On the Front Lines

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Domestic violence victims often don’t know where to turn for help, but the health-care system is an accessible first resort

Wendy Glauser

©2012 Thinkstock

Marcia casey* was hospitalized on numerous occasions — once with a broken arm, another time beaten unconscious — before she left her violent husband. The nurses knew what was happening and encouraged her to end the relationship. “I would say, ‘That’s easier said than done — he’s going to find me,’” recalls Marcia, who is now 50 and lives in Toronto.

That was decades ago. “Today, there are many more ways for women to get help,” notes Marcia, who now works for an organization that aids abused women. Trained health workers can provide immediate protection and help with their future escape plans, as well as provide counselling and refer women to services such as legal aid, says Anne Marie Batten, a registered nurse with Street Health, an organization that provides health services to the poor and homeless in Toronto.

“Women often utilize the health system, so the doctor’s office or hospital can be that lifeline for many,” explains Dr. Rosana Pellizzari, medical officer of health for the Peterborough County City Health Unit and one of the authors of guidelines for physicians on how to respond to intimate partner violence published by the Society of Obstetricians and Gynaecologists of Canada. In her years as a physician, she has helped many abuse victims leave their violent partners.

To begin with, health-care workers take care of the immediate safety of abuse victims. Hospitals can offer women a secure room overnight, if need be, and both health centres and hospitals can ensure safe escorts to nearby shelters. Health centres also provide privacy. “If someone is brought into emergency, a health worker can take her to a separate room away from her partner,” explains Batten.

For women not ready to leave abusive partners, health workers can offer counselling and resources that might save their lives. Many health centres provide resources with a list of phone numbers for crisis lines and other services on a card that can fit in a victim’s pocket or shoe, if need be, says Pellizzari. Batten’s team also helps women craft escape plans. “We tell women, ‘Put your mortgage papers, your keys, whatever documents you need, in a secret place in case you need to leave in a hurry,’” she explains.

Despite the plethora of services, there are many reasons why women don’t open up about abuse or end up choosing to stay in a violent relationship. “A woman may feel she’s at a very high risk if she leaves,” says Pellizzari, who notes that the point of a relationship breakup can be the most dangerous time for an abuse survivor. In addition, “children are also used as weapons by abusive partners,” she says. Many women fear they’ll lose their children.

While legal services ensure that abuse survivors can live safely with their children, and social supports help survivors find jobs and new housing, abused women often have difficulty seeing these positive aspects. “When people are abused, their self-esteem is lower, and it’s difficult for them to trust people,” says Batten.

Marcia, whose husband came looking for her with a shotgun after she left, understands more than most why women are afraid to leave. The support of friends, colleagues and social workers helped keep Marcia safe from her husband until he was no longer a threat. She also knows that, in the long term, there is no reason to stay in an abusive relationship. “I thought my ex-husband would change. He went through anger management and all that stuff, but he still beat me,” she says. “They promise you and they promise you, and it will get better for a little while, but then it will get worse.”

It’s not just the threat of death that health workers worry about. Abusive relationships take a toll on both physical and mental health. Not all physical injuries heal; some can be permanent, notes Pellizzari, recalling tragedies from her own clinical practice. “Violence during pregnancy can endanger the fetus.” Frighteningly, Canada’s largest study of abuse of women, Statistics Canada’s Violence Against Women Survey, found that women who were pregnant were four times more likely to report very serious violence than those who weren’t pregnant. Those who experience gender-based violence have a higher incidence of mental health disorders, which may include depression and drug abuse.

For those who think a friend or family member is being abused, Marcia recommends, “Just be gentle; tell them that you’re there to help with whatever they need.” Pellizzari adds that it’s important to tell a victim that “no one deserves to be abused.” It may seem obvious, but in the thick of constant verbal assault, it’s easy for women to believe they’re not worthy.

For women suffering abuse, Marcia encourages them to make a plan to leave and turn to trusted friends, colleagues and professionals for help. “I love my life. I’m in a good relationship. My colleagues at work are so supportive, and I have a great relationship with my daughter and grandkids,” she says. “It takes a bit of struggle to leave, but in the end, it pays off.”

For those who don’t know where to start, health-care workers can offer tried-and-true advice, support and confidentiality.

*Not her real name.