Lessons from WHO GBV clinical handbook
Gender-Based Violence (GBV) is a sensitive topic that requires professionals working with victims and survivors to be empathetic.
The World Health Organization (WHO)‘Clinical Handbook on the Health Care of Survivors Subjected to Intimate Partner Violence and/or Sexual Violence, Namibia’ has helped doctors, social workers and nurses like Mark Bezuidenhout, an enrolled nurse at Epako Clinic, to be more sensitive toward their patients.
The handbook was initially meant for medical doctors, however, nurses and social workers have also found the handbook beneficial to their work.
“The handbook is very helpful. It makes it easier to deal with GBV clients because it helps us deal with patients empathetically and in ways that benefit them. Previously we often got stuck and did not know what to do next or who to involve,” says Bezuidenhout.
He is also more aware of the different forms of GBV violence. “I’m more aware on how to deal with the rape survivors and those subjected to other kinds of GBV,” says Bezuidenhout.
He has had to deal with patients who are abused physically, emotionally and sexually. The majority are women of reproductive age. “We refer these patients to the social workers for further interventions,” explained Bezuidenhout.
Justina Shoopala is a Senior Registered Nurse at the Rundu State Hospital. One way she has been able to pick up that her patients were possibly being abused is when they would refuse to go back home after being discharged from the hospital.
“Often times they would refuse to tell us why they do not want to go home but with further probing, we would tell that they are experiencing some kind of abuse and then we would refer them to the social workers,” explains Shoopala.
She further notes that when the same patient is admitted to the hospital ‘many times with no signs of serious physical symptoms they also dig deeper to rule out potential abuse. “The training sensitized us on how to ask questions to the client without being insensitive,” Shoopala says.
Audrey Gaes, a social worker for the Ministry of Health and Social Services in the Erongo region has been working with GBV patients sometimes identified by doctors or nurses. Whether the patients go back for follow-up sessions with the social workers depends on their socioeconomic status.
“It is important to establish rapport with the patients because that determines their willingness of the patients to continue. We teach them independence because some of them stay in relationships because of mental, psychological, and emotional dependency. So, they have to be taken through this process,” Gaes said.
Gender-based violence has various causes, the health professionals note. Accessive alcohol consumption and poverty are among the contributing factors that result in GBV. “You will find young girls with sugar daddies who end up abusing them,” adds Bezuidenhout.
He feels that nurses should ask questions when underaged children come to the hospital for antenatal care. “Not every nurse or health worker is aware of statutory rape and that there is a penalty for not reporting it,” observed Bezuidenhout.
This is why training more nurses on the clinical handbook will be crucial, adds Bezuidenhout. “Often times the nurses would just treat the patient for the disease they came for, so I think more nurses should be trained to identify GBV cases so that they can refer the clients who might be experiencing this to the social workers. It would also be great if there can be a unit for such cases where people can come and feel safe,” said Bezuidenhout.
Train the law enforcement officers
While this training has helped Bezuidenhout, he feels that law enforcement officers should also be trained in the clinical handbook. “The handbook is so beneficial that the law enforcement officers could benefit from it. Most of the GBV cases are referred to them so they could really benefit from this training,” said Bezuidenhout.
“The handbook needs to be decentralized, involving the Ministry of Gender, and the GBV unit because for them if they maybe have a rape case, they will just come and say we have a rape case without being sensitive to the client. Confidentiality is important. So, it will be good for them to be trained on the booklet,” added Bezuidenhout.
Angaleni Kangayi, the Regional Chief Social Worker in Rundu agrees that the training should be provided to other stakeholders. “This will help us understand the role other stakeholders are playing in addressing GBV,” said Kangayi.
The impact of COVID on GBV programmes
The Covid-19 pandemic has had an impact on GBV services, says Bezuidenhout. He is the only nurse stationed at the Epako clinic who participated in the training. The first training took place before the Covid-19 pandemic. But, when Covid-19 hit, his attention was geared toward that.
“My work was interrupted by the Covid-19 pandemic because I have been out on vaccination campaigns,” he says. He also does not have a consultation room where he sees GBV patients. “At the moment I’m attending to TB (tuberculosis) patients,” he said. Similar, Shoopala feels that the Covid-19 pandemic has shifted their focus away from GBV and calls on the Ministry and partners to continue their support for the implementation of the Clinical Handbook.