Followup: Genocide Prevention Month

All right, folks. This blog has gotten a lot of hits over the past couple of weeks, but I didn't get any comments on that last post! Did any of you watch a film or read a book about genocide? Do any of you have any recommendations for me or for other blog readers? I'm working on another post about Genocide Prevention Month, but before I get there I would love to hear some input on what you are learning and thinking about. (It's okay if you don't know me; I'd love it if you introduce yourself.)

So... anyone?

Action: Genocide Prevention Month

April is Genocide Prevention Month. April 7 marked the 15th anniversary of the Rwandan genocide, where nearly one million people were slaughtered in three months. Other genocides have begun in April, too--the Holocaust, the Armenian genocide, the Srebrenica massacre in Bosnia. Genocide Prevention Month was established in the United States to be a period of remembrance, and also a period of activism directed toward fighting the forms of genocide that are happening today.

(By the way, if you're interested in the nitty-gritty definition of genocide, click here.)

Over the next couple of weeks, I'll be putting up several posts with suggestions on how you can commemorate Genocide Prevention Month, and turn it into an opportunity for activism. This post, though, is going to focus on what I view as the heart of everything: Education. The first thing I want you to do this month is to read a book and watch a movie. Learn more about genocides that have occurred; feel it.

1) Read a book. The Genocide Prevention Project and the American Booksellers' Association have created a list of "Books of Conscience" that will give you insight into past and current conflicts and genocides. I'm going to post the list in its entirety here, but please be aware I haven't read most of these books.

ABOUT GENOCIDE

A Problem From Hell: America and the Age of Genocide by Samantha Power

The Sunflower: On the Possibilities and Limits of Forgiveness by Simon Wiesenthal

ARMENIA

The Bastard of Istanbul by Elif Shafak

Forgotten Fire by Adam Bagdasarian

A Shameful Act: The Armenian Genocide and the Question of Turkish Responsibility by Taner Akcam

BOSNIA

The Cellist of Sarajevo by Steven Galloway

The Hemingway Book Club of Kosovo by Paula Huntley

Zlata's Diary: A Child's Life in Wartime Sarajevo by Zlata Filipovic

CAMBODIA

Children of the River by Linda Crew

First They Killed My Father: A Daughter of Cambodia Remembers by Loung Ung

DARFUR

Darfur: A Short History of a Long War by Julie Flint and Alex de Waal

Darfur Diaries: Stories of Survival by Jen Marlowe, Aisha Bain, and Adam Shapiro

The Devil Came on Horseback: Bearing Witness to the Genocide in Darfur by Brian Steidle, Gretchen Steidle Wallace

A Long Day's Dying: Critical Moments in the Darfur Genocide by Eric Reeves

Not on Our Watch: The Mission to End Genocide in Darfur and Beyond by Don Cheadle, John Prendergast

The Translator: A Memoir by Daoud Hari

THE HOLOCAUST

The Diary of a Young Girl: Anne Frank by Anne Frank, Susan Massotty (translator)

The Drowned and the Saved by Primo Levi

Maus I: A Survivor's Tale by Art Spiegelman

Night by Elie Wiesel, Marion Wiesel (translator)

Number the Stars by Lois Lowry

Survival in Auschwitz by Primo Levi

RWANDA

Africa's World War: Congo, the Rwandan Genocide, and the Making of a Continental Catastrophe by Gerard Prunier

Deogratias: A Tale of Rwanda by J.P. Stassen, Alexis Siegel (translator)

Say You're One of Them by Uwem Akpan

Shake Hands With the Devil: The Failure of Humanity in Rwanda by Romeo Dallaire

A Sunday at the Pool in Kigali: A Novel by Gil Courtemanche

We Wish to Inform You That Tomorrow We Will be Killed With Our Families
Stories From Rwanda by Phillip Gourevitch


ALSO OF NOTE

What Is the What: The Autobiography of Valentino Achak Deng by Dave Eggers

Let me recommend a couple of others that aren't on this list: When Broken Glass Floats: Growing Up Under the Khmer Rouge by Chanrithy Him, and Left to Tell: Discovering God Amidst the Rwandan Holocaust by Immaculee Ilibagiza.

