Women’s Health Care in Yemen: An Incomplete Prognosis

Below is the article I wrote for the Yemen Times on women's health care in Yemen:

Women’s Health Care in Yemen: An Incomplete Prognosis
In the words of Dr. Fidaa Kayali, when it comes to improving women’s health care in Yemen, “we do not have enough to change. Change implies that you have something complete and that is not the case. Here, we need improvement, and not just improvement, but a lot of hard work. Often, there are lots of plans made, but people don’t do what they should to achieve them.” Of all the themes that could’ve been deduced from my interview with Dr. Fidaa Kayali concerning women’s health care, this statement sums up the situation most substantially.
Everything about Dr. Kayali was inviting, from her warm presence to the extreme display of Arab hospitality that greeted my presence, and my plate, for that matter. While I sensed her to be a warm and genuine individual, I was convinced when she received a phone call from a patient after the interview. The individual who called was being treated outside of the gynecological field and was seeking emotional support. When I inquired about the nature of the patient’s complaint she replied that she sometimes treats her patients in general medicine since they often feel uncomfortable seeking care elsewhere.
That same care and dedication appears to be an active part in all of Dr. Kayali undertakings, as she “tries hard to be a good wife, good mother and good doctor,” despite the strain it may put on her own health. She graduated as a General Practitioner at Aleppo University in Syria in 1987 and after specializing in gynecology, she began practicing in Yemen in 1995. Dr. Kayali has always enjoyed helping others, but with medicine she thought, “Maybe I can help people in a more complete sense.”
While the attitude and actions on the part of Dr. Kayali are inspiring, the statistics surrounding women’s health care in Yemen are frail in comparison. In the World Economic Forum’s Global Gender Gap report of 2008, which examined four major areas of inequality between men and women (health care being one of the four), Yemen received the lowest ranking out of the 130 countries examined. According to a young, educated Yemeni woman whom I will refer to as Aicha, “there is a lack of faith in the health care profession itself here in Yemen. Everyone has either had a bad experience personally or knows multiple people who have.” Several of her family members have had negative encounters with hospitals and health care professionals, finding them to be unprepared for the problems presented to them.
I addressed this issue with Dr. Kayali, explaining my impression that Yemenis don’t trust the health care system and claim mistakes are frequently made. “Is there any legitimacy to this statement?” I asked. “Well…yes,” she answered, quite matter of fact. “There are different components to a system that hold everything together and keep it in check. When you break certain laws there is a system that monitors and punishes when necessary. When you don’t have all the pieces to the puzzle, things don’t work the way they should and certain things are sacrificed. For example, when you teach a child to draw an apple, what do you do? You make points in the shape of an apple and show the child how to trace a line from one point to another. If you forget to include one of the points, then the child ends up making a shape that isn’t an apple. It’s the same here. If you don’t have all the necessary pieces, things don’t come together the way they’re supposed to.”
Greatly emphasized by Dr. Kayali was the need for simplification in women’s health care. “There are many centers, but they don’t speak or act in ways that are appropriate for all backgrounds.” According to Dr. Kayali, medical facilities in Yemen function in the same technical fashion which is not conducive to the lifestyle or level of understanding that most Yemenis posses. Also, she feels many Yemeni women don’t value themselves as highly as they should and because of this, they don’t consider entertaining basic things that would be beneficial, such as regular health care. They need someone else to confront them with the idea of their own self-worth and what it means to preserve it. In Dr. Kayali’s opinion, “this is very important and while things are better now than they used to be, people that work in the medical centers need to simplify their language and understand how to tell very simple women how to take care of themselves and how to love themselves.” She states that as a doctor, “it is my job is to deal with patients as they are, not only as I want them to be.”
As an example, Dr. Kayali referred to the use of brochures. “Brochures are given to direct patients on how to care for themselves, but they don’t always understand how or what the brochures are telling them. However, if I show a woman personally, at a level that she can relate to, how to conduct the given procedure, then she understands.”
