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Mothers and Sons

female health workers
Thai nurses and me at a rural clini

Did you ever hear the riddle about the boy whose father was a famous surgeon? The child grew up fine and strong, but when he was 15-years-old, he and his father had a car accident. By chance, they were taken to different hospitals. The boy’s critical condition required immediate surgery. When the surgeon was called, the doctor said, “I can’t operate on him — he’s my son.” (Hospital rules prohibited physicians from operating on members of their own family.) The mystery to explain is: who was the doctor?

Give up? Of course, the surgeon was his mother, and that is why she could not treat her child. If you took more than ten seconds to answer the riddle, you probably should admit that you’re struggling with gender stereotypes. Don’t worry. Women do not typically think of surgeons as female, either. That’s because in most countries, they’re not. High-level medical specialists, hospital administrators and ministers of health are — on the average — male. Nurses, lab technicians and medical secretaries, on the other hand, are mostly women. This gender hierarchy in health reflects a general trend in other science education such as engineering, environmental sciences, physics and mathematics. The same is also true in the multi billion-dollar health industry where women work mostly in the lower paying jobs.

The UN Commission on the Status of Women has recommended that governments take stronger measures to end the gender gap in science and technology education. But this will take considerable effort because we must undo centuries of male bias. For example, Britain’s elite Royal Society established in 1662 did not admit women until 1945. Unequal access to education, cultural biases against science and technology careers for girls and other lifelong limitations have meant that fewer women reach the top of their scientific fields. By the 21st century only 16 women were awarded Nobel Prizes in sciences and medicine compared to more than 200 men.

We have to learn more about how boys develop positive gender values. Yet we hardly know enough about this process cross-culturally. It would be fascinating to conduct an anthropological study of sons with mothers who are professionals in medicine and science. Do the boys adjust well to the idea that a woman can compete in a man’s world?  When sons grow up, are they more likely to be supportive husbands of working wives? Do they become better teachers so that female students are encouraged to pursue any career they want? My intuitive response is an optimistic “yes.” At least the opportunity is there.

Besides the influence of UN and government policies, changes in men’s attitudes can make a difference. In Sweden, the women’s movement has stimulated a men’s movement for gender equality. This is certainly an interesting trend that merits more attention. Women who have achieved recognition in science and technology can also influence a generation of young men to give gender equality for women and girls a chance. You see, boys need women as role models, too.


Competing on a level playing field

When my daughter was 12-years-old, she came home proudly holding broken blocks of wood. She held them like prize plaques, one in each hand. “Guess what? I broke this with my foot today at tae kwon-do class.” I stared in amazement at the one-inch-thick pieces with their stone-like surfaces. She swore that it was easy if you hit the block fast and hard enough. At my request, she demonstrated the martial arts motions. She clenched her fists in boxing style as the right side of her torso swiftly twisted upward. Her knee locked, then released with an aggressive snap into the air. Only the blood-curdling cry of triumph was missing. I moved aside to give her more room to repeat the kick.

Song-Mee and Judo
Song-Mee and Judo

Judged by traditional Korean standards, her body movements could hardly be called “feminine.” The conventional social rules dictate that female gestures should be close to the body–inward and folded–not splitting apart in the air. A hand should cover the mouth when laughing. The knees should be together when sitting. These conventions of poise and modesty become part of a corporal repertoire that the body learns from early childhood. Playing sports helps the body widen its range of personal expressions and identities. That’s sufficient justification for citizens to support public sports programs for girls.

There are more good reasons to do so. When girls are allowed to compete equally with boys in sports, their self-esteem seems to gain ground. Fathers should not hesitate to make sure this happens. In the l920s, when my mother was in high school, she created a scandal in Pyongyang by playing sports. Her long Korean skirt got a little in the way, but she chased a ball around the courts just like boys. Swimming in the river was also on her list of after-school activities she wanted to do. Her confidence to pursue these interests got a boost when my grandfather publicly supported her “tomboy” behavior.

I’m not suggesting that girls should fight their way through a hockey match or take up violent sports like boxing just to prove their worth. Emulating these “masculine” behaviors are low on my list of what sports should teach girls. However, many lessons like team playing, leadership and discipline are invaluable life skills. Research shows that sports can help girls feel more secure about their bodies–mostly because when playing they are evaluated for how they perform, not just how they look.

