"Emotional" Is Not a Dirty Word

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A couple months ago, in an online discussion about a complicated issue, a friend told me that if I did not have all the facts, any argument or opinion I had could "only be emotional." When the conversation was over, that one phrase really got me thinking.

Let me start by saying I do not believe that statement to be the categorical truth, as there have been many times in life when I have had to make a judgment call on what I do not know based on what I do know; as a mere mortal, it is hard for me to think of many situations when I literally know everything that could inform my opinion or decision. Basing an opinion on known facts and feelings, in recognition of many unknowns, is far from "only emotional." But my friend did have a point in some way. Sometimes having half the facts leads to incorrect and even dangerous assumptions.

But as I thought about it more, something bigger started bothering me than whether or not I needed all the facts to hold an opinion or take an action on something. I realized that the word emotional had been thrown into the conversation with a tone of disdain. As a person who majored in mathematics in my undergraduate days and has loved intellectual debate from as early as I can remember, I realized that I too have often put that which can be proven by logic on a pedestal. I too have used the word emotional as if it were an insult, as if my factual understanding of an issue were superior to any sort of emotional reasoning. Yet as I have grown older and have learned more about life, my path has increasingly shaped me into a person who relies on emotion to relate to others and make decisions. If fact-based reasoning is the pinnacle of understanding, I have to wonder why, as I have (theoretically) grown more mature, have I more deeply valued human emotion, including my own?

I have to admit that I can see many ways in which emotion can lead individuals to make poor decisions or to draw poor conclusions. Emotion has led many a person into an unhealthy relationship, supported poor public policies that seem to treat any odd scapegoat as the enemy, reinforced negative lies that people believe about themselves, preceded hurtful words spoken in the heat of an argument, and the list goes on and on. So I would never say that we should let our emotions rule our lives, or they would almost certainly take over our ability to be peaceful and patient. But does that mean we should then ignore or devalue emotions?

This is where I have to say no. Many emotions are valuable, give evidence of our purpose, and provide unique understanding of the world around us. Experiences of compassion, empathy, love, laughter, and fun are inextricably linked with emotion!

As an example, one issue that really made this clear to me is child sex trafficking. Certainly, one could try to make an intellectually logical argument why we should fight against this industry as a matter of policy, apart from using emotions. For example, perhaps one could try an economic argument about women needing to finish their education to grow their skill sets and to provide better opportunities for themselves and their children, thus improving the overall economic productivity of their countries. Of course, they are less likely to go to school if they are being trafficked for sex at a young age. So if you ran the numbers and saw a good economic result with decreased trafficking, this might prove that fighting trafficking at a policy level makes logical sense. Great! But what if the numbers said that a given country brings in more money by hosting foreign pedophiles who stay in hotels, eat at restaurants, take taxi's, and pay for sexual services, as compared to the economic potential of educating the young trafficking victims? Would it change your view on whether or not we should combat child sex trafficking? For me, the answer is a clear "no," because my primary issue with human trafficking was never about the policy logic; it is more of heart issue.

When I think about children forced to have sex with older men multiple times a day, I feel a gut-wrenching sadness and anger over this injustice deep in my soul, and I know that the logic-based arguments ring hollow compared to the emotional reality. This sense of empathy and valuing of human life far outweighs any bullet-pointed list of non-emotional logical reasons to end this evil. In fact, if I heard someone making an appeal to end human trafficking without any touch of emotional connection, I think I would find myself considering that person unreasonable and irrational.

And from that example, this is what occurred to me. Sometimes emotions are the most rational, logical, sane thing we put forth in response to this world. Sometimes our emotional relationship to an issue leads us to the best conclusion, especially in the midst of conflicting logical evidence. And just like the host of ways our emotions can lead us astray that I listed at the start of this post, sometimes our unemotional logic can lead us astray. Sometimes our unemotional logic causes us to hurt people, because we do not consider the potential repercussions of our actions or policies. Sometimes our unemotional logic decreases our ability to communicate with others. Sometimes our unemotional logic blinds us to ethical and moral considerations that need to take priority. And sometimes it doesn't.

