Mexico - The Last Day

Today was short and marked by several problems such as our translator canceling Tanitra’s ticket back to New York. Dr. Elu decided today – of all the days that she has spent in Oaxaca – she wanted to go to the Santo Domingo Church. We sent our camera guy along and I think he’s talented enough to turn the half hour she spent in the gift shop into good footage.

On our last day here we were lucky enough to catch a documentary about the teachers uprising 2 years ago. I was amazed to see so many women out on the streets protesting, try to stop the military from entering the city, and setting up food and aid stations. As we walked around the city you could still see evidence of the teachers strike, the economy has not fully recovered.

Since it was a short day, I’ll take this opportunity to make one final point about Mexico and reproductive health. Less than one percent of Mexico’s population is infected with HIV (like Niger where I visited last year). This is what they call a contained epidemic, still largely within the community of men who have sex with men and now sex workers. Like Niger, Mexico is spending a great deal of energy on HIV prevention, particularly among young people, before the epidemic spreads. (A concern is that some of the men who immigrate to the U.S. become infected and bring it back to their wives in Mexico.)

In fact, the UNFPA office is preparing for a huge HIV conference in August.

We’ve noticed is that there are no condoms on display in the pharmacies and wonder if there is a stigma involved with buying them and if that means condom use is low.

Place of the Cloud People

Early this morning we headed into the mountains to a town called Tlahuitoltepec for a midwives conference. Dr. Elu told us the drive would take 4 hours but we had Mario Andretti behind the wheel and made it in about two and a half. In 45 minutes we went from dry arid land into the lush tropical pine forest. Pines trees in Mexico?!

The town is one of those places where the lack of access to contraception smacks you in the face. There is just no getting around the child to adult ratio (and here, there are very few men).

The Mixtecas seem very stoic to us, though the kids run and scream and, while we were there, most of them spent their time playing soccer in a courtyard where the walls were painted with the words “no playing soccer here.” A few of the women surreptitiously took photos of Tanitra and we think it’s because they don’t often see Asians (she’s been claiming to be from Veracruz with some success but I guess she can’t fool the Mixtecas). On a side note, the Mixtecas call themselves "People of the Clouds." They live high up in the mountains beyond the fog. As we were standing on the cliffs we could see whiffs of clouds engulfing the valley below. We tried to be respectful when taking pictures of the Mixtecas. They don't like getting their pictures taken because they believe that their soul is captured in the image.

The regard between Dr. Elu and the midwives is clear. She said when she’s around them she feels happy “because they are the experience and the hope.” But, as is the case all over the world, these women are indigenous and are generally not treated well by the larger society.

The midwives expressed a lot of anger that they are not respected by doctors at health facilities. One talked about how it’s very important to the Mixteca that they bury the placenta when a child is born but at the hospital they just throw it away. This is shocking for the Mixteca but the hospitals seem not to care and so the women prefer to use their traditional midwives.

This area (in the state of Oaxaca) is known for an adult band and a children’s band. We had heard someone warming up on a trumpet for much of the morning and it made me think of how awful it was for my mom when I was learning to play the flute. But, when the band set up and started playing, they were terrific. In fact, I was really impressed that they played several songs without a conductor – that’s quite a feat for musicians with many more years experience.

Despite the music, lunch was (again) stoic. The women in village cooked huge pots of food and unloaded them from the back of a pick up truck. We had tortilla soup with chicken, tamales as big as my arm and, of course, Mescal (that was poured into Jose Cuervo bottles from gasoline containers). Apparently, after meals, the Mixteca dance because we were treated to quite a show – including, of course, Dr. Elu.

And then Mario Andretti got us safely back down the mountain.

Maria Carmen Lovefest

Today UNFPA hosted a reception for Dr. Elu which was attended by her family, colleagues in the NGO community and some officials of the Ministry of Health.

Dr. Elu is clearly revered and adored. Her husband told us that she is a feminist but he married her anyway. They married three months after meeting each other and will celebrate their 50th anniversary in December.

We thanked our colleagues at the Mexico City UNFPA office for hosting an event that allowed us to announce Dr. Elu’s award but they thanked us and said that because she was selected, it will help them with their work. It’s really nice for us to hear because, as a small organization, as our award only comes with a grant of $5,000. So we’re especially happy if our award offers the imprintur of “international recognition,” as it sometimes helps women who have to struggle against apathy or opposition from their communities and leaders.

