16 Days: A Dangerous Climate for Women

Hi All,

I just want to share the following article on gender and climate change:

16 Days: A Dangerous Climate for Women

This week, events are taking place across the globe to mark the 16 Days of Activism Against Gender Violence, a campaign to end violence against women, which, according to the UN, 70 percent of women will experience in their lifetime.

Before we can effectively address sexual and gender-based violence, we have to identify the factors and conditions that perpetuate it. This year’s 16 Days theme, “From Peace in the Home to Peace in the World,” focuses on the role of militarism, and highlights how “war, internal conflict, and violent repression have a particular and often disproportionate impact on women and the violence they experience.”

But in many parts of the world, another factor is at play – one that’s increasingly undermining women’s security and putting more and more women and girls at risk: climate change.

Extreme weather and climate change have disproportionate effects on women, especially those from poor, rural communities. Simply because of their roles in society, women and girls are more vulnerable to these events to begin with. For example, during the 2004 Indian Ocean tsunami, four times more women than men reportedly drowned, many because they couldn’t swim or were trying to save their children. Decreasing access to water and growing food insecurity force women to wander ever farther from their homes, putting them at greater risk of violence and abuse.

Likewise, women and girls stuck in overcrowded and poorly-managed shelters or camps face an increased risk of violence, rape, separation from their families, and other hardships (as has been the case for Somali women fleeing drought and famine). Displaced Pakistani women who were interviewed after the 2010 floods said that the demands of purdah (the cultural practice of separating women from men) made it difficult for them to access showers, latrines, emergency supplies, and doctors – with obvious implications for their health and hygiene.

The threat climate change poses to women’s security is likely to grow dramatically in the coming years. Just last week, the Inter-governmental Panel on Climate Change (IPCC) released a report on the relationship between extreme weather events and climate change, and concluded that it’s “virtually certain” (90-100% probability) there will be more frequent and more extreme hot weather this century.

The report also states that we are likely (66-100% probability) to see more frequent intense rainfall, as well as more powerful tropical cyclones. The severity of the impacts of climate extremes was also found to be highly dependent on the level of vulnerability to those extremes – in other words, more women and girls will face greater risks.

More and more, governments and humanitarians will have to respond to extreme weather events and the displacement crises they cause. In doing so, they’ll have to take into account the unique protection needs of women and girls. They will also need to recognize that when preparing communities for natural disasters, or helping them adapt to a changing climate, women must be given a central role.

No one will be spared the consequences of climate change, so we must be ready to respond to women’s needs. Even more importantly, if we’re going to tackle climate change head-on, we’ll have to harness the power of each and every woman. But for that to happen, we must first succeed in making women everywhere more secure, allowing them to realize their potential, and giving them a seat at the table.

Climate Change is Not Gender-Neutral

Unlike most of you, my internship is in the Fall semester. I have been in Geneva Switzerland for a little more than 1 month now, working for IPCC (Intergovernmental Panel on Climate Change). My routine job includes providing the Secretariat, IPCC Bureau, and interested focal points (government members) with a daily media review on IPCC. IPCC assessment report on climate change is released every 6/7 years or so, with the next one due in 2014. Sometimes the news and blogs on IPCC could be controversial as there are many climate change skeptics disproving the research included in the reports or questioning the credibility of the authors and of IPCC itself. It is thus very useful for many IPCC members to be aware of what is being said about the organization., both in bad and good lights, and to give an approriate response when necessary.

The issue of climate change and gender has not been deeply discussed in the climate change debates. However, I read an article today that gives a good glimpse on how events caused by climate change are affecting women more than men.

