In case there is anyone still desperately checking you-kraine, my-kraine for the latest crazy adventures in the Eastern bloc, I would like to make the general announcement that I have moved to Liberia! to continue working in women's health in a completely different setting. Family planning is still an issue, maternal health is still a (huge) issue, and I'm still asserting myself in places where I have no business being and asking prying questions about the sex lives of foreigners. But now it's in Africa.
So, welcome to Liberia! And let's try this whole "blogging" business once again...
Wednesday, July 29, 2009
Wednesday, May 7, 2008
For those of you in the audience who are still awake (I'm sorry for the continued long absences... chalk it up to laziness and a lot of traveling for my field research... I know, I know, I'm pretty important), I would like to provide an update on life in the U-Krane.
I am spending the majority of my time in Ukraine on researching the "obstacles and motivations to use of contraceptive and abortion services" (that's the title of my project), which involves traveling to the various regions of Ukraine (called oblasts) and setting up shop in hospitals, women's clinics, and gynecologist offices to speak with women about their experiences with abortion and contraception. (As a side note: all of these interviews are done under informed consent and according to ethical regulations. I promise.) This has at times proved rather awkward or surreal, due both to my not-yet-perfect-and-often-quite-tactless Russian language skills and to the lack of an awareness of patient rights in Ukraine. For example, I have been led into post-abortion recovery wards and invited to ask the group questions about their experiences (I mean, really?) or some lack of subtlety in my questioning has led doctors to ask aggresively, "Well, you have abortions in the States, too, right?!" (clearly, I said something wrong...). However, at the risk of sounding really touchy-feely, for the most part these interviews have yielded some very frank and meaningful conversations about reproductive health, family, the woman's role in society, and yes, even the future of Ukraine.
The most frequent question that I have been asked is, "How is contraception different in the US?" And the truth is, it's not that different. The contraceptives on the market right now in the States are pretty much the same as the ones available in Ukraine, with a few exceptions (hormonal implants are not widely available in Ukraine, mostly because there is not much of a market for them). Where differences do exist, however, is in the access to and attitudes towards contraception in the respective countries. While contraception is often available on a sliding price scale in the US-- condoms are even free in New York City-- price is a significant barrier for many women in Ukraine, especially those from the rural areas (Ukrainian villages and Ukrainian cities are two totally different ball games economically and socially). In the US, most young people know that they can go to the school nurse or the college health center or a local Planned Parenthood for birth control counseling (this may be less of the case since Bush's abstinence-only policies), but in Ukraine, most people only trust the doctor for providing such advice, and they rarely visit the doctor because of the long waits (no appointments), the under-the-table costs (I'm not kidding, I saw this in action), and the total lack of confidentiality (if you're waiting in the village clinic for a prescription for the pill, the whole village will know about it by the time you're through). There are other pretty major differences in terms of what people believe is safe to use (IUDs are widely popular in Ukraine but not in the US, while the pill, the most popular form of birth control after condoms in the US is thought to cause women to grow tails and beards in some parts of Ukraine).
But one of the most significant differences, as far as I can tell, is a lack of a connection between reproducive rights and reproductive health in Ukraine, a link that is almost too strong in the US. While working at Planned Parenthood, one of our constant refrains was about the way that choosing to use birth control EMPOWERS women, and how the whole issue isn't the morality of birth control or abortion, but the woman's right to CHOOSE either. But when I ask women about their thoughts on "reproductive rights" here, I get blank states (or rather, sort of condescending stares that indicate that they think I don't really know what I'm talking about... who knows, maybe I don't). Seriously, though, whereas in the US reproductive health is a social and political issue, in Ukraine, it is a purely medical one.
I will be the first one to admit that the politicization of reproductive health in the US is often detrimental. When women can't access safe abortion services because of spousal consent laws or abortion clinic protesters, or when the teenage pregnancy rate increases because of abstinence-only education in public schools, there is clearly a problem with over-politicization of some very basic health services and needs. However, in Ukraine, these services are not politicized enough. This missing link is due primarily to a highly medical view of health care (when asked if contraception was purely a medical question, almost all respondents answered "yes"), a lack of a human rights tradition, and a history of antipathy towards “special interest” groups (such as women’s rights) in the political philosophy of the Soviet Union.
