Dumela Botswana!

Dumela is a popular greeting in Botswana. I have been back in Cape Town for a few days now and already missing Gaborone. My short week in Botswana was condensed with warmth, inspiration, and information. I got to meet some amazing people like the Dean of UPenn, Dean of University of Washington, WHO counselors on HIV, UCSF professors, and Botswana midwives to name a few. The presentations were so informative that at the end of the day my mind would be absolutely drenched from thinking so much. Part of it was because the presentations were so thought provoking. I could tell that I wasn’t the only person processing all the information I was presented to daily and forming opinions, questions, and suggestions for all of them. I flew out of Gaborone more inspired than ever and my interest in women’s health issues has been reassured more than ever. During that week we stayed with Professor KD from the University of Botswana. The feeling of being driven around in a BMW and spending the nights in her four bedroom mansion in such a rural area of the world was unique. She seemed like she had worked hard for what she had though so that alleviated the awkward and guilty way I was feeling a bit. Most of the Botswana professors had received at least some part of their training in the U.S. It was one of the few times I felt good about America and its international influence as providing higher education opportunities to the developing world. Those women were truly making a difference in national and international levels and I learned a lot from their strength. I was also lucky enough to meet the former president of Botswana who stepped down in April. From the little bit of information I got from him I learned that he had been a gender equality activist during his term. He was still very outspoken about the power of women and his opposition to gender based violence. I guess something else I liked about President Mogae was that he was very modest when I met him and I didn’t feel like I was shaking a powerful and unreachable figure’s hand but that I was getting acquainted with a colleague. Even though he had flown from Uganda only a few hours before, he had openly accepted the gala dinner’s invitation and didn’t fail to have a good time on the dance floor. I also got a tour of the hospital and the obstetrics ward. Along the way I randomly met Dr. Ryan Phelps, a physician from Baylor working at a Baylor-Botswana HIV/AIDS Children’s Clinic. I was excited to see so much international cooperation. I also saw a Harvard Clinic. Not sure exactly what they specialized in.

After deciding to become an OB/GYN and a gender equality activist and being back in Cape Town I decided to do something I have always wanted to but have never been brave enough to do it. I figured that it was time I faced my fears and that it would make me feel that I could achieve anything. So I jumped off a plane… Ok maybe there are other ways I could have proven to myself that I could do anything I put set my mind on but the adrenaline rush of skydiving was thrilling. Coming down I got a glance of the beautiful view of Cape Town and saw whales and dolphins in the ocean. I have now ticked skydiving off of my list of “things I have to do before I die.”

Dr. Campbell, my U.S. mentor has been in Cape Town for the past week. I feel like I have gotten more done on the research this week than any other week we have been here. I was really upset about not having a clear plan for things and the thought of not being able to finish the project was really making me frustrated. I think that had to do with the fact that no one had formally met with us about the project and with a bit of Dr. Campbell’s supervision I am more hopeful and happy about our performance. We met with Naeema and Shaanaz, renowned researchers in the field of gender issues at the Medical Research Council. It was great to get a brief overview of some of the projects they are running and I hope to be able to stay in touch with them. We are having dinner with them tomorrow night.

Yesterday was an exciting day also. For the first time I got to take part in an NGO decision making meeting. The “One Man Can” project is funded by the Ford Foundation with the purpose of getting across the message of gender based violence prevention. The main setting for the conveyance of the message will be 2010 World Cup. They are planning to work closely with FIFA in order to use soccer coaches and players to become advocates for this cause. I couldn’t believe that an organization was given a large sum of money to capture the audience’s attention at such a venue but I guess anything would work. I think if I had to choose an audience I would direct my efforts to township residents and people who wouldn’t be able to afford a World Cup game ticket. It’ll be interesting to see how those efforts turn out.

Among other things, Jennifer and Tondeleyo from Durban are here the next couple of days so we will be sightseeing with them and showing them the beauty of our home, Cape Town.

The picture here is at a weaving place in Botswana. I loved the women there!

I Love Safaris!

