Caribbean Exploratory [NIMHD] Research Center of Excellence University of the Virgin Islands School of Nursing Grant Support: National Institute on Minority Health and Health Disparities, NIH (# P20MD002286). The Caribbean Exploratory [NIMHD] Research Center of Excellence and Global Health Research Collaboration: Protecting Haitian Women and Children Earthquake Survivors from Violence and Abuse

Betty Dennis, PhD., RN, Elizabeth Sloand, PhD, PNP-BC, Gloria Callwood, PhD, RN, Session VI: Preliminary Trends and Implications

NBNA SYMPOSIUM JULY 13, 2011 Session Objectives Discuss the impact of environmental, social, political climate post natural or manmade disaster on the physical and mental health of survivors. Trends in re-establishing the Haiti infrastructure and communication mechanisms to support health research. Preliminary findings related to Intimate Partner Violence post earthquake. Implications for research project in Haiti to protect women and girls from violence and abuse

Haiti: Post January 2010 Earthquake More than 800,000 persons are internally displaced About 1,000 camps remain Most camps do not have proper lighting Access to a consistent and safe water supply is a concern Toilets, latrines are lacking Clearing of debris and re-building is slow

One of Many Tent Cities in and Around Port au Prince

Canal with Water also Used as Garbage Dump

Public Latrines Adjacent to a Tent City in Port au Prince

Debris like this can be found all around Port au Prince

More rubble

Sexual Abuse and Violence A global phenomenon A socially tolerated violation of human rights An impediment to women’s equality Emotionally traumatizing to others, especially children “…in the aftermath of an emergency, pre- existing vulnerabilities and patterns of discrimination and human rights violations are often exacerbated.” The U.N. Special Rapporteur on Violence Against Women, its Causes and Consequences

Sexual Violence Since the Earthquake A survey by the Center for Human Rights and Global Justice in 2011 found that among the 365 respondents: 14% were victimized by rape or unwanted touching or both 9% reported one or more members of their household raped or forced into having sex when they did not want to. 86% of those reporting were women 14% of those reporting were men or boys

Occurrence of Sexual Violence Post Earthquake Attacks occurred – during the day or the night – when going or coming from getting water – in the victim’s shelter – in poorly lighted areas – with lack of privacy when bathing

Pre and Post Earthquake Studies of Sexual Violence 2005 – 3.1% of households had been victims during the previous 22 months % of individuals were victimized during the first two months after the earthquake % were victims of forced sex 12 weeks after the earthquake % of households report one or more instances of sexual violence. NB. Direct comparisons are not possible, different methodologies and definitions of sexual violence used

Data on Sexual Violence Data on sexual violence and abuse is under-reported due to –Shame –Fear of retaliation –Very low prosecution rates –Intrafamilial nature of abuse –stigma

Sexual Violence Correlations There is a possible correlation with sexual violence and food insecurity(e.g., having not eaten everyday). Different levels of vulnerability in managed versus unmanaged camps. For example, 18% of households in one unmanaged camp reported sexual violence versus 10% of households in a managed camp.

Sexual Violence Correlations Transactional sex- rising prevalence of trading sex for food, money, protection, shelter. Over 220,000 persons died in the earthquake. The damage to family structures was tremendous. This increased the vulnerability of many women and girls. In Haiti, 70% of households are headed by women.

Sexual Violence Correlations Possible correlation between security and sexual violence. There are only 9,000 Haitian National Police for a population of about nine million occupying 11,000 square miles. The earthquake freed 5,100 incarcerated persons. Less than 700 have been re- captured. With the lack of security they have access to camps, especially unmanaged camps.

Recommendations for Change Primary prevention instead of secondary and tertiary prevention to: –Strengthen national commitment and action –Involve the education sector –Strengthen the response of the health sector –Support women living with violence- empowerment approaches such as microfinance and gender equality training –Sensitize the criminal justice system –Support research and collaboration Source: The WHO Multi-Country Study on Women’s Health and Domestic Violence

Implications for research project in Haiti to protect women and girls from violence and abuse Infrastructure and communication mechanisms Adjustment to timelines Conduct situational analysis

Communications Challenges with phone, couriers and –Unreliable phone numbers –Language barriers –Delayed responses to –Unpredictable length of time for international courier delivery Important exceptions –Initial Ethics Committee contact –Professor at NGO

Time Lines Multiple adjustments required to projected on- site team visit schedule –Need to be sensitive to social, cultural and political realities Preliminary visit –Initial contacts –Visual appreciation of gravity of earthquake aftermath –Appreciation of challenges faced by residents

Situational Analysis Prior arrangements for appointments and focus groups difficult –Lack of success in maintaining consistent communications with contacts from first on-site visit –Communication challenges as previously noted Value of contact with NGOs with gender violence focus Value of having a Haitian National with intimate knowledge of Country and key persons on team Importance of personal Contacts

Situational Analysis Ethic Committee Chair responsive to last minute visit –Received ethics Committee approval of research Meeting with Director of General Hospital in Port au Prince –Agreement to identify subjects from hospital clinics Meeting with Director of Nursing School –Assisted our visit to pediatric unit and OB clinic

Situational Analysis Meeting with the Director of Research, State University of Haiti –Amenable to collaborative relationship –Psychologist interviewed for role as Local PI –Nurse interviewed for role of Project Director/Coordinator

Continuing Challenges Communications Developing and maintaining relationships Contract Negotiations –Resident agent Uncertain political climate Cost of doing business in Haiti Implementing project –Training of staff –Assuring adherence to protocol –Data transfer

Last Words We have been given an opportunity to work with vulnerable Haitian women and girls displaced by the January 2010 earthquake. Many challenges have been encountered, and still others must be resolved, however our team consists of dedicated researchers who are committed to working to make a difference in the lives of those we encounter. Frank Lloyd Wright said the price of success is dedication, hard work and an unremitting devotion to the things you want to see happen. This describes our team.

Thank you!