Personal tragedy saw SA academic earn first forensic medicine PhD

The HPCSA has since adopted the screening protocol

A CAPE Peninsula University of Technology academic has become the first person in South Africa to earn a PhD in forensic medicine. His work is helping to improve the forensic accountability with which emergency care providers respond to victims of genderbased violence.

A personal tragedy in 1995 inspired Dr Navindhra Naidoo, acting head of the Emergency Medical Sciences Department, to pursue his field of research.

“My 19-year-old sister was murdered by an ex-boyfriend. I was still studying to be a paramedic at the time and realised that there was nothing in my curriculum that prepared me for that.

“It didn’t prepare us for screening, detecting or preventing these horrible things from happening.”

Naidoo said his key topic focused on gender-based violence, in particular, domestic violence, and sought to understand emergency care workers’ “current and potential response”.

“What we found is that the current responses are deficient. It’s not that the rescuers don’t want to help. There’s a lot of ambivalence largely because there isn’t a sufficient referral system so the practitioners are not guided on where patients need to go and what kind of services might be available.”

Through a cohort design, Naidoo first looked at thousands of archived medical records and found the detection rate of domestic violence or related kinds of genderbased violence, including cases of rape, was 5.1 patient contacts per 1 000 female patients presenting to the Emergency Medical Services.

A ninefold increase in detection following the evidence-informed screening training and implementation translated to the detection of 47.9/1 000 emergency care patients, with no adverse events.

These rates are unprecedented for South African emergency care and support screening-policy implementation.

The difference in domestic violence detection quantifies the extent of the practice gap, with an alarming missed case detection of 42.8 per 1 000 patients (females, 14 years-plus). In consultation with Stanford University, California, Naidoo developed a curriculum for the sensitisation of health workers which was implemented in the Western Cape Emergency Medical Services.

The Health Professions Council of SA has since adopted the screening protocol.

“So about 70 000 practitioners are now ethically obligated by the HSPCA to routinely ask the question about the presence of violence in someone’s life and then to do a risk/safety assessment and provide the necessary support they might need,” says Naidoo.

His work has also served, at the HPCSA, to position genderbased violence as a social determinant of health.

“What we are doing is using emergency workers as sentinels. No other person in the health service actually walks into someone’s bedroom where the abuse occurs to treat them in an emergency.

“The screening helps us to ask victims about the presence of violence and screen for risk, for example, whether there’s the presence of a firearm.

“When there is a risk, they can then advise the victim appropriately and enhance both public safety and practitioner responsivity.”