The article talks about how generally in disasters, the death toll of women is disproportionately higher than that of men. This is proven by the death count in the 2004 Southeast Asia Tsunami, 1995 Kobe earthquake, 1991 floods in Bangladesh, where the number for women could be as higher by as high as 5 times. Arguably, many extreme weather patterns, such as more tornados, flooding, freak snow, that we are seeing lately are due to climate change. In these circumstances, women are less likely to survive as they have weaker upper body strength to climb or cling on to trees, run slower, are less likely to know how to swim, and tend to stay back to look for and protect the children before fleeing. But, much more than that, increasing spread of diseases due to climate change also target women and children the most. In food scarcity conditions, women often get less portion within the family and have to work harder to provide the food, which means going to further places to fetch water and toil the soil. The article also talks about how in acute disasters and social economic disruption, violence and sex trafficking tend to increase, again, with a tendency towards women and girls.

I also attended a movie screening titled "Carbon for Water", a documentary campaigning for the use of LifeStraw, a water filter provided for families in Kenya. In the movie, it is shown that girls as young as 6 years old already have to assume the role of providing food and water for the household. As the draught season becomes more extreme, girls and women have to walk further to find water. Not only, for water, they also have to fetch firewood as fuel to boil the water. Diarrhea and dysentry could be prevalent when unclean water is consumed. These journeys taken daily for water and wood are dangerous as they are susceptible to raping or being attacked by wild animals. The documentary shows how LifeStraws are provided for free to families, with the whole project funded through carbon credit as without cutting trees for firewood and using the for fuel, the carbon print is reduced.

The article and the documentary give a good background and information for me to understand more how climate change effects can be more detrimental to women. I do not, however, believe in striving for gender equality. In its basics, men and women are created differently with different general aptitude and skills. What I do believe in is gender neutrality, that there should be equal opportunity of survival and no difference in honor and respect. Achieving this at the public policy level is still a very blurry subject to me, so I welcome comments from anyone who might know more. But, I'll share more as I learn.

Hope everybody who have been back to the US had a great experience from the internship. Stay safe and stay warm!

Greetings from Reykjavik!

Hi all!

As many of you are finishing (or have finished) your fellowships, mine is just beginning. I arrived in Reykjavik, Iceland on Saturday, and I've almost finished my first week at the Ministry for the Environment. I haven't gotten a chance to see too much yet, but Reykjavik seems like a nice small city, in fact it hardly seems like a city at all. Very few large buildings and no big crowds of people. Everyone seems friendly and everyone speaks English quite well, so the adjustment is not too difficult.

My project here will be on organization of environmental data reporting for Iceland. This is obviously a HUGE project so I will just be taking some preliminary steps to gather some metadata on current information flows, and what kinds of reporting are required by the European Environment Agency. As far as the project goes I have been mainly doing background reading and developing a questionnaire that will help me amass this data from the different environmental organizations here.

In more exciting news, I was invited to accompany the Minister for the Environment to Gullfoss and Geysir yesterday for the opening of a new trail. I was also the unofficial photographer for the trip, so the picture you see above is myself and the Minister at Gulfoss. It was a very nice time, and it was very exciting for me to see these geological phenomena for the first time and see the process of protecting them and making them accessible in action!

Ramadan Mubarak... Eid Mubarak

I recently asked a cab driver to take me to the post office (it always seems to start with a cab story, huh?). He asked me what I planned to purchase, as I may be able to get postal things at other locations. I told him stamps and postcards. He really wasn’t familiar with the concept of a postcard. I think he thought I meant a regular greeting card. “Are you sending your family members a card because you are away for Ramadan?”
“Oh no, I’m not Muslim.”
“Oh, ok.”
I stare into his rear view mirror trying to figure out his body language. Did I make him uncomfortable?
The driver then went on to share a story of cards he’s purchased since the holiday began.

I surely felt awkward that the driver would default to Ramadan greeting cards. But then I wondered how many times I must have done the same thing in the US. I can hear myself now: “Oh, are you done your Christmas shopping?”

The driver was able to help me find a gift shop closer than driving to town. They had a lot of great things, even postcards!

Being a minority is nothing new to me. Black, immigrant, female. Yes, in many circles, I’m used to being the minority. But for the first time, in a very long time, I’ve felt marginalized for my religion.