This is obviously not true with Dr. Elu. While the government is not great on these issues, there is a support in the Ministry of Health and there is no obvious opposition to Dr. Elu’s work these days.

But we were delighted to hear that because UNFPA’s Mexico City office nominated Dr. Elu and their affiliation with her lends them credibility. Often the idea of being the AMERICANS can be embarrassing and hard to live up to. Rita told us a story of visiting UNFPA program in Bolivia several years ago and a woman who begged the Americans to fix her blind child because she was convinced that they could help. I’ve had similar uncomfortable experiences so it’s nice when we can sometimes spin the expectations into something positive for our friends and colleagues around the world.

Afterwards we had to say goodbye to Aldolfo (who was headed to Chicago with veterinarians to translate for them at a conference) and head to Oaxaca – where Mescal became a constantly offered drink. We were treated to full throttle Maria Carmen at the airport and she can be downright goofy. She makes everyone laugh, even when she’s cutting the line. We don’t even know what she’s saying and it’s funny. (She still retains her Spanish accent and I have trouble understanding her when she’s not speaking English.)

Despite all of us being pretty tired, we attended another love-fest for Dr. Elu where my Spanish had to suffice for Tanitra and Rita (a fate fit for no one) and where we were treated to Dr. Elu’s prowess on the dance floor.

Meeting Dr. Elu

The only agenda item for today was to finally meet Dr. Elu and interview her on camera but we filled up the schedule. It worked out pretty well though we had one of those moments when we needed to leave to make our appointment with Dr. Elu but we risked offending several people. Luckily, our translator, Aldolfo, seems to have figured out how to guide us through these cultural misunderstandings (read: get us to do the right thing) without our realizing he’s doing it so it all worked out.

It’s a good thing we have Aldolfo because I keep speaking Spanish to people – really badly. We were surprise to find out that Aldolfo was the go to guy for reproductive rights translations.

The Mexfam clinic we visited is in a poor neighborhood near Xochimilco, far south but still part of Mexico City. They provide a wide array of services including dental care and, we noted, the board at reception specifically listed Diabetes care. The clinic is clean and well-equipped but there was no water in the bathroom. Yesterday Ofelia acknowledged that Mexico receives less international aid for women’s health because, on paper, it looks as if the country is lowering fertility rates and combating maternal mortality. She also noted the disparity between urban and rural health care and she made a special point of saying that domestic violence is a very big issue for Mexico right now.

At 72 and despite her accident, Dr. Elu seems to maintain a great deal of energy. She bounded down the stairs and greeted us at her offices as if we were her long lost children. Born in Spain, raised in Cuba, she married a Mexican man and has lived here for 50 years. She’s got that warm, encompassing Latina personality that can melt the stiffest of Anglo exterior. And she’s hilarious. She showed us the scar near her hairline from the accident last year and insisted that it is not from a facelift.

And she’s a talker. We didn’t mention that she will only give a two minute speech in New York. I think she might have a heart attack and I’m sure she will pretend not to understand.

After all the interviews were finished we went to the zocalo to get footage of Mexican women. The zocalo is the main plaza in Mexico City and the largest in the Americas. It’s bordered by the anthropological remains of the Aztec’s central temple (Templo Mayor) that Cortez leveled to build the Cathedral and the National Palace where the legislature meets and the President lives.

Because it was too late to go into the National Palace, and because you really shouldn’t be in Mexico City without seeing at least one Diego Rivera mural, we went to the Diego Rivera Museum, which was built to house his masterpiece, Dream of a Sunday in the Alameda. This mural was in a hotel across the street but was moved to this location when the hotel was irreparably damaged by the 1985 earthquake. Paco, our camera guy who is a cameraman for telenovellas in his regular life, had no idea there was a Diego Rivera Museum or where to find it. I’ve started accusing him of being Paco el Bolivián because how can you be Mexican and not know the Diego Rivera Museum, I ask you?

Rita invited us all for a drink at the Opera Bar (probably because I had been raving about it). Tanitra describes the place as opulent. Very old school Mexico. Their claim to fame is a bullet hole in the ceiling, reportedly made by Pancho Villa once when he rode his horse into the place and started shooting. With Aldolfo’s help we talked about Mexican politics, the tax structure (which is severely flawed) and life in Mexico and New York. I have been speaking as much Spanish as I can and people are letting me do it without telling me that it’s like piercing their eardrums with an ice pick.

