Yana Mayevskaya – Adolescent Empowerment in Zambia

Over the summer I traveled to Lusaka, Zambia to participate in the evaluation of an adolescent girl empowerment program for an International NGO.  It was an experience that both reinforced my commitment and passion to global public health and at the same time raised challenges for me that I think many of us face when we work outside of our own countries.

The ever-present white Land Cruisers became home for me in Lusaka, Zambia during my practicum. Every day a team of 35 incredible local staff and I would hop into those vehicles, blast the top Zed hits, and head to the compounds in the nearby communities. The group of local female enumerators would spend hours locating and interviewing adolescent girls, asking them seemingly endless questions, ranging from who lives in their household to the last time they had sex. It seems like we wanted to know just about everything we possibly could about these 5,000 girls we would spend time with over the next few months as we evaluated the program.

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I was given the option of staying in the office while I did ‘QC’ (quality checks) or going into the field with the enumerators. I ALWAYS chose the field. I love to be in the mix of things—learning, laughing, and (most importantly) interacting with the project’s intended beneficiaries. However, in the third week of fieldwork, I had two drastically dissimilar experiences that made me question the effect my obviously foreign presence had on this research project.

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In the field, one of my roles was to observe Early Childhood Development (ECD) assessments and to provide feedback for the enumerators. However, in many of the households, the children were terrified of me, and I would have to step outside in order for the enumerators to complete their interviews. During these times, often lasting for a couple of hours, I would hang out with the child’s family members and their neighbors—can someone say a dream come true?? On one such occasion, there were a few teenagers cooking greens and doing laundry with their caretaker right outside the house. I awkwardly stood next to them and put on my big, cheesy smile. I wanted to hang out too! That awkward moment soon passed and moments later we were huddled in a circle attempting to chat about school in broken English and Nyanja, singing songs, and learning to cook greens Zambia-style. About an hour into the hangout session, one of the young boys ran into the house and brought out a photo of himself with a Muzungu (white person), holding it very tightly to his chest with evident pride. The  caretaker followed him out, carrying a bag of peanuts as a gift for me.  She told me:

The kids and I get very excited when we see Muzungus. All of these kids are orphans, and the photo that the boy is holding is his sponsor. All of these kids get sponsored to go to school. They got excited when they saw you because they know that people like you help them a lot.

I did nothing to help these teens. I was welcomed and cared for by this family because of someone else’s kind deed only because I had the same skin color as them. It did, on some level, warm my heart to know that something as simple as a school sponsorship significantly helped this family, even if I had nothing to do with it and even if it wasn’t enough.

A few days later, once again, another child was uncomfortable in my presence. The living room was very small, so I sat in the doorway to observe because I knew that the child needed a bit more space from me. A few minutes later, the adolescent girl’s brother-in-law walks by, stops in front of me and gets noticeably upset:

Why is SHE in my brother’s house?! She is drawing attention to my household! The neighbors will have questions. Did you even talk to my brother? Is she here because we are orphans?    

He was raising his voice and, soon enough, neighbors’ faces began peeking out from their homes. I told him that I could leave, but he just kept repeating that I was attracting attention to his house. My heart dropped. I was sad and uncomfortable. Would the girl’s husband come home and be upset with her? Would his brother-in-law cause a scene after we left? Did my presence negatively impact this research? Later, I was told that it is not unusual for enumerators to be chased out by some families. Still, I couldn’t help but think that my presence made this situation a whole lot worse. Both of these families lived in the same area and included orphans, but they had vastly different (if equally acceptable) responses to my presence in their homes.

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I had an incredible couple of months in Zambia and wished I didn’t have to leave. After I graduate, I would love to live and work internationally, but I know that these feelings will continue to well up and cause me to question the value of my presence in these settings. I love to be in the middle of all the action, but perhaps there are moments when it is better that I step back—and that is absolutely okay!

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Anaise Williams- Aid and “Othering” in Ethiopia

I got there, and I saw this woman standing completely naked washing her dress in the river. I was appalled. But then a few days later, I realized it was because she only has one dress, so she didn’t have anything to wear while washing it. – American woman wearing a red polo featuring a “Teen Mission International” logo with a gold cross

Other middle-aged white woman: Incredible

First woman: It just made me realize, we Westerners are so unsatisfied. We have more than anyone in the world yet we can’t find satisfaction. This mission was life-changing, it made me realize the best way to serve the Lord. All we need to do is give them supplies – you know the women, they’re really good at sewing.

Second woman: I know, they’re so talented, really talented. If only they were educated. In Malawi we were focusing on education and we provided Bible sessions for two weeks in three villages.

First woman (nodding enthusiastically): You know if they have tin for their huts, and if they have food, they’re happy.

 

I overheard this conversation on the plane ride back from my practicum in Ethiopia, where I was working on a program evaluation in Sudanese refugee camps. I realized that, apart from not wearing a red polo, I blended right in with the crowd of missionaries. I had a sudden urge to punch open the window and jump off the plane. What was it about this conversation and their “missions” that made me so angry?

The refugee camps were better looking than I had expected. Mud huts are set up in perfect dynamic blocks, surrounded by neat straw fences with a few holes here and there for small children to stick there heads through to yell and wave at the white land cruisers trundling past. Women walk by carrying packages labeled “World Food Program” on their heads while babies wearing Pepsi shirts with no bottoms cling to their legs and backs. Men sit in circles in the “culture center” talking all morning, and often end up lying down, a bottle of homemade liquor in hand, later in the afternoon. The fact that few people have livelihoods makes the atmosphere dramatically stagnant. Though people are active, it feels like a place to pass time.

It’s strange to be in a community almost completely functioning on handouts. It was even more unsettling to be associated with that aid. USAID, UKAID, UNHCR, UNFPA and WFP signs litter the camp. Do they see me and think I’m the face behind the signs? Is that why they so warmly greeted me? One day we were walking to the camp coffee stall when a woman I had never seen before suddenly appeared and started crying with a smile, hugging me while saying thank you, thank you in Arabic. It was awkward and I felt guilty for receiving her greeting.

