As a medical doctor with specialization in public health, my passion is in promoting disease prevention and early detection. I therefore carry out regular media programs to promote this concept in addition to providing clinical preventive services through my NGO Health and Wellness Optimization (HOW) Foundation. We carry out outreach programs to promote screening services focusing especially on reproductive cancers and sexually transmitted infections.
Few months ago, my health promotion radio program; WELLNESS CONNECT addressed the issue of Sexually Transmitted Infections. 2 days after the program I had this patient, 14 years old female who I will like to call Miss O. She was brought to my clinic by her mother who apparently listened to my radio program with the main complaint of long standing abdominal pain dating back to over 3 years. Miss O lives with her mother, who works as a cleaner in a private school and her step father, a plumber. She has completed her secondary education and currently helps her mother to take care of the house and also the 3 children from her mother’s second marriage who are 7, 5.5 and 3 years old. She started menstruating when she was about 12 years old and have been having her period regularly since then.
The first thing that struck me was the reluctance of Miss O to talk about the abdominal pain. After much prodding, she reveled that the abdominal pain happens recurrently but with no regularity and is not associated with her menstrual period. Whenever she has it, the pain is continuous, excruciating, makes her unable to walk straight and goes away 2 or 3 days after using drugs given to her by her mother. Her mother has taken her to see many practitioners (orthodox, traditional and spiritual) and she has used many drugs especially antibiotics but the pain always reoccurs after a few weeks. She refused bluntly to answer any questions about her sexual history. Her mother believes strongly that she must have a sexually transmitted disease and wants me to check her out to confirm her suspicion that she is no longer a virgin.
When I requested her to lie down for examination, she refused to stand up. Her mother shouted, threatened but she wouldn’t stand up from her seat. I then diplomatically excused her mother out of the consulting room, invited a nurse in and asked her again to lie down to which she obliged. An alarm bell started ringing in my head immediately I tried to expose her abdomen. I noticed she was wearing 3 dresses in the hot weather and to cap it all she was wearing 2 skirts and jean knickers over her pant. When I inspected her vaginal, there were only hymeneal tags seen, a clear sign of multiple vaginal penetration.
At that stage I began to suspect that her abdominal pain may not be a physical one but a somatic affliction. After a lot of prodding, persuasion, promises and assurances, Miss O finally revealed that her step father has been sleeping with her for over 3 years. She revealed that the abdominal pain usually starts immediately anytime she is raped. Apparently, the abdominal pain is more of a silent call for help which unfortunately, neither her mother nor all the other people including health personnel she had consulted heard.
Miss O case became the nudge on my conscience and marks my MOMENT OF OBLIGATION into a journey to advocate and care for victims of sexual assault in Ogun State, Nigeria. Our children (females especially), adolescents and youths are increasingly being sexually assaulted by people who they trust and who ought to protect them. They often have nowhere to turn for help and so they carry the scars untreated and unhealed. In the few instances when the assault is discovered (often accidentally), they hardly get any professional care nor justice as it is treated as a family affair and swept under the carpet. I managed to provide all the medical and psychological support I could to her but I could not but observe that my training as a doctor was really inadequate to properly care for Miss O and there were no public or private institutions in the entire state equipped to comprehensively handle her. I had to consult with a lawyer friend and then report the case to the police despite the opposition by Miss O’s mother that she didn’t want the police brought in.
Miss O case inspired me to take the online course on Prevention and Intervention Services for Survivors of Sexual Assault provided free by the West Virginia Sexual Assault Services Training Academy (www.wvsasta.org) and also to attend a 1 week training program at the Sexual Assault Referral Center of the Lagos State University Teaching Hospital. Today, Health and Wellness Optimization (HOW) Foundation is putting together an intervention project; Positive Action to End Rape (PROJECT PATNER) to train health workers on supporting survivors of sexual assault, train the police on survivor centered care in handling cases, mobilize survivors to speak out, educate the general public to dispel myths about rape and also provide free support services to survivors of sexual assault at our PATNER CENTER. This is in addition to our ongoing services on screening/testing for cancers of the cervix, breast and prostate and also for STIs especially HIV and Hepatitis B. Miss O inspired my colleagues and I in HOW Foundation to rise up in defense of the sexual health and rights of our future generation.
Dr. Adekunle Salako, President, HOW Foundation