I never thought I would be going to multiple safaris here in South Africa. I never wrote about the Aquila safari adventure we had. It was great seeing animals so close. Personally I have never been a fan of zoos… something about animals in cages just never excite me. But this was completely different. Seeing animals in their wildlife home is thrilling. I posted some pictures on facebook. During our trip to Aquila I met Hymie, a forty some year man who was very young and passionate at heart and used to be very active during the apartheid. His talkative nature didn’t bother me as much as bothered others in the van and I learned a lot from him. He has a very interesting past and is hoping to get rich by buying stock. He told me he would pick me up from the airport in his Mercedes in 2010! I also met Mr. Tchan, a lively and travel loving business man. He told me about his travels and how he has seen much of the world. I really enjoyed talking to him and he gave me a travel idea for next year. I am planning to take the Orient Express from Amesterdam to Beijing next summer. It costs about $2000 but all accommodations are provided and I would get to see much of Russia, something I have always wanted to do after my Moscow visit years ago. I hope my parents wouldn’t mind giving me that graduation present!

About work, until now we have identified all rape homicide cases for 1999-2002. the numbers vary for each year but the average is around 30 per year. 2001 had the fewest number of cases with 12. Now we are in the processes of entering the autopsy information of the rape homicide cases in the data tool set. This is a long process but I am starting to like it now that I recognize the difference between lacerations, contusions, abrasions, penetrating wounds, etc. I think I am getting more and more interested in the medical side of this.

Last weekend we went to a city called Knysna. This town was very young and lively and we got to experience the South African night life. The scenery was absolutely gorgeous with the ocean and mountains everywhere. We made it to the Elephant Park where we touched, hugged, and fed elephants (I still have some elephant dirt on my jacket…) We also went to Monkey Land where we saw more monkeys that I have ever seen in my life. It was scary to see how similar they were to humans. The Bird Park was also very fun and picturesque. I have some pictures posted on facebook. It’s been raining a lot here so it’s kind of difficult to go on any sort of adventures. We did get to go the waterfront where I got into a sailing boat for the very first time. I am planning to learn how to sail and own a boat one day.

Next week is looking great. I am flying to Botswana tomorrow so I am super excited about seeing another African country. Will update when I am back!

Khayetlisha and New Friends

It’s been a while since I have written here so I have a lot of updating to do. I will start from a week ago on Friday when I got a chance to go to the largest shanty town in Cape Town called Khayetlisha. The informal housing has around one million residents, a shocking figure of South Africans livings in below poverty lines. I guess what is so strange to me is that you can see towns like this everywhere here. The similarities that I see between Cape Town and Baltimore are in the sense of their vast inequalities in the distribution of wealth. In both of these areas everyone is well aware that this problem exists but a lack of opposition groups and corrupt political institutions is what makes these issues persist. Anyway, as you can imagine I was not sightseeing in Khayetlisha. I went there to see one of the forensic pathologists in our department present the autopsy of a murder case committed in 2004 by no other than two eighteen year old boys who at the time of the crime were about fourteen years old… yea scary… The two boys, one of them in jail and the other free, were chatting and laughing as if they had absolutely no worries in the world. It was definitely one of the strangest things I have seen. What kept running through my mind was “wow, these two kids have killed a human being.” Unfortunately one of the boys’ lawyers decided not to attend the hearing and the court was adjourned so I didn’t get to see the court in session.
After that exciting end of the week we decided to take a trip to Simons Town to actually sightsee. Seeing the little, cute, cuddly penguins made all the painful things I had witnessed flee instantly. Now that I am thinking about it, I think the penguins had far better living conditions than the people in the shanty towns. I felt like I was in another world than the day before staring into the ocean, the mountains around me, and hearing the constant camera clicks of the Asian tourists everywhere. I just wish that the one million plus people here could one day enjoy the beauty of this life that resides right in their backyards.
The rest of that week was sort of monotonous yet productive. Some highlights were finishing going over the 1999-2002 reports and sitting in a pathology lecture. Regarding the data we are now ready to start pulling out the information we need out of the data we have, soon start analysis, and most importantly start the whole writing process.
Then on Saturday things started getting a bit more interesting. We decided to explore our surroundings. We did more than window shopping and came back home a few rands lighter than from when we left the house. Our hungry stomachs led us to a restaurant called Mimi’s, where we had great lasagna and met our American waitress, Crystal. She was really sweet and her New York accent made me homesick. Crystal is pursuing a Master degree in medical anthropology at UCT. Her concentration is the status of women so when we told her about our research project she was really excited. It was good seeing people doing work in the social sciences aspect of what we are doing. I hope she contacts us and that we are able to get to know her better during our time here.
During our return home some other remarkable things happened like running into some people smoking marijuana in their car, a very entertaining passerby scene. After that we met two British medical students doing their rounds at UCT. It was fun to have dinner together and experience Cape Town night life more. I learned about the British medical school system and how 21 year olds are actually having hands-on experience, something you don’t see in the States until the third and fourth year of medical school. Anyway they are great friends to have here and I think we are going to be doing some other fun things together. I still have more updating to do but will continue this today!

