Folk medicine, sex ed. and lies

A desperately needed to see a doctor because of pain in her “woman’s area.” 18 years old, she didn’t know where to go. So her older sister, older brother and male cousin escorted her to a walk-in gynaecologist (A lives in Bishkek, where such facilities are plenty). The men waited outside playing on their smartphones and making small talk while A and her sister spent an hour in discussions, ultrasounds, blood tests. The result: one of A’s fallopian tubes was infected and painfully inflamed. “She’s been touched by the chill,” her sister said when they finally came out. Her brother repeated this to their mother, “a fallopian tube was inflamed by the chill,” he reported over the phone. Their mother seemed appeased by the explanation, if peeved: “how many times have I told her to wear warmer clothes?!”

“The chill” in Kyrgyz parlance causes a Pandora’s box of diseases, from colds and flus to infertility. Young women are not to sit directly on uncovered ground or concrete benches, lest the chill enter their uteri and cause permanent damage. And, as A’s case made me realise, the chill is a cover-up for STDs and taboo sex.

Why do I say this? After A’s diagnosis I read up on inflamed fallopian tubes, and it became clear that the condition is caused by one of two things: either an STD, which if untreated for a long time causes this and other damage to the female reproductive system, or an encoptic pregnancy, a life-threatening condition in which the fertilised egg implants itself in the fallopian tube. In either case, A was having sex.

18 and unmarried, this would be scandalous to her parents and cause real damage to A’s reputation. Even in Bishkek, where Western influence is strong, if word gets out that a woman has slept with her boyfriend before marriage she’s marked as a “floozy” and becomes a target of other men looking for easy sex but not a wife or partner. Lots of young people still do it, and many women bank on the discretion and chivalry of their boyfriends/sex partners not to spread word and to thereby keep intact the public facade of their virginity. When women do become pregnant from such premarital sex, they usually either marry or abort, almost always depending on what the boyfriend has to say about it.

A had been seeing her boyfriend for over a year, so was it really so surprising that they were sleeping together? I probed her relatives a bit, asking “is it possible that A and her boyfriend have been together?” The resounding response was no, they cannot have slept together. Not a hostile “no” or a defensive “no” but a genuine “no, that can’t be,” because A is a good girl and the two are unmarried.

Sex education is nonexistent in Kyrgyzstan. While it is understood that using a condom can prevent STD transmission, most men associate condoms with sex-for-money (read: prostitution) and are deeply opposed to using them with girlfriends and wives. Few Kyrgyzstani’s — both male and female — understand the ovulation cycle or know when women are least and most likely to get pregnant. Most pertinently for A’s case, few are aware to the symptoms or even names of specific STDs and are therefore not likely to recognise them in themselves and others. [The Kyrgyzstan Gov’t Statistics Committee did an extensive study of this and similar health issues in 2012].

"Women's Secrets," published in 1997. A Kyrgyz book on motherhood, love and caring.

“Women Secrets,” published in 1997. A Kyrgyz book on motherhood, love and caring.

This is in no small part why A’s males relative immediately endorsed the chill as a reasonable and true explanation of her condition. Her female relatives also outwardly endorsed the diagnosis, though there’s a big part of me that can’t believe they don’t know it’s an STD. Surely they and their friends have had similar experiences. What had the doctor really said, and had the sister manufactured the chill explanation because she knew it had cultural currency? Did A’s mother believe in the chill, or was she willing to accept it as a convenient cover-up for some wayward teenage behaviour?

In a realm where men won’t use condoms, there’s a widespread taboo on premarital sex and sex is happening anyways, women may benefit from men’s lack of sex education. It allows women more freedom to have sex while avoiding some of its negative consequences: she can keep her honour even after contracting an STD, so long as her male peers genuinely believe it’s just the chill. But if women genuinely lack such knowledge themselves, they are at risk not only for contracting more STDs but also for failing to properly treat themselves. My sense – unscientific as it is – is that many young women learn the hard way, starting out with zero knowledge, contracting an STD and letting it progress to dire stages, then going to the doctor where they get their first glimpses of sexual education. By this point, these young women will have heard the chill explanation throughout their young adulthood and will be prepared to employ it in their own defence.

The doctor gave A a course of medicine, indicating that she had a treatable STD and not an encoptic pregnancy. She’s healthy now, though whether the damage to her fallopian tube will cause permanent fertility problems is impossible to know. So maybe the chill really can cause infertility, not because it freezes your uterus but because it masks the existence of STDs and allows them to go untreated for far too long.

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