Early this month, a 13-year-old girl from Homa Bay was gang-raped and mutilated. The attack was so brutal and savage that she needed reconstructive surgery.
Sexual abuse in Kenya is not uncommon. According to the 2010 National Survey on Violence Against Children in Kenya coordinated by Unicef, one in three girls and one in five boys have experienced some form of sexual abuse.
The physical and mental ramifications of sexual abuse include but are not limited to traumatic injury, contracting sexually transmitted illnesses, unwanted pregnancies, complications during pregnancy, post-traumatic stress disorder, depression, alcohol- and drug abuse and suicide ideation and attempts.
To address these consequences, all health facilities should be equipped to provide comprehensive post-rape care services for victims of sexual violence.
During an extensive research in Homa Bay County on institutional responses to sexual violence against minors, I established that most times, victims of sexual violence have to walk long distances to access health services offered mainly in the sub-county or county hospitals.
These services are often lacking in lower-level health facilities. But even the bigger hospitals are poorly equipped.
Although the medical care is supposed to be free of charge, sometimes, victims incur out-of-pocket expenses as they are asked to buy gloves before being examined or pay for emergency contraceptives. Sometimes they do not receive relevant vaccinations and rarely get counselling.
In addition, some of the health workers are poorly trained to provide post-rape care. They conduct shoddy forensic examinations that may not be useful in court when cases are filed by the police.
One hopes that, with the rolling out of universal health coverage, all health facilities will be well equipped.
It would be better for all health facilities to (re)train their health providers on provision of comprehensive post-rape care. The facilities should have an updated contact list of other service providers for referrals — for example, police officers, children officers, paralegals and non-governmental staff.
Multisectoral collaboration needs to be established with Department of Children’s Services, law enforcement, legal firms, prosecution, Judiciary, probation office and civil society organisations.
This is important for capacity building on management of sexual- and gender-based violence, obtaining knowledge on the type of evidence needed to prosecute perpetrators and providing victims access to legal services, safe spaces and counselling services.
All health facilities need to have a copy of the “National Standard Operating Procedures for the Management of Sexual Violence Against Children”; it provides guidance on care and support for victims.
The health facility should be secure, clean, offer auditory and visual privacy and have storage for confidential documents. The examination rooms require basics such as proper lighting, a sink, running water and soap, a clean toilet and shower.
In addition, sufficient copies of informed consent forms, post-rape care (PRC) forms, police medical form, sexual- and gender-based summary tools and trauma counselling forms should be available for documentation purposes.
Essential equipment, including an examination bed, speculum, magnifying glass, waste bin, camera and forensic supplies (paper bags, evidence tape, gloves, sanitary towels, wound management supplies, culture supplies, lubricant, hospital gowns and extra clothing for those who might need to change) are important for forensic examination.
Finally, the facility should be well stocked with medical supplies such as drugs for prevention and treatment of sexually transmitted illnesses, emergency contraceptives, tetanus toxoids, analgesics, antibiotics and Hepatitis B and Human Papilloma Virus (HPV) vaccines.