Sarah, a nurse from the USA, is working for MSF/ Doctors Without Borders in Honduras. She has been focusing on the response to sexual and gender-based violence, aiming to improve treatment and follow up, as well as links with existing services
Imagine finding the courage to bring yourself to a local health center after you have been raped, only to be turned away by a guard at the door because your physical appearance says that you are not the ‘type’ who should be seen.
Here’s another scenario, a bit more common: You suffered an extremely traumatic ‘violation’ last night and know that you probably need some sort of treatment. The nearest health center is two hours from your home; you have four kids with mouths to feed and if you take the time to travel to the health center you will lose money that would have been made selling ‘knick-knacks’ at your roadside stand. You do not have money for the bus, nor do you have money to pay the ‘toilet use’ fee once you are inside the health center. You also have many security concerns. The road on which you must travel is in an area known to be “caliente” and you fear retaliation by your perpetrators; members of the local gang that has taken over the barrio you must pass through. And then there is the question of reporting the incident to the local prosecutor’s office. You know that your life may be at risk if you choose to present the case to the local authorities.
After weighing the costs, you finally decide to make the journey. You arrive at the health center and are told to wait in a very long line. You wait for two hours and are seen by a physician, but in order to receive all of the necessary tests and treatment, you must wait in ten more lines and make your way to ten more sites.
First there’s the medication to prevent HIV. You were told to take 5 pills, each the size of a grape and you don’t really remember what they were because the doctor told you to take x pill x times in the morning, y pill x times in the afternoon and z pill x times in the evening.
You were then instructed to take 8 more pills to prevent ‘other’ sexually transmitted infections. Then there is the medication to prevent a possible pregnancy: 4 more pills. Your stomach is starting to hurt. It was quite empty before you were told to swallow the 17 pills.
Next you have to receive counseling for your HIV test, located in section ‘A’ of the building. After receiving counseling you have to walk to the other side of the building, section ‘F’ to actually receive the test. They stick a needle in your arm and fill four tubes with dark red blood, but they tell you that the results will not be ready for another week. If you want to know your ‘status’, you will have to return. You desperately want to know your results but you lack the resources and time to return.
You are then shuffled to the vaccination department where you wait in another line, only to find that they are out of the vaccinations, which you need. You are told to return in two weeks; perhaps the vaccinations will be in by then. Next, you are told that you must find the psychologist’s office. Six hours later you are told that you can leave. You have recounted your traumatic story to 7 different people, have been told to come back for seven different follow up visits, are carrying a bag with another 50 pills to take over the next month, even though you have still not received all of the medications that you need. In addition, you are overcome with nausea due to the litany of GI side effects caused by all of the medications that you took and by now you are pretty sure that everyone else in the health center knows ‘why’ you came. Would you choose to seek treatment? I know I probably would not.
Now, imagine a world where things are different
You present to the health center and ask for ‘Servicio Prioritario’. This password, so to speak, assures that you are welcomed in and are immediately brought to a physician who treats you with respect and dignity.
You are offered all of the treatment that you need; in one location; in one stop. Unfortunately, the quantity of pills, which you must take, remains unchanged. Although we are working to develop tools to assist patients in managing this large ‘pill burden’, the challenge of achieving adherence will remain an uphill battle. The physician administers your rapid HIV test and tells you that the results will be ready in 10 minutes.
The same physician that took the test was also able to provide you with the pre and post-test counseling. When he/she is finished, the psychologist enters and after your physician and psychologist have done there very best to coordinate and thus minimize your follow up visits, you are free to go. I forgot to mention; all of the care is free.
Now, if this were the reality, would you consider presenting for treatment?
We believe and we hope that this change is possible
For this reason, we have decided to redirect our efforts and attention toward the public hospital and toward several ‘strategic’ public health centers, where we are working alongside the national staff to strengthen the care provided for the street population and to strengthen the care provided for survivors of sexual and physical violence.
There are MANY barriers and A LOT of work left to be done, but changes are happening; poco a poco.
What is Servicio Prioritario?
The Servicio Prioritario is the medical and psychological treatment for sexual violence survivors. It provides a free and confidential service, giving emergency attention to both the medical and psychological consequences of sexual violence. For instance, it is possible to prevent HIV in the first 72 hours after a patient is assaulted, and provide them with further information to help their recovery.