I identify as Christian, and like many other Americans, have had the pleasure of not thinking twice about being bombarded with media ads regarding Christmas & Easter. Guyana has given me a different experience. Having friends of different faiths has contributed to my being culturally sensitive and aware of different faiths. I’m going to suggest that awareness and empathy will only take you so far in understanding others.

The Muslim and Hindu communities represent a heavy number of the population. Christians are very much present, however, I’ve had the pleasure of gaining understanding about a culture I know little about. Although I have Muslim friends in the US, it has been an amazing experience to live in a country while so many communities are acknowledging such an important holiday.

One day while listening to a local radio station, I heard an advertisement about preparing for Ramadan. I don’t remember where exactly this place was located, I just remember they claimed to be my “one stop shop” in getting ready Ramadan. It reminded me of the taxi driver. When have I ever heard an ad on the radio for Ramadan? Or seen a greeting card in a store that read “Ramadan Mubarak” (Happy Ramadan). Not to say they don’t exist in specialty shops, but it’s really eye opening and thought changing to think about. A ‘minority’ culture in America is a majority culture in Guyana, and now I’m living here.

I have a new found appreciation for my classmates who practice the Muslim faith. Classmate who would have to use the restrooms as an area to pray throughout the day, because there were no appropriate spaces for their needs. Appreciation for my hairdresser who stays committed to her beliefs and would have to take a break while doing my hair so she could wash up and pray; even though this meant some clients getting upset about the waiting time. Appreciation for my friends, here and at home, who would have to go to class during or after a long day of fasting during Ramadan while everyone ate their lunches and dinners during lecture (especially because fasting lasts a whole month).

Yesterday was Eid ul Fitr, the end of Ramadan. The day is often referred to as Eid for short. Eid, means festivity, and Fitr means to break the fast. While I didn’t celebrate Eid with any locals, I definitely felt its presence.

The holiday of Ramadan, marked by month long sun-up to sun-down fasting, is a time of forgiveness, making amends, and growing spiritually closer to God. What a wonderful purpose. It’s also a time where I’ve learned a lot about my self-awareness and another culture.

Instituting a Web of Gender Responsiveness

So I am now at the halfway point of my time here at UNEP HQ. I thought I would share with you a little bit about where I live, what I've been working on, and gender in my workplace.

Nairobi, Kenya
I live in a very nice suburb of Nairobi called Runda. It is the home of many expatriates who work at the U.S. Embassy or the United Nations Office Nairobi compounds that are nearby. I am enjoying my stay in a two bedroom guesthouse within 30 minutes walking distance of work. My landlady used to work for the UN World Food Programme, and my landlord directed safari trips; they are a very nice couple.

Prices in Nairobi for food, taxis, shelter, etc. have increased significantly since 2008 and are actually the same or more expensive than where I study in Troy, NY, therefore, I do a lot of walking. I share this pedestrian trait with many Kenyans. Since I usually forget how to say, "Habari ya asubuhi", I instead just say "Good Morning". It is a good thing that many Kenyans speak English, Kiswahili and their tribal language!

On the weekends I go to an eye hospital (as part of my dissertation research), shopping at the local mall, and to church. Now that I am becoming more comfortable with riding on the matatus, I will venture more often into the city center. I want to see: Kenyatta's mausoleum; the view of Nairobi's cityscape from the Kenyatta International Conference Center; and any museums and art galleries that I can find. There is a great blog called Nairobi Now with all sorts of cultural events in the city.

