Why not Vasectomies?

Some of our donors and supporters have raised the following question:

Birth control from the man’s side is easier and less expensive than from the woman’s. A vasectomy is a less invasive procedure than fallopian tube ligation, and promoting condoms carries the additional benefit of Sexually Transmitted Disease (STD) prevention. So why not concentrate on men’s sexual education, vasectomies, and condoms instead?

We would like to answer this question in the project blog so as to address this particular aspect of Children of the Border’s approach to reproductive planning.

This couple was waiting for their first baby together. The baby died a few months after birth of a simple respiratory infection.

The most important reason is that we are a different kind of organization than most. Almost all Non-Governmental Organizations (NGO’s) that operate in the Caribbean work by sending an ‘educator’ in an air-conditioned SUV, who organizes town meetings about sex, birth control, or whatever issue is most important to the organization. Typically, at the end of the project, if you ask them why the conditions in the field are exactly the same as when they came, you get replies such as “you give talks and more talks and they just don’t listen”.

Children of the Border realizes that this is not the way to run a social program. We make a special effort to operate according to a model that takes into account the specific concerns facing the community. We try to avoid many of the pitfalls of ineffectiveness that too often doom community “education” initiatives to failure. We do not talk down to grown men and women like they were children, we do not offer rich people solutions to poor people problems, and we take responsibility for the failure or success of the work we do.

To convince a man to get a vasectomy and use condoms, there are a huge number of social and cultural stigma that must be overcome. Such an effort requires another man from the community to step up, undergo vasectomy surgery, and testify to others that it did not render him impotent or castrated (yes, this is a legitimate concern in many communities and parts of the world). You need this man to go house by house, and sit down with every other man, away from the crowd, and convince him why it’s the right thing to do for himself, his wife and his family. From all the years we have worked in this community, we know that most men will do what they feel is right and their duty in front of their families and their community. This takes very little money, but it still takes money: we need to hire a man and give him a small stipend (US$120/mo), funds for transportation (motorcycle, gas, maintenance and repairs), uniform and ID badge, train him, and provide emergency medical funds to take care of men who discover they have an STD.

With women, the story is different. They carry the cost of the children. They are the ones chained to the house looking after 8 or 10 kids in absolute poverty for 15 years for each child. They are the ones risking their lives on every birth on a dirt floor 3 hours walking distance from their nearest hospital. To these women, you just have to ask once if they want birth control, and they say yes, right now, and where do I sign up?

At this moment, we have found that the most effective and efficient way to stop unwanted births is by working with those that are highly motivated to change their reproductive destiny. Right now, in this community, those people are overwhelmingly women. Indeed, nearly 100% of women we have spoken with in the community want to have the tubal ligation surgery. They see it as the easiest, quickest way to change their future for the better.

For women, we also already have a program sponsored by the Norwegian Humanist Association through HAMU to protect the Human Rights of their children, and because they are almost always the caretakers and always the ones giving birth, our Human Rights monitors already cover them.

Any complete solution to unwanted births in the forest needs to include both men and women, but so far donors have prioritized the needs of women and children. Although it does not address every problem facing the community, a program to provide women with free tubal ligation surgery would result in economic benefits, more stable family structures, and huge public health progress for a community in which most emergency health problems are directly related to pregnancy and childbirth.

Water for Babies from Pesticide Tanks

Jemena is still at the hospital convalescing from the c-section, and the baby will probably stay in neonatal care for a few weeks. Yesterday I went to her house to tell her family and make sure the kids were eating, and found out that in the last few months they’ve all been using old pesticide jugs to store drinking water.

The water jug still has the label on it.

Here is another drum used for holding rainwater by another family. The label 2,4-D is the main ingredient in Agent Orange used during the Vietnam War as a defoliant by US forces. Today it is widely used as a broadleaf weed killer.

A baby drinking water taken from a tank that used to carry pesticides.

Urgent Needs

You cannot discuss Human Rights with a woman who is 7 months pregnant, lying on the on the dirt floor of her home, and close to miscarrying her child.

Case in point: last Friday as we were going about our census with the Human Rights monitors, a group of people by the side of the road stopped us. We walked up the kill with them and entered a ramshackle house, typical of the family shelters in the forest region. There, we found a young woman, Jemena, who was 7 months into her pregnancy and experiencing severe abdominal pain. Since she was not bleeding, we could not take her to the hospital. In the past, we have been turned away for bringing in such “non-emergency” cases, and told to drive the “morena” (black woman) back to her house. As such, we did not waste our time, and resolved to go to the private clinic the next day after it opened.