Neither emotional reasoning nor purely factual reasoning necessarily define who is right and who is wrong on a given topic or in a particular situation. Neither provides all the right answers on its own. Rather, both are integral to understanding the world, making sound decisions, and leading an abundant life.

Today I will declare.....

"Emotional" is not a dirty word!

Human Trafficking and Slavery Prevention Month

January is National Human Trafficking and Slavery Prevention Month in the United States. In light of this, I thought it would be good to provide some additional information on what trafficking is.

What comes to mind when you hear the word "traffic?" Probably the highways on the way to your place of employment. And that would be a good start to understanding the meaning of the term "human trafficking." The word trafficking literally means the transportation of goods, and the common usage is typically for items which are intended to be used or sold illegally, although the word can also be used to describe legal trade or general commerce. For example, when someone smuggles guns into another country, we call that weapons trafficking, or when organizations transport drugs from a farm to a place of distribution, we call that drug trafficking. In the case of human trafficking, the language refers to the illicit transportation of people, and in the context of the modern day abolitionist movement, the trafficking being referred to is for the purposes of forced labor, sexual exploitation, or any other form of bondage. In other words, human trafficking is modern day slavery.

In recent years, the word trafficking has also been used to describe any form of slave-based commerce, even if it does not involve "moving people," including any child in the commercial sex industry. For example, in Cambodia, some children have been kidnapped or purchased from other countries (like Vietnam) to be prostituted for sex with pedophiles. Yet in many other cases, parents sell their children locally for sex on a nightly basis. In the case of the former, these children have been literally "trafficked" over a border, and in the latter case, these children remain local and may even go home to their families during non-working hours, but the term "child sex trafficking" is applied to them, as well, since they do not have the autonomy to make the decision not to engage in commercial sex work. For more information on child sex trafficking in Cambodia, visit www.agapewebsite.org, or read about my trip to Cambodia this summer here and here.

Adult men and women can also be forced into prostitution. For example, in Eastern Europe, one common tactic is for traffickers to recruit women for employment as waitresses or hostesses in other countries, only to sell them to brothels upon their arrival in the destination country. They are either physically locked up or are kept in brothels through other coercive means. These women are forced to perform sex work until they can pay off their travel and housing expenses, or are not given a future "out" at all.

Human trafficking occurs not only in the form of forced prostitution, however, but also in forced labor. For example, families may migrate from a poor rural area in search of employment and end up working in a factory under dangerous and threatening conditions. One way this can occur is through bonded labor, when families borrow money from a factory owner for initial expenses or food, but the system is set up such that their wages will never be enough to pay back the money owed, and they are therefore never able to leave. Often, the working conditions, hours worked, etc. are extremely unhealthy, and there may be a threat of violence if they try to escape. Some of the workers may be children.

Calimlim home, valued at $1.2M
http://www.jsonline.com/news/
waukesha/29322709.html

This can also occur with domestic or farm labor. A young man or woman may be promised a job on a farm, cleaning a home, or watching a family's children, but upon arrival, may be forced to work without pay and under the threat of violence. If they have been taken to work in another country, their passports will usually be held by their captors. With the threat of violence, no money, no identification, no network of friends or family, the threat of jail and deportation upon escape (whether real or made up by their employers), perhaps even little knowledge of their location or the native language, they are held in bondage. In 2009, for example, a Wisconsin husband and wife, both of whom were medical doctors, were prosecuted for bringing nineteen-year-old Erma Martinez to the United States from the Philippines in 1985 and forcing her to work in their home for years. According to the Department of Justice, "The victim testified that for nineteen years, she was hidden in the Calimlim's home, forbidden from going outside and told that she would be arrested, imprisoned and deported if she was discovered."

