She Belongs Podcast: #1 Gender Based Violence During Disasters
By: Varshini Subhash
Tags: Gender Equality, Gender Based Violence, Disaster Response, Covid 19

Varshini: To kick things off, could you tell us more about what you think makes women in a disaster setting more vulnerable to violence?

Prof. Goodman: It’s important to acknowledge that gender-based violence is much more frequent for women, although it also occurs to men. The statistics say that 1 in 3 women experience some form of intimate partner violence or gender-based violence, which makes it extremely common worldwide. In a disaster setting, many things can go wrong and the outcome could be tied to the culture, norms and environment of the location of the disaster. For example, due to Hurricane Katrina, many parts of the Gulf Coast saw an uptick in intimate partner violence. The reasons for that are probably slightly different than the tremendous gang rape and sexual assaults that occurred after the Indonesian Tsunami. Overall, I think it has to do with vulnerability, lack of resources in the environment and a lack of protection. The traditional roles that a woman plays could also hinder her from seeking help. She has children to nurture, whom she can’t abandon in order to protect herself. She may be responsible for getting food and firewood for the family, which we saw in the violence incited by the Darfur genocide by the Sudanese government. It may also have to do with the mindsets of the perpetrators of this violence — their frustration, their sense of loss and how they have been raised to express this loss and fear. So it’s not so much to do with a massive faceless rapist out in the open, but more of an underlying cause that led to an increase in behavior that is normative and potentially accepted in society.

Varshini: I agree, we often do think of them as faceless perpetrators. From the perspective of a first-responder, how is the experience different in the backdrop of a disaster compared to a hospital environment like Massachusetts General Hospital?

Prof. Goodman: That’s a great point. This question leads me to reflect on how one needs to train and lead in these different settings, because they are quite different. Mass General Hospital and other large hospitals are places that have a multitude of resources at their disposal, be it different specialties, instrumentations or medications. You have trauma surgeons at your command, a blood bank, a pharmacy with antibiotics and an operating room with an anesthesiologist. The other thing that you have is a standard of care, backed up by policies that are based on data-driven medicine.

In a disaster, all these tools are not guaranteed. For instance, Superstorm Sandy caused power outages in the East Coast of the United States and led to massive displacement of people and evacuations from hospitals. There were many disabled people whose kidney dialysis programs had to be moved. It’s been close to 10 years since then and there are people who are still recovering from it, but the infrastructure was still intact at the time.

On the flip side, there are disasters like the 2010 earthquake in Haiti, where the infrastructure was completely destroyed. There were no existing hospitals standing, the government and Parliament was destroyed and many of the leadership of Haiti had been killed. The United Nations tried to run and police the area which was quite chaotic.

One of my most profound lessons actually came from a chaplain from another disaster team who told me that in a disaster setting, there are daytime rules and night-time rules. Daytime rules entail a good standard of care, abundance of resources and great infrastructure. In contrast, during night-time rules you don’t have much and you do the best you can with what you have and this often does not adhere to the standard of care. In many disasters, you’re working on night-time rules, which is very stressful because you know that this baby could have been saved at Mass General Hospital. However, you are in an environment where they die because you are following night-time rules.

Varshini: That is so profoundly heartbreaking. Your research talks about providing treatment to three pregnant women in Haiti who suffered from paraplegia, quadriplegia and fatal heart failure. How do you personally navigate the emotional stress and trauma that comes with witnessing these situations?

Prof. Goodman: I think there is a certain gene for disaster response just like there is a gene for being a firefighter. Everyone else is running away from the fire and then there are some people who run towards the fire. Studies show that psychologically, people who fall in this category tend to have a high degree of self-criticism, probably generated by their own life experiences. Such a personality is inherently very hard on itself. There have been stories of responders committing suicide due to a huge sense of personal failure. So the flip side to this heroism is this fragility and vulnerability to failure, making it seem like it was your fault if you couldn’t save someone.

On a personal note, I will admit that I do have that gene and I have been able to navigate it so far by focusing on training myself and being an overachiever. For example, my first disaster deployment was in 2003–2004 to Iran after the Bam Earthquake. It was a profoundly moving experience to go into that situation, where 60,000 people had died. The complete infrastructure of a small and modern city had been destroyed. However, when we came back, two of my colleagues killed themselves — not right away, but over the next year. I thought about that a lot and decided that I needed more training on how to manage grief, which was the beginning of my journey to becoming a chaplain. I ended up taking chaplaincy training and completing a theology degree, with the goal of trying to figure out how to manage grief. Seeing people die of grief pushed me to respond by trying to be better, by getting my skill set up so that I can manage my own grief.

Varshini: Thank you for sharing such personal details about your journey. I want to touch upon the rise in gender-based violence during COVID-19. Would you classify COVID-19 as a disaster setting? If yes, how do you compare this to your experience in Haiti. If not, what are some differences?

Prof. Goodman: That’s a great question. Ironically, it’s much easier for us to manage something like Haiti than managing COVID-19. We saw this tremendous outpouring of generosity and funds and volunteering to go and help after Haiti. Name any catastrophe and people are running in to help. It is almost like we can get our head around this very discrete, finite moment of loss and destruction and then we rebuild.

When I look at COVID-19, it reminds me of the story where you put a frog in a pot of water and you slowly heat it to the boil. The frog doesn’t realize the imminent danger until it is too late. This pandemic has brought out this exact reaction and after a year of its entry into the US, we can look back with some perspective. We see a death toll of a quarter million people, which is more than most of our wars. It’s interesting how instead of bringing out the best in humanity, this pandemic has brought out hatred, tribalism and anger in society. So yes, it is a disaster, but it’s a disaster for our souls in addition to our bodies.

Varshini: That is such a poignant way to put it. To conclude things, tell us more about the ‘Strength and Serenity’ initiative as well as the training that your team is providing with respect to violence in disaster settings.

Prof. Goodman: Strength and Serenity is a small group, based at Mass General Hospital, which I started a few years ago with some charity donations, to study gender-based violence in the setting of societal structural violence. Many of the reproductive outcomes that we see, such as maternal mortality, cervical cancer, malnutrition are often the endgame in a lifelong battle against gender-based violence. As a physician, I call it the endgame because it stems from this normative environment that allows for abuse and neglect of women. Early intervention could potentially lead to prevention of death and other undesirable outcomes such as children growing up without their mothers.

Strength and Serenity tries to address this in a way that is two-fold. On the one hand, our work is academic, in terms of writing and publications and developing a large database of literature. This is available on our new website to anyone who would like to look at a particular aspect of gender-based violence and use this comprehensive academic bibliography. The other aspect is training, which we started two years ago to help disaster responders in both screening and intervention for people who experienced gender-based violence. The final thread is the ongoing development of collaborative research projects and our current research project delves into obstetrical violence or disrespect and abuse in childbirth, in collaboration with a group in Tanzania. The outcome will be a qualitative and quantitative survey which will give us more insight on why women are abused by providers of maternity care.

For the complete conversation, please check out our episode on any of the following: YouTube, Anchor, Pocket Casts or Spotify.

Credits: Merih Deniz Toruner (Co-Author).

Team: Haleema Ahmed and Nicholas Huang.

Music: Nicholas Huang.