During our training for data collectors, we talked about reflexivity for our project to interview Sudanese refugees about gender-based violence.

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We conceptualized the fact that what the interviewer looks like and represents influences the data and interaction. The IRC had selected translators who are Muslim and from the bordering communities, and one was a refugee herself. The researchers were Ethiopian but none were Muslim and all were highly educated in Addis Ababa. We therefore had three levels of “foreignness” in the room: translators who were not refugees, educated Ethiopian women, and an American. I was not interviewing for this project, with good reason. One researcher pointed out that if I were to interview, the girls might alter their answers to make them seem more needy, with the idea being that if I heard their need they might get further assistance.

In one of my courses at Mailman, a professor described this phenomenon as “the aid game.” Local people, especially those in emergency settings living on aid, know the game and they play it well. They know agencies and what their interests are, and they sometimes put on an act for agency representatives in a way that might continue or increase assistance. While the people are indeed in need and their actions justified, this fosters a relationship that is artificial and lacks transparency. When the khaki-vested white person shows up in the white land cruiser, the people show both their gratitude and their continuing problems. It’s the humanitarian song and dance.

The reason the women on the plane made me angry is that I felt like they were objectifying Africans. They were shaping the people into vehicles for serving the Lord, and they were taking on the authority to label the people’s needs. I don’t doubt that humanitarian aid workers do this too; I’m sure I’m guilty, or will be guilty, of it as well. Not only is this objectifying, but it is also othering. Their dialogue creates an “us” and a “them.” The more I work abroad the more I see it, and it prevents true relationships from being formed. It reproduces the idea that we live in two separate worlds separated by a precarious bridge.

The “two separate worlds” situation is created by two sides: the people playing “the game” and the people labeling the people playing the game with their definition of vulnerability. I’m not blaming local people for playing the game; they’re being strategic. And I’m not blaming missionaries—we’re all susceptible to this type of satisfaction. What I struggled with during my practicum is that sometimes the dialogue (between local people and foreigners, and between foreigners) makes interactions feel fake, like some sort of rehearsed play. It hampers collaboration. It highlights our differences, and it separates us.

And ultimately, I’m not sure what anyone could do about it. One thing that made me feel better while working on this project was that the work was set up collaboratively, and I was able to make real, lasting friendships with the Ethiopians I worked with. And the project was strong in that, to the extent possible, it employed the people closest to the problem.

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Another answer is to live in a place for a very long time and work on relationship building. But home is home, and skin, clothes, language and assets have political and historical meanings. So unfortunately, this is an ongoing struggle that I, as I begin on this career path, am grappling with.

Anaise Williams- Creating Relationships in the Field: Experiences from Dhaka

dhakaOn the first day of lecture in my introductory global health course, the professor asked if Americans working in low-income settings abroad causes more harm than good. I know this is a basic question that we have all heard, but for me it caused a flashback.

It is three days until my flight out of Bangladesh, after a year of ethnographic research on postpartum depression in Dhaka, and I’m standing ankle deep in water in a four feet wide slum road. Trash and a dead rat float near by. Drenched in sweat, all I can think about is a shower and how I shouldn’t have come today. I didn’t have to give gifts to all my informants; I had come the week before but a few women had not been home. I look up and see three shredded pieces of tin that make the walls of some of the shacks appear as prison bars. Through them, the face of one of my informants, a seventeen-year-old named Teeptee, peered through, her baby slumped over her shoulder.

There are of course many different ways that “westerners” work in global health, and therefore many different ways to cause harm and good. For me, I was doing an exploratory, anthropological study on stigma towards mental health and the experience of post-birth stress. I was not providing services, but rather getting to know thirty-six women living in a slum on a very personal basis to understand their life struggles, with the goal being to generate knowledge of a generally neglected population. I did not have any connections with people who would make a program or intervention out of my findings. Is this harmful?

Teeptee and I shared our lives with each other over the course of months. I showed her
pictures of my family, my university, my parents’ house in Maine on the lake. She shared her story of marrying her drug-addicted husband without her parents’ consent, leaving her, a teenage mother, in a situation where her family refuses to help her because it was a love marriage rather than an arranged one. She told me about her husband’s abuse and the time he tried to kill her. My interpreter, an incredible Bangladeshi woman, and I knew that Teeptee enjoyed our company and consistently invited us to return. I consciously made my questions extremely open ended and vague so that she drove the dialog. We had a connection, and it was a safe space for her to open up about her life.

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But was it harmful that I gave her a glimpse of my world? She saw my IPhone, and asked to see pictures of my life. She saw my wallet and the way I regularly bought scores of children treats. She saw the way I walked wherever I wanted, whenever I wanted, unaccompanied by a man.

And before we both realized it, it was time for me to go home. We had been in her space together and I had momentarily felt the harsh reality of her life sentence: and now I could leave. Leave to go back to a bedroom two times the size of her slum home that I share with no one, back to my restaurants, my libraries and theories and lecturers who claim ownership and scholarship of places they have never lived long-term – something I find myself doing all the time about Bangladesh. Is this harmful? There is an argument saying no: her story might not be heard if I don’t share it, her health problems not evaluated, her needs not assessed.dhaka2

The true privilege that characterizes the global power dynamic is that I can have both my world and hers, but she can only have hers. I can go to her home and learn about the tragedies of humanity, but I can step out of it as soon as I want. I can cry with her; I can help her buy baby formula and medicine. She spoke with me, maybe because she wanted to, but it is naive to ignore the possibility that she only talked to me because she wanted economic assistance. I figured this was good for both of us- I get access to a secret world and people in her situation could benefit from research that will hopefully contribute to our general knowledge of how to make the world a better place for women.

