A First World Problem That’s Not So First World: Breast Cancer’s Global Metastasis

In recent years, it has been heartening to see some emerging economies manage to slowly. but surely, surmount one hurdle and then another, and bring increased opportunities to their citizens through more jobs, better education and a stronger presence on the world stage.

But though progress may be good, it can also push other issues to the fore.

Emerging economies inevitably experience growing pains as they pull themselves from poverty. One painful manifestation of this is being seen in a rising incidence in breast cancer.

A recent report found that cancer incidence rates are rising in most countries, even those with traditionally lower rates. (North America and Oceania are stable, while Israel and four European countries have fortunately seen a decrease.)

Yet thanks to the combined power of early detection and advanced treatment, death rates have simultaneously decreased in many other countries as well, making breast cancer a common illness, but less often a fatal one.

However, Colombia, Ecuador, Japan, Brazil, Egypt, Guatemala, Kuwait, Mauritius, Mexico, and Moldova are the tragic exceptions to this rule, and their rising breast cancer death rates are symbolic of the ways countries are sometimes unable to keep up with their growth, with fatal consequences.

In a way, growing countries are getting the worst of both worlds. They haven’t fully escaped the grip of privation, so their low-income populations remain mired in extreme poverty.

Yet their rising middle class is adopting a first-world lifestyle, including a high-calorie diet and less physical activity (spiking up obesity rates), less time spent breastfeeding infants and delayed childbearing. They’re therefore experiencing first world excess—without first world medical care.

To make matters worse, cancer doesn’t immediately register as a problem to prioritize, for others or for the local population. It isn’t a problem many associate with the developing world.

In 2012, Public Radio International covered one doctor at the center of the struggle, Dr. Jackson Orem, who headed Uganda’s Cancer Institute. a country that has been battling a rising cancer rate for some time.

“When you ask for funding for cancer, nobody is going to give [it to] you. But if you ask for funding for these other diseases, they say, ‘All right, your priority is correct, we are going to give you some funds.’ I think that is actually the reason why things are the way they are.” – Dr. Jackson Orem on PRI

An in-depth New York Times report, also from Uganda, painted a similarly bleak picture. Women weren’t aware of what breast cancer really was, and often wouldn’t go to a clinic until the lump had grown so large it would split the skin and begin to fester. At that point, there’s little hope for a cure—only an attempt to eliminate the pain, and access to painkillers is often severely limited.

It’s not a hopeless situation. Though breast cancer is a devastating disease, higher income countries have learned to cope through early screening and aggressive treatment. Given this recipe for success, developing countries are capable of doing the same.

The first step is to raise awareness. We should encourage clinics, health providers, NGOs and other government and civil society actors abroad to make sure breast cancer information is readily available in low threshold locations for girls and women, and that screenings are accessible and affordable.

Across the board, delayed diagnosis in low-income women remains a problem. The later cancer is found in a woman, the poorer her prognosis, so it’s vital to have early screening done. Simply educating the population about self-examination or regular checkups, and enabling clinics to perform this service, could cut the death toll significantly.

A study done by the American Cancer Society and Livestrong estimates the global economic cost of cancer to be 895 billion. That’s 1.5% of the global GDP. Granted, breast cancer is only one form of cancer. However, it is representative of the dangers of not intervening early in rising death rates.

All parts of breast cancer are a tragedy, in all parts of the world. But the developed world has managed to mount a defence against cancer, which is readily implementable. Given the devastating emotional and economic impact, it seems not only cruel, but wasteful, to watch other countries now struggle to do the same.

Featured image: Luz Adriana Villa/Flickr

Creating Safe Spaces for Girls

Talking about sexual and reproductive health with students is always a little bit awkward, even in the best of situations! Having these discussions within a culture that often considers anything related to reproductive health to be taboo, can be particularly challenging – and incredibly important.

In rural Tanzania, such topics are rarely discussed. The national curriculum includes menstruation and reproductive health, but these topics are frequently rushed through, or skipped altogether, by uncomfortable teachers in underfunded, overcrowded schools.