Thuthuzela and More

Yesterday was very eventful. We are done collecting the files that we need to look at for the 4 years we are studying. As I was getting them from the storage I started looking at some of them and the information and pictures are very graphic and sad. It’s going to be very interesting looking at hundreds of those and figuring out if they are rape homicide cases or not. We are going to start doing that tomorrow. We also got a chance to visit an outpatient clinic that takes care of rape cases also. This is the only clinic women can go after they have been raped and in there they are supposed to receive counseling and support. There is a long list of government regulations on what the clinic should do when a patient comes in but I learned yesterday that they only look good on paper. The funding provided by the government is simply not enough to carry our most of those procedures. We got a chance to meet the only forensic nurse in the Western Cape. Sister Bartlett is a wonderful woman who takes care of all rape cases that come to the clinic and appears in courts testifying for rape cases. She was simply amazing. I don’t know how she was taking care of everything on her own. She showed us her normal daily schedule which usually consisted of 6 rape cases per day in addition to several court appearances. The need for more manpower and money in this field is more than I could ever imagine. I think before coming here I would think to myself that why would someone deliberately choose to get involved in this depressing field. When I met Sister Bartlett my question was answered. The immediate satisfaction of helping women in such conditions is present in almost every case. I heard a story about an 8 year old raped by her neighbor and a 17 year old raped by her father. I was completely devastated after hearing all this. We are going to start working at the clinic once a week and contribute in any way we can. I was glad yesterday they did not have any cases come in… Apparently crystal meth has become really popular here. It’s very cheap and accessible especially in shantytowns. This highly addictive drug is a huge reason for the higher rape cases. Men under influence lose control and become very violent. It’s very interesting seeing the mental health aspect of this as well.

On a bright side, we are probably going to Robin Island this weekend. That’s were Nelson Mandela was exiled to. It should be an interesting day trip. Finally got my ticket to Botswana so everything is set. We will be meeting up with Dr. Campbell in Botswana. I am excited about visiting a new African country and being able to participate in the conference.

Stellenbosch and Franschhoek

First weekend here and I have to say that I am impressed with the amount of sight seeing we have done so far considering we have not even been here a full week. Today we visited some of the most famous wineries in Cape Town. Overall it was a very French day I must say. The town was called Stellenbosch and it was a French colony once upon a time. There we went to a winery called Tokara and enjoyed the beautiful scenery around us. The adjacent town was called Franschhoek where we had a great meal in a restaurant called French Connections. I had never tried a combination of apples, mustard, steak, and French Fries but it was absolutely delicious (although I don’t know how French this combination is… sounds more Dutch) I have been trying to study the Cape Town map more and more and familiarize myself with my surroundings. Soon we are going to try the buses and see if we can make it to the waterfront. I don’t think the transportation is as bad as our mentors portray it. I know we have to be careful but sometimes I get kind of bothered by their overprotectiveness. I feel like it takes away from really experiencing life here. Today in Franschhoek we met a potter called Vuyisa Potina. His work was amazing and really inexpensive. I think he could make a lot more in America considering how expensive pottery is there. He said he is trying to go to America and got our contact. He was a really smiley and talented guy. The cool thing was that his shop was shared with a beadworker and a sewer as part of a community project to include more “colored” (as they say here) people in selling what they make. It was a great initiative and I had no idea I would find something like that here. I guess the thing that really surprised me about Vuyisa was the fact that he has such great goals for his life. I hope he is successful and that he doesn’t end up working in a Subway in Baltimore, like many talented people who immigrate to the US and have to take jobs like that just to be able to support their basic needs, and throw away his talent.

Last night was great also. We had dinner with Dr. Cheryl Dennison, a research and professor at the school of nursing, and her research assistant (and that is how we ended up in Stellenbosch and Franschhoek). It was good to see some Hopkins people at Cape Town. They were in Cape Town discussing collaboration with the University of Cape Town on a hypertension study. I can’t imagine making this trip for only a week but it seemed that they had done a fair amount of sightseeing.

