“Welcome to the realities of the health care system in Africa”

On Thursday the 23rd of May, I walked into the military hospital of Abidjan. I was excited to be in a different environment and excited to start my internship. I was creating scenarios in my head of how my first day would go; the people I would meet and the relationships I would create. I was nervous but ready, or so I thought.

My first day in the emergency room in Abidjan.
My first day in the emergency room in Abidjan.

I first walked to the tailor whose place was in the hospital near the restrooms to get the uniforms I ordered the day before. After I changed into my all white outfits, I walked directly to the emergency room. I was at the hospital the day before to meet with the Chief of Service and speak about my goals for this internship. After our short conversation, because of his busy schedule, he showed me around the hospital and the different departments. Before he left me in the emergency room to meet with the head of the emergency department he said to me, “I hope you are ready because the things you will see here, you will never see anywhere else. Unfortunately, we have very little to no resources and we work around that. I think you should visit as many departments as you can. Work closely with the doctors and see how they are managing with their patients. Also lastly, I will advise that you start in the emergency room. That’s where our most serious cases happen and you will definitely learn a lot.”  He did not lie.

After I dropped off my bag, I headed to the doctor’s office. A patient was being rushed into the hospital. He was in a coma for a couple minutes, was barely breathing and his blood pressure was low. My first day had just started. I saw doctors and nurses run around to re-animate the patient. No machines were used on him, unfortunately.  The main room where patients were being consulted in the emergency room was one bed, a desk for the two doctors on duty, chairs for them to sit, a closet that contains some medical supplies, a sink to wash their hands, two garbage cans, and that was it. These doctors were clinicians and relied more on their hands than machines. The patient, after a couple injections and many other things, woke up and was breathing normally. When things quieted down, I finally had the chance to present myself to everyone. The doctors took me close to them and made sure I understood why and how they were doing the things they did to the patients. Throughout the day, they presented me to the rest of their patients as Doctor Soumahoro which made me carry some type of responsibility and made me feel included, or at least welcomed. The waiting room of the emergency room was also filled with patients with different conditions ready to be seen by the doctors. However because they were only two doctors and two nurses present, the wait time could vary between an hour or two or even more sometimes depending on the urgency. When a patient came in, the nurses took the vitals before the doctors saw them. I learned and found myself helping to do the same.

One thing’s for sure, My beautiful country is still developing and is struggling to give the proper resources to their hospitals.  However, I have never seen doctors as dedicated and hard-working as the ones I met here. We worked from 8am to 2pm without a break.  I finally took a moment to drink some water and eat. But these two doctors took no breaks because they felt like their patients were waiting. I left the hospital to go home around 5pm and these doctors were still working. I finally met people who were as dedicated as I am and ready to save the world, and I felt comfortable around them. Here was a place where there is love for medicine and love for humanity, and that love brought me here. “Awa welcome back home. It was a pleasure working with you today and welcome to the realities of the health care system in Africa,” one of the doctors told me before I left. “Thank you and I am ready for the challenge” I replied.

– Awa Soumahoro

 

Research Summaries from a Summer in Bhopal, India

In the following post, I try to summarize the research findings that I’ve come across during my time in Bhopal, India (and share some photos, too).  I’m currently working on a website where I will be posting this as well.  I am also considering doing a photo exhibition at Brandeis to raise awareness on the Bhopal gas tragedy that happened in 1984. Bhopal is a beautiful city, it’s unfortunate that people living here have to breathe clouds of toxic gases and drink contaminated water.
I’m also working on a short video about what social justice means to the staff, doctors and volunteers at the clinic in the face of industrial disasters.  I’ll definitely try to upload that in my next post!
Research Topics & Findings

Social Justice and Industrial Accidents

There are many different ways that large multinational corporations affect local communities in developing countries- environmentally, physically and psychologically (Labunska et al, 1999; Mitchell, 1996). Yet it is only when this global industrialization results in a catastrophic event where people’s lives and health are at risk that the world’s media and legal systems pay attention. However, such attention is often short-lived and lacks any depth of study to monitor the lasting effects on people and communities. Such is often the story with industrial accidents in the developing world- countries with lower safety measures and a greater economic need to win over a large profitable contract are both more likely to harbor an industrial accident (Mitchell, 1996) and less likely to be able to appropriately manage and deal with one. At Sambhavna Trust in Bhopal, I am looking at issues of social justice and health promotion in the context of developing countries affected by industrial accidents, and in particular, the legacy of the industrial accident in Bhopal. I am looking for a definition of social justice that looks to the future, one that aims for a just reaction and response to industrial accidents. The industrial accident in Bhopal, India and its repercussions has been termed ‘the world’s worst industrial disaster’ (Hanna et al, 2005, p.6) and provides a great starting point to explore such a definition of social justice.

