“We will all be faced with experiences of collapse”

La Croce 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 (overall, ed), since at the Panzi hospital we operate on the basis of four pillars: the medical treatment of victims of violence – sometimes extreme, here rape used as a weapon of war -, but also psychological assistance, economic reintegration and legal assistance . We had discussed in particular the therapy through the arts, which we experience in Panzi.

Such as?

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 dramatically. Humiliated women, who hide, who cannot sleep, suddenly go back to eating, to sleep, rediscovering a joy of living. We see it but we have no proof.

→ LARGE SIZE. Rape in the DR-Congo: reconstruction and hope of the survivors

I am a gynecologist, I know how to operate a fistula (perforation of the membrane between the vagina and the urinary or digestive tract, ed), 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 scientifically support them: why do the arts help? Which should be preferred, over which trauma? What protocols to put in place? It is very important to us.

Cinzia Fleury: Over the past twenty years, Panzi has done extraordinary work for the resilience of women: it is known all over 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 the post-traumatic clinic, this work is complex to carry out. However, it is essential: “Healing proves nothing, you have to try the cure”, we learned from Claude Bernard. This will be our role, through this focus on art therapy: when it is not possible to talk about trauma, we have to go through drawing, photography, cinema, the body …

We have been thinking about it for three years with the Panzi teams. 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 will you do it, concretely?

CF: We are planning two biennial missions. Our first project manager, Isabelle Audigé, is a general practitioner and doctoral student, her thesis focuses on the status of victim executioner. She is expected to move to Bukavu in July. Other French researchers will join her to work closely with Panzi’s caregivers and assisted women. What they have suffered is an attack on their own integrity. They also trust to what extent 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 done here is to turn their vulnerability into competence.

What do you mean ?

CF: These women have “experiential knowledge”, forged during the trials they have been through, their care pathway, etc. This knowledge is very valuable, not only for the health system, but also for the defense against sexual violence. The Panzi chair of philosophy will therefore work hand in hand with the University of the sick (Sorbonne University), to train the survivors who wish, in order to transform this knowledge into real skills. Catherine Tourette-Turgis (the founder of the University of Patients in France, ed) in particular, she will come on site for advanced courses from one week to ten days offered to women. We would also like to involve some village communities, to combat the reactions of rejection, of exile that very often follow the rape and plunge the victims into hellish situations.

The question of the impunity of the executioners also arises in the Democratic Republic of Congo. Is fighting, condemning rape perpetrators necessary for the healing process?

DM: This is an important 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. Yet, on a judicial level, we are walking on water. We have made a lot of progress on therapeutic protocols, but the question of impunity of the aggressors remains unresolved. Currently, the victim must provide proof of her attack. But it is 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 could take several weeks or several months to arrive at 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. In 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 it, hoping that these elements can be used by justice.

→ MAINTENANCE. Denis Mukwege: “Women’s courage shows us the way”

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 immediately, ed). She is just a little girl! Society cannot look away. We need some form of justice, of reparation for these women and of addressing the issue of these children. Otherwise, the Congo will go in circles, because the latter risks committing violence in turn.

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

CF: Expectations in this regard are very high, after the multiplication of cases of burnout syndromes at the Panzi hospital (1). The teams no longer want to leave this topic aside. We’ll help them get to the point, working from the caregiver’s philosophical burnout clinic that Valérie Gateau, associate researcher, is developing at the University Hospital Group (GHU) of psychiatry and neuroscience in Paris. This system is based in particular on narrative ethics.

DM: To make you understand, I will tell you the story of one of our psychologist, a courageous woman who has done important work with raped women. After a few years of practice, in contact with these frightening dramas, these tortured daughters and mothers, she herself was struck by a profound trauma. Whenever she saw a patient, she would start crying. It was detrimental to the patients, who told themselves: “But then, even if the psychologist cries, I have no more hope …” His attitude was becoming counterproductive, he had to abandon his mission. It is absolutely essential to strengthen support for caregivers, otherwise we will not be able to help the victims.

Does the chair have a wider vocation than Panzi? Want to learn new lessons in resilience from this “highly vulnerable” terrain that will be used elsewhere?

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

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News

While rape is used as a weapon of war in the Democratic Republic of Congo, ruining the fate of tens of thousands of women, Dr. Denis Mukwege and philosopher Cynthia Fleury have decided to work together on the psychic resilience of these “survivors”. . In the spring, when the latter arrived in Bukavu, they formalized the creation of a chair of philosophy at the Panzi hospital (where more than 55,000 female victims have been treated since its foundation by the gynecologist in 1999).

The protagonists

Nobel Peace Prize winner (2018), Denis Mukwege has dedicated his life to women victims of sexual violence, specializing in particular in post-rape reconstruction. In The strength of women (Gallimard, 400 p., € 20), underlines the importance of a “holistic” approach to treatment. A direct echo of the work of Cynthia Fleury, philosopher and psychoanalyst, full professor of the Chair of Literature and Health at the National Conservatory of Arts and Crafts, in Paris. Last published book: Here lies the bitter. Heal from resentment (Gallimard, 336 pages, € 21).

The challenge

The chair opened in Panzi thanks to the support of the French Development Agency (a budget of 200,000 euros for two years) will initially focus on art therapy. The challenge is not just to provide scientific evidence of the contribution of the arts to the healing process of victims of violence. It also means drawing lessons from this ground of extreme vulnerability, to shed light, more generally, on a world in crisis.

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