A patient returned for follow-up today.
She is a timid 18 year-old whom I met in the middle of the night two weeks ago. She was brought to the maternity ward hemorrhaging with a hemoglobin of four. The normal measurement is 12.
The midwives thought she might be experiencing a miscarriage or an illegally terminated abortion, perhaps with a uterine perforation. But her pregnancy test was negative. As she received an emergency blood transfusion, I took her to the operating theatre (OT) for more thorough evaluation under better lighting and more sterile conditions.
I found multiple vaginal lacerations, as well as a fallopian tube and loops of bowel prolapsing into the vagina because of a wide laceration behind her cervix that penetrated to the peritoneal (abdominal) cavity. I fumed as I repaired the physical damage from the obvious rape. I wondered if, or how, she might receive care for the psychological damage.
Lisa and the team perform an urgent surgery on another patient during her assignment in Aweil, South Sudan. Photo: Saki Mizoroki / MSF
We later learned that she and her boyfriend had gotten into an argument that night. The rape was his way of winning it.
Marriage affords women here some degree of social and financial security, but I was told that this young woman would not have much of a chance for marriage because she was now considered tainted.
During today’s visit, the translator inquired about her recovery and the events that transpired after her hospitalization. Then, with an optimistic stance, he turned to me and declared “the boyfriend has agreed to marry her.”
I felt despondency under my suppressed rage. Is this young woman condemned to live her life with a man who expresses his frustration through violence and dominance? How is this the start of shared life?
I appreciate that there are cultural differences in what marriage means, and it can be radically different from my own experience. Still, mutual respect and trust are essential to the sustenance of our most intimate relationships.
Most days I feel useful to provide women’s health care in settings with so much need. Yet, in my solitary time, I allow the hopelessness expression. I weep for all the powerless, damaged, "tainted" young women.
After the exam, I reassured the patient that her wounds were healing well with no signs of infection. I held her hand a moment, wishing some happiness for this young South Sudanese woman entering adulthood.
I saw apprehension as I looked in her eyes. I turned away, tears in mine.