ROLE OF THE COMMUNITY AND THE HEALTH PROFESSION IN
RESPONDING TO VIOLENCE
Anagha Khot, Padma Deosthali & Sumita Menon
ABSTRACT
The article attempts to explore the various dimensions of intrafamilial violence in a community set-up and the factors influencing it in this environment. It also highlights the key role of the health professionals in responding to violence and the role of the community in preventing violence and caring for the victims of violence.
Bekämpfung innerfamiliärer Gewalt : Rolle von Nachbarschaftshilfe und lokaler Gesundheitsversorgung
Zusammenfassung: Die unterschiedlichen Dimensionen innerfamiliärer Gewalt in einem Slumgebiet in Mumbai und die Faktoren, welche Gewalt in dieser Umgebung beeinflussen, werden angesprochen. Herausgehoben wird dabei die Schlüsselrolle von Berufspersonen, welche im Gesundheits- und Sozialbereich tätig sind. Ferner wird die Rolle der Gemeinschaft bei der Vorbeugung von Gewalt und bei der Sorge um Gewaltopfer betont.
Keywords: Violence, Community, Health Professionals, Strategies to combat violence, Gewalt, Nachbarschaft, Gesundheitsversorgung, Strategien zur Bekämpfung von Gewalt
INTRODUCTION
Over the years, the term violence has assumed varied meanings but essentially violence would mean to torture, to injure, to harass somebody especially to suppress that person. It is a coercive method to assert one's will over another in order to prove one's power. Violence is a manifestation of inequality that is so prevalent between different groups in society. The inequality existing in class, sex, caste, race is evident in the kind of power relations and hierarchy that exists within these. This was the focus of the international conference Preventing violence, Caring for survivors: Role of health profession and services in violence organised by CEHAT from 28th to 30th November 1998 in Mumbai. The main themes were violence against women, violence by the state agency and violence against the minorities. These issues were discussed at length in various sub groups and plenaries over three days. The theme being prevention of violence and caring for survivors, the last day was devoted to discussions on strategies and interventions on combating violence and caring for the survivors.
ROLE OF THE HEALTH PROFESSION IN A COMMUNITY APPROACH
In the light of the above, this article will focus on the role of the community and the health profession in responding to violence. Keeping this in mind it becomes very important to understand the nature of violence as it exists within a community. We refer to community as 'all people living in a specific locality'. Violence exists in different forms within a community, some are more visible than others. Physical violence is visible and could be easily identified as it manifests itself in battering, hitting, and using other kinds of material causing injury. Threats, derogatory remarks, abuses are not easily identified as acts of violence. They assume invisibility as to a large extent these are accepted as a common occurrence - as something natural. One very important unit within the community is the family. Matters within the family are considered as out of bound for anyone else. Therefore visible or invisible violence within this context is not questioned. Furthermore, for most individuals within the community the family is the only source of bonding and security, so each one tries to cope with anything that is threatening to this entity. Therefore violence is considered as a 'private matter' which needs to be handled within closed doors. Violence exists not only within the family but also within other divisions like class and caste. In a community one can see it in relation to access to basic amenities like water, ration, education, among others. There also exists a fatalistic attitude, which accepts violence as part of life, something which one has to endure because that is one's fate. This is the prevalent attitude not just in the home but also in society at large. The response of different agencies such as police, health care professionals also conforms to this view. The essence of the issue of violence, how it can be detrimental to the life of an individual is lost. The surrounding social, cultural, economic and political environment further perpetuates violence by not only protecting it but also seeing that it thrives.
In the present situation, the health professionals can play a crucial role in combating violence. The health profession includes the community health worker, the social worker, nurses, therapists and doctors amongst others. Their role assumes significance, as they are the first contact for any victim. It is natural that when a person suffers from a bruise, a deep injury, burns or even when there has been an attempt at suicide, help is first sought from the health professional, rather than the police, either by the person himself/herself or by others. Moreover, they are perceived as 'non threatening' as they are not part of the family or friend circle and do not carry the image of the police. However today the health profession limits itself to curing and preventing illness. But, they need to understand that they have a responsibility to respond to violence. In the city of Mumbai for example, today the role of a community health worker is confined to treating minor ailments, immunisation and referring cases for antenatal and post-natal care. But, in addition they need to play a more active role. The community level health workers are close to the people, share a similar socio-economic background with the community and have established a rapport with them, so it is possible for them to identify and intervene in cases of violence.