Mexico's #1 Fan

Mexico City is one of my favorite places so when our jury choose a woman from Mexico as one of our honorees, I was delighted to return to a city that I enjoy so much. My mother claims Mexico City should hire me to run their tourism board. I do understand that not everyone considers the sprawl and crowds of the world’s third largest city to be an ideal vacation spot but I love the art, the fact that you can find it everywhere, the architecture, the mix of old Mexico and super hip Mexico. It’s everything I love about New York, only Latino and fantastic in that way.

My reason for coming is Maria del Carmen Elu Cayado, a social anthropologist who brought the problem of maternal mortality into the light in Mexico and forced the government to add it to their national health plans. She was actually selected to be one of our 2007 honorees but before we could contact her, she was in a terrible accident. While driving in Chiapas a bolder fell on the car. She was near death but pulled through. We postponed her award until this year to give her time to recover.

Tanitra, our web maven and my Barometer-of-Cool, is also coming on this trip to learn more about video production. Also, we invited one of our board members, Rita O’Connor to join us. I came a few days early as the last time I had a business trip to Mexico City (back before the Jack Abramoff scandal and the new ethic rules in the House of Representatives that prevent us from taking members of Congress to see UNFPA’s work) I was frustrated at not having a free hour to stroll this city. So I came early and by the time Tanitra arrived Sunday I had already wandered my favorite streets, eaten at some of the city’s trendiest restaurants (thanks to my hipster cousin and traveling companion) and climbed the Piramide del Sol at Teotihuacan. Unfortunately, and to the chagrin of some good friends who were in Mexico City a few weeks ago, I did not get to the Lucha Libre (which means free wrestling and by that they don’t mean it doesn’t cost anything.)

On paper, and in some concrete ways, Mexico is the success story of women’s health. From a fertility rate of more than seven children per woman, the country has lowered the rate to just over two per woman (the same as the United States). But, as Dr. Elu and my colleagues in the UNFPA Mexico City office continually point out, there is a huge disparity between urban and rural women and one fifth of all Mexican women live in Mexico City. So the statistics are skewed to make it seem as if Mexico has transformed their health care system when this is only true in metropolitan areas.

With no specific agenda on Monday, Tanitra and I decided to take a laptop to Mexfam (the Mexico Family Planning Organization, part of the International Planned Parenthood Federation) and see if we could get them interested in our Lifelines project. We met with Ofelia Aguilar, the Director of Operations, and explained that we are trying to build a community of women who are not classified as givers and receivers of aid, but as individuals learning from each other and that, because of the challenging issues of Mexican immigrants in the United States, we thought it would be really great to have some strong, accomplished Mexican women highlighted.

We got a lot of support from the women at Mexfam, even Ofelia who allowed us to post her Lifeline. One of the directors invited us to her clinic tomorrow to interview two of her doctors.

These women only speak Spanish and have graciously allowed us to post their stories in English. This is generous of them. And I also want to point out that it would not have been possible without our excellent translator Adolfo, who is apparently, friends with everyone in Mexico City who works on women’s health issues. Everywhere we went in Mexfam’s considerably large (and beautiful) office compound people waved and greeted him by name.

Check out the Lifelines we got – just search on Mexico.

The end of my trip - You can't bring mangos back to the U.S.

