Image copyrightBENOIT DE FREINEImage captionAbdula Libenge holds a picture of his missing daughter
A court in Belgium is investigating an orphanage for alleged abduction and trafficking of children from the Democratic Republic of Congo. Children were brought to Belgium and adopted by families who had been told they were orphans. Years later, DNA tests have proved that in some cases they were not.
Hundreds of miles north of DR Congo’s capital, Kinshasa, is the village of Gemena. Most people make a living from agriculture or fishing; others are carpenters or shopkeepers.
Abdula Libenge, a 34-year-old tailor, is the father of one of four families in the area who in May 2015 sent a child away to Kinshasa on what they thought was a holiday camp.
Their children never came back. Without access to legal representation or assistance from local authorities, all they could do was wait.
About two years after Mr Libenge’s daughter disappeared, he received an unexpected visit that would finally shed light on what happened.
Belgian journalists Kurt Wertelaers and Benoit de Freine had got wind of an inquiry beginning into adoption fraud in their country.
How the two journalists uncovered a scandal
The Belgian public prosecutor had strong indications that the biological parents of a number of Congolese children adopted in Belgium were still alive, and the pair had set out to find them.
Image captionThe two Belgian journalists: Kurt Wertelaers (L) and Benoit de Freine
Their search led them from Brussels to Abdula Libenge’s workshop in Gemena.
He took them inside and produced a picture of his daughter.
“Taken on the day she left for Kinshasa,” he told them. “She was so happy. We’ll never get the chance to go to Kinshasa. We can’t afford the plane ticket. But she got the chance, and it made us proud.”
It was one of several photos of the group of three girls and one boy, then aged between two and four.
One photo shows them with a young man from a youth organisation, their chaperone to the so-called holiday camp.
“All we have left is this picture and a shoe,” Mr Libenge continued, producing a tiny, white ballet pump for the journalists.
Image copyrightBENOIT DE FREINEImage captionSuriya Muyombe in the village of Gemena holds a picture of her missing daughter
Outside another home Suriya Moyumbe was waiting in tears, clutching a picture of her daughter, who was a toddler when she left and could not yet talk.
“My husband’s family blames me for giving her away for that holiday. I should never have done that. But we all thought it was a great opportunity,” she told the reporters.
Wertelaers and De Freine returned to Brussels to present their evidence and the public prosecutor then travelled to Gemena to gather DNA.
The Tumaini orphanage in Kinshasa has since been shut down.
Belgian-Congolese lawyer Julienne Mpemba is under house arrest and facing criminal charges for her role as head of the orphanage.
Her lawyer, George Balon Perin, has said she “challenges in the clearest way the charges against her”, adding that she is not being prosecuted in DR Congo, where the alleged events took place.
Other people have been indicted both in Belgium and DR Congo, the lawyer has told the BBC.
‘Slap in the face’ for new families
In Belgium, the news was broken to adoptive families one by one.
Some adoptive parents had already voiced their concerns during the adoption process, and told the BBC the news confirmed their fears.
“Knowing DR Congo’s reputation, I was very afraid, but the adoption agency really pushed us towards it and reassured us everything would be legal,” said one father, who declined to named.
“It felt like a slap in the face when we heard. This is what I had always wanted to avoid. And now, despite myself, I have a stolen child.”
One mother described how the agency had poured water on her concerns every time she raised objections. Then one day, her adopted daughter had enough French to start talking about her biological family.
“Once she said ‘you’re not my mummy, Mummy’, when we were reading a fairy-tale.
“I raised the alarm immediately but was dismissed. I thought she might have been talking about an interim, host mother that she had been living with before coming here. But no. It was her mum.”
When the story broke in Belgium, four children were involved. Now, the adoptive parents of a further 15 children are awaiting the outcome of DNA tests.
Why international adoptions can be a risk
“There are people who did not do their job, people who might have benefited financially or in some other way,” says lawyer Georges-Henri Beauthier, who is acting for three of the adoptive families.
