Nawal Nour

A graduate of HSPH in 1999 and of Harvard Medical School in 1994, Nour founded the African Women’s Health Practice at Brigham and Women’s Hospital (BWH), the only U.S. clinic devoted solely to addressing the unique medical and emotional needs of female immigrants who have been genitally circumcised.

"I have a mission–improving women’s health, especially trying to stop the practice and alleviate the pain of women who have been circumcised," Nour said. "Without a doubt, female circumcision is a health and human rights issue. However, the women don’t see themselves as victimized. It’s important to separate the issue from the individual."

She recently won a MacArthur Fellowship, sometimes called a "genius award," for her clinical efforts, education of other health professionals and community outreach. The award provides $500,000 to Nour over the next five years.

Nour speaks frequently to health care providers on the topic of female circumcision. In her talks, she shows pictures of three types of circumcision. Type one, common in Ethiopia and Eritrea, is removing the clitoris, which heals so well that one of Nour’s fellow residents missed it during a routine examination. In type two, the clitoris and inner vaginal lips are removed. Most of Nour’s patients have type three, where the clitoris and inner and outer vaginal lips are removed, with a small opening retained for urine and menstrual blood (Sometimes a stick is inserted while the wound heals to retain the opening). The bloody and painful procedure is often done without anesthesia or medical supervision, she said.

Type three genital cutting increases the risks of bladder and vaginal infections. It makes intercourse painful and delivering a baby even more difficult. For women with these complications, Nour has pioneered techniques based on plastic surgery to reconstruct the tissue, known as deinfibulation, and expose the vagina and urethra.

Last year, with funding from the Office of Refugee Resettlement at the U.S. Department of Health and Human Services, Nour designed a two-day African Reproductive Health Conference for Refugees and Health Providers. She took the workshop on the road for a 10-city tour in collaboration with local community-based organizations from Seattle to Nashville to Lewiston, ME.

"When health care providers walk into a room of a patient who has been circumcised, the goal is to take care of her holistically as a woman, not to see her as a poor victim of circumcision," Nour said. In interviews and news articles, Nour has recounted the story of a woman whose abdominal pains were ignored by the emergency room staff, who instead gathered to gawk at their first example of a circumcised female.

Nour opened the African Women’s Health Practice clinic after extensive discussions with women and families who attended reproductive health workshops sponsored by African community organizations in the Boston area. The clinic is loosely modeled after a similar facility near her mother’s home in London. Yet, in the first months after its opening, the clinic received very few patients. Nour investigated and soon found why: suspicion of her motives, of American medicine in general, and of her alliances within the African community (Different organizations had carried intertribal disputes with them from Africa). Nour made the rounds of community organizations again, assuring them of her intentions and slowly building trust.

Except for Wednesday afternoons spent at the African Women’s Health Practice, Nour works as a general obstetrician-gynecologist caring for nearly 2,000 patients a year and supervising the care of almost 4,000 more patients in her role as director of the BWH resident obstetrics-gynecology practice.

The same year she opened the clinic, every medical school and obstetric-gynecology resident program in the U.S. and Canada received recommendations for the clinical management of circumcised women, penned primarily by Nour, in the form of a slide-lecture module from the American College of Obstetrics and Gynecology.

On her office door, a scribbled sign mounted by her colleagues reads, "Genius at work."