|Miho Yoshikawa speaking at the official launch of the Clinical Handbook on Health Care for Children Subjected to Violence and Sexual Abuse|
©UNFPA Cambodia/2017/Sophanara Pen
The Convention on the Rights of the Child (UNCRC) says that; children have the right to be protected from being hurt and mistreated, physical or mentally. In Cambodia this is not always the case: 1 in 2 children have experienced severe beating; 1 in 4 children have experienced emotional abuse; and 1 in 20 girls and boys under the age of 18 have been sexually abused. There are obvious short term impacts of abuse such as physical injury and emotional trauma, however in the long term we see abuse linked to the development of learning difficulties and tendencies to participate in high-risk activities and behaviour.
Another area of impact is the economy. According to the 2015 Economic Burden of the Health Consequences of Violence Against Children report Cambodia lost at least US$168 million in 2013, the equivalent to 1.1 per cent of its GDP, due to the negative consequences and health impacts of violence against children, in physical, emotional and sexual forms. In 2015 the Cambodian Ministry of Health formulated a set of National Guidelines for Managing Violence Against Women and Children in the Health System. The objective of these National Guidelines is that women and children that experience violence or abuse receive a holistic, effective, and comprehensive response in the healthcare system and referral to appropriate services, including community resources.
Now the Cambodian Ministry of Health in partnership with UNICEF have begun a program in furthering the work done to combat these statistics. In its first phase it has taken the form of a Clinical Handbook on Health Care for Children Subjected to Violence or Sexual Abuse. The handbook will elaborate on the knowledge and skills required to implement the national guidelines.
For the launch of the handbook we spoke with Miho Yoshikawa the Child Protection Officer that headed our work with the Ministry of Health on the clinical handbook. She provided us with some information about the initiative, the reasoning behind the handbook and what we hope to achieve with its dissemination.
What is the aim of the Clinical Handbook?
The aim of the Clinical Handbook on Health Care for Children Subjected to Violence or Sexual Abuse is to assist with the training of healthcare practitioners, such as doctors, nurses and midwifes, to ensure that children who have been subjected to violence or sexual abuse will receive better health care. The contents of the handbook cover all sorts of areas, from identifying the signs of abuse and providing medical treatment and psychosocial support to dispelling common misconceptions.
What is the current situation, why is the Clinical Handbook necessary?
In Cambodia the current situation is that not all health care practitioners have deep knowledge or capacities to provide appropriate treatment and care in a timely manner for children who have experienced abuse. If a child is injured as a result of abuse, both physical and sexual, medical practitioners are likely to be their first point of reference; this makes it vital that these practitioners have depth of knowledge and capacity to give them appropriate care and treatment. There are also some misconceptions in society around sexual abuse, such as the belief that a boy can’t be raped and that physical punishment is needed to educate children and without it they will be spoiled and undisciplined. This handbook will give professionals the ability and backing to start to break down some of these misconceptions along with the knowledge and training to provide victims with appropriate care and treatment.
What is the next step after the rollout of the Clinical Handbook; how are we preventing the Clinical Handbook from becoming another book on the shelf?
The handbook is being succeeded by a Training of Trainers (ToT) that aims to give Government officials and health care professionals at both national and provincial level the skills to train health care practitioners at community level in working for children who have experienced sexual abuse or violence. These new skills will not only contribute to better response to child victims of violence or sexual abuse but also to prevention of further incidents.
There is also a cascade element in the training scheme that supports the implementation of the handbook. The master trainers who receive a ToT are planned to provide training for health care practitioners at community level: Once these healthcare practitioners at community level have training and a good understanding of their role and responsibilities they can advise and train others in the community such as caregivers, parents, teachers or service providers in helping children who are subjected to abuse.
The use of the clinical handbook as a point of reference for this training and in general practice when dealing with a victim of sexual abuse or violence will prevent it from being rendered obsolete.
How has UNICEF contributed to the Clinical Handbook?
UNICEF’s health and child protection experts have assisted the Ministry of Health in the production of the Clinical Handbook through the provision of technical support and helping mobilise various partner organisations who work towards better health care for children. UNICEF has helped to facilitate technical inputs from multiple departments within the Ministry of Health and other Ministries including the Ministry of Women’s Affairs, the Ministry of Social Affairs, Veterans and Youth Rehabilitation. We have also worked with other UN agencies and civil society organisations to enlist their expertise.
Who do you anticipate will benefit from the Clinical Handbook?
Children who have experienced abuse will be the main beneficiaries of the Clinical Handbook as it centres on their wellbeing. We also expect parents or caregivers to benefit from the Clinical Handbook as it gives medical practitioners the skills to provide advice on how to continue to support victims even after they leave health care facilities. It is essential that children receive support in all areas from health care facilities to homes and communities. There is also instruction on how to refer the cases to other social and legal protection services such as social workers, the police, and the courts.
What is the timescale for us to see the handbook affect those who need it?
Our plan for the second and third quarter of 2017 is to develop a training strategy and materials on the use of the Clinical Handbook. In the fourth quarter, the Training of Trainers (ToT) is expected to take place. The overall target by the end of 2018 is to reach at least 45 health care facilities with initial focus on the provinces of Ratanakiri and Kratie. The Ministry of Health has planned to scale up the training across all 25 provinces.