“You have to see all of these people collectively as a truly criminal organisation, that is well organised in DR Congo and in Belgium.”
Facts and rules
Inter-country adoption begins as ad hoc humanitarian solution after World War Two
By 1980s, critics complain it has become a lucrative industry
All countries that receive adoptees are signed up to this treaty by law
Such adoptions should take place in the “best interests of the child and with respect for his or her fundamental rights”
More and more countries that send adoptees have signed up. DRC is not one of them
According to child protection expert Nigel Cantwell, these are not isolated cases.
“There is always a bit of anarchy in adoption when you’re dealing with a country which is not party to the Hague Convention, as is the case for DR Congo. There are so many examples in recent years: Haiti, Guatemala, Vietnam, Cambodia. The list is just huge.”
He believes intermediaries, including children’s homes, need regulating and, if possible, removing from the process. “They are the ones making money. Unless you control the money, you won’t control the corruption.”
What will happen to the children?
A Belgian family court will ultimately decide on the children’s future.
“It’s case by case, but any solution should depend enormously on what the child says. We can’t just go about taking decisions on what we think is good for a child without getting that child’s opinion,” explains Mr Cantwell.
Image copyrightBENOIT DE FREINEImage captionThe families in Gemena see little hope of getting their children back
For everyone involved the next stage will be hard, and Mr Beauthier says the adoptive parents are preparing themselves for it.
“There is this human reflex which is to say ‘no, no. This is my child, I won’t let her go.’ No. That would be unacceptable, and my clients understand this full well.”
For one adoptive father there is no good outcome.
“We really ask ourselves: what is best for this child? And we don’t have the answer. But there isn’t really an answer. We’re all losers in this story.”
In Gemena, Abdula Libenge had little hope of his daughter coming home.
“I know people will say that she is better off in Belgium. And you know, maybe she is, but I don’t think it was up to anyone else to make that choice. And we didn’t get one.”
Kamala talks about going after Joe Biden during the last democratic debate,
Donald Trump siding with dictators over the United States intelligence community, his obsession with the four democratic congresswomen, his abuse of power, the vote to provide 9/11 first responders with benefits, Medicare for all, pharmaceutical companies charging way too much for prescription drugs, political polls, and she reveals what she’ll do if she becomes president
Cara Charles Banks, the head of the hospital which treated victims of the Salisbury nerve agent attacks joins nurses, psychiatrists, cancer specialists and family doctors and is among more than 30 local and national NHS workers recognised in the 2019 Queen’s Birthday Honours.
The NHS at its best: leading the world and leaving no one behind. Don’t let anyone tell you that getting in to government does not matter. Government is not an idea: it is lives saved, potential fulfilled, a country for everyone.
Kyle Knight :Researcher, Lesbian, Gay, Bisexual, and Transgender Rights Program @knightktm
It wasn’t until the 1980s, after a series of nervous breakdowns, that Bo Laurent—then in her 30s—set out to investigate the source of her deep distress.
The truth, when it finally came, was both liberating and traumatizing: Bo discovered she had been born with atypical genitalia, which surgeons had operated on to make her look—arbitrarily—more typically female, inflicting irreversible harm on her in the process, and telling her parents that they should never reveal to Bo the surgery she had undergone as an infant.
Intersex and the City|Huffpost||
Doctors had told Bo’s parents, and Bo herself once she found out, that her condition was so rare there was no one else like her. But after learning the truth from her medical records, and as she traveled the country telling her story, she found this was untrue. Her California mailbox began to fill with letters from people describing similar experiences.
In 1993, Bo, using the name Cheryl Chase, founded the Intersex Society of North America (ISNA) to meet and help people who, like her, were born with biological sex characteristics that fall outside typical definitions—that is, their chromosomes, gonads, or internal and external sex organs differ in some way from what science and society have long deemed to be “male” or “female.”
