The Many Causes of Ultrasound Overuse in Vietnam

In my research for an assignment about Vietnam’s sex ratio at birth (112 males to 100 females in 2008) I discovered some perplexing information about the prevalence of ultrasounds in the country. On average, Vietnamese women have 6.6 scans during pregnancy, with 20% of them having upwards of 10 and some women having more than thirty. The articles I was reading were attributing this over-testing mainly to the wish to know a fetus’s sex. Because the sex ratio at birth has become so male-skewed recently, several papers said that the societal desire for male children, which can increase a woman’s status in her husband’s family, has caused the widespread use of ultrasounds to be used to inform sex-selective abortions. However, you’ll notice that the sex of a fetus can be fairly conclusively determined with several fewer than 6 ultrasounds. Where are the extras coming from?

I learned that for two thirds of Vietnamese women, the reason given for the frequent ultrasounds is purely for reassurance that the baby is “okay”. According to this article about the still prevalent fear of Agent Orange in pregnant women, scans beyond the 1 or 2 necessary for determining sex are primarily to check for birth defects. More than 11 million tonnes of the Agent Orange pesticide was sprayed by American troops to clear foliage during the Vietnam War. Though the risks of being exposed to the chemical today are small, over 150 000 Vietnamese children have suffered birth defects related to it and these images loom large in the national psyche. While having 30 scans over a pregnancy may not be very practically useful, it can provide women with some peace of mind.

However, many women also report that their doctors recommended the numerous scans. After hearing my classmate Danielle’s report on the health care in Vietnam, this begins making sense as well. Though many hospitals and clinics in Vietnam are considered “public”, there has been an extreme commercialization of Vietnamese health care system. This provides an incentive for doctors to use profit seeking tendencies in prescription and diagnosis, including recommending more ultrasound scans than necessary. Do you think recommending these unnecessary tests is a serious problem? What could be done about it?

This extra information showed me that there aren’t just social reasons for the overuse of ultrasounds in Vietnam, but important historical and economic contexts to be considered as well. It serves as a thought-provoking reminder of the complexity of the world around us and will encourage me to be open to learning while away in Vietnam!


Renewed Revolution in Egypt

I get the impression that a lot of people are confused about the situation in Egypt right now. That makes a lot of sense because the situation is, indeed, confusing. Didn’t they just have a revolution? Why would they need another so soon? Some say the answer is that it didn’t work the first time.

You can check out a timeline of the conflict here, but I’ll give a woefully incomplete summary as well. In the midst of the 2011 protests, the President Mubarak stepped down, leaving the country in the hands of the military, who wanted an election as soon as possible. Over 50% of the vote for president was split between progressive and liberal candidates, but the groups who got the most votes were the original regime and the large Islamic movement called the Muslim Brotherhood, whose candidate, Morsi, eventually won. The liberal-minded revolutionaries, who had been the primary protesters, evidently felt betrayed by this turn of events.

As president, Morsi made some questionable and divisive decisions, including giving himself unlimited power to “protect” the nation, somewhat undermining this huge opportunity for the Muslim Brotherhood. 22 million people signed a petition calling for his resignation, and there have been reports of up to 14 million protesters taking to the streets in June. However, in the end it was the military who removed Morsi from office, claiming the intervention was on behalf of the Egyptian people. As we can imagine, the Muslim Brotherhood is unhappy with this turn of events, and the protests and violence continue, with death tolls rising.

What is your opinion of this unconventional military coup? Can it be excused as a popular uprising? This classification will greatly influence Egypt’s international relationships and access to aid; the U.S. has already declared that it cannot financially assist a military coup. Was it wrong to depose Egypt’s democratically elected leader? Was Morsi ruling dictatorially? Many would say so, as he sought power to disregard the constitution in desired situations. What do you think are the biggest problems with democracy?

I think that revolutions, though dramatic and often inspirational, aren’t inherently useful for effecting change. There is a lot of follow through required to actually create the desired impacts of such massive protests; it doesn’t happen organically. Hopefully Egypt can begin this follow through in a more peaceful manner and find solutions that will represent the wishes of its majority.

Don’t Believe That Poster

Have you seen the Don’t Be That Guy campaign? It’s a popular and successful award-winning campaign started by an Edmonton-based group called Sexual Assault Voices of Edmonton (SAVE) that has spread internationally, and I encourage you to check out the campaign’s posters.

