October 5 was just like any other Friday for Denis Mukwege, MD, PhD,—until it wasn’t.
Mukwege, founder of Panzi Hospital in Bukavu, usually spends Fridays in the operating room (OR), repairing the catastrophic injuries of women who’d been raped by soldiers in the Democratic Republic of the Congo (DRC). He was in the OR when his staff unexpectedly crowded in and started hugging him.
That was how the 63-year-old Mukwege learned he had just won the 2018 Nobel Peace Prize, which he shared with activist Nadia Murad, a young Iraqi woman who had been repeatedly beaten and raped while held prisoner by ISIS.
“For me, this prize was really the recognition of the suffering of women of Congo and women who are suffering in conflict everywhere,” said Mukwege, a gynecological surgeon whose efforts to help survivors of rape in his country made him the target of an assassination attempt in 2012. “It gives us hope that maybe the world will really start to think about reparation, that we can draw the red line against the use of rape as a weapon of conflict.”
JAMA spoke with Mukwege a few weeks after he was awarded the Nobel Peace Prize, which he accepted December 10 in Oslo. The following is an edited version of that conversation.
JAMA:Why did you become a physician?
Dr Mukwege:My story as a medical doctor starts with my father. He was a pastor. I got my inspiration when I was 8 years old. I contracted malaria in a country where malaria is common. He would not only pray for me but also give me medicines. When I went with him to visit a child who was very sick with fever, he just prayed and said goodbye. I was a little bit shocked by this. I saw it like an injustice. I asked him, “Why did you just pray and not give medicine?” He said he’s praying for patients, but he can’t give medicine, because he’s not a medical doctor. And I tell him, “Dad, I will be a medical doctor, so you can pray and I will give medicine so the patient can get better very fast.” And he said, “Okay, Denis.”
JAMA:You first trained in pediatrics. Was there a specific encounter that made you switch to obstetrics and gynecology?
Dr Mukwege:When I started to work, I was in the missionary hospital in Lemera [DRC]. Women from around the hospital were coming in bleeding. Each day at least two women were dying because they didn’t get good obstetrical care. I felt okay, it’s good to be a pediatrician, but I think it’s better to be an obstetrician, so you can save mothers and help babies. I went to Angers, in France, where I had done 5 years in obstetrics, and came back to the same hospital in Lemera, not only taking care of women in the hospital but also training nurses and training women who like to support me in the fight against maternal mortality.
Dr Mukwege:Maybe the number decreased a little bit, but we’re still facing the same problem. At the hospital in 2006, 2008, the number was more than 3600 women per year, but today we are treating around half of this number. It’s always a catastrophe, because even to rape 1 woman is enough.
JAMA:Could you explain how rape is being used in the fighting in the Congo?
Dr Mukwege:When I treated the first patient at the hospital, I got the impression that it was unique, committed by someone who lost his mind, because it was a woman who was raped by 7 men. They shot her genitals. They were completely destroyed. The bladder was open, the vagina completely exploded. I was in the region for many years working as an ob-gyn, and I had never seen something like that. We treated the fistula between the bladder and vagina, and after we treated the rectal-vaginal fistula, we did a colostomy. I asked myself how a human could do something like that to another human.
That was in September 1999. In the 3 months at the end of the year, I treated 45 victims, and then I really started to ask myself: What is this? And I could see after 1 year that women were coming with the same problem. After they were raped, many kinds of torture were done: introducing the bayonet, burning the genitals, introducing stakes and things like that in the vagina. And there I really lost all my sense of humanity in the community.
I started to take all the information about women who were coming to the hospital. You could find in 1 village 50, 100 women who were raped in 1 night by the army, each man using different kinds of torture. And all this torture was on the genitals of women. We even treated women who had their breast cut after the rape. Women were raped in front of their family, children, husband, all the community. You could see that it was not sexual, because I treated even babies and very old women. Around 1% of our patients are men. It’s a way to show power. You can reduce the capacity of the population to reproduce, and this can reduce population the same as you can with shooting people.
If you contaminate them with AIDS, you give victims the capacity to destroy people around them by contaminating them with AIDS. This is how the population can be destroyed by rape as a weapon of war. The economy of many places is on the shoulders of women, and when you destroy them, they can’t produce, so economically you also destroy the community. They can’t walk normally, they can’t go to market normally, and so on. In destroying women, you can get the same consequences that you can get with classic weapons. But also, these consequences affect another generation, because when they have AIDS, for example, they can also transmit the AIDS to the next generation.
