What they don’t tell you in Biology class

I had the rare occasion of meeting a childhood friend after 25 years. Sylvia looked just the same as I have remembered her. Slim, fair, perhaps a little older as her pore-less facial skin no longer radiates that ridiculously pinkish glow it once used to.

At 39, she looks better than many women younger than her. Hell, she looks better than me.

As a child, I had always admired Sylvia. I wanted to be just like her. She had that quiet beauty about her and I honestly think she was completely obliviously of it, making her even more appealing. She had a gentle soul. She was smart, athletic and yet graceful. I thought she had it all. So when we reconnected recently, I was eager to find out how life had unfolded for her all these years.

When I saw how little she has changed physically, I imagined life is treating her well.

“I never thought I wanted one but now it’s kinda too late. I wish I had known earlier.”

I thought our dinner had gone splendidly despite my initial nerves. We ate, drank and talked for three hours but those were the words I took home with me that night, along with a bag of left-over barbecued spare ribs. She still eats like a bird.

When Sylvia told me she has been trying to have a baby through in vitro fertilisation for the past two years without much success, I was stunned for two reasons. First, there are not many women of her age whom I know who want a baby and second, the increasing number of women seeking fertility treatment in Malaysia.

According to Sylvia, it’s an emerging multi-million ringgit industry and it’s only the beginning because she pre-empts more fertility clinics infesting the city to feed the increasing demands of couples with reproductive health problems.

“If you don’t believe me, just visit any fertility clinic in the Klang Valley. The queues would make you think that Aphroditus has left town,” Sylvia laughed while I wondered why she mentioned Aphroditus instead of Aphrodite.

I’ve known Sylvia as the type who keeps things pretty much to herself. She listens more than she speaks and so the fact that she revealed something so intimate that night convinced me that she thought it was important for me to know.

“I hope I’m not stressing you out by telling you this. I don’t think women should suddenly readjust their lives because they think time is running out.” She said apologetically. I thought I saw that familiar pinkish hue on her cheeks for a split moment.

Throughout our conversation, I was conscious of the fact that Sylvia was trying hard not to appear desperate. For instance, when she talked about how empty she felt of her 10-year marriage, finally understanding her Mother’s wisdom that every couple eventually needs children in their lives, she would quickly followed the thought by reasserting how much she enjoys her career as an artistic director for an advertising company.

Like 70% of Belgian women who had their eggs frozen, Sylvia wished that she had done hers much earlier. A Belgian study carried out last year revealed that women who freeze their eggs in hope of improving their fertility in later years wish that they have done it at an earlier age. I had also read that American women feel the same way too. I wonder whether this holds true for Malaysian women as well.

Since I have no authority to speak on behalf of all Malaysian women, I shall share a brief history of my family’s fertility.

It was probably in their late teens when my Grandmothers had their firstborns. Both went on to have more than 10 children each, discounting those not carried to full term. The rate of miscarriage was quite high then but the lack of contraceptive awareness made reproductive rate even higher. So it wasn’t surprising for reproductively healthy women my Grandmothers’ generation to have an average of seven to ten children easily.

About half a century later, Mom gave birth to my brother at the age of 29. I was conceived two years later. We are only two but Mom’s siblings have an average of three children each. Dad’s have more.

I suppose it was considered late for a woman back in the 70s to give birth at the age of 29 but my parents had their reasons. Dad had just started his own business and Mom was there to support him every step of the way. Mom told me that it was one of the toughest time of their lives. The constant thought of failure and losing all their savings inevitably meant endless hours of hard work and sleepless nights. Mom said it was all worth it because what would be the use of hoping for a successful business if not to secure her children’s future?

I have just turned 38, married with no children. Both by choice. When I look at the circle of people I spend my time with, I am not an exception but rather the norm. Most of my friends are single and childless. I suspect they are happy just the way they are although I can’t be sure because these things can often be sensitive and private. So I try not to ask.

A survey by the National Population and Family Development Board revealed that the average age of marriage amongst Malaysians is 33. It could be higher now since the data is slightly outdated. Apparently, the number of those who are not married by the age of 30 has doubled since 2007. The common reasons given are that women are finding it harder to find men with equal or better educational qualifications and they have higher expectations in men than before. According to a local university associate professor, the fact that women are getting married later explained the rapid increase of infertility rate.

Many of the women I know are fiercely independent, professionally successful and generously kind. They love their jobs and enjoy their independence and why shouldn’t they? They’ve earned it by working hard and proving they can be as good as men in a society that is still patriarchal at large. Modern women make it clear to the world that they are not defined by their husbands or children. Marriage and parenting have become an option, rather than the norm.

I don’t think the single women I know are averse to marriage or children at all. In fact, I am sure many make good wives and mothers. Not wanting to settle for just anyone has been the common reason I’ve heard. The truth is, I think modern women are caught in two separate worlds – transitioning from a world that was intent on keeping them in supporting roles to one that suddenly expects them to be heroines. I believe somehow along the way, women begin to enjoy their newfound stardom but yet, they are unable to abandon their embedded biological code programmed since time immemorial to ensure the continuous survival of humankind.

I must admit that women have themselves as much to blame for making this transitional period very difficult. We can be very unkind to one another. For example, there are mothers who scorn at single women for living what they deem as irresponsible and selfish lifestyle while single women at the peak of their careers judge stay-at-home Moms as losers who cease to exist but for their children.

I spoke to my friend Siew Mei a couple of months ago and she said one of the most honest things I’ve heard in a long time.

“We’re so afraid of being judged that as women, we can’t even say out loud we want a baby for fear of being seen as a walking biological time bomb waiting to explode. It’s so not sexy anymore for women of our time to admit we want to be mothers, as if acknowledging our biological role is so shameful these days,” she said bitterly. “For the longest time I’ve lied to myself and my friends. I pretended not to have any interest in having a baby simply because I am not seeing someone. If I had a partner who wanted a baby with me, I would be the first one on that train to motherhood.”

Siew Mei is still waiting to find a suitable man who wants to be the father of her child. The last time I checked, she was still optimistic.

Now, here’s the thing I learned from Sylvia which I wish I had been told during Biology class many years ago. Many of us are aware that a woman’s fertility decreases with age. Biology says that each woman is born with a fixed number of eggs. Once a reproductively healthy woman hits puberty, an egg will be released from her ovary to her uterus every 28 days. If the egg is not fertilised by a sperm, it will shed as menstruation and this cycle repeats itself, provided the woman becomes pregnant. Therefore, a woman in her 40s would have less eggs than when she was 20 which then makes logical sense that her fertility would have reduced with age.

What was not told in Biology class is that our bodies release the best eggs first, saving the worst for last. This is also one of the reasons why the chances of delivering a healthy baby becomes lower with older women. It isn’t just because we have less eggs or our bodies are likely less fit or healthy, it’s also because we start “producing” F grade eggs.

“The doctor said I have less than 10% chance of pregnancy. Even if successful, I should have pre-natal testing to ensure my baby is normal. Apparently, if I had sought treatment before I was 35, I would have a greater chance of pregnancy but I didn’t think I wanted children then,” Sylvia said regretfully.

I asked her whether she would have reconsidered her choice if she had known this information earlier.

“Yes, definitely yes. When the doctor told us that we have the final option of fertilising another woman’s egg with my husband’s sperm, I nearly gagged. You can’t believe how humiliating it was for me to hear the doctor described the egg donors as ‘younger women in their 20s’. That their eggs are of ‘top quality’. I felt so shameful and inadequate.”

Sylvia later confessed that she had put her career and freedom above her marriage. Having a baby was on her list of things to do but it was right at the bottom, even after a trip to Bhutan. She thought she could put off motherhood as late as possible. After all, she has always maintained a healthy diet and lifestyle. She thought if Hollywood celebrities are popping babies in their 40s, why couldn’t she?

“By the way, smoking seriously reduces a woman’s fertility. It makes your eggs disappear. Seriously. I’m not kidding.” Sylvia cautioned although I had no idea why she thought I smoke.

I never thought my meeting with Sylvia could give me so much food for thought. For a start, I never thought someone as perfect as her could ever find herself stuck in this situation. I must confess that it also made me uncomfortable for the mere fact that it challenges my own choice.

