Young people often ask us how they can help address issues like sex trafficking or international poverty. Our first recommendation to them is to get out and see the world. If you can’t do that, it’s great to raise money or attention at home. But to tackle an issue effectively, you need to understand it—and it’s impossible to understand an issue by simply reading about it. You need to see it firsthand, even live in its midst.
One of the great failings of the American education system, in our view, is that young people can graduate from university without any understanding of poverty at home or abroad. Study-abroad programs tend to consist of herds of students visiting Oxford or Florence or Paris. We believe that universities should make it a requirement that all graduates spend at least some time in the developing world, either by taking a “gap year” or by studying abroad. If more Americans worked for a summer teaching English at a school like Mukhtar’s in Pakistan, or working at a hospital like HEAL Africa in Congo, our entire society would have a richer understanding of the world around us. And the rest of the world might also hold a more positive view of Americans.
Young people, women especially, often worry about the safety of volunteering abroad. There are, of course, legitimate concerns about disease and violence, but mostly there is the exaggerated fear of the unknown—the mirror image of the nervousness that Africans or Indians feel when they travel to America for their studies. In reality, Americans and Europeans are usually treated hospitably in the developing world, and are much less likely to be robbed in an African village than in Paris or Rome. The most dangerous part of living in a poor country is often the driving, since no one wears seat belts, and red lights—if they exist—tend to be regarded as mere suggestions.
Harper McConnell with a friend at the HEAL Africa hospital in Congo (Nicholas D. Kristof)
American women sometimes do get unwanted notice, particularly if they are blond, but it’s rarely threatening. Once women have settled in at their destination, they usually find it safer than they had imagined. Western women are often exempt from local indignities and harassment, partly because local men find them intimidating. Women volunteers often have more options than men do. For example, in conservative cultures, it may be inappropriate for an American man to teach female students or even talk to women, while an American woman may well be able to teach either boys or girls and to mix with local men and women alike.
There are countless opportunities to volunteer at the grassroots. Most of the aid programs we refer to in this book welcome volunteers, as long as they stay for a few months to make the visit worth the trouble. We’ve noted contact information for these organizations in the appendix. Time spent in Congo and Cambodia might not be as pleasant as in Paris, but it will be life-changing.
Harper, who grew up in Michigan and Kansas, was studying political science and English at the University of Minnesota, not sure what she would do afterward. She had studied poverty and development and was feeling restless and pressured with graduation looming. Then, in May of her senior year, she heard that her church was exploring a relationship with a hospital in Congo. The church, Upper Room, in Edina, Minnesota, understood something important: The congregation should not just be writing checks but also getting actively involved. So Harper talked to her pastor about the Congo arrangement, and by the end of the meeting Harper had agreed to go live in Goma to oversee the relationship with the HEAL Africa hospital.
“We want to educate our congregation about eastern Congo and give them the chance to come and see life here,” she says. “I also provide the church with the reality on the ground to make sure that projects which are dreamed up in offices in the United States actually meet the needs in the field.”
Harper stays in a nice Western-style house in Goma, with the couple who founded the HEAL Africa hospital: a Congolese doctor, Jo Lusi, and his wife, Lyn, from England. Jo and Lyn take up one room in the house, which is always crowded with visitors and guests. And while it provides a sanctuary from the chaos of Congo, the generator still goes off at 10 p.m.—and don’t count on a hot shower. Then there’s the countryside, which often feels as if it’s a century or two behind Goma. One day Harper was bubbling with news: “One of our teams just went to a village that hadn’t seen a car since the 1980s. They called it ‘a walking house.’”
HEAL Africa is a major hospital. Officially it has 150 beds, but there are usually 250 patients, and it manages to accommodate them. There are 14 doctors and a total staff of 210, all of whom are Congolese except for Lyn, Harper, and one other person. The hospital manages to have clean sheets, but there are still just two gynecologists in an area with 5 million people. Getting electricity, water, and bandages for the hospital is a nightmare, and corruption is overwhelming. In 2002, a nearby volcano erupted, and when the lava reached the building the hospital burst into flames. Most of the hospital grounds were covered in eight feet of lava, but with support from American donors, the hospital was rebuilt as soon as the lava had cooled.
