Sarah Moore

  1. Female circumcision: A practice hard to change

    November 10, 2011 by Sarah Moore

    Photograph courtesy of William Warby

    Bettina Shell-Duncan, an associate professor of anthropology at the University of Washington and a Northwestern University alum, shared her research on female genital cutting in an event on campus Wednesday afternoon.

    The lecture, sponsored by International Program Development and the Program of African Studies, was entitled “Between Law, Religion and Tradition: Contesting Female Genital Cutting and the ‘Best Interest of the Child’ in Kenya” and focused on the recent political history of female circumcision.

    Shell-Duncan never intended to study this topic; she actually went to Kenya to research anemia.  While there, however, she attended a wedding and was introduced to the common premarital African practice of what many in the West call genital mutilation.

    Female circumcision, as it is less inflammatorily known, actually encompasses a whole range of practices.  These range in severity from a symbolic nicking of the clitoris to its excision along with the labia minora and labia majora, and variations in between.

    Because her introduction to the practice was so eye-opening, Shell-Duncan has researched it ever since.

    “Since then I’ve studied the practice of female genital cutting much more broadly in Africa and recently completed a study in Senegal,” she said, adding that “the prevalence ranges dramatically across different countries.”

    The prevalence varies even more by tribe.

    “Looking at national level prevalence data masks the fact that there is a lot of variation within any one country and it’s actually best understood along ethnic lines,” Shell-Duncan said.  “People either are or are not from a lineage that practices this.”

    Female circumcision has engendered hot debates over the last several decades, as any clash between human rights and custom is likely to do.  Unfortunately, this is not just a matter of conservatism versus progress or equality; it is also a major health issue.

    The short-term dangers of the practice include hemorrhage from cutting the clitoral artery, local and systemic infection, shock from loss of blood, scarring, urinary retention and pain.  (Shell-Duncan adds that though the latter is a more subjective effect, it is no less important.)

    The long-term dangers are no less appalling: difficulty with menstruation and urination, urinary tract infections, pelvic inflammatory disease, infertility, dermoid cysts and diminished sexual pleasure.  Infibulation, or the stitching together of the vulva to leave a small opening for the passage of urine and menstrual blood, can be especially troubling health-wise.

    Unfortunately, abolishing the practice is not as simple as recognizing the way it can harm girls and women.  Long-standing beliefs protect it, among them that infibulation forms a ceiling over the womb and thus protects birth; that it maintains virginity and fidelity; and that it denotes insider status.  These are hard barriers to overcome in societies that place a great deal of weight on marriageability and community.

    But slowly, Shell-Duncan said, things are getting better.

    “The work that I’ve been doing suggests that there’s a lot of groundwork been laid about expanding notions of children’s rights,” she said. Outreach and education, rescue centers, churches, community declarations and political enactments have added to the momentum.  “All of this indirectly has benefited the ability to address female genital cutting.”

    In the meantime, educating people outside of these areas remains an important step.

    “The topic of female genital cutting is complex, and the practice itself – as well as what measures may potentially reduce the practice – is far from uniform across cultures,” said Sarah Rodriguez, a Ph.D. and senior research fellow in medical humanities at Northwestern University.

    “Dr. Bettina Shell-Duncan’s work is important in showing the complexity of both the issue and the varied attempts, both within practicing cultures and by Western nations and NGOs, that have been made to end it,” Rodriguez added.

  2. Lima through a lens: A chat with Hayley MacMillen

    by Sarah Moore

    Hayley MacMillen spent a month in Peru documenting light access issues.

    Electricity is something most of us take for granted.  Charging a computer, turning on the kitchen lights, toasting a piece of bread…with the flick of a switch or the plug of a cord we have access to safe, reliable, constant, unending power.