She was however right by saying, “I don’t think women should suddenly readjust their lives just because they know time is running out but at least such information would allow us to make informed choices. I regret not knowing because I think I would have done what I could possibly can to ensure that I have the possibility of delivering a healthy baby.”

“If I am financially able, I would even consider freezing my eggs because if I have no problem spending thousands of ringgit traveling, why not preserving something which one day could become life?” She added.

In vitro fertilisation is an extremely costly procedure. It averages between RM10,000 to RM18,000 per cycle of fertilisation. A couple can easily spend up to RM50,000 for a small chance of getting a baby. What hope does it leave for those who have no financial means?

I think in the midst of trying to educate children on safe sex, we have forgotten the importance of reproductive health. We are so concerned about not getting pregnant that somewhere along the line, we’ve forgotten how to.

The original article was first published here on 3 May 2014.

 

Technorati Tags: Fertility,reproductive health,in vitro fertilisation

The sickness of our private healthcare services

“If I keep this oath faithfully, may I enjoy my life and practise my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.”
– The Hippocratic Oath

Mary was entering her mid-thirties when it finally dawned on her that she is reproductively challenged. The thought of her own infertility did play in her mind when she was much younger but her suspicion was only confirmed recently when she was diagnosed for polycystic ovarian syndrome (POS). The strange thing was, the diagnosis did not come from her fertility doctor, who had then been too eager to start her and her husband on the notoriously expensive and invasive in vitro treatment, without first examining their health.

The diagnosis for POS had come up through her own initiative. Once she and her husband decided that they would try to conceive through artificial insemination, Mary thought it would be prudent to go through a full medical check-up, “just to make sure my body is ready for the baby, you know. We’ve read that in vitro is very stressful and we want to make sure that we’ve tried everything possible to make sure that the conditions are conducive,” she said. 

When her blood work came back, her thyroid function tests were elevated. Later, it was her endocrinologist who told her that in addition to hypothyroidism, she might be suffering from POS too. He told her that the sudden and continuous weight gain, increased cholesterol level, development of fatty liver, irregular menstruation, and acne are some of the symptoms of POS.

Mary had initially thought that these symptoms were attributed to her bad eating habits and sedentary lifestyle but it now explains why these unflattering conditions remain unchanged even after her vigorous attempts to eat and exercise better.

“The funny thing is, no one told me about it. The GP (General Practitioner) at the hospital where I did the full medical check-up did not alert me to anything after he examined my test results. All he did was to make me feel bad about my weight and asked me to take another test in three months’ time to see whether there are any changes to my thyroid functions. All this while, I had been wondering why I’ve been battling bad skin and weight gain. If only I had known earlier, I would have been less depressed and feeling hopeless all the time,” Mary said.

“You have most of the POS symptoms. Go home and do a search online. Read up and learn as much as possible about POS and then go see a gynaecologist to seek treatment. You need to solve all this hormonal issue first before you even try to get pregnant. There are other options before you start considering in vitro. Let’s get you fixed up first, ok?”

That was the most honest and reassuring conversation Mary have had with a doctor so far.

After reading up on hypothyroidism and POS on the Internet, Mary discovered that the chances of having a problematic pregnancy would have been high if she had become pregnant either through natural or artificial means. She confessed that much to her disappointment and great horror, she felt that the renowned fertility specialist she saw at a highly recommended infertility clinic in Kuala Lumpur should have informed her of this vital piece of information.

Mary and her husband initially reasoned that the specialist would have alerted them to her condition if only he had bothered to look at their medical records, which they had brought along with them during their first consultation, having thought pre-emptively that the doctor would have asked for it.

“It was going to cost us about seventeen thousand ringgit for the whole procedure and that doesn’t even cover the cost of a second treatment if the first one doesn’t work. With hypothyroidism and POS, the chances of having a miscarriage would have been great.

"Can you imagine how devastating it would have been if we hadn’t known?” Mary asked and added dejectedly, “The thing is, the doctor didn’t even bother looking at our medical records, you know. They just wanted to make money out of us.”

Mary said that on hindsight now, she is not even sure whether the doctor would have warned them of the potential complications if he had known of her conditions. Mary insisted that her endocrinologist is the minority.

“There are definitely good doctors out there, but they are extremely rare,” she said.  She revealed that she no longer trusts the medical service and would turn to her trusted online sites for all her medical diagnosis and query.

“You wonder why we should pay these useless doctors so much when we can find reliable answers online!” She laughed scornfully.

Mary is not alone when it comes to being at the receiving end of bad medical services and not trusting our medical practitioners. It would appear that more and more private hospitals are abandoning the Hippocratic Oath for personal gain.

A medical practitioner revealed that the price of medicine at a private hospital costs a lot more than an external pharmacy. He often advises his patients to buy their medicine from external pharmacies because it makes no sense for them to pay “cut-throat” prices for the same medicine. However, when Kelly tried to do precisely that, the doctor treating her apparently did not take it too well.

“Instead of giving me a prescription for six months as he had recommended, the bastard only prescribed me a month’s worth of medication. In other words, he was ‘forcing’ me to go back to him for a follow-up prescription and that would have meant paying him ninety ringgit for just a bloody piece of paper. Can you imagine that?!”

The Department of Pharmaceutical Services at the Ministry of Health informed that there is currently no law to control the prices of medication at private hospitals. However, it is encouraging when the Head of the Medicine Pricing Unit wrote, “As a patient, you have the right to obtain a prescription from your doctor to buy your medicine from any pharmacy even though it displeases the doctor. I believe that empowered patients can change the current bad habits practised by medical professions so that we can all guarantee affordable medication for the people.”

Vikram, another unhappy patient, shared the experience he had with his doctor when he was undergoing treatment for Hepatitis C. He said that he was mortified when the nurse asked about his treatment in front of other patients while he was waiting for his doctor in a clinic. He understood that the nurse probably asked out of customary politeness but he did not appreciate the fact that in the course of her doing so, other people had learned about his medical condition.

He said that patient information management is lacking in many healthcare facilities and was shocked that this clinic is part of a hospital that has received an accreditation from the Malaysian Society for Quality in Health (MSQH), the national accrediting body for healthcare facilities and services. 

“On top of that, my doctor failed to inform me of all the side effects of the antiviral medication I was taking. There was no counselling or support for me and my spouse. The repercussions of the medication was so great that I felt as if the treatment had ruined an important part of our lives. 

"For each visit, I paid ninety ringgit for a five-minute consultation where the doctor did practically nothing. Thankfully I had a good insurance coverage because the medication cost an arm and a leg. To be honest, I wish I had not undergone this treatment if only I had known of the repercussions. I wasn’t informed properly,” Vikram said regretfully.

As of June this year, 75 percent of public hospitals have received the MSQH accreditation while only 25 percent of private hospitals have. At the international level, only eight hospitals have received the Joint Commission International (JCI)’s accreditation.

The JCI is created by the Joint Commission on Accreditation of Healthcare Organisations, a US government agency, aimed to improve the safety and quality of care in the international community through the provision of education and advisory services, and international accreditation and certification. 

The assessment criteria used by the MSQH is quite similar to the one used by the JCI, except the latter provides additional components such as patient and family education, staff qualifications and education, medication management and use, and the assessment and care of patients; elements which seem to be sorely lacking in our own private healthcare services.

Previously, the government has made several attempts to make it mandatory for all public and private hospitals to obtain MSQH accreditation but these attempts have been put on hold thus far. Although having some sort of national or international accreditation by a recognised and credible agency does boost public confidence, alongside minimising and mitigating clinical and safety related risks, these accreditations do not take into account public rating. The application submission for accreditation is done by the hospital in question and the assessment is then carried out by a panel of surveyors appointed by the accreditation agency. 

There is no consideration for public opinion on how the hospital has fared.

“As a patient, I would like us to have some sort of a scorecard for all the hospital in Malaysia. Something simple for a start and it can be done by civil society, someone independent and done from the patient’s perspectives. 

"What we need is someone who will disguise as a patient to test out the hospitals. So you have this person who goes to several hospitals and says he’s got liver problem, for instance, and then he assesses how the hospitals handle him based on selected key criteria. The problem has to be the same though, so you can compare apple for apple,” Vikram suggested thoughtfully.

