Global Health Reflections

Haiti After the Quake begins with an image of Haiti rising, as it always has, to free itself from suffering and shackles, both real and metaphorical.  How many people know that Haiti was the first country to abolish slavery, and that it’s national sculptural icon Neg Mawon  (“the free man”) survived the quake and still blows into a conch to call others to freedom?

Today the University of Wisconsin welcomes Dr. Paul Farmer to its Distinguished Lecture Series, so it’s a good time to post a review of his most recent book,  Haiti After the Earthquake.  Many are familiar with Mountains beyond Mountains, Tracy Kidder’s award-winning account of Farmer’s work in Haiti.  For those inspired by that book,  I recommend reading some of Farmer’s own writing.  Well-researched and meeting every academic bar, they are also written in an intelligent accessible voice that does not apologize for its passion or its bias –a preferential option for the poor, and all those who suffer or are voiceless. Titles include Pathologies of Power, Partner to the Poor, and Infections and Inequalities.

Farmer’s 2011 Haiti account is true to what he is and has been.  He takes the reader with him through the days after the quake at an hour by hour pace, as he sees patients, tries to engage constructively in the policy development process, and even as he succumbs to fatigue, lying in bed rather than going to safe ground outdoors during strong aftershocks.  Thankfully, he cannot resist weaving in Haiti’s history,  and lessons from his experience in post-genocide Rwanda.  The book does not have the flavor of distilled wisdom, it is too soon for that.  Instead Farmer honestly walks us through complex issues, sharing his own questions with us, trying to imagine realistic scenarios of success, and, perhaps most importantly, channelling the Haitian spirit, insisting on hope as a moral imperative.

In addition to Farmer’s own story the book includes the voices of others who know and love Haiti.  Nancy Dorsinville brings us close to Haiti and its evocative language as she recounts the various ways people named the cataclysmic event.  The earthquake “tranbleman te,”  that thing “bagay la, “ and finally “goudou goudou,” which needs no translation.  One can hear the earth shake.   Walking around the camps with Didi Bertrand Farmer,  seeing her own daughter in the faces of girls who risk rape and abuse when fetching water or walking to the latrine, one is shaken from the protective distance we create between ourselves and disaster.  It could be us, it could be our children, and in a very real sense, it actually is.

Those engaged with Haiti have become familiar with the term “Build Back Better.” Before reading this book I was uncomfortable with the chop chop of that — it seemed to celebrate erasure for the Haiti that was, in the name of progress.  I worried that master plans would bulldoze local places and the small dreams of people who wanted to restore their own homes, streets, schools and churches.  But the voices of Haitians that come through in the book (particularly in the chapter by Michele Montas Dominique, where she summarizes the Voice of the Voiceless project), seem to embrace this idea as a way of making meaning out of the loss, and, provided that they have a say in the plans and designs, it is something that gives them hope.

Haiti Afer the Earthquake is a collection of voices.  People who have worked together for years, come together around a tragedy, and humbly try to record and make sense of it for the rest of us.   These are wise people, people who, I suspect, think and pray together. The book is a first step toward learning what it means to accompany Haiti, to walk with those who suffer, and to be a healing force when we encounter brokenness in our world.  Let’s build back better.

Half the Sky, by Nicholas Kristof and Sheryl WuDunn  documents the hard truths about being a woman on this planet. While some of us choose our spouses, share parenting, and become doctors or astronauts, many are stuck in a cycle of poverty and suffering that includes unfulfilled potential, maternal mortality, slavery and human trafficking, prostitution and survival sex, every  kind of violence, and a lack of choice and safety in relation to their sexual and reproductive lives.  Because I work with programs that address the health of women and children, people often ask me what I think of the book.  Is all this really true?  Did they get it right?

I have read the book three times and each time I am more impressed.  In addition to portraying the lives of women with great dignity and respect, Kristof and WuDunn provide the reader with stories of resilience, cause for hope, and suggested  action that will make a difference.

The first time I read Half the Sky was just before Sheryl WuDunn came to Madison to speak about the book for our local Planned Parenthood chapter in 2011.  I sponsored a table with my neighbor and friend Joyce Bromley, and we decided to invite some of my global health graduate students to join us.  Sweta Shrestha, a “Madison girl” from Nepal,  Aaliya Rehman from Pakistan, Middleton’s own Roman Aydiko, originally from Ethiopia, and Chrstine Kithinji from Kenya.  The topics were difficult, but the evening felt like a celebration — these young women in my circle were saddened but not shocked by these realities. Empowered with education, they are hopeful about being leaders and making change.  As the crowd departed we found ourselves in a circle sharing stories.  Each of these women told of someone who had fought for her: an uncle who defied the family and took his bright young niece to school because he knew she could realize her dream of becoming a doctor, a mother who defied tradition and married for love (and she wore pants!), parents who braved the immigration journey to the US with their children, and a foreign sponsor who kept investing in a young African woman, by providing scholarship support.  All of these young women are leading international lives now, making a difference in public health work here in Madison, and staying engaged in  their home countries.  Sweta leads service learning programs for UW students in her native Nepal,  Roman is engaged in research and quality improvement in Ethiopia, Christine is building a clinic in her home town, and Aaliya, an obstetrician who is proud of her Pashtun origins, is now in Pakistan working to improve maternal mortality.

This fall I assigned the book to my global health honors class for first year students.  “The book made me tremble,” one student told me.  Rereading the book through her eyes somehow made what was already real to me more real.  The raw facts lingered, and the numbers and the truth of the stories sunk in.  Is this really true? I realized it would be almost impossible to tell a false story about the oppression of women and girls, because everything  you can imagine is already happening to a girl–just about every girl you could make up is actually out there.

The subject of the book came up with again with students in my global public health class this spring.  We  discussed the book over coffee before class, and someone asked if I would blog about it.  So I gave it another read through yet another lens.  This is a class where we focus on action: What is the problem? What are the root causes? What works? How can we close the gap between the world we are in and the world we want to be in?  That is our public health mantra, and Half the Sky did not let us down.

Educating women, creating livelihoods through mirco-enterprise, providing health care… these things work.  At the end of the book Kirstof and WuDunn suggest 4 ways to support the  women and girls all over the world who are trying to change their own lives.  It will only take about 10 minutes and it probably will cost you less than you spend on dog food or coffee in a month.

1) Make a people to people microlending loan  (www.globalgiving.org or www.kiva.org).

2) Sponsor a girl (Plan International or Womenfor Women International).

3) Mmonitor news about global women’s issues through www.womensenews.org or www.worldpulse.com.

4) Become a citizen advocate at  the Care Action Network (CAN) www.care.org/getinvolved/advocacy/index.asp

I hope people will read the book and get involved.  As hard as it is to stare down what is happening to girls in our world, change is possible, and women and girls are surviving and rebuilding their lives.

There is a movie based on the book coming soon.  See trailer at:  http://www.halftheskymovement.org/