Riveting Discussion: Child Sexual Abuse As A Public Health Issue

By: Roslyn A. Douglas, MA - Founder of Central Health - Grenada

On Friday May 9, 2014 a panel discussion on the topic, “Talking About It:  Child Sexual Abuse As A Public Health Issue,” was held at the Brooks-Smith Lowe Institute. The purpose of the discussion was to merge the correlation between child sexual abuse and its impact on public health as it relates to the rise in chronic non-communicable diseases, psychoneuroimmunological irregularities and psychological impact. 

The panel, seen in order of appearance in the photo, consisted of St. George’s University’s (SGU) Inaugural Dame Hilda Byno Writer in Residence, Lisa Allen-Agostini; Fatima Friday, Med., a St. George’s University Public Health Lecturer with a special interest in psychoneuroimmunology; Dr. Kecia Lowe, Board Certified Internist and Pediatrician who was recently inducted into the American College of Medicine as a Fellow;  and Malaika Brooks-Smith-Lowe, Founder and Co-Director of Groundation Grenada who served as moderator for the panel discussion and also organized the event. 

SGU’s Writer in Residence Allen-Agostini a journalist from Trinidad and Tobago read an excerpt from her work in progress book, which details the journey of a young girl who became a victim of sexual abuse at the hands of her uncle.  The pages Allen-Agostini read from graphically detailed the hostile home which the child lived in with her mother.  The rapist was visiting.  

The excerpt described a gut wrenching account of a physical and verbal abuse attack endured by the child from her rough and heavy handed mother.  The reason for the beating appeared inconsequential.  It then moved to the first gruesome sexual attack, which occurred after the child’s mother left the house shortly after the excessive beating. A beating that was cut short after pleads of mercy from the visiting uncle.  This particular uncle was the child’s mother’s brother.

Allen-Agostini’s continued to walk the listeners through the manipulative process of the perpetrator.Through her storytelling she showed how the little girl’s uncle used a counter strategy of gentleness and comforting voice tones to sooth the distraught child.  After gaining more and more trust with his apparent friendliness and gentle touches, he slowing and calculatingly began threatening her into submission. After the horrific sexual attack the writer revealed the child’s dichotomy. The child never told her mother of the attack because she was deathly afraid of the physical consequences, to the point it did not occur to her to say anything, while at the same time was intimidated and petrified of her uncle.  The snippet of Allen-Agostini’s work also revealed that the child’s mother noticed the bruises after returning from shopping, but casted a blind eye.  She instead gave her daughter a doll, a gift from the uncle who earlier forcefully covered her mouth to muffle her screams.

After the reading, the program then shifted into a vibrant discussion about how society tends to ignore the ramifications and repercussions of sexual abuse on an individual and its impact on public health in terms of rises in illnesses.  Panelist - Dr. Lowe, listed out some of the unhealthy coping behaviors individuals who suffered this trauma tend to participate in, “Cigarette smoking, obesity, inactivity, alcoholism, drug abuse, depression, suicide, [and] sexual promiscuity.”  Dr. Lowe went on to say, “These people have a higher risk of diabetes, liver disease, cancers, and stroke and general poor health in adulthood.  And that alone can tell you it is definitely a public health issue because these people manifest these chronic non-communicable diseases at higher rates. And this adversely affects all societies.”  

Allen-Agostini who stated that many of her past journalistic articles focused on children and gender issues, introduced the audience to a campaign called,  "Break the Silence."  This initiative is a mulit-pronged approach to protect children against sexual abuse.  One of its aims is to reach victims and their families with a message to speak out and denounce sexual violence against children.  The initiative seeks to engage and encourage influential groups and members of society such as policy makers, health workers, and police authorities to create and/or improve support and care for victims. According to the World Health Organization, “Globally, at least 150 million girls and 73 million boys under 18 years had experienced forced sexual intercourse or other forms of sexual violence involving physical contact.  In several Caribbean countries the first sexual experience of young girls is often, forced; studies have shown that this was the case for 42.8% of girls below age 12.” 

From a psychoneuroimmunological perspective, a field of study that examines the interaction between psychological processes and the nervous and immune systems of the human body, panelist Fatima Friday stated that trauma occurring at a young age can have adverse effects on the developmental process of the human brain causing overdevelopment of the area of the brain that analyzes stress and fear.  This can lead to post-traumatic stress. However, Ms. Friday views child sexual abuse more broadly, “It’s not just a public health issue, it’s an issue of humanity.” She went on to say, “ You can look at your mother’s life, your father’s life to see different connectivity points and ask – how has the way I have been trained by my parents, by my siblings affect the way I treat myself and treat others.  Because that is public health.  How we engage with each other, how we interact is public health as well.”

