Eugenics in Peru

Indigenous Peruvian woman carrying her child on her back with mountains in the background
Quechua Woman and Child. Source: Quinet, Creative Commons

Many people don’t know what the eugenics movement is. Others know what it was, but think it was restricted to Germany’s sterilization—or making people unable to reproduce—of millions of people they saw as unfit: Jews, people with mental and physical disabilities, and the LGBTQ community, among others. However, Germany was not the first or the last to sterilize certain citizens in an attempt to “better the gene pool”; the United States’ policies actually inspired Hitler’s eugenic goals. After WWII, the United States publicly condemned sterilization and eugenics, but the last forced legal sterilization in the country wasn’t until 1981.

Eugenics has operated as a science of improving humans, whereby the procreation of the people deemed fit is promoted and procreation of those deemed unfit is limited. Proponents of eugenics believe nature wins in the nature vs nurture fight; if you’re born into poverty, it’s because you have a gene that’s keeping you there. Throughout history, the groups of people that were deemed unfit were those in low socioeconomic groups, minorities, and epileptics, most of which were women—basically, the people that didn’t fit the mold. They did this under the broad and vague diagnosis of “feebleminded”.

While the sterilization of poor and minority women in the United States is over, eugenics still goes on today. There are groups of people targeted by the modern eugenics movement—one of which is indigenous people. In Peru, almost 300,000 people—mostly poor, indigenous women living in rural areas—were sterilized between 1996 and 2000. Most of these sterilizations were forced or coerced, and some even led to death.

Then President Alberto Fujimori ran on a campaign of expanding health care and lowering poverty rates. However, instead of providing contraceptives to indigenous women, doctors forced sterilizations on them. Fujimori claims that doctors that forcibly sterilized women were not following the strict regulations that were put in place to prevent these occurrences. However, many of the doctors who performed these sterilizations have revealed they were given quotas to fulfill: “Dr. Hernando Cevallos… received an order to sterilize 250 women in 4 days in 1997.”

There were many ways doctors reached their quotas. Some sent public health officials to the homes of women with large families and pressured them to be sterilized even if they wanted more kids. For example, officials visited Gloria Basilio multiple times until she finally agreed. When she changed her mind in the operating room, they restrained and blindfolded her so they could continue with the surgery. Some of these women are illiterate or don’t speak Spanish at all, so the officials took advantage of that and got them to sign the consent forms without them understanding the procedure. Other officials never tried to get informed consent. Women have been pressured to be sterilized moments after giving birth.

These women have been affected in a far greater way than just being unable to have children. One woman had serious medical complications, which were written off by the doctors. She died less than two weeks later at home. She is not the only woman to have sterilization disable or kill her.

Aside from medical complications, they also experience social and mental complications as a result. In the indigenous culture, women are expected to have many children, and women who have been sterilized can no longer serve that purpose. These women can lose a sense of purpose in themselves and also lose the people close to them who were counting on them to have children. Maria Elena Carbajal, a woman who was pressured into a sterilization after giving birth at the hospital, lost her husband because he thought she had willingly been sterilized so that she could be unfaithful without consequences. She found another partner, but he also left her because she could not provide kids. Additionally, these women have to face the fact that they will never have more children—while some will have none at all. Florentina Loayza was only 19 years old when she was forcibly sterilized. She hadn’t had kids, but she wanted some, and she often felt “a deep sadness” whenever she saw a baby.

Another profound impact this has on many women is their connection with religion. Some religions, Catholicism included, believe that sterilization is a sin and that those who have been sterilized, voluntarily or not, have sinned. Justina Rimachi was told by nuns that she could no longer come to church because she had been sterilized. The stigma felt within the walls of a place that felt like home were only relieved by the forgiveness from the priest. He did not tell her it was not her fault, but he did not tell her to leave, so she was grateful.

The crimes against these women were atrocious, and luckily, they are starting to receive attention. In November of 2000, Fujimori stepped down after ten years of presidency. It wasn’t until 2009 that he was arrested and sentenced for some of his crimes, but none of them were for the sterilizations that occurred under his regime.

Some women and their families have received settlements and the Peruvian state promised in 2003 to conduct investigations. However, the Peruvian state continues to deny that the government had a part in the forced sterilizations. They blame instead the public health officials and medical practitioners. To this day, the Peruvian government, which is no longer under the control of the Fujimori regime, has not issued apologies or reparations to the survivors and their families.

While the government continues to deny its role in the sterilization of indigenous people, activists and human rights organizations are trying to call global attention to these injustices. One group, The Quipu Project, has used a free telephone service to collect the stories of over 150 people who have been sterilized, and the number continues to grow. You can hear these stories on their website in Spanish and in English. Not only is this campaign used to bring international awareness to this issue, but these stories are also being used by people fighting for justice within Peru.

COVID-19 and Healthcare

two doctors demonstrate glucometer to patient.
How to make most of doctor’s appointment. Source: Army Medicine, Creative Commons.

COVID-19 has had a significant impact on the lives of billions across the globe from a disruption of our daily lives to the loss of loved ones to the severe financial burden that has been placed on the world economy. One aspect of society that has been disproportionately affected is the healthcare system. Aside from the financial impact on healthcare systems the way we receive our general healthcare is changing rapidly with this new pandemic. While our primary concern internationally is getting control of this pandemic, non-infectious and chronic conditions are still prevalent and at an increased risk of being neglected.

With the increase in COVID-19 cases in every part of the country, people are being discouraged from coming to hospitals and doctors for non-emergent care. This means that primary healthcare visits either have to be postponed or done through telehealth, which is a remote visit. While telehealth is a great way to have normal checkups without having to go to a doctor’s office, many insurance plans don’t cover telehealth, which makes it harder to afford necessary visits safely.

Additionally, many people no longer have the financial stability they used to. With the downturn in the economy, not only are people who are working making less, but there are also some that have been laid off or furloughed and no longer have access to insurance through their employer. A quarter of those that remain insured have deductibles that are $2000 or higher, which they can no longer afford. This means that in addition to postponing primary care visits, more emergent and necessary visits are being put off.