Kelly said the hospital’s ability to deal with complaints is something left to be desired.

“No point. I’ve written to a hospital before to express my dissatisfaction over their service. I haven’t received any response from them. This was last year. It’s like as if the hospital doesn’t really care if you’re unhappy with them. They have patients lined up anyway. So why should they care?”

Sumitra, who is married to a doctor, revealed that medical practitioners often tend to close an eye when their colleagues commit a medical error. This culture is deeply rooted on the notion of solidarity akin to the “I have your back now so that when I need you, you’ll have mine” philosophy.  

This makes it virtually impossible to have a doctor testifies against the other, even when a grave error occurs at the expense of a patient’s life.

Perhaps what Malaysia needs is a patients association such as the one in the United Kingdom. The UK’s Patients Association provides a platform for the people to rate their National Health Service (NHS). The association also runs educational campaigns such as the Speaking Up Complaints Project which encourages patients to speak up against poor medical services and the NHS to improve the way it deals with patients’ complaints. The NHS is ranked as one of the top 20 best healthcare services in the world by the World Health Organisation.

Not all is lost. Malaysia seems to be doing remarkably well in the area of medical tourism. A private hospital in Kuala Lumpur is recently recognised by the Medical Travel Quality Alliance as one of the world’s top ten best hospitals for medical tourists. By taking advantage of the weaker Malaysian currency, foreigners from the Middle East, Europe and Japan are flocking to Malaysia to enjoy better medical treatment.

It would have cost the local patients an arm and a leg to receive treatment in these hospitals but Mary said, “If the service is compatible with the amount I pay for, why not? The problem with the private hospitals here is that I’m not even getting the value for my money.”

While our private hospitals continue to nurse tourists with top notch care, in order to stay competitive alongside South Korea, Thailand and Turkey, have they forgotten our own illnesses along the way?

This article was first published at The Malaysian Insider on 9 October 2013.

 

Technorati Tags: Polycystic Ovarian Syndrome,POS,hypothyroidism,thyroid function test,in vitro,infertility,Malaysian Society for Quality in Health,MSQH,Department of Pharmaceutical Services,Ministry of Health,Joint Commission International. medical tourism,Hippocratic Oath,Medicine Pricing Unit,Hepatitis C,Patients Association,National Health Service

“To sign or not to sign?”

That was a decision I was forced to make one early morning at a private hospital in Kuala Lumpur.

“I’m not signing. The hospital can go fuck itself!” My husband’s mind was made up even before I could blink my sleepy eyes twice.

For a brief second, I almost dismissed my husband’s reaction as a tad too melodramatic and was very close to signing what had already begun to threaten the tranquility of our rare morning together. But I didn’t.

I let out a big sigh and told the young woman at the front desk, “Sorry, I can’t sign this. We won’t consent to this.”

Once I had said it out loud, the look on her face told me that things were not going to be smooth for my husband and I that day. The wide eyes behind her glasses looked shocked, confused and uncomfortable. I might be biased but I thought she also reeked of judgment.

“I’m sorry but this is a hospital policy. You have to sign this if you want to get tested,” she said a bit too timidly. I don’t know how, but she seemed to sense that this would not go down well on us.

I looked at my husband, not as an attempt to persuade but for an affirmation of our decisions.

“Nope. I’m not going to sign.” He walked away to signal his unwillingness to waste any more time on this matter.

I let out another big sigh as I found myself losing patience too.

“Look, we have no problem signing a consent form for HIV testing but we do have a problem with this clause here. See? It says, if tested positive, you guys will be notifying the Government Authorities,” I explained.

“But this is the law,” she tried to convince me.

So if the law requires you to jump off the Penang Bridge, you would?

I rolled my eyes and sighed again.

“I know but we don’t agree with this law. So we’re not going to consent as a sign of our protest,” I said instead.

We were then told to wait at the lounge while she consulted her manager.

After ten minutes, an older woman came and asked to speak to me privately. She ushered me to the corner of the room and said to me in a low voice, “M’am, your medical package includes HIV screening. We’re not sure whether it is possible for us to exclude this testing.”

I stared her. It was my turn to look shocked, confused, uncomfortable and judgmental. By then my patience had hit a record low and I couldn’t help myself but to retaliate in full force.

I can’t remember what I had told her precisely but I surprised myself that day for being eloquent as I made my case. The conviction and anger inside me helped me to articulate my argument to her and in summary, I told her that nobody could force my husband and I to test for HIV/AIDS.

“Of course, of course. You’re right. Let me go and check with the company who offered you the package to confirm that it’s OK for you to go through the check-up today without the test.”

My husband looked defeated. He was convinced that we were not going to have our routine medical check-up that day. In a determined voice, I said to him, “If she comes back and tells us no, I swear I’m going to give them hell.”

After waiting for another 15 minutes, hell remained mine.

For close to ten years, my husband and I had gone through routine HIV tests annually. In fact, before we had our first sexual intercourse, we had ourselves tested. This is how strongly we feel about protecting each other from HIV/AIDS. The episode above was the first time that we had actually skipped a HIV test.

Many of you may wonder why we had made such a ruckus over this.

I had recently learned from a friend that testicular cancer is apparently rather common amongst Canadian adolescents. According to her, because most adolescents are embarrassed to talk about their private parts, many choose to remain silent when they feel an abnormal growth on their testicles. By the time they decide to seek treatment, the cancer has already advanced considerably.

I suppose the same principle applies here, except multiplied by ten because of the stigma HIV/AIDS carries. Because of our strong fear of stigmatisation, we would rather not get ourselves tested. Because of the lack of information, we are not sure what the Government Authorities would do with our medical record. In the meantime, the hospital did nothing to help us understand the procedure of HIV disclosure. If anything, the hospital did everything wrong that day to gain our trust. This problem could have been potentially solved by sound public relations and communications practices but instead, the hospital staff made us felt like we were the enemy.

When I first saw that young woman’s reaction when we declined to sign the consent form, and her subsequent looks after that, I knew that I had made the right choice not to sign the paper. She carried a look that spelled, “They have AIDS. That’s why they’re not signing the paper.” She was very awkward with us. She would tense up whenever we appeared before her. When we went to collect our test results a week later, we felt unwelcomed. The doctor who went through our report dismissed me when I told him that I thought I felt a lump on my neck. He did not even feel my neck. He behaved as if he couldn’t wait to get rid of us.

Act 342, Section 10 (2) is the clause that compels every medical practitioner to notify the government authorities if he/she is aware of the existence of any infectious disease. Under the same section, it also compels anyone, other than a medical practitioner, to do the same. This means, if I know my work colleague has HIV/AIDS, I must report this to the authorities.

In the United Kingdom, the General Medical Council states that a disclosure of HIV positive patient to anyone other than a healthcare professional is unlawful. Their Data Protection Act provides legal redress to people living with HIV/AIDS if their confidentiality rights have been breached. In Malaysia, there is no such law yet unless the personal data is used for commercial purposes.

In the United States of America, hospitals do report to the US Centres for Disease Control and Prevention, but only after they have removed all personal information from the patient’s record. This is mainly because the federal and state funding for HIV/AIDS is often targeted at areas where the epidemic is strongest.

An American survey revealed that one-third of 20,000 respondents knew at least one person who is afraid to take HIV test for fear of prosecution if they are tested positive. More than 60% of Americans do not know whether their state has a HIV specific disclosure law. Accordingly, many people at risk may prefer not to get tested for HIV rather than risk being accused of or criminally charged for non-disclosure if they are tested positive. In a similar survey, when asked what motivated people to disclose their condition, majority of them cited moral or ethical reasons; honesty, love, desire to protect their loved ones. Less than 1% said that the law is the primary motivation.

All these studies point to the understanding that having a disclosure law such as the Act 342, Section 10, does not help to reduce the risk of HIV/AIDS. On the contrary, it has significant repercussions because it stops people like my husband and I from getting tested and seeking appropriate treatment once diagnosed.

Driven by curiosity, I called two organisations* relevant to this subject matter for more information. I could not get through one but the other told me that I could get an anonymous HIV test for free.

