My Love Affair with a Sh*thole Country


I first visited Haiti in 2006. It was not love at first sight, or even a like. I spent a week on a medical mission trip, missing my family and sweating in the operating room while I performed some of the most difficult surgical cases of my career, without adequate lighting and unfamiliar instruments. Climbing the steps of the airplane to return home was a welcome relief from the searing heat of the tarmac and the aroma that is Haiti (think rotting fruit mixed with exhaust fumes and burning charcoal). I’m not sure when the amnesia set in over the next few months, but I was soon planning my return visit the following year. 15 or so trips later, I look forward each visit to spending time in a country that I have visited more frequently than any other.

My  trip last week coincided with the recent comments about Haiti from President Trump. While he was ranting about the immigration of Haitians to America, I was participating in distributing microloans to a new group of 10 Haitian businesswomen. The women received $200 to help fund their small businesses and will be responsible for paying back the loan over 10 months with a low rate of interest. Each of these women has worked hard selling clothes, food, shoes and motor oil to support their families. This is in addition to the daily tasks that a Haitian woman must perform without the benefit of running water or electricity. Entitled or lazy would be the least descriptive terms that I would use.


The following day I worked with one of the Haitian seamstresses that we employ to construct reusable menstrual pads for distribution to Haitian girls. She uses a manual sewing machine and is able to make $4 a day working  5-6 hours. She also participates in menstrual hygiene instruction at area schools so that young girls will have the benefit of knowledge about their bodies and not the fear that her generation of women experienced. She has no desire to immigrate to America away from her family, but wants the opportunity to make her life in Haiti more comfortable.

I am not quite sure why this country has occupied so much of my time, energy and pulled at my heart. The opportunity to leave a frigid Minnesota in January makes the idea of sweating in the operating room more palatable. But is much more than that. Haiti is a land of contradictions – corruption and family strength, sadness and laughter, illiteracy and value of education.  There is very little black and white, rather many shades of grey. But it makes my brain think and try new ideas, something that is more difficult to do in my American job. I have been the recipient of many opportunities in the US, and although I have worked hard and been the first to graduate college in my immediate family, there were many along the way that provided encouragement and a helping hand. I would like to think that I can be that helping hand for Haitians – providing business loans for women, saving a baby’s life when her mother is suffering from seizures/eclampsia, removing an enlarged uterus so that a woman can better perform her household chores and providing education and hygiene products so that young girls are able to stay in school during their period. Yes, Haiti is a destitute country that has suffered from both outside forces and its own corruption. But its people are willing to change that – if we would only give them a fighting chance. And remarks such as those from our President don’t help to provide that chance.

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For those of you who have been following this blog over the past few years, you know that I am passionate about all things related to women’s health care. Considering that my job as an Ob/Gyn physician is intimately interwoven with this topic, it is only to be expected that my children are exposed to my opinions during conversations at home. They also hear about my experiences in Haiti and are often recruited to assist with the construction of reusable menstrual pad kits that are distributed to young Haitian girls to encourage them to remain in school after they start menstruation.

May 28th (5-28) is Menstrual Hygiene Day and is dedicated to creating awareness around an often taboo subject. The 5-28 has significance in that most women bleed for 5 days every 28 days. Although Western civilization has made great strides in the past few decades around menstrual health education, the stigma and embarrassment for young girls persists. My daughters and I were finishing a restaurant meal when we noticed that the girl leaving the table next to us had a large blood stain on the back of her dress. We looked at each other with horror while having a hurried discussion about whether it was less embarrassing to run after her and inform her of the stain vs. letting her find out herself. The decision was made as we heard the door of the restaurant close behind her and our chance was lost. Would we have wasted time in discussion if the bleeding had stained her clothes from a large cut on her leg? The blood is the same but the source so much different.

When my daughter informed me that she was combining both of the above experiences into one argumentative essay for her final AP Composition Essay, I had to smile and then pity the male teacher who was to be subjected to her strident opinions. This same teacher (late 30’s) admitted that he has never purchased feminine hygiene products for his wife and had no advice for sources of information to help support her argument that luxury taxes should be abolished on tampons and pads. Because of the work of humanitarian organizations such as WASH in developing world countries and women’s health advocates in this country, resources for information were plentiful.  I have included the first part of her essay below.

Luxurious Taxes

Toothpaste, sunscreen, chapstick, shampoo, condoms, viagra. All daily items, all exempt from taxes. Daily essential items that are categorized as a necessity and aren’t taxed. Items thought to be a luxury, however are taxed. Flowers, cell phones, nail polish, TVs, computers, and jewelry. They add pleasure to your life. Those items are bought by choice and personal interest. What defines whether an object is declared a necessity or a want? Does the gender of a buyer for an object affect the tax, non-tax ruling? Tampons are taxed, but females need them to tend to their monthly periods. Taxes should be removed on tampons in every state. They are looked upon too lightly and assumed to be more of a extravagance and less of need. They are the “pink tax”.

