round. (On sagittal, which I believe I spelled sagital. It means arrow-shaped. If only I'd been a little more into astrology I might have figured it out-- think Sagittarius!) But that week in DC was kind of a dream come true. I have this memory of reading a magazine article about the National Zoo, specifically about the monkeys in the National Zoo-- this must have been when I was in 7th or 8th grade. I wanted to go to the National Zoo and see them so badly. Who knew that at the end of 8th grade I actually would get an all-expenses-paid trip to DC (Mom and Brian went as well), where I would not only get to see the National Zoo, but all sorts of other great DC sites, as well as stay in a fancy hotel and meet lots of other nerdy kids my own age? It was all a blast. I remember this fancy barbecue at a historical house that had belonged to George Mason (and square dancing with an intern who was so glamorous in my 13-year old eyes), seeing the DC sites, going to some other historic city (Old Town Alexandria perhaps?), and parties at the hotel.
I do remember crying my heart out, like I couldn't stop, after I spelled out. I think it was from all the tension of the event (bright lights, cameras, not to mention months of build-up) as much as disappointment at spelling out. Or maybe I had delusions of winning the bee, who knows. So many things seemed so grievously disappointing at that age, that I just laugh at now.
Other memories: Being on the front page of the Corvallis paper a couple times. (They were sponsoring me so of course were interested in doing features about their little contestant!) Being recognized in the Albany mall once (I guess from my newspaper picture). One little boy I used to babysit was (by his mother's account) so starstruck over his babysitter being on the front page of the paper that he sat at breakfast staring at the paper and refusing to eat. Months were consumed in studying little flashcards with color coded words. (Mom, how many hours did you spend making those cards and coloring the vowels-- ironic that it wasn't vowels that tripped me up but double consonants, in the actual bee!) I remember getting 2 new snazzy (so I thought) outfits for the trip-- my favorite being a baggy turquoise t-shirt tucked into long baggy shorts with a torquise-and-hot-pink on white plaid, all from The Closet. (Ah, early 90s fashion!) That was what I wore in the actual bee. Oh, and the trophy I won at the local bee sitting in the entryway of my tiny junior high school for an entire year. I think I actually felt pretty awkward about all the attention. (Thirteen was a very awkward age for me anyway.) But getting to go to the bee was a once-in-a-lifetime experience.
And now, every year when the National Spelling Bee rolls around and I see those cute, awkward kids on TV, it brings it all back...
I have been at a conference this weekend and also working crazy hours on a consultant project that just threw me an impossible deadline. I am past the deadline, and exhausted from too little sleep and too much conferencing, and drinking coffee in the middle of the afternoon just to keep my eyes open and my fingers typing, and I think I am almost done and then can have a bit of a break tomorrow before my next conference starts on Wed. In the meantime, while I am working away this afternoon, I am taking little breaks to amuse myself with all things Spelling Bee. Their website actually has a quiz you can take to see if you would qualify (well, supposing you were in 8th grade). Supposedly I would, although every year when I watch the kids spell I think that they are waaay smarter than I am. And I also found this fun article about what has happened to some of the champions, when I was looking up what happened to Miss 1992 (who, it turns out, has her own Wikipedia page). The article seems to be quite interested in whether or not they still put their win on their resumes!
So it reminded me that it's that spelling bee time of year again. It's kind of funny, because the last 5 years I have been in DC during it, which brings back memories of my own national spelling bee experience in 1992, here in DC.