I am still jetlagged and tend to get tired at random hours of the day and can’t fall asleep at nighttime… I think I am going to catch up with sleep tonight and we’ll see where the road takes us tomorrow. The bad thing about Cape Town weather at this time is how rapidly it changes. At one minute you have a sun and warmth and the other you are freezing and it pours. I never thought anywhere would be worse than California but I guess Cape Town is right up there.

Going to start work on Monday. Also I want to try to go to the transplant museum sometime this week. Everyone is really proud here that the first heart transplant surgery took place here so I think it’s worth checking out.

At Last

Loud and busy are the first words that I can say so far about Cape Town. It’s the second day of my stay here and after many hours of sleep last night I am finally refreshed and excited to go see the city. It’s a beautiful and sunny today which means that Claudine might be taking us to the waterfront. Yesterday was interesting. It was our first day at the forensic pathology unit. We got a folder full of paper on rape homicide and Dr. Martin’s thesis which is around 100 pgs… I started reading it and so far it seems to be a sad, interesting, and scary piece. Hopefully I get to finish it today. So far I love the white taxis and how they don’t even stop moving when people get on and off… I also love the way people yell out the destination of the taxis. I guess it kind of reminds of Iran. We were told not to get in them but hopefully one of these days Omar or June will take us. Oh I didn’t say anything about Omar or June. They are Dr. Martin’s assistants and super nice. They told us a million times that we will be ok and that they are here in whatever we need them for. They do their best so that we don’t feel out of place and at least from my part so far I can say that I don’t feel like a foreigner. Well I did get the “are you American line?” a couple of times but I think they only recognize the accent and the fact that I was learning the money bills as I was paying for things. I had the best samosa yesterday! Indian food is really popular here due to the large population of Indians. The Indian food here is a lot better than what I have had in the States (I also had meat curry and beryani for lunch yesterday.) I am hoping to get out and try some authentic South African food soon. Maybe it’ll happen today… We haven’t really started work since Dr. Martin is going to back on Monday. So far we are just reading and sleeping, both necessary for the intense research awaiting us.

The Journey Begins

It’s June 2^nd. Which means that I am sitting at the airport drinking my chai and listening to the continuous announcement of “por razones de seguridad el equipaje desatendido sera inspeccionado y destruido…” I am slowly learning to not hear it… I wanted to write this here since I never got a chance to update on the orientation. It was actually a stressful one week for me. I was sick all week and trying to push myself to go to go to bed at decent hours and waking up early wasn’t so easy. Overall though I thought it was great meeting Dr. Martin and having meetings with her and Dr. Campbell. They are both really strong and knowledgeable women. I think I can safely say that they are two of my roles models. The research project seems more intense than I originally imagined it to be. Not having seen a dead body before it’s hard for me to imagine how I would react going to death scenes, performing autopsies, etc. I have been trying to do a lot of reading in the area so that I am somehow professionally prepared for such scenes. Emotionally though, I can’t think of how I could prepare myself. What I have been trying to do is predicting what I would feel and thus far I am forecasting anger and appreciation. I just hope my feelings of appreciation overwhelm those of my anger ones. Right now I am sad, happy, nervous, excited, and tired of feeling so many different emotions. I am also not really looking forward the long journey ahead but I think it’ll be good for me to think about everything. Greg got me the book “Mountains Beyond Mountains” so I will be reading that and wishing that I was Paul Farmer. Inspirations like that help me tremendously in driving me more and more forward. I will be writing more in other airports.

A Blind World

Ever since Bea brought this article to my attention I haven't been able to stop thinking about Elisabeth Fritzl. I read another article on CNN this morning stating that the father is claiming insanity and getting out of his imprisonment. Instead he is going to be in a psychiatric hospital. I can't help thinking about the 19 year old teenager who has never seen natural sunlight her entire life. The damage this man has done to several people of his family is unimaginable and because of this I found it unfair that he would be getting out of his deserved punishment by claiming insanity. There is no doubt in my mind that a sane person would not be capable of committing such an act but I just find the potential verdict too lenient. But then again I can't think of a fair punishment that would measure up to what he did.

