While working with Doctors Without Borders in a country where abortion is illegal, OB-GYN Veronica Ades is falsely accused of performing an abortion.
Veronica Ades, MD, MPH is a board-certified obstetrician-gynecologist. She completed her
Doctor of Medicine degree at the State University of New York at Downstate in Brooklyn, NY, and a Master’s degree in Public Health with a concentration in Quantitative Methods at the Harvard School of Public Health. She completed residency training in obstetrics and gynecology at the Albert Einstein School of Medicine in the Bronx, NY, and a fellowship in Reproductive Infectious Disease at the University of California, San Francisco. Dr. Ades also completed a Certificate in Comparative Effectiveness at the NYU School of Medicine. Dr. Ades has worked with Médecins Sans Frontières/Doctors Without Borders on assignments in Aweil, South Sudan in 2012 and 2016 and in Irbid, Jordan in 2013. Dr. Ades is currently an Assistant Professor of Obstetrics and Gynecology and Director of Global Women’s Health at the New York University School of Medicine (NYUMC). Her clinical work is at the New York Harbor VA, Gouverneur Health, and Bellevue Hospital. She is the Founder and Director of the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence at Gouverneur Health on the Lower East Side. Dr. Ades conducts research on sexual- and gender-based violence and trauma, and runs the Empower Lab at NYU. Read her blog here.
This story originally aired on August 29, 2018 in an episode titled “Abortion: Stories from doctors and patients - Part 2.”
Story Transcript
So in 2009, I moved to rural Uganda to do a fellowship in reproductive infectious disease. I was studying malaria and pregnancy or how malaria affects the placenta when a pregnant woman is infected and it can lead to a whole host of bad complications for the fetus and the mother.
I lived there for three years on and off and in order to do the research, we set up a research facility on the ground of a rural district hospital. The hospital had a referral catchment area of about 500,000 people. To serve the hospital they had two doctors. That’s it. The research facility had eleven doctors, so that seemed unfair.
So in order to rectify that just a little bit, I got a Ugandan medical license and I started working in the hospital. I got permission and I worked on the maternity ward and female surgical wards. I basically ended up taking them over because there really wasn’t anyone else to do the work.
I work with seventeen wonderful Ugandan midwives and they really knew their stuff so they would just call me for C-sections or complicated obstetrics or high-risk pregnancies. It was wonderful.
But I also in Uganda stood out like a sore thumb. Not just my blindingly white skin but also my nearly incomprehensible American accent, my totally weird clothes, and the fact that I liked funny things, like I preferred to buy an old retro moped instead of like a fancy new Bajaj Motorcycle that would have cost the same amount. Nobody could figure out why I wanted that.
But Ugandan culture is very live and let live. I found it to be a lot less judgey and intrusive than American culture so people just figured, “Okay, you do you.”
It helped that I was a mzungu, which is the word for foreigner, because they could write it off to me being a mzungu. It’s an affectionate term. It’s not really derogatory and so I embraced the term. I put a little sign on the back of my very slow, old moped that said ‘Mzungu’ and then all of the fancy motorcycles that were passing me would honk and wave and laugh.
When I would be late on rounds, my patients would say, “Where is my mzungu doctor?” So it was fine. I was like this weird mzungu.
This one day I was leaving work and I ran into a colleague, Emmanuel, who’s a wonderful Ugandan doctor and he asked me to come and see a patient.
He said, “How pregnant do you think she is?”
I looked at her little belly bulge and I said, “About sixteen weeks?”
He said, “I think so too, but she thinks she's two months. Sixteen weeks would be four months.” And he said, “And she wants an abortion.”
Abortion is illegal in Uganda. It doesn’t mean they're not done. They’re done everywhere, actually. There's plenty of people doing them in town, outside of town, everywhere. Everyone knows who’s doing them. There are many hospital staff who are doing them and it’s just done clandestinely, as they call it.
Some of the people doing them are pretty good at it. They're safe. And some are not so great. But it’s accessible. So when I moved there, I had to decide was I going to do abortions or not. I do them in the United States. I’m trained to do them. And I hope that if it was ever illegal in the United States, I hope I'd be brave enough to keep doing them.
But Uganda is not my country and they were not my laws to break, so I felt more ambivalent about doing that. but also if I were to get caught doing an abortion in Uganda, it would compromise everything we were doing in this research facility. We were doing a lot of good for women and children with HIV and with malaria, so I really couldn’t take that chance. I made the hard decision not to do abortions while I was in Uganda and that meant I had to turn down some really tough cases.
Emmanuel and I didn’t want this woman to feel judged for wanting an abortion so we explained to her that we were okay with it but that we couldn’t offer it to her, that we thought she was too far along and we wanted to do an ultrasound. There wasn’t an ultrasound available that evening so we told her to come back the next day.
She didn’t speak English. She only spoke the local tribal language Japadhola, but she had an attendant with her, a friend who spoke English and Japadhola and the woman translated.