I never had access to a computer my last day in Niamey and I felt that the blog was hanging a little. So, in retrospect, here's the end of my experience in Niger.
As a tourist, I was a failure in Niger. I went to the Grand Mosque (with headscarf ready) but it was locked up and the guy with the key was nowhere to be found. Soumana and I went to the Niger Museum on Friday (supposed to be one of the best in West Africa) but, of course, it was closed on the holy day. (Soumana was, apparently, not paying that much attention to prayers last week.)
Instead we had cokes and talked about being 40 and never married, how it's unusual in both our societies and what kind of people give us grief over it. (Soumana suggests that I'm not married because I can't cook and I suggest he's not married because he's rude.)
On Thursday night I was invited to Madam Traore's for dinner which was a really nice dinner with enough food for about 25 people (there were five of us). I now know about 10 French words and Madam Traore knows about 20 English words so the conversation was light. I told her mangos from really hot climates are much better than the ones from hot houses and so on Friday she brought me a bag to take home. They made it to JFK where the customs agents took them from me (and ate them, no doubt).
The business aspect of my trip was considerably more successful. On Friday I went to the other big hospital in Niamey that is part of the University. Two urologists perform fistula repairs and train gynecologists to do the surgery. I met with the senior surgeon, Dr. Sanda who, like Dr. Abdulai at the National Hospital, seems very dedicated and is very good with the patients.
I found the work being done to address fistula in Niger to be really impressive. This is one of those cases where the reality seems to match the claims. Definately, UNFPA is dedicated to addressing fistula in Niger and definately Madam Traore makes a difference.
At dinner before I left for the airport I asked Ghaichatou why she personally thought Madam Traore was worthy of internatinal recognition and she said because she really views the prevention and treatment of fistula as part of the human rights that women deserve generally. She said Madam Traore doesn't wait for money, she just does the work and if she gets more money, she does more work. Finally, she said, Madam Traore is the only woman in the country that can go to the National Assembly lecture the politicians about the treatment of women.

Everybody who speaks English asks if I'm married

I've been on this computer a few times today without managing to get a connection so if you're reading this it means the power didn't go out and I didn't give up for the night.
The staff here have been really patient with my lack of French but they're very young and we have conversations like this:
Me: I need to send an email and the computer isn't working and I don't know what the error message says.Nice Hotel Staffer: Why not?Me: Because it's in French. NHS: Oh, right.Me: That's ok, I can call. Does the paper in my room say that the room phones don't work?NHS: No, you can call.Me: From my room?NHS: No, not from the room. The room hones don't work.
Ghaichatou: Is Deni Robey in the hotel?NHS: Yes, she's here. Ghai: Can you call her room?NHS: She is not answering, she's probably coming. Ghai: Are you sure she didn't leave for the Grand Hotel?NHS: Ah, yes, she took a taxi.
Eight years ago Friday (July 6th) I watched my nephew, Charlie, come into the world. He's been on my mind because this is the first year that I won't be with him on his birthday but he's also my only experience with childbirth. And I'm sure I don't have to go through the litany of differences between my step-sister's delivery and that of most of the women I've met here. I'll just say this one thing because it's pretty interesting. West African women are expected to give birth without crying or screaming. Literally, they are supposed to "suffer in silence." That's a cultural thing, not a poverty thing. (Imagine a whole country of Tom Cruises.)
I'm here to see women's health programs but education comes up again and again. School is free here (through university) though students have to buy their uniforms and pay small fees that are not exactly tuition. But very few children are in school. The Nigeriens I meet keep telling me that the country won't get any better until the kids go to school.
