This analysis was designed as a combined retrospective study and prospective survey. It was performed in the city of Goma and the DOCS Hospital, which is a 40-bed, non-governmental organization-run hospital located in Goma. The study protocol was approved by the Ethics Committee of the Medical University of Goma. Since no direct patient data were retrieved and hospitals were free to present data, written informed consent was waived.
Our study evaluated the time period from Jan 2009 until Oct 2010 and had three main objectives: (1) assessment of the number of victims of sexual violence seeking medical care in the hospitals of Goma; (2) assessment of the availability of key resources to treat victims of sexual violence in hospitals regularly caring for victims of sexual violence; and (3) assessment of the frequency of delivery of three indicator treatments (antimicrobial therapy for sexually transmitted diseases, post-exposure HIV prophylaxis, vesico-vaginal fistula repair surgery) to victims of sexual violence at the DOCS Hospital in Goma.
Hospitals of Goma
Our survey evaluated all acute care hospitals located in the area of Goma. According to the local health care office, hospitals are defined as health care institutions running at least 20 beds. The medical director or the person specifically dedicated to the care of sexually abused females at these hospitals was contacted and asked whether victims of sexual violence were regularly (at least one victim per week) cared for. If persons contacted at each hospital stated that the hospital regularly cared for patients following sexual violence, these institutions were visited and included in the survey. During on-site visits consisting of personal interviews and visits of key hospital facilities (e.g. outpatient department, operation room, laboratory), the number of patients admitted because of physical or psychological sequelae of sexual violence during the observation period was retrieved. Furthermore, data on the following resources were collected using a predefined systematic protocol: number of beds, administrative background, availability of a physician specialized in gynaecological surgery or gynaecology, anaesthetist, psychiatrist or psychologist, post-discharge medical services, laboratory tests to diagnose pregnancy and sexually transmitted diseases (hepatitis, HIV, syphilis), instruments for gynaecological examination, acyclovir, chinolone and/or tetracycline antibiotics, post-exposure HIV prophylaxis, operation room, instruments for basic wound care, instruments to perform gynaecological surgery, basic surgical and anaesthetic resources including an autoclave, suction machine, electric cautery, oxygen, vaporizer to deliver inhalational narcotics, patient monitor measuring at least plethysmographic oxygen saturation, materials to administer neuro-axial anaesthesia, and materials for airway management. Availability of drugs (including expiry dates), laboratory tests (including expiry dates), instruments, surgical and anaesthetic resources was documented as 'always', 'sometimes', or 'never'. Selection of these resources was based on recommendations to manage sexually violated females as published by the United Nations Population Fund (UNFPA) and the United Nations International Children's Emergency Fund (UNICEF), as well as practical experience of the authors.
The DOCS hospital, which is supported by the non-governmental organization 'Doctors on Call for Service', was the first hospital in Goma to care for women following sexual violence. The reason for this was the availability of a specialist surgeon providing surgical care for sexually violated women (e.g. those with vesico-vaginal fistula). Over the years, apart from orthopaedic surgery, the DOCS hospital specialized in caring for sexually abused women. The reason why the DOCS hospital was singled out as an exemplary hospital to provide data on the medical course of the patient in this study is the fact that statistical data on the detailed medical management of women after sexual violence could not be retrieved from other hospitals.
The following data were collected from medical records and the administrative register of the DOCS hospital using a standardized protocol: total number of hospital admissions, number of patients admitted following sexual violence, and percentage of sexually abused patients receiving one of the following treatments: acyclovir and/or antibiotics for sexually transmitted diseases, post-exposure HIV prophylaxis, and/or vesico-vaginal fistula repair surgery. Data were collected for the period from Jan 2009 until Oct 2010.
Statistical analyses were performed using the SPSS 13.0.1 software package (SPSS Inc.; Chicago, Illinois, United States). Descriptive methods were used to present data. Variables are presented as median with minimum and maximum values, if not otherwise indicated.