Nabeela waited for her contraceptive injection with the slack of her sari pulled low over her forehead. The pharmacist, her long braid neatly oiled, dove a needle into the muscle of her patient's left arm with easy grace. In the waiting room, Nabeela's fourth child, almost ten months old, bounced on her sister's lap. The space barely accommodated the women who lined up each morning, leaving daily chores in the hands of their daughters, most of whom had been pulled out of school for just this purpose.
Outside, summer showers fell stubbornly, and muddy streets were clogged with rickshaws like plaque along artery walls. I was a rising second-year medical student, spending the summer running a study on domestic violence screening in Dhaka, Bangladesh. The family planning clinic lay along gondho goli, an alleyway fondly named for its insurmountable stench. Those who passed through moved quickly, pressing a kameez or a shirt tightly against their noses. Skirting around footpath stalls, narrowly avoiding power lines and large cuts of meat that hung ominously, morning commuters left the Bottala slum district and entered the teeming pockets of Dhaka city.
After her injection, Nabeela entered the counseling room, having consented earlier to participate in my research study. She removed the covering over her head, and her dewy eyes came into focus. Only then did I learn that during her fifteen years of marriage, Nabeela had been repeatedly beaten, threatened, and forced to have sexual intercourse by her husband. Once, her arm broke from the force of impact with a steel rod. Another time, a fist to the side of her head shattered an eardrum. Last year, when the abuse became unbearable and she tried to file a police report, she was turned away by a junior official who sneered, "These are matters between husband and wife. They are best resolved at home."
Three months from now Nabeela will return to this clinic, again awaiting the medication to protect against pregnancy from her husband's incessant coercion. Perhaps her tawny arms would bear bruises. Likely, their cause would go unspoken.
In Bangladesh, one in two women has experienced physical or sexual abuse by her husband. Worldwide, 30-60 percent of women have ever experienced domestic violence from their spouses or domestic partners. Health providers are aptly positioned to intervene, especially in communities most vulnerable to unchecked abuse, but often they do not. As one cynical woman noted with a laugh, "Doctors should ask about domestic violence, but they won't find the time."
Moments after Nabeela's buried story was unearthed, she crumpled into sobs, imploring us to help her, to help her children. Then, promptly, she fastened her headscarf as if to reassemble the shards of truth so carelessly dropped. Newly composed, she listened to an explanation of varied resources - legal counsel, shelters, crisis centers - but the stiffening muscles in her face revealed the incongruity of these well-intentioned words with reality. Her fear was the quietest thing, slipping into its reluctant routine with the mute precision of a shadow.
Health-care providers should intervene in social issues that impact health, such as family violence. However, lack of time and sufficient training often prevent them from doing so. Additionally, a recurrent fear is that questioning a patient about domestic abuse will scare her away. But my experiences in Bangladesh suggested otherwise. Instead, women find safety and even a therapeutic unburdening in being able to confide in their physician, even if nothing about their situation changes. Before leaving the room Nabeela turned back, wiping and unwiping the hands that would soon enfold her restless, gurgling baby: Apa, halka laglo. "Sister, I feel lighter."
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the Stanford Medicine Unplugged category.
Amrapali Maitra is a sixth-year MD/PhD student at Stanford studying medical anthropology. This academic year she is based in Kolkata, India, conducting dissertation research on women's health, poverty, and gender-based violence. Her research study in Dhaka, Bangladesh in 2011 was funded by a MedScholars Grant.
Photo by Arttu Manninen