On Monday as we were leaving the Dimol offices a very young girl was waiting outside with her husband. She gave birth two weeks ago and has been leeking urine ever since. Madame Traore was telling her that she could go to the Dimol Center and that they would help arrange the repair surgery. Then, a little like there was an audience, she loudly praised her husband for coming with her and ranted a little about how most husbands don't care. Then the husband told Madam Traore that he had gone to university with her son and, even louder, she went into a small tirade about how the educated men are the good ones and that if more men went to school we wouldn't have so many problems.
(By the way, I asked Madam Traore if she went to the university in Niamey and she laughed and said she only finished secondary school but she just kept working her way up. Three of Madam Traore's children went into medicine - one son is a gynecologist and the Assistant Director of Dimol.)
Niger is a hard place. It's hard for me to explain but the landscape is so bleak, it makes you feel that bleak is all it's ever going to be here. BUT, the Nigerien health workers and teachers and businessmen aren't flocking out of the country. This is definately one of those cases where the work is already happening - just on less than a shoestring.
Back to fistula. And by the way, after four days I realize that I'm not necessarily getting the facts straight - either because these are casual conversations I'm having or because of the language issues or whatever. For example, there are five doctors who do fistula repair in Niamey - but not all at the National Hospital. So, if you're really interested in this stuff, check out the rest of the website or email me if you can't find what you're looking for.
UNFPA donates the equivalent of $100 to the hospitals for each fistula patient who undergos surgery (the government is supposed to provide additional money but I'm not clear whether it does or not). And UNFPA funds Dimol's reintegration strategy - which includes the cost of each patient's recovery at the Dimol Center, the gas to drive her home and the $100 she gets to start an "income-generating activity."
Another UNFPA-funded intiative is the the contraceptive program at the Reproductive Health Center - which is a large, very nice but underfunded clinic in Niamey. The clinic is a project of the Ministry of Health and offers prenatal care, basic gynecology and contraception. The staff seems large, there are supplies and even a sonogram machine but the equipment is old and the written materials haven't been reprinted since the clinic opened in 1984.
(The midwives I've met are all like Madam Traore. They're smart and dedicated and they mean business. I guess years of helping women push babies out and they tell it like it is and don't care who you are. Madam Traore told me tonight that she doesn't want to retire until the Dimol Center has surgical capabilities but she said that she's tired from the stress of 40 years of delivery and the constant stress about the woman and the baby.)
Apparently, USAID funded a lot of family planning in Niger until they closed that particular program in 1998. There was a break in service while the Ministry and other NGOs tried to fill the void but, according to the midwife who showed me around, the use of contraception never returned to rate it had been. But UNFPA funds the women who do come.
The fistula trifectorate: prevention, treatment, reintegration.
I got to sit-in on a weekly group counselling session with the fistula patients at the National Hospital. Women with fistula who make their way to a hospital generally camp out in one of the courtyards until they get surgery (and there are always the stories of women who live in the courtyard for years). At one point, the fistula program at the National Hospital stopped but the women didn't leave. So they had to find a way to start it again.
Dr. Abdulai runs it now and it addition to being really dedicated, he's hilarious. In addition to talking to them about their own worth, he makes them laugh frequently. (I started to explain a couple of times when he had the whole room laughing but it sounded maudlin in the telling. Women who constantly leak urine have a different outlook on life.)
Every 15 minutes or so the computer screen is taken over by scantily clad women and I just don't want to know what the ad is for. The owner of the hotel introduced himself to me in the dining room and asked if everything was ok and I felt like saying, if you could just change the ads so they're for Dimol or the Reproductive Clinic or the Youth Center that would be great. But tonight I'm taking it as my que to turn off the computer.