Courage is another character trait that a challenging physical activity can contribute to girls’ self-image. Many children who study tae kwon-do can’t strike the wood (or a brick) forcefully enough because of a natural childlike fear of self-inflicted injury. As my daughter overcame her apprehension, she pushed herself into the unknown. In so doing, she took an important step forward to improving her self-esteem–she took a chance. That gave her a high score in my books for sportsmanship. But we should add 10 points for what really counted. She bet her right foot on the possibility that she could succeed. That show of courage is the real reason I installed her broken pieces of wood, with historic dates inscribed on the bottom, to the family Hall of Fame, high on a shelf for all to admire. It reminds us that one glorious day she hit a target just right, breaking a block of wood and opening a space that would always be hers.

The Victims: It is time to stop blaming them for AIDS

In the off-hours of Bangkok’s busy nightlife, massage parlor workers take off their number badges and step out of their “fish tank” windows where they have sat waiting for customers to choose them. Dancers unhook themselves from ropes that supported their athletic prances. They gather around steaming cups of tea and catch up on the latest television soap operas. While these daily routines restore a mood of normalcy to the intense, burned-out life of these young women, everyone is aware that nothing about this life is normal. Many of them must provide sexual as well as entertainment and massage services. And since the AIDs epidemic hit Thailand in the l980s, sex work has become a game of hide-and-seek with death.

Non-governmental organizations, government programs and women’s groups have made sure that AIDs awareness has reached the entertainment business. Public health clinics have been set up in the midst of the neon-lit glitter of the infamous Pot Pong tourist district. These show nonstop video health education programs for patients in the waiting rooms. Women’s groups also established outposts in the same area. Activists are determined to raise the gender bias issues. They have highlighted the plight of child prostitutes, the near slave conditions of massage parlors, and the sexist bias of health programs. And their mission is urgent.

I ventured into Pat Pong with a government health worker. An elderly Chinese couple that owned the bar greeted us with a bow and told us that they hoped all the scare about AIDs was just rumor. We told them that the situation was very critical and that their cooperation was an important contribution to remedy the problem.

As the time approached for the health education session to begin, the bar girls came down the stairs from their quarters. I quickly surveyed their faces that were freshly scrubbed and had no makeup. These were young beauties, some looked like they were in their teens, although they probably had false identification cards. They chattered on like Bangkok swallows, pushing close to each other as they settled into the bar booths.

When the NGO nurse arrived, the noise subsided into an obedient silence and the bar girls sat up attentively like students starting the day with their teacher. The lights dimmed and the slide show began with hopeful musical messages about how sexually transmitted diseases are treatable and where to go for help. A somber tone quickly replaced the gay mood. The photos were unusually explicit, showing skin sores and the cancer-eaten flesh of AIDs patients. Some bar girls looked away. Everyone was pretty scared by the end of the slide show.

CC-6 Condom education Thailand
Condom education in Thailand

The young women were very receptive to the main message of the day: “Use condoms.” Heads bobbed in agreement. Lights up. The nurse took out her packets of condoms and did a perfect finger demonstration of how they slip on. Then, she offered one packet to each girl. One by one they knelt in front of this tall figure who assumed an air of a high-class merciful angel. The bar girls received their unusual gifts with their eyes to the ground and hands folded in respect.

Then, one young woman dared to ask: “How can we get men to wear these condoms? Do you have any suggestions?” The nurse answered with an authoritative voice. ”You must tell men that they might get AIDs or diseases if they don’t.” That comment ended the friendly session and everyone said farewell.

The leader of the group, known as “the men’s favorite,” sat down with my translator and me. She assured me that the bar girls took these education messages seriously and were grateful that NGOs wanted to help. The only problem is that they could not make men put on condoms. They couldn’t explain this to the nurse, but this was their biggest problem. Besides, they had learned to be realistic about the tourist business. “If we tell men that they will get AIDS, they won’t come back and we will lose our jobs,” said the leader.

I compared this situation with that some European countries where sex workers were mostly mature, assertive adults, capable of organizing themselves into semi-unions. But these bar girls had barely crossed the threshold from childhood to womanhood. From their perspective, the grand vision of the feminist movement about empowerment for young women would seem out of reach. In the eyes of Thai society, prostitutes are “bad girls,” and, while something must be done about their problems, they live in a world of drugs and crime that is largely hidden from sight.

Nevertheless, a few women’s groups are working to shed light on an underground world of crime, kidnapping and rape. They are beginning to attract public attention. Prostitution is officially illegal, but enforcing the law is another matter. There are networks of sex slave traders who have cast their nets across Thailand’s hill tribes and poor north and northeast regions to entrap more girls. Some of the victims are as young as ten years old. The age slips lower as the AIDS epidemic progresses and the demand– and prices –for virgins increase.

