BEAT BY BEAT
Health professionals play an important role in keeping women from abuse
By MILES DUMALAGAN
Correspondent
 "The sad reality of battered women syndrome is that domestic violence happens everyday," said Dr. Josefina Uson, head, University of the Philippines-Philippine General Hospital Women's Desk at the Philippine Dermatology Society convention last year. "These victims come to the hospitals, to the clinics. We do play a very significant role to detect the victimization, prevent further violence, and also deliver correct management as rapidly as possible."
Women and children are often the victims of domestic violence. Early recognition can save them from further physical and psychological damage. Domestic violence, said Uson, refers to "the intentional intimidation, physical and/or sexual abuse or battering of children, adults, or elders by family members or caretakers."
Health professionals have three main roles in the management of battered women. But sometimes, Uson said, "doctors think that recognition, identification, and the referral of abuse [are] not part of [their] role."
Often doctors find it difficult to deal with their own feelings provoked by the interviews (being angry with the patients and asking them why they do not leave their abusive partners), claimed Uson. Some may even be skeptical upon checkup because the assailant is actually with the patient.
But she stressed: "As health professionals we should not be afraid to ask."
WARNING SIGNS
There are certain identifiable barriers in detecting abuses, she said. These include the lack of awareness to the prevalence, means of identification, severity of the problem, and social and psychological causes of abuse.
But Uson said that if any of the following is encountered, the possibility of abuse must be considered: physical examination findings incompatible with the history; a delay in seeking medical attention; and a pregnant woman who comes with a lot of injuries.
The common types of physical injuries found are contusions, abrasions, lacerations, burns, soft tissue swellings, fractures or sprains, and injuries to the head and neck, breast, chest, and abdomen.
Uson also said that injuries during pregnancy have usually multiple sites and don't usually result from a single act. Doctors should look for bruises or marks that form symmetrical patterns or regular patterns on the back, buttocks, or thighs.
She added: "Bruises may have the shape of the instrument that was used to inflict them, if for example a belt buckle or a cord to strangle the patient; burns by cigarette look like well-circumscribed brown scars, if they were simply accidental they won't look as rounded, as well circumscribed."
Patients may also be unable to move extremities because of fractures and "there could even be injury to the viscera and abdominal trauma."
In sexual abuse the external genitalia have to be examined for scars, hairs, genital infections, bruises, itching in the genital region; genital or rectal bleeding, there could even be difficulty in walking and sitting.
In the review of systems the possible findings may be the following: chronic pain, vegetative functions are affected, there's fatigue, sexual dysfunction, chronic headache, and cardiorespiratory and gynecologic symptoms.
But domestic violence also has an insidious component-psychological abuse. This can involve any nonphysical behavior that undermines the victim or that enables the perpetrator to control the victim. The assailant may use abusive language to humiliate, degrade, demean, or threaten the victim in private or public. Psychological problems include posttrau-matic stress disorder, substance abuse, anxiety, and depression.
Patients may manifest with anxiety, or even with panic. Patients would appear depressed with feelings of isolation and inability to cope. "Some of them may even verbalize or in some cases they can manifest with psychotic symptoms," said Uson.
They may also appear frightened, ashamed, evasive, or embarrassed. The partner usually accompanies the patient and insists to stay close and answer all questions for her. In this case, doctors should take this opportunity in doing the PE to excuse the patient from the partner so they can talk to the patient in private. The victim may also be reluctant to speak in the presence of the spouse.
"This is a very good clue because most of them do not want to disclose for fear of retaliation," said Uson. "There's also denial or minimization of violence by the partner or even the patient."
WHO TO CALL FOR HELP
KALAKASAN Foundation
Kalakasan Women's Crisis Center
Tel: +63-2-7355555
Tel/Fax: +63-2-7358303
Women's Crisis Center
Tel: +63-2-9267744; +63-2-9225235
UP-PGH Women's Desk
Tel: +63-2-5242990;
+63-2-5218450 extension 3072
Philippine National Police (PNP)
166 (for emergencies)
117 (for nonemergencies)
BREAK THE CYCLE
LONDON
Atrocities against women including rape, murder, and mutilation must be stopped, human-rights watchdog Amnesty International (AI) said in March, after reporting that one in three women in the world will suffer serious violence in their lifetime.
"Violence against women is a 'cancer' eating away at the core of every society, in every country of the world," AI secretary general Irene Khan said. "Violence against women is a human rights atrocity. From the battlefield to the bedroom, women are at risk. Governments are failing to address the real 'terror' of our world that millions of women face every day."
Kicking off a campaign against violence in women, AI presented a 122-page report outlining the scale of violence against women--some of whom are "denied the right to ever exist"--and calling for urgent action and changes to international law.
The report pointed in particular at the need for governments to address "cultural" practices such as female genital mutilation (FGM) and so-called "honor" killings.
Each year two million girls between five and 15 years are introduced into the commercial sex market and 700,000 women and girls are trafficked for sexual exploitation, AI said. Around 135 million girls and women globally are estimated to have undergone FGM and a further two million girls a year are at risk of being subjected to it.
"Armed conflict is having a devastating and desperate impact on women that goes far beyond the inherent violence of war," Khan said, adding that civilian women and girls were often mutilated, raped, and murdered as a weapon of war. "Violence against women is not normal, legal nor acceptable and should never be tolerated or justified. It can and must be stopped."
The report highlighted the fact that up to 70 percent of the world's female murder victims are killed by male partners.
AFP
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