A pioneer for FGM care in West Africa

Interview with Charlemagne Ouédraogo

Charlemagne Ouédraogo is a doctor in gynecology at the Department of obstetrical gynecology at the Yalgado Hospital in Ouagadougou, Burkina Faso. We had the great pleasure to meet with Dr Ouédraogo when he was in Brussels for our Webinar on Multidisciplinary support to women affected by FGM. We spoke about clitoral reconstruction, the use of new technologies, women’s sexuality and the need for holistic care for women affected by FGM…

A pioneer country for the care of FGM

It was during a deepening course in Tours, France, that Dr Ouédraogo, then a new doctor in gyneacology, met Dr Madzou, trainer by Dr Foldès in clitoral reconstruction. Charlemagne decided to get trained as well, together with ten other gynecologists.

Burkina Faso, where FGM is legally prohibited since 1996, became one of the first countries in West Africa to benefit from clitoral reconstruction. « I don’t know of any other centres specialised in the care of FGM in the region. There are a few doctors who have been trained in the Ivory Coast, Togo and Senegal, but the cases are limited. » 

Today, the Medical centre where Charlemagne works is part of the Burkinabe national committee against FGM. The two are complementary since the Committee works mainly on Prevention, while the Medical centre offers services to women who have already undergone FGM.

« It wasn’t always easy to get people to accept clitoral reconstruction. They would be a bit sceptical and say ‘but how can you reconstruct that, when it’s been cut?' »

So why do women come for a clitoral reconstruction? A study done among patients of the centre, between February 2014 and February 2015 (68 patients), showed that most came for two reasons : Sexuality (62%) and Identity(38%).  The vast majority have undergone a Type II FGM and were aged between 20 and 48 at the time of the consultation. They were both Muslims and Christians.

For the women, clitoral reconstruction is a personal decision. « Generally, the very close environment are aware of it, the partner, close friends other people do not know about it. It concerns her intimacy, it’s a personal process. Sometimes, the partner will give information to his wife and encourages her to get the consultation, after having seen the information on social networks, for example. »

Reconstruction « campaigns »

Every year the Hospital organises « reconstruction campaigns » in order to recruit and prepare women for the reconstruction, which takes place during two weeks. This is the most intense moment of the Centre and other activities are stopped. These « campaigns » also provide the opportunity for new doctors to be trained in the technique. « Any trained gynecologist can of course repair sequela…  but to do a clitoral reconstruction, you need a specific training. » says Charlemagne.

During the « campaigns » the demand is very high, women come not only from Burkina Faso but also from neighboring countries such as Senegal, Guinea Conakry and the Ivory Coast. All get the same services and pay the same fees, subsidized by the Burkinabe State.

Since 3 years the training on reconstruction is part of the Curricula of gynecologist in Brukina Faso. Thanks to the training campaigns all new gynecologists trained in the country will know how to deal with sequela and do clitoral reconstruction. The training module also includes a module on how to speak about FGM with the women.

In order to respond to the high demand for clitoral reconstruction, Dr Ouédraogo also uses new technologies. « When I get calls from women living far from Ouagadougou, who have found us on the internet, I try to contact gynecologists who live in the region, if I know any, in order for them to do the first consultation with the woman. If I don’t have any contacts I do the consultation via web-cam. It works well for a first consultation. I then ask the woman to do her blood test. Then, she gets her flight ticket, we do a IRL pre-op, and if everything is fine, we operate. »

« We don’t operate women who don’t have a sex life. Women need to have explored their sexuality in order to know where they are at, and what they need ! »

And the results?

« The results on women’s sexuality are positive, we notice that a lot of women who have had clitoral reconstruction express a clear improvement of their sexuality. »

Moreover, the medical consultations are also a good moment for prevention. « We use the opportunity to sensitize women in order for them not to have their children undergo FGM and so that they protect the girls in their environment. For the women that we meet there is no question. Some are very angry at their mothers for letting them undergo FGM. Our role is hen to explain that their parents acted by ignorance but that they did not want to hurt their daughter… »

Developing psychological and sexological care…

Charlemagne believes that women affected by FGM should be cared for in a holistic way, taking into account not only their physical health but also their psychological and sexological well-being.

« There is not only a physical reparation, a mental reparation also has to be done. For a woman who suffered trauma from her excision, the simple physical reconstruction, by a gynegologist, is not enough. Some women need a psychological and sexological therapy in order to feel ‘reborn’ sexually. »

Charlemagne and part of the CeMAViE staff in Brussels

The Medical Centre had the opportunity to staff a psychologist for 3 years. He would follow the women in their clitoral reconstruction process and would see them again a year after the operation. Unfortunately, due to a reorganization, the Centre doesn’t have a psychologist any longer. They are hoping to recruit a new psycho-sexological team soon. « The first experience was fantastic. We are now reflecting on a new partnership with the CeMAViE Centre in Brussels, Belgium, for them to train the staff of our Centre. »

Meanwhile, the gynecologists are the ones to deal with the psycho-sexual discussion with the patient. « We talk with the women, we explain how the clitoris functions, and we also tell them that there is more than the clitoris! That each person has their erogenous zones, that one has to explore, get to know oneself in order to access ones pleasure and orgasm. Some women are reluctant to self-explorations, they are not used to it, they sometimes think it’s against their religion. Generally speaking, our education doesn’t encourage us to discover sexuality. You start your sexual life in secret. Sex education in Burkina Faso doesn’t deal with pleasure but only with unwanted pregnancies… » The Medical Centre of the Yalgado Hospital is participating, in their way, to Burkinabe women’s sexual empowerment.

by Stéphanie Florquin

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Watch Charlemagne Ouédraogo’s contribution in the Webinar by clicking here.

Lisez cet article en FRANCAIS ici.

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