Telltale signs of domestic violence
● Working in a public hospital in KwaZulu-Natal, Dr David Mashabane is exposed to all sorts of recognisable medical conditions and trauma.
But the young intern at Prince Mshiyeni Memorial Hospital in Umlazi was recently confronted with a potentially deadly condition that would have been invisible to many colleagues.
“It was a lady in her early 30s. She came in at around 2am complaining of nonspecific body pains and headaches. She pointed at her shoulder, arms and chest,” said Mashabane. Thanks to specialised training at the University of Cape Town (UCT), Mashabane could diagnose the woman’s condition: she was the victim of intimate-partner violence, and her symptoms were caused by psychological distress.
In the past five years, Mashabane and 1,300 other medical students have gone through the training, which equips them to identify the sometimes subtle symptoms and “red flags” of intimate-partner violence.
Senior lecturer Chivaugn Gordon, who initiated the training, said many doctors misunderstood this form of violence and often looked for physical scars.
“In fact, the vast majority is not physical violence but psychological, verbal and economic intimidation and controlling behaviour,” said Gordon, head of undergraduate obstetrics and gynaecology education at UCT.
“These are not things that will be evident unless the doctor screens for them.”
As a result of their lack of training, many doctors overlook the possibility of abuse and miss an opportunity to help thousands of vulnerable women, she said.
Mashabane, 26, who graduated last year, said the UCT course had empowered him, especially when patients arrive with “scant history”.
“That’s where my intimate-violence antenna kicks in and I will begin to ask specific questions. As a doctor, you have to do that very carefully as it is your responsibility to reassure the patient and make sure she is comfortable to engage,” he said.
Jade Dreyer, who graduated from UCT in 2014 and works as an emergency doctor at a Johannesburg private hospital, said abused women often arrive at the casualty department with their partners.
“During training, we were alerted to the fact that this is common behaviour by abusers. The red flags are difficult to pick up on, and sometimes we miss them, only to have the same patient coming back later.”
The success of the UCT programme is rubbing off on other universities. Julia Blitz, vice-dean for learning and teaching at Stellenbosch University, said its medical curriculum is being renewed to comprehensively cover intimate-partner violence and sexual abuse.
“This training will start in first year and will equip students to identify vulnerable populations, elicit the signs and symptoms of abuse, effectively communicate and provide medical treatment for survivors of abuse, and to consider patient safety and the legal aspects of abuse,” she said.
Gordon said gender-based violence carries a huge price tag for governments because victims have higher rates of HIV, sexually transmitted infections, unplanned pregnancy, miscarriages and serious mentalhealth disorders.
It also affects children born into abusive relationships, with two new studies indicating they are likely to miss out on the benefits of breastfeeding and face developmental, psychological and behavioural problems.