CP+Fistula

Working on getting the picture files added... :)

Observation one is one woman’s experience with obstetric vaginal fistula. Narratives are crucial to expressing and understanding personal identity and its meaning Anthony Paul Kerby, 1991, “Narrative and the Self”, pg. 37.

1AC And thus we begin with the story of Dr. Catherine Hamlin, the founder of Addis Ababa Fistula Hospital, a female who has made a difference in the lives of many women, and who also has her own story.

Catherine Hamlin, PhD, 2001, “The Hospital by the River: A story of Hope”.

1AC [Hamlin Continues]

1AC [Hamlin Continues]

1AC [Hamlin Continues]

1AC [Hamlin Continues]

1AC Observation two is inherency: Currently, the United States Federal Government is not providing doctors nor fiscal support to Niger for fistula. Lauri Romanzi, clinical associate professor of gynecology at Weill Cornell Medical Center/New York Presbyterian Hospital who has traveled to Niger to repair fistulas, 6-10-07 [“Pelvic Reconstructive Surgery and Urogynecology”, blog, http://urogynics.blogspot.com/feeds/posts/default, 7-17-07] Fistulas occur rarely in industrialized countries, at a rate of less than 2%, most commonly a result of gynecologic surgery (82%) and less often due to childbirth injury (8%), radiation therapy (6%) and eroding cancers or infections (4%). For women in developing countries in Africa, Asia and Latin America, the odds are the inverse, with 92% of fistulas due to childbirth and the remainder (8%) caused by complications of gynecologic surgery, cancers or infections (Nigeria 1985, Ghana 1996). Fistula rates in high-incidence countries are difficult to calculate, since countries lacking the medical infrastructure of industrialized nations also lack the bureaucratic infrastructure to gather accurate statistics. Given, however, that childbirth fistula occurred during a birth that could have easily killed the mother, fistula rates are linked to maternal mortality, and therefore maternal mortality statistics, tracked by international health organizations, are a barometer of all childbearing trauma, including fistula. Worldwide maternal mortality rates are 430/100,000 woman, with a wide discrepancy between the US/Europe (11/100,000) and the poorer sections of Africa (1000/100,000), due primarily, if not entirely, to the lack of medical and obstetrical infrastructure. (WHO 1996). Lewis Wall, renowned author on the topic of childbirth injury, highlights a more meaningful statistic in his work, the lifetime risk of maternal death, or "LRMD", which reflects the likelihood that the mother will not survive any given pregnancy and the number of times she will likely become pregnant based on regional birth rates. Overall, the global LRMD is 1:60. In industrialized nations the likelihood is 1:1800; in North America and Europe the rates drop even further to 1:4000. In poor countries, the overall rate is 1:48 with rates as high as 1:7 per-pregnancy death risk in the poorest nations. (WHO 1996). Niger, one of the 1:7 LRMD nations, is a country of 12 million people medically served by 2 urologists and 10 obstetrician – gynecologists with a fecundity rate that is one of the highest on the planet, at an average of 8 children born per woman.

1AC Thus we provide the following plan: The United States Federal Government should recruit and provide obstetricians to Niger hospitals for vesicovaginal fistula repair. We reserve the right to clarify. 1AC Observation three is women’s rights: With only a few doctors to treat the numerous cases of fistula, the victims are subjected to ostracization from their communities. Nigerfistula.org, 2005, introduction.

In some cases, the rectal wall is also affected and there is no control of feces either. The woman is often ostracized by her husband, her family, and her village. She is now an outcast in society. In the West African country of Niger, there are countless young women with this problem. According to United Nations figures, there are only 6 doctors in Niger that are qualified to operate on women with fistula, in order to repair them. In a country of 12 million people with only approximately 414 doctors, this is not an unusual circumstance. But for the women affected by fistula, it is a desperate situation with little hope to be able to be restored to a normal life. It is estimated that for some 200,000 women in Niger, life is filled with humiliation, horrible discomfort and shame of their inability to control their urine and feces. Most of these young women spend their lives isolated, in extreme poverty and ostracized by society. 1AC And these women are excluded from societal roles. Fistula leads to women being excluded from societal roles. Steven Arrowsmith, Catherine E. Hamlin, L. Lewis Wall, September 1996, Obstetrical & Gynecological Survey [“Obstructed Labor Injury Complex: Obstetric Fistula Formation and the Multifaceted Morbidity of Maternal Birth Trauma in the Developing World”, vol. 51, number 9, 7-17-07] Although physicians tend to think in terms of clinically definable injuries, much of the suffering that fistula patients endure is a result of the condition's social consequences. In many rural African cultures, women have a lower social status than men. In addition, the division of labor is often such that women are required to perform much of the heavy domestic labor such as carrying water and firewood or cultivating the fields. Foot drop and pelvic injuries often make performance of these tasks impossible. Although obstetric fistula formation is most common as a complication of a first pregnancy, 11.7 percent of our patients have had six or more children. What happens to the surviving children when their mother's life is ruined in this fashion? The impact of an obstetric fistula on the surviving children of a mother with this condition is an important public health issue about which there are no data.

