Episode 34: Gender-Based Violence & Human Trafficking

Author: Eoghan Colgan    @eoghan_colgan
Special Guest: Kath Gallagher

12/06/19


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Guest Bios

Kath Gallagher

Kath Gallagher.jpg

Kath Gallagher is the executive lead for Gender Based Violence at NHS Greater Glasgow and Clyde.


Show Notes

Eoghan and Kath discuss Gender-Based Violence - why it’s important, how it can present, how to tackle it, and a whole lot more.


Take Home Points

Why it is important

  • health services are the one place that they often present and can access support and safety

Do we miss it?

  • we are certainly missing cases

    • we may lack the confidence to ask

    • people often don’t want to disclose it because they are frightened or fearful of the consequence of telling

      • this might be harm to them or their families

Types of gender-based violence

  • examples include:

    • domestic abuse

    • rape and sexual assault

    • forced marriage

    • female genital mutilation

    • commercial sexual exploitation

  • Scottish Government has a strategy called ‘Equally Safe” - see the link at bottom of page

  • typically it is male power versus a female (but can also be man against man, or female against man)

Who is at risk?

  • anyone can be a victim

    • any age, background or ability

how to identify it

  • some indicators include:

    • BEHAVIOUR

      • they are accompanied by someone who appears controlling of their interaction

        • these people may be introduced as a friend, partner or family member

        • often observing their behaviour can give clues

      • they are evasive about the information they give

      • they appear nervous in the presence of the accompanying person

      • they may demonstrate distrust of services

    • HEALTH

      • injuries from an assault:

        • delayed presentation, or

        • they are inconsistent with how they received the injuries

      • repeated unwanted pregnancies

      • in human-trafficking cases, they may present with work-related injuries suggestive of poor health-and-safety practices

THINGS IN PLACE IN THE DEPARTMENT

  • staff would have access to training and awareness-raising

  • there should be private space for seeing patients confidentially if concerned

  • never use person accompanying them as an interpreter (may not give accurate history and requires their presence at all times)

    • address their communication needs properly

Trying to get space alone

  • ask person to step outside and explain it is routine to get some time alone with the patient

  • better than asking them to leave when you are in the room - they would have the chance to ask the patient if they want them to stay which can be harder to deal with (if they feel pressured to say yes)

If partner refuses to leave

  • if violent to staff or patient - call the police

  • if they refuse then remind them that it is an incomplete exam because you could not do parts of the examination with him present

  • it might be best to arrange a follow-up appointment

right time to ask about abuse

  • sensitively enquire when appropriate to do so

    • “this doesn’t quite fit with what you are telling me”

    • “is there anything you would like to tell me?”

  • if they are nervous - describe your concern and ask them if there is anything else going on

  • you can ask directly if they are resisting

    • you can state your concern regarding the injury or behaviour of those present

If they reveal abuse - how to respond:

  • don’t react - be calm and non-judgemental

  • listen, and see how you can work together to help them

  • believe what they tell you

  • your job is to help them feel safe and that they can trust you

  • let them know about the boundaries of confidentiality

    • if there is risk to children of vulnerable adults you may have to disclose the information in order to protect them

    • otherwise it would be entirely confidential and only shared if they agreed to it (with other medical staff who could help them)

  • assess the level of risk they feel they are under

    • then explore the choices moving forward

    • you will need some prior knowledge of locally-available services

What not to do

  • do not promise that you will keep them safe (you may not be able to)

  • do not promise to solve the problem for them because you can’t (but others will be able to help)


Links

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Hannah BellComment