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Webinar Guidelines

• You will be listening to this webinar through your computer speakers. There is no need to call in.

• There is a chat box located on the lower right side of your screen for the live webinar.

• The live webinar will have a question and answer period at the end but you may type your questions into the chat box at any time.

Chat Box

Non-Conflict of Interest Statement

• The planners, moderators, and presenters for this webinar series do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in this presentation.

• This program is funded by a grant from the New York State Department of Health.

• No commercial funding has been accepted for this activity.

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Welcome to the Asian American Series

• This webinar is being presented live on February 17, 2016 and is being recorded and archived for future viewing.

• You can find answers to frequently asked questions, additional readings and resources, and instructions on registering for a certificate of completion for this series at: ww.advancingcc.org

Schedule for the Asian American seriesJanuary 26 – Webinar 1. Structural Competency and Health Equity: Asian American

Experience in New York City.• Chau Trinh-Shevrin, NYU School of Medicine. Archived and available for viewing at

www.advancingcc.org

February 5 – Webinar 2. Trauma and the Refugee Client: Barriers and Strategies for Care. • Kate Porterfield, Ph.D. Bellevue/NYU Program for Survivors of Torture• Jim Sutton, RPA-C Rochester General Hospital Center for Refugee Health

February 17 – Webinar 3. Violence Against South Asian Women: Understanding Cultural “Competency” of Structures that Heal• Shamita Das DasGupta, Ph.D. Manavi, Rutgers and NYU

February 25 – Webinar 4. Topic: Working with Asian American Communities• Nadia Islam, Ph.D. NYU School of Medicine/NYU Center for the Study of Asian American Health

What is Structural Competency?Structural competency refers to the capacity of practitioners to recognize and respond to the ways in which broad social, political and economic mechanisms contribute to the vulnerability and ill health of the individuals and communities we serve.

Narrative humility, a term developed by Dr. Sayantani DasGupta of Columbia University, is a listening stance that is integral to structural competency. It refers to the humility we must have when listening to other people’s stories because every story contains an element of the unknowable. Narrative humility should used with everyone who walks through your door, not just certain population groups.

In this webinar the presenters will demonstrate the principles of narrative humility as they discuss the best ways to work with refugees.

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The 4 “Beats” of this Structural Competency Program

1. Historical frames of oppression

2. Present day sociopolitical barriers and challenges to health

3. Working with activists advocates within the community

4. Clinical cases

Continuing Education Credits and Evaluation

You can earn CNE, CHES, CPH, or CME credits for this webinar.

Complete the post test and evaluation here:http://www.ualbanycphp.org/eval/SPHeval.cfm?ID=277

Even if you are not earning continuing education credits, we would really appreciate it if you would fill out the evaluation. We value your feedback and are using it in the development of this structural competency webinar series.

Learning Objectives

After this webinar you will be able to:

1. Identify at least two of the major components that support violence against women in society.

2. Identify three key institutional factors that affect South Asian survivors of domestic violence.

3. Recognize three health care issues specific to South Asian Women who experience domestic violence.

4. Name three things we can do to move toward structural competence in handling violence against women.

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Today’s Presenter

Shamita Das Dasgupta, Ph.D.Co-founder, ManaviManavi is a New Jersey-based women's rights organization that works to end all forms of violence against South Asian women living in the U.S. It is the oldest such organization in the United States.

Shamita Das Dasgupta, PhD

Violence Against South Asian Women UNDERSTANDING CULTURAL “COMPETENCY” OF STRUCTURES THAT HEAL

Shamita Das Dasgupta, Ph.D., Co-founder, Manavi

We will discuss:

General understanding of language & definitions

The nature of violence against South Asian women

The role of “culture” in explaining behavior, intimate violence, & health outcomes

Understanding structural biases in violence against South Asian women

A few illustrations – case studies

The role of narrative humility in ameliorating violence against South Asian women

Agenda & Focus

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Immigrant, Indian, Psychologist, Advocate, Community Organizer,

Mother, Grandmother, Teacher, Anti-Violence Against Women Activist

Locating Myself

Shamita Das Dasgupta

Beyond Individualism: Understanding Structural Bias

Structural Bias Definition: Unjustified favoritism displayed by socio-legal institutions that manage peoples’ lives

Characteristics of Structural Bias: Is hegemonic (involves universal domination) Favoritism toward dominant group remains invisible Ensures socio-legal status quo of marginalized communities Politically & materially benefits the dominant group Affects nearly all areas of existence including health outcomes Social change efforts by disadvantaged groups seem ungrateful, privilege

seeking, childish, & destructive

Healthcare providers tend to consider race, ethnicity, & class in the context of how it negatively affects the health of an individual

