What Women’s Rugby Can Teach Us About Body Positivity

Originally published on Medium.

It’s a brisk fall day in Poughkeepsie, the bleachers full of shivering fans as they await the referee to call, “Crouch. Touch. Pause. Engage.” The two teams rise and crash into one another, the oblong rugby ball barely visible amidst the skirmish of legs and dust. With a howl from the opposing side, the ball breaks loose from the scrum, deftly picked up by the scrum half and flicked along the back line. On the sidelines, my grandfather, a pilot during the Cold War, and my father, a dedicated football fanatic, cheer in unison. I don’t think either would have ever expected to have a granddaughter and daughter playing one of the roughest sports in the world against Army’s women’s rugby team. But the rugby pitch is the one place where I’ve felt most liberated and alive in my body. Without trafficking in platitudes, women’s rugby teams are composed of a constellation of shapes and sizes, builds that rupture conventional notions of the aesthetics of athleticism and forge a sense of solidarity that has allowed me to travel the world. I’ve played in South Africa and Ireland, swapped strategies with ruggers on the beaches of Barbados. If you consider cross-cultural exchange an essential element of the Peace Corps, I taught my home stay family that women, too, can be strong and fast, joining the all male rugby matches on the school fields of my village at dusk every night. Any female rugger will tell you that it’s not simply a sport — rugby is an exercise in grit and resolution, learning to love our bodies for the incredible work they do on and off the field.

The Rio 2016 Olympics this summer have been dogged by controversy — political unrest and protests around government corruption, an economic recession, displacement of favela communities, fear of the mosquito-borne Zika virus, and now another doping scandal. The ongoing issues plaguing the Rio Olympics also come on the heels of the U.S. Women’s soccer team’s demand for equal pay and safe playing conditions. Yet few have discussed the premier of rugby sevens at the Olympics this year. Rugby was dropped from the summer Olympics in after the 1924 games, despite the fact that it’s the second most popular game in the world. To an outsider, the sport, often referred to as “football without pads,” may seem inherently masculine — you must scrum, ruck, maul, punt and tackle your way up the field to score a try, lining up in rows like soldiers in the heat of battle. Despite the international rugby fan base, however, women’s rugby has been largely marginalized, victims of the same flawed promotional logic which presumes that people don’t want to watch women play sports. Yet with the competition of women’s rugby teams alongside men’s at the Olympics this year, female players were finally provided with an international spotlight to showcase their incredible athleticism and skill.

I started playing rugby my freshmen year of high school, having tried to join and been promptly denied a spot on my middle school’s football team. The injustice of the denial stung in part because I knew, with many of the players still in the beginning pangs of puberty, I could likely tackle most of the boys on the field. As a travel soccer player for seven years, I was known to take the instruction of tackle a little too literally. I’d been a multi-sport athlete for years before I discovered rugby but my body never seemed to quite fit in the other games I played. I had the endurance and the on-field aggression, but no matter how much I ran and trained, I never cut the willowy figure of so many of my female peers. It sometimes seemed like my place on a soccer team felt as much tied to size as how many points you scored in a game. Girls would examine their bodies in the mirror of the locker rooms, comparing weights and skipping meals even after a hard training session. Even the skimpy running shorts of my cross-country team made me uncomfortable — with no thigh gap to speak of and specks of cellulite, it was hard to feel confident during a 5 K race.