But sometimes, when I think about it late at night, I feel like I was buying her world. I was taking it for my Fulbright stamp of approval, I was sharing it at conferences and in classrooms, I was using it to grow and feel passionate and successful and purposeful.

dhaka4I feared my friend had become dependent on me, after months of sharing her struggle and me listening intently. Then I left, and I know from her words and her situation in a Dhaka slum, that there is no one else she can regularly share her emotional stress with. I know it was good for her to be heard- she told me she wanted her name and story in a book. But when I chose to leave, had the choice to leave, how did that make her feel? My presence undoubtedly gave her hope and demonstrated how there are people who care about her wellbeing. It gave her a glimpse of how things could get better, how there is a world out there that is better. What happened to that hope when I made my last slum visit, gave my last smile and parcel of fruit?

If I knew, I could more readily approach the question of if this kind of global health work causes more harm than good.

 

 

Kathryn Davis- A Day in The Life of a Dar Es Salaam Mapper: Mapping Drainage in Chang’ombe

Photo1_EPD ColumbiaJanuary 14th, 10:30am. We arrive in Chang’ombe ward (an industrial area in Dar es Salaam) after weaving in and out of traffic in the project bajaj (rickshaw) through different neighborhoods. Johannes Peter, a seasoned mapper with the Dar Ramani Huria project, takes another look at his drone imagery printout of the area, and indicates that we’ve arrived at our starting point. He starts the OSMTracker app on his phone, ready to start work (the tracker app helps him to geolocate, and take pictures of interesting areas, with the pictures tagged to a GPS location). Mappers like Johannes detail key drainage and water infrastructure that hasn’t been digitized before, and that can be used for disaster risk reduction planning and flood resilience. He stops to check the map again, and then we’re off looking for drainage systems (our main task for the day). Carolina and I (two Columbia University graduate students, here on a preliminary trip to evaluate the project) are tagging along on a regular day for the Dar Ramani Huria project, to see the work team members are doing in the field.  It’s not easy work, but essential to the project.

Almost immediately, we see drainage on the right side of the wide dirt road, and mark it IMG_3259on the map. Johannes quickly identifies where we are on the map, and starts using the OSM Tracker App to identify the drainage, and to note indications of garbage or other debris blocking it.  He uses his phone to photograph this: the Tracker App automatically geotags the image, to give a visual for other OSM map users. All the data that Johannes collects today will be “digitized” (added to the online map) later, so it’s crucial to get details right, and we spend time noting each part of the drainage system that we can see, including the direction of water flow, which might indicate a drainage convergence at that point, or where drainage ends abruptly with no continuation. Johannes is systematic in his mapping: we cross part of the outer perimeter of the ward, then move down inner roads, stopping each time to note important drainage details.

IMG_3168By now we’re halfway through and the midday sun is shining on us, but with a quick water break we’re off again, to finish the area we’ve been assigned for the day. We see drainage under construction: Johannes indicates that on the map too, as drainage on these roads is likely to change in the coming weeks. We also see that part of one of the roads is flooded after light rain the day before. Drainage can go underground,  or we may need to figure out where the road is IMG_3191from the map: walking these roads and mapping takes a person who is comfortable asking questions, and Johannes, who’s from the city, is always ready to ask people in the neighborhood he’s mapping for help, whether it’s for directions or the name of someone who might know where the non-visible drainage lines go.

After a day in the field, Johannes brings the now annotated maps to BUNI Innovation Hub to digitize. BUNI which is where the HOT team works from in Dar es Salaam when they are not in the field mapping. At this phase in the project, mappers typically work two days in the field, then one day IMG_3180digitizing their field data into the OSM platform. The 22 mappers currently on the project (most of whom have been there since the initial mapping in early 2015), have mapped many wards in the city of Dar es Salaam. The project has completed in detail infrastructure of 21 wards in Dar es Salaam and is now finishing a review of the drainage in these wards, and mapping 32 additional wards.

As we’re pulling away in the bajaj at the end of the day, we IMG_3249asked Johannes about using the data, mapping and being part of the project. He told us that “we are the Humanitarian OpenStreetMap Team. Humanitarian means that we are taking care of people, and this means that some things we have to do voluntarily”. Most of the main mappers (including Johannes) have recently obtained university degrees in urban planning or geography, and are extremely passionate about their work. When he visited the Katavi Region in the southern part of Tanzania to visit family, he saw there were no maps, so he started mapping the area using the skills from he learned from the project. For Johannes, mapping isn’t just what he does at work with the Dar Ramani Project. It’s also something he does in his free time.

Kathryn Davis – Increasing Access to Legal Identity Documents

“He needs the birth certificate for school, or else he can’t take the national high school exam tomorrow”, explained my colleague I worked with in Togo while I was a Peace Corps volunteer. There had been a scramble all morning in the neighborhood to mobilize a dollar here, 50 cents from the women down the street in order to pay the fee and the willingness of a bush taxi driver to take the documents to the administrative building in the regional capital six hours away so that it could be finished by the next day. They say it takes a village to raise a child, well it also takes the mobilization of a whole village sometimes to gain a legal identity document in many places around the world. Being born in New York City, half a world away in St. Luke’s hospital given a birth certificate and identify documents from almost day one I had never had to face what that Togolese high school student and his family faced that day, but it is the reality for millions of people around the world that struggle to gain access to education, social, and health services daily. As fate would have it after several years of focusing on community-based family planning, I ended up having the opportunity to work on a project focused on legal identity documents through the Center on Child Protection (PUSKAPA) this summer for my summer practicum at Mailman.

Participatory Ranking Method Activity

Participatory Ranking Method Activity

PUSKAPA, which is housed at the University of Indonesia focuses on strengthening the lives of children and families and was established in December 2009 with the partnership of University of Indonesia, Columbia University, and the Indonesia Ministry of Planning, supported by other partners such as USAID and UNICEF. One of their main current projects works on assisting vulnerable populations to gain access to legal identity documents (birth certificates, marriage certificates or divorce certificates). Legal identity documents play an essential role in the lives of Indonesians as they do for many around the world and help them gain formal recognition of citizenship and gain access to public services, including education, social assistance programs, and health centers. The project supported under an Australian Government program AIPJ and has been ongoing since 2012, PUSKAPA works with central and sub-national governments, courts, civil society and communities to support the implementation of non-discriminatory, accessible and simplified procedures that increase the number of women and children who receive legal identity documents that facilitate their access to basic services, mostly through advocating for mobile and integrated services in selected districts called Yandu, which has been used to increase access to legal identity.

