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January 21, 2022

W. Wilson scholar Sarah Gieszl travels to Africa to help women in need

By MEGAN CRANTS | February 10, 2011

The Woodrow Wilson scholarship is a prestigious honor given to undergraduate students who are looking to create an independent research project.

One recipient, Sarah Gieszl, has dedicated her time to the reproductive health problems of women in developing countries, specifically working on obstetric fistula and female circumcision.

“Both topics are widely studied by multiple disciplines, but I am using an anthropological lens to focus on some understudied aspects of each,” Gieszl said.

Obstructed fistula is a medical condition that comes about as a result of several days of obstructed labor.

Typically in developed countries, a Caesarean section can be used to relieve the pressure of the botched late-stage labor, but in underdeveloped countries the injury is widely ignored. The baby usually dies and the woman is left with urinary and/or fecal incontinence.

Gieszl is looking at the factors that influence women’s decisions to undergo surgical repair.

“Who decides to seek a repair and who does not? How do these women engage and navigate the very medical care delivery system that failed them when they needed skilled obstetrical intervention? Much existing theoretical work is on preventing fistula [a critical issue], and much intervention focuses on repair camps [an essential step for affected women],” she said.

“My interest is in understanding what I call a woman’s ‘repair response’: which women seek a repair, when they do so, and how they access/manage available family and community resources [financial and human] to get repaired. I found notable differences among women in Ghana versus Bangladesh versus Uganda.”

She is also involved in female circumcision research and is writing her senior honors thesis on it.

“Fistula study introduced me to female circumcision, complications of which some studies ascribe as causing of obstructed labor, for example, when genital scarring impedes delivery.

“Female circumcision was intriguing. It is medically unnecessary and mutilating, but sought after by families and individual women; it is offensive to universal rights, but culturally relevant in practicing communities; it is passionately justified by multiple, disconnected reasons that invoke myths, supposed religious mandates, ideas about cleanliness, beauty, fertility, and femininity; and, most of all, it is persistent despite various, passionate elimination efforts that date to colonial Africa.

I hoped that using an anthropological lens would [help me] discover aspects about female circumcision that explain its persistence and shed new insights on its value to practicing cultures. It also was an opportunity to explore ‘line drawing,’ [which is] defining female circumcision as a human rights violation versus a cultural right. [This] may have unintended negative public health consequences.

“I am also looking at the role and power of the traditional ‘surgeon’ or ‘cutter’ and the significance of circumcision rituals within practicing communities’ informal and formal economies.

Understanding how female circumcision is ‘situated’ within communities may explain why the practice persists despite years of multi-disciplinary intervention, interdiction, and condemnation,” Gieszl said.

“In addition, I am writing a case study on Uganda’s three tribes that practice circumcision: the Pokots, the Tepeths, and the Sabiny. Despite geographic proximity [they are located within 80km of each other] and cultural overlap, the three tribes have very different circumcision practices and very different reactions to Uganda’s new law that criminalizes being circumcised, performing a circumcision, or failing to report a circumcision.”

Gieszl’s interest in the issue of women’s reproductive health began during a 2008 Intersession course in which she visited a Bangladesh repair facility.

She realized that, though the patients were of all ages and stages of health, they all managed to get their repair at the same time in the same facility.

“The patients were a mosaic of women: their age range was 18 to 60; some had one child, some had many; some developed a fistula with their first pregnancy, some after many children; some had a fistula for a few months or years, some lived with the condition for decades; some had intact families, some had been abandoned and stigmatized. Yet these very different women had managed to get their repair at the same time at the same facility,” she said.

“I subsequently learned that few studies inform us about which women seek a repair and who succeeds and fails and why in getting repaired. I see these as pertinent public health issues that can benefit from anthropological inquiry.”

Gieszl has gotten to travel quite a bit in her pursuit of knowledge and has strengthened her interest along the way. She has done research in Bangladesh, Uganda, Kenya, and Ghana.

“I got interested in obstetric fistulas when I had the opportunity to travel to Ethiopia way back in 2005-2007 when I visited the fistula hospital in Addis. But it was really on my trip to Bangladesh when I worked with BRAC and Engenderhealth (very closely, did many field site visits and hospital rounds, where I got to see firsthand fistula repair surgeries, which are led by a female Muslim doctor) and visit women’s reproductive health programs.

It was during 2008 Intersession and I traveled with a student group from the Harvard School of Public Health (HSPH) led by a renowned international public health physician, Richard Cash, MD, MPH. I did an Intersession independent study with Professor Guyer that included participation on Dr. Cash’s student trip.

Dr. Cash knew both Professors Jane and Bernie Guyer when they were in Boston, and therefore was willing to take me on. The trip was an amazing opportunity for me and, I think, demonstrates excellent cooperation across two amazing schools.”

This anthropological view of women’s reproductive health has served as an ongoing project for Gieszl since her sophomore year. She works during summers and Intersessions, and is incorporating it into her senior thesis, which she is also translating into Kiswahili.

“I am fascinated by why people seek and use certain kinds of health care at certain times in their life, and how those decisions affect human suffering and disease burden. Oral rehydration therapy (ORT) is a classic example of an intervention whose success, in part, turned on people being able and willing to use it at the right time. There are many valuable anthropological lessons in the ORT story. Obviously, physical and financial access to care is critical, but I am interested in cultural access as well. I want to better understand women’s fistula ‘repair response’ and therefore, we cannot target and reach the population in need of repairs as accurately as we might,” she said.

“The fact that fistula repair camps are flooded with women wanting repairs is a great success, but I am curious about the women who were not present at the camp. To sum up, my interest in obstetric fistula and female circumcision reflect my belief that reducing the burden of disease requires better understanding of when/how/why people make decisions about (i) using health care services (like fistula repair) and (ii) continuing culturally based health practices (like female circumcision).”

Gieszl makes a point to mention how much she values the opportunities she has been given.

“I most value the opportunity I’ve had to collaborate closely on real world problems with an amazing scholar and teacher, Jane Guyer. She’s guided me to learn to see issues, frame inquiries, and, simply put, ‘think’ differently. She embodies every aspect of the term ‘mentor.’ What a scholar and teacher she is!

I experienced firsthand that the ‘Hopkins’ name opens doors and opportunities around the world for incredible intellectual and human exchange. We attend an amazing institution that affords amazing opportunities for scholarly collaboration and exploration,” she said.

So what’s next for this ambitious researcher?

“I am a senior now and majoring in anthropology and public health, specifically in the natural sciences. My goal is to begin medical school in 2012.

I hope to spend the coming year before starting medical school working on an anthropology or public health project, ideally in East Africa so I can continue to develop my Kiswahili.

My ‘ultimate’ dream job as I currently conceive it? Serving as a physician in refugee health or international disaster relief. That said, I fully intend to approach medical school with intellectual flexibility and no preconceived ideas about a desired specialty.”

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