I guess what has really stayed with me is the fact that there are similar things going on all around the world and not being noticed. Maybe we are too preoccupied with Afghanistan and Iran and what the security alert of the day is. I just don't understand how someone could get away with such a thing for 24 years! I can't stop thinking about his wife and the life she was leading. Sometimes I go back and forth and start blaming Elisabeth and her mother for not taking more drastic measures towards the cruelty of this man. But then again I get upset for thinking that because I think about how naive of me it is to even try to put myself in their position. There are more Saddams around the world but they don't have a specific religion or they don't speak a specific language. They don't live on the axis of evil and are not necessarily part of cults. I wish we would just open out eyes more and see the things that really matter...

Too Far

House of horror' children never saw daylight

• Story Highlights
• Father says he held daughter prisoner for nearly 24 years, fathered 7 children
  
• NEW: Police say Josef Fritzl forced her to write letter saying she had run away
  
• The daughter, now 42, has been missing since 1984, when she was 18
  
• Three children fathered by Fritzl imprisoned with daughter had never seen daylight
  

AMSTETTEN, Austria (CNN) -- Three children freed from a cellar in which their mother had been imprisoned and raped by her own father for 24 years had never seen daylight, police in Austria have confirmed.

Police spokesman Franz Polzer told CNN that 73-year-old Josef Fritzl admitted holding his daughter, Elisabeth Fritzl, 42, hostage in the windowless cell and fathering seven children by her.

"The mother had memories [of the outside world] and got used to the situation," Polzer told a press conference Monday afternoon. "The others knew nothing else."

The main question reverberating from the small Austrian town: How could a man keep his daughter locked in his basement for 24 years, where she gave birth to seven of his children while her mother and three of those children lived upstairs without an inkling of the horrors in the cellar?

Fritzl explained Elisabeth's disappearance by saying she had run away from home, a story backed up by letters he forced Elisabeth to write, including one that begged her parents not to look for her.

Other letters made it seem the missing daughter had left the three children on the parents' doorstep -- when in fact they had been born in captivity in the family's basement.

Elisabeth told police that she and her three children Kerstin, 19; Stefan, 18; and Felix, 5, did not see the light of day during their entire time in captivity underneath the building in Amstetten, a rural town about 150 km (93 miles) west of Vienna.

Elisabeth is described as "very disturbed" and having trouble talking to police about her ordeal, reports CNN correspondent Fred Pleitgen. She went missing in 1984, when she was 18 years old, police have said.

More details also emerged at the news conference about the basement dungeon in which the daughter and her children were kept -- and how her father managed to keep them captive for more than two decades. See inside the cellar prison »

The authorities have revealed that the prison, constructed in the basement of the 1960s building, ran underneath both the building itself and the garden outside.

The entrance was via a small door, hidden behind cupboards in the basement, controlled by an electronic keyless-entry system. Polzer said that the prison was hard to find, even if someone was looking for it, and had been soundproofed.

"Even though they shouted and called they were not in a position to let anyone hear them," Polzer told the press conference.

Polzer said that Fritzl made clear to his wife and other children that the area was out of bounds and they were not to go into the basement. He bought food and took it to his captives in the evening. Watch a report on details of the case »

Detectives made the grim discovery about the cellar earlier this month after Kerstin was hospitalized in Amstetten after falling unconscious and taken to a hospital in Amstetten by her grandfather with a SOS note from her mother hidden on her.

A DNA test was later carried out which revealed her grandfather, Josef Fritzl, was also her father, according to ORF, Austria's state-run news agency.

That sparked a police investigation, which revealed that Fritzl fathered at least six children with his daughter, forcing her and three of the surviving children to live in the cellar of his house, according to ORF's Peter Schmitzberger. Watch police describe the captives' jail »

On Sunday, police searched the hidden rooms where Fritzl admitted he kept his daughter and their children, including sleeping quarters, a kitchen and a bathroom, which Fritzl told police he built, Polzer said.

Amstetten police say they were put on Fritzl's trail following an anonymous tip off. They apprehended the pair on Saturday near the hospital and once police assured the daughter that she would never have contact with her father again, "she was able to tell the whole story," Schmitzberger said.

Elisabeth said her father began sexually abusing her at age 11. On August 8, 1984 -- weeks before she was reported missing -- her father enticed her into the basement, where he drugged her, put her in handcuffs and locked her in a room, she told police.

For the next 24 years, she was constantly raped by her father, resulting in the six surviving children, she said, according to the police statement.

She also told police she gave birth to twins in 1996, but one of the babies died a few days later as a result of neglect, and Fritzl removed the infant's body and burned it in an oven.

