South Africa: Going Viral – Dr Chivaugn Gordon On Medical School With a Difference

With humour and wearing an occasional wig, Dr Chivaugn Gordon teaches medical students about serious women’s health issues. During hard lockdown she delighted students at the University of Cape Town (UCT) with educational videos using household items as props. For example, she created an endometrium (the inner lining of the uterus) from hair gel and red glitter, performed a biopsy on a potato, and showed a chicken hand puppet go into labour.

One video features a patient named Zoya Lockdownikoff – who is a spy – consulting with her doctor about abnormal menstrual bleeding. Gordon, in a blonde wig with round sunglasses, plays Lockdownikoff; and Gordon’s husband, Dr Adalbert Ernst, plays her doctor.

Lockdownikoff explains that the bleeding started when she “did a very complicated backflip to escape a very compromising situation” and that it’s ruining her expensive super-spy coats.

Gordon is head of undergraduate education at UCT’s Department of Obstetrics and Gynaecology, while Ernst is with the university’s Department of Anaesthesia and Perioperative Medicine.

Speaking from her yellow-walled lounge in Cape Town’s Bergvliet, Gordon says: “I became a doctor because I love working with patients. And then I realised, oh cool, I love teaching too. And now I can do these two things together.”

Her desire is “to produce competent, reflective, caring and socially aware junior doctors, and sensitising students to the specific needs of women in South Africa, who are often traumatised and vulnerable, and suffer from many preventable diseases.”

Interest in IPV

For Gordon a driving interest has been intimate partner violence (IPV) which she introduced into her undergraduate curriculum in 2015.

“The aim is to have graduating doctors who are able to recognise intimate partner violence. Everybody thinks that you can’t possibly be abused unless you have a black eye or a fractured arm. But actually, IPV is often more psychological. It’s often psychological abuse. So the challenge is to teach young doctors what are the red flags in someone’s behaviour, or in their clinical presentation, that might indicate IPV.”

Published online in April, Gordon delivered a talk for TEDxUCT called “Tackling IPV, one awkward dad conversation at a time”, in which she notes IPV is “a global pandemic that has been ongoing since time began”. The title refers to Gordon’s father who raised her.

According to a paper published in the journal Lancet Psychiatry last year, IPV is the most common form of violence worldwide; it is most prevalent in unequal societies, and its victims are mostly women and girls. The paper states that worldwide 27% of women and girls aged 15 and older have experienced physical or sexual IPV, but in South Africa the figure is estimated to be much higher, between 33 and 50%.

Gordon contributed to South Africa’s revised Domestic Violence Amendment Act of 2021, through UCT’s Gender Health and Justice Research Unit.

The new legislation broadens the definition of domestic violence to include (above and beyond physical and sexual abuse) emotional, verbal or psychological abuse, which is described as “a pattern of degrading, manipulating, threatening, offensive, intimidating or humiliating conduct towards a complainant that causes mental or psychological harm…including (repeated) insults, ridicule or name calling; (repeated) threats to cause emotional pain; the (repeated) exhibition of obsessive possessiveness or jealousy…”

Gordon highlights the term coercive control. “Because that underpins most serious intimate partner violence. So, somebody who is extremely controlling; they want their partner to do what they want, when they want, and how they want immediately. They normally start isolating you from friends and family so they can spin a narrative of your reality that can’t be contested by anyone else. And it also makes it more difficult to leave.”

Red flags

Gordon highlights some of the IPV red flags that doctors should look for in their patients.

“Depression, anxiety, PTSD, insomnia, [and] things like self-medicating with substances,” she says. “Because when you are living in absolute, abject terror every day of your life, it’s going to manifest in some kind of psychological manner. So, when people have been broken down and worn down and their self-esteem has been eroded it also affects the way they might interact with the healthcare professional.

“Big red flags come out in body language. Usually when someone goes to a doctor, they tell you everything about all their symptoms, because they want you to make them better. So, if you’ve got a patient who is closed off, they’re not making eye contact, they’re avoiding answering your questions, they’re just very reticent and you can’t get anything out of them…then you’ve got to think.”

Gordon stresses that IPV happens across economic strata and in all walks of life. “Every time I run this workshop, a medical student who comes from a very privileged background, from a very financially stable, loving home, comes to me, saying this is happening to her. It happens everywhere. I’ve got medical colleagues, several, who have experienced intimate partner violence. It doesn’t discriminate.”

She notes that a key question to ask is why do perpetrators perpetrate.

“There are a lot of reasons,” she says. “As a country we come from a profoundly traumatised background. We have that massive legacy of apartheid and what that did to families, and the kind of role-modelling and examples that have resulted, which are full of alcoholism and rage against the system, which men couldn’t find ways to express so they take it out on everyone at home. There’s a huge amount of trauma in our country and you know, there’s that old adage that ‘hurt people, hurt people’. Children who have witnessed abuse, including psychological abuse, growing up are much more likely to become perpetrators or victims themselves because that’s the example that was set.”

Turning this around starts in childhood. “We need to allow boys the space to emote and to be vulnerable, we need to teach them how to deal with distress in healthy and non-violent ways,” says Gordon. “We must teach girls that only they are in control of their bodies and minds. We have to teach children the names for their emotions, so that they can be expressed and processed properly, and we have to teach them how to self-soothe.”

Drama or medicine

Inside Gordon’s lounge on a very full bookshelf titles range from The Vagina Monologues by Eve Ensler to the Twilight series, which Gordon – laughing – quickly points out belongs to her husband.

Born in Johannesburg, Gordon wanted to study either drama or medicine. She chose medicine, completing medical school at UCT in 2004. She went on to complete diplomas in mental health and HIV management, and a Master’s degree in Health Professions Education at Stellenbosch University.

Gordon’s own childhood was largely shaped by her father. Her parents divorced when she was two years old. Then her mother passed away in a car accident when she was six. Gordon was in the car when the accident happened.