Gender bias permeates many aspects of medicine in India, the WHO acknowledged the need for integration of gender into medical curricula. CEHAT, in collaboration with DMER and MUHS to facilitate gender perspectives in medical education in Maharashtra . An important contribution of the project has been the development of gender integrated modules across five disciplines namely Community Medicine, Gynecology and Obstetrics, Forensic Science and toxicology, Medicine and Psychiatry for MBBS course These gender integrated modules were tested through a quasi experimental research design to assess the feasibility of teaching gender integrated medical curriculum and also assess whether teaching such a curriculum can lead to positive attitude amongst the students towards gender. The report “TITLE” presents the experience of facilitating gender perspectives for medical students as well as positive changes in their attitudes. An important learning was the need to integrate gender across relevant medical topics throughout MBBS course. This reiterated the fact that gender as a social determinant cannot be relegated to only lectures/elective course; rather they need to be mainstreamed in to the medical curricula to enhance the understanding about the same.
Violence is now widely recognized as a global public health concern. Evidence shows that violence, may take various forms such as caste/race violence, homicide, domestic/sexual violence, rape etc. and causes immediate and long term health and social consequences. In the context of sexual violence, women and children have an invariable contact with the health system. This report provides important learning and insights into the interface between the hospitals and the survivors of sexual violence. It also presents the analysis on the contentious issues such as marital rape; mandatory reporting to the police.This will be an important learning document for those who are keen on creating a comprehensive response to sexual violence. The report highlights the need to establish long term engagement between the health institutions and the survivors of sexual violence.
Gaps in responding to “sexual violence” came into public notice subsequent to force after rape and murder of a young medical professional in New Delhi .The government of India set up an expert committee, Justice Verma Commission ( JVC) to review the gaps in rape response in India . Subsequent to the report findings the rape law was amended to include all forms of sexual violence such as oral, anal sexual assaults as well as non penetrative sexual violence. JVC made specific recommendation to ministries of home, health, women and child and the like to develop a sensitive response to sexual violence survivors. MoHFW took the lead in establishing a protocol and medico legal guidelines for rape response and issued it to different states for implementation.
The Guidance documents for the Police, Judiciary and Public Prosecutor are situated in the context of demystifying medical evidence to them. These guidelines were developed by CEHAT with the contribution of the task force inclusive of Feminist lawyers, mental health experts, health researchers and representatives from health ministry. The documents put forth the role of all the three and the objective is to provide a scientific understanding about the medico legal care to police in the context of sexual violence.
Police: Document aims to equip them with scientific understanding of medical evidence, enabling them to frame requisitions to the health professionals regarding medico-legal examination and evidence.
Judiciary: The document aims to assist courts with the scientific understanding of medical evidence, enable them to frame questions for doctors as expert witnesses in instance of sexual violence.
Public Prosecutor: The document aims to assist public prosecutors in presenting the medical evidence in the courts, guide them to enable presenting medical professionals as expert witnesses and to prevent irrelevant and unscientific questions related to medical evidence in court proceedings.
The first session will be Addressing gender inequalities: Engendering Medical education in Maharashtra, an intervention project by CEHAT in seven medical colleges of Maharashtra on integrating gender in medical education. The second session on strengthening service delivery for VAW and generate evidence for policy development will focus on lessons learnt from implementing health sector models in different states and findings from an intervention study based in a hospital. The third and fourth session will be on assessing health systems response to VAW within legal framework and multi-sectoral response to VAW- principles & strategies to respond to VAW respectively.
Report on the session conducted by Dr. Sunil Pandya and discussant Dr. S.P. Kalantri on Contemporary Issues in Health and Social Sciences.
CEHAT conducted a three-day intensive training for the health care providers on comprehensive response to violence against women and children, their roles and problem solving methods. There were 37 participants who were deputed from government hospitals from various states of India namely Haryana, Jammu and Kashmir, Uttar Pradesh, Chhattisgarh, Maharashtra, Punjab, Delhi. The participants were doctors and nurses from departments such as Gynecology, Pediatrics, Forensic, Surgery, and Casualty that are likely to come in contact with survivors of violence. The objective of the course was to build the perspective to identify the survivors of violence based on health complaints and enhance skills to provide first line support.
The methodology was experiential and interactive, informing participants of theoretical concepts with scope for hands-on learning through discussion of case studies and role plays, followed by Q&A. This provided opportunity for discussion and debate. The participants were inquisitive and enthusiastic and shared various examples of instances that they had intervened in.
