Our remedies oft in ourselves do lie

I sometimes wonder if in another life I was actually a woman –perhaps in one of those what-if lands that we whisper to our children as they are nodding off to sleep. A place where roles are not so much reversed as fluid –changing as necessary, dissolving when needed. Not a perfect place –even a child expects some inequalities, some inevitable disputes- but a place where things even out in the end. Where disagreements are resolved, and fairness, like dust motes in a sunny room, coats even the darkest corners if you decide to look.

And why a woman? In this heavily gendered world, why would I espouse the mysterious side –the other side- when, for now at least, I find myself in an advantaged role? Why, if I have never entertained the idea in any but an intellectual sense, with no real desire to change my here-and-now, nor any wish to partake of other than a thought-experiment, would I think that in a once-upon-a-time story, I might have been what I am not?

I suppose, in part, it is because of the inequities to which many of us with a Y chromosome have so successfully adapted -swept under the carpet in our attempts to fashion the world in our own image. Like the sound of traffic that becomes barely noticeable to city dwellers, we have become myopic to all that isn’t immediately relevant to our own vicinity -our Lebenswelt. And it just seems so unfair.

I don’t want to sound too naïve in my jeremiad, too Pollyannoid in my expectations, but I do expect actions to be judged by what they achieve, not by who performs them. I do not expect a litany of excuses, or worse, a denial that excuses are even necessary.  As a recently retired obstetrician/gynaecologist, perhaps I am overly attuned to the denizens of my former world, but I find myself disheartened by examples of their contributions being overlooked, or at least undervalued. An article that I came across one day, outlined some of the problems: https://theconversation.com/womens-ngos-are-changing-the-world-and-not-getting-credit-for-it-88360

It discusses the role of non-governmental organizations (NGOs) in various countries –although this article specifically examines women’s NGOs and their work in India and Tanzania. ‘NGOs work with governments, community groups and the private sector — to develop and implement programs, monitor and evaluate their progress and help train people working on those projects.’ It would seem that these ‘[…]women’s NGOs played crucial roles in development projects, often mobilizing, organizing and building projects that otherwise would never have launched.’

In India, for example, ‘Women’s NGOs also conducted research to determine whether local communities could afford to pay for basic urban services. They negotiated subsidies, fair pricing and flexible terms of payment with utilities on behalf of marginalized people. They arranged access to loans from micro-finance institutions for households that could not cover the cost of water or electricity connections. And by insisting that water and electricity bills be issued in the names of female heads of households, women’s NGOs strengthened women’s access to property and housing.

‘The NGOs also educated stakeholders about the realities of life for the urban poor, and shared lessons learned in one urban area with NGOs in other cities in India.’

But, the success of their interventions often led to the marginalization of the NGO’s role in whatever successes they’d achieved. ‘[…] women’s NGOs had made vital contributions to the success of development projects, but they were easily marginalized and trivialized once those projects got off the ground. In India, after the success of the pilot projects, the other partners declared that they would “go it alone” and no longer involve the NGO partner in delivering basic urban services.’ Of course, the idea is to encourage self-sufficiency so the NGO can back away, but in many situations, their contributions, as women, were minimized in favour of the usual power brokers. ‘Although the contributions made by the women’s NGOs were critical to the existence and success of the initiatives, they were often dismissed as supplementary and dispensable by the other partners. Because the NGOs’ role of organizing, mobilizing and helping local communities participate in development initiatives was seen as a “natural” extension of women’s care-giving work, it was easy for other partners to diminish and dismiss their contributions. And because the other partners did not fully appreciate the contributions of the women’s NGOs, they were unwilling to share credit for the success of the project.’

The authors -Dr. Bipasha Baruah, Professor & Canada Research Chair in Global Women’s Issues, Western University and Dr. Kate Grantham Research Associate, International Development, McGill University- suggest  some strategies ‘to strengthen and validate the role of women’s NGOs in development partnership projects: A memorandum of understanding (MOU) that defines the specific roles and responsibilities of each partner should be an essential requirement for multiple-stakeholder projects. The lack of such formal agreements entrenches the perception that the role NGOs play is not particularly valuable.’

Call me naïve, but it is dismaying, to say the least, that such formalities are required to validate a helping hand -almost like requiring a contract be drawn up before helping someone cross a busy street.

