INVESTIGATION OF SEXUAL VIOLENCE IN EASTERN DRC that target survivors living in rural villages. With properly trained staff, satellite clinics can provide much of the routine care for post-rape survivors. For those survivors requiring surgery or a higher level of care, the satellite clinic can facilitate referral to a larger facility such as Panzi Hospital. The high number of referrals to Panzi Hospital also has important implications for it as a medical facility. It illustrates that Panzi Hospital has emerged as a regional referral center for sexual violence survivors. To meet these demands as a referral center, Panzi Hospital will require additional trained medical professionals, updated equipment and a reliable source of medical supplies including antibiotics, anti-retrovirals and post-coital contraceptives. Furthermore, the center will require secured and sustained funding if it is to continue supporting the hundreds of sexual violence survivors who present there each year. PATIENT SYMPTOMS In their narrative descriptions of sexual violence, many women reported physical symptoms with pelvic, lumbar and abdominal pain being the most common. Vaginal discharge, vaginal itching and menstrual abnormalities were other commonly reported complaints. Urinary symptoms including incontinence and reproductive abnormalities such as infertility, premature labor / delivery, and miscarriages were also reported by sexual violence survivors. In this study, sexual violence survivors were not directly questioned regarding physical symptoms following the assault. Failure to mention a symptom in the narrative does not imply that the symptom was absent. Therefore, we are unable to quantify specific complaints in the current study. The psychological consequences of sexual violence were also severe for many women. In their narrative descriptions of the violence, women described sadness, anger, fear, anxiety, shame and misery as a result of the sexual assault. In many instances, these emotions appeared to be augmented by pregnancy resulting from rape and by spousal abandonment following the sexual assault. Because this study did not directly inquire about psychological outcomes following sexual violence, we are unable to quantify specific psychological complaints. PREGNANCY Some women reported that they became pregnant as a result of the sexual violence. Management of pregnancy resulting from rape is always challenging even in western countries with advanced health care systems. However, in DRC pregnancy, labor and delivery can be most detrimental to a women’s health. Some experts estimate the maternal mortality ratio (MMR) in Eastern DRC to be 3,000 deaths per 100,000 live births,(58) more than three times the MMR for Sub-Saharan Africa overall (920 deaths per 100,000 live births).(59) Although the risks of childbirth are real for any Congolese woman, they are significantly higher for young girls whose bodies are not mature enough for labor and delivery and for women who have serious pelvic injuries and scarring from the physical damage often caused by gang rape. While some women die during childbirth, many other women suffer non-lethal complications. As illustrated in the qualitative results, many women develop involuntary leakage of urine or feces as a result of fistulas. Fistulas are a well-recognized complication of prolonged or 41