06 Mar 17 23 Jan 18

'You have been heard': A Canadian MSF nurse on delivering care to refugee victims of sexual violence


Courtney Bercan is a Canadian nurse who recently returned from working with Doctors Without Borders/Médecins Sans Frontières (MSF) on-board the search-and-rescue vessel Dignity I in the Central Mediterranean.

Courtney kept a blog chronicling her experiences delivering medical care to refugees and migrants rescued from failing smugglers' boats in the middle of the Mediterranean Sea. The piece below is an excerpt from a blog post she wrote last December, in which she describes meeting a young woman fleeing violence and poverty and the deep and lasting impact sexual and gender-based violence can have.

By Courtney Bercan

It feels a bit vulnerable admitting this to strangers who will come across it, but I always cry after a rescue. Always. Even though my predominant feeling about the work we do is positive. I’m proud to say it’s only taken me four years of nursing school and four years of working to learn to keep it together until after I leave work on an emotional day, but I usually manage to. On this mission, often it’s the day after we disembark our passengers, when the adrenaline levels decline that it happens. I never know what will set me off — for some reason it’s usually mopping and thinking about my siblings during the post rescue deep cleaning that does it. Or seeing a skinny stray dog. Or even just seeing the big, beautiful moon.

'A story that overwhelms my soul' 

I feel the compelling need to be off the ship immediately and in the middle of a beautiful British Columbian forest and I need it right this second. That being impossible, I try comedy, yet I can’t even make it through an episode of Parks and Rec before the rocking sea gets to me and I am sick in the bin of clean laundry beside my bed. I scrub the mess and try to sleep, but as I close my eyes it starts: a face that I cannot get out of my mind and a story that overwhelms my soul makes me sniffle and then sob.

I have been thinking a lot about the lady I wrote about in my first blog post. I have already met so many wonderful, strong, inspiring women who could be her on this journey, but I think the lady I wrote about was on this rescue. 

Her name is Mary* (changed to maintain confidentiality). She’s in her early twenties, but is easily mistaken for someone much, much older. She is from a country that is not war-torn or in the news very often, but one that is rife with poverty and has little opportunity for a woman from a poor family. When she first boards she appears quiet and forlorn. She falls asleep immediately and stays that way for several hours.

She consents to an HIV test and we find she is HIV positive. I can see the look of anguish on her face as she receives the news and her posture slumps even more than normal.

In the evening she asks me for a sweater, as she feels chilled even though the room is at least 35 degrees. I check her for a fever and she has none. It’s my first real interaction with her. It’s 9 pm. I’ve worked 14 hours and am ready to be done for the day. I am not rude to her in replying that it was not the time to ask for a new shirt and she should have asked earlier if she needed one, but if I am honest, I am short and terse. A few minutes later I reflect on how I responded and how miserable this woman looked and I fish a warm shirt that I think will fit her out of the bag of donated clothing and bring it to her. 

'A look of anguish'

The next day I am finishing an assessment with a patient when Pierre tells me that he has just seen Mary, who had vague, full-body pain with no apparent cause, and who after gentle questioning, admits to having been raped relatively recently. She consents to an HIV test and we find she is HIV positive. I can see the look of anguish on her face as she receives the news and her posture slumps even more than normal.

I complete her consultation by offering the stomach-turning combination of antibiotics she requires and offer to fill out a certificate attesting to the fact she has been seen by MSF for issues relating to rape. This experience is harrowing for the patient who often relives the aspects of the assault while relaying the details to me to record. She wants to have this form, but it’s been a long morning for her already and she is feeling sick. We make a plan for her to sleep for a bit then I will complete it with her later in the day.

She sleeps for nine hours solid. Finally, needing to close the hospital, I wake her at 9 pm that night to fill it out. 

This form usually has a legal importance, as it can be used if the woman wishes to pursue charges against the person who assaulted them. As the person who assaulted her is a smuggler, it will likely only help her to receive follow-up care in Italy. To say it bothers me that this woman will never receive judicial justice in this matter is an understatement, but it is the norm with so many victims of sexual violence we see, so I think of this form as saying: “Dear patient, what happened to you matters. It is real. You matter. You are strong. This is not your fault. You did not deserve this and the person who violated you in body and soul should be brought to justice. But even if they are not, please know that you have been heard.”

