Friday, August 22, 2008

Americans for UNFPA Student Award Winner – Bridging the Divide

I hope you’ve enjoyed reading Fatima’s blog and enjoyed the glimpse into UNFPA’s work to improve the health and rights of women in Uganda and Rwanda.  As Fatima showcased, UNFPA’s in-country work is largely dependent on the local needs and really calls on community involvement to build programs that succeed.

As the Americans for UNFPA staff delegate, I had the pleasure of traveling with Fatima and delegates from across the United States. 

Fatima, 2008 Student Award Winner, had a powerful impact on the other delegates, and even more so, on the many women we had the privilege of visiting.  She was able to draw connections, beyond the surface, with many of the women we met – as a Muslim, Somali-American, and student.

Our leadership delegations consisted of eight women, and one man, ranging from age 18 to  60+.  Each delegate brought a unique perspective from corporate executives to an oilfield engineer.

Fatima’s blog offers a sampling of the insightful comments she shared with her fellow delegates daily.  Unlikely many delegates, her college research afforded her the opportunity to visit UNFPA funded fistula programs earlier this year in Eritrea.  From that trip, she was able to share with us an in-depth perspective on fistula – a problem affecting so many women in Africa.

Fatima’s age and position as “Student Award Winner” particularly offered significant hope to the young women we met.  The youth population in Uganda/Rwanda is nearly double that of the U.S. [25% percent of Uganda’s total population is currently between the ages of  15–24 living; compared to 20% in Rwanda and only 12% in the U.S.]

What that means is that, literally, everywhere we went we met young people who were impacted by the work of UNFPA.  From job training programs for women who have been trafficked to HIV prevention and reproductive health services, I was overcome by the young and hopeful faces we encountered. 

And, for our team of delegates, Fatima was able to connect to these young people in a unique and profound way. 

One situation in particular comes to mind.  When we visited the REACH program in rural Uganda we went to a school with about 700 students, many of whom were also Muslim.  They were immediately drawn to Fatima, I think because she didn’t seem as “foreign” as the rest of us.  At the end of our visit, she was asked by the headmaster to share some words of advice with the students.  Needless to say, she was able to connect with the girls, I think because in her they could see a role model.  In sharing her personal story with them, she was able to inspire.  And her insights about the importance of education and stopping FGC (female genital cutting), certainly hit home with both the delegates and students.

I hope that the many readers of both Fatima’s blog and Marie Claire continue to stay involved with Americans for UNFPA.  And for those of you who've caught her travel bug: our upcoming delegations are to Laos in October and Nepal in March 2009.  And for U.S. College students, keep an eye out for news about the 2009 Student Award—applications will be available in December. 

For me, this trip has brought to life the obstacles and challenges facing women in Africa, and given me a deeper understanding of the programs available to tackle these problems.  By sharing this experience with Fatima, I very much hope that readers of her blog understand the importance of US support for the work of UNFPA.

Thanks for traveling along with us.  And, thanks to Fatima for sharing her wisdom with the delegates and with the many young people we met along the way!

Abby Miller

Development Manager 

Gorillas in the forest

We arrived at the Gorilla Nest lodge last night and I had no idea what to expect. I'm not much of a nature girl, so I was imagining all sorts of scary situations- especially involving bugs and huge, furry animals jumping on me while I slept. Fortunately, the lodge was extremely beautiful and prevented animals and insects from coming into where we slept.

The Volcanoes National Park is a two hour drive from Kigali, in the northwest region of Rwanda. I have always been skeptical of safari or nature trips in Africa, just because I felt that the continent was being reduced to seeing animals. However on the trip up to see the gorillas, I realized that eco-tourism is a serious industry in some countries. During our hiking orientation, the guide encouraged us to hire a porter to carry backpacks up the mountain so that we could be providing jobs. Interestingly, he discouraged us from giving money or anything to the kids who would be assembled at the starting point. He explained that this would only promote begging behavior in the children and if they were successful in getting gifts from tourists, they would stop going to school.

The hike up the mountain was really steep at the start, but the guide broke up the difficultly by pointing out flowers and other vegetation. It's a one hour trek up to the forest and it took us another 30 minutes to find the gorilla family we were assigned. I was surprised at how close we could get to the gorillas! Each group is only allowed one hour to view the gorillas and in this time we saw a silverback, a baby gorilla, and a possibly pregnant gorilla. The guides and trekkers in the forest encouraged us to take "snaps" ( pictures) and video, but towards the end I realized just watching the gorillas was a true gift. Even though the hike was physically difficult, I left the forest with a renewed respect for nature.

For many of us, gorillas represent wisdom and knowledge and I kept thinking this was rooted in their eyes. Despite the fact that gorillas only live 35-45 years, I felt like they were witnesses to humanity. During the genocide, many Rwandans spoke of fleeing into the bushes and the entire hike I kept envisioning the forest as a refuge and I wondered how much the gorillas has witnessed. The painful legacy of the genocide is deeply embedded in every part of Rwanda, even in the homes of the gorillas.

