No way! Women doctors?!?!

So this is interesting. A whole blog entry on my feet and I completely forgot to mention the event that rates highest on the MAI (Mom Alarm Index). Not sure if my brain's blocked it out or gone into denial or what. But back in Kongwa, I spent several hours one afternoon walking on tilted, uneven concrete along the side of the highway, wearing a pair of very cheap flats that I pulled out to try to look presentable for government officials. Half an hour in I was experiencing these weird, twinging pains in the inner balls of my feet, but I just sort of adjusted my stride and powered through. That night, however, I realized that my both my big toes, down to the main inner joint, were completely numb. Aaaaaaand....that hasn't exactly resolved, three weeks later. The left is a little better - I think - but the skin over both big toes still feels like it belongs to someone else. I ran it by Dorothee, who's (almost) a German doctor, and she told me not to worry. So I shan't! I have become comfortably numb, as they say. Don't worry, Mom. They're just toes. I have LOTS of toes.

After a pretty slow week at work, I opted to spend Thursday at the Medical Women's International Association conference, hosted this year in Dar es Salaam by MEWATA, the Medical Women's Association of Tanzania. I'm glad I went, and not only for its hilarious motto ("It's Women Doctors!"). There were some really interesting presentations, for one: a lot of discussion about cervical cancer, which is significantly more of a serious problem here than in the States. Quite a bit as well about how to fight brain drain. And then a bunch of smaller studies that I probably wouldn't see at home - "At What Age Do Mothers Plan to Reveal Their Children's HIV+ Status to Them?", for example. (Answer: age 15-18. From the standpoint of preventing the spread of disease, probably too late. Interestingly, moms are also much less likely to ever even tell their female children.) Also managed to meet a very interesting woman working on microbicides; hoping to meet with her again. Good, interesting stuff, right up my alley.

And of course the other intriguing part is getting to see how a big, academic conference goes down in Tanzania. I feel like I've been to more than enough American conferences (my collection of monogrammed canvas bags is nonpareil) so I was comparison hunting. At first glance, you might see the individual water bottles at each seat, the dishes of mints spread along tables, and think the Westernization was complete.

But that would be mistaken. The rather casual approach to scheduling was a key divergence - by the end of the day we were running approximately 2.5 hours behind schedule (a significant improvement over the day before, apparently). There were also quite a few scheduled presenters who simply never showed up, leaving me to wonder sadly about whether flash heating breast milk really DID improve child health outcomes. A "comedic" presentation near the end of the day was definitely the weirdest powerpoint I've ever seen, and reminded me forcefully that I do not understand Tanzanian humor at all. I'll post it if they make it available, but suffice it to say that it featured photographs of a child licking a pig, Robert Downey Jr. flexing, Obama punching someone in the face, and topless women (not in a medical or anthropologic sense). And then, of course, I've found that most American conferences are tragically lacking in group singing and ululating. Tanzanian women have resolved this.

One interesting discussion I had with other medical students there involved the conference's seemingly heavy focus on breast cancer. On one hand, I don't like the idea of dismissing the toll of disease that kills a lot of women, or insisting that we shouldn't discuss one health problem until another one that I or someone else deems more important has been solved. One of my weirder social moments over this past month occurred during a conversation with a friend of a friend. About five minutes after our introduction, he asked what I'd been working on that day and I mentioned some of the statistics I'd been organizing for the Maternal Mortality and Morbidity conference. He actually cut me off, saying "Oh man, that's nothing. Do you know how many women are raped in South Africa each year?" and rattling off numbers. I was sort of trying to get my bearings, which I guess he took as awe, so he announced "I work in HIV/AIDS, you see." It was such an unsettling interaction. The sort of single-minded focus on one particular disease or condition, and the competition among different global health fields to establish their particular issue as THE important issue, can't really be good for any of us.

At the same time, four presentations about breast cancer just struck me as a little...premature, I guess. The average female life expectancy for Nigeria, one of the countries heavily represented at the conference, is only 47, and the rest of East Africa isn't much higher. About half Nigerian women won't ever get the chance to die of breast cancer, honestly. But I suppose US donations to build mammography and other screening infrastructure can't hurt, really. And maybe it'll just lead to everyone's ship rising. Not sure.