Tips on Preventing and Responding to Sexual Assault while Traveling

I was approached by a security consultant, Tanya Spencer, to write a chapter on tips for international travelers to prevent and react to sexual violence.  This is an issue I'm pretty passionate about as I've been working in a variety of places that are pretty sketchy but have always been pretty lucky. I actually first started thinking about this when I was in Paris three years ago and visiting a journalist friend. His young cousin was in town from the US and asked me how, as a woman, I handled my fear of being sexually assaulted or threatened while traveling. I hadn't thought about it properly but the conversation I started having with my female friends about this issue then morphed into some tips that we shared with other women going on their first missions. 

Below is the chapter from the upcoming book called: "Personal Security: A Guide for International Travelers," byTanya Spencer,  

ISBN: 9781466559448 

commissioned and published by Taylor and Francis, LLC.

Chapter 3 EXTREME RISKS - “Sexual Assault: Preventing And Responding As An International Traveler”

Sarah Martin, Consultant and Specialist on Prevention and Response to Gender-based Violence, https://sites.google.com/site/smartindc/

In general, women traveling in foreign countries have the same security concerns as men: Crime does not discriminate and having your hotel room burgled, wallet stolen, or being taken advantage of by a scam can happen to men and women. Therefore, many security measures are the same for men and women. But, a woman traveling alone can be seen as vulnerable  – particularly to sexual assault.

This section has been written with women in mind, but men may find that these safety measures are applicable to their own security awareness efforts as men can also be victims of rape or sexual assault. It has been compiled by reviewing the security manuals of World Vision, Care, and Refugees International. Other resources include the Médecins Sans Frontières “Guidelines for Medical and Psycho-social care of Rape Survivors”, interviews with women travelers in human rights, humanitarian action, and international business, and from my experiences traveling in over 50 countries and specializing in strengthening gender-based violence (GBV) prevention and response in humanitarian settings.

While an understanding and awareness of sexual assault can help you avoid dangerous situations, it is not always possible to prevent rape. Sexual assault is a violent crime and the onus of stopping sexual assault should be with the perpetrator, not the survivor.  With this in mind however, women are sometimes placed in danger while traveling and there are ways to mitigate some of your vulnerabilities. The following tips and ideas have been compiled to help travelers take precautions against sexual assault and respond if attacked. There are also suggestions on how to support a colleague if they are sexually assaulted while traveling.

Rape myths suggest that women are raped by strangers lurking in dark alleys. While this can happen, women are much more likely to be attacked by someone familiar to them – a co-worker, a driver, or a friend. Particularly while traveling, it makes sense to be extra cautious about socializing with men that you don’t know. Most men are unlikely to sexually assault women and women should not avoid all social engagements while traveling. But you should be aware that there have been cases of miscommunication between the sexes and of predatory men using tactics to take advantage of women travelers.

Stranger Dangers

To prevent “stranger dangers”, you should follow the appropriate advice in this book, including the primary advice of looking and acting confident, being alert, and using your common sense. Some additional general tips, specifically for women travelers though probably applicable to men too are:

Overall Tips

• Practice situational awareness. Try practicing “soft vision” so your focus is not only on one point and your peripheral vision is turned on. It allows you to react faster if someone approaches you from the side. It's also good for staying tuned into the vibes in a room, so if other people are getting nervous you pick up on it right away.
• Consider taking a self-defense course in your own country. They will teach you many good tips on general safety that are applicable to every country. Note: Many countries prohibit the importation of Mace or Pepper Spray. If you use this against your attacker, you may be charged with criminal assault yourself. Find out before you travel.
• Learn a few words or phrases in the local language so that you can deter an offender or signal your need for help (i.e., “police” or “fire”). Studies have shown that people are more likely to respond to “Fire” than they are to “Rape”.
• Avoid using an iPod or plugging anything into your ears that might make you less vigilant. This is especially true if you are walking home alone late at night, as you will not be able to hear anyone approaching you.
• Consider putting maps on your smart phone so you look as if you are checking messages rather than looking at a map if you get lost. However, conspicuous use of a smart phone in a crime-ridden area may draw attention.

This is all in addition to the usual security precautions like avoiding walking in dark alleys, parks, or similarly desolated places at night, using trusted taxi drivers/ companies instead of hailing one from the street, and checking the quality of your hotel door’s bolts and chain.

Accommodation

• Avoid full names on luggage tags. Use your first initial and avoid Ms. or Mrs. Some con men will read your name off your baggage tags and attempt to strike up a conversation with you by calling out your first name. They may also use this information to call your hotel to get more information on you.
• Keep the door to your room open when a male staff member is in with you. Male hotel staff are often solicited for sex so may offer their “services” to you. Be firm about turning them down and if they are harassing you, report them to hotel management. If you are in a chain hotel, be sure to report to the management headquarters rather than just the local manager. It also helps to check Tripadvisor.com or other travel websites to see if other solo travelers have reported problems.
• Maintain friendly relations with female staff in the hotel. They may be able to provide support to you if male staff is sexually harassing you.
• For long-term housing, consider sharing a residence with another woman or living in a group home or apartment.
• Carry “Blu-tak” with you when traveling. It is very useful for to make sure curtains close all the way (hair clips can also work for this purpose). It can also be used to put up newspapers or cloth over a window that has no coverings to prevent peeping toms.
• Always wear pajamas or a nightgown that you could run into the streets in. Sleeping naked or in a revealing nightgown might make you think twice before running out of your hotel room in case of an assault.

