Fistulas are a kind of damage that is seldom seen in the developed
world. Many obstetricians have encountered the condition only in their
medical texts, as a rare complication associated with difficult or
abnormal childbirths: a rupture of the walls that separate the vagina
and bladder or rectum. In eastern Congo, however, the problem is
practically an epidemic. When a truce was declared in the war there in
2003, so many cases began showing up that Western medical experts at
first called it impossible-especially when local doctors declared that
most of the fistulas they were seeing were the consequence of rapes.
It had been no secret that nearly all sides in the Congo's complex
civil war resorted to systematic rape among civilian populations, and
estimates were as high as a quarter million victims of sexual assault
during the four-year-long conflict. But once fighting died down,
victims began coming out of the jungles and forests and their
condition was worse than anyone had imagined. Thousands of women had
been raped so brutally that they had fistulas. They wandered into
hospitals soaked in their own urine and feces, rendered incontinent by
their injuries. "Pastors would say to me, 'Jo, I can't preach because
the church is too smelly," says Dr. Jo Lusi, a gynecologist and
medical director at HEAL. (He and Lyn Lusi are husband and wife.) "No
one wanted to be around them. These women were outcasts even more than
rape victims usually are. They would say to me, 'Dr. Jo, am I just a
thing to throw away when I smell bad?' "
Ordinary rapes, even violent ones, do not usually cause fistulas,
although it's not medically impossible. Doctors in eastern Congo say
they have seen cases that resulted from gang rapes where large numbers
of militiamen repeatedly forced themselves on the victim. But more
often the damage is caused by the deliberate introduction of objects
into the victim's vagina when the rape itself is over. The objects
might be sticks or pipes. Or gun barrels. In many cases the attackers
shoot the victim in the vagina at point-blank range after they have
finished raping her. "Often they'll do this carefully to make sure the
woman does not die," says Dr. Denis Mukwege, medical director of Panzi
Hospital. "The perpetrators are trying to make the damage as bad as
they can, to use it as a kind of weapon of war, a kind of terrorism."
Instead of just killing the woman, she goes back to her village
permanently and obviously marked. "I think it's a strategy put in
place by these groups to disrupt society, to make husbands flee, to
terrorize."
The only hope for these women is a difficult operation. It usually
takes several hours, followed by a recovery period of two or three
months. Even then, the doctors may have to try again. Sometimes the
surgeons never manage to restore the patient's continence. "We've had
a hundred fistula cases where there's no hope of recovery," says
Doctor Mukwege. "We tried and tried but were unsuccessful.
Psychologically, it's difficult to bear these cases. They come in here
with great hope, it's very difficult for them but also for me, they
come full of hope, it's so difficult to bear." Last April, he says, a
5-year-old girl was brought to him. Her tormentors had raped her and
then fired a pistol into her vagina. She was operated on twice at
Panzi Hospital without success before being sent to a hospital in the
United States where surgeons tried twice more to repair the damage.
They failed, too. She'll spend the rest of her life with a colostomy
bag.
Culled from: MSNBC.Com
http://www.msnbc.msn.com/id/15704030/site/newsweek/?rf=nwnewsletter
