BY Peninah Irungu and G.P. Pokhariyal

1. CHALLENGES ENCOUNTERED BY COUNSELORS INVOLVED IN COUNSELING SURVIVORS OF CHILD SEXUAL ABUSE: A STUDY OF THE NAIROBI WOMENS HOSPITAL, KENYA BY Peninah Irungu and G.P. Pokhariyal School of External Studies and School of Mathematics, University of Nairobi

2. Key Words: • Child Sexual Abuse (CSA) • Post Traumatic Stress Disorder (PTSD) • Gender Based Violence (GBV) • Sexual dysfunction • Counseling process • Caregivers/ Key informants

3. Introduction • In the recent past, there has been an increase in rape cases in Kenya. Statistics show that every three minutes a woman or child, whether boy or girl is raped somewhere. • Sexual abuse amongst minors has also been reported to be on the increase especially in the Nairobi city slum areas of Kibera, Kawangware, Mathare and Mukuru.

4. Forms of sexual abuse among children • Penetration of the vagina ( defilement or incest) • Sodomy ( penetration of the anus- either in the boys and girls) • Insertion of objects to the vagina/ anus e.g. broken bottles, fingers, guns etc • Oral sex • Indecent assault or unwanted sexual touches ( also fondling) i.e. touches on breasts, buttocks, genitals. • Child prostitution. • Bestiality (using a child to have sex with animals).

5. Effects of Child Sexual Abuse Short term • Shock • Fear • Vulnerability Long term • Anxiety • Depression • Sexual disorders/ dysfunctions • Low self-esteem • Depression • Regressive behaviours • PTSD, • Suicidal thoughts and tendencies

6. What is counseling? • Counseling is part of any positive, healthy, human interaction where people talk about themselves, their concerns, what’s holding them back while others listen and responds in a way that enables some resolution to be found. It may last many years. • What is the importance of counseling? Counseling intervention helps a child to be free of domination of traumatic thoughts through unlocking their feelings. N.B If not done, the traumatic effects spill over into the adolescent and eventually adult part of a child’s life. It is therefore important to investigate the constraints facing the counseling process of survivors of child sexual abuse by counselors

7. About Nairobi Womens Hospital, GVRC Program • The Nairobi Womens’ Hospital is a hospital that seeks to provide holistic care to women and children; men also benefit from the health services. • As a way of giving back to the society, Nairobi women’s hospital in March 2001 established the Gender Violence Recovery Centre (GVRC) as a non-profit making, non-partisan, charitable trust of the Hospital whose main purpose is to provide FREE medical treatment and psychosocial support to survivors of gender based violence. • The centre receives an average of 230 survivors per month, with approximately 45% being children, 49% women and 6% men. The youngest survivor of sexual violence was a month old baby girl while the oldest is a 105 years old woman.

8. Material and Methods • The target population in the study was mainly the counselors who handled CSA survivors. Parents/caregivers and teachers who had in the past handed cases of CSA were also interviewed to know their role in helping the child recover. The study was mainly qualitative • The sitewas chosen because it had the necessary records needed for this research. It also had qualified counselors and excellent facilities needed to counsel sexual abuse cases. • Data was collected through; • Personal Interview guide • Key informant interview • Case study • Direct Observation method

9. Results and Conclusions • Six counselors and nineteen key informants were interviewed. The marital status, age distribution, sex, education level and sources of income of the respondents were recorded. • Factors that influenced and enhanced positive outcomes of a CSA survivor’s counseling session were identified and categorized into various emergent themes. They were; • Relationship between educational level and efficiency of the counselor • Level of experience of a counselor and ease in effectively handling cases of CSA

10. Scatter diagram showing regression of efficiency on education From the findings, it can be observed that the correlation coefficient is =0.66 suggesting a moderately strong positive correlation.

11. Scatter diagram on years of experience versus performance From the findings it can be observed that the correlation coefficient is =0.87 suggesting a very strong positive correlation.

12. Other factors hindering… • Lack of support from caregivers, • Threats from perpetrators, • Incest • Poverty • Domestic violence and dysfunctional families • Premature exposure of survivors by media

13. Areas of recorded improvement after counseling • Self image and self confidence • Self expression • Reduced fear • Change in Sleep Patterns • School performance • Suicidal tendencies

14. Discussion • It is observed that the involvement and support of caregivers is important and a key aspect in child counseling. • Children who had been assisted through counseling were found to be able to explore their pain and come out with a better meaning and understanding of the event according to their age. • The government should take a leading role in trying to reduce these cases. More sensitization should be done to the law enforcers and judicial system on effective handling of these cases.

15. Case study • A five year old girl was going back home after school in the company of her four friends. On the way home, a middle aged man (LK) emerged from a maize plantation and chased the girls. Unfortunately, this girl tripped and fell. The man grabbed the girl and ran back to the plantation. One of the other girls recognized the man as a farm hand to the neighbor and they went to report the incident to the parents immediately. A neighborhood alarm was raised and the all went to homestead where they found the man red handed defiling the girl. The girl was taken to hospital and after clinical intervention and one counseling session, went back to school. She noticed that • her friends were no longer interested in playing with her and on inquiring, the friends simply said that they had been warned against playing or interacting with her in any way by their parents and teachers since she was LK’s wife. The girl’s attitude towards school changed negatively.

16. THANKYOU