International Women’s Day Thoughts on Justice

It is International Women’s Day and I pause as I think about the different women in my life who have shaped me, who have helped me grow in areas that I wouldn’t have otherwise. This group of women don’t look like each other – they range in color, size, shape, and personality. They are from different countries as well as different racial and ethnic backgrounds. But where they differ in those attributes, each one is a strong force of faith, hope, and love.

I am so incredibly fortunate to have these role models and mentors in my life. But she who has been gifted much has a mandate to give back.

Everyone of us view the world through a different lens. My lens is public health, and it’s through a public health lens that I think about justice for women in the world on this International Women’s Day. What I see through this lens troubles me greatly. Consider these facts from the World Health Organization:

  • Approximately 810 women die every day from preventable causes related to pregnancy and childbirth
  • 94% of all maternal deaths occur in low and lower middle-income countries.
  • Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy than other women.
  • Skilled care before, during and after childbirth can save the lives of women and newborns.
  • Violence against women – particularly intimate partner violence and sexual violence – is a major public health problem and a violation of women’s human rights.
  • Global estimates published by WHO indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime.

It feels like a desperately slow road for women’s health and wellbeing. I remember my dismay at my first visit to the women’s and children’s hospital in Rania in 2018. It reminded me of hospitals in Pakistan from my childhood, many, many years ago. Though things in western countries have improved dramatically through the years, little has improved for women in the developing world. I struggle deeply with all of this. I long to see better health outcomes for women, long to see real change occur. I long to see greater justice and focus on women’s health and education, because they are so integrally connected.

I long to see us working toward greater justice and equity in women’s health around the world.

And even as I write this, I am acutely aware that justice and equity are not found in a blog post.

Justice is not an instagram story or a facebook post. Justice is not loud outrage followed by a hot latte. Justice is not one stop shopping or a one time event. Justice is not fired up mirror neurons or copycat anger.

Justice is not pity. Justice is not “poor you!” Justice is not a “noisy gong or a clanging cymbal.” Justice is not meaningless nods or empty words.

Justice, true justice, is hard work and community giving. Justice is partnership over pity. Justice is daily humility, letting others be the teacher. Justice is knowing we will get it wrong, but working to get it right. Justice is loving and serving others when it hurts. Justice is quiet acts of courage that people don’t always see. Justice is hard repentance and soul searching.

Justice comes from a heart of love and a spirit of generosity. Justice without love is like bread without salt – it looks good but it tastes all wrong.

So on this International Women’s Day, I publicly reaffirm a commitment to my small part in this journey. I commit to learning, to growing, to cultural humility, to working toward greater equity in healthcare, to loving and serving well this group that holds up half the sky.

Here’s to the women around the world who have never heard of International Women’s Day, but faithfully do what they have to do to care for their families and communities. Here’s to the unsung heroes, the stories that may never be told, and the the daily sacrifice of so many. Here’s to resilience and strength, resourcefulness and tenacity. Here’s to the million choices that are made by women daily – choices that hold up half the sky. Here’s to women.

Marilyn Gardner

The Return

It was 10 years ago today that my sister-in-law and I arrived in Pakistan to participate in a 2-week medical relief trip.

At the end of the summer of 2010, Pakistan had been overwhelmed by floods with millions displaced. Camps for those who had lost their homes were set up across the country and aid was coming in from many countries around the world. Anytime there is a disaster like these floods, there is a domino effect of problems. Malaria, severe malnutrition, dysentery from poor water supplies, and skin diseases that happen when you have thousands of people living in close proximity to each other.

As my childhood home and love, Pakistan has a special place in my heart and to go back in this capacity was a gift. I returned with far more than I gave. What I didn’t know at the time is that it would change the trajectory of my life, for it was during and soon after that trip that I began to write.