Those with chronic conditions face more barriers than before to receiving health care. Those with underlying conditions are more likely to have a severe case if they contract COVID-19. However, they need continual care that must be done at least occasionally face-to-face. For example, people with cancer must continue to receive treatment, but many times that treatment makes them immunocompromised. Because of the increased risk, many hospitals no longer allow visitors in, which can decrease patient morale. Many patients also run the risk of having their treatment delayed due to coming in contact with someone that has tested positive for Covid-19. Many chronic conditions, like cancer, are time sensitive, so delays in treatment can be devastating.

Another group of people that have had their healthcare greatly impacted by COVID-19 is pregnant women. There are many check-ups that women are recommended to attend when expecting a baby to ensure the best health possible. However, with the pandemic, that has become harder. There is no evidence that pregnancy makes it more likely to have a severe case of COVID-19. Additionally, there is no evidence that it can be transmitted to a fetus. It’s still important that pregnant women do everything they can to prevent coming in contact with COVID-19. To help in that effort, many OB/GYNs have reduced the number of visits pregnant women should attend in person, switching these visits to telehealth visits.

While a mother cannot pass COVID-19 to her unborn baby, the baby can contract it after birth from her or any other caregivers. To prevent spread to new babies, nurses, and doctors, many mothers are tested when they arrive at the hospital to give birth. Additionally, those that have scheduled C-sections are sometimes tested at home.

doctor performing a checkup on an infant
Dusti Tellez, a registered nurse at Naval Hospital (NH) Jacksonville’s maternal infant unit, holds a newborn baby for a checkup. Source: U.S. Navy, Creative Commons

According to UNICEF, around 116 million babies will be born during the COVID-19 pandemic. These babies along with the babies born shortly before the pandemic will be missing important doctor’s appointments. The appointments in the first two years of a child’s life play a large role in the child’s overall health for two reasons. First, children will typically receive vaccinations at these appointments, which will keep them from contracting deadly, but preventable diseases. The growing number of children who will not be receiving their vaccinations on time raises concerns about outbreaks of diseases that we’ve kept at bay while also still in the midst of the COVID-19 pandemic. Second, these visits are a good way to track the health of children early as screening for conditions, such as developmental delays, are frequent, and catching them early can give kids with these conditions a helpful jumpstart. Because of these two reasons, many experts advise parents to keep children’s visits up to date, but parents are still hesitant.

In addition to regular checkup visits, people are hesitant to go to the emergency room when they need to for non-COVID-19 related illnesses and emergencies. Hospital visits in the Baptist Hospital system in Memphis, TN were down 27 percent between March 15 and April 15 compared to the month before. Additionally, they noticed that the people that were coming in were more likely to have to be admitted instead of treated and sent home. This means sick people are staying at home longer for fear of COVID-19, and some are dying at home from treatable conditions.

Finally, there are areas of healthcare that are overlooked when we mention essential healthcare workers. My mother is a home health physical therapist, which means she goes to people’s homes to work with them. She mainly works with elderly people, and often visits nursing homes and assisted living facilities. According to her, these places have stricter requirements than before when it comes to letting people in: visitors have to have their temperature checked and have a symptom screening. Some facilities don’t even allow visitors anymore, even for wound care or physical therapy. While therapy might not seem essential, it is often used in this population to prevent accidents, like falls, that would send them to a hospital, where they would be even more at risk of contracting COVID-19.

While many of the changes to the healthcare system are temporary, like the decrease in general healthcare visits, some may become permanent. Telehealth has been shown to be beneficial for healthcare visits that don’t require tests and scans. In fact, many shy children have felt more comfortable with these visits. Additionally, the precautions taken by nursing homes and assisted living facilities when it comes to screening visitors make sense during flu season as the flu kills the over 65 population at a disproportionate rate. While the pandemic has changed some things for the worst, it has also helped us find where some changes need to be made to increase our safety in the future.

Coronavirus and Racism

informational poster on coronavirus and travel
Coronavirus Public Alert Oslo. Source: Annikdance, Creative Commons.

At this point, I’m sure almost everyone knows about COVID-19. With schools shutting down, conferences being cancelled, and travel being restricted, even those in uninfected areas are affected. However, while some of us are most worried about washing our hands and not touching our faces, some people have to worry about discrimination. Those of East Asian descent are being discriminated against all over the world, whether they’re from China or not, whether they’ve been in infected areas or not, whether they’re sick or not. COVID-19 is bringing out racism that has laid dormant, and, unfortunately, this isn’t the first time it has happened.

Historically speaking—especially before the scientific knowledge we have now—large outbreaks were blamed on minority groups. In 14th century Europe when the Black Death occurred, many looked for an answer, and when they couldn’t find an answer, they found a scapegoat: the Jews. They were seen as nonconformists by the Christian majority and were subsequently blamed for the outbreak that would be known as the Black Death. Many were tortured until they made false confessions and killed, and their persecution continued centuries later.

Since then, almost every major outbreak has illuminated underlying racism within the global community: when syphilis appeared in Renaissance Europe every country blamed another; Irish immigrants were blamed for the 1830 cholera outbreak; and Mexicans and others from Latin American countries were discriminated against during the Swine Flu epidemic in 2009.

Most recently, the Ebola outbreak of 2014 brought out racism towards those of African descent. College admission was denied to two Nigerian students to Navarro College, and a Guinean high school soccer player attending school in Nazareth, Pennsylvania was heckled by the opponent’s fans, who chanted “Ebola” at him. Americans hesitated to shake hands with people of African descent, whether they were American or not, and the US imposed a travel ban to and from West Africa.

What we are seeing now with COVID-19, is similar to what we saw during the 2003 SARS outbreak. While the Ebola outbreak illuminated prejudices towards African Americans, in 2003, those of East Asian descent, regardless of their nationality were discriminated against in certain areas. The three Chinatowns in Toronto, Canada were empty for weeks, East Asians were constantly asked if they were sick when no one else was, and they were avoided when they went out in public. In Canada, there is the stereotype of yellow peril that labels Asians as “unsanitary, lower-class, and alien.” This stereotype obviously found root in SARS and only exacerbated these prejudices.

picture of xenophobia in the dictionary
Spiritual Xenophobia. Source: George Ian Bowles, Creative Commons

Unfortunately, it seems like we haven’t learned from these numerous outbreaks, and the racism and xenophobia along with COVID-19 is way more widespread and way more violent. A man attacked an unidentified woman was attacked on the subway in New York, and reports say that the confrontation was a result of the Asian woman wearing a mask. Like in 2003, the discrimination is not restricted to people of Chinese descent: a man singled out a Thai American lady on a bus in LA. He gestured at her while saying that “every disease ever came from China.” Finally, in Indiana, two men of Asian descent were denied a room at a hotel and told that if they were Chinese, they’d be “picked up and quarantined for two weeks.” All of these attacks were before any deaths occurred in the US.

