 The United Nations says the world is facing the worst refugee crisis since the end of World War II. How does this affect the hygiene and safety for millions of women and girls? What happens when displaced women are menstruating? This past Sunday was Menstrual Hygiene Day. For more on this, we go to Tanzania to speak with Dr. Marnie Summer, who's an associate professor of sociomedical sciences at Columbia University Medical Center. Thank you for joining us. Thank you, it's great to be here today. So you're in Tanzania, we're gonna talk about women, refugees, menstruation. Maybe if we have time, we'll get to a study you're working on now about alcohol and rape. First off, tell me about Tanzania, what's it like today? It's along the Indian Ocean. It is, it is, it's actually fun when you visit here because in the morning, when you head out to meetings, the ocean is very, very, very far out. The tide has withdrawn, and then when you come back at the end of the day, it's full on water. It's steamy, it's the end of the rainy season, so there's pouring sort of trenches of rain every once in a while, but lots of squawking birds and traffic and nice people, so good to be here. From what I've read, it's a peaceful nation. They have about a hundred tribes, but they're not fighting one another. Are you relaxed? I know you have serious, some sad work to do, but are you able to relax and enjoy Tanzania? Yeah, yeah, it's one of those places that I think people really like to work. It's beautiful being on the ocean. It has been a very peaceful and united country since independence, and while there are, I think there's actually 120 ethnic groups or tribes, everybody speaks Swahili, I think everybody in this particular country feels like one nation, and it's a nice place to be. I've been coming here since 2006, so pretty used to being here, but I like being here. Tanzania was first occupied by the Germans during the imperial era at the turn of the 20th century, and then after World War I, the British took it over and then it became its own country. Tell me about Menstrual Hygiene Day, that was Sunday. Yeah. What is Menstrual Hygiene Day? So Menstrual Hygiene Day was launched a few years ago now by an NGO based in Europe. I think it was with funding from the Gates Foundation. What's an NGO? Sorry, a non-governmental organization, so sort of a non-profit, an organization aimed at doing good in the world that isn't part of a government of any sort. And they saw, I think they saw, there was growing attention to this issue of menstruation and particularly around girls in school and the challenges that they're facing, and that there was sort of more and increasing efforts to talk about this issue, to try and bring attention to it with one of the biggest hurdles, frankly, is just talking about it in public, getting people in government, in donor, sort of the parts of the big, those parts of various governments around the world that are donating money to countries to try and do projects, local communities to get people to break the taboo and start talking about the topic. And so I think it was, I'm not sure if they really knew how wonderful it would turn out in terms of just spinning out into people writing about it all over the world, holding Menstrual Hygiene Day activities all around the world. So it's really mushroomed into quite an experience and it was really fun on Sunday watching, things pop up from countries, low-income countries, high-income countries, places all over the world that were trying to break that taboo and make it something that everybody can talk about. The taboo, we have Republican politicians in America who don't understand female reproduction. When it comes to menstruation, Trump said, and I quote, it's too disgusting, I don't want to think about it. I don't want to think about it. I'm not going to clutch my pearls and say, what's going on in these third-world nations? Why don't they talk about menstruation? There is a taboo. What is the taboo in the United States and how does it compare to the taboo and say the refugee camps that you visited in Tanzania? So I think that taboo is widespread, obviously, as demonstrated by our government right now. When I was doing my original study on this in 2006, 2005, and started looking into it as a doctoral student, I would go to dinner parties or other gatherings in the US and people always, they meet a doctoral student, they want to know what you're studying and I would start to tell them about menstruation and very quickly it would be, please pass the potatoes. Let's move on to the next topic. I think that it is historically, if you go back in time, there's anthropology around menstruation. There's this, it's sort of linked with either power women, sort of women having this, that blood is somehow powerful or that it's polluting and dirty and unhygienic and there's fear surrounding it and so it either becomes something people are uncomfortable and scared about, I think when they don't understand it or seen as a way to sort of relegate girls and women to sort of a status of something we don't talk about that diminishes them. And I wouldn't say that that is universal. I think there are cultures and societies that celebrate menstruation. I think that there are some cultures and societies that traditionally girls and women maybe got rest time during their menstruation. Sometimes that one may perceive that as negative, they might have felt banished and they might have been banished and in other circumstances, there may have been a situation where they actually didn't have to do all those chores. But the taboo is strong. People, I mean, in the US, I don't think people talk about it regularly. Maybe the younger generation starts to talk about it. I think that is changing as more and more media does pieces on it. I certainly go to very few dinner parties now where someone hasn't heard