Gender Based Violence (GBV) is a commonly heard phrase in the South African context, and something that is widely experienced either directly or indirectly. It has become more and more crucial to not only provide support to those affected but also to the healthcare professionals who might provide services to them.
Healthcare professionals, like myself, encounter people from all kinds of different backgrounds, and tools in order to ascertain risk or what kind of intervention is needed is always pivotal in the care of clients and patients.
How this can be achieved?
Often where one might first start with is creating a safe, non-judgemental space for the individual to share. This can be achieved through curiosity and not judgement, an empathic approach, and a sensitivity to the emotion that may be elicited for the patient. As often there is a feeling of mistrust and threat for some who are experience GBV, this environment needs to acknowledge this and provide something different.
Often, getting patients to open up and acknowledge that they need help is an important first step. This can also be overwhelming for the patient, and some delicacy will need to be exercised here. There is usually a set of cultural norms that frame conversations and stigma around GBV which a healthcare professional should always be mindful of. We enter particular spaces within larger communities, and such norms or ideas can permeate into our work.
Self-care for healthcare professionals
As such work in communities can be quite challenging, self-reflection and self-care for healthcare workers is crucial. Working in particular contexts where GBV might be prevalent can be taxing on professionals which means strong but compassionate boundaries needs to be practiced, as well as supportive spaces for healthcare workers. Self-reflection is a vital part of understanding one’s own biases, challenges, obstacles to providing services, and other aspects of providing support to patients. Once one has an awareness of this, can effective work take place.
Working with communities and context
Working with stigma can prove challenging, as patients are often so resistant to help seeking behaviour because of it. Therefore, some may feel avoidant or confrontational regarding questioning around GBV. This is where rapport will come in, and can really aid in the patient feeling safe enough to disclose and accept support. Or what it can at least do, is provide a potential space for them to return to should they feel ready to seek out the intervention needed. Creating such safe spaces is so crucial not just for GBV but in so many different contexts where marginalized populations can find refuge.
What is also an important part of intervention is working with possible perpetrators of GBV who might also interact with healthcare professionals. Although this may present difficulties, it may present potential for intervention and improved outcomes for those affected. Possessing an inclusive framework will be important in working with communities.
The lens of inclusivity
A professional’s own beliefs should be examined in relation to gender, sexuality, sexual orientation, and culture. As all of this is encompassed on conversations around GBV. An important note here, is that not all GBV exists within a heteronormative lens, i.e. is a cis-gendered woman being abused by a cis-gendered man. There is so much of nuance and grey area that can exist here that one must be sensitive towards. One way to help with this is to always have an open mind and never make assumptions based upon gender or assumed sexuality.
Sexuality also provides an avenue of exploration to gauge the threat of GBV, as often GBV can manifest in human sexuality, sexual relationships, power within relationships, access or lack thereof to contraceptives, and so many other ways. Power becomes a central component in GBV, and this means that it can present in many ways, sometimes quite subtly. Therefore, GBV may not look like explicit bruising or the marks of physical violence but through coercion, manipulation, misinformation, control, gatekeeping, and in many other ways. Again, always view this through an inclusive lens, and meeting the patient where they are at and their experiences.
GBV is a complex issue, and one should not gloss over or simplify it. We need to seek to understand, be compassionate, and exhibit sensitivity. GBV drastically impacts health on various levels, and this also therefore informs our interventions as healthcare professionals. If we are to make recommendations, the restrictions that GBV can place on that could prove an obstacle in how the patient takes it up. If marginalised patients are not able to access services, or follow through on their healthcare this significantly affects outcomes.
What can a healthcare professional do?
Once it has been established or suspected that a patient or client is involved in GBV it is best to approach them to ascertain as much information as possible. Try to always do this in a calm, compassionate and open manner, as this may be a sensitive matter for the individual and needs to be handled with much care. Once co-operation is achieved, it is best to know who one can refer to in such a situation. Always keep in mind the safety of the person in question, if they are even able to seek out the support needed and if the resources are available for them to do so. If there are minors involved, it will be an important question to consider and therefore shape the nature of the intervention and which parties will need to be privy to it.
To help establish a safe space, the client or patient can try to identify somewhere they can be safe. This can be a relative’s home, the residence of a friend, or anywhere that is considered out of danger. Then it is important to report the matter to the South African Police Service (SAPS) for urgent assistance, to open a case and possibly assist with a protection order. Social workers, counsellors and psychologists are also important resources to assist with trauma debriefing, mental health resources, counselling and many other forms of intervention.
There are also remarkable, reputable organisations who work with those affected by GBV that can be contacted such as People Opposing Women Abuse (POWA), Agisanang Domestic Abuse Prevention and Training (ADAPT), Family and Marriage Society of SA (FAMSA), Nisaa Institute for Women’s Development and Sonke Gender Justice. All of these NGO’s represent great opportunities for referrals for those affected by GBV.
A way forward
Healthcare professionals hold key roles in intervening in the healthcare, support and aid for those affected by and who may perpetrate GBV. This aims towards enhancing healthcare outcomes and make strides in the crisis of GBV in South Africa. Taking all the above into consideration, a working framework to approach supporting patients involved in GBV emerges. This conversation needs to occur in the consultation room and beyond. Relationships between healthcare professionals and those they serve can prove significant gateways to intervention in GBV, and its importance need not be underestimated. Education, compassion, sensitivity, empathy and communication are vital in thinking on a way forward. What is evident is that there needs to be an appreciation and valuing of healthcare professionals, and how they contribute towards a system that can help rather than hinder progress.
SASHA Executive Committee & Membership Committee
Tel: 011 706 2269