These incidents aren’t unique to the Untied States either. In London, a student from Singapore was attacked in a busy shopping area. While he was being attacked his assailants told him, “I don’t want your coronavirus in my country.” He was left with fractures on his face, and he might need reconstructive surgery.

The racism that is emerging is not new, it has just been hidden. The fear that everyone is feeling is being redirected towards previous biases. The student from Singapore reported that he had been experiencing racist comments for the entire two years he had been studying in London. Because COVID-19 originated in China, the racism already present towards those of Asian descent has been exposed, and thanks to misinformation, it continues to grow. Fear has been shown to bring out the racism that already exists within people, not cause it.

In times like these it’s important to know the facts because that’s how we fight this discriminatory fear culture: Asians are no more likely to have COVID-19 than the rest of us. No one is any more likely to get COVID-19 because of their race or ethnicity. Despite the virus originating in China, there is no evidence Chinese people or Asians are predisposed to infection. Secondly, just because someone of Asian descent is wearing a mask, it does not mean they’re sick. In many East Asian cultures, it is normal to wear a mask year-round, not just when you’re sick.

It’s important to spread the facts. One of the biggest factors in discrimination is ignorance, so education is the best way to fight it. People are scared, and that is bringing out the prejudices they’ve kept hidden and might not even know they had. Additionally, catch and correct yourself when you think or do something with prejudice. Start improving our global community by improving your own thoughts.

COVID-19 is a pandemic, and it’s a serious infection, especially for the elderly and those with preexisting health conditions. However, the racism and xenophobia are spreading just as fast. As a global community, we shouldn’t add to the burden of this disease by using it as an excuse to be discriminatory.

Water Insecurity in the United States

Dirty water spilling our of a glass jug
Dirty water spilling out of a large glass carboy on its side. Source: Ildar Sagdejev, creative commons.

Access to clean water and sanitation is rarely something we have to worry about here in the United States; it comes out of faucets and water fountains at a seemingly endless supply. However, in many parts of the world—including some areas of the United States—access to clean water and sanitation is a major issue and can affect more than just people’s physical health.

In 2010, the UN recognized access to safe water and sanitation as a human right, and the issue was included among the UN’s sustainable development goals in 2015. With the UN’s focus on clean water access, many developing countries have started making efforts to increase access. However, many developed countries, like the United States, have neglected to develop their rural areas, which leaves a significant portion of their population without clean water for drinking and sanitation purposes. In fact, their situations can be similar to situations in developing countries.

Many Americans would be surprised to know that in more rural areas, it’s often not uncommon for people to go without a sophisticated sewer and water system because the infrastructure has not yet been built. In Lowndes county in Alabama, a largely rural and agricultural area, less than one fifth of the population has a safe way to dispose of their sewage waste. This issue can cause the sewage to back up into their systems or to overflow to their backyards. Neither of these outcomes are ideal for promoting health.

The people that are mainly affected by water insecurity and a lack of clean water in the United States are those that are already disadvantaged; the higher your income, the more likely it is you will have complete and adequate plumbing. This leaves those that live in lower socioeconomic areas with lower performing schools and fewer resources more likely to experience issues like inadequate plumbing and lead-contaminated water.

The systems that have the most problems are the ones that serve rural communities. When a city has a sewer issue, more people are paying for the water, so the extra cost is distributed more widely. In a rural community, there are less people to distribute the cost across, so it’s harder to come by the money to update the sewer systems. Because smaller communities have a harder time paying for necessary repairs and upgrades, the residents in these areas have to choose between drinking contaminated water or paying for bottled water.

Another issue that arises is when communities have a city water system but lack the appropriate people to run it. Some areas have no one to run their systems, while other rural sewer systems are operated by volunteers. In Kanawha Falls, West Virginia, a resident was elected to clean the water, but failed to test and report the water, and the state threatened to arrest him. Scotts Mills, Oregon cannot afford to hire workers for the water system, so they rely on volunteers and community reports of smells to know when work needs to be done.

Because some systems don’t have the staff and infrastructure to test regularly, many don’t realize their water is contaminated until they experience an adverse health outcome. For example, in Kanawha Falls, cited 2 thousand times over ten years for not testing and reporting water quality, a man who had skull surgery got two infections from the contaminated water. He now has to keep his head covered when he showers.

These problems aren’t exclusively in rural areas; lower-income areas—typically those in minority communities—also experience these problems. The most famous example is the lead poisoning in Flint, Michigan, where 62.6% of the population is a racial or ethnic minority. At one point, the lead levels—caused by improperly treated water corroding pipes—were almost three times past being considered hazardous waste. While the lead contamination was discovered in 2015, Flint is still dealing with these issues today. The lead’s effect on the community of Flint was enormous: children came down with a rash and mysterious illness; experts believe that lead was responsible for 198 to 276 fetal deaths; and twice as many children were diagnosed with lead-poisoned blood than before.

Flint is not the only area that has experienced issues like this, and Flint is not the only community at risk. Using income information and housing age, Vox and the Washington State Department of Health created a map to show what areas are more susceptible to lead poisoning. They also take the potential of lead paint into account, but the map shows that the at-risk areas are mainly cities, especially those that used to be industrial areas. Looking at the cities I know—Birmingham and Chattanooga—I can tell the areas at the highest risk are those that have a large minority population.

Water insecurity affects people’s mental health as well. Those that have less access to clean water experience more emotional distress. One thing many people, especially in urban areas, count on is easy access to water from their taps. However, when that easy access turns out to be harmful, like it is in Flint, anxiety and worry can rise. Parents that unknowingly gave their children contaminated water may feel guilt even though they didn’t intentionally give their children toxic water. In Flint specifically, levels of fear and anxiety were at an all-time high following the news of the contamination. In 2016, there were reports of parents coming to the ER with water-related breakdowns; many were distressed over the health of their children.

In areas where there’s a lack of water altogether, people can face similar issues. A lack of access to water—whether it be a loss of water through drought or a lack of water to begin with—has been connected to decreased mental health. Those in areas that are water insecure may experience anxiety, water-related emotional distress, and insomnia, among other symptoms. Additionally, the effects of dehydration play a role in mental health. Dehydration has been linked to increased stress, anxiety, depression, and panic attacks. Those facing water insecurity are more likely to become dehydrated, so these symptoms should not be taken likely.