Erma Martinez
http://www.jsonline.com/news/
waukesha/29322709.html

Many countries have laws against human trafficking and slavery, yet little enforcement. Consider the dysfunction in the enforcement of even simple laws in some countries or cities. Have you ever driven in a city where there is no one enforcing driving laws, such that cars careen through intersections and veer in and out of lanes in a haphazard way? Similarly, in some places, there are often few, if any, officers enforcing human trafficking laws, or there may be corruption and bribes hindering the enforcement.

Trafficking is not something that occurs exclusively in foreign countries, however, as evidenced by the story of domestic servitude above. Nearby my own place of residence, San Francisco is considered one of the largest centers for sex trafficking in the world, with many massage parlors secretly operating as locales of forced prostitution. These businesses use a variety of methods to evade the law. Because trafficking is primarily "underground," it is unknown how many victims actually exist. According to a 2006 article in the San Francisco Chronicle, "Although it's not known how much money the San Francisco market generates for sex traffickers, federal agents confiscated $2 million in cash from 10 Asian massage parlors during a San Francisco raid in summer 2005."

Here is another excerpt from the 2006 article. (Note that these specific facts may be different by 2013, but this gives you an idea of the scope of the problem):

There are at least 90 massage parlors in San Francisco where sex is for sale, according to the online sex Web site myredbook.com. The site has been around since 1997 and has more than 55,000 reviews of Northern California sex workers. It is used by johns, yet is also a main monitoring tool for law enforcement. On average, there are about eight women working in a massage parlor, police say. That would mean more than 700 Asian sex masseuses working in San Francisco, based on 90 illicit parlors listed on sex Web sites and on police interviews. 

But the scope of sex trafficking in San Francisco is much larger -- women are also forced to work as escorts, outcall girls, erotic dancers and street prostitutes. Women are also placed in "AAMPs" -- Asian apartment massage parlors -- which are little more than apartments rented by traffickers who staff them with one or two sex workers. Business is done by word of mouth, and only customers approved by the owner are allowed in. 

Police in Livermore, Concord, San Mateo and Santa Clara have all found residential Asian brothels in their neighborhoods in 2004 and 2005.

One of the difficulties is that a brothel cannot be shut down unless money is proven to have changed hands for sex services, which may be difficult to show. Even the simple fact that someone is seen by an undercover officer in the middle of performing a sex act is not enough to demonstrate a commercial exchange. The massage parlor can be cited for other infractions, such as providing housing in a commercial building or inadequate ventilation, but that is only a short deterrent. Furthermore, it is difficult to prosecute traffickers, because women are often told by their captors that they will go to jail for confessing to prostitution (even forced prostitution) or for being in the country illegally. Sometimes the doors are not even technically "locked," but the threat of violence is so severe that women feel they have no choice but to stay. Jurors may have trouble understanding why a woman did not just walk out. Women are often too afraid of their traffickers to testify, and indeed, some who have testified in the past have disappeared, had their families threatened, or been maimed at a later time. Many of these "massage parlors" end up paying trivial fines for trivial violations and continue running.

One of the more detailed accounts I have read regarding this issue is the four-part series/special report, "Diary of a Sex Slave" in the San Francisco Chronicle. The first part of the report is the article quoted above. The full series details the increase in trafficking in the Bay Area and the specific account of a South Korean college student, You Mi Kim, who was trafficked to San Francisco and forced into sex work. If you have time, I would highly recommend reading parts one, two, three, and four. They are challenging readings and complicated by You Mi Kim's culpability in her initial financial difficulties from credit card debt, but the deception that led her to originally believe she would be working in a non-sexual industry represents the harsh reality for millions of people worldwide.

To learn more about personal stories and work being done on human trafficking in the Bay Area, consider attending the Freedom Summit in Fremont, CA January 25-26, 2013. Register here!