The next day, the woman came back by herself and I did the ultrasound and she was sixteen weeks pregnant and that’s second trimester. She didn’t bring the friend so I took her to the interpreter from our research facility and I had him tell her that I strongly recommended that she not seek an abortion anywhere because an untrained provider could really do a lot of damage at sixteen weeks. She could end up having hemorrhage or sepsis.
I knew she had five children at home to take care of that’s why she wanted the abortion but that it would be too risky and she would risk leaving them without a mother.
So he did that and she left.
The next day I was juggling the research facility and rounding on maternity ward when I got a call from a man named Sam who’s the senior hospital administrator. Really nice guy. A non-physician who helps run the hospital and had always been really good to me. He asked me to come to his office urgently.
It’s pretty unusual for him. He doesn’t really ask that so I took it seriously and I pretty much dropped everything and went over there.
When I got to his office there were four men in the room already and they were talking. Sam was talking them and he didn’t stop when I walked in to greet me, which was my first clue that something was off because in Ugandan culture it’s very important to greet people, it’s very formal. You always do a handshake. It’s very warm. So it was really weird that Sam didn’t stop immediately and introduce me.
I knew something was up and I’m trying to understand what they're talking about but I can’t really follow. So I’m looking around the room and there's four men there and they're all dressed in identical polo shirts with this embroidered logo that says Uganda Life International.
As an American, my hackles are raised anytime an organization has ‘life’ in the name because I know what that means. It’s an anti-abortion organization. Maybe I’m wrong because this is Uganda, but probably not. But I’m not worried because I don't do abortions in Uganda, so whatever.
I also look further around the room and realized that the woman that I had done an ultrasound on is in the room, but she doesn’t look very happy to be there. Her eyes are downcast and she looks miserable. I don't know. Something is weird.
Finally, the men and Sam explain to me that they say that they have an informant who says that I did an abortion on this woman. That’s easy to clear up. She's still pregnant so I say, “Let me clarify. I did see her and I had her come back for an ultrasound.” I didn’t say she was looking for an abortion because I don't want to get her in trouble. I said, “I did an ultrasound and that’s it. We didn’t do an abortion. I don't do abortions here.”
Sam said, “Oh, great. Doctor has clarified and we can all finish. Great.”
The man in the front who has claimed to be a pastor says, “No. We cannot finish because she has shown no remorse.”
I was kind of taken aback. Why so angry? He was really vicious.
The conversation pretty much deteriorated from there. The men all started chiming in and kind of yelling toward us and making accusations and Sam really tried to fend them off and protect me. I just thought this is kind of nuts because she's still pregnant. It’s so obvious that I didn’t do an abortion but they were so angry that it was very irrational. But I also realized that they were there to accuse me and nothing was going to dissuade them, so that was pretty awkward.
Sam was doing his best and I’m sort of trying to chime in but I don't really know the cultural thing of how to have this argument. And I start wondering who’s this informant that they say that they have? Is it the attendant? She's not there and she wasn’t there the second day. The one who translated or could it be like a spy on the hospital grounds? That seems weird. Or could it be the person who translated for me from the research facility? But he's always been great to me and that would be crazy. I just can’t figure it out. The woman herself doesn’t look very happy to be there.
So as we’re trying to hash it out, I notice that they're using all these legal terms but they're using it wrong. It’s weird because one of them claimed to be a police officer and one claimed to be a legal officer, whatever that is, but then they're saying weird things.
When I say, “I couldn’t have done an abortion because she's still pregnant,” one of them says, “Well, it doesn’t matter because you had criminal intent and criminal intent is still criminal.” And I was like, “That’s not how criminal intent works, dude. This is so irrational.” But they're really angry so maybe rationality isn’t going to help.
Then I realize that there was actually a witness in the room and the woman herself is a witness. I suggest that maybe we should talk to her. So I ask if anybody speaks Japadhola so that we can hear from her. The men all kind of look at each other and it turns out nobody speaks Japadhola and nobody has ever talked to the woman so we can’t actually ask her anything.
Then I realize there was another witness in the room which is Emmanuel, my friend who’s the doctor. So I call him and I tell him it’s an emergency. I didn’t tell him what it is. He doesn’t ask. He comes right away.
The men are still arguing and Emmanuel walks in the room and they don’t even let me tell him what’s going on. But Emmanuel doesn’t want to hear it. He walks right in and he goes, “Good afternoon. I am Emmanuel. I am the Director of the IDRC Malaria Research Center in Tororo, and you are…?”
He shakes the pastor’s hands and all of the men’s hands very formally. For the first time they're kind of like stunned into silence, which hadn’t happened yet. They're a little bit cowed. They're still trying to accuse me of having done an abortion but the tone is really different. It’s not vicious anymore.
Emmanuel doesn’t want to hear it ag.ain from them and he says, he explains what happened the day that we saw the woman and counsel her, but he doesn’t say also that the woman came for an abortion. He just says, “We did an ultrasound.” Exactly what I said because it’s true.
