The recent news of sexual exploitation of children in a care home in Kathmandu has stirred-up the society. It is a most cruel and tragic occurrence and a serious infringement of a child’s rights to health and protection. But it is not the first news and my prayers would be futile if I wished it to be the last. Similar incidents have occurred in the past in different parts of Nepal, neighboring countries and in the world. Though a heinous act against humanity which spreads rage for a few days, the incident repeats. It has been so for ages. The easy access to the news and information sharing might have made the perpetrator think twice and increased awareness on child sexual exploitation in the public.
The World Health Organiaztion (WHO) defines Child Sexual Abuse (CSA) as “the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society”. It ranges from fondling, inappropriate touch to sexual penetration. Studies have shown that one in five women and one in 13 men reported being sexually abused as a child. CSA is a silent health emergency that is prevalent everywhere. Generally, it goes unnoticed, under-reported and poorly managed as it is surrounded by a culture of silence and stigma. Some victims do not recognize that their experience was CSA until adulthood. The main contributing factors are poverty, family separation or being orphaned at a young age, lack of awareness, armed conflicts, among others. Poverty and lack of awareness could be the factor for the recent event in Kathmandu.
Though it looks unreal, CSA often occurs in places normally considered safe: Homes, schools, places for leisure activities. Children lack maturity to understand and report sexual abuse. In addition, they are coerced, sworn to secrecy or threatened by the perpetrator. The habitual perpetrator is usually someone who is known and trusted by the child, is within or close to the family or who has authority over the child. They include fathers, stepfathers, grandfathers, uncles, brothers, cousins, domestic servants, teachers, peers, family friends, employers and others.
There are numerous short-term and long term consequences of CSA affecting physical, mental and social health. Some to list are physical injury, sexually transmitted infections (e.g. HIV/AIDS), unwanted pregnancy and unsafe abortion with its complications, regressive behaviors like bed wetting and thumb sucking, emotional trauma, depression, anxiety, phobia, posttraumatic stress disorder (PTSD), substance use, suicide attempts, poor school performance, rejection by family and society, family disharmony leading to poor parenting and abusive behaviour by the victim in the later life.
The assessment part along with management is very sensitive. The taboo against talking with children about sexuality makes the tasks of prevention programs challenging and discourages sexually abused children from disclosing their abuse. Most of the times, children are inappropriately inquired or examined by the family members for the possible sexual abuse which can be counter-productive, that they will not open up even with the specialists. First thing to be done is reassurance and safety of the child by removing them from being in contact with the perpetrator. These may necessitate measures such as making alternative living arrangements for the child, with relatives/extended family, with whom the child feels safe and comfortable. We should respond in a sensitive manner and prevent re-traumatizing victims.
The government of Nepal has OCMC (One-stop Crisis Management Center) in all the districts. The main aim of the OCMC is to provide comprehensive care for the victim, from examination, psychosocial counseling, management and placement in safe-house if required, all free of cost and from within the same place. Confidentiality throughout the process of management and speedy trial of offenses against children by OCMC has encouraged victims to reach those centers and seek help. If not able to visit OCMC due to threat to life, they can even call the center (phone numbers are available on the internet). In addition, there is a toll-free number (1098) to report child abuse.
Prevention strategies include improving children’s understanding of their bodies, appropriate and inappropriate touch, and who they could reach out to if they have concerns about someone’s behavior, along with body safety training programs in school or community. Strong preventive law and policy and its implementation at the grass-roots is necessary. Everybody in the society should be responsible to identify the children in stress, their change in behavior and report any suspicious activity to concerned authorities. We should not make judgmental comments, always take it seriously what the child is saying, and assure them that they did the right thing in telling. We should tell the child that he or she is not to blame for the sexual abuse and offer them comfortable and protected environment.
It is equally inhumane, to involve in the act of sexual exploitation or not to involve in the act of prevention!
The author is a resident doctor at the Department of Psychiatry, Patan Academy of Health Sciences, Lalitpur