My mom is an OBGYN and she sees female patients on a daily basis that revolve around period defects. Patients are suffering from heavy streaming periods and other dysfunctions that are uncomforting. They have to change tampons more frequently than an average person. Changing tampons every hour is inconvenient and costly.  My mom works with women to try and assist them in feeling more comfortable with the unnatural feeling periods and other dysfunctions of being female and save them time and money from buying so many tampons. However seeing a doctor about menstrual issues becomes even more costly when trying to fix your awkward period malfunctions. Women are feeling embarrassed and uncomfortable.

Tampons. They are declared a luxurious item in thirty-eight states of the United States. On holidays, taxes are removed on some everyday items, however, tampons and pads are still taxed on those special occasions. Tampons are still looked upon as a non-essential item, as if they are used by choice. As if women choose to go out and buy a $7 box of wonderful cotton plugs. As if women choose to have periods every month for an average of thirty-six years of their life. As if women choose to spend close to $2,000 on such a “luxurious” item as a small cylindrical object made of cotton. As if women are being spoiled with an item to protect their blood from leaking out. What a treat.

Tampons aren’t flowers. People wouldn’t buy a box of tampons for their friend’s birthday. Tampons are a common piece of feminine hygiene that keep blood from spilling out uncontrollably and make periods a little less worse. Periods are a naturally occurring part of a female’s life that they can’t prevent, not to mention the berserk side effects of mood swings, cramps and cravings. Tampons and pads have to be used to prevent blood from pouring out and leaking everywhere, time after time after time.  Every second you feel uncomfortable blood shedding; every minute you’re hesitant of leaking; every hour you’re contemplating if you need to change tampons; every day you’re in fear of the current of your flow; every week you wonder when it will be done. Periods aren’t a choice. Tampons aren’t a choice. They are a need. Tampons are calculated to be needed for 456 periods, 38 years, and 2,280 days (2015, Kane) of a female’s life. Tampons are a female necessity.  

Although her grade for the entire essay was high, the one critique by her teacher is evidence that we still have some work to do in this country when it comes to education around menstrual health. He penned ” too graphic”.


The work that needs to be done in developing world countries is even greater.  There is a growing awareness that less stigma around menstruation results in better lives for both boys and girls. Girls that stay in school beyond the age of menstruation because they have access to a private bathroom as well as menstrual pads, also have fewer children and are better able to secure a job to support their family because they have obtained a higher level of education. My involvement with the sewing center at Helping Haiti Work has reinforced what I have seen researched. The need for menstrual protection supplies in schools is recognized, but the thirst from teachers and students for education is even greater. Our Haitian seamstresses have been provided with women’s health training and given charts and pelvic models to use in their educational sessions. For $16 a day they will assist in the distribution of the reusable menstrual pad kits and provide 3-4 hours of education to teachers and students.


My hope is that a future granddaughter will pen a similar essay to the one above for her ancient history class and use our current experiences as the beginning of the end when it concerns the menstruation taboo.




The Power of Globalization

While many of my friends were participating in the Women’s March on Saturday, I was proud to be working with a group of seamstresses who were busy demonstrating the power of globalization and how it can be used to benefit others. 30 women and 1 man showed up to construct reusable menstrual pads for distribution to school girls in Haiti, as well as prepping fabric for our Haitian seamstresses to construct the same kits and earn a livable wage. We were our own march for the equality of women throughout the world, signifying that Women’s rights are Human rights. Helping others less fortunate causes all of us to rise; attempting to divide women by country, sexual orientation or race will only make us more resolute and determined.

The Haitian Birth Plan


If you asked a pregnant woman in Haiti, or any other third world country, what her birth plan entailed, she would give you a blank look followed by the words, “Get the baby on the outside and let me live”.  American birth plans, as detailed in my previous post, are unimaginable for these women. They have heard of women who have died during childbirth or of babies that are stillborn. Misperceptions about pregnancy and childbirth abound and are passed from mother to daughter. These same misperceptions are also frequently present in the medical community. During our medical mission trips each year, we work with health care providers to educate about contraception, safe pregnancy and labor care. The more difficult teaching involves compassionate and respectful care of women. Haiti is no different from other countries who have a large portion of the population that are extremely poor and a small elite that are educated. Working hard each day as a physician or nurse caring for hordes of patients often leaves minimal emotional energy left for sympathy.

