Health-Sector Responses to Intimate Partner Violence Fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response?

This study aims to analyze how middle-level health systems’ managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: “IPV is a complex issue that generates activism and/or resistance,” “The mandate to integrate a health sector response to IPV: a priority not always prioritized,” and “The Spanish health system: respectful with professionals’ autonomy and firmly biomedical.” The core category, “Developing diverse responses to IPV integration,” crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.

Fortification and Frontier: The Project Drawn up by Juan Martín Zermeño for Puebla de Sanabria in 1766

Following the death of engineer General Jorge Próspero de Verboom in 1744 and after a few years of transition in the management of Spanish fortifications, Juan Martín Zermeño took on the role, initially with a temporary mandate, but then definitively during a second period that ran from 1766 until his death in 1772. He began this second period with a certain amount of concern because of what had taken place during the last period of conflict. The Seven Years War (1756–1763) which had brought Spain into conflict with Portugal and England in the Caribbean had also lead to conflict episodes along the Spanish–Portuguese border. Zermeño’s efforts as a planner and general engineer gave priority to the northern part of the Spanish–Portuguese border. After studying the territory and the existing fortifications on both sides of the border, Zermeño drew up three important projects in 1766. The outposts that needed to be reinforced were located, from north to south, at Puebla de Sanabria, Zamora and Ciudad Rodrigo, which is where he is believed to have come from. This latter township already had a modern installation built immediately after the war of the Spanish Succession and reinforced with the Fort of La Concepción. However, Zamora and Puebla de Sanabria had some obsolete fortifications that needed modernising. Since the middle of the 15th century Puebla de Sanabria had had a modern castle with rounded turrets, that of the counts of benavente. During the 16th and 17th centuries it had also been equipped with a walled enclosure with small bastions. During the war of the Spanish Succession the Portuguese had enlarged the enclosure and had erected a tentative offshoot to the west. In order to draw up the ambitious Puebla de Sanabria project Zermeño had the aid of some previous reports and projects, such as those by the count of robelin in 1722, the one by Antonio de Gaver in 1752, and Pedro Moreau’s report dated June 1755. This study includes a technical analysis of Zermeño’s project and its strategic position within the system of fortifications along the Spanish–Portuguese border.