Thursday, December 31, 2009

Life Wishing

Η τυχη βοηθαει τους τολμηρους.
“Luck comes to those who dare” – Greek proverb (and EHS)

On New Year’s Eve 2008, one of the people I hold most dear and I were walking through Hyde Park in a frigid cloud of fog. We decided that freezing our toes off riding a Ferris wheel alongside British five-year-olds was a fantastic farewell for 2008. I am now sitting in Tel Aviv, ready to take a walk on the beach on a day that feels like late spring and smells nothing of the holidays.

Reflecting on a calendar year becomes challenging when its experiences intertwine with a fellowship journey still underway, but I can remember an overarching hope on the eve of both new beginnings: I had wanted to be moved by the world, to be shaken by the shoulders, to in turns feel exhilaration, despair, inspiration, creativity, compassion, anger and contentment. As I think back to the Hyde Park walk and our shared wishful thinking, I am grateful for the moments 2009 brought with it – moments that indeed shook me by the shoulders and allowed me to feel, to experience the world more vividly than I had ever known before.

There has been a task with which I have continually struggled since the beginning of this fellowship journey. The task is called a “Life Experience Wish List” and it resembles loads of cheesy “bucket list” projects. The prompt is as follows: Think of life wishes in three columns. The first is travel endeavors – such as a country or a national landmark or a road trip. The second is life milestone experiences – being a parent, becoming a licensed paramedic, attending culinary school, writing a book. The third consists of activities one wishes to experience at some point in life – swimming in the Dead Sea, being in the tabloids, flying to the moon. I have been pathetically weak at jarring an unrestrained imaginative capacity for the future, at not worrying about what is feasible or immediately within the realm of possibility. On the eve of 2010, here is to filling out our own wish lists, to imagining their components without fear of unfulfilment, to putting ourselves in situations that continue to move us. And while 2009 still lingers, let us borrow from the wisdom of Bob Dylan: “Take care of all your memories. For you cannot relive them.”

Saturday, December 26, 2009

The Strangest Christmas of Them All

We have put up many flags,
They have put up many flags.
To make us think that they're happy.
To make them think that we're happy.

-Jerusalem, Yehuda Amichai 

It has been a very strange Christmas.

I had not fully appreciated my attachment to Greek customs, home traditions, and holiday spirit until I decided to spend a holiday season devoid of snow, jingling, or O Holy Night blasting since November 30. I spent Thanksgiving underwater, seeing my first coral reefs at the Blue Hole in the Red Sea. I then proceeded to get the deepest tan of my year, a testament to the Ugandan sun (and horribly rainy Boston summer). Poppy Christmas tunes--and Jesus--were huge in Africa, but the spirit had yet to have an effect on me. Then malaria hit me, as I belonged in the special and unfortunate 5% of cases that Malarone preventative pills fail to safeguard from the dreaded mosquito-born illness, so I spent my brief return toCairo fighting a 105 fever, blabbering delirious nonsense, eating Kinder chocolate and hoping to fall asleep and wake up in 2010. And then there was Christmas Eve in Bethlehem, which involved a Latin pop concert featuring a woman of perhaps Guinean origin who shouted that she is `African like us`over the loudspeaker, as we ate our chicken shewarma and wondered what the religious pilgrims would have thought of the sight.

Christmas Day found me in Ramallah, walking past churches and mosques (and a Stars and Bucks cafe...), encountering few people in the street, but more decorated trees and Santas than I had taken in all holiday season. I spent the evening eating chips and salsa and drinking sangria in the company of dear friends, experiencing an emotional roller-coaster of reminiscences. I thought longingly of Christmas lunch at home, candles in churches, carols, and our annual escape to the movies on Christmas evening for some much-needed time away from the frenzy. This was a year without the Christmas movie, the presents, the spirit. It is especially strange to experience a time of religious significance in Jerusalem, which boasts a convergence of faiths, but most manifestly displays Judaism and Islam, by virtue of the more outward expressions of faith these religions entail compared to Christianity.

