Consider the analogy of a well functioning health system. A patient comes to the hospital emergency in critical condition. The emergency team springs into action and carries out Standard Operating Procedures (SOPs) to deal with the condition and try and save the patient’s life. Once the acute situation has been handled, the patient is handed over to another team for follow up and recovery. The hospital reviews the case and tries to understand the reasons for the illness.
The hospital looks at the possibilities of where in the chain of the health system such a serious illness could have been caught earlier or avoided altogether. Did the patient go to some other smaller hospital, clinic or general practitioner before landing in the emergency? What kind of treatment was given there? Did the patient have access to primary care services? Did the patient’s socio-economic condition, lifestyle increase his risk for that particular illness? What could the health system do to decrease those risks? In what areas could the health system collaborate with other sectors e.g. education, social services, public health engineering etc. to decrease the risk for similar patients.
In this analogy, the health system is considered as a holistic system. It is not just the emergency where the patient was managed. It is a continuous spectrum from the patient’s lifestyle,his living conditions to his tertiary care management and rehabilitation. In such a system, acute emergencies may continue to happen but their number is likely to decrease as the root causes are being dealt with efficiently, the cases are being managed professionally and there is a system of after-care.
Now consider a poor health system. The same patient is brought to the emergency. The doctors fail to provide proper treatment till the patient’s relatives create a violent scene in the hospital. The tv crew arrives and tickers start running on tv screens. The chief minister takes notice and orders speedy management. The patient is given immediate treatment and discharged. There is no follow up, no review for causes. The chief minister orders a junior doctor on duty in the emergency to be fired for negligence. The media is satisfied. The relatives are mollified and the patient goes home.
In this system, the number of acute emergencies will continue and is likely to increase. Many of the cases of the particular illness will die in smaller hospitals and homes away from the media gaze. There will be a quiet epidemic, only emerging in the public when some brave souls make enough noise to be noticed.
Now substitute the cases of child sexual abuse (CSA) for the acutely ill patient. How we have dealt with this case is just like the patient in the poor health system. CSA is rampant but the Kasur cases came into the limelight perhaps due to some peculiar set of circumstances (according to some reports a land dispute between two parties which led to one party blowing the whistle on the perpetrators).
Moreover the numbers were so big that the relatives felt emboldened enough to protest loudly. The media caught on.
No action was taken till the din got loud enough to reach the higher corridors of power.
Inquiries have been ordered, action urged and the public isduly outraged. The tv, newspapers and social media are abuzz. On cue, the civil society hasgone into a tizzy and organised protests. Some random police officers have beensuspended or fired.
Eventually, as it always does, this din will die down and so will the outrage and the attention.
But will the cases of child sexual abuse end? Let’s be clear. CSA is rampant in Pakistan, both in rural and urban areas. It continues to happen every hour, every day. We have to accept that, openly acknowledge it and then deal with it holistically, not as a one-off anomaly.Like the good health system, we have to deal with the matter from the root cause to the stage of rehabilitation.
We have to work at multiple levels.
At an individual level, as parents, we need to prepare young children to deal with such dangers. Importantly we have to tell the children that they can trust us to believe them and protect them. If children have the confidence to say no, to tell their parents if something bad happens, to know that they will be believed, no one can force or blackmail them as in Kasur.
At school level, it is high time we instituted life skills/comprehensive sexual education in our curriculums. Allowing regressive elements to say ‘haw’ and nip such attempts in the bud as has been done many times must be firmly rejected. Closing our eyes to reality and pretending it is not there is not going to protect our children — educating them and preparing them will.
The media can play a positive role by raising awareness of the issue. Amir Khan’s show on this issue is a good example.It is time to stop sensationalisingand start focusing on changing mindsets.
At community level, civil society organisations are raising awareness, developing education material, running helplines and doingcounselling. Several organisation like Rozan, Pehchaan, Sahil to name just a few, are doing stellar work. They need to be recognised, appreciated and supported instead of being stigmatised and blamed for warping innocent minds or washing national dirty linen in public.
The police needsto be efficient, neutral and helpful. And yes that’s a tall order!
Local government mechanisms at council levels need to be activated (once local governments become functional in all provinces) where complaints can be heard and resolved locally.
Athigher government level, better laws and exemplary punishment for offenders must be ensured. The PM, CM, MNAs and MPAs have to stay in the assemblies and take care of that and then let relevant empowered institutions do their own work professionally.
On the medical side, trained medico legal officers, forensic labs and sensitised professionals must be available who are professionally trained to detect and treat such cases. Follow up, physical and emotional recovery and rehabilitation of each case must be ensured, even if it takes years as it can in many cases. Helplines, counseling and child protection services need to be institutionalised in all parts of the country.
All of this needs to be done and more. All of this needs to be done, continuously, quietly, seriously, when there is no public hullabaloo.
Let’s stop being outraged. Let’s stop being surprised. Let’s just do our bit where we can.