Posted by: joan49 | June 21, 2017

Karen has moved!

As an update for those who may not have heard: I am working in SW Uganda now as a programs advisor with an organization called Medical Teams International (MTI). My job has many facets and involves working with many programs. As I get to know and work with each one, I’ll be sharing stories and experiences about them all, but the first one I want to highlight is the obstetric fistula program.

The World Health Organization estimates up to 2 million women in sub-Saharan Africa and Southeast Asia suffer from obstetric fistulas.  Humanitarian groups who work with these women estimate that number to be far higher.  Uganda is ranked third in the world for the highest number of fistula cases, with an estimated 140,000 to 200,000 women affected, and 1,900 new cases occurring annually.  Obstetric fistulas are usually caused by difficult births.  Many women in sub-Saharan Africa give birth in the bush or in their banana plantations – without a midwife or any other medical assistance.  If there is prolonged pushing or if the baby is in the wrong position, tearing can occur and no one is present to stitch it up afterwards.  Girls who get pregnant in their teens (either because of early marriage, rape or lack of birth control) are at high risk for this as often their bodies are not yet ready to allow passage of a baby through the birth canal. And finally, gender based violence at any age can also cause tearing and tissue damage leading to fistula formation.  Either way the damage goes far beyond mere physical as the girls or women are then ostracized from their families and communities.  The fistula can affect any or all parts of the genitourinary tract from vagina to anus.  The resulting tears cause the women to leak urine and/or feces uncontrollably.  The smell becomes a source of shame and embarrassment, and their inability to properly function as wives and mothers further devalues them in the eyes of their communities.  Forced to fend for themselves and live in isolation in the bush, many die of starvation or infection, others live as half animals in the jungle, hiding during the day and coming out to forage and steal food or supplies at night.

Thankfully, surgery to repair these fistulas is fairly simple and can restore these women to full physical health, even allowing them to give birth again.  Finding these ostracized women and then convincing them to have the surgery, however, is not as simple.

Medical Teams International, partnering with the Ugandan government to provide health service to refugees, began a fistula clinic at the end of 2015, and performed its first successful surgery in April of 2016.  Since then, 59 women have had the surgery with only 3 not successfully healing.  Their goal is to expand services and efforts to reach more women as awareness of the enormity of the problem continues to grow.

One challenge is the long recovery period.  Women must stay at the clinic for up to 3 weeks following the surgery and then cannot resume normal activities of daily living for another 3 months.  Families, and particularly husbands, overjoyed at getting their wives back are often not content to wait the 3 months.  One of the first women to have the surgery was ruptured almost immediately upon returning home by her overeager husband who was not willing to be patient.  Fortunately he has become one of the program’s champions and voluntarily talks to groups of men educating them to not make his mistake, and to wait the allotted time.

Convincing the women to come to the clinic can take weeks and even months of visits by MTI staff to gain their trust after years of being reviled and humiliated.  One woman living in a lean-to she built with banana leaves resorted to alcohol to numb her isolation and loneliness.  She hid from the MTI team who came to visit her for 3 weeks before finally agreeing to talk from behind the tree where she was hiding as long as no one came any closer.  They brought her sugar, salt and flour, luxury items she hadn’t had access to in years.  Finally she accepted the gifts and agreed to meet with the doctor who would perform the surgery.  But when they came to get her on the appointed date, they found her too drunk to travel.  They had to come 3 more times before she finally agreed again and only when they promised that she could sit by herself in the back of the Land Cruiser.  Most of these women have been forced off public transportation and publicly humiliated because of their smell, so she could only feel safe if she knew she would be alone and sitting far from the rest of the team.  Her surgery was successful and afterwards she moved in with her mother.  When the MTI vehicle drove to her new location she saw the vehicle coming while it was still far away.  As they drove up, the staff saw a woman they didn’t recognize dancing beneath an avocado tree.  It took them a few minutes to realize it was her.  She was clean, her hair was no longer in tangled dreads, and she had gained enough weight that her bones no longer protruded.  She was dancing with joy and tears streamed down her face as she welcomed them by showing off what she could now do.  After talking to her for a while one of the team noticed there were no alcohol bottles or wrappers lying in the yard.  She asked the woman if she still drank.  The woman snorted in disdain and then shrugged, “I don’t need it anymore.”