They are rarely aware of or consider how race, ethnicity, misogyny, & class affect their own perceptions & effective healthcare delivery

Most healthcare providers tend to overlook that what they consider individual problems are consequences of historical structural decisions & factors that have & continue to affect a community

Structural Factors & Healthcare Delivery

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Locating medical approaches to racial diversity solely in the bodies, backgrounds, or attitudes of patients and doctors, leaves practitioners unprepared to address the biological, socioeconomic, and racial impacts of upstream decisions on structural factors such as expanding health and wealth disparities.

~~ A. Deaton, 2003

Violence Against Women Is a systematic pattern of coercive behavior that includes intimidation &

subjugation

Establishes & maintains power & control over the victim / intimate partner

Entails abuse that may be : Physical Psychological Sexual Economic Emotional Verbal

Components that Support Violence Against Women (VAW) (DAIP)

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At least 1 in 3 women globally experience battering, sexual violence, & other forms of intimate abuse in their lifetime (UN Fact Sheet, 2015)

Women between 15 to 44 years of age worldwide are more vulnerable to domestic & sexual violence than they are to cancer, malaria, & car accident (UN Fact Sheet, 2015)

15% of all violent crimes in the U.S. is intimate partner violence

1 in 5 women & 1 in 71 men in the U.S. are victims of sexual violence

A Few Facts About Violence Against Women

Domestic Violence & CultureIndividuals perceive, experience, seek help for, react to, and ameliorate violence according to their own groups’ cultural

norms & beliefs

Facilitate help seeking Ensure survivor safetyAdvocate for justice – legal &

social Provide resources Bring social change to end

VAW

Goals of VAW Advocacy

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Battered Women & Healthcare Battered women average 1 visit to ER per year & non-battered

women average 1 in a lifetime Battered women who do not seek any other kind of help will use

the medical system Although 59% battered women visit doctors for their injuries, only

10% are identified & referred to appropriate assistance The financial cost of partner violence is 8.3 billion/year in survivors’

health-care & loss of productivity (NCADV) Victims of violence are more likely to contract HIV & STDs than

other groups

South Asia – South Asians

South Asia includes:

Bangladesh India Pakistan Nepal Sri Lanka Maldives, Bhutan,

Myanmar (At times) Diaspora

South Asians in the U.S.

Immigrants Citizens Wives on Conditional Permanent

Residency (CPR) Visas Derivative visa holders Temporary workers Undocumented Second generation – born &/or

brought up in the U.S.

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Rekha Anwar, a recent immigrant from Bangladesh, comes to a Queens ER complaining of severe chest pain. Dr. Simon, who attends to her, finds Rekhaunkempt, highly stressed, underweight, with high BP, & a sizeable bruise on her left breast. He suspects domestic violence.

Dr. Simon has difficulty communicating with Rekha as she speaks with a different accent. He tries to find someone who speaks her language, but to no avail. Rekha says she has come with her mother and 13-year-old son. The mother seems to be more smartly dressed, put together, & affluent. Dr. Simon asks the mother to translate for her.

By this time, Dr. Simon has spent a lot of time with this one patient. He writes a prescription for pain medication & asks Rekha if he should call the police. When Rekha declines, he refers her to the social worker in the hospital and moves on to the next patient.

Story 1 – Case Study

Violence Against South Asian Women In The U.S.

In Boston, 160 highly educated/working women were surveyed [Raj, A., & Silverman, J. (2000) JAMWA] 35% claimed their current male partner had physically abused

them at least once during their time together

32.5% claimed they were abused within the past year

19% claimed their current male partner had sexually abused them at least once during their time together

15% claimed they were abused within the past year

Intimate Partner Violence Related Fatalities & Near Fatalities in the South Asian Community

(partial data)

Between March 2000 & December 2015:Homicide: 160 (87 women, 25 men, 48 children)Homicide/Suicide: 30 (6 woman, 24 men)Attempted murders: 38 (24 women, 7 men, 7 children)Attempted suicide with DV: 5 (2 women, 3 men)Suspicious disappearances: 7 (7 women)Killed by police: 2 (2 men)

Total 242 (126 women; 61 men; 55 children)

(Collected from India Abroad by SDD)

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A Few Health Care Issues in Violence Against South Asian Women

In the South Asian community, the silencing of battered women is exacerbated because physicians & victims may know each other socially

