“You might not be able to help physically or surgically, but you can help if you are willing to…
“You might not be able to help physically or surgically, but you can help if you are willing to give love”
- Emma Watson in Conversation with Dr Denis Mukwege, presented by The New York Times and how to: Academy.
Co-written by Ellen Lambert.
Trigger warning — This blog addresses sexual violence with extreme violence.
About two weeks ago I attended an event which truly had a profound impact on my life.
Myself and my colleague, Ellen, attended an event entitled ‘Emma Watson in Conversation with Dr Denis Mukwege,’ part of a series called ‘How to Understand our Times,’ presented in collaboration between the New York Times and how to: Academy.
The event was an opportunity to hear Emma and Denis discuss the horrific crimes experienced by thousands of women and girls, his philanthropic work in response, and how we can create a safer and fairer future for women and girls. It was a chance to hear how a medical doctor had recognised not only the physical, but also the mental injury sustained in the trauma, and how this lead to a complete change in the treatment of survivors.
As a young woman myself, living and finding her feet in a time where there is a heavy emphasis on gender equality and movements including Time’s Up and Me Too, I was somewhat aware of the topics that were going to be addressed.
However, there in that room, I could have cried. I could have cried at the things we were told about the violent exploitation and sexual abuse experienced by women and even children. I could have cried at how inspired I felt to be in the presence of two such influential figures.
I was touched way more than I expected to be.
Despite being best known by literally everyone for her portrayal of popular Harry Potter character Hermione Granger, Emma Watson has quickly become renowned for her encouraging work as a women’s rights advocate. At just 29 years old, Watson has used her platform to inform the masses on gender equality issues. She has already created momentum, with her role as a United Nations Goodwill Ambassador and the launch of global ‘HeForShe’ campaign, and shows no signs of slowing down. She inspired many of us in our youth to be strong and independent females, just like Hermione, and she continues to do so now — minus the wand.
Dr Denis Mukwege is a world-renowned gynaecologist and human rights activist. In 1999, Dr Mukwege founded the Panzi hospital in the Democratic Republic of Congo (DRC). He spoke emotively, of the first time a patient came for treatment after being violently raped, and soon after he saw an influx of similar cases. It had soon become a far wider issue in his region, and he knew that something had to be done.
When treating them medically, he began to really talk to them, understanding that often he was the only person there to support these survivors emotionally. From this point on he developed the One-Stop Centre (OSC) model, a holistic approach to treating the survivors of such violent sexual abuse.
I found it very hard to hear details of the rape and extreme violence, and generally the atrocities inflicted on the women and girls, that we heard Dr Mukwege talk about. While these crimes are always abhorrent, hearing that these actions were also inflicted on children under the age of five was a particularly hard pill to swallow. However, it is important that these stories are told so that we can make a change and end this unnecessary torture and suffering.
The OSC model was essentially why I was there and why I am writing this piece on a mental health platform. Survivors of traumatic events, such as the sexual abuse and extreme violence spoken about here, inevitably face psychological distress after the event. However, what is really significant about this event, and what I want to emphasise, is that Dr Mukwege was the first medical doctor to really address these psychological issues as part of his patients’ care. And because this one extremely passionate man took the time to listen, a holistic approach flourished and is now a lifeline for thousands and thousands of women subjected to such atrocities.
Dr Mukwege was appropriately described as “the closest you will get to meeting a Saint,” and after the event I can’t help but agree.
My friend and colleague, Ellen Lambert, has helped me to summarise the OSC pillars. She was also deeply moved by the event and inspired by Denis’ dedication to ensuring women’s rights.
The model, the One-Stop Centre (OSC) is an innovative, holistic, person-centred approach. The model was developed at Panzi hospital after years of treating girls and women who have experienced these atrocities, and it is now being implemented at other institutions.
“OSC gives more than holistic individual care; it provides a platform for achieving a healthy lifestyle at the micro- (the person) and meso- (local society) levels and, if conscientiously and systematically implicated in all health care structures facilitates achievement of the right to health for all on the macro (national) level” (Mukwege & Berg, 2016).
The model is very much a collaborative plan between the survivor and specialists and is aimed at covering all areas of recovery. Treatment plans are based on that foundation of empowering the survivor; all aspects of treatment are based on emphasising the ‘dignified individual with value,’ and supporting all aspects needed to understand the trauma.