The women all receive individual counseling but are also required to take part in monthly group meetings with other women who have received the surgery.  For many, finding out they are not alone is the first real step in healing.  The group sessions are an opportunity for them to share experiences openly with others who understand perfectly.  One of their favorite topics is talking about their husbands.  One woman confides she didn’t tell her husband he had to wait 3 months: “I told him he had to wait at least a year.”  The others roar in laughter.  One woman who hasn’t said a word suddenly stands up and says, “You know what I can do now?  Watch.” And she takes off running.  Her 8-year son, who has only recently been reunited with her, catches up to her, grabs her hand, and they run together laughing in circles around the group sitting under a tree.  Other women jump up and start running too and suddenly everyone is up either running or dancing, laughing and crying.

Sometimes they share more personal stories.  One woman recalls growing up in the Congo where war was part of her earliest memories.  Different tribes or political parties have always fought over land rights, and violence, to ensure terror, is part of the warfare.  When she was 10 her village was attacked.  She was outside hanging laundry when people started screaming.  She watched as her 6-year old brother was struck down by a machete.  Then she was surrounded by men and brought before her parents who were being held down by others.  Boys can grow up to be soldiers so are instantly killed.  Girls aren’t so lucky.  At least a dozen men took turns raping her in front of her parents.  Others ransacked their home.  Her 4-year old sister was found hiding in their house and tortured.  She died from internal bleeding and injuries later that night after the marauders left. When they fled across the border into Uganda their family of 6 was down to 3: her parents and herself.  Another brother was never seen again and to this day she has hopes he escaped.  After fleeing to Uganda, her father left one day and never came home.  Her mother who was also raped that day contracted HIV and died a year later.  With no family to take her in, this woman had been living alone since age 11.  Because she smelled and always had dirty clothes, no one wanted her living with them.  Now for the first time, roughly in her 20s, not only is she healthy, she finally has friends.

Now MTI is struggling to come up with the space needed to expand the program.  Because the women require such a long convalescent time, they can only do a few surgeries at a time because there aren’t enough beds to accommodate the women for 3 weeks.  The surgeon who has been trained to do the surgeries also needs better training.  He learned at a 3-day seminar with a larger group of surgeons from other parts of the country and had no hands-on time with the instructors.  Finding funding to get better training for him, train new surgeons, and build a 10-bed ward just for fistula patients are some of the challenges with which we are faced.  But the local staff who work with this program remain committed and passionate as they admit their lives have all been touched and forever changed by the amazing women so far this program has been able to help.




Posted by: joan49 | January 3, 2014

Catching Up

Below is a belated post from Karen about most of 2012. The Vacation Bible School videos were done the summer of 2013. Karen was just in Oregon for the Christmas season to see her family for the first family Christmas in about 8 years. We’ll get caught up eventually but continue to check on the blog and keep Karen in your thoughts and prayers.

Hi Everyone,

Wow, I’m so behind it’s hard to know where to start now…well, how about where I left off…

Ok, so, the last time I wrote a group of Sri Lankan refugees got stranded in Sikakap when their boat ran out of fuel and they literally washed ashore.  I was busy for 2 months trying to help them  cope with the language barriers and integrate into the local community while waiting for immigration to come deal with them from the mainland.  Well, to sum it up: their experiences in Sikakap DID include a small group of them managing to escape in the middle of the night; then the rest of them becoming model citizens (as they made up for upsetting  the authorities when some of them escaped) by volunteering their labor at the police station, local Catholic church, local mosque, and government office building; a drunken brawl which led to me being called down to the local police station in the middle night, which also undid a lot of their efforts toward becoming model citizens; finally bonding and being accepted by the townspeople; then being unexpectedly arrested by the immigration department right before another escape attempt; and then sent to a refugee camp in Sumatra, escaping (again) from there; and then somehow managing to get to Australia after all – only begins to mention some of their adventures.  Suffice it to say that’s the short version of what happened, and thankfully for most of them – unlike for most refugees around the world – their story had a relatively happy ending. 

Flores Island Village

Flores Island Village

Natural Habitat of Komodo Dragons

Natural Habitat of Komodo Dragons

Komodo Dragon Up Close

Komodo Dragon Up Close

                                              Then Christmas and the New Year of 2013 were ushered in with 2 months of no electricity (ergo no internet), so I couldn’t tell you about all this in more detail, or tell you about my vacation to Yogyakarta, Flores Island, Komodo Island, and the famous volcano Mt. Bromo,

Mt. Bromo

Mt. Bromo

then I knew I was coming back to the states for a visit so it seemed easier to wait anyway…Then my whirlwind visit to the states was WONDERFUL, but FAST, and I learned about all kinds of cool technology that was guaranteed to make my communication abilities easier when I came back to Mentawai (and thus more easily able to update this blog and Facebook, etc.), NONE OF WHICH actually work here, or so I found out upon returning, because apparently the cell phone signal here is not strong enough to support anything outside of, well, let’s face it, we can’t even telephone each other here on the island, so… 