The problem in Ukraine is that the lack of politics and "a human-rights approach" (in NGO speak) in reproductive health means that other sectors do not get involved and that no one thinks to fight for these rights when they are taken away. This hasn't been a problem in the past, since abortion and IUDs were free and frequent during the Soviet period and there aren't as yet very many widely-spread social or religious movements against abortion or contraception use. However, an opposition is developing. There are posters all over clinics, metro stations, and the cities that say things like "Abortion is murder" or "Mama, don't have an abortion," and both the Catholic and Orthodox churches have started campiagns against both abortion and some types of birth control (the so-called "abortive methods"-- which are not abortive at all-- such as IUDs and emergency contraception). If and as these movements develop, there needs to be a healthy pro-choice group (composed of multiple sectors, social, political, and medical) as well that can ensure that women still have the choice to access safe and comprehensive reproductive health services.
There's a fine line to walk between imposing one's cultural view and promoting women's rights. I don't mean to try to transpose US politics on Ukraine (as many international agencies do... more on the Global Gag Rule later...), but one of the reasons that I think that access to health care of any kind is so important is because it provides an individual with choices that they can make about their body, something that is truly theirs. Knowledge about one's body and access to health services are basic principles that allow a person really to have control over their own life on the most basic level. (There's a really good article by Nikolas Rose about this that expresses "the politics of the body" much better than I can.) So it's important for people in Ukraine-- and everywhere, for that matter-- to understand this connection between health and human rights, espcially as the health system develops and transitions from a centralized Soviet system to a more localized, patient-friendly one. Due to its sometimes controversial nature, reproductive health is especially important to protect as a human right.
As my mom says, "you don't have anything if you don't have your health" (thanks, Mom), and since health is such a basic thing, it needs to be fought for from all sides. Put in a more formal manner:
"Where in many countries politics need to be divorced from public health policy in order to guarantee women’s equal access to quality health care, in Ukraine, the politics of women’s rights need to be incorporated into health care issues. Not only will this emphasize the importance of prevention in reproductive health, but it will also increase the number of reform actors pushing for public health development."
I am spending the majority of my time in Ukraine on researching the "obstacles and motivations to use of contraceptive and abortion services" (that's the title of my project), which involves traveling to the various regions of Ukraine (called oblasts) and setting up shop in hospitals, women's clinics, and gynecologist offices to speak with women about their experiences with abortion and contraception. (As a side note: all of these interviews are done under informed consent and according to ethical regulations. I promise.) This has at times proved rather awkward or surreal, due both to my not-yet-perfect-and-often-quite-tactless Russian language skills and to the lack of an awareness of patient rights in Ukraine. For example, I have been led into post-abortion recovery wards and invited to ask the group questions about their experiences (I mean, really?) or some lack of subtlety in my questioning has led doctors to ask aggresively, "Well, you have abortions in the States, too, right?!" (clearly, I said something wrong...). However, at the risk of sounding really touchy-feely, for the most part these interviews have yielded some very frank and meaningful conversations about reproductive health, family, the woman's role in society, and yes, even the future of Ukraine.
The most frequent question that I have been asked is, "How is contraception different in the US?" And the truth is, it's not that different. The contraceptives on the market right now in the States are pretty much the same as the ones available in Ukraine, with a few exceptions (hormonal implants are not widely available in Ukraine, mostly because there is not much of a market for them). Where differences do exist, however, is in the access to and attitudes towards contraception in the respective countries. While contraception is often available on a sliding price scale in the US-- condoms are even free in New York City-- price is a significant barrier for many women in Ukraine, especially those from the rural areas (Ukrainian villages and Ukrainian cities are two totally different ball games economically and socially). In the US, most young people know that they can go to the school nurse or the college health center or a local Planned Parenthood for birth control counseling (this may be less of the case since Bush's abstinence-only policies), but in Ukraine, most people only trust the doctor for providing such advice, and they rarely visit the doctor because of the long waits (no appointments), the under-the-table costs (I'm not kidding, I saw this in action), and the total lack of confidentiality (if you're waiting in the village clinic for a prescription for the pill, the whole village will know about it by the time you're through). There are other pretty major differences in terms of what people believe is safe to use (IUDs are widely popular in Ukraine but not in the US, while the pill, the most popular form of birth control after condoms in the US is thought to cause women to grow tails and beards in some parts of Ukraine).