In Delhi, India, I was staying in a 3 star hotel with a “push button” lock and a chain on the door. Late at night, my colleague came over to share some documents with me and when she left, I forgot to re-chain the door. At 6am,  I awoke to a hotel employee entering with no knock and no call of “housekeeping”. He ran out when I shouted. I ran down to the front desk to complain and they defended the employee. The male desk attendant began to shout at me and when I asked to file a complaint with the manager, I was ignored. Lesson Learned: always make sure your door is locked and hotel staff cannot open it from the outside.

Consider bringing a door wedge to place under the door to delay an intruder from getting the door open. Some women suggest bringing a travel lock or a bicycle chain-lock to secure doors. Make sure the bolts work or change rooms. While this applies to all travelers, experience shows that women are particularly vulnerable in their accommodation and by following the basic precautions, they avoided attempts by men to enter their room.

Taxis And Hired Drivers

• Always look at the ID tag of your taxi driver. Check that the ID tag of your taxi driver matches that of the driver. Don’t be afraid to get another cab if not.
• Be extremely vigilant if your taxi has central locking. You may be locked in without your permission.
• Some women put the identification number of a taxi driver in their mobile phones or take a photo of the driver/photo id when they get into cabs to make it easier to report any problems.
• Try to travel with another person in the cab if you have been drinking so the taxi driver doesn’t take advantage of your impaired state.
• Use a driver you trust –establish a business relationship with a regular “Taxi Guy” – ask your colleagues for a reference for one. Don’t become overly “familiar” with your driver. In many cultures, men think that familiarity is an advance and feel free to approach you.
• Stand in a lighted and populated area if you’re waiting for your driver to arrive at night. A common mistake that many women make is to wait at their “usual” spot even if it is dark and there’s no people around.

Driving Alone

• Do a defensive driving course if you are going to the field or a place with bad roads / drivers. You should know how to drive in sand, mud etc so you avoid getting stuck. It always helps to be able to drive yourself so you are not vulnerable if something happens to the driver.
• Know how to change a tire so you don’t spend hours on the side of the road. Make sure your car is kitted out properly with spares and all necessary tools.
• If driving at night in a dangerous city or a badly lit area, see if you can drive in convoy with friends. Always know your route especially when driving at night.
• Insist that your car have “anti-smash and grab” windows, particularly in countries where carjacking and violent robberies are common.
• Have your mobile phone (or radio) and your keys out as you walk to your car, whether you are parked in the parking lot or on the street. You don’t want to be digging in your bag standing in front of your car door. Keep your mobile phone easily accessible so you don’t have to fumble in your purse looking for it.
• Don’t be afraid to ask someone to accompany you to your car at night. Make sure this is someone you can trust.

Avoiding Unwanted Male Attention

• Consider Your Attire. Women's dress can be a major issue in some developing countries. In some countries, it is considered provocative to show your legs, in others your shoulders, and in others, your hair. In some Islamic countries, women cover themselves from head to toe to avoid unwanted attention. When in doubt, the best option is to dress like a local – see what your female counterparts are wearing. Learn the local dress code as soon as you arrive; buy appropriate clothing locally if necessary. While opinions differ on wearing headscarves, it is useful to dress respectfully of local customs. Covering will not prevent sexual assault (as women from that country who dress modestly are also sexually assaulted) but will help avoid unwanted or lewd attention, and other harassment by local men. Unfortunately, many men in developing countries believe the rumor that Western women are “easy” or that women in bars alone are prostitutes. By not drawing further attention to yourself, you can avoid unwanted advances.
• Consider wearing a wedding ring or wearing one of your rings on the traditional “wedding ring” finger. Especially in conservative countries, a married woman is viewed as the property of another man and therefore off limits. Single women can be considered “available” for all sexual contact. In crime prone areas, make sure it doesn’t look too expensive so it doesn’t become a target!
• Avoid prolonged eye contact with men. Prolonged eye contact with a man is an invitation to flirt. In some developing countries or some societies, any eye contact at all may be considered carte blanche to approach you. Eye contact also may be considered disrespectful in some countries and may invite aggressive behavior from strangers. Wearing sunglasses can help reduce unwanted eye contact. Talk with local women to learn the rules.
• Bring a book or computer to restaurants or hotel bars when dining alone so as to discourage unwanted male attention (although a computer may draw attention to you as “rich” in some places and make you a target for crime). Sit at a table for one rather than the bar. Politely but firmly (and if necessary, loudly) state that you do not wish to be disturbed if another diner is aggressively soliciting you. If you leave the dining room, linger in the lobby near the front desk before going to your room to insure you are not being followed or ask a member of the hotel staff to accompany you to your room.

In 2003, I learned the hard way that a woman sitting alone at a bar is an open invitation to sexual advances. In Gisenyi, Rwanda, I was sitting at the bar in my hotel eating a bowl of Spaghetti Bolognese and a man sat beside me ignoring all of my attempts to be curt and signaling him to leave me alone. Finally, I paid my bill and stood up to leave. He grabbed my wrist strongly and said he would accompany me to my room. I loudly said “I am not interested in you. Leave me alone and do not touch me.” Luckily this embarrassed him and he dropped my hand. I then asked the front desk clerk to walk me to my room. However, I felt nervous for the rest of my stay and ate my dinners in my room after that. Now I usually take a table instead of sitting at the bar and that discourages most unwanted advances.

