Friday, March 9th 2012
The comments on the guest post by “Hazed” demonstrate that she is not the only person to experience sexual harassment in the field. And so I must share with you the next post in this series on harassment while doing fieldwork by “Lady in the Field.” Like “Hazed,” “Lady” is brave to share her story with us. My hope is that some of what happened in this field experience, particularly the aftermath among the various faculty involved, will teach those of us in positions of power what not to do.
It is unambiguous to me that supporting junior scientists and protecting them from mental, physical and emotional harm, not to mention providing them the resources to flourish, should be the main goal of every academic department. There is never, ever an instance in which our science, or a collaboration, should be privileged over this. And yet, that is what happened here.
Let us think together on what administrative, bureaucratic and cultural practices need to shift to put attention and effort towards the most valuable, yet often most vulnerable, resources in science: junior scientists, which includes undergrads, grad students, postdocs and junior faculty.
* * *
It was happening again.
I looked around the seminar table to see if anyone else had noticed. The other graduate students and the professor remained engrossed in debate over an article—no one, it seemed, had registered the panic mounting in my corner of the room. Quietly, I slipped notebook and papers into my backpack and made for the door, offering the apologetic “I have an embarrassing doctor’s appointment—trust me, you don’t want to know” smile.
I walked home, head cloudy, eyes fixed to the ground. When the crossing-guard teased me for returning early—he usually saw me in the morning, as students arrived at the local school, but never in the middle of the afternoon—I nearly burst into tears. Why could I not shake the feeling that everything I did—in fact, everything I thought—was fundamentally bad, that it invited the wrong sort of attention, that I shouldn’t, by all rights, be taking up space in the universe at all? And why did this terrifying train of thought become more persistent with each passing day?
Several miles of pavement under running shoes, a hot shower, dinner, and a frantic journal entry later, the demons receded. I looked at my watch: eight hours had passed since the onset of the episode, and this had been a short one. In its grip, I could not focus; now, released, I was wrung out and hollowed, the way you feel when a fever breaks. No more work would get done tonight.
***
This sort of episode—beginning with the feeling of being “triggered” by some one’s unknowing remark or gesture, progressing into full-blown anxiety and self-loathing, and resolving, finally, in a feeling of mysterious reprieve and exhaustion—had begun to occur after a senior colleague at the remote field site where I did dissertation research spoke to and touched me in an inappropriate and nonconsensual way.
For several weeks following The Incident—like a 1950s TV police detective, I soon began calling it The Incident—I scrutinized my behavior in the days leading up to it, sifting furiously for the thing I had done wrong. Had I been too open with information about myself, made too many off-color jokes? I was wearing a pink shirt at the time of The Incident—did that mean that I was unconsciously soliciting sexual attention? The colleague, Z., had a history of crossing boundaries with graduate students, a history that the administration ignored because of his professional importance. Knowing this, I had tried to be careful around him, but would anyone believe me? The best thing to do, I resolved, would be to deal with The Incident when I returned to the safety of my home community. Several weeks later, though, I learned that I would be required to interact with Z. again at the field site. The prospect of seeing him left me shaking with nerves. I realized that I needed to let the authorities know what had happened.
My graduate advisor, the field station manager, and Z.’s ultimate supervisor, F., all took my concern seriously. I appreciated their acknowledgment that the issue could not be ignored, and I was grateful that F. asked my permission to speak to Z. When F. did speak to Z., however, the process broke down: Z. denied that anything had happened, claiming that any untoward interaction had to be the product of my fantasy or of my instigation. F. and the other supervisors withdrew, refusing to adjudicate. I was left with the fear that my personal and professional credibility had been damaged, without allies at the field station, and, to my distress, in the company of Z., while the other supervisors attended to obligations outside the country.