But one of the most significant differences, as far as I can tell, is a lack of a connection between reproducive rights and reproductive health in Ukraine, a link that is almost too strong in the US. While working at Planned Parenthood, one of our constant refrains was about the way that choosing to use birth control EMPOWERS women, and how the whole issue isn't the morality of birth control or abortion, but the woman's right to CHOOSE either. But when I ask women about their thoughts on "reproductive rights" here, I get blank states (or rather, sort of condescending stares that indicate that they think I don't really know what I'm talking about... who knows, maybe I don't). Seriously, though, whereas in the US reproductive health is a social and political issue, in Ukraine, it is a purely medical one.
I will be the first one to admit that the politicization of reproductive health in the US is often detrimental. When women can't access safe abortion services because of spousal consent laws or abortion clinic protesters, or when the teenage pregnancy rate increases because of abstinence-only education in public schools, there is clearly a problem with over-politicization of some very basic health services and needs. However, in Ukraine, these services are not politicized enough. This missing link is due primarily to a highly medical view of health care (when asked if contraception was purely a medical question, almost all respondents answered "yes"), a lack of a human rights tradition, and a history of antipathy towards “special interest” groups (such as women’s rights) in the political philosophy of the Soviet Union.
The problem in Ukraine is that the lack of politics and "a human-rights approach" (in NGO speak) in reproductive health means that other sectors do not get involved and that no one thinks to fight for these rights when they are taken away. This hasn't been a problem in the past, since abortion and IUDs were free and frequent during the Soviet period and there aren't as yet very many widely-spread social or religious movements against abortion or contraception use. However, an opposition is developing. There are posters all over clinics, metro stations, and the cities that say things like "Abortion is murder" or "Mama, don't have an abortion," and both the Catholic and Orthodox churches have started campiagns against both abortion and some types of birth control (the so-called "abortive methods"-- which are not abortive at all-- such as IUDs and emergency contraception). If and as these movements develop, there needs to be a healthy pro-choice group (composed of multiple sectors, social, political, and medical) as well that can ensure that women still have the choice to access safe and comprehensive reproductive health services.
There's a fine line to walk between imposing one's cultural view and promoting women's rights. I don't mean to try to transpose US politics on Ukraine (as many international agencies do... more on the Global Gag Rule later...), but one of the reasons that I think that access to health care of any kind is so important is because it provides an individual with choices that they can make about their body, something that is truly theirs. Knowledge about one's body and access to health services are basic principles that allow a person really to have control over their own life on the most basic level. (There's a really good article by Nikolas Rose about this that expresses "the politics of the body" much better than I can.) So it's important for people in Ukraine-- and everywhere, for that matter-- to understand this connection between health and human rights, espcially as the health system develops and transitions from a centralized Soviet system to a more localized, patient-friendly one. Due to its sometimes controversial nature, reproductive health is especially important to protect as a human right.
As my mom says, "you don't have anything if you don't have your health" (thanks, Mom), and since health is such a basic thing, it needs to be fought for from all sides. Put in a more formal manner:
"Where in many countries politics need to be divorced from public health policy in order to guarantee women’s equal access to quality health care, in Ukraine, the politics of women’s rights need to be incorporated into health care issues. Not only will this emphasize the importance of prevention in reproductive health, but it will also increase the number of reform actors pushing for public health development."
Tuesday, January 22, 2008
graffiti in Ukraine
Hello! I apologize for my pathetic lack of posts recently. After much soul-searching and a few New Year's Resolutions, I have decided to resume posting (lucky you...). So, much of what I have been doing is wandering around Ukrainian cities, and I have been trying to keep somewhat of a record of graffiti I have encountered along the way. Here it is-- most of these photos are from either Kyiv or Lviv (Western Ukraine). Stay tuned for more Rachel coming soon!
