“F irst impressions last a lifetime.” “Go confidently in the direction of your dreams.” These are the words of wisdom that led me toward my greatest adventure in medical school — an international rotation in Ghana. Pursuing my dream in another country created memories that will last a lifetime and inform who I am as a physician. First Day in the Labor Ward As I entered the labor ward at Komfo Anokye Teaching Hospital, I discovered a large room divided by thick concrete walls. Each section contained pleather beds covered in plastic tarps that patients brought from home. I found myself fascinated by the lack of equipment. There were no IV poles. The background noise was free of the familiar beeping monitors and inflating blood pressure cuffs. You would not find a large TV displaying continuous fetal heart tracings, but on each dividing wall, you would find a Pinard horn, a funnel- shaped instrument used to manually count fetal heartbeats. Intermittently, I would observe Ghanaian medical students place their hands on mothers’ abdomens to count the number and duration of contractions in a 10-minute period. The results would be entered into a pantograph, a paper chart that is used to track labor progression. Even without the lines and monitors, it was incredible to witness the level of medical care being provided within a limited resource setting. As I continued my observations, I discovered that all patients go through “natural births,” predominantly due to the cost of epidurals. One might expect the ward to be filled with yelling and laboring mothers crying out in pain, yet it was surprisingly quiet. No one called out and no one screamed. Instead, I was surrounded by women snapping their fingers, praying and humming through contractions. As I followed a mother’s progress through labor, I was taken aback by her final delivery process. In the “second stage” area, there is no coaching, privacy or family members, just the mother, her midwife and any medical students who decided to observe the delivery. Though it was her first child, the mother was not coached through her delivery. If she did not push adequately, the midwife would hiss in disgust. During the delivery, the midwife made an episiotomy, a surgical cut at the base of her vagina to aid in the delivery, but the patient, unfortunately, sustained a second-degree tear. While repairing the laceration, the patient would pull away due to pain. Each time the patient moved, the midwife would express her anger and displeasure. I struggled to watch as the patient writhed in pain. I desperately wanted to console her, but it did not feel like it was my place. With each unwanted movement by the patient, the tension in the room built. The midwife grew tired and at times, even pretended to give up on completing the repair entirely. Seconds felt like hours as the midwife worked to close the laceration and reunite the mother and her baby. First Day as First Assist “Can I scrub on your C-section case?” “Yes, of course.” The excitement that overcame me was palpable, as the idea of being first assist was merely a dream that I had prior to visiting Ghana. The resident took me through the scrubbing process, which entailed the typical personal protective equipment, rubber boots and a shin-length rubber apron worn over our surgical scrubs. We then scrubbed with pieces of pink soap left in a dish in the scrub room. As the foam collected on my hands, I found myself reviewing the steps of the operation, the patient’s medical history and any complications she was at risk for perioperatively. As we entered the operating room, my heart began to race with anticipation. I gowned and gloved myself and then assisted with draping. We then made the first incision of the elective C-section for a fetus with a genetic disorder of bone growth called achondroplasia. When the baby delivered, his appearance was typical of achondroplasia: frontal bossing and shortened upper extremities. The baby was carefully placed on a nearby table, and then the surgeon’s technique took center stage. He prided himself on minimal tissue manipulation, leaving the uterus inside the abdomen during the repair and abstaining from exploring the uterine cavity for placental remains. We finished the operation and the only evidence of our presence was a small, beautifully closed pfannenstiel incision. First Day Eating Ghanaian Fufu “Are you free for dinner? We are going to try fufu.” As a first-generation Nigerian American, I have consumed plenty of fufu in my life, including the batches that I personally struggled to prepare. Ignoring my familiarity with the dish, I enthusiastically accepted the invitation. My mind drifted over the possible variations of Ghanaian fufu. Would it be made of potato, yam or even plantain? Would it be hard or soft? Sour or neutral? Though fufu, a staple in Nigerian and Ghanaian cuisine, is essentially pounded starch and water, it can be made in numerous ways. I was excited to try this twist on a familiar dish. We left the medical campus and began our journey to a restaurant called Confidence. When we arrived, we each ordered the fufu with groundnut soup and goat meat, a standard in Ghanaian cuisine. Within minutes, the server placed multiple large bowls of water and soap on the table and instructed us to wash our hands. The act heightened the experience, as I felt like a native Ghanaian eating in the proper way. The food came shortly thereafter, and as the bowl was placed in front of me I appreciated the nutty brown color and aroma of peppers and spices. Immediately, I reached into the bowl with my right hand to fish out a piece of the fufu ball floating in my soap. I flattened the fufu between my fingers while simultaneously scooping up the soup, and then lifting it to my mouth. The flavors were bold, yet balanced; new, yet familiar; and most importantly, delicious. For any student traveling abroad, I encourage you to embrace the unfamiliar. If you challenge yourself to let down your guard and experience life in an open, curious and engaged manner, you