U.Vindhya, Professor and former Chairperson, School of Gender Studies at Tata Institute of Social Sciences, Hyderabad campus, oriented the participants about the difference between sex and gender and root causes of gender based violence. Participants found the concept of intersectionality interesting as it brought forth the underlying complexities and helped place the survivor in the social context. This was followed by a session on understanding the link between violence and health and recognizing types and forms of violence.
The second day was facilitated by the CEHAT team. The day began with a session on legal responsibilities of healthcare providers, providing clarity on their role vis. a vis. various laws related to VAW. This was followed by day long practice sessions on strengthening communication with survivors. Participants were introduced to the LIVES model (WHO) to provide first line psychological support. The model was demonstrated by Dr. Sneha Khedekar, the nodal person of Dilaasa at M.T. Agrawal Hospital, Mulund and Matron Sneha Chandan, core group member of Dilaasa at Rajawadi Hospital.
Following the demonstration, participants tried their hand at practicing the model in small groups of threes where they got a chance to play the role of survivor, doctor, observer with the help of case studies.
The third day focused on the response to survivors of sexual violence. The session was facilitated by senior forensic expert, Dr. Jagadeesh Reddy. Participants were familiarized with the nuances of the protocol and guidelines laid down by the Ministry of Health. They got hands-on experience of drafting opinions through sample proformas assigned to them in groups.
The major learning of the health care providers was the understanding of violence, patriarchy being the root cause, strengthening skills on how to ask survivors about violence and communicate first line support and understanding of medico legal care – both theoretical and application.
Participants gave feedback that the well structured training encouraged them to critically analyze and apply the concepts to their work with enhanced understandig
Some health care providers also showed keen interest in setting up hospital-based centers back at their hospitals. They shared that there is a shift in perspective which helped them understand their therapeutic role as well as how to reach out to survivors in a more sensitive and empowering manner.
Gender in Medical Education (GME) is a pioneer initiative in India to include gender in medical education. The need to include gender in a predominantly biomedical curriculum which reinforces patriarchal notions was recognised by CEHAT. The GME project is a joint initiative of CEHAT, DMER and MUHS. As part of the initiative, a two-day workshop was held on February 27 and 28 at St. George Hospital, Fort, in Mumbai. It was attended by around 40 mid to senior level medical educators hailing from public hospitals of Mumbai Pune, Kolhapur, Solapur and Miraj.
CEHAT carried out a workshop on building perspective and skill-development on the response to violence against women and children through a survivor-centric approach on January 8-10, 2018 at Bharathiyar University, Coimbatore, Tamil Nadu. The participants consisted of 25 protection officers with upto 10 years of experience from various districts, one counsellor appointed at the OSC (Kanchipuram District) and 7 District Social Welfare Officers. The Social Welfare Department of Tamil Nadu showed its commitment to the issue of VAW and children by deputing senior officers who participated in the 3 day workshop. The purpose of holding the first round of training with this group was to ensure that the state response is sensitive, since they are major stakeholders.
The 2018 calendar uses simple case studies to demonstrate these principles in practice. The cases are adapted from real incidents from CEHAT's research and experience.
The Centre for Enquiry into Health and Allied Themes (CEHAT) is conducting a 1.5 day workshop on ‘Evidence-based Clinical Practices’. This event, organised by CEHAT in collaboration with DMER, KEM and the UNFPA is aimed for senior medical college faculty members of government medical colleges across Maharashtra, such as heads of the department and associate professors of disciplines such as gynaecology, forensic science, internal medicine, community medicine, psychiatry, paediatrics and surgery departments. CEHAT initiated project “Integration of Gender in Medical Education Project (GME)” in select medical colleges of Maharashtra with the aim to sensitise medical students and healthcare professionals to gender inequality and its interaction with health.
Until now, social determinants of health were rarely included in pure medical studies. The need for awareness and sensitivity regarding patients’ gender and social backgrounds among medical practitioners has been acknowledged by the World Health Organization (WHO). Right from the patient’s approach to the doctor’s evaluation and treatment, gender disparity is evident and clearly visible in the medical field, as proved by CEHAT’s ongoing work in this field.