something about it, isn't interested to hear what I'm doing. But it's really easy for us in the US because we have toilets, we have supplies, we can buy drugstores, we can get on the internet, go to the library, learn whatever we need to know. When you go to lower income countries or you go to refugee camps or other camps for displaced populations, they may not have access to good information. They may not have easy access to any kind of toilet or a safe or a clean toilet or a toilet with a door. They may not have access to water. They may not have anywhere to go at night. They may not be able to get supplies that they need. It's fine to use cloth if that's what you're comfortable using, but maybe they don't even have good cloth. And so I think, and then there are taboos. There are taboos around what you eat about whether or not you can pray in certain places. I've heard taboos around, you can't garden during that time. You can't take care of the animals. You can't be in the kitchen. You have to sleep in a separate place. So again, it's very dependent, I think on the cultural context. So there's I think a significant amount of variation. You should bathe, you shouldn't bathe. So I think it's important to always try to understand and learn what the local taboos are. But I think one of the nice things about this growing sort of form of people trying to talk about it in different countries is to say, okay, what are these taboos? And not to denigrate a culture in any way, but to try to sort of tackle those that may be hindering girls and women's abilities to go about their day and to feel good about their bodies. Did you say you wrote your doctoral dissertation on menstruation? I did, yes. And it was an anthropological study of menstruation? No, I mean, I am in public health. So there are certainly anthropologists in my department at Columbia at the Mailman School of Public Health. But I was looking more at what is the intersection of menstruation in girls' education? There was very little out there and having grown up always having sort of no challenges around getting to go to a good school and getting to pursue the education that I wanted to pursue, I was concerned about the ongoing sort of gender gap in education around the world and started to look into what are some of the issues that we don't know enough about and we don't understand enough about. And there's a lot out there. We know a lot about why girls miss school, why they don't go to school, why they don't finish school. And there are problems with boys too, but I honed in on this one piece that this was back in 2004, but there were references to girls drop out of puberty, girls can't go to school because there aren't toilets, but there was very little actual empirical data on what's actually happening with girls. So that's what I did. I came to Tanzania in 2006 and 2007 to spend a lot of time hanging out with girls and also some time with teachers, parents, religious leaders, trying to understand with my Tanzanian research assistant what was really going on and what was happening around that age in relation to just their own understandings of their body and in relation to sort of their school participation and engagement and ability to manage their periods when they were at school. We are talking to you via Skype. You're in Tanzania. It's pretty amazing that we're able to converse I'm in Manhattan. There are a hundred tribes in Tanzania. Are you able to see the different taboos among those 100 tribes? Does each tribe have a different taboo when it comes to menstruation? So I think there's actually 120 tribes. I think there's even more than a hundred, but I haven't tried to study all of them. When I first came, I was focused on one region of the country trying to understand the tribes in that region. We certainly heard what some of the beliefs and traditions were around menstruation. This was in the northeast part of the country. Traditions were, taboos were diminishing. It's a part of the country where there was pretty strong influence from colonialism. Girls' education was already more well respected in that region. And so initiation ceremonies and other types of traditions that might have been linked to menstruation were already diminishing. That being said, I certainly asked a lot of questions about other parts of the country, and there are some tribal populations, such as the Masai who are in both Tanzania and Kenya, the Zeramo, some of the other tribal groups that have much stronger cultural beliefs around menstruation or around Menarche. Menarche being the first time a girl gets her period. And what that means in terms of initiation ceremony and expectations for her. Do any of these tribes celebrate the first period? Yes, I think they do. I haven't spent time with a tribe that does, but I absolutely heard that in some of the tribes in Tanzania and certainly in other countries, that it is still or was it sometimes celebrated. Sometimes that celebration in some context is linked to the days when girls were expected to be sort of married off or start to have babies at some point after they started menstruating. And so it was almost in some cases, not everywhere, an indication, a celebration both of her young womanhood, but also an indication that she was now becoming ready for sort of that next phase of life. How many understand that it's fertility? I think it's pretty widespread that they understand. And I think that I've always sensed that the recognition of Menarche as even something celebrated or hidden was often linked to the knowledge that it is linked to reproduction. Is that because of imperialism that they understand that? Or does it predate? I think predates. I think it's the natural rhythm of life and probably the societies understood that something shifted at that point in time and sort of had ancient traditions around this sort of period of life when