“The Worst Place to Be a Woman”

Photo by Loran Hollander in Democratic Republic of Congo
Photo by PT Loran Hollander in Democratic Republic of Congo

The following post comes from my dear friend and colleague, Laura Keyser.  Along with another colleague, Loran Hollander, Laura and I connected in 2009 when the two of them needed a willing physical therapist with a heart for global health and knowledge in female pelvic health and obstetric physical therapy.  They were working at HEAL Africa Hospital in Goma, Democratic Republic of Congo for nearly two years and I did everything I could to support them in developing rehabilitation services for women with fistula.  The three of us have continued to grow as collaborators and in friendship, advancing our work in this field, recognizing this program in name as FORI, the Fistula and Obstetric Rehabilitation Initiative, and bringing it under the auspices of The Women’s Action Initiative, parent non-profit of this other little project…Share MayFlowers.  Last Thursday marked 10 years in the United Nations declaration to bring an end to obstetric fistula worldwide and will henceforward be known as The International Day to End Obstetric Fistula.  Laura, Loran and I; WAI, FORI, and Share MayFlowers all are committed to this cause and to the awareness building, education, and action it requires.  Our history bears this out and our future is unfolding, most presently with a follow up trip Laura is planning to Congo in a few short weeks, a work trip she is making to join me in Boston (starting tomorrow!), and Loran’s photos included in a CNN Online story that ran on Thursday.  Feeling curious, ask.  Feeling generous, donate.  Feeling moved, share.  Feeling floral, you can share mayflowers (donate specifically to send MayFlowers with Laura as a gift for women who ‘graduate’ from their fistula care! Donate online or email Jessica@sharemayflowers.org for more info).

I listened yesterday to a podcast of Melinda Gates speaking at Stanford about the work of the Bill and Melinda Gates Foundation.  She called particular emphasis to what she learned and gained by listening and talking to the women she has encountered in her worldwide travels on behalf of the foundation.

An important lesson for us all.


When Jessica asked me to write a blog post about my experiences and perspective on women’s health in a global context, I thought, ‘Sure, this will be easy, I have plenty of international experience and scads of opinions about what works and what doesn’t in terms of providing health care to women.” Then I sat down to write something…and was struck by an exhausting mental fog. You see, I just returned from a three-month stint at a rural, community hospital in the jungles of India. And in the last ten days or so since I’ve been back, I’ve been in a flurry trying to plan my next endeavor to eastern Congo in a few short weeks. Sitting at my laptop for hours yesterday, contemplating the best ways I could contribute to improving women’s health around the world, my thoughts ran in circles as I wrote and deleted, wrote and deleted, wrote and…well, it went on like this for some time. (I managed to scrape together a few paragraphs about why the health of women remains subpar across the globe and how it is tied to poverty, legal rights and socio-cultural beliefs—and how women only seem to be cared about while they’re pregnant.  We rarely acknowledge the health concerns women and girls face across their lifespan.)

And then I thought …you’d much rather hear stories than statistics. The evening fell, and putting my computer aside (in favor of a glass of wine), I sat with my best girlfriend – a teacher, mother, wife, and sister – and started the conversation about women’s health. We talked about her experience giving birth in America, how much or how little her doctor told her about the physical changes her body would go through during pregnancy. We talked about stress incontinence, and how our moms joke about how they can’t run or cough or sneeze without leaking a little. And then she said, “Women just do what needs doing.” They don’t make time to complain or to challenge what has been accepted as normal because they don’t have time between getting out the door to work, picking the kids up from school, fixing dinner, washing the dishes, and everything else that “needs doing”. We see Poise pads advertised on TV, and we think, “there’s the solution!”…we can put one on and keep “doing.” And no one tells us anything different. Not our doctors, not our mothers, not our friends and colleagues. We just do. Until the conversation changes, we will keep on ‘doing.’

And then I thought back to the precious time I’ve spent with the women of the Democratic Republic of Congo, each with her own experience of being a woman in war-torn Congo. Some were colleagues – doctors, nurses, physical therapists, counselors. Some were patients. Some were friends. With them, I started the conversation about women’s health. We talked about rape and domestic violence, and the struggle to earn enough money to feed their children. We talked about our bodies, the changes they undergo during and after pregnancy. We talked in detail about how and why obstetric fistula happens, because it happens a lot in the Congo. We talked about survival in a society that has tragically been dubbed “the worst place to be a woman.” And then we laughed over a shared meal, finding joy in each other’s company, searching for ways to make life a bit easier. And the conversation continued…leading many of my friends, colleagues and patients to find ways to empower themselves, whether through pelvic floor exercises to prevent incontinence, sharing their stories of recovery from sexual violence, or caring for other women and children in their communities. So like many women in the US, the women of the Congo keep on “doing.” They fetch water, they cook and clean, they work, they survive. And they talk, and they share.

And then, I thought about my time in India, where I also worked with women, as colleagues, patients, friends. There, I started the conversation about women’s health. We talked about back pain, pelvic pain and stress incontinence and how physical therapy and exercise can help with these conditions. We talked about marriage and how often, young girls, 15 or 16 years old, are married, sent to live with their husband’s family, and bear children without knowing anything about sexual health or pregnancy (aside from what their mother-in-law might tell them on their wedding night). We giggled and exchanged awkward glances, as we opened up a conversation that, for many, had never been on the table. We shared experiences, we educated each other, we reached out to the impoverished and malnourished young mothers who simply go on doing what needs doing, until someone tells them that the conversation has changed. And we also laughed, shared a meal and found joy in each other’s company, and we searched for ways to make life a little bit easier.

And so, you see, a common thread weaves us all together as women living in the world we live in, doers of what needs doing in our lives. And we raise each other up simply by starting the conversation, by sharing our experiences, by teaching each other about our own bodies, our own sexual and reproductive health, by no longer keeping quiet and hidden, by refusing to accept pain, incontinence, and disability as normal, by working to change the status quo. While women will go on doing, I hope they will also go on sharing. And we can all be a part of that conversation. So, let’s weigh in. Let’s talk about our experiences, our problems, our solutions. Let’s share mayflowers.

-Laura Keyser

Laura Keyser is a physical therapist with U.S.-based experience in pediatrics, neurological and post-trauma rehabilitation and background as a ballet and modern dancer and over 2 years’ experience as clinical faculty at HEAL Africa hospital in the Democratic Republic of Congo.  Through her current work in The U.S., Africa and Southeast Asia with the non-profit organizations Women’s Action Initiative and Global Strategies, Laura aims to prevent disability among mothers and infants and to promote full community participation and optimal quality of life for both.

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