Why did you decide to open the African Women’s Health Center in Boston?
When I was doing my ob/gyn residency at Brigham and Women’s Hospital, I gradually developed a practice for African women who have circumcision…I grew up in Sudan where circumcision was very common. The African women felt comfortable with me because I saw female circumcision as a matter of fact. Then, I approached the leaders of the Brigham and Women’s Hospital [to see] if they were interested in formalizing an African center where we would be focusing on women who had genital cutting and also reproductive health in general of refugee women of African descent.

Was there any resistance to opening the center?
When we opened it up, no one showed up for several months…it was a bit of a puzzling moment. Then around that time, I realized the community thought that I was financially benefiting by opening up the clinic. I had to go back into the community to say I’m a salaried position. If you’d like to come see me, great, but I’m going to see anyone who comes to see me. I intended to provide a service that was specifically for them, but there was suspicion in the community.

Was this suspicion something that came from their experience in the United States or from their homelands?
I think it’s both. The Somali community has come from war zones. It is very rare that people do something good because they would like to do something good for them. I had to work very hard to establish trust to get them to understand that it’s pure recognition that there is a need in the community and my job is to fulfill the need. And that I’m being selfish in that it gives me pleasure to fulfill the need; not [that] there is any other ulterior motive.

The other portion is that in the United States, it gets very difficult for immigrants and refugees to settle here and feel welcome.
 
Where are your patients from?
The majority live in Boston, but I do have women who travel from very far away…some come from Texas and California. I try to prevent that, so I do a lot of counseling on the phone. The goal is to train other physicians and not to have patients travel from afar. Most are immigrants [and] refugees who don’t have much funding, can’t afford the finances or the time to come see me.

And that also goes back to training the residents. Most graduate and leave Boston. For about 10 years, I’ve created a network of physicians who know and are comfortable taking care of women who have been circumcised.

What are the most common misconceptions healthcare providers have about women who’ve been circumcised? Health providers have a very difficult time understanding that a cultural practice exists.  And so when they look at women who have been circumcised, as I try to tell them, even the slightest wince or flinch or disapproval will turn off the patient and will prevent her from ever coming back to that provider because that patient will feel she’s been judged.

For women who’ve been circumcised, it’s a done deal. It’s over. But what ends up happening, it’s as if they are carrying a flag of, ‘I am circumcised,’ or, ‘I’ve undergone female genital cutting,’ along with them, and health providers can’t see beyond the scar and see the woman herself.

In fact, the circumcision is not so much of the big issue. Her biggest issue is resettling in the United States, or how to get her children in the right schools, or how to walk down the street and not feel ostracized because she is wearing a hijab, the veil. So her main concerns have nothing to do with the fact that she’s been circumcised.

What about second-generation children, are there specific concerns you see?
It is incredibly interesting in that adolescents in general are going through a sexual discovery. Even American teenagers are struggling with how they should look…what should they be wearing, what kind of music they should be listening to…all those social pressures come down on teenage girls.

And all that is the same for second-generation African girls. But they have one more thing. They physically do look different than American women. Their external genitalia is different. Something happened to them in their home country and now they do look different…but then how does that play into interactions with boys? So these are themes we are trying to explore, understand and counsel with the teenage population.  

Where do you see your practice five to ten years from now?
My main goal is to become obsolete. The purpose of my work is to train enough new health providers to provide culturally competent care to women who’ve been circumcised and how to do reconstructive surgery. My long-term goal is that everyone feels comfortable taking care of women who’ve been circumcised so there no longer has to be a specialty clinic. When it comes to issues on female circumcision itself…the long-term goal is prevention. 



Elizabeth Barajas-Roman is the associate director of the Population and Development program at Hampshire College.
 

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