IN this legal vacuum doctors and others who provide social services that could educate and inform communities about FGM and protect uncircumcised girls are caught in the ethical bind of trying to show respect for another culture and at the same time guide people away from a harmful practice that is very much a part of that culture. For instance, in response to growing concern about FGM, the American College of Obstetricians and Gynecologists released a statement opposing all medically unnecessary surgical modification of female genitalia (although doctors here continue to perform cosmetic reduction surgery on both the clitoris and the labia), and declared that FGM should be stopped; but its guidelines end there. Some hospitals and doctors continue to reinfibulate women and to say nothing against parents' plans to circumcise their daughters. An article published in 1993 in the American Journal of Obstetrics and Gynecology clinically details one obstetrician's efforts to deliver a child vaginally from an infibulated woman. The article, written as a guide for dealing with such a situation, ends with a recommendation on how to perform reinfibulation and concludes, "The issue of whether the woman will want her own infant daughter circumcised also needs to be discussed so that she can make an individual, culturally appropriate and educated choice."
"My patients say doctors are often shocked when they see them, and don't know how to help them," says Carol Horowitz, an internist who cares for East African immigrants in Seattle. "I try to deal with them with respect and dignity and try to help them with their problems, surgically or nonsurgically." Horowitz says that she is mindful of the risk of offending her patients when she educates them about the harmful aspects of what was done to them or counsels them against circumcising their children—and that some doctors with whom she has worked will not broach the subject at all. "To many patients, a circumcised vagina is normal. Any change is going to have to come from within that community."
Teachers, nurses, and administrators in elementary schools located in areas with many African students are often ill equipped to detect and help a child at risk for mutilation, or to help a child following this potentially traumatizing experience. "There was a time I got a call from someone in northern Virginia," Asha Mohamud says. "They heard of a girl in a school who was at risk. The teacher was teaching about sex education, and the young girl pointed out the clitoris and said, `That part is really bad, and my mother is taking me back in the summer to have that cut out.'" Mohamud tried to find the girl, but by the time the story had reached her, it was too late. The girl had already graduated and returned from her trip to Africa.
"If that family-life teacher was aware, she could have done something immediately," Mohamud says. "It's something also that made the issue more urgent to us. Things are happening here right under our own noses. Girls are probably being taken back right now."
A DESIRE to educate both the officials in her adopted country and immigrants from her native one drives Mimi Ramsey. The New York-based international women's-rights group Equality Now is raising money to fund Ramsey's efforts so that she will be able to spend more time doing what she does best: taking her message to the streets.
In a dark restaurant in Los Angeles paper place mats are decorated with maps of Ethiopia. Shiny red-vinyl booths are filled with brightly dressed residents of the local immigrant community. Original Ethiopian artwork and African posters cover the walls. The smell of cooked meat and the sound of quiet laughter surround the booth where Ramsey sits, with her just-served lunch. Her own conservative dress is more likely to be found in Orange County than in Addis Ababa. She bows her head and prays aloud: "Please, God, save girls from being tortured. Please, God. Please. Thank you."
Just minutes after she begins her meal of traditional Ethiopian bread dipped in a stew of vegetables and meat, she gets up and approaches a table of four Ethiopian men. She exchanges pleasantries in their native language, Amharic, but quickly the conversation turns tense. A few English words are mixed with the foreign ones. A man says, "Tradition." Ramsey replies, "Let's talk about it," and squeezes in next to the men.