Everybody in Niger asks for directions

First - Happy 4th. As there will be no fireworks here (and I am somehow not invited to the party at the U.S. embassy, I've invited some of my new friends to the deck at the Grand Hotel to watch the sunset).
It's occurred to me that it's because I'm often in places where there are large numbers of tourists, there are usually enough people who speak English for me to get by. Not so, here. Soumana is my translator from 9:00-5:00 and I really struggle with the simplest things when he's not around.
And even with Soumana, the cultural differences here make communication a little challenging. Just one example, I told Nourou, the "boss" of the video crew, that I couldn't afford the gas for him to take the the whole crew to the village but that we could fit his cameraman in the vehicle with us. On Tuesday morning, the whole crew showed up and they had even aquired a fifth guy.
Anyway, Tuesday morning, after getting tires and stopping at many roadside stalls for snacks, water (in plastic bags), etc. Madam Traore, Boure the (very serious) cameraman, Nourou (because for some reason he couldn't be left behind), Soumana and I set out to take a young woman, Biba, and her little boy back home.
Biba has been at the Dimol Center for three months. The son she had with her is her 4th child (the majority of fistulas happed with the first delivery) but she had too many deliveries too close together. It's unusual that the boy survived. (I put him at 3 months. He is not unusually thin and while he seemed a little lethargic, I thought it was the heat. It turns out that he is actually 7 months old.)
Biba has had two surgeries to repair her fistula and she actually needs a third but her prognosis is very good. (There are 26 Nigerien doctors trained to do fistula surgeries - largely thanks to UNFPA's Fistula Fortnight in Nigeria three years ago - and four of them practice at the National Hospital here in Niamey.) Normally, Biba would stay at Dimol until she had fully recovered but she wanted to go home and I wanted to see Dimol's "reintegration strategy" so Madam Traore agreed with Biba's promise to return in three months.
There are no road signs in the bush and there are VERY few signs that announce the name of a village (Welcome to Kabe Popluation 230). So, the way you find the place you're looking for out of the thousands of villages is a) find one of the drivers of the bush vehicles that bring villagers to Niamey in the morning and take them home at night and ask him how to get there and b) ask everybody you pass. You meet some very interesting people that way. Occassionally, if you missed an important fork in the "road" but not far back, a kid or young man will jump on the back of the vehicle or cram in beside the driver and get you back on track.
The drive was supposed to take about two hours (I think I said earlier that there was no A/C.) It took four. Apparently, we took a very circuitous route. We drove for long stretches across landscape that, to say it looked like moonscape, would be to exaggerate how much was going on. I mean nothing. There were were times when the only markers to indicate the road were the giant ant hills and times when the only marker was the tire tracks of the vehicle that came before us.
This is the rainy season but there is very little green. The Nigeriens are worried. (Mostly they grow millet and other grains.) One interesting fact that I learned from Madam Traore - most fistulas happen at the end of the rainy season because (she says) a woman's family won't stop working to take her to a health facility if her delivery is going badly. ("Fistula is an illness of poverty.")
On the way we stopped by a village with a health center to ask the nurse, Fatiya, if she would come with us. There isn't a health worker in every village so Fatiya has to travel around and people have to come to her. For her work she makes about $75 a month - which is good by Nigerien standards but apparently not enough to make her independent. The health centers are a project of the President of Niger (Despite many, many heated political debates in the car - in the local dialect Djerma - I really can't tell what people think of the government except that it's not very effective.)
Fatiya looks like she is in her mid-20s and seems very serious about her job. She's been a health worker for three years but she says it's frustrating. Apparently, a company or an NGO or the government donated pharaceuticals at a very low cost but Fatiya was not able to get the houses of her village to donate to a pot of money. She tried to explain that it would be for the good of everybody but they said she would use the money for her own purposes. But she keeps trying.
By the way, apparently the only white people who come to the villages in Niger are doctors because just about everyone who talks to me asks me if I can fix their eyes/hand/wound (even with Fatiya just a few feet away). Soumana has to constantly tell people that I'm not a doctor. (In town, there are few white people but I'm no oddity. Nobody seems to notice my glaring white face in the crowd.)
In the village, the kids are petrified of me. (Possibly because I forgot to take something to hold my hair back in the car and I suspect I looked like a witch.) They crowd around at a distance and the really brave ones will shake my hand if I'm persistent.
When Dimol takes a woman home after her fistula surgery, they send someone ahead to tell the chief and the Imam that they are coming and want to do a presentation for the village. When we arrived the more important men of the village greeted us and little boys gathered around but no women or girls.
(Before I make the following observations I should say that Soumana, the guys on the film crew, the men who work in my hotel and the mostly male staff of UNFPA have been really great to me.) Soumana said you can tell when a village has never been "sensitized" by an NGO (meaning there had never been programs for women or for health, etc. sponsored by an organization like Dimol, CARE, Oxfam, etc.) because they women don't great guests. But if an NGO has been active, the women are much more empowered to come meet visitors.
Madam Traore told the men that the woman should attend the meeting and, duly chastised, the men used the exuse to order the women around - barking at them to come out of the huts and sit down. Then Madam Traore spent about 20 minutes lecturing the men to treat their wives better and about 20 minutes telling everyone about sanitation and their health. Only larger villages have a paid health worker like Fatiya so the women of Dimol are trained in basic health precautions and to identify potential problems. When a woman like Biba returns, it's announced to the village that she is now their health worker and that she may tell them to get medicine or to see Fatiya or that a very young woman should go to Niamey to have her first baby. This is an subtle order to the men not to yell at her because she "inappropriately" tells them what to do.
In front of the village, Dimol also gives the woman the equivalent of about $100 to start an income-generating project (like making soap) because most of them have been abandoned by their husbands so they have no support.
Somehow, the route back to Niamey was "obvious" to everyone else in the car as we went "directly" and in only two hours.