Medical access or lack thereof, appears to be another major obstacle in women’s health care. Dr. Kayali stressed that a large portion of the population lives outside city limits and have minimal access to health care and hospitals. Often, the few hospitals that are within reasonable proximity from the villages have facilities that are severely lacking in resources including blood banks, machinery, and specialists. Additionally, women most frequently visit the doctor due to concerns surrounding pregnancy. While there are some midwives available in the villages for this purpose, these women usually do not have sufficient training in their field and fall short on the treatment they provide.
Yet another component to this struggling system is the nonexistence of preventative care. Aicha recognizes that, “people who live in Yemen are accustomed to treating whatever symptoms they have on their own, whether it’s a cold or something more serious. When Yemenis do visit the doctor, it is because they are already sick; there is no real preventative care. This is the mentality surrounding health care in Yemen.”
Dr. Kayali herself lists preventive health care as one of the more significant challenges in her field, citing pregnancy follow-up, especially for women in the third trimester, as a major issue. “Problems can develop quickly with pregnancy and if women aren’t getting regular check ups, they don’t catch problems that could be serious, such as hypertension and diabetes. There are also many issues that present themselves with home births.” In fact, the NWC report produced by the United Nations states that 40 out of 100 live births occur in health facilities in urban areas and the numbers drop to 17 out of 100 in rural areas. “We receive many cases of women facing problems during pregnancy and we are late in the diagnoses because they wait so long to be seen. If they think things aren’t urgent, women postpone seeing a doctor and the costs are greater.” She also made mention of the importance of communicating any potential problems to the husband as it is not always the choice of the woman where and under what circumstances she will give birth.
Médecins Du Monde maintains that Yemeni women have an average of 6.7 children and 360 women per 100,000 die each year due to complications with childbirth. Furthermore, 75 children per 10,000 die before they reach one year of age. In the poorest country in the Arabian Peninsula where 80% of the inhabitants reside in rural areas, poverty is a constant threat to the population. Regardless of legislation promising relief to the poor citizens of Yemen, patients are still held responsible for 75% of costs. As a result, medical attention is out of reach for the majority of the population. Both Aicha and Dr. Kayali introduced the population’s financial situation as a relevant barrier. Most people simply do not possess the monetary means to visit to the doctor on a regular basis.
Despite this, many that can afford to see the doctor have not been educated on the importance of doing so. Dr. Kayali mentioned that many educated women do come to the doctor on a regular basis, but uneducated women only come when they have a complaint. She feels it is the doctor’s duty to explain the importance of regular check ups on the rare occasion that this sector of the population does come to be seen. However, in an environment that does not encourage nor is conducive to women’s health care, one has to wonder how effective these efforts actually are.
Other factors limiting health care include ongoing problems concerning lack of electricity, a deficiency in clean water, proper sanitation and the limited amount of qualified specialists. These problems can at least partially be attributed to recent cuts in the budget for the Ministry of Health, decreasing from 5.1% in 1998 to 3.5% in 2002. During the interview, Aicha mentioned that “there are a lack of clean facilities at hospitals and clinics in Yemen.” She felt the issue to be of such significance, that when asked what she would change in regards to women’s health care, she suggested, “to create and maintain a system of health standards and regulations for all hospitals and medical facilities,” in order to ensure a clean medical environment and to guarantee that doctors follow accurate protocol for procedures.
When it comes to improving the current system, Dr. Kayali highlights the need to develop a solid plan. “We need to have medical centers readily available to all people in all areas then we should instill the idea of a proper health care mentality through education starting with youth. It is essential that this is done in this order because we can’t teach everyone about health care then not have the means to give it to them.”
In terms of health education, Dr. Kayali recommends that this be implemented simply, in a way that the Yemeni people can identify with. “We should start in schools and with women at home and provide education in the mosques. I don’t care where it’s done, I just care that this information reaches the people, be it through television, radio, newspaper or some other means.”
She also suggests that Yemen enforce one to two years of mandatory work in the villages which doctors would be required to fulfill during their residency period before being given permission to work in the cities. Since the majority of doctors prefer to work in the city, rural areas where there is a much higher demand for medical personnel, are neglected.