Thursday, August 21, 2008

Guilt and Reconciliation

This afternoon we visited the Rwandan Genocide Museum in Kigali. I have struggled to understand the point of constructing museums in honor of massive extermination campaigns. However, the most important aspect of my two hours in the Genocide Museum was witnessing the busloads of Rwandan high-school and university students visiting the museum. Often in developing countries, museums and other historic parks are tourist and foreign visitor hotspots but today, Rwandans of all generations solemnly walked through the memorial.

Walking through the perfectly arranged memorial with the machetes and victim's skulls and clothes from mass graves was incredibly difficult to process. On hand, it's crucial for today's Rwandans to confront the events of 1994 and previous with honesty and respect. But on the other hand, it was extremely uncomfortable to see the products of violence that was completely and conveniently ignored by the rest of the world. Furthermore, some nations were actively training and financing the architects of the genocide and the militia that killed up to one million people. One million people- what does that even mean? One the way out of the museum, one quote let me register what I had just seen. " The interhamwe ( militia responsible for the slaughter of the Tutsi minority) did not kill a million Tutsis, they killed one another, then another, then another"…

I have told many readers I come from a big family- 8 immediate siblings and a huge extended family. Virtually no Tutsi family was left without many family members dead or tortured with living as raped victims or the guilt of surviving. About 25,000 Rwandans are buried at the genocide museum and when I read the names of those buried, I was horrified to realize that every victim was part of a group of 10-12 family. As I walked away, I was disoriented and remembered the hundreds of wedding pictures, vacation snapshots and birthday celebration pictures of the victims featured inside the memorial. Most Americans can look in their family albums and relate because these are universal moments of joy. In each face, I could see my family's faces.

Around the corner from the memorial is the hotel that is featured in Hotel Rwanda, Hotel Des Mille Collines French for "Hotel of the 1000 Hills." For many of us, this blockbuster film was our first engagement with the genocide. As we drove past it, I kept transplanting myself to this scene 14 years earlier and could imagine the roadblocks and the killer mobs. When violent crimes or deaths occur in our homes, we tend to move out because we are not able to live in the same house. Nearly every home in Rwanda was affected by violence- 99% of Rwandans witnessed violence or murder. They don't have the choice to leave because there is nowhere to run to…

Many of us on the delegation felt guilt and anger about how America did not intervene to stop the killing. Even though it is far too late to take anything 'back', we can help Rwanda recover by supporting UN and grassroots programs aimed at unity, peace and reconciliation.

Monday, August 18, 2008

Strongest women in the world

We arrived in Kigali, Rwanda last night. When I hear the word "survivor" I usually think of that TV show that pitted contestants against each other on some remote island, playing games to outlast other players and not be sent home. In Rwanda, when people talk about the genocide those who survived the conflict are called "survivors". Yesterday, we were privileged to visit a survivor's village an hour outside of Kigali and hear from women who survived extreme sexual violence and now live together.

Sevota is an organization that was founded by widowed women and orphans who, at first, came together to cry together. Tears can be therapy. As I sat listening to the testimonies of the women, I realized that in the beginning after being held captive and raped each day, after witnessing your entire family of 100 murdered, and after giving birth to a child that your rapist seeded, healing must first begin by reaching out to other women who have also been subjected to the horrors you have witnessed.

I listened to the testimony of 10 women, 6 who have been sexually defiled and 4 who were left with child by their rapists. All of these women's families were destroyed. Some were raped alongside their daughters and watched as the militias stuffed her body in the village toilet. Two women were snatched from their university and raped by the militias day after day. If they had refused like some of their friends, then they would have suffered the same fate of being raped in public and then killed. At this one school, those who resisted so enraged the militia, that they began to systematically shoot every other girl in retaliation. By the time the machetes stopped hacking, 50% of the girls were dead. We listened to women who fled to the bush after witnessing crazed children and women slaughter their families but then return back to the village after hearing announcements from the local minister that the killings would stop. When they returned to the community, the women and girls were snatched up and brutalized so much that some girls died on the spot while being raped and others were so traumatized they couldn't move.

Nearly 25% of Rwandan women have been sexually assaulted. We saw women 14 years after being raped suffering forever with machete wounds and broken rib bones. Some contracted HIV from their rapists and nearly half of the women spoke of getting fistulas after being assaulted daily for 3 months. Today these women leak bloody urine and refer to themselves as being handicapped. Sexually based violence not only leaves physical and mental scars, but it completely demoralizes the victims and terrorizes the female sex, sending warnings to those who are not raped yet.

