Disabled Women in Kenya Vulnerable to Sexual abuse due to weak laws

justiceShe wears a shy demeanour and does not speak much. Janet* Atieno, has been epileptic since birth, and lives with her grandmother and two of her children In Kanyairo village about 20 km from Siaya town.

The grandmother, a peasant farmer, is the breadwinner to both Janet* and the children. The 27 year old was orphaned at a young age and even though she is able to read and write her comprehension of facts is questionable. Her grandmother says that her metal capability seems to deteriorate as time goes by.

Janet* has had two births yet no man has claimed responsibility for the children laments her grandmother. Some of the men Janet* mention to be the fathers of her children are decent members of the society and have all denied responsibility.

One is a school principal to a secondary school in the village.

“I think some men take advantage of her situation when she experiences an epileptic fit or because she appears to be a little mentally challenged and cannot negotiate well,” explains a community health Volunteer who works in Janet’s village.

The grandmother deeply troubled and frustrated by the state of affairs thought it wise to start Janet on a contraceptive method after consulting other relatives of the girl. None of the family members has thought of pursuing legal intervention about the pregnancies though.

They find it hard to ascertain whether Janet* and the claimed fathers of her children were in a consensual sexual union or whether it was coerced; she does not mention that explicitly.

A study released by FIDA-K in 2009 revealed that disabled women are up to three times more likely to be victims of physical and sexual abuse than their non-disabled counterparts are, which makes them more at risk.

What does the law say?

The law in Section 146 of the penal code criminalises having sex with an imbecile. If found liable one is supposed to face jail, term coupled with hard labour for 14 years.

Sexual offences act section 43 (4) outlaws having sexual intercourse with a mentally unstable person since they do not have the legal standing to consent.

These two legal provisions are enough grounds to prosecute or have investigations about the alleged sex offences.

The mother also has the right to seek for support from the men responsible for her pregnancies.

According to article 53 1E of the constitution every child has a right to parental care and protection including parental responsibility of the mother and father to provide for the child whether they are married or not.

Section 146 of the penal code criminalises having sex with an imbecile. If found liable one is supposed to face jail, term coupled with hard labour for 14 years.

The law has clearly put in place measures to bring to justice those who sexually or physically abuse mentally challenged people but it seems few if not all know about them.

If these laws were followed to the latter, maybe Janet would not have been having two children or some men could be serving jail term for abuse or better still, they would be taking responsibility for the kids.

The subject’s name has been altered to protect her identity.

Call us free on 0800724500 or contact these numbers for help: Child line Kenya-116 and Health Assistance Kenya-1195.

If you wish to contact JOOTRH Gender based Violence Centre, Call 07141388868 or beep for medical attention.

Or contact us via email on:marketing@kmet.co.ke or info@kmet.co.ke Help us break the silence on such instances of human rights violation by sharing your story with us.

Reaping the benefits of quality health financing

Godswill Clinic

Public funding for healthcare is grossly insufficient and many small private clinics serving much of the population struggle to meet demand and finance badly needed upgrades and facility expansion.
Godswill Medical Centre located in Nyalenda informal settlement, Kisumu City is a small private clinic offering health care services to the underserved population drawn from Milimani and Nyalenda estates.
Since its existence in 2001 the facility has been providing medical services mainly to clients who  pay out of pocket.
When it opened its doors the facility offered only curative services. After partnering with KMET in the Medical Credit Fund program they have been able to introduce a number of services among them- youth friendly services, immunization, laboratory care, admission of maternity cases. The centre also provides outpatient services, minor procedures and cervical cancer screening.
Before joining the program the facility only offered basic health care services. Inadequate equipment, poor waste management and improper patient data management characterized the facility.
With time the facility  got a new face lift. They enrolled into  MCF and accessed 2.5 million shillings  loan. This facilitated the purchase of several medical equipment and expansion activities at the centre.

The Medical Credit Fund has a set of standards to rate  clinics as the initial step  is providing a process for them to improve the quality of care they provide. It also provides a technical assistance program around business skills to provide training on the job, to make sure they have audited financial statements.
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This loan helped them move from  two rooms to a spacious facility  adding a maternity wing, Director’s Office, waiting lounge and consultation room.
It has also benefited from several SafeCare training leading to its graduation from Level 1 to Level 2 during 2014 certification survey.
This means the facility has made step towards institutionalizing the provision of quality healthcare, improved staff attitude through team work.
The gradual expansion and provision of quality services gives it the chance to attain a centre of excellence certification in this new certification phase.

“We are helping these clinics build a financial track record showing they have borrowed money and repaid it, and that helps individual clinics,” explains Medical Credit Fund Managing Director Monique Dolfing-Vogelenzang

He furthers adds, “But we hope to reach a tipping point where this market of small clinics, which are providing so much of the health care in Africa, becomes interesting for banks.”

