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Domestic Violence

 

"Screening on Domestic Violence "


1. BOOK Screening on Domestic Violence

Present Screening manual the best possible way to identify abuse. In this manual we offer a screening model according to which every women in every medical department will be screened in routing care according to a special screening form In case of revealing any symptoms and signs of disease related to domestic violence,the patiens should go through of comprehensive screening according to an addition screening forms comprising all fields of medicine. Manual are created on the bases of material and consultations of Family Violence Prevention Fund USA and Ministry of Health and Social Affairs of Georgia

2. Creation Guidelines for Health Care Providers on Medical Screening for Cases of Domestic Violence in Georgia

The main goal was the creation of a universal screening manual which would be the best possible way to identify abuse. Activities included creation of clinical guidelines on routine screening; Develop screening policy and training on these skills prior to implementing screening in medical records; screening form was created with representative Ministry of Health and Social Affairs

Screening model consist of two steps. according to which, every women in medical department will be screened in a routing care according to special form. First step

VALIDATED ABUSE
ASSESSMENT TOOLS


ABUSE ASSESSMENT SCREEN


1) Have you ever been emotionally or physically abused by your partner or someone important to you?
      Yes □ No D
      If yes by whom? ___________
      Total number of times ___________

2) Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by someone?
      Yes □ No D
      If yes by whom? ___________
      Total number of times. ___________

3) Since you've been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
      Yes □ No D
      If yes by whom? ___________
      Total number of times ___________

4) Within the last year, has anyone forced you to have sexual activities?
      Yes □ No D
      If yes by whom? ___________
      Total number of times ___________

5) Are you afraid of your partner or anyone you listed above?
      Yes □ No D

MARK THE AREA OF INJURY ON A BODY MAP AND SCORE EACH INCIDENT ACCORDING TO THE FOLLOWING SCALE:


If any of the descriptions for the higher number apply, use the higher number.

1 = Threats of abuse including use of a weapon
2 = Slapping, pushing; rib injuries and/or lasting pain
3 = Punching, kicking, bruises, cuts, and/or continuing pain
4 = Beating up, severe contusions, burns, broken bones
5 = Head injury, internal injury, permanent injury
6 = Use of weapon; wound from weapon


Second step - In case of revealing any symptoms and signs of the of disease related to DV, the patients go through of comprehensive screening according to additional screening form comprising all the fields of medicine.



 

"State Responses to Domestic Violence Current Status and Needed Improvements”


In 2004 we re-printed a book “State Responses to Domestic Violence Current Status and Needed Improvements” in Georgian language, which became a handbook for NGO’s working on Awareness of Domestic Violence among regional health care providers and creation education and health consulting center.

The book provides recommendations for the measures, ways and means of elimination of violence against women and its cases at national, regional and international level. Also it is intended to serve as a resource for both governmental and NGOs around the world to use in advocating specific changes in the treatment of domestic violence within their country‘s legal system. In addition to outlining the international human rights instruments that support the obligation to adopt domestic violence legislation, the book includes direct input of women working in the field of the domestic violence worldwide, and as such provides an important vehicle for women’s voice to be heard at the highest level of UN system.

 

Building Bridges between Domestic Violence Advocates and Health Care Providers


We are the first in Georgia to work on awareness of domestic violence among health care professionals through the training of 300 physicians from 20 medical institutions in Tbilisi.

Following the project we have created recommendations for Ministry of Health which includes 3 steps of prevention:

I step - Primary prevention to reduce risk-factors. From this point doctors can reveal the cases of violence against children, to take care of the children of victims, because the main risk-factor for becoming abusers in adulthood – is to live in the violent environment.

   

II step - Secondary prevention includes early recognition of domestic violence cases and “treatment”.
It includes: identification, providing appropriate medical care, documentation, assessment of safety, referral to the police or other institutions that work on the problem of domestic violence.

III step - Tertiary prevention includes giving victims of domestic violence necessary supporting and rehabilitation measures for reducing trauma and restoring the quality of life. The doctors must take part in all of these three levels.

(OSCE / ODIHR)

 

Publication of the book “Domestic Violence: The Health Sector Responds”


A manual of doctors was prepared and published as a book “Domestic Violence: The Health Sector Responds”.

The book gives basic knowledge about domestic violence, contains discussions on this problem and on its importance to health care professionals, since domestic violence negatively impacts on health. Abused women have poorer mental and physical health, more injuries, and a greater need for medical resources than non-abused women. Health outcomes of domestic violence has been associated with chronic ailments, psychological consequences, injuries, death, reproductive health risks and problems such as: unwanted pregnancy, sexually transmitted infections (STIs), including HIV/ AIDS, pregnancy complications, miscarriage, stillbirth, low birth weight, gynecological disorders, etc. The children of battered women are heavily affected, either by direct violence or by witnessing the violence against their mothers. Those children are more likely to suffer from learning, emotional and behavioral problems. Also they are at increased risk of becoming abusers and of being abused later in life.

