Walking the long, airy gynecological surgery ward of Panzi Hospital a few days ago, Denis Mukwege saw a face he recognized. He had treated this woman before, five years earlier.
"And now she is back again," he recalled a couple of hours later, his voice leaden with despair. "She was raped again at the beginning of this year, and now she's completely destroyed again."
Dr. Mukwege is a Congolese doctor who repairs the injuries of the legions of women gang-raped as a tactic in the country's 12-year-old war. He is a determinedly optimistic healer, a man who spends his day facing the worst of what humans do and yet still laughs often in a booming baritone.
But this was enough - nearly - to sap his will to carry on.
The young woman greeted him with the love and warmth that all the patients at Panzi have for him, but she had grim news to pass on. She told Dr. Mukwege about a friend she had made during her first stay at the hospital five years before, a young woman whose genitals had also been mutilated and who took a long time to heal. But eventually, that girl too returned home, to a village in southeastern Congo. Last year she was abducted again, this time by the Interahamwe, the remnants of the Rwandan rebel group which carried out that country's genocide in 1994 and then fled into the jungles of Congo.
The militia took her to their forest camp and used her constantly for sex for nine months, until she got pregnant, at which point they released her. She returned to her village mutilated and acutely malnourished - and because of her wounds and her weakness, died in childbirth a few weeks ago.
"She was so happy to get treated - she was really very happy," Dr. Mukwege recalled of her hospital stay. The girl's name was Sibazuri; it means "people are not kind" in Kiswahili. "This Sibazuri, we won't see her again," he added, almost to himself, his huge hands rubbing slowly back and forth across his knees. "What did she do worse than anyone else?"
That morning conversation in the ward had shaken him badly. "I ask myself, 'Why should I continue with this work? I have treated 21,000 rape victims. Will all of these women end up in the same situation?' "
Ostensibly, Congo is a nation at peace, but the truth is that the war in the mineral-rich east, long an economic lure to the country's neighbours, never went away. A 10-month-old peace process specifically aimed at the east began to founder in late August, likely because the 23 armed groups involved saw they risked losing control of Congo's lucrative illegal-minerals trade. Open fighting began six weeks ago, and with it, a new spike in public gang rapes and sexual enslavements.
"The numbers were steadily going down - I'm talking of new cases, we always continued to get women who had been injured two or three or four years before ...," Dr. Mukwege said. "But since Aug. 28, they are going up again. Now we have new cases arriving, of women raped this week."
The return to fighting, and the swell in women arriving bloody and desperate, has demoralized his staff. "We think, 'Why go on? Why work for people who are going to kill each other?' " he asked. "I would not be discouraged with this work if the problem will end - but if you can't see the end. ..."
To round it off, Dr. Mukwege returned from Europe, where he lobbied governments there to do more to end the fighting in eastern Congo, much of it funded by neighbouring countries. Many people, including playwright Eve Ensler, creator of The Vagina Monologues , have been lobbying for Congo's women in recent years. Yet when Dr. Mukwege spoke in Europe, many of the politicians looked at him blankly, he said, saying they had no idea there was still fighting in Congo, no idea the region was the site of the most brutal abuse of women in the world.
That nearly finished him.
"We've been everywhere, we've talked to everyone, but we see no change ...," he said. "I decided I should go back to my village maternelle and raise chickens."
He was joking, mostly. Unfailingly modest, he also knows he is the most powerful advocate Congolese women have. He strides through the hospital's outdoor walkways in a white coat, white pants, white shoes, the only colour a bright red-and-green badge that reads "Stop Raping Our Greatest Resources, Power to the Women and Girls of the Democratic Republic of Congo."
Ms. Ensler calls him a "complete hero;" to the patients he treats, he is one step short of God, a God who flirts and teases and cajoles. Mateso Nabutonzi, 25, was awaiting her third round of surgery last week. She made it to Panzi after living for five years with horrific vaginal fistula she suffered after being sexually enslaved by a militia. "I know I'll be healed, maybe one day," she said, "And I thank Dr. Mukwege. I'm fed here and someone looks after me, and because of him I sleep safely."