My Projects
I have two projects; the first involves consulting on Project Atmospheric Brown Clouds and in particular, its mitigation component Project Surya. Surya means “Sun” in Sanskrit. Project Surya had a pilot phase in India where it: evaluated cookstoves, assessed localized air pollution, assessed women’s experiences with new cooking technologies, and eventually settled on a new cookstove design. This project has three goals: (1) reduce global climate change by decreasing black carbon (a residue of incomplete combustion); (2) reduce deforestation by decreasing dependence on biomass; (3) improve the health of women and children by decreasing air pollution. As a consultant, my role is to report the best practices for gender mainstreaming environmental policy and planning that come out of the Project Surya pilot phase, and, to evaluate the proposed Phase II of Project Atmospheric Brown Clouds to see how gender mainstreaming can be improved.

My second project is to create an annotated bibliography on best practices for gender mainstreaming environmental policy and planning. I am working with a web designer to make this annotated bibliography searchable and sortable when it is published online. This web designer has been working with my supervisor to re-design the UNEP Gender website (the old website is here).

Please note: pictures of the old website (L) and new website (R) were added to this blog entry on 2011-September-16

Gender at UNEP
I find myself fascinated by my supervisor's job and the history of how it came into being.

Apparently, a team was formed in 2007 to look at how to make UNEP a more productive, efficient and effective institution. As part of that team, my supervisor, Ms. Janet Kabeberi-Macharia worked with others to create the UNEP Gender Plan of Action.

Fast forward to 2011, and Ms. Janet Kabeberi-Macharia is now the Senior Gender Adviser for UNEP. She spends a lot of time reviewing prospective employees on HR hiring boards, meeting with individual project managers, and writing policy recommendations and reports, among a range of other activities all of which are tied to gender-mainstreaming. Policy and practice has to be changed at many levels in order to perform a "web of institutionalization" of gender-responsiveness (using Caren Levy's concept). For example, this may involve gender-responsiveness training for staff of UNEP collaborating research centers, as well as the project teams from various UNEP divisions. Also, each project team in UNEP has a team member who also serves as their gender coordinator. Finally this “web of institutionalization” involves changing the organizational composition of UNEP itself to encourage more gender equity in leadership roles and attention to gender mainstreaming by leaders.

This concept of a "web of institutionalization" encourages one to think across scales of an organization in order to implement good policies and practices for gender-responsiveness. Its enactment here at UNEP demonstrates an excellent unity of theory and practice. However its enactment is very difficult. It is neither singularly top-down, nor bottom-up. To be effective, it must encompass both of those modes of institutional change as well as include lateral (instead of vertical) modes that cross-cut divisions, teams, and ideologies.

People who are smart and dedicated to the mission of UNEP may still resist such changes because: (1) it is not a process with which everyone is familiar, and (2) it is difficult to set goals and indicators for this process. It is exciting to be a part of this process for my 10 weeks here at UNEP.

Healthy Relationships

Life in Guyana has been moving at such a rapid pace, that a blog entry is well overdue. Last week I had the opportunity to pilot a workshop on healthy relationships with local school. Here's what happened:

I had the opportunity to pilot my “Healthy Relationships” program for a local private school. The school is located on the west coast of Georgetown and educates children ages approximately 6-16. I thought this was a great opportunity to see what the program would look like on the ground and adjust for any kinks.

I was told that I would have the opportunity to meet with three to four classrooms of children who are in their last years of school (an age range of 14-16). I was not told that I would be meeting with them all at the same time. After entering the school and checking in with the principal, I was escorted to an all-purpose/auditorium room of over one hundred children, ages 6-16. My very formal step by step program went out the window. I was not prepared to discuss sexual assault in front of six year olds, and I was not prepared to facilitate the cries, screams, and side chatter of so many children at once.

The principal explained that the schools are on summer break and the students who are present now are here for summer school. Normally, the students would be in smaller classrooms, but the school uses the all-purpose room during the summer. This was fine; I just wish I had a better understanding of this prior to arrival.

