Case management, referral and review of the monthly register

Medical emergency: the incident occurred about 40 hours ago. HIV post-exposure prophylaxis must start within 72 hours, i.e. before Wednesday 14 October at around 18:00; emergency contraception is possible up to 120 hours. The nearby health centre is out of kits: refer today to the general hospital, accompanied if she wishes and with transport paid by the emergency fund (supervisor's approval by phone).

Safety: assess with her the risk at home and on the way to collect firewood; simple safety plan (do not go alone, timing, reason to give her in-laws for her absence); offer the safe shelter only if she feels in danger and wishes to go. Arrange care for her daughter during treatment if necessary.

Support and follow-up: psychological first aid from intake, follow-up appointment within 48 hours at the safe space, with no home visit that could expose her. Inform her that legal information remains possible later, without pressure. Report the insecurity in the firewood collection area to the coordination mechanisms, anonymously.

• Date and time: 13/10, [time]. Organisation and referring caseworker, phone.
• Receiving service: general hospital, clinical management.
• Identification: code S-27 and first name (consent given for the health service only), female, 24 years old.
• Reason: survivor of sexual violence, incident on 11/10 at around 18:00; request for urgent clinical management (prophylaxis within 72 hours, emergency contraception, care).
• Urgency: very urgent, 72-hour window until 14/10 at around 18:00.
• Consent: signed or thumbprinted, for this referral only.
• Specific needs: accompaniment, transport provided, 2-year-old child with her.
• Feedback: confirmation of care to the referring caseworker, without medical details unless agreed.

Do not record: the account of the incident, the address, the name of the in-laws or information about the perpetrator.

The dates do not give the times: "3 days or less" is used as an approximation of 72 hours.

Sexual violence (rape and sexual assault): 7 cases (V-01, 03, 05, 07, 08, 10, 12). Disclosure within 3 days or less: 6 out of 7 (86%); V-03 disclosed on day 6. Health referral within 3 days or less of the incident: 4 out of 7 (57%): V-01, 07, 08 and 10. Of the 6 timely disclosures, 4 were referred in time (67%).

Critical points: V-05 disclosed the next day but was only referred on day 4: the prophylaxis window was missed even though it was possible, probably because of the stock-out at the health centre; the reason must be established. V-12 refused: her choice must be respected, but check that she received complete information on the timeframes. V-03 was referred on the same day as disclosure.

Consent: 2 files out of 12 not documented (17%), including V-08, who was referred: a referral without documented consent is a procedural breach.

Changes: health referral on the day of disclosure for any sexual violence less than 120 hours old; weekly update of the service mapping (kit stock-outs); transport fund quickly accessible; verification of consent by the supervisor before closing any referral; monthly case review with the team.

I refuse politely but firmly: the information on the people we support is confidential and is only shared with their consent and solely for their care. Giving a list could expose them to stigma or reprisals. I thank the chief for his interest and suggest other ways he can contribute: raising awareness of available services, reporting risk areas (firewood collection), supporting patrols or lighting. I inform my supervisor of the request and record it in the information security incident register. If the pressure continues, the programme coordinator takes over the dialogue with him.