Over the past four years, PUSKAPA and Program on Forced Migration and Health students have engaged in field research in Indonesia on legal identity. Most recently over the summer, PusKaPA hosted graduate students in North Sumatra and West Nusa Tenggara provinces. Myself and two other graduate students Brooke Feldman and Yeray Novoa Medina, recent graduate Cyril Bennouna who is a Senior Research Associate with the Center, along with PUSKAPA staff undertook a mid-line assessment for the project starting in June. While conducting this research we worked under the guidance of PFMH faculty member Dr. Lindsay Stark and Co-Director of the Center Santi Kusumaningrum on research design, tools development, research methodology, and analysis.

The mid-line assessment followed up with couples that had received Yandu services in the last years through the project, and also neighbors who were not apart of the project. The research team sought to answer the question of current barriers to accessing legal identity documents, and used participatory ranking methods along with focus group discussions in the communities. A household survey was also conducted in order to answer the two questions of what changes have their been for women, men or children who participated in Yandu and also do people who access Yandu go on to promote it to others and what is the effect of this? The research team also worked in conjunction with local partner PEKKA in the provinces during the assessment which was highly valuable as they had extensive knowledge and networks of the communities we were working in. Overall, this included 1,403 surveys, and 20 focus group discussions. Data analysis is still ongoing and the initial findings should be finalized soon.

Working in Indonesia on this project was a rich experience that took classroom learning on quantitative and qualitative research into remote fishing communities, palm oil plantations, remote mountaintops in search of the answers to the questions we had determined for the assessment. Indonesia is a country that has extreme diversity, and if answers to barriers to accessing legal identity can be solved there, who’s to say that those lessons cannot be replicated and learned from in other places around the world that have similar issues in the future.

To read more about the Center of Child Protection at the University of Indonesia please use the link below: http://www.puskapa.org/

*This Research is supported by Australia Indonesia Partnership for Justice (AIPJ)

Anjoli Anand – To Work in the Field

The rickety tuk tuk leaned precariously over the edge of the precipice along the dusty, windy road.  Every ditch and burrow left me with a lurching in the pit of my stomach, like that moment when the roller coaster crests to the top of the tracks just before the drop; when your mind races ahead, creating contingencies for your contingencies; when there is time for the hundred decisions, indecisions, visions, and revisions which a minute will reverse.  In the past when I thought about epidemiology, I pictured surveys, data coloring in what a place looked like to give it a greater sense of completeness. I would see researchers working in the field in their cargo pants, hands clutching clipboards, sensible boots on dusty fields.

I don’t think I truly understood what it meant to do the work; what it meant to contend with geopolitics, with history, with memory, until I was crammed into that tuk tuk barreling down a dusty village backroad in the Traeng Trayeung commune of Kampong Speu Province, Cambodia. I had been in these kinds of places before as a doctor to provide medical care, and I knew the frustration of not having enough material resources: IV kits, bags of saline, gauze, medications, etc…but this was something else. The sense of loss here was of something much deeper.

[On April 17, 1975, as the Vietnam War came to its long, messy, exhausting end, bringing with it a brief hiatus in the western world’s interest in Southeast Asian politics, Pol Pot and the Communist Party of Kampuchea, known as the Khmer Rouge, took control of Phnom Penh, the capital city of Cambodia. Their manifesto centered around the idea of an agrarian utopia. An integral part of their strategic and systematic dismantling of a people was to first decimate the intellectual class.]

I had come to Cambodia in 2015 to pilot the use of a retrospective cohort reconstruction as an enumeration method for children living outside of households and family care. My group was going to sample a cohort of children from sometime in the past and find out their household status today. It took months for me to truly understand the method, so one can imagine how challenging it was going to be to explain in rural Cambodia. But my elevator pitch had plenty of opportunities to be refined as we negotiated bureaucratic hurdles and administrative politics to secure permission to conduct our research. Because of our affiliation with a larger study in process, we already had letters from the Ministry of Social Affairs, Veterans, and Youth, the Ministry of the Interior, and the National Institute of Statistics. The study had also cleared the National Ethics Committee. With a preponderance of permission, we thought we were in the clear, but boy were we wrong.

Our plan was to construct a cohort from school registrars, believing that mandatory birth registration was too recent for the children to be old enough for our study. If you’re following along, you’ll note the absence of a letter of permission from the Ministry of Education. In something out of a Shakespearean comedy, we met with the Provincial Office of Education, were instructed to get an official letter from our organization translated into Khmer that requested permission to access the records, bring it to the office of the Provincial governor, bring his letter of clearance back to the Provincial Office of Education, and then bring a final letter from the POE to the district office, who would then phone the commune office in Traeng Trayeung. And of course, all of the above had to happen in person, taking up weeks of valuable time. It was never a question of if we would gain approval but rather when. The question came down to the time, and would we have enough of it left to undertake this massive project.

[In a mere 4 year period, from April 1975 until January 1979, the Khmer Rouge was responsible for the deaths of 3 million people, out of a total population of 8 million. This occurred directly in the killing fields and as the result of forced labor in the provinces. In order to save resources like bullets, these killings were often brutally carried out in form of bludgeoning. A common refrain of the ruling party was to weed out their enemies from the root, resulting in the targeting of entire families. In the killing fields of Cheoung Ek, there is a tree marked as the one used to kill infants and small children.]