Internship with Sister's Arab Forum

Below are some of the goals to I wish to accomplish while I'm abroad:

1.) Experience as much of the culture and conflict from as many angles as possible
2.) Drastically improve my Arabic (inshallah! as they say here or "by God's will")
3.) Gain experience working in the field of human rights through research, publication, and direct contact

I'm trying my best to achieve these goals and others in the time given to me. I'm busier than I've been since college, and older, so I'm starting to feel it. But since I've developed a pattern of pushing myself to the max then adding something else to my plate, I figure, why diverge now? Thus, this week I will be starting an internship with Sister's Arab Forum, a non governmental organization that focuses on promoting intellectual, cultural, social, political and legal rights with the full participation of women with the aim of establishing gender equality. They seem to have a strong hand in various areas of human rights. For instance, two projects I will be working on will include researching and investigating involuntary disappearances (where citizens simply go missing without explanation as a result of being taken by the Yemeni government) and refugee profile documentation, especially for children, as a result of the war in Sada, Yemen.
In addition to being a strong organization with a reputable name, hardly anyone there speaks any English so I'm hoping this will also be an opportunity to improve both my spoken and written Arabic language skills. I will provide more information on the experience after I officially begin.

Interview with Dr. Kayali on Women's Health Care in Yemen

Below is the interview I conducted with Dr. Kayali on women's health care in Yemen. As with before, it's minimally edited for clarification. I've also added an astrix followed by writing in parentheses to express any personal thoughts or clarifications. A good deal of this will be put into the article I'm writing for Yemen Today. Here it is:

Can you spell your name?
Fidaa Kayali

What is your title?
Doctor of Gynecology

Personal Questions:

Where did you receive your education?
"I Graduated as a General Practitioner (Doctor of Medicine) in Aleppo, Syria at Aleppo University in 1987."
"After becoming a doctor I worked as a General Practitioner in Yemen, then came back to Syria to specialize in gynecology and returned to Yemen in 1995 and have been practicing gynecology here ever since."
She says she enjoys having a stable practice and lifestyle here in Yemen.

What motivated you to choose this career path?
"I’ve liked helping people since I was a child. With medicine I thought “maybe I can help people in a more complete sense” *(meaning healing with the whole person in mind including the emotional, physical, and spiritual). I’m a good listener and people feel they can trust me. Without trust from the patient, the patient will not improve. For example, when I prescribe a medication, regardless of the patient’s level of education, I describe as accurately as I can for that individual how to take the given medication and why, as well as side effects or anything else they might experience so that they are educated enough to take the prescription correctly. By making sure they understand what I’m telling them and by being thorough in my details they trust that I’m giving them accurate information."

What do you like and dislike about your job?
"It’s sometimes difficult to have a balance between my work life and my family so while this isn’t something I dislike about my career, it also isn’t an easy challenge. I try hard to be a good wife, good mother and good doctor. While my family thinks I do a good job with this, it’s hard on me and sometimes on my own health because I’m trying my best with everything."

Health Related Questions:

1.) How do you feel about women’s health care in Yemen in general?
"Health care in Yemen needs to be more simplified for people. There are many centers, but they don’t give the good way and good language to help women from all backgrounds (highly educated to no education) so there should be the good language for every level." * (When Dr. Kayali says “the good way” or the “good language,” what she means is that every medical facility functions in the same technical way and it is not conducive to the lifestyle or level of understanding that most Yemenis possess).
"Also, many Yemeni women don’t value themselves in the way that they should and because of this, they don’t consider entertaining basic things that would benefit them, such as regular health care. They need someone else to confront them with the idea of their own self worth and what it means to preserve it. This is very, very important and while it’s better now than how it use to be, people that work in the medical centers should use more simplistic language and know how to tell very simple women how to take care of themselves and how to love themselves. Many ladies her do not feel that they are important so they do not take care of themselves. Many pregnant women deliver at home and many women do not go regularly to the doctor during pregnancy. I should tell them (as a doctor) when to come back and why it’s important…as a doctor, my job is to deal with patients as they are, not only as I want them to be because they are not educated, and this is not their fault. I want to help Yemen, many people here are uneducated therefore, while I should do something to benefit these people, it should be in my own way, through a great deal of simple advice and communication.”
"For example: Brochures are given to direct patients on how to care for themselves *(under various subjects, such as self breast exams for example), but they don’t always understand. However, if I show a woman personally, at a level that she can relate to, how to conduct one of the procedures given in the brochure, then they understand."
"In the Quran in Islam there are many places that talk about proper hygiene and health care. Essentially, it says you should take good care of yourself. Therefore, sometimes using this mentality helps get the point across. In Islam it is your duty to take care of yourself (health care, etc.) - even in health care, we use the expression “tewaqal,” which means “do all you can first, then ask for God’s help.” “I try to remind them (her patients) of this: when I ask God to help me, I should first do what God wants.”

2.) What do you feel the biggest challenges facing women’s health care are currently?