will be rewarded with first impressions that last a lifetime. Opinion The Michigan Daily — michigandaily.com 4 — Tuesday, October 2, 2018 Emma Chang Ben Charlson Joel Danilewitz Samantha Goldstein Emily Huhman Tara Jayaram Jeremy Kaplan Lucas Maiman Magdalena Mihaylova Ellery Rosenzweig Jason Rowland Anu Roy-Chaudhury Alex Satola Ali Safawi Ashley Zhang Sam Weinberger DAYTON HARE Managing Editor 420 Maynard St. Ann Arbor, MI 48109 tothedaily@michigandaily.com Edited and managed by students at the University of Michigan since 1890. ALEXA ST. JOHN Editor in Chief ANU ROY-CHAUDHURY AND ASHLEY ZHANG Editorial Page Editors Unsigned editorials reflect the official position of the Daily’s Editorial Board. All other signed articles and illustrations represent solely the views of their authors. EDITORIAL BOARD MEMBERS ABBIE BERRINGER | COLUMN Believe survivors? I am a woman. I am a survivor of sexual assault, but I don’t want you to simply “believe me” because I wrote this. Why? Because I believe in due process. I believe in “innocent until proven guilty.” I believe the principles of the American judicial system are ones rooted in justice. I know that the system has flaws and corruption has overtaken parts of it. It is hard to come out about sexual assault for many reasons. Corruption within the system often ends up protecting the powerful. However, just because we know this is true, it does not give us the right to label someone “corrupt” or “guilty” without the evidence to support it. It is brave to come forward. I didn’t come forward. In fact, what nearly held me back from writing this piece at all was the fact that I would have to tell my parents what happened to me all those years ago. The knowledge of how much it would hurt them was almost too much to bear. Up until now, only a handful of people knew what happened to me five years ago when I was just a junior in high school. In the days, weeks, months and even years after the incident, what kept me from talking to most people was a mix of complicated emotions: embarrassment, fear and an overwhelming desire to put the whole thing behind me. If I had gone to my parents, they would have wanted me to go to the police. If I had gone to the police, they would have opened an investigation. If an investigation was opened, one thing would have become abundantly clear: There was no evidence. It was just me and him in a dark room, with one other person who happened to be asleep. I woke up and he was touching me, but he didn’t rape me, so I would have no DNA evidence. He didn’t bruise me, so there would be no marks on my body. There were no witnesses, just my word against his, and I know that for good reason the justice system does not allow people to be convicted on hearsay. It is sad. It is sad that I discovered that this person committed almost exactly the same crime against another friend of mine some time before this incident had happened to me. I wasn’t his first victim, and the sickening truth is that I will more than likely also not be his last. Yet the truth is that my word alone is not, and should not, be enough to convict him. It doesn’t matter what the statistics are on accusations of sexual assault. Studies quoted in Vox, the BBC and Vogue have already reported that most people who come forth with sexual assault accusations are not lying. Whether these studies are accurate or not, I do not know. However, I do know that it truly doesn’t matter. As Voltaire once said, Sir William Blackstone echoed and Benjamin Franklin later co-opted: “it is better 100 guilty Persons should escape than that one innocent Person should suffer,” is a maxim that has been long and generally approved. I still believe in this maxim and I think that, as Americans, we all should. This maxim is a protection. It guarantees that someone who would seek to destroy your life on baseless accusations, due to some personal vendetta, or a desire to harm you for one reason or another cannot do that without creating some sort of elaborate plot that frames you as “guilty beyond a reasonable doubt.” The truth is that tomorrow I could come out with a baseless claim against anybody, an old enemy, a bad professor or a former bully, but I am deterred from doing so by the fact that my baseless claim can do no more than hurt their reputation. What I fear is that, in this new world, where the push by the left is to unequivocally believe the accuser, this deterrence will exist no more. If we start punishing the potentially innocent based on nothing but accusations alone, then it encourages those who may seek to destroy someone else’s life to take that avenue. In the world of politics, the corrupt work by trying to ruin the lives of their opponents. If we don’t want the corrupt to win, then we can’t give them the chance to turn allegations into guilty verdicts, because that is exactly what they want. Due to what I have gone through, it is not lost on me that this does and will continue to lead to some of the guilty going free. It is also not lost on me that there is still a culture of mistrust and blatant sexism toward women, one that has enabled sexual abuse to continue running rampant in our society for far too long. Because of my own circumstances, I am very likely to believe the accuser in a sexual violence case, and more than anything I want our justice system to punish rape crimes more harshly. It is a disgusting injustice that someone like Brock Turner, the guilty party in the infamous rape case at Stanford University, only spent three months in prison for his heinous crime because the judge actually cared that his life had been forever changed, as his parents and lawyers argued in court. His life should have been ruined. He didn’t and, in my opinion, still doesn’t deserve to walk free. It physically pains me to think that my abuser walks free and that there is nothing even the justice system is able to do about it, but I know if my word alone could have convicted him that would have been a very dangerous power. I don’t want that power in my hands or in the hands of anyone else. I would rather see my accuser go free, even as tears come to my eyes as I write this, than to know that the power to ruin someone’s life based on an accusation alone has become a reality in the American justice system. So, I ask us all to think about what we should truly believe in. I believe in justice. I believe in due process. I believe in evidence and “guilty beyond a reasonable doubt,” but I don’t simply “believe survivors.” It hurts to say that because I am one, and most people who say they are a survivor are telling the truth, but regardless, you shouldn’t believe me based on my word alone. First impressions How Trump’s got it wrong on trade KIKI OGU | WOLVERINES ABROAD Abbie Berringer can be reached at abbierbe@umich.edu. HANNAH MYERS | CONTACT HANNAH AT HSMYERS@UMICH.EDU W ith the U.S.