LVCT HEALTH’S GENDER BASED VIOLENCE/POST RAPE CARE …

Stories from the field

LVCT HEALTH’S GENDER BASEDVIOLENCE/POST RAPE CARE PROGRAMME

www.lvcthealth.org

LVCT HEALTH’S GENDER BASED VIOLENCE/ POST RAPE CARE PROGRAMME

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INTRODUCTION

World Health Organization (WHO) (2014) defines violence against women as ‘any act of gender based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”. In Kenya, the problem has been identified as ‘serious’ with implications on the development of the nation. 4.5 out of every 10 women age 15-49 have experienced either physical or sexual violence. 1 out of every 4 women have experienced physical violence while 7 out of every 100 women have experienced sexual violence. 14 out of every 100 women have experienced both physical and sexual violence (KDHS, 2008-9).

Based on evidence of prevalence and capacity to offer high impact intervention, LVCT Health strategically focuses its interventions on Sexual Violence (SV) in general with Post Rape Care (PRC) as a key area. LVCT Health’s work in tackling SGBV is comprehensive and covers:

• Community awareness that raises the general public’s engagement and participation in prevention and response to sexual violence. LVCT Health has worked with communities to reduce stigma associated with sexual violence that makes reporting difficult.

• Strengthening prosecutorial processes by enhancing the capacity of service providers on collection and management of the chain of evidence, development of data capturing tools like the Post-Rape-Care (PRC) form, enhancing capacity of local level administrators like chiefs and strengthening community reporting structures to link with the law enforcement agencies on reported cases, sensitizing judicial officers on the Sexual Offences Act to increase number of successful prosecutions on sexual Violence cases.

• Creating an empowering environment for responding to sexual violence by supporting the development of policies, laws, guidelines and standard operating procedures at the national level. Some of the key policy documents that LVCT has largely contributed to include the PRC form, the National guidelines on the management of Sexual Violence in Kenya, the National M&E framework on the Prevention and response of SGBV. These documents are cascaded to the county level to provide standard operating procedures. This is done through the relevant government bodies such as the National Gender and Equality Commission (NGEC), The Gender Directorate that are key on coordination and provision of oversight in the implementation of the developed policies at the National level and the county level. At the County level, LVCT Health has supported the establishment of Cross-sector County GBV Committees which coordinate GBV intervention and take lead in GBV related advocacy at the county.

• Strengthening the clinical response to sexual violence through systems strengthening; capacity building of healthcare providers on quality PRC service delivery through a standardized curriculum, commodity supply and equipping of facilities and strengthening referral linkages between the hospital and other service providers. These initiatives have resulted in quality PRC services and management of survivors of sexual violence.

Intervention


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Results: LVCT Health’s work has achieved recognizable results:

The work done by LVCT Health is best seen from the testimonies of those with whom the organization works with directly. This include survivors of sexual violence, duty bearers trained by LVCT Health, national and county government officials that have closely worked with LVCT in development of policies and in strengthening structures for prevention and response to GBV. The following are their stories.

20,000Survivors provided comprehensive PRC services

Gender Based Violence Recovery Centre4

Police, healthcare providers, Lawyer and magistrates

Service providers trained

4000

supported to offer post rape care servicesPublic Health Facilities124


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THE GENDER VIOLENCE PROBLEM: Who the shoe pinches…

Tetresia(Real name withheld), Sexual Violence Survivor, Nakuru

“I was raped by my brother-in-law who I had not seen in about 19 years. It was about 5:00 pm and I was on medication so I was in bed. A neighbor saw him getting out of my house just after, and came in to ask me if I had seen who had just left my house. I told her that I was too sick to even recognize him and the room was a bit dark; I was not even in a position to turn.

She advised me that I would have to go and seek treatment as it was Albert who had just left my house and it is known that he is HIV positive. She just told me that and left and I was not really aware that something bad had happened to me. The following day the same woman came back to my house to encourage me to report the matter. I had already come to my senses and was aware of what had happened to me and was embarrassed so I told her to just go.”


