On the Forefront of Addressing Sexual Violence in Liberia

In Liberia, baby steps are being made toward comprehensively addressing the needs of rape and sexual abuse survivors. Clinicians and social workers form the frontline of this comprehensive approach. All week the EQUIP Liberia Protection and Health teams have been conducting a  training of 17 clinic staff from across NImba in the Clinical Management of Rape. The training was conducted with the support of USAID’s Rebuilding Basic Health Services (RBHS) and along with staff from International Rescue Committee (IRC) clinics, the Nimba County Health Team and RBHS’ Family Planning and Reproductive Health Advisor, Maima Zazay.

Philip from EQUIP Liberia’s Protection Team talking about legal and ethical issues of treating survivors.

The refugee influx along with Liberia’s own development makes the issue of sexual gender based violence (SGBV) a hot topic. It is the norm in Liberia for violence such as rape or other types of sexual abuse to go  unaddressed and untreated. EQUIP’s Gender Based Violence Program is actively making efforts to shine light on these issues and work with Liberia’s justice system to find perpetrators and get convictions. Truly something that is unheard of in many countries and particularly across Africa.

Trainees work in  groups on case studies.

Along with the justice component of SGBV there is the clinical management of gender based violence. Women (also, men and children) that have suffered these attacks should be seen in the clinic immediately. The training that EQUIP conducted gave clinicians the tools they need to counsel, examine, document, treat, refer and collect forensic evidence for rape and abuse survivors.

Liberian’s always make time to relax! Even during a training!

The communities that the trainees have come from (many from clinics along the Ivorian border) commonly witness the results of this type of violence. The rippling social, physical and psychological issues of such abuse are commonly seen in the communities EQUIP Liberia serves. These issues are not foreign to Liberians because unfortunately during the war many suffered these atrocities.  Cases are unfortunately drastically under-reported and most go untreated for physical and emotional problems that result from such abuse resulting in long term psychological  and reproductive health damage. The participants were eager to learn how to work with the survivors in their area to begin healing and hopefully assist survivors toward justice. The work and documentation of some EQUIP clinicians, in the past, has made it all the way to the Supreme Court.

EQUIP’s Liberian staff conducted the majority of the training. It is amazing to see the poise and the growth of the EQUIP staff as trainers. EQUIP is known for effective trainings and this was no exception!

Lawrina Donkeh, Reproductive Health Supervisor, EQUIP Liberia training on clinical issues

Photos taken by Jessica Hoover, EQUIP Liberia

Trainings that address SGBV open the door in Liberia to discuss sensitive issues and train health care providers to care for those in their communities who have suffered rape or sexual trauma. EQUIP Liberia  is at the forefront of addressing these issues head on through our supported clinics and our Gender Based Violence (GBV) Protection Team.

- EQUIP Liberia Team

Community Case Management of Malaria: Success Stories

Two year old Patience B, was burning with fever while tied to the back of her 6 year old sister Kou.

Kou was drawn by the crowd circling newly trained gCHV, Elina Kolleh, EQUIP’s National Director, Mr. Roland Suomie and National Malaria Control representative, Asatu M. Dono. Both had determined to take a full week to visit every gCHV trained by Equip Liberia in Nimba County under the Community Case Management (CCM) malaria pilot program. They had anticipated the arduous journey required by vehicle over rough, deeply pitted roads, to get to the various remote communities that the pilot program served, but to get to Zahn Glounla had the added challenge of a tippy dug out canoe ride across the Yah river.

Even that did not thwart their determination to ensure the CCMP was a success.

While showing the M & E team her newly acquired back pack, ledger, RDTs and other supplies, Elina noticed Kou watching her. She recognized her and knew her mother, who was working on their farm nearby. Elina sent for the mother to come and gently took the child, inquired about her medical history, checked for fever and methodically completed the RDT (rapid diagnostic test) for malaria). Patience was RDT positive.

By giving ACT malaria medicine within the first 24 hour onset of fever, Elina not only reduced the negative impact of malaria on the child, but also reduced its spread in the community.

Three weeks after the gCHVs successful community case management of malaria training in September, 19 gCHVs had treated 633 under 5 year old children with malaria in their community, 59% of those children were treated within 24 hours since the onset of fever.

One of USAID President Malaria Initiative’s (PMI) global targets is: 85% of children under five with suspected malaria will have received treatment with ACT malaria medicine within 24 hours of onset of their symptoms- a monumental goal in rural Liberia, where access to health facilities can range up to a 25 hour walk! The EQUIP PMI supported Community Case Management of Malaria Program puts that target within reach.

Article contributed by Audry Waines, Equip Liberia

Pictures taken by Roland Suomie, Equip Liberia

Community Case Management of Malaria: Placing health interventions where it counts

 

Zahn Gounla is one of 17 communities benefitting from the first Community Case Management of Malaria program approved by the Ministry of Health in rural Nimba County since the 1990 war. Chosen because of it challenging distance from the nearest clinic, community members have to cross the Yah river in a canoe and walk another 4 hours distance, to seek curative health services.