One woman who was sexually assaulted later found out she was pregnant by her rapists and until she came to Sevota, she couldn't speak. There are still women who haven't spoken, 14 years after the events that started in April 1994. For these women, they might be terrified of speaking out because some survivors who testify are killed in the middle of the night. Some women can't speak because they are enveloped in a constant state of trauma. They say they have nothing to live for, their families gone, homes demolished and futures destroyed. I kept envisioning each woman, surrounded by her 7 or 8 children leading busy, vibrant lives and contrasting it to the woman in front of me today, completely hopeless.

For these women who were impregnated by their rapists, it was excruciating to bear a child for these men who hacked their children in front of their own eyes. One lady told us she was revolted with her fetus and when she returned to her family home when the conflict ended, she only found an uncle and brother who kicked her out as they could not accept a child of the enemy in the family home. When she had her baby, no one from her living family came to the hospital even when it was only up the road from her home. For many weeks she stayed in the hospital, having nowhere to go until a doctor sent a group of women and children to Sevota. She said her child, now 13, was a very difficult boy and blames herself for his attitude issues because she would beat him a lot when he was young. For many of these women, their sons and daughters are now adolescents asking for honest answers about who their fathers are and they are encouraged to speak honestly about what they experienced to their children.

In April 1994, the people of Rwanda suffered a magnitude of pain that humanity cannot understand. Many of us on the delegation felt conflicted just sitting and listening to these women talk. I was thankful for my notebook and pen because I could focus on writing down every word. Every time I looked up, I was unable to look away from their faces. When each bravely testified for us, the others would have an empty look in their eyes and gaze off into corners, others would have their arms folded on top of their heads, looking down. When some women gave testimony, their frail bodies would shake.

At some points, I felt that their souls were removed when they recounted and in front of us were just bodies of women with broken spirits. I am grappling with the ethics of asking women to share these brutal moments of their lives, but I understand from the UNFPA staff that these can be part of group therapies. Personally, I was relieved to hear one woman say that she was happy that we came all the way from America to listen to them speak, because some people who are a part of their community don't want to hear them speak out.

After only one testimony, I felt not only emotionally shattered and horrified to understand that these were only 10 women and millions of women across Rwanda, Darfur and the Congo were subjected to extreme sexual violence. UNFPA has been an early partner of the women and orphans of Sevota, initially funding the center with 1 million dollars. Today they need medical support for women with fistula, various STIs and those with children asked us to be advocates for them so that their children can attain education. Even though women who were raped are considered survivors, their children born after the conflict are not eligible for educational scholarships that the government offers to surviving children.

The Rwandan government has the responsibility to heal and help the entire country recover from the genocide. It is crucial for Americans to support UNFPA because they are a significant partner with the government, filling in the gaps where the government simply doesn't have the means to support small, district level projects. Interventions on the village levels are crucial because there is still distrust and fear, especially when some of the rapists are released back into the very same villages as their victims. For these women, Sevota is a haven.

The American government is blocking the funds that would support projects like Sevota in Rwanda. Perhaps it is easy for the American politicians to make these decisions when they are not shown how UNFPA support is crucial. I can only invite our President and Congress to come to Rwanda see what these groups work towards achieving.

Friday, August 15, 2008

Two Governments, One Bad Plan

This morning we visited the Naguru teen center, a health education and treatment center just outside Kampala specifically catering to the youth populations. It was astonishing to listen to health service providers on the ground describe the impact of PEPFAR's (President's Emergency Plan for AIDS Relief ) strict abstinence versus condom use policy. Recently, Uganda has adopted the U.S. government approach of addressing prevention by emphasizing abstinence only discussions. This shift is not only because U.S. directed funds have many strings attached ( including the no-condom promotion) but is partly attributed to the influence of the Ugandan first lady, who is a born again Christian.

Since embracing the Bush policy in 2003, posters encouraging people to practice safe sex and use protection went down. Like I mentioned in an earlier blog, these cartoon messages are cheap, easy and powerful ways for the Ministry of Health to advocate for behavior change. They can target the entire population and because they rely less words even the illiterate can grasp the meaning. Around Kampala I saw no condom or protection posters, very strange in a country which has constantly engaged in honest, frank conversations about sex, etc.

The more I listened, the more I felt that this plan is actually cruel to women in Uganda because we know what to do but we aren't doing it. I’m my public health classes I’ve learned that medical research has proven condoms as very effective but instead we are advocating a policy with serious holes. Though I have read about the PEPFAR policy being shortsighted or just plain stupid in terms of being a public health strategy to cope with HIV prevention and treatment, today I felt enraged about the implications of this policy. Currently, America is not supporting the UNFPA and it seemed like sheer arrogance for us to further dictate moral values to Ugandans. In fact, instead of accomplishing its missions, I perceive that abstinence only policy is hurting the country by mandating PEPFAR and not supporting UNFPA work. UNFPA funding is different to PEPFAR because UNFPA funds come with no such strings so UNFPA programs can provide condoms and promote usage, based on the wants and needs of each country.