JAMA:Your hospital provides more than medical care to patients. Could you describe the One-Stop Centre Model of Care that you use?
Dr Mukwege:When we started the hospital, we were just treating women on the medical side. We didn’t really get to experience the psychological trauma. But very quickly we discovered the medical care was not enough. After being raped in public, raped in front of the children and husband and the community, women were not ready to go back in the community.
So we created a team of a psychologist and a psychosocial assistant. After 2 years, we found that women were better psychology and physically. But the big question was “How do I go back in my community when no one will accept me, I’m stigmatized, I’m rejected by the family?” and so on. The only one way to get them to go back was to give them the economic autonomy and try to talk with the community, so they can accept them. It was not their fault they were raped; it’s because the society didn’t protect them. So we started the third pillar of our model of care: socioeconomic support.
After a few years, some women, when they became strong enough physically, psychologically, and economically, they needed to try to get the perpetrators to go to court. We have some lawyers who can support them. We can see that the healing of victims of sexual violence is a process. And this process is not only medical, but it’s also psychological, economic, social, and legal.
JAMA:How does winning the Peace Prize affect your work and your relationship with your government?
Mukwege:Now we have many people in the country and outside of the country who are aware of what is happening in Congo. They are also aware of Panzi Hospital, they are aware of this One-Stop Centre, the holistic model of Panzi. To get awareness of what we are doing here at Panzi is one the first consequences that I can see with the Nobel Peace Prize.
We’re still getting calls from the countryside where women are raped. But the government is denying that this is happening. Not supporting women but also denying that it’s happening—I think that it’s a really big problem with the government. I don’t see how they can fight against rape if they don’t accept that it exists.
We can’t develop this country if women are not secure to go to lug water, to go to the market, or to do their business without fearing they’ll be raped again. But today we are still waiting for the government to not only pay reparation but also to protect and recognize all the women who went through this terrible thing. The government should also apologize.
JAMA:After the assassination attempt on your life, you and your family left the country. At that time did you think you might never go back to the Congo?
Dr Mukwege:I was so sad to feel that I would never come back. I thought more about the responsibility I have toward my family, my children, and I just said, “Okay, I did my best, but if this can happen in my house in front of my children …” My friend Jeff, who was taking care of us, was killed in front of my children and myself. I was unable to help. I felt, okay, this is enough. I have to leave the country forever. I will never come back if the situation doesn’t change. So that was my feeling when I left Congo.
JAMA:Did your patients convince you to come back? What motivates you to continue your work?
Dr Mukwege:My patients started to ask me to come back, and I didn’t respond. They wrote to the president of Congo, and the president didn’t answer. They wrote to the Secretary General of the UN [United Nations], and they didn’t get [an] answer. And what they did was so touching for me: “No one wants to help us, so we’ll do it ourselves. We’ll organize ourselves to get Dr Mukwege back because we need him and we will protect him.” They started to sell fruits and vegetables, and each Friday came with $50 to the hospital until they got the ticket for me to come back.
These women don’t have $1 per day for their own life, but they could get $50 per week for me? It was so touching. I felt, “How can I protect my life, only my life? It’s just a single life and thousands of women want me to come back to treat them.” They said, “We’ll protect you. Come back! We’ll take care of you.” It was clear that I would be selfish to not think about thousands of people who are in need and just think about myself. I discussed it with my wife and my children. We thought it was so emotional to talk about all these women who are fighting every day to protect their lives with nothing. I can say nothing, because less than $1 per day, it’s nothing.
I felt that I was very, very small compared to their big heart and big will to protect me. So I decided to come back, and when I arrived at Bukavu, there were a thousand waiting for me. They came with many kinds of food to say, “Don’t worry we’ll take care of you.” And 25 will spend the night around my house, and if someone comes to attack me, they’ll have to kill 25 women.
When you have women that are so strong, you feel just like you are nothing, especially when you think about the sufferings they went through, and they’re still protecting life and not their own life and the life of their children but also the life of a medical doctor. For me, doing what I’m doing, I think the big motivation is the women because I think they have something special inside them. They have love. They love life and are protectors of life. And I think that the duty of service to women, for me, it’s an honor.