both boys and girls, bodies are changing, their sort of way of understanding things is changing, their ability to do more things around the house or in the sort of local community is changing. So I'm pretty sure that predates. So whether or not they use the language of reproduction and fertility, there are things about the language we use that are sort of Western, but that is sort of, I think just the ancient rhythms of life that I think were well understood. And the bleeding, you kind of intimated that that signals power in some cultures. I would assume they see a woman bleeding and not dying and they assume some kind of otherworldly power. Yeah, I think that those aren't societies that I've studied, but when you get into reading the Anthropology Administration and some of the Mary Douglas and some of the other sort of early writers on how menstrual bleeding is considered polluting, but also scary and particularly, I think, to men. So probably some of the silencing around it comes from that. But again, I'm not an anthropologist and haven't really spent a lot of time looking at the sort of ancient taboos and beliefs around it because I'm sort of much more focused on how is it hindering girls and women's lives today? What can we be doing to help to overcome and change that? Let's talk about the refugee camps that you visited in Tanzania. They seem to be taking in women from what countries? These particular camps, I've spent time in a number of camps related to the project I wrote about, but these are Congolese and Burundian populations who've been going back and forth across the border for, I would say, a number of years now. But that's who's in those camps. How are they being funded? Is it through the UN? I think different places. There's UN, certainly UNHCR is there. There are bilateral donors and by that, I mean sort of some of the big Western governments are funding them. Refugee camps are generally the responsibility of the host country government. So in this case, it would be the Tanzanian government runs the camps, but certainly there is a lot of UN and donor support for running the camps into the various, as I mentioned, NGOs earlier, non-governmental organizations that are in the camps helping to respond to the refugee's living circumstances. Is this a permanent state for them? There are Palestinians who are living in Lebanon and they call them refugee camps. They've been there since 1967, some of them since 1949. Is this a permanent base for these refugees? I don't think this particular refugee population, it certainly doesn't have the length of the Palestinians. People have been, so the Burundians who came to the camp, many of them were here a number of years ago when there was turmoil in Burundi. And then at some point, they went back to Burundi and attempted to rebuild their lives there or you know, and then sort of chaos and disruption and violence erupted again. And so they fled, they had fled and they're still sort of fleeing. It doesn't get into the US papers really, but back to these camps. And then the Congolese, so some of these camps have been there for probably over a decade, but have closed at times, reopened at times, gotten smaller at times, gotten bigger at times. They may be more than a decade, I'm not sure. The Congolese, I think similarly back and forth, depending on the elections in the Democratic Republic of Congo, where they're from, there's been violence sort of erupting around those elections that are sort of keeping postponed. So they similarly sort of, when times are peaceful, I think oftentimes people do try to go home and then violence erupts again and they flee again. So these women in these refugee camps in Tanzania, are they living in tents? Are they living in sleeping bags out in the open? How are they housed? So these camps have a sort of range. There are, I don't know that anybody gets sleeping bags, they get blankets. There are many, many, many tents. You certainly see huge numbers of tents. And then for the refugees who have been there longer, and I don't totally know all the sort of machinations of how this works in the UN system, they are building mud house, small mud houses. So there are, I think it's the population that's been there the longest is starting to get moved into these mud brick houses. And then those who are newer are in the tents. What happens if you get your period in a refugee camp? So I would say the resilience of the human spirit is undiminished and they manage, but I think it's very difficult. So the toilets, again, it's important to understand sort of where did these populations come from? Some came, for example, the Bryndians from a more urban environment and may be used to having latrines or some kind of toilet facilities relatively nearby. Others are coming from rural areas who may have had latrines somewhere in their compound or may have been used to sort of going into the forest or someplace nearby. In the camps, in any camps, whether it's refugee camps or displacement internally displaced populations in other countries. In the Tanzanian camps, as one example, there are both household sort of what wouldn't call latrine facilities and also communal or shared latrine facilities. There, when I was there about a year ago, or not even a year ago, about six months ago in these same camps, they were wood structures with sort of this plastic sheeting wrapped around them so they didn't really have a door but you and they're just sort of built behind the houses or built sort of a small number for four households to share. Is there shame associated with bodily functions? I know that we've talked about menstruation but just going to the bathroom, is there shame and embarrassment and a need for privacy in these cultures? I mean, I think it's the same in most cultures around the world. I think just like people in the US, they wanna be able to go and not be rushed