She told police that only her father supplied her and her children with food and clothing, and that she did not think his wife knew anything about their situation

Fritzl lived upstairs with his wife, Rosemarie, who police said had no idea about her husband's other family living in the cellar. The couple adopted three of the children that Fritzl had with his daughter, according to police. He told his wife that his missing daughter had dropped the unwanted children off at the house because she could not take care of them, police said.

When Kerstin fell ill, Fritzl apparently told his wife and the hospital that his "missing" daughter had dropped off the sick girl on his doorstep.

In an effort to find out about Kerstin's condition, the hospital and police asked the media to put out a bulletin requesting any information about the girl or her missing mother, attorney general Gerhard Sedlacek told NTV.

Sometime later, Fritzl brought Elisabeth out of the cellar, telling his wife that she had returned home with her two children after a 24-year absence, police said.

He took Elisabeth to the hospital to talk with doctors about Kerstin's condition, and at that point, authorities became aware of her situation, Sedlacek said.

CNN's Fred Pleitgen, Ben Brumfield and Nadine Schmidt contributed to this report

Costly Myths

I am proud to announce that I have started my literature research! According to my investigations South Africa has the highest rate of rape and femicide (women killed by their partners) in the world! Black women are more likely than white women to get raped and this usually happens on their way to work. There is evidence of serial rapes but no one wants to really admit that. It's unfortunate that because of some people's ignorance innocent women are getting raped or dying.

I have to say I am a bit nervous about how I am going to react to the descriptive records, pictures, and uncooperative officials of South Africa. Don't know if a week of training is going to prepare me all that well for such a challenge but all I can do now is trust in my strength and ability to adapt myself to such tragic occurrences. Hopefully my negative feelings towards forensic medicine will change once (hopefully) we can find some good results.

I started googling my primary mentor, Dr. Lorna Martin. Came across this interesting article on rape in South Africa. The power of myths and the fact that people actually act on these amazes me. Sometimes I just keep thinking , who is really at fault here? I guess it's not such a simple question...

The 'virgin myth' and child rape in South Africa

MRC News Release

In recent months South Africans recoiled in horror as the drama of several brutal child rape cases unfolded. Many believe that the myth that sex with a virgin cleanses a man of HIV/AIDS is behind these atrocities. Not so, says Dr Rachel Jewkes, Director of the MRC's Gender and Health Research Group.

Dr Jewkes and two of her collaborators, Dr Lorna Martin (Department of Forensic Medicine and Toxicology, University of Cape Town) and Ms Loveday Penn-Kekana (Centre for Health Policy, University of the Witwatersrand) believe other factors are to blame for these violent acts.

"The idea that having sex with a virgin cleanses you of AIDS does exist in South Africa and there have been reported cases of this as a motivating factor for child rape, but the predominant evidence suggests that this is infrequently the case," Dr Jewkes says. She quotes Mr Luke Lamprecht, the manager of the Teddy Bear Clinic in Johannesburg, which is the referral point for all child sex abuse cases in the metropolis. According to him, he has only seen one child rape case where the perpetrator believed the myth. This happened some 4 years ago - and the child's mother agreed that the HIV-positive man could rape her 4-year-old in exchange for cash.
"According to another report on child rape which investigated injury patterns, management and outcomes, there was a 1% sero-conversion rate.* This was, for most cases, in the absence of anti-retroviral therapy and therefore suggests that this myth is not an important cause of rape. If it had been, in view of the extensive injuries common in child rape, a higher rate of sero-conversion would be expected," says Dr Jewkes.

No increase

Dr Jewkes says that there is no evidence overall that infant rapes are increasing in South Africa, nor that any of the recent infant rape perpetrators, some of whom have been apprehended, knew they had HIV.

In response to the suggestion that infant rape is new in South Africa, Dr Lorna Martin says: "I have seen rape of babies periodically during the whole of the last decade in which I have been working as a district surgeon and forensic pathologist, and have not particularly seen more recently". Dr Jewkes suggests that the perception of an increase may be related to concerted efforts by the media to search for cases and give them prominence.

According to Dr Jewkes, there has been a recent cluster of 5 cases identified over a 2-month period at the end of 2001. "It is likely that at least one, and perhaps more, of these cases was a copy cat crime, unrelated to HIV. One, and probably 2, of the 5 recent cases were associated with Cape Town gang initiation rituals, which are notoriously extremely brutal," she stresses.*

A violent past

She says the country's past is to blame for the very high levels of interpersonal violence experienced. "Many people in South Africa have been extremely brutalised by the political violence in our past, the disruption of families and communities, high levels of poverty and the very high level of violence of all forms," she says.