I began writing about childhood memories and belonging, about the trip to Pakistan and what it meant to me. I wrote about saudade and identity, about faith and being an adult third culture kid. I wrote and I wrote and I wrote. Soon after, I began a blog. The blog propelled me into writing a book, and then another book that I had begun several years earlier. Writing was my therapy, my way to make sense of so much that had happened long ago.

At the end of my trip, I wrote an essay called “Holy Moments from an Unholy Disaster.” It was later published in my first book, but as I remember the anniverary of that return, I wanted to post it here.

To you who have read my words, who have encouraged me in my writing journey, who have stuck with me through mixed metaphors and my sometimes grammatically dubious sentence structure – I am beyond grateful. You have made my words live by reading them and posting them, by emailing or messaging me to say that my words resonate. I am so thankful.

On this 10 year anniversary of my return, here is the essay “Holy Moments from an Unholy Disaster.”


Given the choice of a five-star hotel or camping, I will pick a five-star hotel every time. I tell friends that anyone who grew up in the developing world with a commode for a toilet and one bath a week would appreciate my love of luxury. So it was with some surprise that I found myself eager to return to Pakistan on a medical flood relief team.

When I first heard news of the floods, I felt a sadness that was somewhat distant and removed. Pakistan was my childhood love and home, but as an adult I have been more connected to the Middle East through work and travel. My connections with Pakistan had been reduced to occasional emails from friends and to moments on the subway when, eyes closed, the rhythmic movement transports me back to the Pakistani trains of my childhood. That changed when I saw a picture in the New York Times of the city of Jacobabad under floodwaters.

Jacobabad, in the Sindh province, was home to my family when I was a little girl. I broke my leg there. My mother’s artificial flowers were stolen in Jacobabad. Mom had planted them around our house to add color to clay that would never grow anything. They provided a source of joy for a few hours and then they were gone. The New York Times photograph hit my heart in a way I had not anticipated, and through what could only be a work of God, an opportunity came about for me to participate as a nurse on a medical relief trip to care for internally displaced people in northern Sindh.

I never imagined that my life for a short time would resemble a National Geographic feature story. Although I grew up in Pakistan, raised my family in Islamabad, and lived for seven years in Cairo, my current reality is downtown Boston, where I drink a Starbucks coffee daily. I shop at Ann Taylor and get frustrated when my hot water runs out or I don’t have time to put on my eyeliner. But in early September the idea of working with victims of the flood suddenly became real and I became cautiously excited, knowing I may not have what it would take but willing to take that chance.

On October fifteenth, accompanied by my sister-in-law, Carol, and thirteen thousand dollars worth of donated medical supplies, I boarded an Etihad airliner and flew via Abu Dhabi to Karachi ending the journey in Shikarpur, Sindh. Outside the Shikarpur gates, a kilometer from the hospital where we were based we passed the burnt remains of a convoy of twenty-seven trucks that had been featured in the New York Times “Pictures of the Day,” and I realized that I hadn’t paid as close attention to the location of that picture as I perhaps should have.

The two weeks that followed were filled with holy moments. I watched as a mom pointed to heaven in thanks for food distributed to her family. I laughed with children at my own mistakes in Urdu and Sindhi. I prayed in the depths of my soul for the baby who looked like a skeleton at four months of age and for the emaciated mom who held that child with the love only a mother could have. I put shoes on the ulcerated feet of an ancient woman, countless stories written into the wrinkles on her face. We delivered a sewing machine to a widow who danced with it on her head. We saw and served people created in the image of God. These women and children in their beautiful, brightly colored clothing were “no mere mortals” and dear to the heart of God.

Our team — a doctor, two nurses, a community healthworker, interpreter and food distributors — were like a mini United Nations. We represented six people groups and six different languages, but we shared a unity in purpose and spirit that gave us efficiency, laughter and joy. In fourteen days we covered eight villages, surveying needs, running medical camps, and distributing food. Mud huts, tents provided by USAID, and charpais combined with chickens, roosters, water buffalo and cow dung completed the setting and tested our nostrils and stamina. But everyday provided a new adventure and new moments of awe.