For a young, single person, living in a place like Goma can be tedious and confining. Harper broke up with her boyfriend of two years when she moved to Congo, and although she regularly gets marriage proposals from drivers, there isn’t any dating scene. Once she contracted malaria and ended up in her own hospital. But she felt a measure of pride at finally enduring the standard African ailment. As she was lying feverishly in her hospital bed, nourished by an IV drip, she awoke thinking that she saw Ben Affleck looming over her hospital bed. She soon realized it was not a figment of her delirium: Affleck was visiting Congo and had come by to wish her well.
There are also compensations for the lack of shopping malls and Netflix movies. Harper has undertaken two major projects that make her excited to get out of bed each morning. First, she started a school at the hospital for children awaiting medical treatment. It can take several months before children with orthopedic problems receive care, and they often come from rural areas with no decent schools. So Harper found teachers and put together a classroom. The children now can go to school six days a week. At the age of twenty-three, Harper became the principal of her own school.
Second, Harper started a skills-training program for women awaiting surgery. Many of the patients, like Dina, spend months at the hospital, and they can now use the time to learn to sew, read, weave baskets, make soap, and bake bread. Typically a woman chooses one of the skills and then works with a trainer until she is confident that she can make a living at it. When the woman leaves, HEAL Africa gives her the raw materials she needs—even a pedal sewing machine, if she has learned tailoring—so that she can generate income for her family afterward. Those who have trouble absorbing vocational skills are at least given a big block of salt so that they can break it up and sell little bags of salt in the market to survive. The ability to earn a living transforms the women’s lives.
“The women are so excited about Harper’s program,” said Dada Byamungu, whom Harper hired to teach sewing. As we talked, a raucous group of women surrounded Harper, teasing her and thanking her in Swahili, all at the same time—and she was laughing and retorting in rapid-fire Swahili. Dada translated what the women were saying: “They say that they will lift Harper up and make her their queen!”
If you were to come to dinner at our home, you would see lovely woven reed placemats made by women at HEAL Africa. Harper has set up a little shop at the hospital to sell goods like these that the women are making, and she’s trying to sell them on the Internet and in American department stores as well. If you’re an American university student, there’s something else that Harper did that may be more relevant: She is setting up a study-abroad program for Americans who want to spend a month at ULPGL, a university in Goma. The Americans will take courses with Congolese students, spend time in the classroom and the field, and write research papers together in small groups.
Harper also tries to encourage donors in the United States. The hospital has an annual budget of $1.4 million, more than one third of which is co
ntributed by individual Americans (more information is at www.healafrica.org). Only 2 percent of those donations go to overhead and administrative expenses; the rest is plowed into the hospital. The hospital even accepts gifts of airline miles, to fly staff back and forth, and it eagerly welcomes volunteers and visitors.
“I’d rather have someone come here and see what’s going on than write a check for one or two thousand dollars, because that visit is going to change their life,” Harper says. “I have the privilege of hearing from church members and other visitors about how their time at HEAL Africa has turned their worldview upside down and changed their lifestyle at home.”
As Harper jabbers away in Swahili with her African friends, it’s clear that she is getting as well as giving. She agrees:
There are times when all I want is a fast Internet connection, a latte, and a highway to drive on. Yet the greetings I receive in the morning from my coworkers are enough to keep me here. I have the blessing of carrying a purse sewn by a woman waiting for fistula surgery at the hospital and watching how these new skills have changed her whole composure and confidence, of celebrating with my Congolese friend who was accepted for a job right after he graduated from university, of seeing children in school who previously never had the chance, of rejoicing with a family over their improved harvest, of dancing with my coworkers over a grant awarded for a program. The main factor that separates me from my friends here is the opportunities I was given as a first-world citizen, and I believe it is my responsibility to work so that these opportunities are available to all.
