HealthRight International

Russia’s massive and dysfunctional prison system – second only to the United States in prisoners per capita – and the judicial system that feeds it have recently been featured widely in international media.  While women make up just 8% of those incarcerated in the country, they are particularly vulnerable to the life ruining isolation conferred by a prison sentence.

  A recent article in the St. Petersburg Times described the incredible stigma and rejection faced by women prisoners.  A psychologist and author of a book on women in Russian prisons is quoted as saying: “a sentenced woman is typically rejected by her husband or partner, her friends, her colleagues and social circle.  By contrast, women rarely abandon men over imprisonment.”  HealthRight International social worker, Elena Efimova, agrees, noting that for many men, serving time in prison is almost expected, and his wife and children wait for him and are excited to welcome him home.

Elena Efimova, HealthRight Social Worker

Elena leads a weekly pre-release seminar in a women’s prison near St. Petersburg, Russia, and counsels former women prisoners, as part of her work with HealthRight and our local partner, Doctors to Children.  She is accompanied to the prison by a lawyer, a drug addiction specialist, and a doctor from the government AIDS Center, which is the only source of HIV treatment in the country.  Many of the prisoners are HIV-positive (a precise percentage is not made public, but experts suggest that the percentage is far higher than in the general population), and nearly all have had some experience using drugs.  During the seminars, prisoners are encouraged to visit a city-based government crisis center, supported by HealthRight and Doctors to Children, upon release to seek help adjusting to life on the outside, accessing medical treatment, entering a drug rehabilitation program, and resolving family conflict.  Most women who visit the crisis center are completely overwhelmed by their circumstances and are grateful for the quiet counseling rooms, safe child play area, and community of women who are struggling with all of the same problems.  The women quickly become friends, caring for each other’s children and sharing tips on finding a job.  They are linked by the harrowing experiences that have taught them how to survive, and their determination to learn how to live.

This project is supported by the Elton John AIDS Foundation.

HRC volunteer Dr. Ellen Kelman speaks to training participants about how to conduct an effective forensic psychological evaluation.

Sixteen medical and mental health professionals from various parts of Arizona gathered in Phoenix on September 22 for a Human Rights Clinic volunteer training, held at the offices of the International Rescue Committee. Katie Ruhl, an attorney who formerly worked for the Florence Immigrant and Refugee Rights Project and who is now employed by a private firm in Tucson, presented to the group on the forms of immigration relief available to survivors of torture. Deborah Presken, a physician and dedicated Denver Human Rights Clinic volunteer, outlined the process of conducting an effective medical evaluation to document the signs of torture in survivors, while Ellen Kelman, a psychologist and veteran Human Rights Clinic volunteer in Phoenix, described the elements of a typical forensic psychological evaluation. Lisa Matos, HRC Project Director, had kicked off the morning by offering an overview of HealthRight’s work and the HRC’s history, and I concluded by training participants in how to conduct an effective needs assessment and refer survivors who receive evaluations to our Access to Support and Services for Survivors of Torture (ASSIST) program.

Many of the training participants work in the field of trauma, with some currently providing treatment to refugees, asylum-seekers, and other survivors of torture. Regardless of experience level, participants expressed enthusiasm about the opportunity to be trained in conducting forensic evaluations for torture survivors, acknowledging that there is a great need for such services targeted to immigrants in Arizona. We look forward to continued growth in the HRC’s Phoenix and Tucson volunteer networks; the willingness of our volunteers there, both old and new, to offer their time and expertise allows us to continue offering our life-saving services to survivors of torture in Arizona.

Kelly Barneche, HRC Program Associate

HealthRight Outreach clinic touches lives

In our efforts to build access to health for excluded communities, HealthRight runs outreach clinics in sites throughout northern Kenya. On the 21^st of February, 2012 HealthRight International took its outreach in West Pokot to the Senetwo location in a village known as Chepturnguny.

This particular village was picked as an outreach site because of its great distance from the next nearest healthcare facility, and the fact that it had the groundwork in place of a non immunizing dispensary. It is approximately 20 km from Chepareria Sub District Hospital which is the closest hospital in the area. It has a catchment population of 1,373. Most of the patients who responded to our mobilization came for immunization (27) and antenatal care (8), and we distributed a total of 22 nets for the afore mentioned vulnerable groups. However, we were also able to see some few cases that required referrals. This included 5 infants suffering from malnutrition due to the absence of rain and a total of 15 patients for general ailments.

One of the patients for whom we could provide a referral was an adolescent woman who suffered from cancer of the mouth.     . Priscah Chepsal ,14yrs old ,is the first born child in a family that is run by her mother, as her father is mentally challenged. Prescah and her family live 2 km from Chepturnguny Dispensary. When Prescah started suffering from a swelling on her cheek, her mother attributed it to a fall. The swelling persisted and progressed to a wound, at which point the child was taken to Chepareria to a private facility. That facility simply gave her a course of antibiotic injections, but by the time she received her fourth shot, the tumor in her mouth had begun to lose teeth as a result of the growth of the tumor inside her mouth. Prescah’s mother decided to seek treatment in Chepareria sub-district hospital, where they finally diagnosed the growth as cancer  and referred her to Kapenguria district hospital and subsequently to Moi Teaching Referral hospital. After such a challenging journey towards health care, Prescah’s mother was forced return home due to the lack of funds. There, she was convinced to seek the services of a traditional healer. Unfortunately, the traditional healer could not improve the situation, and the tumor advanced to an oozing abscess that had  formed a communicating hole to the outside of the chin. When HealthRight encountered Prescah, the swelling inside her mouth had grown so rapidly that it obstructed her throat.

