A recent report has alleged that a doctor working at a government hospital had sexually abused children, as well as used children at the hospital to produce child sexual abuse material (child pornography).
Such an activity, if true, is a horrible violation of children, a complete failure to uphold the medical code of conduct, and possibly a lapse in prevention safeguards.
It is important to ask how did this even happen? And to multiple children! There should be safeguards in place at all health facilities to protect all children (and adults) from sexual abuse.
These should apply to all government agencies, civil society organisations (CSOs), child care and education facilities, and anyone dealing with children.
The minimum safeguards or standards expected when managing a patient either in the clinic or ward setting, or supporting a child in any setting, are outlined below. A full set of guidelines endorsed by many Malaysian CSOs can be found here.
Having A Written Child Protection Policy
It is mandatory that the Ministry of Health (MOH), other government agencies, CSOs, and child care and education facilities have a written child protection policy that is read and agreed to (signed) by all staff and management at the centre.
The policy should be updated in line with evolving understanding and evidence on child protection.
Ongoing Staff Training
All staff working with children should be trained on child sexual abuse and general prevention measures that need to be adopted for the safety of children on their premises or the services they provide.
Routine Vetting Of All Staff Working With Children
It is important to ensure that all new and existing staff members working with children are safe individuals. This would include a background check on references and character, and a criminal background check.
Sadly, this is difficult to do comprehensively in the Malaysian context, as our national sex offender registry is incomplete and the process time consuming.
Routine And Mandatory Safety Rules On Working With Children
It is important to implement and maintain safety rules in working with children. Sex abusers are often people who appear “safe”, helpful and keen to work in positions that involve children. Hence, it may be difficult to spot them and we need mandatory safety policies in place.
The key safety rules in working with children include:
The ‘Two Adult Rule’
Adults should not be allowed to work with or examine children on a one-on-one basis. It does not matter whether it is male to male or female to female; everyone who works with children must have a chaperone.
In the hospital and clinic setting all doctors, whether male or female, when examining children, must have a female nurse to accompany them. It would be unacceptable to have two men examining a male or female child, teenager or adult.
This is why the recent MOH directive to move nurses away from specialist clinics is of concern. Children as patients are not just seen in the paediatric clinic. They are also seen in many other department clinics like ophthalmology, ENT, orthopaedics, dermatology, etc.
Many teenagers are also patients in the adult medical and gynaecology clinics.
‘Open Door’ Policy
In addition, all counselling and other activities by MOH, CSOs and other government agencies should have an “open door policy”. This means that there is a “window” in the door or a side window through which others can see what is occurring. This should also apply to teachers and kindergartens.
Safety Of Premises
All buildings, compounds and the surrounding area should be evaluated by the management for potential locations where abuse can occur. Steps should then be taken to rectify problems (e.g., hole in the fence, poorly lighted areas, toilet safety, etc).
Audits And Credentialing
It would be ideal that MOH, government agencies, CSOs, and child care and education facilities have periodic internal and external audits of child safety procedures to ensure the service or centre has met the appropriate standards for child safety.
An independent credentialing system is required to rate the safety of all services for children.
I hope that this horrifying incident will spur MOH, private health facilities and other government agencies to re-evaluate their safety prolife and measures to safeguard all children and teenagers.
No child or teenager should ever be sexually violated in a health setting.
Dr Amar-Singh HSS is a consultant paediatrician and child disability activist.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