CHAPTER SIX
Maternal Mortality—One Woman a Minute
Preparation for death is that most Reasonable and Seasonable thing, to which you must now apply yourself.
—COTTON MATHER, IN A SERMON,
ADVISING PREGNANT WOMEN
No one reading this book, we hope, can fathom the sadistic cruelty of those soldiers who used a pointed stick to tear apart Dina’s insides. But there is also a milder, more diffuse cruelty of indifference, and it is global indifference that leaves some 3 million women and girls incontinent just like Dina. Fistulas like hers are common in the developing world but, outside of Congo, are overwhelmingly caused not by rape but by obstructed labor and lack of medical care during childbirth. Most of the time, such women don’t get any surgical help to repair their fistulas, because maternal health and childbirth injuries are rarely a priority.
For every Dina, there are hundreds like Mahabouba Muhammad, a tall woman who grew up in western Ethiopia. Mahabouba has light chocolate skin and frizzy hair that she ties back; today, she tells her story easily, for the most part, occasionally punctuated with self-mocking laughter, but there are moments when the old pain shines through in her eyes. Mahabouba was raised in a village near the town of Jimma, and her parents divorced when she was a child. As a result, she was handed over to her father’s sister, who didn’t educate her and generally treated her as a servant. So Mahabouba and her sister ran off together to town and worked as maids in exchange for room and board.
“Then a neighbor told me he could find better work for me,” Mahabouba recalled. “He sold me for eighty birr [ten dollars]. He got the money, I didn’t. I thought I was going to work for the man who bought me, in his house. But then he raped me and beat me. He said he had bought me for eighty birr and wouldn’t let me go. I was about thirteen.”
The man, Jiad, was about sixty years old and had purchased Mahabouba to be his second wife. In rural Ethiopia, girls are still sometimes sold to do manual labor or to be second or third wives, although it is becoming less common. Mahabouba hoped for consolation from the first wife, but instead the woman whipped Mahabouba with savage relish. “She used to beat me when he wasn’t around, so I think she was jealous,” Mahabouba remembered angrily, and she paused for a moment as the old bitterness caught up with her.
The couple wouldn’t let Mahabouba out of the house for fear she might run away. Indeed, she tried several times, but each time she was caught and thrashed with sticks and fists until she was black, blue, and bloody. Soon, Mahabouba was pregnant, and as she approached her due date Jiad relaxed his guard over her. When she was seven months pregnant, she finally succeeded in running away.
“I thought if I stayed, I might be beaten to death along with my child,” Mahabouba said. “I fled to the town, but the people there said they would take me right back to Jiad. So then I ran away again, back to my native village. But my immediate family was no longer there, and nobody else wanted to help me because I was pregnant and somebody’s wife. So I went to drown myself in the river, but an uncle found me and took me back. He told me to stay in a little hut by his house.”
Mahabouba couldn’t afford a midwife, so she tried to have the baby by herself. Unfortunately, her pelvis hadn’t yet grown large enough to accommodate the baby’s head, a common occurrence with young teenagers. She ended up in obstructed labor, with the baby stuck inside her birth passage. After seven days, Mahabouba fell unconscious, and at that point someone summoned a birth attendant. By then the baby had been wedged there for so long that the tissues between the baby’s head and Mahabouba’s pelvis had lost circulation and rotted away. When Mahabouba recovered consciousness, she found that the baby was dead and that she had no control over her bladder or bowels. She also couldn’t walk or even stand, a consequence of nerve damage that is a frequent by-product of fistula.
“People said it was a curse,” Mahabouba recalled. “They said, ‘If you’re cursed, you shouldn’t stay here. You should leave.’” Mahabouba’s uncle wanted to help the girl, but his wife feared that helping someone cursed by God would be sacrilegious. She urged her husband to take Mahabouba outside the village and leave the girl to be eaten by wild animals. He was torn. He gave Mahabouba food and water, but he also allowed the villagers to move her to a hut at the edge of the village.
