Surgery Offers Hope to Mutilation Victims

KITGUM, Uganda – Sabina Abwo is a victim of one of the most horrifying tactics of Uganda's northern war: her lips and ears were sliced off.

Abwo said she believed she then would be killed by rebels, who abducted her when she ventured from a refugee camp to fetch firewood. Instead, the 30-year-old was sent back as a living, mutilated warning to others not to support the government.

Many of those mutilated over the 19 years the extremist Lord's Resistance Army has been fighting in northern Uganda are overcome with shame. Dust and flies get into ears and mouths that cannot be closed. Eating and drinking are clumsy exercises.

Now, there is hope for some. This month, in the first large-scale attempt, volunteer surgical teams gathered in this northern town to reconstruct the lips of 15 patients in an initiative of the international medical aid group Medecins Sans Frontieres, the Dutch government and the Dutch Interplast Foundation, which conducts reconstructive surgery in poor countries.

The medical teams will return every three to six months to provide follow-up care for the initial patients and to treat new ones. Organizers say they are not yet sure how long the program will continue, as that depends in part on funding and how many patients come forward.

Aid agencies had other priorities earlier as the war sparked disease and hunger that still kill 1,000 people a week more than would otherwise be expected to die in the region.

"Now the programs are settled in place and functioning ... there is room to look at such special programs," Christine Schmitz, Medecins Sans Frontieres director for Uganda, told The Associated Press.

Abwo, who was among the first 15 in the reconstructive program, will need more surgery but already was looking forward to a better life.

"There is great improvement when I eat, except for the lower lip," she said at Kitgum's St. Joseph's Hospital after doctors removed stitches from her lips.

Before, "I drooled all the time," said Abwo, a mother of seven. "It was difficult for me to socialize. ... People never laughed at me and they never teased me, but I had this sneaking suspicion that they were secretly doing that."

The volunteer team that operated on her included Dr. Kalanzi Edris, one of only two plastic surgeons in Uganda; Dutch surgeon Rein Zeeman; a Ugandan anesthetist from Kampala, the capital; and an anesthetist and nine nurses from this town.

At least 20 people showed up after MSF and other aid workers put out word that help was available. Doctors determined that only 15 could be treated because of limited facilities in this impoverished region.

Some victims could not be operated on because they received only rudimentary first aid after mutilation, leading to the infection of the wound and the formation of large scars.

Organizers decided to work in Kitgum to save the cost of transporting patients. They also believed patients would have a better chance of recovery in familiar surroundings, where relatives could lend support after surgery.

Lips were reconstructed from skin removed from the cheeks, Edris said. Damaged ears and other mutilations were not initially addressed, as these would have required more sophisticated equipment. Also, victims who had lost their lips were determined to be suffering more.

In a country that has known little peace since its 1962 independence from Britain, the mutilation victims are testimony to a war that has targeted civilians, many of them children.

The cultlike Lord's Resistance Army is led by a shadowy figure, Joseph Kony, and made up of the remnants of a northern insurgency that began after southerner Yoweri Museveni took power in 1986. The group has declared it wants to replace Museveni's government with one guided by the Ten Commandments. Its numbers are believed few, but it has thrived on creating fear.

The government also has been accused of atrocities and of herding civilians into camps to ensure the rebels find no supporters in the countryside.

According to U.N. estimates, the rebels have abducted at least 25,000 children, using them as fighters or sex slaves. The children are forced to slice off ears or lips, then told they will never be accepted back into their communities after taking part in such brutality.

Speaking in a barely audible voice, Doreen Aciro said she, Abwo and 11 other women were captured by rebels in March.

They were split into two groups and forced to march at least three miles into the bush. The rebels sought information on army deployment and the location of refugees, said Aciro, 40.

The rebel commander, who looked like he was between 17 and 20 years old, then pulled out a razor blade and gave it to a 10-year-old fighter, ordering him to cut the women's ears. He then told the boy to cut Aciro's lips and those of Abwo, who was standing next to her.

"I am very, very angry with these children because when they get you, they cut your fingers, ears, nose and even your limbs," Aciro said.

She needs multiple surgeries to enable her to close her mouth.