While PEPFAR can be attributed to lengthening many people's lives by providing access to lifesaving ARV drugs, it is completely missing the point of providing preventative services that work. Out of 1000 youth tested monthly at the Naguru center, 35-40 people are HIV positive. This is just one of several district health centers and furthermore, there are thousands who haven't been tested. Yes, abstinence has a strong place in the prevention education and should definitely be part of early youth awareness programs, just like promotion of being faithful, BUT condom use should also be equally stressed. The reality is most of Uganda are young adults and guess what, youth will always be engaged in sexual activity.

Not only should we be concerned about reducing new HIV infection rates, we need to also be concerned about teen pregnancy. In many ways, condom use can promote safe motherhood by delaying pregnancy in teens with small pelvic bones.

Many of us in the delegation were complete blown away by how professional the teen health center is. We were also demoralized and angry about how a woman's access to a better life was being obstructed. Instead of supporting the Ugandan women to make choices about their futures and bodies, the American government ( and by extension, the American people) are forcing them to lead lives which we ourselves find unacceptable. The U.S. and Uganda are both nations which currently support plans that don't work but the vast economic difference is the American advantage. In the US, women can get access to many services whether it is birth control, or the ability to put unwanted children up for adoptions. Perhaps our own luxuries make us blind to what global women are suffering from. What struck me the most is how the situation for women in American or in Uganda are truly not that different in the way the government chooses to address sex.

with peace,


Thursday, August 14, 2008

Partnering with the “Guardians of Our Culture"

Today we visited the headquarters of the Ugandan NGO called Reproductive Education and Community Health (REACH). UNFPA funded REACH’s efforts in it’s early stages to support efforts promote the end of female genital cutting (FGC) and empower girls through education. The mission of REACH, which was established in 1996, clearly states that it exists to stop genital cutting, by using a culturally sensitive approach. I was so inspired by the story of REACH and an excited to tell everyone about the achievements of REACH and Ms. Beatrice.

In 1996, before the “cutting season” was slated to begin, REACH began campaigning to the community to abandon the practice of FGC. Amazingly, there was a 66% drop in the number of girls that were circumcised. After hearing about the success of the program, international media like the BBC flocked to Kapchorwa to profile the group that was behind such incredible statistics. At the time the roads to the villages in Western Uganda were impassible and but following the success story that drew many foreigners to this region, the government invested in tarmac roads and now, the roads are amongst the best outside of the capital city.

At one point, the current president came to visit the program. When the president of Uganda comes to the rural areas, there is often an expectation that food and transportation costs will be provided for locals who witness his visit. Unfortunately, there weren’t enough resources to properly accommodate the many villagers who came to the REACH program site during that time. As a resulted many of the villagers felt disgruntled and banded together as a feeling of resentment emerged with the community. Justifiably, they felt used and the anger was directed to REACH and the Western journalists who in their opinion were "making a business on us but they did not feed us or transport us."

This bitterness fuelled community members to target REACH, declaring that this program was taking away their traditional practices. The impact on young women was widespread. Teenage girls were offered incentives to revert back to the practice…cash and goats were distributed to girls who were circumcised. By the cutting season of 1998, nearly 1100 girls were circumcised This was a huge setback and sent the developers of REACH back to the drawing boards.

The backlash against the anti-FGC/M initiatives of REACH was caused not only by economic tensions but also a lack of emphasizing how REACH would be culturally sensitive. Eventually REACH integrated cultural sensitivity as a means to accomplishing their ultimate goal and in 2006, the Kapchowra village reported zero circumcisions.

One way REACH has achieved success today is the integration of the Sabiny elders in condemning the practice and telling young girls it is no longer important to be circumcised to prove strength. For a society which prioritizes cultural ceremonies like FGC as an important link in preserving tribal identity, it is extremely powerful to have the blessings of the elders who are referred to as the "guardians of the culture.” They have created alternative rites of passage incorporating other ceremonies to replace the massive festival-like atmosphere of the cutting seasons.

Hearing Ms.Beatrice explain this part of REACH's history illustrated to me why culturally sensitive models are crucial in ending FGC/M. For me, it’s important to remember that amongst the Sabiny tribe female cutting is a test of physical strength. Alternative rites of passage can help women still pass “this test.”

Female genital circumcision/cutting/mutilation is practice endemic in my Somali culture. Over the years, I have come to use the word "cutting" to refer to the practice since I find it both sensitive and accurate. Recently, as more people become more aware about the practice, they unfortunately refer to these women as being "mutilated" and this is problematic. Having grown up with many women who were circumcised, I believe it is imperative for Americans to understand that using words like "mutilation" alienates women who have been circumcised.