Thursday, October 18, 2007
I would give my left arm for a metro map of Kyiv. Or a bus map. Or a trolley map. Or any map. Google maps-Kyiv reveals just a large grey expanse of nothing with a little star in the middle to signify that, oh yeah, I guess you're located somewhere in there. I have been kind of blindly wandering around the city, making use of my ever-so-helpful "how do I get there?" vocab, which is, of course, completely UNhelpful when I forget the response vocab. So I was puzzled and slightly offended when I saw an enormous map of the New York subway system on my co-worker's office door. I had traveled ten hours and an ocean away and all this city could provide me with was a NEW YORK subway map? I had just finished being completely lost in THAT city, and here was a map. Sorry, but too little too late, Kyiv. Nice try.
It's equally disorienting when my other co-worker admits to me that he and Olha and Bohdan and Olena and just about everyone else get together frequently to talk about "the States." And when the Ukrainian interpreter with the project-- born and raised and educated IN KYIV-- sheepishly calls himself a "California Boy." And my Ukrainian friends puzle over why I would ever come to Ukraine (one girl asked me if I was trying to be "extreme"), that is, when they're not talking about how they want to move to London or Germany or New York. I came to Kyiv to get the Ukrainian experience, and what I am finding is that I am learning more about the good side of the United States and Europe than I ever knew existed.
This West-philia is not rooted, however, in a hatred of Ukraine, at least not as far as I can tell. Ukraine has only existed as a nation since 1992, and while there is certainly a really strong sense of Ukrainian national identity (some guy yelled at me the other day to "learn Ukrainian" when i spoke in my pathetic broken Russian at the nationalist university that I attend), there isn't a really clear idea of what sort of shape that identity is going to take in terms of a nation. Ukraine has, in the past, been dominated by tsarist Russia, but Poland, and even by Nazi Germany. None of these regimes were particularly beneficial to Ukraine, and in fact, often really awful (Stalin orchestrated a nationwide famine to "put Ukrainians in its place" and Germany turned the population against itself). But the Ukrainian population and identity continued to develop, and was, in fact, even fortified by some of these experiences.
And now, Ukraine is pretty unique in the fact that it is a very "developed" nation with a highly educated population, some very modern cities, and no real state history to speak of. The big question in Ukraine is not about "bringing the country into the 21st century"-- it's already there-- but instead establishing some sort of paradigm for it to exist in. There is pressure from some of the country to re-align with Russia; many think that even though Putin is kind of a dictator, at least he is a strong leader with some vision for the country. However, much of the country wants nothing to do with Russia, and instead wants to join NATO or the EU, following the example of other ex-Soviet states such as Poland and Romania, but alienating Russia and Belarus. Meanwhile, the Ukrainian government has shut down for a few months post-election while each party either prepares a remix of the Orange Revolution or challenges the results. This uncertainty about where the country came from and where the hell it is going is the source of New York subway maps on walls and longing for Germany. It's not so much yearning for those PLACES as it is yearning for a model.
In the meantime, however, people go to work, raise families, and hold conversations where one party speaks in Russian and the other responds in Ukrainian. They watch Italian movies with English subtitles and a woman translating those subtitles into Ukrainian over a loud speaker. They complain about the government, the "Soviet attitude" of waitresses or guards, but they just sort of get on with their lives. In a way, it seems like Ukrainians are kind of used to being people who speak Russian, watch movies in Italian, wear clothes with English slogans, and plan to move to Europe or America, but are still very much Ukrainian.
It's equally disorienting when my other co-worker admits to me that he and Olha and Bohdan and Olena and just about everyone else get together frequently to talk about "the States." And when the Ukrainian interpreter with the project-- born and raised and educated IN KYIV-- sheepishly calls himself a "California Boy." And my Ukrainian friends puzle over why I would ever come to Ukraine (one girl asked me if I was trying to be "extreme"), that is, when they're not talking about how they want to move to London or Germany or New York. I came to Kyiv to get the Ukrainian experience, and what I am finding is that I am learning more about the good side of the United States and Europe than I ever knew existed.
This West-philia is not rooted, however, in a hatred of Ukraine, at least not as far as I can tell. Ukraine has only existed as a nation since 1992, and while there is certainly a really strong sense of Ukrainian national identity (some guy yelled at me the other day to "learn Ukrainian" when i spoke in my pathetic broken Russian at the nationalist university that I attend), there isn't a really clear idea of what sort of shape that identity is going to take in terms of a nation. Ukraine has, in the past, been dominated by tsarist Russia, but Poland, and even by Nazi Germany. None of these regimes were particularly beneficial to Ukraine, and in fact, often really awful (Stalin orchestrated a nationwide famine to "put Ukrainians in its place" and Germany turned the population against itself). But the Ukrainian population and identity continued to develop, and was, in fact, even fortified by some of these experiences.
