Midwife discusses her FGM related work at UCLH

Interview with Yvonne

Midwife Yvonne Saruchera at University College London Hospital (UCLH) talks to Fiona Shaw

How was the clinic first set up?

That actually I don’t know because I’ve been doing it for just a year, but I know that Dr Sarah Creighton started this clinic 20 years ago. Whether she started it up with a nursing or midwife input at that point but I actually don’t know the history.

So how is it arranged now?

The way it works now is that we have 4 clinics a month – one is consultant led and the other 3 are led by me. Referrals come in from GPs, self-referrals and from midwives. I see them, make an assessment, and see if they need deinfibulation (a surgical procedure to open up the closed vagina). If they need deinfibulation, they come to the consultant clinic which is on the first Monday of every month. I’m learning how to do it, I’ve done a few now, but the consultant leads on that. And when we’ve done the deinfibulation, we see them 4 to 6 weeks afterwards to see that everything is fine – in most cases they are all fine.

Aside from the physical aspects of FGM care, do you offer psychological services?

That’s the biggest thing, a big big big thing. We don’t really have any funds for psychological support which is a shame, a big shame. So the women are asking for it and we had a visit from the public health minister and we highlighted this to her. Her response to that was we need the evidence. So if we gather the evidence that there is the need for it, I think we’ll get the psychological support and funding. But in the meantime we get women who are asking for psychosexual support, and for that I went to see the (people at the) Margert Pyke Centre, and they’ve offered to see our women in a self-referral process. Interestingly, women do ask for it but when it comes to it and when you say you can go to this clinic, I don’t think anybody actually has been there.

Why do you think that is?

I don’t know if it’s the self-referral or they get very shy about doing the whole thing even though they need it. I think it’s quite a big challenge to then actually access the service but, at least we’ve notified them of the service. Whether they utilise it or not is another thing but I think we need to explore why they are not.

I’ve read that this clinic is completely female run – is that correct?

Yes, and if we had males in the clinic it wouldn’t function. To get them to attend is a challenge. Like today, I don’t know how many I’m going to get – I should have around 6 people. So if you put men in the clinic then none of the women would come.

Obviously women recognise that there are long term health implications of FGM. What do you think is stopping women from coming to you and stopping them from curbing the practice?

Okay so, what’s happening now is that anybody who has FGM if they are pregnant, they should come to see us. Now you find that the women who are not having any problems, who’ve had normal births before, they find they don’t have any medical issues. If you offer them this kind of appointment, they’re not going to come, because they don’t have any issues. The women who have issues do not miss their appointments. The women who are having menstruation problems, women who are aware that the vaginal introitus is restricted when it comes to having the baby. They might not have any symptoms but they are anxious that when it comes to the baby, the baby might have trouble, they come. The women who self-refer, those ones definitely come. So we know that there’s a group of women who always come but a group of women who do not have any issues and have just been told to come to this appointment – they see no point in doing it.

But do you think there is still a point for those people to come – those who feel there is not?

I think there’s a point in terms of education, because it’s the time we can capture them and discuss each person’s issues and just make them aware of their rights and for their children, to protect their children. There’s a point in that.

But what I’m thinking of doing now for this group of women is to combine their appointments – when they come in for their midwifery booking appointment or any contact with midwives, if we identify each and do the talk we need to do for them and offer them anything else if they want anything else. I think if we do it as a combined appointment it we be more effective than bringing them here. Because it is yet another appointment for them, and they don’t see the value in it. And so I think that the next thing that I’m planning to do this year is to train all the midwives to be able to make an assessment because I think they should all be able to do that. And then, we need to report to the Department of Health. We originally thought that if we could see everyone in this clinic; that would be enough. But we’re losing certain women, we’re losing quite a lot. And I think we know that they come to their ante-natal appointments, so why not combine them? If somebody’s FGM then you say I would like to have a look, make an assessment, have an educational chat with them and then I think that’s done, because I think that’s all that we can do. Those that need psychological support, then we can refer to this clinic, and we can see how we can help them a little bit more. Or those that want – you know there are lots of them who are traumatised by the whole process, I think those ones can be directed to this clinic and we can see what we can do for them.

In terms of going on to protect young women and girls who have not undergone FGM, do you feel that the women are receptive to you discussing it or is it something that’s still quite difficult to broach with people?

I would say the majority of the women I will see, they are very traumatised by this and they are really not keen to do this to their children. And they have the freedom because here they are liberated because the pressure to do it is not as much as when they were (at home), when it was done to them and their mothers were under pressure to do it. So it’s different for them and so the majority of the women – actually I have never come across a woman who has come and said ‘oh yeah we are getting our daughter ready for this’, most women say before you even start the education talk, they say ‘oh we wouldn’t do this to our daughter because it was very traumatic, and there is absolutely no need to do this and there’s no point’. So this generation, we can be comfortable that they are unlikely to do it. But we understand that there’s pressure from grandparents, or when they go and visit, it could be done without their knowledge. But in terms of the parents being conscious of that, I think they are more aware.

As you said, you are seeing women who were more traumatised, have more issues. Do you think that maybe the women you are not catching, those would be the women you actually need to have this conversation with and are maybe more likely to go on and continue the practice?

Most likely, most likely. I think there’s a possibility. I think we have a big job to make sure that everybody has access to this service and make it easily accessible for them as well. And I think the GPs will need to be a starting point, because everybody has a GP at least. If every GP has this service and they have records of all the women that have FGM, then they’ll be able to reach those ones who are not so willing to come forward on their own. But I think the emphasis from the government so far has been the hospitals, but I think the emphasis should be in the community.

The other interesting thing is, we’re getting young girls who are coming in self-referral, and they are coming in to get this reversal done. We’ve had as young as 17 year olds, come in and wanting to have their reversal done. So you know even the young girls themselves they are coming forward and wanting to get some help.

And hopefully bit by bit we can stop it happening in the first place?

I think so. I think they have a big role in ensuring that it doesn’t happen to their younger sisters, their younger friends, the younger community, because they are already speaking up. I think they just need more support to do that. And I think the organisations are empowering them to have that voice and speak.

Now the other issues that are coming up, we’re getting women mainly from West Africa, they are coming in. I don’t know if you’ve heard that there’s this surgeon in France who reconstructs the clitoris. And so we get quite a few women who come in and ask could they have this operation done. And it’s obviously not an operation that we’re offering in the UK and we don’t know how effective this operation is. So, we’re getting a group of women who are saying ‘well my friend had it done and everything has improved incredibly and so there must be some point in trying it out – could you refer us from the NHS to France?’ So we can’t do that. But there’s more and more coming.

It’s interesting to see how it’s not just the physical issues you’re getting, it is sort of reclaiming this sexuality that women have been robbed of.

Exactly that. But you find that most of them are West African. Not really Somalians, Ethiopians, actually we’ve have some Eritreans who have come in and said that. But the majority of them will be from Nigeria, from Sierra Lione, from Gambia, all saying ‘I’ve heard about this operation’. I suppose it is also to do with their French connections from colonial days.

What do you think the biggest problem at the moment is for the clinic?

It’s just getting them to come – if they see no point in coming. But having said that there are also women who are having problems and should be coming and they don’t. So I think the way round it is to make sure that everyone has the skill to do it and we can do it at whatever meeting they have with the woman.

Republished from Genderal Studies. Date: ?Jan/Feb 2015