Many non-South Asian physicians are reluctant to question South Asian women about the cause of their injuries (Puri, 2000)

Many non-South Asian mental health practitioners ignore cultural and structural dynamics in domestic violence and thus, risk of misdiagnosing South Asian battered women

Nearly half of South Asian women have Limited English Proficiency (LEP)

What to do? Interpretation free of cost; translated materials Language linesWeb based translation Share resources “I Speak” Cards

Language Access

Let’s Talk About Story 1

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Key Cultural Factors that Affect South Asian Survivors

Culture

Socialization & religious background

Prohibition against leaving marital home

Ideology of good wife & mother

Glorification of sacrifice

Belief in divine guidance

Key Institutional Factors That Affect South Asian Survivors

Class Lack of financial resources Involvement in family business Western adherence to time

schedule Western concept of mental health Structured vs. unstructured

interaction Short vs. long term goal setting

Residency status Lack of information & life skills Racism

Facilitate your seeking help

Discourage you from seeking help

Assume you are living in a town in Pakistan

where your spouse is working temporarily. You

don’t speak Urdu and you don’t have many

close friends. Your spouse is being verbally

abusive and has even slapped you a few times.

Last time he hurt your eye. You are going to see

a doctor today. Your doctor speaks sketchy

English but is friendly. You want to speak to him

about the violence you are facing at home.

Note three factors that could:

Exercise

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Help Seeking Behavior of South Asian Women• Fear & shame of involvement with law enforcement• Embarrassment about reporting certain types of crimes;

e.g., family violence• Language barrier• Lack of knowledge of the U.S. legal & other systems• View of immigration/legal system as arbitrary & oppressive,

especially after 9/11/01 & in the context of recent anti-immigration sentiments

• Mental health help is perceived as unnecessary, unacceptable, & foreign

Rekha Anwar, the recent immigrant from Bangladesh we have already met,comes to the same Queens ER she visited before. This time she is with her 13-year-old son who is in distress.

Dr. Simon, who had treated Rekha earlier, attends to the son. He finds the sonhas a broken arm. The injury seems at least a few days old. Given his pastexperience with Rekha, Dr. Simon suspects child abuse. Upon questioning, themother says her son fell off a high structure in school but didn’t complain aboutthe arm until the night before.

Dr. Simon treats the son and reports the incident to the appropriate hospitalauthorities & CPS.

Story 2 - Case Study

Let’s Talk About Story 2

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South Asian Women’s Relationship with Structures of Legal ‘Justice’

• Memory of colonial British rule: Law enforcement & judiciary as the repressive arms of the administration

• Continued Mistrust: Law enforcement violence after independence

• History of high custody rape• Corruption in legal systems• Corruption among lawyers• Experience of racism & police brutality in the U.S.

Can we expect to create positive health outcome for battered women without advocating for justice?

Moving Toward Structural ‘Competence’ in Violence Against Women (VAW)

• Battering & sexual assault are not individual but socio-political structural problems

• All structural biases help maintain status quo & benefit the dominant group

• These structures are not just steeped in racism & classism but also xenophobia & misogyny

• Be suspicious of over-diagnosis of anything in one group, including trauma

• Identify practitioner & structural biases & advocate for change

• Develop collaborations between VAW advocates & healthcare practitioners must happen

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ReferencesDeaton, A. (2003). Health, inequality, and economic development. Journal of Economic Literature, XLI, 113-158.Fact Sheet on Violence Against Women. United Nations. Retrieved from http://www.un.org/en/women/endviolence/pdf/VAW.pdfNational Statistics on Violence Against Women. National Coalition Against Domestic Violence. Retrieved from: http://www.ncadv.org/learn/statistics/nationalPower and Control Wheel. Domestic Abuse Intervention Programs. Retrieved from: http://www.theduluthmodel.org/training/wheels.htmlPuri, S. (2007). The trap of multiculturalism: Battered South Asian women and health care. In S. D. Dasgupta, S. (Ed.), Body evidence: Intimate violence against South Asian women in America (pp. 139-151). New Brunswick, NJ: Rutgers University Press.Raj, A., Silverman, J.G. (2002). Intimate partner violence against South Asian women in Greater Boston.Journal of American Medical Women’s Association, 57(2), 111-114Shukla, S. (2003). India Abroad: Diasporic cultures of postwar America and England. Princeton: Princeton University Press.

Contact informationShamita Das Dasgupta, Ph.D.shamitadas@hotmail.com