And now, Ukraine is pretty unique in the fact that it is a very "developed" nation with a highly educated population, some very modern cities, and no real state history to speak of. The big question in Ukraine is not about "bringing the country into the 21st century"-- it's already there-- but instead establishing some sort of paradigm for it to exist in. There is pressure from some of the country to re-align with Russia; many think that even though Putin is kind of a dictator, at least he is a strong leader with some vision for the country. However, much of the country wants nothing to do with Russia, and instead wants to join NATO or the EU, following the example of other ex-Soviet states such as Poland and Romania, but alienating Russia and Belarus. Meanwhile, the Ukrainian government has shut down for a few months post-election while each party either prepares a remix of the Orange Revolution or challenges the results. This uncertainty about where the country came from and where the hell it is going is the source of New York subway maps on walls and longing for Germany. It's not so much yearning for those PLACES as it is yearning for a model.
In the meantime, however, people go to work, raise families, and hold conversations where one party speaks in Russian and the other responds in Ukrainian. They watch Italian movies with English subtitles and a woman translating those subtitles into Ukrainian over a loud speaker. They complain about the government, the "Soviet attitude" of waitresses or guards, but they just sort of get on with their lives. In a way, it seems like Ukrainians are kind of used to being people who speak Russian, watch movies in Italian, wear clothes with English slogans, and plan to move to Europe or America, but are still very much Ukrainian.
Tuesday, October 16, 2007
Friday, October 12, 2007
arrival et. al.
Hello Everyone,
While I mean this blog to be more than just a virtual way for me to spill my guts to who ever will listen, I did want to start off with a general notice of my arrival, safety, and relative happiness. I arrived in Kyiv about a week ago, and I was taken directly to my apartment in the center of town by my company's driver-- pretty corporate for a reproductive health NGO, but I'm beginning to realize that "professionalism" is kind of distilled down to symbolic things here. And I was certainly greatful for a ride, so I am not complaining.
I live in the middle of the city, about 4 blocks from the main drag (Kreshatik street) and about 10 mintues from all of the major attractions (mostly churches... cathedrals sort of dominate the landscape. Actually the architecture here and in Russia sort of tells the story of the history of the place: there are all sorts of cathedrals left over from when the church really ran the show. These sit next to larger Soviet concrete buildings-- the ugly, gray kind-- left over from the USSR. And now all sorts of enormous glass and steel buildings are shooting up, exidence of the growing wealth (in some parts of the population) and arrival of business. Anyhow, I live right downtown in a "historical building" in a comfortable apartment with tall ceilings and big windows. It's pretty chilly right now, since the city does not turn on the municipal heat until mid-October. My roommate is great, very easy to live with.
My job is proving to be a lot different than I thought it would be, in a good way though. The reproductive health situation here is completely different from that in the US: the abortion rate is far higher than any other European nations or the US and there is little to no stigma attached to it. However, the majority of the population relies on traditional (rhythm method, LAM, and wihtdrawal) rather than modern (hormones, IUDs, condoms) contraceptives. The goal of the project that I am working with is to lower the abortion rate by instead promoting modern birth control, primarily the pill. (I have a little bit of a problem with this, since I have some objections to the pill and the way it is widely and irresponsibily prescribed.) This is difficult though, since the Ukrainian health care system is completely top-down and "free," meaning that doctors and buildings are paid for, but nothing else. We are trying to promote government, clinical, and pharmeceutical reform, but it is difficult when there is political chaos in general and no incentive for the system to change. The project has done quite a bit though, including training several health care practioners and pharmacists, helping to pass the Reproductive Health of the Nation Program, and establishing a partnership with pharmaceutical companies to get affordable birth control into pharmacies.
My job consists mostly of writing, and right now I am working pretty closely with a consultant who is helping the Medical Post-Graduate Institute to develop a new kind of approach to teaching health care management. It sounds dry, I know, but is actually pretty interesting. There is all this talk about how the health care manager is really the patient advocate, which is half stupid business school speak and half kind of interesting.
