Maureen Maramba works as a clinical officer in Macalder Sub-County Hospital in Migori County, in western Kenya. For the past 5 years she has gone beyond her clinical duties to support survivors of sexual and gender-based violence (SGBV) to attain justice.
The mother of two has been working in the outpatient unit of the hospital where cases of gender-based violence (GBV) – and specifically SGBV – are received. The brutal realities of SGBV are on full display in such environments, with an added sense of normalization from the community. Maureen explains, “when violations result in pregnancies, it is the minor that is victimized. They can be branded as ‘cheeky’, with some health care providers offering antenatal care without questioning why a minor is pregnant.”
At one point a 12-year-old child was brought to the office because they were sick but after further interrogation, we realized that she had been defiled and was pregnant. So, in addition to the antenatal care, we further interrogated the case and realized the perpetrator was an old man who was convicted and sentenced to 30 years in jail.
Most cases presented to medical facilities are not brought in as defilement but rather as illness – it is upon the clinical officers to unearth the underlying cause. However, the ability to do so is heavily dependent on whether clinicians have knowledge in handling cases GBV cases. Relying on information from the guardian(s) is never enough as the perpetrators are frequently close family members.
Walking the whole journey with the survivors
Maureen is part of the Trainers of Trainees (TOTs), supported by UN Women, within the Joint Programme on Reproductive Maternal Neonatal Child and Adolescent Health (RMNCAH) that ensures clinicians are adequately equipped to handle SGBV cases effectively. Through this, Maureen and her peers are able to build the capacity of more clinicians on handling SGBV cases within their respective health facilities. She explains:
“The training is crucial mostly in addressing unnecessary referrals. Nyatike, as a sub-county, is a vast area. When a defilement case is presented at a dispensary, it should be handled at that level rather than being referred to the sub-county level where it is treated as a medical case. Most cases are lost along these referrals as survivors are either children, or they do not have the financial means to travel to where a trained clinician can be found.
In the past year we have had four cases which have gone through the courts of law that have led to successful convictions but we have another five cases ongoing. Some of which I have already presented the Post Rape Care form and the P3 form (used by police for recording cases) as evidence and are in the advanced stages, while the others are in their initial stages.
I can attribute the successful conviction for the cases I have handled to walking the whole journey with the survivors to ensure that they get justice. When they see that someone is willing to walk with them throughout this journey, it is encouraging to them.”
The training also incorporates a crucial component of evidence collection through documentation. This is vital for presenting evidence in a court of law. Error in evidence collection is the point at which most cases can be challenged. Building capacity in this area goes a long way towards achieving convictions and, as a result, changes the narrative and mindset within the community that violence against women and girls is a crime.
Human being, mother and healthcare provider
Maureen started handling GBV cases out of passion and out of the desire to help women and girls within the community but it is an emotionally draining job.
“As a clinical officer, walking with survivors along the path to justice is not part of my duties. I do it as a passion so I’m forced to balance between my duties as a clinician and appearing in a court to provide evidence. My colleagues have been supportive, covering for me even as I attend court.
My lowest moments have been losing two cases. One was because I was unable to be in the court at that particular time since – I did not have the financial means to get me there. The other was because the survivor’s parents did not proceed to the police following the the medical report, so the case just died and was never followed up.”
This lack of follow up remains a challenge and there is a clear a disconnect between the number of cases responded to by medical services and cases reported to law enforcement. This is the gap Maureen has identified and serves to bridge but there are also more practical challenges she encounters:
“Because of the remoteness of the area and its proximity to the courts, I am forced to travel using police transportation alongside the suspected perpetrators. I am forced to chose between that and losing the case with the later not being an option for me however risky it might be.
As a human being, a mother and a healthcare provider, I want that child to grow up thinking: someone cared enough and supported me, listened to me, and showed that concern. As clinicians we are their last hope to attaining justice, just giving them drugs and letting them go is betraying that hope.”
Supporting the policy environment
In addition to enhancing the capacity of medical personnel to efficiently and effectively handle GBV cases, UN Women has also supported the policy environment around SGBV within the county through the development of the POLICY ON SEXUAL AND GENDER-BASED VIOLENCE. It articulates a strategy and actionable priorities, giving guidance on effective leadership; stakeholder coordination and collaboration; strengthening service delivery; strengthening evidence and data for decision making; and meaningfully engaging the community in SGBV prevention and response.