Dangers From “Friends”

While avoiding stranger dangers is relatively easy to do, dangers from friends, associates, and colleagues can be more of a challenge because these are men in your daily life and for vast majority of them, they present no danger to you. “Sophie’s” story can show how even “fun” coworkers can be a threat.

One of the problems we have is stressed-out aid workers going out dancing and drinking after a long hard day. The women want to dance and have fun but some men don’t know how to stop at no. I had a friend who had to come into my room and stay with me for the night because her supervisor kept calling her on the phone and knocking on her door all night trying to have sex with her. She felt like it was her fault because she had danced with him that night but because he was married, she thought it was safe. 

Every woman has the right to go to dinner with friends, wear what she likes and act in the way that she chooses and not be raped. However, when traveling in a culture that is foreign to you, an ounce of caution can help improve your safety and maintain your security.

Social Situations

• Exercise caution when meeting someone you don’t know well. An evening date with a group of people to a public place is far safer than an evening alone with a new acquaintance. If you are going out alone, be sure to make sure someone knows where you are going and when you expect to return. Make an appointment to check in with a friend or security if unsure about the person you are meeting. You can also tell your date that you have a security curfew and must check in with the security officer.
• Speak up! Communicate your wishes clearly. Be sure to make male acquaintances know that you are meeting for business or friendship purposes. Do not invite business acquaintances to your hotel room, ask them to wait in the lobby while you go up to the room.
• Assert yourself. Insist on being treated with respect and remind the acquaintance of what is unacceptable in your own culture.
• Be cautious when accepting food or drink from strangers in restaurants or bars. There have been many reported cases of women being drugged and sexually assaulted by men who buy them drinks in bars. Rohypnol (the brand name of Flunitrazepam), or "roofie", is a Benzodiazapine, a prescription pill similar to Valium that can be ground up and mixed into a drink by someone who wishes to rob or sexually assault you. They cause sedation, a feeling of extreme intoxication, and amnesia. The drug's amnesiac effect lasts at least eight hours and most people have no memory of events while you under the drug's influence.
• Roofies may have a bitter taste when dissolved in alcohol; be alert to a strange taste in your drink. When placed in a light-colored drink, some will turn the beverage blue. If your water or gin and tonic turns blue, dump it and be especially alert; someone has tried to drug you.
• If you suddenly feel unusually drunk after just a small amount of alcohol, quickly ask for help (preferably not from the strange man next to you at the bar who may have given you the roofie) - you might have just a few minutes of alert behavior left to you.
• Don't drink anything you did not open yourself or that you didn't see being opened or poured.
• Don't accept a drink from someone you don't know unless you see it being opened or poured by a bartender.
• Always watch your drink at parties and bars. If you leave your drink unattended, get a fresh one to be on the safe side. (Rohipynol advice taken from Student Travel Advice from Iona College at http://studenttravel.about.com/od/springbreak/a/roofies.htm).

Most female travelers probably have read similar advice about protecting your drinks (and food) while out. 

Carol, an international development worker, shows that a bartender can also be part of the threat scene. In this case, it would have been better to heed the forewarning about the reputation of the establishment and avoid it.

"In East Timor, there was a nightclub that was notorious for women being drugged and sexually assaulted. Everybody knew it was a problem so they kept their drinks close. However, a friend of mine was drugged and made it home safely. She reported it to the owners who were aware of the problem and trying to investigate to see if it was anyone who worked with them. Another friend woke up next to a man she knew the next morning who treated her very rudely. She had no memory of going home with him or even flirting with him. We suspected it was a bartender and that men would bribe him to drug women they found attractive.":

Sexual Harassment at the work place

Many security manuals focus on the issue of assault by a stranger. Unfortunately, sexual harassment by co-workers in the field is also a problem. Studies have shown that women are more likely to be sexually assaulted by someone that they are acquainted with than by a stranger. Seemingly mild-mannered colleagues can become sexually aggressive when out of their normal world. Spending long hours in bars or hotels socializing with female colleagues can cause them to throw caution to the wind and act in ways they might never consider in their home country. Alcohol can exacerbate this problem.

Many companies have a sexual harassment policy but still employees are often intimidated or afraid to react because of fear of not being taken seriously or because of the difference in authority between the aggressor and the employee. In my line of work, as a specialist on gender-based violence, I’ve heard too many stories like Julia’s.

One of my first volunteering abroad experiences, I met another foreign woman in a cafe and we were chatting about our jobs working for charities. She eventually disclosed that a colleague in the organization that she worked for had sexually assaulted her. She felt like she could do very little because of his position, the importance of their work and her fear of disrupting it, and a host of other reasons. So she was telling this stranger (me) in a café rather than reporting it to her office

Read up on your company’s sexual harassment policy. If they do not have one, demand that Human Resources create one! Many organizations have insufficient sexual assault policies that provide very little support for the survivor and are designed by insurance agencies to protect the organization. Women should read these policies before traveling and know what support you can get from your organization, if a colleague or someone outside the organization sexually assaults you. 

This is Lina’s advice, vowing to never again accept a superior brushing aside sexual harassment.