I tell Mary all these things after she tells me the full story of her violent and terrifying experience — that she has been heard, that she is strong, that she matters, that she did nothing wrong and that none of what happened to her is her fault.

“Dear patient, what happened to you matters. It is real. You matter. You are strong. This is not your fault. You did not deserve this and the person who violated you in body and soul should be brought to justice. But even if they are not, please know that you have been heard.”

No quick fix

This message is hard for me to deliver even in English, and I hope my mostly terrible French is conveying the exact message I am trying to relay. The woman's countenance has not changed — she looks completely defeated and like she has already had enough hardship for a thousand lifetimes in her 20-something years, but I see her eyes water as she hears me. It’s one of those moments where I know that unlike cleaning a messy wound, watching a fever dissipate, or even seeing a critical patient get medically evacuated, there is no quick fix here.

I am just a person trying to make something way beyond myself a little bit better and that is not usually possible. 

My normally messy writing becomes obsessively neat while I record the details of her experience on paper as though somehow my painstakingly carefully made letters will give more weight to the importance of this certificate when it is read by her, by law enforcement or by other healthcare providers in the future (as she chooses to disclose it, of course). I have to be satisfied that we have been able to find her, hear her story, provide her some physical treatment and a referral for future care as she leaves the hospital that evening. 

Antonia (the medical team leader) has arranged for extra follow up and support for Mary in Italy, and the next day she disembarks into the hands of people that I trust will treat her with the respect, kindness, and the competence that she deserves — but as I say goodbye and wish her well, she is still as downcast and slumped over as ever. We both know she has a long road ahead of her, even if she is allowed to stay in Europe.  

We say goodbye to the last of our passengers and do a basic clean of the ship. We have a few hours off and the crew and I have a bit of time in the port city to walk around and eat dinner. We chat and laugh and take silly pictures. We (ok, mostly I) eat multiple gelatos and return to the boat to set off again, and here I am where I started writing this: laying in bed, seasick and overwhelmed with the picture of this woman in my head.

I felt “off” all afternoon and attributed it to the four hours of sleep I had and the coffee my nervous system hates, but now I realize that I just feel horrible about what Mary and the other sexual assault victims we treated have been through. I feel terrible that I was short with her that first night, when I had no idea what her story was and wonder how many other times I let fatigue get to me and wasn’t as patient as I should have been.

I start to cry hard and call my mom, who through my worst moments and Skype connections around the world somehow always manages to make me feel okay about life again. We talk for a few minutes before the call drops. I give up on sleep and start to write this. 

Not always a happy ending

I wish the follow-up story about the woman who inspired my first blog was happier. I wish it was an uplifting and cheerful one (I have lots of those, as well). But this is the woman I feel like I was writing about and her story is so, so common.

I wish we didn’t live in a world where just by accident of birthplace, two women sitting side by side are separated by so much — one  has had a life of relative peace, health, and security, and the other has had a life of poverty, violence, and struggle.

I wish she didn’t have to battle to survive and fight to cross a desert then a sea to even have a chance at the benefits of a life I’ve always known. As usual it’s at this point in the downward spiral of my thoughts that I have to admit to myself that there is not much more that I can do in this moment than send her all my energy and wishes for strength, forbearance, future peace and happiness. 

So, to the woman who has just used all her money in the world to make a journey far from everything and everyone she knows, sailed from the shores of Libya in a horribly dangerous dinghy to the middle of the sea and onto the Dignity I, and then from our boat to the shores of Italy: I now know a tiny bit more about you, your life and your journey. I want you to know that you are strong. You are intelligent. You are beautiful and capable. You are resilient — your journey thus far and the little bit that I know about you proves that. I wish you things that I struggled to put into words when I was with you, and even now. I wish you all the absolute best for this life.

Bon courage, ma sœur.

Disclaimer: women pictured in the photographs are not the woman the author of the blog is writing about

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