In cultures where women's roles are defined largely in terms of reproductive functioning, a woman's obligation to satisfy her husband's sexual needs is often intimately intertwined with her own sense of self-worth. Vaginal injuries often make intercourse impossible, and the constant stream of urine makes it otherwise unpleasant. Although infertility is a devastating problem to couples in any culture, in Africa this is a problem of tremendous significance. Large families may be the only source of help for agricultural labor, and since governmental social welfare programs are nonexistent in most African countries, children are the only hope one has for security in old age. The fetal mortality in obstructed labor is staggering. According to our records, 7882 of 8543 fetuses involved in prolonged obstructed labor died in the process (92.3 percent). Of 9196 patients on whom data are available, 6283 (68 percent) had no living children. The widespread problems of amenorrhea, cervical injury, and postfistula pelvic inflammatory disease in women with obstetric fistulas mean that many women will never have another chance at childbirth. Furthermore, almost 50 percent of our patients are divorced or separated from their husbands. This compounds an already disastrous social situation even further.

Many African religious groups, especially Muslims, require personal cleanliness as a prerequisite for worship. Fistula patients are obviously unclean, and this often excludes them from participation in religious activities. This further diminishes their sense of self-worth. Their odor is offensive and they cannot control the constant stream of urine that runs from their vaginas, down their thighs and legs. In order to deal with this never-ending problem, the families of these patients often remove them from the main family dwelling into a peripheral hut, sometimes forcing them to live out doors. Not uncommonly, they are forced out of the family compound altogether. Unskilled, illiterate, impoverished, socially isolated, and reeking of urine and (sometimes of feces) these women truly are the wretched of the earth. 1AC Furthermore, this silencing that women experience in their lives is a horrific example of dehumanization. Sandra Lee Bartky, Professor of Philosophy at the University of Chicago, 96, Feminisms and Pedagogies of Everyday Life, page 237.

1AC This silencing of women is considered violence. December Green, 1999, (Wright State University Director, International Studies Program Professor of Political Science) Gender Violence in Arican- African Women’s Responses

1AC Military, Economic, and Ecological Problems Can Only be Solved by Understanding the Role of Gender in the International Sphere. Tickner-Associate Professor of Political Science at the College of the Holy Cross-92 Gender in International Relations http://www.ciaonet.org/book/tickner/tickner12.html

In previous chapters I have argued that traditional notions of national security are becoming dysfunctional. The heavy emphasis on militarily defined security, common to the foreign policy practices of contemporary states and to the historical traditions from which these practices draw their inspiration, does not ensure, and sometimes may even decrease, the security of individuals, as well as that of their natural environments. Many forms of insecurity in the contemporary world affect the lives of individuals, including ethnic conflict, poverty, family violence, and environmental degradation; all these types of insecurity can be linked to the international system, yet their elimination has not been part of the way in which states have traditionally defined their national security goals.Previous chapters have also called attention to the extent to which these various forms of military, economic, and ecological insecurity are connected with unequal gender relations. The relationship between protectors and protected depends on gender inequalities; a militarized version of security privileges masculine characteristics and elevates men to the status of first-class citizens by virtue of their role as providers of security. An analysis of economic insecurities suggests similar patterns of gender inequality in the world economy, patterns that result in a larger share of the world's wealth and the benefits of economic development accruing to men. The traditional association of women with nature, which places both in a subordinate position to men, reflects and provides support for the instrumental and exploitative attitude toward nature characteristic of the modern era, an attitude that contributes to current ecological insecurities. This analysis has also suggested that attempts to alleviate these military, economic, and ecological insecurities cannot be completely successful until the hierarchical social relations, including gender relations, intrinsic to each of these domains are recognized and substantially altered. In other words, the achievement of peace, economic justice, and ecological sustainability is inseparable from overcoming social relations of domination and subordination; genuine security requires not only the absence of war but also the elimination of unjust social relations, including unequal gender relations. 1 If, as I have argued, the world is insecure because of these multiple insecurities, then international relations, the discipline that analyzes international insecurity and prescribes measures for its alleviation, must be reformulated. The reconceptualization of security in multidimensional and multilevel terms is beginning to occur on the fringes of the discipline; a more comprehensive notion of security is being used by peace researchers, critics of conventional international relations theory, environmentalists, and even some policymakers. But while all these contemporary revisionists have helped to move the definition of security beyond its exclusively national security focus toward additional concerns for the security of the individual and the natural environment, they have rarely included gender as a category of analysis; nor have they acknowledged similar, earlier reformulations of security constructed by women.