ISNA became an eddy of activists, a support group for traumatized people who had more questions than answers, and the birthplace of momentous historical agitations such as “Hermaphrodites with Attitude.” Their mission was to convince the medical establishment to respect intersex people’s rights to health and bodily autonomy by stopping “normalizing” surgeries on children before they were old enough to understand the procedures and consent to them.
Speaking Truth to Power
ISNA’s message was not anti-doctor, or even anti-surgery, but pro-informed consent. Operations to alter the size or appearance of children’s genitals risk incontinence, scarring, lack of sensation, and psychological trauma. Surgery to remove gonads can amount to sterilization without patients’ consent, and then require lifelong hormone replacement therapy. The procedures are irreversible, severed nerves cannot regrow, and scar tissue can limit options for future surgery.
Bo and the other early ISNA participants believed the truth would soon set them—and future generations of intersex people—free. Their thinking, as Bo told me when we first met in the fall of 2016 near her home in Sonoma county, California, was: “As soon as we get our stories out there, this will all stop. Once doctors realize the harm they’ve done, they’ll change their minds and methods.”
But it wasn’t that simple.
Convincing the medical establishment proved to be significantly more complicated than anyone expected.
A change in medical paradigms requires a shift in understanding what the medical evidence shows—in this case, an acknowledgment that, although empirical data remains incomplete, there is now substantial evidence that medically unnecessary surgery on infants and young children with intersex traits often causes significant harm. Conversely, there is little evidence of its putative benefits, and certainly no empirical basis on which to conclude that the supposed benefits are real, let alone that they outweigh its harms.
But it’s not easy to suggest that doctors are engaging in practices that violate their patients’ basic rights—the white coat signals a lot. As an endocrinologist in Boston told me: “Aside from clergy, who else in our society but doctors do people listen to about the heaviest life and death, sickness and health questions?”
The Default-To-Surgery Paradigm
The medical paradigm that ISNA was up against had calcified in the US in the 1960s when John Money, a psychologist at Johns Hopkins University, theorized that gender in infants was malleable and surgical interventions could unproblematically determine lifelong gender identity. Operations on intersex bodies had been conducted sporadically around the world in prior decades, but it was Money’s infamous 1967 case of recommending female sex assignment surgery on a male baby following a botched circumcision that cemented the theory as the default medical practice.
There were no clinical trials, no consideration of the potential risks, just a hypothesis from an elite practitioner based on his marquis case—which became known as “John/Joan”—driving the theory’s momentum. The outcome was, in fact, disastrous. In 1997, the patient’s psychiatrist and a sexology professor in Hawaii exposed the trauma the boy had suffered, and how Money had knowingly distorted the truth in his publications. The child had, in fact, not grown up to identify as a woman, but a man—and transitioned in his 20s.
In 2004, the patient, David Reimer, committed suicide.
The default-to-surgery paradigm, however, had already become entrenched and, in fact, was already being exported around the world.
Despite the horrors of Reimer’s story, Bo and ISNA continued to believe there was no reason to demonize doctors. The goal was to tell the stories of people who had undergone medically unnecessary surgery at an early age, explain to the medical community the destruction these surgeries had done to intersex people, and detail how surgery had failed to deliver the supposed benefits of “normalcy” and happiness.
This was their tactic to move the needle and start advocating to help intersex adolescents and adults seek the care they actually wanted. And then, the thinking went, the non-consensual surgeries would stop, social awareness would garner acceptance, and the intersex community could flourish.
“We were naive,” Bo said 25 years later.
Resistance and Inertia
ISNA only ever staged one public protest—in 1996 in Boston, at the annual conference of the American Academy of Pediatrics (AAP). It was a small group, and many participants were allies, but it struck a chord. The anniversary of that protest, October 26, is today marked as Intersex Awareness Day worldwide.
Although Bo herself was invited as a keynote speaker at an AAP conference as early as 2000, even having a seat at the table did not have linear impact.
“Doctors [would tell] me that the parents of intersex kids they’d operated on were happier than the parents of kids whose lives they’d saved,” Bo said, adding that most doctors could not say how the patients themselves felt about it once they reached adulthood because the doctors simply didn’t know—they had lost touch with them.
