Dr Phoebe Abe-Okwonga: FGM Activist And Physician

Dr Phoebe Abe-Okwonga MB ChB, MSc(CTM ), FRSA is a General Practitioner (GP) and Community Health physician who has practised for many years at the Yiewsley Health Centre in West Drayton, Greater London, England – where she holds an hour-long free and open clinic every Monday and Friday lunchtime, even in lockdown, for any woman who has undergone female genital mutilation (FGM).

Phoebe, a widowed mother of five originally from Uganda, completed her medical studies decades ago in the UK and has been concerned about FGM for many years. There are, she says, some 200 million women and girls now alive who have endured FGM, and around 130 to 140 thousand of them live in the UK.

FGM causes many health problems, both physical and psychological, ranging from infection and blocking of the birth canal to depression and even for some severe post-traumatic psychosis.  It often also ruins intimate relations, and sometimes marriages, as women struggle to maintain their lives in the face of discomfort and sexual difficulties.  Small surprise, then, that some women find their way to Dr Abe, hoping for treatment of their physical, psychological or intimacy problems.

Phoebe’s free clinics are for an hour every Monday and Friday from noon to 1pm. At first it was just a few women, but now new patients come constantly.  In one year alone she identified 53 FGM sufferers in a total of just over five thousand women in her Greater London practice area. Five were under fifteen; another in her 30s walks with a stick. Others are on kidney dialysis or have even had a kidney transplant.  Yet some attend the surgery not because of FGM (they are not aware of the damage it can do), but rather because they have back pain or suspect an infection; and many have already consulted other doctors who did not discern or even just ask whether FGM might be the underlying cause of their distress.

Clear medical records are essential

In such cases it is obvious that clear records must be kept, but far from all GPs, we are told, actually report the diagnosis of FGM via the NHS code for their patient’s condition.  The discretionary diagnostic code is there to be used, but often it is not; and this in turn makes for difficulties in following up also the ‘at risk’ girls and young women in a patient’s family, even though they too make be expected by elders to undergo FGM.  Without the coded information, and without a proper record of other female family members, FGM can continue unchecked; and the NHS will not even be aware that there many more girls and women at risk or already suffering.

But who to whom should Dr Abe refer her patients, once diagnosed, for specialist attention?  And how can other FGM survivors / victims who don’t get to Dr Abe’s surgery find the help and support they so badly need?  In truth the answer is, maybe the much needed services often just aren’t there.

Particularly for women who experienced FGM years ago, perhaps now past their child-bearing years, the chances of receiving an FGM diagnosis are low.  These women may present with back pain, infections and much else when they come to see their doctors, but some doctors are unlikely unilaterally to discern the underlying cause of the illness.  There is currently not enough training and focus on FGM for that clinical insight always to arise.

One of Phoebe Abe’s personal objectives is simply to maximise awareness that women from many different ‘cultures’ and parts of the world, some of them British citizens, may have experienced FGM; and that, in turn, if not dissuaded these women’s daughters may meet the same fate.  FGM in the UK (and many other parts of the world) is strictly illegal and can result in severe punishment under the law; and it can cause huge and enduring health problems for any girl or woman who experiences it.  But to eradicate the practice requires explicit legal and public health messaging; and to remediate its harm requires repeated and focussed clinical training.

The Dr Abe FGM Association Worldwide

And so Dr Abe devotes much of her energy and time to promoting these messages.  She has her own Dr Abe FGM Association Worldwide, where she aims to nurture ‘GOOD British Citizens’; she spreads the word about ending FGM everywhere she can, from the All Party Parliamentary Group in Westminster of which she is an associate member, to the community groups with which she has connection, and also to meetings of medical consultant specialists – who all too often don’t realise how widespread FGM is in Britain – and to trades unionists across the UK and political parties at their conferences. Towns and cities Phoebe has visited in the past decade include Hillingdon, Liverpool, Manchester, Nottingham, Oxford, Reading and Westminster.  And now she focuses on radio, TV and other media outlets, never relenting in her determination to stop FGM entirely.

