In the central-west Indian State of Maharashtra, health professionals are pioneering a better way to prevent, root-out and respond to violence against women.
One in three women experience intimate partner violence or sexual violence in their lifetimes. Yet, in the past, survivors seeking medical care here were patched up and sent home without further help.
“I remember treating a woman living with violence, all I could do was send her home,” says Dr Nisha Jha, a physician at the Aurangabad Hospital, one of three hospitals applying new methods.
“Later that night, I wrote a poem about it. I wish I could have helped her escape.”
It was arguably worse for survivors of sexual assault, who were marched to hospital by police officers for invasive examinations and faced a barrage of questions that compounded their trauma.
“Staff would say, ‘Another curse has landed. They do what they want, and then they come to us,’” says Dr Shrinivas Gaddappa, Head of Obstetrics and Gynecology at the Aurangabad Hospital.
“As soon as a woman came in, we would take them for a ‘two-finger test,’ and ask them; ‘How many times did you do it? Did you feel anything?’”
“But since our training, we’ve stopped doing all that. Today, we treat them with dignity.”
Violence against women is a major public health and human rights issue, with intimate partner violence and sexual violence among the most pervasive forms of violence against women.
Health workers are often the first professional contact point for survivors, and in 2013, WHO released the first global guidelines for healthcare providers to respond.
The guidelines aim to raise awareness of violence and give direction on how to identify survivors, providing first-line support, treatment, psychosocial support and mental health care.
In Maharashtra, 25 trainers, heads of department and managers from three hospitals - Aurangabad, Miraj and Sangli - have passed on the knowledge to 220 more doctors, nurses and social workers.
“We have to go through the L.I.V.E.S process slowly. That’s listening, inquiring, validating, and enhancing safety and support,” says Dr Anita Basavaraja, Head General Medicine at the Miraj Hospital.
“All this gives us time to speak with them and develop a rapport.”
“We selected three departments - obstetrics and gynecology, general medicine and casualty - as women often seek medical care there,” says Sanjida Arora from CEHAT - the Centre for Enquiry into Health and Allied Themes - a nongovernmental organization that is assessing the impact of the trainings.
“Domestic violence has always been there,” says Dr Pallavi Sapale, the dean of the Miraj Medical College and Hospital, “before, we only saw the ones that were visibly bruised, but now we spot the clues.”
“Those that chose to stay under the radar, or didn’t explain the roots of their injuries, were often missed, as we just took things at face value. But now, our staff can pick up the clues.
”From the first survey of the training programme, it’s clear there has been a big improvement in the knowledge, attitudes and skills of health workers in addressing violence against women.
“I feel very empowered,” says Bhushani Deep, a Social Services Officer at the Sangli Hospital. “My view of the women that come in has changed, and I feel more confident that I can help them.”
The focus is on safety, confidentiality, privacy and a sympathetic response to build trust for a continuum of care, and as such, all three hospitals have rearranged their facilities to improve privacy.
Information on where to find further support is made available to all patients, and with increasing numbers of survivors placing trust in hospital staff, women who have been helped are ringing in more survivors.
“The numbers are huge,” says CEHAT’s Arora. “In just nine months, they’ve identified and responded to over 500 cases.”
Key findings from the application of WHO’s guidelines in Maharashtra will be shared with partners from government, civil society and key professional bodies across India, with an eye on being rolled out nationwide.
WHO, in line with commitments under its global plan of action on strengthening the role of the health systems in addressing violence against women and girls, is facilitating similar training programmes in Namibia, Pakistan, Uganda, Uruguay and Zambia.