There's not much to say about the bee itself. I spelled out in the first round. (On sagittal, which I believe I spelled sagital. It means arrow-shaped. If only I'd been a little more into astrology I might have figured it out-- think Sagittarius!) But that week in DC was kind of a dream come true. I have this memory of reading a magazine article about the National Zoo, specifically about the monkeys in the National Zoo-- this must have been when I was in 7th or 8th grade. I wanted to go to the National Zoo and see them so badly. Who knew that at the end of 8th grade I actually would get an all-expenses-paid trip to DC (Mom and Brian went as well), where I would not only get to see the National Zoo, but all sorts of other great DC sites, as well as stay in a fancy hotel and meet lots of other nerdy kids my own age? It was all a blast. I remember this fancy barbecue at a historical house that had belonged to George Mason (and square dancing with an intern who was so glamorous in my 13-year old eyes), seeing the DC sites, going to some other historic city (Old Town Alexandria perhaps?), and parties at the hotel.
I do remember crying my heart out, like I couldn't stop, after I spelled out. I think it was from all the tension of the event (bright lights, cameras, not to mention months of build-up) as much as disappointment at spelling out. Or maybe I had delusions of winning the bee, who knows. So many things seemed so grievously disappointing at that age, that I just laugh at now.
Other memories: Being on the front page of the Corvallis paper a couple times. (They were sponsoring me so of course were interested in doing features about their little contestant!) Being recognized in the Albany mall once (I guess from my newspaper picture). One little boy I used to babysit was (by his mother's account) so starstruck over his babysitter being on the front page of the paper that he sat at breakfast staring at the paper and refusing to eat. Months were consumed in studying little flashcards with color coded words. (Mom, how many hours did you spend making those cards and coloring the vowels-- ironic that it wasn't vowels that tripped me up but double consonants, in the actual bee!) I remember getting 2 new snazzy (so I thought) outfits for the trip-- my favorite being a baggy turquoise t-shirt tucked into long baggy shorts with a torquise-and-hot-pink on white plaid, all from The Closet. (Ah, early 90s fashion!) That was what I wore in the actual bee. Oh, and the trophy I won at the local bee sitting in the entryway of my tiny junior high school for an entire year. I think I actually felt pretty awkward about all the attention. (Thirteen was a very awkward age for me anyway.) But getting to go to the bee was a once-in-a-lifetime experience.
And now, every year when the National Spelling Bee rolls around and I see those cute, awkward kids on TV, it brings it all back...
I have been at a conference this weekend and also working crazy hours on a consultant project that just threw me an impossible deadline. I am past the deadline, and exhausted from too little sleep and too much conferencing, and drinking coffee in the middle of the afternoon just to keep my eyes open and my fingers typing, and I think I am almost done and then can have a bit of a break tomorrow before my next conference starts on Wed. In the meantime, while I am working away this afternoon, I am taking little breaks to amuse myself with all things Spelling Bee. Their website actually has a quiz you can take to see if you would qualify (well, supposing you were in 8th grade). Supposedly I would, although every year when I watch the kids spell I think that they are waaay smarter than I am. And I also found this fun article about what has happened to some of the champions, when I was looking up what happened to Miss 1992 (who, it turns out, has her own Wikipedia page). The article seems to be quite interested in whether or not they still put their win on their resumes!
Friday, May 15, 2009
the country with 1 psychiatrist and 3 obstetricians
I'm in an all-day workshop and killing time during the presentations that don't interest me by catching up on some journal issues that have been collecting in my inbox. This is one of those articles that makes me think, I know things are this bad but I still can't believe that they're this bad!! And reading about obstetric fistula is something that always makes me want to go bawl my eyes out.
As a side-note I recently finished the Bury the Chains, a book about the abolition of the slave trade in Britain that I cannot recommend highly enough (by the author of King Leopold's Ghost, which is equally rivetting and excellent). Anyway, there was some fascinating history in it about what happened to freed slaves, including one group that was first settled in Newfoundland (!!) and then finally sent to Liberia. Wilbeforce and a lot of the other abolitionists had grand, utopian aspirations for the Liberian colony; it was supposed to be a model society and prove that former slaves could be resettled in free and productive colonies. Things did not turn out that way, and the country has had a horrific history.
Liberia does have Africa's first female president (yay!), Ellen John Sirleaf, a woman who everyone seems to be excited about.
