Chapters 4–7 Summary

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Last Reviewed on April 28, 2020, by eNotes Editorial. Word Count: 1371

Chapter 4

In Woineshet Zebene’s rural Ethiopian village, when a man is unable to earn approval to marry the girl he desires, he kidnaps and rapes her in order to “[improve] his bargaining position.” A girl has little value once she loses her virginity, so her family usually agrees to the union. Once they are married, the rapist can no longer be prosecuted.

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Woineshet was thirteen when she was kidnapped and raped by at least four men, including the man who wished to marry her. Woineshet’s father was a migrant worker, and he had seen women in Addis Ababa “holding meaningful jobs, enjoying rights and a measure of equality.” He wanted more for his daughter than to be the wife of a rapist. He encouraged Woineshet to get medical confirmation, then helped her file charges in a village court.

Fearing prosecution, Woineshet’s rapist “devised a solution.” First he kidnapped, raped, and beat the girl again. Then he took her to court, where he and village “officials” explained that it was futile to resist any longer: the attacks would continue until she gave in. Unable to find justice within rural tradition, Woineshet fled to Addis Ababa with her father. There, her case inspired an international campaign that “shamed [Ethiopia] into changing its laws.” Now, if a victim marries her rapist, he can still be prosecuted for the crime.

In section two, subtitled “Mukhtar’s School,” Kristof and WuDunn explore Mukhtar Mai’s efforts to change Pakistani culture from within. Her story begins “in the village of Meerwala,” where rape is used as a way to convey collective guilt upon a dishonored family.

In 2002, Mukhtar’s young brother was raped by heterosexual men from a “higher-status clan,” who then accused him of sexual deviance to “[cover] up their crime.” As punishment for her brother’s “illicit sex,” Mukhtar was sentenced to gang-rape by the village council. She then went home to die by suicide, “the expected way for a woman to cleanse herself and her family of shame.” But Mukhtar’s parents and cleric persuaded her that what had happened was “an outrage against Islam.” Instead of punishing herself, she told police that she wanted to press charges against her rapists.

Pakistan’s President Pervez Musharraf “sympathized” with Mukhtar and awarded her $8,300 in damages. She used the money to start a school, believing education to be the impetus for equality. When her advocacy attracted international attention and donations, her portrayal of a wayward Pakistan became “embarrassing” for President Musharraf, who ordered the young activist to be subdued like a radical dissident. Nevertheless, Mukhtar has gone on to expand her campus to include a secondary school, “a free legal clinic, a public library, and a shelter for victims of violence.”

Chapter 5

Nowhere is rape more rampant than in the eastern provinces of the Democratic Republic of the Congo. In this war-torn nation, women are viewed as easier targets than oppositional forces, and “Congolese militias” often use knives, guns, and bayonets to cause devastating internal damage during sexual assaults.

Kristof interviews a seventeen-year-old survivor, Dina, who was raped by five militia members. Before leaving, her attackers “shoved [a] stick inside her,” creating fistulas (abnormal connections) between her bladder, rectum, and vagina. She was homebound, incontinent, and unable to move when her family learned about a medical aid organization, HEAL Africa, that specializes in injuries like Dina’s. HEAL Africa sent a plane to transport Dina to their hospital, where her surgery was a success.

Harper McConnell, an American missionary, lives on the HEAL Africa campus in Goma, where she coordinates her Minnesota church’s charitable contributions. She is the principal of a school she founded for children receiving medical treatments, and she directs the vocational skills training program for women awaiting or recovering from surgery. The authors believe that more young people, particularly college students, should follow Harper’s example. The only way for Westerners to truly understand international poverty is to “live in its midst.”

Chapter 6

In developing nations, most fistulas are caused not by foreign-body trauma, but by “obstructed labor and lack of medical care during childbirth.” Without intervention, obstetric injuries can lead to ostracism, disability, and death. In this chapter, the authors interview two young Ethiopian women who have suffered from fistulas, as well as the practitioners who have cared for them.

Mahabouba Muhammad was fourteen years old and seven months pregnant when she ran away from the abusive elderly man who had bought her as a second wife. She could not afford a birth attendant and tried to deliver her baby alone, but her pelvis had not yet developed enough to accommodate passage through the birth canal. After seven days of labor, Mahabouba lost consciousness. She awoke to learn that the baby had died and the trauma to her body had left her unable to walk or control the flow of urine and feces from her fistulas.

The villagers, including Mahabouba’s aunt, considered the teenager to be bad luck. They moved her to a distant hut, removed the door, and left her to be eaten by hyenas. She fended the animals off with a stick, then crawled to a nearby village, where a Western missionary was able to transport her to Addis Ababa Fistula Hospital. There, Australian gynecologist Catherine Hamlin was unable to completely repair Mahabouba’s fistula, because too little viable tissue remained. Hamlin instead performed a colostomy, redirecting waste products to an abdominal pouch. Mahabouba has recovered, but her colostomy requires ongoing care that prevents her from moving far from the hospital. She now works with Dr. Hamlin as a senior nurse’s aide.

Simeesh Segaye was nineteen and married when she endured an obstructed labor. It took days to get to the nearest hospital, by which time the baby had died and Simeesh had been left “crippled and leaking urine and feces.” Her family then tried to send her by bus to have the fistula repaired, but her stench so offended the other passengers that she was not allowed to board. She was abandoned by her husband and left to live alone in a hut beside her parents’ home, where she lay in the fetal position for so long that her muscles formed contractures and she could not stand.

After two years, Simeesh’s parents could no longer bear to watch their daughter suffer, so they sold everything they owned in order to pay a private driver $250 to take her to a hospital. She was transferred to Catherine Hamlin, who repaired the fistula. Former patients helped with physiotherapy, and Simeesh was eventually able to make a full recovery.

Chapter 7

Prudence Lemokouno had been in labor for three days when an untrained birth attendant sat on her stomach and “jumped up and down,” trying to assist the baby’s egress but instead rupturing Prudence’s uterus. Her family paid a man to take her seventy-five miles to the nearest hospital on the back of his motorcycle. There, Dr. Pascal Pipi told them he would perform a lifesaving emergency C-section for one hundred dollars, but Prudence’s family said they could raise only twenty dollars. Kristof “stumbles upon” the scene accidentally, during an unscheduled visit to investigate maternal health in rural Cameroon.

The otherwise “pleasant” Dr. Pipi views the local peasants contemptuously. He is “furious” that Prudence’s husband, a public school teacher, is angrily demanding that the doctor perform the surgery. When it becomes clear that Prudence will soon die, Kristof says he will pay the eighty-dollar difference. He and his videographer, Naka Nathaniel, donate blood to be transfused prior to the procedure. The journalists wait hours for Dr. Pipi to begin the surgery, only to learn that he has gone home for the night to teach Prudence’s “uppity” husband a lesson. By the time he operates the next day, the infection has advanced, and there are no antibiotics available to treat it.

Edna Adan is a nurse-midwife and former first lady of Somalia who has used her prodigious education and experience to found a maternity hospital in the “breakaway republic of Somaliland.” Outfitted with “hand-me-downs” from international donors, the Edna Adan Maternity Hospital houses some of the most rigorously-trained medical staff in the region.

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Introduction and Chapters 1–3 Summary

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Chapters 8–10 Summary