The Incident was not repeated—with me, at any rate—either then or in subsequent field seasons. The role of Z. on our joint project, however, had to be settled, and F. was determined to reconcile us to one another. The way to do this, F. decided, was to impel me to back down from my position: namely, that something inappropriate had happened, an apology was in order, and ombud-style mechanisms of arbitration needed to be created to handle future concerns. F. explained to me why these requests were wrong-headed: Z. had suffered enough without apologizing, he said. I had willfully and unjustifiably damaged his reputation. My American feminist radicalism (by the way, was I a lesbian? or had I already been sleeping with Z.?) disqualified me from making rational statements about protections for students, and saucy male behavior was the norm at the field station—no other young woman needed help rebuffing unwanted attention, so why should I? The sort of disturbed emotional state I was manifesting, not to mention my insistence on being overly analytical, were sure to cause me intimacy problems of the kind that plagued his relationship with his wife. Finally, while my professional persona was too subservient—this was obvious from the way I acknowledged the contributions of peers to my work—my recalcitrance radiated “threat,” and that was not to be tolerated.
My graduate advisor agreed with me that F.’s reactions were retrograde. He valued the collaboration with F., however, and pointed out that my taking formal action would effectively terminate that collaboration. As a student dependent on my advisor for research funds, supervision, and credentialing, I chose not to pursue formal action.
The internal contradictions in testimony from Z. and from F. suggest that they were guarding not so much a perception of the facts—what did or did not happen—but a set of limitations on their responsibility in the world. I believe that reluctance or refusal on the part of supervisors to take recuperative or preventive action came from a place of fear: What would it mean for their careers if they were to upset the system? They did not know how to operate differently, and they did not and do not understand why making academic science safe for people with limited power is important. I believe, too, that they are ignorant of the costs imposed by the current system on students and on others with limited leverage.
***
Many months later, as I stalked around my house, wracked by intractable irritation and jumpiness, a sardonic voice in my head remarked, “Dude, you’re not in ‘Nam anymore.” Political incorrectness aside—and appropriation of the experience of a veteran, an experience I certainly cannot claim, aside, too—it was then that I realized that my body and the deepest parts of my mind had, in effect, not come home from the field. These parts of me were on the lookout for Z.—and, more to the point, for F.—everywhere: in mentors, colleagues, and friends; in well-meaning compliments and casual generalizations; in the social tics of status-seeking that characterize our sapient primate species. A trusted therapist helped identify that the symptoms, which included fury, nightmares, vigilance, and paralyzing self-doubt, were similar to those of post-traumatic stress disorder. With her help and the financial support of the university, I was able to get effective treatment.
For several months, I marveled at every day that dawned and closed trauma-free. That I no longer need to marvel suggests that freedom from trauma has become normal for me, and I’m profoundly grateful. That I needed trauma treatment to complete my PhD is a sign not of a flaw in my character but of a problem in the system that produces scholars. So, to recap:
- It is in everyone’s interest to maximize safety in working and learning environments. Coping with abuses of power drains time, energy, and other resources from productive activities, like scholarship.
- It is particularly important for people in positions of power to understand themselves as stakeholders in the welfare of students. We need to be able to distinguish between our intent and the effects of our actions. Intent is insufficient. Listening and collaborative action are required.
- Students need contracts and institutional protective mechanisms to ensure that their concerns can be safely expressed and addressed without conflicts of interest or unwarranted repercussions. These are necessary, even if challenging to design and implement, when the student is working with multiple institutions and in multiple locations.
Friday, March 2nd 2012
E. coli image by Nathan Reading via Flickr Creative Commons pool. E. coli is bacteria often present in the vaginal microbial community of individuals with bacterial vaginosis.
In parts 1 and 2 of the vaginal pH redux, I have of course spent the majority of my time discussing vaginal acidity. You might have noticed a layer of the conversation beginning to assert itself, though, concerning vaginal microbial communities, or vaginal flora. The interplay between the composition of the vaginal microbial community and vaginal pH is a pretty interesting one – which state drives the other? How much variation do you find among healthy women? What are the conditions under which these communities evolved or asserted themselves?