Reviving health care in Liberia
The Lancet, Volume 373, Issue 9671, Pages 1239 - 1240, 11 April 2009
Margaret Harris Cheng
Liberia is rebuilding its health system after years of brutal conflict. But providing care for those traumatised by the war presents many challenges. Margaret Harris Cheng reports from Monrovia.
In rich, reassuring tones Benjamin Harris, Liberia's only resident psychiatrist, calmly describes the mentality of many people in the country after the conflict: “People used to say Liberians are slow to anger [but] now there are many maladaptive and dysfunctional behaviours and a markedly decreased anger threshold. A small incident can spark extreme violence: burning, stoning.”
Walk through the streets of Liberia's capital, Monrovia, which is more like a beachside suburb than a city, and you do not feel the fear or foreboding that Harris' words might instill. But you are very aware that most of the people around you are young, and that most of them, although very friendly, do not seem to have much to do to occupy their time.
It is these, the children of the conflict that started in 1989 and officially ended in 2003, whom Harris says constitute a population-wide psychiatric emergency. It has been estimated that one in ten Liberian children were recruited as soldiers. “The war lasted a long time. Most young adults grew up during a disordered period and received little nurturing.”
“The needs are great. A household-based survey found that 43% of the survey participants had symptoms of post-traumatic stress disorder”, says Harris. “The biggest community-based problem is substance abuse. It has permeated the country. Just about anywhere heroin and other drugs can be purchased and used.”
The violence, particularly the gender-based violence prevalent during the war, when abduction, forced labour, beating, rape, and coercive sex became almost a norm, did not end when the hostilities officially did. According to a UN protection monitoring report, there were 2745 reported cases of domestic violence and 302 cases of rape (in a country with a population of just under 3·5 million people) between January and November, 2008.
In 2007, the Liberian Demographic and Health Survey found that almost half of women aged 15—49 years had experienced physical violence, with husbands and partners being the most common perpetrators. 18% had experienced sexual violence and 10% reported that their first sexual intercourse was forced.
Although the war is over, the stories people tell, whether of witnessing the murder and rape of parents and siblings, or of being forced to join rebel groups as child soldiers, and participate in cannibalism, murder, and rape, are still fresh and the pain and horror raw.
Anusanthee Pillay, seconded by UN Development Fund for Women as gender advisor to Liberia's Truth and Reconciliation Commission (TRC), discovered just how raw when she decided the best way to tackle the enormous task of seeking justice for the many woman raped and mutilated during the conflict was to organise community dialogues.
Working with an organisation representing different women's groups she sought a range of women in different parts of the country and asked them to meet her to “talk about the TRC process, to tell us what they need”. The answer was simple: they needed to talk. “The women didn't want to think about anything until they could talk about what happened to them during the war…Every single one of them told a story that was so terrible. They had witnessed the most terrible things.”
“A 9-month pregnant woman had been raped. One woman refused to be raped. They couldn't overpower her, so the soldiers just took a knife and slashed her vagina…Every one of these women had been raped or violated. We were in tears, listening…we had no idea that these women would come with these stories.”
Such a litany of horror might easily overwhelm those seeking to help and heal. But Pillay says it had the opposite effect. It galvanised her team, making them want to do more than simply listen. “Some of the facilitators said they didn't want to come back unless they are going to be able to do something for the women. I didn't want it to be like other post-conflict countries where you pick up the women, clear out their stories, then dump them. We've documented the cases who need immediate attention and are identifying service providers and are giving names and addresses of people who need help.”
Here Pillay raises what is possibly Liberia's biggest current challenge: getting comprehensive medical help to the hundreds of thousands who so desperately need it. Liberia has some of the world's worst health indices. The UN Development Programme's human development index for 2008 puts Liberia in fourth bottom.
