Australian nurse Kiera Sargeant arrived in southern Nigeria just one month after Médecins Sans Frontières (MSF) opened its clinic for sexual violence care. As Medical Team Leader she watched the project grow within the first year from receiving not quite 20 patients a month to around 60 a month. The new service relied on quality of care and extensive community networking to encourage victims to seek assistance. A survey found that 47 percent of female undergraduates living in local university hostels had suffered sexual violence. (An Australian study found that 75 percent of respondents had been sexually harassed and 25 percent sexually assaulted.) Photo above: Keira with colleagues.

Keira writes: My first MSF field assignment was a nursing role in South Sudan, but for my second assignment this time in Nigeria I was offered the position of Medical Team Leader, a position that can be filled by a nurse or a doctor in a MSF project. I oversaw the sexual violence response and was responsible for staff health. Then, because it was a new project with a small team and we didn’t have dedicated personnel for pharmacy, I also had to look after that. In addition I was involved in emergency response planning and assessing medical needs outside of Port Harcourt [the city where the clinic was located]. So I was lucky I was able to travel quite a lot, to see the countryside and the way people live outside the city.

When I go somewhere new, I spend a month getting to know the project really well and getting to know the staff. We had a rough start with the illness and, in the end, passing of the family member of one of our staff. But it kind of brought the team closer together. I’d never looked after staff health before but was able to work closely with the clinic’s national staff doctors to support the team in this way.

A lot of my work was trying to increase the capacity of staff and also outreach and sensitisation to try to reach project targets, such as the number of consultations. Initially we didn’t have an outreach officer, but from January 2016 onwards we did, with a social worker as well. That was able to help push the project to the next level.

The clinic was open 8am until 5pm initially, but then we started seeing a steady increase of patients coming around 5pm. This was difficult to handle because it meant our staff weren’t able to go home on time. So it was agreed we could expand our hours. The clinic opened 7am to 7pm from October 2015. We were pleased to see a gradual increase in patients and were climbing towards 30 new patients per month towards the end of the year.

We were offering a three-month protocol for sexual violence victims. After the initial consultation we asked them to come back on Day 7, then Month 1, then Month 3. We had to strategise to encourage them to attend these follow-up appointments. We were concerned as much about their psychological care as the medical side of things and the need to ensure Hepatitis B and tetanus vaccinations, also their post-exposure prophylaxis to HIV.

Improving access to care

The Port Harcourt clinic looks after very young children to quite mature adults. We made sure that the rooms were child-friendly and approachable. In the beginning our set-up was very nurse-patient-doctor oriented, but by the end we had playmats and a coffee table rather than a doctor’s desk, to make the rooms comfortable. The children were one of the reasons we extended the hours; there were a lot of victims who were children who would come to us after school.

For other victims, they might have left at 8am the same morning but maybe they had to catch five different buses to get to the clinic. We also had people coming from the neighbouring state, travelling almost a whole day. Why travel so far? Because they may have already had to spend money to report their case to the police and our care is free. We encouraged people that if they could justify why they couldn’t pay for transport, then we would pay. Often they hadn’t eaten for a day so we would go and get them some lunch. All of us as staff were quite confronted by this. And it was important also because we couldn’t ask our patients to take their tablets — the STI prophylaxis or any other medicine — on an empty stomach.

Reaching out to communities

We went to a university to talk with a college group: students and teachers. There was a study released in late 2014 reporting that 47 percent of undergraduate women living on campus at University of Port Harcourt had been sexually assaulted at some stage during their degree. The perpetrators include intimate partners, other students and teaching staff. In our session, as an example of sexual violence we were talking about coercion and how if a teacher says ‘I won’t pass you unless you sleep with me’, that is considered rape. Everyone burst out laughing, the students and the teachers, saying ‘No, that happens all the time!’

We all looked at each other — the nurse who was doing the presentation, the assistant project coordinator and myself; now we knew that the study was true. But we were faced with the dilemma of how to explain the issue further so that our message would be accepted. Everyone was quite worked up. So we said, ‘We’re not here to argue with you as teachers or as students, but you need to know what your rights are as human beings. It’s not fair if someone pressures you into having sex to be able to pass your degree.’

Yet sexual assault on campus is something to consider closer to home: in 2015 in Australia a National Council of Students study revealed that 75 percent of respondents, female university students, had been sexually harassed and 25 percent sexually assaulted.

Every time we did sensitisation it was a powerful experience. We managed to secure spots for 13 weeks on two different radio stations and had people listening and ringing up and asking questions that were very relevant. International cases like the young teenage girl who was raped in India on a bus had made news in the south of Nigeria and people referred to that when we were talking about the different effects rape can have and the different stages people who’ve been raped go through.

There is hope

So many of the patients’ stories are horrifying, yet we would see them leaving the clinic feeling happy. We established a wall area called the Tree of Hope. Some of the messages were amazing: ‘there is life after rape’, ‘there is hope’, ‘don’t give up!’, ‘the MSF team are here to help you’. There was some really lovely feedback and that made me feel happy about what we had achieved as a team, that we were managing to reach more and more survivors and being able to give them the care they need.

I was so proud of the team, it was really overwhelming sometimes. From not knowing much about sexual violence the national staff became very passionate about it, wanting to make a difference. Someone like me can only really be there to support and guide. The project wouldn’t be where it is if it wasn’t for that team.

• MSF Port Harcourt sexual violence clinic opened in June 2015.
• The clinic exceeded expectations in caring for 450 patients in its first year.
• A 2014 study at University of Port Harcourt found that 47 percent of female undergraduates living in university hostels had suffered sexual violence.
• In Australia, a 2015 National Council of Students study found that 75 percent of respondents had been sexually harassed and 25 percent sexually assaulted.
• Sign the petition to stop the privatisation of the 1800RESPECT rape line.

Previously on Nurse Uncut:

• Modern day slavery
• Rachel: from operating theatre nurse to field coordinator