On The Road

I am heading off for my first fact finding trip outside of Delhi this afternoon! I will be investigating the status of health facilities in the state of Maharashtra. A former intern for Human Rights Law Network and I will be checking to see if these facilities are meeting basic requirements such as having running water, electricity, on-site trained medical doctors, safe and sanitary conditions, that they are accessible by road even in the monsoons, and are open daily. We will also be interviewing staff and patients to see whether pregnant women who are below the poverty line are receiving the health benefits promised by the government of India. The government wants to encourage women to deliver in hospitals instead of at home in order to try to reduce the maternal and infant mortality rates. To do so, health benefit schemes have been created to provide these women with free deliveries in hospitals. They should not have to pay for any health services related to the pregnancy or delivery, including transportation to and from these often far away and hard to reach facilities. Additionally, each woman that is below the poverty line should receive a small cash incentive for each delivery done in a hospital (amounting to about 10 US dollars). I am excited to see for myself the reality of the health system and to travel out to the countryside.

I have been trying to get out and explore more of Delhi lately as well. Humayan’s Tomb, a UNESCO World Heritage site, was spectacular. I also checked out the Red Fort and Lodi Gardens, which is my new favorite spot in Delhi. Nature, wildlife and peacefulness combined with amazing tombs and mosques from the 1400’s!

One thing I am struggling with a bit here is not feeling completely comfortable exploring on my own. If no friends are around to join me, I usually love wondering and discovering new places by myself. However, being the extremely tall female foreigner stands out and attracts a whole lot of attention. The extremely tall female foreigner who walks alone is even worst. My lovely day in the park was a little bit tainted by the three creepy men who followed me around. I was able to dodge each one and nothing bad happened, but I am a little sad that I should probably refrain from exploring by myself.

Of course, my mindset is partially a result of the important issues worked on at the office every day. For instance, last week I attended my first protest in India with several people from the office. The protest was organized by several women’s rights activist groups in Delhi, opposing the arrests of human rights activists in the state of West Bengal. They were arrested for trying to meet with the Chief Minister of the state to address women’s safety concerns after recent rape assaults. The prevalence of rape and violence toward women here is certainly at the forefront of the growing women’s rights movement in India, particularly since the fatal December gang rape in Delhi.

Meaningful Work

I am really enjoying the work I’ve been doing so far for my fellowship in the Reproductive Rights Unit at Human Rights Law Network. It is such a great feeling to work on important issues and be surrounded by people who are passionate about standing up for what is right. I have learned so much already and I haven’t even been in India for two weeks yet!

Already I have helped draft a petition to be filed in the Supreme Court of India requesting a revision of the country’s law on abortion. Currently, women in India can only get an abortion past the 20th week of pregnancy if her life is at risk. But there is no exception for risk to her physical or mental health. In cases where the fetus is diagnosed with severe abnormalities (which can only be determined after the 20 week cut-off), women are either forced to pursue unsafe abortions by people who are not medically trained (which contributes to India having the highest maternal mortality rate in the world) or they are forced to carry the fetus to term, only to watch it die a few hours after delivery. In either situation, the pregnant woman’s physical and mental health are in serious jeopardy. I researched personal stories of women who went through this in order to appeal to the Supreme Court to include an exception for health in India’s current abortion law.

I also planned a two day fact finding mission in Gujarat, a western state of India, to investigate whether medical follow-up was conducted on the thousands of girls, age 10-14, who were part of an HPV vaccine study. Many of the girls and parents were not fully informed about the vaccine before they were administered, many suffered from bad side-effects and a few died from the vaccine. I almost had the chance to travel to this far off destination and conduct the fact finding with two co-workers, but unfortunately the train waiting list had other plans for me.

So I stayed in Delhi this week and was able to work on another Supreme Court petition, this time focused on access to contraception. Just over 40% of the population has access to effective contraception, of which two-thirds underwent sterilization operations. 95% of sterilizations are done on women in this very male-dominated culture. Last week I spoke to a journalist who called to get a quote from my supervisor about the prevalent problem of women being coerced into getting sterilized. Here is his interesting article, “India’s Poorest Women Coerced Into Sterilization,” which was published on Tuesday: http://www.bloomberg.com/news/2013-06-11/india-s-poorest-women-coerced-into-sterilization.html

Today I began my newest project to create a training module for paralegals in India on the rights of women, adolescents and children to accessing health services. Hopefully the manual will help paralegals in advising people on what their rights are and how to access the health services promised to them.