"We receive many cases of women facing problems during pregnancy and we are late in the diagnoses because they wait so long to be seen. If they think things aren’t urgent, women postpone seeing a doctor and the costs are greater."
"Another issue is that if a women’s husband travels, she will often wait for her husband to return home as she needs someone to take her to the hospital; another problem that postpones diagnosis."
Dr. Kayali sees this as a big problem. "Not everyone lives in the cities and those outside of city limits have minimal access to health care and hospitals. They have some midwifes in the villages for pregnancy cases, but these women usually do not have sufficient training in their field. Often, with hospitals near the villages, what facilities they do have are severely lacking in resources (blood banks, technology, specialists, etc). Not everything is the fault of education *(she uses the word “facilities” as oppose to “government”) and sometimes indirect messages are better."

3.) How do you think the challenges you mentioned can be addressed?
"We need to start to make a plan. We need to have medical centers readily available to all people in all areas then we should instill the idea of a proper health care mentality through education starting with youth. We must do it in this order because we can’t teach everyone about health care then not have the means to give it to them."

4.) Do you think that the lack of thorough health care can be, at least partially, blamed on regulations mandated by Islam; can Islam and quality health care for women co-exist?
"No, if regulations are placed on health care through Islam, it is because those enforcing the regulations are interpreting Islam incorrectly." According to Dr. Kayali Islam says:
A.) We are responsible for ourselves, our health, what we eat, and how we clean ourselves. Allah always says he loves every human being and has given us the ability to work with our minds. We should use this gift to our highest advantage.
B.) In the Quran, scientists are given the highest place in paradise because they make the best use of their mind, so why would God ask us to make sure we use of our minds to the highest ability and then punish us for it?
C.) Also, it is written that for every disease there is a medicine, as was said by the prophet Mohammad, therefore people must work to find the treatment for whatever disease exists.

5.) How do normal women feel about coming to the doctor, especially the gynecologist?
"Educated people come regularly, but uneducated women only come when they have a complaint so it is the duty of doctors to explain the importance of regular check ups. Poor people do not have the money to come regularly, though they are more likely to come during pregnancy, if they come at all."
"When it comes to their bodies, women can be very shy, especially for their first visit, but this is not a big reason for women not to come. This is not “haram” in Islam. *(In Islam, “haram” means not good or against religious beliefs) Some women do think that showing their whole body is not “allowed” in Islam, but when I am gentle and patient with them and when I explain to them that this isn’t the case, they have no problem continuing with the exam."

6.) What is something you would change about the health care system for women in Yemen if you could?
"We do not have enough to change, change implies that you have something complete and that is not the case. Here we need improvement and not just improvement, but a lot of hard work. Often, there are lots of plans made, but people don’t do what they should to achieve them; this very important to note."
"We should improve all emergency centers (for women, children, everyone and everything), this is very important. Anyone, you, me, and anyone reading this, if they have emergency and they’re in Yemen, they should go around and look at the actual facilities available. There are enough ERs, but not enough facilities in these ERs. There are many new hospitals, but ERs are still not working efficiently, sometimes they lack the appropriate number of beds, staff, facilities, etc. Emergency Centers are needed by everyone everywhere, so this is a very critical development that needs to occur."
"I also hope they start to enforce (in Yemen) one or two years of mandatory work in the villages (like a residency) as a doctor before they can work in the cities because all doctors want to work in the city. This is a requirement in Syria and it would be beneficial to have it applied here."
"Additionally, if we could successfully mix science and Islam we could do a lot of good for society because I believe when you want to communicate with people you communicate with someone in a way that’s suitable for them. When we have the correct Islamic mentality, there’s room for a lot of improvement. I believe that everything that comes from God is here to help us."

7.) What role do you think education plays in this struggle?
"Start education (regarding health care) simply. Start in schools and with women at home. Give education in the mosques. I don’t care where, I care that this information reaches the people (through television, radio, newspaper, etc., the best method depends on the area where the people you’re targeting live)."

8.) Do you think women are properly educated about health care, their bodies and the options available to them?
"No. Education should be started in schools in a way that’s suitable for the country (sex education in US for example could be used as a guideline, but it must be applied differently so that it's tailored for Yemen).
It’s important to mix Islam with science, because currently we only have Islam."