I believe that human trafficking is a true public health crisis affecting nearly every part of the world. I discussed a couple of ways to get involved in my previous posts about International Justice Mission's "Freedom Commons." See those posts here and here. For other ways to make a difference in the fight against trafficking and for more information on trafficking resources in your specific state, check out The Polaris Project.

Final (Belated) Cambodia Update

Letter co-written by Matthew & Kristen Campbell

Dear Friends,

Merry Christmas and Happy New Year from the Bay Area! We wanted to (finally) write to give an update about our trip to Cambodia this past summer. We really appreciate your prayers and support and want to let you know about how God is working in Cambodia and in us.

Our experiences on this twelve-day trip included some light-hearted ones in which we experienced some interesting aspects of Cambodian culture, and others which broke our hearts as we learned about some of Cambodia’s violent history.  On a lighter cultural note, we both tried fried tarantula (Matthew popped a whole spider in his mouth just like the picture of our friend Mark to the left!), and we each had a bite of durian cake, which is made from a notoriously stinky fruit. We also learned how silk is made by hand!

Perhaps the deepest impressions, however, were left by our visits to the Tuol Sleng Genocide Museum and the killing fields, as we learned that around 25%-35% of the population of Cambodia was killed during the Khmer Rouge regime of the 1970’s. At the start of the regime, all of the cities were evacuated, with people being told they could return home in a few days. In reality, families were forced into years of agricultural labor in the countryside, with the hope of developing a Communist agrarian society. Intellectuals, doctors, teachers, monks, even those who wore glasses (which were believed to represent education, wealth, or elitism), as well as anyone who opposed the regime leader (Pol Pot), were killed as enemies of the state. At Tuol Sleng prison (a former school), people were interrogated and tortured, sometimes by soldiers as young as twelve years old, and then taken to the countryside to be brutally murdered and left in mass graves (which are known as the killing fields). Out of nearly 20,000 people that went through Tuol Sleng, there were only seven survivors. Moreover, Tuol Sleng is just one of many interrogation prisons that were located throughout the country. Many other Cambodians who were not killed directly died of disease or starvation due to harsh working and living conditions in the countryside. The individuals who lived through this experience are now the parents and grandparents of today, and we learned that this historical backdrop is an important part of understanding the problem of human trafficking in Cambodia.

So what did we actually do in Cambodia? We primarily partnered with Agape International Missions (AIM) to run “Kids’ Club” at the Rahab’s House community center in a town called Svay Pak.  This town is known to be a “destination location” for pedophiles. At Kid’s Club, we sang songs, danced, told Bible stories with puppets, and did arts and crafts with the children. We were told that five years ago, nearly every one of the of the children in Svay Pak was being trafficked (sold for prostitution).  The very community center where we were holding Kid’s Club was a former brothel of underage prostitution that AIM and International Justice Mission (IJM) helped to shut down. Today, due to the work of a variety of nonprofit organizations, children in this town are much less likely to be abused; however, more work is left to be done.  The pastor at a new church in this village knew for certain that 17 girls in attendance at Kids’ Club were being trafficked. This represents tremendous progress, yet it was still heart-breaking to know that some of the six to twelve-year-old girls sitting in front of us were being forced to have sex with adult men (many of them “sex tourists” from the West) on a nightly basis.

In addition to Kids’ Club, we had time each day to use our individual gifts to assist AIM in a variety of ways. AIM recognizes that child sex trafficking is a complex issue requiring a multi-faceted solution, so they have a wide variety of ministries attacking the problem. For example, AIM runs a gym where pimps and traffickers can mingle with aid workers. As a result, some of these pimps and traffickers have renounced their former ways and are helping to turn other perpetrators around. Some of the men from our team got to spend time at the gym with the traffickers and have conversations with them.

