By Bethany Corrigan, Senior Technical Advisor – GBV, PSI
This November PSI stands with people around the world to celebrate a global commitment eliminate violence against girls and women. In my last post, I talked about PSI’s role in a greater multi-sector, collaborative fight against the many-headed beast that is GBV. Over the next 16 Days of Activism, I will share an example of a GBV project implemented by PSI in Myanmar to illustrate how partnerships are the best way to attack more than one head of the beast, simultaneously. In a recent trip to Yangon, Myanmar I had the honor to meet four partners, each of whom represents a specific type of response to the beast, and together pooled their specialties to implement a program called, Breaking the Silence: Addressing GBV in Myanmar. Over the next two weeks, I will share their stories.
Inside Dr. Aung Moe’s clinic, it’s peaceful. It feels friendly here. Just outside of the main drag of town, his doors are accessible, yet apart from the major traffic of Yangon. His kind face, calm voice and pleasant staff are comforting.
One day, a young woman came to this clinic with, “vaginal discharge, low grade fever and abdominal pain.” Dr. Aung Moe treated her against infection and she went home. Back she came the next day with “profuse bleeding,” and blood pressure so low he started an IV. His re-examination revealed a foreign object – a stick and leaves about 6” long inside her cervix. Through confidential and nonjudgmental discussion led by Dr. Aung Moe, this brave young woman disclosed she had been raped, and self-terminated the resulting pregnancy. After Dr. Aung Moe stopped the bleeding and normalized her blood pressure, he referred her to a community-based organization to access other support like counseling, safety strategies, and legal advice. The young woman followed up with the referral and received counseling and other support.
Dr. Aung Moe’s practice is in the PSI-supported, Sun Quality Health Network of Myanmar, and this story of sexual assault and physical complications is typical of what these doctors encounter. Data tells us that healthcare providers are often the first contact survivors of violence make following assault or abuse. Unfortunately, the data also tells us that survivors are unlikely to disclose violence to those healthcare providers. Survivors may explain away bruises, or seek treatment without explanation for their symptoms. This is why PSI and other organizations must focus on building the capacity of doctors to respond like Dr. Aung Moe – as frontline support for survivors. But this mandate isn’t always easy.
Historically in Myanmar, issues such as “gender based violence,” or “domestic violence” have not been acknowledged to have serious medical, developmental, and economic effects, making it difficult for any one sector to take responsibility. For example, when questioned, doctors in Myanmar have said that domestic violence is not a medical issue, and they were not trained to respond to it. They believe these issues are “between a husband and wife” or “legal matters.”
Dr. Aung Moe was one of several physicians to participate in the Breaking the Silence program to address GBV (domestic and intimate partner violence against women and girls). In this project, PSI trained doctors on how to discuss violence with their patients, respond to need and refer to partner organizations for resources beyond immediate medical care. PSI also disseminated resources to doctors like a medical provider’s handbook on GBV, as well as posters and handout information about violence to raise awareness of their patients. I asked Dr. Aung Moe how the young woman from the example above disclosed the sexual violence. He acknowledged that she came to him first with a physical complaint, but through awareness and trust he was able to address more. “I think she came to me because of other complaints like discharge and bleeding, but she might see the GBV posters in my clinic and know I can help her. So, she told me about the story and seek support because she trust[ed] me. I have seen many GBV cases in the community. I hoped to be able to help them in some ways; at least I can refer them for further support… We could not do anything for survivors [of violence] before this program, [there was] nowhere to refer. We were not technically competent. After this program, we understand the referral pathway and can connect GBV survivors to the correct places. So, I can help clients, not only medical treatment, but also [with connection] to other services.”
As Dr. Aung Moe described, even aware, motivated doctors cannot provide everything for survivors, but partnership can lead to comprehensive services. Partnership also helps direct policies and laws and increased community awareness. Dr. Aung Moe, “GBV program will be more successful if NGOs, Government sectors and clinicians are working together. Law enforcement is important. Laws and legislations need to be changed. The situations are getting better now, but it should be better than this and we have to move forward.”
In the next post I’ll share how PSI is working to support partnership building with an inspiring community based advocacy organization.