Despite her young age, 18-year-old Khrystyna* was very much looking forward to having a baby and was preparing for the birth of a girl. However, the toxic relationship with her husband overshadowed the joy of motherhood. Even during the woman’s pregnancy, 18-year-old Volodymyr* repeatedly started quarrels without grounds and controlled every Khrystyna’s move. After childbirth, the situation reached its apogee. Volodymyr set fire to his wife’s house, and frightened and beaten Khrystyna was hospitalized with multiple injuries.
“It seemed to me then that the whole world was against me and I would never get out of this state. But the specialists of the medical and psychological care unit believed in me and proved that life can be different”, the girl said.
The doctors of the unit in Rubizhne not only provided Khrystyna with the necessary medical care, but also effectively referred her to specialists from other facilities to provide the woman with legal support and further work with a psychologist. She and her child now feel safe in a shelter for victims of domestic violence while the trial of the perpetrator continues.
The medical and psychological care units are usually located at multidisciplinary hospitals, have modern medical equipment, diagnostic kits (or rapid test systems), medicines, etc. for protection of reproductive health, HIV prevention, treatment of sexually transmitted diseases, prevention of unwanted pregnancies and provision of emergency care to victims of rape. Currently, there are 17 such units in Ukraine. Six of them are in the Donetsk Oblast, 5 – in the Luhansk Oblast; others are located in Vinnytsia, Mykolayiv, Kharkiv, Kryvyi Rih, Odesa and Kherson. Each unit provides 24-hour free assistance on the basis of anonymity. In addition, most of them have a separate entrance.
The main advantage of this model, compared to the usual gynecological unit, is the special training of personnel in working with female victims of violence. Therefore, the active identification of those in need of assistance forms the basis of the units’ operation.
Thus, according to the specialists of medical and psychological care units in Pokrovsk, during the examination of patients they pay attention not only to the objective symptoms, but also to the women’s behavior, the condition of their skin.
“We conduct not only vaginal, but also general examination very carefully. Cuts, bruises, scratch marks, broken nails, torn hair make us carefully ask additional questions. If a woman is scared, nervous and introverted, this is another reason for us to learn more about the environment in the family”, said a doctor in Pokrovsk.
In addition, if women with signs of violence attend other medical facilities in the city, the specialists of the unit are informed about it.
Tete-a-tete consultations
One of the specifics of the units is the confidentiality of patients. In order to build a trusting relationship with patients, the specialists of the units do not require the disclosure of surnames or other personal data.
“Quite often we just write “pregnant woman A” or “pregnant woman B”. We always check whether the woman is ready to contact the police and make the case public. If she agrees, we offer assistance and always provide all the necessary contacts of other service providers, we offer shelter for her to isolate from the aggressor. We even offer psychological assistance over the phone, without identification”, says Ivan Tsyganok, director of the Pokrovsk Perinatal Center.
The specialists emphasize that approaches to working with victims of domestic violence and gender-based violence are very similar to the rules of working with HIV-infected women and are based on trust between the patient and the doctor. That’s why nurses and midwives often leave the unit during consultations.
According to Natalia Necheporchuk, head of the Women’s Clinic at the Rubizhne City Hospital, “the art of working is to transform the initial anonymous consultation into a serious intervention”.
“As a rule, when a person hides own name, she is hiding the problem. And violence mustn’t be silenced”, the doctor assured.
Working with aggressors
The specialists often encounter cases of total control of women by men. Given that, doctors try to make tete-a-tete contact with the woman in order to find out all circumstances of the situation and provide assistance.
“We registered a woman, who was pregnant for the 7th time. And the husband didn’t let her attend the in-patient hospital. He repeatedly insisted on home birth. During infrequent meetings, we convinced her that home birth in her case was a big risk. Because with each pregnancy the risk of bleeding increases”, said specialists in Pokrovsk.
In such cases, doctors also often communicate with male aggressors and inform them about the consequences of their behavior.
The specialists of medical and psychological care units emphasize that, according to statistics, all outbreaks of reports of violence coincide with holidays and official days off.
“We analyze every case and almost always alcohol is the main trigger of domestic violence. During the March lockdown, no cafes, restaurants were open and there were only 3 emergency situations. Gradually, this number increased, and in July, as many as 21 were registered”, said Natalia Necheporchuk.
In addition to victims of violence, unit specialists advise on cases of unwanted sexual intercourse, prevention of sexually transmitted infections and pregnancy planning.
Moreover, all units are inclusive due to installation of special gynecological chairs, which are adapted to the needs of persons with disabilities and different physiques.
*The names have been changed for privacy and safety reasons.
The medical and psychological care units were established by UNFPA Ukraine together with the implementing partner Women’s Health and Family Planning Charitable Foundation with the support of the UK Government.
