is a woman, is not a woman?

Disclaimer - This one is pretty graphic. It includes descriptions of female genital mutilation (FGM), childbirth and abuse.

These past few weeks have been - rough? eye opening? One wednesday morning I walked into the CSCOM, where I wasn't planning on staying long. Soon I found out that a woman was about to give birth, and I figured I would stick around to help out the Matrones as I normally do. I found the woman alone on the dirty, dusty floor of the recovery room, wiggling on her side as she rode through her contractions, all by herself. She looked older, probably in her forties with buzzed graying hair that looked bare and vulgar without her headwrap. Her American third-hand shirt was the color of the sandy ground, and a torn grey skirt was covered in her embryonic fluids. Perplexed by this site, I walked into the birthing room as the Matrones brought in a timid looking 19 year old. She had just given birth the day before, and as she was unable to make the 12 mile trek to the CSCOM she gave birth at home. The Matrones were yelling at her for not coming into the CSCOM to give birth as the girl looked down in shame. They put her on the birthing table, legs apart with her feet on the stirrups. And there it was. The scars from her circumcision had torn during the birth, leaving a wad of torn flesh where her clitoris should be, her labia torn. Likely, she was recircumsized in preparation of her impending birth, a common practice here. Traditionally, it is thought that a child should pass through a "purified" canal to enter the world. As if the clitoris is a septic tank. I was not suprised; 95% of women here undergo some degree of FGM, which ranges from cutting the clitoris to complete mutilation of the vagina. This, however, was far more extensive than any other mutilation I have seen. The doctor came in and began sewing the torn area. Of course, there is no anesthetic available, and the girl began breathing deeply with shut eyes as one of the matrones held her hands forcefully behind her head, yelling at her to keep her legs open. As the surgery continued, she left to tend to the birth of the woman on the floor. The girl in front of me was now writhing in pain, her eyes popping as she grips her thigh. I felt faint. I've seen much gorier surgeries before, but this tiny girl was wide awake and helpless. She screams as the doctor sews stich after stich. I know hes only doing his job, but at the moment I hate him as if he embodies all the men who allow this to happen. There is nothing to do but hold her hand. I am meditating to take away this pain in an area that should glow with pleasure and new life and is now a dark sewed up hole, a crater of pain which she is ashamed to feel. The rough work of the doctor and the cast off complaints of the Matrones who continue to yell at her "negligence" seem callous as she strains to keep her legs open.

When the surgery is over, twenty minutes later, the Matrones tell her to get up and throw her clothes, dismissing her without a thought to her pain and exhaustion. She carefully stands with eyes rolled back with tears and walks out, back to a 12 mile walk home to a husband I pray will leave her alone until she can heal. In the meantime, in the so called recovery room, Founeba finally pulls out an ashen, tiny infant from the writhing woman who doesn't seem to have much awareness of where she is or why shes there. She is muttering that the woman did not have any pre-natal consultations. The baby is premature, tiny and grey and barely breathing. But its alive. I am often amazed here at the resilliance of the human body, especially the fragile infants that always seem to just make it. And truth is, too many of them don't (infant mortality rate here is 15%). But back to the woman who now lies on a dirt and blood covered mat on the floor. Founeba is yanking at the whitish grey umbilical cord as if its a pulley, but its still apart of this woman now and I can almost see her uterus jerking with each pull that I can measure by her breathy moans. The afterbith won't come out. I breathe in as I watch Founeba dig her hand all the way to her wrist, and she is twisting her hand trying to grasp the placenta while the womans moans are deeper now and pleading. After a minute she pulls the spongy mass out, and I think of movies where the medicine man pulls out a human heart through his mouth. It all seems ridiculous but also perfectly rational and completely real. And so its done. The woman is helped up and shown the bed where her baby lays, and she lies next to it like so many mothers here I've seen, looking absolved yet newly burdened, exhausted.

It is difficult to watch these scenes, obviously, and I am always toying with the question: what is a woman here? What makes them different then what I'm used to? As an individual they seem like a non-entitiy, medlded into 13 year old brides and 15 year old mothers. I think one of the most frightening things about the day was what I interpreted as the apathy of the matrones, at least in their exterior behavior. Yes, patient care here has never really been prioritized, albeit mentioned, in their health trainings. It often seems like their idea of "professionalism" goes hand in hand with a sense of superiority, which comes across as condescending, intimidating. But I think one of the survival tactics for al women is the all too familiar victim blame. Because if its the woman's fault for not going to her pre-natal consultations or trekking 12 miles to give birth, then this will never happen to them. Blaming their men for not paying for their wives' healthcare, or blaming tradition for continuing this damaging pracice of FGM - these are huge barries, and not in their immediate control. So instead of a sisterhood of understanding they villianize their neighbors or just look the other way.

A few days later I was telling my sitemate about what I saw. She told me about the day before, looking out at the road that connects to our villages and seeing a girl wedged between two men, who was sobbing as the men hit her. As the bus stopped for a minute, two of the men in her village jumped into the bus with sticks to help in her beating. My friend knew these two men well. She asked her host mother why they were beating her, what she had done. The girl was on her way to a village to marry a man, miles away from her family and her boyfriend, who she was forbidden to marry as she was promised to his other man. How dare she cry. We both sat with tears, because, goddamnit, this is not just a TV commericial, this is our home now and our neighbors and friends. And its hard to not feel helpless.

The reason for my visit to her village was a different wedding, that of her host brother. During the two day long celebration, the bride is concelead under a thick white sheet that covers her face, as she does her "bride duties" of washing dishes and cleaning. This tradition is to hide her face, as the young brides are normally sobbing through it all. Its not so different than our wedding veils, but until now I never imagined its role this way. Here though, it is perfectly logical. Its fine that they are leaving their families at 12 to marry strangers. The message is clear - just hide the tears and pretend its all ok, for traditions sake.

But most of the time I don't feel so helpless. A week later one man from my village's health committee came to me after attending a conference against FGM, and my doctor and matrones and I discussed how it is an important issue to breach here. We discussed beginning some campaigns in my village to raise awareness about its dangers. This week I also saw one of my host mothers pack her bag after I witnessed my host father try to attack her during some argument before dinner. Maybe she'll come back, maybe not. But I was proud that she stood up to him. And yesterday, I got a ride into Kita with the my doctor. He was on his way to the Gendarmerie to file a police report against a teacher who raped his wife's 13 year old sister. He was angry, and told me how this is a real issue here. And the more I talk with the younger women in my village, the more I see their desire for change. The girls in high school tell me they want to wait to get married, go to high school and maybe university. No more hiding, please.