Jennifer Scott worked hard to become a doctor. But when she faced the ills of women in the Democratic Republic of the Congo, she realized her technical skills weren’t enough.
“At the end of a long clinical day, I was able to interact with maybe 15 women and help them. But . how do I help them more?” asked Scott, a resident in obstetrics and gynecology at Harvard-affiliated Beth Israel Deaconess Medical Center.
Though the nonstop days as chief administrative resident would be enough for many doctors, Scott has taken on the additional role of a researcher for the Harvard Humanitarian Initiative (HHI), an interfaculty program that seeks to draw on the expertise of Harvard’s various Schools to improve humanitarian and disaster relief response.
“That’s where the research comes in,” Scott said. “The cases and the numbers give power to the women’s stories. [They allow you] to stand in front of organizations and say, “This is what’s happening. What can we do as a global community to stop this, or prevent this, or meet the women’s needs?”
Scott works with a small team of researchers on the HHI’s gender-based violence program in the Democratic Republic of the Congo (DRC). As part of a research team, Scott is involved in a retrospective records review, led by Susan Bartels, of victims of sexual violence who came to Panzi Hospital in the provincial capital of Bukavu from 2005 to 2008.
The Congolese women are caught in an epidemic of sexual violence that has swept the region during a series of armed struggles that began in 1996 and have cost more than 5 million lives. Some experts believe that rape in the region has become a weapon of war, with 200,000 women attacked over the past 12 years. The brutal assaults often go beyond rape and may include mutilation and violation with foreign objects.
The women who have been assaulted stream into Panzi Hospital seeking medical care and treatment from infections. Once there, they receive treatment, counseling, and for the most vicious assaults, reconstructive surgery.
HHI has been working with Panzi Hospital since 2007, when HHI visiting scientist Julie VanRooyen met Panzi Hospital founder Denis Mukwege in New York. After he described the plight of the region’s women, VanRooyen said she had to try to do something. What resulted was first a clinical collaboration between HHI and Panzi, administered through Harvard-affiliated Brigham and Women’s Hospital, and then a research project whose aim is to extract information from the intake records of women who’ve come to the hospital in recent years.
The work of Scott and other HHI researchers has begun to bear fruit. A review of one year’s records – 2006 – provides an outline of the violence. Unlike similar violence in other nations, that in the DRC is most likely to visit a woman at home, at night. Further, most women are gang-raped, and many are abandoned by families and communities after the assaults, complicating recovery. The statistical picture being drawn by HHI has attracted the attention of the United Nations and nongovernmental organizations.
Reaching out to understand
HHI Co-Director Michael VanRooyen, an associate professor of medicine and of public health and director of Brigham and Women’s Hospital’s Division of International Health and Humanitarian Programs, said that Scott brings a unique combination of skills and personality traits to the HHI research team. Despite being a typically overscheduled resident at BIDMC, Scott has taken on additional duties as chief administrative resident. Whether it’s writing up research results, creating presentations for review boards, or conducting research, Scott is always ready to help HHI.
“She’s absolutely unbelievable in her focus and productivity, combined with a wonderful, nice, serious personality,” VanRooyen said.
Jennifer Leaning, professor of the practice of global health and HHI’s other co-director, said that not only is Scott a fine physician whose patience and accuracy serve her well in a setting like the DRC, but she doesn’t forget why the research is being conducted in the first place.
“She doesn’t lose sight of the individual patients for the statistics, of why it takes six months for this person to come forward after being raped, or why they came unaccompanied from a place 70 miles away, on foot,” Leaning said.
Leaning said Scott is a good field researcher, describing her as tough and intrepid, and said she’s one of several at HHI who are specializing in the problems of this region, not only understanding the data, but also the language, the culture, and how to get around on the street.
Scott grew up in Colorado, the daughter of a University of Colorado hand surgeon who has lent his skills to some of the world’s poorest people living in Haiti.
She received a dual pre-med and economics bachelor’s degree from Middlebury College in 1999. Scott then took a break to travel and work before attending medical school, where she completed a joint M.D./M.B.A. program at the University of Colorado in 2005.