Early circumcision can be as traumatic as child rape. Besides the medical complications, there is a severe lost of trust and security when children are sent to be circumcised by their own parents. I make this comparison to plead that when we talk about this subject, its careful to be as sensitive as possible and realize that heavy handed approaches (even if they are well intentioned) will always do more harm. After centuries of colonization fresh in memory, many African societies which continue to practice genital cutting will continue to point to patronizing interventions as examples of Western arrogance and this will be enough stimulus for its continuation.

UNFPA once heavily funded this organization, but today REACH is an independent NGO making it an example of a sustainable program. UNFPA's initial belief in the REACH program grew to become a strong partnership and leaves a powerful example of success.

What I appreciate in REACH's mission statement is that they are taking a popular counter-argument away from those who promote FGC. In my opinion, REACH is the best strategy for ending FGC because its greatest asset is its grassroots foundation. Right before we left Ms. Beatrice she explained that there is inadequate funding to fully carry out the anti FGM-campaign with the community. I can’t help but feel disappointed at the United States is not supporting UNFPA’s work to help implement programs like those of REACH in other areas of Uganda or around the world.

The United States has defunded UNFPA for the past 7 years, depriving financial support for groups like REACH and giving women of the world the impression that Americans don't believe in the mission of REACH and the rights of young girls and women. As you may know, the U.S. is the only country in the world to withhold funds from UNFPA- the largest international source of assistance for women- for reasons that are political, not financial.

It makes me thankful for organizations like Americans for UNFPA, that are helping to show the world that Americans do believe in women’s health and rights globally. There are lots of ways to get involved with Americans for UNFPA work, check them out at Also-- I just noticed that the Americans Express Members project took at Ad on Marie Claire.Com that is posted just next to my blog. Americans for UNFPA is involved in the Amex Project and this is the last week for them to get votes for their End Fistula- Global Woman's Health Project. I've had the fortune of visiting fistula hospitals funded by UNFPA in Eritrea and I can say that their support is invaluable. If you can take a minute to vote for the project please do so at: End Fistula- Global Woman's Health Project-

Wednesday, August 13, 2008

Women NEED to Speak Up

Throughout this trip, I have sensed the surprise of the locals when they see me traveling with a white, American delegation. I am of African descent and I wear a headscarf and in many ways seem odd in this group. But I can connect to many Ugandan people on 2 levels - being African and Muslim. Some of the locals even speak to me in the local language and I have been welcomed with countless "salaams,” a traditional Muslim greeting. Today provided me a rare opportunity to reflect on my presence in the delegation and what message I was communicating to Ugandan girls in particular.

REACH is a Ugandan NGO that works to stop harmful traditional practices like female genital cutting (FGM/C). Because FGC in Uganda is a right of passage, REACH has created alternative initiation rituals. This group primarily works in Kapchowra, Western Uganda where the Sabiny are amongst the few Ugandan tribes who continue to practice FGC. Ms. Beatrice serves as the director general and is among the few female activists who don't shy away from honest discussion of reproductive health. This is ironic, because here in Uganda women can have the public space to discuss their sexual and reproductive rights openly. But in the United States reproductive health has become too polarized. I feel as if Americans don't really engage with women's health and human rights issues and neglect to understand the magnitude of problems that can arise from childbirth (ranging from fistula to maternal mortality).

After we arrived at the Nanyata primary school in Kapchowra, a REACH program site that incorporates the anti-FGC mission into its curriculum, I was delighted to learn that the majority of the children were Muslim because I felt that our bond was greater than nationality. We sat outside under a giant tree with rain clouds low in the distances and were treated to schoolchildren performing skits and singing. Throughout the performances, I could feel the curious stares of the children and wondered what they were thinking. Right then Ms. Beatrice caught me off guard by asking me to share words of encouragement with the children, especially important since I was a Muslim woman and not the typical foreign visitor.

Initially I was completely flustered but as I looked into the crowd of young faces, I could only stress education as the single biggest tool for creating a future. It’s not a coincidence that I am a university student and find myself in Africa. Being in college has expanded my understanding of history, leaving me hungry to learn more. But today I felt that I was also a role model. I don't like talking about myself in such lofty ways, but I pictured how seeing another black, Muslim woman was a powerful message to the children. I tried to stress that the biggest difference between FGC in Somalia and Uganda centers around choice. In Somalia, young girls have no choice about what is being done to their bodies but here in Uganda teenagers can choose. Amongst the Sabiny, female teens between the ages of 15-19 chose to be circumcised because it has been an integral part of their culture. The cutting ceremony is a test of strength since the courageous girls do not cry. Over lunch Ms. Beatrice stated cutting is "not relevant today" and I couldn't agree more. If FGC is a test of strength in this community, I couldn't help but wish that females achieving a high school diploma could one day be regarded strong women. The way I see it, with more education in schools, young women will be able to make more informed decisions about their bodies.