It was the most un-Christmasy of Christmases. I have just returned from watching a breath-taking sunset on the Mt. of Olives and wandering around the Old City, hearing call to prayer echo alongside church bells as Jews are about to mark the end of Shabbat. I am just beginning to feel I am about to defeat malaria and am just beginning to think that this will be a Christmas I will remember more fondly than I had suspected.

Monday, December 14, 2009

Fabrics of Development

On a recent drive from Kampala to Gulu, I had the pleasure of talking to Halle Butvin, an Ohio native who transplanted herself to Uganda to found and direct One Mango Tree. One Mango Tree is a small ‘social business’ – an initiative that produces bags, apparel and accessories from beautiful local textiles while endowing the women tailors with vocational training, a salary and benefits with which to advance their economic empowerment. The story of One Mango Tree is a testament both to Halle’s own charisma and determination and to the ability of creative initiatives for job creation to effect positive change through economic development.

Halle first visited Uganda in 2006, in the wake of a peace treaty ending the civil war that raged for over 20 years. As part of a group trip that sought to expose students to applications of conflict resolution through work with youth and direct engagement with the local community, Halle also observed women in the market, sewing and tailoring to produce apparel, handbags and other accessories. What if women were systematically trained to process fabrics, sew and create these products in an environment that could enhance their skills and provide them with steady salary to secure their livelihoods? In the coming years, the idea behind One Mango Tree fermented and with it grew the number of tailors, diversity of products and marketing outreach of the business.

The One Mango Tree production room in Gulu

Watching the women of One Mango Tree at work in their production room in Gulu felt a lot like peeping into a family function. There are babies crawling between the fabrics or chasing the lizards around the compound on the back of their siblings. (Halle has expressed a desire to build a small nursery for the tailor’s children in the future.) There is laughter drowning out the sound of the sewing, there are mini fights, there is lunchtime conversation over new pregnancies and whether husbands are allowed to ‘stray’. The women work extraordinarily hard, sometimes staying through the night to produce bulk orders for shipping internationally. One of them has assumed team leader responsibilities, delegating the production of coin purses and laptop sleeves, while another is welcoming the new tailors who have arrived today. Through a recent partnership with the International Organization for Migration (IOM), OMT is employing some of the most vulnerable women in Northern Uganda and training them in sewing and production. Some women are ex-combatants, others had their first child when they themselves were practically children. All stand to benefit from both the training and the camaraderie of belonging to an association of employed women. When I asked one of the tailors who has been with One Mango Tree for two months how she became so skilled at what she does, she said “One Mango Tree taught me. I did not know how to sew when I came here.”

A One Mango Tree tailor at work

My conversation with Halle and own observations of life in the One Mango Tree compound personalized some of the development lessons I had theoretically understood but had never quite seen at work. I now have a better, though still to-be-nuanced, conception of how capitalism can be a friend of development, as Nick Kristof has put it, as a compelling salary, steady job and related benefits can incentivize women to seek employment, lending a firmer structure to their lives. I am also beginning to understand the delicacy of the amalgamation of Western business and marketing standards and an emphasis on local practices. One Mango Tree uses Ugandan fabrics and employs Ugandan-based tailors, adhering to ‘fair trade’ specifications, the benefits of which extend beyond the Starbucks-friendly title to include the facilitation of economic development for the region. It was a joy watching Amy, who also moved to Uganda from the US because of her intimate knowledge of the conflict and desire to serve this community, exercise her specialty in creative direction and photography to devise concepts for the marketing of oven mitts or headbands. More gloomily, I was introduced to the harsh realities of money management here – when I asked one of the tailors if she was excited about the upcoming holidays, she said “no. money, money, money”, while another asked what the best way to sustain savings is when her husband asks her to turn over her salary to him.