 

Five past midnight in Bhopal

At five past midnight on 3rd December 1984 a pesticide plant in Bhopal owned by the American company Union Carbide leaked 40 tons of methyl isocyanate gas (MIC) into the surrounding environment (Broughton, 2005; Hanna et al, 2005; Mitchell, 1996). MIC is highly toxic and can be fatal. Short term effects on people’s health include burning in the respiratory tract and eyes, blepharospasm, breathlessness, stomach pains and vomiting. These acute symptoms can lead to death by choking, reflexogenic circulatory collapse and pulmonary pedema, as well as damaging the kidneys, liver and reproductive organs (Sriramachari, 2004). Through the night of 3rd December 1984 thousands of people died- the official number remains unknown; the Government of India declares the death toll to be at least 3800 (Broughton, 2005), while other estimations by independent organizations, NGOs and the International Campaign for Justice in Bhopal (ICJB) vary between 10,000 and 30,000 (ICJB, 2010; Eckerman, 2005). A further 100,000- 150,000 people are estimated to have permanent injuries as a result of the MIC exposure and the stillbirth rate in those affected increased by up to 300% (Eckerman, 2005). The overwhelming majority of those affected were living in bastis (local term for temporary, substandard accommodation communes) surrounding the factory, where birth records were rare and number of inhabitants unknown. Mass cremations and burials began the day after the accident. There are varying reports on the specific causes of the gas leak though it is clear that poor maintenance of the plant since it ceased production months earlier, led to the magnitude of the problem; several key safety systems were switched off under Union Carbide Corporation’s instruction, including the MIC tank refrigeration system, in order to save money (Eckerman, 2005; ICJB, 2010; Hanna et al, 2005).

 

Ongoing Effects

The deserted Union Carbide factory still stands, unvisited except for the occasional journalist or trespassing children since the accident. The site of the disaster was never cleared or cleaned of its toxic waste. The factory continues to omit toxic, poisonous gases from the many abandoned sheds, storerooms and solar evaporation ponds holding up to 27 tons of MIC and other gases (ICJB, 2010; Hanna et al, 2005). These chemicals have leaked into the soil, contamination the groundwater source for approximately 25,000 Bhopalis who live nearby (Bhopal Medical Appeal, 2010; ICJB, 2010). A Greenpeace study found chloroform, lead, mercury and a series of other chemicals in the breast milk of mothers living in proximity to the factory (Labunska et al, 1999). The factory and the chemicals within continue to cause death, breathing difficulties, damaged eyesight, reproductive complications, growth stunting, accelerated cancers and a range of other ailments and malformations for survivors and their children (Hanna et al, 2005).

 

Union Carbide’s response

Since December 1984 Union Carbide has consistently refused to identify the chemical agents that caused the accident for legal liability reasons- making effective treatment for survivors difficult (Bhopal Medical Appeal, 2010). In addition, the corporation has still not confirmed what was in the toxic cloud in December 1984 (Dhara & Dhara, 2002). There is a chance that the cloud also contained HCN (hydrogen cyanide- a more deadly gas formed when MIC reached 200 degrees Celsius) so patients were originally administered with sodium thiosulfate- a known therapy for cyanide poisoning but not for MIC exposure. Despite patients responding well to the sodium thiosulfate, Union Carbide withdrew an initial statement recommending its use when they realized the extra legal implications of cyanide poisoning (Mangla, 1989; Varma, 1989; Anderson, 1989; Dhara and Dhara, 2002). This is one of the many claimed ways Union Carbide attempted to manipulate, disguise and withhold scientific data to the disadvantage of victims (Broughton, 2005). To date no comprehensive scientific research has been funded or carried out into effective treatment for those affected by the accident in Bhopal (ICJB, 2010).

The American chairman of Union Carbide in 1984, Warren Anderson was arrested for culpable homicide just days after the disaster but paid USD 2000 in bail then fled India and has yet to return. Warren Anderson, along with other Union Carbide workers from the American contingent, continues to escape criminal charges. Major questions regarding safety, negligence, causes and clean up remain unanswered by those responsible.

