Interfaith Lecture Recaps

Emily Perper | Staff Writer

Johanna Mendelson Forman began her lecture on Thursday with a chilling scenario.

“If you can imagine a whole city … that is filled with tents, and you’re sleeping alone, and maybe you don’t even have a full tent around you; you don’t even have four walls, but you have blankets or quilts, sometimes blue plastic sheeting that’s given out by humanitarian agencies. There’s no electricity and no lights, so it’s dark,” she said. “And suddenly you hear a rustling, and then you hear the sound of the knife cutting through the sheeting. And before you can scream, a man, or a group of men — often they come in gangs — crashes through the opening. They grab you. They push you down. They rape you. And often, all of this is done in front of your children.”

Forman’s Interfaith Lecture on Thursday in the Hall of Philosophy, “The Slaughter of Eve: Women and Violence in Haiti,” focused on the tragic prevalence of sexual violence in Haiti. Forman has served as the director of peace, security and human rights at the United Nations Foundation and as an adviser to the United Nations in Haiti.

This wasn’t Forman’s first time at Chautauqua.

“About a decade ago, I sat here, talking about the problems of a country that had come out of a very violent past and was trying to rebuild,” she said. “In some ways, while I’m happy to be here, it’s unfortunate that we have to continue talking about the kind of violence that takes place in Haiti.”

Forman spent a portion of her lecture on Haiti’s dysfunctional history and said the country is often considered “the poster child for things that could go wrong in development.”

The Haitian government was dominated

by authoritarian rulers, army coups and general corruption, she said.

“My mission is to really illustrate the pervasiveness of (violence) and to explain why poverty, lack of governance, lack of the rule of law and a judicial culture makes women’s complaints really part of the problem, and the culture of impunity continues,” Forman said.

She said that the January 12, 2010, earthquake further delayed political progress. “The election was postponed a year after the earthquake … only about 23 percent of the population was able to vote,” she said.

The earthquake incited other serious disasters, such as a cholera outbreak, she added.

“This is the eighth time since 1991 that the United Nations has returned to Haiti, and the Haitians, because they do have an elected government now, feel as though they are an occupied nation,” Forman said. “This does not create great relations.”

But the United Nations Stabilization Mission peacekeepers are the only arbiters of order in Haiti at this time, and they can only do so much, she said, and the Haitian army was disbanded in 1994. Only a United Nations-trained police force remains.

Forman described the wretched conditions of Haitian prisons. When the earthquake destroyed the prisons, 5,000 prisoners fled once the gate broke.

“There is much evidence to believe that people who are attacking women and children in these camps are people who’ve escaped from the jails,” Forman said.

United Nations police officers have arrested many of these criminals, but the physical and mental damage done to women and children as a result of their sexual crimes is irreparable, she said.

She explained that rape is a security issue, as well as a health and human rights issue; rape undermines public order, destroys families, prolongs conflict, prevents women from taking part in peace negotiations and often leaves the attacker unpunished. Until 2005, rape was not a part of the criminal code in Haiti, Forman said. The audience was audibly shaken.

Forman explained that the bureaucracy involved in reporting rape is complex, doing more to discourage than encourage women to pursue their perpetrators: the rape must be reported within 72 hours and documented, and for illiterate women, these requirements are virtually impossible.

But Forman said several groups managed by Haitian women who are also rape survivors have an access to the refugee camps that United Nations forces do not and can help traumatized women to deal with the results of their attack.

“Women are now becoming part of the solution in Haiti,” she said.

Despite all of the evidence to the contrary, Forman said she is hopeful for the future of Haiti. Several solutions may prove viable. The first of these is the brainchild of American architect Oscar Newman, which Forman calls “defensible space for women.”

Currently, there is no lighting in any of the 25 large tent cities in Haiti. Toilet and shower facilities are isolated and located on the edges of camps.

“How could we create space for human beings to live in without being the victims of violence?” Forman asked.

There are several factors to the concept of defensible space; Forman mentioned territoriality, natural surveillance and an image or physical design that provokes a feeling of safety and milieu.