9.) Every year, more and more women are becoming doctors in Yemen, why do you think this is? What do you think this will mean for health care in Yemen?
"This will ultimately improve health care because these women understand both Yemen and health care and know how to communicate with the local population and the women here (their mothers, sisters, etc.)."

10.) Many Yemenis don’t trust the health care system and say many mistakes are frequently made. Is there legitimacy to this in your opinion?
"Well, yes. There are different components to a system that hold everything together and keep it in check. When you break certain laws there is a system that monitors and punishes when necessary. When you don’t have all the pieces to the puzzle, things don’t work the way they should and certain things are sacrificed. For example, when you teach a child to draw an apple, what do you do? You make points in the shape of an apple and you show the child how to trace a line from one point to another. If you forget to include one of the points, then the child ends up making a shape that isn’t an apple. It’s the same here. If you don’t have all the necessary pieces, things don’t come together the way they should."

Dr. Kayali's Home

If you've been keeping up with my posts, then you know I'm writing an article on women's health care in Yemen and that I recently conducted an interview with a female gynecologist in Sana'a. For those of you who haven't been on the edge of your seat awaiting my next entry, consider yourselves officially informed.
Dr. Kayali, originally from Syria, has been practicing and living in Yemen with her husband and children for around fifteen years now. She was kind enough to invite me over to her home in Sana'a last week to be interviewed. Despite my very distant relationship with Arab culture growing up, I see similarities in random places. I always connected the extreme warmth my mother (born and raised in Louisiana, but of Syrian descent) showed guests was a southern trait and from what I know from my experiences down south, it is. However, Arab hospitality surpasses even that of the south and I have to wonder if for my mother, her influence wasn't a combination of the two.
I probably gained fifteen pounds during the three hours I spent at Dr. Kayali's home for an interview that could have been wrapped up in one third of the time; though I thoroughly enjoyed every minute of it. Between the tea with mint, coffee, juice, and grand assortment of Syrian baklava, candied almonds, and chocolates that were consistently being refurbished on my plate, I had enough sugar to last me the rest of the month. Dr. Kayali seems to be a warm and genuine individual. I was particularly convinced of this when she received a phone call from one of her patients after the interview on her personal phone. Apparently, the woman who called is being treated for an ailment outside of gynecology, but Dr.Kayali says she sometimes treats her patients in general medicine since they often feel uncomfortable going elsewhere. As it turns out, the woman on the phone was calling for moral support in anticipation of a possible surgery.
On a professional level, Dr. Kayali shared some insightful comments on women's health care. While her English is very good and while she is a very intelligent women, there were times where she had difficulty expressing her precise thoughts. This posed little problem as I only needed to ask her to clarify what she meant, and though it may not have been presented in the most graceful language, she was always able to clearly get her point across. I've edited the interview (minimally, just for more clarity) and will post it next for those interested in hearing her thoughts.
At the end of the interview Dr. Kayali and I continued to talk for almost an hour further. She expressed some additional insights in regards to health care in Yemen that I wish I had been more prepared to take down (since they came after the interview had ended) so I had to rush home and jot them down later.
I ended up meeting her husband and daughter and received an invitation to join for a traditional Syrian dinner during January when her son will be home which I eagerly accepted. She was especially pleased when I told her at the end of the interview that my mother is of Syrian descent. After which she told me that she would love to have me to her home in Syria as they still have most of their family there. She urged that if I end up going to let her know so she could have her family assist me if she, herself, would not be there. When I finally left, she was insistent that I be driven home instead of having to pay for a taxi.
Dr. Kayali and her family were incredibly kind to me while I was in their home, but people in Yemen and in the Middle East in general tend to be this way. I didn't experience any kind of culture shock when I came to the Middle East, but I can't help but wonder if I might not experience one when I return home, where people tend to look at you like you have a problem when you say hello for no reason in particular.

