For women aid workers, health care often a 'compromise'

While pregnant with her daughter, Ghilda Chrabieh worked for Mercy Corps in Rwanda, Syria and the Philippines, among other countries, before giving birth to her baby in Canada. Chrabieh relied on her doctor back home in Lebanon and stayed in regular touch via WhatsApp. Now, Chrabieh is based full time in Nigeria as Mercy Corps director of humanitarian programs. She still relies on apps like Viber and WhatsApp to talk with her gynecologist and her nearly 2-year-old daughter’s pediatrician. Otherwise, she tends to watch and wait it out when she sees her baby develop a rash, for example, and she always returns to Nigeria with a cache of birth control pills. “Obviously it is not easy. It is very tough, and sometimes it was like, ‘I just want to go home right now,’ but then, I signed up for the work,” said Chrabieh, recalling her experience with her pregnancy. “I don’t know if compromise is the right word but it is the only thing I can think of. It is a question of managing expectations.” Aid workers linked to major organizations have the benefit of health insurance and steady salaries that allow them to seek health care, when needed, outside of their host countries. But female expatriate aid workers based in developing countries without quality health care services may face many of the same problems that local women face throughout their lives, like lack of nearby access to safe abortions or pre- and postnatal care. As Devex’s interviews with female aid workers show, even with the safety net of health insurance, women aid workers still sometimes ignore or more often self-treat medical issues, take vacation time to cross borders to receive care for their health care or look to their doctors abroad for assistance. While aid organization operates differently, U.N. agencies will give workers a list of U.N.-approved doctors, according to Barbara Stilwell, who has worked for the World Health Organization. It’s common to not have a U.N.-approved doctor in a country where you are based, but instead in a neighboring country, Stilwell said. Stilwell has worked out of various countries, including South Sudan and Palestine, last from 2013 to 2015. During that time, she could cross into Israel to treat her asthma attacks and self-treated for other issues, like a urinary tract infection. She would also stock up on birth control, since she said there might be issues with the quality of the drugs in certain countries. “If you are really lucky, two things may happen. You can walk to a pharmacy and buy stuff yourself. In Palestine I knew the names of the medicine and I could buy some stuff and the pharmacist would sell it to me,” said Stilwell, who now serves as senior director of health workforce solutions for North Carolina based organization IntraHealth. Another time, in Uganda, Stilwell developed a urinary track infection following a minor surgery. She went to the doctor recommended on the U.N. list and received wonderful treatment, though she says she got lucky that the doctor was nearby. Often, Stilwell, who has been doing aid work since 1992, will look to International SOS, which provides virtual medical and clinical advice through a membership service, with the understanding that U.N.-approved doctors may not be based within the country where she is working. “Aid workers still have more options than local women,” she said. “That is definitely true and it is kind of an ethical dilemma, one that is your face all the time. I can fly to Kenya to get this or that... what happens to women who die at the roadside? There is no easy way to solve that except to improve the health systems. There should not be poor solutions for poor people.” One 43-year-old African woman who works for CARE International in an African country spoke of her complicated struggle to treat hyperprolactinaemia, which has led to irregular periods. The treatment for the condition has also caused fatigue, bloating and mood swings, making it difficult to keep pace with her demanding workload and travel schedule. This CARE employee asked that she remain anonymous, given the personal nature of her medical condition. While she has sought treatment in her host country for general care, she still returns home once a year to see her gynecologist and stays in touch with her doctor via Viber. She will otherwise ignore her symptoms until she is able to talk with or see her doctor back home. For more basic issues like a yeast infection she will consult a general practitioner where she is living. Cultural factors complicate her care and can make health care stressful, she said. She once had a scary episode during which she bled heavily, and another during which she struggled to receive a prescription. Her sister wound up bringing the medication with her during a trip. Ease with male doctors can also be an issue. “Especially being an African woman in an African country and a lot of the doctors are male, so as soon as I start explaining the problem, they ask, ‘Do you want to have children?’ And I have to say, ‘That is not what I came here for,’” she explained. “They think that childbirth should be your primary concern so you have to push back and say, ‘That is really none of your business, that is not what I came here to talk about.’” Chrabieh, 37, of Mercy Corps, says that women considering aid work should understand that they are “signing up to a certain lifestyle.” “Any child who is thinking about having a child in country similar to Nigeria has to compromise and accommodate to what exists or find alternative solutions,” she said. “I totally love what I do, but it does not mean that I don’t question myself sometimes. When you get pregnant and give birth you perceive things differently.” While Chrabieh says she was not able to speak directly to any experience with abortion, she noted that aid workers would likely have a difficult time finding a safe option for this procedure in country. Overall, medical and health support for women aid workers needs to be rethought, according to the CARE employee, who recommended looking into employing more in-house or external experts. “We need to think through a little bit more about what it means to be a woman working in this conditions and what are the implications are for us, health wise,” she said. “We really don't have the people to talk to about these things.” Devex Professional Membership means access to the latest buzz, innovations, and lifestyle tips for development, health, sustainability and humanitarian professionals like you. Our mission is to do more good for more people. 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