1AC And The Local IS Global – the Public/Private Distinction Underlying Gender Inequality Pervades All Levels of Analysis and Its Hierarchies that Create Militarism, Sexism, and Racism on a Broader Scale

Tickner-Associate Professor of Political Science at the College of the Holy Cross-92 Gender in International Relations http://www.ciaonet.org/book/tickner/tickner12.html

The pervasiveness of internal conflict within states in the latter part of the twentieth century and the threats that militarized states pose to their own populations have called into question the realist assumption about the anarchy/order distinction. Critics of realism have also questioned the unitary actor assumption that renders the domestic affairs of states unproblematic when talking about their international behavior. Claiming that militarism, sexism, and racism are interconnected, most feminists would agree that the behavior of individuals and the domestic policies of states cannot be separated from states' behavior in the international system. 70 Feminists call attention to the particular vulnerabilities of women within states, vulnerabilities that grow out of hierarchical gender relations that are also interrelated with international politics. Calling into question the notion of the "protected," the National Organization for Women in their "Resolution on Women in Combat" of September 16, 1990, estimated that 80-90 percent of casualties due to conflict since World War II have been civilians, the majority of whom have been women and children. In militarized societies women are particularly vulnerable to rape, and evidence suggests that domestic violence is higher in military families or in families that include men with prior military service. Even though most public violence is committed by men against other men, it is more often women who feel threatened in public places. 71 Jill Radford suggests that when women feel it is unsafe to go out alone, their equal access to job opportunities is limited. 72 Studies also show that violence against women increases during hard economic times; when states prioritize military spending or find themselves in debt, shrinking resources are often accompanied by violence against women. Feminist theories draw our attention to another anarchy/order distinction-- the boundary between a public domestic space protected, at least theoretically, by the rule of law and the private space of the family where, in many cases, no such legal protection exists. In most states domestic violence is not considered a concern of the state, and even when it is, law enforcement officials are often unwilling to get involved. Domestic assaults on women, often seen as "victim precipitated," are not taken as seriously as criminal assaults. Maria Mies argues that the modernization process in the Third World, besides sharpening class conflict, has led to an increase in violence against women in the home as traditional social values are broken down. While poor women probably suffer the most from family violence, a growing women's movement in India points to an increase in violence against educated middle-class women also, the most extreme form of which is dowry murder when young brides are found dead in suspicious circumstances. Eager to marry off their daughters, families make promises for dowries that exceed their means and that they are subsequently unable to pay. 73 In 1982 there were 332 cases of "accidental burning" of women in New Delhi; many more cases of "dowry deaths" go unreported. 74 1AC The Current Approach is Dysfunctional. Failure to Include Analysis Based on Gender Hiearchies Makes it to Avoid Nuclear Annihilation Inevitable. Tickner-Associate Professor of Political Science at the College of the Holy Cross-92 Gender in International Relations http://www.ciaonet.org/book/tickner/tickner12.html Realist models of international relations have been built on assumptions of rigid boundary distinctions between outside and inside, anarchy and order, and foreign and domestic. The outside is portrayed in terms of dangerous spaces where violence is unsanctioned. This threat of violence must be guarded against and controlled if security on the inside is to be achieved. Feminist perspectives point to the inadequacy of these boundary distinctions for understanding the roots of conflict and suggest other possible ways of thinking about national security. By emphasizing the interrelationship of violence at all levels of society-- as well as its relation to family violence, which also takes place in spaces that are usually beyond the sanction of the law-- these feminist perspectives can help us to rethink such boundary distinctions. Threats of nuclear annihilation and environmental degradation and the interdependence of states in their economic relations all suggest that statist approaches to national security are becoming dysfunctional. We can no longer afford to think in terms of the hierarchical boundary distinctions fostered by the exclusionary we/they attitude of the modern state system. Technologies of modern warfare have broken down boundaries between protectors and protected. Interventionist practices of great powers in the conflicts of weaker states, as well as ethnic strife caused by the lack of coincidence between state boundaries and the various nationalities living within these internationally sanctioned borders, blur distinctions between domestic and international violence. If this feminist analysis has suggested that true security can be achieved only with the elimination of rigid hierarchical gender distinctions, the same conclusion could apply to the hierarchical distinctions through which we have been socialized into thinking about the international system.