"I was sexually harassed by a colleague, repeatedly, during one of my early field assignments. Our boss would insist that we go into the field together – sometimes this meant lengthy car rides, with ample opportunity for him to put his hand on my leg, proposition me, or ask me “do you know how beautiful you are?” As, I was in my early 20s, and new to international work, I hesitated before complaining to the boss. When I did, I should have been better prepared. I didn’t know if the organization had a sexual harassment policy. I should have checked. He said that because I am from that part of the world, I should know how the men are. “Do you expect him to admit to it?” he asked me. “It would be like nailing jello to the wall”. I’ll never forget his response – and never accept that as an answer again."

If you find yourself in a similar situation, the best advice is to:

• Tell your colleague firmly and clearly that his actions are making you uncomfortable and you consider it to be sexual harassment (or that they are in violation of your company’s sexual harassment policies). If possible, put this in writing so you have proof for management.
• Maintain professional boundaries with colleagues and limit alcohol consumption, if necessary. While socializing can be a fun and sometimes, necessary part of your travel, having clear boundaries can stop any potential miscommunication.
• Do not be afraid to report problems to your superiors. Do it early. Keep a written log.

What to do if sexually harassed physically threatened or attacked

There is no single right or wrong way to respond to an attack and each situation is different. Only you can decide whether or not to resist your attacker. You can try to: talk your way out of it, give in to the demands made of you, shout for help, flee or fight. Note: Never risk your life or safety for material possessions – your principle objective in any assault is to survive with as little harm as possible.

Sexual Harassment

• Ignore the advance. If a man is trying to get a reaction and finds he cannot, he may stop.
• Confront him. If you politely ask, “Were you speaking to me?” the annoying party may feel embarrassed, especially if his actions were based on fear or insecurity.
• Get help. Do not try to cope alone.
• Say no - If you're being groped or touched inappropriately in a crowd, know how to say, "Leave me alone!" or “Do not touch me!” loudly in the local language. Learn how to shout “Police” or “Fire” to draw attention.
• Find a local woman or group of women to help you if you are being pressured or followed by a strange man. In many countries, women will gather around someone being harassed and denounce the man publically.

Physical or Sexual Assault

• Do not hesitate to call attention to yourself if you are in danger: scream, shout, run, or sound the horn of your vehicle. Dress in ways that do not limit your movements (long tight skirts or very high heels).
• If you think you're going to be raped, some women travelers have suggested making yourself as physically unpleasant as possible by pretending to vomit. Others have suggested trying to kick or strike the attacker’s genitals although it may encourage further violence from the assailant or an arrest for assault in some countries where women have few rights.
• Shout “FIRE!” or “POLICE!” in the local language as unfortunately, studies have shown that people are reluctant to be involved in rape and may not intervene if you shout “RAPE!”.
• Carrying a whistle has been recommended by some travelers as this will draw attention to you and discourage the perpetrator.

If you've been sexually assaulted or raped

It's not your fault. Remember: Nothing that you have done has caused you to be raped and you may not have been able to prevent it. Social stigma and dangerous myths still remain (in all countries) and the people whose job it is to assist or support you in this situation may not. You have the right to pursue the treatment you need and the right not to report the rape if that is what you wish to do.

In a foreign land, the social services that you expect from your home country may not be available. Most legal systems are woefully unsupportive of rape survivors. You can seek in-country support for accessing services and guidance on appropriate approaches to authorities. Your embassy can assist in sending assistance in some cases or in recommending an embassy approved medical practitioner. If in a humanitarian setting, some NGOs such as Médecins Sans Frontières or the International Rescue Committee can provide support and medical care as they are situated to provide services to rape survivors. Most medical organizations should have Post-exposure Prophylaxis for HIV prevention from needle sticks for employees.

You can seek help if you are the victim of this crime of violence. You are in control of what happens next. Seeking medical care from local providers or reporting to the police may not be a prudent option but the choice is yours. Local colleagues can offer some advice on this matter as they will be familiar with the reputation of local hospitals, police departments, and other services.

Medical Care

There are many steps you can take to protect yourself from unwanted pregnancy, HIV/AIDS infection and sexually transmitted infections. These actions are time sensitive. Find medical help immediately. You can insist on having a female medical person present – although lack of certified trained female practioners is a problem in many countries. You can also ask for a female nurse to be with you during the medical exam. Many countries have mandatory reporting laws and the physician is required to report the assault to the police. In all cases, you should insist on medical attention first as many of the steps outlined below are time sensitive.

If medical care is not available, there are some actions you can take yourself to protect yourself from unwanted pregnancy or HIV infection.

• Within 72 hours of a sexual assault, in order to reduce risk of HIV infection, you can take post-exposure prophylaxis (PEP), an anti-retroviral. Ideally, the PEP should be administered within 4 hours of the attack. PEP is administered for 28 days and can have some rather severe side effects so should be administered by a medical professional who can provide counseling to help you. Many health care agencies have PEP available for accidental needle sticks or assaults on their employees. If the hospital near you does not carry it, approach medical officers in embassies or large corporations.

• Within 5 days (or 120 hours), you can receive emergency contraception to prevent pregnancy. Emergency contraception is usually a heavy dose of oral contraception (available in many pharmacies as “the morning after pill” or the “La pilule du lendemain” in French or “La píldora del día después” in Spanish.) If you don’t have access to “emergency contraception” but have access to oral contraceptives (birth control pills) check and see if you can put together 1.5 mg of Levonorgestrel. This pill should be taken as soon as possible. The longer you wait, the less effective it becomes.
• If you go not get your period within 21 days, you should seek out further medical care. Some female travelers carry emergency contraceptive pills with them in remote areas in order to be able to prevent pregnancy in case of rape.
• You should get a tetanus shot if there has been broken skin.
• STI treatments: You may be at risk for transmission of Hepatitis B, Chlamydia, Gonorrhea, Syphilis, or Chancroid. Seek medical attention as soon as possible to be treated for these illnesses.