The Indian Government declared itself the sole representative and legal spokesperson for the Bhopal ‘victims’ in an Act passed in 1985 (Broughton, 2005; Hanna et al, 2005). Union Carbide successfully brought the case to Indian courts, and after a five year legal battle made an out-of-court settlement payment to the government of USD 470 million (Broughton, 2005). Compensation channels were rife with corruption and incorrect data. Survivors facing chronic illnesses due to the gas leak received a maximum of USD 500 as compensation, if they were granted anything at all, which in most cases was not enough to cover the medical costs alone (Sarangi, 1995; ICJB, 2010). Outstanding criminal charges against Union Carbide and Warren Anderson regarding cleanup of the factory have ben brought to New York but never come to fruition. In February 2001, Dow Chemicals merged with Union Carbide forming the second largest chemical manufacturer in the world. Dow Chemicals (the name retained) claims not to accept any responsibility for a factory it never owned (despite paying liabilities for previous Union Carbide cases based in Texas, America) (ICJB, 2010).

 

Sambhavna Trust

Lying in the heart of the community of those affected by the Bhopal disaster of 1984 is the Sambhavna Trust. Just 200 meters from the abandoned union carbide factory, the Sambhavna (meaning ‘possibility’) Trust Clinic is the only facility providing free treatment to both gas and water affected persons. Since its establishment in 1996, it has provided free Western medicine, Ayurvedic and Allopathic treatments to those affected by the industrial disaster. Sambhavna also does community health outreach programs for those unable to travel to the clinic and records health data on patients to assist research studies.

Sambhavna is internationally funded by private donors and is locally managed. The clinic is also a member of the International Campaign for Justice in Bhopal (ICJB) and provides a key hub for people to obtain information and resources regarding the ongoing legal claims and their rights.

 

Social Justice in Bhopal

Talking to the victims of the disaster as well as the staff members, volunteers and doctors at Sambhavna, I am beginning to form a clear definition of what social justice means for the twenty five year long Union Carbide case in Bhopal and the health and wellbeing of those affected.

 

References:

Anderson, N. (1989) Long term effects of methyl isocyanate, in Lancet, Vol.2, Issue 8662, p. 1259

Bhopal Medical Appeal, (2010) Online Updates and historical information. Accessed July 2013 from: http://www.bhopal.org

Broughton, E. (2005) The Bhopal Disaster and its Aftermath: A Review, in Environmental Health: A Global Access Science Source, 4:6, accessed July 2013 from: http://www.ehjournal.net/content/pdf/1476-069X-4-6.pdf

Dhara, V.R & Dhara, R. (2002) The Union Carbide Disaster in Bhopal: A review of health effects, in Archives of Environmental Health, p. 391-404.

Eckerman, I. (2005) The Bhopal gas leak: Analyses of causes and consequences by three different models, in Journal of Loss Prevention in the Process Industry, Vol 18, p. 213-217

Hanna, B; Morehouse, M & Sarangi, S. (2005) The Bhopal Reader, New York, The Apex Press

International Campaign for Justice in Bhopal (ICJB), (2010), Online updates and historical information. Accessed July 2010 from http://bhopal.net/

 

– Alina Pokhrel ’15

Summer Ends and Fall Begins at NARAL!

I’m very excited because as my “summer” internship comes to a close I will continue working with NARAL as a fall intern! Working with this organization has been so incredible, I’m so excited to continue as the election heats up. Next week, Sept. 6th, is the primary followed by the general election on November 7th. Until then, NARAL is in full election mode, which will entail me spending all of my time on different campaigns.

After the election, we immediately jump into legislative mode preparing for the upcoming session, understanding our opponents’ proposed legislation, and beginning to work with allied organizations, local community leaders, and legislators themselves. I’m very excited for all that is upcoming in the next few months.

This summer has been an incredible experience for me. I think it’s really shed a lot of light onto my future career goals. I am certain that I want to be in the non-profit area. I have decided to postpone a graduate degree as most programs prefer candidates to work a few years in the field. This internship has allowed me the opportunity to speak with real role-models currently doing the things I see myself doing, and allow me to understand the paths, their advice, their experience, and their future aspirations.

While so far my experience with NARAL the connections I’ve made, and the things I have learned have been invaluable, I am just extremely excited to continue on and get different experience in the legislative field. I’m excited to transform from an intern whose main job was to focus on electoral politics and campaigning,  to an intern who gets to really delve into the legislative process. Therefore, I’m extremely excited to learn more about the other aspect of NARALs work.

