Zambia: A safe space for the treatment of child survivors of sexual abuse

UNICEF One stop centre Lusaka EWH 12 Nov 15 cropped 2LUSAKA, Zambia, 17 November 2015 (UNICEF/By Elizabeth Willmott-Harrop) — “The figures are alarming and steadily rising. We treated 116 children in August, 146 in September, 162 in October,” explains Dr. Lalick Banda, paediatrician at the UNICEF-supported One-Stop Centre for the treatment of child sexual abuse in Lusaka’s Paediatric Centre of Excellence.

“I do not know why cases keep going up. Is it that there are more cases, or that children and the community are more empowered to report? We do not know the answer to that at the moment,” said Banda.

The One-Stop Centre, one of 35 in Zambia, is staffed by a clinician, psychosocial counsellors and the police. Malama*, has just arrived with her baby son and 14-year-old daughter Joy*, who according to Malama has been defiled by a man known to the family.

Malama explains, “He took Joy and drove her 160 kilometres to his uncle saying he wanted the uncle’s permission to marry my daughter. The uncle said no, that she is too young, but this man, he still defiled her. Now we are here waiting to see what injuries she may have, what diseases.”

As a result of her visit to the centre, Joy was offered counselling, an examination and all necessary medical care including post-exposure prophylaxis (PEP) anti-HIV medications.

The One-Stop Centre provides medical records which can be used by the police as evidence in prosecutions. The privacy of the survivors’ are protected in the records. Indeed the first police interview often takes place in the safe space of the centre. Medical personnel may then be asked to act as witnesses in court cases.

“The police are reluctant to prosecute where there is no evidence of injury, and there is a gap in health worker knowledge on sexual crimes. This is partly why conviction rates of perpetrators are very low at around 5 per cent. We therefore conduct multidisciplinary training in gender based violence, violence against children and sexual crimes. We have reached 20% of Zambia’s districts so far,” comments Dr Banda.

Conviction rates could also improve across the country with the generation of higher quality evidence. The Lusaka One-Stop Centre has the only colposcope in Zambia, used to see and photograph internal injuries. The One-Stop Centre also collects DNA specimens, but they are in storage as there is no processing facility in Zambia.

This lack of evidence particularly hinders the prosecution of wealthy perpetrators. Dr Banda explains, “High density areas such as one block with 20 households are far more likely to report offenders. However the more affluent areas do not report. Family members are told to cover it up or get out. Or the perpetrator hires a powerful defence lawyer.”

Annie Sampa-Kamwendo, UNICEF Zambia Project Officer for Child Protection, agrees: “I heard of a case recently where an uncle staying in the family home was sexually abusing a daughter of a relative. The mother was ready to report the case to the police and press charges but was told by her husband ‘if you report my brother to the police you are not living here anymore.’ She is completely dependent on her husband financially, so she dropped the case and the uncle still visits the family home – she did not even have the power to stop that.”

While much needs to be done, Zambia is taking positive action to combat Violence against Children (VAC). The Central Statistics Office is developing a national database on gender based violence (GBV) and VAC, with 6 of 10 provinces already piloted. Meanwhile Zambia’s latest Demographic and Health Survey (DHS) for 2013/2014 contained a section on “Domestic Violence” for the first time. Meanwhile Zambia has also conducted its first national VAC Survey with UNICEF support, which revealed that 1 in 5 girls and 1 in 10 boys in Zambia experience sexual abuse before the age of 18.

The One-Stop Centre provides vital learning and expertise to contribute to this growing awareness around VAC, acting as a centre of excellence for the care and treatment of child sexual abuse in Zambia.

While the centre is doing excellent work in supporting child survivors of sexual abuse, Dr. Banda explains so much more could be done with investments in technology and also in personnel. “What we need most of all is to build staff capacity– we really need more skilled personnel and more training.”

The centre is due to introduce Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) which is one of the most effective long term trauma treatments. Dr. Banda continues, “Again we need staff training so that clinicians can identify features of severe emotional trauma in children.” Dr. Banda has also used CT-CBT to help survivors testify in court who were literally rendered speechless by their ordeal.

Malama sits quietly before speaking again. “I thought this had only happened to my child. But when I came here to the centre and saw so many children, I realised it is a common problem. What are the government doing about child abuse?” she asks.

Willmott-Harrop is a UNICEF editorial consultant.

*Names changed to protect their identities.

Photo Caption: Dr. Lalick Bamba of the One-Stop Centre Lusaka, advises the mother of Joy, aged 14, who has just been defiled. The piece of equipment in the background, a colposcope, is used to see and photograph internal injuries which the naked eye cannot detect. The evidence is used in prosecutions of sexual abuse. However it is the only colposcope in Zambia.

Credit: © UNICEF/ESARO Elizabeth Willmott-Harrop, Zambia 2015

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