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May 5, 2014 / calebdresser

Nyakibale

Three days ago, I plunked a fat red duffel bag onto the concrete floor of my new home in the international house at Nyakibale Hospital. I’ll be here a year, working as Uganda Program Director for the Global Emergency Care Collaborative, an NGO that trains Emergency Care Providers to perform assessment, diagnosis, and a wide range of treatments and interventions on their own.

 

I’ll be maintaining this blog to some degree, but needless to say, I’m pretty busy with the transition into my new role. In addition, I won’t be posting much of my actual work here (professional decorum and all that!), but I will be writing some posts on the GECC blog from time to time. If you’re interested in seeing some of what we’re up to over here, clinically and otherwise, check out http://globalemergencycare.org/category/news/ in coming weeks.

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September 14, 2012 / calebdresser

An Open Letter to the People of the Muslim World

I cannot speak for anyone but myself. This is what I wish to say.

To the Libyans protesting against the killings in Benghazi, thank you. You have been heard, and we recognize how much courage it takes to apologize on an international stage while gunmen watch from the sidelines. To the local soldiers and police fighting to protect our embassies in Sana’a and Cairo and elsewhere, thank you. You have put aside whatever private anger you may harbor in order to help us. To Muslims everywhere who recognized that a malicious video does not represent the beliefs of most Americans, thank you. You are able to recognize extremists when you see them, something we must both grow better at doing.

You have your radicals; we have ours. The radicals get all the attention; as a result, we must learn to separate these individuals from the larger mass of our respective societies. Our responsibility is two-fold: we must work to contain their effects within our own countries and – much more difficult – we must learn to look at one another and see people, not headlines written about madmen.

If I were to take the headlines I read as the whole truth – which some Americans do – I would be fooled into thinking that the Muslim world was a cauldron of violence whose people were dangerous and wholly opposed to my way of life. This is an image that is just as inaccurate as that espoused by some members of your societies, who see America as seeking to corrupt and destroy your way of life. These misperceptions frighten me, for they are in large part invented fears that have come to hold a central place in determining the course of events on a global scale.

What gives me hope is the fact that, with the exception of a handful of extremists who grab headlines, we are decent people – whatever our faith. Here in America, I have been fortunate to share classrooms and restaurants and dinner parties with people of every faith and to learn from their stories.

Though I am not a Muslim, I have had the privilege of living in Muslim countries and learning that you, like most of my fellow Americans, are people with whom I am genuinely glad to share this world. On the edge of a park in Sumbawa, you took the time out of your day to make sure that I, a total stranger, was safe and happy. On a train in India, you found me and returned a camera worth more than your salary for a month. In a restaurant in Dubai, you sat beside me because I looked lonely, though neither of us could speak a word in the other’s language. On a heavily mined ridge in the Horn of Africa, you showed me where to place my feet, and all day you lugged a rifle through the glaring sunlight to make sure I was safe.

We are not crazy. Neither are you. True, there are many details we disagree about, but by and large we all want to live honest, peaceful lives. We want the freedom to follow our beliefs and conduct our affairs in accordance with our religious, ethical, and cultural convictions. Some of these beliefs do conflict – we are committed to freedom of speech, even as you are committed to the inviolability of name of the Prophet Muhammad – but even this is not insurmountable. While we cannot apologize for our belief in the importance of a free society, we can express our tremendous sorrow at the fact that someone chose to abuse this freedom in a way that did you harm.

We have had our differences of opinion, our arguments in sidewalk cafes and hospital corridors, but even when you have been very angry at what America is doing, you have never once blamed me.  When American aircraft attacked targets – people – a few hundred miles to our south, you took the time to translate the news for me before explaining how upset you were. We had tea together the next morning as friends.

You have had the integrity to see me as a person, as a well-meaning member of a fallible society, and even as I recognize that your societies are also fallible, you have earned my respect. It is my hope that we as Americans can continue to deserve yours, and that you will give it freely. My belief is that this will only be possible if we can learn to see one another as individuals, rather than stereotypes, on both sides of the walls that extremists seek to build between us.