Femme International is an NGO that promotes women’s health through education, with a focus on menstruation. Menstruation is a major reason why girls in developing communities miss school or drop out together due to a lack of sanitary resources and the oppressive stigma that surrounds the topic.

Photo Credit: Femme International

Femme’s Feminine Health Management program is sensitive in nature: menstruation is very taboo to discuss, as are issues of sexual health, female anatomy, and even family planning! However, Femme recognizes that having these conversations with young women is critical to keeping them healthy and in school. Girls need to understand their bodies, and understand how to properly take care of themselves.

To get the girls talking, our team of local facilitators work hard to establish a safe space within the classroom. It is essential to establish an atmosphere of openness, respect and acceptance, and this is often done by sharing personal stories and experiences in a girls-only environment. In fact, one common question is for the facilitator to describe her own first period! Stories like these always break the ice, and helps everyone loosen up, and laugh. Sharing these stories helps girls realize that menstruation is a shared experience, and nothing to be ashamed about.

Talking openly and with confidence about these issues puts the girls at ease, and encourages them to contribute to the conversation. And it usually doesn’t take long! It only takes a few minutes for the girls to begin to open up, and share their own stories, even begin to ask specific questions about their bodies.

For the girls that aren’t as confident, an anonymous question bag is passed around. This gives them the chance to ask the sensitive questions they want to, but are too shy to do so out loud. The facilitator collects the bag at the end of the workshop and reads through the questions, often times leading into larger health issues faced by the girls.

While the FHM workshops focus on reproductive and menstrual health, participants will often bring up related issues they are experiencing or confused about. These have included serious topics such as sexual assault, rape and female genital mutilation; to lighter subjects like boyfriends and PMS symptoms. Girls need a safe space to ask these questions, and having a trained facilitator present gives them access to reliable and accurate information.

Conversation and education are powerful tools for change, and Femme’s programs are committed to using these to change the language, and feelings, associated with menstruation and reproductive health from negative to positive.  Creating this safe space is essential to helping girls understand their bodies, and using conversation and education to help them feel comfortable and confident.

To learn more or donate to Femme’s health education programs in East Africa, visit our website here!

Remembering America’s Lost Women

Growing up in Pakistan, I was a rule breaker. I got in trouble for speaking my mind and making my own choices, two things good Pakistani women were not supposed to do. Until I broke a rule that could not be fixed or overlooked, falling in love with a Shia man, though I came from a Sunni home. In Pakistan, our families were at war, so we went to Canada. North America was my safe haven, a place I could make my life choices without fearing shame and violence.

America afforded me an escape from the fear of honor violence, the abuse thousands of women around the world experience for bringing dishonor to their families. This violence can take the form of physical, emotional or sexual assault, female genital mutilation and forced marriage.

America was my safe haven, but, unbeknownst to many, it is not safe for everyone. Honor violence is not a problem relegated to countries like Pakistan; every year, thousands of girls in North America experience honor violence and even lose their lives to honor killings. Families – mothers, fathers and siblings – abuse, assault and even strangle, stab or shoot their daughters, wives and sisters for being too “Western” or “promiscuous,” refusing an arranged marriage or even just looking at a boy.

Many decades may have passed since I made trouble in Pakistan, but I remain a woman known for speaking her mind. And in my mind, this situation is intolerable and it must be stopped. There is no place in the United States and Canada for shaming and abusing women into submission, forcing them to marry men they do not want and live lives they do not choose. In 2014, I stood up, with eight other women, and we made the world listen with the award-winning documentary Honor Diaries, drawing attention to issues of honor violence in western cultures. Other films and movements have joined us and we have made incredible gains in policy and awareness. Task forces have been formed, data is being collected and, most importantly, paid attention to.

Unfortunately, there is still much more work to do. Forcing a woman into marriage remains legal in 43 states. Women are beaten and even burned with acid, but the nature of what they are experiencing all too often goes unnoticed. Honor violence is a hidden crime that is overlooked more than is conscionable.