This is why I love to read: I believe that reading breaks down the barriers between groups and peoples. It gives us the chance to see from behind someone else's eyes, to get inside their skin. It humanizes everyone, including the reader. And I like to believe that this process--of humanization and the destruction of superficial barriers--is a crucial part of creating a world where genocide is unthinkable. So do a little something to get more human: read a book of conscience this month.

2) Watch a film. A good film does the same thing as a good book; it puts you into another place and time and makes you capable of feeling what someone else feels. I'm going to list some that I can vouch for personally, and others that I haven't seen but have heard recommended. Some of these films are feature/fiction films, and some are documentaries. Some are about the genocides listed above, and others just share similar themes.

FILMS I HAVE SEEN:
Schindler's List
Hotel Rwanda
War Photographer
Pray the Devil Back to Hell
Rabbit Proof Fence
Life is Beautiful

FILMS I HAVEN'T SEEN (but have heard recommended):
The Devil Came on Horseback
The Killing Fields
Sometimes in April
Darfur Now
Blessed is the Match
My Neighbor My Killer
Ghosts of Rwanda
The Diary of Anne Frank
Shake Hands With the Devil: The Journey of Romeo Dallaire

Feel free to list other recommendations of books and movies in the comments section! And if you'd like to write a book review or film review for this blog, just let me know!

Issue: Water

"The human right to water is essential for living a life of human dignity. It is the pre-requisite for all other human rights."
(Kofi Annan)

Yesterday (March 22) was World Water Day, and this coming week (March 22-28) is World Water Week. It's perfect timing for this blog to address the world water crisis. Water is often discussed in conjunction with sanitation, but for today's post I am just going to focus on water.

Across the world, nearly 900 million people lack access to clean water. This lack of access to water poses a huge public health problem; every day, 4,200 children die of water-related diseases. (An estimated 125 million children under the age of five live in households that do not have regular access to clean water.) Most of these children dying of water-related diseases are die from diarrhea--an illness that kills an estimated two million children every year. Incredibly, the number of diarrhea-related deaths around the world is currently on the rise.

This is a big, big deal and it directly affects roughly 1/7 of the world's population.

There are really two linked issues when we're talking about the world water crisis: water scarcity, and water quality.

The water scarcity issue is particularly prevalent in Africa, where vast tracts of the land is dry and receives little rain. In some rural regions, women walk ten miles a day to fetch water for their families--carrying 40- or 50-pound water containers--and during the dry season, women may walk nearly twice that distance. (You'll notice I said women, not people--water-gathering is typically considered a female activity, linked to domestic reproductive tasks, and across the world women generally bear the brunt of water-collecting labor.) In fact, the World Health Organization has estimated that African women and children spend, collectively, 40 billion hours a year gathering water.

You can imagine that this takes its toll on women and families in various ways. Health problems can develop from carrying heavy loads long distances (even, in some cases, curved spines and pelvic deformities that cause problems during childbirth). Pregnant women who carry these heavy loads suffer increased health risks. Women and girls traveling alone can be vulnerable to violence and rape. And in some families, girls are required to gather the water--a task that can take so much time that it makes it impossible for the girls to attend school. This time-consuming activity also prevents women from working in other income-generating activities or vital domestic tasks (or caring for their own health).

In the West, we're always being exhorted to drink eight glasses of water a day. Certainly this would be good, healthy advice for anyone, but it isn't an option for much of the world. In fact, one flush of a Western toilet uses as much water as the average person in the developing world uses for a whole day's washing, drinking, cleaning and cooking.



So once a woman has spent half her day collecting and carrying water, the difficulty still hasn't ended. Because chances are, the water she found is not clean or safe for her family to drink. Issues of water quality affect people in urban and rural areas alike.

My own personal introduction to the water quality issue came when my husband and I were living in Mozambique. We were conducting a research project that took us out to a rural village with our research assistants to do some interviews. We noticed a hole in the ground toward the center of the village, and we went to take a look. This was the water supply for the entire village: A crumbling hole dug in the ground--not even a well--with dirt and dead insects floating on top. I remember feeling sick: Even though I'd read about water quality issues, I looked down at that dirty water and imagined scooping up a cup of it for a child to drink, and I felt the world's inequity sink down into my bones.