Bo and other advocates made compromises along the way, some of which led to rifts in the community. During my research on intersex issues around the US, I heard a range of opinions, for example, on what happened in 2006 when Bo agreed to work with a group of physicians on the “Disorders of Sex Development Consensus Statement”—a collaborative paper produced at a conference in Chicago.
An intersex activist in her 60s told me she left the movement when ISNA “allowed the high priests of medicine to call us, ‘disordered.’” Another said he understood the compromise to get a seat at the table, but was disappointed it never produced results: “We’re still seen as freaks that need to be fixed 20 years later.”
In the past decade, activists have worked to claim the space that the “DSD” consensus statement staked out. They quickly replaced “disorders” with “differences”—and today human rights bodies and even a handful of clinics use that language as well. But the default-to-surgery paradigm persists.
A father of a two-year-old child with intersex traits who is a clinical psychologist told me: “If you want to fuck somebody up psychologically, start calling a part of their body deformed and then see how that works out. The whole idea of disease and even the message the surgery sent is that there was something wrong that we had to fix.”
New Words, Same Ways
Despite shifts in terminology, and despite increasing controversy even within the medical community, the cohort of doctors who specialize in intersex treatment has largely clung to the default-to-surgery paradigm. The tone has changed: at least in their writing, doctors now mostly avoid construing surgery as a “quick fix” but rather a “legitimate option.” Teams of specialists— “DSD teams”—that sometimes include mental health providers typically meet with parents as part of the decision-making process.
But despite these advances, the surgical status quo remains largely intact. And medical justifications for cosmetic surgeries ring increasingly hollow.
For example, a 2015 article co-authored by 30 DSD healthcare providers reflecting on genital surgeries stated: “There is general acknowledgement among experts that timing, the choice of the individual and irreversibility of surgical procedures are sources of concerns.” It continued: “There is, however, little evidence provided regarding the impact of non-treated DSD during childhood for the individual development, the parents, society….”
Too often, as in the article by the 30 DSD doctors, the absence of evidence becomes part of the justification for continuing early surgery. The social hypothetical—fears of stigma for the child and chaos for family and society if surgery is delayed—continues to trump the actual harm that people who have undergone surgery suffer.
The foundational medical principle—“do no harm”—seems to dictate exactly the opposite: a moratorium on medically unnecessary cosmetic surgery on intersex children too young to consent unless and until there is evidence that the benefits outweigh the harms.
Real Risks Versus Hypothetical Happiness
There is now a growing body of outcomes data showing that early surgery can lead to physical and psychological harm, if not catastrophe, for intersex people. One of the many risks of “normalizing” surgery is assigning the wrong sex. Add to that the risk of needing additional surgeries to repair mistakes (I interviewed one person who had undergone 39 surgeries to keep his body functioning after a cosmetic operation in adolescence damaged him).
Then there’s scarring, incontinence, loss of sexual sensation and function, psychological trauma including depression and post-traumatic stress disorder, the risk of anesthetic neurotoxicity in young children, and the need for lifelong hormonal therapy.
In 2017, Dr. M. Joycelyn Elders, Dr. David Satcher, and Dr. Richard Carmona, all former US surgeons-general, wrote that they believed “there is insufficient evidence that growing up with atypical genitalia leads to psychosocial distress,” and “while there is little evidence that cosmetic infant genitoplasty is necessary to reduce psychological damage, evidence does show that the surgery itself can cause severe and irreversible physical harm and emotional distress.” They said: “These surgeries violate an individual’s right to personal autonomy over their own future.”
Despite the data, many physicians who perform the surgery continue to be unmoved. A New York urologist unabashedly published a paper in 2007 documenting how his clitoral surgeries were proven effective and “nerve sparing.” The evidence he offered was produced by inserting vibratory devices in post-operative patients—in some cases, seven-year-old girls—and asking them how strongly they felt it.