Like any good program manager, I decided to work with what was given to me. The school had audio equipment and I was able to use a microphone to ensure the entire room could hear me. I discussed three types of communication (aggressive, assertive, and passive) as planned and asked the children to do a drawing exercise as planned. The exercise was difficult to facilitate because I only had enough crayons for about 30 children but had a classroom of over 100. The older kids were kind enough to use their own pencils or pens, and those who did not have did an excellent job at sharing. The teachers present were helpful in going around and checking in with the students for the duration of the drawing exercise.

The program also included a role play on the different types of communication. I selected six volunteers and three of them dropped out when they realized they would have to do the role play in front of their peers. So I just lectured to make up for that time and filled in for one of the "skits". The kids seemed to enjoy their school mate acting out "aggressive" behavior with me.

For the last phase of the program we divided the group into a "girls only" and "boys only" section. We were able to separate the room using black boards and space dividers. A program associate from the office joined me to facilitate the remainder of the program. He lectured the boys on topics of aggression and anger management while I spoke with the ladies about bullying other girls and rights within a relationship.

I lectured a little bit about changing who you are to get the attention of someone who likes you. The students did a good job at highlighting this doesn’t work because you can’t pretend forever. I got so many great answers! I also talked about what everyone could do to stop rumors and bullying because they hurt other people’s feelings, and no one deserves to have lies spread about them.

The conversational part was also a challenge, as the younger girls really couldn’t pay attention for very long and the older girls wanted to just ask questions about boys who cheat on their girlfriends. I think this is understandable considering that someone age six probably isn’t dating yet and older students may be better at dominating the conversation.

I asked the girls if anyone was in a relationship and the entire room said no. So, I asked if anyone had a friend who was in a relationship and the entire room said yes. I thought it was very cute.

I told the girls we’d spend the remainder of the time discussing relationships with partners and relationships with friends or classmates. There are different types of relationships, but you have a choice in what you do to keep each one a healthy relationship

There is clearly lots of work to be done in this area. When I asked the girls what you would do if your partner hit you, the responses were “poison him”, “stab him”, “poison his family”, and even “jump out of the window and say he pushed me”. I was expecting answers along the lines of hit him back. OH. WOW.

I was very aware that the children were mostly likely repeating things they’ve heard adults say. I really wanted to drive home that there are other options, so I emphasized trusted adults and trained professionals that the students could talk to if they or a "friend" were ever in this situation: a teacher, social worker, nurse, or counselor at the Ministry. When I mentioned the Ministry, unfortunately, a lot of students spoke up about how the office was unreliable. The girls were eager to share how “friends” had been turned away because they were too young. They yelled over their peers stories of counselors who never showed up for their designated appointment time and they, well their “friends” felt discouraged to reschedule. Unsure of how to buffer this anger, I spoke very loudly to calm the room down. I explained there are many choices in where they seek services, the Ministry was just one of many options, and moved on to my next question.

I wanted to emphasize the importance of warning signs. Your partner will not punch you in the face on a very first date. Everyone says that domestic violence is a “cycle” however no one ever breaks down the cycle: abusers uses phases of honeymoons and then violence in conjunction with power and control to oppress their partners. I also wanted to address the myth that only men can be abusers. If you, as a female, are hitting or verbally abusing someone with whom you are involved romantically, then you are an abuser and you need to get help regarding your unhealthy relationship. I didn’t get very far in this discussion. The girls wanted to focus on what do to in the event of actual abuse.

Rather than focusing on “my program” and “my guidelines” I again decided to meet the students where they were. I wasn’t sure when I would meet with them again, and understood for some girls, they might be asking such questions because they are experiencing violence now. I used the remainder of program time to answer specifics on where to go and what to do if you are experiencing these issues now, as well as where to go and what to say to help a friend who may be in trouble.

I felt very defeated at the end of my program. I felt under prepared and poorly advised. I wondered if things would have been better if I had known the structure of the “classroom”. Did the kids learn anything? What was the point in me even coming?

As I gathered my materials and made my way to the door one of the girls (younger teenager) stopped me to shake my hand. She said thank you for visiting and invited me to come back again. I was so delighted I did not want to let go of her hand.

