Global Health Blog

  1. Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment

    December 8, 2014 by Lajja Patel

    Sarah B. Rodriguez teaches in the Medical Humanities and Bioethics Program and in the Global Health Studies Program at Northwestern University. Global Health Portal blogger Lajja Patel recently spoke with Sarah about her new book Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment. Here is an excerpt from the interview.

    Source: University of Rochester Press

    Source: University of Rochester Press

    About the book (from the publisher): 

    In the nineteenth through the mid-twentieth centuries, American physicians treated women and girls for masturbation by removing the clitoris (clitoridectomy) or clitoral hood (female circumcision). During this same time, and continuing to today, physicians also performed female circumcision to enable women to reach orgasm. While the opposite purposes of these clitoral surgeries (to either contain a perceived excessive sexuality or to remedy a perceived lack of sexual responsiveness) may seem paradoxical, their use reflects a consistent medical conception of the clitoris as a sexual organ. In recent years both the popular media and academics have commented on the rising popularity in the United States of female genital cosmetic surgeries, including female circumcision, yet these discussions often assume such surgeries are new. In Female Circumcision and Clitoridectomy in the United States: A History of a Medical Treatment, Sarah Rodriguez presents an engaging and surprising history of surgeries on the clitoris, revealing what the therapeutic use of clitoridectomy and female circumcision tells us about changing (and not so changing) medical ideas concerning the female body and female sexuality.

    Can you tell us a little bit about your background, and your research interests?

    My background is in the history of American medicine and my research area of interest is in women’s reproductive and sexual health since the late 19th century. I’m interested in history for history’s sake but I’m also interested in how history frames how we think about current medical debates and issues. I came to be interested in global health via my work on the topic of this book. Almost everyone conceives these methods as nonmedical procedures that don’t occur in the U.S. unless it’s by immigrants, but this is not the full picture. Historically, in the United States, female circumcision and clitoridectomy were done on white, native-born women as medical therapy.

    Can you tell us about some of the history on female circumcision and clitoridectomy as discussed in your book?

    To give you a little bit of a background, clitoridectomy is the removal of the external clitoris, while circumcision is the removal of the clitoral hood. Some physicians in the U.S. started using these procedures (at least based on published documentation) in the mid 19th century. At that time, physicians were using it to treat masturbation in women and girls. Physicians believed that there were poor physiological outcomes from masturbation – poor outcomes not in the moral sense but in the sense that people would become ill. Some physicians used clitoridectomy as a therapy for masturbation until at least the 1960’s – that’s the last published reference I found. Physicians also used female circumcision to treat masturbation and they used that therapy until at least the 1960s as well.

    In addition to using female circumcision as a therapy for masturbation, however, beginning in the 1890’s physicians published reports of using female circumcision to enhance female orgasms. When I first discovered this use of the procedure, I didn’t think it made sense because physicians were (seemingly) performing female circumcision for polar opposite reasons: to enhance orgasms and to stop masturbation. After further research, I realized that both were being used for a similar goal: to treat culturally non-normative sexual behavior. Whether a woman was masturbating or not having an orgasm with her husband during sex, both behaviors were regarded as culturally inappropriate. If a woman was not having orgasms in the “appropriate” heterosexual manner with her husband, then the clitoris was seen to be at fault. The only “culturally appropriate” and “medically healthy” sexual behavior would have been to have orgasms with one’s husband. Female circumcision and clitoridectomy were medical therapies used to reinforce culturally normative sexual behavior.

    While there is no evidence to suggest these procedures were frequently used, they were also not anomalies. They were commonly known enough to end up in some pediatric and gynecology textbooks, for example. And the reason why practitioners were performing these procedures was very much embedded in cultural ideas (and ideals) of normative female heterosexual behavior.

    While you were writing this book, which populations were you hoping would read your book?

    Definitely other historians and medical anthropologists. But I hope that people who work on policy/outreach/ education surrounding the issue of FGM also read it. And I’d love for people more broadly interested in women’s health and women’s history to read it.

    Do you recall some challenges you had while writing this book?

    One challenge was finding sources – you have to work with whatever documents are left. The majority of my sources are the published reports of physicians, but then all of these documents are from the perspective of the physician. Women’s voices don’t appear until really the 1970s when a few women began publishing about their experiences.