Feminists report the underlying causes of prostitution are poverty at one end of the problem and efficient sex trafficking organizations at the other. Impoverished rural parents “sell” their daughters under the guise of paying a job “broker” to help girls find a city job at prices as low as $200. But the broker is really trafficking girls from rural villages to cities. Changing hands many times, the victims may find themselves in tea rooms as child prostitutes; later, they are moved into the bars and massage parlors servicing international tourists and businessmen.

Clients from Germany, France, and England have been lured by ads like this one posted by a Swiss travel group: ”Slim, sun-burnt and sweet, they (Thai prostitutes) love the white man in an erotic and devoted way. They are masters of the art of making love by nature, an art that we Europeans do not know.” Japanese, Chinese, Thai and Arab businesses also entertain at establishments where customers can to step into the back rooms for a little “special treatment.”

The tragedy of prostitution in countries such as the Philippines, Korea and Indonesia, is that the victims have often been blamed for the AIDs epidemic. In many countries, sex workers are portrayed as the new “Typhoid Marys” who are the carriers of the HIV virus. Health campaigns often focus exclusively on the health education, control and surveillance of prostitutes — not their male clients. And as if this was not enough, improved surveillance among prostitutes has meant that those who have contracted the virus lose their jobs without health insurance or job compensation to cushion the blow.

It is time to stop blaming the victims. Women activists have called for more legal action and health education directed at the organizers of sex trafficking and at male clients. More concerted action is needed because the HIV/AIDS epidemic kills the most vulnerable women and girls. Worldwide, more women than men have AIDS and UN AIDS reports that HIV prevalence among female sex workers ranged from 6.1 percent in Latin America to 36.9 percent in sub-Saharan Africa.

But let me end my story with a reminder of how rural poverty lies at the heart of the matter. Several months after my Pat Pong visit, I traveled in the poor northeast region near the Laotian border. I met a couple on their farm who were caring for a young child. “She belongs to our daughter,” they told me. “There is no father, so we are taking care of her.” Then, proudly, they told me of their beautiful daughter, how she left to find work in the city and is now working in a big restaurant. I asked the name of the restaurant since I would go back to Bangkok and might take her greetings from them. They said that they didn’t know, but the job must pay very well since she sends money home every month. I looked at the child and remembered the bar girls in Pat Pong. I told the couple that perhaps I will meet their daughter in the city, but I did not say where it might be — in a restaurant, bar, or hospital for AIDS patients.



When Boys Will Not Be Boys

The visit to the Tunisian mobile health clinic took us out of the city past the Roman viaduct towards the mountain villages. Tunis disappeared behind a winding upward road. Sparse settlements dotted the slopes and draft animals poked along the road. I spotted a girl on a donkey heading our way to the edge of the mountain village. Her water pails were slung on its back. I thought: That’s progress; girls often have to walk while the boys get the rides. Crowds of Berber women, some wearing beautiful earrings and long skirts bustled around the mobile unit, a white truck.

Girl on donkey, Tunisia
Berber girl gets a ride…that’s progress

Children and some men sat squatted nearby, watching us pull along side. I was impressed to see the health clinic. Modern, spotlessly clean and well equipped, it was hard evidence the government was serious about making contraceptives and reproductive health services accessible to everyone – even remote tribes. On this visit, I was particularly interested in the family planning policy and its emphasis on reaching men and boys. According to the director of the programme, by orienting the reproductive health services to both men and women, doctors have been much more successful. This was known as a “couple’s approach.” I wanted to know more from the men’s point of view.

I heard the inside story from the clinic’s physician. He was a young man who had left all of the trappings of a highly specialized career in order to complete a round of service to rural areas. When he talked about health services for men, he explained that ideally this clinic should start early by reaching out to boys. However, he said that was one of the most difficult parts of his assignment. Typically, girls come in with their mothers when they are very young so he establishes friendly relationships with them. When they reach puberty, he can count on seeing them as patients. Boys are different. They may tag along with their mothers as children, but when they grow up they shy away from his health center.

He thought that the problem was that boys do not confide in fathers or other adult male family members. Having no one to mentor them in the ways of life, they experience the mysteries of changes in their bodies’ functions and appearances on their own or with peers. The brave behavior associated with boys fails when it comes to mustering up the courage to walk into a reproductive health center. It seems boys will not always be boys. Few, if any, ever show up. Yet, the doctor said that he knows they suffer from many disorders including urinary tract infections and, occasionally, sexually transmitted diseases.