More Teenagers Seeking Long Term Contraceptives to avoid dropping out of school

In the remote village of Kopanga some 30 kilometres away from Migori town, a 30 year old mother and her daughter of 15 walks into a dispensary for family planning services but do not directly say so.

Benta Aoko James, a housewife and mother of eleven children visited Kopanga Dispensary after getting word from a community health worker that there is a health event offering free reproductive health services.

When it is her turn to see the nurse, Benta asks in Luo: “Doctor I would like to know how many eggs I have left, I have given birth so much.”

The nurse, Alice Wachilwa is taken aback by Benta’s request but deduces that the mother requires counselling on family planning.

As she opens up, it becomes clear that Beta’s worry is her expanding family and her 15 year old daughter who she says is seeing boys and may end up with a pregnancy.

“My daughter is in class seven and I would not like her to drop out of school, please talk to her,” she appeals.

The Daughter-Immaculate Achieng is the second born of the eleven children while the first born, a boy aged 17, had dropped out of primary school.

The nurse counsels Benta who settles on a non-hormonal IUCD for birth control saying that she likes the fact that it can help her avoid pregnancy for over 10 years.

The daughter while having a separate session with the nurse confesses that she has a boyfriend with whom they have been having a sexual relationship.

Immaculate and her boyfriend who is also a student haven’t been using any contraceptive.

She says she knows of friends who use injectable contraceptives but she has never tried it herself. “Some girls around go for Depo but I haven’t tried it,” she acknowledges.

After undergoing a pregnancy test and counselling on sexual reproductive health, Immaculate also choses an IUCD as her preferred method of contraception.

“I am happy because I know I will give birth only when I want and I thank the nurse for talking to the girl,” Benta beams.

She however, expresses fears that her husband would not be pleased to find out that their daughter is on birth control.

Elsewhere in Siaya County, 16 year old Consolata Adhiambo walks into Ngiya Dispensary purposely to get a contraceptive. Like her counterpart in Migori County, she has ever had that talk with her mother regarding early pregnancies.

Consolata Adhiambo is a form two student and says she has seen a number of her peers drop out of school never to resume again due to pregnancies. She does not want to go down that path. She wants to complete her studies uninterrupted and one day become a teacher though she has a boyfriend.

She tells me that her mother has always insisted that prevention is better than cure and advised her to come to the dispensary and seek for a birth control method.

Consolata is lucky because on the particular date, a team of health providers from an indigenous NGO, Kisumu Medical and Education Trust from came to the Dispensary to offer free family health services and talks.

She is attended to and settles on an implant, a method shot in the arm and prevents pregnancy for 3 years.

According to the 2008-2009 KDHS data, 42% of women aged 15-19 years in Migori County have begun childbearing while at least one in ten (10 per cent) women aged 15-49 years have had a live birth before age of 15 in Siaya County.

In Kenya, there is a draft bill on Reproductive health that proposes to allow adolescents access to contraceptives with or without their parents’ consent.

Suicidal| “A lady defiled at 16 and later to be assaulted by husband”

sgbv1According to the sexual offences act of 2006 a perpetrator of defilement can get up to life imprisonment and there are a variety of penalties charged on those found guilty of any sort of gender based violence.

Are these laws practical to a common mwananchi?

The answer to whether these laws protect the survivor remains unclear when Suzy* (name altered) a 24 years old orphan adopts a suicidal mind after undergoing multiple cases of gender based violence.

Suzy had to drop out of class eight due to lack of school fees and left Kisumu for her grandmother’s place in Western Kenya. Until then she used to stay with different relatives.

While at her granny’s place she was defiled and got pregnant at a tender age of 16.A few months later she miscarried.

Later on the young girl got married as an escape from her problems and settled with her husband in Kisumu’s Obunga estate but her escape was not the refuge she had imagined.

After getting her first child, her husband changed. He started beating her up. She also became a victim of verbal abuse which subjected her to both emotional and mental torture.

As if that was not enough, she had to live with the worst kind of humiliation any woman would ever go through; having a husband who makes you sleep on a mat as he lies in your matrimonial bed with different concubines!

Concerned community health workers shared her case with KMET. She was followed up and after some consultation the husband agreed to enroll her for the hairdressing class at KMET SFC.

Suzy thought he would change but the assault and unfaithfulness continued. When she could not bear it anymore she stopped attending classes. She even became ill and her husband never took her to the hospital.

With all hope gone, she was now contemplating suicide.

Due to her absence from classes at Kmet’s SFC, her teacher organized a secret house visit only to find her in a very destitute state.

She was then taken to KMET’s youth friendly clinic for medical care and psychological counseling. We then contacted her elder brother living in Eldoret who accepted to take her in as she recovered.