    How long did it take you to write this book?

    I initially started exploring this topic while an undergraduate for my honors thesis. I took it up again for my dissertation, but then moved to other topics for a bit. I then wrote one article and again let it sit. So, you can say, I’ve had an on again, off again relationship with this project for a long time. The short answer is, it’s taken me several years.

    If you had this on and off- relationship what finally inspired you to go ahead and write this book?

    I felt the need to give a more full accounting of the history of these practices than what I was able to do in an article. Also, I suppose I did it for the challenge of it – others told me that I’d never have enough material for a book and I thought otherwise.

     

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  2. APEC Climate Agreement: Too Little Too Late?

    December 1, 2014 by Haley Lillehei
    pollution-changchun-net.jpg

    A power plant pollutes the air over Changchun, in northeastern Jilin province. Photo Source: South China Morning Post

    Last May I wrote a post on my experience with pollution while in China. The smog was, without a doubt, my least favorite part about spending a summer in Beijing. Not only are the extreme amounts of pollutants gross to breathe in and bad for the environment, they are also bad for our health. And since my 2012 trip, the problem certainly hasn’t been getting any better – a recent study estimated 670,000 people died from smog caused by coal consumption in 2012.

    These deaths were linked to a tiny particulate pollutant (PM2.5) in smog that contributes to premature deaths from strokes, lung cancer, coronary heart disease, and chronic pulmonary disease.

    To understand the level of pollution in China, it is helpful to look at a benchmark. According to the World Health Organization (WHO), the upper limit for safe pollutant levels of PM2.5 is 10mcg per cubic meter. In China, in the year 2012, hundreds of millions of people were living in areas with pollutant concentrations far above this level. In fact, 157 million people were living in areas with PM2.5 concentrations over 100mcg per cubic meter, ten times the WHO’s safety limit. Since 2012, the problem has only gotten worse.

    The researchers behind the study were interested in putting numbers on the social and environmental costs of the heavy Chinese reliance on the fuel and the resulting pollution. The results are even more dim than one might have imagined – they found the combined cost of damage to environment and health to be 260 yuan (~45USD) for each ton produced and used. For a country that uses approximately 4 billion tons of coal per year, the expense is massive.

    Despite the large monetary cost the researchers found, their estimate may still be too conservative. Although they took into account the health care costs of the aforementioned causes of death, they overlooked smaller but very common health issues caused by pollution, like asthma and other respiratory issues.

    Li Guoxing, from Peking University’s School of Public Health, remarked in an interview with South China Morning Post: “The health cost [of the study] is only based on the premature death figures due to the limitations of our research data. It could be way higher if we also include medical costs for other chronic illnesses.”

    Beijing clearly knows some work needs to be done. In lieu of the Asia-Pacific Economic Cooperation forum that took place a few weeks ago, the city tried to clean up its act in hopes it would help clean up the air. Flowers were planted, streets were swept, residents were encouraged to leave town, home heating was temporarily cut off, and factory production was ordered to be delayed or stopped, among many other measures. This was the biggest international event to take place in Beijing since the 2008 Olympics, and China was ready to pull out all the stops.

    Beijing’s clean-up may have foreshadowed what was to come. On November 12, Chinese President Xi JinPing and President Obama announced an agreement to curb pollution. This agreement is being hailed as landmark – the US and China represent the world’s two largest carbon polluters, together accounting for 45% of the world’s greenhouse gas emissions.

    Obama and Xi shake hands. Photo Source: Economist

    In the agreement, which has yet to be approved by the World Trade Organization, China pledged to put a cap on its quickly growing carbon emissions by 2030, as well as increase the amount of non-fossil fuels used to 20% of all energy used by 2030.

    These ambitious goals are the largest steps China has taken to reduce it’s pollutant levels in recent history and the agreement is being widely praised around the world. Some, however, fear it is too late.

    Can the agreement and the resulting goals make a real dent in the social and political costs of pollution in China, as well as around the world? It remains to be seen. What I am certain of, however, is that any move in the right direction is better than no move at all.

