Dr. Neil Kennedy recently told me he sees an average of 20-25 cases of child sexual abuse a month referred to Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.
I wasn’t sure I heard him correctly.
“Yes, that many,” he confirmed. “I was working a shift last month when I saw three in one day.”
Our conversation was part of a discussion on sexual violence in Malawi. Kennedy, head of pediatrics and child health at the University of Malawi’s College of Medicine, proceeded to dispel any doubts about the scale of this problem.
He called attention to a report titled “Suffering at School: Results of the Malawi Gender-Based Violence in Schools Survey,” which was published in October 2005 and based on interviews with more than 4,400 youth from various segments of society.
“Almost one in four children have been forced to have sex against their will,” the document states. “Repeat victimization is common.”
Indicating that little has changed in the six years since that report was published, Malawi’s Daily Times newspaper recently reported that it carried 16 stories covering 22 cases of child sexual abuse for the months of August and September 2011 alone.
Tackling child rape in Malawi is “messy,” Kennedy sighed.
He recounted an example.
A mother brought her seven-year-old daughter into QECH, the largest health centre in Blantyre, with a case of tuberculosis. TB is a common indication of HIV, and so doctors suggested the girl be tested; the result came back positive, but the girl’s mother swore that she was negative – and an HIV-test of her own confirmed that.
Other possible causes of transmission were subsequently ruled out, and doctors came to suspect that the young girl had been raped. The mother refused to believe it was possible, but agreed to further examination.
Indeed, doctors found every physical indication that the girl had been raped, both repeatedly and over an extended period of time.
There was now a dilemma.
The doctors involved in the case knew the girl’s father, knew that he was HIV-positive, and were certain that he was the man who had assaulted the girl. But doctor-patient confidentiality forbade them from telling anybody about the man’s HIV status, without which, there was significantly less evidence on which to make a case.
Furthermore, the girl refused to say a word about anything that had happened to her. And for the same reasons that doctors couldn’t reveal anything about the father’s health, they were also forbidden from sharing what they had discovered in their examination of the girl.
So what could be done? Ask that question and the matter grows even more complicated.
Speaking alongside Kennedy was Esmie Tembenu, child justice magistrate for the Government of Malawi. She called attention to a massive gap between the number of incidence of sexual assault recorded at hospitals and the significantly-fewer cases filed with police.
“Most victims of sexual abuse in Malawi do not report that they have been abused,” Tembenu said. “The information I have in my office is that as much as 90 percent of cases of sexual abuse are not being reported to police.”
She counted off an extensive list of contributing factors as to why this is the case. Among others, family members are reluctant to report incest, rapes that occur in extramarital affairs are often concealed, and in cases of child rape, it’s not uncommon for parents to take a bribe from an assailant in exchange for a promise not to press charges.
There are also serious economic considerations a Malawian woman might take into account before reporting her husband for a crime that will put him in jail for years, Tembenu continued.
In a wealthy nation like Canada, it’s easy to say that there is no reason in the world for a mother to conceal the abuse of a child; but the realities of life in an impoverished country such as Malawi are rarely so simple.
Let’s say that the household in question falls within the World Bank’s definition for extreme poverty (surviving on less than the equivalent of US$1.50 a day) and is comprised of a mother, her husband –the sole breadwinner for the family– the child that’s being raped, her two brothers and a sister, and their two cousins –orphaned from their biological parents because of HIV or AIDS.
If this woman were to have her husband sent to jail, she would find herself left with seven mouths to feed, abysmal prospects for employment, and virtually none of the social security or welfare programs common in the West. With the crime reported, abuse of the child would likely stop, but without her husband’s income, what would happen to the rest of this woman’s family?
Like Kennedy said, dealing with cases of child rape in Malawi is messy.
The “solution” to situations like the hypothetical one outlined above, he said, is usually to send the victimized child to live in another village or to one of the country’s crowded orphanages. But that, of course, goes nowhere near the root of the problem, and leaves a child rapist free to assault other young girls.
This state of affairs may seem bleak. But Kennedy said that he actually sees reasons for optimism.
When he first started seeing child victims of sexual assault at QECH two years ago, there was no follow-up capacity whatsoever. Now, thanks to a push by UNICEF and the UK’s Department for International Development, as many as 40 percent of sexually-abused children are enrolled in counseling programs and receiving regular psychological care.
There are also encouraging signs that Malawi, as a society, is dropping taboos around discussions of sex and sexual assault, Kennedy noted.
“Malawi is going through a huge culture shift about this,” he explained. “It is getting easier to talk about sex […] and we know that perpetrators are growing more frightened because of this.”
The seven-year-old girl discussed at the beginning of this article still lives with the man who raped her. Authorities know who he is, but lack the evidence required for a prosecution. However, it was “made clear” to the man that if the sexual abuse didn’t stop, police would catch him. Now authorities can only hope that he has heeded their warning.
And the girl is now receiving regular counseling at QECH, Kennedy reported – though she’s yet to say a single word about anything that’s happened to her.
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