Katie Beck / Medical Coordination Manager and Nurse / Raleigh International
Katie Beck is a Registered Nurse with a specialist interest in Emergency, Expedition and Travel Medicine. She has worked on a number of overseas expeditions and in remote environments, and is currently Medical Co-ordination Manager and Deputy for Safeguarding at Raleigh. In the second of our articles on safeguarding, Katie builds on Jono Oldershaw’s article on safeguarding vulnerable adults and younger people, exploring the role of the medic in protecting everyone involved with expeditions from maltreatment.
If you’d like to hear more, Katie will be presenting at this weekend’s World Extreme Medicine Conference 23-25 November in Edinburgh. Tickets are still available to buy here and you can also view the lecture on Facebook livestream.
Safeguarding: A Broader Definition
Safeguarding has traditionally been the term used to describe ‘the action that is taken to promote the welfare of children and vulnerable adults, and to protect them from harm’ (NSPCC). However, increasingly the term ‘safeguarding’ is no longer only used in the context of protecting children and adults who meet a pre-defined criterion of ‘vulnerable’. Ever broader definitions are being adopted that recognise vulnerability is relative and aim to protect everyone from harm, whether perceived as vulnerable or not. In practice, safeguarding now refers to all incidents of harm that occur as a result of maltreatment or abuses of power. For example, sexual assault or harassment, exploitation or domestic violence.
Recently, The Charity Commission released a new definition of safeguarding as ‘the range of measures in place to protect people in a charity, or those it comes into contact with, from abuse and maltreatment of any kind.’ Protecting Children and Vulnerable Adults remains a fundamental part of this and for more advice on how to do this, see Jono Oldershaw’s excellent article here. However, this particular article will focus on how medics can ensure necessary steps are being taken to protect everyone involved with expeditions (both directly and indirectly) from maltreatment.
An Organisational Approach
Whoever you work with or volunteer for, big or small, safeguarding should be at the centre of expedition planning and ingrained at every level of the organisation. Responsibility for safeguarding should be shared by the safety team as a whole, and everyone taking part in the expedition should know how to raise concerns. However, expedition medics should pay particular attention to safeguarding, because although these issues are not purely medical, there are often medical elements to them (both in terms of mental and physical health). While in an expedition setting, people often approach the medic first following a safeguarding incident. If organisers fail to consider safeguarding at the planning stage of the expedition, there is a danger that issues may be left for the medic to deal with alone. It is therefore in a medic’s interest to ensure that adequate procedures, time, support and training are available to ensure the correct handling of the situation.
There will always be a risk of harm occurring during an expedition, but there are several questions you can ask to ensure the organisation is doing everything they can possible to safeguard participants, staff, and locals alike:
Is the risk of harm recognised?
People participating in expeditions or overseas projects may be particularly vulnerable to sexual harassment and assault. Groups are tight-knit, often away from infrastructure and law enforcement, outside their usual safety and support networks, in a country with different culture and laws, and they are often reliant on one or two individuals for their safety. Certain demographics might also be more at risk, for example women and those from marginalised communities such as LGBTQI+ and ethnic minorities. This is particularly true in countries and communities with significant cultural differences. It is important to realise that the group are not the only people at risk, expedition organisers should also take seriously their ethical duty to protect those the expedition will come into contact with. Disparities in wealth and attitudes between locals and expedition members may leave local communities vulnerable to harm and exploitation too, as highlighted in a number of high-profile cases recently.
Organisations routinely risk assess physical dangers, and increasingly psychological ones too. However, there is often a blind spot when it comes to the risk of safeguarding issues, perhaps because risks are not obvious, are often human, and can be taboo. When creating a risk assessment, careful thought should be given to the potential for individuals to perpetrate sexual, financial, physical and emotional abuse. Remember that leaders, members, locals and anyone else that comes into contact with the expedition have the potential to be both to be victims and perpetrators of harm.
Thought must also be given to the types of projects undertaken and the potential for contributing to wider institutional abuse. For example, visiting or volunteering in orphanages should be completely avoided: see here for why.
It is impossible to mitigate against all risk of abuse, but there are some steps that can be taken reduce the risk, which we explore below.
Is there a Safeguarding Policy?