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Rugby was a whole other animal entirely. Perhaps due to the tenacious nature of the game, rugby attracts a certain strength of character in players. You have to not only be willing to throw your body against an oncoming opponent — you have to look forward to it, relish it. It’s not bloodlust so much as an opportunity to test the boundaries of your body in a way that is rarely afforded to women. In an expose on the history of women’s sports forThe New York Times, Padawer explains how sport, as the province of strength, has traditionally been thought of as a masculine domain. People worried that women would become too “mannish” and unattractive if they developed the kinds of musculature needed to compete. Athletics were so stratified along gender lines in the early 20th century that a Women’s Olympics was established in 1922, which, despite the success, recapitulated sexist conceptions of sport. The controversy over what kinds of sports women were permitted to play often swirled around discourses of propriety, beauty and femininity. It’s not surprising that the rise in diets and exercise among women was also contemporaneous with the shift in the beauty paradigm towards the celebration of slim women. Particularly during the aerobics craze of the 80s and 90s, women were encouraged to tone and sculpt the presumably plasticine female form into a trim and fit figure. Fat shaming partially emerges from the perception that body transformation is possible so long as you have the right will power. And yet women are expected to run, lift weights, and strength train not to improve the functionality of their muscles, but rather to fulfill the aesthetic pleasure of a “healthy” body. Let us not forget how Australian swimmer Leisel Jones was castigated for being “too fat” to compete in the London 2012 Olympics or the intense body scrutiny and shaming female gymnasts are subject to.

Harvard Women’s Rugby, Rugged Grace

Harvard Women’s Rugby, Rugged Grace

Perhaps part of the reason women’s rugby has remained on the fringes of sport culture is that rugby, more than any other sport I’ve played, accepts all bodies as good bodies. What matters most is your ability to handle the ball, run fast and hit hard. Women who might be characterized as overweight in other settings are celebrated in the forward line for their ability to hold up a ruck. It doesn’t matter if you can run a six-minute mile as long as you can crash the defense and stay onsides. In part due to the physical nature of the sport, rugby also engenders a new relationship with your body and the bodies of your teammates. You might spend most of the game with your head in between the thighs of the locks or looping your arm around the crotches of the first row in a scrum. There is no room for insecurity about your weight if you’re being lifted by two women in a lineout. Your body is not only the vehicle for winning the game — it’s the barrier the stands between a defender and your teammates on the back line.

The women on my high school rugby team were self-possessed in a way I’d never even imagined. I’d grown up thoroughly uncomfortable in my own skin, constantly pinching my stomach and my hips like calipers to measure the body fat. I hated my body — it always felt too big, too broad, the “wrong” side of athletic. I’d go on dates and men would comment on the breadth of my shoulders, the distinct curvature of my calves and I’d wince, unsure how to respond. Rugby changed the way I looked at myself and fundamentally altered my relationship with my body. Suddenly, my shoulders were hailed as battering rams for tackling, my big thighs perfect for pushing through a maul or throwing off a defender. I came to value my body for its strength rather than its size, the girth of my arms an indicator that I had been training well and would be able to throw that much further. I ran mile after mile not to whittle my waist down but so I knew I could stay in for both 40-minute halves and still outpace the defense. For so long I’d been self conscious about wearing shorts or skirts. Yet after games or on the ride back from tournaments, we’d lovingly compare incipient bruises, wounds from the battles we’d fought. I suddenly found myself wanting to show off my body, picking outfits that would flaunt my cuts, scrapes and purpling bruises, as well as the muscles that had helped us win so many games.

Rugby has inspired healthy body image for many of its female players. Back in 2014, the Harvard Women’s Rugby Team published “Rugged Grace,” a series of photographs of the players in their bras and underwear with inspirational messages scrawled across their shoulders, stomachs and legs, notes from teammates about what they appreciated about one another’s bodies. The images include phrases like “so strong,” “ripped,” “power ≠ size,” “battle scars” and “fearless.” These women joyfully flaunt their bodies, unabashedly exposing their body hair and stretch marks to completely dismantle the ideal body type and instead celebrate the kinds of bodies that make up a team. The project emphasizes a more inclusive notion of beauty. Recently, Emory Women’s Rugby launched the “Because of Rugby” campaign to spotlight the incredible capacity for rugby to empower its players. Bethany Studnicky, who has been playing rugby for 15 years writes, “Because of Rugby I am proud of my body.” Other testimonials discuss finding strength in beauty and beauty in strength, becoming more confident in their bodies and overcoming mental health issues through rugby. Photographer Alejandra Carles-Tolra also documented the women’s rugby team at Brown University, noting, “I hope people see my photographs as a celebration of these women’s strengths and identity, which I believe play an important role in challenging the meaning of masculine sports, and pushing the boundaries of female identity.”

