An article on female genital cutting describing the social aspects of the practice in Sierra Leone can be read in conjunction with viewing a short video of an interview I had with Isha Daramy-- a woman from Sierra Leone who describes her work on maternal and child health and comments on her own experience with the female genital cutting procedure. Well, today I'm welcoming Isha Daramy Kabia to our class, and looking forward very much to hearing general thoughts about women's health in Sierra Leone. Isha is from Sierra Leone. She's a midwife. She's going to tell us briefly a little bit about herself and how she came to become a midwife. And then I'd like to talk about your general impression of what the major issues are for women's health in Sierra Leone. Thank you. I went to England-- of course I went to early school in Sierra Leone in a Catholic school-- St. Joseph Convent. And from there, I came to England when I was 19 years old. And I did my SRN, which here you call RN. And after that, I worked for a few time, and then went to do my midwifery, which is my main-- my major subject at the moment. And of course, in England, we only had-- unlike the State, we never used to have a degree in nursing. But then the change came, and every nurse or midwife should go and have a degree. So I did a post graduate course in England at the Guildhall University, and then proceeded to a master's degree in management studies. And after that, I worked for a while. I took a retirement and went to Sierra Leone. Of course, I've been going in and out of Sierra Leone looking at the health issues there. Of course, it's not the same as it is in England. So my aim was to go back home and take back what I have studied and better our health sector in Sierra Leone. And what's the name of the organization that you founded, I understand? Well, before even I found that organization, I started with training of traditional birth attendant in 1990. That was way before the war. And I had a lot of friends in England who contributed to the building of the small clinic where we trained 41 traditional birth attendants, at the time-- they're very important, and most of the births in Sierra Leone were attended by traditional birth attendants. But then their skills needed to be improved, and that was how I came around training 41. Can you describe a little bit about the training of the traditional birth attendants? How extensive is their practice? Well, when I went home, the government also was training traditional birth attendants at the time, but the training was about, say, three weeks. But when I look at those people, most of our traditional birth attendant had never been to school. And of course the profession as we call it, is being transferred from mother, sisters, aunties, and grandmas. And those traditional birth attendants are also the Soweis. The Soweis are the people who go through the female circumcision. So they are the people who attended the births. So when I got there, I saw the way they delivered the babies. It's very traumatic. I left them to do the delivery to study how they did it. Then we had a six month training of traditional birth attendants. We had two weeks in training. All the pregnant women in the area had to come into the center. We had already built the center. They come to the center, and then we look at the issues. We look at each pregnant woman, the problems they have, like hypertension, anemia— all those issues. Since they cannot read, it's just the sight, the senses-- training of the senses. They look, they touch, and see what it is. And I think that went on very well. Now, if I understand you correctly, you said that these traditional birth attendants not only attended births and ensured healthy births, but were the very people who may be practicing female genital cutting-- or female-- you refer to it as female genital circumcision? That's right. I know that the WHO refers to this process as female genital mutilation. Exactly. Could you comment on the use of the terms? Well, actually, I was lucky enough to be in the first conference to eradicate female circumcision in Addis Ababa in 1990. In fact, they sponsored me to build the first clinic where we train. Because I told them categorically that in Sierra Leone-- because I was talking about Sierra Leone-- it is above 95% of women are circumcised. And to eradicate it-- and it is a traditional issue. You cannot just get it out. So, in that case, if we go through the health education-- like the Soweis and the traditional birth attendants-- and if we go through them, we might be able to succeed in reducing the act. So they sponsored to build this clinic. But then, I told them it's something that has to be-- it might die a natural death if we allow it. Because, for example, I'm a member of that society. But I would not have put my daughter there, right? I would not, in my own choice. But if my daughter wants it, be it be. It would be a choice for her. So we train these people, and sometimes we have obstructed levels due to that. And I just called them, and I said, well, this is the result of something. And they do understand. So do you believe that it will die a natural death? Just because people are learning more about the health aspects or the illness aspects of female genital cutting? I doubt it very much, now, because it has been accelerated, and it has been criticized, and also, it has been called all sorts of names like “barbaric.” And it is the people's secret society. It's a secret society that has a meaning in the culture. So if you want to eradicate it-- in fact, eradication was not the word. You have to say