Fellow Since 1994
This description of Mmatshilo Motsei's work was prepared when Mmatshilo Motsei was elected to the Ashoka Fellowship in 1994.
Mmatshilo Motsei has established the Agisanang Domestic Abuse Prevention and Training program (ADAPT), a clinic-based program that trains health care and social workers in accurate detection and appropriate interventions for survivors of gender violence. Following the first democratic elections in South Africa, Mmatshilo was appointed a national advisor to the government on women and gender. From this vantage point she has been able to spread ADAPTs methodology throughout South Africa.
The New Idea
Mmatshilo's first goal is to make everyone -- the general public and the professionals -- aware of the physical, sexual, and emotional trauma domestic violence causes millions of South Africa women regularly now. Second, she seeks to equip community and health care workers and their institutions to diagnose and deal with abusive situations quietly and effectively. Towards these ends she has created the Agisanang Domestic Abuse Prevention and Training (ADAPT). Through ADAPT, Mmatshilo seeks not only to reduce the incidence of violence in the home, but also to transform existing approaches to women victims of violence in clinics and hospitals, in health care training institutions, and at the national policy level. ADAPT will teach women and men in existing community-based organizations about the dynamics of family violence. It will also train them how to counsel effectively, how to increase community awareness of the problem, and its serious consequences, and how to formulate and press for better hospital/clinic policy and more appropriate "treatment" for battered women.
Continuing political violence, increasing rates of alcoholism and violent crime, the illegitimacy of the law, poverty, the trauma of racial "inferiority", and rapid urbanization have built up an almost unbelievable culture of violence and fear throughout South Africa. Amid desperate attempts to curb public violence, little attention has been paid to its concomitant violence within the home. At the policy level, within the public sector, and in the struggle for national liberation, the connection is seldom made between abuse in the public and private spheres. The majority of South African men view violence against women as a secondary issue, unrelated to the struggle for national liberation. As a result, many people perceive violence against women as normal, as being condoned by the traditions, laws and values of their society. Many men believe "tradition" and "culture" justify "disciplinary" actions against their partners, actions that are often degrading and all too often result in severe physical injuries, hospitalization and sometimes even death. Recent surveys show that at least one in six South African women are regularly abused by their male partners. Of these women, most will visit health institutions to seek treatment for their physical injuries and psychological trauma. In fact, in ADAPT's pilot community, at the Alexandra Health Clinic, Mmatshilo reviewed and analyzed 389 records of women with histories of assault. The victims, some of whom were pregnant at the time, were attacked with weapons ranging from bare hands to knives, bottles, hammers and axes. In all, 482 injuries were recorded, with 61 women requiring hospitalization. Some of the most common reasons for hospitalization were fractures, deep scalp lacerations and penetrating chest wounds causing internal injuries. Given the dearth of services for battered women, the clinic or hospital is usually the first contact point for women victims of violence. Strangely, however, Mmatshilo's research has shown that health care workers rarely identify victims of abuse. When they do, health care professionals tend to blame victims for provoking the violence. In Mmatshilo's study, only 17 percent of the women who sought medical attention for their injuries were identified as victims of domestic violence and in 78 percent of the cases neither the cause nor the assailant were recorded. This inattention is now the norm because health institutions have no policy guidelines for handling women victims of violence.
The first phase of Mmatshilo's project concentrates on building support for abused women through training health and community support workers. Mmatshilo will start with ten women from existing community organizations in Alexandra, one of the townships outside Johannesburg that has recently experienced terrible political violence. Mmatshilo will then use consciousness-raising exercises and workshops to promote self-awareness and to train these women about gender issues, domestic violence, counseling and intervention. Mmatshilo's next goal will be to create battered women's shelters, a particularly sensitive issue due to the housing crisis in Alexandra. As an interim measure, she has persuaded a Johannesburg institution to reserve two beds for Alexandra women. ADAPT will staff this starter facility. In its third phase, ADAPT will convene conferences for health care training institutions focusing on violence against women as a health care issue and on creating more gender-sensitive curricula. The conference proceedings, as well as ADAPT's workshops and interviews, will be translated into a manual that will help health workers empower women at the hospital and clinic level. ADAPT will negotiate placements for student nurses participating in the project, and will lobby health policy makers and providers for broader recognition of the problem. ADAPT will also attempt to get to the root of the problem by initiating support groups for men to increase their awareness about gender violence and its consequences. ADAPT will also try to find other ways to involve men in reducing violence against women: it perceives this to be a critical part of its work of advancing women's human rights. Mmatshilo is planning a video project to explore the underlying cultural, economic, religious and political factors that contribute to the problem of violence. She hopes it will provide a powerful way of waking people up to the enormity of this so far unrecognized problem -- particularly for those who cannot read English. It should also be a useful training tool. ADAPT will also try to introduce an ongoing education program within the community and primary school system.
In 1976, after writing her matriculation examination, Mmatshilo began nursing in a rural hospital in the Eastern Transvaal. While continuing her training, however, she became frustrated by the regimented and racially distorted nature of her nursing education. She was trained to provide medication to tuberculosis patients, without questioning inequality in health care. She was taught that ignorant mothers are to blame for malnourished children. Mmatshilo first became aware of domestic violence while working as a registered nurse in a hospital emergency department. At this stage, she treated the injuries but could do nothing to break the recurring cycles of violence. After working for two years at this hospital, Mmatshilo completed a nursing degree at the University of the North, majoring in nursing education, community health and psychology. Again, her official training encouraged her and the other nurse trainees to be submissive. After graduation, Mmatshilo worked for six months as a nursing tutor in Tembisa Hospital, outside of Johannesburg. However, dissatisfied with the static and racially biased syllabi and teaching methods, she joined the Center for Health Policy at the Wits Medical School. In conjunction with the South African Domestic Workers' Union and with the Wits-based Project for the Study of Violence, Mmatshilo then conducted a study on violence against domestic workers. For the past two years, utilizing her knowledge and with her new goals in mind, she has been preparing the ground for ADAPT.