Life: Whole Person Care and Forced Marriage
GMIMS Blogger and current medical student Anthony Jones shares his experiences of whole person care teaching at medical school and in particular the world of forced marriages and their effects on patients.
More and more in medical education, awareness and understanding of ‘whole person care’ is identified and reiterated as a key component of the curriculum. In my second year in response to a BMJ article I had read, I did a project about forced marriages as part of the ‘whole person care’ unit. I recently re-read my project and thought I would share the issues that surround the elimination of an archaic and evil practice. I hope this issue convinces you of the value of thoroughly listening to patients and reiterates the value of the consultation skills related to whole person care that you will learn revisit throughout your medical education and career.
Currently, people who are faced with the prospect of a forced marriage are protected by civil law. A FMPO can be taken out by the victims or by their representatives and the idea behind it is to change the behaviour of someone trying to force a person into marriage. They are however hard to monitor and with no immediate ramifications for breaking them, it is quite a weak piece of legislature. Ultimately the issue is whether or not to criminalise it, but people fear that it will mean less people will report it. Sameem Ali, labour councillor for Manchester’s Moss side, told the observer magazine in 2012; “Criminalising forced marriage would push the issue under the carpet... We can forget about the victims, they will not come forward”. The article tells us Ali’s story which is harrowing. She was taken to Pakistan from the UK when she was just 13 and forced to marry. She was a mother by 14. The nine months of pregnancy are filled with hospital appointments, check-ups, and scans etc. even if the pregnancy is complication free. Ali must have come into contact with a lot of doctors in that time and yet no one identified her situation.
Those who disagree with Ali argue that if it were criminalised there would be more of an obligation on medical professionals and more awareness generally, so such cases wouldn’t happen without the perpetrators being reprimanded. Maybe this is placing naïve faith in a legal system that thus far has been ineffectual, but intuitively I think the issue of coming forward is more complicated than people’s fear of prosecution. But Ali is insistent that she would never have resorted to legal action; “Because I didn’t hate her (her mother). I still cared for her”. This is despite physical and verbal abuse from her mother and being a domestic servant in her own home from the age of seven (having spent the previous six and a half years in a children’s home). She explains that a lot of Asian girls are similarly reluctant to publicly oppose their own families.
Jasvinder Sanghera is an example of someone who disagrees with Ali. She fled her family to escape her own forced marriage nearly 30 years ago. Years later her sister killed herself by setting herself on fire to escape her own forced marriage hell. Her charity, Karma Nirvana, has done its own research and found that from 1620 people, all but two (neutral responses) unanimously support the criminalisation of forced marriage. Forced marriages are criminalised in Germany and Denmark and there has been no decrease in the reports of forced marriage. She argues that nobody would be forced to use this law, so what is there to lose?
This was the discussion in 2012, and now in 2014 as part of the Anti-Social Behaviour Crime and Policing Bill, new proposals criminalising forced marriage are undergoing their penultimate reading in the House of Lords. Whether you think this is a good thing or not you will have to decide for yourself, and I have scratched at the surface of both sides of the argument from two very well-informed sources.
It is a thought provoking and important issue for medics as it is a societal problem that will be rife in many of the community’s doctors and future doctors will work in. An understanding of the issue and an appreciation of the duty of a doctor with regards the issue, drawing on the principles of the value and responsibility of caring for the whole person, means that hopefully you as prospective medicals students, will keep a close eye on the issue over the coming months and do the best by the victims and the future victims of this practice throughout your medical careers.
GMIMS Blogger Anthony Jones is currently intercalating in Medical Humanities between 2nd and 3rd year at Bristol Medical School. He wrote a play aged 11 and won the BMA news Medical Journalism Competition in 2013.