Challenges in sustaining a Challenges in sustaining a hospital based crisis centre: hospital based crisis centre: Learnings of the first hospital Learnings of the first hospital

based crisis centre in Indiabased crisis centre in India

Sangeeta Rege CEHAT

OverviewOverview

Dilaasa: the first hospital based crisis centre in Dilaasa: the first hospital based crisis centre in IndiaIndia

RationaleRationale Salient featuresSalient features Major achievementsMajor achievements ChallengesChallenges Creating a sustainable modelCreating a sustainable model Journey aheadJourney ahead

Contribution of the Women’s MovementContribution of the Women’s Movement

Highlighting the issue of violence against women in 1980’s by bringing the custodial rape in the public domain.

Providing a gendered lens for questioning the entire spectrum of oppression. It is rooted in caste, class, religion and gender.

Initiating and establishing different spaces for women in the form of informal shelters, counselling services etc.

Rationale for setting up a crisis centreRationale for setting up a crisis centre

Health care providers ( HCP)may be the first contact for a Health care providers ( HCP)may be the first contact for a woman facing GBV. woman facing GBV.

Doctors are in a unique position to probe for any history of Doctors are in a unique position to probe for any history of violence .violence .

They are trained to identify the cause of injury, burns and They are trained to identify the cause of injury, burns and differentiate between injuries caused by fall or assault.differentiate between injuries caused by fall or assault.

Public health system is the only place to provide important Public health system is the only place to provide important medico legal evidence.medico legal evidence.

Objectives of the state/NGO Objectives of the state/NGO partnershippartnership

Dilaasa is a joint initiative of the public health Dilaasa is a joint initiative of the public health department of Mumbai and CEHAT, a research department of Mumbai and CEHAT, a research organization working on health issues of organization working on health issues of marginalized people. marginalized people.

Objectives:Objectives: Training the hospital staff Training the hospital staff Equipping the department with feminist perspective on Equipping the department with feminist perspective on

counselling. counselling. Gradual withdrawal and retaining monitoring activity Gradual withdrawal and retaining monitoring activity

Salient features of DilaasaSalient features of Dilaasa Dialogue, cooperation, democratic decision Dialogue, cooperation, democratic decision

making, joint ownership and women centered making, joint ownership and women centered approach. approach.

Crisis intervention services linked to shelters, Crisis intervention services linked to shelters, legal aid agency and other women’s legal aid agency and other women’s organizations.organizations.

Use of research tools through all stages.Use of research tools through all stages.

Salient features of DilaasaSalient features of Dilaasa

Change in the information system. Change in the information system.

Awareness programs in out patient departmentsAwareness programs in out patient departments

System of ongoing trainingSystem of ongoing training

Achievements Achievements

Establishment of a nonjudgmental, Establishment of a nonjudgmental, compassionate, safe, confidential space for compassionate, safe, confidential space for women. women.

Bringing the feminist perspective to a Bringing the feminist perspective to a mainstream public health system. mainstream public health system.

Increase in referrals over the past 3 years .Increase in referrals over the past 3 years .

No. of women referred to Dilaasa No. of women referred to Dilaasa Department Year

2003 Year

2002Year

2001

Casualty 50 50 20

Out Patient Department 19 29 14

In patient department 64 29 32

Hospital staff 26 21 23

Other organisations 2 24 8

Self referral 71 25 7

Community 16 24 4

No information 0 2 3

Postures/Pamphlet 20  - - 

Total 268 204 111

Achievements Achievements

Twelve staff emerged as trainers and trained 833 Twelve staff emerged as trainers and trained 833 HCPs on domestic violence over two years.HCPs on domestic violence over two years.

Program is being replicated in 4 other hospitals Program is being replicated in 4 other hospitals

Challenges in sustaining such a model Challenges in sustaining such a model

Integrating the understanding about Integrating the understanding about violence into practice is difficult.violence into practice is difficult.

No routine screening No routine screening

Weak medico legal documentationWeak medico legal documentation

Counselling not valued as a health care Counselling not valued as a health care needneed

Challenges in sustaining such a modelChallenges in sustaining such a model

One time training is not enough One time training is not enough

No budget for ongoing training within public health No budget for ongoing training within public health departmentdepartment

Over-enthused staff get into arbitration with the Over-enthused staff get into arbitration with the abuser, overriding the autonomy and breaching her abuser, overriding the autonomy and breaching her confidentiality. confidentiality.

Challenges in sustaining such a modelChallenges in sustaining such a model

Fear of dilution of the feminist perspective after Fear of dilution of the feminist perspective after CEHAT withdrawal CEHAT withdrawal

Professionals not interested in training on DVProfessionals not interested in training on DV

Violence perpetrated by the health system in terms Violence perpetrated by the health system in terms of hierarchy ,as well as domestic violence faced by of hierarchy ,as well as domestic violence faced by the staff is something that needs to be addressed.the staff is something that needs to be addressed.

How to create a sustainable model How to create a sustainable model

A hospital based crisis centre can run with high A hospital based crisis centre can run with high level of commitment from collaborating partner. level of commitment from collaborating partner.

A separate room and hospital staff assigned to A separate room and hospital staff assigned to such work brings a sense of ownership to such work brings a sense of ownership to sustaining the department.sustaining the department.

The nursing staff play the role of carers and The nursing staff play the role of carers and spend long period with the patients: can be spend long period with the patients: can be trained as Para counselors .trained as Para counselors .

How to create a sustainable model How to create a sustainable model

Need to collaborate with staff of peripheral hospitals Need to collaborate with staff of peripheral hospitals such as the Primary Healthcare Centers (PHC). This such as the Primary Healthcare Centers (PHC). This will help in early identification of abuse and timely will help in early identification of abuse and timely referrals.referrals.

The partnering external organization needs to The partnering external organization needs to provide technical expertise in training, monitoring provide technical expertise in training, monitoring and evaluation.and evaluation.

The Journey AheadThe Journey Ahead Initiating the issue of GBV within the medical Initiating the issue of GBV within the medical

curriculumcurriculum

Violence faced by providers needs to be Violence faced by providers needs to be addressed.addressed.

Expand DV work at all levels of the public health Expand DV work at all levels of the public health systemsystem

Community health workers(CHW) are an important Community health workers(CHW) are an important link between the community and health system. link between the community and health system.

Training sessions conducted by the core Training sessions conducted by the core team of the hospitalteam of the hospital

Thank you Thank you