Water insecurity and lack of clean water access disproportionately affect minorities and rural populations. This means these already disadvantaged groups are more likely to experience the adverse effects. Clean water access is considered a human right, but even here in the United States there are people suffering from a lack of clean water.

The Global Waste Trade

trash on Garbage Beach in Malaysia
Water Pollution with Trash Disposal of Waste at the Garbage Beach. Source: epSos.de, Creative Commons.

While the United States’ recycling numbers are nowhere near the highest, as a country, we continue to recycle more and more each year. Many people are able to send items for recycling from their home, which has made it easier for the average person to recycle. However, most people don’t know where their recycling is going after it leaves their house. Ideally, it goes to be sorted and then is sent to be recycled, but that is not always the case.

Before China’s foreign waste ban began in 2018, the United States sent over 70 percent of its plastic waste to China to be recycled, which China used to fuel its manufacturing sector. Because of the profit they made and their environmental regulations, they were able to cheaply take contaminated plastic and sort it. However, as China has moved away from manufacturing and sorting through contaminated plastic has become less profitable, they have less of a need for the recycling. Since they have stopped accepting foreign recyclables, recycling has become immensely harder for the countries who relied on China for a consistent way to affordably recycle plastic waste.

China bought so much of the United States’ recyclable waste that we never created the infrastructure to recycle all of the waste we create, so when China stopped accepting our recyclables, those in charge of recycling had to figure out where to send it. Much of this waste ends up in a landfill instead of going to a recycling plant.

Additionally, the Chinese recyclers needed to figure out what they were going to do after they would lose the majority of their business as well. Some liquidated their assets, hoping to make a final profit on decades of hard work, while others decided to take their services to other areas, often illegally. These illegal recyclers set up in countries where they are able to hire workers cheaply and can take contaminated shipments because the government can’t track their work like it can a recycling plant that is set up legally. This means they are able to pay more and still make a profit, which attracts countries like the United States and the UK.

Many countries in southeast Asia, like Malaysia, have been affected by schemes like this. When the US could no longer send their waste to China, we almost tripled our exports to Malaysia. With the growing market, many illegal recyclers have been able to fly under the radar. They edge out legal recycling plants by paying more for the recycling and taking highly contaminated plastics, about 70 percent of the which is unable to be recycled, is burned or discarded to pollute the nearby areas.

The increasing number of illegal recyclers is taking a toll on the environment and the people living near illegal recycling plants. Illegal recyclers don’t have to properly clean contaminated water sources, which can affect nearby villages water sources. While legal recyclers have to pay to properly dispose of unrecyclable plastic, illegal recyclers can dispose of the unrecyclable waste easily and cheaply by burning it. This releases toxic chemicals into the air, which can make people in nearby villages sick. In Jenjarom, Malaysia, residents “began suffering en masse from headaches, respiratory problems, skin allergies and other ailments.” Additionally, the fires that are meant to burn the plastic often are not monitored and can become uncontrollable very quickly. They are extremely difficult to extinguish and can be dangerous to firefighting crews as many don’t wear masks.

Even those that are set up legally have been found to not follow regulations. Within the first year of the Chinese plastic ban and Malaysia’s new government, over 100 recycling companies lost their permits to import plastic waste because they didn’t follow regulations. They were able to reapply for permits after three months.

Because of these issues, the top three importers of plastic waste—Malaysia, Thailand, and Vietnam—have temporarily banned plastic waste imports, and all three are also working towards a permanent plastic ban. Developed countries, such as the United States and the UK, will have to figure out how to properly dispose of their plastic waste in an environmentally friendly way.

The blame is not all on illegal recyclers; companies from developed countries, in an effort to save money, send contaminated plastics to illegal recyclers without vetting them. These exporters have an “out of sight, out of mind” mentality that is damaging our global ecosystem. The American citizens—along with citizens of other developed countries—believe their recyclables are being recycled, while instead they are being sent to illegal recyclers that are further damaging the environment.

The international waste trade cannot feasibly continue like this. Norway’s proposed solution was to add plastic waste to the Basel Convention, which would impose more regulations on its trade. Since being added to the Basel Convention in May of 2019, plastic waste could not be sent to countries that aren’t a part of the convention. This ensures that plastic is not being sent to countries that do not have the infrastructure to properly recycle or dispose of it. Additionally, it would add more transparency to the trade deals; citizens of the exporting countries would know where their recycling is going. One downside to adding plastic waste to the Basel Convention is that not every developed country that exports plastic waste is a part of it: most notably the United States.

Another solution proposed has been to transition from a linear economy to a circular economy. In a linear economy, which is what most countries are a part of, a material is made, used, and the disposed of. In a circular economy, materials go through a cycle, and as little as possible is disposed of. A transition such as this one would not be easy, but it might be necessary to maintain our level of consumption.

China’s plastic ban brought to light just how much plastic we use and discard—not only for the importing countries like Malaysia, but also for the exporting countries. Part of the problem is our level of consumption, but another huge issue is the lack of transparency surrounding how our plastic is recycled. It is not enough to place our plastic waste in a recycling bin and expect it to be recycled; as consumers of plastic waste, we must demand that those exporting our recyclables are being honest about where it’s going.

Women are Disadvantaged in Female-Dominated Fields

Women and man standing on unequal sized stacks of coins
Gender Pay Gap. Source: The People Speak!, Creative Commons.

What do nursing, teaching, social work, and librarianship all have in common? Those working in these fields are underpaid, under respected, and mostly female. Pink-collar professions, or female-dominated fields, are considered less-respectable than other fields, and history points to the fact that mainly females work in them to be the cause.

Most of these jobs were once dominated by men, and when they were, they were highly respected. For example, before the late 1800s, teaching was a profession for men only; it was highly respected and well paid, but as females began to take these jobs, that quickly changed. This trend is similar for the other pink-collar professions mentioned—with the exception of social work because it is relatively new as a profession—and similar to trends in other pink-collar professions.

