The night shift: Joining an ambulance ride for raped women
A call comes in at 4:58 p.m. The night shift hasn’t yet started, so the day team that has been working since 7 in the morning goes out.
We leave at 5:30. There’s no explicit rush. The 11-year-old isn’t bleeding. She’ll still be stunned at the administrative police station in Embakasi, a low-income neighborhood in Kenya east of Nairobi’s central business district, sitting in what looks like a school uniform, whether the ambulance gets her at 5:10, 5:15, or 5:30.
There’s a drop-off to make before we go get the 11-year-old. A woman at the clinic needs to leave. She looks to be in her late teens or early 20’s. I stand next to her outside the clinic, waiting to jump into the Land Cruiser. It’s parked with its back almost flush against the building. The driver needs to pull it forward before the woman can get into the back. In silence, we wait for the driver for a few moments. She’s better prepared for the misty, muddy Nairobi rainy season than I. She has on clean, closed-toed shoes while I am in worn Birkenstock sandals with the remnants of September’s navy blue polish on a few toes. I feel a bit shabby standing next to her.
I wonder if the woman’s been raped. She must have been. She’s here, and there’s no Médecins Sans Frontiers (MSF) logo on her clothes, but she seems too collected. I’ve interviewed rape survivors before, but never anyone it had happened to very recently. I didn’t realize I expected recent survivors to appear shattered, completely confused, half-drugged, maybe crying—definitely red-eyed.
MSF has been operating in Kenya since 1985. They opened a clinic dedicated to serving sexualized violence survivors in Nairobi’s Eastlands district after contentious 2008 elections wrought fighting and a subsequent uptick in rape. The clinic has become the biggest gender-based-violence project the organization runs in the world. It is part of a larger treatment facility that serves 2 million people across these poor neighborhoods in the capital of Kenya. MSF has four ambulances that traverse the area. One is solely dedicated to sexualized violence.
In 2016, MSF treated 2436 confirmed rape cases from this district. More than half of the victims were under 18. Nine percent were men. Seven percent were under 5 years old.
The ambulance and clinic’s busiest times are Friday and Saturday night between 5 p.m. and 12 a.m. It’s an early November Friday, and I’m here to ride in the ambulance for this peak time.
I get in the front with the driver, Aggry Mwalo and Paul Odera, the community health educator. It isn’t the time to ask what happened to the woman in the back. Mwalo, the ambulance driver, knows significantly more about the American electoral system than I do, so we talk about that. I try to keep up. We sit in heavy traffic. Of course there’s traffic—it’s a Friday in Nairobi and we’re on the road out of the collection of the teeming slums that make up Mathare, the neighborhood where the clinic is based.
The woman in the back doesn’t have a home. She’s been staying at the MSF shelter for the past few days, but the shelter is meant to be a temporary rest stop so she’s being brought to a safe house where she can stay longer. It takes a while to find the place. Odera gets on and off the phone with the shelter’s coordinator. Eventually, we get to a parking lot, and she’s handed over to a welcoming-looking woman.
Once she’s out of the car, Odera explains to me that the woman is a Congolese refugee with nowhere to turn. Earlier this week, three men raped her. Six percent of the survivors that come through the MSF clinic are refugees.
Now we head to the police station in Embakasi to pick up the 11-year-old girl. We inch southeast. Odera is getting calls from the base checking on our status. The people taking over the night shift have arrived and the transition needs to be made. We’re a speck in an ocean of traffic, though. The entire trip is only 12 miles, but that will take at least an hour. The day staffers are going to leave late.
It’s dark by the time we make it to the station. The girl is inside with her mother. A few uniformed policemen amble about, their voices echoing against the concrete walls.
When the clinic opened, MSF circulated the number for the sexualized violence ambulance at police stations, local NGOs, and schools. They hosted discussions and gave out contact information. To avoid stigmatization and to keep their employees safe, the organization requests that survivors meet them at a police station or other safe public space instead at a private home.
Back at the clinic, after 8 p.m., the 11-year-old girl starts in the medical area, which is called the Blue House, to get her vitals taken before she’s sent to the adjacent Lavender House, the sexualized violence center, to meet with a counselor and a clinician. Once she’s behind a green screen having her heart monitored and blood pressure taken, I learn that her stepfather had raped her.
Fifty-three percent of the women and girls, men and boys that come to the clinic know their assailant.
We don’t stay more than a few moments. A 2-year-old in the nearby Shauri Moyo neighborhood needs picking up. The shift switches.
Traffic has cleared, so this ride doesn’t take long. The mother, wearing a Detroit basketball jersey, is standing outside a partner clinic with a chubby-cheeked toddler on her hip. The little girl’s skin is smooth as only a baby’s skin can be. She was “defiled” (as the health educator phrased it) by her 4-year-old brother.
In cases like these, MSF advises that the both children receive therapy. The little boy couldn’t know what he was doing, says Josephine Kamau, the health educator on the night shift. She says that the boy must have been acting on something he’d seen before.
Shauri Moyo is closer to Makadara Primary Health Care, a public clinic that has satellite services with MSF staff on site, than the Mathare base, so we’re going to take her there.
The gate is locked and the lights are off when we arrive. The driver beeps a few times. Kamau huffs and explains that because of the ongoing nurses’ strike the security guards are lax, wanting to make it clear that the hospital isn’t open. Only NGOs can get inside. Since June 5, nurses have been boycotting work, demanding that the government honor a collective bargaining agreement. Right now only private practices and people paid by NGOs are at work. Tonight, the people working at Makadara and the other satellite program, Mama Lucy Kibaki Hospital, are paid by MSF. Sometimes pregnant women give birth outside, at these very gates the educator says. According to the Daily Nation, a national newspaper, the number of Kenyan mothers dying from complications of childbirth has doubled this year.
I stay with the ambulance at until 12 a.m. The drop-off and pick-up rhythm continues steadily the entire time.
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