One challenge of this summer was reconciling my ideas of justice with my ideas of politics. In my opinion, politicians think more about winning elections and less about sticking to their moral compasses.  This makes many of these politicians no less of wonderful, compassionate, dedicated and hardworking people with incredible intentions – but it does compromise the representation. Unfortunately, this is nationwide, both on small local scales and larger national scales. This idea that to win elections, games must be played – compromises the integrity of the system. When I’ve witnessed wonderful politicians have to vote against things that they believe in, or vice versa, solely for some political game, it really hurts as a constituent and someone who is working to get them elected. So in that sense, it has deflated my hope for politics as a vehicle for social justice.

Lastly, I want to mention a closing reflection from this summer. I am a young, energetic, enthusiastic and idealist 22 year old woman. Yet everyday something new happens, or I understand something better, or see a connection for the first time and realize how many problems there are in the world. Yet every day, I meet someone new working to fix them. So I guess the reflection is, that as dedicated as I am to this type of work I must remember that I am only one person, and that if I can change one small thing I’ve accomplished a lot. So I’m trying to narrow my scope and realize that Rome wasn’t built in a day.

Check out this blog post I wrote for Naral!

– Becca Miller ’13

Midpoint at NARAL Pro Choice

Photo source

It’s been a little over a month since the beginning of my work here at NARAL and I’m enjoying it more and more as we get further into the summer. Many of my goals were focused around gaining experience in the non-profit world, making valuable connections, and really taste-testing to see if this is something I’d want to pursue in the future With this in mind, I think I’m progressing well.

For me, politics, as in running for office, doesn’t seem like the medium of change I want to pursue. I want to be part of the most effective way of making change. My supervisor’s job includes both the legislative and political side by lobbying for legislation, working in the statehouse, making valuable connection with senators and representatives, and really being on the front lines of passing effective and necessary legislation. In addition, he spends a lot of time working to get pro-choice candidates elected. These two aspects of change are not only essential for progressive initiatives (working from both the policy and elected official sides) but also are part of a job that I really feel interested in.

My academic goals of learning more about pro-choice legislation, the act of lobbying, what it takes to run a non-profit, and actual reproductive rights have also been coming along. Everyday I feel like I’m learning more and more about the topics themselves, but also how they fit into my life.

In addition, I’m building a lot of skills related to this type of work. I’m becoming familiar with grassroots organizing techniques, constituent relations, working with state legislators and aides, and campaigning. Campaigning has been a really large portion of my skill set because campaigns are complicated and almost take on lives of their own. There is just so much involved. First, one must get a large volunteer base and intern base if they want to run a successful campaign since campaigns rely on manpower. Secondly, they require a lot of organization and planning to run a successful campaign, which includes door knocking, phone banking, and data entry as the main components. All of these activities are not simple. They require a lot more than face value. The hours are long, the jobs can be tedious and intense, and the response isn’t always ideal. But running an effective and credible campaign is extremely important, and I feel very lucky to be able to be part of so many incredible campaigns.

All of these skills will absolutely transfer into both future academic and career pursuits as I’m building a large skill base, getting experience working for a non-profit, and learning empirical knowledge about women’s health and reproductive rights.

One thing I’d like to quickly address is the misconception that NARAL is a pro-abortion organization. In fact, NARAL and it’s employees are routinely called “baby killers” and other things that are just as vulgar and untrue. NARAL works for women to have choice, access to medically accurate information, and a full range of control over their bodies. It does not promote one option over the other, it does not deny that abstinence is the most effective way to avoid pregnancy; it does not promote abortion as a form of birth control. It works for women to be able to have full control over their own bodies. You don’t want an abortion? Don’t get one. It’s as simple as that. But every woman, regardless of race, class, sexual orientation, or age, should have full control over her body. Being pro-choice, is not anti-child, anti-family, anti-religion, or anti-anything. It’s being responsible and respectful. There are so many undeniable correlations between access to reproductive rights and increasing education, health, financial independence, and aspiration outcome.

As a young woman, I understand what is at stake in this election – at this time. The fact that reproductive rights are even still in question is an absurdity that boggles my brain daily. I understand that fighting for the right to have control over my body is essential and something that cannot be taken lightly. Even with waning faith in the political system, I understand that voting in this election (both state and federal) are essential in the promotion of my rights as a 21 year old Brandeis student who wants to be able to decide if, when and how I have a family. If you are reading this post, male or female (because this is important for men and fathers as well), remember that this election is really important and regardless of your own personal views, choice is choice – and a constitutional right that is being threatened and must be protected.  Please vote pro-choice in 2012. In my next blog I will be attaching a Massachusetts Voter Guide, which shows which candidates are standing behind this fundamental right.