Dr. Angel Rivera is a microbiologist who is the lead author of a study on baboon and human vaginal microbial communities (he’s lead author on this one too, also worth a read). As it turns out, he also works down the street from me, and his collaborators are anthropology colleagues of mine, Profs. Rebecca Stumpf and Steven Leigh. So for the third and final part of this series, I decided to interview him to learn more about research into the vaginal environment to understand what questions need to be answered, and how research in this field helps us improve human health.
What is your name and title? What is your research about?
My name is Angel J. Rivera. I am postdoctoral associate for the Energy Biosciences Institute at the Institute for Genomic Biology (IGB) at the University of Illinois, Urbana-Champaign and my doctorate is in microbiology.
Until recently I was part of the Host Microbe System theme at IGB were I’ve done research on bacterial communities structure of the vaginal tract in primates (specifically baboon and mangabeys) the differences and similarities between each primate hosts and the relationships, if any, to that of humans.
We examined different aspects of the bacterial communities present in this niche, (1) Community structure in a troop of baboons where conditions where consider homogeneous. (2) The differences between humans and baboons and (3) the presence of antibiotic resistant genes in host that have never been expose to antibiotics before.
Your paper demonstrates very different vaginal microbial communities in baboons and humans. How much of this is due to endogenous variation in pH, and how much to environmental differences?
For some time now changes in the acidity and/or alkalinity of the vaginal tract has been a point of contention when considering “normal” community structures and changes within it as a consequence of pH. You see, this can be considered a classic “chicken or the egg” case. In the case of humans, is the pH low because of the dominant bacteria living there or are the bacteria living there causing the pH to be low? The answer is a little more elusive than we would like to admit. Vaginal tissue cells can produce metabolites (acidic compounds) that can lower pH, however no study has been done where one can see if the tissue produces enough for certain bacteria to colonize and further acidify the environment with their own metabolic byproducts. I believe there are researchers investigating this.
How does variation in pH impact vaginal microbial communities and bacterial infections? What are other health implications?
Vaginal pH represents the first line of defense against undesired bacterial or yeast species. The acidic nature of the vaginal environment prevents the organism from surviving or simply proliferating. Also, the bacterial species that seems to colonize harmoniously in the female tract (Lactobacillus sp.) prefers and maintains such and environment. The added bonus, if you choose to see it that way, is that these same bacteria can provide other mechanism to defend its environment (competition, antimicrobial compounds, etc.) ultimately protecting the host from an unwanted infection.
Conversely, researchers have found that changes in pH may set the stage for a community shift or imbalance that appear to be a precursor for disease states in the vaginal tract. One of the most common diseases in women is bacterial vaginosis. This condition is said to be the result of an imbalance that displaces lactobacilli form the dominance position and allow others, mainly anaerobic bacteria to take over.
One of the consequences of this happening is the danger it presents to pregnant women exhibiting preterm birth complications. As the undesirable bacteria become dominant some of those species can migrate up through the uterus and colonize the amniotic fluid. The precise reasons why this happens are not yet elucidated but researchers are putting special attention on the mechanisms. Treatment, however, is available.
In short, women would be wise to follow healthy practices and try to avoid unnecessary perturbations (douching, fragrant hygiene products, or other irritating chemicals) that may increase their possibility of developing infection.
Tell me one exciting new thing you’re working on right now.
I’m currently putting the finishing touches on a manuscript that reports microbial communities comparison between baboons and mangabeys. In our previous studies we found substantial differences in the microbiota of baboons and humans. We reason this could be a result of the evolutionary distance between humans and baboons as they diverged approximately 25 million years ago. If phylogenetic distance explains differences in the vaginal microbiota, then primates with more recent shared ancestry should have bacterial communities that are more similar. We found that although mangabeys and baboons are evolutionarily closely related their vaginal microbiota differ considerably. Even though there are remarkable differences between the vaginal microbial communities in the mangabey and the baboon, these two monkeys still have more similar vaginal flora than either of them do compared to humans.
I consider it fun to do this thought experiment. If we step away and trace the hominid lineage and then try to characterize each or some steps of the lineage perhaps we can see trends that may provide a picture of the microbial-human coevolution.
