Doctor Julia Stinshoff has worked for a year at a centre in Papua New Guinea that gives survivors of domestic and sexual violence psychosocial and medical support. Here she talks about her work at the centre run by international medical charity Medecins Sans Frontieres (MSF), in Tari, a remote rural area in the country’s Southern Highlands. The centre also runs an operation theatre.
We see a lot of fractures, lacerations, soft-tissue injuries as well as open wounds. These injuries are mostly the result of women being beaten by their husbands or immediate families.
People come here after being victims of extremely violent abuse. We see many fingers amputated as people tried to protect themselves from attacks and many fractures on the upper body.
I’ve seen women having been kicked with safety boots even when they are pregnant and children beaten up violently by their fathers or mothers.
We also see violent trauma that needs urgent surgery where people barely survive... and then they have to go back to their family and the husband who has abused them.
We see all segments of the population but most victims are women. We also have victims of sexual violence and that affects everyone including children.
In Tari, we have an average 65 new cases of domestic violence a month and between 10 to 20 cases of sexual violence a month but we know this is only the tip of the iceberg. These are people who can come forward and seek treatment.
Sometimes people don’t know they can get help so we have outreach activities in the community to raise awareness. Sometimes they are too scared or too ashamed to come forward.
It’s very rural and some women have to walk 12 hours to reach us. For sexual violence it’s often more difficult for them to come if it’s a long distance. It’s not safe for women to travel alone in Tari.
VICTIMS BLAMED FOR RAPE
When they come after (suffering) sexual violence, they first undergo a medical exam and we treat their wounds, give them emergency contraception, vaccines against hepatitis B and Tetanus, sexually transmissible infection treatment and post-exposure prophylaxis, which has to be given within 72 hours of the attack in order to prevent HIV infection.
We also provide them with a medical record if they want go to the police or file charges. This is really important because this document allows them to seek justice. In Tari this is done mainly through traditional village courts. No one would believe them without this document.
They also receive counselling. If they can’t go back home immediately, we help them stay in a safe house, in a secure location. We also offer emotional support but it’s a really new concept here and there is no network of other actors in place to support or protect them.
There’s a lot of stigma attached to rape. If the girl is not married the family can be angry because the bride price they will get when she marries will be lower. Sometimes they are angry because it brings shame on the family and they blame the victim.
If the woman is married, the husband can get upset because ‘she’s been “used” by another man,’ as they say, and can also blame her for it. So we see women who are scared to report rape.
Tari is a beautiful place, very picturesque. Somehow you wouldn’t expect this beautiful place to be the centre of so much violence.
It’s hard to get a clear picture of what feeds this violence. It’s a very traditional culture and the mining and fast development in the area interferes with this. There’s more violence and alcohol (because of development). More money flows in as well but it’s not distributed evenly. There are lots of fights over land ownership. These could all be contributing factors but it’s hard to say.
Sometimes with really severe violence or rape I just can’t understand how it can be that extreme. But people are really tough and resilient; they hardly complain.
I remember one time a lady who had come with a big laceration on her skull. She waited till we finished stitching her up and pulled her arm out from under her other arm and her hand was missing! She had been waiting for us to treat her without moaning, complaining or even saying that she had had her hand chopped off.
What I find difficult is we hear of a lot of young women hanging themselves because they get no support and can’t get out of that cycle of violence. Each death causes more fighting as it will lead to claims for compensation. We had the case of a girl who was raped. In return the family went to the sister of the perpetrator and raped her. That led to more fighting and a cycle of violence.
Medically it is also challenging to deal with open skull fractures and amputations. We have limited resources to deal with such serious injuries. There are limits to what we can do and it’s also difficult to accept these limits.
For example we don’t have all the diagnostic tools, ventilation for patients or blood banks so we have to find the family in the village and convince them to give blood. Sometimes they don’t want to because of traditional beliefs.
It’s also emotionally challenging to see how much they suffer, especially because it happens again and again or when you see rape victims being blamed, but the outcome of our work is positive and we focus on trying to make a difference for them and it’s rewarding to see how grateful they are.