Creating camps in cul-de-sacs rather than grids and centralizing latrines instead of building them on the camp borders will also help to create a defensible space, Forman said.

“Is this going to be a quick fix? No,” she said. “But is it going to be a way to start getting people to think about how we put people in safe places? Absolutely.”

The second solution is to work with the international legal system, Forman said.

She said she believes this solution will take a long time.

“But we can train Haitian police … to be sensitive to women as victims,” she said.

Confident in the abilities of current Haitian president Michel Martelly, who has committed to initiatives like using taxes to rebuild its schools, Forman said, “There is a new attitude that the government will take its responsibility to protect as something that it takes seriously.”

It will take time, she said, but rebuilding is possible.

“If we understand that the people with the resources and the drive want to stand behind a government and begin to do the hard work of politics, then I think we can get to a place where Haiti can be repaired,” she said. “I think the fate of women and children, as awful as it is today, can be turned around.”

Emily Perper | Staff Writer

It’s all about women, and she’ll explain why in fives.

“For ancient Egyptians, five was for worship” — Dr. Afaf Meleis raised her right hand — “and it was for offerings”  — she extended her right hand  — “and it was on temples to keep the evil eye away, which now is the khamsa that’s used in so many cultures … (and) brings its owner happiness, luck, health, good fortune and safety. And that’s what we want to bring to women of the world.”

So it should come as no surprise that Meleis chose to organize her lecture, “Empowered, Healthy Women: Overcoming Universal Challenges,” by fives.

She started with five reasons she loves visiting Chautauqua: her admiration of Rev. Joan Brown Campbell, the “warm and inviting” Chautauqua community, the presence of her colleagues and opportunities to make new friends, intellectual stimulation and spiritual inspiration.

“I simply love this place!” she said.

Meleis is the Dean of Nursing of the University of Pennsylvania and directs the university’s WHO Collaborating Center for Nursing and Midwifery Leadership. She is also Council General Emerita of the International Council on Women’s Health Issues.

“This talk today is about advocating for safe womanhood and diplomacy about women’s health, diplomacy that’s not about health in general but is particularly about women’s health,” she said. “This is not about maternal-child health; it’s not about women as reproductive beings. This is about women as productive human beings. It’s about half the population of this world who are vital for productivity, for economic security, and for peace. … This is about safe womanhood, not safe motherhood.”

In her next set of five points, Meleis shared the experiences that fuel her passion for safe womanhood.

First, she listened to the stories of women around the world. Meleis has traveled to 60 countries and researched formally in 10, but her own roots inspired her.

“My listening actually started with my own grandmother … who was illiterate in terms of education but she was wise in terms of life,” she said.

Half of her grandmother’s children died at a young age.

“She helped me ask the questions — why she didn’t get help with her birthing and why so many babies died — which are the questions we’ve been asking this week,” Meleis said.

Her second inspiration was her grandmother’s determination to secure an education for Meleis’ mother, who went on to become the first woman to receive advanced nursing degrees in the Middle East.

“It was my mother’s knowledge, perspective, compassion, and passion and diligent work as a nurse-midwife that ignited my passion for women’s health,” she said.

Her third inspiration was her childhood friend. Close to tears, Meleis described how her friend, who was just 12 years old, left one summer and never returned, fated to be a child bride.

Nursing was her fourth inspiration.

She said she learned that nursing and midwifery help to solve many of the health issues women face.

Her extensive research, in countries from Brazil to Yemen to the United States, was the fifth factor.

This same research helped her to identify many myths about women’s health. She shared five of these misconceptions with the audience.

Pregnancy, she began, is not a wonderful time for all women. The No. 1 killer for women between ages 15–19 is the complications that arise from pregnancy.

“For many disadvantaged and marginalized women, (pregnancy) comes with grave risks,” Meleis said. “A woman dies every 90 seconds from a pregnancy complication. What’s even more staggering is that 90 percent of these deaths are preventable.”