"Because of Rugby," Emory Rugby, Buzzfeed

“Because of Rugby,” Emory Rugby, Buzzfeed

The inclusion of women’s rugby in the Rio 2016 Olympics this year is not merely a matter of gaining a more international audience. While Title IX often makes the news for college sexual assault scandals, the law was also enacted to ensure that men and women have equal opportunities to participate in athletics. When I got recruited to play rugby in undergrad, I was lucky enough to attend a Seven Sisters college that had championed women’s sports since the 1800’s. Many women are not given the same opportunities to play or to see women’s rugby teams compete on a local or a national scale. Female rugby players are not only demonstrating that their athleticism and skill is equal to that of their male counterparts, but they also offer an alternative to prescriptive health and beauty norms. We can celebrate the US Women’s Rugby team for their tenacity on the field, their handling skills, and their endurance without quibbling over whether or not their weight in any way undermines their status as Olympic level athletes. Young girls and boys were able to watch the women vie for the Gold Medal, subverting conceptions of masculine sports and proving that women, too, can be warriors.

2015 in Review: Geek Girls and Gender

The Geek Anthropologist

By Emma Louise Backe

For several years, TGA founder Marie-Pierre has been conducting research on the fraudulent phenomenon of “fake geek girls,” a category of women who ostensibly “pretend” to be geeky or interested in geeky things for male attention. This supposition that the geek identity is predominantly male and that geeky space must subsequently be policed for inauthentic intruders came to a head during the 2014 Gamergate controversy, in which certain groups of men not only felt that women participating in the gaming industry were somehow less committed or faking it, but also believed that feminist oriented criticism would destroy the industry and undermine creativity. While the bias that drove Gamergate may seem to be fairly niche, many of the sexist ideologies spill over into the broader entertainment industry, sphere of pop culture, and conception of “strong female characters.” The same logic of “fake geek girls” is…

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Violence and Victimization: Misogyny in Geek Culture (And Everywhere Else)

The Geek Anthropologist

“Men are afraid women will laugh at them. Women are afraid men will kill them.” –Margaret Atwood

The GamerGate controversy has driven increased attention to the video game industry, while also highlighting the violent misogyny that can pervade geek culture. For those just getting up to speed, GamerGate circulates around two specific women within games: Anita Sarkeesian of Feminist Frequency, and Zoe Quinn, who recently developed the (non)Fiction interactive game Depression Quest. After launching Part II of the webseries “Women as Background Decoration,” Sarkeesian was harassed online and received threats against her and her family. The onslaught of antimony directed at Sarkeesian included a barrage of sexual slurs that condemned Sarkeesian for her cultural commentary on the objectification and abuse of women in video games and other forms of geek media, blaming her and her ilk for “ruining” the gaming industry. Although celebrities like William Gibson

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Tendencies Toward Violence

At this point, I’m sure we’re all familiar with Elliot Rodger and the shooting at UC Santa Barbara, triggered, ostensibly by the shooter’s desire to seek retribution against a group of women, if not the entire sex of women, he believed owed him their attention and attraction. The New York Times’ most recent article on the subject, “Why Can’t Doctors Identify Killers?” explores the problematic conflation of violence and mental illness that has pervaded coverage of the slaughter. Mental illness does not predispose people to violence, and yet articles and commentary continue to circulate positing direct connections between the two. Richard A. Friedman writes, “Large epidemiologic studies show that psychiatric illness is a risk factor for violent behavior, but the risk is small and linked only to a few serious mental disorders. People with schizophrenia, major depression or bipolar disorder were two to three times as likely as those without these disorders to be violent. The actual lifetime prevalence of violence among people with serious mental illness is about 16 percent compared with 7 percent among people who are not mentally ill.” http://www.dispatch.com/content/graphics/2011/01/23/bc-health-mentallyill-vi-art-gj2bbm9j-1mental-illness2.jpgAs the article stipulates, not only is the supposed correlation between mental illness and violence inaccurate and damaging to public perceptions of mental illnesses—these events and attitudes also have repercussions throughout the world. As a First World country, whether we deserve it or not, we serve as a model to Third World and developing countries. Instead of setting a good example and precedent of how to deal with acts of violence, as well as proper treatment and understanding of various psychological states, we are presenting harmful and dangerous models of the mind and public peace.