The men keep trying to say that they have an informant and he then kind of goes off on them and he says, “You know what? I am angry. I am very angry. I am angry because you bothered this doctor, that you called her without calling me. You should have called me first. I am the Director of this research center. Everybody in this hospital knows me. Everybody in this community knows me. And you know you should have called me. So I am angry that you took her away from her work. She has important things to do. You should have called me. It is disrespectful.”
The men are shocked at this point. And I was shocked too. He was really good.
Then Sam sees that now this is going well and he jumps in and he says, “I am embarrassed. I am embarrassed how am I going to apologize to this doctor who has done so much for this community? Not just the patients, not just the staff in this hospital but the entire Tororo community.”
I was like, whoa, this is amazing. You know, you have to do this show and so the men really kind of are backtracking, like, “Well, we weren’t really saying that. It’s okay, actually.”
So I realized that Sam and Emmanuel have my back. And they're still going. They're still going off on them and I can sort of take a minute and breathe.
I start thinking it’s still scary. This is absurd but these men seem powerful in town. They're using crazy terms and they seem to be bluffing but could they actually do this, right? I mean, criminal intent is still criminal is not a real thing but maybe Uganda is a dysfunctional country and there's corruption. A few months ago, some midwives were arrested and we had to march down to the police station to demand an explanation. So could I be arrested and put in a Ugandan jail? Emmanuel and Sam have my back but these men seem important.
Also, even if not, are people going to believe them? This is a community I've been working in for a long time now but are they going to think that I did this? Are they going to believe these Ugandans instead of me? Are they going to look badly on me and all my good work just out the window and now have I compromised the research facility? So that’s a little scary.
But Emmanuel and Sam are kind of doing their thing and as they're ranting about how many people I've saved, I start thinking about it and I think, I remember the woman who almost bled to death on the OR table, right? Where were these men then? Or the fifteen-year old who had a seizure from eclampsia in maternity ward, or the children in the malnutrition ward, or the two-year-old child who died in the nurse’s arms of malaria while I was running an oxygen concentrator to her, the oxygen concentrator that I raised money to buy. Where were they? If they want to save souls, why don’t they come and help me save these souls or people.
I get really angry at this point. And when I get angry, I sometimes cry and so I realize that I’m about to cry. There's so much fear and there's so much anger, I’m going to lose it and I don’t want them seeing me cry. So I get up and I walk out of the room and I go find my friend Julia and I just burst into tears.
She's a Ugandan doctor and she is just bluntly dismissive of these men. She's like, “They're ridiculous.” First of all, she knows what the organization is. She tells me that it’s a section of an American organization called Human Life International. What they do is they're a religiously-based organization. I think they're in Texas. And they get these sections in different countries and they go and try to rout out abortion providers.
But she says that if they wanted to find somebody doing an abortion, there were plenty of Ugandans in town they could have caught doing abortions. Everyone knows who’s doing them. What they wanted was a mzungu and so that’s why they targeted me because I was a mzungu.
But then she laughs and she goes, “They messed with the wrong mzungu.”
I laugh a little but I’m still crying and I’m still kind of nervous.
Then a while later Emmanuel comes out and he says, “I sent them away. They went running away with their tails between their legs. I told them to come apologize to you but they're not going to because they're cowards.”
And I don't really want to talk to them. I’m going to cry if I have to see them. I thank Emmanuel and he apologizes to me, which he didn’t do anything. He saved me.
Then I run into Agnes, who’s the principal nursing officer which is like the head nurse. She had actually been in the room the whole time but I knew she couldn’t say anything because she's a nurse and a woman. She runs up to me and she wraps me in this huge embrace and she starts sobbing and apologizing to me. I don't know if she's apologizing for not saying anything in the room or for what happened but she doesn’t have to apologize. I know why she couldn’t say anything and she didn’t do it.
But she says to me, “I hope you won’t stop your work.”
It never occurred to me that I ever would. I love the work. And it surprises me because she's not the only person who says it to me. For the next two weeks, everyone from leadership to midwives I know really well, to nurses I don’t really know very well, stop me as I’m walking around the hospital to shake my hand and apologize for the trouble on behalf of the whole community. It’s a little funny because as an American, it would never occur to me to do that, to apologize on behalf of the community for something that I had no responsibility for, but it is very Ugandan and everybody does it.
But also it’s interesting because the thing that made me the most vulnerable, the thing that made these men want to target me is also the thing that protected me. I stand out like a sore thumb. Everyone knows where I am at all times on the hospital grounds, in the town, I’m so visible. How could I ever do a clandestine abortion when everybody knows where I am all the time? I could never do anything in secret. So that was kind of interesting.
But I also realized that this whole time I'd been thinking that I wasn’t a part of this community but they had been welcoming to me, that I was such a weirdo, that I didn’t fit in. but it turns out that being part of the community means spending time there, doing work, being there. Being part of a community isn’t about being the same as everybody else, it’s about being there and being part of a group. Even though I thought that I didn’t fit in, it turned out I was right where I belonged. Thanks.