“Total anonymity? How come the law doesn’t apply to you guys?”

“That’s because we’re an NGO. There are a couple of NGOs around that do anonymous testing. Do drop by and get yourself tested. It’s important.”

Free anonymous testing with an NGO versus a private hospital that doesn’t seem to give a toss, it’s a no brainer really who will have a more successful campaign against the spread of HIV/AIDS.

* The identities of the organisations have been deliberately kept confidential to avoid getting them into trouble with the authorities.

This article was first published on The Malaysian Insider on 5 March 2013.

It generated quite a bit of discussion on a friend’s Facebook. According to this friend, the local NGOs are not exempted from reporting to the Government Authorities if you’re tested positive for HIV. He also left a comment on my Facebook and here’s what he said:

“Also, at the NGO, you are testing live with a person, who then gives you the result. You are no longer anonymous to him. Some people don't go to such NGOs because they may know people from the community who are volunteers at the NGO. So actually, this creates a different problem. People who would go for such testing in spite of the social barriers (being recognised, reporting, etc) are already monitoring their sexual health -- even if some do test positive eventually. The problem is getting people for whom the lack of anonymity prove a deterrent. Some people also have to overcome the guilt of being judged for being irresponsible at such an NGO as these NGOs have been aggressive in promoting Safe Sex messages with moralistic overtones (you are irresponsible if you don't use condom, you are a slut if you have multiple sexual partners, etc). It is a lot to overcome for most people. In Taiwan, their anonymous testing works like this: you get your blood taken for testing and you are given a code and a phone number to call; you call the number and tell them your code and you get your result without needing to reveal your name at all.”

Another person left a comment on this article:

“As a matter of fact[ly], both Malaysian and Singaporean law requires medical practitioners to report patients tested positive for HIV. Both deport and ban entry to foreigners if tested positive while in the country.”

Technorati Tags: HIV/AIDS disclosure law,anonymous HIV testing,stigmatisation facing people living with HIV/AIDS,Act 342 Section 10,Act 342 Section 10(2),US Centres for Disease Control,General Medical Council,United Kingdom

The chronicle of 2011’s Resolution [Part 3]– The attack of the Jelly Belly beans

This is a new series chronicling my journey towards looking fab by the end of 2011 (well, preferably before the year ends but who am I kidding, right?). Read Part 1 here and Part 2 here.

Jelly Bellies are not just candies. They’re a lifestyle. An expensive lifestyle if you’re in Malaysia.

According to its website here, there are 50 different types of flavours, each bearing a fun name that any nail polish maker would love to covet. According to a colleague, the Sizzling Cinnamon tastes like tiger balm, so maybe that’s an inspiration for tiger balm companies if they’re thinking of revamping their image and expanding their demographic target groups.

I can’t remember when I tasted my first Jelly Belly. It must had been a long time ago (possibly when I was in university and a Canadian friend might had introduced them to me) but the memory of how they taste like, the rubbery and gummy texture and fruity smell have stuck in my mind since then. So, when I went back to the US last October, I got into a gas station and remembered to buy some during a road trip to Chicago.

When the American Council for Young Political Leaders (ACYPL) delegation from the US came to visit not too long ago, they brought along one of their most famed and beloved candies. Yes, it’s none other than the Jelly Belly.

They were giving out these 7 oz clear can 30- flavour edition (see picture on the left) at meetings. Of course, some didn’t appreciate them and gave it away, much to the other’s delight. I guess, Jelly Belly is a willy-nilly after all (I’m not even sure whether I’m using the sentence correctly).

One of the pleasures of having a mix-pack such as these, is the burst of unidentifiable flavours all mixed together in your mouth. It’s not uncommon to expect a series of mixed reaction as the candies slowly melt and release their flavours onto your palate. Some of my favourites  are the buttered pop corn, toasted marshmallow and A&W root beer. What I hate are the licorice, Dr. Pepper or anything cherry. So, you’ll be hearing a series of, “yummmm….” and quickly followed by a “ewwww….what the hell?!”

And ladies and gentlemen, that’s why I love Jelly Belly beans.

Anyway, what does this have to do with my 2011 resolution, right?

So, E and I were running a really quick errand at a grocery market last night. At the check-out counter, I stumbled across rows of Jelly Belly on a shelf nearby. Although they were all accompanied by cut-throat price tags, I couldn’t help the temptation of picking up a mix-pack. E, stopped me and literally pushed me away from the shelf and reminded me that those yummy beans were going to cost me RM50.

I, of course, lost my self-control and the ability to think rationally. All I could think about was the beautiful places these beans had brought me to once, not too long ago. E wouldn’t hear of it and she went all Jelly Belly nazi on me and needless to say, she won.

I wasn’t happy but on hindsight, I’m glad she stopped me because I would be upset to pay so much for something which would inevitably cost me much more. So, thank you E for being such a good friend (unlike V who bought us cream puffs. That’s evil!)

I end this with a poem as an ode to the Jelly Belly.

It started off with "KE and jelly babies"
all because of the 3 ladies and their bellies
who don't want to be mistaken for the tele-tubbies
So they all agree to help each other get rid of the flabbies
and now it ended with “E and the Nazis”

p/s: This resolution sounds very promising so far and off to a good start. I haven’t lost any weight despite having less than 2 weeks to go and we’ve all declared a moratorium for Chinese New Year! God, I need someone to sponsor a personal trainer for me!!!

Technorati Tags: Jelly Belly,Sizzling Cinnamon,Buttered Popcorn,Toasted Marshmallow,A&W root beer,ACYPL,Dr. Pepper,licorice

The chronicle of 2011’s resolution [Part 2] - I am hungry and grumpy. Give me a cookie now!!

This is a new series chronicling my journey towards looking fab by the end of 2011 (well, preferably before the year ends but who am I kidding, right?). Read Part 1 here.

I am beginning to understand why Oscar the Grouch is grouchy all the time and why Cookie Monster wolfs down his cookies in that famous noisy and crumbly fashion. They have been put in a strict diet since Monday! Oh, wait….ME TOO!!

I may appear composed but do not be deceived by this composure as I’m screaming bloody murder deep inside.

Day one of this dieting is putting me in grumpy mode. Don’t get me wrong. I didn’t exactly starve myself because I ate all three meals today. I started this morning with an orange and a cup of mocha, followed by lunch of rice, fish cake and vegetables, an apple right before tea time, nuts and raisins before dinner and roast chicken and potatoes a few hours ago. I was tempted to tell myself to go screw myself and to hell with it all (yes, I am grumpy!) but Lorelai Gilmore saved me.

E & V, if you’re reading this, I hope you’re as miserable as I am.

(Whose freaking idea was this anyway? Grrrrrrrrr…….)

Technorati Tags: Cookie Monster,Oscar the Grouch,Lorelai Gilmore

The chronicle of 2011’s resolution [Part 1] – Be phat and not fat!

This is a new series chronicling my journey towards looking fab by the end of 2011 (well, preferably before the year ends but who am I kidding, right?).

I was uncertain whether I should even blog about this but as an afterthought, if it’s going to humiliate me into achieving my resolution, why not?

Life has been rather wonderful for the year that is 2010. I’m working on an exciting project, I’ve been writing regularly, I’ve got a husband who finally took to keeping things clean in the house and feeding me well (maybe a bit too well) and above all, I’ve got a beautiful and lovely cat that keeps growing on me.

It would look as if life couldn’t get any better, right? Well, nuh-ah - WRONG!

Everything seems well except for my weight that is intent on making my life miserable and I’m not just talking about me being vain. I’m talking about me being utterly uncomfortable with my body weight and losing my self-esteem as a result of it. I have refused dinner invitations from friends whom I haven’t met awhile because I am too ashamed to meet them. I can’t bend over to tie my shoe laces because my belly gets in the way. I am also getting his horrible image of me not waking up in the morning because my heart has been working overtime without receiving any gratitude or TLC and  finally decides to give up on me. Only by then, everything would be too late.

So, why this resolution? Seems a bit too cliché and fluff, no? This is the sad part. I can do the whole giving up smoking and I’m pretty sure I can do the giving up drinking as well. But, giving up oily, deep fried and fatty food, consisting of all sorts of chemical, sugar, salt and other poisons that make them taste soooo good is going to be the toughest thing I would ever have to do. Damn those skinny chicks who can eat whatever they want!