Liberians have a life expectancy at birth of just 35 years, an infant mortality rate of 71 per 1000 livebirths and the mortality rate for children under 5 years is 110 per 1000 livebirths. Although still very poor, these numbers actually represent a halving of their 1992—96 mortality rates for infants and children under 5 years, something most commentators attribute to consistent immunisation campaigns, even during the conflict years. However, during the same period maternal mortality has doubled to 994 deaths per 100 000 livebirths, making Liberia one of the most dangerous places on earth for a woman to give birth (panel).
Panel
Improving women's health in Liberia
At the Fistula Rehabilitation and Reintegration Center—a UN Population Fund (UNFPA) project deliberately located in one of Monrovia's poorest satellites, Jacob Town—a “graduation ceremony” was underway for the first 17 women to not only have their obstetric fistulas (many of them both vagino-vesical and vagino-rectal) repaired but also to undergo training in either tailoring, baking, soap-making, or fabric dyeing. The ceremony was a celebration to mark the end of their training and the beginning of a new life. Along with their graduation certificates they were given the materials and money needed to start a business back in their home villages.
In 2006, the UNFPA's Rose Gakuba started working with John Mulbah, one of Liberia's few obstetricians (there are three) to set up a fistula repair programme based at Monrovia's main hospital, the John F Kennedy Memorial Medical Center. “A survey done in 2006 found fistula was of much greater importance in Liberia than anyone realised”, said Mulbah.
A team of five (two surgeons, two nurses, and an anaesthetist) were dispatched to Nigeria to learn fistula repair techniques. Later, another delegation went to Niamey in Niger to observe and learn from their fistula rehabilitation programme. From this trip and from visiting fistula programmes in Ethiopia and Mali and working with surgeons from those countries, they were able to put together an integrated programme involving assessment via outreach teams in rural hospitals, along with surgical management and rehabilitation.
So far, 332 women, most of them aged between 11 and 20 years, have been treated. The 17 graduates are the first to have gone through the entire fistula rehabilitation programme. Hence, the experience of other African nations is now being applied in Liberia to assist the thousands of women living with fistulas.
Now that the country is no longer officially in the post-conflict humanitarian crisis phase, the emergency relief funds are pulling out, along with their medical personnel. This transition, from acute crisis to development, is problematic because the country itself is not yet ready to take over the systems now run by the big relief agencies. 50% of health facilities are run by non-governmental organisations (NGOs).
The ministry of health has recently done an audit of all the facilities, from tertiary hospitals down to unmanned rural medical posts, in the country. The result was somewhat disheartening. Some were not even staffed and many lacked the reliable power supply, water, drugs, and equipment the most basic clinic should have.
Achieving adequate staffing levels is particularly difficult—most skilled health workers left during the war years and those left behind missed out on even a basic education, making it hard to find suitable candidates for fast-track training courses. John Snow International has estimated that the country needs to increase their total health-care workforce by close to 10 000 people, including finding 4223 nurses, 842 doctors, 1143 midwives, 249 medical assistants, and 249 pharmacists; skilled staff that cannot be created overnight.
Despite the challenges, the ministry of health has set about upgrading not only its clinic walls but also the quality of the health services being provided within them. The NGOs have been informed they must all submit performance-based contracts for the facilities they are currently running and prove they are meeting the standards set by the ministry. This move has ruffled quite a few feathers in organisations not used to being asked to prove their worthiness.
But doing things differently is what building a health system out of the rubble of a protracted conflict is all about, says Nestor Ndayimirije, WHO's representative in Liberia. “Post-conflict countries are very very different from other countries…Here in Liberia, some times you have to rebuild or re-engineer what was there.”
Nestor said WHO realised that mental health was too low on the priority list and appointed Harris as a consultant to develop a national mental health policy. Harris has managed to come up with an innovative programme.