August 4, 2012 / calebdresser

The Boatyard

The boatyard was a patch of sloping gravel in the slum behind the government hospital. The men – it was only men – who worked it did not know that they were unusual. They took great baulks of smuggled hardwood from the interior and, amid piles of wood chips and discarded plastic bags, transformed them into sturdy open boats nearly thirty feet in length. The boats carried home-made lateen sails and were brighly painted, so the tourists liked to photograph them as they passed through the bay. The tourists did not bother to photograph the boatyard. This was the final, cinching mark of its authenticity. It felt good to be in a place where working wooden boats were built by hand.

July 12, 2012 / calebdresser

At the Friday Clinic

She did not cry. She did not wriggle or kick or look away. She watched him with blank unfocused eyes because he was in front of her. When he was not in front of her, she watched the wall. It was made from slats of split palm and did not reach the ceiling. There was bird shit on it because the clinic was only open one day per week. She did not know enough to be scared.

July 10, 2012 / calebdresser

In Diego Suarez

Down in Diego for a day or two. Might have time to write, might not, and internet is a bit iffy… we only have power two hours a day.

 

Image

 

Some huts in the village called Tanabau. We run a weekly clinic in the schoolhouse. Its a one or two hour hike east of Maventibao.

 

 

June 29, 2012 / calebdresser

Bienvenue a Madagascar

Arrived in Antanarivo this morning abour 3am. Spending two days here; after that, a flight to the north to meet people from the NGO I will be with this summer.

Here we go again…

July 20, 2011 / calebdresser

Who would choose to be a woman?

The midwife had nearly finished a difficult stillbirth delivery when she looked up from the bloody mess in the bucket and sadly asked, “Who would choose to be a woman?” Her question stuck in my head. For me, it has come to symbolize all the frustration and unfairness and inequality that are everyday facts of life for the women here. I’ve been planning to write about these issues almost since I arrived, but the more I learn the more difficult it is to convey my thoughts in a neat little essay on the internet.

It’s hard to know where to start. The issues are too far-reaching and pervasive to permit a simple explanation. I had hoped to write a piece that would explain the “how” and the “why” of the issues, but it’s simply too complex. So – here is the unvarnished “what” of these problems, in no particular order. Draw your own conclusions.

Women can’t make their own medical decisions. When a woman comes into the hospital here, she is treated the same way we would treat a child at home. If she needs induction, someone has to call the husband. If she needs a caesarean section, someone has to call the husband. If the husband isn’t available, the nearest male relative has to make the decision. Even in emergencies, the hospital isn’t legally permitted to perform procedures without a consent form signed by a man who has authority to make decisions for the woman. As might be expected, this policy sometimes kills women and often kills their babies. It also leads to some stunning contradictions – if the midwives here were to become pregnant and need a C-section, they would have to convince their husbands to sign the form, even though the midwives know far more about what the procedure is and why it is needed. Not to mention that, at the end of the day, it’s their body.

The C-section issue blends into the larger problem of family planning. Almost everyone here does family planning: they plan to have big, big family. We routinely see women who are coming in to have their tenth or even twelfth child; the highest number I have seen is fourteen. The desire for unlimited numbers of children leads to significant conflicts of interest when it comes to making medical decisions. A woman can only have a C-section three or at most four times, and typically once she’s had one C-section, the rest of her deliveries will also have to be C-sections. Clearly, having a C-section puts a severe limit on her ability to keep popping out kids, so husbands will often refuse consent and delay surgery as long as possible, sometimes until after the baby (or mother) is already dead.