And yet, as the authors point out, ‘It’s unfortunate they must “justify” their long-term involvement in such initiatives, but it may be incumbent upon them to make their contributions to the project more visible to the different partners and to the development community at large.’ And perhaps more especially, ‘[…] the specific challenges and opportunities that NGOs working on gender equality, or those that define themselves as feminist NGOs or women’s NGOs, face — when participating in multiple-stakeholder projects.’

Okay I understand, I guess. Let’s see… Outside agencies have to help women help each other, because otherwise the communities will forget who helped them. No, that can’t be right… Okay then, outside agencies have to publicize the fact that women are able to help… Uhmm, no? Well then, how about the agencies claim credit for facilitating the things that women have been doing for millennia…

I’m clearly getting old and cloistered in my years. Many of those things I had once assumed were self-evident, I now find were merely wide-eyed hopes -inexperienced beliefs, as devoid of truth as the fairy-tales I told my children. I have obviously not tasted all that I am supposed to sample despite my age –and yet, I still believe that help knows no gender. Goodness is not biased, nor is succour credited only to those crowding around and pointing at themselves when the patient is finally ready to be discharged.

But, perhaps I read too much poetry, too much Kahlil Gibran, when I was young; perhaps you cannot believe poetry; perhaps it is simply not enough –even if it speaks truth to power:
‘there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; they give as in yonder valley the myrtle breathes its fragrance into space. Through the hands of such as these God speaks, and from behind their eyes He smiles upon the earth.’













The Feminist Egg

Once upon a time, I suppose that one of the characteristics of Age was its hubris. After a certain age, it was easy to dismiss most new things as mere variations on time-tested themes –additions, clever perhaps, intriguing even, but still accretions. Ecclesiastes lived in old minds: The thing that hath been, it is that which shall be; and that which is done is that which shall be done: and there is no new thing under the sun. And yet nowadays, even the quickest peek over the shoulder calls that into question. Maybe it always did, but without the publicity it now entertains.

New things –truly new things- are often the hardest to accept, especially if they fly in the  face of cherished beliefs sufficiently entrenched as to be regarded as not merely true, but obviously true -common sense, in fact. It took generations to accept evolution –and now it seems only sensible that the random acquisition of those traits that help survival will be the ones selected for in the next generation. It was not an upwardly purposeful spiral that inevitably led to homo sapiens; evolution doesn’t change cows to humans –it just eventually creates cows better able to survive in whatever milieu they find themselves. And randomly –the unfit are still granted existence, but if they are not suited, they pass on little benefit to their progeny.

It’s true that animals –mammals, especially- do attempt to influence desirable traits in their offspring by choosing healthy partners exhibiting those characteristics. Hence various mating rituals and dominance contests amongst the males; hence elaborate male bird plumage, presumably a proxy, recognizable by a receptive female, as indicative of a primus inter pares. And yet it was probably regarded as curious in premodern societies that a female would be accorded any important choice, let alone that of selecting what she wanted in a partner. Although there has always been a cadre of women who have made their marks throughout recorded history, the examples are sadly limited –curtailed no doubt, because it was usually men writing about what they felt was important to document.

Fortunately, times are changing, as is the realization that each side of the gender divide is equipotent. Just how fluid the roles are is a constant source of wonder to me. Even in these days of Darwin, I am amazed at the still unsuspected porosity of the envelope. And while it no longer seems unusual or unlikely that an information-processing organism like, say, a bird might be able to select an appropriately endowed mate based on observable clues, it is still surprising –to me, at least- that selection duties might be conferred on a more microscopic scale: on an egg, for example.

I first encountered this idea in an article from Quanta Magazine: https://www.quantamagazine.org/choosy-eggs-may-pick-sperm-for-their-genes-defying-mendels-law-20171115/  I have to say it reminded me of Hamlet’s rejoinder to the sceptical Horatio on seeing Hamlet’s father’s ghost: ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.’

The competition in sexual selection was thought to be pre-copulatory –‘After mating, the female had made her choice, and the only competition was among the sperm swimming to the egg. This male-oriented view of female reproductive biology as largely acquiescent was pervasive, argued Emily Martin, an anthropologist at New York University, in a 1991 paper. “The egg is seen as large and passive. It does not move or journey but passively ‘is transported’…along the fallopian tube. In utter contrast, sperm are small, ‘streamlined’ and invariably active,” she wrote.

