Doctors in Palu learn to recognize signs of family violence and support victims
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PALU, CENTRAL SULAWESI – Dr. Fai’zah A.Salim was not convinced. When a five-year-old boy was presented with injuries his parents attributed to him falling off a ladder, she suspected otherwise.
Trained by UNFPA to identify both physical and psychological signs of domestic violence, she referred the boy to a social counselor. Shortly afterwards, he explained what really happened - how his father beat him for mischief.
“Recognition is the first step to being able to help,” Dr Salim said. “We need to do a lot more than treat symptomatic wounds.”
The Public Health Centre, or Puskemas, where Salim works, is part of a UNFPA pilot programme to combat gender-based violence and other forms of domestic violence. The programme covers 11 districts in Indonesia, including Palu, the capital of Central Sulawesi. Under it, UNFPA supports the government in policy making and trains health care providers. Local partners are encouraged to advocate for victims to come forward and seek help beyond getting their wounds treated.
This is an aspect of the project Dr Salim and her colleagues take seriously. They have organized community forums and worked with associations in the Centre’s coverage area to encourage women to come forward.
The results are clear. In the first quarter of 2023, staff at Puskemas Sangurara had already identified seven cases of domestic violence, compared to between one and two over an entire year in the past. “Is it because of the advocacy or because we are better trained to recognize the symptoms of gender-based violence? Probably both,” she said.
Despite significant progress in gender equality, including increased access for women and girls to education, employment and health services, gender-based violence remains a serious public health and human rights concern in Indonesia, said Norcahyo Budi Waskito, Project Officer at UNFPA Indonesia. National policies, strategies and legal documents have been put in place. However, these have not always been implemented at the local level. The government has recognized the need for a systematic solution to ending gender-based violence and has partnered with United Nations agencies such as UNFPA and UN Women.
The number of reported cases has increased from 216,156 in 2012 to 457,895 in 2022, according to the National Commission on Violence against Women. This suggests that efforts to encourage more victims to come forward is having an effect. But the numbers represent is only the tip of the iceberg, as what goes on behind closed doors in a family home is still considered taboo by many and reporting it carries a stigma.
Shame is not the only reason that keeps victims from coming forward: there is also a financial disincentive. Annisa Rahmah, an emergency room physician at Palu’s Anuta Pura hospital, says several victims choose to walk out once she identifies cases as domestic violence, because the treatment would then not be covered by government health insurance. “It is depressing to see them walk away,” she said. Those who stay get complex treatment, including psychological counseling. The hospital, whose staff have participated in the UNFPA training, connects them with NGOs that can offer legal support if the victim chooses to press charges. When the victim is a child, it is the prerogative of the head of the hospital to turn to the police.
“We work on one case at a time, but at the same time hope to change mindsets in the society at large,” she said.
Victim support
Besides training medical staff, UNFPA also supports community organizations and NGOs. In Palu, women’s organization Libu Perempuan, for instance, has 30 volunteers to help victims. These include psychologists and lawyers. The association also runs a safe house, where currently two families live, and organizes training programmes, including trainings for men on the prevention of gender based and family violence.
“It was an important mindset change in society that helping victims is as critical as bringing perpetrators to justice,” says Maya Safira, programme coordinator. All of her colleagues participated in UNFPA courses.
In a country of 280 million people and over 7,500 districts, UNFPA’s training in 11 districts can only go so far. But Programme Officer Budi Waskito says the pilot project offers a model other donors or the government can replicate: “We provide a recipe but cannot cook every meal.”
UNFPA works closely with the Ministry of Health, so that training it offers can be scaled up by the government. It has helped the ministry develop a training manual for medical staff, response guidelines for hospitals and guidelines for local advocacy programmes.
The Ministry of Health is looking into replicating the success of this project, said Kartini Rustandi, Director of Reproductive Health Age and Elderly.
“The Ministry of Health realizes that the role of health workers is very large, not only in medical management but also in carrying out early detection, providing information on allegations of violence against women and children,” she said. “The Ministry of Health continues to make efforts to accelerate equitable distribution of health facilities capable of managing violence against women and children and capacity building for health workers either through regular budget funds, specific budget allocation or in collaboration with donors.”
For Dr Faiza, the goal is clear. “Until we have prevented every case of gender-based violence, we have more work to do. And we are doing it.”
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