Just because it's not 125 degrees does NOT mean it's not hot

I started this morning by missing breakfast which turned out to be a very, very bad idea. I also skipped the security briefing and am counting on the fact that nobody who cares about that is reading this. They just tell you that there are problems in the north on the borders of Libya, Chad and Algeria and I'm not going there. I asked the UNFPA Representative here if she was suggesting that I don't look Nigerien enough (take a look at my bio photo to get that joke).
Instead I went to the bank where the nice man behind glass waved my hundreds of US dollars and the millions of CFAs they bought for all to see. So blending, I'm not.
Today we started shooting a short documentary that takes us to Dimol, a non-profit organization that deals largely with fistula. The camera crew is four guys (I expected two) and one of them actually has to hold a large boom mic. I feel like there should be some added special effects to this video shoot. Because I was at the bank longer than I expected, the crew went to Madam Traore's clinic to shoot and, as luck would have it, there was a woman delivering this morning.
In the afternoon, we (me, my translator, the film crew, Madam Traore, her ob/gyn son and several of her staff members) went to visit the Dimol Center where women wait for their fistula repair surgery or recover from it. (Our very own air-conditioned caravan plodding across Niamey.) It's a beautiful Center in a sparse area of town that's just being developed. Madam Traore told me she tried for two years to get the land to build the Center but it's lucky for everyone who will live nearby because they brought power lines and plumbing to the neighborhood. That's a nice twist.
The heat, my empty stomach and the five different languages made it tough for me to follow the conversation (even with a translator) so I helped with soap-making. (All I really did was stir the pot.) I've heard others say it but it's true that women whose fistulas have been recently repaired smile and laugh a lot.
This evening my UNFPA chaperone and I went to the Grand Hotel, the best spot in town to watch the sunset over the Niger river. This is one of the places where the elite of Niamey, the grungy American kids (because it's in Lonely Planet) and an odd assortment of expats socialize. We solved our big question to each other - that my FIRST name is Deni and her first name is Ghaichatou - and she told me a lot about her work on fistula in medical school. She started by translating for Americans who came to Niger to train local doctors in repair surgery.
Then we ate Italian food. Seriously.
Tomorrow we leave at 7:00 to take one of the women from the Dimol Center back to her village, which is 140 kilometers from Niamey and the car is not air conditioned.

Arrival in Niamey, Niger

The best part about my job is meeting some of the most amazing women in the world (seriously) who measure their success in terms of change within their societies. To get to meet some of these women on their home turf and see how things actually get accomplished well, that's not something I'll ever take for granted. It's not just the fact that these women stand up against cultural norms and take them on that impresses me (although, of course, it does). It's also their patience to make these changes - little by little, year after year - that inspires me. In the U.S., we want to see change RIGHT NOW.
I arrived in Niger this afternoon to visit Madam Salamatou Traore, President of the non-profit organization, Dimol, (more on that later) and to visit UNFPA programs. Niger, a landlocked country in West Africa is bordered by Libya, Chad, Algeria, Nigeria, Mali, Benin and Berkina Faso. The official language is French (which I don't speak, unfortunately) and the country is more than 80% Muslim. There are just under 13 million people here. The life expectancy at birth is 44 years and the fertility rate is just over 7 children per woman. The rate of HIV, however, is low at 1.2%. Niger is a constitutional republic with a President and a Prime Minister. It ranks last on the United Nations Development Fund index.
The Air France gate agent at JFK airport told me he has friends in Niamey (the capital) and that it was 54 degrees celcius on Friday. I've never gotten the hang of celcius so, against my better judgement, I asked him what that is Ferenheit. 125 degrees. "But it's a dry heat." It's the last thing I heard before I passed out. (Not really.)
On the way here, I kept reminding myself that women in Niger live with that kind of heat all the time (this is just a little south of the Sahara, after all). Since most Nigeriens live on less than $1 a day, they probably don't have the air conditioning (such as it is) that I have in my hotel room and many of them don't have nice, cool water coming out of the shower head, either.
We're so spoiled. It is not 125 degrees, by the way.
I arrived at the Niamey airport and was only expecting a driver but instead, Dr. Kinni Amoul Ghaichatou was there, too. She has been helping me with the arrangements for this trip. Actually, I booked the ticket and she has graciously done everything else. She is much younger than I expected and has only been working for UNFPA for about a year. When I asked her how she liked it, she said, "I love it." I told her I love my job, too and aren't we lucky that we can say that.
Even more amazing, Dr. Ghaichatou works on fistula for UNFPA. (That and her excellent English are how she got assigned to show me around this week.) Fistula is a hard topic and she must see real change as possible for her to love her work.
Dr. Ghaichatou is Nigerien, attended university here in Niamey and studied public health. She did her thesus on fistula. I'm looking forward to hearing more about her work but today was all about planing for the next five days.
(Please forgive spelling and grammatical mistakes - it's been a long trip.)