It wasn't until Esperanza Huayama awoke in a ward full of moaning women who were lying two in each bed and saw the stitches in her abdomen that she realized what had happened — she had been sterilized.
"We were just innocent country women. They tricked us," she says of a mass sterilization program imposed on hundreds of thousands of poor, often indigenous, women in Peru during the hard-right presidency of Alberto Fujimori. "They treated us like animals."
Fujimori is now serving a 25-year jail term for pocketing government funds, directing death squads and systematically bribing crooked journalists to smear his opponents. But one crime neither Fujimori nor anyone else has faced justice for is forcing poor women to have their tubes tied within a massive campaign unveiled in 1995, in the middle of his 10 years in office.
Now, two decades on, the victims of the policy have their best chance yet of getting justice for what human rights activists say was one of the biggest forced sterilization programs since the Third Reich.
Prosecutors in Peru are looking into 2,000 individual cases and are due to announce in January who, if anyone, they will indict. The current government of center-left President Ollanta Humala is also due to launch an official registry of victims this month.
The road to get here has been long and winding. Three previous criminal prosecutions in forced sterilization cases have been shelved. But the current probe has international pressure behind it because it got under way after human rights groups took the Peruvian state before the Inter-American Commission for Human Rights, prompting the Humala administration to agree in October to relaunch the investigation.
According to Peru's official human rights watchdog, the Defensoría del Pueblo, 272,000 people, including 20,000 men, were sterilized during the Fujimori regime. Some rights activists say the figure could be even higher.
"It seems there were many more. We just don't know how many more," says Marina Navarro Mangado, Amnesty International's Peru director. "There are many women who have been unable to talk with investigators. They live in remote areas and can't even get to provincial capitals."
How many were conned or coerced into undergoing the procedure remains unclear, but the testimony from thousands of victims across Peru suggests it was a large proportion.
Amnesty is now supporting the women's demands, including compensation and care for the physical and mental legacy of their experience, new health ministry protocols to ensure the abuses are never repeated, as well as criminal prosecutions of those responsible.
The day before Huayama's operation in 1996, a government health worker on a motorbike had showed up out of the blue at Rodeopampa, the remote hamlet in Peru's northern mountains, where she still lives with her husband and their seven grown children on their smallholding where they grow small amounts of wheat, corn, potatoes and other Andean tubers, and rear a few pigs, chickens and guinea pigs.
The health worker told her she needed to go to the provincial capital Huancabamba for a free checkup, medicines and food. Huayama, who is unable to read or write, says she did what she was told and departed at dawn on the following day on the three-hour bus ride down to the city.
When she entered the clinic, however, she says she was rushed by nurses to the operating theater. "Quickly, hurry up," Huayama, now 59, says she was told. A doctor then administered general anesthetic, although not enough to completely knock her out.
"They didn't fully put me to sleep. I could feel them cutting even though my eyes were closed," Huayama remembers. The doctors were already leaving as she came to, she says.
"The pain was terrible," she adds, describing how she was discharged an hour after waking up and took the bus home. Some of the other patients headed back to their villages on foot, limping up steep mountain paths into the night just hours after surgery.
Huayama — who says she was three months pregnant at the time of her operation and that months after the procedure the child was stillborn — now leads a local group of 240 other women from her remote province who also say they underwent forced sterilizations.
Billed as a family planning and poverty reduction program, the project was initially lauded internationally. The United Nations helped fund it while the Clinton administration provided $35 million through USAID, Washington's international aid agency.
The first complaints emerged in 1997 with reports that patients — typically poor and often indigenous women from the mountains and the Amazon with limited education — were being bullied and tricked into undergoing procedures they had not freely chosen. Soon the trickle of accusations turned into a raging torrent.
The big question now is whether prosecutors decide that coercing women into the sterilizations was part of official state policy, and therefore whether Fujimori or any of his ministers are indicted.
The decision could hardly be more political, with Fujimori's daughter, Keiko, 40, consistently leading the polls by nearly 20 percentage points ahead of next April's first round presidential vote.
Despite the human rights abuses and larceny on a grand scale, many Peruvians still view the jailed president as a savior for crushing the bloody insurgency by ferocious Shining Path guerrillas and dragging the nation out of hyperinflation. His daughter has cultivated that legacy, including allowing rumours to swirl that, if elected, she would pardon her father who Transparency International once ranked as the world's sixth most corrupt head of state based on the $6 billion dollars of public money that vanished on his watch.
She is a fierce opponent of Humala and her National Force party, which draws much of its strength from conservative Catholics and evangelicals, is the largest in Peru's single-chamber national congress. Although she has been attempting to moderate the party's image, many of her supporters advocate bringing back the death penalty and, ironically, oppose abortion even for rape victims.
She is not giving interviews at the moment, her spokesman told VICE News. But in past public statements, Keiko has blamed the sterilizations on rogue health ministry personnel, citing "individual responsibilities of doctors who did not respect the protocols".
Alejandro Aguinaga, a current National Force congressman who was deputy health minister and then health minister from 1994 to 2000, also declined to comment. His spokesman said that it would be inappropriate while prosecutors investigated the case, adding: "This is eminently a political issue and we are in an electoral period."
In addition to the issue of consent, prosecutors may also look into the numerous allegations that the sterilizations were regularly carried out in a rush by non-specialist doctors in unhygienic conditions without proper anesthetic and little, if any, post-operative care.
'It was horrible, terrible. At least we knew that the ones who were in our hands were being treated responsibly.'
One doctor involved in the sterilizations says the orders to operate — including unrealistically high targets for the number of procedures — clearly came from above.
Anesthesiologist Rogelio del Carmen said that the small surgery where he worked with a gynecologist and the other two surgeons in the city of Piura on Peru's northern coast, received an order to carry out 250 sterilizations in three days.
"It was absurd. When I first read it, I thought it said '25'", said del Carmen. "It was clear that whoever had given that order was not a doctor. It was a sick attitude."
Del Carmen says that he and his colleagues initially refused, despite being summoned to an intense meeting with ministry of health bureaucrats, but he did eventually carry out around a dozen sterilizations in another clinic after witnessing patients being operated on in conditions that put them at risk.
"The conditions were appalling. We knew the patients' hygiene and health were not being assured," he told VICE. "It was horrible, terrible. At least we knew that the ones who were in our hands were being treated responsibly."
There is plenty of evidence that many patients never fully recovered. Huayama, for one, complains of pains in her stomach and legs, and difficulty walking, that stop her working in the fields.
"I just couldn't take it anymore, and It still hurts," she says. "They told me after the operation to take some pills for the pain, but what good is that?"
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