Together we can

Alone we can do so little, together we can do so much to save children

Kratie province, Cambodia, 12 July 2019 – It’s a sunny day and, at 2 PM. The Kratie Provincial Referral Hospital is as busy as it can be. Sitting in front of a closed-door room, women and children occupy a row of chairs waiting for their turn to undergo a prenatal check-up or health consultation.

Dr. Chom Chan Visotharin, Deputy Director of Kratie Provincial Hospital and Head of Maternity and Pediatric Section, together with doctor, Oeu Sotheary, Deputy Head of Maternity and Pediatric Section, listen carefully to their patients.

 “Today is a busy day for us, especially in the morning”, Dr. Visotharin says, “As usual, there are many patients here, both women and children who come from different places—including ethnic minority groups.”

Some of the children who receive pediatric care at Kratie Provincial Hospital are victims of violence, commonly in the form of sexual abuse.

The Kratie Provincial Referral Hospital is one of 60 health facilities in the northeastern provinces (Rattanakiri and Kratie) that currently implement the Clinical Handbook on Health Care for Children Subjected to Violence or Sexual Abuse.  This document was developed and endorsed by the Ministry of Health (MoH) with technical and financial support from UNICEF in 2017.  The handbook provides guidance and supports the training of healthcare practitioners to become first-line support for children who have experienced violence. The Clinical Handbook encourages a support framework which addresses a child’s emotional, physical and safety needs following a violent act, as well as outlining the provisioning of relevant medical treatments, psychosocial support, and referrals to specialized agencies, such as social and legal aid service providers.

At the the Kratie Provincial Referral Hospital, there are four healthcare providers who have participated in the four-day training on the Clinical Handbook, including Dr. Visotharin and Dr. Sotheary.

Children are brought here by family members, social workers from the Provincial Department of Social Affairs, Veterans and Youth Rehabilitation (DoSVY), community workers from NGOs or police officers.

“Since we received training, we have been trying to do what is best for the child.  First of all, ensure his or her safety, assessing the emotional and physical impact, and provide immediate and long-term care and support to child victims as well as families”, explained Dr. Sotheary.

Both doctors feel that they are better equipped to identify and screen children who have experienced violence or sexual abuse. “I have learned a lot from the training. Normally, it is very difficult to get a child who has experienced abuse to talk and it takes time to explain things carefully and calmly. After attending the training, I have learned techniques that help me build a rapport with the child in a few simple steps of asking questions appropriate for the age. As we develop trust with the child then, he or she is willing for examination,” Dr. Sotheary said.

Dr. Visotharin and Dr. Sotheary were also trained as provincial trainers for the whole of Kratie province, helping to roll out a series of training sessions based on the Clinical Handbook for medical practitioners working at both the Operational District (OD) and Health Center (HC) levels.

Collaboration between different sectors is key to ensure a successful implementation of the Clinical Handbook. In 2018, the MoH organized a one-day workshop aiming two goals:  mobilizing government officials and medical practitioners at the district and provincial levels; and improve their understanding of the health sector’s response to violence against children. Over 75 participants attended the workshop, including healthcare providers from referral and provincial hospitals and health centers, government officials and NGO workers in the areas of social work, gender, justice and education.

“We have been able to provide more appropriate support to child victims since the implementation of the Clinical Handbook began. Now we can help children beyond medical treatment. We know where to refer the case to get psychosocial support and other specialized services” Dr. Sotheary stated.

Mr. To Dong, Deputy Head of the Child Welfare Office Provincial Department of Social Affairs, Veterans and Youth Rehabilitation (DoSVY) in Kratie province attended the workshop in 2018.

“I was inspired by the workshop. I learned that the violence again children is serious issues in Cambodia. It is not only a human rights violation, but it is very serious public health concern. It causes children’s lives, their mental and physical health and has it costs hardly for the society as well,” said Mr. Dong.

Since the workshop, Mr. Dong has become an impassioned activist against child targeted violence. He is working with other government authorities and NGO personnel to better protect children. He also shared what he has learned at the workshop with his colleagues.

Mr. Dong’s colleague, Ms. Doung Daneth, Officer of the Social Welfare Office, DoSVY in Kratie also works closely with healthcare practitioners to protect children. The Kratie Provincial Referral Hospital is one of the facilities where she often sends children who have experienced violence or sexual abuse and require specialized care and support. She finds that the healthcare providers at this hospital  are very helpful, ready to provide medical care, respond to children’s physical, emotional and psychosocial needs and ensure their safety.

“I find the collaboration with the healthcare providers easy. They welcome us and are very helpful all the time. Whenever I bring my client (child victim), they communicate and treat children in a way that children feel safe and comfortable”, Daneth said.

“Collaboration from all partners is very important when we response to child victims of violence or sexual abuse. Alone we can do so little; together we can do so much to save more children”, Daneth stated with conviction.

Since 2018, a total of 137 medical practitioners from 60 health facilities have been trained on health sector responses to violence against children – possible largely as a result of the generous contributions from the Government of Australia and the Government of Japan. At least 47 children, mostly from ethnic minority groups, have benefitted from this initiative. The MoH will take this key programme intervention to scale, expanding its reach to a total of 300 healthcare facilities in 15 provinces, an important step in ensuring the continued protection of Cambodian children throughout the country.