Another important aspect of AIM’s ministry is the development of fair trade factories that provide formerly trafficked women (once they are sixteen years or older) with training in a trade.  One of the problems with child sex trafficking is that those who are rescued may feel that they have no skills besides prostitution, and ultimately believe they have no choice but to return to sex work for “good pay” or find work in a sweat shop for insufficient income. AIM is providing an alternative by opening factories that pay fair wages and provide a work environment which is much safer than most alternatives. These factories provide a living wage, family-style lunch, free child care, and one hour of education to workers each day. So far AIM has opened one factory and is aiming to have ten factories running within two years. Many members of our team had the opportunity to visit the first factory, and some members of our team used their experience in fashion design to consult on the clothing patterns being used, the methods of sewing being employed, the quality check processes, and the layout/design ideas. We also feel hopeful that over time, through both national economic change and through the education AIM is providing to the rescued women and to the children of Svay Pak, young people may have (and create) an even wider variety of economic opportunities in future. Perhaps some of the children we met will fill the vast gaps left by the Khmer Rouge regime's systematic extermination of the nation's professionals decades ago.

AIM also runs a school for grades K-12 and pays for the most promising students to attend local private schools after grade six. The students and teachers were eager to learn, and this is where we were able to help! It is a special treat for the students to attend arts classes between all of their academic study time. Matthew taught guitar classes every day for several hours, and Kristen taught a liturgical dance class. The Sunday before we left, one student played a guitar song during church, and the dance class (equal parts male and female) performed a worship dance in the Sunday service.

In between the Kids’ Club activities each day at AIM, our team also drove to several factories in the area, which manufacture bricks, to distribute clothing we had collected for the children. Some of these kids take a van to Kids’ Club every day, and they are easily identified by their extremely dirty clothing and their penchant to fall asleep, even during loud singing. These children live in one-room shacks and squalor, and many help their families make bricks in dangerous working conditions. Their joy at receiving the packages of clothing was tremendous, yet our hearts were heavy to know that their needs remain great each and every day.

Towards the end of our time in Cambodia, we had the opportunity to visit Agape Restoration Center, a home run by AIM for rescued victims of child sex trafficking. We planned a luau-themed party for the girls there, including a lunch together, nail and face painting, games, and more. It was a lot of fun, and it was very special getting to see how resilient these young women are!

Throughout the week, we also dropped in on some other organizations that are fighting trafficking in Cambodia, including Hagar International, International Justice Mission, and Bloom Asia (a cake business in Phnom Pehn—the capital city—employing formerly trafficked women). They explained some of the ongoing challenges, such as underage prostitution moving “underground” in recent years as a result of the success in shutting down child brothels. While the brothel closings show progress is being made, the underground activity is much more difficult to prosecute, and corruption remains rampant in Cambodia’s law enforcement. Despite these difficulties, we also felt encouraged as they shared about how each of their organizations is uniquely contributing to end child sex trafficking.

Overall, we feel that God showed us a lot about what He is doing in Cambodia and how much is left to be done. After returning home and pushing through traveler’s sicknesses, we have had more time to process; indeed the experience was very inspiring and eye-opening. We feel confident that God is calling us to serve abroad for about two years when Matthew finishes his graduate school program, although at this point we are still not sure in what part of the world that might be.  As part of our discerning process, our plan is to make a short-term trip to another country this coming summer. Perhaps God will ultimately point us to a new place for our longer term service, or He may send us back to Cambodia!

Our team also shared responsibilities for keeping a group blog throughout the trip, which details our daily events: http://www.mppcmission.org/trips/cambodia/2012aug/index.htm Please feel free to contact us with any questions you may have, and thank you again for your prayers and support!

In Christ,

Kristen & Matthew Campbell

Human Trafficking Hotline Flyer

A while back, I wrote about International Justice Mission's launch of the "Freedom Commons" webpage. This is a website showing steps that you as an individual can take to combat human trafficking. For example, the site provides form letters that you can send to your representatives in Congress regarding upcoming votes on trafficking-related legislation.

One thing I did recently from this site was to print out and post flyers in my community for the National Trafficking Hotline. These flyers provide information about what trafficking is and the phone number for a confidential toll-free hotline that you can call if you are a victim of trafficking or have suspicions about an instance of trafficking. Download the flyer here!