The next morning at 6:30, we took Jemena to the clinic. They claimed that they would not see pregnant women that day, only people that wanted physical exams. Judith, our Human Rights monitor, blocked the door, begged, argued, and stood right in front of the examination door until they agreed to attend to our patient.

Estela, our Haitian HR monitor stands with the two women we brought down from the forest. We provide transportation on the motorcycle in the picture. Without the HR monitors, the women would be denied medical attention.

They ordered an ultrasound, but the specialists were on strike and there would be no ultrasounds for 10 days. They told us that we could take her to the hospital in Barahona, which is only 2 hours away. Unfortunately, this was not a viable option, as it is impossible for a Haitian to pass through the military checkpoints on the eastbound highway.

By Monday, Jemena was bleeding and could barely walk. This time, we took her to the emergency room, where she endured an hour of yelling, humiliation and mistreatment. She was told that she was a stupid animal for being in such a poor condition. Despite the verbal abuse and discrimination that she suffered, our monitors were able to obtain a written doctor’s order that would get us past the military checkpoints to Barahona.

Jemena's house.

On Tuesday at 4:00am we were at Jemena’s house on a motorcycle to pick her up. Still bleeding, she endured a thirty minute ride to the bus stop, where our HAMU-sponsored Human Rights monitor was waiting for her.

At Barahona, we paid for paramedics to unload her from the bus and clean up the blood spilled during the two hour journey. At the hospital, we paid for the ultrasound, food, medicine, and bribes for the corrupt nurses who would not treat Jemena without first extracting their cut.  At the end of this three-day saga of unspeakable suffering, Jemena gave birth by Caesarian section to a ti fi, a girl.

Unfortunately, the baby girl was eight weeks premature, and weighed only two pounds. The hospital will release Jemena on Friday, but we still don’t know about the baby. A two pound premature baby would probably die within day at Jemena’s house.  Their drinking water comes from a canal used for cattle, and that source is an hour’s walk away from her home.  We hope the hospital will keep the baby for at least a week. We do not have a place for Jemena to stay in Barahona, so she will have to return home and wait for us to bring the baby.

We made sure Jemena's children were taken care off while she went to the hospital.

A situation like this would have cost several thousand dollars in the US, but on the Haitian-Dominican border we were able to solve it with a few hundred dollars (and still counting).  Still, this is about 10 months’ worth of our emergency medical budget. In other words, it is imperative that we allocate a larger amount of our funding for medical emergencies. There is no point in providing services in the field of education and Human Rights if we are unable to stop entirely preventable human suffering and death.

Our donors from DR Schools are taking care of the school for the children. The American Humanist Association is interested in supporting our efforts to offer free birth control (so far, about 98% of the surveyed women want it). The Norwegian Humanist Association through HAMU is supporting the Human Rights monitors that fight tooth and nail to overcome the obstacles that poor immigrants like Jemena face every day.  Without our HR monitors, people like Jemena and her daughter would not be treated at the hospital. Jemena would not have gotten through military checkpoints and she would not have been given the opportunity to earn Dominican citizenship and a birth certificate for her new daughter.  Without HAMU and our monitors, both Jemena and her baby would be dead.

We desperately need funds for medical emergencies like this.  We refuse to allow preventable deaths to happen on our watch. We need this funding so that when our next emergency arises, we can provide for those affected.  While our ultimate goal is to provide long term solutions for the underlying problems that result in emergencies like Jemena’s, it is imperative that Children of the Border have the ability to support the community while we seek funding and transition towards implementation of family planning programs and other community health measures.

School Window Bars Installed

Here are some images of our contractor installing the bars for the school windows. We immediately started the process of getting new desks and tables, which we should have in a couple of weeks.  With all luck, the kids will be studying in a brand new classroom next semester!

Work on the School Is Underway!

Last week we hired a local contractor to install window bars at the school building, and the work has begun!

The window bars will allow us to order new chairs, desks, and educational materials without fear that they will be taken during the night.  A new level of security is coming to the school at El Mogote!

A few pictures of Yorky, our contractor, at work:

Family Planning and Birth Control: The Issues and a Solution

For years we have noticed the negative effects of uncontrolled childbirth in the forests. Men earn on average $2 US per day for work in the fields, and six to ten children are often far too many mouths to feed. Additionally, women lose their productive potential by being constantly pregnant and forced to care for young infants. The living conditions are the worst in the Americas.  Children are forced to raise younger children, and they are often plagued by disease, hunger, and too little attention from their parents who are constantly working from dawn to dusk.  Giving these families control over their reproductive futures will give them a means to decide how large a family they want, increasing their ability to work productively and allowing them to care for the children they already have.