Sorry for the bleeding heart speech, but I feel if I’m going to be writing about my goals, it’s important to state what it really all comes down to: getting the community together to help protect choice.

For a snapshot on some of the legislation I’m working on, visit these sites:

Photo source

– Rebecca Miller ’13

First Week at NARAL Pro-Choice

Photo credit: Ruth Weld

It’s been a few weeks since I began my work with NARAL Pro-Choice Massachusetts, the state affiliate of NARAL Pro-Choice America. I have really been enjoying my time here and am sad at how quickly it is going by.

The main mission of this non-profit organization is to create, build, and maintain a grassroots constituency to protect every woman’s right to make her own decisions regarding her reproductive choices, whatever they may be. NARAL does many things to protect women and their right to choose including mobilizing supporters, working to elect pro-choice candidates, passing pro-choice legislation, conducting research on reproductive topics, and leading initiatives to improve the reproductive health equity within Massachusetts. Given this summer’s extreme importance as an election summer and the significance of reproductive issues within the campaigns, this summer is an exciting and crucial time to be working with NARAL.

My internship is basically divided into two parts; office work and campaign work. My role in the office consists of many different responsibilities like data entry, sitting in on endorsement interviews with candidates for the Massachusetts legislature and various other tasks. I am also responsible for tracking Worcester County state elections and following all the local politics to keep track of our endorsed candidates. In addition, I work as the legislative intern which entails keeping track of NARAL’s priority legislation, writing fact sheets, following policy in the statehouse, and working to prepare for the next legislative session as this one comes to a close in July.

The other main part of my internship is working on the campaigns of the candidates we endorse.  This is really exciting because I get to work on multiple campaigns; meet a lot of incredible people, network, and get important experience being part of a campaign. When I’m on a campaign I’m doing everything from making constituent calls, going door to door, and yes, more data entry.

I became interested in NARAL when I referred to their database for help with a research project, showing the link between the oppression of women and access to birth control and abortions. I was impressed and inspired by their research and policy initiatives. I knew that I wanted to work for a non-profit dealing with social justice and women’s studies, so after researching NARAL’s functions and the opportunities available over winter break, I applied for an internship to test the waters in the non-profit world.

Photo Credit: Ruth Weld

My first week was wonderful. It involved an all day-training with other interns at local non-profits like MassEquality and Women’s Political Caucus. I learned a lot about NARAL itself, but also the goals of small political non-profits and how they work. Later that week, we had one of our biggest canvassing events at Gay Pride Boston 2012. It was an incredible experience. The main goal of the day was to increase our membership. This event was really fun, action-packed, and a great introduction to the internship. It’s also just a really wonderful experience to be surrounded by people who are all coming together to fight for equality.

My learning expectations are based around my desire to further figure out which medium of advocacy for justice I want to pursue. This internship will help me to clarify my career path and allow me the opportunity to test the non-profit world.  As a rising senior, I’m really looking forward to using this internship as a way to further my understanding of my career goals and potentially make vital connections for the future.

Before I close this first post, I think it’s really important to share something I learned within my first week at NARAL. Massachusetts has always been seen as an extremely progressive state and many people are proud to live here. While this is true, sometimes the legacy of Massachusetts being progressive allows us to take a backseat and assume things about our laws. Despite Massachusetts’ extreme leadership in healthcare and commitment to public health, Massachusetts is one of only four states in the entire country that still has an outdated law on the books, from the 19th century, that bans all abortions. In addition, there is another provision that bars all birth control to unmarried couples. These archaic statues have not been enforced for many years especially given federal cases like Roe v. Wade, which is potentially why there has been little to no movement to get rid of them. Yet in the wake of recent attacks on reproductive freedom, Roe v. Wade does seem like it’ll be threatened in the near future. If this becomes the case, and it is overturned, abortion and birth control will become illegal in Massachusetts. We cannot stand for this. One of NARAL Massachusetts’ main legislative priorities is working as hard as possible to get this archaic and unjust legislation repealed as quickly as possible. Be on the lookout for ways you can reach out to your state legislators to make sure this legislation is repealed.

Sorry for the detour! Overall my internship has been incredible and I’m really looking forward to the rest of the summer.

Check out NARAL:

To see if your legislator is pro-choice, click here.

– Rebecca Miller ’13