To understand why pink-collar professions are underpaid and undervalued we must first understand hegemonic masculinity. This is the idea that society has an ideal form of masculinity that is valued by many but attainable to very few. In fact, the main people who are able to meet this standard are fictional characters: Captain America, Wolverine, etc. In Still a Man’s World: Men Who Do “Women’s Work,” Christine Williams explains that this ideal puts pressure on the men who ascribe to it to push anything feminine away, including the jobs dominated by females. Hegemonic masculinity’s standard changes based on the dominant culture, but one aspect that remains is the need for dominance over femininity.

When women enter male-dominated professions, they experience discrimination and sexual harassment, which could deter them from staying in the field and negatively impact their mental health. However, when men enter female-dominated fields, they experience almost no discrimination. Tokenism is the idea that a minority group in a workplace or academic area will experience disadvantages and harassment. However, where other groups face discrimination, men benefit from being tokens. During higher education for male-dominated jobs, females experience many of the significant disadvantages of being tokens: women studying for these positions have heightened visibility, which can make them feel like they have to succeed because they feel responsible for the advancement of their gender in that profession. Additionally, the dominant group—in this case men—may be threatened by their presence, causing the dominant group to isolate tokens and pressure them to conform to the prevalent culture.

However, when men begin schooling for female-dominated professions, they generally don’t experience these challenges. Male professors tend to take male students under their wing, which gives them a boost in their classes and professionally—an advantage that most token groups wouldn’t regularly receive. Having a mentor is a great advantage to anyone training professionally, so the advantage these men receive over the women in these female-dominated fields is exponential. Additionally, while most tokens experience sexual harassment, men don’t experience sexual harassment in female-dominated fields. In fact, the group that typically experiences harassment in female-dominated professions is females; even though it’s at lower levels in high-wage female dominated fields, sexual harassment is still a big problem in female-dominated professions. Most tokens are the group discriminated against, but in the case of female-dominated professions, females still experience disadvantages starting in professional school.

Women continue to experience disadvantages after professional training as well. Most people have heard of the glass ceiling: the invisible force keeping women from reaching executive and other higher-up positions. While there is a higher proportion of women in executive positions in female-dominated professions, women still face a barrier: the glass escalator. The glass escalator is the invisible force pushing men—sometimes despite their wishes—to executive and administrative positions. This, in turn, leaves women with more experience in lower paying and lower ranking positions. Some men would rather stay in positions considered low-ranking, like children’s librarian, geriatric nursing, or lower elementary school teaching, but feel pressure to move up because of stereotypes of the work men should be doing. Others realize they will move up quickly and enter these fields with the goal of quickly becoming a reference librarian, ER nurse, principal, or other high-ranking positions. Regardless of the male employee’s intention, they are pushed past women into higher-ranking positions or specialties.

While there are more women in these professions, there is still a significant wage gap. This is not necessarily directly due to implicit sexism: because men often occupy the higher status—and therefore higher paying—jobs, men in female-dominated professions earn more than women. This is compounded by the problem that these jobs are underpaid to begin with. Regardless of the pay when men dominated these professions, when women began to dominate these fields, they immediately had lower wages. When professions like teaching and librarianship first became feminized, single women were those that flooded the fields. It was rarely the intention of these women to stay in the field after they were married, and women typically had someone else to rely on for financial support, so employers paid them less because they could. However, even when the attitude towards working women changed, the pay didn’t. Women in female-dominated professions are underpaid, while men are pushed to the positions that have higher pay.

The problem is not men; it is society’s view on women and “women’s work”. As a society, we underappreciate emotional labor and care-work, and many of the jobs involving this are female-dominated. There is the perception that anyone can do these types of jobs, even though most require education beyond high school. Because our culture values aspects of masculinity over femininity, men are pushed into more highly respected, masculine areas of female-dominated fields, which keeps equally qualified women out of those positions. As a society, we must work to value female-dominated professions based on their impact and importance rather than the perceived value of the person doing the work.

The Criminalization of Mental Illness

Prison cell block
Prison cell block. Source: Bob Jagendorf, Creative Commons.

It is no secret that the United States has an issue of overcrowding prisons, which can lead to many issues regarding quality of life in prisons. Overcrowding in prisons is not just a problem in the United States; over 100 other countries also have this issue. In many countries, the criminalization of mental health is a factor that is compounding the issue. Individuals with severe mental illnesses not only need treatment that prisons don’t provide, but also can be put in dangerous situations when they are in prison. Despite this, they are more likely to end up in prison than in treatment.

Up until the 1960s in the United States, when someone had a severe mental illness, they were typically placed in a mental institution or asylum. In an effort to provide patients in mental institutions better community-based care and reduce government spending, the process of deinstitutionalization began. However, that is not how it played out. While the movement gave those with mental illness more rights and turned society away from locking them up, it released some that would have benefitted from long-term care that community centers could not provide. However, with many patients moving out of long-term treatment facilities, many of these facilities were shutting down. This left community mental health centers to try to treat illnesses they were not originally intended to. Another issue arose when insufficient funding was allocated for the community mental health centers, further overwhelming the new system. Because the difficulty of the transition from institutionalization to community care was underestimated, many—then and today—have gone without treatment. The lack of treatment for serious mental illness, like Schizophrenia, has led to the incarceration of many people with mental illness who should instead be treated.

Not Guilty by Reason of Insanity

Another issue that has contributed to the criminalization of mental illness is the difference between the clinical definition of mental illness and the legal definition. The diagnosis of mental illness is dictated by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The law, however, sees mental illness as symptoms that impair mental functioning. The main diagnoses that fits into the legal definition are psychotic disorders, such as Schizophrenia. Even if someone has been diagnosed with a psychotic disorder, when pleading not guilty by reasoning of insanity, their lawyer must show that they were having symptoms at the time of the crime that contributed to said crime. This can be a difficult task as some states require that the symptoms are so severe that the defendant didn’t know that the crime was illegal. Even in cases where the defendant has shown this to be true, some juries will give a verdict of guilty to ensure that someone is held accountable for the offense.

Some states have gotten rid of the insanity plea altogether, while others have changed it to “guilty because of mental illness” meaning after treatment, they must serve their sentence in prison. This can sometimes put the progress a patient has made in jeopardy, as prisons are not a suitable environment for maintaining a newly achieved healthy mental state. In states where not guilty by reason of insanity is still in effect, those found not guilty by reason of insanity are supposed to be released after sanity has been restored. Yet, this is rarely the case; due to fear they will go off their medicine and commit the same violent crimes, many are held in treatment facilities indefinitely. With the threat of this outcome overhead, many opt out of the not guilty by reason of insanity plea and are instead place into a prison where they will not receive the appropriate care.