However, HealthRight acted quickly.  After meeting her during the outreach, she was referred to another facility. HealthRight and available staff undertook  a small fundraising effort to facilitate her travel to Moi Teaching and Referral Hospital in Eldoret, a national hospital where high quality treatment for this cancer is available.

Voices from the Community
Since 2005, HealthRight International has been implementing a project in West Pokot County to improve the lives of mothers and newborns. The project was developed in response to the fact that many pregnant women did not attend antenatal clinics and then deliver at home, a trend which is associated with high maternal mortality rates. Through concerted effort, HealthRight managed to inform the community about the importance of going to antenatal clinics and delivering in the hospitals. However, even when the community had demonstrated a desire to attend clinics and deliver in hospitals, certain barriers remained. Many women lived so far from the hospital that they needed to travel there before going into labor. However, the cost of extended hospitalization before birth prevented many women from accessing medical care. To solve this challenge, HealthRight came up with a Maternity Waiting Home (MWH) model, or a “kiror”, to accommodate mothers for free in a location where hospital health workers can easily monitor them as they await the onset of labor.
Currently, we have three kirors, one at Ortum Mission Hospital, one at Kapenguria district hospital and one at the Kaibichbich Health Centre. At any one time, each kiror can accommodate about 20 pregnant mothers.
HealthRight recently held a community awareness event, attended by women who were staying in the kiror or who had stayed there in the past, as well as supportive members of the community. Here’s what some of them had to say about their experiences.
Everlne Chemket Kaptilit, (traveled over 50kms to the kiror) “I am expecting my first born and decided to come to the kiror since I have seen mothers who have successfully given birth in the hospital. There are so many challenges facing pregnant women in our area. It is difficult to get vehicles and one has to mobilize the community to carry a pregnant mother using man made stretcher in the absence of a vehicle especially where there are no roads. This is more expensive than the money one would have spent at the hospital”
Gladys Cheposepoi (traveled over 40kms from Sina to Ortum) “a kiror is like a home where you are comfortable knowing that there is someone who cares about you and will detect any complications.”
Joyce Samson (traveled with a friend to the kiror) “We are two pregnant women from our village in the kiror, and if we had not come to the kiror, one of us would have had a problem because the baby was big and was delivered through cesarean section.”
Florence Musa, (traveled over 30kms from Sekerr) “there are so many problems facing pregnant mothers with little or no information about the kiror.” Florence was referred by a traditional birth attendant (TBA) and will share information about her experience with her community when she goes back home.

Written by Lopa Basu, MD,
Human Rights Clinic Volunteer, Baltimore, MD

TRANSGENDERED: A JOURNEY TOWARDS SAFETY?

The drive to Rappahanock Regional Jail in Stafford, VA was long. I was about to meet my first transgender client through the Human Rights Clinic of HealthRight International. Reviewing the notes from the attorney and the client’s history of past persecution in Mexico for being a transgender woman, I contemplated the traumas experienced by her and other transgender people who have been victims of torture in their home countries and seek asylum in the United States.

The initial interaction with the clerk behind the desk was frustrating as she asked me for numerous documents to prove my identity as a physician and repeated questions regarding clearance to see my client. The language interpreter arrived with the attorney shortly after and it immediately felt like a powerful female team who shared minority experiences and felt empowered to help our client. The attorney asked to wait in the waiting area as she was giving a ride to the volunteer interpreter, however, the clerk quickly turned cold and stressed that attorneys were not allowed to wait in the empty waiting area.

Nancy, the language interpreter, was an eager, energetic student who brought two books that highlighted difficult medical and social science Spanish terminology. She was astute and well-versed on the difficulties of Hispanics attempting to make a home in a current political culture riddled with fear-driven tactics involving immigration legislation. Nancy, even at her young age, was already creating a role as an advocate for vulnerable populations and we both bonded over our excitement to meet our client and attempt to record her story.

After an hour of waiting, we were escorted down a long concrete hallway to the medical rooms to meet the client. Before entering the small, sterile medical room, a quiet young detainee was sitting in a chair. She wore a bright orange jumpsuit and had long brown hair, pulled back in a ponytail. Within minutes, she politely entered the medical room and avoided eye contact. Her facial hair was thick and her quiet voice was warm and calm. As I introduced myself, the client seemed relieved that we were both women. I explained that we would be asking potentially difficult questions about her experiences in Mexico and tears rolled down her face as she prepared herself to relive the traumas of her past. She had a quiet strength and explained how she struggled as a small child with her gender, how she ran away from home at a young age and joined the local circus, creating a family of wanderers with whom she shared her insecurities and fears. As we started to ask her more about her trauma, she described a haunting day when she was invited by one local man on a date and was quickly taken to an abandoned house where his friends met them. She started to breathe more quickly and tried to formulate the words to explain how she was beaten and gang raped by all four men. As her tears continued to roll down her face, she kept repeating in Spanish: “I screamed for help and I cried, but no one came to help me.” It was eerie how several sentences could never capture the enormity of her experience. It was as though what she described as an incident of an hour, felt like days for her as she was left there after the men ridiculed her and threatened to kill her asking her if she now felt like a woman.

At one point during the interview, she asked for medication to help her calm down, but somehow we were able to get her to breathe deeply and slow down her words. One of the most difficult parts was asking the interpreter, a young woman herself to clarify graphic images and words to record the survivor’s personal story.

Before we left the room, she repeatedly thanked us for our help and as we walked out, I felt a huge heaviness. The interpreter and I walked in silence until we returned to the front entrance of the detention center.

I got in my car and drove down the same long, winding, wooded road that had brought me to the detention center. I couldn’t help wondering- ‘How many other transgender people suffer such traumas? How could we give a voice to these vulnerable populations? Even if my client is granted asylum status in the US, will she not suffer the same discrimination in our own country?’