and be private and I think also importantly, they wanna feel safe. If there's no door on the toilet, if there's no lock on the inside of whatever door may be there, then you're vulnerable. Are you saying there's a universal need for privacy when it comes to bodily functions? Because I've read about the Romans who would just sit in public and defecate. This was in ancient Rome, they would go to the marketplace and- I don't know if that still exists. I haven't been anywhere where that's, I've done research administration in about six countries and advised on studies and probably another 10. I don't think it's ever come up that people were comfortable managing their periods and probably their other bodily functions in public. That is a universal trait in humans. I would take probably in most cultures it's something that people do privately but I don't know that they necessarily do it individually always. I was a Peace Corps volunteer in Eritrea in East Africa a long time ago and just as in the US, two women will get up at a restaurant and go to the bathroom together. People will sometimes go off together to the forest to do their business. And why do they go off together? I think good company, someone to accompany you. I would say in context such as a displacement camp or refugee camp, they may go for safety reasons. They may go together. Women would be private about their periods because they're so vulnerable and weak that they're endangered. So they'd want a door. They want to be alone because men are lurking. Yeah, I don't know that they're weak so much. I would just say that you can't sort of change whatever cloth if you need to wash, if you got blood on your skirt or your clothing. It's messy unless it's sort of towards the end of your period in which case it's less messy. So you just need time and you need space to manage it and to not be worried somebody's gonna walk in or harass you or sort of catch you in the middle of that when you're squatting or whatever body posture you use to manage. I guess the word weak is wrong but vulnerable and you're not feeling well. As I understand it, when it's that time of the month you wanna lie down and it's not always a pleasant experience as I have seen in my house. Yeah, I think again it depends. I would say I certainly get cramps and it's pretty uncomfortable for a day or two a month but I, and I think there's some women and adolescent girls who have it much worse than I do and may have to stay home from work or school or really lie down for extended periods. And then I've certainly met girls and women who tell me I barely feel it. So I think that there really is the range. Many of us are uncomfortable. Many of us just sort of push through. I think one of the advantages you have in a, or I certainly know I am fortunate to have is access to pain medications. So I can take whatever I need to do for the first day or two and go about my day and it may be a little uncomfortable but I'm certainly used to it. Some cultures may not be comfortable with the idea of pain medication. It's not something they're familiar to. It's not something they feel is appropriate but in other places it may be that they could really use pain medication and it's just not something that's accessible or something that they've been introduced to and that with pain, not to say I'm pushing medicine but it certainly enables me to get through a lot of sort of difficult months. So again, I think there's a spectrum but many women certainly and adolescent girls are uncomfortable particularly for the first day or the day before the day, the second day. Well, some of the resistance here in the United States to women in the military was how they're gonna sit in a foxhole in the middle of the battle when they're getting their period. What is your answer to that? I mean, my answer to be how primitive is that? There's resistance to women and also have been in historically all sorts of positions including the presidency because who knows what may happen. They might get hysterical when they get their period. I think that we manage. I think that Gloria Steinem's comment, what would the world look like if men could menstruate? I think, you know, girls and women soldier on, you know, literally or figuratively and they would find a way to manage, so. Okay, that's a vague answer. You're talking to a man in his 50s. So more specifically, how would they manage in the foxhole? Well, yeah, I mean, there are a lot of men here in America who don't understand menstruation. It is a private thing. It's a bodily function. The cliche is that women are vulnerable when they're menstruating. They don't feel well. They wanna lie down. They need my doll. Their personality, this is the stereotype that their personality changes when they're menstruating. The same way my personality changes when I stub my toe and I'm in pain. Tell me where I'm right, where I'm wrong when I bring up the stereotype. So I think that probably that stereotype is utterly wrong for a lot of women and girls and perhaps a little bit more right for some of them. And maybe it's just pieces of that stereotype for different women. I think that certainly for many women, it's uncomfortable. You have cramps, your boobs hurt, maybe you retain sodium, so you feel thirsty, your stomach doesn't feel right. So certainly there's a lot of physical discomfort. Again, wide range, depending on the adolescent girl or woman. And I keep saying adolescent girl because at least I think they get forgotten a lot as sort of a very big part of the population that's menstruating. And often are struggling to sort of learn how to manage it. You use a tampon, you use a pad, you use a cup, some women are on sort of fertility, sort of family planning that sort of regulates their cycle, it's predictable, it may lessen the cramps or the amount of bleeding. So certainly I, and then in terms of your