Prop 4: Abortion Waiting Period and Parental Notification Initiative

For those of you who haven't read up on the propositions yet, Proposition 4 is on the ballot this year in California.

The initiative prohibits abortion for unemancipated minors until 48 hours after physician notifies minor’s parent, legal guardian or, if parental abuse has been reported, an alternative adult family member.

It's also called "Sarah's Law" after a 13-year-old girl who passed away from a botched abortion after having a relationship with a 39-year-old sexual predator, Gary Cross. When she became pregnant, he took her to an abortion clinic and then resumed sexual relations with her, all without her parents' knowledge. Sarah's mom found out about the abortion after coming across related paperwork in her daughter's room.

Anti-Prop 4 arguments include the very realistic fear that more minors will opt for illegal and dangerous abortions. Communication between minors and their parents/guardians is never uncomplicated; teens probably fear that their parents would react irrationally and/or hurt them. Whether that fear is real or perceived, it affects a minor's behavior at such a crucial, traumatic moment. Another argument cited is that no law can mandate family communication; rather, it's something that has to come naturally. And what if it doesn't? Then take the lesser evil, because a safe abortion is better than an illegal one.

I am against abortion. I think it's killing an innocent being that was meant for life, if not for our intervention (ie, abortive procedure). Does this mean that I don't care about the poor minor in this traumatic situation?

Of course I care. But I think instead of figuring out ways to deal with the symptom of the problem, such as rules regarding abortion among minors, we need to concentrate really hard on figuring out ways to reduce unwanted pregnancies. Of course, they will still happen. But when they do, we need a plan. A plan that supports life--both the life of the baby and the life of its young parents (who are kids themselves). Two wrongs don't make a right; there's no real way to undo a pregnancy. Does having an abortion make a minor whose had a sexual relationship mentally sound and "over it"? I don't think so, having been through a pretty rocky decade myself at that age. It's short term relief, but the emotional wounds leave big scars you have to deal with sooner or later.

I don't have a real answer. I just know that what needs to be done is to focus on prevention, and on building a society where support systems are in place for minors who would be at risk for this kind of behavior. And when sex and unwanted pregnancy happen, there should be support for that, too. There are plenty of young people who DO choose to carry their babies to term. What makes them different? Probably less hopelessness, more of a support system, more emotional maturity. Doesn't every minor deserve that, pregnant or not?

In a way, maybe Prop 4 will help some families. I agree that it will backfire in many ways, particularly in families where communication isn't possible. I know in my own family, when I was a minor, communication definitely didn't feel AT ALL possible, so I can only imagine what it's like in families with more diverse challenges. But in those families where parents or guardians are ready to reach out and help their minor, maybe it will force-foster some needed healing. Because when a teen is pregnant and wants an abortion, clearly something isn't going right.

Ramblings, on becoming a doctor

“When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. Tis the same cause that wears out
Our bodies and our clothes”

From Bertoit Brecht's A Worker's Speech to a Doctor

I'm visiting home this weekend and am fascinated watching my sister interact with her newborn child. He is such a helpless little thing. As my sister said, anyone can do anything to him, and all he can do is cry. It's an obvious point, but I guess that degree of fragility is something we don't often encounter in daily life.

It got me thinking about the above excerpt from Brecht's poem. One of the reasons I love medicine as a profession is that people come to you with their problems, and you get to fix them. Anyone reading this will probably immediately think, "Oh yeah? Is that how it works? Because that isn't how it's been working!" Nevertheless, it is that idea(l) that attracts me to the field.

It's a scary thought, not to be taken lightly. As a physician, you are asking someone to come to you in their most vulnerable state, helpless as a baby (let's leave litigiousness aside for the moment). You have powerful drugs at your disposal, compounds that can wreak havoc on the body, or fix it instantly, or some compromise thereof.

Small things make a huge difference. Maybe your marriage is in trouble, or your teenager is a nightmare. Maybe you're depressed. Maybe your finances are suffering. Maybe you don't want to talk about it. Maybe you do. Maybe you shouldn't, but maybe you should.

How will I know if I don't ask?