It’s natural to wonder why everyone wants to have so many children. While the men’s motivation is somewhat ambiguous, ranging from ensuring some support in their old age to general concerns about masculinity to helping make Somaliland “a big country like America,” the women’s motivation is much simpler. If a woman doesn’t produce plenty of children, her husband will just go out and take a second wife (up to four are permitted under Islam) and she will be forgotten in a decaying house somewhere. If she keeps having children, she is more likely to remain in her husband’s favour and be better supported, along with her children – at least until menopause. Desperate middle-aged women sometimes show up saying they think they are pregnant, only to tell us that their last period was more than a year ago. Whether on not they can still have babies, the trip to the hospital for a maternity consult probably does good things for their status in the eyes of their husband.

Pregnancy (or lack thereof) is not the only reason for unnecessary trips to the hospital. At any given time, we usually have one or two women on the wards that are perfectly healthy, medically speaking. These usually get listed as something along the lines of “hysteria” or the more politically correct “conversion syndrome.” Their symptoms are usually mild, and change depending on who is asking them questions. Their history usually involves a fainting episode – the relatives bring them in if they don’t get back to normal fairly quickly – but a mysterious lack of any bruises, cuts or scrapes from the fall. Lab results, if any are taken, always come back normal.

Most of these women fall into two broad categories: teenagers who are psychosomaticizing the stresses of puberty and impending marriage, and older women who want some attention and a break from their families. Both of these groups of patients point to a larger problem: there is no psychological safety valve for most of the women in this society. The whole structure of their lives is dictated by others. There are no opportunities to go to the mall with friends, relax at the beach, take a vacation, or heaven forbid choose their own husband or get thoroughly drunk at the bar. The only thing they can do is adopt the sick role, bask in the attention of their family, snooze in a comfortable hospital bed for a few days, and try not to think about the future.

All of these problems are attributable to women’s lack of control over their own lives. Some of the other problems are even more aggressive. Essentially every single woman whose delivery I have been involved with has had some form of genital mutilation, including quite a few that obstructed the birth canal so much that the baby couldn’t get out until the midwife made some strategic snips with her scissors. While some people say that fewer young women have been having these procedures done to them in recent years, there are no solid statistics. We’ve had at least one teenager come in with abdominal pain resulting from an FGM that completely obstructed her opening to the point that her first periods couldn’t get out; the hospital’s OB/Gyv had to drain nearly a litre of stagnant blood. Brides-to-be, some as young as 15 or 16, sometimes come in to have their FGMs opened before their wedding night. It’s an ironic and extremely painful start to the marriage: the snipping procedures are done in the same room to which these women will return, year after year, for their deliveries. It’s hard to say whether they are marrying the husband or the hospital.

Even after her early years of marriage are over, women don’t have much of a chance. While husbands are supposed to support each of their wives equally, the majority of the men here are addicted to khat. Given the choice between feeding their families and feeding a khat addiction, many of them choose khat and head for a shady tree to chew away the afternoon. As a result, the women sometimes have to fend for themselves and their children or hide the money that families living in the UK or America send back as remittances.

As with most of the social issues here, it’s hard to see a clear path forward to a brighter future. Most women are caught in a viscous cycle, and unless they are willing to forgo the marriage that their family expects and try to make a career for themselves, they don’t have any easy way to break the cycle. Education, empowerment, employability training would help, but in an economy that staggers along from day to day through the charity of the Somali diaspora, these can only do so much. Even now, our educational efforts with women are hampered by their continual need to go off and tend to the needs of their families. Typically, if a son and a daughter go to school together, the son studies in the evening and sleeps in the morning while the daughter is helping with the supper, cleaning the house, and ironing his clothes. As a result, girls typically fall further and further behind in school.

Even if a woman wants to have fewer children, the system here says it isn’t really her decision. Marriage is considered to be as much the family and the clan’s business as it is the bride’s. Clandestine birth control clinics would incur the unbridled wrath of an armed populace if they were discovered, and it’s hard to picture any of the NGOs here adding another item to their long list of security concerns. Working on the men, trying to inculcate attitudes that favour family planning and that value a woman for herself rather than her baby-making potential, is equally difficult. This is a place that is ripe for new ideas.