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Theophila Murage – Nurse, Nakuru

There was this survivor of sexual violence who was brought by community members. They had rescued the child from the father who was violating her. The girl had no mother, she died sometime back. She was living with her father and she was only 10 years old. She would do all the household tasks for the father and then he would take her to bed. The community were saying that this man was living with HIV. When the child was brought she could not talk because she was with the dad. I talked to the father, I talked to the child and told them that I needed to do some tests for them. The father was quite apprehensive, he did not want to be tested, said he had been tested a long time ago and he was fine with that. Eventually he agreed. I did the tests for both of them. As the tests were running I asked to talked to the girl alone, the girl was able to open up to me and told me that the father was sodomizing her. When I did the head to toe examination I found the hymen was still intact but the girl was having incontinence of stool (bowel incontinence - proving she had been sodomized). When the results came out, both the father and girl were HIV positive.

LVCT Health runs interventions educating and empowering sex workers so that they can prevent the occurrence of sexual violence in the course of their work and when it occurs to know what to do to seek clinical assistance. LVCT Health also works with survivors of sexual violence be they minors or adults.

I was in class 7 when it happened. It was a Saturday afternoon and I was fasting and I had gone to church to pray. I was on my way home but was late. A boy came from behind me. I heard footsteps behind me but did not know the boy was following me. He caught me and I fainted. When I came to, I found myself in a house with him. I started screaming, but nobody came to my help. He told me that my life was over that I would not live. I panicked and fainted again. When I came to I found myself on the road in Manyani Estate. I was bleeding a lot and was surrounded by people. They asked me where I lived. I was ashamed and I did not want to tell them where I lived and asked them to just let me go home alone.

– Anne Wanjiku, 14 yrs, Rape survivor


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A while back I met a client in a club, after negotiations we went ahead and I gave him the service. He then produced a knife, threatened to kill me if I did not hand over to him all the money I had, including what he had paid me. I did not know this person; there was nothing much I could do. I came to LVCT shared with the staff member, Irene. But on stuff like getting raped, I know where I can go. I know that the first thing I need to do is go the hospital and save my life first.

– Sylvia Auma, Sex Worker & Peer Educator, Kisumu

INTERVENTION

Emily Kiragu, Nursing Officer, Naivasha PGH – Gender Violence Section

Community Linkages – catches those who fall..

Gender based violence survivors come from the community, they come either directly or through referral from the police stations. Once they come here, we do the clinical management. We see them, we examine, we do trauma counseling, and we give medication and also do follow-ups. We then go back to the police station and then the community. It is like a circle because they are from the community, to the hospital, to the police station and back to the community so we have to work hand in hand with the community. We have referrals and linkages because we have to link to the community, it is vice versa, from us to the community and the community to us, we have to link to them because gender based violence cannot be handled single-handedly, we have to deal with it in a multi-sectoral way. We need all the other departments that are going to help us in the management of the survivors. The clinical management is done within our set up but we may refer depending on the case. We may find that clients have to go to the police station because it is a crime, sometimes we may find that we need to refer them to the Children’s department especially where we have children who are at risk and may need shelter. Other cases we may refer to the Gender office.

For us to succeed, we initially formed a committee within the hospital set-up. In this committee we included people from all the departments where our survivors go through, that’s the outpatient, laboratory, records and trauma counselors. In that committee we were looking at issues of how best we can handle the survivors. We later realized we cannot make it alone because once we are through with our clients they are still going out there so we formed another bigger committee, a multi-sectoral committee where we included the police officers, the children officers, the Gender officer, the Judiciary, probation and Ministry of Education because we realized that all these departments have a role to play in issues of gender violence. We also have the District Officer (DO) on board because we expect him to assist with the communities and chiefs because most of these cases are sometimes reported to the chiefs first and the chiefs will have to refer them to us.