Sometimes I frankly cannot believe that they let me into medical school. That assuming all goes according to plan, I will be a doctor and I will have this huge responsibility of someone's life in my hands. That I will have a pad on which I write treatments that could do a lot of damage to another human being. Or if I become a surgeon, that I will be fiddling around inside a fellow person.

But wasn't that the dream? Isn't this what I've been striving for, that very responsibility? Didn't I write in my medical school applications that there was nothing I wanted more than to be in this position?

And it's true, it is still true. There's nothing I want more. I don't know how this sounds, but I want to be a resource, a beacon for people. I want to be a giver like a tree that bears fruit. You pluck the fruit and it grows more, no problem, no questions asked. It bears so much fruit, in fact, that sometimes the tree bends over with the weight of its bounty. I want to be like that, if God wills it.

I pray I never forget what Brecht is referring to. The exquisite vulnerability of that moment with a patient. Eventually, it will be up to me: I can treat their symptoms (or what I perceive to be their symptoms), or I can treat them whole.

I'm sure I have no idea what I'm talking about right now, but I'm also sure that what I'm saying is true.

Food for thought from Infidel

I’ve read quite a few novels this summer, but Ayaan Hirsi Ali’s Infidel has probably been the most provocative. While I oppose with her fundamental conclusions about Islam, I do agree with some of her injunctions against traditional Muslim culture.

That fundamental point of disagreement is this: I think she fatally misinterprets Islamic tradition as being part of the Quran—the word of God is NOT the same as what your imam or Quran school teacher tells you, necessarily, nor is the word of the Prophet in Hadith. She’s had some seriously crooked people/institutions rear her in their seriously crooked (mis)interpretation of Islam.

Anyway, while I think she takes her frustration out on the Quran when she should be directing that energy against opportunist, backwards interpreters of the scripture, I found her account of refugee camp life and her criticism of faith-based schools particularly interesting, especially as I was interacting with kids who had been through this unfathomable experience. I wanted to share some excerpts:

“The UN began to distribute food; basically they handed rations to people who claimed to be clan leaders, and these people either kept it for their own families or sold it.”

“It began happening al the time: Kenyan soldiers came at night to rape Somali women who were alone without protectors. And then all these women would be shunned and left to die.

This is what my grandmother had meant when she warned me: if you are a Somali woman alone, you are like a piece of sheep fat in the sun. Ants and insects crawl all over you, and you cannot move or hide; you will be eaten and melted until nothing is left but a thin smear of grease. And she also warned us that if this happened, it would be our fault.

It was horrible. Everyone in the camp called themselves Muslims and yet nobody helped these women in the name of Allah. Everyone was praying…but no one showed compassion.”

And on Muslim schools (this is the author’s opinion; I personally know nothing about Muslim schools but imagine it’s similar to Islamic tradition/culture):

“Muslim schools reject the values of universal human rights. All humans are not equal in a Muslim school. Moreover, there can be no freedom of expression or conscience. These schools fail to develop creativity—art, drama, music—and they suppress the critical faculties that can lead children to question their beliefs. They neglect subjects that conflict with Islamic teachings, such as evolution and sexuality. They teach by rote, not question, and they instill subservience in girls. They also fail to socialize children to the wider community.”

I believe strongly in gender equity, like Hirsi Ali, but I also think men and women were created to fill different roles in life (I’m thinking particularly about family life). Different, but equal. I also believe in creationism—to me, evolution is an undeniable truth, but within a species—but I agree with the author in that whether you believe it’s true or not, children need to be educated about the ideas that exist in the world they’re living in. That’s the only way they can make real choices and be intellectually and spiritually strong enough to believe in something worth standing up for.

A new outlook on my future in global health

Yesterday I had lunch with my dad, and we got to talking about global health. He's not against aid to Africa; on the contrary, he was the one who accompanied my mom to Kenya last year, when the project was in its incipient stages. But he always seems to ask, "Why not India?" Considering that we are definitely Indian, and speak Indian languages, and eat Indian food, and know Indian culture, and have family there, it's a more than legitimate question. Why Africa?

