MULTISECTORIAL APPROACH IN MANAGEMENT OF SURVIVORS OF SEXUAL VIOLENCE
This article revolves around the holistic management of victims/survivors of sexual violence in the Kenyan region. This encompasses all the aspects of life that in the long run reduces the complications of sexual violence if at all they are followed to the latter. In most cases, management of sexual violence for survivors in Kenya is done in an atomistic way such that the victim doesn’t achieve complete liberty from the sexual violence episode. This culminates to later psychological, physical, mental and emotional distress that disturbs the victims. To sum up the introduction, the male child has being neglected when it comes to sexual assaults management. When the term sexual violence hits the headlines, all eyes turn on the girl child manipulation rather than focusing also on the boys who are assaulted. Most of the boys/men who are affected end up shying away from opening up to people about the assault. They face challenging psychological trauma because of the societal and community attitudes about men and their masculinity.
DEFINATION OF TERMS
Multi-sectorial management–when you manage something or a situation using the multi-sectorial management, you encompass and counter the problem in a holistic way such that you cater for all the possible outcomes that could come with it. Different disciplines interact to facilitate the positive recovery of a certain victim.
Sexual Violence – sexual act committed against someone without their consent or without them freely getting submissive to the act. It includes accomplished or attempted penetration of a victim. Examples of sexual violence include:-
- Date rape
- Drug induced /alcohol facilitated
- Non-physically forced sexual act in which happens after a person has been verbally pressured or by methods of intimidation without their consent
- Spousal rape
- Statutory rape
- Sexual abuse with people with disability
Survivors of sexual violence – these are the victims who have survived accomplished or attempted sexual violence. They are often psychologically unprivileged.
Gender Based Violence (GBV)–this is any type of cruelty directed or targeted against at individuals or groups on basis of their gender. According to research, a significant number of women will at some point in their life experience gender based violence. However, the number of boys/men who experience GBV is unknown.
MULTISECTORIAL APPROACH IN MANAGEMENT OF SURVIVORS OF SEXUAL VIOLENCE
In the scaling up of multi-sectorial approaches to management of survivors of sexual violence, we take a look at the various sectors or disciplines that are responsible for taking over the mandate to assist the survivors of sexual violence. The disciplines involved in the multi-sectorial management of survivors of sexual violence include:-
- Health Management
- Psychosocial Management
- Security Management of the victim.
- Legal /Justice Management of the victim
The collaboration of this disciplines facilitates quick recovery and positive psychological state of the victims. In case any of the disciplines is omitted, the chances of recovery fully from the ordeal could complicate in the future or culminate to worse situations for the individual.
Discussions on the following disciplines
The health sector includes the Ministry of Health, training institutions for future medical personnel,hospitals, health centres and also health supplies. How can the health sector contribute to the scaling up of multi sectorial management of sexual survivors in Kenya? The health sector can achieve this by firstly, decentralising the health centres in the rural areas to bring the medical services closer to common ‘mwananchi’. This would encourage more sexually abused persons to seek medical help rather than when the health centre is kilometres away. In addition, it prevents complications that would arise due to the sexual violence as they seek medical help.
Secondly, the medical personnel should be well trained and available at the health centres for immediate cost free management of sexual violence. The medical prophylactic drug management that includes prevention of STIs, HIV/AIDs and also pregnancy should be administered per hospital’s protocol of treatment.In case of referral, then urgency could be a priority. Assessing the victim’s general health condition, in terms of head to toe assessment, psychologically and their cognitive level or knowledge of what happened to them is also a great intervention that assists in better outcomes of management. The health professional can also offer initial counselling in their primary contact with the patient after the medical management. This is vital because at this point, the victims are in great psychological derailment.
Next, the health professional can also provide forensic evidence that could be used in court for legal matters. Being the primary people in contact with the patient, full data collection including patient’s verbal history, laboratory investigations and body assessments can help the victim in court.
The health professional can also scale up the multi-sectorial management of survivors of sexual violence by maintaining confidentiality of the victims health history. By doing this, the help many people especially those who have been sexually abused feel free to report cases to medical professionals. This would increase the number of survivors of sexual violence visiting the health centres and opening up about their experiences.