Finally, I have found inspiration in the powerful personal stories. Unlike me, Amy was well-versed in Ugandan history and politics when she got here, moved by the stories of child soldiers and the plight of forcefully recruited child combatants during the civil war. Her professional transition to Uganda for a project predating her One Mango Tree involvement was not smooth, but she has persevered through the bureaucracy and unanticipated obstacles to apply her creativity to One Mango Tree. Halle herself joked about all the things she had never expected to learn, such as assessing how many raw materials to purchase for a massive order, getting shipments through Ugandan customs or other tidbits that essentially amount to running a small factory. Halle left her job in DC and moved her life to Uganda shortly after founding One Mango Tree. In her story, I admire the fearless in starting anew, her drive to identify those who can teach her what she herself does not know about the industry (by her own admission, she knew very little about retail and textiles at the onset), and the way in which passion, dedication and energy sustain her through a wholly new experience.

Prior to founding OMT, Halle co-led another group trip to Uganda with another woman whose courage and relentless drive I admire… who happened to be an Insight fellow last year. I am continuing to love the coincidences of this journey.

Sunday, December 13, 2009

Googling Mango Flies

Ailments are a favourite topic of conversation in Gulu. The gooey-er the medical issue, the better. Did you hallucinate that you were a different person while you had malaria? Did your ankle swell to the point that your shoe did not fit from a spider bite? Did you see a black mamba snake wrapped around your shampoo bottle while in the shower? Bowel movements, their frequency and type are narrated in elaborate detail as well, complete with mentions of the status of the movement of worms through one's system. There is a certain heroism to all these anecdotes, an air of "I lived to tell the story" accompanying every gruesome retelling. Tell us all about it, preferably over dinner, hence ensuring that the mildly paranoid among us will be up just a bit longer tonight, scanning the ceiling for creepy crawlies. The latest terror answers to the name ‘mango flies’. These flies allegedly lay their eggs on damp laundry and little larvae can then find their way into one’s epidermis, causing myiasis - which brings with it itchiness, pain and swelling until the tiny little animals burst out of the skin. The best home remedy is vaseline, a dab of which on the bite will 'suffocate' the creatures and cause them to rear their ugly head sooner.

The dust creeping into one’s every crevice and less-than-squeaky-clean standards of living can magnify even a small medical issue into a serious problem. An otherwise innocuous cut on a friend’s ankle turned into a staph infection, causing her foot to swell and requiring that we create our own icepack by cooling a bag of rice.  Another friend’s undetected case of malaria brought us all to Gulu Independent Hospital, where we witnessed scenes straight out of the “Theater of the Absurd.” We asked for soap only to find that there is not a single bar in the entire hospital (!) These standards of care cannot just be chalked up to “this is Africa” and culturally relative approaches to medicine; they are unacceptable for any patient in any part of the world. And yet, as a friend wisely pointed out at the time, it is hard to be tremendously upset when the reason the nurse has not changed a drained IV in two hours is that she is one of maybe three professionals attempting to care for a burn victim with haphazard supplies in the next room. This is almost an inevitable reality in a country and part of the world where the lack of large numbers of medical professionals, shortage of training for them and existence of resources at the whim of aid packages can turn every hospital visit into a nightmare. Thankfully, after a lot of negotiating with doctors and nurses and a few sleepless nights, everyone seems to have recovered nicely – a fate that does not similarly grace our Ugandan counterparts with even more limited access to care and financial constraints for receiving it.

And because no rant is complete without one’s own sob story, here is the Tale of the Itchy Eye (ex-pat cliché: check). After having talked about prevention of illnesses in various settings with local women and children this week, I absolutely failed to practice what I preach (hold that preaching thought, it will become ironically important very soon). I woke up with an itchy eye a few days ago. There was no puss, or zit-like structure at the end, or redness, so I ruled out pinkeye and scratched liberally. After a couple of days of this wise treatment plan combined with CVS eye drops, my eye decided to start crying at its own volition, swelling up and feeling like termites had taken up permanent residence inside it. Like every good paranoid woman, I have read my fair share of stories of how many spiders crawl into one’s ear or mouth in a lifetime (answer: 4? Maybe?), so I finally decided to bring myself to a medical professional before I ended up having to find comfort in an eye patch and pretending I am Johnny Depp.

