The Health System Response to Gender-Based Violence in EECA: A programmatic package Communicating with Survivors A Survivor-Centered Approach

The Health System Response to Gender-Based Violence in EECA: A programmatic package Survivor-Centered Approach The survivor has a right to: Be treated with dignity and respect instead of being exposed to victim-blaming attitudes. Choose the course of action in dealing with the violence instead of feeling powerless. Privacy and confidentiality instead of exposure. Non-discrimination instead of discrimination based on gender, age, race/ ethnicity, ability, sexual orientation, HIV status or any other characteristic. Receive comprehensive information to help her make her own decision instead of being told what to do.

The Health System Response to Gender-Based Violence in EECA: A programmatic package Basic Principles of Support of Survivors Protection and safety Active listening and believing the victim Non-judgmental and empowering support Right to self-determination and consent Support the victim to make informed decisions Confidentiality

The Health System Response to Gender-Based Violence in EECA: A programmatic package Communication Skills Active listening Barriers to active listening Understanding and empathy Mirroring Asking open questions Validating the experience, building trust and avoiding judgmental reactions Giving information rather than advise Taking a stand against violence Gaining control, validating strengths and building faith in oneself Sources: United Nations Women: Virtual Knowledge Centre to End Violence against Women and Girls (2011): Survivor-centred approach. ( approach.html) WHO (2003): Guidelines for medico-legal care of victims of sexual violence, Manual, Geneva. approach.html FUND (1998): Improving the health care response to domestic violence – a trainer’s manual for health care providers, Manual.

The Health System Response to Gender-Based Violence in EECA: A programmatic package Exercise: Interviewing the Victim and Further Appropriate Responses Case Study 1, 2 and 3 on Handout 2 Situation: The victim has arrived at the health centre to ask for advice. Discussion takes only 15 minutes (=based on practice experience). The doctor/nurse is interviewing the victim of violence: Role play based on case studies above. Observer gives her/his comments after role play. Parties: Victim, doctor/nurse, observer ->See also: Handout 1 “Communicating with survivors” and Handout 2 “Exercise Communication”

The Health System Response to Gender-Based Violence in EECA: A programmatic package Exercise: Discussion Questions Victim: How did I feel? Which questions were helpful/ useful and encouraged me to talk more? Which questions were not that helpful/ useful? Doctor: How did I feel in my role? What was the most difficult for me? What did I handle well?

The Health System Response to Gender-Based Violence in EECA: A programmatic package Start the Interview on Violence “I am going to ask you some quick, routine questions that I ask all patients in order to understand their health. I may be jumping from topic to topic so I can get the big picture and then we can go back and talk about what is important to you.” “I am concerned that your medical problem may be the result of someone hurting you. Is that happening?” Connect the inquiry to something the patient has already said. Example: “You mentioned your partner’s substance abuse, temper, stresses, etc. When that happens, has your partner ever physically hurt you or physically fought with you or threatened you?” “Many patients have health problems because of fights with their husbands. Do you know anyone who has had that problem? Has that problem ever happened to you? Is it happening to you now?”

The Health System Response to Gender-Based Violence in EECA: A programmatic package Sample Screening Questions to Follow up an Opening “Sometimes the people we care about hurt us. Has that happened to you?” “Has your partner used physical force against you... or property... or someone else when fighting with you?” “Has your partner (family member, etc.) physically hurt or threatened you?” “Have you been pushed, shoved, grabbed, or slapped by your partner? Has your partner attacked property or pets or others when fighting with you?” “Have you been physically hurt by your partner?” “Are you afraid of your partner? If so, what is your partner doing that makes you afraid?” “Has your partner humiliated you or controlled you in a harmful way?”