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Papua New Guinea: Integrated package of care to survivors of sexual and family violence
Survivors of family and sexual violence in Papua New Guinea now have greater access to quality medical and psychosocial care with the opening of a new Médecins Sans Frontières/ Doctors Without Borders project in the capital, Port Moresby.
At the 9 Mile Clinic, a health centre in a busy Port Moresby settlement area, Médecins Sans Frontières has begun seeing patients and training local staff to provide integrated care to survivors of family and sexual violence. In the first month the team has already cared for dozens of survivors.
Clinical supervisor Martha Pogo says it is crucial that care is available close to home, because survivors can not always easily access referral hospitals due to poor transport or the severity of their injuries.
“One lady who came in to the clinic had been beaten by her husband when she was two or three months pregnant,” says Martha. Beaten, kicked and punched all over, including on the abdomen. She lives just a few houses away, but she couldn’t come in straight away because she had a miscarriage after the incident and she was bleeding. She was so weak, she was crawling. When she could stand up and take one step at a time she walked right into the room and was seen by me. She was grateful she could walk in and get help because she didn’t have the strength to walk to the bus stop.”
Five essential services
The Port Moresby project builds on Médecins Sans Frontières' experience in Papua New Guinea's second biggest city, Lae, where more than 13,000 survivors of sexual violence were treated between the end of 2007 and June 2013. Médecins Sans Frontières has recently successfully handed over the Lae project to the Papua New Guinea Department of Health, but will continue to support the project remotely.
At the 9 Mile Clinic, Martha is training nursing officers to provide the same minimum package of five essential services that are provided in Lae. This is a simplified treatment protocol which ensures patients receive the most urgent treatments all in one session. The five services are: emergency medical care for wounds; psychological first aid; prophylaxis for HIV and medicine for other sexually transmitted infections (STIs); emergency contraception; and vaccination to prevent Hepatitis B and tetanus.
Although Martha is training experienced nursing staff, there are several gaps in their knowledge. Patients are also surprised to learn they can prevent HIV if they present within 72 hours of sexual violence.
Martha says the knowledge about sexual violence and the importance of medical treatment for survivors is so much stronger in Lae, where she worked for a year, than in Port Moresby. “It shows how far we’ve come.”
Some patients have missed out on urgently needed treatment because of the lack of medical knowledge. Psychosocial nurse Rolling Morgan says one young patient, aged six, had been sexually abused by a family member a year ago and was still suffering from an untreated STI. After receiving treatment at 9 Mile Clinic her symptoms began to clear within a week.
“For a little girl to have a chronic STI is horrifying and heartbreaking,” says Rolling. “That she was walking around for a year not knowing what had happened to her body, and that the doctors she saw weren’t aware or weren’t understanding, was confronting on many levels. But it was wonderful to be able to concretely help medically.”
Need to talk
In addition to providing direct medical care, the 9 Mile Clinic is gaining a reputation as a safe place where survivors can come and talk, whether they suffered sexual violence an hour ago or years ago.
“We’re in a settlement area, not necessarily a safe area, but the clinic is turning into a place where people want to come and share their stories because they know that quality care is being offered,” says Rolling.
Martha Pogo recalls that the first patient the Médecins Sans Frontières team treated at the clinic was a teenager who had suffered sexual violence two years earlier but had never felt comfortable enough to share her story. “She wasn’t suffering from any medical condition; she just wanted to talk to someone. After two years, she finally felt we were the right people to talk to,” says Martha.
In Port Moresby, Médecins Sans Frontières is working within existing health facilities, supporting and training local nursing officers. Médecins Sans Frontières has appreciated the health facilities’ willingness to collaborate and learn a new approach.
Ultimately, the Médecins Sans Frontières team hopes the nursing officers will be able to train their colleagues to provide the same five essential services.
“It makes me really happy to see these young nurses so passionate about something new to them and seeing that they’re the ones in charge of it. Hopefully this means that survivors of sexual violence will have access to the medical care they need for a long time to come,” says Rolling.
Plans are underway to expand the project to more urban health centres, plus larger family support centres in Port Moresby’s main referral hospitals. This two-tiered approach means that survivors can receive care close to home at the urban health centres, but also access more in-depth care at the family support centres if needed.
Ultimately Médecins Sans Frontières plans to work with health centres and referral hospitals in more remote regions of the country. The team will provide direct care and clinical supervision, with the goal of ensuring more survivors in Papua New Guinea have access to the clinical care they urgently need.
In addition to the project in Port Moresby, MSF works in Tari running a Family Support Centre. MSF also supports primary and maternal-child healthcare in the Buin Health Centre in Bougainville. MSF began working in PNG in 1992.