Legal Response: To report or not?

If you are assaulted, you must decide whether or not to report the crime. If you report the crime, in most cases the police will want to question you about the circumstances of the event and in most countries, will likely demand a hospital examination. Most developing countries are not well-trained or supported in providing services to rape survivors. You might find that you are subjected to unnecessary medical investigations, responsible for providing proof of the rape and treated with judgment and lack of empathy.  Reporting sexual assault is encouraged in order to punish the perpetrator and prevent attacks on other women, but it is a personal matter for you to decide whether or not you wish to pursue legal action. In some countries, the treatment by the legal system may further traumatize you and not lead to prosecution so decide for yourself what you wish to do and do not allow anyone to pressure you.

Getting support from your employer

Do not be afraid to ask work for some time off – use sick leave or personal leave since it is not vacation time.  You are entitled to recovery from these incidents: Your agency should support (and possibly fund) this. Ask human resources about identifying counselors or therapists who can be available to you (either in your home office or via phone if you choose to stay in the field). It’s important to ask about how much counseling your agency will pay for. Many survivors find that they need to talk in confidence to someone to deal with trauma around the event – someone who is not related to their workplace.

Supporting a colleague who has been sexually assaulted or raped

In some cases, you may be traveling with someone who has been raped. This causes a lot of anxiety and fear as people may be afraid to “do the wrong thing” or further traumatize the survivor. It is important for survivors to know that they went through abnormal events and that their emotional reaction to those events is normal. Guilty feelings may appear, therefore it is important to communicate explicitly that sexual violence is not the fault of the survivor. There are many myths, false beliefs, and misconceptions around sexual violence. Many cultures blame the victim for the sexual assault. If the individual expresses feelings of shame or guilt, be sure to address them directly. Give a clear message that sexual violence is never the fault of the survivor: The crime is the fault of the perpetrator.

There are ways that you can help your colleague recover from this criminal act. As rape is an extremely disempowering experience, your focus should be on trying to empower the survivor in all areas possible, restoring her ability to feel that she has control over her body (by asking consent before each action – calling the police, informing your office, hugging or touching her, etc), and reducing further victimization by avoiding diminishing her control over the situation (not talking about her without her consent) or taking decisions for her. Do not pressure the survivor to take decisions she is not comfortable with. In general:

·       Be respectful

·       Maintain confidentiality

·       Be non-judgmental

·       Be consistent

·       Be patient

·       Be empathetic

·       Allow the person to cry

·       Avoid “Why Questions”

·       Don’t force the person to talk if they do not want to.

·       Don’t criticize their choices.

·       Support them in their choice to leave the situation or maintain working if they desire it.

"Four Hours in Jail for Not Trusting My Instinct" Solene, humanitarian aid worker 

I'm used to traveling alone, but one time in Dakar, I was on a work trip with my husband. We went to a colleague's house who invited us for a drink at his local bar. When we arrived, I looked around and realized that we were the only foreigners and this place was obviously not safe! I thought we should left immediately. But then I thought, don't worry you're not alone this time, don't be paranoid, and I ended up not saying anything.... And we stayed. 15 minutes later the police raided the bar, arrested 2 or 3 drug users (dealers?) and ended up arresting us after my co-worker argued with them. The cops said it's unlawful to be out without your passport when you're a foreigner so we spent 4 hours under arrest until someone at my office came to negotiate our release. That night I learned a big lesson: trust your instinct at all times. If you feel something is wrong with the place, leave (and carry a copy of your passport at all times)!

 “Hotel Allowed Someone To Bribe Their Way Into My Room: Luckily, It Was My Boyfriend”

Anita, international business traveler

I was in Nairobi for business and my boyfriend was going to fly in to meet me at the hotel. His flight was really late so I fell asleep waiting for him. I woke up terrified to the presence of someone in the room. My boyfriend had arrived, and wanting to 'surprise' me, he was able to bribe the clerk to let him into my room. Thankfully it was only my (now ex!) boyfriend. Always keep the chain on the door.

Alarm! Red Flag! Danger, Will Robinson, Danger!

Well - I have had a rough week... actually probably a rough six weeks. I went to Nepal for two weeks to set up a donor monitoring mission which was not so bad - the Nepalis are such lovely people and Kathmandu is an interesting and charming and chaotic city - filled with (as some Indian man i met in the airport limo told me) "Hindu Characters". I enjoy being in Nepal - greeting people by saying Namaste, casually passing shrines and stupas, and ancient beautiful buildings - flying on planes called Buddha Air or Yeti Airlines.

But then I went to Afghanistan. At first it was fun - I have a potential blog post in here to compare and contrast my law breaking NGO ways with the UN discipline I"m supposed to maintain. I was sleeping in a shipping container, seeing old friends, commuting in armored cars, training (which I love). But it wore me down eventually - the relentlessness of work, the dreariness of the place (despite some beautiful touches like the rose garden and honeysuckle in front of my little apartment), and the never ending watchfulness you develop. I flew from Kabul to Delhi to Bangkok - had a 12 hour layover where I literally changed out the contents of my suitcase from Salwar Kameezes to sundresses and headed back to the airport to Frankfurt and Oslo. I had a brief romantic interlude in Copenhagen with this man that I adore but who is extremely elusive and then back to Bangkok. In the meantime, suicide bombers blew up the hotel I had been working in while I was in Kabul.