In some parts of the world, a proverb describes cultural attitudes toward pregnancy: “To be pregnant is to put one foot in the grave.”

“There is a global shortage of nurses and midwives … because of lack of investment … because of lack of valuation of the work that those caregivers provide, because these are women’s professions,” she said.

Investment in these professions has not been a part of programs like the President’s Emergency Plan for AIDS Relief or other foreign aid packages.

But Meleis emphasized this is not just a problem in faraway countries.

“In the United States, one in five women of reproductive age lack health insurance and can’t afford prenatal care,” she said. “We rank 50th among the nations with the lowest rates of maternal mortality. It’s unforgivable.

The second myth is that motherhood is joyous for all women. For one, female children are devalued in some societies.

“When we put our gender glasses on, we find out that (technology) has some perils for motherhood,” Meleis said. “Mothers suffer the loss of their daughters before they are even born… They abort them because society does not like having daughters.”

She referenced the book Unnatural Selection by Mara Hvistendahl, who estimates that 163 million girls have been aborted since 1970 because of their sex.

In addition, malnutrition plagues motherhood.

“Malnutrition is the cause of one-third of all maternal and childhood deaths,” she said.

Malnutrition leads to delayed cognitive development, which can affect a country’s overall economic development.

Other phenomena, like hunger and human trafficking, complicate women’s ability to care for their children. Again, Meleis emphasized that such problems are local to the United States as well as global.

The third myth is about women and work.

“Women comprise half of the global population and workforce. They earn 10 percent of the world’s income,” Meleis said. “Women’s jobs outside the home tend to be the worst compensated, the least secure and the most dangerous.”

She said a lack of legal protection encourages manipulation, abuse and exploitation, and the work that women do inside the home is not counted by governments as “real” work.

The fourth rumor is that marriage is bliss. One out of seven women are married before the age 15, she said.

“Child marriage is one of the major obstacles preventing 600 million girls from getting their education and reaching their full potential,” Meleis said.

Child marriage also increases the risk of contracting diseases like HIV, she said.

“This is not unusual in the United States, so please don’t sit here and think this is happening somewhere else,” said Meleis, citing the incidents surrounding Warren Jeffs and the Yearning for Zion Ranch in 2008.

She said honor killings pose a serious problem, and according to the United Nations, 5,000 women are killed annually.

“Marriage is a risk factor,” Meleis said, referencing a “culture of silence” that causes a woman to worry her husband might take a second or third wife if she complains about her situation.

The fifth myth concerns urbanization.

“It contributes to scarcity of resources, lack of infrastructure, the provision of a social network … women face new health risks,” Meleis said.

Of the world’s people who live in urbanized areas, 32 percent reside in slums, and 70 to 80 percent of those who live in slums are women, she said.

Meleis then named five national and international actions that are happening today that treat “women as whole, rather than reproductive beings.”

First, Meleis discussed political progress in the United States.

“President Obama and Secretary of State Hillary Clinton made girls and women central, not mothers and not pregnant women only, but girls and women, central in U.S. global health programs, advocating also for maternal and child health,” she said.

Obama requested an increase of 20 percent funding for global maternal and child health programs, and appointed Melanne Verveer to the position of ambassador-at-large for Global Women’s Issues, she said.

Meleis said she regards Verveer as an influential, articulate spokesperson.

The U.S. State Department recently released new information and ideas to combat human trafficking.

“When you have a report like that, it becomes a key diplomatic tool,” Meleis said.

Former first lady Laura Bush has developed the Women’s Initiative, which encourages women in the United States and abroad to take part in the political sphere.

“(The initiative) looks at how to give (women) a voice in the election process and put them in parliaments,” Meleis said. “It encourages girls and women (in the United States) to transform their communities.”

In addition to actions in the United States, Meleis explained the positive impact of the G8 Summit. Canadian Prime Minister Stephen Harper introduced a multi-billion-dollar initiative to target maternal and child health.

“It’s focusing on nutrition and relationships and immunizations,” Meleis said.

