Sunday, November 27, 2011

Involuntary Sterilization, Cowboy Doctors, and the West in Africa

J from Tales from the Hood sure knows how to cheer a girl up.  By sending her a story about someone bragging about participating in a non-consensual sterilization in Tanzania!

Now, this is not some big well known person, and there are lots of stupid people on the internet, posting about doing lots of terrible things.  So why does this warrant a post?  Well, maybe, because J felt the need to "share the love" with me, and now I want to share it with you, so we can stare open-mouthed together.  But also, because even though this is just one guy posting about doing stupid things in developing countries, I think his mindset is reflective of a far more common, and deeply damaging, mindset in aid workers: "We're here to help.  Therefore, we're helping."  And also: "We know better than the poor people (after all, they are poor, and we are not)."  Neither of those are true, as J and others have meticulously documented.  So, into the meat of our story.

The blog's author, Erik, is a doctor working in a village in Tanzania.  A Tanzanian doctor comes to his house at 9 pm, asking for help:
"Hello Dakatari, come on in." We never used each others name. Only Daktari. It's how it is done. The challenge was to use it in every single sentence.
"Daktari, I wonder if I could beg a little help from you this evening. We have a little bit of a problem, Daktari."
"Happy to help, Daktari. What's up?"
"Daktari, a woman has come in to the clinic tonight. She is pregnant and has been in labor for two full days. She has been with the village Traditional Healer for the whole day."

The Traditional Healer. Say no more. Straight away I knew this was not going to go well. Each village had a Traditional Healer/Witch Doctor who practiced ancient arts of medicine. These techniques included ritual skin cutting, herbs and randomly placed sticks through punctures. I'm sure that many of their methods worked, but the only ones we ever saw were the ones that didn't. In those cases the patients would be dragged to our hospital as a last resort. They were usually in septic shock, nearly dead or horribly late for treatment like our Sunday night patient.
The woman needs a C-section, and the Tanzanian doctor has an injured hand, so can't perform the surgery himself.  Eric is hesitant since OBGyn isn't his specialty, and he hasn't performed a C-section in 20 years, but he ultimately agrees.  The patient's health takes a turn for the worse during the operation:
"How's it going up there, doc?" I asked. Everyone who wasn't a Daktari, I called doc. It was simpler.
"Hmmmmmm..........." I thought he didn't understand my English. I spoke slower.
"How is she doing, doc?"
"Hmmmmmmm...................Well, Daktari, maybe she is not breathing. I cannot be sure," he said without an ounce of panic. I thought: that's a little nonchalant for what he's talking about.  
They begin CPR:
"Daktari, the epidural injection must have gone too high and paralyzed all her nerve function," I said as I started doing chest compression over her sternum.. I heard a rib crack with a loud POP under my hand and I winced.
"Yes Daktari. I believe that is correct," said Dr. M. She is a young woman and this is her fifth baby. She has a good heart."
Fifth baby, I thought. Holy shit. All I could think of was five orphans.
"C'mon, cmon," I said to no one in particular, "this cannot go down like this."

Thursday, November 10, 2011

Joe Paterno Hurt Children, Too

Child sex abuse is perpetrated by criminals, but enabled by thousands of adults who perpetuate a culture of shame and self-doubt for its victims. One of those adults is Joe Paterno. The University Board was absolutely correct to remove him as head coach. He had an opportunity to prevent harm from occurring to children, and he chose silence, shame, and rape culture over that opportunity. A University is in the business of educating young people to be responsible adults. Right now, at Penn State, their role models are few and far between.

The crime of childhood sex abuse is two-fold, each piece doing its own part to damage the child’s psyche: first, the abuse itself, then the cover-up. The cover-up is integral to the crime, and in fact part of the crime itself, because most childhood sexual abuse is perpetrated by someone close to the victim—a relative, a friend of the family, a religious leader…a coach. The abuser knows that to the child, sex is shameful, and uses this as a weapon to enlist the child in the cover-up. They also use their authoritative position, whether simply as an adult, or as a mentor, teacher, parent, or coach, to convince the child that the abuser’s behavior is normative, and that it’s the child’s perceptions that are out of whack. The child comes to believe they have done something wrong, because if not, why can’t they talk about it? This shame and isolation on top of the abuse itself causes irreparable harm.

In the case of this particular cover-up, Sandusky couldn’t have imagined that he would have so much help. So many other adults had internalized the idea that sex is shameful, and thus sex abuse something to be hushed up, and authority is not to be questioned (especially not football authority!), that they covered up Sandusky’s crimes for him. And in doing so, they, too, hurt children. They participated in the second crime of sexual abuse, just as damaging as the first.

When a graduate assistant witnessed Sandusky raping a child, he left. He then reported the incident to Joe Paterno, who met in hushed rooms with administrators to decide what to do about this “situation.” They decided to ban Sandusky from bringing children on campus, and restrict his access to certain areas. Anyone involved in those conversations should be fired.

Imagine, you see a member of the faculty savagely beating his child in a classroom. Do you tell him not to bring his children on campus anymore? What on earth good would that do? No. You call the police. It’s the difference between something being “not the type of thing you want to be around” and “not the type of thing that is legally allowed.”

Childhood sexual abuse victims, more than anything, need to be able to say that what happened to them was wrong, that it was a crime, and that it was not their fault. Adults like those at Penn State rob us of the ability to put a name to what happened to us—to say, “A crime happened here.” By backing slowly away from what he’d seen instead of intervening and calling the police, that first adult on the scene told that child: You’re not a victim—you’re a pervert. You deserve to be banned with the coach. His actions said, what’s happening here is twisted, messed up. And you’re part of it. The other adults who took no action to find or help the victim, investigate the crime, or bring its perpetrator to justice supported this view, sending the same message: we don’t want that kind of business here. It’s shameful. But they didn’t call it a crime. If it was, they would have called the police, acted as witnesses, and warned the campus about the predator on the loose.