South Sudan: A patient-centered approach to caring for a survivor of sexual violence

MSF INternational President Dr. Unni Karunakara visiting South Sudan

South Sudan © Corinne Baker/MSF

Ngueny Deng Pal is the mental health supervisor at the Doctors Without Borders/Médecins Sans Frontières (MSF) project in Lankien, northeastern South Sudan, not far from where he grew up. Here, Ngueny shares his story of practicing patient-centered care to treat a woman who had survived sexual violence.  

I will call her Mary, which is not her real name. Mary had been treated at our hospital after experiencing sexual assault. After the medical team had seen her, they asked if she would like to talk to someone about how she was feeling; she said yes. 

I’m the mental health supervisor here in Lankien. The MSF hospital here is the only hospital in the area; people travel long distances to reach us. A year ago, we began offering mental health services alongside physical health care.  

In most communities in South Sudan there are taboos around sexual violence. It’s unthinkableyou simply cannot believe that this would happen to you. And those taboos feed into other people’s attitudes too. Mary’s husband had learned of the assault and had left her because of it. In his eyes, she had been “ruined. 

In that first counseling session, Mary described huge, overwhelming feelings. She didn’t know what to do. She felt like her future had ended.

"This is what patient-centered care is all about: recognizing and supporting patients’ rights to make decisions about their health."

I asked her what she thought might help. What were the alternatives available to her? Together, we went through everything she could think of. I didn’t guide her to one conclusion or anotherthat’s not the job of a counselor. But I did give her the space to think about it with someone else, so she wasn’t just on her own at home. 

One of the things Mary brought up was traditional coping mechanisms in South Sudanese culture. In our community, we have traditional healers who you can go to when you’re unwell or if there are difficulties in your life. Mary wondered if that was something that might make a difference for her.  

MSF does not recommend traditional healing rituals for patients or see them necessarily as a form of therapy. But as a counselor, my role was to support Mary to identify ways of dealing with this trauma that were meaningful for her. This is what patient-centered care is all about: recognizing and supporting patients’ rights to make decisions about their health. By this point, we’d been talking for a long time, so I asked Mary if she would like to take some time to think, and to come back for another session.  

When she returned, we talked it through and she made a decisionshe would go to her father and, if he allowed it, they would go to the traditional healer.

"I had decided to work in mental health because I could see the gap that we have here in South Sudan."

At our next meeting, I could sense the change in Mary immediately. The discussion with her father had gone well. They had gone to the healer together and he had performed a ritual, which had left Mary feeling relieved. She said she felt like she could go on with her life again. Maybe she would even look for a new husband. 

So, then our session shifted. We used the same approach: talking through her options for what she wanted to do next. 

The last time I saw Mary, she was married again and very happy. She told me how glad she was that she had come to our service. She was feeling well and was ready to finish our sessions, but she told me that the work we’d done together had helped her a lot by giving her new strategies she hadn’t known before. 

It was a very nice moment for meI had decided to work in mental health because I could see the gap that we have here in South Sudan, where there are real needs but very little treatment or support available. 

I’m proud of the work we are doing here, and I also know how much change like this is needed in our community, where there can be real stigma attached to mental health care. My hope is that that people like Mary will talk about their experiences of counseling, and the next time someone is facing something similar, they’ll feel more confident in taking the same steps she did.

The MSF hospital in Lankien is a lifeline for people affected by violence in this remote area of Jonglei State. MSF teams in Lankien also provide treatment for malnutrition, HIV, tuberculosis, and other needs.