Organization skills

The World Health Organization (WHO) clinical manual on gender-based violence (GBV) is an eye-opener for doctors in Namibia

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When Dr Ifeolu Oyedele first learned that he would be undergoing training on the “Clinical Manual for the Health Care of Survivors of Domestic Violence and/or Sexual Violence” from the World Health Organization (WHO ), he didn’t think he would learn anything new from the session.

In fact, he was already sensitized by his medical training to see signs of abuse and trauma. It was only by attending the September 2021 training session that he understood the seriousness of gender-based violence and domestic violence (IPV) and the trauma it causes to victims.

“The training opened my eyes to what happens after seeing GBV patients. The impact of the training was that I now started giving higher priority to sexual assault cases,” said Oyedele, acting chief medical officer at Rundu State Hospital. He adds that before the training, he and other doctors at the hospital did not really prioritize victims of GBV.

Previously, patients who came to Rundu State Hospital for a sexual assault case had to wait long hours for a doctor to attend to them. Patients have been told to wait until doctors’ lunch hour to be seen due to the high number of patients that doctors at state health facilities attend daily. This changed because Oyedele realized “the sensitive nature” of these cases.

“We would schedule their appointments from lunchtime, but now after the training, instead of giving her (the victim) a date, I would see her as soon as possible, basically, I would end up my current patient, then I would see him and do the rape kit,” he explains.

He further clarifies, “My eyes have just been opened to the sensitive nature of the issue and that they’re going through a lot of psychological stress and trauma and telling them to wait, and that they haven’t bathed or showered is a little insensitive. I do it now as soon as possible”.

Oyedele works in the gynecology ward and when doctors in other wards detect cases of GBV or IPV, they are referred to her. “It’s only my service that takes care of these cases because we have the gynecological experience,” explains Oyedele.

Oyedele is one of 282 medical professionals trained in the clinical manual nationwide. The aim of the training is to orient health professionals, mainly doctors and nurses in public health institutions, to identify signs of abuse in patients.

Doctors and nurses are trained to see clinical clues and identify violence that healthcare providers are likely to miss in their patients. Doctors and nurses are also trained to show empathy when dealing with victims of GBV and IPV.

Dr. Leonard Kabongo is the chief medical officer in the Erongo region. He was also trained on the “Clinical Manual on Health Care for Survivors of Domestic and/or Sexual Violence, Namibia”.

“In the past, all we did was a quick physical examination of the patient and concluded there were no signs of rape or sexual intercourse and that was it. But we now know that GBV and IPV are not always physical,” says Kabongo. Thanks to the manual, Kabongo has developed the ability to listen to his patients. He was also able to transfer these skills and other lessons provided in the manual to other doctors in the country as a trainee trainer.

“It’s very important to listen because the story of the assault or violence actually guides you on how to approach that person (survivor) and where exactly you will focus while listening,” explains Kabongo. By actively listening to his patients, Kabongo also learned to empathize with his patients.

Timely response

Dr. Alice Kabongo is Chief Medical Officer at Gobabis State Hospital. She says doctors at public health facilities have to deal with many patients, which sometimes makes it difficult to prioritize sexual assault cases.

“Although we know that GBV cases should not wait because it is an emergency, sometimes we are forced to use the triage system where we prioritize who we go to see. For example, if it is a young patient, we take care of it at any time of the day and if it is an older patient, we let it sleep in the department and we see it in the morning,” Alice explained.

Meanwhile, Kabongo (Leonard) believes that while public hospitals are busy, GBV survivors also need urgent attention. “We are triaging to care for patients who need urgent medical attention, including survivors of IPV and GBV, as they are also emotionally hurt and need support and a place of safety,” Kabongo explained. GBV and IPV are emergencies, he stressed.

Also, time matters, especially in the case of a sexual assault. “If you wait too long to attend to the patient, you lose that opportunity to prevent infections, so there are medications they need to receive, prophylaxis they need to receive to prevent certain types of infections that could result of aggression,” he adds.

Similarly, waiting too long to care for a sexual assault patient increases the risk of losing forensic evidence. The result is that there will not be enough evidence to prove in court that a sexual assault took place. “Forensic evidence actually disappears over time, so the more time that has passed, the more evidence has disappeared,” Kabongo adds.

Forensic kit

Both Dr. Oyedele and Alice have been using the rape kit for years. Oyedele says he studied the instructions in the rape kit manual and did so accordingly. “I just followed the manual that came with the rape kit. It’s already part of my job, so it didn’t increase the workload,” Oyedele explained. However, not all doctors know how to use one, says Kabongo. The training was also helpful for doctors who didn’t know how to use the forensic kit, Kabongo adds.

“Most doctors don’t really have exposure to forensic examination, such as how do you collect evidence appropriately and how do you defend yourself in court if called as an expert witness,” a- he explained.

Exposing doctors to the forensic kit during training boosted their confidence, Kabongo adds. “And that’s another powerful piece of training that actually helped select the evidence appropriately.” In the past, we have had cases dismissed due to lack of evidence, including tampering with evidence. Now people know when to open the rape kit,” he said.

In the event that they are summoned to court for a case of GBV or IPV, doctors who have undergone training know what type of evidence to present. “If I come to court and lawyers ask me questions, I know how to answer. It’s all part of the clinical manual and I think it’s really empowered doctors to effectively advocate for their cases,” says Kabongo.

Abuse knows no gender or age

While it is common for women and girls to be the faces of GBV and domestic violence, they are not the only ones to experience abuse, Kabongo points out. Clinical manual training is about people and that includes men and boys.

“Men and boys can also be subjected to this type of violence and they too need care,” he adds. Oyedele says the patients he sees for sexual assault and other forms of GBV are mostly women of childbearing age.

“The youngest patient I have seen for suspected abuse is three years old and the oldest is 41,” says Oyedele. He keeps records of GBV patients he has treated since October 2020. “Even if they are picked up somewhere, they refer them to me,” he adds.

GBV survivors must be protected

Meanwhile, Alice credits GBV training on the clinical manual for her alertness and ability to pick up on subtle clues and investigate alleged abuse. “We take a complete patient history to rule out abuse,” she says.

Yet she believes more needs to be done to protect survivors of GBV and IPV. People who come to the hospital for obvious abuse need to be protected, she says. Right now, the first point of contact for these patients is the emergency department where everyone can see that they “have been abused”, says Alice.

“Gender-based violence is a sensitive issue and we need a place where these people can be seen and received. For now, we send them to a ward or to the Old Theater of the hospital when we suspect abuse. But we advocate a corner where they can be seen in private,” says Alice. She also believes that more health professionals should be trained and that a designated doctor should be appointed for these cases.

“The only problem is that we work in an environment where there is a shortage of doctors. In other hospitals, there is literally a separate doctor who takes care of these cases and does not have to take care of other patients,” agrees Oyedele. The response to the manual has been overwhelming, with some doctors asking for more training, Kabongo concludes.

The “Clinical Handbook on the Health Care of Survivors Subjected to Intimate Partner Violence and/or Sexual Violence, Namibia” is an initiative of WHO in collaboration with UN Women, the United Nations Population Fund and the Ministry of Health and Social Services. The handbook draws on the work of professionals who are dedicated to preventing and responding to GBV.

Distributed by APO Group on behalf of the World Health Organization (WHO) – Namibia.

This press release was issued by APO. Content is not vetted by the African Business editorial team and none of the content has been checked or validated by our editorial teams, proofreaders or fact checkers. The issuer is solely responsible for the content of this announcement.