The importance of positive role models cannot be understated, especially when the public roles of women are limited. As a young child, I had strong women role models to look up to including my Somali grandmother, a single mother of ten children. Many girls today voiced their ambitions to be doctors, nurses, headmistress or engineers and I was delighted to hear this, especially after the other female delegates explained they, too, were nurses and engineers.

We also visited a secondary boarding school and met Agnes, a charismatic, confident, and outspoken student leader of the REACH program in her high school. Agnes completely blew me away and was such an inspiring product of youth empowerment clubs. Often when visiting schools or clinics, women can be shy and reticent but Agnes was an excellent public speaker. As one of the delegates stated, women should not only have the right to speak, but need to speak up in order for their societies to fully understand their lives. This remarkable young woman reminded me strongly of Ms. Beatrice. Both have the immense courage to speak loudly and clearly about genital cutting, simply stating that they are beautiful, just the way God made them. It is time we all listen.

With peace,

Tuesday, August 12, 2008

The future of Uganda

Today marked the start of our first complete day of site visits and meetings. We met many young, professional advocates who all share this desire to determine the future of their country. Some were highly educated with university degrees and others were former sex workers with no formal education. All of these women shared the desire to give back to their community and prevent other youth from risks they faced and from ever feeling hopeless or uninformed.

Despite seeing extremely impoverished areas and being confronted with stories of abuse of young teenage girls, I never left a site feeling depressed. Instead, talking with the people on the ground and recognizing the fierce pride in their initiatives left me with the impression that young Ugandans are embracing their accountability to fellow countrymen and women eagerly. This feeling of responsibility in the face of inadequate resources leaves me with great respect of their devotion and just as hopeful for the future.

We started the morning meeting with the outgoing Ms. Uganda, Monica. Like any other beauty queen, she was beautiful, statuesque and well-poised. Additionally, Monica is a positive local role model, often visiting village schools promoting the importance of school attendance and establishing rural based orphanages. Recently she channeled her energy into starting the Nurture the Future orphan foundation.

Monica lost her father at young age and her mother in her late teens. She confided that the death of her mother occurred the week of her important end of year exams and it was nearly impossible to study because she was very close with her mother. If it wasn't for her older brother encouraging her to study, Monica could have easily been another of the common orphan/drop-put statistic. Instead, having experienced and struggled with the loss of her parents, Monica has become both an advocate and activist to help fostering education opportunities for all children, especially orphans. Her courage is a great hope to the children she meets.

From there we met former sex workers who with the help of the Ugandan Youth Development Link (UYDEL) have been able to find other sources of income to support themselves. Based in the outskirts of the city, UYDEL works with former commercial sex workers, providing vocational education like hairdressing. Often, children from the rural areas flood to find jobs in Kampala but they are deceived and forced into unpaid labor jobs. I was shocked to find out that sex workers are paid just 30 cents, just enough for a snack and juice from the street vendors. In the Chimumbaza district where these woman live, I met a young woman who was a former sex worker but now teaches other sex workers how to braid hair and offering basic business skills so that they can re-enter society with some skills to generate independent incomes. For the UYDEL staff, her story is an example of a success story and gives hope that many other young women can become empowered.

Many of the young women and children who I saw today have seen many traumatic events and are thankfully able to get various psychosocial and health counseling. Seeing them in the clinics and centers gave me hope that they might be out of harm's way, hopefully having already seen the most difficult years of life.

The investments the social workers and activists have in their causes are integral to ensuring that more children attain access to education and get off the streets. When I asked what UYDEL could accomplish with more money, the answer was simply "education".

Good night!

Monday, August 11, 2008

Welcome to Kampala

I am finally here in Kampala, Uganda! I say "finally" because it took nearly 2 and half days of travel to arrive at the Entebbe International Airport and around an hour to drive into the capital city. While the flight was sometimes painful (14 hours, non-stop), the drive was an amazing introduction to the Ugandan lifestyle for four of us on the delegation. We passed Lake Victoria, the source of the Nile River and drove past groves of banana trees, with its leaves big, bright green and waxy looking. Ugandan music blared from cars and from tiny shops on the sides of the road, where teenagers and children seemed to run from shop to shop. Dusty brick red roads dipped into valleys and hills all around the main highway, leading to rectangular concrete homes with laundry hanging in the breeze. The sides of the highways were very busy with children selling tomatoes, fresh pineapples, and other vegetables.

Most of the shops we passed were painted bright pink, yellow or green and their slogans boasted "we can keep you in touch", or " we are everywhere you go". After a while, I began to realize that these ubiquitous buildings were cell phone companies. Sometimes, the same brand would be across the street from each other! Cell phones are extremely popular here, since they are much cheaper than landlines and just like in the US, major brands offer promotions package to sign on new customers.

