Juliet Albert, Acton Africa Well Women Clinic - DFID Girl Summit 2014

""It is just the tip of the iceberg. We see women with complex perineal trauma....fistulas, they are in pain every day or their lives..." - Juliet Albert

Panel Discussion: Spotlight on Progress A6 - Supporting and Empowering Those Affected by FGM and Child, Early and Forced Marriage

Context
This is one of the 14 "Spotlights on Progress" video-recorded sessions that took place at the Girl Summit 2014 in London on 22nd July. The sessions were organised to spark conversations and share best practice between practitioners from around the world, between grassroots activists and ministers, and across all the issues of female genital mutilation (FGM) and child, early, and forced marriage (CEFM). Girl Summit is a project of the Department for International Development (DFID), UK.

A featured panelist of this Spotlight session was Juliet Albert, Specialist FGM midwife, who talked about her work at the community-based Acton Africa Well Women Clinic in the UK.

Profile of Speaker

Juliet Albert is the Specialist FGM Midwife at Queen Charlotte's and Chelsea Hospital, part of Imperial College Healthcare NHS Trust. She set up and has run the Queen Charlotte’s FGM clinic since 2003. She also established, and is Project Lead for, the community-based Acton African Well Woman Clinic. It is a pioneering midwifery-led clinic where deinfibulation is carried out using local anaesthetic in a small GP surgery.

Project strategy and key points made in the presentation:

The Acton African Well Woman Centre is a community-based midwifery-led clinic for women who have undergone FGM. Acton in West London has a large Somali community so many of the women they treat are from Somalia - one of the countries with the highest rate of FGM in the world. It is a project funded by Ealing Primary Care Trust in partnership with Queen Charlotte's & Chelsea Hospital (Imperial College Healthcare Trust). It seeks to make treatment accessible and cost-effective, and is a service run by women for women.

The clinic carries out the de-infibulation procedure, a surgical procedure to open up the vagina closed due to FGM type III, in a GP surgery and is done under local anaesthetic in order to make the process as quick and stress-free as possible. They will also refer to hospital-based treatment and specialist trauma consultations when required.

Juliet Albert explains the need to provide support to women affected by FGM before they get pregnant as well as during pregnancy, as most women only get seen in hospital when they are pregnant and until then have suffered for many years with urinary tract infections, and painful periods caused by FGM. In addition, they realised there was a need to reach women before they get married: Women may have come to the UK at the age 7 or 8 and grown up in the UK. If they were still in Africa, they would be "opened" by their mothers-in-law or husbands before a wedding night, but this "service" does not exist in the UK. The clinic therefore provides the necessary de-infibulation procedure. The clinic receives over 1000 phonecalls a year from women who are getting married. Both the hospital-based clinic which Juliet Albert runs and the Acton African Well Woman Centre see 200 pregnant women and 100 non pregnant women every year.

The centre also has a specialist health advocate and a psycho-sexual counsellor. The centre also provides ongoing training and awareness sessions for Queen Charlotte’s and Chelsea Hospital and have provided training for Ealing Hospital’s midwives, health visitors, school nurses and other Ealing healthcare professionals including frontline non-clinical staff; and to student midwives at Thames Valley University.

The speaker explains that in order to reach out to women, especially women who were not pregnant, the clinic made an advert for Somali TV to give details of the free drop-in service. This was seen as an appropriate channel as many of the women do not speak or read English, or even read Somali. The advert resulted in a great increase in patients and since then the clinic has only relied on word-of-mouth to let people know about it's services.

Juliet Albert makes the point that it is important that the services fast-track women, seeing them within 2 weeks. These women have the courage to come and access help and if they are left to wait for 6 months, they will be forced to have forced penetrative sex, which can cause a whole range of further health complications.

Women also don't want to go to a male GP, so it is important that women can self refer and that clinics such as this one can bypass the GP referral system.

She stressed that this is "just the tip of the iceberg. We see women with complex perineal trauma....fistulas, they are in pain every day or their lives..." In light of this, she described some of the obstacles in providing holistic care to women in the UK due to slow referral systems for specialist gynaecological services, which means that women can wait for 6 months to see an expert to treat more severe conditions resulting from FGM. Another challenge is financial support. Although the clinic is being supported by the NHS, funding is always uncertain and they are always in need of more resources and more help.

Click here to view an interview with Juliet Albert on Somali TV.

Click here to view a BBC documentary on the work of the Acton Africa Well Women Clinic.

Overview of the "Supporting and Empowering Those Affected by FGM and Child, Early and Forced Marriage" session:

As outlined in the programme summary document handed out at the summit:
"This spotlight discusses the different types of services that we must ensure people affected by FGM and child, early and forced marriage have access to, highlighting the importance of providing a holistic package of support. The spotlight will showcase initiatives which provide medical, counselling and advocacy support, and programmes dedicated to supporting the needs of married girls. This spotlight will hear others’ experiences and discuss what we can learn from them."

As summarised by the panel organisers following the panel discussion:
"The panel of speakers shared their experiences of frontline service provision or programming to support those affected by FGM and CEFM. In discussions on FGM and CEFM, the need to break the cycle of shame were emphasised, and the need to listen to those affected. There was a lot of positive reflection that after many years of campaigning on these issues, people were finally getting a platform to share the reality of girls’ and women’s experiences. However it was agreed that much more needed to be done. There was consensus that a holistic response was needed, that services and programmes needed to consider women and girls whether pregnant or not, and married or not, and that although there were workable models out there to eliminate both practices, these needed to be scaled up."

The session was opened by Leyla Hussein, activist and founder of Daughters of Eve and Dahlia Project.

The speakers, in order of appearance, are:
Isobel Shirlaw Head of Justice Initiatives, Refuge
Dr Venkatraman Chandra-Mouli Department for Reproductive Health and Research, World Health Organisation
Jasvinder Sanghera CBE Chief Executive and Founder, Karma Nirvana
Dr Edna Adan Ismail Founder and CEO, Edna Adan Maternity Hospital and Chancellor, Edna Adan University
Juliet Albert Specialist FGM Midwife, Queen Charlotte’s and Chelsea Hospital (Imperial College Healthcare NHS Trust), London
Doris Bartel Senior Director of Gender and Empowerment, CARE USA

The session is moderated by Susan Bookbinder, journalist, broadcaster, columnist and media consultant with a particular focus on FGM.

Footage of this (available below) and other "Spotlight Sessions" are available on DFID’s YouTube channel.