There was, for me, an added bonus. Almost anyone who was raised in a country other than his or her passport country can relate with the immigrant experience. The sense of isolation, nontransferable skills, and being ‘other’ can creep up at the oddest of times and result in a deep loneliness and sometimes conflict with one’s passport country. Our lives are lived between worlds.

But for those two weeks I was not other. I was home. I saw friends who knew me when I was young, received blessings from men who worked with my father and women who had deep friendships with my mother, walked through compounds to the embraces of old friends, and was woken yet again by the call to prayer. These were holy moments that I had not anticipated.

A wise friend once told me that there are times in our lives when we need to remember who we are. During those two weeks, I was given the gift of remembering who I was.

Since leaving Pakistan as a child, I, like many, had to redefine my faith. It has often been a painful process. I struggle with unanswerable questions about life and God. This trip back was a humbling reminder that the God who sustained me when I was six years old at boarding school, crying into my pillow, is a God who still provides holy moments in places where real life happens.

I arrived back in JFK International Airport in New York City after twenty-three hours of travel and within a few minutes felt ‘other’ again. I faced a moment of confusion as I looked at the Immigration line options. Was I really a resident alien? An alien? No. I was a US citizen, shaped by cultures and moments that were not of my own making. In that moment I recognized that the peace of belonging happens deep in my soul and that peace can transcend the outside circumstances.

 I don’t know why I was given the gift of going. That is a mystery to me. But I know it was Grace.

International Women’s Day 2018

Every year I write about International Women’s Day – the day set aside to honor women, to highlight the critical role they play in all of life. From nurturing life at its earliest stages to nurturing families, communities, and countries, women are critical to human survival. Not only do women change the world within homes and communities, but they also change the world in their workplaces. But there are still huge changes that need to happen so that women can not only survive, but thrive.

The very first International Women’s Day took place in New York City in 1909 on February 28th. In 1917, the Soviet Union declared March 8th a national holiday. It is interesting that the first countries to embrace International Women’s Day were socialist and communist countries. (That, my friends, is an observation, not an opinion.)

Though I believe implicitly in the importance of this day at every level, this year I find it more difficult to write about. I feel curiously uninspired and not a little discouraged. It seems that we can’t even agree on Women’s Day, let alone anything else. Sometimes we women are our own worst enemies.

As I was thinking about this, I decided that today I would highlight a project that I have been involved in this past year and introduce some of the unique women who have participated in the project.

Let me give you a little history: I began my job working for a state department of public health nine years ago. I began in a consultant role, and three months later I was hired as a full-time employee. The program I work for is a federally funded women’s health program that focuses on breast and cervical cancer screening in underserved communities. Two years after I started I began asking aloud if we might think about doing a project with the Muslim community in Massachusetts. It’s a big, diverse community and I believed we had a lot to learn about the community. Every year I brought it up. Like a record that is scratched and broken repeating the same thing over and over I would say “What about the foreign-born Muslim community? What can we learn in this community?

A year and a half ago, we received funding to do an assessment on attitudes toward breast and cervical cancer screening in the foreign-born Muslim community. I was over the moon.

We finished the assessment this fall, and our next steps are working side by side with the community and taking what we have learned to develop community and health provider trainings.

This project has been a gift. In an era where Muslims are seen as ‘other’ and therefore suspect, I have had the privilege of meeting with Muslim women from many parts of the world. All of them were born elsewhere and most came here as refugees. I have met doctors from Syria, Algeria, and Iran. I have met public health professionals. I have met housewives and many in the service industry. Every one of them has experienced untold loss, and many can never go back to their countries of origin; many cannot go home.

There’s Heba, a brilliant doctor from Syria. She has embraced this project and opened her heart. She is a gifted teacher and watching her speak to her community is amazing. Besides this, she has a new baby boy and a four-year old daughter.