“We will use all available resources [and] all available health workers”, said Harris, outlining a 5-tier system relying heavily on psychiatric care in the community. “At the base we use information programmes to inform the community about risks associated with various behaviours. At the next tier we will train and support teachers, traditional healers, and NGO staff to recognise potential problems and make referrals. The third level is the primary health-care level, where staff will be given broad-based training in managing all aspects of health care to equip them to provide care at their level of expertise. The fourth level involves formal mental health care in general hospitals and the fifth level is tertiary facilities, very small units for specialised services dealing with mentally abnormal offenders, those who need custodial care.”
This model is a radical departure from the type of psychiatric care offered in Liberia before the conflict.
“There was a functional mental health system but not an effective one”, said Harris.
So rebuilding Liberia's health system is a huge task but not a hopeless one. And, in asking the impossible of the few people with the skills needed to tackle it, it is a task that is yielding some interesting solutions to daunting problems. As Rozanne Chorlton, UNICEF's representative in Liberia, puts it: “People like to say that working in Liberia is like flying in a plane while still building it. But I prefer to say its like having the scaffolding around the building while you are working in it.”
As a side-note I recently finished the Bury the Chains, a book about the abolition of the slave trade in Britain that I cannot recommend highly enough (by the author of King Leopold's Ghost, which is equally rivetting and excellent). Anyway, there was some fascinating history in it about what happened to freed slaves, including one group that was first settled in Newfoundland (!!) and then finally sent to Liberia. Wilbeforce and a lot of the other abolitionists had grand, utopian aspirations for the Liberian colony; it was supposed to be a model society and prove that former slaves could be resettled in free and productive colonies. Things did not turn out that way, and the country has had a horrific history.
Liberia does have Africa's first female president (yay!), Ellen John Sirleaf, a woman who everyone seems to be excited about.
Reviving health care in Liberia
The Lancet, Volume 373, Issue 9671, Pages 1239 - 1240, 11 April 2009
Margaret Harris Cheng
Liberia is rebuilding its health system after years of brutal conflict. But providing care for those traumatised by the war presents many challenges. Margaret Harris Cheng reports from Monrovia.
In rich, reassuring tones Benjamin Harris, Liberia's only resident psychiatrist, calmly describes the mentality of many people in the country after the conflict: “People used to say Liberians are slow to anger [but] now there are many maladaptive and dysfunctional behaviours and a markedly decreased anger threshold. A small incident can spark extreme violence: burning, stoning.”
Walk through the streets of Liberia's capital, Monrovia, which is more like a beachside suburb than a city, and you do not feel the fear or foreboding that Harris' words might instill. But you are very aware that most of the people around you are young, and that most of them, although very friendly, do not seem to have much to do to occupy their time.
It is these, the children of the conflict that started in 1989 and officially ended in 2003, whom Harris says constitute a population-wide psychiatric emergency. It has been estimated that one in ten Liberian children were recruited as soldiers. “The war lasted a long time. Most young adults grew up during a disordered period and received little nurturing.”
“The needs are great. A household-based survey found that 43% of the survey participants had symptoms of post-traumatic stress disorder”, says Harris. “The biggest community-based problem is substance abuse. It has permeated the country. Just about anywhere heroin and other drugs can be purchased and used.”
The violence, particularly the gender-based violence prevalent during the war, when abduction, forced labour, beating, rape, and coercive sex became almost a norm, did not end when the hostilities officially did. According to a UN protection monitoring report, there were 2745 reported cases of domestic violence and 302 cases of rape (in a country with a population of just under 3·5 million people) between January and November, 2008.
In 2007, the Liberian Demographic and Health Survey found that almost half of women aged 15—49 years had experienced physical violence, with husbands and partners being the most common perpetrators. 18% had experienced sexual violence and 10% reported that their first sexual intercourse was forced.
Although the war is over, the stories people tell, whether of witnessing the murder and rape of parents and siblings, or of being forced to join rebel groups as child soldiers, and participate in cannibalism, murder, and rape, are still fresh and the pain and horror raw.
