Dr Irene Gacheri tells the BDLife that she is the first Kenyan to study for a doctorate in forensic nursing. A relatively new career in the nursing field and well-paying in foreign countries, where a forensic nurse earns anything from $60,000 to $130,000 a year (Sh7.8 million to Sh16.9 million), she says what she hopes to change most is the knowledge gap in Kenya.
“What drove me here was the desire to change the image of nurses. Initially, people thought we assisted doctors. We are not doctors’ assistants! We have our own scope of practice. Secondly, forensic nursing is one of the new specialities.
In Kenya, it has not been formally introduced, even though the nursing council requires that we teach undergraduate nurses at least 26 hours,” says Dr Gacheri who is also the Assistant Professor at the School of Nursing and Midwifery at Aga Khan University.
She talks about how she started from the lowest level, a certificate course, to a PhD.
How did you get here, where you are the first to hold a PhD in forensic nursing?
I didn’t go to university directly. My parents couldn’t afford the fees for Baraton University, so I started at Maua Methodist Hospital where I studied for my certificate in nursing. I then worked at the Presbyterian Hospital and Kenyatta National Hospital before going to the US.
Because of my work experience, I was given the green light to do my undergraduate in general nursing at the University of Evansville in Indiana, US. When I came back, I did my internship and worked in some hospitals.
Later, I did my Master’s in Mental Health and Psychiatric Nursing at the University of Nairobi. From 2013 through 2015, I then did my Doctorate in Forensic Nursing still at the University of Nairobi, supervised by both local and foreign lecturers.
Yes. When I was about six years old, I got into an accident. My brother, cousin, and I were riding a bike that they had stolen from my dad when he was in church. I stayed in the hospital for two weeks and enjoyed seeing the nurses. It was the uniform that wowed me at first, and then I saw what they were doing; taking care of those who were unable to take care of themselves. I saw people being brought in on a stretcher and then walking out of the hospital. I told myself that I wanted to be this person who helps people.
Getting a PhD in forensic nursing isn’t child’s play, I assume. Is there a point where you felt like giving up?
If I didn’t drop out of school in Maua, then I knew I was going to be a nurse. There was a night that I was in the outpatient wing, and this family came with a person with no limb and a green paper bag. “Daktari hata ile mkono alikatwa ndio hii (Doc this is the hand that they chopped off).” The hand had been cut the previous night, so obviously, it was dead.
I was a senior student, but nobody had told me what to do. I called the doctor and the senior nurse, and they gave me instructions on how to treat the patient. Quite a number of patients would also come in with deep stab wounds. It bothered me then, but I never had nightmares or trauma.
Seeing patients who have been abused, raped, or mutilated can be traumatising. How do you ensure it doesn’t get to you?
You have to separate yourself from what you see at work. For instance, what bothers me a lot is children. I cannot be a pediatric nurse. I love children so much that I do not want to see them suffer.
As an escape, I could talk to someone that I trust. Two, I listen to music a lot; gospel and songs tha don't have curse words. The other thing I have is the gift of sleeping anytime, anywhere. So, when the going gets tough, I just lay down, put the TV set on, and sleep.
Most nurses opt for known specialties; how did you settle on forensic nursing?
At the end of my first year of my Master’s degree, I took a day off to relax at home. At 1pm, I got a phone call from my brother-in-law. He never called me much.
Actually, my relatives don’t call me much during the day, because they know my work is engaging. So he told me, ‘Somebody attacked your brother and your father wants you to call the others (my siblings) and come.’ I asked, ‘Attacked in what way?’ He responded, ‘I think he has been injured.’ I could sense something was wrong. He then told me, ‘Your brother was killed last night in Meru.’
By the time he was calling me, the police had not arrived at the crime scene. That is where my journey in forensic nursing started. I saw one of the roles of a forensic nurse is death investigation.
We buried him, and I came back, but for a month I couldn’t sleep. I thought there had to be something that nurses could do about crime. I came across forensic nursing, and I asked myself, ‘What is this?’ I went and read and saw it is the relationship between nursing and law. I went further and found the name of the founder of forensic nursing, and I asked a friend in the US to help locate her.
I emailed her, and she agreed to externally supervise me because I told her I wanted to pursue my Doctorate of Philosophy in Kenya but I did not want to go back to the US.
Sometimes the relationship between the victim and offender can be pure; there are no red flags... How then do you join the dots?
Through learning, I wanted to understand how criminals think. Two, how can a nurse tell who’s a victim of trauma, and among the victim's belongings what do I need to keep? Traditionally, we are taught that if a patient comes to you and they are dirty, make sure they are clean, then take care of them.
But now, in the forensic world, if you clean up the dirt, you have tampered with evidence. Thirdly, if my spouse is the one who is fighting me and I come to you with a black eye and I’m with him and I tell you I fell on the stairs, I want you as a nurse to ask yourself, 'Does the injury tally with the history you have been given?'
Also, if I am asking you questions and he is the one answering you, that is a red flag.
As a lecturer, what do you find rewarding about teaching forensic nursing?
When a student writes back and says, ‘I suspected, investigated further and was able to resolve it’…that makes me happy. Because teaching involves raising their suspicion index. Initially we used to say what the patient tells you is correct.
What skills do you need to be a forensic nurse?
A Bachelor in general nursing because forensic nursing is a course taught as a unit in the fourth year. Two, be able to identify a forensic patient because most of them will not admit to being hurt for lack of knowledge or fear. So, if you identify who they are, identify what evidence needs to be collected very fast because some of it is minute. Involve all the protocols needed and document very well.
Any shortcomings?
On my first days, I encountered a five-year-old child, who had been sexually abused by her 50-year-old uncle, who also injured her spine and she could not walk. I asked the mother, ‘Do the police know?’ she said, ‘No…we finished this traditionally.’ I asked why? ‘The wazees (elders) said it is better for the peace of the family because we’d embarrass the uncle.’
Luckily, the psychiatrist I was with contacted the police. The challenge with forensic nursing is that it requires multidisciplinary collaboration. Other than we the healthcare workers, in Kenya, we don’t know how to work with police, lawyers and vice-versa.
What careers are in forensic nursing?
Quite many... You could be a general forensic nurse examiner –if we suspect trauma, we could call you to investigate), a sexual assault nurse examiner either pediatric or adult, forensic mental health nurse and death investigator – work together with the police to investigate the crime scene or lawyers in litigation to give your expert opinion. You can also teach, or nurse patients in various wards.
Is it a well-paying career?
Yes, it is. In countries where this is established, the payment will be between $60,000 and 130,000 per year (Sh7.8 million to Sh16.9 million). Because this career requires a very highly specialised skillset, forensic nurses are paid better than regular registered nurses.
In Kenya, it is a new speciality so when it picks up, I do expect forensic nurses to be well trained because they will have two trainings: general nursing and forensic nursing.
Do you consider yourself successful?
Absolutely! I am fulfilled. At 52, I’m successful because I am the first one to have a PhD in forensic nursing. I’m also successful in my teaching job, as I have taught at four universities.
Do you plan to retire? Most people with specialised skills don’t really retire.
I don’t intend to work beyond 60. That is my cut-off working age, unless on a consultation basis. I will be grateful to leave with my head held high. Self-care is something I have learned quite well. I take my mental health seriously. I avoid negativity, and I also exercise four days a week.