A few minutes after she walked away, another young teenage girl came over to shake my hand. She explained that my program was very special because I gave “good advice”. The topics were important to her and her friends, and teachers never really talk about relationships at school. She told me that I am welcomed to come back and visit again.

I felt so appreciated. I felt that even if I had only reached just a few girls, perhaps my time was valuable. I also saw that there was a need to discuss these issues. My program materials must be precise and fool-proof to get these points across. Those who implement these projects, furthermore, need to be genuinely passion about addressing this topic. When it comes to discussing intimate partner violence, I’m glad that I was able to do just that, even if it was only for two hours during one afternoon in the school's all purpose room..

First week at UNEP HQ in Nairobi Kenya

I started working at the beautiful and sustainable UNEP HQ in Nairobi on Monday July 25^th. I have the privilege of working in a zero energy balance building. That means that, over the course of a year, all of the building's energy needs are met by the solar panels mounted on the roof tiles. Not only does this building have a zero energy balance, but the builders were very careful to use local supplies (including local architects, construction firms, building materials, etc.) as much as possible. Also, rainwater is harvested to feed the beautiful fish ponds and both this rainwater and graywater (from the bathrooms and utility rooms) are used to irrigate the beautiful themed internal atrium flora, as well as the nearby lawn. With such gorgeous, tranquil surroundings, my work space is very inviting.

Less relaxing is the pace at which Quality Assurance Section (QAS) moves. QAS operates under the Executive Office of the UNEP and helps measure the impact of UNEP projects and programs. Within QAS, I am working with the senior gender adviser to the UNEP, Ms. Janet Kabeberi-Macharia to identify projects in the Resource Efficiency & Sustainable Consumption and Production priority area that might benefit from: (1) my expertise in theories of contextually appropriate innovation; (2) my expertise in theories of knowledge circulation; (3) policy suggestions for further gender mainstreaming.

Originally, at the request of Ms. Kabeberi-Macharia, I identified two (out of 6) UNEP priority areas that best fit my interests: Resource Efficiency and Sustainable Consumption (RE&SCP) and, Harmful Substances and Hazardous Waste. At the time, both Ms. Kabeberi-Macharia and I were considering how my project at the UN could best fit the topic of my dissertation research which is avoidable blindness. Its theoretical premise actually fits quite well with the UNEP priority area of Resource Efficiency –Sustainable Consumption and Production (RE&SCP), in particular the following areas: a model of sustainable financing; working with international institutions; facilitating S-S cooperation; emphasizing national ownership.

Together, Ms. Kabeberi-Macharia and I have started to identify some specific projects in the area of S-S Cooperation, that I might work with. In each, I will try to identify and advocate for specific policy measures to inculcate gender responsiveness (where women are encouraged to participate as decision makers in policy) and gender mainstreaming (where I advocate the incorporation of sex-disaggregated statistics and consideration of women's equality and women's empowerment into policy decisions).

While, as a Ph.D. Candidate, I have read a lot of feminist science studies and feminist technology studies literature, how such literature translates into policy practice was previously unknown to me. From Ms. Kabeberi-Macharia’s website on Gender Issues in UNEP, I accessed the glossary where I learned about the terminology used by policy professionals to discuss some of the same goals that feminist scholars have. If any of the other CWWL fellows have some other resources to share on the policy practices of gender mainstreaming, and gender responsiveness, I would very much appreciate them.

Greetings from Kiribati!

Or, as one might say it here, Kam na mauri ni Kabane!

I have been here on Tarawa, the teeny tiny atoll that constitutes the capital of the Republic of Kiribati (pop. 100,000-ish), for almost two months now and have been terribly remiss in posting to this blog. My excuse is that I was busy learning as much as I could, as fast as I could, about this country and its health system, so that I could actually be of use to the Ministry of Health during my brief stay. I have so loved reading what each of you post-ers has had to say about your placements, though, and now want to offer at least a few thoughts on the not-very-well-known part of the world where I have been living.