Because of the law’s strict definition of mental illness, many are being placed in already crowded, underfunded prisons. Because of the lack of mental health professionals, prisoners in some states, including Nebraska, may not receive medications for mental illnesses or have access to talk to counselors. This can cause the reemergence of once-controlled symptoms, making the prisoner with a mental illness a danger not only to himself, but also to others. Additionally, many with severe mental illness are put in solitary confinement for long periods of time. Psychologists who have studied the effects of solitary confinement have seen a pattern of increased mental health problems in people who were originally neurotypical. If this is true, the effects on prisoners with mental illness could be devastating. Not only are people being sent to prison when they should receive treatment, they are also being put in situations that make their symptoms worse and make it harder to reenter into society if their sentence allows.

Substance Use Criminalization

In addition to violent crimes committed because of mental illness, many nonviolent acts associated with mental illness are criminalized; Substance Use Disorders are recognized by the DSM V and are therefore diagnosable and treatable, but the law instead criminalizes it. While at any given time there are more convictions for violent crimes, more people are sent to prison a year for drug-related crimes than violent crimes. Studies have shown that those imprisoned for drug-use are unlikely to receive treatment and often return to using drugs once released because they lack the resources that treatment would have given them. Sending people with Substance Abuse Disorders to jail does not improve their illness.

Not only those with Substance abuse disorder are affected by this criminalization; those diagnosed with another mental illness are five to eighteen times more likely to have a comorbid Substance Use Disorder. This can further prevent someone who needs treatment from receiving it. Most prisons don’t have adequate resources to treat prisoners with mental illness, so imprisoning people for crimes that are directly tied to mental illness can be detrimental to their treatment and future.

Current solutions

Some states are trying to combat the increasing proportion of prisoners with mental illness not receiving treatment. With our corrections system slowly catching up with our understanding of mental illness, states—like California—are beginning to consider replacing their old jails, not with new ones exactly like them, but instead with centers focused on rehabilitation. They are not calling for moving all criminals with mental illness out of prisons, but instead treating those with mental illness while they serve their sentence. Additionally, they do want to increase the diversion from jails, but that will be done on a case-by-case basis and only for those who have committed a crime because of mental illness.

Stigma

Ultimately, the criminalization of mental illness has a lot to do with the stigma surrounding it. The general population connects mental illness with violence, which leads to harsher punishments. As a society, we need to reduce stigma before any change can happen. If we continue to see those with mental health problems as inherently violent, they will continue to be prosecuted and sentenced unjustly.

Healthcare Disparities for Rural Communities

Hospital closed sign directing patients to the next nearest hospital
Hospital Closed. Source: Nigel Goodman, Creative Commons

Access to healthcare is one of the biggest predictors of health. When someone has access to healthcare, they are more likely to seek treatment for and catch chronic diseases in early stages. This can greatly improve health outcomes and quality of life. However, when access to healthcare is restricted in any way, health outcomes and quality of life decrease, those who need consistent treatment may go without, and preventable deaths increase. Rural areas disproportionately face decreased access to healthcare, which greatly affects the health and productivity of these already disadvantaged areas.

Lack of Insurance

There are many barriers to healthcare that rural Americans face. First of all, there is a lack of insurance. This is mainly because insurance premiums are more expensive in rural areas than they are in urban areas. Urban areas have larger populations, which encourages more insurance companies to compete with each other, driving the costs of premiums down. Additionally, their larger population means the cost of medical expenses can be spread among more people. This also lowers premium prices. Because these two factors are not present in rural areas, they are left without affordable healthcare.

Additionally, many people in rural areas have incomes that fall in the gap between qualifying for Medicare and being able to afford private insurance. Medicare is available to specific low-income groups. In states that haven’t expanded Medicaid, the most common income limit for Medicaid eligibility is 43 percent of the Federal Poverty Line and childless adults are excluded regardless of income. These qualifications leave over 2 million adults in the United States uninsured.  Insurance is important because it can help cover costs of healthcare which can otherwise become insurmountable. Those without insurance are less likely to seek healthcare, and when they do, it is typically worse quality than those with insurance receive.  Additionally, when an uninsured individual does seek healthcare, the costs are sometimes too high and turn into medical debt. Since much of the rural population is uninsured, these problems plague many of them.

Closing Hospitals and Pharmacies

Those that do have insurance still face a bigger problem: many rural areas don’t have hospitals within a twenty-minute drive. 25 percent of those living in rural areas report that they have to drive at least 30 minutes to get to the nearest hospital. In fact, almost one in four rural Americans say access to adequate healthcare is a major issue for them. Additionally, many hospitals in rural areas are shutting down, leaving communities without the healthcare they are used to. Since 2010, there have been over eighty rural hospital closures, mainly in the southeast. These hospital closings have a devastating effect on the communities they were a part of. Mortality rates for accidents, heart attacks, strokes, and anaphylactic shock risedue to longer ambulance rides. Additionally, residents may be unable to attend routine appointments because of transportation limitations; much of the rural population is elderly, which restricts their ability to drive, and public transportation is less common in rural areas than urban areas. This also means that with the onset of troubling symptoms, residents of rural areas may wait longer to see a doctor because of the inconvenience.

Many rural areas also lack pharmacies, which can hurt those who rely on prescription drugs for good health. Even the rural communities that have hospitals may lack a pharmacist, and many of the pharmacies in rural areas are in danger of closing; many have already. This is due to higher costs of medications at rural pharmacies and lack of pharmacists in rural areas. This can have a devastating effect on residents, as many go periods of time without their prescriptions—like Insulin or medication for depression— until they can get to the nearest pharmacy. Additionally, pharmacists in rural areas are helpful in educating the community on when they can use over-the-counter meds and when patients should see a doctor.

But why are hospitals and pharmacies closing? They have few patients, many uninsured, and they are greatly affected by states’ refusal to expand Medicaid. Medicaid expansion, which 14 states have not ratified, would close the gap between those that qualify for Medicaid and those that can pay for private insurance. As discussed previously, those with insurance are more likely to seek medical care, which would bring more business—and therefore, funding—to hospitals and pharmacies, making them less likely to close. Additionally, they lack the staff required to stay open. 99 percent of students in their last year of medical school report they plan to live in communities with over 10,000 residents. Without a staff, a hospital cannot stay open.