We selected a site about 3 hours away from Phnom Penh. In the Cambodia of August 2015, the congestion of City is short lived and rapidly gives way to widely-spaced homes dotting rice paddies and mango plantations. We chose a rural site because the methodology is easier to implement if you have a stable population with little out-migration. But here is where knowing the history of a place becomes important, if not vital. The Cambodia of August 2015 is a product of a generation that was not allowed to foster a culture of education or stability. As a result, migration is high everywhere. Families travel between provinces for a season at a time to work in a plantation. When they bring their children, they are usually enrolled in the local school for a period of time before they all move on to the next village/commune/district/province.

Instability and migration manifest themselves in ways that are less obvious, as well. Our cohort was composed of children born between 1998 and 2002. They were typically enrolled in school for the first time at age 5 in grade 1. Today, over 10 years later, among the children who remain in school, who remain in the commune, who have not left to work in a factory in some other province, it is rare to find a child who has advanced beyond grade 6. It is accepted and normalized that children will attend school only some days of the week, the remaining time spent either helping at home or in some other income-generating activity. This isn’t to suggest that the Cambodian people believe in this status quo. Every interview we held with a village chief, a community member, a child, reinforced how desperate they were for education, for consistent schooling, for opportunities a lost generation never had. But how do you fill the gaps left by such targeted brutality when you don’t have the tools? Who will be your teachers? Whose history are you learning? Who has written it?

[40 years later, survivors of that incredibly violent, bloody, and destructive period continue to fight for basic recognition and justice from an international community that, for years after reports of genocide and crimes against humanity broke through, continued to offer the Khmer Rouge legitimacy and a seat at the table. In 1997, the Cambodian government petitioned the UN for assistance in organizing trials. In 2006, the judges for the Extraordinary Chambers in the Courts of Cambodia were finally sworn in. In 2010, the first guilty verdict was passed against Kaing Guek Eav, alias Duch, for crimes against humanity and breaches of the Geneva Conventions. Pol Pot himself underwent a show trial in 1997 and was sentenced to house arrest. He died in 1998. ]

A visit to the killing field of Choeung Ek, where only 8,000 victims of the over 20,000 have been exhumed, where you are cautioned to stay to the path and not disturb the bones you find, is a lesson that in the end, we are all forced to face the truths of our collective history, no matter how deeply they are buried. And it is no mistake that the Khmer Rouge commandeered a school at Tuol Sleng and turned it into a brutal detention center where people were held for interminable periods of uncertainty before being sent to their death. There is a powerful kind of cognitive dissonance found in a bare cot where a prisoner was chained and tortured, lying in the middle of a classroom with the chalkboard still hanging.

Today, that same cognitive dissonance is found in the accumulation of those small bureaucratic impediments to research despite a desperate desire to make things better, in the politics of who can advance, in the challenge of just putting one foot in front of the other in the direction of school. As my tuk tuk rolled along the village backroads, my stomach turned not only because gravity always wins, but because of what our being there, doing this work, represented to the villagers and the expectations they had of us. Maybe our presence would finally bring much needed resources to the commune to better outfit schools, to allow children to attend classes more often than just some days a week. One of my biggest challenges in working in the field was not the actual data collection, but rather mitigating expectations while bearing honest witness to history and collective memory. It is as important and delicate a task to understand the root of expectations as it is to be faithful to the methodology. Data is often what is needed to convince people of the true magnitude of a problem in an objective way, but it is empathy, understanding, and recognition of shared humanity that fills in the details of a place and of a people.

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Figure 1 Killing Field at Choeung Ek Genocidal Center

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Figure 2 A successful crossing of an actual bridge over actual water.

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Figure 3 A tuk tuk can adapt to just about any set of circumstances

Katie Morris – “It turns out that humanitarians also care for their own.”

The Mahama Refugee Camp, located on the border of Rwanda and Tanzania, opened in early 2015 in response to increasing numbers of Burundian refugees fleeing growing tensions in Burundi. In this post, Katie Morris, a 2014 PFMH/MSPH alumnus, reflects on World Humanitarian Day and the work of her emergency response health team in the Mahama Refugee Camp.

[22 August 2015]

This past Wednesday, August 19th, was “World Humanitarian Day.” Perhaps there is no better place to celebrate than in the new Mahama Refugee Camp, on the southeast order of Rwanda and Tanzania, where humanitarians in their color-coded t-shirts, caps and vests are anything but hard to spot as they buzz around building shelters, feeding mothers, collecting information on adolescents, and contemplating the impending later shortage problems. They’re a diverse group – mostly Rwandese or Burundian, over worked, under paid, dehydrated, and stressed. You’d have no clue though, unless you looked at their timesheets, budget lines, cracked lips, or nightly sleep cycles. Instead, their faces show smiles and compassion, their work reveals endurance and aptitude.

Over the past 2 weeks, my team of humanitarians have more than earned their red vests and caps. They’ve taken an arid plot of land scattered in lumpy brush and sloped down towards a river, and made it into a functional health post. A team of 2 doctors, 3 nurses, and 3 Burundian medical students has cared for more than 1,000 sick patients in the first week of operation.

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At the end of July, Mahama Camp was stretched beyond its capacity with 32,500 Burundians settling within its cramped borders. UNHCR camp management decided to hold the newly arriving Burundian refugees in the transit centers on the border for a couple weeks while NGOs expanded capacity for shelter, food, water, and health care in the camp.

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The organization I work for took on the challenge of the health post, located in the new area of the camp and designed to address the outpatient health needs of 10,000 new arrivals and reduce the growing burden of sick patients crowding the camp’s only health center. Since August 10th, around 900 new refugees are bused into the camp from the transit center each day. There are estimated to be around 17,500 Burundian refugees waiting in the transit centers, anxious to get away from the horrors they experienced trying to leave their homes, hopeful they will be reunited with loved ones, and desperate for the basic needs promised upon reaching Mahama Camp.