There’s Afsaneh. Afsaneh is from Iran and she is also a doctor. She too has welcomed the project, leading dynamic focus groups so that we can learn from her community.

There’s Houria from Algeria; Saida and Naima from Somalia; and Annam from Pakistan. All of them have offered their unique perspective and stamp on the project. They are diverse in age, culture, and views of Islam, but all of them care deeply about their communities and their faith.

Those of us who are working on the project have been received into the broader Muslim community with uncommon generosity and grace, sharing meals and conversation, brainstorming sessions and ideas. Although we could easily have been viewed suspiciously, we weren’t. Instead we were welcomed with arms and hearts wide open.

And we have learned so much. Women shared honestly and openly about their views towards women’s health in particular, and the health care system in general.

I’ve learned a lot in this project, but one of the biggest things I keep coming back to is that change takes time. For me, being bold for change meant being persistent in my request for time and funds to do this project. Being bold for change means humbly going to a community and saying “I don’t know enough. Please help me understand more.” Being bold for change means going out of your comfort zone and hearing another point of view, another side of an issue. Being bold for change means building bridges that connect, not walls that divide. All of this takes time.

Today on International Women’s Day, I celebrate this project even as I remember the bigger picture that shows me so much more needs to be done. Happy International Women’s Day 2018 – All is not lost. 

Building bridges means moving beyond my enclave of cultural comfort to a place of cultural humility and willingness to learn.”*

____________________

*from Between Worlds, Essays on Culture and Belonging

Cross-cultural Connection

Recently I went to an outreach center in a different part of the city, a few blocks from the subway and behind the mosque in Roxbury. This area is perhaps the most diverse area in Boston. Here people from all over the world find their homes in apartments and houses. Residents are from Somalia, The Sudan, Ethiopia, Iraq, Senegal, Nigeria, Ghana and many more places. A large community health center in the middle of the community attempts to meet a myriad of health and social needs of residents.

We have tried to outreach to this community with health education for about a year and a half. We partner with a community based organization who are part of the community and committed to working within to make it a healthier and better place to live. I love this group. They are smart and funny. They work hard to create safe places where health messages can be heard and understood.

Tuesday was a breast health education session delivered to Somali women. They were all over 50 years old so in the age range where the majority of breast cancer cases are found to occur. Through interpreters and funny stories, poignant re-telling of hard events and sharing of different cultural beliefs we went through the session page by page. Time stopped as we gathered in a hot room talking, listening, learning. Between trainers, attendees, and a colleague we were from Nigeria, Ghana, Ethiopia, Eritrea, Somalia, and America.

This is where I learn why certain myths about breast cancer exist – for they don’t come out of mid-air, rather they are based in stories and events. This is where I learn that the women present believe that trauma to the breast causes breast cancer. “We come from a place where there is war” says one. “And the soldiers take their guns and hit us in the breast to keep us moving. Then we get breast cancer.” We talk about this and I’m not sure how far we get. It will take more conversations, more events, more relationship building to convince them that this is not founded on fact, on evidence, but on story.

This is a world I love. A world where interpreters and native speakers gather with others and connect over a common cause. A world where it doesn’t matter that the session was supposed to take 45 minutes and it took an hour and a half. A world of women from different cultural backgrounds, where I in my western clothing and they in their Somali clothing, head scarves wrapped tight, could begin the long dialogue of understanding. A world where skin color varies from pale cream to glowing, dark brown and every shade between.This is a world that resonates soul deep. My heart was full of the joy of connection and belonging. This is a world I know. A world I love.

It’s times like these that the early mornings and occasional mediocre days of the working world fade into the background, gloriously overshadowed by cross-cultural connection and with this, contentment.

