Thursday, August 23, 2018

Bystander no more: health worker acts to end violence against children

By Ayphalla Te and Pharin Khiev

Midwife Korn Vichera stands in front of the
Chang Krang Health Center in Kratie province.
© UNICEF Cambodia/2018/Ayphalla Te

Kratie province, Cambodia August 2018 –Twenty-seven-year-old Korn Vichera is a midwife in Chang Krang Health Center in the beautiful, remote district of Chetborey, in the eastern province of Kratie.


Chetborey is five-hour drive from the capital Phnom Penh and those that make the journey will discover an idyllic, rural destination covered by abundant, thick forests and lush agricultural land.

Around 11,000 people live in the area and Vichera is proud to serve this community.

Vichera has been a midwife for five years and enjoys interacting with children and providing them with health check-ups and follow-up care.

Despite her rewarding job, Vichera witnessed worrying signs that some child inpatients were victims of violence and abuse.

She knew she could provide routine care, but it was obvious some of these children needed more help than she could offer.

Vichera said that when she came across a child with an injury, it did not occur to her to check with the child if the wound was due to violence.

“In the past, I did not know how to support the children suffering from violence,”  she said.

“All we knew was to transfer the children to the provincial hospital, or to provide treatment and send the children home. I felt very sorry for them, but did not know what else I could do.”

Vichera weighs a baby ahead of administering
a vaccination, as the mother looks on.
© UNICEF Cambodia/2018/Ayphalla Te

Fortunately, the dilemma was resolved after Vichera attended a training course on the Clinical Handbook on Healthcare for Children Subjected to Violence or Sexual Abuse. 

The intensive four-day programme equipped Vichera with skills to understand different forms of violence and the emotional, physical and behavioural effects it leaves behind.

She is now more aware about the child-friendly support services a health worker can provide to a child victim.

She said: “Before the training, I did not consider verbal abuse or neglect as a form of violence.

“As for the sexual abuse, I learnt that even showing a pornography picture to a child is considered a [form of] violence.

“I also changed my attitude. When talking to a child, I try to use words that make them trust us and tell their story.

“Now when a child comes to the health centre with an injury, I always try to inquire about the causes because I am afraid the injury was due to violence.”

Medical staff are one of the first points of contact for children exposed to violence and abuse.

This strategic position provides a unique opportunity to administer immediate care and emotional and physical support.

Practitioners can play a critical role in referring the victim and their families to appropriate professional services, as well as raising community awareness that violence against women and children is a societal problem that needs drastic action. 

To capitalize on this situation, the Ministry of Health (MoH), with technical support from UNICEF and financial support from the Government of Canada through the Together for Girls initiative, has produced the Clinical Handbook on Health Care for Children Subjected to Violence or Sexual abuse.

The handbook aims to ensure prompt and adequate responses by healthcare staff to child victims and guidance on first-line support, medical treatment, psychosocial provision and referral to key social and legal protection services.

Additionally, a training strategy and manuals on the use of the handbook were developed by MoH with support from UNICEF and the Government of Australia. With these manuals, a pilot training was provided to 30 public health workers in Kratie province in January 2018.

Vichera makes her way to conduct outreach care
for marginalized families in La’or village, in Chang Krang commune.
© UNICEF Cambodia/2018/Ayphalla Te

For Vichera, the impact of the handbook and associated training has been enormous – not just in terms of knowledge change about child protection, but also in terms of self-empowerment.

She said: “After the learning, I felt very happy, because I could help my community and do more for the children around me.

“For example, when a child experienced violence and came to the health centre and they did not know where else to go or what to do, now I can probe for more information from the child and contact the commune chief and local authorities to investigate the case and save the child.”

Vichera is hopeful more health practitioners nationwide will receive the same training and embark on a transformative journey like herself.

She wants to set up a child-friendly room for vulnerable children in her work place. She has also spoken out against violence against children when visiting vulnerable families during her monthly outreach visits.

Vichera with a vulnerable family in La’or village. 
She is now a child protection advocate and is highly active
in communicating the message of protecting children from all forms of violence.
© UNICEF Cambodia/2018/Ayphalla Te

Vichera’s story is a vivid example of how filling the knowledge gap and leveraging the existing health structure can lead to a new solution and better services and protection of children in Cambodia.

MoH, with support from UNICEF, is planning to roll out training on the handbook nationwide so the country’s health workers can become a powerful force in the fight against violence against children.

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