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A Minnesota health advocate’s crusade brings harmful skin lightening out of the dark

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STAT NEWS — MINNEAPOLIS — Karmel Square is a hub of the Somali community here, a colorful, cheerfully noisy hodgepodge of vendors and restaurants unofficially known as the Somali Mall. Amira Adawe stops by often to buy tea and chat in Somali with friends and relatives wearing hijabs and flowing, floor-length skirts. They greet her with smiles and hugs, and she calls them “auntie.”

Her visits are more than social, however. The public health advocate scans market shelves for skin lightening creams that may contain harmful toxins — tubes and jars sold under names such as Fair & Lovely, Prime White, and Miss Beauty 7 Days White.

Some women use the creams in hopes of erasing dark spots, but many rub them over their entire bodies multiple times a day in hopes of whitening their brown skin. The practice pervades many cultures in Africa, Asia, the Middle East — and many immigrant communities in the U.S. — and Adawe has made it her mission to end it.

She began her crusade as a graduate student, after she discovered that creams sold in many Twin Cities ethnic markets contained levels of mercury thousands of times higher than the amounts considered safe by the U.S. government. But her concerns go beyond the physical harm to women. She worries as much about the damage to their self-esteem.

newsnisideIn Somali and other cultures, the lighter-skinned daughter is often seen as more beautiful, Adawe explained recently; in fact, the Somali term for light-skinned — cadey — is considered a compliment. “It’s used as a term of endearment,” she said, “but I think it’s so wrong to say it.”

Public health agencies in several major cities have launched their own investigations of tainted skin creams, occasionally getting advice from Adawe along the way. And now Adawe has created The Beautywell Project, to combat the stigma faced by women with darker skin and take on the industry that promises them beauty in a jar.

By day, Adawe is now a manager for the Children’s Cabinet of Minnesota Gov. Mark Dayton. In her “spare time,” she hosts a weekly radio show in Somali that reaches 80,000 people worldwide. She holds educational outreach sessions in Minneapolis and Kenya, talks with imams, and presents at national and international conferences. Sooner or later, most anyone connected with the skin-lightening issue seeks out Adawe. She fields personal pleas for help from Somali men in Minneapolis worried about their pregnant wives rubbing cream on their skin, as well as calls for help from Kenya, Canada, and Australia.

“We can’t address this issue without discussing beauty, what it means and ways to redefine beauty, as well as discussing and educating individuals about wellness,” she said in an interview.

She admits her goal is ambitious. The stigma runs deep, and skin-lightening creams are a multibillion-dollar business overseas, despite bans and public campaigns against the products in many African countries. In the U.S., creams are often smuggled in and sold in small, ethnic markets like at Karmel Square or purchased on the internet. They have been found in Somali, Hmong, Mexican, Dominican, and West Indies communities from California to Minnesota to New York. Users, and even sellers of the creams, are often unaware that they are harmful or illegal.

Somali women are reluctant to speak openly about skin lightening, and Adawe faced resistance when she began her research seven years ago. Her persistence impressed Jim Koppel, who was deputy commissioner of the Minnesota Department of Public Health at the time.

“It’s a very tight-knit community, and this put her in a tough place,” he said. “It could have had a negative impact on the businesses [that sell the creams], both financially and potentially for legal problems, and was of great concern to her personal reputation. And she went ahead and did it and continues to speak out.”

“I had to be brave enough, and, fortunately, the community saw it as an issue” and supported her, Adawe said. “That means a lot to me.”

A topic few wanted to talk about

One recent afternoon, Adawe was 35 minutes into her radio show, broadcast from the studio of KALY, 101.7 FM, a Somali-American station tucked into a corner of the International Bazaar in Minneapolis. She had been talking nonstop about skin lightening, peppering her fluent Somali with a few English words — endocrine system, mercury, hydroquinone, prescription.

Then she turned to the phones, murmuring in understanding as she listened to a female caller from a Minneapolis suburb. Do you have any more feedback, Adawe asked in Somali.

“Women who practice skin lightening and who have experienced skin damage or illness should come to the radio and discuss their experience without disclosing their names,” the caller said in Somali.

Adawe nodded. The topic of skin lightening is a delicate one, both overseas and in immigrant communities in the U.S. While the stigma associated with dark skin is deep, admitting to using skin-lightening creams is also taboo, thwarting efforts to track the prevalence of the practice. As adept as Adawe is at navigating the delicate social norms and customs of the Somali-American community she’s part of, when she began her research in 2011, she could find only seven women who would talk about their use of skin creams.