This workshop, sanctioned by Maharashtra University of Health Sciences (MUHS), is a pioneer attempt to include gender as a component in medical education in India, and would dwell on the need for gender in medical education, current efforts, informed consent and communication strategies, privacy and confidentiality, respectful maternal care, care for survivors of violence and clinical checklists for implementing gender-sensitive health care. CEHAT will also release gender integrated medical education modules on Forensics and Toxicology, Medicine, Obstetrics and Gynaecology, Preventive and Social Medicine, and Psychiatry.
The timings for the workshop are as follows:
Friday, November 24: 9:30 am to 5:00 pm
Saturday, November 25: 9:30 am to 2:00 pm
It will be held at the YMCA, Mumbai Central.
The One Stop Scheme by the Ministry of Women and Child Development has presented the opportunity to influence the current crisis intervention services. Through this scheme, crisis intervention centres called One Stop Centres have been established or are underway in various states across the country with the objective to provide integrated support and assistance to women affected by violence, both in private and public spaces and to facilitate immediate, emergency and non-emergency access to a range of services including medical, legal, psychological and counseling support under one roof to fight against any forms of violence against women. For effective implementation of these OSC, counselors must work in coordination with the hospital within which or near which they are located. Violence against women has been recognized as a health issue under the National Health Policy, 2017. The link between violence and health has been acknowledged along with the recognition to create services to respond to survivors. In 2005, The Protection of Women from Domestic Violence Act, was developed to offer civil remedies and reliefs to women facing violence. In 2012, the Protection of Children from Sexual Offences Act was introduced. Both these laws have brought in the role of support persons and Protection Officers, generating a growing reliance on counselling services. It is imperative that counselors be trained to respond to different forms of VAW and children and be equipped with the perspective and skills in responding to VAW.
CEHAT has been instrumental in developing an evidence-based model to respond to VAW and children. In 2014, the MOHFW laid down the guidelines and protocols for medico-legal care for survivors of sexual assault including psychosocial support. CEHAT had the opportunity to present its evidence based work of having established Dilaasa, a hospital based crisis centre in collaboration with the Municipal Corporation of Greater Mumbai. This evidence-based model has also featured in the leading international medical journal Lancet.
CEHAT is pleased to announce its National Course on counselling survivors of violence. The course is aimed at building a critical feminist perspective on the issue of violence against women and children and enhancing skills of the participants in responding to survivors of violence.
Feminist counselling has been accepted as one of the most effective counselling method for women living in abusive relationships as it questions power and inequality within the relationship. It encourages women to understand what they are experiencing in context of inequalities that arise out of larger oppressive structures. This form of counselling is gender-sensitive and has been used effectively while engaging with various vulnerable groups including transgenders and boys.
A key objective of the National Health Policy 2017 is to align the private sector towards public health goals. Its main strategy is to ensure free comprehensive primary care provision by the public sector, supplemented by strategic purchase of secondary care hospitalization and tertiary care services from both public and non-government sector to fill critical gaps. The key mechanism of strategic purchasing is insurance schemes. Thus in the larger context of ensuring Universal Health Coverage, government funded health insurance schemes seek to play a very large role. Services would be strategically purchased from public as well as private sector to improve health outcomes, reduce out of pocket payments and minimize moral hazards for the purpose of scaling up the schemes and made more effective. The policy provides for preferential treatment to collaborating private hospitals/institutes for CGHS empanelment and in proposed strategic purchase by Government. However, we need to ask critical questions such as: What have been the various bottlenecks, successes and failures of the existing national and state level insurance schemes? What are the lessons learnt so far for these to be scaled up? What have been the experiences of the users? What has been the experience of for-profit private health sector? What are the pros and cons for adopting the insurance approach to realise the goal of Universal Health Care? What are the crucial gaps that need to be addressed for health systems strengthening for UHC and how?
Themes for the conference:
1. Critically evaluate the role of government funded health insurance schemes. What has been the experience of the public and private sectors vis-a-vis the insurance schemes?
2. Evidence based learning from the various National level and State level insurance schemes and their role in improving health outcomes, health equity, reducing out of pocket payments and moral hazards to improve scalability and efficiency.
3. Role of State in Health Systems Strengthening for UHC: Infrastructure, human resource, regulations, standardization, quality assurance, etc.
Culminating in the celebration of Human Rights Day, the fortnight from 25th November-10th December 2016 is observed worldwide as a campaign to end VAW.
This year's calendar is aimed at creating awareness about gender in medical education.