Frontline health workers at the forefront of efforts to stop GBV

Gender-based violence (GBV) has been prioritised by President Cyril Ramaphosa and work is now being done to examine the experiences of frontline healthcare workers and explore what needs to be achieved to address and improve the services offered to women in need.

“Not By Accident” is the title of a collaborative work by a panel of experts looking at the condition of services offered by paramedics, medico legal practitioners, healthcare workers and psychosocial service providers to domestic violence victims in SA.

Dr Navin Naidoo, who lectures in paramedicine at the School of Health Sciences at the University of West Sydney, worked on a study of “GBV under the EMS (Emergency Medical Services) lens” in the Western Cape.

“Most scenes of these attacks are the bedrooms or kitchens of homes. And because there is no way of currently classifying the emergency calls made, a lot of information about what is going on remains unknown and unmeasured,” Naidoo said.

A domestic violence victim makes an emergency call, which is then diverted to the police or for the dispatching of an ambulance, depending on the seriousness of the attack.

In some cases the address falls into a “red zone”, which requires an ambulance to stop first at a police station for an escort, before entering an area deemed too dangerous to visit without police protection. And then there is the time at the hospital, where ambulance staff sometimes have to wait to be helped.

“And so you have patients being compromised by delays. And then when the patient does make the report, you will find that it is recorded on the file as ‘stabbed with a screwdriver’, rather than ‘stabbed by her husband’,” Naidoo said.

Ambulance drivers and paramedics often fear going into danger situations, which is rational and real, as well as having an irrational fear of legal consequences in cases where they might be perceived to wrongly accuse a parent of child abuse, or similar allegations, he said.

“So there is a need for protection of both the providers of the services, as well as those who make use of them.”

Lecturer and emergency care practitioner Wesley Craig said because there is no system for categorising, directing or assessing GBV cases, “you can’t measure the problem. So it’s difficult to put interventions in place because you don’t know what you are dealing with.”

Research in 2017 found that out of 1,000 patients seen, only five were noted as domestic violence victims. But screening training was done and a repeat of the study found that almost 43 out of 1,000 cases were recorded as domestic violence.

He said 2017 research found that out of 1,000 patients seen, only five were noted as domestic violence victims. But screening training was done and a repeat of the study found that almost 43 out of 1,000 cases were recorded as domestic violence.

He believes the mandatory classifying of domestic violence cases would lead to a record of a chain of evidence because “domestic violence is cyclical in nature and gets worse over time”.

“If EMS workers catch it early, there could be a prevention of future harm,” he said.

Dr Chivaugn Gordon, head of obstetric and gynaecology undergraduate training at the University of Cape Town (UCT), is an advocate for intimate partner violence (IPV) training for all medical students.

“It is not done at many universities, yet IPV is more common than ailments like diabetes or high blood pressure. And it is only really treated when the violence is physical or sexual. The problem is when it is silent and psychological.

“We need to be explicit — IPV is a legal and social problem, but it is also a medical problem. And it doesn’t help to deal with a fracture and not deal with the psychological harm,” she said.

Prof Abigail Hatcher, from the Wits School of Public Health in Johannesburg, said a pilot intervention project titled “Safe and Sound”, conducted with the Gauteng health department and aimed at screening women in need of antenatal care, had been successful in identifying domestic violence victims and getting them help and support.

“We found that a single one-on-one session with a trained nurse was enough to offer a woman information of protection orders, trauma counselling, planning for future safety and active referrals for help,” she said, adding that patients saw the interview as a safe and private opportunity to speak.

This had, however, resulted in staff members suffering vicarious trauma. And the high numbers of pregnant women under the age of 19 indicated a need for screening of adolescents too.

Dr Genine Josias, a skilled clinician practising at the Thuthuzela Clinical Forensic Centre in the Western Cape, said another problem was that care centres were generally viewed as NGOs and separate from public hospital services.

As a result, they continued to be understaffed and under-resourced, while having to operate around the clock and work with the police and National Prosecuting Authority (NPA) as a multidisciplinary service, she said.