In Mathare, in the Eastlands district of Nairobi, the extra hours, coupled with a toll-free number and free ambulance pick-up service, have been instrumental in getting a high percentage of women to present to MSF’s clinic within 72 hours—79 per cent in 2015.
Project Coordinator Corinne Torre has seen the dramatic changes in timely access for victims.
“At the beginning we only opened the clinic Monday to Friday, on a daily basis 8am until 5pm. But as there seemed to be an increased incidence of violence during the evenings, nights and on the weekend, and people in the slums cannot necessarily get access to transport, the result was that people were not always able to reach the clinic when they needed to. So we added an ambulance service, which is quite new for MSF, to pick up the patients. We coupled this with a toll-free emergency phone number that we communicated through “action days” via street theatre, in meetings in schools, in sensitisation sessions in health facilities, police stations, and to chiefs and other community leaders.
As a result we’ve seen a huge increase in patients. In 2011 we received an average of 150 new cases per year. In 2015 we grew to more than 2,400 cases in the year, or almost 200-240 cases per month.
In fact, we have two ambulances. We added one more ambulance in 2014 because we also need to refer patients. They sometimes require further examination that we can’t provide. Our clinic provides medical care: we admit the patient doing the first medical examination, testing for HIV, providing necessary drugs and vaccines (post exposure prophylaxis for HIV, and to treat sexually transmitted infections). But if they have fractures or considerable injuries we have to refer them to another hospital.
Some patients also require long term shelter, protection, or legal referral, and we can refer them to a partner organisation with the second ambulance. If they are particularly vulnerable—for example, they have suffered repeat assaults or a pregnancy as a result of the rape; or, they are a minor—we always accompany them.
So we have one additional ambulance just for referring the victims to the hospital, or to a partner organisation if they require shelter; or to pick up a patient for scheduled follow-up (external counselling or psychological consultations). And if they are particularly vulnerable—for example, they have suffered repeat assaults or a pregnancy as a result of the rape; or, they are a minor—we always accompany them.
We also pick up patients for scheduled follow-up—external counselling, or psychological consultations.“
The Mathare project has changed considerably since the start. What began in 2008, just after the post-election violence, as a slow increase in patients who had been sexually abused within that particular eruption of violence, has become a constant flow, in a context where violence is endemic.
To the question of why, Corinne replies, “We were dealing with only Mathare at the beginning, but now we are dealing with all Eastlands, which means we are covering a population of about two million people. But why we have so many cases isn’t because we have more sexual violence in Nairobi county. It’s because we have increased our services and we adapted the program to the context. Not only did we create greater access to medical and psychological care, but we believe we have supported neglected victims in a way that gives them more dignity.”