*Content note: This blog contains details about sexual and gender-based violence*
For the last six months, I’ve been working in Nigeria with MSF.
There are, as to be expected, international staff from many countries speaking many languages, including several French speakers. I told them that some South Africans (not me) like to say “born up a tree” instead of “bon appétit” before eating… but they didn’t love that.
You can’t help but think about language in work and life here.
For most of my time in Nigeria, I have been working as the outreach manager for an MSF sexual violence project in the southern city of Port Harcourt.
Port Harcourt is in Rivers State, known for its diversity of language and culture.
Our logistics manager was from Niger, to the north, and could talk to groups of Hausa speakers about our services. However, the most commonly understood language is Pidgin English which led us to the implement a successful radio awareness campaign about MSF services on a popular Pidgin channel. But still, from talking to the outreach team, I know there are parts of the city where people speak a different dialect and so would not necessarily understand everything.
What are the right words to use when discussing sexual violence? Are there right words? Victim or survivor? Assault or abuse?"
Language, quite clearly, has its limitations.
I can’t understand my French colleagues when they speak too fast. Some groups of Nigerians don’t understand a more modern dialect of Pidgin. And, of course, understanding of particular words can vary among people even within the same language.
Using the “right words”
Words and their meanings are surely paramount when talking about sexual violence.
From my experience in Port Harcourt (and from also working on MSF’s sexual violence project in the city of Rustenburg in South Africa), there are many factors that make it difficult or sometimes impossible for people to seek medical care after experiencing a rape.
The word “rape” itself could be one. The outreach team is sensitive to this when talking to groups of people in a market, school or church. What if someone defines rape differently from how MSF defines it?
While in Port Harcourt someone said to me, “it’s very rare for an adult to be raped.” In order for an adult to be raped, he said, there would need to be “force,” “guns” or “sharp objects.” If someone’s experience didn’t fit that category of assault, how would they know that they could seek help?
And even if we do use the “right words” when carrying our awareness raising, how many words can a person absorb? How much is too much? How much is known already? How much do they even want to know?
In the Port Harcourt project, we worked on simplifying what we said, in the hopes that as much information as possible would be retained.
This included basic information about medical and psychological services, as well as how accessing care as soon as possible (within the first 72 hours after a rape) also means accessing medication to prevent HIV and other sexually transmitted infections.
For me, working in this field and having these discussions regularly, talking about sexual violence becomes normal. But it is not for most people, and we have to be aware of this.
What our teams know about sexual violence has been shaped by many things, including structured training and education. So, it's useful to reflect on this in team discussions when planning our approach.
But what are the right words to use when discussing sexual violence? Are there right words? Victim or survivor? Gender-based or sexual violence? Assault or abuse? Perhaps the way we talk is more important than the words we use, or maybe it’s a mixture of both. And even if we get that right, remembering or retaining information does not always lead to action.
Thinking of all the barriers that may exist for someone to access care after sexual violence, knowledge of the available services alone is not always sufficient.
These are ongoing questions we asked in Port Harcourt and are echoed in many MSF projects.
Talking about fistula
Closer to the border with Niger, in the north, I recently began working in Jahun in the predominantly Hausa speaking Jigawa State.
MSF runs a large maternity project for complicated and emergency childbirth (CEmONC - Comprehensive Emergency Obstetric and Neonatal Care) and provides surgery and support for women affected by obstetric fistula.
Often caused by a very long and difficult labour, a fistula is a hole between the bladder and the vagina or the bladder and the rectum. It results in a continual leak of urine and/or faeces that may need several operations to repair.
A woman in labour should never see the sunrise twice"
Her in Jahun, my task is to assess the health promotion of the fistul project and how it can be enhanced.
I arrived a few days before the thirteenth final discharge ceremony for the fistula ward, celebrating 120 patients who are “dry” and able to return home to their families. (You can read an account of this event, here)
MSF speakers stressed that a woman in labour should never “see the sunrise twice”, and should be sent to a hospital as soon as possible as an obstructed labour is what causes the fistula. MSF doctor Geert, who has visited Jahun to perform fistula surgeries many times, told the crowd: “Fistula is 100 percent preventable.”
Having watched him perform a fistula surgery, this was both good and devastating to hear. That simple message, “a woman in labour should never see the sunrise twice”, is surely not too many words…
“What matters is the approach”
In carrying out my assessment, I have spent time in the fistula ward with a dynamic and compassionate MSF counsellor, Bilkisu, who has attended all 13 final discharge ceremonies.
She explained the Hausa translation for fistula is “yoyanfisari” - "yoyo" meaning “leaking” and “fisari” meaning “urine”.
In her work, she has learned how some women define a yoyanfisari as being caused by evil spirits.
To address this, Bilkisu gives regular health education sessions to women and their relatives on how fistula is caused, as well as provides occupational therapy exercises to aid recovery.
She quickly finds out what women already know, and assesses how much information to share with them, emphasising that “what matters is the approach.”
Some patients leave the ward and act as fistula ambassadors in their community, referring other women with fistula to MSF. However, there are other patients who have been learned about the importance of a hospital delivery, usually a caesarean section, for future pregnancies and yet still give birth at home without the professional medical care the need.
Bilkisu acknowledges the complexity around these decisions.
The final decision for appropriate care may be determined by many factors, other than having heard the right words.