Equip Liberia, in partnership with USAID and the Ministry of Heatlh, launched the pilot training of 21 general Community Health Volunteers (gCHV) in September 2010. (CHA’s) Community selected gCHVs have an average 7^th grade education, requiring trainings to be simple, where necessary translated into dialect and with much time given to demonstration, practice and role plays.

Malaria is very common in Liberia.

It constitutes about 35% of outpatient consultations.

It is estimated that there are 4-5 malaria episodes annually in children aged 0-5 years. (LIMIS 2008).

Since the gCHVs serve deeply rural areas, their competency is carefully evaluated before being given the tools to confirm malaria through RDTs (Rapid Diagnostic Tests) and given the medicine to treat the under 5 population in their community.

Community sensitization on the issues of prevention is also an important function of the gCHV. Counseling of mothers and caregivers on early health care seeking behavior, regular use of Insecticide Treated Nets, proper compliance to medicine regime and follow-up are key responsibilities of gCHV.

Story contributed by Audry Waines, Equip Liberia

Tomorrow: How Equip Liberia’s gchv’s life-saving malaria treatment skills saved one child’s life

The Work Continues in 2011

Forgive us for failing to post. Things have been a little crazy around here. Between holidays, clinic accreditation and thousands of refugees from the Ivory Coast the blog has taken a backseat, but a New Year is here and opportunity to redeem our failed blogging past! We will “try small”, ok?

In case you haven’t been watching or listening to international news lately let us fill you in. In November 2010 the Ivory Coast (Liberia’s eastern border country) had an election in which the incumbent, Laurent Gbagbo, was beat by his opponent, Alassane Outarra. In the weeks following the election there was much debate over the true winner. Gbagbo claimed that he was the winner and guess what? So did Outarra. Gbagbo has since refused to relinquish power although many world leaders and the U.N. have agreed that Outarra is the rightful winner. There was violence in Cote D’Ivoire’s capital Abidjan and more violence along tribal and religious lines across the country. Thousands (25, 000 + are registered with UNHCR) of Ivorians have sought refuge by crossing the border into Liberia and Guinea, primarily Liberia.

An Ivorian man crosses the river that separates Liberia from Cote D’Ivoire to bring his aging mother across to safety.

Thousands of people have crossed into Liberia since November in these 3 dugout communities.

EQUIP Liberia work spans nearly every corner of Nimba County.

Nimba County shares it’s western border with Guinea and it’s eastern border with…you guessed it…Cote D’Ivoire.

Nimba County highlighted in red shares an eastern border with the Ivory Coast.

The majority of Ivorian’s that have crossed into Liberia are in Nimba County. They are spread across communities that dot the border of Liberia. EQUIP operates several clinics that have experienced a dramatic refugee influx since the November elections. EQUIP is responsible for maintaining our clinics along the border as well as responding to the burgeoning health needs of the refugees in our clinic catchments. EQUIP has also taken on the water and sanitation needs of these communities. Our pump and well technicians have raced up and down the border repairing pumps and rehabilitating broken water points so that these communities can have adequate, clean water sources for the increased population.

Words don’t seem adequate to describe the tireless way that so many of EQUIP Liberia’s Liberian staff have worked to help their Ivorian brothers and sisters. While many of the ex-pats working with EQUIP have had to sit in meetings with UNHCR and other large NGOs our Liberian counter parts have driven out to the border areas nearly everyday since the end of November. Many of them working through the holidays to meet the needs of those communities. For many of them the memories are not so distant of a time when they fled over the Ivorian border in search of safer ground. They are the real heroes of this situation. They have distributed supplies, reported important details of the situation, repaired wells, and educated the refugee populations on safety issues. The work has been great, but EQUIP’s staff has risen to the challenge with incredible willingness.

Unfortunately there is no end in sight to the situation in the Ivory Coast. Gbagbo has not relented and the U.N. has not yet ousted him. It seems to be a waiting game for everyone, both for the international community and the refugees waiting along Liberia’s border to return home. Over the next weeks and months UNCHR has plans to move the refugees from the Liberian host communities and into a camp. EQUIP will still be in these communities long after the refugees have gone. We will be working to maintain quality health services and water and sanitation for Liberians and Ivorians alike.

Community members observe one of our WATSAN technicians assessing a broken water point.

The refugee response has taken over much of our time and work, but there is still much to do on our regularly scheduled projects…already in progress! We received some exciting news last week! EQUIP Liberia has been approved by charity: water for another round of funding for water and sanitation. charity:water visited Nimba a few months ago and recently reported about their time in Liberia on their blog!

Read what charity:water had to say about their experience with EQUIP Liberia and the water and sanitation impact in Liberia.

charity:water is a great organization and an even better partner in WATSAN work. This funding will provide clean water sources for many communities as well as build the capacity of our EQUIP technicians to care for the water and sanitation needs of their people. We are excited and grateful for the opportunity to continue our WATSAN work and our relationship with such a great partner!

Thanks for reading this blog. Thanks for believing in the work that is being done here in EQUIP Liberia’s little corner of the world. Please continue to check back here for updates on refugee crisis and EQUIP Liberia’s impact on communities across Liberia.

Peace,

The EQUIP Liberia Team