Lack of Specialists

In many rural areas, including those with hospitals, there’s a lack of specialists, like oncologists and OB/GYNs among others. Specialists typically work in large hospitals that have adequate resources, so they tend to reside in cities. This means that those with specialized needs often have to drive to the nearest city to receive care. Traveling can pose a problem to many rural Americans as many of them are older, but this also affects many younger rural inhabitants as they may not have the time off from their jobs to drive hours to receive specialized care. This leaves many without treatment that they need and worsens health outcomes. This is especially concerning considering many rural communities have higher rates of diseases than urban communities do. Specifically, “rural African Americans have higher rates of cancer morbidity and mortality than other rural residents and have higher rates of comorbid conditions” according to Robin Warshaw from the Association of American Medical Colleges. Rural African Americans also have higher rates of disease than urban African Americans. This makes the fact that specialists are not easy to access even more concerning, especially considering they are the largest rural minority. Minorities in general have less access to healthcare, and living in an area that doesn’t have easy access to healthcare in general can exacerbate this issue.

Low Health Literacy

The healthcare system is complex, which means that patients have to work to understand what care they need and when they need it. The ability to do so is called health literacy. Studies have shown that health literacy is important to health outcomes. The higher level of health literacy a person has, the more likely they are to seek out preventative care, such as screening tests and immunizations, that can catch diseases in early stages or prevent them altogether. If a patient doesn’t understand what the doctor tells them, they are less likely to be comfortable enough to seek care. Additionally, higher health literacy rates make it easier to understand how to manage existing conditions. In addition to less access to healthcare, rural Americans have lower health literacy, which compounds their health problems. However, because rural citizens are less likely to have access to health care, it is especially important for them to have high health literacy, which can be attained by using programs that work to educate patients and clinicians on the importance of patients having an active role in their healthcare.

Solutions

Rural healthcare in America is a big problem, but it can improve. In addition to the health literacy programs, there are many solutions to close the gap in healthcare between rural and urban areas. While the common medical school experience trains students for work in populated areas, a consortium of 32 medical schools has created a rural healthcare track with their medical schools. This not only puts more doctors in rural areas, but also trains them for rural areas’ specific health needs. While the program is too new to see a significant increase in rural healthcare professionals, the majority of students who have gone to residency have stayed in rural areas and are studying specialties that are in much needed in rural areas. Additionally, there are many scholarships for those planning on practicing medicine in rural areas, further encouraging medical students to practice in areas in need of doctors.

The Nutrition and Health Crisis in Venezuela

Child wears hat that says Venezuela on it and stares off into the distance.
ELEICOES 2013 NA VENEZUELA. Source: Joka Madruga, Creative Commons

The current president of Venezuela, Nicolás Maduro, was elected in 2013 by a very small margin. During his first term, the Venezuelan economy took a turn for the worst. He was reelected for a second term in 2018, but his opponents feel that the election wasn’t valid because many of the other candidates were made ineligible to run or even jailed, so the National Assembly does not recognize his presidency and considers the presidency vacant. According to the Venezuelan Constitution, in cases of a vacant presidency, the leader of the National Assembly (currently Juan Guaidó) takes over as president. Guaidó has very little political power because the military still supports Maduro.

I first heard about the political and economic unrest in Venezuela when I went on an exchange trip to Spain in May of 2016. My host family had moved to Spain eight months earlier because their jobs had been the first affected by the economic downturn. They were lucky that the dad was a Spanish citizen—it was much easier for them to move to Spain than if none of them had been citizens—but many Venezuelans have not been so lucky.

Protests in Venezuela
Venezuelan Protests. Source: Trong Khiem Nguyen, Creative Commons

Since 2015, health statistics have been underreported—if they’ve been reported at all. December of 2016 marked the last report from the Venezuelan Ministry of Health. This report describes an alarming increase in previously eliminated and controlled infectious diseases, such as malaria and diphtheria, and in maternal and infant mortality rates. The report has many alarming statistics, but aside from that, it is the last one to have been published. Additionally, the Health Minister who published the report was fired immediately afterward.

With no one within the country reporting on the health needs and statistics of the people, it is nearly impossible for other countries to give external aid. Additionally, even when aid sent, the Venezuelan government refuses help. Even nongovernmental organizations (NGOs) are forced by law to refuse help: the Supreme Court ruled in 2010 that any NGOs receiving financial assistance from other countries would be committing treason. This has a devastating impact on the citizens as they are not receiving the help that they need.

The situations in the hospitals are dismal. According to a survey conducted by the political opposition, many services in hospitals are not consistently available, if at all, due to lack of supplies. Many supplies have gone missing from public hospitals and clinics, and those being shipped in often are embargoed and never make it past the ports. The reason is unknown, but many suspect it has to do with the corruption of the government. This has forced patients to bring their own medical equipment—which can include anything from medicine to surgical equipment—when going to the hospital, so they know they’ll have what they need. Private clinics, which have most of the supplies they need, ask for payment in US dollars, which means only the wealthiest can get that level of care. This leaves the average citizen without proper medical care in a country where the government is actively keeping lifesaving materials out of the hands of doctors.

Because of the low levels of health care, many diseases are reemerging and worsening. Between 2008 and 2015, there were no cases of diphtheria reported and one case of measles reported. However, in the past three years, over one thousand cases of diphtheria and over six thousand cases of measles have been confirmed. These statistics show a lack of vaccinations in children, which is potentially due to limited vaccines available. Malaria rates, which were once controlled through pesticides, medication, and reduction of mosquito breeding areas, have increased by over ten times from 2009 to 2017. Tuberculosis cases more than doubled from 2014 to 2017, which is even more concerning with the cases of untreated HIV on the rise as well. According to the Human Rights Watch, “Venezuela is the only country in the world where large numbers of individuals living with HIV have been forced to discontinue their treatment as a result of the lack of availability of antiretroviral (ARV) medicines.” 90 percent of HIV positive Venezuelans have to live without ARV medicines, and these people are majorly susceptible to and will be severely affected by the many diseases that are on the rise. Because all of these diseases are on the rise and the limitations of hospitals, maternal and infant mortality rates in Venezuela have risen back to their levels from the 1990s. Venezuela is the only Latin American country where this has occurred.