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Men’s Health – A Priority For Ministry of Health

By: Roslyn A. Douglas, Founder of Central Health - Grenada

Statistics released by the Ministry of Health indicate that Grenadian men are dying more than women in many chronic illnesses such as cancer, heart disease and diabetes. As such men’s health has become a major concern and a priority for the Ministry of Health.  Efforts ranging from evaluating surveys, conducting training sessions for healthcare professionals and community focused health education sessions, began last year with plans to continue throughout 2014.

Ministry of Health's Director, Primary Health Care - Dr. Francis Martin

Director of Primary Health Care, Dr. Francis Martin summarized an analysis of the causes of death in Grenada over a 10 year period, which revealed men are dying more than women in many of the chronic illnesses, “We have looked at the data, the mortality data over the past 10 years and put those data together in one graph. And what those data together in one graph shows is that [out of] the 10 leading causes of death in Grenada – the most in terms of share quantity is cancers.  Cancers are the leading cause of death in Grenada and on the heels of that is cerebrovascular diseases.  So you are talking about strokes, heart attacks and what have you. Pulmonary disease is next and metabolic disease, which is like complications of diabetes comes in fourth.”    

Although cancers are the number one cause of death in the 1o year analysis, overall Grenadian men are dying more than women in many of the other diseases, “So the cancers, the cardiovascular diseases like strokes and heart attack and so on and the diabetes and respiratory problem are leading at the top. And of those leading at the top men are actually leading ladies in those as well, except in the case of some metabolic diseases that has to do with ovarian issues, hormonal issues, and thyroid issues,” said Dr. Martin.

To determine the cause of the number of male deaths, the Ministry of Heath reviewed surveys and studies conducted on men regarding their health. The results showed that lack of accessibility, concerns about confidentiality and lack of targeted education were reasons why some men do not seek a health care, “One of the things men said was, because the health centres only open for a certain amount of hours during the day, the time at which they are at work, they are not able to access care. And so what we have done in terms of the Primary Health Care, one of the first things we did was to extend the opening hours of the major health centers, and so men now can access care after 4 pm. Since the extended hours were implemented, feedback shows that the health centers are being utilized more in the evening than in the day; which is wonderful news. If this is a sign of what’s to come, then this is an exciting time for Primary Health Care in our country,” said the Director of Primary Health Care.

Another indicator that surfaced as a reason why men appear apathetic towards their health is lack of education.  “The second thing that men indicated was they felt as though the main thrust of the health care programs were not put together and directed towards men.  It was more so towards women and children,” said Dr. Martin.  He went onto say that over the past few decades, health systems in the Eastern Caribbean and other parts of the world’s focus on women and children.  These efforts have resulted in reducing maternal and mortality rates, however at the same time focus on men has fallen behind.  “So because of that, one of the pillars of our Primary Health Care program is what we called community outreach where we can focus on vulnerable groups.  We have already started one of those is called the Men’s Health Outreach.  We actually advertise [and] mobilize some men for one afternoon and we go out and do screenings for them - blood pressure, blood sugar, blood testing for prostate and all sorts of things.” He enthusiastically added, “So in the next few months and certainly within the next few years to my mind that is the kind of strategic position we will be taking. Trying to find the vulnerable groups and putting together programs specifically for those groups.” 

Although there are a number of health clinics around the island, in a separate interview, Permanent Secretary for the Ministry of Health Aaron Francois stated another reason why men do not seek medical assistance is due to concern about breach in confidentiality.  “What we found out is that in a lot of the cases, men are very reluctant to attend or to visit health practitioners.  Whether it is a medical centre, or a doctor.  Men tend to wait very late, when their situation becomes desperate, to visit the doctor.”  PS Francois went on to say in extreme cases some men chose to go to a clinic that is not even within their own community, “You would find assuming a man goes to one of our centres and based on the situation, based on what the complaint is – he would not want the issue to be divulged to the wider community.  So you would find that a man would leave his centre - local, and go to another centre for attendance.”  To address this issue PS Francois said that the Ministry of Health has communicated this concern to practitioners with the intent to make the environment more comfortable for men.