In most countries, the epidemiology of boys’ sexual and reproductive health problems is mysterious to health planners. The UN Population Fund (UNFPA), which has championed women’s sexual and reproductive health and rights, is also a strong advocate of the same rights for men and boys. It recognizes that cultural traditions can have gender-specific negative effects on boy’s rights and freedoms. As it turns out, boys, like girls, can grow up hidden behind a veil of social taboos. Even industrialized countries that pride themselves on modern approaches to youth problems have only begun to acknowledge that the health data on adolescent boys is dismal. With drugs, alcoholism and teenage pregnancy top on the list of priorities, boys’ sexual and reproductive health falls by the wayside – only to be picked up again when it is too late.

Let’s remember that just because doctors are available doesn’t mean that boys will consult them. A starting point would be to counsel men who attend family planning clinics to learn more about their sons’ needs and advise health administrators on how to best adapt services. Progress has to start with an admission of ignorance. We cannot assume that backward traditions affect only girls. Sometimes, boys are also the losers.

A Dog’s Life

Its a dog's life
Its a dog’s life

If you are a dog-lover, you will be interested to know that tourists rate Geneva as one of the world’s most “dog-friendly” cities. This is not a trivial honor. In France and Switzerland, where dogs are pampered like children, a municipality’s attitude towards them can be considered a measure of its moral fiber. For some foreigners, Geneva appears to be a canine utopia where citizens guarantee dogs the right to first class access at restaurants and public parks.  Most owners can provide their loyal pets with basic needs like housing along with occasional amenities such as warm beds and treats. Geneva citizens boast about their humane treatment of animals, but is their claim justified? I thought so until my recent visit to that city.

On the surface things looked pretty good. Geneva offers better habitats for dogs than cities like Beirut or Bangkok. Such is the disdain for dogs in the Islamic tradition that a Muslim’s worst insult would include “dog” in a string of profanities. In Bangkok, polluted waters and toxic dumps afflict many animals, so they have chronic skin sores. In those cities, a dog’s life is a wild and dangerous existence. Needless to say, the people living in slums share their lot. Although Beijing and Seoul may offer strict ordinances to control pollution, I wouldn’t want to be a dog in either metropolis. Dogs are reportedly kidnapped, caged, fattened then served up as dog soup.

Geneva citizens, on the other hand, put dogs in front of the plate, not on it. At the most elegant lakeside restaurants, dogs happily sniff the cordon bleu aromas while lingering under the tables. When dining at a famous beef bistro, I spied a large gold retriever strategically positioned among fellow beef lovers. Between pats on the head and admiring greetings from the waiters, she licked her paws and eyed her midnight snack. Swiss pets return the favor of their public privileges with characteristic national civility. I never saw a dog beg at another client’s table. Few things in Switzerland are enigmatic, but how pets abide by a code of good behavior is a true mystery.

Life for dogs is equally congenial at the Geneva Botanical Gardens. On a sunny spring Sunday, owners treat them to long walks along the lakeshores. One day, I spotted a dachshund running about without his leash. No one seemed to think he was overstepping his bounds when he ran off to greet other dogs. All pets without leashes were presumed to belong to someone, and I never saw a homeless dog wandering about. The owner would call out occasionally, and the dog dutifully rejoined the family walk. (I observed that Swiss children behaved in a similar fashion).

My opinion was increasingly favorable and I was about to give Geneva the Legion d’Honneur medal for canine treatment when my friend, Rudo Mungwashu from Zimbabwe objected. She pointed out that since large numbers of Swiss are smokers, those with pets must subject them constantly to second-hand smoke. Dogs often frequent smokey bars and restaurants, so pregnant dogs and puppies must be also affected.

I had seen alarming evidence about second-hand smoke for humans—that it increases children’s risk of middle ear infections, respiratory diseases and asthma and that it causes heart and lung diseases in women. The WHO report on gender, women and tobacco states that prolonged exposure to second-hand smoke can cause lung cancer and that women who live with partners who smoke may also be at great risk for heart disease. All that is bad news for pregnant women, children and pets who live with smokers. However, I had never seen any statistics on the impact of second-hand smoke on dogs. Animals were invisible in the national health statistics and exposure to secondhand smoke was an unknown—but possible—cause of canine death. Rudo had a point. As a true dog lover, I had to disqualify Geneva as a dog’s heaven.