Family

I'm not sure how in depth I've talked about the students and employees here at the Yemen College for Middle Eastern Studies, but I assure you, we are an eclectic bunch. The students range from ages 18 to 78, though most are in their mid to late 20s and come from various locations around the world. Canada, England, America, Germany, Australia, Tanzania, China, and Sudan are some of the locations we represent as a whole.
I have made some wonderful friends in my short time here and I've noticed that when people travel together they tend to get closer to each other at a faster pace than if they were interacting in their own country. The specific kind of closeness developed between people is somehow different as well, though I'm at a loss for adjectives. This group especially has gotten close, fast. We live, study, work, eat and travel together so it's almost unavoidable.
We come from different countries, backgrounds and belief systems. Character wise we all have similar interests and there are commonalities, but on most levels we couldn't be more different from each other. Some of these people I love, most I enjoy, and some I have to remind myself to have patience with, but regardless, we are family.
That is the attitude and feeling I have being with everyone here. If we all attended the same school in our country of origin, I doubt more that a few of us would have been friends with the other, not that there's anything wrong anyone of us, we're just so different in so many ways. Being together in this kind of a situation forces you to see the person for who they are, realize that they are both exceptional and flawed in their own ways, and except them for whatever those may be.
It seems that everyone here takes care of each other. The closest scenario to this that I can recall was playing premier soccer when I was younger. It sounds silly, but hear me out. It was a highly competitive team so there were girls coming from all over the state, sometimes driving over an hour just to get to practice, not to mention hours on end traveling to games and tournaments every weekend. These girls came from different towns, schools, and income levels and all of us where more different than we were alike. We didn't always get along, but no matter what happened we supported each other. We were a team, a family if you will, brought together over this one common interest.
I never thought I would have that feeling with a group of people again as it's a rare thing to come by. I only hope that it can be maintained as people here are constantly coming and going from one term to the next. It will be interesting to see how relationships evolve over the next 5 months. Either way, it's nice to have this place as an escape from the intensities that decorate daily life here in Yemen.

Interview on Women's Healthcare with Aicha

Here's the interview I spoke of in the post "Yemen Today" with Aicha, a twenty-three year old educated Yemeni woman, on the topic of women's health care. The information written that has an Astrix before it just means that its information I added after interview that I thought might be relevant to address in the article itself:

Interview on Women's Health Care
Date: November 8, 2009
Interviewee: Anonymous (will refer to her as Aicha)
Interviewer: Danielle Giacchetti
Occupation: Accountant
Age: 23, Gender: Female, Nationality: Yemeni

1.) How do you feel about women’s health care in Yemen generally speaking?
-"It could use improvement."
     Both her mother and sister have had bad experiences with hospitals and health care professionals, finding them unprepared for the situations in which their expertise was needed.
     Example: Aicha told the story of her sister who became pregnant, but when the baby died unexpectedly, she had to have a surgical procedure to remove the stillborn. This is a basic and not uncommon medical procedure requiring the use of an anesthetic. Aicha’s sister was given a form of anesthesia without it being tested on her prior to her exposure at the hospital and ended up having an allergic reaction which put her in a coma for almost 24 hours.
*In the US, both diagnostic testing and a pre-anesthesia interview must often be completed before a person enters surgery

2.) What do you feel are currently the biggest challenges facing women’s health care?
-"There are a lack of clean facilities at hospitals and clinics in Yemen."
-"The environment in Yemen does not encourage nor is it conducive to women’s health care."
-"People’s financial situation."
-"Lack of time due to devotion to family and other duties."
-"Lack of faith in the health care profession itself: everyone has had a bad experience themselves or knows multiple people who have."

3.) How do people in Yemen cope with health care problems if citizens rarely visit the doctor?
- "People who live in Yemen are accustomed to treating whatever symptoms they have on their own, whether it’s a cold or something more serious. In addition, when Yemenis do visit the doctor, it is because they are already sick, there is no real preventative care. This is the mentality surrounding health care in Yemen."
     Example: Aicha is a twenty-three year old woman who has never seen a gynecologist.
*In the US, when a girl turns 18 or before then if she is sexually active, it is highly recommended she go the gynecologist to get a pap smear. It is required to see a gynecologist if she wants to be put on birth control. This practice is the norm amongst the majority of women in the States (I need to look up exact statistics for US and Europe).

4.) How do most Yemeni women feel about going to the doctor, especially the gynecologist?
-"Women (and the population in general) do not believe in going to the doctor here."
     Aicha believes is one of the biggest reasons why people don’t go.
-"Body image and comfort around doctors may at times be a factor in women neglecting their health, but this is not a significant issue. Most women who are shy about being examined and treated by a doctor also become much more comfortable with the process after pregnancy and childbirth."
-"The reasons that most women don’t seek health care when they should are more frequently rooted in social and cultural influences or mentalities."
     Additionally, Aicha notes that women become careless about themselves in Yemeni society due to their overwhelming responsibilities to their home and family and because of their financial circumstances. A lack of money and time, therefore, are also significant obstacles for women’s health. However, Aicha feels the mentality of the people towards health care and their lack of trust in the medical field comes before factors of time and money.
-"Health care in Yemen is not a priority. It is not a part of the culture and preventative health care is not recognized here."

