DOMESTIC VIOLENCE DR LEE OI WAH, PEGAWAI PERUBATAN U48;HBG
CASE SCENARIO <ul><li>An ambulance is called to a residence for an unconcious female. On arrival, a man was sitting outsid...
INTRODUCTION <ul><li>Battered victims and batterers/perpetrators come from all economic & education levels,all racial & cu...
INTRODUCTION <ul><li>A significant public health problem; more than </li></ul><ul><li>5 million women battered annually wo...
DEFINITION <ul><li>A pattern of  assaultive  and  controlling behaviour  including physical, sexual & psychological attack...
DOMESTIC VIOLENCE ACT,1994 <ul><li>The commision of any of the following: </li></ul><ul><li>Willfully of knowingly placing...
DOMESTIC VIOLENCE ACT,1994 <ul><li>Confining the victim against the victim’s will. </li></ul><ul><li>Causing mischief or d...
THE COST OF BATTERING <ul><li>SURVIVOR </li></ul><ul><li>higher rate of alcohol and drug abuse </li></ul><ul><li>depressio...
THE COST OF BATTERING <ul><li>BATTERER </li></ul><ul><li>employment problems </li></ul><ul><li>alcohol & drug abuse </li><...
PHASES OF VIOLENCE <ul><li>Tension or build-up phase </li></ul><ul><li>~ increased tension building </li></ul><ul><li>Batt...
HISTORY <ul><li>S  -  Do you   feel  SAFE  in your relationship? </li></ul><ul><li>-  Should I be concerned for your  SAFE...
HISTORY <ul><li>F –  Are your  FRIENDS  aware that you have  </li></ul><ul><li>been hurt? </li></ul><ul><li>Do your  FAMIL...
HISTORY <ul><li>E –  Do you have a safe place to go in an  </li></ul><ul><li>emergency ? </li></ul><ul><li>Do you have an ...
HISTORY <ul><li>Other clues: </li></ul><ul><li>~  DELAY  between time of injury & presentation for treatment. </li></ul><u...
PHYSICAL EXAMINATION <ul><li>CENTRAL PATTERN OF INJURY </li></ul><ul><li>~head & neck </li></ul><ul><li>~ chest </li></ul>...
PHYSICAL EXAMINATION <ul><li>DEFENSIVE INJURIES </li></ul><ul><li>~ forearm bruises </li></ul><ul><li>~ forearm fractures ...
PHYSICAL EXAMINATION <ul><li>MULTIPLE INJURIES IN VARIOUS STAGES OF HEALING </li></ul><ul><li>~ bruises </li></ul><ul><li>...
MANAGEMENT <ul><li>Assessment of injuries </li></ul><ul><li>Treating injuries </li></ul><ul><li>Preserving & documenting e...
BRUISES BITE MARKS
INJURIES IN VARIOUS STAGES OF HEALING
Women’s Aid Organization Malaysia
THANK YOU
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Domestic violence