Anusanthee Pillay, seconded by UN Development Fund for Women as gender advisor to Liberia's Truth and Reconciliation Commission (TRC), discovered just how raw when she decided the best way to tackle the enormous task of seeking justice for the many woman raped and mutilated during the conflict was to organise community dialogues.
Working with an organisation representing different women's groups she sought a range of women in different parts of the country and asked them to meet her to “talk about the TRC process, to tell us what they need”. The answer was simple: they needed to talk. “The women didn't want to think about anything until they could talk about what happened to them during the war…Every single one of them told a story that was so terrible. They had witnessed the most terrible things.”
“A 9-month pregnant woman had been raped. One woman refused to be raped. They couldn't overpower her, so the soldiers just took a knife and slashed her vagina…Every one of these women had been raped or violated. We were in tears, listening…we had no idea that these women would come with these stories.”
Such a litany of horror might easily overwhelm those seeking to help and heal. But Pillay says it had the opposite effect. It galvanised her team, making them want to do more than simply listen. “Some of the facilitators said they didn't want to come back unless they are going to be able to do something for the women. I didn't want it to be like other post-conflict countries where you pick up the women, clear out their stories, then dump them. We've documented the cases who need immediate attention and are identifying service providers and are giving names and addresses of people who need help.”
Here Pillay raises what is possibly Liberia's biggest current challenge: getting comprehensive medical help to the hundreds of thousands who so desperately need it. Liberia has some of the world's worst health indices. The UN Development Programme's human development index for 2008 puts Liberia in fourth bottom.
Liberians have a life expectancy at birth of just 35 years, an infant mortality rate of 71 per 1000 livebirths and the mortality rate for children under 5 years is 110 per 1000 livebirths. Although still very poor, these numbers actually represent a halving of their 1992—96 mortality rates for infants and children under 5 years, something most commentators attribute to consistent immunisation campaigns, even during the conflict years. However, during the same period maternal mortality has doubled to 994 deaths per 100 000 livebirths, making Liberia one of the most dangerous places on earth for a woman to give birth (panel).
Panel
Improving women's health in Liberia
At the Fistula Rehabilitation and Reintegration Center—a UN Population Fund (UNFPA) project deliberately located in one of Monrovia's poorest satellites, Jacob Town—a “graduation ceremony” was underway for the first 17 women to not only have their obstetric fistulas (many of them both vagino-vesical and vagino-rectal) repaired but also to undergo training in either tailoring, baking, soap-making, or fabric dyeing. The ceremony was a celebration to mark the end of their training and the beginning of a new life. Along with their graduation certificates they were given the materials and money needed to start a business back in their home villages.
In 2006, the UNFPA's Rose Gakuba started working with John Mulbah, one of Liberia's few obstetricians (there are three) to set up a fistula repair programme based at Monrovia's main hospital, the John F Kennedy Memorial Medical Center. “A survey done in 2006 found fistula was of much greater importance in Liberia than anyone realised”, said Mulbah.
A team of five (two surgeons, two nurses, and an anaesthetist) were dispatched to Nigeria to learn fistula repair techniques. Later, another delegation went to Niamey in Niger to observe and learn from their fistula rehabilitation programme. From this trip and from visiting fistula programmes in Ethiopia and Mali and working with surgeons from those countries, they were able to put together an integrated programme involving assessment via outreach teams in rural hospitals, along with surgical management and rehabilitation.
So far, 332 women, most of them aged between 11 and 20 years, have been treated. The 17 graduates are the first to have gone through the entire fistula rehabilitation programme. Hence, the experience of other African nations is now being applied in Liberia to assist the thousands of women living with fistulas.
Now that the country is no longer officially in the post-conflict humanitarian crisis phase, the emergency relief funds are pulling out, along with their medical personnel. This transition, from acute crisis to development, is problematic because the country itself is not yet ready to take over the systems now run by the big relief agencies. 50% of health facilities are run by non-governmental organisations (NGOs).