5.) Do you think that the lack of thorough health care can be, at least partially, blamed on regulations mandated by Islam? Can Islam and quality health care for women co-exist?
     Aicha doesn’t feel that the practice of Islam is the problem as Islam and proper medical care don’t conflict. The reasons stated above (question #4) are the contributing factors to the lack of health care for women.

6.) What role do you think education plays in this struggle and do you think women are properly educated about health care, their bodies and the options available to them?
-"Education plays a big role as Yemeni’s are not taught about the importance of regular health care."
     As Aicha has stated previously, it is simply not a part of the culture here.
*Children are not given sex education as in the US, for instance, where most boys and girls are taught about their bodies and how they will be changing over the coming years. Also, the importance of yearly doctor visits or preventive health care is not addressed.
-"As far as women are concerned, they are aware of the options available to them only in regards to pregnancy."

7.) What is something you would change about the health care system for women in Yemen if you could?
-"I would make two main changes. I would enforce the idea of a proper health care system in schools, (such as) things like yearly check-ups, etc."
*In order to start institutionalizing the idea of health care to change the mentality of the people
-"Second, I would create and maintain a system of health standards and regulations for all hospitals and medical facilities."
*To ensure a clean medical environment and to guarantee that doctors follow accurate protocol for procedures.

8.) Is there anything else you would like to say in regards to this topic that you think is worth mentioning?
-"Women in Yemen are very patient so they endure pain, especially with the financial situation being what it is."

Tourism Article on Buker

Buker, a historical village not far from Zakatin and Kowkaban, is nestled within the rocky cliffs of the hills that constitute the area. While the hike to Buker from the roadside is only a little over a mile in distance, the trek itself may pose quite the challenge, though the pay off is well worth the effort. The trail is rugged and switches from a steep uphill climb to a sharp descent while the shifting rocks beneath your feet force you to keep your balance and attention focused on each individual step. However, the children belonging to the village just before Buker have no problem gliding up and down each crevasse at a speed that is nothing less than impressive.
You’ll find the site located a little less than 50 kilometers west of Sana’a with an altitude well over 3000 meters. According to the Yemeni’s at the site, many Imams lived out there lives here, making the area historically significant to the Yemeni population. Unfortunately, much of Buker was destroyed in the midst of civil war in the 1970s. Due to Buker’s remote location, if you intend to visit, be sure to find lodging in one of the neighboring villages, Kowkaban being one of the more popular choices for accommodation.
A unique feature of this location is the buildings constructed into the sides of the mountain. Once you reach your destination, which also protrudes from the mountainside, other surrounding structures become more visible. While I personally enjoyed the ambiance and architecture of these ruins, what I found truly impressive was the view and scenery. Weaving through the old homes to the left of Buker, there is a cliff that overlooks every direction for miles on end. Neighboring homes below, surrounding mountainsides, and green valleys jumped out from the landscape as I greedily struggled to take it all in at once.
I recommend eating a late breakfast, packing a lunch and beginning the hike around 1pm. By the time you get there, eat lunch and explore, it will be approaching late afternoon, giving you enough time to get back before it gets too dark, but enabling you to view the clouds moving in over the area. This was my favorite part of the trip. As I stood over the edge, overwhelmed by what my eyes were taking in, the nearby cloud cover swiftly moved over me. I was literally standing in a cloud, getting glimpses of the region as the midst drifted in and out.
For those interested in history, architecture, and nature and for those who don’t mind roughing it up a little in the process, this is a mystical experience I would not let pass by.