Honor Diaries was one stepping stone towards justice and what is right, but now, we need your help to lay the next brick. We want to wake up the US and create a national day of memory for the victims of honor – those who have lost their lives in the name of “honor.” We have teamed up with Jasvinder Sanghera CBE from Karma Nirvana UK, who has succeeded in creating a national day of memory in the UK. We hope to create a national day of memory in the US on the same date, July 14th, uniting women and men across the globe in solidarity.

We can stand up and declare that enough is enough, this will not go on in my backyard. Shame and abuse in the name of culture and religion are not condonable, and we will not sit idly while they are wielded as weapons to destroy the independence and fierce inner beauty of these young American women. Because when we do nothing, they lose more than their independence. They lose their lives. Join us in creating change. Click here and petition US policymakers to institute a national day of memory.


The author, Raheel Raza, is an author, diversity consultant and activist for cultural diversity and interfaith harmony. Her mandate is “there is unity in diversity.”

The Young Women of Tutorial High

Walterine, Principal of Tutorial High School; Image c/o Elisabeth Epstein
Walterine, Principal of Tutorial High School; Image c/o Elisabeth Epstein

I met Walterine during my Baltimore to Guyana layover in the Panama City airport. Seeing that I was reading a Guyana guidebook, Walterine, a proud Guyanese, excitedly sat down next to me and began asking about my trip and my plans while in Guyana.

​I explained to Walterine that I worked with Girls’ Globe and would be speaking with women and girls at Georgetown Public Hospital Corporation (GPHC). Coincidentally (and serendipitously), Walterine worked as the principal of a local high school. Loving the Girls’ Globe mission, she invited me to visit her school and speak to her girls about women’s and girls’ empowerment.

Happily, I accepted.

Last week, I had the fantastic opportunity to work with 200 young women (aged 13-14) at Tutorial High School. Not only were students engaged and excited to share their ideas about gender equality, but they also were incredibly knowledgeable about gender-related issues.

FullSizeRenderAfter telling the girls a little bit about myself and about Girls’ Globe, I gave a brief introduction about why ensuring gender equality and empowering young girls is crucial for development – tackling topics like HIV/AIDS, family planning, economic security, maternal health, education, and more.

But I wasn’t there to talk. I was there to listen. I wanted to hear their perspectives on gender equality and empowerment.

At that point, I separated the class into several smaller discussion groups, giving each table a poster and a different question to answer.

A few of the questions included:

  • What is your favorite part about being a girl?
  • What are some of the challenges of being a girl?
  • Why is gender equality important to you?
  • What does empowerment mean to you?
  • What are some of the barriers to gender equality?
Classroom at Tutorial High School; Image c/o Elisabeth Epstein
Classroom at Tutorial High School; Image c/o Elisabeth Epstein

While the girls brainstormed their answers, I began to realize how daunting a task staying in school could be – not only due to outside factors, but to the school building’s infrastructure as well. The classroom was long and narrow, with only three dusty chalkboards, no erasers, and one piece of chalk. The room, when filled to capacity (as it was), didn’t allow for the vast majority of students to have a clear view of a chalkboard. Square holes dotted the walls, allowing a cool breeze to sweep across the room – a necessity for a school that lacks air conditioning in a tropical climate. However, as a consequence, outside noises easily distracted and students in the back struggled to hear. In such an environment, it would be easy for anyone to drift off, daydream, and fall behind, inevitably causing a snowball effect that could haunt the rest of your life.

Students share what empowerment means to them; Image c/o Elisabeth Epstein
Students share what empowerment means to them; Image c/o Elisabeth Epstein

When the groups finished brainstorming, each group presented their answers to the entire class. I was blown away by the honesty and creativity of these young women. Students took on difficult topics and responded in various and equally impressive ways. Although each group was powerful in its own right, I have to admit I had a few favorites.