The ministry of health has recently done an audit of all the facilities, from tertiary hospitals down to unmanned rural medical posts, in the country. The result was somewhat disheartening. Some were not even staffed and many lacked the reliable power supply, water, drugs, and equipment the most basic clinic should have.
Achieving adequate staffing levels is particularly difficult—most skilled health workers left during the war years and those left behind missed out on even a basic education, making it hard to find suitable candidates for fast-track training courses. John Snow International has estimated that the country needs to increase their total health-care workforce by close to 10 000 people, including finding 4223 nurses, 842 doctors, 1143 midwives, 249 medical assistants, and 249 pharmacists; skilled staff that cannot be created overnight.
Despite the challenges, the ministry of health has set about upgrading not only its clinic walls but also the quality of the health services being provided within them. The NGOs have been informed they must all submit performance-based contracts for the facilities they are currently running and prove they are meeting the standards set by the ministry. This move has ruffled quite a few feathers in organisations not used to being asked to prove their worthiness.
But doing things differently is what building a health system out of the rubble of a protracted conflict is all about, says Nestor Ndayimirije, WHO's representative in Liberia. “Post-conflict countries are very very different from other countries…Here in Liberia, some times you have to rebuild or re-engineer what was there.”
Nestor said WHO realised that mental health was too low on the priority list and appointed Harris as a consultant to develop a national mental health policy. Harris has managed to come up with an innovative programme.
“We will use all available resources [and] all available health workers”, said Harris, outlining a 5-tier system relying heavily on psychiatric care in the community. “At the base we use information programmes to inform the community about risks associated with various behaviours. At the next tier we will train and support teachers, traditional healers, and NGO staff to recognise potential problems and make referrals. The third level is the primary health-care level, where staff will be given broad-based training in managing all aspects of health care to equip them to provide care at their level of expertise. The fourth level involves formal mental health care in general hospitals and the fifth level is tertiary facilities, very small units for specialised services dealing with mentally abnormal offenders, those who need custodial care.”
This model is a radical departure from the type of psychiatric care offered in Liberia before the conflict.
“There was a functional mental health system but not an effective one”, said Harris.
So rebuilding Liberia's health system is a huge task but not a hopeless one. And, in asking the impossible of the few people with the skills needed to tackle it, it is a task that is yielding some interesting solutions to daunting problems. As Rozanne Chorlton, UNICEF's representative in Liberia, puts it: “People like to say that working in Liberia is like flying in a plane while still building it. But I prefer to say its like having the scaffolding around the building while you are working in it.”
Thursday, May 14, 2009
the orphan trade
I'm very aware of one heart-breaking aspect of international adoptions-- American families desperately wanting to adopt and spending months and years navigating foreign red tape before finally bringing home children who truly need homes.
But I had never heard about this heart-breaking side-- children who aren't orphans essentially being trafficked to adoptive families in the West. It's horrifying.
The Orphan Trade (Slate.com, 5/8/07)
But I had never heard about this heart-breaking side-- children who aren't orphans essentially being trafficked to adoptive families in the West. It's horrifying.
The Orphan Trade (Slate.com, 5/8/07)
Tuesday, May 12, 2009
Monday, May 11, 2009
two things that are rocking my music world
A few months ago I bought Jon Foreman's Spring/Summer/Winter/Fall EPs as a birthday gift for J, and then had them sitting in my closet for a few months where of course I couldn't listen to them. Finally J's birthday arrived and we have both been listening to them a lot the last week (so nice to have a husband who mostly likes the same stuff I do!). They are awesome stuff!!
Also, my friend Carolyn (who has introduced me to lots of great music over the years) was here over the weekend and told me about Pandora.com, and all I can think is "Why did I never know about this before??" It is not only free internet radio, but it is incredibly nifty-cool personalized free internet radio-- you put in a song or artist that you like, and then the Music Genome Project (so they call it) picks songs for you. You can pause and skip songs, and so far it's been a ton of fun and a great way to discover new music!