     

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  3. In Sickness and in Health: Panel Discusses Health Trends in Evanston and Skokie

    November 28, 2014 by Lajja Patel
    Courtesy of Sean Su"

    Courtesy of Sean Su

    Last Tuesday, the Evanston Public Library in collaboration with the Village of Skokie, the Erie Family Health Center, and NU International Program Development, hosted a discussion on current health trends in the Evanston and Skokie neighborhoods. The event was titled “In Sickness and in Health” and consisted of a panel of three speakers: Evonda Thomas-Smith, director of the Evanston Health Department; Dr. Catherine Counard, director of the  Village of Skokie Health Department; and Dr. Avery Hart, Chief Medical Officer of Erie Evanston/Skokie Community Health Center.

    Northwestern Global Health Professor Michael Diamond introduced the event as the first of many discussions that will be organized by the Hircules Health Hub, which is a project committed to providing easier access to health information by collaborating with other community health organizations. As a part of this new project, Northwestern global health students will be volunteering to operate desks at the Evanston and Skokie Public Libraries starting in Spring 2015 in order to provide information about the latest health concerns in the respective communities. The group will also be holding monthly discussions on various health themes, such as nutrition, cancer, etc. in order to empower local community members with knowledge about maintaining their health.

    In addition to introducing the concept of local community health desks at the Evanston and Skokie libraries, the event also served as an opportunity for the Skokie and Evanston health departments and the Erie Family Health Center to provide summaries of the latest health trends in Skokie and Evanston.

    The leading health concerns in the Evanston community was asthma for the youth and obesity for the older population, said Evonda Thomas-Smith, Director of the Evanston Health Department.  However, through a number of surveys distributed in the community, the Evanston Health Department found that the top pressing health concern in the community was access to health care. Similarly, Dr. Catherine Counard, director of the Village of Skokie Health Department, said that according to surveys, Skokie residents reported that access to care and health information was also the most pressing health concern in their community.

    Dr. Avery Hart, Chief Medical Officer of Erie Evanston/Skokie Community Health Center, said, “Every day I’m seeing new patients, and each one has his own story or her own story, but these are all stories that revolve around not having access to healthcare.” The mission of the Erie Family Health Center is to provide affordable health services to those in need. Due to its location on the border of Evanston and Skokie, which is comprised of various ethnicities, the Erie clinic is employed by culturally diverse employees and also offers interpreters for over two hundred languages. Prior to the launch of Erie in 2013, residents without health care had no way of receiving health services.

    Throughout the entire discussion, the three panelists continued to emphasize the power of libraries in serving as a resource for health information. The traffic of local residents that come through libraries in addition to various books and library resources available make it the perfect location to host community health desks. The idea of collaboration between health care providers, community health leaders, and local Health Departments is key in making information about health care more transparent and affordable to the public.

    The twenty-five audience members included medical providers, public leaders in healthcare, faculty and students from Northwestern’s Global Health Studies program, and the general public.

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  4. New York Times Video Journalist shares reporting experiences with Ebola

    November 26, 2014 by Arianna Yanes
    Medill professor Craig Duff and Ben Solomon of the New York Times discuss Solomon's reporting on Ebola in West Africa.

    Medill professor Craig Duff and Ben Solomon of the New York Times discuss Solomon’s reporting on Ebola in West Africa.

    Ben Solomon, New York Times International Video Journalist, spoke to students and faculty on Monday about his experiences around the globe. He particularly focused on his recent months in Liberia, one of three countries impacted most by the current Ebola outbreak. Through his videos, Solomon brings a human element to the numbers and statistics of the epidemic.

    “People are learning from the videos and people are gaining experience by seeing them,” Solomon said.

    Solomon went to Liberia knowing it would be interesting to follow an ambulance and show the variety of situations encountered each day. In three and a half weeks, he shot his piece, “Fighting Ebola Outbreak Street by Street.” Much of that time was spent proving to the ambulance driver, Gordon Kamara, that his video work was worthy. However, after putting in the time, Solomon says gaining Gordon’s trust was one of the most satisfying things in journalism. The clip is difficult to watch, capturing the struggle, tragedy, and frustration of the Ebola virus.

    At the speaker event, Solomon detailed his experience with Ebola, addressing his own emotions in close proximity to the virus.

    “I felt very confident in my safety there,” Solomon said. “But that’s not to say I wasn’t scared.”

