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A new medical facility in Berlin is offering what its founders describe as the most comprehensive treatment available in Europe to victims of female genital mutilation. Doctors say the goal of the Desert Flower Center is to help women become whole again, by ridding them of the physical and psychological pain resulting from forced circumcision.

But as NPR's Soraya Sarhaddi Nelson reports from Berlin, most victims are reluctant to get help. First, a warning to listeners: This story contains some graphic descriptions and may be inappropriate for children.

UNIDENTIFIED MAN: (Foreign language spoken)

UNIDENTIFIED WOMAN #1: (Foreign language spoken)

SORAYA SARHADDI NELSON, BYLINE: A dozen African and Middle Eastern immigrants gather for a sewing class at the Mama Afrika center in Berlin.

UNIDENTIFIED WOMAN #2: (Foreign language spoken)

NELSON: Most of these women had part or all of their external genitalia cut off years ago. The practice, called female genital mutilation in the West, is a time-honored tradition across religious lines in most of Africa and in parts of Asia and the Middle East. The World Health Organization says about 140 million women and girls are living with the health and psychological consequences of FGM.

Its proponents say cutting girls in this manner enshrines their purity and virtue.

HADJA KABA: (Foreign language spoken)

UNIDENTIFIED WOMAN #3: Yah.

KABA: Yah?

UNIDENTIFIED WOMAN #3: Mm-hmm.

NELSON: Mama Afrika founder Hadja Kaba asks one of the students if she's been cut. She answers yes, and holds up the cloth that she is sewing.

KABA: (Foreign language spoken)

NELSON: Kaba says: No, not the cloth - down there.

The woman shakes her head and turns back to her sewing.

(SOUNDBITE OF A SEWING MACHINE)

NELSON: Kaba, who helps integrate immigrants into German society, says it's hard to get her clients to open up about female genital mutilation, even if they are suffering ongoing medical problems like abnormal growths or incontinence. It's a taboo topic even among proponents of female circumcision, most of whom are women.

KABA: (Foreign language spoken)

NELSON: Kaba says her clients may live in Berlin but are still firmly entrenched in the culture of the countries they left behind. So when she tells the women about the Desert Flower Center, a short drive away that can make them whole, most of them change the subject. But Kaba doesn't give up.

(SOUNDBITE OF A CROWD)

NELSON: Her persistence is finally rewarded when one of the student seamstresses agrees to talk about her circumcision. She is the wife of an African diplomat. Fearing retribution from relatives, she asks NPR not to identify her.

UNIDENTIFIED WOMAN #4: (Foreign language spoken)

NELSON: The woman says she wants to get reconstructive surgery at the new clinic. She hopes that if the doctors rebuild her genitalia, sex will be easier and more enjoyable for her. But she says she's won't go to the center because she's afraid her husband won't approve. And she's worried about her young daughters. Their relatives are already talking about circumcising them when they return to Africa. The older girl is nine, the same age her mother was when she was circumcised.

Kaba explains that in many African nations, a woman is considered unclean if her genitalia are intact. It's that belief plus her aunt's promise of gifts and a big party, which Berlin resident Jenny(ph) says drove her to get circumcised more than two decades ago in Sierra Leone. She agrees to be interviewed provided NPR not use her last name.

Jenny says she was 19 at the time she was cut, making her older than all of her friends who had the procedure done.

JENNY: And they were laughing at me, saying, look at her, you know. They were telling me I'm unclean. I'm dirty so you are tempted to do it.

NELSON: Jenny recalls how the women who took part in her circumcision braided her hair and carried her to a hut made out of palm leaves. She was blindfolded and the women stood on her arms and legs to keep her from moving.

JENNY: Yeah. And they lay me on the ground. I don't know what happened, I just feel a very sharp pain, you know? That's, it's un-describable on this Earth, you know? The way you feel, it's like you are already dead, yeah.

NELSON: Twenty four years later, Jenny nervously sits in the waiting room of the Desert Flower Center in Berlin. The center is located inside a hospital specializing in women's health care. She hopes doctors here can undo the misery that she says has defined her life since her mutilation.

JENNY: It makes me so sad. Sometimes, I am just depressed in my house - like two, three days, just I cannot go out. You know, why should I go out? Nobody love me.

NELSON: While she fidgets in her chair, another patient comes out of the doctor's office and sits down next to her. Her name is Senait Demisse and she's an Ethiopian nanny working for the former Somali supermodel who funds the Desert Flower project.

JENNY: (Foreign language spoken)

(LAUGHTER)

NELSON: Jenny discovers the nanny, who came from Poland, recently had the reconstructive surgery and peppers her with questions. Demisse tries to reassure her.

SENAIT DEMISSE: All is good. Don't be scared, eh?

(LAUGHTER)

JENNY: It's unbelievable. It's just like normal? Like normal women? It's normal like before, like a normal woman.

DEMISSE: The pain, I don't remember.

JENNY: No, I mean the way it looks, like your- excuse me...

DEMISSE: Yes, looks like (unintelligible)...

JENNY: OK, it's real.

DEMISSE: ...it is not by one time.

JENNY: OK, it looks very real.

DEMISSE: Step by step, yes. It takes six months to be...

JENNY: OK, develop. OK. OK.

NELSON: Weeks later, Jenny has her own surgery. Her doctor, Roland Scherer, says she's doing well. He's the head consultant at the Desert Flower Center, which opened last fall and expects to treat up to 100 victims of female genital mutilation a year. The care is free to patients and is covered by German health insurance or donations. Scherer says the center takes a holistic approach, caring not only for these women's surgical needs, but their psychological and social ones.

ROLAND SCHERER: Women, if they want to have an operation, they have a very long history of traumatic situations. And so, it's not only the operation.

NELSON: He says that oftentimes, the husbands demand a divorce if the woman chooses to get the reconstructive surgery. Other victims like Jenny are single and feel ostracized in Europe, where women who've been mutilated are objects of pity or treated as if they aren't normal.

Scherer says it's a struggle to find patients even though activists estimate there are 24,000 female genital mutilation victims living in Germany alone. Scherer says doctors here often fail to recognize women who've been cut.

SCHERER: Especially for these female doctors, gynecologists, the knowledge in Germany is not so widespread. And so we make now training programs for them, because this is one of the most important ways to tell the patient that there is a center.

NELSON: The center also works with immigrant groups like Mama Afrika to try and get these women to seek care.

KABA: This is for Tripoli - flying from Tripoli.

NELSON: Mama Afrika founder Kaba says she'll do whatever she can to get her clients to go to Desert Flower, although she doesn't plan to get reconstructive surgery for herself. She thinks the millions being spent on the medical facility would have more impact if the money were used to stop female genital mutilation in the first place.

KABA: (Foreign language spoken)

NELSON: She says the funds should go to educate health care givers and village elders in the countries where female genital mutilation is widely practiced. Kaba says that just about all countries officially forbid the procedure, but it continues anyway because governments don't want to fight long-standing traditions.

Soraya Sarhaddi Nelson, NPR News, Berlin.

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