So if you haven't heard Jon Foreman plug him into Pandora and see if you like it!
Also, my friend Carolyn (who has introduced me to lots of great music over the years) was here over the weekend and told me about Pandora.com, and all I can think is "Why did I never know about this before??" It is not only free internet radio, but it is incredibly nifty-cool personalized free internet radio-- you put in a song or artist that you like, and then the Music Genome Project (so they call it) picks songs for you. You can pause and skip songs, and so far it's been a ton of fun and a great way to discover new music!
So if you haven't heard Jon Foreman plug him into Pandora and see if you like it!
Wednesday, May 6, 2009
CS Lewis quote- longing for beauty
It was when I was happiest that I longed most...The sweetest thing in all my life has been the longing...to find the place where all the beauty came from.
Till We Have Faces
If you haven't read Til You Have Faces you should-- it's a powerful book (as if Lewis wrote any bad books).
Till We Have Faces If you haven't read Til You Have Faces you should-- it's a powerful book (as if Lewis wrote any bad books).
Monday, May 4, 2009
someone else's love story
I just stumbled onto this this morning-- from a series Salon.com is doing called "Americans Talk About Love." This one made me laugh, but also feel challenged to love more in my own marriage-- so I thought it was worth sharing.
This was my favorite part:
Love that grows out of something like what we have is stable and deeper than first love at first sight. Some pretty face might turn out to be garbage. Sometimes when we watch TV, beautiful girls on "Judge Judy," then they open their mouth, well, that's it. There is more than just a nice face and making love.
Gerd, 66, and Dina, 79
This was my favorite part:
Love that grows out of something like what we have is stable and deeper than first love at first sight. Some pretty face might turn out to be garbage. Sometimes when we watch TV, beautiful girls on "Judge Judy," then they open their mouth, well, that's it. There is more than just a nice face and making love.
Why we are getting along so good is we ... I don't know how to express it in English, but maybe you get the idea ... I'm not living my life, I living her life. I try to do everything as good as possible to make her happy. If she tells me I need two pounds of potatoes, we go together and buy those two pounds of potatoes.
Sunday, May 3, 2009
springtime and life is good
Lately I’ve been noticing something: life is good. The last two weekends I’ve spent good chunks of time gazing at art and reveling in nature, and have been moved to awe and tears and pure joy at the beauty of the world. I’ve been wanting to eat everything in sight (and cook til I drop)—everything just tastes so good. Music amazes me (we just discovered Jon Foreman of Switchfoot fame’s EPs fall/winter/spring/summer—awesome stuff) and I’ve been writing more fluidly than I have in I don’t know how long. This is helpful because I have a book deadline in less than a month (book I’m writing with my boss, first draft is due June 1 and final draft Sept 1!!)—but I’ve even written a couple poems in the last couple weeks. (Lots of work to do still before I’ll let anyone read those!) What is this strange creativity that is bubbling up everywhere??
I’m sure it has a lot to do with the thaw (finally!) of the weather here in Boston—blue skies and flowering trees do wonders for the soul. But more than that I think I’m feeling good. Okay, I am not totally clear of pain, exhaustion, and occasional bad attitude tantrums, but things are definitely getting better. The fibromyalgia and chronic fatigue that have been hanging around the last 2 years—maybe longer?—have left me feeling like the “old” me is something of a long-lost distant acquaintance. So it’s nice to have that gal (the one who feels like living life!!) around more.
I should mention that I've also been feeling like photographing everything in sight! We've just had two really great weekends and the pictures probably tell the stories better than I could here. So click your way on over to picasaweb.google.com/joelandallison and check out the photo albums of Joel's birthday weekend in Providence (this weekend) and our beautiful day hanging out in downtown Boston last weekend-- and the Art in Bloom album, if you want to see lots and lots of pictures of flowers. :)
Here are a couple pictures of us:
in Boston Public Gardens, on the day last weekend it reached the 90s!
at Waterfire in Providence, this weekend
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