When I got back, I was tired. so very very very tired. Like sleeping all day on a Saturday and Sunday in a hot rather fevered state with a deep lack of energy I've never experienced. I didn't feel depressed, I literally felt like I was a completely de-charged battery. My brain was still working but my body wasn't. It was worrisome. Now of course, me being me, I immediately thought - maybe I'm depressed! Burned out! I had just been in Scandinavia and watched two Finnish and Swedish films (One of which railed on and on about the youth today who can't hold down a job without becoming burned out within six weeks). My American Capitalist work ethic kicked in and said - HEY! Because you were out sick last summer, you can't hack it anymore! You are weak! So I joined a gym, got a personal trainer and started working out. It worked! I had lifts in my energy but I still felt not right. So I went and found a therapist. Done. Probably stress! And working on sexual violence is tiring. And I had some friends going through some things that was mildly stressful. My nerves felt stretched though - I was on a phone call one day and it was all I could do not to scream and throw the phone out of the window into the pool. And nothing that bad was going on. Time for a vacation??? Then the horrible Norwegian terrorist blew up the Government building next to where I had been interviewing in Oslo. Hmm - extreme terrorist attacks following my every move.

Finally, someone pointed out to me that it might be physical... which made sense... I had struggled with an upper respiratory infection when I got here, then got some nasty intestinal thing that came to plague me in Laos and Pakistan, and I had been sick for almost a year when I moved to Europe. New continent - new antibodies needed. Plus traveling in Pakistan and Afghanistan is tiring. I heard a miraculous story of a man I know who was run down and very snappish and angry. He went to a doc, found out he had a parasite, they gave him a pill and he literally could fell it making him better. I wanted that pill. I was tired, snappish, easy to offend, and slumping into not caring about anything.

So the fantastic admin assistant at the office made me an appointment for the next day at the Bumrungrad hospital. I went in and got all the exams - stool, urine, and blood (hey - I'm a humanitarian aid worker - I like to talk about stool, urine and blood!). I couldn't give more samples though because I was leaving the next day for a training in Pakistan. I only had a 2 day window of opportunity for any treatments because then I was off to Nepal and then off to Europe for holiday. In Pakistan I felt a bit better. At least my energy and time was taken up by the demanding training participants. But my patience was thin and I was in love with my comfy Marriott bed and never wanted to leave it.

I flew home on the "red-eye" and went immediately into the hospital to get my test results. I felt haggard. I just wanted to know what parasite I had so I could get that magical pill. The lovely doctor gave me the good news first - blood tests were fine - no anemia, no cancer, no bad thyroid, no bad liver. Stool tests fine - no parasites (disappointment!) but the urine test showed I had an infection. Now my co-worker in Afghanistan had a UTI which was making her feverish so I know that they can have weird results on the body. Aha! I thought - that's it. But then the doc sent me to the Ultrasound room. I got an ultrasound - in an aside, I mentioned that I used to have kidney stones. Back when I was 24 - in both kidneys - but I gave up coca cola and now I was fine! Well guess what. I'm not fine.

The doctor sent me immediately to the urologist. They discovered an almost 2 inch kidney stone in my ureter of my right kidney that was blocking my kidney, sending urine back up into it and infecting it. How had I not felt it? Dunno. So, I thought... lithotripsy! I've had this before. No problem! Nope. The doctor said it was too big not to operate on and he wanted to do it right then and there. Cut a big incision over my hip and go in and fish out the stone. I was terrified. My closest friends in Bangkok were mostly out of town. The doctor was confident but I have never had surgery before. I texted my friends. They were shocked. I went into surgery. Right before the nurses came to get me, I was really sad and felt very alone. Then I thought of my mom. In the 60s, she was living in Taiwan with my father and had me. This was before men were in the delivery room. I channeled her energy- she was a fighter - and I thought - well if she could do it 40 years ago, I can do it now. So I just sucked it up.

So now... where am I? After surgery in a foreign land and five days in the hospital recuperating and two days in my apartment coming to terms with the fact I have a 10 inch scar on my hip, a tube in my bladder and kidney, and a postponed return to Europe... I am feeling a bit better. Unable to sleep really... and feeling vulnerable but the exhaustion is gone and hopefully my energy will return.

I don't have any lessons to share. I just feel sick and vulnerable and a bit more mortal. It's not going to be the suicide bombers of Kabul that will get me! It will be something ridiculous and human like a kidney stone.

Frog in a pot of water

While I was in our project in the highlands of PNG, I was "evacuated" with staff by a 10 seat prop plane that was chartered to fly in, pick us up, and deliver us back to the capitol. It was actually quite emotional - after a meeting where the management informed the national staff why we were leaving and everyone hugged goodbye, we rolled out of the compound in a convoy of white landrovers to the airstrip followed about ten minutes later by crying staff - I felt like I was in an episode of M*A*S*H. My colleagues were worried about leaving patients and colleagues behind and wondered if they would ever return. Despite the fact that I had only been there three days, I was emotional too and even felt some tears in my eyes when we took off down the old dirt runway.