My weight has fluctuated so much over the past few years. My fittest form was when I was in secondary school while I was doing ballet as a serious form of extra-curricular activity, my university years when I would frequent the local student union disco nights at least twice a week and dance all the English custard off and of course when I was starved in countries like Timor Leste and Afghanistan. I weighed around 50 – 55 kg then. Now, I must weigh more than 65 77 kg  (I finally weighed myself at the strike of 12am on 1 Jan 2011) as I haven’t been able to weigh myself for fear I’ll keel over from fright and die before I get to fit into a respectable dress size again.

So, moment of desperation calls for desperate measure. Two friends of mine, E, V and I have decided to have a pact. We’re going to try to  lose 1 kg for each month of 2011. We’ll be monitoring our weight and the person who does not stick to the bargain for that month will pay RM50. Seeing how stingy I am, I think it’ll motivate me unless I get really depressed and start going on a junk binge and adopt a to- hell-with-life attitude.

I don’t know how I’m going to do this because I’m feeling hungry again. Would I be able to resist the temptation of eating my favourite fast food of all time? As my friend V would say, “That’s your internal problem. We’re not interested about how each of us do this or what kinda problems we have. We’re only concerned about the result, ok?” Yeah, so much for moral support, pal.

So if you’re a friend, I beg of you not to be polite to me about my weight. Be tough and yet encouraging and supportive of my 2011’s resolution so that I can be phat again!

The next time I blog about this, let’s hope I am not RM50 poorer.

Sex, drugs and HIV/AIDS

This article was first published in The Malaysian Insider on 9 November 2010. Below is the original version.

It was another quintessential night in Chow Kit; hot, humid, red and reeking with the thick smell of danger for those who would shun the district. Celeste, Joanna, Samantha and Lola lined the street of Lorong Haji Taib. In between small chats with each other, they call out indiscriminately to men walking by; teasing them unabashedly in their deep hoarse voices. For those who bother to play along, they are rewarded with flying kisses.

The night was slow but not devoid of excitement. Just as the night, they came slowly and quietly for them. They are ambushed by a group of uniformed policemen. Lola and Samantha manage to escape. Celeste and Joanna are quickly handcuffed and brought to the police station.

Less than 24 hours later, Celeste is released. Joanna? Dead. But not before being forced to perform sexual favours on the commanding officer while being restrained by his two subordinates. They eventually “finish” her off by applying multiple blows to her skull when she refuses to let them take her from behind.

Joanna never had a chance.

Celeste returns with a mission. She saw what they did to Joanna and vowed never to end up as another unclaimed corpse. She pleads with her friends to stand united and fight for their honour and lives. Together, they vow never to be silent again.

Celeste’s blood-chilling and piercing cry, “Joanna dah mati!” would echo in their minds forever.

It may not be as real as Poh Si Teng’s acclaimed documentary “Pecah Lobang”, a Freedom Film Fest winner in 2008, but that was the script used by the Bar Council MyConstitution Campaign team to send out a strong message to sex workers and Mak Nyahs at the Jom ke Chow Kit Carnival at Lorong Haji Taib on 31 July 2010.

Above: The MyConstitution Campaign team

It took the team a few days to put together the skit but not without first spending hours after hours debating and deciding on a suitable yet effective message. Most of the team members were lawyers but none of them knew what sort of message would make an impact on one of the oldest professions in the world.

Lawyers are useful when it comes to giving advice on what to do when one is being arrested but what can they tell a highly stigmatised community who not only are prime targets of the police and religious authorities, but also vulnerable to abuse and violence?

Joanna

That was when the team decided to tell the story of Joanna, a transsexual sex worker who died in police custody.

The message was simple. It is louder when four persons scream at the same time than just one. The chances of being heard are higher if you continue to scream. Sooner or later, someone will hear you.

The crowd responded. They laughed and cheered when they saw Celeste, Joanna, Samantha and Lola blowing kisses in the air. The atmosphere turned sombre and quiet when Joanna was being tortured by the officers. Some wore grave expressions on their faces as they watched Celeste bringing news of Joanna’s death and crying out in anguish. They clapped thunderously when the girls came together and agreed to do something about it.

The image of helpless Joanna being forced to face her opponents alone is more real than imagined. Most of us are aware of the discrimination and injustice faced by the community of sex workers, yet we choose to keep silent and stay ignorant of it. While we will readily acknowledge the right to live, life without dignity and justice is not a life worth living.

The organiser, the PT Foundation (PTF), is to be commended for providing an opportunity and platform for people living with HIV/AIDS, sex workers, drug abusers, men-who-have-sex-with-men (MSM), gays, lesbians, bisexuals and transgender people to learn more about their rights and HIV/AIDS. Combating HIV/AIDS is after all one of the UN Millennium Development Goals.

According to the Ministry of Health’s statistics in 2009, there are 86,000 reported cases of HIV/AIDS in Malaysia. Everyday, 15 Malaysians are diagnosed HIV positive and the majority of them are men. 34% are in their twenties. The high-risk groups are surprisingly not sex workers, drug users or homosexuals. They are fishermen, factory workers, long distance drivers, housewives and heterosexuals.

Jeremy

Speaking to Jeremy provided a sense of comfort and assurance. He came across as someone who is wise and easy to talk to; and he is a gay man who occasionally also drags or crossdresses as a woman in special functions such as at the Jom ke Chow Kit Carnival.

Jeremy works towards educating and sensitising people on the importance of safe sex, sexuality and self-acceptance - all the right qualities to help fulfil PTF’s objectives.

I first spotted Jeremy when he was standing in front of the stage with a microphone in his hand. He was giving out a series of HIV/AIDS related trivia. It was difficult not to notice him as he was dressed in a black body-hugging t-shirt, hot pants, black stockings and Mary Jane shoes. In addition to his thick make-up, he was a picture of confidence and determination as he asked the crowd, “Can you get HIV/AIDS by holding someone’s hands?” while loud pumping techno beats were playing on the background.

Later in a private interview, Jeremy disclosed that he had come a long way before his family and friends accepted his sexuality. He was reluctant to call this episode in his life a problem but preferred to see it as a challenge instead. He added that at the end of the day, what’s really important is for a gay person to come to terms with his own sexuality, first. But it is important to take the time to figure out who he really is before arriving at that critical juncture.

When asked whether he faced any discrimination while growing up as a homosexual, he answered no. He explained that Malaysia is that sort of country where you would not get into trouble if you do not tell. An example is how PTF is not allowed to publicly inform people that they provide counselling to gays, lesbians, bisexuals and transgender (GLBT) people. They may only call it “sexuality counselling”.

He also said that while law enforcement authorities do not harass PTF directly, they face many obstacles when trying to implement their HIV/AIDS education and prevention programme for sex workers in massage parlours, karaoke lounges, motels and nightclubs. These places are raided by anti-vice enforcement officers and too often in the presence of PTF, which consequently prevents the businesses from wanting to engage with PTF.

When asked who his hero is, Jeremy declares that he is his own inspiration. His father once told him in an acceptance speech, “Whatever you do, you’re an adult now. You’re responsible for your own life.” He said that it is important for everyone to be themselves because in the end, it is up to each individual to find out who they are and to grow comfortably into their own shoes.

Eddie

Such positive self-image was unfortunately not seen in Eddie, a 39 year-old former drug user. He was seen sitting alone at the back of a tent, quietly colouring his face with bright blue paint.

When I asked him what he was doing at the Carnival, he insisted that I would not be able to stomach his answer. “If I tell you, you won’t be able to take it. So, I rather not say anything,” he said to me again and again and all the while avoiding eye contact.

After some coaxing, he revealed that he is HIV positive. He said most people who learned about his condition would run away. We ended up having a long chat about his life story.

According to Eddie, he started using drugs when he was 15-years old. His family moved to Kuala Lumpur from a small village in Negeri Sembilan. He experienced culture shock and was not able to adapt to city life. Due to existing family problems, he experimented with drugs and it subsequently became a means of escape for him.

