Fistula

argus title : fertility control essential for all women

This week Parliament rejected attempts to reduce the time within which a woman can legally obtain an abortion.

In the days before the vote, I was struck by the anti-abortion lobby’s energy and its continuing ability to set the terms of the agenda despite considerable public disagreement with their position.

I wondered, not for the first time, why anti-abortion campaigners, if they are indeed “pro-life”, don’t campaign for legislation to oblige the state to resuscitate late foetuses if there is potential for viability. This would not deny women the right to end late pregnancies, but would oblige them to accept that if a viable foetus left their body, it would be the sole responsibility of the state, with a duty to protect its interests as a separate human being.

I can only assume that anti-abortionists don’t campaign for this because the real issue is not the “life of the child”, but a desire to control women’s fertility. The leaders of the religious right, who set the agenda on this issue, have no place for women’s rights. They know that without control over their bodies, women have little real chance of equality.

It is true that in the USA and Europe women have gained some control over their fertility, although as we have seen it remains constantly under threat. However, in other respects, even in the West, women continue to have far less control over their bodies than men, with only limited ability to prevent domestic violence, sexual exploitation and rape.

In many developing countries the situation is far worse for there many women have no control at all. All too often young girls, weakened by malnutrition and exhausted by heavy work, walk for miles to collect water or fuel. Many are forced into early marriage, in some cases well before their bodies have fully developed. Thereafter they are at risk of domestic violence and rape. Without access to contraception or abortion, they give birth in agony and many lose their children. Those who attempt illegal abortion, often die.

As Kate Hawkins of Sussex University’s Institute of Development Studies said this week “Every 8 minutes a woman dies in the developing world due to unsafe abortion in countries where termination of pregnancy is illegal or safe services are unavailable.” She points out that throughout the world “at least 13% of maternal deaths are due to unsafe abortion.”

Regrettably, there is no very vocal lobby to end these maternal deaths or the deaths of, or injuries to, mothers and children resulting from childbirth in unsafe conditions. Many churches pray for an end to abortion, but few for an end to infant or maternal injury or death.
One of the common causes of child deaths and maternal injury is obstructed labour in conditions where caesarion sections are not available or unaffordable. Deaths and injuries often occur. Where mothers do not die, a result is often obstetric fistula - a dreadful complication which in the West was eradicated in the late 19th century, but in developing countries continues to blight the lives of millions of women. It is most prevalent in sub-Saharan Africa and Asia.
Fistulas develop over many days of obstructed labor, when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to surrounding tissues, which necrotize and rot away. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder (called a vesicovaginal fistula) and sometimes between her vagina and rectum (rectovaginal fistula). This results in permanent incontinence of urine and, in 20% of cases, faeces as well.