In short, as I have (maybe unsuccessfully) tried to depict in the photos above (of exactly the same view, but at different tides/times of day) Kiribati can be either "the BEST!" or "the WORST!" depending how you look at it.

Here in Tarawa, you may at all times be within 100 meters of what I reckon is the most beautifully-aqua lagoon in the world, but you are also, no doubt, aware that this gorgeous body of water lays claim to the highest concentrations of E-coli in the world (understandably, given the limited access to water and sanitation with which most of the population struggles).

The temperature may never rise above 86 F or fall below 79 F, but combined with the humidity and salty sea air, one soon learns, this means that the smallest and most insignificant cut you ever had will turn into a festering, infected wound with high sepsis potential if not attended to immediately and consistently for the next month (difficult in a place where band-aids or similar products are unavailable)… your shoes will grow mold… and any and all electronic devices will develop a series of unexplained malfunctions of varying severity and annoying-ness.

A camping trip to a nearby island may take you to the most idyllic beach, with straight-out-of-finding-nemo-quality snorkeling, and the most generous picnickers with whom to share a lunch of coconuts and fresh fish, but it may also entail a night spent fearing for your life while gale-force winds blow your tent over (think splintering poles and wet nylon plastered to your face) and down the beach with you in it, torrential rains all the while filling it with just enough water to thoroughly soak everything you own… and you might at first be thankful that at least the wind also blew the mosquitoes away…for a minute.

Perhaps more importantly, a visit to the doctor might be quick and free, and (if you’re lucky and you have sought health care early and for a relatively common and easy-to-treat condition) result in prescriptions for exactly what you need at no charge. Whatever it is you need, though, might be out of stock at the one-and-only pharmacy and not be expected back in until the next ship comes... in a month.

Thanks to the hospitality of many i-Kiribati and some wonderful new friends, I’ve been able to maintain an outlook of the "BEST!” variety in almost every area of my Kiribati life, and I have learned a ton from my experiences inside and outside the Ministry of Health.

The majority of my working life thus far has revolved around research into how pain treatment and palliative care are provided in Kiribati, how delivery of these services could be improved, and what a national policy to support increased access might look like. This research has given me an excuse to visit a range of health centers, clinics and hospitals in the capital and on more remote outer islands, and to speak at length with a wide range of health care providers and administrators. I have been able to explore issues of drug supply and distribution in a fantastically complicated and remote setting (Kiribati is made up of 32 different islands spread over 3.5 million kilometers of the pacific ocean); issues of education and training of health care providers in a country with no medical schools; the transition in health care delivery strategies and public health priorities demanded here, as in many developing countries, by a growing burden of non-communicable diseases (NCDs); and, finally, health care seeking behavior, particularly among women, who, as in many other places, tend to prioritize the needs—health and otherwise—of their children and other family members above their own.

One of the most memorable and eye-opening experiences I have had in Kiribati took place on a small boat in rough seas off the coast of Abaiang, one of the atolls just north of the capital, Tarawa. I was on my way, with the Abaiang Medical Assistant (thanks to a recent E.U.-funded program, each of the outer islands has a health center staffed by a Medical Assistant, who, as a nurse who’s been given a bit of additional training and salary, essentially runs the entire health system of the island—from disease surveillance and vaccination programs to health promotion/NCD prevention/anti-smoking campaigns; from emergency medicine to food safety and palliative care—on his or her own and in communication with doctors at the main hospital primarily through CB radio) from the main island to one of the even smaller and more remote is-lets that is also part of his catchment area. Huge waves broke over the bow as he drove, soaking everything in the boat that wasn’t very securely wrapped and fastened inside a waterproof tarp, and salt-ily splashing into our eyes so often I was unsure how he could continue to steer the boat. There was only one seat, so I was using one of the tarp-wrapped bundles to cushion the impact of wave after wave of into-the-wind, tailbone crushing, impossible-to-predict-the-exact-direction-or-intensity-of blows to the hull.