That brings me up to the present.  CFK, one of the NGOs I work with here, just had a 3-day retreat for some team building and relaxation, so we got to become Superheroes and build homemade costumes and go on missions to save the world, or in our case, win some chocolate candy.  It was great fun and a great time of renewal – now I am back in Mentawai and am able to post this only with the help of a generator to boost the internet signal, and with the help of my good friend, media specialist extraordinaire, and my own personal real life superhero, otherwise known by the alias Joan49… 

By the way, it was SO GREAT to see so many of you while I was in the states!!!!! For those I didn’t see due to the ridiculous and highly unfair rate at which time speeded up the few weeks I was back, know you will be first on my list for next time…

Now it’s time to go make soup with the deer meat I bought from one of my neighbors who killed the deer in the jungle this morning…

Peace and cheers,


Posted by: joan49 | August 25, 2013

Vacation Bible School Day 5

The Bible Helps Us Stand Strong

Posted by: joan49 | August 10, 2013

Vacation Bible School – Day 4

Trusting God Helps Us Grow Strong

Posted by: joan49 | July 28, 2013

Vacation Bible School – Day 3

Prayer Helps Us Grow Strong

Posted by: joan49 | July 22, 2013

Vacation Bible School – Day 2

Families and Friends Help Us to Stand Strong

Posted by: joan49 | July 13, 2013

Vacation Bible School 2013 Day 1

Posted by: joan49 | October 1, 2012

The Story of Boat 2

Ok, so, the second boat of refugees, totaling 43 people were in a slightly different situation. Their boat engine had finally broken beyond what just “creativity and prayer” alone could repair, and plus they ran out of food, so after floating adrift for 10 days and then being rescued by a fishing boat off the coast of North Pagai island, they were only too happy to get down off their boat and except the government’s offer of food and a place to stay. The government turned the local gymnasium, which was actually a center set up for tsunami victims two years ago and then later converted into a gym, back into a center for the refugees with mattresses for sleeping and small kerosene stoves for cooking. This group, too, were adamant about going to Christmas Island, but seemed to realize the negotiation status was not something they had at the moment.

Boat 2 refugees in the gymnasium.

Because this group was more cooperative from the get go, the local community quickly warmed to them and was eager to help in any way needed. When their same efforts were rebuffed by the first boat for no discernible reason, hard feelings quickly arose against the first boat who was acting, in the eyes of the community, just plain rude. This was the state of their relationship when I joined the mix 8 days into the hunger strike.

From stories shared by members of the first boat, I was able to explain to the community how terrified the first boat was of being sent back to Sri Lanka. They had heard stories of refugee boats landing in other countries, like Cambodia or Malaysia, and being poisoned after being invited to eat by the government, or being beaten and sent back to the country as soon as they disembarked despite promises from the police or government that they would not be harmed. Of course the community and local police indignantly insisted that those scenarios could never, and would never, take place in Sikakap. The refugees on the first boat, to their credit, were willing to believe the good intentions of the local people here, but what if the larger government ordered them to hurt the refugees under the threat of repercussions to their own families if they did not cooperate? The local people of Mentawai were stumped by this kind of paranoia as such thoughts and deeds have never occurred here, and could not be imagined, but it spoke volumes to the trauma experienced by the refugees and gave insight into the kind of terror from which they were running. The fact that nothing terrible had happened to the members of the boat who had already disembarked was offered as proof to the first boat that Sikakap’s efforts to help were sincere, but the first boat feared they were being baited into a trap. As soon as they stepped off their boat, they worried that they, along with all the members of the other boat who had been treated well, would be immediately arrested or worse.

