A proactive approach to violence
Finally in this section it is important to think briefly about what you can do to prevent violence against children. Much of this approach is about education – for example the fact that you are working through this study session indicates that you are taking a proactive stance in the prevention of violence against children. You can now share that education by working with your patients and their communities as an advocate to raise awareness and promote non-violent values in their everyday lives. There are many opportunities to share your learning, for example in the way that you talk one-to-one with a parent about how they discipline their child, or you may run a campaign or other wider awareness-raising activity. You could work with your organisation and with other professionals (for example in law and/or education) to create accessible and child-friendly reporting systems and services. You should consider a child protection charter for your own health facility. (This is discussed in Study Session 4 of this module.) You could include children in the consultation for any education and measures of prevention so they are educated in their own rights, and not solely dependent on adults to advocate on their behalf. Try to develop and promote health services and systems that are accessible, child-sensitive and accountable. Where possible implement or support research efforts and the collection of systematic data that can contribute to a bigger picture of education about violence against children. (More information on how to do this can be found in Module 5.)
Activity 3.4: Flo and her mother
Read the case study below and answer the following questions.
- Can you identify any of the risk factors or protective factors in this case using the ecological model you looked at in Section 3.3 of this study session?
- What positive interventions did Damtew make in this case?
Flo is 13 and lives with her mother, Hanna, and five younger siblings. Flo used to go to school, but last year her father died of HIV and so she had to stay home and support her mother in caring for her brothers and sisters.
Damtew is the community health worker who has responsibility for Flo’s village. He met Flo one day when she walked 3 miles carrying her little brother to the clinic outpost for medical treatment. She had no money and was desperately worried about the little boy. Damtew found her waiting at the end of clinic hours and took them both in for a consultation. Fortunately the treatment for the little boy was very simple, but Damtew was more worried about Flo. She was clearly tired and malnourished and showed signs of abuse in the bruises he noticed on her upper arms. He asked some careful questions and learned about the family circumstances, and that Flo was very proud to be helping her mother to care for her siblings. Damtew sent her home, but made a note to discuss her situation with his colleagues.
A week later, Damtew had the opportunity to discuss Flo and his concerns with another health worker. He talked about the risk factors for abuse, and the physical signs he had observed. Damtew’s colleague suggested that he talk to one of the community elders who live in Flo’s village.
The next day Damtew had cause to go to the village, and was able to meet with the community elder, Yared. They discussed Damtew’s concerns, and Yared was able to provide some more background information. He had observed that Flo’s mother worked very long hours to support her family financially, and sometimes she beat Flo out of tiredness and frustration. Damtew and Yared agreed a plan and went to visit the family that evening. They asked to speak to Flo’s mother alone, and Yared began by talking about how Flo’s father was missed within the community, and how difficult it must be for Hanna to manage the family without him. Hanna began to cry, and they talked for a long time about all her daily challenges and how much she loves her children and wants the best for them. She knew that Flo was giving most of her food to the younger children, and was missing her education, and this contributed to Hanna’s frustration that led her to hit Flo when they argued.
Yared suggested that Flo and the older children be allowed to go to school, leaving just one child to be cared for during the day. Hanna’s mother would be able to cope with the little one, and a social programme at the school means that the children would all be fed a hot meal for free at lunchtime. Hanna agreed to the plan, and Damtew exacted a promise from her that she would stop beating Flo.
Mostly the plan has worked very well. Flo and the other children are at school and Hanna’s mother, who would not have been able to cope with all of them, is very happy looking after the baby. Hanna is still very tired and often frustrated, but Damtew made sure one of the teachers at school is looking out for Flo and Hanna has so far not beaten her again. Sometimes Flo stays home if one of the other children is sick, because someone has to care for them while Hanna works, but if they are absent for more than 3 days the teacher will come to visit and lets Damtew know if treatment is needed.
Thanks to Damtew’s careful intervention, Flo is no longer suffering neglect or physical and emotional abuse, and remains living happily with her family.
Compare your answers to those at the end of the study session.