‘Beginning in the 1970s, however, the science began to undermine that stereotype. William Eberhard, now a behavioural ecologist at the Smithsonian Tropical Research Institute, documented all the ways that females can affect which males fertilize their eggs even after mating.’ For example, ‘Internal fertilizers have their own methods of what Eberhard dubbed “cryptic female choice.” Some female reproductive tracts are labyrinthine, complete with false starts and dead ends that can stymie all but the strongest sperm. Some females, including many species of reptiles, fish, birds and amphibians, that copulate with more than one male (which biologists estimate are a vast majority of species) can store sperm for months, even years, altering the storage environment to stack the odds to favor one male over another. Many female birds, including domestic chickens, can eject sperm after mating , which lets them bias fertilization in favor of the best male.’

The plot thickens. These strategies seem only to select whose sperm to allow access to the precious as-yet unfertilized eggs. But even sperm from the same individual can vary. So, are things just left to chance? Are we still talking Darwin here? And are the combination probabilities proposed by Mendel that depend on randomness still in the picture?

It would seem that the egg itself may have a say in which sperm it uses, and that unlike the voting system in many democracies, it may not be just the ‘first past the post’ -the marathon winner- who gets the prize.

The article presents several theories as to how the egg may be able to ‘choose’, but as yet there seems to be no clear indication as to whether it always happens, or whether it is just able to weed out some potentially damaging or clearly unsuitable ones by the signals they emit –or fail to emit… Sometimes, anyway. Mistakes clearly occur; abnormal genes do manage to slip through, leading to abnormal embryos –some of which are unable to develop enough to survive.

But that there may be yet another layer of protection built into the system –another unsuspected surveillance system- is what intrigues me. And that, once again, it seems to invest the power of a truly critical decision with the female is a cautionary tale for those who cling to the shredding coattails of androcentrism. It is simply another piece of evidence, if more were needed, that Life and all that it enables, is not a zero sum game. It is not a contest between genders, but a journey together. Still…

Let there be spaces in your togetherness.                                                                                      And let the winds of heaven dance between you.
Love one another, but make not a bond of love.
Let it rather be a moving sea between the shores of your souls.
Fill each other’s cup but drink not from one cup.
Give one another of your bread but eat not from the same loaf.
Sing and dance together and be joyous, but each one of you be
alone – even as the strings of a lute are alone though the quiver
with the same music.
Give your hearts, but not in each other’s keeping.
For only the hand of Life can contain your hearts.
And stand together yet not too near together:
For the pillars of the temple stand apart,
And the oak tree and the Cyprus grow not in each other’s shadows. –Kahlil Gibran –

I couldn’t resist.






For my Pains, a World of Sighs

What does pain look like? An intriguing question to be sure, but one I hadn’t even thought to ask until recently. Pain is one of those things that, like St. Augustine’s quandary over Time, presents a similar difficulty in defining. The International Association for the Study of Pain made a stab at it: ‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,’ but somehow, it seems to lack the immediacy of its subject matter –it stands, like an observer, outside the issue. Poets have done a better job, I think. Emily Dickinson, for example: After great pain, a formal feeling comes. The Nerves sit ceremonious, like tombs’; or Kahlil Gibran: ‘pain is the bitter potion by which the physician within you heals your sick self’; or even Oscar Wilde: ‘Pain, unlike Pleasure, wears no mask.

But I was reminded of another of Wilde’s observations -‘We who live in prison, and in whose lives there is no event but sorrow, have to measure time by throbs of pain, and the record of bitter moments.’- when I read a CBC article from November, 2016 entitled ‘Indigenous children, stoic about their pain, are drawn out with art’ http://www.cbc.ca/news/health/aboriginal-youth-art-pain-hurt-healing-1.3852646

‘”Aboriginal children feel and experience pain just like anyone else. It’s just that they express their pain very differently,” said John Sylliboy, community research co-ordinator with the Aboriginal Children’s Hurt and Healing Initiative.

‘”They don’t necessarily verbalize their pain, or they don’t express it outwardly through crying or through pain grimaces,” he told CBC News.’