Therefore, the health professionals first need to acknowledge and be sensitive to the fact that violence exists in society. Secondly they need to understand the structures that perpetuate violence in society, be it the family, health system, police, education, the institution of marriage. It is imperative for them to comprehend the power dynamics existent between the different groups in society. Lastly the health profession can be a link between the victims and other agencies like an NGO, a response centre for violence victims and the legal system. It therefore becomes necessary to train the health profession through various methods for both the professionals in the system and those undergoing training. Here, we would like to give an example of a training kit and manual developed by CEHAT, which lists down intensive protocol that needs to be followed by doctors who are examining victims of rape. The thrust here is to sensitise the doctor to the cruciality of identifying each and every bit of evidence that would help the victim in future (D'Souza 1998).
NEED FOR A COMMUNITY LEVEL CAMPAIGN
It is necessary to address violence as an issue of public interest. There are different levels at which one needs to address violence. It begins with accepting that violence exists, creating systems that can reach out to the victims, working out strategies to care for and rehabilitate the victims of violence, mobilising community groups to prevent violence as well as to support victims of violence. In India there are many indigenous ways in which the community groups are responding to victims of violence. For example in the state of Madhya Pradesh, bhajan mandals (groups of religious singers who are respected and awed in a community) confront the family where violence is evident and communicate that this is not the accepted norm in the community. They help in creating a social pressure on the perpetuators of violence. In order to protect and strengthen organisations and professionals, who take responsibility for helping violence survivors and preventing violence, it is necessary to widen the base of workers by de-professionalising the treatment and rehabilitation of violence survivors. This is a must because violence in itself is multidimensional in nature and therefore it has to be dealt with likewise. In a nutshell in responding to a victim of violence the approach should not limit itself to just the medical treatment but should address other aspects such as the psychosocial, economic aspects as well. There is a pressing need emerging for a multi-disciplinary approach so that more people and more systems are sensitised and involved in this pursuit.
As stated earlier, violence is considered to be 'personal' and addressing it, makes it 'political'. It is necessary to create community support for individuals and organisations working on the issue of violence. This can be done by helping caregivers sustain their efforts and expertise in the face of political hostility and physical danger. Further by strengthening individual efforts by networking and collaborating between groups, organisations and movements as well as by providing an orientation to the health aspect of violence to community based organisations (CBOs), who encounter violence survivors in the course of their work and are committed to helping them. Lastly by creating an environment for integrating awareness and knowledge about violence into health systems by incorporating it into health and medical education and facilitating the rehabilitation of survivors by integrating the work of the health services with other social services and the legal system.
OUTLINE OF THE RESEARCH-PROJECT 'FAMILY VIOLENCE IN SLUMS'
An effort is being made by CEHAT in this direction through its work in the area of domestic violence in an urban slum in the city of Mumbai. One important aspect of its work is the training of community health workers, wherein it is consciously incorporating the understanding of violence, its impact on health and methods of dealing with it at the community level. It will also undertake a study wherein one would examine the prevalence, nature, causes, help seeking behaviour and community response to intrafamilial violence against women, understand existing psychological, legal and medical support mechanisms and to seek the women's opinions and values about existing and wanted services and help women understand the social, political and economic contradictions which are the root of this violence and to take action against the oppressive elements of their reality. This would help in the establishment of a response cell for survivors of violence in a slum area, the team being multi-disciplinary.
CONCLUDING REMARKS ON VIOLENCE IN RELATION TO HEALTH
Violence has a drastic impact on the physical and mental well being. It is an epidemic, which is fast spreading and needs urgent redressal. If health is considered to be a human right then anything endangering this would measure upto violating the basic right of any individual.
REFERENCES
D'Souza, Lalitha. 1998. Sexual Assault of Women and Girl Children. Collection of Medical and Forensic Evidence, Medical Treatment and Psycho-social Rehabilitation. A Manual and Evidence Kit for the examining Physician. Mumbai: CEHAT (Centre for Enquiry into Health and Allied Themes)
Curare 22 (1999) 1:35-37
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