To survivors like her, the sexual offences act and protection against domestic violence act may only exist in the books they are written.

Call us for free on 0800724500 or contactthese numbers for help: Child line Kenya-116 and Health Assistance Kenya-1195.

If you wish to contact JOOTRH Gender based Violence Centre Call 07141388868 or beep for medical attention.

Or contact us via email on:marketing@kmet.co.ke or info@kmet.co.ke
Help us break the silence on such instances of human rights violation by sharing your story with us.

Fistula|Pariahs in their Society.

fstulaWhat is fistula?

Fistula is a tear in a woman’s bladder or rectum that causes her to constantly leak urine or faeces.

Two million women suffer from the condition with 50,000 to 100,000 new cases occurring every year worldwide.

The main causes are prolonged labour, botched Caesarean section and sexual assault.

Are their types of this disease?

There are two kinds of fistula.

Obstetric fistula which is an abnormal opening in the birth canal. It’s an injury that occurs during child birth, usually when a woman is in labour for too long or when the delivery is obstructed.

Traumatic fistula which is an abnormal opening in the birth canal between the bladder and rectum resulting in incontinence. It’s an injury caused by rape or sexual violence

Does it affect women in Kenya?

More than two million women in Kenya suffer from fistula complications. This situation is further aggravated by delayed treatment because of limited facilities.

Most victims suffer pain and stigma. The cases are high in parts of North Rift, Western and Nyanza region.

Who is mostly at risk of fistula?

Most fistulas occur among women living in poverty, in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children, notes UNFPA.

Are they factors that increase one chances of getting affected?

The risk of obstetric fistula often begins when young girls get pregnant early, before their bodies are able to safely sustain a pregnancy. The unease surrounding sex education in Kenyan schools is one of the reasons for early pregnancy due to a lack of accurate reproductive health knowledge,

Female Genital Mutilation: Infibulation, practiced in some communities, which involves the cutting and sewing up of a girl’s genitalia leaving a match-stick size hole for the passage of menstrual blood is especially harmful. This hole is then crudely cut open during childbirth, something which could end up severing the bladder.

Myths and misconceptions surrounding fistula

Fistula is sometimes linked to taboo conditions such as HIV/AIDS, abortion and infertility. Fistula survivors may be thought to be bewitched or cursed, or may be accused of being promiscuous. There is also a refusal by some women to give birth in hospitals due to the belief that they will receive injections that will cause infertility, or be forced to have unnecessary Caesarean births.

 Stigma

Women and girls with fistula are often abused, beaten, abandoned, and isolated. Without repair, fistula may cause a fetid odour, frequent pelvic and urinary infections, painful genital ulcerations, infertility and nerve damage to the legs.

Affected women may miss out on crucial information on treatment and support, due to a lack of social interaction.

Home therapies

Due to the stigma associated with leaking urine, women sometimes refuse to drink water, making the urine more concentrated and resulting in the burning of the vulva; some also develop kidney disorders. In some communities, women seek to control the seepage of urine by inserting hot rods in an attempt to “seal” the fistula, causing more damage.

Lack of reproductive health education coupled with widespread ignorance of the basic facts also contributes to misconceptions. Because even medical personnel have insufficient information this has hindered timely referrals for the patient’s.

   Is there treatment for fistula?

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy.

Typically the first step in treating a fistula is an examination by a doctor to determine the extent and “path” that the fistula takes through the tissue.

In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator to delay the need for surgery to a more appropriate age.

Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess).

Various surgical procedures are commonly used, most commonly fistulotomy, placement of a Seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from re infecting the channel).

Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.

According to the UNFPA, only 7.5 per cent of women are able to access fistula treatment.

Cherangany Nursing Home, Kitale in Trans Nzoia County which partners with KMET offers these services for free. Patients are refunded their transport once they get to the facility and the corrective surgery done.

In Siaya county, on June 22 to June 25 there will be a free gynaelocology examination at Sagam Hospital. KMET is partnering with the hospital to reach out to patients seeking corrective fistula surgery.

By Don King and Ashiembi Pauline

How well are hospitals prepared to handle sexual violence cases?

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A family in Kisumu’s Nyalenda estate is yet to come to terms with an incident where their two-year-old daughter has been defiled but no one brought to book since the girl is not able to talk.

It was a normal evening in the month of May 2015 when Pat* went out to play with other children within the neighborhood while her mother was taking shower.

Later on Pat’s mother, a 20 year old tailor, looked for her and found her at neighbor’s place, playing but upon reaching home, Pat said she wanted to go for a short call and this is when her mother noticed that her under garments was unusually dirty, characterized with some fluids.

She shared her fears with Pat’s dad who had already arrived from work and they both felt something unusual had happened to their daughter.

They tried to question Pat if anyone had touched her but she was too traumatized to say anything. They decided to take Pat to Kisumu County hospital where a provider examined Pat and confirmed that she was indeed defiled.