Though she would rather such an initiative focus on empowering women, she said she was encouraged by the parts of the initiative that went beyond disease prevention and treatment.

Meleis praised United Nations Secretary General Ban Ki-moon.

“(He) speaks so passionately about (women’s health) … he also appointed Michelle Bachelet the under-secretary of UN Women,” she said.

Bachelet was the first female president of Chile. Her full, formal title is Under-Secretary-General for Gender Equality and the Empowerment of Women.

“The priorities (of the committee) are about ending violence, expanding women’s voices and leadership and enhancing economic empowerment,” Meleis said. “All those lead to better maternal and child health, but (don’t only) focus on maternal and child health.”

The fourth factor is the emphasis on the investment and training of midwives and nurses, demonstrated by World Health Organization and United Nations’ call for 1 million more health care providers.

The fifth action is an initiative taken by Meleis’ own University of Pennsylvania.

“We are preparing a capacity of future physicians and nurses who think about women and women’s health,” Meleis said. “(University of Pennsylvania) President (Amy) Gutmann invited 25 presidents of universities from 25 countries, and we partnered with the United Nations in calling for each of those universities to come up with a plan on how their participation in their own country (can help to empower women). We developed a white paper to be a model for other organizations.”

To conclude the lecture, Meleis offered six actions for the audience to consider.

• A is for Act, Advocate and Ask questions.
• B is for Be a voice and Be involved in your neighborhood.
• C is for Collaborate.
• D is for Dispel myth and Disseminate accurate information.
• E is for Engage with groups working for the safety of women.
• F is for move Forward.

“Make sure wherever you are, that you advocate for accountable maternity leave, benefits of eldercare, for childcare, for public safe places for women,” Meleis said. “We need to be enraged and nurture a passion for making a difference in the world.”

UPDATE: The story has been changed to correct the spelling of Afaf Meleis’ first name.

Emily Perper | Staff Writer

“What is the value of a mother’s life?”

Then: “What is the value of your mother’s life?”

These questions, posited by Dr. Jean Chamberlain Froese, the founder and director of Save the Mothers, began her presentation, “Am I My Sister’s Keeper: Addressing Maternal Mortality in the 21st Century.”

The audience mulled over her questions. There were murmurs of “I wouldn’t have enough money!” and “Priceless!” at 2 p.m Tuesday in the Hall of Philosophy.

Yet the discrepancy in maternal mortality in developing countries demonstrates something else.

“All mothers are not worth the same — or so it seems,” Froese said.

In addition to her work with Save the Mothers in Uganda, Froese works as an obstetrician while at home in Canada during summers. In 2006, she received an International Community Service Award from the Federation of International Obstetricians/Gynecologists.

“I really saw at a young age about the discrepancy between the health and the spiritual well-being of people in the developing world,” she said. “And so I decided that one day I wanted to be a missionary doctor somewhere in Africa.”

She said her travels around the world provoked her to ask herself, “What is my responsibility as a Western-trained obstetrician … to that woman out in the village who can’t even access a simple antibiotic to save her life or the life of her child?”

Froese offered four answers to the question, “Why should we care, and more importantly, why should we act?”

First, there is the moral imperative.

“It’s the right thing to do,” Froese said.

Second, saving the lives of mothers saves the lives of children.

“Four million babies die as a result of unsafe motherhood,” she said.

Third is the economic aspect. Saving the lives of mothers saves money, and the financial figures matter to politicians. Investing in safe motherhood could save an estimated $250 million in Uganda alone, Froese said.

Fourth, equipping hospitals to serve the needs of women is “building a health system for all.”

Froese said the tools needed to perform a cesarean section on a woman could also perform an appendectomy in a man. Similarly, blood transfusions for women bleeding after delivery can help injured car accident victims, and antibiotics can be given to pregnant mothers and to children with pneumonia.

“Building this … health system that saves mothers’ lives also saves the whole community,” Froese said.

One obstacle to the prevention of maternal mortality is the fatalism that pervades some communities in Africa, Froese said.