In addition to the health crisis, there is also a nutrition crisis. The last nutrition data published was in 2007, but many Venezuelans report only eating yuca or a tin of sardines for their one meal of the day. According to the UN’s Food and Agriculture Organization (FAO), 11.7 percent of the population is undernourished, meaning they are not getting enough nutrients. This is severely affecting Venezuelan children; as of March 2018, 17 percent of children under 5 in lower income areas of Venezuela have moderate acute malnutrition (MAM) or severe acute malnutrition (SAM)—a 7 percent increase from February 2017 and a level of crisis.  According to WHO, the fatality rates for children under the age of five who have SAM and MAM are between 30-50 percent, so it is important that children not only have access to healthy food, but that hospitals also have access to the necessary treatments, and at this time that is not generally the case in Venezuela. Pregnant women are also affected by MAM and SAM, which can lead to adverse outcomes during pregnancy, childbirth, and the child’s infancy.

Venezuela is not the only country that is experiencing a health and food crisis. However, many countries have these issues due to lack of resources, funding, or aid. While Venezuela is experiencing an economic downturn, they have been offered plenty of aid, which they have repeatedly refused. Additionally, the lack of reporting health and nutrition statistics is concerning for many reasons. First, this most likely means that no one, including the Venezuelan government, knows the extent to which the Venezuelan citizens are suffering. Second, it shows that the Venezuelan government is willing to conceal the level of suffering experienced by its citizens in order to protect their image, instead of asking for assistance; it sends a message that they do not care about the wellbeing of the citizens they are supposed to serve and protect. The UN continues to urge the Venezuelan government to let them send assistance, warning that their situation can become much worse than it already is, but they continue to refuse and push back on any assistance offered and put the lives of their citizens on the line.

The Refugee Education Crisis

Child writes in workbook at a desk.
Getting Syria’s children back to school in Lebanon. Source: Russell Watkins/Department for International Development, Creative Commons.

Now more than ever, people are fleeing their home countries because of war, persecution, or violence, hoping to find a better life in a different country. In fact, we haven’t seen a refugee crisis this large since World War II: there are 70.8 million refugees worldwide, and estimates show that around 37 thousand people are forcibly displaced every day. They risk their lives to escape a situation they feel they won’t survive, but when these refugees finally find a place they feel safer in, they face new challenges, including the education of their children.

Children, in every society and culture, are the future; they will grow up and have an impact on society. The significance of the impact and whether it’s positive or negative is greatly affected by the child’s education. If a child is refused an education, it will be hard for them to positively contribute to society. Additionally, a lack of education can prevent people from knowing their rights and being informed about their health.

For refugee children, education is even more important. In addition to the importance of education in general, education can give a child back their sense of identity and purpose after being stripped away from everything they know. Often, refugee children are taken to a country that is much different from their native country, especially with regards to culture and language. However, receiving an education can lessen the growing pains, especially if teachers are trained to help children from different cultures and speak different languages. Additionally, going to school can help children learn the intricacies of the new culture by being exposed to it for extended periods of time.

While it may seem obvious that education is important for every child, the education gap between refugee and nondisplaced children continues to grow. Worldwide, 91 percent of children attend primary school, but only 63 percent of refugee children attend primary school. While the number drops for secondary school across the board, the decline is much more dramatic for refugee children: only 24 percent of refugee children will attend secondary school. This is alarming because secondary school is typically the minimum level of education needed to attain a desirable job. The vast majority of these children, who are already put at a disadvantage, have even less of a chance of receiving the education they need.

Worldwide, there are many reasons refugee children are not receiving a quality education. First of all, the language in their new country may be different from any language they speak, which could cause them to fall behind in their studies. Second of all, there may be discrimination and bullying, which can make it much harder to focus on and excel at their studies. Additionally, in some areas, there may be limited spots in secondary schools for refugees, limiting the number of refugees that can receive an education. Finally, many refugees are denied the right to attend school, as many governments have policies in place that block their enrollment. These policies can include the requirement of residency documentation, which is nearly impossible to attain, essentially making their enrollment in school impossible.

In the US, there are two laws in place that are meant to protect children’s education: the Flores Settlement and Plyler v. Doe. The Flores Settlement outlines the regulations and restrictions regarding detaining minors, including refugees, at the border. It ensures proper treatment within detainment centers and includes a section specifically regarding education. Children are required to receive an individualized educational plan including basic education and lessons in English. However, in June, there were reports that the Trump administration decided to suspend many services in juvenile detainment camps, including education, because of a lack of resources. This act would’ve gone directly against the Flores Settlement.

Plyler v. Doe protects the rights of undocumented children to get a primary and secondary education, stating that they fall under the Equal Protection clause in the Fourteenth Amendment. Plyler v. Doe shows that in this country, every child has a right to an education. However, this right is not always granted. There are many schools that require birth certificates and ask about immigration statuses as a way to keep undocumented children out of school, even though it is illegal.

There are many benefits to the communities that accept refugees. Many of those against admitting refugees to Europe, the United States, or wherever they may live, cite the economic strain refugees put on the government as their reason for opposing the intake of refugees in their country. However, they are ignoring the fact that through taxes refugees generally boost the economy more than they strain it. This can only be improved by educating the children as well. The best way for someone to positively impact the economy is to be well educated; in a study done over 40 years comparing 50 countries’ economies and education levels, they found that the higher the average cognitive ability, the faster the gross domestic product (GDP) increased. If a country refuses to educate any of the children that live there—including refugees—it will not only negatively affect the children, but will also negatively affect the entire country. Additionally, schools that allow refugee children will have more diversity, which promotes higher levels of tolerance, not only among them, but also among parents and the community.

It is imperative for the development of the individual and the well-being of the host country that refugee children have the opportunity for an education. However, it is not enough to just give them access to an education. They must have the resources necessary for them to succeed, such as teachers that are willing to work with them through language barriers and accurate credit for courses taken in their native country, among others. They must be given the same opportunities that the other children in the country are given if they are to succeed and we are to close the gap in education between refugee and nondisplaced children. Many countries have already started making an effort to close the educational gap and take down barriers: Turkey has made significant efforts to prepare school-age refugee children for a transition to Turkish schools, and Ecuador has passed laws to give undocumented Venezuelan children easier access to school. There are many benefits to the education of refugee children and ignoring them will have grave consequences for refugees and the communities they are a part of.