It’s been a busy 10 days of work!

PHRGE Revisited: A public health epidemic among Nicaraguan sugarcane workers

I’ve always hated being a student, I just I always saw it as a necessary evil to get where I wanted to go.  That being said, there are times where I’ve wished I was back in law school, often so I could justify going on co-op again!  So during a recent period of unemployment, that’s exactly what I did, and the road I took kept leading me back to my time as a PHRGE fellow.

For my last NUSL co-op (in fall 2009), I served a PHRGE fellow at Oxfam America in Boston, in their Private Sector Department (PSD).  The two projects I worked on the most during my time there was the PSD’s Access to Medicines project, and Oxfam America’s pilot of their Poverty Footprint methodology.  The Access to Medicines project allowed me to expand on my understanding of legal interventions related to pharmaceuticals – something I had started to work on during my first co-op at the Illinois Attorney General’s office, working on multi-state pharmaceutical litigation.  At Oxfam, it was interesting to see the interaction with pharmaceutical companies in a global context, and how dynamics in the private sector worked in addressing the need for access to medicines in developing countries.

The second project, the Poverty Footprint, would have more far-reaching impact on my current work, although I didn’t realize it at the time.  At the time, Oxfam was piloting this methodology to evaluate how a company’s supply and production value chains impacted the lives of workers and communities within those value chains.  The initial two companies evaluated were Coca-Cola’s operations in El Salvador, and SAB Miller’s operation in Zambia.  Both companies are a major buyer of sugar in the respective countries, and it was the first time I began to understand how the demands of multi-national corporations affect operations of an industry like sugar in small local communities in developing nations.

Nicaraguan sunsets can be pretty spectacular.

Nicaraguan sunsets can be pretty spectacular.

Fast-forward three years.  In fall of 2012, I had just finished a post-graduate legal fellowship, but the organization I had been working for had taken a big financial hit during the Great Recession and couldn’t afford to keep me on payroll after the fellowship funding ran out.  As I settled into my post-employment job search, I realized this might be a good time to do another “co-op” to gain some additional job experience.  I figured anything would help in this ultra-competitive job market.

Opportunity presented itself in the form of La Isla Foundation (LIF), a small public-health focused NGO based out of León, Nicaragua.  LIF was founded in response to the alarming growth of an epidemic of Chronic Kidney Disease of unknown origin (CKDu) among western Nicaragua’s sugarcane workers.  Chronic Kidney Disease, also known as chronic renal disease or chronic renal failure, is a degenerative, progressive condition marked by the gradual loss of kidney function.  In developed countries, the causes of CKD are usually obesity, high blood pressure, and diabetes.  However, early research shows that these risk factors are not present in CKD patients in Western Nicaragua; here, the disease is of unknown origin (CKDu).  Because renal function declines at a gradual rate, death from chronic kidney failure is often slow and extremely painful.

Community members attending the funeral of a former sugarcane worker who suffered from CKDu.

Community members attending the funeral of a former sugarcane worker who suffered from CKDu.

According the Pan American Health Organization, the annual death toll from chronic kidney disease has more than doubled over the past ten years, from 466 in 2000 to 1,047 in 2010[1].  It is estimated that that since 2000, the disease has killed more than 24,000 people in Nicaragua and El Salvador alone[2]. However given the inconsistencies in reporting causes of death in the region, some believe that the toll is actually much higher.  In contrast to CKD in high income countries, CKDu in developing countries presents at a much earlier age.  In the communities where LIF works, men as young as 19 have been diagnosed with a disease and patients have succumbed to the illness as early as 21 years old.

Getting to know the sugarcane communities in western Nicaragua, I’ve been able to really see how the global value chain for sugar impacts rural communities in everyday life.  In the case of CKDu in Nicaragua, the workers’ place within the sugar value chains might literally be killing them, and few options for alternate employment exist.  I’ll admit, the issues are complex, and getting familiar with the details of the work can be depressing at time, but I love it.

And that’s coming a long way from not even knowing what a value chain was prior to my PHRGE co-op at Oxfam.

Purvi P. Patel, JD/MPH

PHRGE Fellow (fall 2009), NUSL ‘10

 

To find out more about La Isla Foundation and our work, go to www.laislafoundation.org, or like us on Facebook.  To contact me directly, write to patel.purvi.p@gmail.com.