mood, I would say the vast majority of my co-workers or family members have absolutely no idea when I have my period. And I'd say that's probably the case for most adolescent girls and women. Maybe I sometimes feel a little emotional once a month and maybe I'll share the reason that I think I am or am not. I do think all of that is very real. We each noticed rhythms in our body. Whether anybody else has any idea what's actually happening, I'm less certain that they really do. I think women and girls are masterful at hiding it in societies around the world. I think one of the things that is really nice about the sort of the outpouring of sort of new media and entrepreneurs and advocates out there talking about it is this realization that a lot of us have been doing the same thing to hide it and manage it. Maybe we don't wear white on those days of the month so we don't have to worry. If we have some kind of leak or accident that anybody's gonna know, we track it on a calendar so we can be ready and be carrying things. Although another thing for men to know is that it can be really irregular and some girls and women get it like clockwork and other skip months and others. It's not something like on the 28th of every month that's when you get it. It's very well. What, is there such thing as sink sisters? I've heard about this. You know, I don't know what the science is. I will say there are times in my life when I've spent a lot of time with women and we seem to start menstruating around the same time but I don't know the science and I don't know if there's anything to that. And what do these women need from the United States? Are we providing enough? The Trump administration has a new budget you write about. They have a new budget. They wanna give an extra $50 billion to the Pentagon. We have enough money to bomb Yemen and yet two thirds of that country is facing famine. What is the Trump administration doing about all this? You know, it remains to be seen. Certainly it doesn't look very well. Look very good. The funding that traditionally would go to organizations such as UNFPA and some of the other UN organizations that are a huge part of a response to assuring that girls and women's reproductive health needs, menstrual hygiene needs, whatever they are are being met, whether it's in displacement camps, refugee settings or just other low income contexts. It suggests they're gonna cut the budget for public health across America and funding that goes to both science and refugee response around the world. And all of these have huge implications for meeting girls and women's needs, whether they are in such contexts or whether they're in living in a rural part of, for example, Tanzania and looking to some kind of development project that is going to assure that there are adequate toilets in that school or support a government that is trying to do a better job at assuring that the curriculum includes content that they need so they know about their bodies, they feel empowered and have sort of strong self-esteem around how to manage their period and sort of their future fertility if they so choose. Yeah, one of my daughters said to me, and I just find this hard to accept as a man, but I accept it, is that you cannot address economic inequality until you address pro-choice issues. A woman's right to an abortion has to be established before you can then venture into the realm of income inequality. That was hard for me to understand when my daughter told me that. I'm taking from what my daughter said, menstruation and the problem women face as refugees is a serious issue that might have to be addressed before we get to the larger issues, right? It's a basic need. Yeah, I think it's a basic need, and I think one of the things we come up against is people suggesting it's not a life-saving issue, it's they're not dying of their periods, but some of us would suggest how do you go stand in line to pick up your distribution in a displacement camp if you have to wait online for four to six hours to get your supply for that month? How do you walk whatever distance you need to walk to fetch water for your family? How do you go find firewood? How do you just interact socially with those around you or sit in a classroom for eight hours a day or teach in front of a classroom of young people if you don't have access to safe, clean toilets, if you don't have some kind of supply, whether that's a cloth or a pad or whatever it is that culturally and sort of economically is your choice or available. And if you don't have the information you need about your body, I think some of the areas we need to learn more about, there's been a real groundswell and attention to what are the challenges girls are facing in schools in low-income countries and the female teachers. We've spent a lot less time looking at how are girls and women managing in workplace environments? How are they managing to go about their day in marketplaces, in factories, in business offices? How are they taking buses and transiting? I think ultimately girls and women are incredibly resilient and strong and they find ways to manage and they use extra, extra cloths and they wrap things around their waist so if they have an accident nobody sees. I don't want in any way to suggest they're not out there doing their best but it's inequitable, you know? I don't know the difference between a panty shield, a Tampax or a Kotex. I don't, you know, I just don't. Most men, I think don't. I would assume that third world nations don't have Kotex machines and Tampax machines in every restroom. What do they use? You say cloth? Well, just to clear the record, we don't have them in the US either in every restrooms. Most of our restrooms don't have them either. So you have to have a supply with you or you have to be somewhere near a drugstore which fortunately if you're living in the US there's often some kind