When a person drinks unclean water (any water from a non-purified source, which can include groundwater, contaminated rainfall, floodwater, or river water, to name a few), that person is vulnerable to various waterborne diseases. Diarrhea, cholera, and typhoid are the most common diseases that are transmitted through unclean water supply. There are dozens of other waterborne diseases--giardiasis, guinea worm, etc. (These are all diseases that occur from drinking unclean water; I am not even going to go into diseases that are connected to standing water, like malaria, dengue fever, or schistosomiasis and related parasitic infections--maybe in a future post.)


This interesting document is a reminder that water scarcity and quality are not necessarily issues of physical scarcity, but that the Africa water crisis is "structurally induced scarcity." In some cases, the world water crisis has been accentuated by politics, economic interests, and even unscrupulous marketing practices. I can't resist mentioning an issue that I find particularly telling:

Back in the 1970s and 1980s, people began to learn that Nestle and other baby formula companies had been aggressively marketing infant formula in less-developed countries. The suggestion implicit in the marketing campaigns was that babies would grow fatter and healthier with formula than they would with breastmilk. Many women (who grew up in communities where breastfeeding was previously the normal--and even only--way of feeding a baby) began to give their babies formula instead, in response to the marketing campaigns. And this is what happened: Families began to spend money they didn't have on infant formula they didn't need. They began to mix the formula with the only water sources they had, which were often unclean. And, since the formula labels were often in a foreign language like English (or because the mothers had not been to school or learned to read), the mothers often used very small amounts of the formula, to make the container last longer.

You can imagine what happened. In addition to losing the natural benefits of breastfeeding (like passing antibodies on to the babies, facilitating the release of bonding hormones, and having a natural method of fertility suppression and birth spacing), the families lost money and inadvertently exposed their babies to the dangers of unclean water and malnutrition. And babies got fatal diarrhea. And babies began to die. You can read more about this in Gabrielle Palmer's marvelous book, The Politics of Breastfeeding, which I highly recommend.

When I worked with UNICEF in the Philippines, I learned that UNICEF still will not accept monetary or in-kind donations from Nestle, because Nestle has continued to promote the use of baby formula in the Philippines, undermining the health of babies and accentuating the already-enormous issue of water impurity and children's health.

We already have technology for many solutions to the world water crisis. In some cases, solutions are free: Encouraging a cultural return to exclusive breastfeeding, helping urban communities negotiate with their local governments to extend clean water systems to the entire community. Other solutions are well-established and cost-effective: Creating rainwater collection systems, or digging pumps and wells in rural areas to create access to groundwater sources. There is very little mystery behind the world water crisis. It's an issue of distribution, and with increased resources this is something the world community should be able to make fast progress on. Despite this, the world water crisis is actually becoming worse over the past few years. As the world's climate changes, communities are being subjected to more drought and the drying-up of water tables. It's urgent.

There are many, many organizations that are working on clean water and sanitation issues around the world. I'd like to introduce you to one project that I particularly like: Tap Project.



There are a number of ways you can get involved with the Tap Project.

1) Are you planning to go out to eat anytime soon? Click here for an interactive map, which will show you restaurants in your community that participate in Tap Project. At these restaurants, you can donate $1 (or more, of course) to Tap Project.

2) Learn more about becoming a Tap Project volunteer in your community or workplace by clicking here.

3) Make a donation (or learn more about using eBay's Giving Works program) by clicking here.

4) Or (this is even quicker and easier), text the word "TAP" or "AGUA" to UNICEF (864233) to make a $5 donation!

5) Check out this cool article in the New York Times to see some of the great ad campaigns that have been created to help Tap Project.

Do something for World Water Week...

Followup: Sudan

You can read my original post about the conflict in Sudan by clicking here.