More recently, in July 2017 when a hospital in South Carolina settled a medical malpractice suit for its surgery on an intersex infant for nearly $500,000, a psychologist with more than 20 years of experience with intersex patients dug in his heels and defended the status quo. “I never question people’s experiences,” he said. “What I do question is whether their experiences are generalizable to others.”
Bioethicists have documented physicians’ reluctance to change the status quo for decades. Katrina Karkazis, an ethicist at Stanford, wrote in her 2008 book on the topic a number of “folk myths” that doctors perpetuate: “[A]s increasing numbers of studies have begun to demonstrate poor surgical outcomes, some surgeons and other clinical specialists discount even these findings,” she wrote, explaining that doctors believed their surgical techniques were always improving so data from past patients was irrelevant.
Karkazis wrote: “By charging that adequate studies are impossible because they will always assess old techniques, surgeons and others deflect current as well as future scientific and anecdotal evidence of poor surgical outcomes.”
In 2015, when patient advocates and ethicists publicly resigned from the largest research initiative on intersex healthcare to date—a multi-site university hospital project funded by the National Institutes of Health—citing frustration with the continuation of medically unnecessary surgeries on intersex children, one bioethicist wrote in her resignation letter that she was finished with “being asked to be a sort of absolving priest of the medical establishment in intersex care.”
Ending Unnecessary Surgeries
The experience of those who have undergone early surgery and the principles of medical ethics suggest that doctors should weigh evident harm over hypothetical benefits. The real question doctors should be asking is how many more of their patients need to suffer before medically unnecessary surgeries end.
Medical and policy leaders have noted the need for a fundamental change in approach. United Nations human rights experts; the World Health Organization; Amnesty International; Physicians for Human Rights; every major lesbian, gay, bisexual, and transgender legal organization in the US; the American Medical Association Board of Trustees in 2016; three former US surgeons general in 2017, two US pediatrics associations later that year; and intersex-led organizations around the world have called for an end to medically unnecessary non-consensual surgeries on intersex kids.
Many providers who care for intersex children have become increasingly uncomfortable with the current paradigm, but there remains a lack of clear, centralized standards of care for intersex patients.
And so the inertia persists. ISNA has dissolved and Bo has retired from activism, but a new generation of intersex people, whose bodies were operated on decades after Bo’s, have taken up the fight. For Intersex Awareness Day 2017, activist Pidgeon Pagonis staged a protest outside the Chicago hospital where, as a child, Pidgeon’s clitoris, vagina, and gonads were all surgically altered without Pidgeon’s consent.
The hospital issued a public statement saying it was “committed to open communication with the Intersex community and fully respect the diversity of opinions that exist in affected individuals.” But a leaked internal communication struck a rather different tone, perhaps revealing why doctors continue to perform these surgeries decades after they became controversial even within the medical community. In it, the hospital called the protesters’ demands “extreme,” and said the group was targeting hospitals across the country.
Bo told me: “No one has proven that the interventions are necessary to do on an infant…. Even if you find some people who had early surgery who are happy, that doesn’t mean it’s safe or necessary…. There are probably happy people. But there are a lot of very unhappy people—ruined people.”
Alabama abortion doctors could face up to 99 years in jail in newly approved state abortion ban
The Alabama House passed a near-total abortion ban, refusing to allow an amendment for cases of rape and incest. The bill’s author said the legislation is a “direct attack” on Roe v. Wade.
Alabama Gov. Kay Ivey signs new abortion restrictions into law on May 15, 2019.OFFICE OF THE GOVERNOR OF ALABAMA
Alabama Gov. Kay Ivey just signed the state’s controversial near-total abortion ban. The new law is the most restrictive anti-abortion measure passed in the United States since Roe v. Wade was decided in 1973.
The legislation — House Bill 314, “Human Life Protection Act” — bans all abortions in the state except when “abortion is necessary in order to prevent a serious health risk” to the woman, according to the bill’s text. It criminalizes the procedure, reclassifying abortion as a Class A felony.