    This is not the case with many people living around the world today, as Hayley MacMillen discovered when she visited Peru in Summer 2011.  Through a Weinberg Grant, MacMillen traveled there to document, using video and photography, light access challenges among Peruvians in the nation’s capital. On Tuesday afternoon, she shared these experiences at Global Cafe’s Students in the Field series.

    MacMillen, a philosophy major and global health studies minor, participated in the Global Health in Europe program last year.  The summer before, fellow global health minor Caity Callahan brought her an interesting proposition.  Callahan had been contacted by Novica, a company that sells handcrafted products online, about finding ways to provide light for artisans after daylight fades; she wanted MacMillen to document the process.  Without hesitation, MacMillen said yes.

    “I basically spent my junior year taking as many journalism classes as I could, playing catch up so I could get there and know what the hell was going on,” she said.

    By the time she arrived in Peru, she had a firm understanding of the journalistic issues at stake, as well as the kind of story she wanted to tell.  Though Novica had helped bring her down and was interested in getting a story on its micro-lending programs, MacMillen saw a conflict of interest in only reporting the story they wanted.  She decided instead to pursue the issues that interested her most: getting safe electricity to Peru’s poorer inhabitants.

    “This is the more compelling story, this is the story that’s actually here, and this is the story that’s going to help me avoid those ethically murky areas,” she said of her decision at the time.

    Throughout the next three weeks in Lima and a further five days in the Peruvian countryside, MacMillen learned a lot about electricity in Peru.  For one thing, the issues were very different in the city and the country.  In the city, where access was easy but electricity was expensive, many people simply piggy-backed off neighboring lines, but this was unreliable, illegal and sometimes even dangerous.  The country was a purer example of a lack of access, MacMillen said.

    Through video and photography, conversations with artists and a personal blog, she recorded her experiences and interviews with the people she met.  Now that she is back in the United States, she is trying to figure out what to do with the thousands of photos on her computer and working on putting together her video essay.

    “It’s really a documentary, but that just sounds so intimidating,” she laughs.

    Hayley MacMillen was named the 2011 Lee F. Anderson Memorial Global Education and Engagement grant winner.

    Check back with the global health portal in the coming months to view MacMillen’s video.  In the meantime, feel free to check out her personal blog, Lima Through a Lens.

  3. Halting pandemics in their tracks: EpidemicIQ

    October 28, 2011 by Sarah Moore

    Lalith Polepeddi is working to reduce the impacts of pandemics, and hopes one day to find ways to avoid them altogether.

    Students of Global Health 301: Introduction to International Public Health had the chance Thursday morning to talk to alumnus and researcher Lalith Polepeddi about his work tracking and preventing epidemics.

    The talk, which took place in Northwestern’s Frances Searle building and was attended by about 40 students, focused on Polepeddi’s work at Global Viral Forecasting, a San Francisco non-profit whose stated purpose is develop a global system to prevent pandemics. And how are they doing that?

    With data.

    “Our goal is to detect, track and forecast all outbreaks around the world,” said Polepeddi, who majored in biological sciences and computer science. The project, named EpidemicIQ, is part of the Global Virus Forecasting Initiative’s overall mission to reduce the amount of time between an outbreak and its spread.

    “Dramatic failures in such pandemic control, such as the ongoing lack of success in HIV vaccine development twenty-five years into the pandemic, have shown that this wait-and-respond approach is not sufficient,” states the GVFI’s website.

    It is this lag – of often two weeks, Polepeddi said – that he and others in his field find agonizing. A direct result of the fact that epidemics seem always to catch people by surprise, the lag prevents immediate action and creates spending waste. Polepeddi wants to change this “reactive” state of global health to a “predictive” one.

    To do this, he and fellow researchers collect the kinds of data that can inform them about the spread of disease. Sometimes this means medical information, but sometimes this simply means mobile phone records, or information from blogs, Facebook, Twitter.

    “The majority of the world is already connected via mobile phones,” he said, explaining that mapping phone records can paint a picture of who is connected to whom, and therefore of the lines along with a pandemic is likely to spread.