I had spotted an eye clinic in Gulu town, so I waltzed in there, only to notice that the sign says it is also a dentist’s office and clinic for babies, prompting me to hope that the same individual does not treat all the above specialties. The clinic resembled a stall in the market – no electricity, partly open air, shelves with exposed medicine of sorts everywhere and a curtained off examination room. When I ask for the ophthalmologist, I am informed that there is one… but he is also the preacher at one of the churches and he was currently giving the Sunday sermon, so I would have to come back at a later time.

I am currently waiting at the nearby café with internet, two hours after I was told the doctor would return, hoping that this ophthalmologist-turned-pastor can soon provide some healing beyond extending spiritual words of comfort. The rest of the Ugandans surely know how to make one feel cared for and loved—on my walk here, various strangers stopped me to tell me to “not cry, baby, it will all be alright”, assuming that the mini cataract on my right side was an indication of sadness, as opposed to infection.  Enveloped in the kindness of strangers and witnessing the true effects of more grave disease on others, it is hard to allow frustration at the system and self-pity for too long. Hence, I am enjoying some delicious Ugandan ice cream, googling "can a spider crawl into your eye while you are sleeping" and continuing to be in (perhaps unfounded, ominously) high spirits until further notice.

Update: Just conjuctivitis. I got some eyedrops--and a blessing from God--and will be on my way, resting in the comfort that fellow motorcycle riders will not think I am winking at each of them as I zoom past.

Thursday, December 10, 2009

Rethinking Impact

As recounted earlier, my fellowship work and journey have motivated me to reassess my views on humanitarian impact. This is a process that has continued in Gulu, Uganda, where over 200 NGOs work with the local population to offer medical services, educate, train, empower, provide opportunities for economic development and alleviate suffering. Some aid workers have suggested that Gulu boasts the highest concentration of aid workers in post-conflict communities worldwide. With this in mind, and with an amount of skepticism about the overlapping work of many NGOs and their lacking capacity for 'Monitoring & Evaluation' and impact assessment, how does one ensure that an additional aid worker, an additional project, an additional grant can make a difference?

Nicholas Kristof and Sheryl WuDunn's Half the Sky highlights how impact can take place at a smaller scale, on a more personal level, in ways that are just as significant. The book echoes Tracy Kidder's Mountains Beyond Mountains, Greg Mortenson's Three Cups of Tea and Paul Collier's The Bottom Billion, three of my favourite books on development theories and initiatives. Half the Sky chronicles the challenges women face worldwide and posits development approaches to alleviating them, weaving anecdotes with hard numbers and policy theory with grassroots campaigns and local initiatives. My favourite anecdote, tying back to the theme of impact and moving one to action, is a Hawaiian parable that reads:
A man goes out on the beach and sees that it is covered with starfish that have washed up in the tide. A little boy is walking along, picking them up and throwing them back into the water.
“What are you doing, son?” the man asks. “You see how many starfish there are? You’ll never make a difference.”
The boy paused thoughtfully, and picked up another starfish and threw it in the ocean. “It sure made a difference to that one,” he said.

Sunday, December 6, 2009

A Baby Born in an IDP Camp

Human beings are not born once and for all on the day their mothers give birth to them, but that life obliges them over and over again to give birth to themselves. - Gabriel Garcia Marquez, Love in the Time of Cholera

At first glance, the camp for Internally Displaced Persons (IDP) in Paicho does not look remarkably different from other local communities and their establishments in Northern Uganda.  Clusters of mud huts are interspersed with a mini-market, a school, a health center, a giant phone tower and farming beds in which the residents grow their own vegetables and pursue agricultural projects. As a result of the 20-year civil war, more than 1.8 million Ugandans have lived in IDP camps like Paicho, nearly 80% of who have returned home since the 2006 ceasefire. A little under 400,000 remain in the camps to this day.