On Wednesday (World Humanitarian Day) it was my turn to take the triage shift for the incoming convoy of new arrivals. Of course, being one of those days where nothing seemed to be going the way it should, the convoy was delayed and they weren’t expected to arrive until 6 or 7pm – the time we are usually en route to our office back in the nearest town, having closed up the clinic. That evening, as my colleagues were all packing up for the day, I was trying to find a way to change my attitude into a better one, so that I too could wear my red vest and cap without people knowing how exhausted, anxious, and frustrated I felt.

It turns out that humanitarians also care for their own. Instead of getting into the land cruiser that was waiting to take them back to the office and onto their homes after their already-12+ hour work days, my staff decided that they were going to stay and help me and a colleague receive the new arrivals in a gesture of pure solidarity. Our team, in our uniforms of red, wandered across the bush to wait for the dust storm that would signify the incoming convoy of new arrivals.

The buses started arriving moments before sunset and the timing was just right to catch the expressions of the boys, girls, women and men as they disembarked with arms full of blankets, high energy biscuits, and oddly shaped bundles of worldly belongings. They were herded into corridors for the police to check their bodies and belongings, and then directed to a line where they would wait for porridge and a place on the floor of a hanger to sleep. That’s the instant my attitude changed.

Their expressions in that moment of disembarking revealed the emotions that I realized I would be experiencing if it was me in that convoy. Their faces showed exhaustion, fear, hope, hunger, excitement, resignation. I think that for them, it was a point that “shit got real.” They had traded their lives of insecurity in Burundi for the status of refugees in Rwanda and anxiously awaited confirmation they had made the right choice. But for me, this was the point that I realized that they were not the “1,000 new arrivals” or even “Refugees” as their new ID cards proclaimed. These people are individual humans feeling the same emotions that any one of us would feel in their same situation. I am so grateful for the short glimpse of their expressions that night, against the setting sun, because it enabled me to share in their humanity and completed the picture of why those humanitarians in their color-coded caps and vests continue the endless work they started.

That night, after tending to several feverish children and an older woman having a panic attack, our team in red piled into the Land Cruiser after a 16 hour work day and had a dance party along the bumpy road–grateful for the humanity we all shared, humanity that manifested itself in emotional vulnerabilities, goofy dress codes, and Rihanna dance tunes.

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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61489-1/fulltext

Be a Man-Respect Women! Challenging Gender Norms in Bosnia and Herzegovina and across the Balkans

Arielle Juberg – Bosnia and Herzegovina – August 10, 2015

Arielle Juberg, a current PFMH/MSPH graduate student, conducted her practicum with the Young Men Initiative, a program in the Balkans that seeks to promote healthy lifestyles, reduce violence among young men, and prevent gender-based violence.

As a New Yorker, I’m used to keeping track of my time. Six hours of sleep, three hours at work, one hour on the subway; my days are neatly broken up into separate responsibilities and activities. When I read that Public Health and Humanitarian Assistance (PHHA) students were required to spend eight to twelve weeks in an international practicum, I tried to convert this into my hours-and-minutes mode of thinking. Unlike most other certificates at the Mailman School, which measure practicum activity by the hour, the PHHA certificate measures the weeks that students spend completing public health research abroad. Logistics may account for part of this difference; it can be difficult to quantify ‘working hours’ when your job is interrupted by electricity outages or long trips through rural areas. Within a week of my arrival in Bosnia and Herzegovina, I realized that the difference between measuring ‘hours in the office’ and ‘weeks in the field’ is more than just numbers on paper. If we are seeking to contribute positive changes in another country and culture, we must seek meaningful and genuine interactions with individuals and communities outside the environment.

I arrived in the city of Banja Luka in May with few contacts and fewer leads on a place to live. With only ten weeks in the city, renting an apartment seemed unnecessary, while a long hotel stay would be extravagant. Luckily, I found a room to rent with a family whose members included a toddler (I’ll call him Ben). On my first weekend in Banja Luka, Ben, his mother, and I walked through the city. Banja Luka is the second-largest city in Bosnia and Herzegovina, with an estimated population of 200,000. The city is well-known for its parks and green spaces. We wandered into one of the parks so Ben could play. Almost immediately, he noticed a shiny blue tricycle by the playground. Ben is currently infatuated with anything with wheels and quickly claimed the tricycle as his own.  As he happily rode around the playground, the owners of the tricycle, who may have been 3 and 5 years old, took notice. First, they followed him, yelling for him to stop peddling. Next, the older one attempted to stop the bike and pull Ben off. He yelled at his brother to punch Ben. Finally, the younger one cemented himself in front of the bike, grasped the handlebars, and thrusting his head forward, snarled at Ben.

How did a 3-year old and a 5-year old learn to yell, intimidate, and punch? Why were these the first actions they took when faced with the loss of their tricycle? Even as an adult, their immediate and aggressive behavior frightened me. While it may be inevitable that children argue over toys at the playground, their behavior reflects the acts they’ve witnessed and the lessons they’ve been taught.

In many countries, including Bosnia and Herzegovina, boys are brought up to be tough, dominant, and strong. Showing emotions signals weakness, and dominance is determined through violent acts like yelling, bullying, and fighting. I saw this clearly reflected on the playground; when confronted with a problem, even toddlers resorted to physical and verbal violence. This pattern continues as boys get older, with the violence and its consequences growing more dangerous. Young men can be both the perpetrators and victims of violence. In a recent survey, young men in Sarajevo, the capital of Bosnia and Herzegovina, reported troubling levels of violence; 46% had punched, kicked, or beaten another young man in their life, 44% had humiliated a peer, and 46% had participated in a group fight in the past [1].

The harmful effects of a dominant masculine ideology go far beyond young men. Just as boys are taught to be strong and forceful, girls are rewarded for submissive and gentle behavior. These conflicting gender roles have been identified as one of the root causes of gender-based violence. Women may experience physical, sexual, or psychological violence when they disagree with a male member of the household or appear to challenge his authority. In a setting where violence is an established means of settling disagreements and establishing dominance, searching for a ‘reason’ for a specific violent act misses the point. When violence is a social norm, the least empowered members of society will always be vulnerable.