A little background:
In the area where we work in the highlands, its extremely violent and neglected. The people there still wear traditional clothing often and they conduct elaborate tribal wars. Because of the violence, there's been almost no one working there for years. We run a project focused on sexual violence, domestic violence, and surgery for violent injuries. For the past few weeks, there's been a bunch of drunk men with seriously big machetes (one was like 3 feet long!) breaking into the hospital and shouting death threats at the staff. Since we are a neutral agency, we don't use armed guards so all we can do when they come in is lock ourselves in the compound.

Since the authorities woudn't do anything about security, management decided to "send a signal"by evacuating the staff. The community was so pissed off at the authorities for problems in the past that they sent 20 people to kill the CEO with machetes and spears three months ago. So security is a big issue. But the people in PNG are very emotional - it was hard to communicate what the "signal"was that we were sending...
the community was also incensed that we were leaving so they staged a demonstration outside the hospital threatening to burn the place down. Which we were afraid they might do. So as we were packing up on Tuesday night for our 11am evacuation flight, we heard gunshots from right outside of our "doublewide" trailor (or prefab house as its called in PNG) where we were staying. The radio handsets that we are all required to carry with us everywhere went off and we were told that we had to hunker down.

It's been a while since I heard gunshots... in DC, it wasn't that unusual but in Amsterdam, if I hear that sound, I assume its a car backfiring. I've grown accustomed to peace - even though I work in war zones. On the Ethiopia-Somalia border, I saw men running around with automatic weapons but I don't recall hearing shots.

I was staying with a psychologist and a doctor in the prefab house and we had all been chatting as we packed so we all went into the hallway and sat on the floor while our unarmed guards went out to investigate. Then there was another gunshot from closer to our house. We realized that we had the door to our house still wide open but were too afraid to run past all the windows to close it. So we decided to crawl into the shower and sat there for thirty minutes until we got the all clear. Since the UK doctor was listening to Kelly Clarkson whle she was packing, we had to continue to listen to it while we sat there wondering what was going on. So I got to contemplate the fact that I might be killed by a crazy drunk man while sitting in a shower of a doublewide lstening to Kelly Clarkson. Not exactly how I thought I would check out.

In the end, it it was all fairly uneventful. Supposedly the police were "checking their weapons" or one of the drunk dudes that has been harrassing the hospital was in an altercation with another guy and someone pulled a gun. Everyone seemed to think it was fairly uneventful and we had some laughs about sitting in the shower later on. But now that I think about it, I feel more like the frog in the pot of water that doesn't know how hot its gotten until its boiled. The violence in Papua New Guinea is so pervasive that it's hard to see it. The people are so sweet and friendly and nice but there is a potent brew of an unfamiliar culture based on payback and revenge and home brew that gets angry men drunk faster.

Sometimes I think about the risks that I take in my line of work. In general, I have a higher than normal tolerance for risk, I suppose. But sometimes I think that I have become immune to thinking about danger which is a bit scary. I wasn't really scared when we were crouched on the floor, I stayed calm and we thought of options. I remember being scared in Lebanon when the bombing started and I realized I had no idea what to do if the building I was in was bombed. Preparation has always helped me feel calm - if I know what I'm supposed to do, I can just go on auto pilot. But in PNG, I felt scared in the nightclub in Lae but not in the hospital compound in Tari.

The Guerrilla disease

I haven’t worked in Latin America (proper) since 1997 when I worked with Witness for Peace and NCOORD looking at issues in Nicaragua and Guatemala and this trip to Colombia marks my return to the context. In 1999 I lived in Guatemala for a little while mostly to study Spanish (and drink beer, and dance meringue, and go to movies with my friend Jamie). I always wanted to return to work here but there are so many capable locals who can do the work that they don’t really need many folks from the US to come down. On top of that, the US has played such an active role in many of the conflicts (overthrowing the Chilean government, supporting the Argentine dictators, overthrowing the Guatemalan socialist leader, Arbenz on behalf of the United Fruit Company, waging war in Panama, Nicaragua and El Salvador, and our continuous attempts to over throw Castro in Cuba) that American do-gooders aren’t that welcome. In particular, Colombia has “suffered” from particular attention by the US government. Our insatiable appetite for cocaine has made the route from the coca fields from Coca right up the Central American peninsula quite dangerous. There’s money to be made there and the overlap between political battles between the government of Colombia waging a war against terror against left wing guerrillas with the aid of “paramilitary” groups combined with the money to be made in a land grab to run cocaine, grow bananas, pineapples, avocados, coffee, and tobacco has made life hard for the peasants (indigenous people, people of African descent, and mixed “mestiza” population) who work the land and try to scratch out a living. The US government spends a lot of money arming the government of Colombia to “fight narco-traffickers and terrorists” with little to show for the 1.7 million USD dollars per day that the US Government gives to the army but the longest running civil war in the world and the most internally displaced people in the world (an IDP is a “refugee” who has not crossed an internationally recognized border).