It was in those interviews that women told her that they apply the creams to their entire bodies three times a day, sometimes while pregnant or breastfeeding. Most mixed several creams together and stored them in the refrigerator.

Adawe had been suspicious of the creams since her childhood. Growing up in Mogadishu and Minneapolis in a health-minded family (her mother was the head of the maternal and child health bureau in Somalia), she watched with concern when friends’ and relatives’ skin reddened or grew discolored from using skin lighteners. Adawe is grateful for the message she received growing up with the darkest skin of three daughters: “I’m so fortunate I came from a family who embraced me for who I am,” she said.

When Adawe became a county public health educator and a graduate student at the University of Minnesota School of Public Health, she was finally in a position to act on her concerns. She purchased 27 samples of creams to test for the toxins she suspected were present.

The tests confirmed Adawe’s fears, revealing that 11 of the products contained mercury, a known neurotoxin. Mercury has been banned in skin-lightening products by the Food and Drug Administration since 1973; the legal limit is 1 part per million. Adawe still remembers the shock she and the pollution control agency specialists who did the testing felt when they saw the results reaching 33,000 parts per million.

FDA spokeswoman Lauren Sucher said mercury is on a short list of prohibited ingredients in cosmetics. “The FDA has been aware of mercury as a potential allergen, skin irritant and neurotoxin for decades,” she said in an email.

Poisonous to the nervous, digestive, and immune systems, it is often found in unlabeled or mislabeled creams; sometimes it’s listed as “mercurous chloride,” “calomel,” “mercuric,” or “mercurio.” Just touching a washcloth or a mother’s cheek that has been rubbed with the products could be harmful to a baby, the FDA notes, interfering with brain and nervous system development.

Yet the agency was able to inspect only 0.3 percent of 3 million cosmetics shipments last year, and it tested just 364 products even though “adverse findings” are discovered in 15 percent to 20 percent of the products tested, the FDA said last June in a letter to New Jersey Congressman Frank Pallone Jr.

Even skin-lightening products sold legally in the U.S. often contain ingredients other countries recognize as potential health hazards, Adawe said. Hydroquinone, a potential carcinogen that is banned in Europe, Japan, and elsewhere, is often found in the creams, as are steroids, which can cause acne, thinning of the skin, and hypertension.

Adawe’s testing in 2011 triggered immediate action: The Minnesota Pollution Control Agency cracked down on suppliers (in a raid on one popular store, inspectors found about 20 boxes full of products that contained mercury); the FDA investigated; and the Minnesota Department of Health warned of the danger.

Elsewhere in the country, similar scenarios were playing out. Alerted through data from local and national surveys, health departments embargoed products, conducted home visits, and notified manufacturers and health agencies in other countries. In New York, for example, after finding eight skin creams with mercury after inspecting products from 22 stores, city health workers now visit stores incognito to identify products of concern, said Wendy McKelvey, executive director of environmental health surveillance and policy.

Once notified of the dangers, there’s “pretty good compliance,” McKelvey said. “They’re not wanting to sell hazardous products.”

Adawe is often consulted because she understands and is trusted by the affected community.

“I think it’s extraordinary what she’s doing,” said Lori Copan, a research scientist for the California Department of Public Health. “A person from the community is a much better spokesperson than someone working in a public health department in terms of motivating and speaking the language and being one of them. It would be fantastic for all of us in public health if we had a community leader like Amira.”

The value of that cross-cultural competence is often in the details. Inspired by Adawe’s study, an ongoing biomonitoring project in Minnesota looking at chemical exposure in pregnant women and babies now tracks urinary mercury. With Adawe’s input, the program has fine-tuned details such as how to phrase questions in surveys about use of creams.

“If you ask directly, ‘Do you use it?’ they will never, ever answer,” Adawe said. To get at the truth, she said, it’s better to start by asking what kind of moisturizer they use.

Initial results of the yet-to-be-published study show that more than 30 percent of pregnant Asian women who spoke Hmong in their interviews had high levels of mercury and received special follow-up to help them reduce their exposures. “The higher levels were likely from using skin-lightening creams and eating certain kinds of fish higher in mercury,” said Jessica Nelson, an epidemiologist and program manager at the Minnesota Department of Health, where Adawe works as a legislative liaison. (The Somali portion of the study isn’t finished yet.)

