Translator: Maria Pita Reviewer: Elisabeth Buffard
We are in the midst of a global pandemic.
A hidden disease is threatening everyone in this room
and everyone watching.
One out of every six people in the world,
more than a billion people,
will be directly affected by one form of this disease in their lifetimes.
It can often leave no physical marks,
so it can be missed by healthcare providers.
It's so powerful that it devastates economies.
The US Department of Justice reports that one form of this disease
was responsible for the loss of 127 billion dollars per year,
and that's just in the US alone.
This devastating disease
is violence against women and girls.
I'll refer to this as VAWG. [Violence Against Women and Girls]
You might be thinking: "Hold on, that's not a disease!"
But this is my lens.
I'm both a medical doctor and an epidemiologist,
which is not a skin doctor,
but a public health scientist, studying patterns of disease.
Disease shapes how I think about public health problems and their solutions.
There's actually no universal definition of disease,
so I'll define it as an abnormal condition, with a cause,
that affects an organism.
The abnormal condition is the violence.
Unlike a viral disease, like smallpox,
the root causes of VAWG, Violence Against Women and Girls,
are sociopolitical in nature,
like gender inequality and unequal power relations between men and women.
But ideas spread and ideas infect,
so in this case VAWG is absolutely viral.
VAWG harms both men and women, across generations, in different ways.
Boys who witness their fathers abusing their mothers
are more likely to be abusive in their own relationships.
Women and girls experiencing violence are at an increased risk
for many serious outcomes,
including traumatic brain injury,
depression and fatal outcomes, like homicide, suicide,
and fetal death during pregnancy.
Modelling VAWG as a disease reframes this problem
and it highlights the urgency of global commitment to address it.
Consider how we once responded to smallpox,
once a horrifying disease that devastated up to 50 million people around the world.
But once it received global commitment,
a tremendous investment of resources
led to an unprecedented global vaccination campaign.
And in 1980, humanity achieved what was once unimaginable,
smallpox was eradicated.
[WORLD HEALTH 1980 smallpox is dead!]
Let's address VAWG the same way, with science and a global commitment.
Let's consider the different forms of VAWG,
the barriers to treatment or progress
and then solutions to overcome the barriers and move forward.
I've seen VAWG in different contexts:
from health centers in Kenya, Israel and Brazil,
to a refugee camp in Greece and health systems in the Philippines,
to right here in the USA.
Like different strains of a virus,
there are different forms of VAWG,
including honor killings, child marriage and more.
Today let's consider the most common forms of VAWG worldwide:
sexual violence and intimate partner violence.
Intimate partner violence can be sexual, physical or psychological.
Many of us have seen boys groping girls,
and many of us ignore this.
But this can escalate.
I've been in a community where men had a specific room,
in their homes, to beat their wives.
I've met a girl who went to the police with imprints of hot irons
burnt into her thighs, to pry her legs apart for rape.
And I've met a woman who lay awake terrified at night
because her husband kept a knife beside their bed,
and threatened to kill her, every night, for seven years.
There's one more story I want to share with you
and it demonstrated to me why we need to reframe VAWG as a disease.
I'm working in an East African health center, alongside a male doctor,
who is over six feet tall and he cares deeply about his patients.
We meet Lily, a thin-boned, 17-year-old girl with high cheekbones,
who comes in, standing with her head bowed down
and her eyes glued to the ground.
Lily has been raped.
When the doctor asked Lily to lie down on the examination table,
she shuts her eyes and she quietly whispers: "No."
She doesn't want to be touched
and she's not able to talk about what she's been through.
And in this moment, my heart breaks for Lily.
I turn to look at the doctor and he looks completely helpless.
He doesn't know what to do
and he's uncomfortable to examine a girl who has been raped.
And so, he decides to discharge her and he sends her home,
without any medications to prevent unwanted pregnancy
or sexually transmitted infections like HIV,
and without any referrals that recognize her risk of post-traumatic stress disorder
or her need for legal counselling.
Can you imagine a patient with a heart attack being sent home
because the doctor doesn't know how to respond?
Because of the language barrier I had with both Lily and the doctor,
I was helpless to change what happened.
And to this day, I feel deeply sorry that I wasn't able to do more.
This was a pivotal moment for me.
It brought to my attention the gaps in medical response around the world.
Lily's story is not unique.
This is happening in all countries, including right here in the USA.