Boat 1

The boat who had willingly disembarked seemed calmer and less paranoid on the surface, but revealed the fragility of their own mental state when immigration officers from Padang (the closest big city to Sikakap on the mainland) came to Mentawai to try to escort them to the immigration office in Padang so they could begin being processed as legal refugees. When the immigration officers arrived on the weekly ferry early Wednesday morning, the first boat had only just broken their hunger strike the night before and was still refusing to disembark, so immigration focused on the second boat instead. Using me as their translator, they explained that the refugees would need to come with them back to Padang, but the refugees instantly refused and insisted on being sent directly to Christmas Island. They did not trust the immigration officers and wanted to deal only with IOM, the UN refugee organization who was waiting in Padang to meet with the refugees. Unfortunately, IOM could not come to Sikakap to negotiate with the refugees directly as IOM also has a standing agreement with the Indonesian government to not get involved as refugee advocates until the refugees have agreed to cooperate with the government first. It took me several phone conversations with IOM, to convince the refugees that the government would absolutely not send illegal refugees to Christmas Island as per their agreement with Australia, and that the only way they could meet with IOM was to agree to accompany the immigration officers back to Padang. Fearing a trap as well, they had a list of conditions they wanted met first including identification badges clearly stating their status as refugee – not criminals – and they wanted to be kept together and allowed continued freedom to use their cell phones (only 2 had cell phones that had been given by Sikakap locals), etc. I salute the immigration officers who came that day as they were amazingly patient and kind to the refugees, and agreed to as many of their conditions as they reasonably could. It seemed to be going well and I felt like we were finally about to reach a solid agreement when suddenly a final latent fear of the government seemed to emerge, and they suddenly insisted that an international NGO member accompany them to guarantee that the government would hold its promises. They wanted me to go, but I had already promised the first boat I would not leave as a condition for them breaking their hunger strike (which also taught me that from this point on all negotiations with either group will have to be WITHOUT using my physical person as a bargaining tool). Since there are no other foreigners in Sikakap, this was a condition that could not be met. “Tavi”, the spokesperson for this group and the only one who spoke good English translated this to the other refugees, and suddenly they panicked. I can now say I have witnessed the phenomenon of mass hysteria as “Tavi” who only seconds before had been calm and rational suddenly started jumping up and down screaming wildly that they would rather the government just give them poison right now and let them die rather than agree to any other terms. All 43 of his group seemed to start shouting at once, pumping their arms in the air, and apparently demanding poison. It was a bizarre moment, and almost in slow motion I saw out of the corner of my eyes the military soldiers who had accompanied the immigration officers shift their military rifles in their arms. I immediately waved the immigration officers back against the far wall, grabbed “Tavi’s” arm and forced him to suddenly sit down with me on the floor. That forced him to stop shouting and the rest of his group stopped shouting too, and also sat down on the floor. Speaking slowly and looking them each in the eye one by one, I reiterated everything that had happened to them since they arrived and stressed how well they have been treated, how cooperatively and kindly the immigration officers were trying to meet all their requests, etc., but also reminding them they were in the middle of nowhere (Mentawai), and that there was no possible way to have an international NGO person go with them because THERE ARE NO INTERNATIONAL NGOs in Mentawai. Gradually they started to relax and started nodding in agreement and understanding as “Tavi” translated to them everything I said. After several tense minutes of them talking among themselves in their own language, “Tavi” finally announced that they all agreed to go if at least a few of their other conditions were met. I walked back to the immigration officers and soldiers who were all waiting by the far wall, and related the conditions and terms to all of which, thankfully, the immigration officers agreed.
As this took most of the morning, there was only time for a quick lunch and packing their scant belongings before being transferred 10 at a time in the back of a pick-up truck to the ferry waiting to start its 14-hour night-long journey back to Padang.
Hugs and tears were exchanged with many of the local community who had grown quickly attached to these strangers who landed so unexpectedly in our midst, and a large group accompanied them to the boat to wave them off.

And so that’s how one boatload of 43 Sri Lanka refugees came to go to Padang, and one boat of 53 refugees remained in the international hub of absolutely nowhere, also known as Sikakap, Mentawai…