When I was in Haiti this fall, I had the chance to deliver 20  reusable menstrual pad kits that contained the new “high flow” pad to the birth center of Heartline Ministries. The facility is beautiful while also providing whole woman care for pregnant Haitians. Many of the women in their care have conflicting feelings about pregnancy and use the time of prenatal care to better accept their situation as well as provide for improved bonding after birth. Strengthening Haitian families works to prevent children from becoming orphans – a situation that is all too common in Haiti.

You can learn more about Heartline Ministries here. Our  Days for Girls high flow kits were distributed and  met with  favorable ratings, which is not common when you try something new in Haiti. The following video was made by Troy and Tara Livesay, directors of Heartline Ministries, depicting the birthing experience for a Haitian woman at their center.



The cover story for a  recent Newsweek (here) details the fight to end shaming about periods in both  the US and abroad.  Mention of the word “period” has tripled in mainstream media over the past 5 years.  Even Donald Trump has entered the shaming discussion around menses when he commented about Megyn Kelly and “blood coming out of her eyes”.

My previous post about Menstruation – the last taboo is the most visited post I have created. Since publishing that post 2 years ago, the articles that have been published on the topic and organizations that have been created to increase awareness and accessibility for  feminine hygiene products have exploded. Finally, we are beginning to bring the conversation about a natural process that happens monthly to almost every woman, from early adolescence until midlife, out of the closet. By speaking more openly, we will also reduce the myths and lies that surround 12 weeks of our lives each year.

In the history of the world, pregnancy and childbirth are other female only functions that has been cloaked in secrecy. It was considered poor manners for women to be seen in public once their abdomen was large enough to signify that they may be pregnant. They became confined to their homes until the child was born and for weeks afterword (this is the source of the term “estimated date of confinement” or EDC) Men were not allowed to enter the room where childbirth was taking place, as the room and air were considered unclean. Instead they hung out in bars or waiting rooms while their wives were experiencing the most treacherous journey of their lives. Fortunately, we have moved beyond this system and now expect fathers to not only be present in the delivery room but also an active participant. This has made fathers more sympathetic to their partners as well as increased participation in the lives of their children.

Can we accomplish the same progress with awareness about menstruation that we have with childbirth?  My daughter recently showed me this video (here) that would lead me to believe that the answer is yes. The discussion for girls about menstruation usually occurs during sex ed class in fifth grade and between mother and daughter. Although boys have their own version of sex ed at this same age, it involves the mechanics of a period and not the social or financial impact. What if boys in high school health classes had to wear a pad for a few days and find a bathroom or supplies at the last minute? An economics lesson would be used to  calculate the cost of feminine hygiene products over the course of a year and then a woman’s lifetime. Discussion around period shaming and slang with their female classmates would benefit both boys and girls.

The precedent for this education in high school has already been set. Boys and girls can be seen carrying around a “smart doll” for a few days during their health class, needing to feed and diaper the doll on a real-time schedule, including waking at night. This experience has been shown to increase awareness about the responsibilities of parenting, helping to decrease teenage pregnancy. Might not the same awareness improve with a “Menstruation Day”?

The awareness about menstruation that needs to be accomplished in the developing world is far greater than here in the US. Many young girls never have a conversation with their mother or older female relatives before they start menstruating. They have often seen or heard of a relative dying in childbirth by bleeding to death, so they often think that that is what is happening to them. If the family is struggling to feed themselves and live day to day, their is seldom money to pay for feminine hygiene products. Old rags, straw, grass and sitting on a blanket are a poor substitute for a clean, absorbent piece of cloth. Thankfully, this has become a hot button topic in the NGO circles and has lead to many innovative products to serve the needs of girls and women. I am currently working with Days for Girls to create a sewing center in Haiti that creates reusable menstrual pads for sale as well as providing menstrual education to girls in area schools. In speaking with our seamstresses, we have been amazed at the lack of knowledge about female reproduction that exists even among adults. The following  quotes  were given to us by recipients of our program:

“The ‘culture of concealment’ surrounding menstruation has influenced women to feel ashamed about their bodies, and this imposed shame makes us docile, unquestioning consumers of products that are neither good for us, nor the environment.” School headmistress

“Girl’s kits are so amazing! They feel so comfortable against my skin, they absorb so well, they did not feel sweaty or hot, they are super cute! They do not stink at all! And oh my, they save so much money!” Student recipient of a menstrual pad kit


Bring the word “period” out of the closet. Advocate to eliminate the luxury tax that is imposed on feminine hygiene products. Talk to your workplace about putting free tampons/pads in bathrooms. Let’s help our sisters in the developing world by increasing awareness here at home.



