Originally published in ARROW for Change (AFC) Vol.1 No.3 1995

By Dr. Sylvia Estrada-Claudio, a medical doctor who works with NGOs fighting for social justice, national sovereignty and women’s emancipation in the Philippines, including on health and reproductive rights.

I became a doctor long before I became involved with women’s groups. I had an excellent medical education, but formal education never taught me how to handle cases of raped women and to look for signs of violence and abuse against women and children in the emergency rooms of our training hospital. It was only when I began to work with women who were trying desperately to deal with this hidden epidemic that I began to realise how neglected these women were. And, as I got a second education in the community, the biggest thing I had to do was to unlearn certain myths.

One myth states that violence against women is a minor problem perpetrated by a few misfit men. I realise now that many men are involved. As I began to understand the many forms that abuse might take, and the almost infinite variations in behaviour that constituted abuse, I realised that we would be hard-pressed to isolate a particular action on the part of a particular men and say, “this is pathologic, this is within the bounds of normal.”

Another myth that I had to deal with, was that violence was a problem of some other community, or some other country, or some other region, or some other class or race of people. Again, the statistics worldwide tell us the truth. Violence against women occurs in all societies, across all races and classes. It happens to women in both modern and traditional societies. Indeed, it is a global phenomenon and a concern. In 1985, the United Nations (UN) passed its first resolution on violence against women. More recently, in 1993, the UN General Assembly passed a Declaration on Violence against Women.

Furthermore, in almost all major conferences sponsored by the UN in the nineties, from the human rights conference held in Vienna to the population conference in Cairo and the women’s conference in Beijing, there has been recognition that violence against women is a serious problem and that governments must take steps to stop and prevent this violence.

Cause and cure. The most critical lesson that I have learned with regards to the health problems of women, including the problems that arise out of violence, is that in order to be able to diagnose and finally heal, it is necessary to understand the larger context that spawns the violence. That context is the exploitation and oppression of women in many societies. It is a context that is also stated in Paragraph 118 of the 1995 Beijing Platform for Action:

… the fear of violence, including harassment, is a permanent constraint on the mobility of women and limits their access to  resources and basic activities. High social, health and economic costs to the individual and society are associated with violence against women. Violence against women is one of the crucial mechanisms by which women are forced into a subordinate position compared with men…

Yet, it is the effort to deal with this context that is most difficult, and therefore most likely to be neglected. The greatest difficulty is for men and women to accept that this oppression exists. This is why even the most battered of women may not tell their physician or take the necessary steps to end the violence in their relationships despite the dangers. This is also why, despite the indisputable evidence, doctors, medical schools and the health profession as a whole may not have responded adequately to the epidemic of violence against women. Hence, the understanding of this context is essential to all stages of diagnosis, therapy and prevention.

Only when one realises that the oppression of women is part of society, is one able to understand that men’s behaviour is skewed towards aggression against women and, therefore, it may be difficult to make the cut-off between men’s normal actions and their hurtful ones. This is why the problem is so prevalent. The understanding of structural causes of violence is the basis for what is called in our profession a ‘high index of suspicion’ when it comes to this disease. In the same way that tuberculosis is so prevalent in poor societies because of the structural problems that lead to poverty and overcrowding, so do a society’s gender inequities lead to the violence that causes ill-health of women. Women’s groups worldwide have also learned that healing occurs for abused women when they realise they are not alone and when they are shown that they have a right as human beings to be free from harm. Healing and prevention can only occur when women not only understand their right to bodily integrity and health but find the strength to assert those rights.

Violence against women is a health problem that has pandemic proportions because of general ignorance and neglect as well as the refusal of some to change. But, like other pandemics, it can be stopped. Governments, professional bodies and people in general should recognise the problem, understand the causes, and begin to take the painful personal and societal changes that are necessary.

She is a 62-year-old woman who does housework and laundry and she has come to consult me, at the request of her employer, who knows of my work with economically disadvantaged women. The woman has asked me to tell her which of the lab examinations and medications prescribed for heart disease are truly important because she is poor. We go into history taking, what happened and when. “It seemed to be just nerves,” she says, “until one day last month my whole body went cold, I could not breath or move and they had to rush me to the hospital. That’s when they gave me these lab requests and medications. They say it is for the heart disease,” she continues, “I have not been able to buy any of them”. I take her blood pressure. It is normal. She is not taking any hypertensive, nor can I detect anything unusual on chest examination.

I am puzzled but still respectful of another doctor’s work. I tell her that we will help with the lab examinations but that I would like to get these done and see the result before I advise her on the drug therapy. But the old woman keeps saying, “You know, it may be just nervousness”. This propels me to voice my own puzzlement over the diagnosis of hear disease, given the physical examination and her atypical history I ask in my joking manner, “Maybe there is nothing wrong with you, maybe there is something wrong in your life, maybe with your husband’s fist?” (I use the Filipino expression, magibat ang kamay. Literally translated, “his hands are heavy”). She breaks out into a wry and weary smile. “Ever since I married him,” she says, “he would hurt me or the children whenever he has too much to drink. Now I only have to think of him drinking and I get nervous”.

I call her employer and urge that she be given time off for counseling with the Women’s Crisis Centre, Manila, a women’s group dealing with these issues. She leaves, still with the agreement to go through with the lab examinations, monitor her blood pressure and return with all results. And I am left wondering. I realize how narrowly I could have missed uncovering the woman’s history of violence. I wish that I could say that this is an unusual case, which deserves to be written up for a medical journal. But it isn’t. I also wish that global statistics do not verify what my practice tells me: violence is a major health problem for women in all communities and women who have suffered from violence are not properly diagnosed by the medical profession most of whom are still blind about women’s health issues.