After something like two hours of this, it occurred to me that we were taking this boat because it was the best one available—much more comfortable, everyone said, than the canoes that were once the only means of travel between islands. A couple of other things also occurred to me: 1) If I were suffering from appendicitis, or even a tooth-ache, this trip might just qualify as torture. It might also be my only hope of getting to a hospital. Under such circumstances, unless I was in very dire straights, I most likely wouldn’t choose to see a doctor unless he came to me. 2) This is the trip the Medical Assistant has to take at the drop of a hat, every time a shipment of vaccines comes in—not to mention any time a patient on the islet needs any kind of specialized care or medication—sometimes with little notice. The fact that the Medical Assistant does not, himself, own a boat and must borrow one for every trip, just adds to his burden. 3) This might amount to what one would call a difficult link in the cold chain supply system.

It is not so much that I didn’t previously know about a whole range of difficulties in reaching remote populations—here and everywhere else—with health care. It just hadn’t ever been made so totally, absolutely, and (literally) painfully clear to me how some of those difficulties manifest themselves.

Of course, consistent with the theme of Kiribati’s being simultaneously “the BEST!” and “the WORST!” we were also at that very moment, driving into the most vibrant sunset I’ve ever witnessed, reflected off of the deepest-blue ocean I’ve ever seen, and headed towards the palm-tree-studded silhouette of that quintessential paradise island I once thought only existed in travel brochures.

Farewell to Lithuania - for now

A view of Vilnius from my recent hot-air balloon ride!

My time in Lithuania is coming to a close (I really can’t believe it’s been ten weeks already!), and instead of writing about gender and policy this time, I’m going to focus on some of the smaller details of my experience here.

One of the questions I’m asked the most lately is, “What will you miss about Lithuania?”  So here are a few answers:

- The food! How very outdated it is to think that post-Soviet countries lack access to fresh or diverse cuisine. The food here is excellent, and even without eating meat, I’ve still done quite well for myself. Some of the dishes I’ll miss the most (but not necessarily Lithuania’s healthiest ones) are tinginys (“lazy man’s cake,” a delicious, unbaked cake of chocolate, butter and biscuits); kepta duona (fried Lithuanian black bread with garlic); and Lithuanian hot chocolate (pretty much melted chocolate in a mug).  I’ll miss Cukatos, my favorite café in town, and the friendly staff there who memorized everything I liked and didn’t like. I won‘t miss worrying about bacon hiding in my food, though.

- Vilnius, or at least the Vilnius I saw. What I mean is that ten weeks has given me an introduction to Vilnius, but I haven’t finished the book  In the same way that you don‘t really know NYC if you never leave Manhattan, I can‘t claim that I truly know Vilnius without having spent much time in the suburbs or outside of the center and the Old Town.  But I have done my best to explore, learn, and grow in this place, thanks especially to the wonderful people who have helped show me the way.  I will miss taking winding roads to work, the quaint and colorful shops and streets, and the offbeat, funky details in the graffiti, window sills and and decorations of this town.

- And most of all, the people. I have so much love and gratitude for the people I’ve met here; they have been generous, open, and amazingly, they’ve been willing to befriend someone who was only in town for a few short months.  I will miss my friends in Vilnius, our conversations and adventures together.  I feel very fortunate to live in NYC, a city where so many people pass through, and so I’m confident that I will see many of my friends here again.

Soon I’m leaving for new lands, namely Latvia and Estonia, where I’m traveling with a friend before returning to the U.S..  I’m excited to come back to my life in New York, but it’s bittersweet, since I’ve had such a positive experience living in Lithuania.  For now, I will say not “viso gero” (Lithuanian for ‘goodbye’) but rather “iki” ( ‘see you later’), and hope that it won’t be too long before I can say “labas!” (‘hello’) again!