Also, after you print out the flyer and put it up, you can tag your efforts in an online interactive map here!

This is such an easy thing to do, yet it has the potential to change someone's life. So try it! Put up flyers at your workplace, church, community center, or other local establishment, and become a modern-day abolitionist!

IJM Launches "Freedom Commons"

Hi friends!

You may be interested to know that International Justice Mission (IJM) just launched a website to help us regular folks take action against human trafficking. Among the many resources on the site are opportunities to email the presidential candidates and/or your congressmen to make the issue of human trafficking a priority.

Check out the site, and please forward to others: http://freedomcommons.ijm.org/

Obstetric Fistulas: A Preventable Tragedy

I recently read a book called, "Half the Sky: Turning Oppression into Opportunity For Women Worldwide," by Nicholas Kristof and Sheryl WuDunn. The book discusses some of the most pressing issues facing women today, what is currently being done to help, and what still needs to be done to alleviate the problems. Kristof and WuDunn essentially argue that the oppression of women is the most important problem of our time and that many other social ills would be at least partially remedied if the status of women improved worldwide.

The book covers some extremely interesting topics, from human trafficking to educational opportunities to maternal and fetal health. Some of the issues the authors discuss were completely off my radar previously, but they have since struck a deep chord in my heart. The stories told by Kristof and WuDunn are among the most heart-wrenching I have ever heard, and the work being done to combat some of these injustices is truly inspiring. I would like to cover some of these topics, one in this post and then hopefully others in upcoming posts.

Today, I want to write about obstetric fistula, a serious injury to a woman as a result of prolonged obstructed labor in child birth. I had never heard of this condition until I read "Half the Sky." And what I read horrified and saddened me.

Obstructed labor is defined by the World Health Organization (WHO) as the situation where "the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions." The WHO also states that the most common cause of obstructed labor is a baby with a head too large to fit through the mother's pelvic brim. Other potential causes are a mis-positioned baby, and in more rare cases, locked twins or pelvic tumors. In the United States and other developed nations, obstructed labor is treated with surgical instruments that help the baby progress (such as forceps or vacuum extraction), or by cesarean section delivery. Due to these methods, most women in the U.S. with obstructed labor ultimately have a successful delivery. However, according to the WHO, "neglected obstructed labor is a major cause of maternal and newborn morbidity and mortality."

If left untreated, obstructed labor can cause asphyxia of the baby, leading to brain damage or death. In addition, prolonged obstructed labor can result in organ damage to the mother, and in very serious cases, obstetric fistula, a hole in the vaginal wall that connects the vagina with the bladder or the rectum or both. This condition is almost never seen in the United States, which is one of the main reasons I had never heard of it (and why even many OBGYN's in this country will never encounter it or learn to treat it). Obstetric fistula generally occurs in developing countries, where women often deliver children at home with an unskilled birth attendant or no attendant at all and may wait days to go to a hospital if the delivery is not progressing smoothly.

Once a fistula develops, the affected woman will be unable to control her bladder or bowel movements and will leak bodily fluids from her vagina.

The good news is that surgical procedures do exist to repair 90% of fistulas. The bad news is that many women who develop this condition have no access to a hospital that provides treatment and/or lack the funds to pay for it. If left untreated, a woman will essentially leak fluids for the rest of her life, and depending on her circumstance, may be divorced by her husband, abandoned by her family, and/or ostracized by society for the uncontrollable body functions and the odor of urine and excrement that she emits.

In "Half the Sky," Kristof and WuDunn tell the story of Mahabouba Muhammad, a young Ethiopian girl who was sold by a neighbor to be the second wife of a sixty-year-old man. Mahabouba was beaten by the man and his first wife, and when she tried to run away, she was caught and beaten even more severely. When she became pregnant, she feared for her life and the life of her unborn child, so at seven months, she finally made an escape back to her home town. When she arrived, she discovered that only her uncle remained, and he allowed her to stay in a hut nearby. I think it is best to tell the rest of the story in Kristof's and WuDunn's own words, from pages 94-95 of the paperback edition of "Half the Sky."