Adawe isn’t resting: She’s happy that skin lightening has been established as a public health issue. Still, Adawe said there’s plenty more to be done. Next up, she said, is trying to reframe what it means to be beautiful. She’s developing a curriculum for schoolgirls and outreach sessions focused on men, teenagers, and new teachers, which will revolve around the question: How do we change the narrative of what is beauty?

“My dream is that every woman stops using skin-lightening creams and trying to change their color,” she said, “and that they are happy for who they are.”

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Minnesota

Minnesota terror case shows challenge of predicting attacks

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MINNEAPOLIS (AP) — After Tnuza Jamal Hassan was stopped from flying to Afghanistan last September, she allegedly told FBI agents that she wanted to join al-Qaida and marry a fighter, and that she might even wear a suicide belt.

She also said she was angry at U.S. military actions overseas and admitted that she tried to encourage others to “join the jihad in fighting,” but she said she had no intention of carrying out an attack on U.S. soil, according to prosecutors. Despite her alleged admissions, she was allowed to go free.

Four months later, the 19-year-old was arrested for allegedly setting small fires on her former college campus in St. Paul in what prosecutors say was a self-proclaimed act of jihad. No one was hurt by the Jan. 17 fires at St. Catherine University, but her case raises questions about why she wasn’t arrested after speaking to the agents months earlier and shows the difficulty the authorities face in identifying real threats.

“She confessed to wanting to join al-Qaida and took action to do it by traveling overseas. Unless there are other circumstances that I’m not aware of, I would have expected that she would’ve been arrested,” said Jeffrey Ringel, a former FBI agent and Joint Terrorism Task Force supervisor who now works for a private security firm, the Soufan Group, and isn’t involved in Hassan’s case. “I think she would’ve met the elements of a crime.”

Authorities aren’t talking about the case and it’s not clear how closely Hassan was monitored before the fires, if at all. When asked if law enforcement should have intervened earlier, FBI spokesman Jeff Van Nest and U.S. Attorney’s Office spokeswoman Tasha Zerna both said they couldn’t discuss the case.

Counterterrorism experts, though, say it seems she wasn’t watched closely after the FBI interview, as she disappeared for days before the fires. But the public record in a case doesn’t always reveal what agents and prosecutors were doing behind the scenes.
Authorities are often second-guessed when someone on their radar carries out a violent act. Some cases, including Wednesday’s mass shooting at a Florida high school that killed 17 people, reveal missed signs of trouble. The FBI has admitted it made a mistake by failing to investigate a warning last month that the suspect, Nikolas Cruz, could be plotting an attack.

U.S. officials were also warned about Boston Marathon bomber Tamerlan Tsarnaev two years before his 2013 attack, though a review found it was impossible to know if anything could’ve been done differently to prevent it. And the FBI extensively investigated Omar Mateen, the gunman in the June 2016 Orlando nightclub shooting. As part of an internal audit, then-FBI Director James Comey reviewed the case and determined it was handled well.

Hassan, who was born in the U.S., has pleaded not guilty to federal counts of attempting to provide material support to al-Qaida, lying to the FBI and arson. She also faces a state arson charge. One fire was set in a dormitory that has a day care where 33 children were present.

Although her attempts to set fires largely failed, Hassan told investigators she had expected the buildings to burn down and “she hoped people would get killed,” Assistant U.S. Attorney Andrew Winter said in court. He added that she was “self-radicalized” and became more stringent in her beliefs and focused on jihad.

Hassan’s attorney, Robert Sicoli, declined to talk about whether the family saw warnings. Her mother and sister declined to speak to The Associated Press.

According to prosecutors, Hassan tried to travel to Afghanistan on Sept. 19, making it as far as Dubai, United Arab Emirates, before she was stopped because she lacked a visa.

Prosecutors say that when the agents interviewed Hassan on Sept. 22, she admitted she tried to join al-Qaida, saying she thought she’d probably get married, but not fight. When pressed, she allegedly told investigators she guessed she would carry out a suicide bombing if she had to do it but she wouldn’t do anything in the U.S. because she didn’t know whom to target.

Hassan admitted that she wrote a letter to her roommates in March encouraging the women to “join the jihad in fighting,” prosecutors allege. The letter was initially reported to campus security, and it’s unclear when it was given to the FBI or if the agency made contact with Hassan before the September interview.

It’s also unknown how closely U.S. authorities were monitoring Hassan between the interview and Dec. 29, when she was barred from traveling to Ethiopia with her mother. Prosecutors say at the time, Hassan had her sister’s identification and her luggage contained a coat and boots, which she wouldn’t have needed in Ethiopia’s warm climate.