When asked the question “What does empowerment mean to you?”, Shannae, 13, responded with a poem:

Give but don’t allow yourself

to be used.

Love but don’t allow your

Heart to be abused.

Trust but don’t be naive.

Listen to others but don’t 

Lose your own voice…

Another group with the same question drew a cartoon of a man and a woman talking. The man asks the woman if he could touch her private parts. The woman responds, “No, but you can touch your own.” (At which point in the presentation, the room erupted in laughter.)

When describing the challenges of being a girl, one group had each group member trace her hand on the poster and, within the lines of her own hand, write a challenge. A heartbreaking question, these young women answered with strength and courage, proudly presenting their poster to the class.  Challenges listed included bullying, low self-esteem, boys, peer pressure, puberty, and not being wanted.

As expected, the favorite and most exciting question to answer was “What is your favorite part about being a girl?” Answers included a wide range of activities such as manicures and pedicures, exercising, listening to music, going to school, and more.

I am honored to have had the opportunity to meet these incredible and smart young women. After feeling the class’ energy and hearing their ideas, I am confident these girls are already on the path to success. And as much as I hope the girls learned a lot both from me and each other, I am positive that I learned a lot more from them.

I’ll soon be returning to Tutorial High to repeat this lesson with a younger class – and I can’t wait to see what they’ll teach me.



An Interview with Nadia Hashimi, Author and Girl Advocate

A few weeks ago, I had the opportunity to attend a book signing where author Nadia Hashimi spoke about her newest novel, The Pearl That Broke Its Shell. Pearl tells the story of a young Afghan girl (Rahima) and her great-great-grandmother (Shekiba) who both dress as boys to overcome incredible gender inequities. I read the novel a few weeks prior and absolutely fell in love with the story and its cast of strong female characters.

Nadia proudly supports women’s and girls’ empowerment and was excited to share more about her book and her life with Girls’ Globe. You can find the entire the interview below.

c/o William Morrow Publishing
c/o William Morrow Publishing

How did your background and/or personal life influence the story of The Pearl That Broke Its Shell?

My parents came over to the United States from Afghanistan in the early 1970s.  They initially had the intention of returning to their homeland after a few years, but then the Soviet invasion happened and Afghanistan went into a downward spiral and it wasn’t safe for them to return.  It was because of these events that I was born in the United States.  From a distance, I’ve watched my counterparts (my female cousins) have a very different experience growing up in war-torn Afghanistan.  This made it really important for me to be grateful for all the opportunities I’ve had.

Most of the characters in The Pearl That Broke Its Shell are strong women and girls, particularly Shekiba and Rahima. What character did you most enjoy writing? Who do you relate to the most? Why?

Thanks for calling them out as strong female characters.  I’d have to say I enjoyed writing Khala Shaima, the disfigured and defiant aunt, most of all.  Because she’s got a deformity, she is somewhat liberated from the traditional rules and restrictions of society.  She’s an old maid and goes around telling people (even men) exactly what she thinks.  She’s the voice that eggs Rahima on, urging her not to give up and to question what people think girls should or shouldn’t do.  She makes education and literacy a priority.  Since I was blessed with a family that supported me all the way and never set boundaries on my potential, it’s hard for me to put myself in the shoes of most of my characters.  Thank goodness for that.

What inspires you to write books about empowered women and girls?

I write about empowered women because that’s what interests me and because I hope some younger readers will be inspired by the characters.  I think all girls need to learn to assert themselves.  While much better than the world depicted in Pearl, even western society doesn’t always afford girls the same potential as boys.

Without giving away spoilers, what was your favorite scene to write in The Pearl That Broke Its Shell? Why? 

Toughest question.  I’ll say, without giving much away, that it felt really good when my characters were able to turn a positive corner.  Their experiences are pretty grueling and I was very invested in them as people.  At the same time, some of the hardest scenes to write are actually really important to me because they depict the brutal way some girls are treated.  Child “marriage” (such a euphemism) is really tough to think about when you get into the gritty details but that shock factor is what draws empathy and awareness.

