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Teaching Health Workers to Treat Survivors of GBV in Rwanda

This blog is the first in a series of three IntraHealth is publishing in recognition of the 16 Days of Activism Against Gender-based Violence.

A couple of months ago I was in Rwanda and was heartened by the tremendous work of my Rwandan colleagues to create programs that support and teach health workers how to offer nonjudgmental, competent care to survivors of gender-based violence.   

In Kigogo, I walked through a local health post and wondered about everything a woman who had experienced sexual violence would have to do just to get herself to this clinic. Would she go to the police first and then be told that she needed to get a medical exam to file rape charges? Or was she in so much pain that she came to the health post first? Did someone in her home or perhaps a local community health worker see her in the aftermath and send her here? Was she lucky enough to borrow money from a neighbor for a ride? If not, how far would she have to walk over the hilly and rugged terrain and rutted dirt roads to reach this clinic? But I take comfort in knowing that if a woman is able to find her way to the clinic I sat in, she will be in the capable and compassionate hands of my colleagues. The staff here are part of the IntraHealth HIV/AIDS Clinical Services Program, which is committed to training health workers on how to provide confidential, sensitive, and comprehensive care to women or children who have experienced violence.  So what exactly does this mean in practice?

It means the receptionist in this clinic is trained to ensure that any woman who reports sexual violence is seen immediately. The physical and emotional repercussions of such an experience warrant immediate attention, and a woman who waits too long without being seen may talk herself out of pressing charges or into going home where she may not be safe. At the Kigogo Health Center and other places like the Kibagabaga District Hospital, a woman who reports sexual violence will be ushered immediately into the office of a nurse such as Glycerie, who is a trained in counseling. Glycerie will talk to the woman about the process for treating her at the clinic and seek her informed consent before offering her a physical or gynecological exam.

If the woman consents, a nurse or doctor will examine her and collect specimens. She will be tested for pregnancy and sexually transmitted infections, including HIV. These lab tests will be prioritized to give the woman her results as quickly as possible. The woman will be offered emergency contraception to prevent unwanted pregnancy and post-exposure prophylaxis to prevent HIV and other sexually transmitted infections. The staff will ask her what other types of support she might need. She will be given her medical record, instructions, and support to report the crime to police if she chooses to do so. Clinic staff can also connect her with a shelter if she does not feel safe going home or with economic support services offered through local nongovernmental organizations.   

The HIV/AIDS Clinical Services Program stresses the imperative of treating each woman with respect and compassion in every interaction from the community health worker, to the nurse, to the doctor, and to the police officer. It has piloted programs that respond to gender-based violence in two districts. Week-long programs train hospital staff and police together on how to respond to violence. The hospital staff and police, in turn, train teams from the community health centers. Volunteer health workers also run community education campaigns to teach people about the importance of seeking health care within 48 hours, when prophylactic treatment to prevent pregnancy and sexually transmitted infections is most effective. The programs also work to build stronger ties and collaboration between local health centers and district hospitals to ensure that victims who want to seek a rape prosecution have the medical forms needed to do so.

Although some survivors struggle to get the care they need because they can’t afford transportation to the clinic or because clinics run out of pregnancy tests or rape kits, increasingly health workers are able to respond to survivors’ needs. Like many places, violence against women is a long-standing and ingrained form of human rights violations in Rwanda, but it was also one of the weapons of choice during the 1994 genocide. The government of Rwanda has taken and is taking important steps to combat this legacy of gender-based violence by requiring that gender-based violence services are offered for free at community health centers. Rwandans have also made tremendous strides in tackling the root cause of gender-based violence—gender inequality. Today, the Rwandan parliament boasts the highest percentage of female parliamentarians in the world.