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Domestic violence

  1. 1. DOMESTIC VIOLENCE DR LEE OI WAH, PEGAWAI PERUBATAN U48;HBG
  2. 2. CASE SCENARIO <ul><li>An ambulance is called to a residence for an unconcious female. On arrival, a man was sitting outside the house and yelled </li></ul><ul><li>“ Ambik ler, ada kat dalam”. </li></ul><ul><li>Paramedics found a pregnant female lying semi-concious on the floor of the living room. Blood is coming from a small laceration wound above her eye,which is surrounded by a large bruise. On the floor is a bottle of Ketchup that apparently had been smashed against the wall. She was then sent to the hospital;her husband DID NOT follow the crew to the hospital!She was discharged home after 24 hrs observation at the hospital. </li></ul>
  3. 3. INTRODUCTION <ul><li>Battered victims and batterers/perpetrators come from all economic & education levels,all racial & cultural groups,all religions and all ages. </li></ul><ul><li>In 1995, 80% of homicides in Alaska were related to domestic violence. </li></ul><ul><li>National Crime Survey in Mexico, 48% of all incidence of domestic violence against women were never reported to the police. </li></ul>
  4. 4. INTRODUCTION <ul><li>A significant public health problem; more than </li></ul><ul><li>5 million women battered annually world-wide. </li></ul><ul><li>The only category of crime in which the perpetrator frequently remains on the scene; </li></ul><ul><li>expecting NO negative consequences </li></ul><ul><li>perceiving intervention as a violation of their </li></ul><ul><li>rights. </li></ul>
  5. 5. DEFINITION <ul><li>A pattern of assaultive and controlling behaviour including physical, sexual & psychological attacks as well as economic control, which adults or adolescents use against their intimate partners. </li></ul>
  6. 6. DOMESTIC VIOLENCE ACT,1994 <ul><li>The commision of any of the following: </li></ul><ul><li>Willfully of knowingly placing the victim in fear of physical injury. </li></ul><ul><li>Causing physical injury to the victim by such act which is known or ought to have been known to result in physical injury. </li></ul><ul><li>Compelling the victim by force or threat to engage in any conduct or act , sexual or otherwise;from which the victim has a right to abstain. </li></ul>
  7. 7. DOMESTIC VIOLENCE ACT,1994 <ul><li>Confining the victim against the victim’s will. </li></ul><ul><li>Causing mischief or destruction or damage to property with intent to cause or knowing that it is likely to cause distress or annoyance to the victim ;by a person against : </li></ul><ul><li>His or her spouse </li></ul><ul><li>His or her former spouse </li></ul><ul><li>A child of the offender’s spouse or former spouse. </li></ul><ul><li>An incapacitated adult. </li></ul><ul><li>Any other member of the offender’s family. </li></ul>
  8. 8. THE COST OF BATTERING <ul><li>SURVIVOR </li></ul><ul><li>higher rate of alcohol and drug abuse </li></ul><ul><li>depression & suicide </li></ul><ul><li>miscarriage </li></ul><ul><li>CHILDREN </li></ul><ul><li>emotional disturbance during childhood </li></ul><ul><li>re-enact the violence during adolescence or adulthood. </li></ul>
  9. 9. THE COST OF BATTERING <ul><li>BATTERER </li></ul><ul><li>employment problems </li></ul><ul><li>alcohol & drug abuse </li></ul><ul><li>homicide </li></ul><ul><li>arrest, fines & imprisonment. </li></ul><ul><li>COMMUNITY </li></ul><ul><li>lost wages, sick leave </li></ul><ul><li>absenteesim, non-productivity. </li></ul>
  10. 10. PHASES OF VIOLENCE <ul><li>Tension or build-up phase </li></ul><ul><li>~ increased tension building </li></ul><ul><li>Battering incident </li></ul><ul><li>Calm or honeymoon phase </li></ul><ul><li>~ lessening of tension. </li></ul>
  11. 11. HISTORY <ul><li>S - Do you feel SAFE in your relationship? </li></ul><ul><li>- Should I be concerned for your SAFETY ? </li></ul><ul><li>A - Are there any situations in your relationship </li></ul><ul><li>where you felt AFRAID ? </li></ul><ul><li>- What happens when you & partner ARGUE ? </li></ul>
  12. 12. HISTORY <ul><li>F – Are your FRIENDS aware that you have </li></ul><ul><li>been hurt? </li></ul><ul><li>Do your FAMILY members know about the </li></ul><ul><li>abuse? </li></ul><ul><li>Would FAMILY or FRIENDS be able to </li></ul><ul><li>help or support you ? </li></ul>
  13. 13. HISTORY <ul><li>E – Do you have a safe place to go in an </li></ul><ul><li>emergency ? </li></ul><ul><li>Do you have an Escape plan if you have to </li></ul><ul><li>leave? </li></ul><ul><li>Would you like to talk with an advocate to </li></ul><ul><li>develop an emergency safety plan ? </li></ul>
  14. 14. HISTORY <ul><li>Other clues: </li></ul><ul><li>~ DELAY between time of injury & presentation for treatment. </li></ul><ul><li>~ FREQUENT VISITS for vague complaints without evidence of physiologic abnormality. </li></ul><ul><li>~ Suicides attempts </li></ul><ul><li>~ RAPE including marital rape. </li></ul>
  15. 15. PHYSICAL EXAMINATION <ul><li>CENTRAL PATTERN OF INJURY </li></ul><ul><li>~head & neck </li></ul><ul><li>~ chest </li></ul><ul><li>~ breast </li></ul><ul><li>~ abdomen </li></ul>
  16. 16. PHYSICAL EXAMINATION <ul><li>DEFENSIVE INJURIES </li></ul><ul><li>~ forearm bruises </li></ul><ul><li>~ forearm fractures </li></ul><ul><li>CHARACTERISTICS OF INJURIES </li></ul><ul><li>~ finger nail scratches </li></ul><ul><li>~ bite marks </li></ul><ul><li>~ ciggarette burns </li></ul><ul><li>~ rope marks </li></ul>
  17. 17. PHYSICAL EXAMINATION <ul><li>MULTIPLE INJURIES IN VARIOUS STAGES OF HEALING </li></ul><ul><li>~ bruises </li></ul><ul><li>~ fractures </li></ul><ul><li>INJURIES DURING PREGNANCY </li></ul>
  18. 18. MANAGEMENT <ul><li>Assessment of injuries </li></ul><ul><li>Treating injuries </li></ul><ul><li>Preserving & documenting evidence </li></ul><ul><li>Plan for patient’s safety </li></ul><ul><li>Access for counselling </li></ul><ul><li>Access for police reporting & legal aid </li></ul><ul><li>Access for shelter if needed </li></ul>
  19. 19. BRUISES BITE MARKS
  20. 20. INJURIES IN VARIOUS STAGES OF HEALING
  21. 21. Women’s Aid Organization Malaysia
  22. 22. THANK YOU

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