1AC Observation four is solvency: The United States needs to take action in Niger to help the population by providing doctors to perform surgery on fistula patients as well as train other doctors how to perform the surgery. Sarah Wilkins, Reporter, November 18, 05, World-traveling ambassador happy to call Del Mar home, http://www.delmartimes.net/articles111805.html

A native of Finland, [Owens Kirkpatrick] she served as United States Ambassador to Niger from 1999 to 2002. Before that, she performed as Director of the Office of European Security and Political Affairs, Director of Inter-American Affairs at the National Security Council and Minister Counselor for Political Affairs at the U.S. Embassy in Mexico City. Owens-Kirkpatrick’s career does not end there, but spans back to 1983, when she, then a political officer with the U.S. State Department, was deployed during the military rescue operation in Grenada. Her role as ambassador is held dearly, and the Niger she called home for three years is a “really wonderful and fascinating country.” “But it needs a lot of support and help from the outside,” Owens-Kirkpatrick said, citing its rank by the United Nations as the world’s poorest country. “A lot of people survive on practically nothing.” Ninety percent of the nation relies on subsistence agriculture, she said, and thousands have died from starvation and malnutrition. “There is the need for a very active international effort to help them,” she said. That sense of forging a real, goal-based international support system became her passion. Owens-Kirkpatrick said the prevalence of talk without actions can be very frustrating. “The key to international efforts is to produce visible and tangible results in real peoples’ lives, she said. “It’s not handouts, but helping them help themselves. It doesn’t necessarily cost a huge amount of money, but it does require that you really care and engage.” Non-forceful approaches are particularly important to Americans, she said. “We have begun to lose our reputation of caring for other people,” she said. “We’re being criticized a lot for trying to solve international problems with force rather than soft power, and I think a lot of work needs to be done to signal that the American people still do care a great deal.” She said America needs to communicate personally, at the grassroots level, as well as politically. In Niger, Owens-Kirkpatrick was particularly involved with a disease called obstetric fistula, a postnatal condition, affecting women in places without sterile birthing facilities and medical care. “Women in Niger are often too small and underdeveloped to give normal birth, she said. “The labor gets obstructed and they often rip, and have to live with this condition without any medical help.” She said many women hear of a doctor’s arrival by radio or word of mouth, and some walk more than 60 miles to receive surgery. Still, she said, many women have not been accessed because of shame associated with the condition. “Their husbands leave them, (saying) they smell and they’re ill,” she said. “So they’re not always anxious to identify themselves.” With the help of American doctors, Owens-Kirkpatrick has participated in helping almost 400 women receive surgery. She also worked with training local doctors to perform the surgery. 1AC And its cheap-the cost for surgery, counseling and post-operative care is a minimal 300$ per patient. Fightfistula.org, 7-18-07, (“Fistula information”, http://www.fightfistula.org/fistula_faq.asp#6)

5. Can fistula be “cured”? Yes, fistula is treatable as well as preventable. Reconstructive surgery can mend the injury, and success rates are as high as 90 percent for uncomplicated cases. (For complicated cases, the success rate is closer to 60 percent.) Two weeks or more of post-operative care is needed to ensure a successful outcome. Counselling and support are also important to address emotional damage and facilitate social reintegration. The average cost of fistula treatment – including surgery, post-operative care and rehabilitation support – is $300. 6. How much does it cost to treat a fistula? The United Nations Population Fund has estimated that the average cost of fistula treatment – including surgery, post-operative care and rehabilitation support – is $300.

1AC And the surgery is preventative-untreated fistula can cause early death, ulcerations and infections among other diseases and conditions. Fightfistula.org, 7-18-07, (“Fistula information”, http://www.fightfistula.org/fistula_faq.asp#6)

Left untreated, fistula can lead to frequent ulcerations and infections, kidney disease and even death. Some women drink as little as possible to avoid leakage and become dehydrated. Damage to the nerves in the legs leaves some women with fistula unable to walk, and after treatment they may need extensive physical rehabilitation. These medical consequences, coupled with social and economic problems, often contribute to a general decline in health and well being that can result in early death.

With obstetricians, surgery and further training can be easily achieved. L. Lewis Wall, Department of OB/GYN at Wash U. in St. Louis, 9-30-06, Lancet [“Obstetric vesicovaginal fistula as an international public-health problem”, Lancet 2006; vol 368: 1201-09] In the meantime, the backlog of unrepaired fistulas continues to increase throughout these impoverished countries. Since fistulas by themselves are not fatal, the millions of women thus afflicted continue to live lives of unremitting misery, while tens of thousands more are added to their ranks every year. The basic techniques needed for fistula repair have been known for more than 150 years.3,68 Most recent advances in fistula surgery have come in the areas of improved anaesthesia, synthetic suture materials, better urinary catheters, and techniques of tissue grafting, rather than from breakthroughs in basic science. Fistulas can be repaired at minimal cost with low-technology surgical operations done under spinal anesthesia, yet even these basic surgical services are unavailable in most developing regions.3 Pilot studies have shown that the techniques needed to repair uncomplicated fistulas can be taught quickly and efficiently to doctors who already have basic surgical skills.69 There are even spectacular cases in which intelligent but uneducated individuals with good manual dexterity can be taught to become expert fistula surgeons.