Medical management of domestic violence (1)

FOR too many women who are victims of domestic violence, especially for those who have been abused physically and emotionally, the hospital may be a place to visit for succour and strength.

My first case of domestic violence was as a young, single doctor in my late 20s. On this particular day, I had reported for night duty at the hospital where I was into private practice. A good-looking woman, who ran an after, school class in the city, came in for consultation: The following conversation took place.

Patient: Good evening.

Doctor: Good evening, how may I help you?

Patient: My husband beat me this night.

Doctor: Sorry, did you? have any injury, cut, bruises, blood or swelling because of the incident?

Patient: No injury, please admit me, she said.

Doctor: Admit you. (This is the first case of domestic violence I will be treating).There is no injury, no bruises and I can’t see any signs of physical trauma.

Patient: Yes, I want him to come and pay. Please, let the nurse call to inform him, I am on admission.

Doctor: Ok, I will admit you because of emotional trauma and inform your husband that you are on admission.

We discharged the patient the following morning. She was happy and appeared to be more stable emotionally and she even exchanged her contacts with some members of staff of the hospital. Her husband came around to pick her and paid the hospital bill even though he wondered why an overnight bill would be so high.

We gave him the breakdown of the bill that comprised such things as consultation, counselling session (psychotherapy), accommodation, feeding, and medication fees.

He exclaimed, ‘All these in one night’.

I met the same woman about two years later; she expressed her appreciation for the way we handled that case. She is now reconciled with the husband. She said the counselling sessions helped them as a couple.

This is to encourage many women, who are victims of domestic violence to come forward, seek succour in the hospital or other accredited organisations.

Domestic violence is an abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or has had a dating or engagement relationship.

It is a pattern of coercive behaviour used by adults or adolescents to control their partners. It involves physical assault or the threat of it.

Types of abuse in domestic violence

They are physical, verbal, emotional, psychological, sexual, economic and spiritual.

Causes

There is no specific cause of domestic violence. Women at the highest risk of being the victims of domestic violence include those with male partners, who abuse drugs (especially alcohol), unemployed or underemployed, and are or have been in a romantic relationship with the victims.

Drugs and alcohol do not cause domestic violence. Sixty-five per cent of DV cases have no substance abuse involved.

Poverty also is not cause of DV. DV crosses all socio-economic, cultural and racial boundaries.

Signs and symptoms indicating domestic violence

Chronic pain or areas of tenderness, especially at the extremities, bruises, welts, edema or scars.

Others are swelling of eyes, shoulder dislocation, chronic headaches, sexual assault, signs of choking on throat, split lip depression, addiction to prescription, medications, alcohol, and/or illegal drugs.

Symptoms of post-traumatic stress disorder, suicide attempt, isolation from friends and family-only ties seem to be with partner. Work absenteeism/lateness indirectly brings up the subject of abuse.

Impact on children

Boys who witness violence against their mothers are 10 times more likely to abuse in adulthood than boys from non-violent homes. (Parents be warned.)

Children who live with DV victims face increased risks, which lead to negative outcomes and affect their well-being, safety and stability. They are exposed to trauma, neglect, and direct abuse, losing one or both parents

Impact on women

Women who suffer from DV experience depression, higher stress, and lower self-esteem, more likely to smoke tobacco, drink during pregnancy, receive less emotional support from partners, have depressive symptoms, and develop a chronic mental illness. They may have unplanned pregnancy, unprotected sex, sexually transmitted infections, intentional termination of pregnancy.