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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

David R. Buchanan

Second Advisor

Aline C. Gubrium

Third Advisor

Karen Kalmakis

Subject Categories

Public Health


This study examined the experiences of practitioners facing the challenges of providing services to female survivors of sexual violence in Kenya. Specifically, the study examined how health practitioners understand their experience in responding to the needs of sexual violence survivors, how they view these women, in what ways they are helping them to heal, and in what ways the health system fails to help these women. In-depth interviews were conducted with 28 health practitioners, from eight post-rape care facilities located in Nairobi, Kenya. The questions focused on the practitioners’ workload, challenges and rewards, the emotional impact of working with survivors, and recommendations for improving the quality of services that they provide. The study documented a myriad of detail about the working conditions of the practitioners, the problems they face, and the quality of services they provide. The results revealed three findings that were particularly salient and significant. The most striking result is the severe shortages of personnel, equipment and competency in delivering services to survivors. Second, the study uncovered complex and troubling issues concerning the question of "genuine" clients. In recounting their experiences, the practitioners described cases where it became apparent that the women presenting in the clinic had not actually been raped, but used the pretext to obtain HIV pre-exposure prophylaxis medication. Thus, doubts about the veracity of the client’s story added to the emotional drain on the providers. The third significant finding was the great pressure exerted on survivors not to report or to follow-up on cases when the perpetrator was a family member. The experience was less often voiced as feelings of shame about the act of incest, but more often expressed as the fear of financial ruin for the family if the male primary income earner were sent to jail. An explanation for the occurrence of these disparate results points to common origins in social structural inequities driven by the global political economic policies that perpetuate poverty and dependency throughout Africa and the developing world. The results of this study have many important implications for improving the quality of services provided to rape survivors in Kenya.


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