you might reduce it, because it's deeply rooted. And to eradicate it, I don't know how you're going to do that. But it has been accelerated, because people become very annoyed the way they approach. But when I went to Addis Ababa, that was the first time I told them, I said, you got to do it in a very, very skillful way, and respectful way, as well. But of course, they didn't. Now they're coming back to it. Now they've started calling it female cutting, and now they're going to say age of consent. So they're coming back to what I told them in 1990. And the damage has been done. Because people have become adamant, and it is-- Adamant to persist? Yeah. Adamant to get it going. Because people have been-- they think you're interfering in what I believe. And the people who championed it at the beginning don't even-- they are not members. And this is a society which-- it's a secret society. You don't talk about it when you don't know about it. So the first thing I told them, as well, I told them that there are educated members of the society who would be able to champion it and talk to the people respectfully. And of course, in Sierra Leone, the person who champion it was not a member of the society. And of course it was exposed. She wrote books. And writing books did not help, because most of the people who are engaged in it cannot read those books. They don't even have radios. So the practice is still going on. One quick question. Not to dominate this conversation with this topic-- although it is a topic of concern, since it's not just a health issue, but also a human rights issue, many people would argue-- and I think most people would agree-- both a health and human rights issue. To what extent is the income to people who practice the procedure a factor? In other words, if they-- I've read that sometimes some of the interventions involve offering a different-- Incentive. A different incentive or an incentive to stop practicing the procedure. Well, the incentive to stop-- it might work. It's what? It might work, but it's not the main issue. The main issue is, it's their profession. And it is their beliefs. It's the belief that is innate. That is the key issue here. The incentive-- you can give the incentive. It might minimize it. And it takes time. It's not something that you rush. It really needs time. And like I said, it might still die a natural death, that the future generation might just ignore it. Because of further education, or what kinds of intervention? Well, because of further education, and because of the knowledge that they have come to it. And it's not as secret as it used to be. It has its advantage by opening up, because people know what it is, now. Because when I went, I didn't know-- we are not told. They just said, it is part of coming from adolescence into womanhood. And I think, like I said earlier on, it is a big, big association that will empower women, because it is really-- it's the only society where women are completely in charge. So we could have done it another way-- through there, empower women to be whatever they want to be. Let's move from this topic-- though it's probably related to others-- to talk a little bit about early marriage and early childbirth, and in the context of another question, which is in Sierra Leon, what would you consider-- if you could-- the major health issue that-- and/or human rights issue that women face? Well, I think-- to my thinking-- my own opinion-- is that it's education. Education? Education. If a woman isn’t educated-- there is a high rate of illiteracy, which is a problem. Because when a woman is well educated, she can think for herself, she can provide for herself. it's the means of provision. Because if you depend on the man to provide for you, of course you see whatever that man is trained to see. You cannot argue, can you? I mean, when women get married in Sierra Leone, like the tradition-- especially those who've never been to school-- automatically, the husband take charge of the whole family. And of course, if you try to cause trouble to the man, you are hindering your family. So there is a little bit of a problem there. And also, women don't own, in those days-- they're not sort of themselves. They don't own themselves. They are owned by the man. If a man die, you go over to the brother. I mean, all those things we have then, but now, they are changing through education. And women are-- girls are increasingly attending school? They're attending schools and, of course, they have been travelling around, and communication is doing a lot in the world. I mean, the means of communication has increased and has become easier. So people learn from what is happening from other place, and so sort of pick the good from the bad-- because every country has got its good and it's got its bad. Can you comment on changes or effects of the war on women now, still? I know that it-- I mean, war disrupts so completely that development and education falls by the wayside when the country's at war, but-- Everything around us have got two ways. It’s got its advantages; it's got disadvantages. I think the war has—let us see first the disadvantages. A lot of people have lost their relative. A lot of people cannot stand on their own, because that relative that has been lost may be the main bread winner. And also, we know we have a lot of rape cases, because it's always the women who suffered. Although in Sierra Leone, it's not only the women. We have a lot of amputation with men being amputated-- both men and women were being amputated. So that's the bad part of it. And of course, there's a lot of destruction. People