It was the work and persistence of the Center for Reproductive Rights, the Latin America and Caribbean Committee for the Defense of Women's Rights (CLADEM) and the Center for Justice and International Law (CEJIL) that found a forum that got Peru to acknowledge its abuses against women. By bringing this first-of-its-kind women's human rights case through the Inter-American Commission on Human Rights - which helps governments reach out-of-court settlements - Peruvian officials agreed to provide the victim, Marina Machaca, with psychological and material reparations. For all Peruvian women, the outcome of the year-long negotiations produced an agreement to create a commission that will recommend and implement needed changes in the country's health care and judicial systems to ensure these abuses no longer occur.

One of the groups participating, CLADEM, was represented by Giulia Tamayo, winner of this year's Amnesty International Award - presented last week - for her work with the victim and other poor women willing to report the abuses they suffered from those in the public health system.

"This agreement, and the government's acknowledgement of responsibility, sends a strong message to women in Peru and Latin America whose rights have been violated that justice can served," said Luisa Cabal, a Center for Reproductive Rights staff attorney who helped bring this case through the international legal framework. "And it shows poor, rural women who never expect to find justice that, with courage, justice does exist." The results also demonstrate, Cabal added, "that if women around the world continue to push for their reproductive rights through this international legal framework, countries will begin to respond."

For Machaca, the settlement includes psychological care for as long as she needs; providing her with land and materials to build a house; and with property in a public market to sell her wares, along with materials to start her vendor business. For women throughout the country, Peruvian officials agreed to study the creation of centers for sexual abuse victims in Lima, Puno and Arequipa, and will review and implement a series of proposals produced by a commission to revamp the health service and judiciary systems in regard to women. The commission, which will begin its work in 30 days, includes representatives from the Center for Reproductive Rights, CLADEM and CEJIL. They expect to finish their work and oversee implementation within six months.

In addition, the doctor who raped Machaca has been dismissed.

It took amazing heroics on Machaca's part to speak out against the doctor who assaulted the then 19-year-old street vendor from the rural hills of Juliaca in 1996. Machaca had gone to the Carlos Monge Medrano Hospital nearby for a headache and fever and instead was forced into having a gynecological exam and then was raped by Dr. Salmon Horna - a doctor previously charged with the attempted rape of a 15-year-old girl. Yet Machaca was ridiculed when she filed a complaint with the medical examiner, and in a 1997 trial Dr. Horna was found not guilty.

The Center for Reproductive Rights and CLADEM conducted an 8-week fact-finding mission that uncovered 50 cases - including Machaca's -- where women were abused by health care providers in five regions of Peru. Machaca and others were featured in a documentary, Silence and Complicity, which was shown to international audiences at the Hague and elsewhere. It came as a great surprise when Peruvian officials agreed to participate in the October hearing of the Inter-American Commission. The reparations and health and judiciary systems revamping are the result of these negotiations.