Turning the Tide on Sexual Violence

Posted in GUMC Stories

How do you rehabilitate a country known as the “rape capital of the world”? According to Ranit Mishori, MD, MHS, you do it one health care worker, one police officer, one judge at a time.

The country is the Democratic Republic of Congo, and rape long has been used there as a weapon of war. All too often, those who commit sexual violence will never be accused, arrested, stand trial or see the inside of a jail. Rape victims may not come forward because of the stigma of rape, and because the police and the courts are not effective in their response, says Mishori, who is director of the Global Health Initiatives program within Georgetown’s Department of Family Medicine.

But while that situation is true for many countries — recent news stories from New Delhi, India, illustrate the problem — there are many people within the Congolese justice system who want to protect women by getting tough on the rapists, Mishori says.

So she got to work last year on a plan to help them. Mishori has long been associated with Physicians for Human Rights (PHR), whose mission is to use medicine and science to stop mass atrocities and severe human rights violations against individuals. Since 2006, Mishori has been part of PHR’s asylum network, conducting evaluations in Washington, D.C., of individuals seeking asylum in the U.S. due to torture or ill treatment in their native countries.

Mishori and her family medicine faculty colleague Christina Gillespie, MD, MPH, have used their experiences in the PHR asylum program to train residents to conduct asylum examinations.

Two years ago, Mishori was asked by PHR if she was interested in assisting in the creation of a program in Africa to train specialists in how to document cases of rape. “Would I be interested? There was no hesitation,” she says. “When you are involved in human rights, one of the main issues is gender-based violence, so of course I said yes.”

“Like sponges, soaking up help”

The program she helped create and and institute during a 10-day visit to the Congo last October works with “all the players” that a woman who has been raped could interact with.

“Whom would she go to first?” Mishori asks. “Sometimes it would be a healthcare professional or it might be the local police. She may go directly to a lawyer and then, if everything works out, she may get to court with a judge. So, we work with all of these folks so that everybody is on the same page as far as best practices in bringing a rape case to court.”

But there are roadblocks at every turn, she says. “For example, physicians don’t have the training to be able to identify, take a history, and more importantly, document rape in such a way that the forensic evidence is admissible, not only in court, but in a way that the police can understand,” she explains. Use of medical jargon is one such issue. A little example — doctors in many countries commonly describe the location of an injury to an orifice as if one was looking at a clock. “We would say there is a tear at 6 o’clock — but lawyers not familiar with this shorthand could assume the tear happened at 6 in the morning.”

And seemingly simple things like using a Q-tip to take a sample of vaginal fluids is problematic in the Congo “because hospitals and clinics don’t have a reliable supply of Q-tips,” she says. Mishori adds that there is little privacy in the rooms where rape victims are examined because no extra money is available for drapes. “There are different cultural expectations and standards regarding patient comfort and privacy,” Mishori says.

“There is also a lot of misinformation, such as the belief that a speculum used for a vaginal examination can cause an abortion,” she says. “So we needed to establish a baseline of anatomy, and terminology, as well as the protocol about what needs to be collected and how that should be done.”

The desire to help rape victims is very real, and health care workers, the police and the courts are eager for assistance,” Mishori says. “When I was there, training them, they were like sponges, soaking up all the help we could provide.”

Many other organizations are working with the rape victims. “If more women have cases that are strong enough to be brought to court and have good outcomes, then it may empower more women to come forward. So it is a very delicate yet important domino effect that may reach a tipping point — so to speak.

“The people of the Congo do not want that title of the ‘rape capital of the world’ anymore. Who would want to have their country known for that?” she says. “It should be recognized for its beauty and for the people, who are extremely friendly and helpful.”

Mishori is gratified that she was given the opportunity to help the Congolese, and she is now working on a PHR project training Syrian health care providers to document evidence of rape. As part of its Program on Sexual Violence in Conflict Zones, PHR is expanding its project in Congo to Uganda and South Sudan, among other places in Africa.

She says her global health work fits well with Georgetown’s social justice mission and with the university’s broad interest in the developing world. Mishori adds that working in these settings puts daily living in the U.S. into perspective. “I hope that Georgetown medical students and residents at all levels are aware of how lucky we are with what we have here, despite acts of violence in our country highlighted in the news,” she says. “We have so much, and, therefore, so much to give.”

By Renee Twombly, GUMC Communications