lose their houses-- everything. So that is more like the disadvantages. And of course, people went to other countries and see what is happening there. That's an advantage. See how they progress and they come back with an idea, because some of them had never traveled. They only went because there was a war. And there they picked up some-- even learned a trade from wherever they found themselves. And of course, it also is an eye opener to the individual-- see how hard people work in another country, and then come back. And of course, education boomed after the war, because people who had their children abroad were able to survive, and their children used to send few things for them, or even send them across. So they think, there, the education, they saw the value of the education in that respect. So education becomes a lot-- especially the girls. When you educate a girl, like you know, you educate nation. So the girls were more looking after their relatives than the men. So people-- it brought a lot of sensitization to education, and to the way of living. And also, people think they should have houses. Everyone now want to have a house. Before, we are blind to this sort of thing. People have houses, but you don't think it is a main issue to have a home where you could bring-- so that's another big advantage of opening up. And also, the trade. People can go up and down to other countries and do trade. So there is an advantage of the war. And of course, the disadvantages-- like I had already said-- they're there. So thinking in terms of women and girls, specifically, I know that education rates are rising, to some degree, among both boys and girls. And so more girls are going to elementary school. Could you comment on the interventions that you think are the most important? You've mentioned education. But we wonder about the question of early marriage, early childbirth, violence against women, and female genital cutting. With education, the early marriage has been ruled out. Has it? Well, of course, because if you start, you want to go to the end of education-- to the end of wherever you find yourself. And the marriages, you don't get married maybe till when you're over 20, 25, and so forth. You finish your education around that time. So the early marriages are also a problem to young people. And we have an extensive family planning program, as well, because this is-- the parent might be willing to put you to education, but if you get pregnant, that's what happen. That's the end of your education then. But another thing that has crept up because of that-- you can have your baby now and go back to school, like the West. Because when I went to England, I saw people-- I remember my experience was there was the girl who had twins. I was in the midwifery Class, and she had to be escorted to the examination hall to take her exams. Whereas in Sierra Leone at that time, when you're pregnant, that's the end of your education. Even your parents might even disown you. But now, I don't think it is the best of things, but it gives a chance to the girl child to continue their education. So-- So if you had an opportunity-- which in fact you have now, by being taped-- to say whatever you would like to say to students around the world-- not just in the United States, but around the world-- about your attitude toward health of women, what would you say? Well, I will first of all say continue with your education. Get the highest degrees that you can get. Get the highest education that you can get. Then try and think about marriage. Because when you do that, you got a better chance of educating your child, because you can afford it. For example-- I mean, I was lucky. I went to a convent school, which was a private school, but most of my colleagues in Sierra Leone did not have that opportunity. But then when I had my son, I put him in a private school because I have now realized the value of education. So the best thing for a girl to do is get yourself educated first, and then get a nice career, and then marriage. And now people go to school very early. I mean, we get doctors at age of 24. And time pass. It's all the 30s, 32, you become a doctor-- a medical doctor. But now 24-- even in Sierra Leone, we have young girls as 24 who are qualified doctors. So there is a lot for them. You don't even think about, well, I'm getting old. I'm going to have a child. What am I going to do? I'm getting to 30s. So by the time she is 28, she has already got her qualification. She's got a good job. And of course she goes on and have a child. And she's matured to look after that child. Because that is the other thing. A child cannot look after a child. So if you have a child when you are 13, 15, 16, you look at that child like a doll-- is not a human being to you, because you still have that early stage where you play with dolls, and things like that. So my message, now, is girls, there is a better world for you-- awaiting you. And I want to tell you this-- when a woman is educated, she thinks better. I wouldn't say she thinks better than a man, but I would like to say that. I might not be right, but that's my opinion. When a woman does something, she does it well. And if we-- all women-- and the world is coming towards the women, now, as I can see. If you look at key positions in the world, they are being held by women. And things are changing. We never heard about women Prime Ministers. So the sky is the limit for young people coming out today. And I think you're going to be the future of the world. But you can only do that when you are educated. That's my thought. Thank you so much, Isha.