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“After she left I dragged myself out of bed and went to Medical (PGH). I was referred to a room labeled as Youth……I narrated to them what happened and they referred me to Block 8 where I found Mrs Murage. I told her my story and mentioned that Albert was once very sick and was even admitted in hospital some years back during the time when we had not seen each other. I was examined and I was very worried that he had infected me with HIV yet I suffer from ulcers, I felt like I was already dead. After examination she recommended that I report the case to the police which I did and was given a P3 form. I went back to the hospital and was given medicine which I continued taking. I went back for a review on the appointed date and was tested again. She also counseled me and I realized that this thing happens to both children and adults. I was encouraged that this is something that happens and got the strength to go on. Since then I now know that rape can happen in any way to anyone at any time.”

- Teresia Sexual Violence Survivor

Wambui (Real name withheld), Rape Survivor

Clinical Interventions…from where does help come…

(After being raped) My grandmother immediately took me to hospital where we saw Dr. Murage who treated me and gave me some counseling. I was then enrolled for further counseling sessions. We were counseled in a group and we would go there every month. I would go to the sessions with my grandmother, but in the sessions they would group the older and younger people separately. In the sessions there was a lot of encouragement, sharing stories and talking to each other. At first I was scared and I had decided to drop out of school. This all changed after I started going for the sessions; I realized I was not alone. When I began talking, I gained courage and I decided that I want to be a lawyer someday, and I know I will be a lawyer.


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Benard Kioko, Officer Commanding Police Station, Nakuru

Training...for quality services to all

SGBV is part of crime so such cases are handled together with other crimes within the crime branch in most of the stations. Here in Nakuru Central (police station) we have an office specifically that deals with these offences.

Our officers have undergone a lot of seminars organized by the NGOs like LVCT Health. Out of our officers from the 14 units, 3 or 4 out of 10 have the skills and knowledge to handle cases. The gender desk (at this police station) is well established through training and has been there for a long time. It has evolved to the current status and in terms of service delivery; it is serving so many people to their satisfaction. This is because it is equipped and people (those manning it) have the knowledge. The vision of the police is to have every police station with an established gender desk, what we are lacking is resources.

Sometimes the NGOs and other public institutions lack basic knowledge about security and how investigations are carried out so they take sides. But with us, we know that everything that is reported to the police we treat it as allegations. So we always want to go further, for the person who is complaining to implicate the person being accused through documentary evidence, through circumstantial evidence so that we can take that case to court.

We enjoy a cordial relationship and we have no issues with the Judiciary. We are the ones who take the cases to court so if they are poorly investigated we will have a problem with the Judiciary. We have forums, the Court users, where we meet the Judiciary and try to come up with a better working relationship. We also work very well with the Ministry of Health, especially the Provincial General Hospital. We also work very well with the NGOs and Human Rights organizations, we are accessible to them and we do share information.

As a peer educator I was trained (by LVCT Health) on safe sex which covers a lot of topics like family planning, STI screenings, HIV including how to prevent re-infection if you are already positive. I was also trained on how I can mobilize and sensitize my fellow sex workers and give them health education, refer them and do follow ups, distribute condoms and lubricants. The first thing I do is to mobilize them then I give health education on different types of topics. Family planning, PEP, STIs, how those who are HIV positive can get care, do referrals and distribute and demonstrate condom use. Skills of a sex worker, these are skills on bargaining on condom use, type of sex and cash.

– Sylvia Auma


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Grace Njagi, Nursing Officer, Nyeri PGH

If I may say, before the training we did not take great care of the clients. I think it was because of ignorance. For example, before then, they would come, we send them back to the police for documentation, then they come back, already they are wasting time, then we request for a HVS (High Vaginal Swab) for spermatozoa. We also had poor notes, some of our doctors would get scared when they went to court, and some would even decline, because they feared harassment by the magistrates in the courts because of the scanty notes. I can’t even tell whether before the training we use to give the clients Post-exposure prophylaxis (PEP) or even the Emergency Contraceptives (EC). Clients would come, they’d be walking around on their own but since we got the Post Rape Care forms our documentation has improved.