“There’s a real fatalism in many parts of the developing world: ‘It was God’s will that that happened,’” Froese said. She said she understands that such a reaction is natural in the face of the tragedies the people have experienced.

“We have to, again, help people think about things differently … teaching people that it actually is in your hands. … God is ultimately in control, but he’s also given you resources,” she said.

In addition to the hopelessness, Froese described “three deadly delays.” The first is the delay of the home; women might be miles from a facility that could provide adequate care for them, and finances are typically in the hands — literally — of the paternal household figure, who works outside the home.

The second delay is the delay of transportation. Women have to walk, wait hours for a bus or ride a bike down dirty roads to find health care.

The third delay is the delay of medication.

“There’s a huge barrier, even at the health facilities, of saving mother’s lives,” Froese said. “There’s not enough treatment out there to help these women … suffering because they’ve been in labor for too long.”

Unsafe motherhood has resulted in what Froese refers to as two million “21st century lepers” — women infected with fistulas.

“At least 50 percent of the delays are attributable to (the delays of the home and transportation),” Froese said. “(The purpose of Save the Mothers is to) train indigenous leaders within strategic contexts and professions to address those three delays — especially those two delays that I as a health worker can never address.”

Froese discussed the changing attitudes she has witnessed and how Save the Mothers uses the media to reach out.

“We’re targeting journalists who can give the messages about safe motherhood (and) how to save mothers’ lives,” she said.

Froese provided several examples of how the idea of safe motherhood is moving into the political sphere in Uganda. One-third of the House of Parliament in Uganda is women, and six of these women have been a part of Save the Mothers.

“(They’ve) brought new legislation for safe motherhood that makes the government accountable … it’s a start to get the government involved,” Froese said.

A part of Ugandan President Yoweri Museveni’s manifesto centered on the imperative surrounding maternal mortality.

“One of the things he was focusing on was safe motherhood … that is unbelievable that he would get up in front of the whole country and say, ‘You know, we have to improve maternal health in our own country,’” Froese said.

Changes in the budget also show improvement.

“When there’s money being delegated to safe motherhood, then you know there’s going to be real action on the ground,”  Froese said.

Froese expounded upon several of Save the Mothers’ goals: “Save the Mothers is hoping to expand into all of east Africa now and … to improve the facilities as well, to make mother-friendly hospitals,” she said.

“Mother-friendly” doesn’t mean Western standards, she added, but rather describes facilities with the basics — like running water.

Froese concluded her presentation by reassuring the audience members that they would be able to help to promote safe motherhood in different ways during different seasons throughout their lives.

“We can all do something. We can all be our sister’s keeper,” Froese said. “The question is, will we?”

Emily Perper | Staff Writer

The facts speak for themselves. HIV/AIDS is an equal opportunity killer.

Thirty million people are currently infected. Instead of targeting the young and elderly, the disease most frequently kills those between the ages of 15 and 40.

“If we don’t act on this, it’s a lack of faith, hope and love,” Ambassador Mark Dybul said.

On Monday, Dybul presented “Faith and Global Health: Opportunities and Challenges to Create a More Perfect World.” Chautauquans arrived at Hall of Philosophy more than an hour early for the first Interfaith Lecture of the 2011 Season.

Dybul was the United States Global AIDS Coordinator from 2006 to 2009. He currently serves as the co-director of the O’Neill Institute for National and Global Health Law at Georgetown University, where he is a Distinguished Visiting Scholar.

To give context for his passion, Dybul briefly traced the growth of global health.

“The history of development isn’t particularly attractive,” Dybul said as he explained that development began with colonialism and imperialism, adding that the positive aspects of missionary zeal ran counter to the political and exploitative tendencies.

Dybul called the Cold War the worst period in the history of global health. Helping other countries prevent disease was a way to expand the United States’ sphere of influence. Aid did not come from a place of altruism but from a desire to form alliances. “Post-colonial guilt” was more about subliminating feelings of responsibility than finding permanent solutions.

A new era emerged with the drafting of the Monterrey Consensus on Financing for Development, published in 2002 by the United Nations, which altered the way the world approached global health, Dybul said.

