Sexual assault on children is social emergency — Ghana’s first Forensic Nurse, Harriet Odoley Klufio
The role of forensic nurses in cases of abuse is very important, especially to the abused. Forensic nurses are a critical resource for anti-violence efforts. However, until 2017, this country did not have a forensic nurse.
Thankfully, Ghana now has a forensic nurse in the person of Harriet Odoley Klufio (HOK), who is also a child protection specialist and advocate at the Child Health Department of the Korle Bu Teaching Hospital.
She is a nurse midwife, holds a Bsc degree in Nursing Psychology and Sociology as well as a Master’s degree in Public Health from the University of Ghana, Legon.
She qualified as a full forensic nurse from the Georgia Network to End Sexual Assault, Atlanta Georgia, USA in 2017.
Mrs Klufio spoke to Daily Graphic’s Augustina Tawiah (AT) about her work as a forensic nurse and child abuse cases. Excerpts of the interview are captured below.
Augustina Tawiah (AT): Who is a forensic nurse?
Harriet Odoley Klufio (HOK): Forensic nurses are at the frontline of helping victims of violent crimes. The forensic nurse provides comprehensive care to victims of violence, while demonstrating competency in conducting a medical forensic examination, which includes evaluation for evidence collection and provides effective courtroom testimony.
The forensic nurse shows compassion and sensitivity towards victims or survivors of violence. Forensic nursing is not a separate nursing care. It is integrated into the overall care needs of individual patients.
The Child Protection Unit at Korle Bu takes care of children 16 years and below. Together with the doctors at the OPD, management of the abused victim starts immediately the patient arrives. My work as a forensic nurse is to provide physical and psychological care to the victim, conduct a medical forensic examination, collect evidence of the abuse and together with the senior OPD doctor fill the police form for effective testimony in court for prosecution of perpetrators of the violent crime.
AT: Do we need forensic nurses in this country?
HOK: Forensic nursing came about in the developed world in order to give prompt attention to cases of abuse reported to hospitals, to avoid losing essential evidence due to delays victims of violence suffered because of attention given to more critically ill patients. The forensic nurse is, therefore, trained to handle victims of abuse comprehensively.
Yes, we need a lot of forensic nurses because the cases are rife, especially in the rural areas where people take advantage of vulnerable children and molest them. In the rural areas, doctors are scarce. Most are managed by physician assistants who can team up with the forensic nurse in the care of the abused patient.
Without specific training and education in forensic medical care to both doctors and nurses, the fight against domestic violence will remain very difficult. Experience in the courtroom shows that some violent crimes go unpunished, as medical reports are inadequate for successful prosecution and vice versa and innocent people may find themselves behind bars.
AT: What motivated you to take this specialisation?
HOK: My first encounter with an abused child was in the year 2010 as an OPD nurse at the Child Health Department of Korle Bu. A lady approached me about her seven-year-old son who was a victim of sexual violence by her own teenage brother in senior high school.
I immediately had compassion and decided to handle the lady and her son with utmost care and sensitivity as required in the management of survivors of abuse.
I also realised there was a gap in the Ghanaian healthcare system with regard to the skills required in conducting forensic medical examination and care of victims of violence by forensic nurses, unlike the Western World where there is advanced nursing practice in forensics. I immediately knew I had to acquire the necessary training and education in order to become a forensic nurse.
Though there was in existence a Child Protection Unit at the Department of Child Health which was established in 2009 with Professor Ebenezer Badoe as the paediatrician in charge of the unit, it lacked a forensic nurse. In 2016, Mrs Klufio was fortunate enough to get the opportunity to study as a Forensic Nurse with the GNESA, Atlanta, USA.
AT: How critical is compassion, care and sensitivity to the healing process of the abused person?
HOK: Anytime a child is abused, they go through stages of trauma called traumagenic dynamic model. That child is injured psychologically. He is inflicted with abuse and the feeling and attitude are shaped in the developmental way such that, if you are not sensitive to that child’s plight, you may not be able to help them come out of the dysfunctional state. They will, therefore, need somebody who will understand and help them recover quickly.
A child who has been abused sexually is sometimes beaten by parents for being a bad child. Some are also blamed for the abuse they have suffered. But if you take time to understand that this is a child who has been coerced to do something that is not appropriate, you will sympathise with them and treat them with utmost care and compassion.
AT: Were you not worried the forensic nursing was a grey area in the country?
HOK: I knew beforehand that in our part of the world, it would take time for me to be recognised after going through the specialisation, but I was not perturbed, because I was aware that if I got the skill and knowledge, I would make a big impact. Victims come to the hospital and there should be somebody who must be able to evaluate, assist and manage them.
Even for the preventive aspect, there must be somebody who should be doing a lot of advocacy so that it does not occur again. Who is willing to do that? I think I am better placed and willing to do it and my greatest motivation was to help victims of abuse and also champion the need to train doctors and nurses in medical forensics.
AT: Do you record a lot of child abuse cases in this facility?
HOK: We see from 30 to 40 cases of child abuse every year and sexual abuse comprises 80 per cent of the figures.
AT: In what state are the cases that you see here?
HOK: We have had sexual assault cases in children who have been severely injured and must go through at least two surgeries because the child has been torn open from the vagina to the rectum, due to the force with which the male adult (paedophile) penetrated sometimes toddlers as little as two years.
We’ve had some young girls below 16 years that acid had being poured on by their boyfriends. Parents sometimes beat children till they become unconscious and are rescued by co-tenants to the hospital. Some mothers and grandmothers can be so negligent in using hot water to bath babies without checking the appropriate temperature for the child, resulting in severe burns in these children and sometimes death.
Abusive head traumas to babies are sometimes the result of misunderstandings between husband and wife. Father or mother gets so frustrated and vent their anger on the innocent babies, resulting in head injuries to the children.
Sometimes during routine examination on children, we are able to unearth abuse in the home, for example cigarette marks, cane marks and, in extreme cases, that of hot irons.
AT: How are children affected by child abuse?
HOK: Children suffer both psychologically and physically from abuse. The long term effects of abuse in children can be life threatening and also result in disabilities. Sexual abuse in a child may result in sleep disturbances, temper tantrums, phobias, school problems, low self-esteem, sexual behaviour problems, depression, attempt to commit suicide and engage in self-destructive behaviours, substance abuse and other delinquent behaviours that lead to criminal activities.
Children must be trained to report anyone who tries to undress and fondle them. They must be made to know it’s their body and no one has the right to touch it. They must immediately run and shout for help. The boy child can also be violated sexually and must also be trained to resist any attempt on them.
Sexual assault of children is a social emergency that must be addressed. Children cannot protect themselves. The society must protect children.