Study on Domestic Violence and Primary Care in Indonesia, Slides of Social Psychology

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DOMESTIC VIOLENCE:

UNDERSTANDING THE

RESPONSIVENESS OF PRIMARY

HEALTH CARE SERVICES

N.K. Endah Triwijati

Faculty of Psychology

Universitas Airlangga

DV

widespread & pervasive

insidence & impact

1 per 4 women;

“in silence”

Fatal effect: being

killed/ killing spouse

“non fatal” effect:

Physical health, mental

health, Chronic stress-

related problems,

reproductive health,

negative health

behavior

lost of

productivity &

employment;

healthy & able to

compete

generation

Added health care

cost, community

services, legal

process;

witnessing 

direct violence

anxious,

depression, school

performance,

Low self esteem,

rebellious,

aggressive

women childre

n

stat

e

IMPORTANT! preventing domestic violence, rather than just

treating its consequences

CONDITION IN INDONESIA



Started in mid of 90s: health sector involves

in handling DV cases



Consentrates on tertiary prevention: dealing

with the impact on women’s physical health

& medicolegal (visum et repertum)



Secondary prevention of DV is still new ideas,

eventhough Department of Health have

produced books related to this issue (the

concept as well as what & how to do

secondary prevention)

4

5

HEALTH sector

Crucial & Strategic

Prevention function

Individual HCP

Structural

Constraints

SECONDARY

Early detection

Personal &

Social Barriers

Systemic

barriers

Impact Med.training

Professional

Socialization and the

Intergenerational

Transmission of

Abuse.

Efek Teori

Medicalization of

Social Problems

Limitations of Mental

Health Models.

Inadvertent

Retraumatization

Changing Theory and

Incorporating Context

global economic

pressures

standard of care:

symptomatic

reduction

Medical based

referral network

Silent

patient

Universal

screening

PRIMAR

Y

TERTIARY

Integral Psychology

(Ken Wilber, 2000a, 2000b)

interior exterior

individual

collective

collectiv

e

individual

interior exterior

“it”

Behavior & Organism

Behavioral

“I”

Self &

Consciousness

(intentional)

“We”

Culture & World view

“its”

Social system & environment

RESEARCH QUESTIONS

Does the experience of violence in HCP’s subjective

awareness and intersubjective awareness about

domestic violence and patient-victim of DV influence

the ways in which they responds to patient-victim of

DV when they encounter them

I argue that only by understanding the integral notion

of subjective consciousness of medical professionals,

their inter-subjective realities, we can construct an

integrative intervention to develop responsiveness of

the HCP services to domestic violence

LISTENING GUIDE ANALYSIS

four steps:

1. listening for the plot: I at- tended to the main themes,

absences, contexts, and landscapes

2. I-poems: underlining each “I” and verb and/or associated bit

of text to construct a poem

3. listening for contrapuntal (multiple) voices: involved at least

two additional listenings for contrapuntal (multiple) voices.

In some participants, more than two voices emerged

4. composing an analysis.

As HCP:

strongest

memory of

patient–victim

(PV)

Observation:

cases of

colleagues:

structural

violence & victim

of DV

Experience in

education

Experience in

the family:

Core Family

Parent’s In-

law

Parent

Type of V

activate the

process of

identifying

Victim of

DV

Participan

t

Responds

Pattern

Physical

respond

STRONGEST

IMPRESSION –

judging:

perpetrator –

victim’s relation

Individual’s

characteristic &

contributions

other people (who,

how)

colleague &

superior responds

position of SELF

BEHAVI

OR

KNOWLEDG

E

W

H

A

T

Violence

(what,

tolerance,

level of

seriousness

Gender

(roles,

traits,

nature)

Power

relation

Familialism

Work

place

Family

Education

curricullu

m

society

indications of

conflict, inter-intra

sphere dissonance,

traumatic experience

one’s existence

W

H

Y

SUBJECTIVE

BELIEFS

STRUCTUR

AL

FACTORS

CULTURAL

BELIEFS

Familialism ideology very strong stir their personal & family life 

influenced their implicit theory and responds  tolerate DV 

limitized their respond to empower the patient

Dominant responds tend to escalating danger: trivializing &

minimzing the abuse, blaming victim & not respecting patient’s

autonomy (giving prescriptive responds)

there is no institutional support related to their safety nor

building their capacity to be able to responds

instead the following norms are still strong: “5minutes/patients”,

“preserve good image of HCP as well as Puskesmas”, “curing

perspective”

Necessary conditions for HCP

willingness: Secondary

Prevention : clarity of

delimitation of HCP professional’a roles:

o

in relation to the patient (universal

screening)

o

Revitalizing Puskesmas

Unravel HCP’s constrain as individual &

member of community

o

Fear of safety of their individual/family

life & that of patients’ (perpetrator

retaliation vs safety support from the

puskesmas)

o

Preserving reputation of the

puskesmas & profesional role

Practical understanding: causal factors,

the dynamic of violence, legal literacy

Intervention to the

System of Puskesmas :

o

Engaging all HCP in all

department & relevant

professional association

o

Institutional support:

regulations, infrastructure

o

revitalizing the function of

puskesmas as publich health

center