The program is fantastic for targeting perpetrators of violence rather than its victims. Instead of telling women, “Don’t drink, don’t go out at night, don’t wear revealing clothing,” it tells potential rapists, “Don’t rape people, even if they’re drunk, alone, or wearing revealing clothing.” Many people believe that this tactic may not be as successful, but six months after these ads went up in bars in Vancouver, the city saw its first drop in sexual assault rates in several years. Whether this 10% decrease in sexual assault is directly caused by the poster is, of course, debatable, but it certainly hasn’t hurt and Vancouver is by no means the only place this is happening.

Two manipulated posters.

In the last week, posters have been put up around the University of Alberta campus to parody the successful anti-rape campaign. The posters use images from the Don’t Be That Guy campaign, but change the text to have the opposite meaning, for example, “Just because you regret your life choices, doesn’t mean it’s rape.” The tagline of these posters is Don’t Be That Girl. Apart from violating copyright, the new manipulated posters are incredibly offensive, and send a dangerous message to anyone who reads them. It has been said that around 0.6% of rape accusations are false, but these posters could grossly distort people’s perceptions of such occurrences. It’s hard enough for rape victims to come forward already, and Canada has very low reporting and conviction rates; we don’t need to promote the myth that all claims of rape are founded on regret as well. The victims portrayed in the Don’t Be That Guy posters aren’t all female, either, the campaign is notable for including gay pairings as well as straight ones.

The “parody” posters have been taken down and SAVE is deciding how to respond. I happen to be of the opinion that rape-apologies and victim-blaming are not humorous enough to be considered parody, however. There are people who will take Don’t Be That Girl seriously, and that’s a problem for all of us.

Cause Marketing: Win-Win?

Cause marketing is enormous. Nearly 90% of the 30 most recognized not-for-profits in 2010 were either engaged in cause marketing, or wanted to start with it soon. Cause marketing is transaction based fundraising, involving branding partnerships between corporations and NGOs to connect commercial products with good causes in order to sell.  We see this all the time. Coca-Cola saves polar bears, (Product) Red treats diseases in the developing world, and everything pink fights breast cancer. The campaigns are conceived of as win-win scenarios: the nonprofits get money and attention while corporations get to be associated with good causes and fuzzy feelings.

While this kind of marketing can be a boon for the receiving NGOs that are able to dedicate staff and time to such an enterprise, not all organizations have the resources and expertise to do so. For them, participation in cause-marketing can be destructive. These fundraising efforts are certainly a loss for consumers as well, at least in terms of information. We are being fed one dimensional stories, with simple problems and even simpler fixes. “Buy TOMS, they will change the lives of children in the developing world.” What remains to be seen is how positively or negatively cause-marketing can impact the cause itself. Is the injection of funds worth the oversimplification of the issues? There are other potential risks as well, including diminishing direct donor interaction, and damaging the non-profit brand by association, especially if there is not a good fit between the cause and product. We can also get into questions of how much money actually reaches nonprofits or talk about issues like pinkwashing.

The main problem I see, which is discussed in some detail in this report from the University of Guelph, is that if people believe solutions for international development and other problems can be reduced to consumption choices, many will be content to do only that. Ethical consumption must be an important part of our everyday lives, but it’s not going to make all the necessary changes on its own. Our world is a complex place requiring complex solutions. Properly intentioned and executed cause marketing can improve lives and the environment, but I’d like to see more people making more conscious and thoughtful decisions to promote health, development, and sustainability as well.

No Place for Climate Change Refugees

It has been estimated that the world may see upwards of 200 million climate change refugees by the year 2050. These people may be forced to leave their homes for a number of reasons: rising sea levels, natural disasters, and shifting weather patterns that make farming and everyday life impossible. However, as with much of the discourse on climate change, there is a problem with the farsighted nature of such an estimate. This is not an issue that can be dealt with at any point between now and 2050. The refugees and political tensions over climate change are already here.

