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Throughout the past few weeks our country has been in a state of fear and dread following the alarming number of incidences of gender based violence. This epidemic (now referred to as “Femicide”) has created an uproar that lead to the start of campaigns, social media discussions and collective action.

On the 5^th of September 2019 our university (University of Western Cape) suggested a total shutdown preceded by a silent protest on campus in order to partake in the fight against femicide. We as Physiotherapy students were on block during this time which meant that we would have to go to work that day. A discussion started on one of our class’s social media platforms as the majority of us felt that we needed to partake in this very urgent crusade. “The majority” changed to the entire class when one of our classmates mentioned that she herself is a survivor of gender based violence and would like to have our support on this matter. We all felt the need to show of support to not only our friend and colleague, but also to each and every female who lost their innocence, self-respect or lives to gender based violence.

When we emailed our coordinators we were not given permission to partake and were informed that our responsibility to our patients take favor in this situation. Personally, I was torn. I knew I had a responsibility towards my patients. However, I knew how the events of the past few weeks have made me feel: Hopeless and scared. So before I left for work, I sat in my car and I thought long and hard about this ethical difficulty I was facing. I honestly did not know what to do.

I ended up choosing my patients, and went to work. But this situation sparked a debate within me. What about our responsibility to our fellow females? What about our responsibility towards our mothers, sisters, friends and colleagues? If something is not done to try and stop the brutal murder and rape of our gentle sex, could a loved one be next? Could I be next? And the question that haunts me the most: What about my responsibility to our future generation, to my daughter? If we do not promote or stand for change today are we just dooming the women of tomorrow?

Gender-based violence is currently considered a major health risk for women globally, especially in South Africa (Dunkle, 2004). This study found that an experience of violence in childhood, particularly sexual violence, has been identified as a risk factor for experiencing violence in adulthood, a phenomenon known as “revictimization”. This phenomenon verifies the urgent need for intervention in order to break the cycle of abuse and secure a safer and brighter future for our future generations.

Estimating the precise incidence of gender based violence in South Africa is challenging seeing as not all incidences are reported (Dunkle, 2004). Yet, all analyses lead to the conclusion that gender based violence in South Africa is at epidemic levels. A study conducted in 2009 found that there were 3,797 female homicides during that year, of which 50.3% were from intimate partner violence (IPV) (Abrahams et al., 2009). This means that during the year 2009, a total of 10 women were murdered per day through gender based violence. This national IPV mortality rate of South Africa was more than twice the rate found in the United States (Abrahams et al., 2009).

Police recorded 177,620 reported crimes against women in the 2017/18 financial year according to the latest available SAPS annual report (Merten, 2019). This report also stated that 36,731 sexual offences, including rape, assault and the murder of 2,930 women were listed in the 2016/17 financial year.

Currently, South Africa has one of the world’s highest gender based violence rates in the world, whilst some experts say it is comparable to countries that are at war. The Crime Against Women in South Africa Report by Statistics SA recently reported that the occurrence of femicide is 5 times higher than the global average. This means that in South Africa, women are 5 times more likely to be killed due to gender-based violence committed by men (“South Africa’s shocking gender based violence statistics – Alberton Record”, 2019).

Alarming rates of murder and rape were presented by the literature a decade ago, yet here we are. Yet, our current statistics are scarier than ever.  We are STILL mourning the loss of thousands of innocent women and children, while the people of power still have nothing to say and nothing to show. Where does that leave us, the people of this country? Doesn’t it leave us with the responsibility to DEMAND change by taking action?

According to Thomas & Louis (2013) collective action can be effective in achieving broader social change goals to the extent that it influences public opinion and participation. Individuals who are sympathetic to the issue, but do not actively participate in the solution were labeled as “sympathizers” and it was found that collective action can be used to influence the sympathetic bystander to partake in the search for a solution (Thomas & Louis, 2013). This study suggested that through collective action, we as South African citizens can finally be heard by our leaders. And judging by our current situation, any chance of change should be utilized.

Health care professionals are expected to make decisions that favor the patient’s needs (Cameron, Schaffer & Park, 2001). This study found that students’ principles, when faced with an ethical dilemma, focused on doing what was ‘in the client’s best interest’. That is exactly what I did during my personal ethical dilemma. I favored my patient’s needs despite MY need to take action.

This was quite the ethical difficulty and until that day I never thought of ways to deal with these complex situations. Hurst (2005) confirmed that ethical difficulties are widespread in clinical practice and it was found that it is not necessarily feasible or desirable to have ethics consultants involved in all of them. However, in some cases they proved to be useful (Hurst, 2005). Furthermore, it was found that even when seeking help, health care professionals may not be confident that an ethics consultation service would provide the right, or an effective, kind of assistance. It is evident that when faced with an ethical difficulty, we as health care professionals tend to do what WE feel is right.

After reading the available literature, I am still not sure if I made the right decision. It’s clear that it was only a decision I could make. I certainly made the right decision for my patients, as they received the treatment they had the right to. If this was the right decision, despite our horrific reality, when will it be acceptable to favor something above my patients? If it is considered unethical to favor something much bigger than any of us?

Reference list

1. Abrahams, N., Jewkes, R., Martin, L., Mathews, S., Vetten, L., & Lombard, C. (2009). Mortality of Women From Intimate Partner Violence in South Africa: A National Epidemiological Study. Violence And Victims, 24(4), 546-556. doi: 10.1891/0886-6708.24.4.546
2. Cameron, M., Schaffer, M., & Park, H. (2001). Nursing Students’ Experience of Ethical Problems and Use of Ethical Decision-Making Models. Nursing Ethics, 8(5), 432-447. doi: 10.1191/096973301680195364
3. Dunkle, K. (2004). Prevalence and Patterns of Gender-based Violence and Revictimization among Women Attending Antenatal Clinics in Soweto, South Africa. American Journal Of Epidemiology, 160(3), 230-239. doi: 10.1093/aje/kwh194
4. Hurst, S. (2005). How physicians face ethical difficulties: a qualitative analysis. Journal Of Medical Ethics, 31(1), 7-14. doi: 10.1136/jme.2003.005835
5. Merten, M. (2019). PARLIAMENTARY WOMEN’S DAY DEBATE: Official statistics prove War on Women is real – and pretty words are mere lip service. Retrieved 10 September 2019, from https://www.dailymaverick.co.za/article/2019-09-04-official-statistics-prove-war-on-women-is-real-and-pretty-words-are-mere-lip-service/
6. South Africa’s shocking gender based violence statistics – Alberton Record. (2019). Retrieved 10 September 2019, from https://albertonrecord.co.za/225326/south-africas-shocking-gender-based-violence-statistics/
7. Thomas, E., & Louis, W. (2013). When Will Collective Action Be Effective? Violent and Non-Violent Protests Differentially Influence Perceptions of Legitimacy and Efficacy Among Sympathizers. Personality And Social Psychology Bulletin, 40(2), 263-276. doi: 10.1177/014616721351052
8. https://www.batimes.com.ar/news/argentina/campaigners-demand-action-after-january-surge-in-femicides.phtml