Kampala is bustling city with nearly 3 million people and Uganda's overall population is about 30 million. Originally Kampala was comprised of 7 hills but today numbers 21 hills, partly because development has boomed in the last 10 years. Additionally the fertility rate in Uganda is amongst the highest in the world, with the average woman giving birth to 6 or more children. A population surge like this can be destabilizing because the younger the country's population, there more able-bodied fighters are available to fuel conflicts in the region. In Uganda, 60% of households are headed by someone 18 years old or younger. Clearly, teen pregnancies contribute to these sobering statistics and indicate the need for reproductive health education.

Hearing these numbers and facts was overwhelming but it's important to understand that many groups have worked successfully in providing prevention and treatment in Uganda. Tomorrow afternoon, the delegation will visit a NGO that specifically works with the youth to educate about HIV/STI/ and teen pregnancy prevention. This particular group reaches out to teen commercial sex workers (usually female) and helps empower them with jobs in addition to leading health intervention.

Many buildings and billboards in Kampala are advertisements to buy Coca-Cola or NestlĂ©'s milk, but others are also public health posters . One member of the delegation pointed out her favorite of an old man and a quote hovering near him- "Do you want this man to stop sleeping with your daughter? Then why do you sleep with his?" This poster is part of a campaign to stop older men from seeking out younger women and another poster clearly stated "no cross generational sex". Most of these posters are blunt, but I guess honesty about health is necessary to promote safe behaviors and reaches out to everyone. I'll keep an eye out for these public health fliers and hope to include a picture in an upcoming blog…

Good night,

Sunday, August 10, 2008

Traveling to Uganda & Rwanda

My name is Fatima and I'm incredibly excited to be a part of the American for UNFPA's delegation trip to Uganda and Rwanda. I am studying international health and development at Stanford University and hope to graduate this spring. When I first heard that I was chosen as the student award winner, I was totally humbled. Out of all the people that applied, I couldn't believe I was given the chance to witness and learn from the work of women abroad. I treasure this opportunity to see the struggle and survival of women and learn from their resourcefulness and experiences.

My parents are from Somalia but I grew up in the quiet suburbs of Texas. When I first told my family (parents, aunts and uncles) about my trip, they were supportive but cautious. As witnesses to the civil war in Somali, they are justified in being nervous. But I want to show them and the readers of this blog a different type of Africa, beyond the usual depictions of today's Africans as starving, sick and warring people. In just 2 days, I will be traveling to 2 gorgeous countries, Uganda and Rwanda. Although this region has a long history of civil strife, they are also known as the "green pearls of Africa" with bright green hills and deep blue lakes. Many have heard of Uganda in the context of politicial instability and Rwanda will forever be associated with genocide of April 1994, however on this trip I would like to take the incredible opportunity to talk and listen to the many local women I hope to meet.

I grew up around many educated and independent Somali women in my family and they served as powerful role models, sparking my passion for women's health and gender equality. On this trip, I will be reporting back about the important work of UNFPA such as outreach programs to teenage commercial sex workers in the slums of Kampala, visiting fistula hospitals and speaking with genocide survivors in Rwanda. One aspect of the work of UNFPA I deeply respect is the commitment to empowering women globally and the way it accomplishes these goals in culturally respectful ways.

As long as I remember, I have wanted to be a doctor and writer. Growing up, I remember watching the war in Somalia with my parents on CNN in our living room, eagerly listing to international reporters and aid workers who covered the famine and civil war. I gained both knowledge and a sense of responsibility and I have always hoped to address this in a dual approach, medicine and journalism. I want to report the problem and share people's lives and provide context but I also want to use my hands in places of great need.

Lately I have been questioning the point of my trip. Why is American for UNFPA providing this opportunity? I am still a student and I can't provide the technical interventions, nor donate millions but I can solely focus on conveying the essence of what I see, smell, feel to all those who can't travel half away across the world. Together, we can expand our understanding of the issues and advocate for the work of UNFPA and the lives of the millions of women affected.
I hope you check the blog each day and I look forward to hearing what y'all think!


Friday, August 8, 2008

A Social Death

As a consequence of fistula, the mother emanates an unpleasant odor often driving her husband away and causes her to be socially ostracized, pushing her to isolation and depression. She is condemned to a life of loneliness – without the companionship of her husband, friends and children. While she does not die, the development of a fistula is akin to social death as the village treats the fistula victim as a scourge- pushing her to live at the edge of the community with no social support. Research shows that girls and women with fistula often eat alone, sleep alone, and pray alone. As the women were wheeled into the surgical floor, I noticed the how frail the women were- most exhibited physical signs of extreme malnutrition, some women’s backs curved and others with deep cracks on their feet, skin peeling off.