[1] See Pan American Health Organization, Distribution of Deaths by ICD–10 Chapters, available at http://phip.paho.org/views/DeathsbyChapters/DeathsbyChaptersdetailedcausesofdeath?:embed=yes&:comments=no (last visited Apr. 11, 2013) (comparing deaths in Nicaragua under Chapter XIV, Diseases of the genitourinary system for chronic renal failure, unspecified and end stage renal disease for2000 and 2010).

[2] Michael Weissenstein Associated Press, Mystery disease kills thousands in Central America (Feb. 9, 2012), Deseret News, available at http://www.deseretnews.com/article/700223653/Mystery–‐disease–‐kills–‐thousands–‐in–‐Central–‐America.html (last visited Apr. 11, 2013).

PHRGE co-op spawns community storytelling project in Costa Rica

While a student at Northeastern University School of Law, I was fortunate to be able to pursue two human rights co-ops with the support of the Program on Human Rights and the Global Economy. I completed my first co-op during the summer of 2010, staying here in Boston to work with Physicians for Human Rights. My fourth and final co-op was a PHRGE create-your-own international co-op that sent me to the Caribbean side of Costa Rica. There I worked with NUSL alumnus Emily Yozell to learn about the precarious state of land ownership and the threat this poses to the cultural survival of local Afro-Caribbean communities.

Puerto Viejo is one of several coastal communities in Costa Rica's Talamanca region.

Puerto Viejo is one of several coastal communities in Costa Rica’s Talamanca region.

Thanks to the support of PHRGE, I was able to spend three months living among and learning from these communities. I began collecting interviews and established a website to broadcast local stories and explore the legal aspect of this conflict between sustainable development, human rights and local dignity versus environmental conservation. I was both intrigued by the complexity of the issue and moved by the stories of those I met. When I returned to Boston last summer to graduate and study for the bar exam, I knew I wanted to keep working for these communities.

In the past year I have returned to Costa Rica twice and established The Rich Coast Project, a community storytelling and collective history project aimed at advancing the social, economic and cultural rights of coastal Afro-Caribbean populations and other communities along Costa Rica’s southern Caribbean coast. Through the combination of new media storytelling and legal research, we will tell the communities’ side of the story and explore alternative approaches to the competing aims of sustainable development and environmental conservation.

Luba stands in front of her home in Manzanillo, where she lives with 5 family members. She is one of several local residents who is facing the threat of demolition for allegedly violating the coastal zoning law that restricts development within 200 meters of the high tide line. The majority of the town of Manzanillo, which was founded over 200 years ago, is located within this area.

Luba stands in front of her home in Manzanillo, where she lives with 5 family members. She is one of several local residents who is facing the threat of demolition for allegedly violating the coastal zoning law that restricts development within 200 meters of the high tide line. The majority of the town of Manzanillo, which was founded over 200 years ago, is located within this area.

Ms. Narcisa Hancel "Titá" is an important matriarch in the village of Manzanillo. She is a granddaughter to the community's founders who settled in the area during the 1800's, you can see her grandfather Peter Hansel's grave at Manzanillo's Miss May point overlook and her parents' graves in the village graveyard. Titá has lived in Manzanillo for her entire 85 years: "a true born Costa Rican." Now several of her children and grandchildren have criminal cases filed against them for building their homes inside this village which was decreed to be outside the protected area upon it's creation, but later determined to be inside the wildlife refuge without consulting or respecting local people's rights.

Ms. Narcisa Hancel “Titá” is an important matriarch in the village of Manzanillo. She is a granddaughter to the community’s founders who settled in the area during the 1800’s, you can see her grandfather Peter Hansel’s grave at Manzanillo’s Miss May point overlook and her parents’ graves in the village graveyard. Titá has lived in Manzanillo for her entire 85 years: “a true born Costa Rican.” Now several of her children and grandchildren have criminal cases filed against them for building their homes inside this village which was decreed to be outside the protected area upon it’s creation, but later determined to be inside the wildlife refuge without consulting or respecting local people’s rights.

The project will work with local advocates to produce a collective memory of the area and its people, tracing the historical process of development and examining the impact of national conservation policy over the past several decades. This process will be supported by the simultaneous development of an online resource of community archives, legal research, and educational materials aimed at promoting widespread understanding of the complicated legal forces at play.

The goal of the project is to use creative advocacy to build the case for keeping the local people on their land, showing that not only is it the right thing to do, it will also produce better results for the people and the environment.