Tourism Article on Zakatin

When planning a vacation filled with outdoor adventures, ancient architecture, and beautiful beaches, Yemen is rarely a country that comes to mind for the average traveler. Truth be told, Yemen is thriving with unknown history and unique locations, so much so that it’s easy to pass right through a worthy tourist site without even recognizing it. This is exactly the scenario that would have unfolded on my way to Zakatin had I not been in the company of the local population.
My van crept its way around the winding mountain roads that decorate this region of Yemen (Zakatin is around 50 kilometers west of Sana’a) and came to a halt at the side of the freeway without any indication that we had arrived. I followed my guide across the freeway we had just veered from as a line of children, who seemed to emerge from the rocky landscape itself, trailed behind. Approaching the opposite side of the road, it became obvious what the mountain side had been hiding. To my left, an ancient town rising from the inside of the bluff stared back at me and I was embarrassed for not noticing the heftiness of village fortress beforehand. To the right, I found a trial leading down, up and through various ancient buildings, providing a brilliant view of Zakatin itself, not to mention to countryside below.
This architecture was not lacking in its size or design, but due to the color and texture of the stone, wood and dirt used to construct the village, it seemed to blend in with the rest of the surroundings. Making my way from left to right, I climbed up a lengthy staircase in order to reach the inside of Zakatin. I was taken aback by the simple beauty of the old doors, brick rooms, and darkened crevasses that composed the homes and buildings of this once flourishing town. Currently, it is only inhabited by a handful of families.
I continued further upward and the more I climbed, the more aware I became of Zakatin’s position, resting 3000 meters above sea level. The altitude was prevalent, but proved to be a fair exchange for the view at the top. Mountains, valleys, and distant towns were some of the spectacles to be observed and all the while, children scattered the rooftops playing games of chase with metal rods and wheels. When I visited there were no other tourists and the isolated atmosphere added to the authenticity of the experience.
While this location is worth a visit, the town won’t take too long to explore once you’re there; maybe an hour or so. You may want to check out Buker, Kowkaban, Shebam, Hababah, Tawila, Chuba, or Jebel Honum, as all are close by. Zakatin is somewhat isolated and if you plan on spending the night in the area, it’s recommended to head off to one of the neighboring locations just mentioned in order to find adequate accommodation.

Yemen Today

I think I've mentioned before that I've started writing articles for Yemen Today magazine. It's not the most prestigious publication, but one of the best I've seen in Yemen. This month I've written articles on Zakatin and Buker, two tourist sites, for the a section they've decided to dedicate strictly to destinations worth visiting in Yemen. Unfortunately, there is little to no information available on either of these places online or in the few tourist books I own, so my articles really focused more on my experience than on factual information. I've included both in the following posts in case you wanted to read about them. I'll also post some of the pictures I took at the cites so keep a look out.
In addition to tourism I also decided to write about women's health care or lack there of, in Yemen. I've had to delay the publishing date because both female gynecologists I set up appointments with bailed on me at the last second or in the interview itself. Who'd have thought health care would be such a touchy subject? However, I've scheduled an interview this week with yet another female gynecologist so hopefully this one will pull through.
As soon as I finish the article on health care I'll post it online. In the mean time, I've interviewed a local Yemeni woman about her views in this area to get a feel for how Yemeni women feel towards this subject. The woman I interviewed is 23, well educated, fluent in English and wished to be left anonymous, so I'll refer to her as Aicha. Some of her testimony will be included in the article, but if you'd like to see what she had to say on a grander scale, I'm also posting her interview after the two tourism articles.

Running Joke

Every weekend I plan a day trip to a tourist destination in Yemen for the students to visit. It’s always nice to get away from the city for the day and the drive is usually entertaining since we’re all piled into the same bus. Where ever we go we’re generally a spectacle, but for whatever reason (probably because my hair refuses to stay brown, it keeps fading back to blond even though I’ve died it twice), I seem to draw the most attention. One of the students commented on this unfortunate phenomenon and asked if anyone had offered a price for me. I'd like to say he was joking, but unfortunately, that's a reality here. I told him only in Egypt, where a man had offered my male friend 300 camels in exchange for me.
The students, of course, loved this despite the obvious element of insult behind it. When we arrived at the town we were visiting that day, low and behold, what would happen, but for the local population to start a bidding war over yours truly. Impeccable timing. One man offered 700 camels, then the next went to 900, until reaching the final bid of 1500 camels. Apparently, I should be flattered by the grandeur of this bid, but please forgive me for not fainting with excitement. The male students thought this was hysterical and at one point I told Nate, a friend of mine, that if I saw him accept any camels from any one of the men here, they'd all be up shits creek without a paddle.
The incident has now become a running joke amongst everyone here. Whenever we're short on cash it never fails that someone will suggest offering my had in marriage. The boys especially love telling the story to the local Yemeni's here who, thankfully, don't equate my self worth with camels and therefore, can see the humor in the situation.