Since the beginning of March, there have been some major developments in the crisis in Darfur. Last week, the International Criminal Court (ICC) issued an arrest warrant for Omar Hassan al-Bashir, the president of Sudan. He has been charged with war crimes and crimes against humanity; this arrest warrant is significant because it is the first time that the ICC has ever issued a warrant for a sitting head of state. (You can read more about the ICC here.)

In response to the issuing of the warrant, the al-Bashir government rejected the authority of the ICC, and promptly issued a statement saying they would be expelling 13 major non-governmental organizations (NGOs) that are distributing aid in the Darfur region, including Oxfam, Care International, Doctors Without Borders, and Save the Children. This is obviously a political ploy, an attempt by al-Bashir to "raise the stakes," and it's one that will have a devastating impact on the lives of millions of people.

The government began kicking these organizations out of the country a few days ago. NGOs like these have been providing ongoing aid to millions of displaced people across Darfur and Southern Sudan. The UN warned that "the loss of these non-governmental organizations means that more than one million people will be without food, 1.5 million without health care, and over one million without drinkable water" (read the full article here). You can listen to or read a March 10 NPR story about the situation in Darfur here.

Aid organizations predicted that the Sudanese population could begin to feel the effects of these expulsions within a few days--so, that means today. I read that some NGOs from Asian and Arab countries have applied to begin working in Sudan, in attempt to fill some of the gaps left behind by the departure of these major NGOs. This is a small glimmer of hope, but the information trickling in from Darfur is pretty dire. Save Darfur has up-to-the-minute information on their website.

A couple of things you can do:

1) Sign up, if you haven't already, to receive e-mail updates with action alerts from Save Darfur.

2) Click here to send a letter to Secretary of State Clinton, urging her to make Darfur an immediate priority.

3) Send a postcard to President Obama. He has issued some strong statements over the past few days, but we need to hear more. According to this interesting article, President Obama has "moral authority" in this area because of his African heritage, and we need to keep the pressure on him to be an unwavering voice about this conflict.

Followup: Democratic Republic of the Congo

A few months ago, I posted about the conflict in Democratic Republic of the Congo (DRC). Please click here to read my post, if you haven't already.

The conflict is still raging. In fact, it's the deadliest war our planet has seen since World War II. People are still dying and being displaced from their homes. Women are still being raped with impunity. Eastern DRC is the most dangerous place on earth for women.

I've been receiving frequently e-mails from the organization Raise Hope for Congo, and I've been able to write letters and sign petitions through their action alerts. This week, I got an e-mail describing the Congo Challenge. For the next three months, the organization is encouraging people to learn more about the crisis in the DRC and become involved in raising the profile of the conflict, and in generating awareness about the atrocities occurring in conjunction with the war. They will be sending e-mails with suggestions on how to get involved, "whether you have 5 minutes or 5 hours," they say.

I want to encourage you to sign up for the Congo Challenge, to read the e-mails, and to become activists, whether that means writing letters to politicians or publications, signing petitions, or using social networking to spread awareness. You can sign up by clicking here. This isn't asking much... but at least it's something.

Followup: Maternal and Newborn Health

I just want to send out a few more items that may be helpful to those of you interested in learning about maternal and newborn health. Let's start in the U.S. In my last post I gave you the link to UNICEF's State of the World's Children address, but the publication offers little information about maternal mortality in the U.S. We need information about domestic maternity care, because the maternal mortality rate in the U.S. is currently the worst it has been in decades. One resource that offers great information (from mothers' perspectives) about maternity and postpartum care is Childbirth Connection's New Mothers Speak Out Report. Click on the link to read more about childbirth in America.

Moving back to international issues of maternal and newborn health: This video made me smile. You can read more about this awareness-raising campaign at Oxfam UK's website.



Also, might I recommend this photo gallery?

Issue: Maternal and Newborn Health

The United Nations Children's Fund (UNICEF) recently released their annual report, The State of the World's Children, for 2009. Every year this report offers an in-depth look at one particular issue affecting children around the world. This year the report is entitled "Maternal and Newborn Health," and it assesses the health and well-being of pregnant women and new mothers and their babies around the world.

Doesn't the picture on the front sort of make your heart grow a few sizes?

