Within the medical and other health professional curriculum, training, and practice in medical settings, domestic violence has not been addressed as a public health concern. Consequently medical staff in hospitals are neither sensitised to the issue of domestic violence, nor are they equipped to respond to survivors. The dominant perception of health professionals is of domestic violence as a ‘personal issue’ and not within the domain of health and illness. The training modules for ‘Dilaasa’ were designed based on this assessment of the dominant view. Although crisis centers are situated only in two hospitals, routine trainings are carried out by trained staff across 5 hospitals in Mumbai – Bandra Bhabha, Kurla Bhabha, MT Agarwal, Rajawadi and Cooper Hospitals. In addition to this CEHAT also conducts trainings for private and public health care providers across the country, on the issue of Violence Against Women and Health.
Routine trainings within the hospitals are carried out by a ‘core group’ of health care providers in each hospital. Intensive training has been provided to the ‘core group’ within each hospital. These core group members ensure coverage of all hospital staff to orient them to domestic violence as a gender and public health issue as well as the role of health providers. Ongoing inputs are provided for core groups to enhance their perspectives and skills, for example, on topics such as improving quality of care, clinical ethics, patients’ rights, the people’s health movement in India and medico-legal responsibilities of health professionals. Steps have been taken to institutionalise training through the formation of a ‘Training Cell’ for the MCGM, which consists of members from core groups of different hospitals. The Training Cell would eventually be responsible for planning and running regular training sessions for orientation and for updating knowledge and skills.
Training process and content is carefully planned, with a view to perspective-building, as well as developing knowledge and skills for screening women experiencing domestic violence and for counselling. The emphasis is on understanding domestic violence as an issue of power and control rather than only looking for symptoms and providing medical care. The training covers issues such as understanding of the concept of domestic violence as a health issue, its consequences on women’s health, roots of domestic violence, patriarchy, role of health systems screening methods, communication skills and eventually how to become trainers. The tools used for training include role plays, case studies, and discussion debates, etc. The training content is packaged to fit into the busy schedule of the public hospital without compromising on quality and weakening its impact on trainees.
Development of Curricula for Doctors and Nurses:
Violence Against Women and Role Of Health Care Providers: National Course For Health Professionals
This national level course on violence against women is aimed at health care professionals in order to bridge gap that exists in medical education on the issue of gender-based violence and the role of healthcare providers. The 9-day course structure has been developed in collaboration with health care providers and provides an intensive understanding on gender, patriarchy, intersectionality, human rights, ethics, inter-linkages between violence and health, and skill building for responding to survivors of violence. The methodology followed in the course are largely participatory which includes role plays, debates, presentations by participants, analysis of case studies.
Developing a set of modules for student nurses at Dhule nursing college
As part of the training on Violence Against Women (VAW) the team is involved in conducted training at Dhule nursing school and medical college. The team has developed modules for the trainings. The modules were designed to include an understanding of concepts as well as application. Concepts such as gender, sex, forms of VAW, patriarchy were discussed on the first day while the second day had the nurses demonstrate their roles in responding to the issue of Domestic Violence through role plays. Two batches of nurses comprising of 30 participants each were trained using a three day module. This module was included in the ASHA training.
Training Civil-Society Organizations:
From 18th – 20th October 2013, CEHAT organised a workshop at YMCA International, Mumbai, to present strategies to engage with the health sector for responding to violence against women. This is based on CEHAT’s engagement with the health system for the past 13 years, which includes the establishment of hospital-based crisis centre Dilaasa, development of protocols for hospitals and capacity building of health professionals across the country in responding to VAW. India is on the brink of important changes in the sphere of violence against women, including the reforms in current practices in the health, police and judicial systems of India. One such important reform is that of establishing 100 One Stop Crisis Centre (OSCC) in the public hospitals as directed by the Planning commission of India. This workshop aimed to provide participants with an understanding of linkages between violence and health, the newly enacted laws on VAW and their relevance to the health sector, as well as operational aspects to set up OSCCs. It was attended by officials (such as nodal officers NRHM, Medical Officers from public hospitals, representatives of State Resource Center for Women) from State Governments of Rajasthan, Kerala, Maharashtra as well as members of various non-governmental organizations from Kerala, West Bengal, Gujarat, Chhattisgarh, Rajasthan and Uttar Pradesh.
Training Community based Volunteers on Domestic Violence:
The women seeking services at Dilaasa had expressed need for support at the community level. In order to be able to meet such a need, we identified one community based organisation (CBO), Navjeet Community Centre. It works in a slum in Bandra. In 2005-2006 a series of trainings were conducted in order to create a deeper understanding on the issue of domestic violence in the community setting. In the second phase of training, the community volunteers were trained in basic counselling skills. Case studies related to their daily lives were developed and we encouraged the participants to get into the role of a counsellor. Most of the principles, values and techniques related to counselling were woven around the case studies itself. A feminist counselling methodology was specially developed for grassroots workers. This had proved to be a challenge. Issues covered during the training included principles and techniques of feminist counselling, values of a counsellor, techniques/skills in counselling and the like. The coordinator of the community centre has started a counselling centre. Working at the community level continues to be an important part of our activities.