Family and community rejection and a Congolese led mediation intervention to reintegrate rejected survivors of sexual violence in Eastern Democratic Republic of Congo.

Our purpose in this study is to describe the multiple and inter-related health, economic, and social reasons for rejection and to provide an example of a Congolese-led family mediation program to reintegrate survivors into their families. We conducted this study in Eastern Democratic Republic of Congo (DRC) and included two focus group discussions and twenty-seven interviews. Rejection extends beyond physical dislocation to include economic and social aspects. Family mediation is a process requiring knowledge of traditions and norms. Understanding the context of rejection and supporting promising local reintegration efforts will likely improve health, economic, and social outcomes for the survivor, her family, and her community.

A Congolese community-based health program for survivors of sexual violence.

Many survivors of gender based violence (GBV) in the Democratic Republic of Congo (DRC) report barriers to access health services including, distance, cost, lack of trained providers and fear of stigma. In 2004, Foundation RamaLevina (FORAL), a Congolese health and social non-governmental organization, started a mobile health program for vulnerable women and men to address the barriers to access identified by GBV survivors and their families in rural South Kivu province, Eastern DRC. FORAL conducted a case study of the implementation of this program between July 2010-June 2011 in 6 rural villages. The case study engaged FORAL staff, partner health care providers, community leaders and survivors in developing and implementing a revised strategy with the goal of improving and sustaining health services. The case study focused on: (1) Expansion of mobile clinic services and visit schedule; (2) Clinical monitoring and evaluation system; and (3) Recognition, documentation and brief psychosocial support for symptoms suggestive of anxiety, depression and PTSD. During this period, FORAL treated 772 women of which 85% reported being survivors of sexual violence. Almost half of the women (45%) reported never receiving health services after the last sexual assault. The majority of survivors reported symptoms consistent with STI. Male partner adherence to STI treatment was low (41%). The case study demonstrated areas of strengths in FORAL's program, including improved access to health care by survivors and their male partner, enhanced quality of health education and facilitated regular monitoring, follow-up care and referrals. In addition, three critical areas were identified by FORAL that needed further development: provision of health services to young, unmarried women in a way that reduces possibility of future stigma, engaging male partners in health education and clinical care and strengthening linkages for referral of survivors and their partners to psychosocial support and mental health services. FORAL's model of offering health education to all community members, partnering with local providers to leverage resources and their principal of avoiding labeling the clinic as one for survivors will help women and their families in the DRC and other conflict settings to comfortably and safely access needed health care services.

Evaluation of medical supplies essential for the care of survivors of sex- and gender-based violence in post-conflict Eastern Democratic Republic of Congo.

The fundamental concepts set forth in the formal Post-Conflict Needs Assessment (PCNA) initiative created by the United Nations Development Group have the potential to be adapted to assist local groups in documenting the needs of and the provision of health care to survivors of sex- and gender-based violence (SGBV) in Eastern Democratic Republic of Congo (DRC). In partnership with Congolese health care providers, we took the first step in advocating for a locally-adapted and focused needs assessment through the development and administration of surveys to providers in the South Kivu Province, DRC. The content of the surveys was largely based on lists of medical supplies deemed essential for reproductive health and for the care of survivors by the Reproductive Health Response in Crises Consortium. The providers in both urban and rural settings considered many of the supplies identified on the surveys necessary for the care of survivors (84%; p < 0.05) but considered few accessible (26%; p < 0.05) in their particular clinical settings. Providers also felt that the existing list of supplies was inadequate to meet the needs of survivors, and also that providers needed ongoing training to improve supply procurement and management, more knowledge of the needs of male survivors of SGBV, and more educational opportunities to improve the quality of care to survivors. Given the deficiencies expressed by providers in the surveys, this study demonstrated a critical need for a locally-adapted and focused needs assessment to improve health services to survivors.