Part of the Peace Corps volunteer’s role in country is to foster a better understanding of America abroad, partially to counteract the negative attitudes and perceptions of the United States. Ever since arriving in Fiji, I’ve had to dispel some very unsettling misconceptions about the US. I’ve been asked on several occasions whether everyone in America owns a gun and what it’s like to live in such a “violent” country. There is something deeply ironic and disturbing about these questions, especially when they are posed by residents of a country with a history of cannibalism, police brutality, ethnic warfare and violent military coups as recently as 2001. To many Fijians, America is a far more dangerous, anarchic place than Fiji, a country run by a military dictatorship. These foreign conceptions of America, though informed largely by Hollywood movies and sensationalized international media, are not, however, occurring within a void—as The Onion, Slate, Flavorwire, the Twitter trend #YesAllWomen, and many others have pointed out, we have had a string of violent massacres in a country that is supposed to espouse peace and protect its citizens from harm or terror.

As I’ve written about before (see Mental Health and Mental Illness in Fiji), the Fijian health care system and its practitioners are also struggling with newly introduced, Western concepts of mental health and psychological models of the mind. During my conversations with the nurses at my site about their patients with mental illnesses, whom they glibly refer to as their “mental cases,” the nurses all seem to lack a basic understanding of the differences between epilepsy and schizophrenia. Yet, as if to allay my fears or assert their expertise, many of the nurses are quick to assure me, “But they’re not violent,” as if all patients with mental illness have, are or are prone to violence. When I was visiting a local boarding school for secondary students with the health team, I noticed a sign outside the dispensary, where a lock had apparently been stolen.DSCF1277 The sign condemned the theft and indicated that such an act of robbery is “a sign of mental illness,” espousing that criminality is similarly connected to mental illness. According to this framework, Fijians generally consider people with mental illness to be criminal and violent.

These attitudes stigmatize an already stigmatized, misunderstood and underrepresented community, in Fiji and elsewhere. Rather than generating sympathy and support, equating violence with mental illness propagates further distrust and enmity towards people who desperately want treatment and care, while obscuring or ignoring the larger machinations and structural factors that produce and permit ongoing acts of violence. Patriarchal attitudes that objectify and sexualize women, while perpetuating damaging stereotypes of masculinity and how masculinity should be performed vis-à-vis cultural attitudes about femininity and gender roles, create societies in which violence against women has become normalized. According to the Fiji Women’s Crisis Center report “Somebody’s Life, Everybody’s Business!”,

            Fiji’s rates of violence against women and girls are among the very highest in the world. 64 % of women who have ever been in an intimate relationship have experienced physical and/or sexual violence by a husband or intimate partner in their lifetime, and 24% are suffering from physical or sexual partner violence today […] Overall, 72% of ever-partnered women experienced physical, sexual or emotional violence from their husband/partner in their lifetime, and many suffered from all 3 forms of abuse simultaneously. (2013:2)

We need to confront culturally entrenched attitudes toward gender and misogyny. Some incredible articles written by both men and women about how misogyny kills confront the fact that many Americans do not want to acknowledge the way we are hobbled and damaged by problematic gender stereotypes. This is an opportunity to create a larger discussion and promote a global movement that changes the way we think and talk about gender, mental health and violence. Without a healthy model of the mind and treatment of mental health, dangerous misconceptions and prejudices about mental illness are going to be reproduced around the world. There is a ripple effect to how we talk about and respond to these events and we as a country need to recognize the repercussions our actions have not only domestically, but globally as well. How can I serve as an ambassador of American culture when the very problems I see acted out in Fijian daily culture have horrible resonances in my own country?

Notes From the Field: Gender in Fiji

(The name of the woman I interviewed has been changed to ensure her anonymity. The pseudonym was chosen both for the mythological role the character Salome has played in understandings of gender and because the name is very common around Fiji.) 