I'm going to try to offer an overview of some of the issues presented in SOWC 2009, but obviously my efforts will be limited; the report is 158 pages long, packed with information. I really encourage you, if you're interested in this subject, to click here to read the report. You can view it as a pdf file or request a paper copy. The blocks of italics in this post are direct quotes from SOWC.

"In the developing world as a whole, a woman has a 1 in 76 lifetime risk of maternal death, compared with a probability of just 1 in 8,000 for women in industrialized countries. By way of comparison, the lifetime risk of maternal mortality ranges from just 1 in 47,600 for a mother in Ireland, to 1 in every 7 in Niger, the country with the highest lifetime risk of maternal death."

When we're talking about maternal deaths (the term used to describe deaths that occur during labor or as a result of labor), there are two types of causes. "Direct causes" are obstetric complications (like post-partum hemorrhage, infections, eclampsia, or obstructed labor), or complications from abortions. These causes may be labeled as actually causing the mother's death. But there are numerous other "indirect causes," as well, which contribute to the emergence of these direct causes. Common indirect causes of maternal death include:

*Anemia
*Poor nutrition
*Lack of birth spacing (e.g., having too many babies one after another, without giving the body time to recuperate)
*Malaria
*Iodine deficiency
*HIV/AIDS
*Undeveloped anatomy (e.g., young girls whose bodies are not developed enough to bear children)
*Inadequate hygiene (which can cause maternal-neonatal tetanus)
*Poverty

In other words, if a woman is sick and weak and undernourished, her chances of having a normal, uncomplicated labor are greatly diminished. This list is partial; there are many other factors--both biological and socio-cultural--that make labor more dangerous than it needs to be.

Obviously, the health of the laboring woman/new mother is inextricably linked with the health of her baby. These factors that contribute to unusually dangerous labors and serious health problems also contribute to health problems and deaths for newborn babies.

"The latest estimates from the World Health Organization, which date from 2004, indicate that around 3.7 million children died within the first 28 days of life in that year. Within the neonatal period, however, there is wide variation in mortality risk. The greatest risk is during the first day after birth, when it is estimated that between 25 and 45 percent of neonatal deaths occur. Around three quarters of newborn deaths, or 2.8 million in 2004, occur within the first week – the early neonatal period."

The ten countries with the highest death rate for children under the age of 5 are:
1. Sierra Leone
2. Afghanistan
3. Chad
4. Equatorial Guinea
5. Guinea-Bissau
6. Mali
7. Burkina Faso
8. Nigeria
9. Rwanda
10. Burundi

"Some 86 per cent of newborn deaths globally are the direct result of three main causes: severe infections – including sepsis/pneumonia, tetanus and diarrhoea – asphyxia and preterm births. Severe infections are estimated to account for 36 per cent of all newborn deaths. They can occur at any point during the first month of life but are the main cause of neonatal death after the first week."

There are so many ways to promote maternal and newborn health. One of the crucial keys is prenatal care and adequate nutrition. When women are well-nourished and healthy, most labors proceed well without complications. However, this is not as simple as it sounds; the current and ongoing World Food Crisis that is driving food prices up around the world is making it difficult for women to meet their basic nutritional needs, let alone consume the extra calories that pregnant women need. And lack of access to basic health care for infections and illnesses (such as malaria) makes women even more vulnerable to complications.

One crucial element to decreasing maternal and newborn mortality is to provide training and resources to traditional birthing assistants, or midwives. Training programs (like this one, in Afghanistan) can integrate traditional and modern knowledge about childbirth, and provide midwives with much-needed supplies (like soap, clean towels, razor blades, receiving blankets, etc.) and training on techniques they may not be familiar with (such as infant resuscitation). Increasing pregnant women's access (before, during, and after labor) to trained labor assistants can ultimately result in the following crucial elements:

*Better management of infectious diseases (Prevention of malaria has been shown to decrease premature births!)
*Ongoing promotion of breastfeeding
*Prenatal and antenatal visits and assistance
*Improved hygiene practices
*Treated mosquito nets to prevent malaria infections in mothers and newborns
*Kangaroo mother care (e.g., skin-to-skin contact and on-demand breastfeeding) for low-birthweight babies

And of course, it's important to improve access to emergency obstetric care for babies and women with life-threatening conditions. Then, some of the best ways to promote child survival are to ensure that the child is exclusively breastfed, provide access to basic health care and immunizations, and prevent the child from contracting diseases like malaria.