Next: Part 3–Back at the ranch with the first boat…

Posted by: joan49 | September 18, 2012

The Story of Boat 1

Hi Everyone,
Here is a summary of what’s taken place since I got involved with the refugees. I had heard the news that 2 boats of refugees from Sri Lanka had arrived in Sikakap on Sept. 1, when one ran out of fuel and the other broke down, but assumed the government was handling it and didn’t think that much about it except as a surprisingly weird-out-of-the-ordinary story for life here in Mentawai. As it turns out, one of the boats was hunger striking and refusing to leave their boat until their demands were met after it became clear that the government was not simply going to sell them fuel and let them go on their way. I got called in on the afternoon of Day 8 of the hunger strike when over 10 people on the boat began passing out. Only then did I meet them and become aware of the real situation. Because a few of them spoke broken English and no one here in the local government does, I was able to communicate with them, and so the local police asked me to help with translating.
The police were trying, obviously, to convince them to eat and get down from their boat while waiting for further information from Jakarta as to how to handle this. The refugees were terrified the police were going to arrest them if they came off the boat and send them back to Sri Lanka. They told me they would rather starve to death here than get sent back. They were also hoping that by hunger striking, the government would simply sell them the diesel fuel they needed and let them be on their way. Turns out the Indonesian government, at the desperate request of Australia, has agreed to not help boat refugees go to Christmas Island because Australia is trying to encourage refugees to come through the refugee centers via legal channels, not by boat which is extremely dangerous. Hundreds, if not thousands, of refugees are killed each year trying. When I finally convinced the refugees that they were not going to be allowed to just continue their journey they said that they would continue hunger striking until they were allowed to meet with IOM, International Organization of Migration, which works under the UN Refugee unit (UNHCR). They felt confident IOM could help arrange their immediate transport to Christmas Island.
In the meantime, I was able to communicate to them the police and locals public health concerns that diseases arising from the lack of sanitation on the boat could spread to the community. The fact that 53 people crowded on a tiny fishing boat had not bathed for almost 2 weeks in tropical heat was odorously obvious starting about 20 feet from the boat. The nuns from the local Catholic clinic who were helping start IVs on the unconscious patients wore face masks to keep from getting sick from the smell. The police promised me they would not arrest anyone who stepped down from the boat, so finally the refugees agreed that the children and women could go to the Catholic clinic to bathe, and the more severely ill patients could be taken there for treatment on the condition that I personally accompanied them both ways to guarantee their safe return, and that they be brought back to the boat by 7pm so they could hold their nightly prayer meeting together. I also insisted that a 4 month pregnant woman on the boat who was extremely ill be allowed to eat. After some discussion amongst themselves, they unanimously agreed to allow her food, but the woman herself refused for a while longer not wanting to break solidarity with her fellow refugees. Eventually, though, we convinced her to eat for the sake of her baby. The refugees gave me a list of email addresses and asked my help in sending out their story to generate public interest which I promised to do. I was also able to negotiate with the police to return the boat batteries which the police had taken for fear the refugees would run. I explained that the batteries could not power the engine but only provide electricity so they would not have to sit on the boat in the dark at night. Thankfully, the police agreed, and so after 10 days of hostility (all of the above actually took place over Saturday/Sunday/Monday) both sides were more at ease and felt like some progress was being made. On Tuesday, Day 11 of the hunger strike, I told the refugees I was planning to leave Sikakap the next day, and they immediately panicked and said if I left that there would be no one there left to help them. Even if a government official from Padang came who spoke English they would not be able to trust him, because only with me, a foreigner, did they trust I could not be bribed  They promised to do anything I said if I stayed, so I agreed to stay on the condition that they break their hunger strike. They agreed, and so the nuns and I spent the next few hours rounding up a kind of soft mush made from boiled rice which was the only thing I allowed them to eat after so many days of fasting…
We are currently waiting to hear where they will be sent in Indonesia, probably to a detention camp. Sadly, they do not have many options and none of them sound good…most likely they will be left waiting in a detention camp for at least several years…please keep praying for them.

Next: Their story continued, and what happened with the other boat…


Posted by: joan49 | September 17, 2012

Refugee Background Info

Hi Everyone,
Here is some more background information on this situation. The first boat of refugees made up of 43 people of whom 4 are children, 4 are women, and 2 are men over the age of 55, left Sri Lanka by boat on Aug 3. By breakdown of religion they are 20 Hindus, 22 Catholics, and 1 Buddhist, but all of Tamil ethnicity. Their boat, a small fishing trawler not meant for trans-oceanic voyages broke down several times while in the Indian Ocean. With no mechanic on board, they fixed the engine with “creativity and prayer” until finally it broke down again and they could no longer fix it. Fortunately, they were then close to Mentawai, and so the tides eventually brought them ashore to Silabo, a small fishing village several hours from Sikakap. The local people called the police in Sikakap who were then able to tow their boat to Sikakap on Aug 29th. The second boat, also a small fishing trawler, made up of 53 people of whom 4 are women, 3 children, and 2 men disabled physically from surviving bomb blasts. Their religious breakdown is: 47 Catholics and 6 Hindu. As with the first boat, they are all of Tamil ethnicity. They said the current government in Sri Lanka is anti-Tamil, and forced them from the villages and moved them to “concentration camps” where they were frequently terrorized and brutalized. Many women were raped and killed, 25 people have disappeared from the village since 2009 with no word as to whether they have been killed or are being held in prisons. The people had to ask permission even just to go fishing or searching for food in the jungle, and this request was often denied. Many of them have scars from gunshot wounds, or shrapnel wounds from bomb blasts. One man had his leg amputated at the knee and now wears prosthesis, another had his right leg severely broken so now it is several inches shorter than his left. Unable to stand the conditions, they escaped to South India, procured a boat and set sail on Aug 9th. They ran out of fuel on Aug 19th and floated for 10 days until reaching Malakopak, a fishing village on the South Pagai island and also close to Sikakap. Again the police were called, and their boat brought to Sikakap. Both boats had the goal of reaching Christmas Island where they were confident they would be granted asylum.

More info to follow soon.

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