By Elizabeth Mehren
Monday, June 7, 2004
Women who have undergone female genital mutilation can be made to feel like clinical curiosities. But at the African Women's Health Center at Boston's Brigham and Women's Hospital, treatment is delivered with cultural understanding.
BOSTON (WOMENSENEWS)--Mona was just 7 years old when her female relatives led her away and performed her genital mutilation. In her village in Somalia, women underwent the most radical form of genital cutting, leaving no trace of the clitoris and little remnants of the labia.
"It was very painful," Mona recalled, rocking gently as she nursed the youngest of four children. "I had no choice. My aunts, my mother, my grandmothers--they didn't see it as aproblem. They saw it as something we just did."
When she came to the United States three years ago, Mona (who did not want her last name used) said medical care was a problem because of her genital cutting. Some doctors were appalled when they examined her, said Mona, 32. Others were curious, treating her like a laboratory specimen; even summoning nurses and other physicians so they could see what genital mutilation looked like outside a textbook. And no one seemed to know what to do about recurring problems, such as infections, that are common among whose genitalia have been cut.
The same set of concerns prompted Dr. Nawal Nour to start, in 1999, the African Women's Health Center at Brigham and Women's Hospital here--this country's only clinic for women who have undergone cutting. Without what she called "culturally competent care," Nour feared cut women in this country would avoid medical treatment altogether.
"Access to health care is about feeling comfortable with your health care provider," explained the 38-year-old Sudanese-American physician. "If a woman comes in with a headache and turns into a guinea pig, we have completely blocked her access to health care."
Although the procedure has been illegal in the United States since 1997--when then-Rep. Patricia Schroeder sponsored a bill to outlaw female genital mutilation --Nour said about 170,000 girls and women in this country have undergone genital cutting or are at risk of it. About 140 million girls and women worldwide either have been genitally cut or will have it done, Nour said, citing figures from the World Health Organization.
Nour was still a medical resident when she began to attract a following among African women in New England. Word about a female, Arabic-speaking doctor circulated in the area's burgeoning immigrant community. In turn, Nour began working with organizations that aided African immigrants in Boston.
Her "little niche," as she called the specialty practice she developed, exploded from a handful of patients five years ago to close to 1,000 today. Armed with a master's in public health to go with her bachelor's degree from Brown University and her medical diploma from Harvard, she also did research in minority health policy, asking African female immigrants directly about their health care needs.