Spreading the Word on Sexual Violence

How do you change hearts and minds? Well, we certainly don’t have anyone “by the balls”, as Chuck Colson (a presidential adviser to LBJ) said, so we will have to rely on persuasive argument. Rates of sexual and gender based violence (SGBV) in Swaziland are shocking. Recent studies by UNICEF and the Centers for Disease Control in Atlanta (2015) say that 37.6% of children have been sexually assaulted in the Kingdom. A sixth of women reported that have been forced to have sex.

Gender based violence is basically women being abused. It does not just happen in Swaziland. The figures for other African countries (Uganda 46%, Tanzania 60%, Nigeria 81%) are much higher. Oppression of women, whether by sexual domination or physical aggression, is all about wielding power.

We use the term “survivors” rather than “victims”. Some might feel that insisting on using “survivors” is just playing with words. But to me, a survivor is someone who has kept going after an awful event, they are recovering, putting the past behind them. On the other hand, a victim is the name for someone who is still in trouble, suffering and defined by what happened to them. Survivor is active, victim is passive.

The MSF clinic at Matsapha has a dedicated unit for SGBV. To avoid referring to it as the “rape clinic” we call it “Room 72”. This is a reference to the need to get help within 72 hours of a sexual assault to get effective, preventative medical care. Where needed, we give emergency contraception, drugs to prevent survivors from developing HIV (“Post Exposure Prophylaxis” – PEP), a cocktail of antibiotics to deal with potential, common sexually transmitted infections, and vaccinations against hepatitis B and tetanus.

I analysed our statistics recently. Our clinic has seen 62 cases of sexual violence this calendar year, aged between 2 and 50. Almost all the survivors are female. Just three out of 62 are male. Two thirds of the survivors are school-children, aged between 7 – 19.


We spend a lot of time, money and energy on health promotion. It was sound sense to target maidens attending the Umhlanga ceremony to raise awareness of our services. We have a dedicated toll-free number available twenty-four hours a day, with a trained psycho-social counsellor offering advice. We hand out bright blue business cards, written in English*, to advertise the clinic. Larger postcards, written in siSwati and English, explain in greater detail why it is essential to get treatment as soon as possible. We have newly designed posters to hang throughout the district.

I want to target schools, both Primary and Secondary, in the surrounding area. We have plans to hold debates for older pupils, and use storytelling, poems, drama for the younger ones. But this needs approval from the Ministry of Education. I have had very fruitful meetings with officials from the regional office, but we now have to pitch the idea to the national Director of Education in Mbabane. It isn’t easy getting an appointment.

In Swaziland, health promotion campaigns start with the traditional leaders in the community, the chiefs and indvuna. These are usually older men. The meetings can drag on for hours, as everyone wants to have their say, even though their opinions are almost identical. As the dialogue is in siSwati, I find it really difficult to follow the action, even with a translator scribbling notes for me on a pad. Nevertheless, they are powerful “opinion formers”, so convincing them about the need to prevent SGBV is an important part of the campaign (regardless of the fact that virtually all perpetrators of SGBV are male).

Last week I attended a meeting of men at Kwaluseni Community Centre. It was scheduled to start at 9am, but the participants took their time to arrive. Eventually, we commenced at 10:30am. I was pleasantly surprised to see some younger men in the group, as well as the usual mkhulus (grand-dads). After introductions, I tried a trendy approach, asking the participants what they knew about SGBV, did they have any experience of it, what did they think of it.

This led to a wide-ranging discussion for twenty minutes. “Rape is the fault of those young girls wearing provocative short skirts,” said one older man. Another man questioned the parenting style, “because fathers and brothers must be involved when it comes to how the women dress.”

I just had to respond to this. “So if I park my car and leave the keys in the ignition, I might be foolish. But if you give in to temptation and steal it, you will still be breaking the law.” This triggered much nodding of heads and mumbling.

“Some people are so poor that the whole family has to sleep in one room,” said another.

Finally, a younger man spoke up, “Is this meeting supposed to be a free for all? It’s wasting time. I want to hear from the doctor and nurse what services they provide!” That was a bit of a shock for the old ones, who are used to chewing the fat around the campfire in the evenings.

I took the floor and told the meeting about the services we provide in Room 72. “Did you already know this?” asked the psychosocial counsellor. Most of the audience had no idea that anti-retroviral medication taken within 72 hours could prevent HIV infection.

The discussion moved on to the rape of young children. The men could not understand this, and thought the perpetrator needed help as they must be mentally ill. “Those people need Jesus, to make them behave like humans.”

I spoke about young children being sexualised by older children who had downloaded pornography onto their smart phones. One man in all innocence said, “Yes, when I am watching a porno DVD, my children come into the room to see it, too.”

“We can’t control our children now, because of children’s rights. It’s a crime to beat a child, so how can we influence their behaviour?”

“We have moved away from traditional solidarity in the village and now people act like animals. Not so long ago, the whole community helped to raise children. Now you cannot criticise a neighbour’s child without offending the parents.”

“But some men do harm under the influence of alcohol. How can we stop men from drinking?”

I spoke about the Umhlanga slogan “Discipline to correct, but not to hospitalise.” The maidens understood that physical discipline was needed to make them behave, but this must not be so severe that children needed medical attention. The psychosocial counsellor told me that the audience were shocked by my making this observation. They said that they were fed up with being told what they must do by visiting dignitaries, and it was refreshing to hear from someone who understood their culture. Gulp.

“You should have invited women to this meeting,” said another youngster. “We will be holding another meeting with the women next week,” said our psychosocial counsellor. “But we wanted to speak to you as respected members of your community so that you could influence the behaviour of other men.”

The audience formally thanked us for coming and said that they appreciated the good work we were doing. The men filed out to get their free dinner – cow tripe and intestines, with maize meal pap. Uncharacteristically, I declined to join them.

I noticed that there were two plastic bags on a chair behind reception. One was filled with cow hooves, the other was a cow’s head.

“That’s the meat for next week’s meeting,” said our community educator.

“So the men are eating the insides. We will be eating the outside corners. Who gets to eat the good bits in between?” I asked.

When no one could answer me, I remarked, “I suppose the cow had its head and legs on for ten years. Another week won’t make a lot of difference.”

“Don’t worry doc, I think they have a refrigerator here.”

* English has a much larger vocabulary than siSwati, so it takes fewer words to express the message.

By Dr Alfred Prunesquallor

Maverick doctor with 40 years experience, I reduced my NHS commitment in 2013. I am now enjoying being free lance, working where I am needed overseas. Now I am working in the UK helping with the current coronavirus pandemic.


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