Until I really got to know all these students and delve into their personal histories and, more importantly, the history of their place of origin (Southern Sudan, specifically Bor Town), this was my question too. I love India. I may not speak the languages my parents do, but something happens to me when I go there, oddly: I feel at home.

Anyway, if it's language we're talking about, why not Mexico? I speak pretty good Spanish and have grown up around Latino culture. Why not the urban poor of San Francisco, for that matter? The needy communities of Santa Ana?

Those are all legitimate questions, no doubt. How did we become all about Southern Sudan?

Sudan is not a cause (if I can momentarily reduce it to that) that we sought out, it's something that just happened. We weren't looking to work in this particular part of the world, necessarily. Most of my global health experience is in Central and South America. And last year I did a project in India.

But there's something about Africa's need that is staggering right now. I know well that the indigenous in Chiapas have suffered unspeakable violence in the highlands--I'm thinking of the 1994 Acteal Massacre that earned the Pillar of Shame. I know that Hindus, Muslims and castes and subcastes (the Gujjars and Meenas, when I was last there) have been at it for centuries.

But right now, I feel that Africa is in a crisis mode we as members of the human race cannot ignore. Particularly, Sudan right now is in crisis. A whole nation is utterly torn apart, and at its heels are Ethiopia and Somalia and Rwanda. The instability is staggering. This extent of civil upheaval, of human cost, is among the greatest of international atrocities. Yes, the Acteal Massacre was horrific. It almost took our breath away to hear Manuelito's account of it (a survivor who lost both parents and several family members, including babies). But what about the 1991 Bor Massacre no one talks about? Yes, the social and political drivers are not comparable. But I'm talking about human suffering and consequent human need. So for me, and for my mom, that is why Africa.

(Banner from the film "Not Lost" on the Lost Boys of Sudan)

Faith-based schooling in East Africa

State House Girl's High School in Nairobi


Osama bin Laden once said, “You are either with the Crusade, or Islam.” This summer, that definitely seems true—in Mexico, it was the Crusade, and in East Africa, it’s Islam (and the Crusades, too).

In my two-week crash course on Kenyan secondary schools, I learned that almost all (if not all) schools incorporate religious education as a required part of the curriculum. There simply are no secular secondary schools (or so few that choosing to go to one is not an option for most students). In the fee structure for each term or year (3 terms in a year, 4 years total), the Bible is included as a necessary expense. Masses are held, and religious classes are mandatory. You even get a grade that factors into your point total. A part of the national exam administered at the end of high school, called the KCSE (Kenyan certificate of secondary education), is devoted to religion—if you are Muslim, you take the Muslim version, if Christian, likewise. You have two or three choices—I think Hindu is now a choice, according to Kwai, What if you decline? It is rare, but possible. Most people don’t decline—they already have their tidy social designation.

Anyone who knows me can predict where I’m going with this: why not let people think for themselves? Why make religion part of the curriculum at all? What are you going to teach, anyway? Piety 101? Charity, modesty, honoring your parents? Those are life lessons. You have to choose them all by yourself.

But there’s more to it than that. Everyone is so neatly categorized. In Southern Sudan there’s the Dinka, the Nuer and the Murlee, and more that I don’t know about. In Kenya there are clear lines between Somalis, Ethiopians, and other expatriates. Within each nationality, clans and subclans exist. You should know your family’s ancestry; it’ll help you in case you need to stay at a distant relative’s home, or if your people are at war. A relative won’t turn you down or leave you hanging; it would look bad. Clan/tribe/family ties are so strong in places like East Africa (eg Sudan, Somalia, Rwanda)—no coincidence that these are nations utterly torn apart by civil war.

Of course, they’ve had help from outsiders, no doubt about that. Khartoum in Northern Sudan is the #1 slave trade spot. Egyptians have historically come there to steal human beings—particular Southern Sudanese—for bondage. The discovery of oil has drawn often destructive, purely self-interested international attention (like China’s). But the fact remains that the Hutus and the Tutsis tore each other apart on their own, as did the Hawiye and Darod in Ethiopia, and the Nuer and Dinka in the Bor Massacre in Southern Sudan (in 1991). They didn’t need any help.