What else do you think people should know about vaginal pH and microbial communities?
As I mentioned before the cell lining in the vaginal tract epithelium does produce compounds that are of acidic nature setting the stage for those bacteria that prefer this setting and that further acidify the environment. It has been suggested that low pH prevents undesirable microorganisms from establishing dominance and causing adverse effect. There are even some reports that claim viral infections (HIV) could be deterred if conditions are maintained at low pH and certain species of bacteria (lactobacilli) dominate vaginal tract communities. We still have very little understanding on specifics about vaginal tract pH and its relation to “normal” or “healthy” states in women.
As for microbial communities, well these have profound effects in human development, function and health. From the moment we are born to the moment we cease to exist microbes accompany us. I think it is important that people understand this and even consider that our microbes can be personal physiology indicators. Another set of fingerprints, if you may. Let me provide some examples:
- Recent studies tell us that microbial structures can vary within different ethnicities. Women of white ethnic background have communities dominated by lactobacilli species. However, black and in particular Hispanic women can have a completely different structure where lactobacilli are NOT the dominant organisms yet they are considered to have a “healthy” vaginal tract.
- In our own studies with baboons we have found that even when environments, diet and life style are very similar (captive troop) their vaginal communities exhibit differences. This has been also observed in humans. The truth is, these observations have been reported since the sixties and seventies but it is now that we have the technologies to more accurately confirm the findings. Interestingly, most if not all of these studies are snap shots of the microbial communities at the moment samples were taken leading us to believe that these communities are comparatively invariant. What I’m trying to point out is that bacterial communities in any environment are fairly dynamic. This is especially true in a niche like the vaginal tract where a significant amount of perturbation (menstruation, hormonal patterns, sexual activity, douching, etc.) occurs over any woman lifetime.
- Longitudinal studies are underway and preliminary results tell us that vaginal communities of nearly all women are dynamic and exhibit marked changes in the relative abundance of species over time.
Thanks to Dr. Rivera for his time!
Tuesday, February 28th 2012
Image of cut limes by Smabs Sputzer found via Flickr Creative Commons.
In my last post I covered the safety and efficacy of acid-promoting tampons. Marc Abrahams, of Annals of Improbable Research and Ig Nobel fame, sent me an article about the intravaginal use of lime juice to prevent HIV by Nigerian women. The particular paper he sent me (Mauck et al. 2008) provided a fairly rigorous assessment of whether douching with 25%, 50% or full strength lime juice could be safely tolerated while reducing vaginal pH. But this paper opened up an entire world to me around broader issues of HIV/AIDS in Africa, about race, and the context-dependence of the way science is perceived.
Pucker up?
An important cultural practice among Nigerian female sex workers involves the use of lime and lemon juice douches (Imade et al. 2005; Mairiga et al. 2010; Sagay et al. 2009). Women report that douching with lemon and lime juice increases vaginal dryness and tightness (Mairiga et al. 2010), which makes me wonder for whom lime juice is improving sexual pleasure. In a survey of Nigerian sex workers, a majority of participants used lime juice douches, and those sex workers who douched had more sexual partners. The majority of these participants douched for sexual pleasure and hygiene first, and a slight majority also used it as contraception and to reduce infection (Mairiga et al. 2010). Most women used a 50% or 25% concentration of lime juice, diluting it with water. Further, participants who douched with lime juice actually had higher infection rates, including gonorrhea and bacterial vaginosis (Mairiga et al. 2010). The confounding effects of the greater number of sexual partners in the lime juice user group means there is no way from these data to tell if the lime juice is the cause for the increased incidence.
Other studies are more troubling. Unlike the acidic tampon folks, Sagay et al (2009) used colposcopy and Pap smears to assess the vaginal epithelium in women who used lemon or lime douches. Sagay et al (2009) found an association between lemon and lime juice douching with cervical dysplasias (abnormal changes in the cell wall), which puts one at increased risk for cervical cancer.