    Collecting phone data, in other words, is an accurate measure of mobility. So if there were news of an outbreak in the Democratic Republic of Congo, for example, scientists and global health workers could use phone records to overlay a network and predict along which lines the disease would spread.

    “It’s a little bit creepy,” he jokes, “but if it’s anonymized we should be able to make use of it.”

    This is one way to move from away from a reactive model and toward a predictive one. Unfortunately, changing the current state of affairs is not that easy.

    For one thing, information can sometimes be hard to come by. While news outlets and the Internet are viable sources of information in many locales around the world, in many they are not. Records from doctors visits would be useful indeed, but are largely unavailable due to doctor-patient confidentiality. Language barriers can also be a problem.

    Nonetheless, said Elizabeth Barden, who teaches the class, utilizing technology to its full potential – and especially in the ever-crucial realm of public health – is more important now than ever.

    “Harnessing it efficiently and effectively is so important,” she said, adding that Polepeddi’s approach could help students find ways to make a difference that don’t start with an MD.

    “There’s such a need for this kind of work in global health and the applications are huge,” she said. “For students it reinforces the point that you don’t need to be a physician to make a big impact.”

  4. Water quality in the Navajo Nation: An interview with NU Professor Franz Geiger

    October 26, 2011 by Sarah Moore

    Geiger's "Navajo Nation Water Quality Project" offers a simplified, easy-to-use look at the best places to obtain water on the reservation.

    Several years ago, while researching hexavalent chromium (the carcinogen made famous by Erin Brokovitch), the Northwestern University professor of chemistry received a call from a Navajo physicist asking him to take a look at water contamination on the Navajo Reservation in the Four Corners region. He did, and discovered that not only was much of the area’s well water badly polluted, there was excellent data detailing the contaminant levels of individual sources.

    Gathered by the EPA and Army Corps of Engineers, the data is key to providing a map to residents of which wells were safe and which were not. Though it was originally in completely unusable form, Geiger is turning that data into a convenient, legible model that anyone can use. He sat down with the Global Health Portal to explain more about it.

    What is the water situation like on the Navajo Reservation?

    There is such a small density of people on this land that it doesn’t make sense to build water pipes for everyone. It doesn’t even make sense to give everyone electricity. There’s a big disconnect between technological infrastructure in this part of the US and the surrounding land, and they get their water from wells. It’s really just cowboy country. So here’s a hand-cranked well that’s been running for thirty or fifty or a hundred years and that’s how you get your water: you fill up these large barrel containers with water once a week, and one barrel is for doing dishes and the other is for making coffee and brushing your teeth. This is 2011.

    Why is using this water a concern?

    This land is extremely rich in uranium ore – it’s effectively yellow cake. When you read Judy Pasternak’s book [Yellow Dirt: An American story of a poisoned land and a people betrayed] she tells about the women essentially being smothered in yellow cake as they washed their husband’s jackets when they come home from the mining jobs.

    Most of [the mines] are closed down now, but they are closed down in a way that is not proper. Many of the contractors did a crappy job: I’ve got photos where we stand in front of a mine that’s literally just covered up with cinder blocks. During the rainy season you’ve got torrential events and they flood the mines. The water inside the mines drops in pH and becomes very acidic, which dissolves minerals inside the mines. When you have uranium and other metal ions you also have essentially every other metal ion you can imagine, and many of those are toxic.

    Municipal water comes out of a very deep well, and no matter where you go those are going to be fine. But the natural wells aren’t dug nearly as deep as a true deep-water aquifer. This is Western movie country, so there’s many hills and valleys and springs that feed artesian wells that aren’t deeper than a few tens of meters. That’s essentially the stuff that collects all these metal ions.

    So the EPA data tells people which mines are safe and which are not. Why can’t people use the data without your help?