“Men are up here,” Salome begins, gesturing above her head, as if at the top rung of a ladder, “and women are always down here,” she finishes, bending forward from her sitting position so that her hand barely brushes the soles of her shoes. “We are always treated like we are under men,” she explains, elaborating that in traditional Fijian culture, “men are always the heads of the families,” even though, “women have to be at home all the time. Some women have to do all the work.” This work, however, is gendered and often separated into the public and private spheres. “Women’s work” includes housework, like cooking and cleaning, as well as tending to the children, while “men’s work” typically means physical or manual labor, such as working in the fields or the plantations, although men also dominate the public sphere of civil servant jobs as well, such as shop owners, police officers, government officials and teachers. The gendered dimensions of work, however, have begun to change and bleed over into one another. Salome notes how more women are now doing “man’s job” and “man’s work,” including both acquiring gainful employment, like becoming a nurse, and doing more physical labor in addition to their expected domestic chores. “We are the helper,” she elaborates. “Everything is for men. Everything has to be the last for women.” These gendered dimensions of work are often expressed as “inside” vs. “outside” work, and although women have started to adopt more stereotypically masculine roles, men have not become more flexible and learned to cook for themselves or assume more responsibility in the domestic sphere.

Salome, a woman in her fifties who runs the Maternal and Child Health Clinic at a local hospital, expresses the internal contradictions and inherent misogyny of Christianity endemic of the way gender is generally understood in traditional Fijian society. She references a doctor she heard speak, who apparently claimed that men have a “hormone by God which directs them that they are the head of the family.” She notes that the different positions men and women hold in Fijian society are due to the fact that men and women were “created differently” in the Bible—Eve was made from the rib of Adam. When I asked her what part of the Bible stipulates that women should be treated as lesser than men, though, she faltered, uncertain. “Maybe Genesis?” she hazarded. According to her reading of the Bible, Adam was bored and couldn’t take care of himself. That’s why God created Eve—to ease his boredom and help to take care of him. Already there seems to be a complicated internal logic—men are considered superior to women, and yet they couldn’t have survived without the presence of women, and women were created (so to speak) due to the ineptitude of men. The irony of this logic, however, doesn’t seem to register for Salome, though she articulates these internal contradictions. She states that women are “not strong like men,” and yet “we [women] can handle the consequences,” as in the pain and struggle, of being a woman, including pregnancy, delivery and child rearing. Men and women, therefore, have different kinds of strength. There are moments when she elevates the strength of women over men. Laughing, she says to me, “I don’t think any men can handle [the pain of] childbirth. If they could, they would only have one child.”

Salome delves into the family dynamics of a typical Fijian home. Women are not allowed to speak up or voice their opinions when men are around, and they usually have to get permission from their partners or spouses if they want to leave the house. And yet men “can’t be alone without women. Women can stay longer alone, men can’t stay longer alone without women.” Apparently, if the husband were to pass away, it is acceptable for the woman to continue to manage the household as a single widow and often succeeds as the new head of the household. If the wife passes away, however, men immediately go looking for another woman or wife to clean the house, cook the food and take care of the children.

When asked about the health issues that plague women in Fiji, Salome turns to a discussion of violence in the household, or “commotion in the family” as she calls it. As an MCH nurse, her work also falls under the category of family planning, so she gets insight into the daily lives of Fijian families. Divorce, extramarital affairs and domestic violence, as well as rape, are the problems she gravitates toward throughout our discussion. While women are expected to stay home, “men always go clubbing,” and “husbands are always drunk and disorderly.” She says that violence in the family is not necessarily new—husbands and wives often fight over money, food or other social problems, such as conflicts over religion or maintenance of the monogamous relationship. Rape, she explains, happens because “we [women] are showing our body to people,” referencing the changes in modesty and dress in Fiji. Fijians increasingly have access to Western television, movies and magazines, which has also triggered a shift in the younger generation away from the traditionally modest and conservative sulu jaba, which includes a long skirt down to the feet, and a blouse that covers the shoulders. Younger women and girls are starting to experiment with Western clothing, wearing tank tops and shorts, fashion decisions that Salome believes are to blame for rape. Gender-based violence in Fiji, I recently learned from a report released by the Fiji Women’s Crisis Center, has reached epidemic proportions, especially considering the culture of silence that socially sanctions the “discipline” of women who speak or act out of turn. Yet Salome exclaims that women were created “to be loved, not to be kicked or punched—that’s why the rib is so close to the heart,” returning again to the Genesis of Eve.

