Transcript PowerPointpresentation Module 6

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
6. Medical examination and
care
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Aim of this module
• To provide an overview of the different steps
involved in
– providing first-line support to patients disclosing GBV
– taking a medical history and undertake a physical
examination
– providing treatment and follow-up care, with a focus
on patients who experienced sexual violence and/or
suffer from pre-existing and GBV-related mental
disorders
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Outlook
•
•
•
•
First-line support
Medical history
Physical examination
Treatment and follow up care
– Injuries
– Unwanted pregnancies, STIs & HIV
– Psychological/mental health interventions
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
First-line support
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Elements of first-line support
(WHO 2013)
• Be non-judgemental and supportive, validate what the
woman is saying
• Provide practical care and support that responds to her
concerns, but does not intrude
• Ask about her history of violence, listen carefully, but do
not pressure her to talk
• Help her access information about resources
• Assist her to increase safety for herself and her children
• Provide or mobilize social support
• Ensure the consultation is conducted in private and
inform women of the limits of confidentiality
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Medical history
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Steps for medical history
1. Obtain
informed consent
• Explain all
aspects of
consultation
• Explain limits
of
confidentiality
• Ask patient to
sign or mark
consent form,
if required by
law
2. Take complete
medical history
• the time since
assault and
type of assault
• the risk of
pregnancy
• the risk of HIV
and other STIs
• the woman’s
mental health
status
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Tips for interviewing
• Ask her to tell in her own words what happened
• Avoid unnecessary interruptions
• Be thorough, some patients may purposely avoid
embarrassing details (e.g. oral sexual contact, anal
penetration)
• Use open-ended questions and avoid questions starting
with “why”, which tends to imply blame
• Address questions and concerns non-judgementally
(using a calm tone of voice, maintaining eye contact, and
avoiding expressing shock or disbelief)
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Physical examination
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Checklist: general principles
 Explain the medical examination
 Ask her to disrobe completely and to put on a hospital
gown, so that hidden injuries can be seen
 Examine both serious and minor injuries
 Throughout the physical examination inform the patient
what you plan do next and ask permission, always let
her know when and where touching will occur, show and
explain instruments and collection materials
H24
 Patients may refuse all or part of the examination
 Provide medical and legal (forensic) services at the
same time, in the same place, by the same person, if
possible
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Treatment and
follow-up care
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Treatment of injuries
• Refer patients with severe, life-threatening
conditions for emergency treatment right away
• Try to treat patients with less severe injuries
(cuts, bruises, superficial wounds) in situ.
• The following medications may be indicated:
– antibiotics to prevent wounds from becoming infected
– a tetanus booster or vaccination (according to local
protocols)
– medications for the relief of pain, anxiety or insomnia
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Prevention of unwanted pregnancies,
STIs & HIV
• Emergency contraception
• HIV post-exposure prophylaxis
• Post-exposure prophylaxis for STIs
H25
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Treatment of psychological/mental
health outcomes (1)
• Where referral possibilities are available: refer
survivors with pre-existing diagnosed or IPV-related
mental disorders to specialist health care providers
for psychological/mental healthcare interventions
• Some interventions may be performed by primary
health care providers, in line with WHO mhGAP
guidelines that apply to non-specialized health care
settings
• In settings with limited or no referral possibilities,
provide psychological first aid support
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Treatment of psychological/mental
health interventions (2)
For survivors of IPV (or mental health outcomes of nonpartner violence)
• For survivors with pre-existing diagnosed or IPV-related mental
disorders: provide mental health care in line with WHO mhGAP
Intervention Guide
• For women who are either breastfeeding or pregnant: consult with a
specialist for use of psychotropic medicine
• For women who no longer experience IPV but are suffering from
PTSD: arrange for psychotherapy (cognitive behavioural therapy
[CBT] or eye movement desensitization reprocessing [EMDR])
• Mother-child intervention (though not always feasible): offer children
who are exposed to IPV a psychotherapeutic intervention, including
sessions with and without their mother.
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Treatment of psychological/mental
health interventions (3)
For survivors of sexual violence
1. During the first days of the assault
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continue providing first-line support, but not psychological debriefing
provide written info on coping strategies for dealing with severe stress
2. Up to three months post-trauma
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continue first-line support
apply “watchful waiting” for 1-3 months after the event
arrange CBT or EMDR interventions (only if necessary)
provide care in line with the WHO mhGAP Intervention Guide if the person
has any other mental health problems
3. After three months post-trauma
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assess for mental health problems
if suffering from PTSD, arrange for PTSD treatment with CBT or EMDR
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Treatment of psychological/mental health
interventions (4)General Principles
• Ensure patients’ informed consent and safety
• Therapies should be implemented by a trained health
care provider with a good understanding of sexual
violence
• Consider pre-existing mental health conditions
– Higher likelihood in rape survivors
• Consider pre-existing traumatic events (sexual abuse in
childhood, IPV, war-related trauma)
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