Medical care begins with a consultation from a physician, where they are medically examined so that a plan can be put into place for further treatment. Tests for things such as HIV, pregnancy, syphilis, secondary consequences of injury are performed. Really making sure to treat and test for all of the effects of the crime and where needed, referring to specialists.
What is unique about the treatment is that the survivors are treated depending on the amount of time that has passed since the sexual violence occurred. For example, when a lot of time has passed since the trauma, medical treatment becomes far more complex and the psychological effects become a lot more important.
Dr Mukwege’s role began as a medical doctor, mainly performing surgeries on the physical injuries endured; but what struck me the most was when Dr Mukwege spoke of how these survivors would wake up after their surgeries and would immediately ask about their families. This selfless-ness is what gave him the strength to continue his work, however emotionally draining it may be. This is something that really hit us, taking on other people’s issues is a selfless act in itself, yet it is the selflessness of others that helps him in his mission.
When he started treating girls and women subjected to this sexual abuse with extreme violence, Dr Mukwege soon realised that it wasn’t just the physical consequence that needed to be addressed, it was also the mental pain. This is when he created the second pillar, psychological therapy.
Similarly to the start of medical care, psychological supports begins with an evaluation with a psychologist, so that a care plan can be designed, unique to the individual and their needs. As well as talking therapy as a means of emotional support, a large part of this pillar is the additional activities provided. Drama and music therapy is offered, to promote processing of experiences in different ways and to support relief.
With the nature of the crimes experienced, it is not uncommon for the survivors to experience depression, anxiety, post-traumatic stress disorder and other psychiatric disorders. These women and girls are referred to specialist treatment.
What is also prominent in this pillar is that where necessary, support and counselling can also be given to the survivor’s families. For example, relatives may need support to address their anger over the situation or feelings of guilt, and often support is given to prevent marginalising harm of the survivor.
At one stage, Dr Mukwege was performing up to 10 surgeries a day, yet still found the time to talk and listen to these survivors. Despite this, and still doing around 10 surgeries in an average week now, Dr Mukwege maintains that these are the easier days, in comparison to the days he spends providing psychological support.
When Watson asked how he approaches not having all of the answers for his patients, Dr Mukwege regarded that these are the hard moments, having someone in front of you, crying alone with no support. He loses sleep because he cannot solve all of their problems. But the one thing Dr Mukwege said he could do was to give love. Everyone needs love and he has seen first-hand how when they have love, their whole lives can change.
“Everyone can give something if you think of the person in front of you. You might not be able to help physically or surgically, but you can help if you are willing to give love.”
This quote will stay with both of us for a very long time. And we can’t help but feel how lucky it is that Dr Mukwege is there and of support in the DRC.
Socioeconomic support is perhaps one of the more surprising elements of the model. To most of us the medical care seems obvious, the psychological care understandable, but the socioeconomic support really demonstrates how above and beyond this individual was willing to go to help these women and girls regain their lives.
For a lot of girls and women in the DRC, their trauma can lead to rejection from their families and society. Survivors after rape will often live with a label of what happened to them. While it cannot change what has happened, and the survivor will never forget, this pillar can help them to regain strength and re-establish their value as a woman and in her society.
Occupational therapy activities such as basket making, flower arranging, sewing and knitting are provided. Developing such skills and socioeconomic actions can redevelop social networks. Mukwege fondly told us a story of a few women who had become soap-makers, they had soon grown their business and were providing for their villages, proudly returning to the hospital to provide him with their soap which had transformed their lives.
Such programmes support a survivor’s reintegration into society, giving them skills whereby they have something to contribute.
When survivors are very young, Panzi developed a programme to support sending these girls to school. Dr Mukwege noted how important this programme is, especially as many are subjected to rejection. The schooling helps them to grow strong, but also strong economically. The schooling programme has so far successfully sent 5000+ girls to school.
With regards to community reintegration, between 40 and 60% of women who seek treatment at the Panzi Hospital are unable to return to their communities once they are discharged, as briefly mentioned above. This can be due to the extent of their injuries or because of ongoing violence in their villages. Most often though, it is because of the deeply engrained stigma that surrounds sexual violence in the Congo.
A double tragedy occurs. After being raped, many women are mocked, disowned and expelled from their homes by their husbands and neighbours because they are believed to be unfaithful and to bring misfortune. It is reported that some people believe that a mother’s milk is poisoned forever after they are raped.