In 2011 I was trained by LVCT Health in post rape care. We now don’t start by sending them off to the police but we start by managing them. Now when our clients come we are able to decide if we are going to give the clients Post Exposure Prophylaxis (PEP) or Emergency Contraception (EC) pills. There is now a lot of confidentiality; also there is easy identification of clients nowadays we take the responsibility because most of our staff have been trained and sensitized. We have trained nurses, doctors, clinical officers and the laboratory people. Even our casuals and the watchmen, almost everybody in the hospital has been trained on post rape care. Even if the client is lost in the process and comes across any of us, may be even one of the casual workers, they will be directed in the right place and from there the qualified personnel take over.

We have had trainings funded by LVCT Health. They have trained police, chiefs, members of the Judiciary, especially police manning gender desks, like Kisumu Central Police Station is manned by a police woman who is trained, same with Kondele. The trainings at the community level is on creating awareness on referrals.

- Jane Obiero, Director, Gender and Social Development, Kisumu County


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Theophila Murage - Nurse in Charge of GBVRC, Rift Valley Provincial General Hospital

Clinical Infrastructure…mending the hurt

The survivors that we get in our recovery center and in the hospital per se are survivors of physical violence, sexual violence, psychosocial kind of violence and many more. Their ages cut across. We deal with survivors of sexual violence more than the others. The most reported cases are between 12 and 17 years but it varies from month to month. We have less reporting from male survivors, especially from 18 years and above but when we have the boys whose complainants are the parents, they usually report but when it is a man above 18 years they are usually shy. The lower socio-economic status class report more. For the minors, those who come, do so with their guardians. There are two survivors who were brought to the facility by their mother – they came because they were actually violated by their biological father – the survivors were able to verbalize what had actually happened, they gave us the story of whatever had happened.

First we take the survivor as an emergency. If there was any issues they had, either psychological or physical assault, we deal with that one first. Then we take the history from the survivors, we do the investigations, the examinations, then we are able to fill the post rape care form. The post rape care is the one used to fill in the P3 form, then we refer them to the police. If at all they had come from the police, they usually come with the P3 because the facility does not have the P3 forms, so we fill in the P3 forms – there is someone assigned for that – then they go back with it. If it somebody who need to link to a lawyer, we have lawyers , if it someone who needs to be rescued we take them to the rescue centers which are faith based because the government now does not have any, but if we need to rescue a child through government institutions then we take them to the police.

When it comes to sexual violence and psychosocial support, and even the physical violence itself, these are people who are really traumatized so we do the counseling part of it. We do trauma counseling and continue with follow-ups. We have a support group, we do the linkages for them. We link them to the communities where they can get help.


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Byron Giorgiadis – Youth, Naivasha:

Community Outreach; strengthening prevention efforts…

“We as young people are also involved in combating SGBV by using edutainment - aiming to entertain as we educate. The Picha-Tamu youth groups started as a volunteer group; giving our mobile phone numbers and our time to create a ‘quick response team’ to respond to any case reported of sexual violence. We sensitize the survivor, walk them through the challenging procedures and processes that follow abuse. We accompany them right up the last phase when after they have received treatment we go to the police.

We youth are focused on issues of sexual and gender based violence because we are affected too. As youth groups and people who are capable of doing things and creating change we decided to be there for our sisters, younger brothers and our mothers. We thought that it would be good to support the work that LVCT Health was already doing. We felt that the system in place then was not really favoring the survivors. They were still victimized and traumatized as survivors. Today we are doing something about this

We were moved because every now and then we see that organizations like FIDA (Kenya) are the ones talking for women, groups like Women Empowerment Link and other women serving organizations so we asked ourselves, why is it that it is only women talking for women? What if we as their brothers came out and talked on behalf of our sisters and also try to show that when we can come together and show that we can do something and show that SGBV affects all of us. We as a community can act collectively and individuals to do something. This motivated us and so we decided to do something with some support from LVCT Health. We are here close by, willing ready and determined to give them a hand”

One of my achievements is that I have been able to reach many girls in hard to reach places with condoms. Many people feel embarrassed going to buy condoms but a peer educator like me makes it easy for them. The girls often say “Kasupuu nowadays walks with a book distributing condoms, it looks like she is making a lot of money”. I only get paid a token, Ksh. 2,000 (about US$ 23). This has helped in increasing availability of condoms and enhanced condom usage. As a result pregnancy among us has gone down and I believe infection is not as rampant as it was way back.

