CULTURE: WOMEN AND HEALTH IN SENEGAL
Change and challenge is in the wind as 2008 comes to an
end. The same is true when examining this month's ReachMD XM 160 special
series - Focus on Global Medicine. We take a look at both the changes and the
challenges impacting global medicine.
How an outsider helps change a culture from the inside.
Welcome to a special segment - Focus on Global Health. You are listening to
ReachMD XM 157, The Channel for Medical Professionals. I am your host, Dr. Maurice
Pickard and joining me today is Molly Melching, founder and executive director
of Tostan. She has also won the Sargent Shriver Distinguished Service for
Humanitarian Service and the Conrad Hilton Humanitarian prize.
DR. MAURICE PICKARD:
Thank you very much Molly for joining us.
Oh, thank you for inviting me.
DR. MAURICE PICKARD:
First of all, what is Tostan and what language is it in.
Our Tostan is a Wolof of word that means breakthrough. It
literally means the hatching of an egg, but we in fact use it to mean spreading
of knowledge. When people learn in their own language and their national
languages, then Tostan works in 19 African languages. They learn new
information and then they share it with their relatives, their friends. They
spread the word and people start getting the information may need to make very
important decisions. So, Tostan is very meaningful. It is a very meaningful
word to us.
DR. MAURICE PICKARD:
I know Tostan has its headquarters in Senegal and that is
where you have lived for a long time, I know that initially you came there with
an educational motive or an educational vision. How did you go from being educator
into human rights and how did human rights education on a village level teach
or improve health for the larger community.
Well, actually I went to Senegal to study at the
university. I was going to finish my masters at the University of Illinois and
I went for 6 months and so it was really just a personal thing when I went to
finish my masters, but when I got here, I got so excited about the culture and
the society and I was learning so much myself about Senegal and African culture
and tradition that I became interested in staying and I originally worked in
the children center and was teaching 3 children in their own language and with
stories, traditional songs and poetry and theater and then moved to a village
and in the village, I then started working on an educational program for the
community that would really respond to their needs and priorities as expressed
by they themselves, and as we worked on this program in 1988, UNICEF started
funding us and we moved onto many different communities, and we were confronted
with new demands and request by the population for themes and one of the themes
that women wanted particularly to learn about was their own health and as we
started working on that, on those modules to teach women's health, we realized
that it was critical to start with human rights, because if women do not know
their rights, how can they actually stand up for their health, how can they
even use their health center or how can they defend their rights to do family
planning, how can they tell their husband look, you had been off in the city
and now, we are little bit worried about HIV AIDS and we wanted you to get your
test, I mean women would never have dared to speak out on these issues before.
Learning human rights gave them incredible confidence and made them much more
proactive than they had been in the program that we had been doing for years.
When we started introducing human rights, there was a huge change in what women
were able to accomplish once they knew about human rights and one of the most
amazing things that happened was that women decided on their own to abandon the
practice of female genital cutting.
DR. MAURICE PICKARD:
Could you give me an idea statistically how frequent female
genital cutting is in Africa and how many countries are involved.
Female genital cutting is a tradition that has lasted for
2200 years, originally began we believe, in Egypt with the Favorers and in the
Favorers court, as he started marrying women who were infibulated, nephronic
infibulation, women started practicing this so that they could even marry into
the Favorers court or be a concubine and as women saw that they could move up
in status, they actually practiced starting moving down and as there was
migration out of the Egypt and across the Africa, it spread and particularly in
countries such as Malawi where there was a hierarchy with the empires and
Mandinka empire, which spread this practice even further and in the Senegal,
for example, in Senegal, FGC is practiced by 28% of the population, but that
figure is very deceptive, because when you look at the different ethnic groups
within the Felony ethnic group or the Mandinka ethnic group, actually it is
much, much higher. It is just a role of ethnic group that does not practice
FGC. So, when you work in Mandinka village, you will find that all of the
Mandinka is their practice, in fact it is like a social convention. If you
don't practice it, you won't get a husband and this is what Tostan learned, as
we started doing our human rights work that women were not even able to discuss
this because it was a social norm, a social convention that was just expected
of them and they couldn't imagine that if their daughter was not cut, they knew
no man would want to marry their daughter, so of course they have to do it.
They were trapped in this convention. Even if they themselves have problems,
now, I knew a woman, an amazing woman, she told me that her daughter died
during this tradition and she said the most incredible thing was that when her
younger daughter then was ready to be circumcised that time, she said you would
think that I would say no. She said because it was a most horrible experience
to have all the girls go off for the circumcision ceremony and she was the only
mother that was not called and then they finally called her in the morning and
said your daughter has died and she is already buried. She said you would
think and she started crying when she told me this. She would think that with
my second daughter, I would say no, I don't ever want to take the risk. She
said, but I had no choice, Molly. And then she looked at me and she said, this
is what human rights education has done for me. It has given me choice.