Most women give birth in the forest, either because the Dominican authorities make it very hard for them to use the hospital (which they have a right to use), because they are afraid of the bribes nurses and others will extract from them (ohh, have we had to deal with corrupt nurses), or because they don’t have transportation, as the hospital is about 3 hours walking distance.

As the HAMU/Human Rights project progresses, we started a census and interviewed the women of the community, and found a very interesting trend. If our local Human Rights monitor, a Haitian woman from the same community, asks if they would like “family planning” or “childbirth control” methods, they will respond that they want nothing to do with that, some say, for religious reasons. But if our monitor asks if they would take the pills or injections if we provide them for free, about 50% say yes, and a startling 100% will say they would undergo the surgery.

A little more talking and it is clear that the Haitian women living in the Dominican forests want to take control of their reproduction. Most women will have their first child when they were 15 to 16, with a man 10-20 years older than them, then several years later find a permanent partner and have from 6 to 8 children (or as many as 15) by the time they are 35.

The women of the community are very aware of the advantages of family planning, and have a strong desire to reclaim control over their family’s future.  If given the means to prevent unwanted pregnancy through tubal ligation surgery, these women can put a stop to the endless cycle of needless suffering brought on by repeated high-risk childbirth in the isolated forest communities.

We are now working on proposals for a pilot project to pay for the surgeries of 20 to 50 women.

We estimate that each surgery, including transportation, hospital supplies, and a small stipend so that they can feed themselves and their children during the time of convalescence, would cost about US$200.

Our two Human Rights monitors have already undergone the surgery, one of them paid by us, and she is very happy with the results.  We hope to be able to offer the other women of the community the same choice and the same opportunity to improve their lives, their children’s lives, and their prospects for a happier, healthier, and more productive future.

School Update

We have painted the school of El Mogote twice, dug and built a latrine, and are ready to order the chairs and desks. One problem persists: when the children are not in school, local farmers use the building for crop storage, even though there is an adjacent building for that.  This leaves the school very dirty, and the chairs and desks get stolen.  At this point, the teacher can only take a limited amount of books, as she travels by motorcycle and cannot carry the 50 lbs of books we have donated.

For this we have contacted a local ironworks contractor who will install bars on the school windows and a metal door with lock so that only the teacher has access to the building.

This photo is our the contractor taking his measurements for the estimate. He comes highly recommended and has experience working on similar projects in Haiti.

HAMU Project Started

Last January 2007 we received the good news that the Norwegian Humanist Association, through its Humanist Action for Human Rights (HAMU) branch, had approved our project proposal to defend the human rights of Dominican children of Haitian descent living the forests around the southern border town of Pedernales.

HAMU aims to promote the human rights of the oppressed. It operates by raising funds in Norway and then supporting local secular, non-profit and non-governmental organizations in the global South.

The project is well underway. We interviewed candidates and hired two women from the community: a Dominican with years of experience in the day-to-day defense of the Human Rights of Haitians in the Dominican Republic, and a bilingual Haitian from the community we will serve.

We have provided our monitors with ID and documentation to prevent harassment by abusive authorities, a motorcycle to reach remote areas of the forest, and a bank account to cover their field expenses.  They are now prepared to begin work as Children of the Border’s first Human Rights monitors, striving to serve their community and improve living conditions for the region’s poorest and most disadvantaged.

The monitors will keep watch over the community and maintain our record of Human Rights abuses by the police, military and others.  They will aid with emergency health care of children and pregnant women, and keep records of all births in the forest communities, deaths at birth, and deaths of children. All of this information will be used in our database of community health information.  Additionally, the birth records will document that the children are Dominican citizens according to the Dominican constitution, entitled to birth certificates that provide them with the same access to health care and education that their lighter-skinned counterparts get (see this NY Times article for a recent article on this issue).

The monitors have already begun their work with a census of the community to set baseline standards from which to measure the progress of the project.

Library update

Last August we purchased the building that will host the community library for the children of Las Mercedes, with funds provided by the membership of the American Humanist Association.

With the help of the community, we cleaned the yard, repaired the walls and painted it. With the help of the volunteers that came with us, we made and painted new bookcases.

Getting the building was a major step, but we still need to do many things before the library is operational:

1. Books. We have about 2,000 books in California awaiting delivery. To ship the books via regular carriers cost several thousand dollars, a lot more than the books are worth, and probably more then they would cost to buy in the DR. We are thus seeking ideas and contacts that could help with the delivery logistics and costs.
2. Windows and bars. We need to fix at least one window and install security bars. This will help us install a computer (already have it ready, from a donation), and protect the books when the library is closed.
3. Small repairs. Some of the walls still need small repairs, the interior needs to be repainted and finish the latrine installation.
4. Operational funds. While the library will be staffed by local volunteers, we need funds for a small stipend for an official caretaker.