Indeed, Phoebe Abe has even written and published her own book, launched in Parliament in 2015 – FGM Female Genital Mutilation: an A-Z Guide – containing the insights of many activists and professionals seeking to end FGM.  The proceeds of book sales go towards the Dr Abe FGM Association Worldwide. (Nor, very wisely, does Phoebe focus solely on the more distressing aspects of life in her country and continent of origin, as this joyful video shows.)

Dr Abe’s patients tend to come from, or share  a heritage with, a part of the world where Type III – the most extreme sort of FGM, where everything is actually sewn up – is practised.  Amongst the concerning features of FGM which she has noted in her patients are twice as many caesarian section deliveries (49%) compared to normal UK prevalence (25%), a far higher incidence of Hepatitis B, HIV, congenital syphilis and chlamydia, a high incidence of pelvic inflammatory disease and very high rates of secondary infertility and depression.  Yet often women have not even been de-infibulated (ie had their genitals properly re-opened and repaired) and they have been offered, for instance, physiotherapy for incontinence, rather than attending to their actual wounds.

FGM causes life-long suffering

Dr Abe insists strongly that the underlying causations of all this suffering be addressed, rather than just dismissing patients with unhelpful remedies.  Most of the women she sees have contracted infections from unsterile FGM ‘procedures’, or are in marriages which are monogamous for them, but not for their husbands (who may have several ‘wives’).  In a presentation at the University of Oxford Phoebe put it like this:

We call upon authority to get proper funding for community-based centres where women and girls can attend with properly qualified individuals with specific FGM interests and knowledge. 

There should be serious further feasibility studies on the health of these individuals.

With widespread demand now, and health professionals being trained and the community being made aware of the impending serious medical and social problems arising in this group, we may be on the road to success in caring for their individual needs.  Proper examination, investigation, management and appropriate referrals for these patients will give them back their healthy lives, and will also save big future costs for the NHS.

In such a context Phoebe Abe’s demand for funds to train clinicians and provide proper support for the victims and survivors of FGM surely becomes compelling?

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Read more about FGM and Health.

Your Comments on this topic are welcome.  
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Books by Hilary Burrage on female genital mutilation

https://orcid.org/0000-0002-6684-2740

Eradicating Female Genital Mutilation: A UK Perspective (Hilary Burrage, Ashgate / Routledge 2015).
Full contents and reviews   HERE.
 
FEMALE MUTILATION: The truth behind the horrifying global practice of female genital mutilation  (Hilary Burrage, New Holland Publishers 2016).
Full contents and reviews   HERE.

FURTHER INFORMATION AND ACTION

There is a free FGM hotline for anyone in the UK: 0800 028 3550, or email: fgmhelp@nspcc.org.uk

Details of NHS Specialist Services for FGM here.

More info and posts on FGM here.

Activists, service providers and researchers may like to join the LinkedIn group Female Genital Mutilation (FGM): Information, reports and research, which has several hundred members from around the world.

Email contact: via Hilary

[NB The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, which has a primary focus on FGM, is clear that in formal discourse any term other than ‘mutilation’ concedes damagingly to the cultural relativists – though the terms employed may of necessity vary in informal discussion with those who by tradition use alternative vocabulary. See the Feminist Statement on the Naming and Abolition of Female Genital Mutilation,  The Bamako Declaration: Female Genital Mutilation Terminology and the debate about Anthr/Apologists on this website.]

PLEASE NOTE:  This article concerns approaches to the eradication specifically of FGM.  I am also categorically opposed to MGM, but that is not the focus of this particular piece, except in any specifics as discussed above.  Anyone wishing to offer additional comment on more general considerations around infant and juvenile genital mutilation is asked please to do so via these relevant dedicated threads.  Discussion of the general issues re M/FGM will not be published unless they are posted on these dedicated pages. Thanks.