Women's Refugee Commission, 122 East 42nd Street 11F, New York, NY 10168-1289, USA.
Confl Health. 2013 May 21;7(1):12. doi: 10.1186/1752-1505-7-12.
Given the challenges to ensuring facility-based care in conflict settings, the Women's Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization's Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings.
A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age.
Qualitative feedback contributed to an understanding of the model's feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment.
Data speak to the promising "feasibility" of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not accessible for women and girls that need it most.
鉴于在冲突环境中确保医疗机构提供服务所面临的挑战，妇女难民委员会及其合作伙伴一直在探索一种以社区为基础的方法，为缅甸东部克伦邦遭受性侵犯的幸存者提供医疗服务。这种新的模式通过授权社区卫生工作者为遭受强奸后的幸存者提供护理，将 2004 年世界卫生组织（WHO）的《性暴力幸存者临床管理》机构方案转化到社区层面。这项创新研究的目的是检验社区为性暴力幸存者提供医疗服务的安全性和可行性，为在人道主义环境中建立替代护理模式的证据基础做出贡献。
2011 年 7 月至 10 月进行了一项过程评估，从接受培训的社区卫生工作者、传统助产士和社区成员那里收集定性反馈。在试点和非试点地区，对最高级别的医疗保健工作者进行了两次焦点小组讨论。在克伦邦，召集了 8 次传统助产士焦点小组讨论，以及 10 次育龄男女焦点小组讨论。
定性反馈有助于了解该模式的可行性。试点社区卫生工作者对为性暴力幸存者提供社区护理表现出兴趣。传统助产士证实了提供这种护理的重要性。社区卫生工作者非常清楚需要保持保密性并提供富有同情心的护理。他们在提供治疗时并没有过多地关注安全问题。
数据表明，社区性暴力后护理具有“可行性”。要回答安全性问题，还需要更多的时间、提高认识和更大的服务人群。该试点项目试图将机构方案转化为社区层面，为那些最需要传统性暴力后护理方法但无法获得护理的妇女和女孩提供解决方案。