In fact the US influence here is so strong that I’m supposed to pretend I am Dutch or any other nationality besides American. I’m an attractive target for political guerrillas to trade with the Colombia government and I can put the teams here in danger because the patients will fear that I’m a spy from the government and the paramilitaries. While my experience in Lebanon with Hezbollah taught me that its better not to lie as they usually know already what nationality you are, I’ve resolved to say “I live in Amsterdam, the Netheralnds” and “I flew here from Holland” – all of which is true. It’s hard though because my Spanish isn’t great nd we’re not supposed to speak English in front of strangers including in bars or restaurants or in the clinic in front of patients. I mostly stand around listening eagerly and hoping to catch a few words. My dormant Spanish has made a creaky comeback and I can chat to an extent as long as the other person doesn’t speak too quickly. My vocabulary is good by my grammar sucks. I mostly limit myself to banal observations about how hot it is or how delicous the frijoles I'm eating are.

After 10 years of focusing primarily on Africa with some focus on Haiti, Nepal, and Sri Lanka – I’ve finally made it back to South America. I’m learning a lot here. Many of the issues that plague the people of Latin America also plague the people of Africa, Asia, Eastern Europe, and the poor in North America… in particular, the disease of the poor are the ones that have the most restrictions on how you can treat them. One that I found particularly interesting is Leishmaniasis also known as Kala Azar. It appears to be a larvae from a but that when you are bit, injects parasites into your blood and you have wounds that won’t heal on your legs and arms and you can get parasites in your spleen, liver, and bone marrow. The bugs that carry this disease in Colombia live in rotted wood. In Colombia, we mostly treat women and children with this disease because they are the ones who are gathering wood or water and going out into the jungle the most. However, in many of the mountainous areas of Colombia, there are also a high number of Leishmaniasis cases.

The disease is very stigmatized and known as the Guerrilla disease. Therefore the government requires mandatory reporting of anyone who has this disease (violating their right to privacy) and strictly controls access to the medicine used to treat it. As we see mostly women and children, we are trying to lobby the government to drop this stigmatizing treatment of these patients and let us treat them so they can go on with their lives. While I have seen access to healthcare controlled for certain ethnic populations (poorly staffed and run health clinics for the Acholi in Uganda or the Ogadenis in Ethiopia), this is one of the first times I’ve encountered a disease linked to political issues.

First impressions of New Delhi, India

Beep Beep! Hooooooooooooonnnnkkkk! Beep Beep!

That's my first impression of New Delhi and one that hesn't changed much in the past 2 1/2 days. I arrived about midnight on Wednesday and the MSF driver took me to my hotel. We dodged traffic (a free flowing carefree thing where you signal moves with your horn and ignore red lights, pedestrians, lane dividers, and giant trucks). Over giant overpasses and through enormous roundabouts we went. Amsterdam and Washington DC are rural villages compared to this place. After coming through a million diversions due to ongoing construction of the new metro line we went until we finally arrived at my hotel, the hotel Vikram, an unassuming little place with a lovely view of the Metro construction and highway.

I then checked into my hotel room. It was pretty quiet... until I went into the bathroom. It's not unlike showering on a major highway. But I'm a heavy sleeper and in the bedroom with the overhead fan on for white noise and the curtains shut, you don't really hear the horns in the background.

After two days in the office getting ready for the workshop, I finally stopped working long enough on Saturday to try to see some of the town. The first thing I did was go to buy some yarn for an exercise for our training. The doorman sent me down to Central Market in a rickshaw (basically bicycle attached to seat for two on the back). I assumed since it was a bicycle, it wasnt'far away and we would be going down residential streets - Nope! Off we went in the little rickshaw onto the major highway that runs in front of my hotel. I often think that the only way I survive on these trips of mine is a very underdeveloped sense of danger. I just held my skirt down around my knees and tried to look unconcerned.

After running aroudn the market and getting some rope (since yarn appears to be a foreign concept), I got back into a rickshaw to go to the hotel. This time, the rickshaw driver found an even more congested route back to the hotel. At one point, trucks, and buses were overpassing us and honking. He pulled into the "left turn lane" near the hotel and we sat in the middle of the largest roundabout you've ever seen in your life as cars, motorcycles, tuk-tuks, and trucks roared around us. Then he made a break for it.



I decided to upgrade for the second portion of my trip and get a tuk-tuk (three wheeler scooter) for my excursion out shopping. Again - back onto the highway and ripping through traffic honking away. All the rickshaw drivers can do is ring their bells to join the din but the three-wheelers have a proper horn. At every intersection, we stop and every inch of space is filled with motorbike drivers with women perched on the back, men on bikes with giant loads of wood, people on foot, policeman on motorbikes with their supervisors behind them, and more three-wheelers. I was so relieved to finally get to the destination.



It was called Hauz Khaz, an urban village that promised to have art galleries, antique shops, and other goodies to explore. After looking in the gorgeous antique shops and realizing that I could afford things I just had no idea how I would get them home. The "urban village" is on the grounds of a beautiful park containing the ruins of the tomb of Firoz Shah which means the "Royal Tank" - which is a reservoir and overlooks a lovely green mandmade lake where people loll about in the grass and chat with each other and young lovers hold hands and gaze at each other soulfully. A bunch of men were playing cricket with some young boys. I sat in the park for a while where I made the acquaintance of every teenage boy in town, I think.



Anyway, it was lovely and warm and breezy and the teenage boys were polite and curious. I didn't feel threatened by them and I heard them discussing the mystery of how I can be American but live in Amsterdam amongst themselves later. After another nervewracking ride back in the three-wheeler, I returned to the hotel.



The meeting participants are arriving tonight and I'm having dinner with one of the facilitators who is Indian and has promised to navigate the restaurant choice for me. Tomorrow, the Taj Mahal!!!