Hassan later ran away from home and her family reported her missing Jan. 10. Her whereabouts were unknown until the Jan. 17 fires.

Ron Hosko, a retired assistant director of the FBI’s criminal division who has no link to Hassan’s case, said that based on an AP reporter’s description of it, “I would certainly look at this person, not knowing more, as somebody who would be of interest to the FBI.” However he cautioned that the public doesn’t know the extent of the agency’s efforts to monitor Hassan, including whether she was under surveillance, what sort of background investigation was done and how agents might have assessed her capacity to follow through on a threat. He also said the FBI might have made decisions based on her mental capacity.

“Not every subject requires 24/7 FBI surveillance,” he said. The reality is that hard decisions on resources are being made constantly, with the biggest perceived threats receiving the most attention.

“I’m sure there are plenty of days where they hope they are right and they are keeping their fingers crossed,” he added.

Stephen Vladeck, professor of law at the University of Texas, said monitoring possible threats is a delicate balance, and law enforcement can’t trample civil rights while trying to prevent violence.

“This is a circle that can’t be squared,” he said. “We are never going to keep tabs on every single person who might one day pose a threat.”

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Minnesota

Minneapolis flier warned against Muslim ‘inflirtation’ in local politics

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CITY PAGES — Last Tuesday, the day of Minnesota’s political party caucuses, anti-Islamic fliers signed by “your neighborhood infidel” appeared throughout Minneapolis’s Cedar-Riverside Neighborhood, which has a high concentration of Somali-Americans.

The typo-ridden fliers read that a new “MEGA-MN organiation [sic] would like to give a notice that we will not tolerate any inflitartion [sic] from sharia-loving muslims at our prescient [sic] caucus.” The statement continued with equally inflammatory and grammatically deficient lines.

“Clearly, forms of politics has led your country to a shithole state, but this is AMERICA and we will not stand for you muslims bastard. [sic].”

At the top, the flier featured a “TRUMP Make America Great Again” banner.

The flier went public thanks to a tweet from DFL State Rep. Ilhan Omar, who posted a picture of one the day after caucuses were held.

In a subsequent tweet, Omar replied to someone’s question to say the fliers had been reported to the police and the FBI.

Minneapolis Police Department spokesman John Elder said police are aware of the incident and monitoring it, but no action had come from the fliers.

“At this point, from what we know, there has been nothing threatening,” he said.

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Arts & Culture

History Theatre’s ‘Crack in the Sky’ shows the struggles immigrants face

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Jim Walsh

Last Sunday afternoon, as most of America was fixated on downtown Minneapolis and the Super Bowl, a group of Somali-American and African-American actors quietly milled about the History Theatre stage in downtown St. Paul and talked about the importance of storytelling and their own families’ immigration tales.

It was one of the last rehearsals for “Crack in the Sky,” a new play based on Ahmed Ismail Yusuf’s life story and his 2013 book, “Somalis in Minnesota,” that makes its world premiere Saturday at the History Theatre. And while Yusuf’s story of a young shepherd boy’s journey from Mogadishu to Minneapolis is getting the full theatrical treatment, the focus of the play is on the power of the written word.

“A book can change your life, and teachers are not your enemies; they are your best friends,” said Yusuf, who learned to read and speak English when he came to the United States from Somalia as a high school dropout in the late 1980s. He discovered Maya Angelou’s “I Know Why the Caged Bird Sings” and devoured it over two weeks, using the Somali-English dictionary to translate Angelou’s poetic words about overcoming hardship and seizing the day.

“Ahmed is really interesting, because a lot of Somalia people today travel here to seek refuge in Minneapolis,” said Ashwanti Ford, the actress who plays both Yusuf’s mother and Angelou. “Ahmed moved to the States before all the terror and the war broke out in Somalia. He came here to seek an education, and when he was here the horrible things started happening in his country. So this is taking place in the ‘90s, when he hasn’t seen his family in years or months, versus today, when we can be a Facebook click away from seeing someone.

“He’s inspired by Maya Angelou to write, because he read her books and he said to himself, ‘If she has overcome all of this stuff in America, then I can overcome what I’m going through now and I can write my story.’ So it’s him, coming to America and seeking an education, and learning that he wants to be a writer. Through teachers and family members, he learns that he wants to tell his story, a really significant story that is so empowering, and inspire people to keep pushing forward and remain resilient. When I got the call to audition, I was so excited because I’ve always loved Maya Angelou. My mother was a poet; she has all her books.”