When I asked whether men and women are created equally, she nodded in affirmation, saying, “We are all human beings.” But when I asked how Fijian women could be treated more equally to men, she reverted to the entrenched hierarchies, stating, “Women can’t go up.” She suggested that education might help to bring equality to female Fijians, but didn’t seem to think it was culturally appropriate for women to have the same rights as men. Men could only go “down” to the woman’s level, but the women can’t ascend the stratified social system. “Fijians, we still look at it differently,” she justifies. Men may be “weak,” and women may be “strong,” but even this empowered woman is hesitant to level the playing field, or predict that equality will come any time soon.

Discussions in the Clinic

The Fiji Ministry of Health has recently rolled out a new method of evaluating doctors’ and nurses’ performances on the job. Based on a point system, nurses and doctors need to pursue activities outside their hours spent attending to patients to ensure that they are expanding their medical knowledge and capitalizing on their time spent in rural settings. In fact, many nurses are expected to spend four out of their five days working doing community outreach in their assigned zones, conducting workshops or doing home visits to follow up on patients that may not have easy access to the hospital or clinic. As I begin to carve out my own niche at Korovou Hospital and Health Clinic, considering that I am neither a nurse nor a doctor, and much of the medical information I possess came from curiosity rather than collegiate training, I’ve found that one way that doctors and nurses can earn points is through Continuing Nursing Education or CNE. Anyone in the hospital or clinic can put together a CNE—usually they are presented by nurses who have just received specialized training in a particular topic, such as mental health awareness or maternal and child care, and want to share their new knowledge with the rest of the staff. As outreach opportunities in the villages and settlements around Tailevu have been fairly limited, I’ve presented two CNE’s for the staff here.

My first CNE was on customer care. Like so many hospitals and clinics, Korovou is dreadfully understaffed. Sometimes only one doctor is available to see all the patients, with only two nurses assisting in triage, one in the IMCI, one dentist and one dental therapist, one nutritionist, and two nurses in the MCH clinic. The waiting room, when the hospital opens at 8:00, may have as many as twenty to thirty adults and children waiting to be seen. Villages in Tailevu have certain transportation days for the MCH clinic, and two MCH nurses may have to see over fifty women and their babies before the lunch hour. Due to the disparity between available nurses and patients, the staff usually has to rush through their examination of the patients and keep a fairly steady pace of intake to ensure that all of the waiting visitors are seen. This can sometimes lead to a callous or insensitive attitude towards patients who may otherwise be scared, frightened and confused. From experience, I know that hospitals in the United States can be some of the most alienating and victimizing spaces a person could experience. I have never yet had a positive experience at the hospital. I’ve anxiously paced waiting rooms waiting to be seen for hours, feeling like the staff was deliberately ignoring me. I’ve been yelled at by nurses for injuring myself when I was already suffering from physical and emotional anguish about an injury. I’ve been shoved behind curtains, cold and hungry, for hours on end, wondering if the doctors had forgotten about me. Nurses, doctors, neurologists, and specialists have told me that my perspective on an injury was wrong, and that my emotions were invalid. I’ve been patronized, devalued and objectified by hospitals in the United States, and I know, based off of my training in medical anthropology, that I’m not the only one who’s feel injured and dispossessed by the very people they sought help from.