Ironically, the girl did not receive any medical attention, but was given a treatment appointment for the next day. Worse still, the case was never reported to the police.

According to the survivor’s mother, there was no need to report the incident to the police because their daughter would not talk hence cannot identify the perpetrator.

Unfortunately for Pat, she was not to receive any medical care for five days; not even the HIV prevention drugs commonly known as PEP due to the back and forth referrals she kept she was given at one of the at one of the referral hospitals in Kisumu County.

‘Every time I went, I found a different provider who would refer me to the one who served us first. Since he was not in, they kept giving me appointment for a next day that never came. I gave up,’ laments Pat’s mother.
Five days later when she could not get help at the government hospital, she went to a nearby private health facility.

After assessing the case, daughter and mother were referred to the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) where Pat was finally attended at the gender violence recover centre.

She was admitted for a week and underwent treatment for the physical injuries. She could not be started on HIV preventive drugs since the seventy-two hours period for initiating PEP had elapsed.

Although discharged, the child still goes for psychosocial support services at the JOOTRH Gender Violence Recovery Center, the only of its kind in Kisumu County.

The centre houses clinical officers, lab technologists, trauma conselors and recovery rooms dedicated to gender and sexual violence cases working from 8 a.m – 5 p.m on weekdays. The KEMRI/CDC supported centre however does not operate on weekends and at night.

Pat is not just a defilement survivor but her case also exposes the loopholes in our county health facilities that may add to the pain of sexual gender based violence survivors. Pat’s story raises some serious questions concerning the plight of sexual gender based violence survivors.

Do our health facilities have the capacity and resources to handle survivors of sexual violence? Is the public aware of what to do in case of sexual abuse?

Call us for free on 0800724500 or contact these numbers for help; Child line Kenya-116 and Health Assistance Kenya-1195.

If you wish to contact the JOOTRH Gender Violence Recover Centre Call 07141388868 or beep for medical attention.

Or contact us via email on:marketing@kmet.co.ke or info@kmet.co.ke
Help us break the silence on such instances of human rights violation by sharing your story with us.

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Stolen innocence: Defiled and Assaulted at 10.

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It was a normal Friday for her. She went to school as usual but that evening turned out to be the darkest and one she might probably never forget since the scar will always remind her.

Mercy (name altered) who is a ten year old girl in standard three was visited by one of her school friends at home in Nyamasaria (Kisumu Sub County) and around 6.00 pm she had to escort this friend just like many kids do.

They walked for a while then she bade her friend goodbye and turned back to go home too.

On her way, it is alleged that she met a motorcycle operator who offered her a free ride home which she willingly accepted.

Back at home her mother was patiently waiting for her to return but so much time seemed to pass by without a sight of the first born in a family of three children.

When it was getting too late, she launched a search in the neighborhood for Mercy and even informed her husband who had gone upcountry that mercy was missing.

The search was in vain and the disturbed mother had to retire for the night not knowing where her daughter was and hoping she was safe wherever she was.

At about 5.00am the next morning, she had a knock at her door and on opening, her daughter was standing there, with a Good Samaritan who had brought her home, but all was not fine.

The girl was wounded in the head and around the neck. She managed to tell her mother that a bodaoda operator had forced himself into her private part, stabbed her with a knife on the shoulder and was even threatening to kill her.

How she escaped from the hands of this man is not known but she knocked at the door of this lady at 3.00 am already a defiled child looking for refuge.

She was rushed to Kisumu sub county hospital where she was admitted as her father who had travelled back went to report the incident to the police.

The Doctor confirmed that the girl was defiled and they had put her on Post exposure prophylaxis (PEP) to take care of the risk of HIV infection.

The Doctor also found traces of grass and soil inserted in the girl’s privates. Due to the girl’s swollen head and face; a CT scan or an MRI was to be done but unfortunately the parents could not afford the cost of the tests.

KMET got in touch with the Kisumu County Gender Technical Working Group who came onboard to offer assistance. Due to these interventions, with the help of FIDA and PLAN international, there was a resolution to airlift Mary to Nairobi women’s hospital for specialized treatment. KMET offered to Fuel the ambulance and psychosocial support to both the parents who were evidently traumatized and the girl when she gets back.

The man who damaged the happy childhood life of Mercy is still at large, how many more young kids will fall his prey?

KMET implores you to join forces with us and other partners to put an end to sexual gender based violence by reporting any known case to the police or any civil society group around your area.

Call us for free on 0800724500 or contact these numbers for help; Child line Kenya-116 and Health Assistance Kenya-1195.

Help us break the silence on such instances of human rights violation by sharing your story with us. It is through the documented cases that we can demonstrate how real the situation is and influence programs to support survivors and their families.