Mahabouba couldn't afford a midwife, so she tried to have the baby by herself. Unfortunately, her pelvis hadn't yet grown large enough to accommodate the baby's head, a common occurrence with young teenagers. She ended up in obstructed labor, with the baby stuck inside her birth passage. After seven days, Mahabouba fell unconscious, and at that point someone summoned a birth attendant. By then the baby had been wedged there for so long that the tissues between the baby's head and Mahabouba's pelvis had lost circulation and rotted away. When Mahabouba recovered consciousness, she found that the baby was dead and that she had no control over her bladder or bowels. She also couldn't walk or even stand, a consequence of nerve damage that is a frequent by-product of fistula.

"People said it was a curse," Mahabouba recalled. "They said, 'If you're cursed, you shouldn't stay here. You should leave.'" Mahabouba's uncle wanted to help the girl, but his wife feared that helping someone cursed by God would be sacrilegious. She urged her husband to take Mahabouba outside the village and leave the girl to be eaten by wild animals. He was torn. He gave Mahabouba food and water, but he also allowed the villagers to move her to a hut at the edge of the village.

"Then they took the door off," she added matter-of-factly, "so that the hyenas would get me." Sure enough, after darkness fell the hyenas came. Mahabouba couldn't move her legs, but she held a stick in her hand and waved it frantically at the hyenas, shouting at them. All night long, the hyenas circled her; all night long, Mahabouba fended them off.

She was fourteen years old.

When morning light came, Mahabouba realized that her only hope was to get out of the village to find help, and she was galvanized by a fierce determination to live. She had heard of  Western missionary in a nearby village, so she began to crawl in that direction, pulling her body with her arms. She was half dead when she arrived a day later at the doorstep of the missionary. Aghast, he rushed her inside, nursed her, and saved her life....

Obstetric fistulas are so troubling to me for multiple reasons.

The first is the terrible suffering it produces for those who must live with it, from the incontinence, to the indignity of the stench of bodily fluids, to the emotional cost of often losing the child, followed by the complete societal rejection that many women experience.

The second reason this complication is so troubling is that it is largely preventable. As I stated above, obstetric fistula is almost never seen in the United States, because women in obstructed labor have access to modern medical care before their labor is able to progress to that point. This should not be the exception in the world, but the standard of care for all women.

Furthermore, obstructed labor is more common in very young women who have not yet developed wide enough hips to allow for vaginal delivery; in many cultures, it is common for young teenagers or even pre-teens to be given in marriage and to conceive children. Delaying marriage and child rearing by a few years can make a world of difference, yet many young girls do not appear to have this option due to cultural or financial pressures. And without adequate access to health education, pre-natal care, and attended delivery, these young girls are put at even higher risk of problematic deliveries.

Another reason this condition is so distressing is that it is most often treatable once it occurs, but many women do not have access to the treatment. Given that poverty or lack of concern for women's health are largely to blame for prolonged obstructed labor in the first place, these are also core reasons why fistulas go untreated. The women who are most likely to get fistulas are the same women who are least likely to be able to access surgery. Unfortunately, this fate can subject a woman to a lifetime of completely unnecessary humiliation and despair.

As Kristof and WuDunn put it, obstetric fistula is the modern day leprosy.

The fact that this preventable and treatable condition is inhibiting the lives of nearly three million women worldwide is a true injustice, and something must be done! I confess that my heart has been able to remain hard to many troubling things in this world, but when I read the stories of women with obstetric fistula who have been castigated by society, I have no other option but to be heart broken. We must value the lives and dignity of women, and we must recognize that child birth is the basic reproductive function of a woman, not some fluffy privilege that should only be safe for the chosen few. The lives of these women and their children are not disposable - they are precious and sacred! These are real people, not objects to be cast aside by society or ignored out of apathy. Dignity matters!

