In high school a special guest was invited and he spoke to us about abuse, he referred to abuse as: anything that is used abnormally (outside of its intended use) be it power, resources, or people. According to the World Health Organization abuse is the intentional use of physical force, threatened or actual, against oneself, another person, or against a group/community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, underdevelopment or deprivation.
I was placed at a tertiary hospital and on this particular day I was asked to accompany fellow student to suction a patient in case they needed help. Mr P* was a 38 year old male that was admitted due to an anterior cerebral infarct with bulbar involvement, he was unable to speak nor was he able to perform activities of daily living. He took instruction well until it was time to suction which would result in him biting the suction tube and biting his own tongue. We asked one of the nurses to assisted us but she evidently treated the patient with contempt which prompted me to ask why, she then explained to us that he was a known gang member and abuser, his girlfriend had been treated at the hospital on many occasions and just recently. This situation brought clarity to her behavior earlier although the nurse was allowing her personal feelings to determine the kind of care she provided as a health care professional. This upset me as I had treated women who suffered domestic violence, the idea of treating an abuser to return to their previous level did not sit well with me but as a future physiotherapist that is what I would have to do. Later that day the ward was buzzing with activity and the nurse who had assisted us earlier informed us that Mr P’s girlfriend and aunts had just been escorted by security. It was not visiting hours as yet but the three ladies gained access to the ward and found him, they then proceeded to take pictures of him whilst laughing and after being discovered the girlfriend gave him a “warm klaap’ (hot slap) as the nurse described it. I will be completely honest and admit that I laughed and this made me admire Mr P’s girlfriend for a moment, she had been a vulnerable victim but in that moment she was not. In the next moment I could not help but worry about how her actions (along with her aunts) would have consequences.
Mr P in this instance was the victim not only was he physically assaulted but he his rights were infringed upon as he did not consent to pictures being taken of him, especially since these pictures were intended to humiliate and degrade him. The hospital and staff had a responsibility to protect and failed, the women would not face any repercussions for their actions, I asked the sister in charge of the ward about what would happen next and she explained that they would “investigate” with a smile on her face. I informed my clinician and she said she would follow the matter but she could not do anything from her side. Mr P started to hallucinate the following day and to be restrained; the doctors and therapists were called in for a meeting to discuss a way forward.
South Africa has one of the highest incidences of domestic violence in the world.Sadly, domestic violence is the most common and widespread human rights abuse in South Africa. Every day, women are murdered, physically and sexually assaulted, threatened and humiliated by their partners, within their own homes. Organizations estimate that one out of every six woman in South Africa is regularly assaulted by her partner. Although the exact percentages are disputed, there is a large body of cross-cultural evidence that women are subjected to domestic violence significantly more than men .Determining how many instances of domestic violence actually involve male victims is difficult. Some studies have shown that women who assault their male partners are more likely to avoid arrest even when the male victim contacts the police. Another study concluded that female perpetrators are viewed by law enforcement as the victims rather than the actual offenders of violence against men. Other studies have also demonstrated a high degree of community acceptance of aggression against men by women (Ellis, 1989).
The situation challenged the way I thought because on one hand the patient is a known abuser and gang member whilst on the other he was a victim of abuse whilst in a vulnerable state in hospital. His girlfriend who always played the role of victim was now the aggressor and instead of breaking the cycle of violence and walking away she retaliated. A part of me wanted to write it off as self-defense on her part as she wanted to protect herself which would make my predicament better, but I realize that male abusers can also be victims. At that present moment it was important that I treat a patient as I would any other patient and although I could not offer counseling to him given his state I could still provide quality healthcare respecting his rights as a patient. Setting aside personal opinions and beliefs to subscribe to ethical codes and standards of care is an ongoing challenge as they highlight discrepancies within myself and the professional I aim to be one day.
Ellis, D. (1989). Male abuse of a married or cohabiting female partner: The application of sociological theory to research findings. Violence and victims, 4(4), 235-255
Olive, P. (2007). Care for emergency department patients who have experienced domestic violence: a review of the evidence base. Journal of Clinical Nursing, 16(9), 1736-48. doi: JCN1746
Stinson, C. K., & Robinson, R. (2006). Intimate partner violence: continuing education for registered nurses. The Journal of Continuing Education in Nursing, 37(2), 58-62.