“Then they took the door off,” she added matter-of-factly, “so that the hyenas would get me.” Sure enough, after darkness fell the hyenas came. Mahabouba couldn’t move her legs, but she held a stick in her hand and waved it frantically at the hyenas, shouting at them. All night long, the hyenas circled her; all night long, Mahabouba fended them off.
She was fourteen years old.
When morning light came, Mahabouba realized that her only hope was to get out of the village to find help, and she was galvanized by a fierce determination to live. She had heard of a Western missionary in a nearby village, so she began to crawl in that direction, pulling her body with her arms. She was half dead when she arrived a day later at the doorstep of the missionary. Aghast, he rushed her inside, nursed her, and saved her life. On his next trip to Addis Ababa, he took Mahabouba with him to a compound of one-story white buildings on the edge of the city: the Addis Ababa Fistula Hospital.
There Mahabouba found scores of other girls and women also suffering from fistulas. On arrival, she was examined, bathed, given new clothes, and shown how to wash herself. Fistula patients often suffer wounds on their legs, from the acid in their urine eating away at the skin, but frequent washings can eliminate these sores. The girls in the hospital walk around in flip-flops, chattering with one another and steadily dripping urine—hospital staff joke that it is “puddle city”—but the floors are mopped several times an hour, and the girls are too busy socializing with one another to be embarrassed.
The hospital is run by Catherine Hamlin, a gynecologist who is truly a saint. She has devoted most of her life to poor women in Ethiopia, undergoing danger and hardship while transforming the lives of countless young women like Mahabouba. Tall, lean, and white-haired, Catherine is athletic, welcoming, and wonderfully gentle—except when people suggest she is a saint.
“I love this work,” she said in exasperation the first time we met. “I’m not here because I’m a saint or doing anything noble. I enjoy my life tremendously…. I’m here because I feel God wants me to be here. I feel I’m doing some good and helping these women. It’s very satisfying work.”
Catherine and her late husband, Reg Hamlin, moved from their native Australia to Ethiopia in 1959 to work as ob-gyns. In Australia, they had never seen a single case of fistula; in Ethiopia, they encountered fistulas constantly. “These are the women most to be pitied in the world,” Catherine says firmly. “They’re alone in the world, ashamed of their injuries. For lepers, or AIDS victims, there are organizations that help. But nobody knows about these women or helps them.”
Fistulas used to be common in the West, and there was once a fistula hospital in Manhattan, where the Waldorf-Astoria Hotel is today. But then improved medical care all but eliminated the problem; now almost no woman in the rich world spends four days in obstructed labor—long before then, doctors give her a C-section.
In 1975, Catherine and Reg founded the Addis Ababa Fistula Hospital, and it remains a lovely hillside compound of white buildings and verdant gardens. Catherine presides over the hospital, living in a cozy house in the center of the compound, and she plans to be buried in Addis Ababa alongside her husband. Catherine has presided over more than twenty-five thousand fistula surgeries and has trained countless doctors in the specialty. She is an exceptionally skilled surgeon, but because some patients don’t have enough tissue left to repair they are given colostomies, so that feces leave the body through a hole made in the abdomen and are stored in a pouch that must be regularly disposed of. Patients with colostomies require ongoing care and live in a village near the hospital.
Mahabouba is one of those who couldn’t be fully repaired. Physical therapy got her walking again, but she had to settle for a colostomy. Still, when she had recovered her mobility, Catherine put her to work in the hospital. At first Mahabouba simply changed linens or helped patients wash, but gradually the doctors realized that she was smart and eager to do more, and they gave her more responsibilities. She learned to read and write, and she blossomed. She found a purpose in life. Today, if you were to visit the hospital, you might well see Mahabouba walking around—in her nurse’s uniform. She has been promoted to the position of senior nurse’s aide.
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