Médecins Sans Frontières cares for survivors of sexual violence in Kamrangirchar, an overcrowded slum on the outskirts of Bangladesh’s capital, Dhaka. Dr Georgina Woolveridge, from Hobart, recalls some of the women she met in her six months working in the slum clinic.
“A woman walks into the clinic, shoulders hunched from the burden she’s unaware she’s carrying, feet shuffling lest she aggravate a far-off abuser simply by her presence, a red token in her hand announcing her as a survivor. Her face places her in her 50s, decades ahead of her real age in her early 30s. Her son sits on her lap and she tends to him with detached ambivalence, the same flattened affect that continues throughout the consultation. Her hands dance, telling the history far more fluently than her lips. To the cheekbone that knows her husband’s fist, the upper arms stained purple in defiance of restraint, to her uterus where multiple children were lost or let go. She pulls at the folds of her dress, showing off shins scarred by years of marriage. This two-person show is performed by a single stone-faced woman, breaking only for fleeting maniacal laughter as she brushes over a long-healed two-inch scar on her forehead, instilled by a flying CD for a reason she can’t or doesn’t care to remember.
"To the cheekbone that knows her husband’s fist, the upper arms stained purple in defiance of restraint, to her uterus where multiple children were lost or let go"
She’s one of millions of faces joining a club she would happily decline membership in, an unwilling alliance of females subjected to sexual or physical violence in Bangladesh. However she also belongs as a patient of Médecins Sans Frontières, a survivor warmly welcomed in to the clinic to begin a long and slow process of healing, one that unfortunately reaches its limitations as quickly as she reinforces she has no choice but to return to the abusive situation. We provide her with medical care, as well as mental health support, revolutionary in a context in which the concept of psychosocial wellbeing is entirely abstract. Then she goes on her way, with the knowledge that we’re there for her if or when there’s a next time.
Just like the 17-year-old patient before her with a two-year-old on her hip and three uncarried pregnancies, two terminated by abuse and one electively with magic pills from a local unregistered pharmacist. Just like the woman weeks before who was beaten so severely her 32-week pregnancy was miscarried. Just like the woman months prior presenting to the clinic with her arm bending erroneously between elbow and wrist, following an incident with her husband the night prior. Each time we provide as much medical intervention as is required – from screening for blood borne viruses, treatment for suspected sexually transmitted infections, termination of unwanted or unsafe pregnancies, or referrals to the closest centre when the physical trauma exceeds our capacity in the small slum clinic.
Six months in a foreign land can teach you many things – colourful insights into cultural tapestries, stark lessons in tolerance and abrasive schooling on your own boundaries, where they’ll bend or where you’ll break. Despite my limited Bangla, the messages were often not lost. In medicine, a patient’s body language can speak truths greater than their tongue, telling historical tales while the conscious brain commandeers the spoken word with rehearsed phrases like “it’s not that bad”, “I’m sure he cares for me”, or “I have no other choice”. Women and girls of Kamrangirchar, a 4km2 urban slum housing more than 500,000 people just south of Bangladesh’s terminally overpopulated capital city Dhaka, have long learned these phrases, coping mechanisms in a society that is indifferent to their suffering.