Another interesting point that I will elaborate on further: NO ONE speaks Ukrainian here. In fact, I spoke Ukrainian in a restaurant and got laughed at. All of my Ukrainian friends speak Russian, and so, it seems, does everyone except for the people at my nationalist-leaning university (I got yelled at for speaking Russian there... jeez louise).
In any case, this place is a trip. In the two weeks I have been here, I have seen a bar fight (some guy ripped off his shirt and broke a chair over another guy's head!), a Communist party rally (Fascism will not stand!), a Ukrainian Nationalist rally, and been snuck into a concert by a creepy-looking guy with bad teeth. So that's that for now. I'm still having difficulty understanding that I LIVE here, but I assume as more of my dreams occur in Russian and I start to curse Ukrainian bureaucracy the way the locals do it will sink in.
Rachel
While I mean this blog to be more than just a virtual way for me to spill my guts to who ever will listen, I did want to start off with a general notice of my arrival, safety, and relative happiness. I arrived in Kyiv about a week ago, and I was taken directly to my apartment in the center of town by my company's driver-- pretty corporate for a reproductive health NGO, but I'm beginning to realize that "professionalism" is kind of distilled down to symbolic things here. And I was certainly greatful for a ride, so I am not complaining.
I live in the middle of the city, about 4 blocks from the main drag (Kreshatik street) and about 10 mintues from all of the major attractions (mostly churches... cathedrals sort of dominate the landscape. Actually the architecture here and in Russia sort of tells the story of the history of the place: there are all sorts of cathedrals left over from when the church really ran the show. These sit next to larger Soviet concrete buildings-- the ugly, gray kind-- left over from the USSR. And now all sorts of enormous glass and steel buildings are shooting up, exidence of the growing wealth (in some parts of the population) and arrival of business. Anyhow, I live right downtown in a "historical building" in a comfortable apartment with tall ceilings and big windows. It's pretty chilly right now, since the city does not turn on the municipal heat until mid-October. My roommate is great, very easy to live with.
My job is proving to be a lot different than I thought it would be, in a good way though. The reproductive health situation here is completely different from that in the US: the abortion rate is far higher than any other European nations or the US and there is little to no stigma attached to it. However, the majority of the population relies on traditional (rhythm method, LAM, and wihtdrawal) rather than modern (hormones, IUDs, condoms) contraceptives. The goal of the project that I am working with is to lower the abortion rate by instead promoting modern birth control, primarily the pill. (I have a little bit of a problem with this, since I have some objections to the pill and the way it is widely and irresponsibily prescribed.) This is difficult though, since the Ukrainian health care system is completely top-down and "free," meaning that doctors and buildings are paid for, but nothing else. We are trying to promote government, clinical, and pharmeceutical reform, but it is difficult when there is political chaos in general and no incentive for the system to change. The project has done quite a bit though, including training several health care practioners and pharmacists, helping to pass the Reproductive Health of the Nation Program, and establishing a partnership with pharmaceutical companies to get affordable birth control into pharmacies.
My job consists mostly of writing, and right now I am working pretty closely with a consultant who is helping the Medical Post-Graduate Institute to develop a new kind of approach to teaching health care management. It sounds dry, I know, but is actually pretty interesting. There is all this talk about how the health care manager is really the patient advocate, which is half stupid business school speak and half kind of interesting.
Another interesting point that I will elaborate on further: NO ONE speaks Ukrainian here. In fact, I spoke Ukrainian in a restaurant and got laughed at. All of my Ukrainian friends speak Russian, and so, it seems, does everyone except for the people at my nationalist-leaning university (I got yelled at for speaking Russian there... jeez louise).
In any case, this place is a trip. In the two weeks I have been here, I have seen a bar fight (some guy ripped off his shirt and broke a chair over another guy's head!), a Communist party rally (Fascism will not stand!), a Ukrainian Nationalist rally, and been snuck into a concert by a creepy-looking guy with bad teeth. So that's that for now. I'm still having difficulty understanding that I LIVE here, but I assume as more of my dreams occur in Russian and I start to curse Ukrainian bureaucracy the way the locals do it will sink in.
Rachel
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