– Sylvia Auma, Sex worker & Peer Educator, Kisumu


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Jane Obiero, Director Gender & Social Development, Kisumu County

Coordination & Partnerships

(In Nyanza) the Gender Technical Working Group was formed way back in 2012 because gender violence was rampant in Nyanza. In Kisii we had a lot of FGM cases, towards Siaya we had a lot of domestic violence and wife inheritance and in Kisumu sexual violence cases cuts across. We brought on board Government and NGOs. In 2013 we formed the Kisumu Gender Technical Working Group (in line with the new administrative units after the 2013 general elections), still comprising of relevant government departments and NGOs. We are a team of about 25 although the number is still growing as we still bring in more members. From the Government we have the Children’s Department, Ministry of Education, Department of Social Development, Ministry of Youth, Ministry of Health, The Police, and The Judiciary. From the NGOs we have AfyaPlus, LVCT Health (who are co-secretaries for the team), Women Concern, Voices of Women, Nyarwek, and FIDA.

At the County level, (The Gender TWG) is mostly doing coordination. We meet, we receive issues, we share experiences and when there is an activity like 16 Days of Activism (against Gender Violence) we come together, we come up with a budget and everybody says what part they can chip in.

Our strategic plan started way back in 2012, we were doing it ourselves without a consultant. We talked to the Ministry in charge (Youth Affairs) and Mr. Wafula (from LVCT Health) offered himself as a consultant…we selected a small team of five from the TWG who would work on the strategic plan then we present what we have done to the larger group including Mr. Wafula. Members would add additional input and Mr. Wafula would fine tune it. Finally we launched it early this year, so now we have a Strategic Plan for the County. The main players were LVCT Health, they printed the first 100 copies, and Mr. Wafula would assist us in fine tuning the document. The County Government was also a key player because they are the ones who funded the launch and were to print 500-1000 copies for distribution. The Strategic Plan talks about the main issues in Kisumu County that we are grappling with so any partner will look at it and see what they can do.


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“If not for LVCT, I’d be finished by now. In terms of knowledge, LVCT has saved us, has saved many sex workers. I was trained here at LVCT. It had become too much; I was on the brink and LVCT saved me. I opened up and they (LVCT) thought, we can save this lady by training her on safe sex. So I was trained on safe sex and was also trained on how to reach my colleagues out there. I am now a peer educator but I also continue with my sex work”.

– Sylvia Auma, Peer Educator

LVCT Health continues to work with communities to reach that goal: a time where no one lives in fear of sexual violence, no one is stigmatized for having survived sexual violence and the community is willing and able to respond to the needs of such an individual. This is achievable…one step at a time.


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LVCT Nyanza Regional Office Kisumu

Tivoli CentreP.O Box: 3294-40100, KisumuTel: +254 057 2020906/46, 2025945Email: [email protected] Eastern Regional Office Embu

Embu VCT Centre

Tujenge Building, Eastern Hotel EmbuTel: +254 068 31602 Email: [email protected]

Our contactsLVCT Head Office Nairobi

Off Argwings Kodhek RoadP.O Box: 19835-00202, KNH NairobiGSM Lines: +254 724 256026,+254 722 203610; +254 733 333268Tel: +254 20 2646692, 2633212Fax: +254 020 2633203Email: [email protected]

LVCT Training Institute Nairobi

Kilimani Business CentreP.O Box: 19835-00202, KNH NairobiTel: +254 3861879Fax: +254 020 2633203Email: [email protected]

Connect with us

www.lvcthealth.org, www.gbvhivonline.com, www.one2onekenya.org LVCT Health (@LVCTKe www

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LVCT HEALTH’S GENDER BASED VIOLENCE/POST RAPE CARE …

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