Haiti: “Every single case we saw was complicated, and touching and difficult and emotional”

Dr Lisa Searle from Tasmania has recently returned from Haiti where she was setting up a new sexual violence clinic in Port-Au-Prince.

“Marie* was 15 years old and was on her way home from the market when she was raped by a couple of men; people who were unknown to her. When she told her parents her father said: ‘you’ve disgraced the family, you’ve disgraced yourself, you’re never getting married and you can never come home again’. Her father beat her and kicked her out of home.

So when she came to us, at Médecins Sans Frontières (MSF) sexual violence clinic in Port-Au-Prince, she was incredibly distressed, she had nowhere else to go. We were able to prevent unwanted pregnancy and HIV and other sexually transmitted infections.

We also had a safe place where she could stay for a few days. During that time our social workers and psychologists worked with her, and also organised for her father to come in. We held some supervised sessions with Marie and her father, giving her father the chance to express what he was scared of and why he was so angry. After a few days of talking and negotiating, she reconciled with her father and he accepted her back home again. So that was an incredible outcome. As she was getting ready to leave she came and gave me a big hug and thanked me for everything we’d done. I was very touched.

More violence, fewer services

Sexual violence has always been a big problem in Haiti, but before the earthquake there were lots of Haitian organisations providing sexual violence education and treating victims. When the earthquake hit in 2010 we saw an increase in sexual violence. That’s a known phenomenon: whenever there is a disaster, whether it’s a natural disaster, an outbreak of war, or instability, the rate of sexual violence dramatically increases. Combined with that, most of the organisations that were offering care to victims of sexual violence were destroyed. So it was kind of a ‘double whammy’ – a big increase in sexual violence, combined with a loss of services. It was quite horrific.

It’s now been 5.5 years since the earthquake, but many people are still living in precarious and overcrowded conditions in displaced person’s camps, putting women at risk of sexual violence. Plus, the services that were available have still not been rebuilt.

After doing an assessment, MSF set up a new sexual violence project in Port-au-Prince this year. The clinic provides comprehensive medical and psychological care for survivors of sexual violence, with a doctor and psychologist available 24-hours a day. We see a lot of patients at weekends and at night, when other clinics are closed. All patients have at least one psychology consultation when they first arrive, and we then arrange follow up depending on their needs. My role was to set up the clinic, be the medical supervisor, and to make decisions about the medical aspects of the program. I recruited all the medical staff to work in the clinic, and developed a week-long training program that all the staff went through. I also supported the medical staff in seeing the first patients and answered their questions.

Working in the community

One of the most important things that we’re doing is health promotion to raise awareness about sexual violence and the services we offer. We had an incredible team of community health workers, who were all highly educated. It was really amazing to watch them work. We did a lot of work with community groups and churches, and information sessions at police stations around the city. We also visited schools and worked with children on issues like gender equality, and provided training to teachers so they are more empowered to identify students at risk.

Every single case we saw was complicated, and touching and difficult and emotional. We saw a real mixture of cases. More than one third of the patients were under 18, so that’s a very significant percentage of patients who were young girls. There was also a mixture of sexual violence committed by intimate partners or people known to the victims, and sexual violence committed by unknown people. You do see quite a lot of people who have been attacked by someone they’ve never seen before in the street; that accounts for about half the people we see.

It was very confronting seeing so many children who have experienced sexual violence. One of the things I found quite interesting and confronting was that often these girls don’t understand the implications of what’s happened to them. In Haiti we were seeing quite a lot of very young girls, 12 or 13 years old, but usually their mother was in a lot more distress than the young girl. It’s very difficult for the young girl to understand what’s happened to her, and what the implications are. In some cases it might be some time before she actually realises what’s happened, and although the immediate medical and psychological care she receives is crucial, she will likely be affected for the rest of her life.”

* Name has been changed to protect the patient’s identity