    They could but the data is in scientific format. You have to know what it means, be able to read it, understand basic chemical concepts like concentrations – what is a microgram per liter? What is a mole per liter? So here’s my aluminum: 79.7. Here’s my arsenic: 9.7. What does that mean? Are these apples, are they oranges, are they kilograms? Does this number mean I’m going to die when I drink this day-to-day? Can I make baby food for my kids with this water? This is meaningless data for people who aren’t trained in the science, which doesn’t meant the intent was bad, it just means the data is not in a format that is readily understood by the stakeholders.

    So your website is designed as an interactive model that compresses this data into useable form. What does it offer the community?

    At this point the project is a number of years in the running, and what I like about it is it really is a general method of getting data to the general public. What does the public do with that data? Here on the reservation they can say, “Alright, I’m going to opt out of feeding my babies with food prepared using water from my well.” There is a limit to this, though, because when you give livestock contaminated water, you end up ingesting it anyways. That has already happened for two generations on the reservation – it’s really a problem. But I think there’s an immediate benefit in having the information available because you can tell people, “Don’t go to this one, go to that one.”

    Without that you have little guidance on what the community can do while all the lawsuits and all the litigation are either being assembled or pushed up the flagpole. But here we have a tool that says “This is your current situation; you can make a choice.” At least at this point, the data is available.

    The minerals in the wells are quantified by whether they are over or under the maximum allowable safety limit. Does that mean that anything under the limit is safe?

    The maximum limit is very often not a limit that scientists or biologists recommend. The limit is the result of a compromise between what allows you to provide a safe, tolerable concentration of the contaminant while at the same time allowing the industry that produces that contaminant to continue employing people. Just because it’s at a certain level doesn’t mean that there is or is not a problem.

    Look at contamination here in the city of Chicago from coal-fired power plants and the number of asthma occurrences in children on the South Side. The reason why there’s a limit to what can be done there is that at some point you will be faced with, “Do I keep the power plant open, or do I have another $50 million to build an alternative energy source?” If I don’t have that, I don’t have a choice. I have to live with the reality of an increased number of children with asthma. That’s the cost of keeping the lights on and a big reason to go green.

    How are people on the reservation responding to your project?

    The issue is complicated from the perspective of society and cultural heritage. Imagine someone came to you and said, “Okay, I’ve done measurements, even though you didn’t ask me to, and the soil on the house you just bought is full of lead.” Number one, you would want to move, but number two, there’s no way you could sell your house because now you have to disclose it. The value is going to tank, your mortgage is going to be underwater, so to some degree this is the worst thing that can happen to you – not just to your health, but also to your finances. People just don’t want to know, because as soon as they do they are responsible for taking action. So this is a real Catch-22 in terms of providing solutions. I think it’s a great case for government involvement because besides that, no one is going to do anything.

    On the Navajo Reservation it’s not the property that’s the issue, it’s the fact that the Navajo culturally have an obligation to maintain the land pristine, as it was given to them by their forefathers. So now that they are learning that this land is in effect poisoned, they are in a position of conflict with regard to their charge. A lot of them don’t want to hear about it.

    So how are you publicizing your data right now, and how is Groundswell Educational Films (video here) helping you?

    While the site is publicly available, there is no link to it yet – though the URL is available upon request. Instead what Groundswell does is shop around the idea of a website. Once there’s a critical mass of people that really want to see it, then we will push the button. But right now this is the equivalent of taking a bucket of ice-cold water and throwing it into the face of a sleeping person. So while it’s very powerful and meaningful data, at the same time you have to be very careful how you put it to use.

    The story of the generations of how families on the Navajo Reservation were affected by the United States’s pursuit of nuclear weapons, and by working the uranium mines, is chronicled in Judy Pasternak’s Yellow Dirt.

    Geiger is now working to provide a similar web model for the DePue Superfund Site. Their story is here.

  5. Working to improve lives: Northwestern’s Global Health Program

    October 16, 2011 by Sarah Moore

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