A majority of women who develop fistulae deliver dead babies and are subsequently abandoned by their husbands and ostracized by their communities, both because of their inability to have children and their foul smell.
It is estimated that in Ethiopia there are some 100,000 women suffering with untreated fistulae. The World Health Organisation estimates that approximately 2 million women worldwide have untreated fistulae and that each year around 100,000 develop the condition.
Less than 6 in 10 women in developing countries give birth with any trained professional, such as a midwife or a doctor. In Ethiopia, it is 1 in 10. When complications arise, as they do in approximately 15% of all births – not least because of the incidence of female genital mutilation - there is no one available to help the woman.
The experience of Berhane, a fifteen year old Ethiopian girl, is typical. Berhane was pregnant with her first child. She squatted for days on the mud floor of her husband’s hut with no one to care for her, but her mother in law. In agonising pain she was unable to cry out for fear it would disturb his husband’s sleep. By the third day she was sure her baby was dead. It was not until the sixth day that she delivered her tiny dead baby.
She cried herself to sleep that night and awoke to find her bed soaked in foul-smelling urine. Despite her efforts to keep clean, her husband left her, her family disowned her and the villagers shunned her.
According to pioneering Australian obstetrician Dr Catherine Hamlin, the root causes of fistula are poverty and the low status of women and girls, which amongst other factors cause malnutrition, small stature and stunted growth. She said: “Poverty is the basic factor. The girl child is the last one to be fed in the family, she has to look after the old people first, the men, then her husband and or her brothers. Lastly she will get food because she is the last person to be of any importance in the family…the girl.”
But, fistula is both preventable and treatable. Dr Hamlin, who with her late husband Reginald co-founded the Addis Ababa Fistula Hospital in Ethiopia, has been has been successfully treating women and girls with fistulae without charge for almost 50 years. Berhane was one of them.
The Hamlins came to Ethiopia in 1959 and found a country with virtually no services for expectant mothers and none for treatment of obstetric fistulae. In fact, when they arrived they had never even seen one.
Reginald and Catherine quickly began to learn everything they could about obstetric fistula and perfected a surgical technique to mend the injuries. In 1974 they set up the Fistula Hospital, which over the years has treated over 30,000 women.
Many patients are very young, though others have suffered for decades. Many have walked for hundreds of miles to reach the hospital, enduring great hardship and humiliation as they travel. Though some are helped by their families, they are unable to use public transport because their smell is so offensive. Some have experienced years of social ostracism.
Currently, the hospital is able to successfully treat over 90% of the fistulae that present to the hospital. Of those who are successfully treated, many go back to their families. Some are able to give birth and are offered caesarian sections if they return to the hospital.
Some women choose never to return home, remaining at the hospital where they receive an education and in some cases are trained as nurses. One remarkable former sufferer is now able to skillfully perform the operation which saved her.
Sometimes the injuries from the obstructed labour are so extreme that the patient can never be completely cured. They may require ongoing medical care and can never return to their villages. They too are offered employment in the hospital where they are able to help others with similar disabilities.
Catherine Hamlin, now well into her 80s, still operates and has fundraised to set up several other hospitals. She has ensured that the issue of obstetric fistulae is securely on the UN agenda and has received numerous awards and accolades, including nomination for a Nobel Peace Prize.
Despite increasing fame, Hamlin’s priorities remain the same. She tells of a father who had sold his only ox to travel many miles with his daughter so she could be treated. She asked him how he would manage on the farm without an ox and he replied “I don’t mind, I want my daughter to be cured”. A few days later some visitors to the hospital heard his story and collected enough money to buy him two oxen.

The daughter, who had serious injuries and will probably never be able to marry again, now works as a nursing aid in the hospital.

To support the work of the Fistula Hospital contact “Ethiopiaid” on 0207 201 9981.

Lady Boys

Argus title :

As I walked through Brighton this week I noticed that publicity materials for the Ladyboys of Bangkok have appeared again – and that this year there are metal street signs directing traffic to the “Sabai Pavilion” in which they will perform.

Usually, these almost indestructible street signs are used for events such as the Lions Carnival or various trade and hobby fairs which, over generations, have taken place in Brighton and Hove. The fact that they have been issued for the Ladyboys suggests that the Council now views them as a Brighton “institution”, in effect, part of our culture.

I wonder if I am the only Brightonian to object. I do not want the city in which I live to be defined by events such as this. I can’t understand why a Council which has expressed increasing concern about the proliferating number of local lap-dancing clubs in the city, allows such a show to occupy one of its most prominent venues – one which is passed by virtually every bus route in the city.

It is true that the Ladyboys don’t strip in the ways that lap dancers do. However, like lap dancers and pole dancers their purpose is sexual titillation of men for money. However talented they may be as dancers or musicians, their appeal is based not upon their artistic ability, but upon the fact that they are young men performing, very convincingly, as if they are sexually provocative women.

The Ladyboys purport to live out a stereotype of femininity – obsessed by fashion, beauty, make up and sex - which may corresponds to the desires and fantasies of the Nuts and Zoo generation of males, but has little basis in the reality of women’s lives. Many women spend their lives resisting such stereotypes and are therefore deeply offended by male entertainers who appear to re-inforce the worst manifestations of them.

The fact that the Ladyboys are there year after year indicates that there are many people who are keen to watch them. However, the fact of their popularity does not in itself justify the use of Council-owned public space – or the fact that for weeks on end the general public is excluded from it. The fact that the Council has given permission for such long term annexation of public green space implies approval of this form of entertainment - and even that there is some public interest involved in promoting it. It is unclear why this should be.
The Ladyboys’ publicity machine is keen to present the troupe as part of “Thai culture” which they claim has a long tradition of accepting a so-called “third sex” – though interestingly there appears to be no “4th Sex” of Thai women dressed up and acting as men.
Apologists for and promoters of the show say “ladyboys” have been performing across Thailand for centuries. In 2003 an Argus reporter was informed that ladyboys “gained a new lease of life in the Seventies with the advent of disco.” The truth may be a little different. According to other observers, Thai ladyboys were revived, rebranded and remarketed to entertain well-heeled western tourists, who came to enjoy fine beaches and, in many cases, cheap sex with people too poor to refuse a good offer.
As is now well-known, inadequate protection for young children and adolescents coupled with extreme poverty, brought many Thai youngsters into the sex industry and ushered in sexual exploitation on a grand scale. Thailand became a haven for paedophiles and the Thai government is now struggling to bring this under control.