Much of this violence is directed towards women and girl children - a result of the marked gender inequalities in our society, a culture of male sexual entitlement and climate of relatively impunity in which rape is perpetrated. "The root of the problem of infant rape, as with rape of older girls and women, substantially lies at these more mundane doors. It should be regarded as part of the spectrum of sexual violence against women and girls," Dr Jewkes voices.

Prevention

According to her, infant and child rape will only be prevented if all forms of violence can be reduced in our society, poverty reduced, and a climate of gender equality and respect for women and girl-children promoted.

She also thinks that rape ought to be redefined. "All acts of coercive sex should be regarded as rape, irrespective of the circumstances. And communities should develop an environment where men are deterred from rape through threat of punishment."

"To do this, more resources are needed for expanding the provision of medical staff trained in sexual assault examination and extending police and social work capacity for investigating and assisting rape cases."

---

http://www.scienceinafrica.co.za/2002/april/rape.htm

Domestic Violence associated with malnutrition??!?!

While searching on the web I found this interesting article on an association between domestic violence and malnutrition in India. Just proves even further how all public health issues are interrelated.

In Women And Children In India, Domestic Violence Associated With Chronic Malnutrition

Main Category: Women's Health / Gynecology
Also Included In: Pediatrics / Children's Health; Public Health; Nutrition / Diet
Article Date: 26 Apr 2008 - 4:00 PDT

In a new, large-scale study exploring the link between domestic violence and chronic malnutrition, researchers from the Harvard School of Public Health (HSPH) have found that Indian mothers and children experiencing multiple incidents of domestic violence in the previous year are more likely to be anemic and underweight. The findings were published online in The American Journal of Epidemiology and will appear in an upcoming print issue of the journal.

"This is strong evidence that domestic violence is linked with malnutrition among both mothers and children. In India, the withholding of food is a documented form of abuse and is likely correlated with the perpetration of physical violence," said S V Subramanian, associate professor of Society, Human Development, and Health at HSPH, and co-author of the study.

The study population included 69,072 (aged 15-49 years) women and 14,552 children (12-35 months) from the Indian National Family Health Survey of 1998-99. The participants underwent face-to-face interviews by trained personnel, and the data collected included body measurements, blood samples, and information on women's and child's exposure to domestic violence in the previous 12 months.

The researchers found that women who reported more than one instance of domestic violence in the previous year had a 11% increased likelihood of having anemia and a 21% increased likelihood of being underweight, as compared to women with no such history. This difference was not explained by the mother's demographic information. The associations between domestic violence and nearly all nutritional outcomes were similar for children.

The data suggest a relation between domestic violence and malnutrition among women and children in India. The authors note that preventing domestic violence could be just as effective as a pharmaceutical approach in combating anemia among women. The authors believe that one possible explanation is empowerment, such that perpetrators of domestic violence often use several types of abuse, including physical and psychological, to control the behavior of their family members. In India, the withholding of food as a type of abuse could be a factor in the link between physical domestic violence and nutrient deficiencies that cause anemia and underweight. Additionally, domestic violence has been strongly associated with a woman's inability to make decisions for herself and her family, including the choice of types and quantities of food she prepares

The authors' second explanation is that the link between domestic violence and nutritional deficiencies may also reflect the effects of psychological stress. Women and children who experience domestic violence tend to have higher levels of psychological stress, which has been associated with anemia and being underweight.

The authors believe that reducing domestic violence is clearly important from a moral and intrinsic perspective, and that this study provides a compelling case to also address the problem from the perspective of health effects. "More efforts need to be focused on the 'non-health' aspects or 'social' conditions that influence health conditions, and domestic violence represents one such adverse social/contextual aspect that we've identified in Indian society," said Subramanian.

http://www.medicalnewstoday.com/articles/105188.php

Botswana here I come!!!

Just found out the other day that the department for Women, Gender, and Sexuality has decided to award me the money I need to be able to travel to Botswana. I am super excited about the conference and I am glad this is actually going to work out. Orientation is coming up pretty soon. I will be recording my experiences during that week. We are supposed to be doing literature research and group presentations during that week so I am glad I will have more specific knowledge on the research.