‘So many hoops to go through’
“A Crack in the Sky” is being staged at a time in America when Donald Trump — who disparaged the Somali community in Minnesota when he said, “Everybody’s reading about the disaster taking place in Minnesota” just before he won the White House — has issued travel bans and made immigration difficult at best.

Ahmed Ismail Yusuf

“The play is not exactly confronting it, but it shows the struggles an immigrant faces,” said Yusuf. “There are so many hoops to go through that maybe a normal American, an ordinary person, might not even notice it. But it is just quite out there for an immigrant. An immigrant is not exactly the leeches that Donald Trump has painted them to be. They are people who are contributing; they are people who are appreciative of the opportunities they have when they are here.”

“I just hope that when people come to our play that they will realize that not everyone decides to wake up one day, pack up their bags and go, ‘OK, I’m going to emigrate. I’m going to leave everything I’ve known my whole life behind,’” said actor Mohammed Sheikh, who portrays the young Yusuf. “Nobody does that. It’s not an easy thing that you can just decide. It’s not a road trip, you know? It’s a decision that can cost you your life, that can cost you identity, that can cost you happiness, that can cost you just about everything.

“And I just hope that when people come, they will realize that regardless of our skin color, regardless of what we believe in, regardless of how we pray, we’re all fighting the same battle, which is to survive to see another day.”

A Somali proverb
“A Crack in the Sky” gets its title from the Somali proverb, “If people come together, they can even mend a crack in the sky.” Not only does the play detail Yusuf’s immigration tale, it tells the story of what many Somalians and Somali-Americans have faced coming to America over the last two decades. These days, however, daily headlines about deportation and racism provide a stark background to Yusuf’s mostly joyous tale of coming to America.

“I’m getting something more valuable than any prize” by being part of “A Crack in the Sky,” said Sheikh. “Lessons, motivations, and the determination to succeed as a first-generation immigrant in this beautiful country.”

Mohammed Sheikh

He continued his monologue animatedly, as if writing his own story for the stage.

“I’ve been in the United States for three years, and I’ve worked for six months now. I’m basically going through the roller-coaster right now that the character that I’m playing is going through: sending money back, being here, young in your 20s, having ambitions to accomplish a lot, but at the same time the little that you’re making, or the little that you’re getting, you have to divide it into many portions, you know?

“So my family is back in Africa, my mom and my siblings are back in Africa; my dad is here, so it saves me a lot of the trouble that my character experiences. I haven’t seen my youngest siblings or mom for three years. I want to see them, I want to touch them, I want to be with them, but hey, it is what it is. And that’s exactly the same thing Ahmed has dealt with. There are a lot of scenarios and plot twists that I can relate to.”

Angelou wrote, “Prejudice is a burden that confuses the past, threatens the future, and renders the present inaccessible,” and, “There is no greater agony than bearing an untold story inside you.” Both truths will be brought to life through March 4 at the History Theater, which has been telling immigrant stories for 40 years.

Impact of travel bans
“I was hoping to have my family join me this year, but with the travel bans going on, I might not be able to for two or three years or until Trump leaves office,” said Sheikh. “It has a huge impact, to be honest with you. A lot of us are trying to bring our families over for the sake of giving them a safe sanctuary, for our kids to become someone, to study without worrying about gun violence or the city being overtaken by another militia.

Ashwanti Ford

“Trump is a hateful person, that’s all I have to say. He’s a hateful person and whoever agrees with him or sides with him, I would hope they would evaluate the humanity and look deep within because you can only imagine I haven’t seen my baby sister since she was 5. She turned 7 last month and she’s, ‘When are you going to come visit me? What are you bringing me?’

“She thinks it’s just a bus away or a simple plane ride, but it’s a lot more than that. Now I’m forced to wait until I get my citizenship because with everything that’s going on today. … You know, I’m Muslim, I’m young, I’m black, my country’s on the ban list, my grandmother’s 78 and I haven’t seen her for 17 years. My grandfather’s 91 and I haven’t seen him since I was born; he’s the last grandparent I have from my mother’s side.

“I have my green card, I could go. But my family keeps on telling me, ‘No, you don’t have to do that with everything, the FBI agents, the undercovers, the travel ban, everything, just wait until your citizenship.’ It’s painful, but I have to do it.

“I’m grateful, man. It could have been worse. I’m sure it’s just a matter of time before we see another day.”

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