The health training institutions e.g. medical colleges and universities can teach the students exclusively on the management of sexual violence both by involving students in regular symposiums and conferences that talk on Gender Based Violence (GBV); this helps in creating awareness to a greater extent and also increasing the number of people who are able to identify and counsel such victims of society. Additionally, they can achieve this by exposing the students to the community who help advocate for Gender Based Violence at grassroots level.
In this sector, the focus in mainly on the victim’s psychological and sociological status. This includes their emotions and thoughts. This is the most dangerous stage that could easily worsen and destroy a victim’s personality, self-esteem and health condition. In this stage, scaling up of the multi sectorial management of survivors of sexual management can be achieved by critical counselling, emotional support while using the effective methods to boost their self-esteem. Incase they feel neglected, abused, lonely or dejected by their fellow or close friends, most of them end up in a long term wave of depression, antisocial personality, episodes of nightmares or can even develop the Post Traumatic Stress Disorder.
The first people who can boost the victim’s psychosocial needs are the families, close friends, relatives or even the first contact people e.g. health professionals. A positive take on the assaulted lady/gentleman by being supportive and offering loving and caring counselling could be of great impact in preventing conditions such as Post Traumatic Stress Disorder.
A counsellor may be of great help at this stage to try explain to the victim the pathology and end results expected after the sexual violence ordeal. Research has it that when one is aware of the repercussions of the problem, they tend to cope well with the situation as compared to those without the knowledge. This helps alleviate emotional and physical pain.
Secondly, linking the sexual violence survivors to people who have been in their situations at one time and have actually made it in life. This will not only boost their self-esteem, but also increase their hope and self determination to continue pushing despite the odds. Group therapy can also steer up the multi-sectorial approach whereby the sexual survivors are ‘hunched up together’ and they share their experiences by themselves or in presence of a moderator (counsellor or activist) who coordinates the discussion.
In depression, pharmacotherapy has been used to counter the depressive episodes. However, the key management remains supporting the victims by emotional support and alleviating the feelings of shame and guilt in them.
This is the phase which is normally neglected by most sexual violence survivors. Most cases of assault don’t arrive at this level in Kenya. If this sector is fully utilised, it will scale up the multi-sectorial management of survivors of sexual violence. It has become the norm in Kenya for the community to raise uproar of a suspected female assaulter roaming in the streets freely without being captured. This demoralises the sexual violence survivors attitude and makes them see as reporting the culprit to the security officers as a waste of time.This could be promoted by arresting and making sure the culprits appear in court for punishment that should include ‘serious’ jail sentence. This could also be promoted by setting strict rules on sexual violence and hefty penalties if lines are crossed. This would encourage the survivor to report the assaulter and also offer them a sense of security when they are aware of the hefty jail sentence thus help boost their self-esteem.
SECURITY / SFATEY
How could security and safety enhance the management of sexual violence survivors? Security is the state of being free from danger. The police officers and military personnel should act and track down the sex-offenders in the soonest time possible. The more the rapist/sexual assaulter is out there roaming freely, the more the sexual survivor gets stress, anxiety and aggravates the situation to depressive mode. The survivor would get calm and feel they have security when the culprit is apprehended and locked up. This increases their esteem and confidence even for getting back to school and interact with other students or friends freely. It enables them to perform the day to day activities without fear. This reduces anxiety, fear and stress but promotes effective recovery from the stressor.
They can also review rules that cater for the safety of the witnesses e.g. the victims of abuse so that they may not be attacked before they are able to give evidence. Ensuring 24-hr surveillance is of importance until the perpetrators are taken to court and jailed may account to the victim’s recovery process and relieve them of anxiety and depression.
To sum it all up, the end result/ aftermath of sexual violence includes both acute and long term physical and psychological effects. The victim should receive comprehensive holistic care that would cater for both long and short term results. Some may need management or treatment for life. The continuous management is to prevent the following complications:- distrust of others, Post Traumatic Stress Disorder, Depression, Flashbacks of the rape incidents, Guilt and Shame among others which may worsen the condition of the post assault victim. Lastly, the major indication for post assault patients would be on their psychosocial aspect as it plays a major role in their coping mechanisms.