This abandonment makes victims of sexual violence extremely vulnerable physically, psychologically and financially, especially if they are left to raise their children alone without any support from their husbands.
Acknowledging the vital importance of socio-economic reintegration for survivors, Dr Mukwege co-founded an aftercare centre for women unable to return to their homes, fittingly named the “City of Joy”. A new Netflix documentary grants us entry into the “city” which first opened in 2011 and has since enabled over 1200 women to continue their healing and plan for a stable future. “Each day at the City of Joy is a lesson”, as their website says.
At the city of joy, women and girls receive housing, meals, and valuable life skills. Specialist trainers equip the women with skills in self-defence, farming, knitting, sewing, massage, culinary arts, soap making, and theatre. These are skills that can be applied to future ventures but also act as a form of therapy.
Women attend lessons in English and Mathematics and are given microloans to support them in launching micro-enterprises. They are also provided with a comprehensive education in sexuality and the skills and confidence to demand their rights if and when they are violated.
Women officially graduate from the city after 6–12 months, and as graduates each individual is expected to use their newly acquired skills to become a leader in their community and to establish support groups for other young women. Again, from their website: “On their graduation the new wind has taken them fully alive to their communities to lead and tell other women to protect themselves.”
The city of joy has been life-changing for many women. Detailed case studies demonstrate how these brave women have transformed themselves from victims of sexual violence to social workers, nurses, restaurant owners, farmers with new land, journalists, immigration workers, tailors, students, herbalists and much more.
The fifth and final pillar of the OSC model refers to the enhancement of women’s rights through legal assistance and representation.
Justice is not something that tends to be immediately demanded by victims of sexual violence. During his talk, Dr Mukwege explained that it is often after women recover physically, psychologically and economically, that they develop a courage and capacity to question why this happened to them, and to demand that their attackers receive punishment for their actions.
The majority of attackers currently manage to escape any form of punishment, despite the fact that Congolese law upholds the equality of the sexes and mandates the elimination of discrimination against women. This sends a strong message to society that women, their thoughts, and their feelings are not important, and that sexual violence is acceptable within society.
A message like this normalises violent behaviour and increases the chances of future attacks.
To support women at this pivotal point in their healing journey, the Panzi foundation introduced a legal clinic to enable victims to develop and prepare a case against their attackers with the guidance of professional lawyers.
The foundation provides full financial coverage for all legal proceedings. They pay for the judge, the lawyers of both the victim and the defence (as of course, everyone is deserving of a fair trial), and they even create “mobile courtrooms” for individuals living in remote parts of the country.
Hundreds of cases have been filed each year since the legal clinic was introduced.
A well-known trial led to a local politician and eleven co-members of his militia to be convicted and sentenced to life in prison for the “widespread, systematic rape” of over 40 girls aged between the ages of 6 months and 12 years.
In terms of outreach, the clinic trains paralegals in the community to get the laws on the protection of women more widely known and understood through public awareness campaigns, and they regularly lobby the Congolese government to take the issue much more seriously (with success). In 2015, the Congo adopted a law regarding women’s rights and parity, and drafted a project to set up a fund for reparations to benefit the victims of sexual violence.
When Dr Mukwege first opened the Panzi hospital he realised that rape was being used as a tactic of war. Sadly, the reality has still not changed today. The nature of these crimes occurring in the DCR are not just crimes directed at the individual, it is used as a tactic of creating terror. And it is not ok.
The importance of the different pillars of the model is not only to heal the physical and emotional pain, but to also get justice, teach protection and to end silence. Dr Mukwege spoke passionately about how silence is a tool which helps rapists to continue these atrocities, because they know they can’t speak out; the most important thing is to break silence and use our voices as its own weapon against rape. It has got to a point where survivors feel guilty for what has happened to them, unintentionally protecting perpetrators and preventing help seeking. These pillars not only heal, but work against that.
The OSC model serves to demonstrate the extraordinary work that started with one doctor so passionate and caring that he took the time to listen and be of emotional support to his patients. What Dr Mukwege has done is truly inspiring and has the potential to really transform the lives of survivors everywhere.
Ellen and I both left the event feeling as though we need to do more and completely in awe of these two individuals who are doing all that they can to make a change and improve the lives of women everywhere.
The talk concluded by Dr Mukwege providing the details of how to support the Panzi Foundation and it only felt right to include these details here. If you would like to contribute to this amazing cause, you can here.
header image source: Image from Emma Watson on Instagram