During the time off, Scott worked for a year with AmeriCorps in a community clinic in Denver. While there, she helped with the clinical work, developed a database of diabetic patients that tracked treatment and outcomes, and conducted outreach programs. In her travels she visited Southeast Asia and stopped in Australia and New Zealand. She returned to the United States for medical school interviews before leaving again for Central America.
Scott said the trip – particularly the Southeast Asia and Central America legs -was her first real exposure to the broad variation in economic situations that exist in the world and got her thinking about how difficult it might be for someone in extreme poverty to move beyond it. She also realized that in choosing her medical specialty she needed a skill, such as obstetrics and gynecology, that would be useful in whatever setting she found herself.
While the trip opened her eyes, she regretted she didn’t have the chance to really get to know the communities she passed through. In the summer of 2002, while in medical school, she remedied that, traveling to Ghana for two months to work in the small village of Humjibre. During her time there, Scott began to understand the cultural views that color women’s health issues.
“That helped my perspective during medical school. If we learned a new topic, a new disease treatment, I asked how you might do that in a place with no electricity or [in a place] where you might not have all of the technology or medication,” Scott said.
Scott started a four-year residency program at BIDMC in 2005. The program has five- to six-week blocks of time set aside for residents to explore possible career paths. During her first block, Scott worked at a Hamlin Fistula Center in northern Ethiopia. The center is dedicated to repairing fistulas, which are tears between the vagina and the bladder or the anus that occur most commonly from obstructed labor. Fistula repair is practiced infrequently in the United States since the advent of cesarean sections has greatly reduced their incidence. In the developing world, however, fistulas still occur regularly, and can leave women incontinent and in need of surgery.
The experience gave Scott more clinical knowledge about fistula repair, but she found herself wondering about the underlying factors that lead to the damage in the first place: early marriage and resulting pregnancies for women whose bodies are not fully mature, and a lack of access to health services that result in women laboring for days in childbirth far from medical care.
Though she could assist in a fistula repair, Scott realized that she didn’t know how to design programs to address their underlying causes. When she returned to Boston, she enrolled in “Humanitarian Studies for Residents,” a course partly taught by HHI Co-Directors Leaning and VanRooyen.
“I learned more about this region of the Eastern Congo and more about the details of what women of the Eastern Congo endured in the conflict,” Scott said. “I just couldn’t stop thinking about it. I just wanted to figure out a way to help them or contribute to the work that is being done.”
Scott got involved with HHI’s research during her next elective, in January 2008. She went to the DRC for the first time, joining Jocelyn Kelly, today HHI’s research coordinator, and Sadia Haider, division director of family planning at Beth Israel Deaconess Medical Center.
Scott dove into the records review research, examining and personally inputting data from 500 attacks that occurred in 2006, and analyzing data from many more. In February 2009, Scott returned again to the Congo and worked with local partner organizations to expand the review to encompass three additional years. She also trained three local Congolese data entry technicians to help speed up the input.
Scott, who plans to enter Brigham and Women’s Hospital’s two-year Global Women’s Health Fellowship in July 2009, said she’s surprised that the number of attacks doesn’t seem to have declined even though peace talks are ongoing. She thinks often not only about the women whose stories she’s read, but also about the fate of the many women who didn’t make it to Panzi.
“I feel initial sadness about the fact that this could take place and another human being could cause . such suffering. I feel angry that it’s gotten to this point and it’s still happening,” Scott said. “There are some days too when I feel naturally overwhelmed by the extent of the problem and understand that it’s deeply rooted. It’s not just sexual violence, it’s in the fact that girls don’t go to school, that they marry early, that their roles in the family and community are restricted. Conflict creates all sorts of new vulnerabilities for women who are already vulnerable.”
Scott said she learned a lot about compassion from her mother, who was always helping people down on their luck. Though she understands she can’t solve the Congo’s problems on her own, Scott knows she can still have an impact on lives.
“My mother, who would take anybody in, taught me to ‘be present’ for someone who is suffering. It doesn’t have to be a heroic gesture, it can be something small,” Scott said. “As one person, what can you do but to just be present: working with people, collaborating, being open to trying new things, being adaptive and responsive. I think with that sort of intention, something good could come for the people here.”