A closer look will reveal that the relative emptiness of the camps, once crowding multiple individuals to a single mud hut, creates an eerie sense of idleness. NGO trucks and buses full of aid workers occasionally disturb the peace of the road, causing a hurricane of red soil and rocks to twirl through the camp. These aid workers comment on the mixed blessing that is the gradual emptying of the camps: On the one hand, it signifies progress in a form of upward mobility, as individuals seek to establish anew a home of their own; on the other hand, it means that resources and activities are limited for those who still remain at the camp. Because food aid distribution ended in the camps last year, as the region became more stable, famine has become an increasing concern for the individuals with either no access to land on which to grow their crops or income with which to purchase food. Thus, images of starving children with distended bellies carrying their multiple siblings on their backs as they stare idly into space recur in Paicho – images to which one does not become desensitized however many UNICEF awareness campaign posters she has encountered.

Children outside mud hut homes in the Paicho IDP camp

Judy is a medical practitioner and midwife at the Ante-Natal Care Center of the Women’s Clinic at Paicho IDP camp. The world could use more people like Judy. With a beaming smile, she single-handedly diagnoses and seeks to treat the women from Paicho and surrounding camps, tackling the challenges of childbirth in a post-conflict zone, HIV/AIDS, and maternal and infant mortality. Even though Judy has no full-time staff and families rely on her to resolve more issues than she can handle, she still agreed to offer seminars for the empowerment of young women at the IDP camp. Fewer than ten minutes after meeting Judy, and with a line of women waiting for medical care outside, I offered to run the first of such sessions for women the following day.

Judy and I at work at the women's health clinic

When I arrived at the health clinic prior to my time with the young girls, Judy asked me to survey the women waiting on their sexual practices and health histories. Privacy and medical confidentiality do not carry the same weight in Uganda as they do elsewhere. Given that my knowledge of Acholi is confined to “how did you sleep” and “hello/thank you” (genius – it is the same word: afoyo), Judy asked English-speaking patients to translate for their solely Acholi speaking counterparts. This caused me to reflect on the hilarity of the parallelism of this situation to the US, whereby the doctor would have to ask a patient in the waiting room to question a fellow patient in front of 30 other patients on the frequency at which she has unprotected sex. The answers to the questions were not entirely surprising, but remained heart-wrenching.

A 22-year-old girl was on her 4th pregnancy. A 32 year-old woman had been pregnant 7 times (4 live births and 3 either still births or early infant deaths) and tested positive for HIV on the 2nd month of her 8th pregnancy. Ethical dilemmas and speculations abound. What to make of the woman who tested positive for HIV after many negative tests in the past, but whose husband has tested negative? Was she raped? Is the husband a carrier but in too early a stage to register on the test? Of the 34 women whose stories I recorded that day, six were HIV-positive – in a country whose HIV prevalence rate of 5% is otherwise considered miraculously low and serves as an example of public health interventions and education.

Of these 34 women, 17 are pregnant with babies due within the next two weeks. There are only 3 ‘mama kits’ to prevent the mothers from hemorrhaging excessively and stop the spread of communicable diseases in infants, such as many strains of Hepatitis, typhoid and yellow fever. There are also no sterile or sanitized medical instruments or running water – let alone fetal monitors and ultrasounds. Judy would call a woman’s name, ask her to lie down and undress behind a curtain that still left her private parts in very public view, and then would attempt to decipher the condition of the fetus mostly by palpation. It is impressive how even in these conditions, some mothers can bear healthy children and live to tell the story, especially considering the (understandable) attachment of European and American mothers to deluxe maternity wards and constant monitoring. Yet, these very conditions give birth to the hair-raising fact: Maternal mortality kills a woman a minute worldwide.

I had never before seen a baby being born. Judy called from a back room of the clinic and I entered, only to see a woman who was allegedly due in two weeks undergo the last stages of labor. I motioned towards the exit, ready to lead one of the empowerment seminars with which I am significantly more comfortable and for which I am more qualified, but Judy would not hear it. Twenty minutes, a lot of pushing, a lot of blood, but very little crying later, I met a little baby girl. My time at the clinic, around the women, at the camp, and in Gulu has been full of bittersweet moments of witnessing extreme depravity and need alongside fierce optimism and an unmitigated desire to make peace work and development a reality. Looking at the little girl, even with the weight of everything I learned about contagious disease, HIV/AIDS, infant and maternal mortality just in the next room, I could not help but be filled with this optimism myself.