Let me just give one example of how adequate prenatal care and effective care-provider training can work together. In Africa and Asia, over 30 percent of maternal deaths result from postpartum hemorrhage. The risk of hemorrhage is greatly decreased when a woman is healthy and nourished, and a few basic techniques can prevent hemorrhage. For example, the World Health Organization recommends delaying the clamping and cutting of the umbilical cord until it stops pulsing; this alone significantly decreases the risk of hemorrhage.

In addition to all these logistical factors, there are many socio-cultural factors that need to be dealt with to improve women's and babies outcomes. Here are a few things that have been proven to have a positive effect on maternal and newborn health, according to SOWC:

*Increasing educational opportunities for girls
*Decreasing gender discrimination (and letting women make choices about their health care, rather than having those choices dictated by husbands or communities)
*Preventing child marriage and early child-bearing by undeveloped girls
*Abandoning female genital mutilation (which causes many extra complications for child-bearing, e.g., accelerating the risk of post-partum hemmorhage and obstetric obstruction)
*Involving men and adolescent boys in maternal and newborn health and care (and focusing on family units)
*Creating supportive environments for women and babies
*Stopping violence against women (One example here: A study of 400 villages in rural India revealed that 16% of all deaths among pregnant women were due to partner violence. Cross-culturally, rates of violence against pregnant women are high)

One thing that this particular report didn't mention, though, was the risks that can also come along with the overmedicalization of birth. For instance, in the United States, over 30 percent of women give birth via Cesarean section. Best estimates suggest that perhaps five to ten percent of births require Cesarean intervention (and, in fact, SOWC presents similar figures). Unnecessary C-sections result in a host of risks to mothers (permanent injury to the bladder or uterus, infection, blood loss, damaged bowel functioning, future pregnancy complications, death, etc.) and babies (premature birth, breathing/lung problems, cuts and injuries, side-effects of anesthesia, difficulty breastfeeding, etc.) The United States tends to have extreme cases: On one end of the extreme are women who can't afford access to basic prenatal health care; on the other end, the trend toward non-medically-indicated elective (and expensive) C-sections that pose considerably more risk than a normal vaginal delivery.

On the child mortality list that I mentioned earlier (where the highest child death rates are closest to the top of the list), the United States comes in at number 151 out of 189; this means that there are 37 countries with lower infant-mortality rates than the United States. The countries with the best statistics (meaning the most babies who survive infancy) tend to be countries that provide a "best of both worlds" approach, where women have adequate access to prenatal care, good nutrition, supportive cultures and systems, and care providers trained in supporting natural childbirth processes, as well as emergency care. In other words, the technology exists to save mothers and babies in obstetric emergencies (and people have access to it), but low-intervention births are still considered the ideal situation for women and babies.

In case you're interested, here's the list from 151 to 189, so you can see all the countries that have better child survival rates than the U.S. The best in the world? Sweden.

United States 8 151
Cuba 7 156
Hungary 7 156
Poland 7 156
Thailand 7 156
Australia 6 160
Canada 6 160
Croatia 6 160
Estonia 6 160
New Zealand 6 160
United Kingdom 6 160
Belgium 5 166
Cyprus 5 166
Israel 5 166
Republic of Korea 5 166
Malta 5 166
Netherlands 5 166
Switzerland 5 166
Austria 4 173
Czech Republic 4 173
Denmark 4 173
Finland 4 173
France 4 173
Germany 4 173
Greece 4 173
Ireland 4 173
Italy 4 173
Japan 4 173
Monaco 4 173
Norway 4 173
Portugal 4 173
San Marino 4 173
Slovenia 4 173
Spain 4 173
Andorra 3 189
Iceland 3 189
Liechtenstein 3 189
Luxembourg 3 189
Singapore 3 189
Sweden 3 189