Nor did they receive any. Yeah, it’s true that civil strive had to do with internal tribal/clan conflict, but it’s much more complex and much larger than I’m pretending for the purpose of this post. And regardless, for wealthy nations to stand by when the chips are down, and step in when they eye something shiny, is in some ways more abominable than the civil unrest itself.

If You Knew

If you knew what my life has been like, you wouldn’t look at me this way when I ask you for a thousand more shillings, call you three times to see if you got my email, take up half an hour of your time outside your hotel even though I wasn’t on the list of “accepted students” you posted outside the office. With the note saying how hard it was to choose, how you wished us all well with our pursuit of education.

If you knew I only eat a meal a day, and that’s why I called you to ask for more money, after you’d already made a check out to my school to pay my fees, you wouldn’t lose your patience with me.

If you knew my only motivator growing up was fear, maybe you would understand why I didn’t tell you in the interview I had an outstanding balance at my school.

If you knew this scholarship means I’ll finally be able to go to boarding school and get out of my uncle’s house where I work all day to earn my keep, with no time to study, maybe you’d pick me even though I get C’s and D’s.

If you knew I could get 3 masters degrees for the price of your 1, maybe you’d see it’s worth it to put me through medical school.

If you knew I have no idea where my parents are, whether they’re dead or alive, maybe you’d be as shocked as I am to see how you talk to your mom sometimes.

If you knew I’ve seen a man almost shot over a jerry can of water in the refugee camp, you’d see that it’s not just a bottle of water to me.

If you knew that my features are typical Southern Sudanese, and that this fact is grounds for a life of discrimination, both in Kenya and in my own country, you’d understand how much more fighting needs to be done to be able to say that “everyone is equal”.

If you knew I’ve seen hyenas too, eating dead bodies while I was fleeing civil war, you’d realize wild animals are not just “beautiful” and “peaceful” they way they look on safari.


If you knew the only reason I showed up to your hotel was to say it’s okay you didn’t pick me, I’m happy for those you did pick—they’re my brothers.

If you knew that if you don’t pay my school fees now, my mom says I have to go back to the cattle camp in Sudan next month.

If you knew my ulcers make it impossible to eat whatever food is available to me, let alone study.

If you knew I look nice and presentable because I wore my very best clothes to come to meet you.

If you knew this chance to study means the difference between a wasted life and a future full of hope.

If you knew. If you knew. If you knew.

Tutaonana!

It's our last day in Nairobi and I'm really sad to leave, for so many reasons. Hence the title; tutaonana means goodbye/we'll see each other again in Kiswahili. One of the reasons I'm sad involves the fact that I'm two and a half weeks away from life in med school in Irvine. It has it's positives, but I'd much rather be here in Kenya talking to kids about how to complete their education and get ahead in life. But God has a plan and I can't be anything less than excited about it, because it always ends up better than I ever could have imagined. And that's the truth.

Anyway, there's so much to write, but the last week has been a whirlwind of paperwork and phone calls and haggling over school fees (yes, haggling, my mom is a genius by God's grace) and tying up loose ends. Running to the bank to make out banker's cheques to pay term fees for the upcoming school term. Converting between kenyan shillings and dollars, and withdrawing from the ATM, which is very stingy with letting us access our own money. We've also met with all the students, and had a real, delicious Sudanese meal at Kwai's house. That was probably one of my favorite things that happened here, actually. To eat traditional Sudanese food with some of the accepted students who we've been working with to sort out all their school and personal information was really nice. We'd been all business before, but this was purely a social event. It was a definite highlight. Even some of the very gracious applicants who weren't accepted came to share the meal, which I appreciated so much.

We are in the process of scanning all the life histories and photos of the students who applied but were not accepted this year, so that we can put them up on a yet-to-be-created website. God willing, the plan is to connect these students with donors other than the ones already involved in Universal Unity, Kiva-style. We'll keep everyone posted as this unfolds; there were a LOT of applicants so it will take a few weeks to sort everything out online.

There's so much to write about and think about, thankfully I have a whole 24 hour journey ahead of me to do all of that :).

More later.