Cynthia Fleury & Denis Mukwege: “We are all going to be faced with experiences of collapse”



The Cross The Weekly: Why and how did you decide to join forces, from Paris to Bukavu, to help women victims of sexual violence?

Denis Mukwege: We had the opportunity, during one of my trips to Paris, to discuss with Cynthia Fleury the “holistic” care of women (as a whole, editor’s note), since at the Panzi hospital, we work on the basis of four pillars: the medical treatment of victims of violence – which is sometimes extreme, rape being used here as a weapon of war –, but also psychological care, economic reintegration and legal assistance. We had discussed in particular the therapy through the arts, which we experience at Panzi.

How?

DM: Some patients are so traumatized that narrative therapies are of no help to them, at least initially. But when they sing or dance together, their condition improves markedly. Humiliated women, who hide, who can’t sleep, suddenly go back to eating, sleeping, rediscovering a joy of living. We see it but don’t have the proof.

I am a gynecologist, I know how to operate a fistula (perforation of the membrane between the vagina and the urinary or digestive tract, editor’s note), I know what to do on the operating table in case of fibrosis, etc. On the other hand, I do not have the skills to decipher the springs of the psychic reconstruction of the victims, even if I perceive the results. This chair of philosophy will allow us to support them scientifically: why are the arts helpful? Which ones should be preferred, vis-à-vis which trauma? What protocols to put in place? Its very important for us.

Cynthia Fleury: Over the past twenty years, extraordinary work has been done at Panzi for women’s resilience – it is known around the world. But there is a deficit of what is called the“evidence-based medicine”, in other words, the burden of scientific proof. It must be said that, in the field of medical humanities such as post-traumatic clinic, this work is complex to implement. However, it is fundamental: “Healing proves nothing, you have to prove the cure”, we learned from Claude Bernard. This will be our role, through this focus on art therapy: when talking about the trauma is not possible, we have to go through drawing, photography, cinema, the body…

We’ve been thinking about it with the Panzi teams for three years now. Thanks to the financial support of the French Development Agency and its subsidiary Expertise France, we will be able to get to the heart of the matter.

How are you going to do it, concretely?

CF: We are planning two two-year missions. Our first project manager, Isabelle Audigé, is a general practitioner and doctoral student, her thesis focuses on the victim-executioner status. She should move to Bukavu in July. Other French researchers will join her to work in close collaboration with the Panzi caregivers and the women supported. What they have experienced is an attack on their very integrity. They confide moreover to what point the psychic follow-up is decisive for them. These women say: “Without that, I would have died”, in the sense of “dead inside”. They perceive there a possibility of rebirth. One of the challenges of the work carried out here is to transform their vulnerability into competence.

What do you mean ?

CF: These women have “experiential knowledge”, forged during the ordeals they have gone through, their course of care, etc. This knowledge is very valuable, not only for the health system but also for advocacy against sexual violence. The Panzi chair of philosophy will therefore work hand in hand with the University of patients (Sorbonne University), to train survivors who so wish, in order to transform this knowledge into real expertise. Catherine Tourette-Turgis (the founder in France of the University of patients, Editor’s note) will notably come on site for one-week to ten-day master classes offered to women. We would also like to involve certain village communities, to fight against the reactions of rejection, of banishment which very often follow rape and plunge the victims into hellish situations.

The question of the impunity of the executioners also arises in the DR-Congo. Is fighting against, convicting the perpetrators of rape, necessary for the healing process?

DM: This is a major question. For more than two decades, the Congolese population has been subjected to acts of war, indescribable massacres, of which women and children are the first victims. And yet, on the judicial level, we are treading water. We have made a lot of progress on treatment protocols, but the question of the impunity of attackers remains unresolved. Currently, the victim must provide proof of his attack. But it’s extremely difficult… This system leads them not to file a complaint. Take the case of a woman raped by an armed group, more than 200 kilometers from a health center: it may take several weeks or several months to get to the hospital. How do you want to collect evidence in such a context? When a woman has the courage to testify, to denounce her executioner, she must be helped. At the hospital, we collect the stories of these women, the place, the time of the crime, sometimes the identity of the aggressor if they know him, hoping that these elements can be used by justice.

The current situation is a shame for all of us. There, I just saw a very young girl with a baby in her arms (born from the rape she suffered, Editor’s note). She’s just a child! Society cannot look away. We need some form of justice, reparation for these women and dealing with the issue of these children. Otherwise, the Congo will turn in circles, because the latter risk committing violence in turn.

Another aspect of the chair concerns the “care of caregivers”. Why is this crucial in this context?

CF: Expectations are very high in this regard, after a multiplication of cases of burnout syndromes at the Panzi hospital (1). The teams no longer want to leave this subject aside. We are going to help them get down to it, by working from the philosophical clinic of caregiver burnout that Valérie Gateau, researcher associated with the chair, is developing at the University Hospital Group (GHU) Paris psychiatry and neurosciences. This system is based in particular on narrative ethics.

DM: So that you understand, I will tell you the story of one of our psychologists, a courageous woman who carried out major work with raped women. After a few years of practice, in contact with these appalling dramas, these tortured daughters and mothers, she was herself affected by a deep trauma. Every time she saw a patient, she started crying. It was deleterious for the patients, who said to themselves: “But then, if even the psychologist cries, I have no more hope…” Her attitude was becoming counterproductive, she had to abandon her mission. It is absolutely crucial to strengthen support for caregivers, otherwise we will not be able to help victims.

Does the chair have a broader vocation beyond Panzi? Do you want to draw new lessons on resilience from this “high vulnerability” terrain, which will be used elsewhere?

CF: Yes, it is absolutely key. It must be understood that we are all going to be confronted with experiences of collapse. Our societies will have to deal with resources at risk, whether these are the repercussions of climate change or resources such as individual freedom, which, as we have seen, under the effect of the health crisis, can be rationed. But here, resilience protocols are being invented. For Panzi, for Africa but also the whole world. This hospital, far from the victim vision, is a territory of innovation, of design theory; vulnerability is both a knowledge vector and a capability lever. In other words, we learn together, it’s an extraordinary adventure!

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