In the USA, a study published in 2013
showed that over 80% of emergency departments in the US
did not provide complete care following a rape.
There is a pattern here.
Health systems around the world are often not recognizing VAWG as a health problem.
I'm an obstetrician and gynecologist
and I once submitted a proposal to a North American medical school
proposing to examine the healthcare response to intimate partner violence
with the focus on pregnant women.
Many women and girls experiencing violence around the world
often turn to health services as a first and trusted contact.
But this is the response that my proposal received:
"This research does not really represent obstetrics and gynecology research."
Let's reframe VAWG as a disease
because we need health systems to rapidly address three barriers to progress.
Number one: VAWG is massive.
According to global statistics,
one out of every three of the women among your family, friends and colleagues
has been beaten, forced into sex or otherwise physically or sexually abused.
What surprises me, as a doctor, are the global numbers for pregnant women.
Intimate partner violence in pregnancy is many times more common
than diseases we frequently diagnose in pregnant women,
like diabetes and high blood pressure.
Barrier number two: VAWG is marginalized.
It is underfunded in health budgets around the world.
Barrier number three: VAWG is mismanaged.
I slaved through hundreds of sleepless nights in my medical training
to learn about many diseases,
but like many thousands of doctors, nurses and midwives around the world,
I graduated with no formal training on VAWG.
Many countries around the world
do not have guidelines for clinical providers,
outlining a standard of care on how to respond to VAWG.
As just one example, in 2014, I worked with a team of researchers
and we found that in Latin America and the Caribbean,
over half of the countries had no clinical guidelines.
Given that VAWG is massive, marginalized and mismanaged,
how do we ensure that Lily's doctor will know how to respond in the future?
Lily's doctor, like all healthcare providers in the world,
needs training.
Like a 3D session I helped organize in 2014 with a team of local Rwandans.
At the beginning of this training,
only 26% of the participating health providers
felt confident to provide care for survivors,
but by the end of this training, this number increased to 96%!
Lily's doctor, like all healthcare providers in the world,
needs to learn to better coordinate with legal services.
This is crucial worldwide.
In the US, the Department of Justice
reports that two out of every three rapes and sexual assaults
are not reported to the police.
And introducing nurses trained to do forensic medical exams,
increases the number of cases that patients report
and increases conviction rates.
How different would Lily's life have been if her doctor had proper training
before meeting her?
Just like we can vaccinate against viral diseases,
we can vaccinate to prevent cases of VAWG by using education and interventions
aimed at gender inequality and other root causes.
It is vitally important that both men and women are vaccinated
and are involved in the cure.
This works.
In Uganda, a study in which community leaders worked with both men and women
to learn to equalize power dynamics, over three years,
cut a woman's risk of physical violence from her partner by half.
This is the transformative power of education.
What would the world look like if we eradicated VAWG?
Millions of women and girls would be at lower risk
for drug and alcohol dependence and debilitating depression.
And if they could instead realize their full creative potential
and achieve their dreams,
who knows what TED talks they would deliver?
An entire generation of boys could grow to thrive
in healthy relationships with women.
And let's not forget about the 127 billion dollars we no longer lose in the US
related to rape.
Evidence shows us that interventions work to lower cases of VAWG
and they don't take generations, but just a few years.
Just like the human body reacts to a disease with an immune response,
we are seeing some signs
of an international immune response to VAWG.
My former medical school has introduced VAWG into their curriculum.
Since we demonstrated the lack of guidelines in 2014,
a few more countries in Latin America and the Caribbean
are now requesting support to develop guidelines and carry out trainings.
But this is nowhere near enough.
There is still resistance worldwide and too many girls like Lily in the world.
So here is what we need to do.
Health policy makers, we need you to prioritize VAWG in your budgets,
we need you to implement, to develop and implement guidelines in your countries.
Health educators,
get VAWG training programs into every medical and nursing school
around the world.
Doctors, nurses and midwives,
commit to routinely asking your patients if they feel safe in their relationships.
Too many women and girls are silently affected by VAWG
and you can play a critical role in supporting these women
and minimizing the health impact.
Philanthropists and funders, scientists working on VAWG,
working on gender inequality and other root causes of VAWG
need your support.
And everyone else, join in, share your voice at #curevawg
if you want your health system to respond to this pandemic.
For all of the women and girls in your lives,
let's all be a part of the global immune response.
Thank you.
(Applause)