So what can be done? Let me start with the remainder of Mahabouba's story from page 96 of the paper back version of "Half the Sky." You will recall that she ended up at the house of a missionary in a nearby village:

...On his next trip to Addis Ababa, he took Mahabouba with him to a compound of one-story white buildings on the edge of the city: The Addis Ababa Fistula Hospital.

There Mahabouba found scores of other girls and women also suffering from fistulas. On arrival, she was examined, bathed, given new clothes, and shown how to wash herself. Fistula patients often suffer wounds on their legs, from the acid in their urine eating away at the skin, but frequent washing can eliminate these sores. The girls in the hospital walk around in flip-flops, chattering with one another and steadily dripping urine - hospital staff joke that it is "puddle city" - but the floors are mopped several times an hour, and the girls are too busy socializing with one another to be embarrassed....

 ...In 1975, Catherine and Reg [Hamlin] founded Addis Ababa Fistula Hospital, and it remains a lovely hillside compound of white buildings and verdant gardens. Catherine presides over the hospital....She is an exceptionally skilled surgeon, but because some patients don't have enough tissue left to repair they are given colostomies, so that feces leave the body through a hole made in the abdomen and are stored in a pouch that must be regularly disposed of. Patients with colostomies require ongoing care and live in a village near the hospital.

Mahabouba is one of those who couldn't be fully repaired. Physical therapy got her walking again, but she had to settle for a colostomy. Still, when she had recovered her mobility, Catherine put her to work in the hospital. At first, Mahabouba simply changed linens or helped patients wash, but gradually the doctors realized that she was smart and eager to do more, and they gave her more responsibilities. She learned to read and write, and she blossomed. She found a purpose in life. Today, if you were to visit the hospital, you might well see Mahabouba walking around - in her nurse's uniform. She has been promoted to the position of a senior nurse's aide. 

This is a both a tragic story that never had to be and a wonderful story of redemption. According to Kristof and WuDunn, 90% of fistulas are repairable, with the operation costing around $300. (According to other sites I have seen, it can be closer to $450, but regardless, this is much less than a typical operation and rehabilitation in the U.S.) People like Catherine and Reg Hamlin are starting hospitals to serve these women around the world. Of course, there are still vast regions without hospitals, people who are unaware of the locations of the nearest hospitals, and women who are unable to afford the costs of care.

So what does that mean for a person like me? Truth be told, I am still trying to figure that out. I am not a doctor or a nurse who can fly away and perform a fistula repair surgery. I am not a counselor who can help women reintegrate into society. And I live very far away from where most of this is happening. It is very easy to feel distressed and saddened from the comfort of my home and then to go back to my everyday life. But that seems too easy and too wrong.

For a start, I am trying to get the word out about fistulas through this blog and through conversations with friends. Secondly, I have decided to support some organizations that are providing fistula surgeries or are building new hospitals to do so, and I would encourage others to do the same. Some of the organizations mentioned in "Half the Sky" are listed below. Thirdly, well, I am still working on the thirdly. I am not sure where this newly found knowledge will take me, but I hope that God can use me in some way to make a difference. Kristof and WuDunn do offer some non-medical ideas, their main one being to support education of women and girls. Apparently, one study showed that giving girls a new $6 school uniform every 18 months increased the likelihood they would stay in school and thus delay marriage and pregnancy until physical maturation. These are the types of solutions even non-medical professionals can actively support, and perhaps this sort of indirect route is where God will take me. That remains to be seen, but I will keep you updated if I am inspired in a particular direction.

I hope this issue lands on your heart as it has mine and that you too resolve to act in some way.

To learn more about obstetric fistulas or to support organizations that are already helping provide prevention and care, take a look at these sites:

• http://www.fistulafoundation.org/
• http://worldwidefistulafund.org/
• http://www.healafrica.org/