It is for this reason that any sex entertainment imported from Thailand - however apparently anodyne and innocent - should be carefully scrutinised. I for one would want to know that none of the young men involved was introduced to the profession when very young, particularly given that they freely acknowledge that many have received hormone or surgical treatment, such as breast implants.

Nothing like this would previously have been available to “traditional” Thai members of the “third sex” and so it has to be assumed that these medical interventions have been undertaken to increase the ladyboys’ appeal to the western market.

Many of these young men are so astonishingly like women that one has to question whether medical intervention in their cases may have taken place when they were in early adolescence or even when they were pre-pubescent.
Of recent years, in interviews, the Ladyboys have tended to make no reference to their early lives. However, back in 2003 they were less circumspect. An Argus article included an interview with a Ladyboy called Lee, then aged 28. The journalist wrote that he “first embraced the ladyboy lifestyle aged 13”. There is also a reference to another performer, called Maya. Then aged 43, Maya had been performing as a ladyboy for 30 years, again from the age of 13.
In this context it is disturbing that Farida, another Ladyboy, said she had known she wanted to be a ladyboy at the age of three, saying “I am happy with who I am. I like to make myself look beautiful. My parents always accepted me living my life like this, though it is expensive to have the treatment.”

In our ostentatiously “open-minded” city, we may believe that by tolerating the Ladyboys’ entertainment we signal an inclusive attitude to transgender people. It may be comforting to think so and to assume that the experiences of these individuals are similar to those of British transsexuals. However, Thai and British societies are very different – not least because in this country most male to female transsexuals don’t have to perform on stage for the delectation of heterosexual men.

The uncomfortable truth is that we don’t know whether these young boys had a genuine choice. It is uncertain what education they received and what options they had for other careers. In an economic situation in which families are terribly poor, struggle to eat and cannot pay medical bills, children must work – and those who are beautiful are at particular risk of exploitation. It may not have happened in respect of these entertainers, but we don’t know. What we do know is that in Britain those who become private dancers and sex workers are disproportionately likely to have been exploited or abused in childhood.

There is national concern in Britain about the sexualisation of childhood and the fact that pre-pubescent and adolescent girls are increasingly being driven to define themselves in terms of sexual attractiveness. In our own city, great concern has rightly been expressed about very young girls being involved in pole dancing classes. The Council recently stopped the classes taking place on council premises – a decision with which I completely agreed.

However, if we are concerned about our own adolescents, we need also to be vigilant as to the safety of children elsewhere. Thirteen is far too young to be embracing such a lifestyle.

Ladyboy entertainment is presented as if it were an amalgam of an exotic west end show, a drag act and a Carry-on movie. It may have elements of all of these things – it seeks after all to appeal to a western audience – but it springs from a society which is profoundly unequal and in which there is serious poverty and exploitation.

Many years ago we agreed as a city not to allow circuses involving animals. We thought ourselves too humane for that. Yet in these Ladyboy shows we permit the parading of human beings as curiosities, for the purposes of amusement, titillation and embarrassed or shocked excitement.

We may dress this up as entertainment, but arguably it is little more than a sophisticated and sanitised version of a 19th century freak show – and with less of a freak show’s honesty.

Anti-semitism and Crying Wolf

Argus title : My fears for this event in our city

A senior Sussex police officer is likely to receive “words of advice” from his own force following criticisms of peace campaigners protesting about the 2006 Israeli bombing of Lebanon.

In a letter sent to and published by The Argus last year, Ch Supt Moore said the decision of peace campaigners to hold their protest in Palmeira Square - an area he claimed was home to a large population of Jewish people - was a “deliberate attempt to provoke and incite”.

However the Independent Police Complaints Commission (IPCC) upheld an appeal made by three of those who attended the demo that the comments were “inaccurate and inappropriate”.