Comment: 16 Days of What?

Last week marked the start of the annual United Nations campaign for 16 days of activism for no violence against women and children. 

In South Africa, President Jacob Zuma visited a shelter for victims of abuse in Braamfontein, where he said he was impressed by the fact that survivors are called clients as opposed to victims, and called the centre "user-friendly". 

The Western Cape's MEC for community safety Dan Plato visited Bredasdorp, where the young woman Anene Booysen's murder took place in February this year. Noting the number of women raped on a weekly basis in the province, he said the "shockingly high" figures were "alarming".  

I'm sure politicians and policy makers are satisfied with the token display of acknowledgement, pointing out the obvious. They will probably do it all over again during next year's campaign, by which time the situation would at best remain unchanged, or have worsened. 

Don't get me wrong: I'm not writing this as another cynical, dissatisfied South African dismayed at the politics of our country; ready to pack my bags for Australia. I write as a committed doctor working in the public sector, who is shocked by the scourge of violence in our country, and the lack of real commitment to change it. 

Overwhelming violence 
Anyone who has ever worked in the emergency centre or out-patient department of a South African public hospital will tell you that the amount of trauma as a result of interpersonal violence is overwhelming. Among the general influx of injured patients are women who have been battered, bruised or stabbed by their partners. 

Amid this violence, often the only thing a health care worker can do is focus on suturing and bandaging its physical results and not think too much about the many individuals that lie behind the gargantuan numbers. 

What I have found most disturbing in dealing with this daily reality is how quickly I stopped being shocked, and stopped questioning why this was happening. I became numb and accepting of this pathological situation, perversely seeing it as the norm. And I am sure I am not wrong when I think this numbness is felt by many other health care workers. 

But this is not normal. The bruised and broken bodies we see every day are indicative of a society that has made no real progress towards bettering the majority of South African women's lives because our government continues to implement policies that perpetuate harsh inequality. Women receive the shortest end of a miniscule stick – they are the casualties of one of the most violent and unequal societies in the world.

Problematic data collection
I will agree with Plato that these numbers are "shockingly high". Last year, 64 000 rapes were recorded by the South African Police Service. 

It is estimated that a woman is killed every six hours by her intimate partner. And the worst bit is that these numbers more than likely do not illustrate the true scope of the problem. 

Violence and injury statistics are not collected routinely at health facilities: in many facilities, only patient head counts are considered and not the conditions being treated. As such, at a primary health care level, there is no clear way for health care workers to report the number of violent injuries they treat, despite the fact that violence, injuries and trauma form part of what the national department of health calls the country's "quadruple burden of disease". 

This means data has to come from specific centres for survivors of gender-based violence, of which there are far too few, or police dockets. The latter relies on women reporting violence, which is significantly restricted by structural failings such as limited transport, poor infrastructure, and too-few police stations. Moreover, survivors may also fear retributive violence. As such, the true scale of epidemic goes largely unnoticed and unquestioned by us, the people tasked with facing it on a daily basis, as well as politicians and the policy makers with the power and resources to change it. 

Address social drivers 
I believe that if politicians and policy makers spent real time in public hospital emergency centres witnessing what happens over weekends – not just engaging in token visits when trendy campaigns occur – they would be driven to implement stronger interventions. 

Decision-making from a distance with insufficient evidence offers a skewed perspective. It leads policy makers to believe that ceremonial visits to centres for survivors or quoting alarming statistics is sufficient, when what is needed are community-specific interventions and a radical societal shift. 

To deal with prevention of the problem, we must contend with the social roots of violence in communities. It would include joblessness, inequality, lack of housing and social support and alcohol abuse, of which all stem from an exploitative, racist society, largely unchanged despite democratic dispensation.

And as a form of treatment, interventions must be individually tailored so that each woman receives the care she deserves. Unless comprehensive and definitive action is taken, all women and children in every town are at risk of being the next Anene Booysen.

Indira Govender is a public health specialist, working as a doctor in the public sector.


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