Policies will be tailored to the specific context of expeditions, but every expedition should have something. It might not be called a ‘safeguarding policy’ (although increased awareness of safeguarding would make this an example of good practice) but, there should be something that outlines the steps that are taken to protect children, vulnerable adults, and the wider population from harm and maltreatment. ‘We don’t need a safeguarding policy because we don’t work with children’ doesn’t wash anymore.
Is there a Code of Conduct?
Safeguarding aside, a code of conduct is a medic’s best friend, as so many medical incidents on expeditions can be avoided by people behaving well! It may feel patronising, but by establishing boundaries early you help to foster a culture of respect and leave no excuse for poor behaviour in the future. It should outline the expected standard of behaviour during the expedition and could include reference to:
- The consumption of alcohol and other drugs
- Adherence to safety protocol
- Respect for others
- Equal opportunities
- Acts of violence
- Respect of local traditions and customs
- Working with children
- Illegal activities
- Relationships between leaders and participants
Codes of conduct should apply to all members and be available for reference throughout the expedition. It can be a useful tool for nipping any inappropriate behaviours in the bud before they escalate. The code of conduct should also clearly state the consequences of infractions.
Are the staff and participants suitably background or reference checked?
Knowing to what level this has been done may help reassure you that safeguarding is being taken seriously. The level of background check that is suitable will depend on the context. If you are on commercial expeditions or expeditions that are not working with children or vulnerable adults, Disclosure and Barring Service (DBS) checks for participants may not be appropriate or possible. Similarly, if staff or participants are from outside the UK, background checks may be difficult to obtain. However, some considerations should be given to ensuring staff, and wherever and whenever possible participants, are of good character and unlikely to present a risk to others.
Are staff and participants trained in safeguarding?
Ideally organisations would incorporate safeguarding into Health and Safety briefings for an expedition. This would ensure consistent and mutually understood routines and procedures. Topics that should be covered include:
- The concept of safeguarding
- Responding to and reporting a disclosure
- Recognising and reporting safeguarding concerns
- Consent
- Code of Conduct
- Diversity and inclusion
Are there any specific risks that should be mitigated in particular ways?
Every group and environment are different, but examples of things that should be considered are:
- Suitability of accommodation and gender mix
- Minimising interaction with children or vulnerable adults, or ensuring boundaries are established prior to interaction
- Privacy and security, especially at night or around washing facilities and toilets
- Local laws or practices that may pose a risk to some members of the expedition e.g. anti-homosexuality laws or attitudes to women
Is there clear documentation and are reporting processes for safeguarding concerns explicit?
You should be clear about how to document concerns and if, when, and to whom they should be referred. Consideration should be given to:
- Confidentiality and consent for information sharing
- Statutory obligations (for children and vulnerable adults)
- Routes of communication with the outside world
- Alternative means of communication
If an expedition leader is the only means of communication with the outside world and they are the perpetrator of harm, then the organisation has created an unsafe situation.
Only when you give someone a voice will they use it. Reporting of incidents is rising, probably not because incidents are more common, but because people feel more able to report, and feel that expedition providers/employers have more responsibility to support them.
How are safeguarding concerns responded to?
This is a particularly important question for medics to ask as often they will play a critical role in the response to more serious safeguarding incidents. Some things to consider are:
- Mental health support plan: What resources do you have for supporting mental health? This is everything from mental health first aid to local services, and specialist over the phone psychological support.
- Plan for the reporting of safeguarding concerns about children or vulnerable adults: more here.
- Plan for referring or signposting adults to services.
- Plan for reporting to local police and services
- Serious sexual assault response plan. Serious sexual assaults can be incredibly difficult to deal with whilst on an expedition. This is exacerbated without a good pre-existing plan in place. You are likely to have limited access to specialist medical and psychological resources and could be working in a country with a radically different legal infrastructure and attitude to sexual assault.
A Sector-Wide Responsibility
The world is waking up to the fact that abuse, especially sexual abuse can happen anywhere and to anyone. Most recently, the Oxfam Scandal and the #metoo movement have shown that no sector is immune. Expedition organisers need to learn from this, recognise their responsibility, and be prepared and equipped to protect not just their participants, but all of the people their programmes come into contact with.
Further Reading
Whether the expedition provider is a charity or not, this guidance published by The Charity Commission gives clear and practical advice which is relevant across many sectors.
Photo: Katie Beck.
