Care of women with FGM in Burkina Faso
We had the 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…
Burkina Faso: A pioneer for the care of FGM
It was during a course in Tours, France, that Dr Ouédraogo, then a new doctor in gyneacology, met Dr Madzou, who had been trained by Dr Foldès in clitoral reconstruction. Charlemagne decided to receive training 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 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 carried out among the centre’s patients, 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 networks are aware of it – the partner, close friends etc… and 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 encourage her to consult after having come across information on social networks, for example.”
Every year the Hospital organises “reconstruction campaigns” which take place during two weeks and help to recruit and prepare women for the reconstruction. This is the most intense annual period at 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 carry out repairs … but to do a clitoral reconstruction, you need 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 receive the same services and pay the same fees, subsidized by the Burkinabe State.
Since 2017, training on reconstruction is part of the gynaecology curricula in Burkina Faso. Thanks to the training campaigns all new gynaecologists trained in the country will know how to deal with the results of FGM 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 receive calls from women living far from Ouagadougou, who have found us on the internet, I try to contact gynaecologists who live in the region 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 tests after which she buys her flight ticket, we do the pre-op, and if everything is fine, we operate.”
“We don’t operate on 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 experiece a clear improvement in 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 debate. Some are very angry at their mothers for having them undergo FGM. Our role is then to explain that their parents acted in ignorance but that they did not mean to harm their daughter…”
Developing psycho-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 gynaecologist, is not enough. Some women need psychological and sexological therapy in order to feel ‘reborn’ sexually.”
The Medical Center had the opportunity to employ a psychologist for 3 years. He would accompany the women in their clitoral reconstruction process and would see them again a year after the operation.
Unfortunately, due to a reorganization, the Centre no longer employs a psychologist. 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 in Belgium, so that they may train the staff at our Centre.”
Meanwhile, the gynaecologists are the ones who have the psycho-sexual discussions with the patients. “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-explore, they are not used to it, they sometimes think it’s against their religion. Generally speaking, our education doesn’t encourage us to explore our 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 committed to contributing to Burkinabe women’s sexual empowerment.