When Dr Ifeolu Oyedele first learned that he would be going for training on the World Health Organization (WHO)’s ‘Clinical handbook for the health care of survivors subjected  to intimate partner violence and/or sexual violence’ he did not think he would learn anything new from the session.

In fact, he was already sensitized through his medical training to see signs of abuse and trauma. It was only while attending the training session in September 2021 that it dawned on him the seriousness of Gender-Based Violence and Intimate Partner Violence (IPV) as well as the trauma it causes to the victims.

“The training opened my eyes to what happens after we see patients of GBV. The impact the training made was that I was now starting to give the sexual assault cases a higher priority,” said Oyedele, the Acting Senior Medical Officer at the Rundu State Hospital. He adds that before the training he and other doctors at the hospital did not really prioritize GBV victims.

Before, patients who would come to the Rundu State hospital for a sexual assault case had to wait for long hours before a doctor would attend to them. Patients were told to wait for the doctors’ lunch hour to be seen because of the high number of patients doctors at the 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 (victim) an appointment I would just see her as immediately as possible, basically I would finish my current patient and then see them and do the rape kit,” he explains.

He further elaborates: “My eyes were just opened to the sensitive nature of the issue and that they are going through a lot of psychological stress and trauma and telling them to wait, and they haven’t bathed or showered is a bit insensitive. I now do it as soon as feasible”.

Oyedele works in the gynaecology department and when doctors in other departments pick up cases of GBV or IPV they are referred to him. “It’s only my department that is dealing with these cases because we are the ones with gynaecological experience,” explains Oyedele.

Oyedele is one of 282 healthcare professionals trained in the clinical handbook nationwide. The purpose of the training is to orient health professionals, primarily doctors and nurses at government healthcare facilities to identify signs of abuse in patients.

The doctors and nurses are trained to see clinical cues and identify violence that healthcare providers are likely to miss in their patients. The doctors and nurses are also trained to be empathetic when dealing with victims of GBV and IPV. 

Dr Leonard Kabongo is a Chief Medical Officer in the Erongo region. He was also trained on the ‘Clinical Handbook on the Health Care of Survivors Subjected to Intimate Partner Violence and/or Sexual Violence, Namibia’.

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

“It is very important to listen because the story of the assault or the violence is actually guiding you on how to approach this individual (survivor) and where exactly your focus will be as you are listening,” explains Kabongo. By actively listening to his patients, Kabongo has also learned to empathise with his patients.

Timely intervention

Dr Alice Kabongo, is a Senior Medical Officer at the Gobabis State hospital. She says that doctors in the state health facilities have to attend to many patients and that sometimes makes it difficult to prioritise sexual assault cases.

“Although we know that GBV cases should not wait because it's an emergency we are sometimes forced to use the triage system where we prioritise who we will see. For example, if it's a young patient we will attend to them at whatever time we have that day and if it’s an older patient we let them sleep in the ward and we see them in the morning,” explained Alice.

Meanwhile, Kabongo (Leonard) feels that even if the state hospitals are busy, GBV survivors equally need urgent attention. “We do a triage to attend to patients who need urgent medical attention, including survivors of IPV and GBV because they are also hurt emotionally and they need support and a place of safety,” Kabongo explained. GBV and IPV are emergencies, he emphasized.

In addition, time is of importance, especially in the case of a sexual assault. “If you wait too long to attend to the patient you are losing that opportunity to prevent infections, so there are medications that they need to receive, prophylaxis which they need to receive to prevent certain types of infections that could be the result of the assault,” he adds.

Equally, waiting too long to attend to a sexual assault patient increases the chances of losing forensic evidence. The result is that there will not be sufficient evidence to prove in court that a sexual assault has occurred. “Forensic evidence actually disappears with time so the more time has elapsed the more the evidence is gone,” adds Kabongo.

Forensic kit

Dr Oyedele and Alice both have been using the rape kit for years. Oyedele says that he studied the instructions on the rape kit manual and has been doing it accordingly. “I just followed the manual that comes with the rape kit. This has already been part of the work I do so it didn’t add to the workload,” Oyedele explained. However, not every doctor knows how to use one, says Kabongo. The training was also helpful to the doctors who did not know how to use the forensic kit, Kabongo adds.

“Most of the doctors are not really exposed to forensic examination, for example, how do you collect the evidence appropriately and how do you defend yourself in the court of law if you are summoned to be an expert witness,” he explained.

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

In the event that they are summoned to court regarding a GBV or IPV case, doctors who have undergone the training know what type of evidence to present.  “If I present myself in court and I’m being asked questions by lawyers I know how to respond. All these come as a component of the clinical handbook and I think it has really empowered doctors to be able to defend their cases effectively,” Kabongo explains.

Abuse knows no gender or age

While it is common for women and girls to be the faces of GBV and IPV, they are not the only ones who experience abuse, Kabongo emphasizes. The clinical handbook training touches on the human being and this includes men and boys.

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

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

GBV survivors must be protected

Meanwhile, Alice credits the GBV training on the clinical handbook for her alertness and ability to pick up subtle cues and probe suspected abuse. “We take the patient’s comprehensive history to rule out abuse,” she says.

Still, she feels that more needs to be done to protect survivors of GBV and IPV. People who report to the hospital for obvious abuse need to be protected, she says. At the moment, these patients’ first contact point is the casualty department where everyone can see they “have been abused,” says Alice.

“GBV 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 in the Old Theatre of the hospital when we suspect abuse. But we are advocating for a corner where they can be seen privately,” says Alice. She also feels that more medical professionals should be trained and a designated doctor should be assigned for these cases.

“The only issue is that we are working in an environment where there is a shortage of doctors. In other hospitals, there is literally a separate doctor who attends to those cases and doesn't have to attend to any other patients,” agrees Oyedele. The response to the handbook has been overwhelming with some doctors requesting more training, concludes Kabongo.

The ‘Clinical Handbook on the Health Care of Survivors Subjected to Intimate Partner Violence and/or Sexual Violence, Namibia’ is an initiative of the 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.