It just came to my mind that I haven't really explained what I will be doing this summer. Here is a little blurb on that:

For the MHIRT, I will be working at the University of Cape Town in the Gender Health and Research Unit under the direction of my primary mentor Dr. Lorna Martin, Department Chair, Division of Forensic Medicine, faculty of Health Sciences and my secondary mentor Lillian Artz, director of the Gender Health and Research Unit. During this time I will be involved in the Cape Peninsula Rape Homicide Study, a regional investigation of the incidence of rape homicide in the Cape Peninsula District, encompassing Cape Town and its surrounding townships. I will be responsible for collecting data about rape homicides from police investigating officers as well as abstracting data from the autopsies conducted by Dr. Martin.

I will also be learning about the other studies on domestic violence and sexual assault being conducted in the Gender Health and Research Unit. As part of this research team of students and faculty investigators, I will participate in research team meetings and be part of research presentations. Moreover, I will have the opportunity to spend time at the Gender Based Violence Research Unit of the Medical Research Council of South Africa where I will be mentored by Dr. Naeema Abrahams and Shanaaz Mathews and learn about Gender Based Violence research in that setting, as well as research addressing the interface of HIV and Gender Based Violence. Finally, I will have opportunities to observe general health care provision and sexual assault interventions at the University of Cape Town Hospital, nursing education classes at the University of Cape Town School of Nursing under the supervision of Dr. Sinegugu Duma, and visit the local domestic violence shelters.

And this is what I asked for in my grant submission:

To further enhance my summer experience of 2008, I am requesting funding to attend the International Congress on Women’s Health (ICOWHI) which will be held in Gaborone, Botswana from July 9th to 11th. The theme of the conference is “Women’s Health across the Life Span: The Girl Child, Safety, Health and Development.” During the three days of the conference I will be able to familiarize myself with the ongoing international research on this topic and expand my expertise. By participating in this program I hope to be able to better understand the cultural barriers that play a role in the delivery of care and the implementation of research studies. The conferences sub-themes are all related to my research and interest. Some of the topics include legislation related to the girl child, health policy and practice, HIV/AIDS and related issues, child caregivers, child trafficking and slavery, mental health and development, female Genital Mutilation (FGM), Vesico-Vaginal Fistula (VVF), child abuse and substance abuse, and education and the girl child. Familiarity and competency will not only help me with my research in the short run, but also will allow me to become skillful in reaching my desired future career as a physician addressing health disparities specifically among women.

ok now to start studying for finals. will be posting during orientation week or if anything new comes up!

Preps in Baltimore

It may be too early to write my first post but I just wanted to record everything from the very beginning.

I met with my mentor Dr. Jackie Campbell around 2 weeks ago. Before going, of course, I googled her and found out all these amazing things about her. She deals a lot with Women's Health issues and violence against women. Also apparently she appeared in the Oprah Show and talked about violence against women. There are a million pages about her and the cool things she has done. I have to say women like her really inspire me especially in a world where gender based violence and inequality are still important issues. Any way, our conservation was pretty fruitful and she was very friendly. She introduced me a million new books she had read on the history of South Africa. I hope to at least read some of them. I was glad to know that other than career interests we share a love for novels!

Got my package in the mail today basically saying "start getting ready." I have to take care of vaccinations, passport and travel logistics. Looks like pretty thorough package with some handouts about the history, what to expect there, etc. I still have to go through all of it and figure out what I need to do.

I don't think it has hit me yet that I am going to South Africa this summer, especially with Physics, Epi, etc...

Right now I am also in the hunt for some free money. The International Council on Women's Health Issues Conference is going to be in Botswana in July. To my surprise a ticket from Cape Town to Botswana is almost $700 (yes I converted it right) plus the $100 registration plus my expenses for staying there. So the one week conference is going to come out to almost $1000!! Don't really know what direction to go asking for money. Tried asking Children of Persian but Mahnaz hasn't responded yet. Will update here if anything changes.

Also just wanted to explain a little bit about the name of the blog for those of you who think "man I am never going to remember the address." Well Kaapstad means Cape Town in Afrikaans and Spes Bona is the city's motto which means "Good Hope"... kind of sounds like "Believe" huh? and that's all I wanted to say about that...

ok I think this was a long enough first post,

hasta luego!

P.S. I will be posting other people's pictures of Cape Town for now and my own soon hopefully!!