The bacha posh tradition is a major aspect of your novel. Can you explain more about it? Is it still present in Afghanistan? 

In Afghanistan, boys are valued over girls for all the same patriarchal reasons that exist worldwide.  Boys carry on the family name and are supposed to care for their parents as they age (not really true in today’s world).  Some families without sons feel that they are lacking and often are pitied by others in the community.  By transforming a daughter into a bacha posh, a boy dressed as a girl, they are able to restore honor to their family.  They might also believe a bacha posh will bring good luck to the family and that they’ll have a true son in their next child.  It’s not something every family does, but happens commonly enough that nearly any Afghan living in Afghanistan knows of one.  It does still occur but my belief and hope is that it die out as the societal value of daughters rises.

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Girls' Globe blogger @epstein85 had a wonderful time speaking with Nadia Hashimi last night about her new book 'The Pearl That Broke Its Shell.' The novel tells the story of two Afghan women who live parallel lives a century apart. Rahima is living the legacy of her great-great-grandmother, Shekiba, and through the hardships she endures, she draws strength from this relationship. They share a common tenacity, a desire to survive despite incredible challenges. Filled with strong female characters, 'The Pearl That Broke Its Shell' is a must-read for any girl advocate. Learn more about the author and the book by visiting NadiaHashimi.com. #book #reading #literature #genderequality #Afghanistan #feminism #sheroes #MENA #girlsinspire #girls #women #childmarriage #VAW #girlpower #WomenInspire

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The Pearl That Broke Its Shell discusses many important issues in Afghanistan: political corruption, child brides, violence against women, and gender inequality. In your opinion, is Afghanistan becoming a safer place today than it was during Shekiba’s time? How do you think these issues will impact Afghanistan’s future and the future of Afghan girls?

These issues are crises in Afghanistan.  A corrupt government cannot effectively provide for or protect its daughters. When school funding disappears into the pockets of politicians, young students suffer. When girls are married young, they are more likely to experience health problems or even die during childbirth/pregnancy.  They are unlikely to go to school and more likely to be abused.  Add to this the knowledge that it is really hard to break out of a cycle of poverty or violence in a family, and it’s easy to believe some Afghan girls simply don’t stand a chance.  The landscape is changing, though.  It is a much safer world than it was a decade ago and many Afghan women are thankful to the western nations who helped free them from the oppressive Taliban control.  Women are now part of government again. They are becoming working professionals and contributing members of their families.  Young girls can look up to assertive, accomplished women in their communities and be inspired to do great things.

What are your plans for the future? Will you be writing more books about women and girls? About Afghanistan?

I have a second novel that will be released July 2015 called, When The Moon Is Low. It’s the story of an Afghan family beset by tragedy by the brutal Taliban regime.  A mother is forced to make some really harrowing decisions and, with her family, flees Kabul.  As they make their way across Europe, Saleem, the barely adolescent son, is separated from the rest of the family.  As he struggles to reunite with his mother and siblings, he floats into the dark world of human trafficking.  It is a coming of age story for a young boy, a marriage and a family as a whole.

I’m currently working on a middle grade version of The Pearl That Broke Its Shell, in which Rahima makes a guest appearance.  I’ve also got two other stories in the early works.  One is another Afghan story but the second is not.  As an author, it’s incredible to be able to write about anything under the sun.  The possibilities are endless, as long as you can create compelling characters and an intriguing plot.

Can you recommend books and/or organizations for those interested in learning more about the women and girls of Afghanistan?

I’d recommend Fariba Nawa’s Opium Nation.  Fariba is a brave journalist who provides an eye opening glimpse into the opium trade in Afghanistan and how it impacts individuals, particularly children. Also, However Tall the Mountain, by Awista Ayub, is a great true life story of what athletics can do for Afghan girls. For organizations, check out Women for Afghan Women.  Their interventions are making a profound difference in the lives of Afghan girls and women.