If you are interested in knowing more about The Rich Coast Project and ways you can support or be involved in our work, Visit www.therichcoastproject.com or email me at kbeck@therichcoastproject.com. You can also connect with us on Facebook, Twitter, Flickr and YouTube.

George Hansel has lived in Punta Uva his entire life, a small town founded by his grandparents. He has many fond memories of growing up in this tight-knit community, where neighbors treated one another like family and shared whatever they had.

George Hansel has lived in Punta Uva his entire life, a small town founded by his grandparents. He has many fond memories of growing up in this tight-knit community, where neighbors treated one another like family and shared whatever they had.

First Fact Finding Mission

It was 113 degrees today when I left the luxury of the air-conditioned office to go on my first fact finding mission (already, on just my 3rd day)! I went with a Hindi speaking co-worker to interview a new young mother who had just given birth at a homeless shelter, check on the health of the baby, try to ensure that a doctor will come soon to check on them, and investigate the level of sanitation and standard of living in the shelter. Well, this place was not what I envisioned a shelter to be. There was not much more than walls and a roof to this 4 story building. No beds… just men, women, children and infants sleeping on the ground. Stray dogs doing their business throughout the shelter. Other than one manager, it didn’t seem like anyone was working there. But on the other hand, kids were smiling and playing, and everyone seemed to be helping and looking out for each other. This was my first time seeing an infant on its first day of life. She was just 7 hours old and so tiny. Out in this heat, dust, pollution and swarmed by flies, I have trouble imagining how this frail little baby will survive. But then again, all the older children running around likely had a similar start in life.

First Days in India

I made it to India! I will be here for 10 weeks, working for Human Rights Law Network in Delhi, thanks to the PHRGE Fellowship. Today is only my second day here, but my first impressions are good so far.

First of all, I don’t feel nearly as much like a zoo animal as I did when I studied in Beijing, China. As a 6 foot tall white female, I was gawked at, pointed at and even chased down the street with cameras. Here, I am certainly getting some surprised looks, but luckily it has not been too intense.

Transportation has been exciting… Exiting the airport, I was an easy target for an attempted taxi scam. But luckily I was advised by former PHRGE fellows on how to get a legit taxi for a reasonable fixed price. When I declined the five men who immediately swarmed around me, whisked my bags into their car and reluctantly answered my request to know the price before I got in (which was almost 10 times the amount of a fixed price taxi), they nicely gave me my bags back and said “your money, your decision” with a smile.

The driver who finally took me to my new house had only a vague idea of where we were going and had to ask about 20 different people along the way how to get there through these crazy streets. Those silly white lines on the road mean nothing and my land lady says there really are no road rules. The streets are jam-packed with buses, cars, taxis, auto rickshaws, bicycle rickshaws, motorcycles, bicycles and pedestrians. And there is constant honking. While honking at home generally means “move it slow poke” or “watch out,” here it seems to have many more meanings: I’m turning right, I’m turning left, you’re about to crash into me, move out of the way, don’t pull into my lane, don’t cross in front of me, or I’m coming through at full speed no matter how slow you cross the street. Riding in an open air auto rickshaw with no seat belts makes this pretty exciting.

When I finally arrived, my new land lady quickly made me feel at home. I am staying with Mrs. Malik, a woman who several former fellows stayed with in the past and recommended. I am renting a nice room on the roof of her house and am very thankful for the air-conditioner, as it is over 100 degrees. However, she informed me that it should not run for more than 5 hours at a time or it will “burn”(?) She told me to wake up and turn it off at 2:30am and just use the fan to circulate all the cool air already produced. Hmmm. Well, since I was waking up every 1-2 hours anyway due to the lovely cold I caught the day before arriving in India, I followed instructions. But by 5am I couldn’t take it anymore and had to turn it back on.

Today I planned to go to the nearby market in hopes of finding an electrical adapter so I could recharge my American technology to stay connected to home. But because I am sick  and now have no voice and the market is full of small vendors who would likely be aggressive bargainers, my land lady hailed a rickshaw to take me instead to a big air-conditioned mall. Ah, much better than trying to avoid heat stroke. Luckily she gave me a quick tour of the neighborhood so that I could better direct my rickshaw driver coming home this time. Considering I can barely talk today, I was pleased with my first haggling experience and was able to convince a rickshaw driver to take me home for just 10 rupees (.18¢) more than my land lady had bargained to get me there. Not too shabby for the voiceless foreign girl.

I am excited to start my first day of work tomorrow and will hopefully meet other interns to join me in exploring our new surroundings.