‘These children are socialized to be stoic about their pain, to hold in their pain.’- Margot Latimer, Centre for Pediatric Pain Research, IWK Health Centre in Halifax. ‘”We noticed we weren’t seeing any First Nations youth referred to our pain clinic at the IWK hospital and wondered why that was so.”‘ It didn’t make sense, she thought — especially since research shows that chronic illness in First Nations communities is almost three times higher than in the general population. Aboriginal children are especially vulnerable, says Latimer, with higher rates of dental pain, ear infections, and juvenile rheumatoid arthritis.’

I found it very moving, and yet disturbing, that ‘[…] cultural traditions, and lingering effects from the residential school system, are some of the reasons Indigenous kids pull on their suit of armour against pain and hurt.’ But they’re children, and perhaps not yet completely shackled to all the subtleties of culture. ‘A group of Indigenous children and teenagers from four First Nations communities in the Maritimes were asked to paint their pain, to express their hurt through art. Researchers were hoping to tease out emotions from a population more inclined to show resilience to pain.’ But soon after, the children began to depict not just physical pain, but emotional pain as well. As Sylliboy points out, ‘”These kids told us about loneliness, sadness, darkness, bullying, hopelessness. It’s not the typical anxiety [or] depression. It is more complex than that.” “To these clinicians who are just asking about physical pain and not looking at emotional pain as well, it is important, because Aboriginal kids are showing us that there is no difference between emotional and physical pain”, said Sylliboy. “It’s just pain.”‘

And I learned another thing about pain –or maybe about children – ‘It’s all about creating a safe space for the children when they come to the hospital, says Latimer.  She says it’s about learning a bit about them and gaining their trust. “When they come to the health centre, or a physician or a nurse practitioner, they want to tell their story, but we do not train health professionals to assess pain that way.”’

It reminded me of a patient I first met in the Emergency Department at the hospital when I was the gynaecologist on call one night. Edie, an aboriginal woman arrived with heavy bleeding –she was  apparently in the throes of miscarrying an early pregnancy- and had brought her eight year old son to the hospital because she had no one to take care of him at home. The bleeding settled shortly after her arrival and an ultrasound in the department revealed that there was no further tissue left in the uterus, so fortunately we didn’t have to take her to the operating room. But the process of diagnosis and decision was not instantaneous. Although the little boy, Timmy, was clearly frightened, his face stayed neutral. And yet it seemed as if he was peeking through hole in a fence, and I could see his eyes carefully following my every move. One of the nurses volunteered to sit with him in the waiting room while I examined his mother, but I was the last one he stared at before leaving; I was the thing he didn’t understand.

I decided to let Edie rest on the stretcher for a while before discharge, and I thought I’d reassure Timmy before I left. He was sitting on the too-big chair as quietly and unmoving as an adult and when I approached, he stared at me like a deer hiding in a forest.

“Your mom’s going to be okay, Timmy,” I said with a big smile.

But he still seemed just as frightened, and stayed silent for a moment. “There was blood on her pants,” he mumbled, perhaps making sure I’d noticed. He allowed his eyes to venture out further into the open and he examined me again. “And she was hurting…”

What do you tell a little boy about his mother’s suffering? I knelt down on one knee in front of him so our eyes were on the same level and put a hand on his knee. I couldn’t  think of anything else to do. “She’s not hurting now, Timmy,” I said and smiled again.

He looked at my hand and then he finally smiled. “Can she go home now?” When I nodded, he reached out and carefully touched one of my fingers, and then when I didn’t pull away, he patted my hand.

I never saw little Timmy again, but a few weeks later, Edie came to my office for a follow-up visit and to thank me for seeing her in the hospital in the middle of the night. “Timmy was really impressed,” she said and smiled. She ruffled through her purse and brought out a rumpled piece of paper she’d nonetheless folded carefully. “He drew this for you, doctor,” she said proudly, and handed it to me.

When I opened it up, it was a drawing of a hand in red crayon.

“He said it was to thank you…” She seemed embarrassed, and hesitated before continuing. “I asked him why he drew it in red…” she said.

She still seemed embarrassed, so I stayed silent until she felt ready to continue.

Edie studied me for a moment with her big brown eyes, still uncertain. Then her face relaxed and a big smile appeared. “He said maybe you were one of us, now…”

I could have cried.