International Women’s Day – We have come far, but not far enough

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College visits are on my calendar for child #4, the first time we as a family have made this journey for a daughter. Spending time on a college campus with a son who is a potential freshman is much different than a daughter’s visit. For one matter, there is more conversation happening between parent and child. Just like shoe choices, girls need to visit more colleges before making their final decision.

As a potential college student in the late 1970’s, I visited 2 colleges, both within a 2 hour drive of my home. I was the first person in my extended family that had considered a college degree and my parents had no clue about the process.  America has come a long way since my college visits in the late 1970’s. Today 55-60% of college freshman are women, 50% of medical school enrollees are women and 90% of ob/gyn residents are female. But what happens after women graduate and get into the workforce still needs some attention. America is one of the few developed countries that does not have a paid maternity/paternity leave policy. Childcare is disproportionately expensive and the reason that many women in low paying jobs are unable to use their skills outside the home. Sexism is still a factor in most workplaces – now more subtle than overt and possibly more difficult to address.

After working in the field of medicine for 24 years, you would think I could become immune to some of these injustices, but it still hurts when you spend 30 minutes explaining surgical options to a patient and at the end of the conversation the patient asks who will be performing the surgery. “I thought you just delivered babies and weren’t a surgeon”. Surgical instruments are made with a one size fits all mentality – unfortunately I have hands that are on the smaller end of normal. Surgeons who perform their job well are driven, expect perfection from themselves and others, directive and need to put their emotions aside at times. Those qualities are often not consistent with a traditional female role.  I have had male physician partners inform me that two children for a working woman is sufficient and I was not an adequate parent when I increased my family size. Others have informed me that a marriage will suffer if a wife brings home more income than a man (my husband is firmly on the other side of this statement and we have been married for 31 years).

All of the above aside, I feel very fortunate with my life circumstances when I compare myself to the majority of women in this world and especially those women I work with in the developing  world. They frequently have no options for work outside the home as all of their day is spent performing household tasks – cooking, fetching water, taking care of children.  They are forced into marriage at a young age and don’t have the option of contraception to delay childbearing or space our their children. Education is often not available to female children or they leave school early to help their mothers with household chores. Women are seen as possessions, only to be discarded if they do not produce children (or more importantly male children) or have an illness.

It is not a surprise that the happiest nations in the world are those who come closest to sexual equality. They may not be the richest countries, but countries like Iceland, Denmark and Sweden acknowledge that woman have a place in the workforce by supporting paid maternity leave of up to a year and subsidized childcare. 30-40% of government positions are held by women, which helps to influence legislation.  Contraception is low cost and available to all women, whether they work for a religious institution or private corporation. These provisions benefit not only women but also their partners and families.

So while we need to work with developing nations to empower women and girls, we also need to work for change in our own country so that women have equal choices to men once they graduate from college and enter the workforce.


School girls in Haiti receiving reusable menstrual pad kits and education about menstruation

Menstruation Sensation


February 2014 was when I read my first article about the need for feminine hygiene products in the developing world. My blog post, The last taboo – Menstruation, written in April 2014 has been the most viewed of my posts as well as the post that has generated the most traffic from international viewers. There has been an explosion in international awareness of this problem for girls and women and this awareness has driven incredible innovation in a short amount of time. Along with an increase in feminine hygiene products for the developing world has come a breakdown of barriers around the discussion of this taboo subject. Both of the organizations described below provide an educational component to their work, teaching young girls about their bodies and how to safely care for themselves.

Aakar Innovations in India has developed a disposable pad using agricultural waste. This pad is biodegradable as most rural villages lack proper sanitation. Aakar has recently expanded to a “business in a box” model in which others can purchase the equipment needed to set up their own small business. Twenty one such small businesses are now operating in India and one in Kenya. This business can provide employment for 15 women and produce 2000 pads a day.

SHE in Rwanda has been using the refuse from banana growers to create absorbent, biodegradable disposable pads. In the past  growers had no market for the used banana trees, but now they are being paid for their waste. The factories are locally owned franchises that employ local woman and sell a superior, less expensive product.

So what does all of this mean for Haiti? It allows us to collaborate with these organizations as well as other NGO’s already in Haiti to bring women choices for feminine hygiene. Just as in a developed country, not all women use the same product throughout their reproductive life. Haitian women may not have as many choices as the aisle in Target, but they should have a choice between reusable and disposable. And the disposable product should not be an environmental problem (it can take hundreds of years for a plastic pad to decompose).

Helping Haiti Work, a non-profit I started in 2012 to give Haitian women microloans, is exploring the possibility of starting a new venture that would produce these disposable pads. We are using nursing students to trial both the reusable and the disposable pads and give us feedback.  Hoping that we are the first menstrual pad factory franchise in Haiti!