Part of the challenge Fijian hospitals and clinics also face is use. Though the waiting rooms are almost always bursting with patients (at least before the lunch hour), the Ministry of Health is struggling with getting people to come in and seek treatment at their hospitals and clinics. Most Fijians have a hierarchy of resort that relies on village or folk remedies. Herbal medicine and massage therapy are often the first remedies sought out when a person becomes ill or injured. The traditional herbal medicines are easily accessible and cheap, and have been used, and therefore trusted, for centuries. Hospitals, on the other hand, may be extremely far away from the more rural and isolated villages and settlements in Fiji, and the cost to get to the hospital may be a further deterrent. Though care and medicine are free, paid for by the Ministry of Health, there seems to be a basic attitude of mistrust and suspicion of hospitals, a negative perception that hospital and clinic staff need to actively dispel. Not only do the hospital staff feel the need to prove that allopathic medicine is useful and effective, as long as you use it correctly and don’t default, but they also have to make the vale ni bula a welcoming, safe space where patients can feel safe seeking treatment. Otherwise, people will continue to visit hospitals and clinics only as a last resort, when the illness or injury have become so bad there’s very little the staff can do to heal or repair them.

Considering all these factors, I decided to present on customer care to the doctors and nurses in Korovou. I outlined the importance of establishing a rapport with the patients by creating an open, welcoming relationship between the carer and the client. I explained that if patients feel validated and supported by the hospital staff, they are less likely to lie about their medical history, more likely to be compliant with medications, more likely to return in a future instance of illness or injury, and more likely to recommend others to seek treatment at Korovou as well. This trust needs to be earned but will have long-term payoffs for both the hospital and the patients. I introduced the concept of clinical ethnography, which is a recent development in medical anthropology that is beginning to be employed in clinical biomedical settings, such as American hospitals. The concept of a clinical ethnography, as Arthur Kleinman outlines in his essay “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It” (PLOS Medicine, 2006), utilizes the critical, empathetic, self-reflexive methodologies used by anthropologists as they write ethnographies to create a “thicker” understanding of a patient’s health and wellbeing. As Kleinman relates, “Anthropologists and clinicians share a common belief—i.e., the primacy of experience. The clinician, as an anthropologist of sorts, can empathize with the lived experience of the patient’s illness, and try to understand the illness as the patient understands, feels, perceives, and responds to it” (1674). Clinical ethnographies and illness narratives, most importantly, take into account the social and cultural factors that impact and inform an individual’s health status. As Steven Feierman and John M. Janzen outline in the introduction to their collection, The Social Basis of Health and Healing in Africa, “Just as disease is not an independent variable in social analysis, so therapeutics is also embedded in and reflecting the concepts, values, institutions, and power relations around it […] In other words, health, however defined, is not something that ‘just happens’: it is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease” (xvii). Not only is an individual’s understanding and approach to healing inflected by the culture or cultures in which they’ve been raised, but the social world they inhabit—their economic situation, kinship network and level of access—also contribute and to a large degree determine illness etiology and treatment options. Paul Farmer has spent his illustrious career outlining the ways in which structural factors contribute to an individual or a community’s health; his numerous essays and ethnographies have capitalized on the stories of people’s lives who have become victimized by structural violence to the detriment of their health. Illness, consequentially, often comes with the results of inequality.

These social and holistic insights into health could not be more important than in clinics in Fiji. Korovou Hospital and Health clinic serve the whole province of Tailevu, which includes hundreds of villages and settlements. Many of these villages are extremely remote, made even more inaccessible by the poor roads and bad weather, which often impedes the occasional truck or lorry that would brave the treacherous conditions. In these remote villages, most people still survive on a subsistence basis—living off of their plantations and backyard gardens, their water source a local stream, river or reliance on rainstorms. To reach Korovou, women might have to walk miles to the nearest highway, and then pay for transport to the hospital and back, an expense they may not be able to afford, even though care at the hospital is free. The most recent crop of the plantation may have been less than expected, and the family may be struggling to find enough food to feed their whole family, especially since Fijian families tend to be fairly large. A mother may therefore be sacrificing her own health to ensure that her children get enough to eat. These social and structural factors need to be considered in a clinical assessment of any patient, especially since doctors and nurses may become frustrated if they’ve given the same instructions to a patient over and over again but they continue to “default” on their medication. A patient’s “compliance” to whatever biomedical treatment is prescribed to them is contingent upon their level of structural vulnerability.