    He described Ebola as an “intimate” disease, one that goes between loved ones who touch one another. The disease tears families and communities apart, preventing people from interacting with sick patients.

    “[Ebola] destroys trust in a powerful and sad way,” Solomon said.

    The second clip, “Dying of Ebola at the Hospital Door,” shows the difficulties Ebola patients face in accessing treatment. Centers are overcrowded and understaffed, leaving some patients to wait for hours while other are turned away.

    Although the news coverage of the outbreak is dwindling, Solomon warns against getting comfortable and thinking that the outbreak is ending.

    “Epidemics move in waves,” he said.

    The last clip shown at the event, “Inside the Ebola Ward,” sheds light on the conditions of the treatment centers by taking viewers inside their walls. The clips are worth viewing, providing visuals to contextualize the information in the news.

    As one of the workers says in the treatment center, “There is no mercy from Ebola.”

     

     

     

     

     

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  5. Students of Global Health: Dennis Hong Liu

    November 20, 2014 by Emily Drewry

    IMAG1352If he had to give one piece of advice to incoming medical school students, Dennis Hong Liu (pictured, second from left) would tell them to get as much exposure to new things as possible. As someone whose journey has taken him to Mexico and the world of global health after undergraduate study, he has experienced firsthand that you never know what might spark your interest somewhere down the road.

    Now in his second year at Northwestern University’s Feinberg School of Medicine, Liu originally hails from San Diego, California and attended UC-Berkeley. During his undergraduate years, Liu studied integrative biology with the goal of attending medical school post-graduation. He spent his free time volunteering at a Hepatitis B clinic that delivered free vaccinations, outreach and education to underserved areas, attempting to address the large prevalence in the Bay area.

    Upon coming to Feinberg, Liu heard about the Northwestern University Alliance for International Development. The group, founded in 1999, organizes student trips to Latin America and India to provide free medical care to underserved populations. The organization conducted significant outreach to medical students to generate enthusiasm about practicing medicine abroad. “NUAID really came to the students,” Liu says. “The more I got to find out about it, the more I trusted it.” He got involved, drawn to the organization’s team-based approach, and took on a leadership role in planning a month-long trip to Mexico between his first and second years at Feinberg.

    The trip itself was, according to Liu, “the highlight of my first year of medical school because it pushed me outside my comfort zone.” The team spent three weeks shadowing in local clinics, taking Spanish classes, and preparing for the final week, where they put on a workshop for a group of forty traditional midwives, known as parteras, who came from various cities of the state of Oaxaca. It was a valuable lesson in maternal and fetal health, as well as the importance of cultural exchange. “I gained a perspective about how medicine works in other countries that I would never get in Chicago,” he recalls fondly.

    The nine-member team partnered with Child Family Health International, a San Francisco-based NGO that helped in the creation of the community programming. In the end, Liu’s responsibilities went far beyond organizing plane tickets, staying in contact with local coordinators and getting the team together. In the end, he says, “the fact that I had a lot of responsibility as the trip leader to get the workshop going, it was an invaluable leadership opportunity.”

    Liu was introduced to the concept of global health at Feinberg, never having been abroad to work in medicine. The group he took to Mexico was very widespread with experience in the field, he recalls. “Global health is emphasized at Northwestern,” Liu says, calling the opportunities at both the undergraduate and graduate levels “fantastic.”

    The experience taught students how doctors across the world deal with limited resources and what kind of patient outcomes they see, despite the challenges. “These are life lessons I learned from global health that I am unable to replicate [in the classroom],” Liu says. Additionally, upon his return to school following the trip, Liu found his confidence in his medical skills had reached a new level. “Having had to practice physical exams and other medical history taking in Spanish, once I got back to Feinberg, performing history taking and physical exams were easier.”

    Now that he is back in the swing of things in Chicago, Liu has returned his focus to the goal of one day becoming a surgeon. His interest in global health sparked, he hopes to one day integrate global health projects into his surgical practice. His interest isn’t specific to one area of the globe, but rather focused on the opportunity to work with underserved populations.

    Above all, Liu is grateful for the opportunity he had to enter the realm of global health. “Global health has become an area I want to explore more in,” he says. [The trip] reaffirmed my desire to go into medicine.”

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