Ivory Coast: Why I'm Here.

Two ladies in Wama, Ivory Coast, explaining to that they were circumcised, but their granddaughters won't be.

So. You’ve probably been wondering what exactly I am doing here in Ivory Coast.

I am here evaluating a female genital mutilation (FGM) prevention project.  I know, how light and uplifting, right? 

FGM refers to the practice of female circumcision, which can take many forms, but almost always involves the complete or partial removal of a girl's genitalia and in some cases also involves sewing up of the vaginal opening.  It is practiced across Sub-Saharan Africa, north-eastern Africa, and western Africa and in many Middle Eastern countries. With immigration it is also been recorder in many European countries, the US, Canada, Autralia and New Zealand.

The practice was first started out of the belief that a circumcised woman would not cheat on her husband while he was away. The practice can cause extreme pain, infections, hemorrhage, problems with childbirth, cysts, obstetric fistulas, sexually transmitted infections, and higher risk of newborn death. It can also cause psychological trauma, pain during intercourse and low libido.

I must say, I have known about FGM for a long time. I wrote a paper about it in college. I had seen cases in the hospitals in Chad and Ethiopia, but it was not until this trip that I truly absorbed just how bad the practice can be.

The project that I am evaluating is in a region called Séguela. Here, girls are circumcised after they have their first period. When a girl starts menstruating, her family begins to plan her circumcision and to arrange her marriage. In the year that follows, money is saved up and put aside in order to have a big celebration.  For that entire time, the girl must stay inside her home, as leaving is a sign of promiscuity that will not be respected by her community. On the day of her circumcision, the girl’s hymen is checked. If it is intact, she is paraded around her village and given gifts by her community.  She is then considered ready for marriage.  If her hymen has been broken before the ceremony, there will be no celebration and the girl will be shamed.

The people that I have spoken with say that the belief that a circumcised woman is more faithful remains, but that the practice of FGM also persists because it is a tradition passed down from generation to generation.  People worry that if they don't do it, people will think that they are poor or that their daughter is not a virgin. It’s also a celebration akin to some weddings in the western world – an opportunity celebrate and to show off wealth and one’s status in society.  In Séguela the practice is actually passed on by the mother and women have been the most resistant to stopping it.  They fear that not only that without it their daughter not be respected or able to get married, but that they themselves will lose status in their village.

All of this is bad.  Really bad. The arranged marriage, the idea that a woman who has had sex should be shamed, the idea that a woman should not enjoy sex. But the part that makes me cringe the most, is that this whole process takes place with absolutely zero anesthesia of any kind, and its usually a local woman with no qualifications at all that does it with nothing but a razor blade or a knife. In other words, its torture. Straight up.

One girl recounted the story of being pinned down by many women and blindfolded so that she could not see the woman who was cutting her. Now she says she is traumatized – she can’t talk about the experience without crying.

The good news is that there is progress being made.  This project and others like it, by collaborating with local NGOs, authorities, and cultural and religious leaders, has had some success in raising awareness about the risks involved with circumcision, as well as promoting gender equality and women’s rights.  In 2009 Séguela had an over 80% prevalence of FGM, in 2013, most of the younger women we spoke to said that they had not been circumcised and did not plan on circumcising their children.

My job here is to help measure this progress in order to inform future programs as there are still many communities that have not benefited from them.   By speaking with various community members, former practitioners, authorities and project staff, we can better understand what elements of the project were effective in reducing FGM prevalence and which elements were not.  This information will inform the design future FGM prevention projects. My personal goal, and why I do this kind of work, is that every project carried out be more effective than the one before it, and that we use every bit of information that we have to prevent FGM and the needless suffering that it causes from happening in the future. 

For more info please read this.

Hotel Président, Yamassoukro, Ivory Coast

Last night on the way to Abidjan from Séguela, our my colleagues and I stayed at the Hotel Président in Ivory Coast's capital, Yamoussoukro. It was awesome.

The hotel was built by the government of the Felix Houphouët-Boigny, the first president of the Ivory Coast in the 1970s, presumably to cater to politicians and diplomats. When you walk through its front doors it feels as though you are stepping back in time. Everything is perfectly preserved. Eero Saarinen tables abound, as do those spectacular dome vanity lights.  The bathrooms are lined with orange and brown tiles and have Lucite cigarette holders next to the bidets.

So long, CG

I meant to post this on our move day, but I got a little side tracked with, well, moving.  So now I'm posting it from my hotel in Daloa, Ivory Coast. We're definitely excited to get settled in our new home, but will definitely miss  our old neighborhood, Carroll Gardens, with its restaurants, shops and old school Italian feel.

A Lovely and Disorienting Day

I am in Abidjan, Ivory Coast.

I just got back from having lunch with a new colleague of mine, a Rwandan doctor named François. François, I learned, happened to have worked for Doctors Without Borders (MSF) Holland  in the east of Chad, while I worked for MSF Holland in the East of Chad. We were bordering on giddy when made this discovery.  Let me tell you:  it’s pretty rare to meet anyone who has ever worked in Chad, let alone the east of Chad, which borders Darfur. Outside of colleagues that I worked with and whom I see at MSF functions, I have never met a single person who has ever worked there.  And here I am in the Ivory Coast, neither François or I still working for MSF, and we are so caught up in trading horror stories of our work there you would  think we were old buds.

Chad, at least while I was there, was not an easy place (sadly I doubt it is any easier now).  It’s hot, dry, there was low-level but ever-present conflict, violence, poverty, theft, malnutrition, scorpions, you name it.  It was always the media-starved, borderline-invisible-but-almost-equally-as-bad, next-door-neighbor to Darfur.  Even within MSF crowds, when you meet someone who has worked in Chad, you subconsciously give them the nod: respect.

Now I am back at the hotel, doing the following:

• Reminiscing about Chad. Happy but also a bit sad that I will not likely be going back, and almost definitely not in that capacity.
• Coordinating with Dave while he buys tiles and grout without me. This is stressful for Dave, because I have left him with a series of aesthetic decisions to make himself.  Dave aims to please, and he also knows that I care much more about the color of the grout than he does, so I feel for him having to make these decisions in my absence.
• Buying toilets online.
• Casually working on questionnaires about female genital mutilation prevention in rural Ivory Coast.
• Fighting jet lag.
• Struggling to wrap my head around it all.

Note: the pictures above are from Am Timan, Chad, in 2007.  If you are interested in learning about MSF's work there, check out House Call... to Chad, a blog written by a Canadian doctor working there.

Also: Make no mistake.  Working in the East of Chad is hard.  Living there, as a local or a refugee, is infinitely harder.