Medica Zenica

So yesterday we had an amazing meeting with a very well-known organization which provided rape crisis services, shelter, therapy, and a safe house for women during the war. They have written some articles about their work that have been translated in to English and which i had read very early on in my research of this topic. So I felt kind of ´star-struck´ to be there in person.

I will try to summarize the meeting, but it will be difficult because it was easily the longest meeting I/we have had with anyone here. The woman we talked to even joked that when you ask her about Medica´s work it is like pulling the thread on a sweater and more and more unravels. The other note before I start is that we brought Lejla (our translator) because we had been told we would really need her, but the woman Mariana to whom we spoke used perfect English so that was kind of funny.

So Medica Zenica offers a very holistic set of services for women and children, including physical health (medical and gynecological care), psychological (therapy and groups), family interventions (sheltering women and children, interventions for children), education (for women job training in hair styling, sewing, upholstery, etc and they have a kindergarten for children in the shelter), and advocacy for them women and children. They work based on these holistic, multi-discipilinary, feminist, and humanistic values. The fundamental belief of Medica Zenica is that RECOVERY IS POSSIBLE!

One of the things Mariana talked about is that basically nobody came to the clinic and said, ´I have been raped and I need help.´ This is partially because of stigma and also because the Bosnian language is ´euphemistic´ (as she put it). She said women would talk about other women by saying, ´you should talk to her because she doesn´t feel well´ or they would talk in therapy about ´when it happened´ without mentioning the Bosnian word for rape. Even the 25 out of 150 raped women they served during the war did not say they were raped and often were in denial that they were pregnant, so Medica was involved in a stages of recovery process with them to help them come to terms with what happened to them and accept the fact that they were raped and they are pregnant.

The stages of recovery model that they use is based on trauma work of Judy Hermann and others, but they have adapted it to be most relevant for the Bosnian women and the circumstances in which they found themselves. Here are the stages of recovery that Mariana described to us (which may not occur in a predictable order and may be circular or overlap, especially if there is ongoing trauma, such as in war zones where maybe a woman is recovering well until she hears her son whom she has worried about has been killed or something else awful has happened):

1. Breaking the silence by telling a ´person of confidence´ what happened (this could be a therapist, not more often it was a friend or neighbor or relative.

2. Dealing with the confusion and the memories that come up when one begins to talk and break the silence.

3. Admitting and believing that the violence did happen (moving through denial).

4. Connecting with one´s own vulnerability.

5. Directing anger where is belongs (at the perpetrator, not at the self or the body or the baby born of rape).

6. Connecting with one´s own spirituality.

7. Finishing or completing the gestalt process and taking steps for the future (projecting for the future).

During the war, Judy Hermann´s important book, Trauma and Recovery was translated three separate times in to Bosnian because the clinics using it had no way to contact one another because of the fighting. It shows how useful the book was though because at least three separate places used Hermann´s work as guiding principles for their interventions with women.

Hermann´s principles of recovery from trauma also follow stages, and the way Mariana says Medica offers interventions follow this pattern:

1. Establish Safety, build confidence and relationship
2. Build the woman´s strength resources (focus on and build on existing strengths within the woman and her family and community)
3. Projections for the future (building new relationships, fostering and reconnecting with old relationships, planning and making strides toward a new future)

The other text that Medica uses extensively is by a survivor of Nazi concentration camps called Finkel (the book is called ´Why didn´t you kill yourself´). He talks about his experiences and the 4 main principles that Medica Zenica found applicable to their work are these:

1. What happened to you was not the worst thing that could have happened (keeping the trauma in perspective).
2. Bad experiences can be helpful (you can develop new strengths or skills or resilience that you could not have developed in any other way than through the trauma you experienced).
3. No one and nothing can take away your previous life (your life and existence before the trauma are not lost or gone).
4. There is an expectation that you will ´suffer with dignity´ as a human being.

One of the most important things about the way that Medica does its work that I really could relate to because of my background and my own work is the idea of healing occurring in a relational context. The way Mariana put it was simple and straightforward: one relationship hurt you and another relationship can heal you.

She also talked about Maslow´s hierarchy of human needs and how a person needs basic safety and physical/biological functioning to be intact before one can even begin to work through trauma. So they provide the women a safe place to stay (with armed guards) and they feed them and house their children, restoring a sense of safety and relative normalcy (to the degree it is possible in war).

She also referred to a famous quote which basically says, ´The best way to forget is to remember.´ This means that in order for trauma to stop haunting a person, it needs to be given the attention and remembrance that it is calling out for (through nightmares, hypervigilence, intrusive memories, etc).

She talked about the experiences of some women who had given birth to babies who resulted from rape, and this was one of the most intense parts of the discussion. Of the 25 pregnant raped women, about 1/2 were able to have abortions at Medica (many of them were late in the pregnancy and dangerous for the mother, but the surgery was made available to them because it was their deepest wish not to give birth to these babies). Of the 12 that gave birth, 6 kept the babies and 6 gave them up for adoption. If the women were willing to feed and keep the baby for the first 40 days, that was the best option to try and develop a relationship between mother and infant, but some of the women did not want to even see or feed the baby because the baby itself was a traumatic reminder (especially for girls who were virgins before the rape).

Mariana told us about a woman who agreed to keep her son, but vacillated between caring for him and neglecting him. She would leave him for days with the other mothers in the house and often she could not even look at him because he reminded her of the rape, his father, and all the associated war trauma. One of the nurses took special care of the baby and eventually during a period when the mother was really incapable of taking care of the baby, Mariana came in to work to find a note in the logbook written by the nurse: ´I took baby home.´

The nurse kept the baby at her own house and cared for him for several months until the mother was stable enough to take him back. It is this kind of caring and commitment that I respect and admire so deeply. I will never forget how Mariana said those words, because they sounded like the kindest thing I could imagine: ´I took baby home.´

She also told us another powerful story about a woman who chose to keep her baby daughter. It was complicated to introduce the baby to her family, so Medica helped her plan out the best way to do this. First the sisters and mother visited the woman and the baby at the Medica clinic a few times over a period of months. Then the female relatives started talking to the father and other male relatives about the existence of the baby over more months. Finally, when the father was ready (after a year or maybe more), the woman brought the baby to the family home. Her father (baby´s grandfather) said, ´Give me the baby.´ The woman handed the little girl over and the father said, ´She is ours.´ Nothing else. (meaning that they were claiming the baby as a member of the family, the ethnic group, she is only ours, not of the enemy or the other).