Thank you Nadia for your amazing insight on girls in Afghanistan. We can’t wait to read your upcoming novels!

Access to Justice: A Change is Going to Come

Now I am free. A female sex worker and child. Photo Credit: Laurenz Paas for Theatre for a Change
Now I am free. A female sex worker and child.
Photo Credit: Laurenz Paas for Theatre for a Change

Written by Catriona Cahill, Development Officer, Theatre for a Change

In 2012, the United Nations Population Fund revealed that around 34% of the 52,000 female sex workers living in Ghana have had an unprotected sexual encounter with the police against their will.

Just over one-third of all women in Ghana have experienced physical violence; the majority of women report that it is most often a sexual partner committing the crime. With sexual violence already prevalent throughout society, just imagine how it is intensified within the industry of sex work where women feel they must necessarily subordinate themselves to their clients.

Yet, with only 9% of female sex workers in Ghana reporting a non-discriminatory standard of treatment from the police, it is no wonder that only half of them would consider seeking justice after suffering any form of abuse. Statistics such as this make a strong case for advocating for the rights of these women: the right to report abuse, the right to access justice and the right to live a life free from fear.

The current project by Theatre for a Change working with female sex workers in Accra is titled Access to Justice.  Twenty women from two of the poorest communities, Old Fadama and Railways, are participating in the project which first focuses on behaviour change, then advocacy, then access to service provision. Everything about Theatre for a Change is rooted in participation; all projects take place in circles; performances are always in the round. This approach stems from the philosophy of Augusto Boal, author of Theatre of the Oppressed. Boal believes that, through theatre, ‘the oppressed’ can explore and identify solutions to their own problems; change comes from within.

When I first visited Accra in March, the Access to Justice Project was in its infancy. Within the four-walled security of Jamestown Community Theatre Centre, the women were just beginning to explore and show symbols of change: alterations in how they held themselves, a greater eagerness to speak. Together, through improvisation, role play and enormous trust, they began to identify their own risky behaviours and explore solutions.

The community gathers to listen to an interactive radio drama Photo Credit: Theatre for a Change
The community gathers to listen to an interactive radio drama
Photo Credit: Theatre for a Change

As the project has moved forward, the women have become empowered to enter into their communities and tell their stories to the people who need to hear them the most: the police service, the brothel owners, the clients, the men. They play out scenarios that their audience can identify with and invite them to step in and change the course of events.  Together they explore alternatives and discover solutions while attitudes are challenged and changed. Here we see further elements of Boal’s philosophy creep in: Theatre for a Change does not remove the actors from the spectators – dividing walls that Boal said were symbols of oppression – instead the audience is encouraged to participate. ‘The walls must be torn down’ Boal demands: the oppressed are making theatre their own.

Just a few weeks ago, the walls were torn down in spectacular fashion as the once closed doors of Jamestown Community Theatre Centre were flung open to welcome brothel owners, chiefs and members of the community for a radio listening club. Together the group sat in solidarity to listen to the women participate in an interactive radio drama, broadcast across Accra and the Central Region, highlighting the rights of sex workers.

The changes I witnessed back in March were just a part of this bigger process. I just hope these changes continue to grow and seep out into these women’s lives. I hope a change is going to come for them and their communities that means that they can live without penalty or fear. And I hope these words of one of our former participants will soon be echoed by them all:

‘My first strategy was to stay away from him…then he will lay ambush and attack me in town….one day I mustered courage and looked straight in his eyes like you taught us to have eye contact when we want to be assertive and shouted back at him for the first time and he just left me there without touching me. Previously I could not look him in the eyes or talk back at him…now I am free.’ – Program Participant

About the author:

Catriona Cahill lives in London and worked behind the scenes in commercial theatre for four years before joining Theatre for a Change in 2014. She was based in Ghana for four months before joining the UK team as Development Officer.

To find out more about Theatre for a Change’s work in Ghana or Malawi please visit their website or follow us them on twitter.