TTUP: Tell us a bit about yourself. Where did you grow up?
CJA: My parents are first-generation immigrants from Jamaica, and I grew up in Connecticut. There is a large Jamaican immigrant population in that area, and my parents have always been very socially conscious and entrenched in their community, helping Caribbean immigrants attain citizenship, ESL classes, etc. My dad founded a newspaper, the West-Indian American, and growing up I was very exposed to social consciousness and serving the community. That's where I developed my own sense of responsibility to give back.
TTUP: Your credentials are impressive to say the least. How did your studies impact your career?
CJA: The defining moment of my career was during the spring semester of my senior year at Hopkins. I took a course called Women in Pre-Colonial Africa (which I thought was just an easy A). I just so happened to have read Alice Walker's book, Possessing the Secret of Joy (sequel to The Color Purple) over the Christmas break before the class. The book follows the life of Tashi, who underwent female genital mutilation; up until then I had never heard of the practice, and the book was so riveting (...) that it opened my world to this entire cultural practice.
The topic, including its historical and cultural underpinnings, became my thesis that semester. In medical school, that became my focus. Through an internship while at Cornell University, I did a lot of community activism and outreach to newly-arrived African immigrants who had undergone female circumcision. That helped solidify my public health interest in this issue. I already had a strong liking for caring for the mom and the unborn child, but I decided to pursue a career in Obstetrics & Gynecology because of this. I was sure this was my life calling, so I did my residency at the George Washington University Medical Center, and the three hospitals we covered served a large East and West African population, many Somali and Sudanese women.
CJA: There are many challenges with cultural sensitivity. Most U.S. medical doctors do not have any prior training or knowledge of the practice, and the usual reaction to it is 'this is just barbaric' - which is the classic response of most people in the West. Unfortunately, it is not the best approach when trying to build a relationship with these communities.
Female circumcision has deeply cultural underpinnings; it's done as a way of preserving chastity before marriage, ensuring a woman's honor and marriageability, and is often done on young girls from infancy up to 16 year-olds. Most are between 5-8 years old. Often there is no anesthesia and no sterile equipment, which can cause infections and long term complications such as recurring UTIs and menstruation and/or sexual problems.
"We can't start attacking their practice by belittling the culture. Instead, we should be more sensitive, as they may not see it through the same lenses in which we see it. That's proven to be my experience, since I've built my entire career around this."
"This is the only clinic like it in the country, although there are other hospitals trying to replicate our model in Utah and Georgia. But so far we're the only ones of the kind."
CJA: Our OB/GYN Department is working with the University of Arizona College of Medicine - Phoenix, in an effort to partner with the University of Buea in Cameroon to start an OB/GYN residency training program there. This is part of a larger national consortia of U.S. medical schools who are partnering with various countries across sub-saharan Africa to reduce maternal-child deaths and other complications in childbirth.
CJA: We are always looking for ways to enhance what we do, so we are always looking for volunteers and donations, whether monetary or material. Once a year we have a huge Christmas party, and we receive donations from all over the Valley (Phoenix metro). Churches, organizations, community groups and individuals donate items such as car seats, strollers, diapers, baby and adult clothes, detergent, sanitary napkins, bed sheets, etc. We start collecting all the supplies in September, and a few days before Christmas we give it all away to our patients, especially the ones who have delivered within the past year .
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Dr. Crista Johnson-Agbakwu is an Obstetrician/Gynecologist at Maricopa Integrated Health System, Phoenix, AZ, where she is Founder and Director of the Refugee Women’s Health Clinic (RWHC). She is also a Research Assistant Professor of the Southwest Interdisciplinary Research Center (SIRC), which is a National Institutes of Health funded National Center of Excellence in minority health and health disparities at Arizona State University.
She received her undergraduate degree from The Johns Hopkins University, medical degree from the Weill Medical College of Cornell University, and completed her residency in Obstetrics & Gynecology at the George Washington University Medical Center. She subsequently completed a fellowship in Female Sexual Medicine at the University of California, Los Angeles and then became a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan where she obtained her Masters in Health and Health Care Research examining disparities in reproductive health care among refugees/immigrants through mixed-method Community-Based Participatory Research (CBPR).
Her August 2011 article in The Female Patient, “Female Genital Cutting: Addressing the Issues of Culture and Ethics,” dealt with social issues, but also offered physicians clear instruction on how to treat circumcised patients. Her new research, to be published later in 2012, will look at the views of Somali men. More >