He spent most of his adult life in and out of prison and rehabilitation in Sungai Buloh and Kajang. He still remembers starving in prison where inmates were under-fed and often resorted to eating left over fish bones and banana peels. When asked whether he was ever physically abused by prison guards, he replied, “Only if you disobey them. That’s all I’m willing to say.”

He said many inmates died in rehabilitation due to their weak and frail physical conditions, mostly pronounced by poor nutrition. Like him, most of them had no families or friends who would miss their absence. The moment they all discovered how low they had sunk, they would drop out of their lives.

Eddie added, “It hurts. It hurts greatly to see how they looked at me with disgust. Once when I came out of rehab, I had the will to turn over a new leaf. I really wanted to change my life. When I got home, my mother and sisters were busy cooking the whole day. Do you know why? They had planned to feed me well and then send me away for good. I never saw them again.”

When asked whether he is afraid of death, he paused briefly before admitting that he is more afraid of dying a painful death and being alone.

I asked him whether he ever regretted his actions that have led him to this situation, he answered bitterly, “Of course! Who would want to live like this? Because of my health condition and medical treatment, I’m feeling sick all the time. I can’t find work and I have no money or friends.”

Access to assistance

That night, 40 people were arrested by the police on their way to the Carnival which incidentally, was endorsed by the Ministry of Health. They were apparently tested for drugs. As fellow columnist, June Low wrote in her blog, thanks to the police, these 40 individuals missed out on a chance to learn more about the risk of HIV/AIDS.

There is something fundamentally wrong when people are being stopped from having access to help. It is morally sinful when people are being deprived of such an opportunity.

Is it because they are different? Is it because they are considered as moral pariahs?

It is time to ask ourselves these questions.

What makes these people different from us? What makes them so contemptible that we allow them to fight their battles alone? Does that not make us even more contemptible for not coming to their defence?

Finally, how many of us actually give ourselves to others without expecting anything in return; whether it is for love, sex, financial security, companionship, procreation or power?

Answer this truthfully and you’ll know that we are all the same in the end.

I asked Eddie what keeps him alive.

He replied, “What keeps me going is that every year I vow to change my life for the better. I vow to take my methadone and anti-retroviral treatments more diligently. I vow to secure a job to keep me financially independent. I’ll be 40 soon and I think there’s hope. After all, isn’t it true what the Western people say about life beginning at 40?”

The question is: will he live to see that change?

What they don’t show you on Malaysia Truly Asia advertisements (Part I)

This article was first published here in the Malay Mail on 9 June 2010 .

MY father is a self-made man. I suppose that qualifies him as one of those people able to say that we can be authors of our own destiny.

I recall him explaining a Chinese proverb to me once, some years ago. The proverb tells of the destinies of two mice — one born in a sack of rice and the other, in a sewer — two similar creatures but with different fortunes.

The proverb assumes that their destinies were fated from the moment they came into being. I was reminded of this proverb when I took a road trip to Kampung Bertang Lama, home to a Semai community in Pahang, on May 22. We were there for the first MyConsti’s “Program Memperkasakan Orang Asli dengan PerlembagaanKu”.

What I saw was the imperfection of humanity and the ugly side of reality. Apart from being shocked, what I saw made me ask this question: Would I be who I am today, had I been born in this community?

The answer was a humbling one. I have spent the past six years working and living in under-developed countries in Asia and Africa.

At no point in time did I think that Malaysia is also a nation where there are communities in need of education and empowerment as the people I worked with in Timor Leste, Afghanistan, Ethiopia and Cambodia.

I suppose the towering skyscrapers of Kuala Lumpur somehow impeded my vision of the real Malaysia. Or I was too busy trying to reach the top of that mountain of rice that I failed to see the sewer just round the corner.

One of the most heart-wrenching images I have seen was the sight of an emaciated infant, no more than three years old, desperately trying to squeeze a drop of milk out of his mother’s deflated breast. The mother, equally hungry and weak, looked up imploringly to the sky, possibly praying that God will be merciful that day.

The only things getting fed were the flies that congregated by the dozens on the faces of the mother and child. That was Ethiopia in 2008.

In Kampung Bertang Lama last month, I saw children terribly malnourished walking around naked with distended bellies. They looked almost like miniature pregnant women far into their third trimester. Some of them wore what looked like angry-looking scabies all over their skin, including the soles of their tiny feet. What is a treatable skin infection is left to thrive because the whole village receives medical treatment infrequently.

I was informed that only two adults are literate in a community of more than 500 people. This information made our campaign booklets “The Rakyat Guides” irrelevant. It was not an exaggeration because when I tried to encourage a girl, aged six, to draw a picture of her village on a piece of paper with colour pencils, she shied away and giggled nervously. It became apparent that she had never held a pencil in her life when I clasped my palm over her tiny hands and guided her fingers onto the piece of paper. We both drew a flower together. She laughed with obvious delight at the result.

When I encouraged her to try it out on her own, an immediate fear seized her. She looked lost. I couldn’t bring myself to ask her name despite wanting so much to write her name down for her to see.

It was for the selfish reason that I rationalised it would be easier to leave later if I did not form any attachment to her.

Fear is as debilitating a disease as poverty, if not worse. Growing up in a society which placed great emphasis on education, I was informed there was apprehension by the Semai community that our formal, national education system offers little hope of retaining the Semai identity and cultural heritage. This fear is not unfounded.

According to UNESCO, while universal education programmes provide important tools for human development, they may compromise indigenous language and knowledge transmission. As such, it may inevitably contribute to an erosion of cultural diversity, a loss of social cohesion, and alienation and disorientation of indigenous youth (see: www.unesco.org).

According to some of the older Semai, they heard many horror stories of young Orang Asli leaving their homes and abandoning their cultural identities once they receive an education.

In the end, it is easy for them to conclude that education does not mean development, at least not for the community as a whole.

For the Orang Asli, their identity is often defined by their deep connection with their ancestral land, not economic migration or individual ambition.

* LIM KA EA is the executive officer of the Constitutional Law Committee (ConstiLC) of Bar Council Malaysia (www.malaysianbar.org.my/constitutional_ law_committee).

The views expressed in this article are personal to the writer and may not necessarily represent the position of the Bar Council.

The ConstiLC is running a two-year nationwide MyConstitution campaign launched in November last year. The campaign was born of the collective desire of the ConstiLC’s membership of more than 150 members made up of lawyers, academics, students, media persons and activists to increase awareness of the Federal Constitution among all Malaysians – “Untuk Merakyatkan Perlembagaan”.

A unique, first-of-its-kind “The Enlightened Rakyat Workshop”, jointly organised by ConstiLC and Leaderonomics, will be conducted on July 10 (9am-6pm) at Menara Star in Petaling Jaya, as a means of enabling Malaysians to learn about themselves — the choices you are able to make, the impact you can have over Malaysia and the skills you have as a leader. Youths are especially encouraged to sign up, and space is limited to 50 participants only.

Visit http://www.perlembagaanku.com/2010/06/the-enlightened-rakyatworkshop/ to register and go to Facebook page www.facebook.com/MyConstitution for more information, or Twitter at www.twitter.com/MyConsti.

A personal matter of hygiene

I started doing my nails way before nail salons sprouted in Kuala Lumpur like weeds. At that time, Mom was appalled with what she saw as frivolous behaviour; paying someone to do my nails. Now, she understood that many women wouldn’t be seen dead in public functions without their nails done (although she’s not a convert yet).

Occasionally, I like my eyebrows threaded and plucked too. As far as personal hygiene is concerned, I limit myself to haircut, manicure, pedicure, facial, eyebrows trimming and body scrubbing. There’s one thing which I’m intrigued with but never have the courage to try. I’m thinking that most of you would have guessed what I’m referring to.

A few years ago, I was having my nails done at a beauty salon. A beautiful young lady in micro-mini skirt walked in and she was quickly ushered into a private room. I thought nothing of it except for envying her long slender legs.

A few minutes later, I heard a horrifying scream coming from the room. For that split second, I did wonder whether I was at a beauty salon or the dentist. The scream continued intermittently. The manicurist attending to me smiled apologetically and told me that the girl was having a Brazilian wax.

