For the past two months, I worked at a sexual violence project in Guatemala City for Doctors Without Borders/Medicos Sin Fronteras or MSF. I'd travelled several times to this beautiful, culturally diverse country, but was not aware of the rising violence. Guatemala and other Central American countries are on the transportation path of cocaine shipments to the US. With increased drug activity, narco-traffic has exploded as have gangs. Murder rates are phenomenal - 16 to 18 a day in the capital city!
Guatemala also has a legacy of atrocities committed against the civilian population during the two decade civil war. Remnants of that war include a culture of fear and silence. Atrocities such as rape continue in the public eye, but that eye is blindly turned away. The judicial system is ineffective, rarely prosecuting offenders (5% of cases get to court).
Fortunately, I was not on the front line hearing the horrific stories, but our doctors and psychologists and social workers gave emergency attention to these vulnerable patients. The majority are women and attacks come from unknown assailants. But the victims are also children violated in their own homes by relatives. And "secondary victims" such as family members also require psychological assistance.
My role was Medical Coordinator, overall in charge of the medical aspects of the program. One task was to write the protocols for our program in Guatemala. The government has their protocol, but it's based on cheap and available drugs, and not based on sound medical science. For example, gonnorhea is treated with Cipro and Hepatitis B vaccine is not available. MSF is more nimble and well funded and can provide quality care free of charge to all.
One of my biggest challenges was to begin the conversation about elective termination of pregnancy in a country where it is illegal. Obviously, in the case of pregnancy from rape, many women will request abortion. And MSF's position is to assist women in their reproductive health decisions regardless of legalities. Credible organizations exist who will properly perform terminations, but with coded phone calls and confidential exchange of information. The team, in the Guatemalan spirit of fear and silence, had never spoken openly about this issue although women had made requests for these services. Once we opened the conversation and discussed the way forward, the doctors and psychologists and social workers breathed a collective sigh of relief to have ideas shared in the open.
MSF is opening another violence program in Honduras where the violence, amazingly enough, is even worse. The murder rate is higher. Statistics are hard to obtain for sexual violence, but the needs are great. And contraception is illegal.
I tell myself, we are here to help because the system is failing. Changes and improvements come slowly. But we can help one patient at a time.
Sue Averill, RN, BSN, MBA
co-founder One Nurse At A Time