“It moved from the paternalism of the past,” he said. “Development was actually about a partnership.”

Under the George W. Bush administration, Dybul helped to lead the President’s Emergency Plan for AIDS Relief, “the largest international health initiative in history for a single disease,” according to its website.

Dybul mentioned several other successful development initiatives: The Global Fund to Fight AIDS, Tuberculosis and Malaria; the President’s Malaria Initiative; and the Global Alliance for Vaccines and Immunisation.

“The American people are the largest contributors to all of these,” Dybul said.

The initiatives Bush supported may have seemed contradictory to his socially and fiscally conservative political stance, but Bush’s personal faith influenced his decision to support funding for global health development, Dybul said.

He added that when asked, Bush referenced his personal faith and quoted part of Luke 12:48: “When someone has been given much, much will be required in return.”

After years in government, Dybul understood that bureaucracy tended to distort originally well-intentioned movements and exacerbate human fallibility.

“Development and health were not about government-to-government relationship; they’re about people-to-people relationships,” he said. “And that meant faith-based organizations, the private sector, everyone needed to be engaged.”

Faith-based organizations are positioned uniquely in the global health arena. The World Health Organization reported faith-based organizations provide 90 percent of orphan care and 50 to 75 percent of healthcare in Africa.

On a continent where there are 12 million orphans, orphan-dominated villages have emerged in which the oldest person in a village is between 15 and 20 years old. Although they were recently children themselves, they cared for the other village children. In such situations, faith-based orphan care is a significant help, Dybul said.

Philosophically faith-based organizations differ from other institutions, he added.

“At its best, faith is a profound openness to otherness,” Dybul said. “People of faith see the image of their creator in others, and therefore see the others as deserving of love and respect and are hopeful they will receive it.”

Dybul made note of two important factors that set faith-based organizations apart from other groups.

First is the reclamation of the original purpose of the missionary zeal of colonial times, balanced with a continued rejection of paternalism.

“Faith and faith communities see the dignity and worth of every human life, and that means every human life has the ability to own its future … that person doesn’t need to be told what to do,” Dybul said, reiterating the importance of the shift from paternalism to equality.

The second factor is the recognition of the value of the whole person, not fixating on his or her disease — “caring for the mind, body and soul.” And while faith-based organizations are not the only organizations to do this, it tends to be emphasized within them.

The link between maternal mortality and the well-being of children is significant. Children whose mothers perish in childbirth are 10 times more likely to die themselves within two years, according to the UNICEF website.

At the time of the United States’ founding, maternal death was as common in the U.S. as it is in Africa today. This fact, Dybul said, shows that mortality rates can change.

There are both cultural and economic obstacles to combating HIV/AIDS.

“Stigma against HIV has been a very significant problem in faith communities, in part because of … some of the people who are involved — men who have sex with men, drug users, sex workers — and in part because it’s about sex. And sex is not a comfortable conversation for a lot of faith-based organizations,” Dybul said.

He explained that a “culture of life,” a central and valued part of many faiths, has come into conflict with the concept of contraception.

“There is always opportunity in challenge, and we have the opportunity to grow in wisdom together,” he said.

He acknowledged the difficulty of such an initiative in economically challenging times but also stressed that these solutions were “simple (and) inexpensive.”

Such measures include procedures like male circumcision, which reduces the spread of HIV/AIDS by 60 percent. Giving HIV/AIDS medication to the uninfected prevents them from getting the disease.

“(Treating the disease directly) drives down the amount of virus in the body so it reduces the ability of a person to transmit the virus by 96 percent,” Dybul said. “By putting these things together, what we call combination prevention … we have the science to drive HIV into the ground — to make it virtually go away.”

Dybul believes it is possible to continue to heal HIV/AIDS patients and to remain economically responsible.

“We surely can get our fiscal house in order while at the same time saving and lifting up lives and ensuring we’re using the money we have wisely, being stewards of this world, of our resources,” he said. “We know when we act out of faith and love, anything is possible.”