Then there is the study I was first sent by Marc (Mauck et al. 2008). The study authors grouped participants into groups that would douche or soak a tampon with water or lime juice dilutions of 25%, 50% and 100%. Of the 47 women enrolled in the study, 40 completed the full douching protocol. Two women from the 100% group and one woman from the 50% group discontinued due to severe vaginal epithelial disruption or irritation. But even among the women who completed, it’s not a pretty picture:
For instance, while plain water didn’t produce significant symptoms in the tampon or douche group, a majority of these participants had vaginal epithelial disruption based on colposcopy findings. Water is pH neutral, which is more alkaline than even a vagina with abnormal flora (women with bacterial vaginosis, for instance, often have a pH around 5.5). So any kind of water insertion from a soaked tampon or douching negatively alters the normal vaginal environment.
It’s clear, though, that the 100% and 50% lime juice concentrations were the worst for women. In addition to the epithelial disruptions noted above, women using concentrated lime juice via the tampon method had significantly raised local inflammatory markers including interleukin (IL)-8 (Mauck et al. 2008). Why is lime juice so harmful to vaginal health? It probably has something to do with all that citric acid, since lemon and lime juice have the highest citric acid content of all commercially available citrus juices (Penniston et al. 2008). Perhaps it reduces pH, but it is also an irritant that increases permeability of the cell wall and thus likely promotes, rather than reduces, infection.
To give you a sense of how awful inserting lime juice into your vagina is, here are the types of epithelial disruptions the study authors observed (Mauck et al. 2008):
- Disrupted blood vessels
- Peeling
- Erythema (redness)
- Discharge
- Tenderness
So not only does lime juice not appreciably or consistently lower pH, it can hurt you and increase your risk of disease. You are practically shredding your vagina if you do this.
Broader sociocultural issues of puckering up
Given how much discomfort the women in the Mauck et al (2008) study experienced, I am sure that women who do douche with lime juice are well aware that it is not the most comfortable experience in the world. So, why do they do it?
As I mentioned earlier, most of the women surveyed about their lime juice douching practices are sex workers; surveys of family planning clients showed a far lower incidence (only 4 out of 100) compared to sex workers (163 out of 200) (Imade et al. 2005). Most of the women surveyed used diluted preparations of lime juice, at 25% or 50%, so it’s possible they had fewer symptoms than participants at the full concentration in the Mauck et al (2008). And remember, part of the allure of lime juice douching is that it supposedly increases sexual pleasure (Imade et al. 2005; Menard et al. 2010).
Dr. Rubidium happened to point me to an ethnographic study of douching practices in Haitian immigrant women that, while obviously about a different population, provides some context. I want to share a particularly useful quote:
“The reasons underlying feminine hygiene practices are multifaceted and are related to broader sociocultural norms defining what is expected of women, by men and by other women: to be pròp, or clean, with one’s body, inside and out; to be free of any vaginal secretions, which are often construed as infectious or otherwise dirty; and to be sere, or tight, to increase sexual pleasure for male partners. The practices have been adapted and reconstituted over time to fit the needs of women in particular historical and cultural contexts, although women commonly engage in feminine hygiene practices for prevention and treatment of infections and as part of routine personal hygiene” (Menard et al 2010: 264).
Here, you can see the ways in which both women and men may police women’s bodies, and unfortunately see normal, healthy vaginal activity (like discharge or secretions) as signs of uncleanliness. The authors later point out that a wet vagina may be seen as a sign of promiscuity and infection in this sample; this could further reinforce the idea that sex with a woman with a dry vagina is more enjoyable.
In this context, it’s hard to not place lime juice douching within the spectrum of cultural practices enforced to control women, from female genital cutting, to diets, to cosmetics, to scores of other ways women alter their bodies to fit a culturally-sanctioned norm. And just as we can demonstrate the ways in which women may choose these practices, or find empowerment in some of them, I don’t know that it is really possible to parse out a woman’s agency from the institutional inequities that increase her chances of making certain choices. That is, a woman may choose any of these actions and be well aware of the benefits and consequences, but she is still aware of, and sometimes constrained by, a culture that dictates both.
