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The role of the physician advocate in sexual violence against women

Dr Astrid Batchelor

Sunday, August 06, 2017

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THE patient is always the prime concern of the physician. Studies have shown that physicians consider advocacy for their individual patients as an accepted component of ethical practice. However, are our physicians meeting the requirement for public advocacy?

Public advocacy, a more expansive mindset, requires more than helping individual patients to access and receive services; it requires addressing the root of the problems our population faces.

Its definition can be extrapolated from the American Medical Association proposition of the term to mean: “Action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise.”

Physicians are well fitted to function as public advocates for health. They are keen to observe and identify the correlation between social factors and health determinants that culminate in medical issues and illnesses in the population. Therefore, this poised critical position should be leveraged strategically to influence citizens, policymakers and national leaders for positive outcomes in their communities and nation. Every physician can become involved in public advocacy on different levels, ranging from medical society affiliations, liaising with the media, to policymaking and national health care reform.

According to Dr Mark Earnest, an author of several physician advocacy and professionalism works: “To commence the work of public advocacy, we have to identify if the problem is amenable to advocacy, define the problem and its scope, identify and engage strategic partners, develop a strategic action plan, and lastly, communicate an effective message necessary for effective advocacy.”

Sexual abuse against girls and women has reached catastrophic proportions in Jamaica, with rates increasing each subsequent year despite under-reporting. The Office of the Children's Registry recorded approximately 16,790 reports of sexual abuse against children over an eight-year period from 2007 to 2015. Of this enormous number of abused children, 15,457 (92 per cent) were female.

The Ministry of Health's data shows that the youth are significantly affected by HIV. Girls, however, account for the larger percentage of cases in the 10 to 29 age range, with HIV being reported as high as four times more prevalent in girls of the 15 to 19 age group, with the majority of cases being linked to sexual abuse and violence.

In Jamaica there are many factors contributing to sexual abuse. It stems from the early exposure of our children to sexual activity in the home, which may be seen when families live in one-room housing; 'consensual prostitution' of girls by their families for monetary support; incestuous sexual abuse; poor socialisation of males; economic and educational disparities, et cetera.

The ramifications of sexual abuse and violence overwhelm the victims, their health and the health services with a burden of gargantuan proportions. Apart from the physical injuries of the assault, such as bruises, lacerations and fractures, sexual violence can lead to pregnancy. Unintended and unwanted pregnancies may lead to illegal and possibly unsafe abortion practices, the outcome of which may be life-threatening sepsis and even maternal death. For those who choose to continue with the pregnancy, that child may become a victim of neglect, rejection, depression, and child abuse due to the psychological trauma experienced by the mother.

A victim who is sexually assaulted undergoes acute stress and, after the assault, a rape-trauma syndrome often occurs, which leads to post-traumatic stress disorder and an increased need for psychological and psychiatric services. Various long-term health effects are associated with female sexual assault, such as patient-reported symptoms of diminished levels of function, alterations in health perceptions, chronic pelvic pain, sexual dysfunction, and decreased quality of life.

We cannot fail to acknowledge the risk of contracting sexually transmitted infections, including HIV, syphilis, chlamydia, gonorrhoea, and the cervical cancer-causing human papilloma virus (a preventable and therefore unnecessary cancer that robs women of their lives).

Evidently the length and breadth of this problem is vast, therefore the strategy to effect change will have to be greater.

Physicians will have to play their part on an individual basis to provide emergent and ongoing care to the victims: Assess, document and treat injuries, obtain appropriate samples and testing for STIs, provide infectious prophylaxis, arrange emergency contraception if needed, counsel, report to appropriate authorities, and refer for psychological needs; as well as practise screening for sexual abuse as a useful tool for identifying persons at risk for STIs and psychological counselling needs.

Public advocacy requires that doctors be involved in patient care beyond the doctor's office and get invested and engaged in social and economic change. We need to support and partner with organisations aimed at health promotion and leadership. There is the recently launched Jamaica Aids Support for Life's 'End Violence Against Women & Girls' media campaign to raise awareness about the effects of violence and the spread of HIV nationally. The Pan American Health Organization is making a special appeal with the 'Leave No Girl or Woman Behind' initiative to eliminate violence against women and girls, and achieve comprehensive care in sexual and reproductive health, including family planning and access to information on sexuality.

We, as doctors, need to become more involved in the fabric of transformation and re-educate our population about the pervasive harmful societal stereotypes of what it is to be a man or a woman if we want to reduce gender inequalities. This will not only target women at risk of abuse, but also men at risk of becoming abusers and those with abusive behaviours.

In the medical office, we must inquire if girls are attending school and what factors may be preventing them from doing so, and contact the relevant authorities to ensure the conditions that will allow women to have economic autonomy in the future.

Physicians need to be informed and connected with the various agencies where girls and women can seek help to facilitate the timely access to further care, as well as use the opportunity to engage the media houses to expose health problems, communicate awareness and how to access help.

Lastly, we must get involved in the legislative process of health care and policymaking to lobby for the rights of women and girls in order to establish a comprehensive health care infrastructure for our women and for the nation at large. After all, healthy people advance the welfare of the whole human race.

Astrid Batchelor, MBBS, is a local Ob-Gyn in training, and Junior Fellow Legislative Chair at the American Congress of Obstetricians and Gynaecologists.

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