Readers – I want to connect you to an amazing resource today! A friend of mine from years past has started a service called Kids Books Without Borders. Gail grew up overseas in France with a British mom and an American dad. And she loved to read! She has collected over 2000 books! 2000 BOOKS!!! And she now extends this love of reading and books to those who live overseas. All she asks is that you pay the postage. This is what Gail says:

Does your family live overseas and enjoy reading?  I have collected over 2000 books, available to you. I will send you a box of books to a US address or directly to you overseas.  All books are free. If shipped in the US, postage is also free.  If shipped overseas, I ask that you pay half the postage. Check out my website and submit a request.  I will then send you my booklist, so you and your family can shop!  

Think Christmas! Think Books! And then contact Gail at kidsbookswithoutborders.wordpress.com

Broken Made Stronger

Today’s post is written by Brooke Sulahian. Brooke and I have never met, but every time I receive an email from her I stop and read it. Because Brooke has a passion and a mission: to see women who are suffering with fistula healed and whole. She began an organization called Hope for our Sisters, Inc. with a mission statement that is simple and enormous:

“Changing the lives of women, one woman at a time”

I hope this post by Brooke brings you both hope and a challenge. In fact, i would love for this post to generate funding for one more surgery! just $450.00 to give hope! You can read more about Hope for Our Sisters, Inc. by going to the website.

My heart broke in Angola, but it was not Angola itself. Abject poverty, lack of sanitation, and poor medical care options abound. However, Angolans display pride in late-night celebrations and the care invested in each basket made and produce sold. The paradox of pride and joy midst sadness and need.

My heart broke anew when I dove deeper into the realities of fistula, a medical condition caused by obstructed labor and/or trauma leaving women incontinent, resulting in isolation from family, friends and society, lack of dignity, and loss of hope. Lives destroyed.

My door was open. My first trip to Africa. I dreamt of this journey since reading about fistula in 2010. Friends and family supported me with prayers and financial aid. Yet, constant questions took residence in my mind.

Why was I going to Angola? I’m not a doctor. I don’t speak Portuguese. I am simply a wife and mom who said, “Yes”, when called to speak out for our sisters with fistula. Was that enough? Through God, Hope for Our Sisters, Inc., (HFOS), had been fruitful, but I still had questions. In the end, I went.

I traveled with three HFOS team members (Kristen and Paul Coats, Jean Campbell) to visit the Evangelical Medical Center (CEML) in Lubango and bush hospital in Kalukembe, where we fund fistula surgery. We hoped to meet fistula patients to enable us to more effectively raise awareness, help others find healing, and work to prevent this horrific condition. God surprised us as we met fifteen precious fistula patients! Through Audrey Henderson, nurse, fistula advocate and interpreter, we respectfully captured their stories through pictures and video.

Another surprise awaited us as Dr. Steve Foster invited us to watch fistula surgery. Ana* was first to the operating room. Filled with fear in a new environment and unable to speak Portuguese, what amazing courage it took for her to come to CEML. At 20, having lost her first child during labor, Ana* longed for healing from fistula. Joy replaced her fear as she took this brave step towards restoration.

Celia* developed a fistula after her sixth pregnancy. In December 2012, at 29, abandoned by her husband and damaged by fistula, she left her three children with family to travel all day to the hospital. As Celia* awaits healing at the Patient Village, she displays amazing resilience; smiling, laughing, and teasing with fellow fistula patients, living as one victorious.

Luisa*, 32, stays at the Patient Village of the state hospital in Kalukembe, the one remaining former missionary hospital of the 150 before Angola’s civil war. Abandoned by her husband in 2009 after developing fistula and losing her child, Luisa* arrived in December of 2010. After nine unsuccessful fistula surgeries, she remains hopeful. Successive surgeries often decrease the chances of healing, but Dr. Foster recently helped a patient become dry after eleven surgeries. There is hope. Luisa* and fellow fistula patient, Joaquina*, have become each other’s “family” as they await healing.

As for me, I returned with a broken heart. A cost we must all be willing to pay when pursuing justice and healing. An incredibly minor cost in comparison to that paid by those robbed by injustice, but a true cost nonetheless. However, it can make us stronger.