The doctors and nurses in Korovou seemed to respond fairly well to the presentation, and acknowledged that they were sometimes short with patients due to stress and frustration. They voiced the same concerns that most hospitals and clinics share: when you’re understaffed, how do you offer the most empathetic and best care—which often requires taking the time to get to know the patient, learn their life story, and reassure them as a person rather than a case study or a statistic—and treat the large number of patients waiting to be seen in a timely fashion? It felt invigorating to be discussing such a central principle of my training in medical anthropology with practicing health workers, to be able to put theory into practice.

The second Continuing Nursing Education presentation I gave was on the elimination of violence against women. November 25 was the International Day for the Elimination of Violence Against Women, and I thought the occasion was an excellent opportunity to raise awareness on the topic, especially considering my experience in gender-based violence, and begin a conversation with the staff about cultural attitudes towards gender and violence. If sexuality is taboo, sexual assault, domestic violence and rape fall into a whole other level of taboo topics. Since I’ve been in Fiji, I’ve heard accounts from other volunteers who either saw domestic violence occur in their home-stay or witnessed women with bruises and cuts from their spouses. According to the World Health Organization, 1 in 3 women will experience physical and/or sexual violence by a partner or sexual violence by a non-partner within their lifetime. Violence against women is such an invisible, yet pervasive, problem that almost no research on the topic has been conducted. One of the only sources I could find who had attempted to survey the prevalence of violence against women in Fiji came from the Fiji Women’s Crisis Center based in Suva. Their statistics noted that in 2010, there were 887 reports of violence against women, though their website emphasized that there are very few resources available to women who have experienced violence, and thusly limited safe spaces to report the crime.

If violence against women is a culturally acceptable act, and is often dealt with within the family, and therefore considered a private, rather than a public matter, than victims are considerably less likely to seek shelter or remuneration from outside the family. Indeed, most instances of violence against women are perpetrated by someone they know—a friend, family member or intimate partner. If a woman is economically dependent upon her abuser, she may be afraid that reporting the crime would make her even more vulnerable. In the very terse discussions I’ve had about the issue with Fijians and other volunteers, outside intervention is rare and most people simply look the other way when they see or hear abuse occurring in the home. Indeed, the Fiji Women’s Crisis Center website writes, “Sexual assault and violence against women is condoned, reporting of violence is discouraged and women are counseled that it is a sin to divorce and separate by many religious leaders.” Without a social structure that discourages and villainizes violence against women, victims won’t have the social support they need to seek help and cycles of violence will continue to reify themselves generation after generation.

I didn’t end up being able to give the presentation until December 2nd because the hospital was so understaffed, but the date still falls within the 16 Days of Activism that the Fiji Women’s Crisis Center is promoting to increase awareness around the country about violence against women. Though the staff seemed keen for another presentation, I was surprised at how glib their response to the issue was. One of my co-workers, whom I respect and admire, started making jokes about the issue. After the presentation, she turned to me and said, “Thank you for your presentation. It is a very important topic, I guess,” the final clause seeming to undermine the imperative and urgent tone I had tried to strike throughout the presentation. Unfortunately, after the presentation, the doctors and nurses had to leave to catch their buses back home for the night, which forestalled any conversation I was hoping to have about cultural attitudes towards gender-based violence, the services available, and their own experience, as Fijians as well as health clinicians, with the issue. Women’s rights and female empowerment are issues I cannot separate from my role as health worker, especially when I think about the injustices wrought upon female Fijian bodies at the expense of their health and their happiness. Fiji will remain a developing country with an uncertain economy so long as the Fijian women, who are some of the strongest people I have every met, remain subservient and secondary to other members of society. Thankfully, there are some incredibly inspiring women in Fiji who are actively working to promote change and female empowerment throughout the country. The Fiji Women’s Rights Movement and the Women’s Groups in villages around the country are starting to speak up and disrupt the patriarchy that has thus far been shielded under the auspices of cultural tradition. Other indigenous groups around the Pacific, such as the Maori women in New Zealand, have also begun to advocate for a critical discussion about the role of gender in culture. I hope that my role here in the next two years will be to make their voices heard and support them in building a culture in which men stand alongside women, respected and safe. tumblr_mx9qgq6Ss21qgu9k8o1_500