of drugstore, convenience store where you can go. Hasn't there been talk of free Kotex? Yeah, there has, there has. But in terms of low income countries, generally people use pads, disposable pads, like, you know, the ones with wings on them, you know, a panty liner just, you know, is for lighter days when you don't have a lot of blood coming out. A regular pad, it comes in different sizes, is better for the first few days. And a lot of women use disposable pads in low income countries if they can afford them or they use homemade pads. We use, there's now a whole booming industry of reusable pads. In many cultures they've traditionally just folded over cloth and found ways to hold that in place so that they can sort of go about their business and then if they can't afford cloth or don't have that, sometimes they just use paper. It starts to go down or they stay home and then there's societies of which I know much less about that don't use anything and just lead and stay close to home. And what did they do 3,000 years ago? I have no idea but I think it depends on where you're talking about. My guess is, yeah. Right. We've been talking with Dr. Marnie Summers. She's an associate professor of sociomedical sciences at Columbia University Medical Center and she's in Tanzania today. Before you go, and by the way, thank you for taking time to be with me. Looking at the Republicans, there seems to be carelessness and conscious subjugation of women. There's one part of these Republicans in Washington who are consciously subjugating women and then there's the Republican who innocently doesn't care. I don't know anything about fertility and menstruation. What do you want from me? How much of the menstruation problem women face in third world nations is because men just don't care because it doesn't involve them, as Gloria Steinem said. And how much of it is a conscious subjugation where they're aware that by making it hard for women to tend to their menstruation, it weakens them and keeps men on top. You know, I don't know how I would split that. I'm not sure that many people, frankly, think about menstruation. I think that probably there's a lot more. The men who act intentionally, I think gets at more of the reproduction issue and baby making issue. I think most men honestly just haven't thought about it. They don't menstruate, they don't know what it feels like. I think one of the reasons, even amongst the community that has been trying to do something about this issue, a lot of the engineers who work on toilets in a lot of these contexts are men and just frankly didn't think about it. It's not something they'd experience. It's not something they're familiar with. I do think that the fact that women's bodily needs and adolescent girls' bodily needs are deemed less of a priority, are deemed unimportant and in fact are deemed something that can be pushed back on or not supported, obviously is hugely problematic. But whether any of them have really thought about how their actions are impacting sort of a girls or women's ability to manage her period, I'm guessing is highly doubtful. What can we do to help? I think you can help to break the taboo. You can talk about it. You can help at least in the countries where you live and work to make it something that is acceptable to have conversations around, support those organizations, push back on governments that aren't providing adequate toilets, water, and information to the girls and women in their societies. And even in the high income countries, I think there's a growing realization that homeless girls and women and others may not have the supplies that they need either and sort of girls and women are women in prisons. So I think that finally there's, it's something coming out of the closet as it were and it should never have been in the closet. Natural, normal part of half the world's sort of all the girls and women out there of reproductive age that we're all experiencing. Right, are there any charities specifically that you think are worthy? Yeah, I mean UNICEF has been doing a lot. WaterAid in the UK has been focused on sort of strengthening toilets, save that children is doing a lot. I have a little nonprofit called Grow and Know. We've been developing puberty books that include content on menstrual hygiene administration for girls and for boys. How can people find out about Grow and Know? www.growandknow.org. It's publishing books for girls about girls. Girls and boys, we do careful data. We work with girls and boys in different countries. We work with the national governments and we collect girls' stories about their first periods and how they manage and we come up with a book with local illustrators, local publishing companies and then we sort of work with the government to get approval so it can be distributed in schools and then recognizing that nobody at all talks to boys. Some people talk to girls but nobody's talking to boys about wet dreams, erections and girls' periods. Just tell them to listen to this show because that's all we talk about. Our wet dreams, erections, women's periods. When I was a kid we used to trick or treat for UNICEF. Yeah. That's a UN organization. Are they a good organization? Yeah, they're a good organization. They, Columbia University where I am and UNICEF for the last five years have been hosting a virtual conference on addressing the issue of menstruation in schools and they really have been leaders in trying to push countries around the world to work with the national governments to at least try and address the issue in schools and it was something that UNICEF was responding to in the refugee camps in Tanzania as well. Fantastic. Dr. Marnie Summers, an associate professor of socio-medical sciences at Columbia University Medical Center, she joined us today from Tanzania. Thank you so much for your work and your time. Thank you for having me.