DR. MAURICE PICKARD:
And I wonder what the response of the women who are called
cutters who do this, they really view themselves as honorable kind people.
They don't view themselves as?
No, they are helping the mothers to make their children
successful and so we soon learned and this is what one of the most important
aspects of the Tostan program is that this one woman I told you about Maria
too, she could not abandon FGC alone. The reason she was able to abandon is
because Tostan in our program taught this core group of people, women, men, and
adolescents about the dangers. We didn't tell people to stop. We merely
informed them of the dangers. We allowed a form of space where they could
openly talk about these issues and discuss some of these experiences that they
have never talked about before. Maria too had never told anyone what happened
to her daughter. So, by coming out and talking about these things for the
first time, it allowed people to come together and Tostan helped to facilitate
them coming together from many villages that might have been for us and
difficult to get together, you know, to come and transportation and having to
eat and spend the night. So, we had facilitated their coming together and
discussing these issues on their own as an extended family for whom this
tradition had been so critical for so many years. This form allowed them to
make these important decisions as a united family and deciding together as of
tomorrow, no one will practice this again and in that way, no girl would be
ultra-sized, no girl would be marginalized and not marriageable. So, this was
the critical thing that we discovered and we discovered it through the
villagers themselves. We later found out from a scholar at the University of
California in San Diego that this is how foot binding ended in China that women
had wanted to end this practice, but they couldn't because it was required for
marriage. A woman who did not have bound feet would not have a husband. So,
what happened in 1895 to 1907, there were marriage clubs established where
people would sign in and say our daughter will not have bound feet and our sons
will never marry a girl that has bound feet, and this allowed people to stop
safely and this is what happened in Senegal and we went from one village
abandoning in 1997 in Malikounda Bougoula to today where we have had over 3300
communities abandoned female genital cutting, coming together publicly
declaring that together we are family, are ethnic group, we have decided to
stop this practice because we are moving towards health, we are moving towards
human rights, we want our community to be in good health to be happy and
prosperous and we can do this if we continue on with these practices.
DR. MAURICE PICKARD:
United States hears all the time just say no, and I can't
help it make that association just saying no isn't enough, the change has to
come from within, is that what actually happened with Tostan.
It is. I think that when there is a question of a social
norm that people have the habit and the customers doing things and they have
never questioned them before, coming up with the message saying the people stop
this now, actually can have the opposite of sex. It could make people more
defensive and reactive and say, wait a minute, who are you to be telling me
what to do? This is something I have been doing for years. My mother did it,
my family did it, my grandmother did it. How dare you? So, this was the
reaction I think that many people have gotten when they tried to get others to
stop things, especially something like female genital cutting. Whereas, going
and informing people and trusting people and saying you are going to make the
right decision when you have the right information trusting that people, you
know, might take them a while, but that if they can do it under the proper
condition that is getting together the group that is concerned by this practice
and discussing it with them, allowing them to come together and say, let's come
up with a different social norm that will be more beneficial to us as a group
in the future and then actually witnessing people doing that is much more
productive in the long run to behavior change, then trying to you know put up
posters, stop this, don't do that, it really and we have seen this also in
Africa, has really led to people being even more resistant, marching against
people who are trying to do this. It is understandable. We would do the same
way. So, I feel very strongly that information and education is critical and
others, we believe that human rights education really help to give people an
idea of where they wanted to go and what would the framework was. Human rights
provided that framework for them. We wanted society in which there is peace
and security where there is help in education and lack of violence and lack of
discrimination, you know, when FGC you couldn't marry someone who didn't
undergo FGC, so they said look, this is a practice that have led the
discrimination, we want to end this because we believe that is not good, even
our religion speaks out against the discriminatory practices. So, it really
helped tremendously to understand social norms and how they work to use those
rather than going in and just putting up signs, stop this now, this is bad, and
this prescriptive messaging.
DR. MAURICE PICKARD:
I have read where, when 2 women get together, there is hope
and where there is 35, you can change the world.
I want to thank Molly Melching, founder and executive
director of Tostan, an organization that through education has made both men
and women in Senegal, in the greater African continent aware of human rights
education and proved that leaving to changes in long established cultures, such
as female genital cutting and how eliminating this has opened the culture up to
I am Dr. Maurice Pickard, your host and you have been
listening to a special segment on global health. To listen to our on-demand
library, visit us at reachmd.com. Thank you for listening.
Thank you for listening to our special series - Focus on
Global Medicine. As we celebrate this annual holiday season, everyone at
ReachMD wishes you and your family a happy holiday and a successful new year.
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