I first heard of the term Brazilian wax in Sex in the City and hence was familiar with the procedure. Nevertheless, I must confess that I was a tad surprised that Malaysians have started adopting it.

Since then, I began to hear more and more women I know who have their zones down under taken care of. Some personal testimonies I received were equivalent to that horrifying scream. Women have described to me how painful and uncomfortable this treatment can be. On top of this, they are subjected to vulnerable positions which are normally more suited for private bedroom activities. A gynaecology’s scrutiny would have been less invasive compared to this. Yet, some have told me that they can’t live without it.

So yes, my reluctance to try a Brazilian wax stems from my unwillingness to be placed under such humiliating and vulnerable positions in the hands of a complete stranger. Lying face down on all four and spreading my butt cheeks to expose my privates so that someone else can strip off unsightly pubic hair is too much for me to handle. However, I do admire the women who can; those who attend to it and those who get it done.

All these trimming, filing and plucking has made me ask this question: Since when did we start to think that personal hygiene isn’t such a personal matter anymore? We have begun to leave what our foremothers would have regarded as extremely private matters in the care of strangers? We expose our bare feet, discoloured toe nails, untrimmed cuticles and what not, right in front of someone else’s face to have them cleaned for us.

In some manners, women in the olden days were much more mysterious and fascinating. They turned up in public looking their best and got everyone wondered how did they do it? Now, everyone knows where a woman could get this and that done.

I used to get amused when I watched movies showing aristocrats being undressed, bathed, dressed and having their hair combed by a chamber maid. I often thought to myself then, “Damn. Don’t you guys have hands?” But when you look at how we willingly pay someone else to take care of many parts of our person, what difference does that make? The only difference is, only few could afford such luxury in the olden days but now, many of us can.

The bottom line is, whether it’s a frivolity or not, many of us cannot seem to live without. In the end, it’s really a personal matter when it comes to matters of personal hygiene.

As our standard of living and level of education increase, there’s no denying that many urban Malaysian women are now much more eager to engage and share hygiene and beauty tips. I just hope that these women would be as equally eager to engage and share personal health care such as breasts and pelvic examinations. After all, you can’t possibly care about your pubic hair without caring for your vagina first.

“Our World. Your Move” Campaign: Celebrating World Red Cross and Red Crescent Day

“All can, in one way or another, each in his own sphere, and within his own limitations, do something to help move the good work forward.”

These powerful words were uttered by Henry Dunant following the Battle of Solferino 150 years ago. The founder of the Red Cross/Red Crescent Movement was one who believed that individuals have the power to make a difference and why not? He was a living example of how one person managed to change the ethics and conduct of warfare which is enshrined in the Geneva Conventions.

On 24 June 1859, Henry Dunant, a Swiss businessman arrived in a small town in Solferino while on his way to Algeria. He witnessed the Battle of Solferino (part of the Austro-Sardinian war) which resulted in 40,000 soldiers on both sides dead or wounded in a single day. They were left on the battle field with no medical assistance. Horrified by the sight, Dunant abandoned his business plan and instead devoted to care for the wounded. He mobilized the local population to distribute aid to wounded soldiers without discrimination and this became the basis of humanitarian law.

This year is particularly special for the Red Cross/Red Crescent Movement (International Federation of Red Cross and Red Crescent Societies, IFRC; International Committee of the Red Cross, ICRC; and National Red Cross/Red Crescent Societies, NS) because it is the 150th anniversary of the Battle of Solferino, 90th anniversary of the IFRC and 60th anniversary of the “modern day” Geneva Conventions and most significantly the 4th Convention.

I will not attempt to provide the historical background of the Red Cross/Red Crescent Movement in detail. Instead, I would like to focus on the National Red Cross/Red Crescent Societies, IFRC and my own experience with them.

It wasn’t until five years ago when I first heard about the IFRC. When we talk about the Red Cross, we often think about the ICRC and since I met my husband who works for the IFRC, I began to understand more about the Red Cross/Red Crescent Movement.

There is a Red Cross/Red Crescent society in almost every country today. In Malaysia, we have the Red Crescent society and as a child, I remember being a member of the society in primary school. Unfortunately, I associated the society with marching in the sweltering heat of our tropical climate. I did not learn first aid, neither did I volunteer to raise fund for any victims of natural disaster. At that time, AIDS did not exist yet and I was definitely not aware of any food insecurity situation in the country, if there ever was. I hope that things have changed since then because being a member of the Red Crescent society is not about engaging oneself in boot camp activities.

About twenty years later, I learned that the IFRC is a federation of all the Red Cross and Red Crescent Societies and is based in Geneva, Switzerland. Unlike the ICRC, the IFRC is represented by the National Red Cross/Red Crescent Societies from each member state, very much like the United Nations and each country can only have one National Red Cross/Red Crescent Society (based on one of its seven fundamental principles of unity).

Although the IFRC carries out all the activities one would expect; disaster management, food security, health, etc., one of its main functions is also to provide capacity building and support to local national Red Cross/Red Crescent societies. As such, a huge bulk of its mandate is to work closely with local NSs.

When my husband received a job placement in Ethiopia, I volunteered for the Ethiopian Red Cross Society (ERCS). It was then when I first learned about the dynamics of the Red Cross Movement having lived and worked with those who were either involved with the IFRC, ERCS or ICRC. I would say that the experience was invaluable as it broadens up my own scope of understanding in terms of human rights as well as institutional operations.

Some would like to define humanitarian law as the human rights aspects of war and what this essentially means is that even during a civil or international conflict, the basic rights of soldiers and civilians must be observed regardless of political, religious, gender, racial or other forms of orientation. Although this is more or less what the ICRC’s mandate is, the IFRC and NSs often concentrate on humanitarian relief during times of war and peace.

In many ways, I find that working for the Red Cross/Red Crescent Movement provides instant satisfaction when compared to the United Nations, which I worked for as a human rights officer several years ago. For instance, when there is a natural calamity, swift responses and actions are taken. There is no long discussion on diplomacy, international relations, politics or law. The main concern that triggers the whole movement is to save lives.

At a lower level where natural disasters are not the main issue, the Red Cross Movement concentrates on more basic needs such as health care, food distribution and over the past few years, tackling issues concerning climate change. Issues such as religious, political, cultural or criminal convictions are never in question. Neutrality is by far the most important principle which governs the whole Movement. To me, this is the essence of human rights.

Having said this, the intricacy of institutional relationships between the three entities (IFRC, NS and ICRC) can be a challenge and if so, it is mainly due to the issue of independence (they are all essentially independent bodies).  Nevertheless, due to their guiding principles of neutrality and humanity,  it is less complicated than the UN which is governed by State Members where politics often become the main issue of contention. The NS itself is independent from its own national government and hence should not be influenced by state policies.

As we slowly move into an era where human rights have become a major topic of concern, I would assume that many people often find it too daunting and dangerous to join in the struggles of activists who are often threatened by arrests and prison convictions in countries where civil and political rights are considered as devious forms of activities. If so, I would strongly encourage you to take up a humanitarian cause instead. While it is less “controversial”, the impact is not any lesser.

Providing basic needs to victims of natural disaster, learning first aid to save lives when it is needed, sensitizing people on HIV/AIDS and climate change, encouraging breastfeeding, educating people on road safety, etc. are all heroic acts that count towards sustaining humanity. You don’t have to become a champion for human rights by marching on the street in protest of government frailties, but you do need to take actions against other threats.

In conjunction with this year’s World Red Cross and Red Crescent Day, let’s remember what Henry Dunant said 150 years ago:

“All can, in one way or another, each in his own sphere, and within his own limitations, do something to help move the good work forward.”

IT IS OUR WORLD AND YOUR MOVE.

p/s: For more information, please refer to http://www.ifrc.org and http://www.icrc.org.

When the non-marginalised becomes marginalised

One day, I had an interesting discussion with my boss, who is the Country Representative of the NGO I am volunteering for. She lamented on the fact that so many NGOs, donors and government institutions are giving so much attention to HIV/AIDS programmes that those who are inflicted by less severe diseases such as diabetes are being ignored.