 

Physicians can play a crucial role in detecting, referring and caring for women living with violence. Unfortunately, physicians frequently treat only the symptoms of battered women’s injuries. Most battered women who are seeking medical attention are sent home to the same unsafe situation that was the original cause of their injuries only because of the physician’s lack of appropriate training to support, identify and, treat the victims of domestic violence.

The main aim is to raise awareness of domestic violence among physicians, to improve health professionals clinical skills on how to appropriately screen domestic violence, document domestic violence in the medical records, assess patient’s safety and develop a safe plan how to refer victims to domestic violence.

The material in the book is based on up-to-date literature and international experience.

 

“Awareness of Domestic Violence among regional health care providers and
   creation of educational and health consulting center“


Health-care professionals are often the first to contact the women suffering from the effects of domestic violence. Therefore, they need a guidance to develop a pragmatic and sensitive approach to recognise the signs of domestic violence and care of victims

The goal of the project was:

  • To create Educational and Health Care Consulting Center, where trainings for health care professionals dealing with Domestic violence would be held. The trainings would be organized in 4 regions of Georgia: Mtxxeta-Tianety, Shida-Kartly, Kvemo Kartly, Satsxe-Dzavaxety where works Anti-Violence Network for health care providers.
  • To develop a multidisciplinary and co-ordinates co-operation involving NGO, local authorities, judicial, law endorsement and migration authorities.
  • To organize round tables in Tbilisi for health care providers, policy makers, hospitals, trainings for Parliament and Ministry of Health representatives.
  • To train 163 health care teams in Mtxxeta-Tianety, Shida-Kartly, Kvemo Kartly, Satsxe-Dzavaxety i.e. general practitioners, gynaecologists, obstetricians, psychiatrists, surgeons and nurses.
  • For the first time in Georgia with the support of OSCE-ODHR the victim women can get free Ultrasound examination, doctor consultation and laboratory test on STD and so on.

In the Centre works a Hot Line. One-to–one counselling provides an opportunity for people to talk through problems with counselling. Counselling is not advice-giving, but it enables people to talk about their feelings and explore their concerns with someone ready to listen.

We organized a Round Table - ”Elements of effective collaboration between domestic violence advocates and health care providers and governmental representatives”, the goals of which was to bring together the head of hospitals and ambulances (where we held trainings) and representatives of Ministry of Health, Parliamentary and also representatives of International organizations which work on Reproductive Health Problems to share our experiences, give our recommendations for implementation and creation of corporation with them.

   

Achieved Results

First in Georgia:

  1. Raised a problem of domestic violence among health care providers in 4 regions where works Anti-Violence Network.
  2. Created training center for doctors
  3. Created medical consultation and examination center for victims
  4. Created hot-line for medical consultation
  5. Women’s Center is ready to conduct ultrasound examination
  6. In the Women’s Center we set up biochemical examination
  7. In the Women’s Center we can treat neuroses
  8. Established corporation with the head of hospitals and ambulances where we held trainings with representatives of Ministry of Health, Parliamentary and also representatives of organizations.

Recommendations

  • Developing and implementing public health-domestic violence awareness/education campaigns.
  • Domestic violence trainings for health care providers in regional parts of Georgia.
  • Develop a comprehensive training manual and offer training workshops around the country to help doctors, nurses, medical students.
  • Perform active lobbying on behalf of increased funding for DV women's services and strengthened health policy response on the local, national and international level.
  • Create 15 hour credit program for family doctors, gynecologist, therapeutic, neurologist, pediatricians which will be new vision of this problem.
  • Develop protocols for screening abuse; develop procedures for complete documentation of battering in the medical record; make use of domestic violence referral lists.
  • Lobbying Ministry of Health to implement domestic violence screening standards in all hospitals.
  • Formed network of organization where victims can get assistance.
  • Implemented domestic violence standards and required all hospital departments to have the following in place:
    --written domestic violence protocols specifying the scope and conduct of patient care (including objective criteria for identifying and assessing possible victims of abuse, and policies and procedures that define the hospital's responsibility for collecting, retaining, and safeguarding information and evidentiary material);
    --plan for educating staff about domestic violence identification, treatment, documentation; and a list of private and public community agencies that provide help for abuse victims.
  • Set-up certificate and credit-hours program in the postgraduate training system
  • Negotiated a process of creation of educational program for doctors which gives them possibility to receive full information about the pathology which is the reason of DV and the ways of its treatment.
  • Counseling services for men who batter. Developed a therapy method and counseling services for men who batter.
  • Women’s support (self-help group) - place where they will connect and interact, where they hear about others struggles, and where their witness effective change and where they get consultation advises
  • Established domestic violence resource center. The center serves as a professional library for information DV. The center will be meeting place for doctors, NGO’s representatives and central clearinghouse for dissemination information and publications on DV.
  • Established Close Corporation with Ministry of Health includes them in implementation program.
  • Established close corporation with Parliament.

 

Publication of the BOOK – “MEDICAL ASPECTS OF DOMESTIC VIOLENCE”

We prepared and published a book: “Medical Aspects of Domestic Violence”.

   
 


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