How do you change an established social norm? The Young Men Initiative, coordinated by CARE International with local NGO partners, seeks to reduce both interpersonal and gender-based violence by promoting gender equality and a positive, non-violent model of masculinity. The program has been implemented throughout the Balkans, including Bosnia and Herzegovina, Croatia, Serbia, Kosovo, and Albania. Through a series of interactive workshops led by facilitators, young men in high schools grapple with topics surrounding gender, gender norms, and violence. Early results show how the program can push back against established norms. In Kosovo, 69% of participants initially agreed that physical strength was a man’s most important quality; after the program, only 42% agreed with the statement- a statistically significant result [2]. Beyond the classroom workshops, the Young Men Initiative has launched Budi Muško (Be a Man) clubs in the high schools. The clubs, which include both young men and women, focus on combatting peer violence and gender-based violence while promoting knowledge of sexual and reproductive health. Budi Muško members plan awareness campaigns, host public events, and learn how to work with their peers concerning these topics. Through these clubs, young advocates work together towards a common goal and most importantly, take ownership of the campaign. In the future, they will be the leaders who work for a more equitable and non-violent society in the Balkans.

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Be a Man Club members from Banja Luka, Bosnia and Herzegovina raise awareness about the dangers of drunk driving (photo by Perpetuum Mobile)

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Be a Man Club members in Belgrade, Serbia (photo by Center E8)

This is what I’ve learned about going abroad to work for eight to twelve weeks. You may fly to your destination without knowing a soul, but you quickly develop close relationships. While I was in Banja Luka, I could help to protect Ben from the bullies who would punch and hit him for taking a ride on a tricycle. But I wasn’t there for too long, and I can’t protect him as he grows up. By targeting norms surrounding masculinity and violence, the Young Men Initiative can change the society that Ben grows up in. Tricycles will continue to be appealing, and children will undoubtedly still argue over toys at the playground, but violence doesn’t have to be part of this experience.

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Be a Man Club members from Mostar, Bosnia and Herzegovina participate in an event for International Men’s Health Week (photo by Youth Power)

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Be a Man Club members in Sarajevo, Bosnia and Herzegovina (photo by Association XY)

Monitoring and Reporting Attacks on Education in North Kivu, DRC

In June 2015, Elburg van Boetzelaer, a recent PFMH/MSPH graduate, and Lina Rojas, a current graduate student, worked closely with Rebuild Hope for Africa (RHA) to evaluate the Monitoring and Reporting Mechanism (MRM) of attacks on education by armed groups in North Kivu, Democratic Republic of Congo (DRC). Here they write about their work with RHA and the study. 

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Armed violence against schools by militant groups threatens students and school personnel across the world, depriving children from their right to education, and further damaging the already fragile future of states in context of armed conflict. In order to track disruptions of education by armed groups the UN Security Council (UNSC) Resolution 1612 established the Security Council Working Group on Children and Armed Conflict to manage the new Monitoring and Reporting Mechanism (MRM) for grave violations against children. Among the six grave violations tracked by the MRM are attacks on schools, including attacks on school personnel, and threats against these persons. The DRC has had an active MRM for 10 years, having been selected as a pilot site for the mechanism’s rollout in 2005.

In response to the need to strengthen the monitoring and reporting mechanism of attacks on education, and following a study that was conducted in 2014 in South Kivu, the Columbia Group for Children in Adversity (CGCA)—an extension of the Program on Forced Migration and Health–in partnership with Rebuild Hope for Africa (RHA), has conducted a study in the province of North Kivu, Democratic Republic of Congo (DRC). The study aimed to appraise the effectiveness of efforts to monitor and report attacks on education through semi-structured interviews with key informants of 35 organizations including government, UN agencies, and civil society organizations, while exploring the veracity of key informant reports and avenues for improving the surveillance of such incidents.

For the purpose of the study ‘attacks on education’ were defined as follows: intimidation, theft, indoctrination, recruitment, abduction, kidnapping, illegal incarceration, injury, abuse, torture, sexual- or gender-based violence, forced labor, forced marriage, and murder, whether in school or on the way to school, as well as military use of schools, and partial or total destruction of school buildings or other facilities, by an armed group.

Key informants identified a number of challenges that impede the efficacy of the MRM in monitoring attacks on education in North Kivu. Constant insecurity that dominates North Kivu, poor infrastructure, a lacking phone network and the absence of an official mail system make the effective communication and reporting of incidents from affected schools almost impossible. In addition, a vast majority of key informants were unfamiliar with the MRM, including government officials, representatives of international and local NGOs and representatives of the educational system. The few informants that were familiar with the MRM expressed a lack of confidence in the mechanism; the main reason being the MRM’s inability to actually capture attacks on education due to a lack of information sharing between key stakeholders, as well as a lack of financial and human resources to fulfill the requirement of verification of attacks prior to their inclusion in the MRM. The unfamiliarity of key informants with the MRM, suggests a need for awareness raising, training and technical capacity building in order to ensure meaningful participation in the MRM of representatives of education institutions, government, UN agencies and (inter)national NGOs alike.

A total of 113 attacks on education that took place between December 2013 and June 2015 were reported by key informants in Goma, providing a description of the incident, the name of the school and its location, the suspected perpetrators and the date of the event. About 20% of these reported events were chosen by the researchers for on-site verification, based on reachability, security, and diversity of sources that provided the reports. In this way, 23 schools in three different territories were chosen across the province for verification. Of the 23 schools that were chosen for verification, on-site informants including schools directors, teachers, religious leaders, and village chiefs confirmed 19 reports. Therefore, 83% of the reports of attacks on education were considered confirmed. During the visit to the 23 selected schools, interviewees described two additional attacks, which had occurred in those schools that had not been reported by key informants in Goma.  An additional 25 schools that were nearby the initial 23 were visited where no attacks on education had been reported by key informants in Goma. On-site informants at 20 out of the 25 schools (80%) reported that the school had been attacked during the period under study. Some schools were affected by multiple attacks between December 2013 and June 2015, resulting in 27 distinct attack reports within those 20 affected neighboring schools. Thus, a total number of 29 attacks not known to the key informants in Goma were added during the field verification process. The high number of additional attacks that were documented during the on-site verifications (an additional 26%) suggests a probable underestimation of attacks on education in North Kivu when surveillance is solely based on key informants in Goma. Further illustrating the importance of including local and community based representatives from the education and child protection sector in the monitoring and reporting of attacks on education, and strengthening communication and reporting pathways.