Many of these women were brought to the hospital by their parents or brothers. One of the doctors had become particularly close to a 16 year old girl with a clubbed foot, who was accompanied and supported by her doting father- she did not have fistula but a congenital abnormality that caused her to leak. Not all patients are shunned by their families and many women had been supported by their parents, husbands or siblings to seek care. The persistence of the women who actually make it to the hospital is not an indication of success, because for every 1 woman who comes 10 more couldn’t afford the journey or were too scared to travel outside their house when confronted with the ugly side of humanity. So, these surgeries are only treating the ‘tip of the iceberg’ since nearly 3 million women with obstetric fistula still need treatment.

The commitment of the Eritrean government* to repair the health infrastructure is a hearting sign of developing countries diagnosing their weakness and not simply applying bandages in the face of crushing poverty. These stronger health infrastructures are crucial to the achieving better maternal health- so that fistulas never occur.

*The Eritrean fistula team have consistently partnered with the Ministry of Health, the UNFPA, and local healthcare providers to shape brighter futures. In the past six years, together they have helped to strength the country’s fistula policies and established the Fistula repair center and hostel. For more information about the Eritrean Maternal Health Project and the UNFPA’s programs in Eritrea please refer to

Thursday, August 7, 2008

A Safe Place

Eritrea‘s culture is vibrant and its people diverse with 9 ethnic groups and a 50% split between self identifying Muslims and Christians. Across the courtyards of the fistula ward, bright cloths were hanging out to dry having been hand-washed to remove of the lingering stench of urine. The fistula wards were a place of healing and sisterhood. Sometimes the surgeries were successful, other times the women continued to leak because of the extent of scarring and damage. In the mornings, the doctors came in to examine the post-operative patients and the leaking women would turn on the sides or pull their blankets over the heads to hide their tears and disappointment. For these women, the head nurse (affectionately called “Sister”) and other patients provided comfort and encouragement- next time, maybe next time surgery would heal them.

The ward is a safe space for the women and on the last day of the surgical mission, the patients invited the team to a special coffee ceremony. We walked into the decorated ward, with flowers and grass carefully placed on the linoleum floors, and saw the women in their colorful shawls sitting around the coffee pots waiting eagerly for the doctors to take their seats. The ceremony deeply touched us because we were privileged to be included. The women danced to traditional Eritrean music, blaring from an old stereo and invited us to join them. We were pretty bad dancers, but then one of the doctors managed to hook up her I-pod and played some Beyonce and Black-Eyed Peas- we explained “this is our music” and were met with blank stares and giggles.

Luckily, I brought my digital camera to the ward this day, and I started to snap pictures of the patients, showing them on the screen how they looked. As I took more and more snapshots, the atmosphere in the ward became less formal as everyone wanted their pictured taken. The smiles and laughter humbled the team and we realized many of them had never seen their pictures.

Wednesday, August 6, 2008

God Will

I recently had the opportunity to visit Eritrea as a part of the Eritrean Maternal Health project. The Maternal Health project was founded by Stanford Medical School and supported by UNFPA and the Eritrean Ministry of Health. One if its major concerns is obstetric fistula.

Obstetric fistula is a childbirth injury that happens as a result of obstructed labor in places where medical care is largely unavailable. As a woman- typically young, extremely poor and illiterate- squats for days alone, attempting to deliver her baby, the trauma adds up and an internal hole develops. Contents from the bladder and rectum cannot be willfully controlled, so the fistula victim constantly leaks urine and/or feces. The corrective solution for the medical aspect of this disease is a surgery, which costs around $300 and is often done for free usually in endemic areas, but barriers to surgery include transportation, lack of infrastructure and limited resources of the state to reach out to very pregnant woman in the countryside.

Eritrea is a rural nation with hills and rough terrain. Traveling in the rural areas consists of riding on a camel, constantly going up and down and potentially causing more trauma to the fistula patient. Dr. Hapte, one of the OB/GYNs (and father figure for the fistula patient) at the Mendefera Hospital ( the same site of the Eritrean National Fistula Center) spoke of the shame of traveling on buses when the fistula patient is still leaking- sometimes other bus riders forcibly evict the leaking woman because of the strong urine smell.

I am a Somali-American woman who practices covering my hair with hijab- so in many ways, I looked like many of the woman. Many of the patients in Eritrea were Muslim women. Names like “Fatima”, “Zahra”, “Mariam” and “Zeinab” filled the pages of the simple hospital logbook. My “salaams” were met with timid smiles and then eager questions about who I was, where I am came from and why a Somali-American was in Eritrea. After sometime, I realized that these women were expecting that I would turn my nose in disgust and were hiding their catheters (bags that hold urine) from me, hiding their shame. It was strange to them that people would care to talk to them when from the past months and years, their families and societies had pushed them away. Many women have internalized this and believe that the fistula condition was “God’s will”.