- China trade war and the sanctions on Iran and Russia dominating much of the news these days, U.S. trade policy has become the spark of much controversial debate. To me, this didn’t make much sense. Any Economics 101 professor would have told you in the first week of class that trade benefits all. But when I looked into it, it seemed that there was a consensus among some of the world’s highest-ranked officials that free trade was not equal to fair trade. And so, in order to figure out the truth behind all of this, I decided to interview one of our own experts in international trade: Alan Deardorff, University of Michigan’s John W. Sweetland Professor of International Economics and Public Policy. When it came to the definition of free trade, the answer was pretty obvious: in Deardorff’s words, “eliminating barriers such that trade could flow freely.” But fair trade was much more ambiguous. The term had begun to be used freely “to mean any trade (an individual) didn’t like.” For example, when a country subsidizes one industry over another, the industry’s competitors would view the trade as largely unfair. But if, say, China, decided to subsidize their exports, the U.S. consumer population would benefit, as “we’d get cheap stuff.” Similarly, if a company were to outsource manufacturing to a country where labor and input costs were cheaper, it could also be viewed as unfair by domestic suppliers. But, the real question is, if these allegations of unfairness were addressed, would trade become more efficient and less “unfair?” According to Deardorff, “that kind of unfair trade benefits us. Our country overall (would) be better off if we freely import from countries that want to sell to us, regardless of what determined the prices that they’re offering.” That said, there is, in fact, a legal definition of unfair trade. Economic dumping occurs when a country exports for a price that is lower than the selling price locally. Now, this is controlled by laws that allow a country to put tariffs that would offset the price gap that dumping creates. But, that said, these anti-dumping duties are not often used by the U.S. except for specific cases in industries such as steel. Evidently, this “type” of unfair trade is obviously not what President Trump is talking about. Rather, the current administration has been fixated on the tariffs that China has imposed on us, calling their acts of protectionism completely unfair and harmful to the U.S. Tariffs traditionally have two effects. One, they “raise the price to the (country’s) buyers,” and two, they “lower the price to the (country’s) sellers.” As long as the country is small, the effect of a tariff is localized and there is no change in the world price. However, “when a country becomes very large, there is the possibility of pushing down the exporter’s price.” According to studies done by Deardorff, though, “there is no country (not even the United States) that has enough share of the world economy (to significantly affect the world price).” That said, tariffs instituted by countries like China do have the potential to affect U.S. producers. But, the extent to which our producers versus China’s consumers are getting hurt by a tariff is mixed. Obviously, U.S. producers will lobby for subsidies regardless, as it is in their political interest to do so. One popular case of this recently is the soybean industry. With that in mind, our administration’s reaction in putting our own tariffs in place to combat the “inequity” created by the Chinese tariffs have doubly hurt our consumers. In fact, when I asked Deardorff about this, he said that there actually is a proper response to countries that have overstepped their boundaries by implementing high tariffs in filing a complaint with the World Trade Organization. The WTO would investigate the measure and determine whether the tariff is justified or not. In a perfect world, the United States should have paused, evaluated the conflict with China and filed an appropriate complaint. Rather, we hastily implemented tariffs which resulted in an escalation of the conflict, throwing us into a trade war. Neither country is really justified in their actions, and now the international trade scene has been turned upside down. Trump seems to think that our trade deficit with China is the main cause of our conflict. However, trade deficits by nature are just a means of a company dealing with specialization. When a country buys more than it sells, it’s simply a matter of specialization and relative comparative advantage. Though trade deficits are not ideal in that we really should be producing for ourselves, there is no wrongdoing of China’s that is causing the imbalance and, according to economist Joseph Gagnon, “there is no evidence that high tariffs reduce (trade deficits).” The U.S. has unequivocally got it wrong on trade. We are sacrificing free trade in the name of protectionist policies that are isolating our country from the rest of the world and creating major political and economic harm. It doesn’t align with Democratic or Republican policy. It’s just plain wrong. Adithya Sanjay can be reached at asanjay@umich.edu. ADITHYA SANJAY | COLUMN Kiki Ogu is an M4 at the University Medical School.