Then I started to think about what she said and realised that at a certain level, there is a lot of truth in it and it doesn’t just stop at HIV/AIDS. Not so long ago, I was talking to a Cambodian colleague of mine while we were visiting Tom Dy Centre, a shelter for women rescued from human trafficking and sexual exploitation. I was somehow amazed by the comfort and infrastructure at the centre and when you step out from the centre, the surrounding area is much closer to the reality in Cambodia; bare, under-developed, poor road condition with flimsy and small wooden houses built on thin poles. This is just a few kilometres away from Phnom Penh city centre.

When I asked my colleague about the community’s perception and reception towards the women, she told me that while some may be inclined to  disparage them, many do harbour some form of jealousy. It is not surprising since many of them are struggling to make ends meet while the women at the centre are being given free health care, vocational training courses and reintegration packages to help them start their own small businesses.

Adoption of  orphans is extremely popular in Cambodia. It is common to see Cambodian children dressed up in decent clothing and sent to international schools. Although these children are being given a chance to have better education and standard of living, the majority of Cambodian children drop out from schools  before the age of 12 in order to help their parents support their large families, especially girls.

I recently had the opportunity to meet the Executive Director of a local NGO called the Health Centre for Children. I was pleasantly surprised to learn that their reintegration approach  for trafficked and sexually exploited children are very different from others which I have come across. Their approach is very much about integrating community needs and ownership whereby families and communities of the reintegrated children all get a piece of the pie. The NGO will provide loan or other forms of incentives to help develop the community as a whole. In addition, community-based activities such as campaigns and group sessions to talk about issues concerning human trafficking and sexual exploitation are held regularly. All these activities will help to inculcate a common sense of responsibilities towards protecting the children.

For me, this is obviously a more effective and sustainable approach towards preventing further exploitation of children. For a start, it tackles the root cause of the problem. The majority of women and children are being  trafficked or sold as slaves  because of poverty. If you want to get rid of this form of modern-day slavery, you have to develop the community and provide the children with education.

In a country like Cambodia where more than 90 percent of the population live beneath the poverty line, it is hard not to think that nearly all of them are marginalised, in our standard. For the average Cambodian who barely makes more than USD40 a month, it doesn’t help them to think that one must be a victim of some sort of severe crisis, chronic disease or crime in order to receive help and attention. For the majority of them, better infrastructure, employment, education, basic health care, food and water will help improve their lives tremendously.

I am not saying that those whose lives have been tragically compromised by HIV/AIDS, trafficking, forced prostitution, disability and other hardships do not deserve the attention we are giving, but I think it is time for humanitarian institutions to adopt a more community-based programmes so that the non-marginalised will not end up being marginalised.

The 21st century slavery (Part VII)

 

There is a traditional Khmer saying, “If Heaven could cry, then Cambodia would never know drought.” Today, I heard Heaven’s cry.

This afternoon, I sat at a meeting with AFESIP, discussing our next action plan for a market research we have been doing for the past few weeks. We have prepared two separate sets of questionnaires to be answered by rescued victims of human trafficking and forced prostitution sheltered by AFESIP, and vocational training centres run by government and non-governmental organizations for disadvantaged women. The purpose of these questionnaires is to consult the women’s views on what sort of training skills would interest them as well as to understand the reality of the job markets in Cambodia.

We took a field trip to Kandal and Kampong Cham provinces last week to visit a girl, formerly a resident of Tom Dy Center, who is now running her own hair salon in Khsach Kandal district and the Women Development Center (WDC) run by the Ministry of Women’s Affairs in Kampong Cham. We soon realised that our interview with the manager of WDC ran on for more than one and half hours. We figured that we need to be more efficient with our questionnaire as we are going to interview more than two hundred respondents in the next three weeks.

At the meeting, we discussed about the number of residents in each shelter in order to ascertain the number of days needed to carry out the interview. AFESIP runs three such shelters in Phnom Penh, Kampong Cham and Siem Reap. We are unable to ask the residents to fill in the questionnaire since many are illiterate and instead have to rely on staffs and volunteers to carry out face-to-face interviews. When we asked AFESIP how many residents are taking training courses in their centre in Kampong Cham, they told us 12 although there are 35 residents in total. We then wondered what the other 23 women do at the centre.

Reluctantly, one of AFESIP’s staffs told us that the rest are three to five year-old girls. I was unable to disguise my shock and bewilderment, much to the discomfort of my Cambodian colleague who was sitting next to me. He whispered shamefully into my ears that this is Cambodia and it is common to have girls that age to be sexually exploited. In a way, I wished that I hadn’t display such shock and remorse so openly because many Cambodians I  met often feel shameful towards the atrocities committed in their country. It feels almost as if the whole country is so overwhelmed by countless account of tragedies from poverty to human rights abuses that they believe these tragedies only happen here.

When I looked down at the questionnaire in front of me, all those questions asking the women whether they would like to run their own businesses, or whether they prefer to learn silk weaving, etc. seemed so obscene. These questions are not meant for a 3 year-old because she is not meant to be in the shelter to begin with.

I know for a fact that child sexual  exploitation is not uncommon here. I read it on the paper almost every other day about which sex offenders have been prosecuted and I see campaign posters on the back of tuk-tuks around the city. But not until I hear it with my own ears, do I begin to hear the cry of Heaven so loudly and heart wrenchingly.

The 21st century slavery (Part VI)

Dreams, aspirations and reality

I had an interesting discussion with some people recently about employment opportunities for the rehabilitated women. The issue was about whether an expat living in Cambodia would be willing to hire these women as nannies. This idea came about when I discovered that there is a high demand for nannies here among the expat community. In Phnom Penh, there is a high concentration of international NGOs and UN agencies and since it is a family accompanied mission area, many staffs bring their families along. When both parents work, it is common for them to hire a nanny to look after their children.

Unfortunately, there is very little supply for this since many expats require nannies to speak basic English. So, I thought there may be an opportunity there if these women are trained in this field. On top of that, I also thought that perhaps it might provide a good family environment for the women. One of the main concerns we have when assessing the types of marketable jobs for the women is to ensure that their work environment will not expose them to the risk of being trafficked or forced into prostitution. Jobs which require them to spend  huge amount of time in the street or male-dominated outlets are likely to present them with such threat, although not entirely so.

However, while keeping in mind that their interest and well-being are a priority, it doesn’t mean that the potential danger it might bring to others should not be considered. So, the debate was whether nanny is a suitable job for the women. Some of the comments I received were valid as well as an indication that the stigma attached to the women, regardless of whether they were forced into prostitution or not is very much present.

Most of the people I discussed with said that they would not be willing to hire these women as a nanny. The reasons were not solely based on the fact that they were sex workers but  also the psychological vulnerability of the women. Some expressed that the women may not be psychologically well enough to be entrusted with the responsibility of handling children. This is particularly a concern if they are HIV positive too. This is a valid point especially when it involves the well-being of a child. If a nanny agency were to be established for this purpose, then there must be sufficient policies and standards to ensure accountability.

There are a few who said that they would be willing to consider if the women were indeed being forced into prostitution and a strict screening process should be carried out to determine this. Then, there were some who raised the question of whether it is a legal or ethical requirement for the women to reveal their past. My thought on this was that if their past identity would become a basis for discrimination, then perhaps they are not legally bound by it.

Finally, there was one person who asked whether it is wise to limit the women to domestic jobs only because by virtue of that, we are narrowing down their options based on their education level. Perhaps we might want to encourage them to become more than just nannies, domestic helper, waitress, etc. After all we don’t really know what are the aspirations and dreams of these women. We might not expect them to be rocket scientist or doctors, but secretarial or managerial positions may be some of the options.

The truth is, judging from the cultural aspect and reality of the situation, it is not an easy task if we were to cater to each and every woman at the centre. There are presently more than 50 women being rehabilitated at the centre and we certainly would like to see the women achieve something which they can be proud of but at the same time, the more pressing issue to tackle, bearing in mind the limited resources available, is how to ensure that the women can earn some money while maintaining their dignity.

There are very few women who have seized the opportunity to hold professional jobs, mainly with AFESIP. Then, there are the majority who said that they would be happy with any jobs, as long as they get one. So, in the end, it is up to the women. If they desire to be something more and show the potential to achieve that, then the doors remain open to them.