Married woman, broken bones.
“Would a male lion destroy a female lion’s genitals? It’s unthinkable.”
Who: Panzi Hospital
What: Treats survivors of sexual violence and women with severe gynaecological problems.
In Bukavu, Congo, you cannot always rely on the electricity to work. The fistula Dr Mukwege is operating on is deep inside, and is difficult to get at. Will he be able to help the woman on the other side of the operating screen who is staring at the ceiling with her eyes wide open? She is in pain and frightened and he does not want to cause her unnecessary suffering.
He knows that her future may depend on whether or not he succeeds. A fistula means that the genital area has been badly torn, usually as a result of a childbirth gone wrong. If the baby gets stuck in the birth canal on the way out, the walls between the vagina, bladder and rectum can tear, and she will begin to leak and to smell. She might have difficulty having a normal sex life and having children.
A Congolese woman who cannot have sex or bear children is no longer a real woman. Some cannot be fully cured. Even when Dr Mukwege has done everything humanly possible, the women sometimes refuse to go home. They no longer have a life, they will be mocked and cast out, and their husbands often refuse to take them back. What alternatives do they have, other than taking their place on the bench outside the famous gynaecologist’s office and hoping?
A woman who has 'been the wife of' a rapist, or even, in the worst case, borne his child, is disowned frighteningly often.
Panzi Hospital was at first known as ‘the fistula hospital’ when it was founded in 1999, but the war victims soon took up more and more of the beds. Mutilated, raped and traumatised women sought out the well-ordered hospital area. Many of them had been driven out from their families. A woman who has “been the wife of” a rapist, or even, in the worst case, borne his child, is disowned frighteningly often. When things were at their worst, they made up 77 per cent of all the patients in the ward for female Survivors of Sexual Violence (SSV). Today that figure has fallen to 50 per cent. There are fewer military attacks and there are more hospitals to treat the victims.
Since the project started in 2004, the hospital has treated over 35,000 survivors of sexual violence. The fistula patients, such as the terrified woman on the operating table, can also be seen as victims of war. Countless health centres around the country have been forced to close for security reasons. It has always been difficult to have medical care for a complicated childbirth in Congo. In many places today it is totally impossible.
As far as Dr Mukwege is concerned, it is all related. The view of women as subordinate beings, whose only purpose is to give birth to and raise children – that, and to do most of the work as well, of course – makes him furious. He talks about women’s right to orgasm – which our interpreter cautiously translates as “sexual satisfaction”. He describes the uniformed rapists as “worse than animals”.
“Would a male lion destroy a female lion’s genitals? It’s unthinkable.”
He talks about women’s right to orgasm – which our interpreter cautiously translates as 'sexual satisfaction'.
The patients we are able to talk to, after considerable negotiation, are victims of both military and civil violence. Judith, a tiny, mini-woman was born with a muscle disease and is the size of an eight-year-old. She was raped by two civilian bandits on her way home from church. At first she did not dare to tell anyone because she was ashamed, but in the end she was unable to ignore the fact. How would her tiny body cope with pregnancy and childbirth? At Panzi Hospital it did. One week ago her baby was born by Caesarian section. The boy is completely healthy, and very beautiful, his proud mother tells us.
The hospital has 416 beds. Around half the patients are treated under the SSV project, which is run with funding from the Swedish Pentecostal Mission (PMU) and the European Commission Humanitarian Aid department. The rest of the hospital is an ordinary hospital which treats both women and men and where the patients pay for their care.
Most of the women in the SSV unit remain at the hospital for a long time. The period of care varies from 10 days to many months. A fistula patient normally stays for three months. Some do not want to go home once their treatment has been completed. Some simply cannot go home.
“For those who are not welcome home we offer transit accommodation at Dorcas where they have time to come to terms with their situation and consider their future,” says Dr Nene Rukunghu who co-ordinates the care at the SSV unit. “They receive an education there, they are taught to read, write and count, and given vocational training.”
For those who are not welcome home we offer transit accommodation.
A small room at the hospital houses the legal project. Women can come here for help with making a police report, questions of inheritance, property disputes and other things. For example, under Congolese law if a man has abandoned his wife and children, he still has an obligation to support them. Panzi has “women’s rights houses”, where specially trained advisers seek out and receive victims of violence, in eight villages.
“In the last year alone we have succeeded in taking 141 cases to court and in 55 cases we have secured a conviction,” lawyer Yvette Kabuo says proudly.
The sound of drums can be heard from a copse in the hospital grounds. The travelling music and theatre group visits the hospital every second week. The patients, wearing colourful dresses, gather in a swaying ring. Social assistant Yvette Bunvanja stands in the centre and welcomes them all:
“We all have our problems, including me. But joy, music and song help us to carry our burdens. Are you there?”
“We are here!” reply the women in unison.
“When you hear the drums you will feel happy.”
We all have our problems, including me. But joy, music and song help us to carry our burdens.
And that signals the beginning of one and a half hours of singing and dancing games. “What does the rooster say? Cock-a-doodle-doo! What does the rooster do? Puffs up his feathers!” The other side of the ring answers in song and dance: “What does the cow say? Moo-oo-oo! What does the cow do? Butts with her horns!”
The tension is released, a group who have recently undergone surgery and are too weak to stand, sit on a bench bleating and clucking, and everyone is laughing.
Afterwards Yvette tells us about other forms of therapy:
“When a patient is admitted she is given a medical examination and then she sees the psychologist. We offer various forms of therapy depending on what she has been through: group therapy, individual counselling or narrative therapy.
The narrative, which comes from the women herself, is illustrated along a time line (a rope) and with sources of happiness (flowers) and sorrow (stones).
“When the patient reaches the biggest stones she usually tries to avoid them. My job is to help her to manage to lift those stones too. It is very difficult. In our culture we have no tradition of talking about problems, or of thinking in psychological terms. According to the Bashi tribe’s rules women do not talk in public, in any situation.”
In our culture we have no tradition of talking about problems, or of thinking in psychological terms.
Yvette has taken many courses and learned how to talk about rape and mutilated genitals. Other people’s rapes, that is. When we ask why no-one in Congo talks about the ‘normal’ partner violence, about men beating and raping their wives, she smiles sadly:
“We haven’t got that far yet. Not even those of us who work with the question. If my husband comes home drunk and beats me I would never tell anyone. In our private lives we have only taken a few small steps.”
“The only good thing to come out of all the abuse during the war,” says Dr Mukwege, “is that we are finally beginning to talk about the violence. More civil rapes are being reported, for example when the perpetrator is a neighbour or teacher. But what happens within the family is still ‘private’. Women are still seen as objects to satisfy men’s lust, without their own rights. We still have a lot of work to do.”
Maternal deaths: Just over 900 deaths per l00,000 births ****
Number of children/woman: 5.2 (2011)
Abortion legislation: Abortion is forbidden, even when the mother’s life is at risk.
Law against rape within marriage: No
Violence against women in close relationships: 1.8 million women will be raped during their lifetime. Congo is the second most dangerous country in the world for a woman to live in.