Indonesian doctors act on tell-tale signs of family violence
When the parents of an injured five-year-old boy told Dr. Fai’zah A. Salim that he fell off a ladder, she was not convinced and suspected otherwise.
Trained by UNFPA in the Central Sulawesi capital city of Palu to identify both physical and psychological signs of domestic violence, she referred the boy to a social counsellor. Shortly afterwards, he explained what really happened and how his father had beaten him for mischief.
Recognition is the first step
“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 Dr. 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. 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 treating their physical wounds.
The results are significant. In the first three months 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,” Dr. Salim said.
Serious concerns about gender-based violence
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, a Programme 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 UN agencies such as UNFPA and UN Women.
The number of reported cases has increased from around 216,000 in 2012 to close to 458,000 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 probably do not represent the full picture, 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, said some 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 are offered a treatment package, including psychological counselling.
Besides training medical staff, UNFPA also supports community groups and non-governmental organisations (NGOs). In Palu, the women’s organisation Libu Perempuan, for instance, has 30 volunteers – from lawyers to psychologists – to help victims. 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, UNFPA Programme Officer Budi Waskito said the pilot project offers a model other donors or the Government can replicate.
“We provide a recipe, but cannot cook every meal,” he said.
UNFPA works closely with the Ministry of Health so that the 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 guidance 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 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,” she said.
For Dr Faiza, the goal is clear.
“Until we have prevented every case of gender-based violence, we have more work to do,” she said. “And we are doing it.”