The quantity and quality of the total 142 reported attacks on education (113 by key informants in Goma, and 29 during on-site verification) attest to the need for an enhanced monitoring system for attacks on education in North Kivu, as this number is considerably greater than the number that was reported in the UN Secretary-General Report on Children and Armed Conflict, which documented 34 attacks on education in 2014, including the use of schools for military purposes, affecting 31,000 children in the entire DRC.[1] This study demonstrates the feasibility and affordability of an active surveillance system based on key informant interviews and on-site verification to monitor disruptions of education in North Kivu. As regular active surveillance will provide a better understanding of patterns of attacks on education in the province and contribute to more effective advocacy, prevention, response, and protection efforts, the repetition of this study, twice annually and preferably by a local NGO is strongly recommended.

[1] United Nations Secretary-General (UNSG) (2015). Report of the Secretary-General on children and armed conflict in the Democratic Republic of the Congo. S/2015/409. 5 June 2015.

Cyril Bennouna, MPH ’15: Attacks on Education, Research Methods & Lessons Learned

In early June recent PFMH grad Cyril Bennouna presented his latest research looking at attacks on education. Rosemary Nzuki of Columbia Global Center Nairobi reports on the panel and discussion below. You can learn more about the work being done at Columbia Global Center Nairobi here.

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Education under attack report released in Nairobi

11 June 2015; Nairobi, Kenya…

A group of thirty key stakeholders from the education sector in Kenya gathered at the Columbia Global Centers – Africa to deliberate the future of education in areas plagued by insecurity and conflict. The stakeholders were drawn from the Ministry of Education, various United Nations Agencies and Non- Governmental Organizations, such as the United Nations Children’s Fund (UNICEF), European Union, United Nations High Commissioner for Refugees (UNHCR), Adventist Development and Relief Agency, and the United States Agency for International Development (USAID) among others, as well as universities, including the University of Nairobi, Kenyatta University and Columbia University.

The purpose of the meeting was to disseminate research findings carried out in Somalia and the Democratic Republic of the Congo (DRC), especially in light of recent events in the east Africa region. The meeting also presented a valuable opportunity to convene a diversity of experts to explore strategies for better protecting schools and universities from attack, while improving monitoring systems. The research was a result of collaborative efforts between Columbia University and Protect Education in Insecurity and Conflict (PEIC), a program of the Education Above All Foundation.

The research sought to characterize the frequency and type of attacks on education in countries of study and to advance new methodologies to strengthen timely monitoring of such events. In recent years, violent attacks on education have become an important issue for the public and policymakers alike, with major attacks being widely covered by the news media, from the kidnapping of school girls in Nigeria by Boko Haram to the deadly attack on Garissa University College in Kenya by the militant Somali group Al-Shabaab followed shortly after by the bombing of the Ministry of Education in Mogadishu..

In his opening remarks, Dr. Belay Begashaw the Regional Director for the Columbia Global Centers – Africa termed the discussions as timely and welcomed the group as they came together to discuss and identify solutions to this critical issue.

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Figure 1: Dr. Belay from the CGC – Africa makes his opening remarks at the start of the presentation

Professor Neil Boothby from Columbia University and one of the authors of the report reiterated the importance of the topic, noting that education in conflict areas had far-reaching implications on the economic and social development of the affected areas.

Dr. Kimani Njogu from Twaweza Communications provided the context of the research.  His presentation dubbed the climate of fear, sought to highlight the actual problems that students in these areas were facing, the consequences of the attacks, and possible  strategies that organizations in the area could undertake to help combat the situation.  These included among others holding people to account, inclusive governance, conducting more research into the nature and scale of attacks, more partnerships and collaborations between the government and industry players.

Cyril Bennouna, the principal researcher, took participants through the research methodology and findings. He highlighted the definitions of attack used for the research, the way his team received reports of attacks and verified the quality and reliability of these reports through triangulation and the existing gaps in the monitoring and reporting process identified during the research. In his conclusion, Mr. Bennouna suggested that there was need for strengthening legislation, policies and practices around child protection issues; there was need for the integration of local knowledge as a source of credible information as well as the strengthening of partnerships between civil society organizations, education administrators and the international community. He also reiterated the need for varied data collection methods to enhance monitoring and reporting of attacks on education.

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Figure 2: Participants keenly follow Cyril Bennouna’s presentation

Participants engaged in a panel discussion with the representatives from the Ministry of Education in Kenya lauding the research as a long overdue, noting that the government was keen to have more reports focusing on the cause of conflict.

Participants from Kenyatta University echoed the same when they noted that there was need for a similar research to be carried out in North Eastern Kenya to aid in the development of a contextualized curriculum that would address issues causing the attacks.

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Figure 3: One of the participants makes her contribution during the panel discussions

 

Participants from the Non – Governmental Organizations applauded the research as timely and one that confirmed that inclusion was the ultimate solution to conflict. A representative from UNICEF called for follow-up meetings to explore how the research findings could be used to enhance collaboration in the industry with a common goal to address the problem.

In her closing remarks, Dr. Margaret Sinclair, the main sponsor of the research, thanked the participants for taking time to attend the panel discussions and put out a call to the participants to consider sponsoring more research for more context-specific reports that would allow tailor-made peace building activities that would put an end to the conflict.