In a population where only about 2% of women have access to modern contraception practices but maternal mortality is 1,549 deaths per 100,000 births (Mairiga et al. 2010) (for comparison, maternal mortality in the US, while high for a developed country, is around 13.3 deaths per 100,000), I imagine women, particularly sex workers, are going to try just about anything to increase their economic output and decrease their chances of pregnancy and disease.
I found one website that tries to provide a balanced perspective on the usefulness of lime juice douching in preventing HIV. One contributor explains (without citations, so I couldn’t follow up) that lime juice can kill HIV, but that the concentrations needed to do so harm the vagina and actually increase the risk of HIV transmission. I appreciated the perspective of another contributor who tried to separate out the call to not douche with lime from other white culture-prescribed practices:
“As discussion continues about the ‘sensibility’ of using lime or lemon as a douching agent and its efficacy as an HIV preventive measure, I think it is an opportunity for us to look at this practice critically especially as it has taken deep roots in our society. It goes beyond Jos and I hope we all know.
It will do us no good to look at it as ‘the white guys are here again’. Can we deny the reality that our women use lime to douche?”
Here, the author is reminding the reader of the ways in which other science and health recommendations come from white folks which, given the historical context of colonization, racism, slavery, genocide and oppression, is understandably met with suspicion. The author also seems to be pointing out that Nigerians are perfectly capable of interrogating this issue and figuring out a solution. And in fact, most of the papers I found on the topic had Nigerian lead authors, suggesting this isn’t just an issue where white folks are sweeping in and telling Nigerian women how to handle their bodies.
Douching of any kind, and lime juice douching in particular, does not provide contraception, does not reduce infection risk (it may even increase it), and causes significant vaginal irritation. Educating women about these issues is certainly important. But perhaps more important is to resolve the major economic and health inequities that drive women to make these decisions, and to create mechanisms to produce more scientists in developing countries. When women have more control over financial resources they are more likely to reject patriarchal or problematic cultural practices that cause physical harm. And when scientists have training and resources to ask the questions they find important or interesting, they can tackle the major problems facing their society.
This issue is a complicated one, and not one where I pretend to have the final word or any particularly strong expertise. So as always I welcome your thoughts and comments, including any places where any reader sees a need for me to think better on privilege, race, or gendered cultural practices.
Acknowledgments
I want to thank Dr. Rubidium for the suggestion on the Menard et al paper, and for sharing her perspective on an earlier draft of this post.
References
Imade GE, Sagay AS, Onwuliri VA, Egah DZ, Potts M, and Short RV. 2005. Use of lemon or lime juice douches in women in Jos, Nigeria. Sexual Health 2(4):237-239.
Mairiga A, Kullima A, and Kawuwa M. 2010. Social and health reasons for lime juice vaginal douching among female sex workers in Borno State, Nigeria. Afr J Prm Health Care Fam Med 2(1):Art #125, 124 pages.
Mauck C, Ballagh S, Creinin M, Weiner D, Doncel G, Fichorova R, Schwartz J, Chandra N, and Callahanm M. 2008. Six-day randomized safety trial of intravaginal lime juice. J Acquir Immune Defic Syndr 49:243-250.
Menard J, Kobetz E, Diem J, Lifleur M, Blanco J, and Barton B. 2010. The sociocultural context of gynecological health among Haitian immigrant women in Florida: applying ethnographic methods to public health inquiry. Ethnicity & Health 15(3):253-267.
Penniston K, Nakada S, Holmes R, and Assimos D. 2008. Quantitative assessment of citric acid in lemon juice, lime juice, and commercially-available fruit juice products. J Endourol 22(3):567-570.
Sagay A, Imade G, Onwuliri V, Egah D, Grigg M, Musa J, Thacher T, Adisa J, Potts M, and Short R. 2009. Genital tract abnormalities among female sex workers who douche with lemon/lime juice in Nigeria. Afr J Reprod Health 13(1):37-45.