I return to America with greater passion as we continue to raise awareness of fistula. Since these sisters cannot afford to pay for surgery, HFOS’s donors and supporters enable us to fund free fistula surgeries. For less than the cost of a new iPhone ($450), the life of a woman or girl suffering from fistula can be physically restored, paving the way for social, emotional and spiritual healing.

160 fistula surgeries funded…many lives restored…more to come…

*Names have been changed to protect these sisters who so openly shared with us.

Brooke F. Sulahian is the President and Co-Founder of Hope for Our Sisters, Inc. For more information about Hope for Our Sisters, Inc., or fistula, please go to the website at hopeforoursisters.org or visit the Hope for Our Sisters, Inc. page on Facebook.

We Have Work to Do! State of the World’s Mothers – #SOWM

During my flood relief trip in Pakistan a couple of years ago I witnessed severe malnutrition among babies and toddlers. Break your heart malnutrition and hunger. Shout for joy Plumpy’nut solution in some cases. Moms and babies have my heart – probably because I am one and I had five. Getting a good start in life changes a generation and with catastrophes like floods and earthquakes, the chances of having that good start decrease.

For the past 14 years Save the Children has published an annual report on the state of the world’s mothers. The report is long and detailed, providing key findings as well as giving recommendations. The data includes information from 176 countries on the health of children, health of mothers, and economic well-being. Finland came in first and Congo came in last.

This year’s report was released yesterday. Here are just a few of the findings:

The birth day is the most dangerous day for babies world-wide.

More than a million babies die on the first day of life, usually from preventable causes. While great progress has been made around maternal/child mortality, newborns continue to be the most vulnerable of all with little progress made around their health and survival.

Three primary causes of death were identified.

These include complications during birth, prematurity and infections. For all three of these there are interventions that work, that are effective, that can change these statistics. The number of newborn deaths could be reduced by 75% if these preventive measures were put into place. That’s a staggering success rate!

The interventions cost pennies to put into place – from 13 cents a day to $6 a day.*

  • steroid injections for women in preterm labor (to reduce deaths due to premature babies’ breathing problems);
  • resuscitation devices (to save babies who do not breathe at birth);
  • chlorhexidine cord cleansing (to prevent umbilical cord infections); and
  • injectable antibiotics (to treat newborn sepsis and pneumonia).

This is a big deal. Give a baby a healthy start and you change a generation, one baby at a time. Where it stands now is a public health crisis. 

So what do we do? How can we help? If you’re pregnant you help by taking care of yourself, of your baby; by eating right and getting prenatal care. Others of us can pass this information on – if we live in countries that fall at the bottom of the list find out what we can do in both big and small ways. If we live in the United Kingdom or the United States – take a look! The United States falls 30th despite spending approximately 18% of its GDP on health care. This is just sad.

  • 1 of 2,400 women in the United States will die from a maternal cause. This statistic is the same as Iran.
  • In the United States 60% of newborn deaths occur on that critical first day of life.
  • The United Kingdom fares better but not great at number 22 on the list. 

Take a look at the report linked below and the Save the Children website. Learning about this is the first step in making a difference! I’ve also included a link to a Huffington Post article that has a great infographic you can share. Huffington Post infographic.

What do you think of the statistics and the low cost interventions? Have you had maternal child health experience where you have seen these interventions work? Would love to hear from you in the comments! 

Code Pink

October is breast cancer awareness month. In my work this is an important month. It includes legislative breakfasts, educational sessions, screening events, and op-eds for newspapers.

Despite the plethora of information on breast cancer there are times when the information gets lost in the shuffle of life. Messages that would best go from our heads to our health get lost. In an effort to change that I’ve posted an infographic on breast cancer. It’s a different way of looking at what may be old information.

My hope is that you will not only look but act — if you’re young make sure the older women in your life see and know the facts; if you’re older make sure you are regularly screened; if you’re a survivor, share your story! We need to hear it.

Make October more than pink ribbons – make it action!

Code Pink