As merely one example, the border between Bangladesh and India has seen rising tension, particularly in the past six years. Many people used to disregard the border, crossing it for work, shopping, and particularly immigration. As well as by poverty, Bangladeshis are driven to migrate to India by the massive  climate change the country is seeing. Rising temperatures affect water availability and viability of farmland, floods devastate villages, and countless fishermen are seeing their catches decline. The number of illegal Bangladeshi migrants in India is not known, but estimates range up to 10 million. In reaction to this, the Indian government fenced much of the Bangladesh-India border in 2007, and began boat patrols for the parts of the border spanning water. However, the most controversial part of the border control is the shoot-on-sight policy enforced by the Indian border patrol.

In its efforts to prevent cross border migration, the Indian Border Security Force (BSF) has been reported to have killed many hundreds of Bangladeshis. The BSF has also been accused of abducting and killing children, and arbitrarily killing civilians. The Human Rights Watch has condemned the BSF, but though this policy has ended lives, broken families, and terrified countless Bangladeshis, many continue trying to cross.

Indo-Bangladeshi Barrier

People who are braving bullets for the chance of a better life are clearly facing some sort of desperation. And yet at this point in time, many countries, including Canada, do not accept climate change as a reason for a refugee claim. When homes and livelihoods are being destroyed by environmental events, it can pose as much risk to these people’s wellbeing as many forms of persecution. Why then, aren’t they being protected? The executive director of the Bangladesh Center for Advanced Studies has stated the belief that the Western countries, which played the greatest role in triggering climate change, should take these refugees in, since they are the ones who indirectly displaced them. Do you think such an arrangement would be just? Does India also have an obligation? Solutions for dealing with people displaced by climate change will be crucial in the near future, but they are also crucial now.

Adventures and Activities

Hello all, I am sorry to have neglected writing for so long! But now that studying for the LSAT has concluded, I can finally convince myself to get back into it. A couple things have happened during my absence. First, my classmates and I found out our placements, extremely exciting news that we’d been awaiting for some time. We have about three months left in Canada, counting down to our departures, and I now know that I will be leaving for Hanoi, Vietnam to work at the Center for Marinelife Conservation and Community Development (MCD Vietnam) for eight months. MCD Vietnam is an NGO that works for sustainable development in a number of coastal areas, supporting both the natural ecosystems and the local communities. I don’t yet know what my job will be within the organization, but I am excited to find out more, because MCD Vietnam does some very interesting and important work!

Also in recent news, INDEVOURS has started in full force for the summer. As part of our marketing course, we are working hard to raise money to help with the costs of our field placements. Last night we held our first event of the summer, a Battle of the Bands. With fun games, great music, and creative fundraising, I believe we were successful! I’m looking forward to the rest of our activities this summer, and continuing to write about interesting issues. I hope you will join me!

Constructed Wetlands and A (Developing) World of Opportunities

Since I found out during a project last year that constructed wetlands are recognized as an important opportunity for sustainable development, I have been quite excited by the possibilities!  Wetlands are very environmentally valuable because of the many ecosystem services they provide, including water purification, flood control, and promoting biodiversity.  Man-made wetlands do essentially the same things as natural ones, and have great potential as a wastewater cleaning resource.  Over the course of my project I was very surprised to find that wetlands have the ability to remove nutrients, hydrocarbons, heavy metals, and more undesirable substances from water systems.  They have added advantages over traditional water treatment methods because they can be used as parks or for recreation, and provide habitats for many species. The technology has already proven very effective in many cases, including a number in my very own Ontario, Canada.

However, though wetlands are remarkably effective and a great opportunity in the developed world, I would argue that the greatest potential for constructed wetlands lies with the Global South. Over 1.1 billion people lack access to safe water worldwide, and 99% of all water, sanitation, and hygiene related deaths occur in the developing world.  Wastewater treatment infrastructure tends to be very costly but population growth and resource degradation mean that it is in higher demand than ever.  I think that constructed wetlands are an innovative response to this issue, one that we need to acknowledge as a viable alternative.

In addition to having relatively low initial costs, wetlands are fairly easy and quite cheap to maintain, making them very appropriate for implementation in the developing world. Constructed wetlands have been suggested as an option for dealing with water treatment and access in many places, including Nairobi, but I believe it is an option that deserves much more consideration. With the efficient water purification and positive externalities that accompany wetlands, they appear to be a very strong option for improving the health of people and ecosystems, one that we need to consider more frequently. Constructed wetlands are a creative but very well supported and suited prospect for water treatment in developing countries.

Do you agree? Are there alternatives for water treatment that you’re particularly fond of?