PORT VILA, Vanuatu - Dr Jimmy Obed, Psychiatrist at Vila Central Hospital, explains why the new Standard Operating Procedure (SOP) for the clinical management of Sexual and Gender-based Violence (SGBV) is a vital step towards supporting women and children who experience violence.
Vanuatu has one of the highest prevalence rates of violence against women and girls, and the highest prevalence of sexual abuse of girls under 15 years in the Pacific and globally (1). These figures are not customary collateral damage, these are human rights violations and have long-term traumatic repercussions on survivors, both physically and mentally. Any policy, procedure or action aiming to reverse these figures and respond to the needs of survivors are not charity, they are essential steps towards safeguarding the inherent dignity and equal and inalienable rights of all members of the human family.
In Vanuatu, and in many other countries in the Pacific, misunderstandings and misinformation about the complexity of Sexual and Gender-based Violence, has led to practices that deprive survivors (children and adults) of their right to receive comprehensive care, limiting their access to psychosocial and legal assistance, and ultimately recovery.
Sexual and Gender-based Violence is not a disease, yet survivors need specific response services that work with and for them. The physical and psychological trauma endured is allencompassing and as such need a holistic intersectoral approach to treat the visible and invisible scars, but most importantly to set in motion the ecosystem that can support recovery, safety, and possibly prevent further damage.
"Action aiming to respond to the needs of survivors are not charity, they are essential steps towards safeguarding the inherent dignity and equal rights of all members of the human family."
With the launch (2) of the new Standard Operating Procedure (SOP) for the clinical management of Sexual and Gender-based Violence (SGBV), which will apply to all healthfacilities in Vanuatu, the Ministry of Health has cast the safety net far and wide. The SOP strengthens the ties among all those involved in delivering emergency response services.
Before, cooperation among healthcare services involved in SGBV cases relied on a shared understanding among professionals operating across the same corridor, the SOP has formalized and enhanced such cooperation.
The procedure looks at the survivor’s health in its entirety, physical and psychological, also covering sexual and reproductive health, connecting all the health care professionals involved in SGBV response. In addition, it creates referral systems between the Police Family Protection Unit (FPU) and the Ministry of Health (MOH) to effectively respond to the physical, legal, and psychosocial needs of victims of violence. All departments involved are aware of their individual roles and responsibilities as part of the response ecosystem.
The SOP has aligned the services available to survivors, it is up to the survivor to decide if and when to access any of them, honouring the survivor's right to self-agency and dignity. The SOP also looks at the capacity of the infrastructures activated in SGBV response and its staff, listing the minimum requirements3 of the facilities needed to create accessible and safe spaces for survivors. With the new SOP, professionals are able to draw a complete diagnosis beyond what is visible, and can therefore refer survivors to different types of support and care covering both the immediate and long term consequences of trauma.
The reflex to treat survivors holistically and attend to the person’s physical and mental health will take a while to consolidate, but we are on the right path towards that systemic change.
THE MIND SHIFT
The SOP emphasizes a mind-shift in the design of services, from service-driven to survivor-centered care. The SOP challenges the understanding of what it means for medical staff to respond in an appropriate, efficient, and survivor-centered manner. The focus on service providers' accountability and responsibility in the effectiveness of the services provided is crucial. The core concepts and general guiding principles at the heart of this SOP are informed by human rights and gender equality, and aim to ensure safety, confidentiality, and respect of the wishes, rights, and dignity of the survivor.
The SGBV SOP (4) provides guidance on processes and procedures for the survivor’s pathway to ensure they receive the appropriate care they need during and after clinical examination and assessment. This allows other referral services, beyond emergency response, to continue to support survivors when needed.
"To heal the trauma, a collective radical mind shift needs to occur also in the narrative we use to tell stories of violence and survivors."
MAT MO PIG
The SOP attends to the needs of survivors but it does not eradicate the root-causes of gender-based violence. The procedure unveils and demands the need to respect human
rights and deal with trauma beyond violence.
To heal the trauma, a collective radical mind shift needs to occur also in the narrative we use to tell stories of violence and survivors. It's not about semantics, it is about values and rights. No one is entitled to or can acquire the right to violate another human being. Marriages are not an exchange of property rights over women. Regardless of the bride price and dowry paid, human rights are not for sale.
The stigma and blame customarily attributed to the survivor, and the Kastom practice of exchanging valuables to compensate and silence the issue outside the judiciary rule of law, have often decriminalized human rights violations and prevented victims from voicing their trauma and claiming their rights to justice and health.
There is a place for rituals, community practices, and reconciliation, yet they cannot override human rights. Trauma and healing take time and space. It is a process which needs to be respected and cannot be fixed with an exchange of mats.
ROAD TO RECOVERY
Violence and trauma are intergenerational, they are passed on, and they hinder health, peace, and prosperity in our communities. The road to recovery is a continuous process of iteration and inclusion. Mental health is built every day, and it is everybody’s and every community leader’s business.
We need to create safe spaces to talk about violence and work together across Vanuatu’s community pillars: with chiefs, churches, women, and youth, to ensure a peaceful sustainable future for our communities. We need to start looking at how we are educating niVanuatu and provide them with the skills and knowledge to articulate and express emotions in a healthy and constructive way. We need to start addressing self-care, and self-agency in putting one’s mental health first.
A future without violence is possible and is the only way for our communities to thrive.
This Op-Ed was originally published by the Vanuatu Daily Post and the Pacific News Service on 01st November 2022.
- The 2011 GBV Survey# found that 60% of women who have ever been in a relationship have experienced either physical and/or sexual violence by a husband or intimate partner in their lifetime, while more than 2 in 3 (68%) experienced emotional violence. Vanuatu Women’s Centre in partnership with the Vanuatu National Statistics Office, 2011 GBV Survey.
- Vanuatu, 3rd December 2021, the launch was supported by the EU-UN Spotlight Initiative Programme
- The Health Facility Readiness and Service Availability report in December 2020 showed that 0% of facilities are able to provide minimum services for gender-based violence (GBV) that meet global standards (54% of facilities reported offering at least one GBV service).
- SOP seeks to clarify the referral processes between MOH and Police and others for improved response to victims/survivors. In addition to MOH and Police, there are other key stakeholders including the Department of Women’s Affairs (DWA) and non-government organizations, such as Vanuatu Women’s Centre (VWC) involved in supporting survivors of GBV and child abuse in particular the Ministry of Justice and Community Services (MJCS) Child Desk, that will be included in the SOP to ensure clear referral pathways. The relationship and referral systems between the Police Family Protection Unit (FPU) and Ministry of Health (MOH) is critical to effectively respond to the physical, legal, and psychosocial needs of victims of crime.
The Spotlight Initiative is a global initiative of the United Nations which has received generous support from the European Union. Its aim is to eliminate all forms of violence against women and girls.